hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|IL,"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.",,,,,,,,,,,,,,,,
Gateway Regional Medical Center,9/25/2025,3.0.0,Gateway Regional Medical Center,"2100 Madison Ave, Granite City, IL 62040",0006395,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,payer_name,plan_name,modifiers,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,estimated_amount,standard_charge|min,standard_charge|max,standard_charge|methodology,additional_generic_notes
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities,216,MS-DRG,,,,,Inpatient,,,235066.79,141040.07,Aetna,Commercial,,141040.07,29.8,29.8% of Medicare Base rate X weight,141040.07,4732.88,7963.87,Fee Schedule,29.8
Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC),470,MS-DRG,,,,,Inpatient,,,13886.51,13886.51,Aetna,Commercial,,9803.88,29.8,29.8% of Medicare Base rate X weight,13886.51,465.99,5554.6,Fee Schedule,29.8
CT-CATH FLUID DRAIN,10030,CPT,,,,,both,, ,1071.33,2.00,Aetna,Commercial,,1071.33,29.8,29.8% of Medicare Base rate X weight,1071.33,35.95,428.53,Fee Schedule,29.8
I&D ABSCS SMPL/SGL,10060,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
I&D ABSCS COMP/MULTI,10061,CPT,,,,,both,, ,1519.68,911.80,Aetna,Commercial,,1519.68,29.8,29.8% of Medicare Base rate X weight,1519.68,51.00,607.87,Fee Schedule,29.8
INC & REM FB SQ SMPL,10120,CPT,,,,,both,, ,1519.68,911.80,Aetna,Commercial,,1519.68,29.8,29.8% of Medicare Base rate X weight,1519.68,51.00,607.87,Fee Schedule,29.8
INC & REM FB SQ COMP,10121,CPT,,,,,both,, ,6179.00,3707.40,Aetna,Commercial,,6179.00,29.8,29.8% of Medicare Base rate X weight,6179.00,207.35,2471.6,Fee Schedule,29.8
I&D HEMATOMA/FLUID,10140,CPT,,,,,both,, ,6179.00,3707.40,Aetna,Commercial,,6179.00,29.8,29.8% of Medicare Base rate X weight,6179.00,207.35,2471.6,Fee Schedule,29.8
PNXR ASP ABS HEM CYT,10160,CPT,,,,,both,, ,1519.68,911.80,Aetna,Commercial,,1519.68,29.8,29.8% of Medicare Base rate X weight,1519.68,51.00,607.87,Fee Schedule,29.8
I&D CPLX PO WND INF,10180,CPT,,,,,both,, ,10829.40,6497.64,Aetna,Commercial,,10829.40,29.8,29.8% of Medicare Base rate X weight,10829.40,363.40,4331.76,Fee Schedule,29.8
DEBR EXZ/INF SKN <10%,11000,CPT,,,,,both,, ,2393.60,1436.16,Aetna,Commercial,,2393.60,29.8,29.8% of Medicare Base rate X weight,2393.60,80.32,957.44,Fee Schedule,29.8
DEBR EXZ/INF SKN E A,11001,CPT,,,,,both,, ,2393.60,1436.16,Aetna,Commercial,,2393.60,29.8,29.8% of Medicare Base rate X weight,2393.60,80.32,957.44,Fee Schedule,29.8
DEB SKN BONE FX SITE,11012,CPT,,,,,both,, ,10829.40,6497.64,Aetna,Commercial,,10829.40,29.8,29.8% of Medicare Base rate X weight,10829.40,363.40,4331.76,Fee Schedule,29.8
DEB SUB TIS 20 SQ CM<,11042,CPT,,,,,both,, ,1519.68,911.80,Aetna,Commercial,,1519.68,29.8,29.8% of Medicare Base rate X weight,1519.68,51.00,607.87,Fee Schedule,29.8
DEB MUSC/FSCA <20 SQ,11043,CPT,,,,,both,, ,2393.60,1436.16,Aetna,Commercial,,2393.60,29.8,29.8% of Medicare Base rate X weight,2393.60,80.32,957.44,Fee Schedule,29.8
DEB BONE 20 SQ CM/<,11044,CPT,,,,,both,, ,6179.00,3707.40,Aetna,Commercial,,6179.00,29.8,29.8% of Medicare Base rate X weight,6179.00,207.35,2471.6,Fee Schedule,29.8
DEB SUB TISS EA ADDL,11045,CPT,,,,,both,, ,6179.00,3707.40,Aetna,Commercial,,6179.00,29.8,29.8% of Medicare Base rate X weight,6179.00,207.35,2471.6,Fee Schedule,29.8
DEB MUSC/FSCA EA ADL,11046,CPT,,,,,both,, ,6179.00,3707.40,Aetna,Commercial,,6179.00,29.8,29.8% of Medicare Base rate X weight,6179.00,207.35,2471.6,Fee Schedule,29.8
DEB BONE EA ADDL,11047,CPT,,,,,both,, ,6179.00,3707.40,Aetna,Commercial,,6179.00,29.8,29.8% of Medicare Base rate X weight,6179.00,207.35,2471.6,Fee Schedule,29.8
PARG/CUTG B9 SGL LES,11055,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
TRIM SKIN LESION 2-4,11056,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
TRIM SKIN LESIONS >4,11057,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
TNGNTL BX SKN SGL LES,11102,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
TNGNTL BX SKN EA ADD,11103,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
PUNCH BX SKN SGL LES,11104,CPT,,,,,both,, ,1519.68,911.80,Aetna,Commercial,,1519.68,29.8,29.8% of Medicare Base rate X weight,1519.68,51.00,607.87,Fee Schedule,29.8
PUNCH BX SKN EA ADDL,11105,CPT,,,,,both,, ,1519.68,911.80,Aetna,Commercial,,1519.68,29.8,29.8% of Medicare Base rate X weight,1519.68,51.00,607.87,Fee Schedule,29.8
INCIS BX SKN SGL LES,11106,CPT,,,,,both,, ,2393.60,1436.16,Aetna,Commercial,,2393.60,29.8,29.8% of Medicare Base rate X weight,2393.60,80.32,957.44,Fee Schedule,29.8
INCAL BX SKN EA ADDL,11107,CPT,,,,,both,, ,2393.60,1436.16,Aetna,Commercial,,2393.60,29.8,29.8% of Medicare Base rate X weight,2393.60,80.32,957.44,Fee Schedule,29.8
RMV SKN TAGS<=15 LES,11200,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
RMV SKN TAGS EA ADDL,11201,CPT,,,,,both,, ,233.12,139.87,Aetna,Commercial,,233.12,29.8,29.8% of Medicare Base rate X weight,233.12,7.82,93.25,Fee Schedule,29.8
DEBRIDEMENT NAIL 1-5,11720,CPT,,,,,both,, ,233.12,139.87,Aetna,Commercial,,233.12,29.8,29.8% of Medicare Base rate X weight,233.12,7.82,93.25,Fee Schedule,29.8
DEBRIDEMENT NAIL >6,11721,CPT,,,,,both,, ,233.12,139.87,Aetna,Commercial,,233.12,29.8,29.8% of Medicare Base rate X weight,233.12,7.82,93.25,Fee Schedule,29.8
RMV NAIL PLATE SGL,11730,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
RMV NAIL PLATE E ADD,11732,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
EVAC SU HEMATOMA,11740,CPT,,,,,both,, ,486.84,292.10,Aetna,Commercial,,486.84,29.8,29.8% of Medicare Base rate X weight,486.84,16.34,194.74,Fee Schedule,29.8
TT F/C/M/N/A/G/H/F,14040,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
TT F/C/M/N/A/G/H/F AD,14041,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
WND PR T/A/L 100SQCM,15002,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
WND PR ADL 100 SQCM,15003,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
WND PREP F/N/HF/G,15004,CPT,,,,,both,, ,2393.60,1436.16,Aetna,Commercial,,2393.60,29.8,29.8% of Medicare Base rate X weight,2393.60,80.32,957.44,Fee Schedule,29.8
WND PREP F/N/HF/G ADL,15005,CPT,,,,,both,, ,2393.60,1436.16,Aetna,Commercial,,2393.60,29.8,29.8% of Medicare Base rate X weight,2393.60,80.32,957.44,Fee Schedule,29.8
PINCH GRFT UP TO 2CM,15050,CPT,,,,,both,, ,2393.60,1436.16,Aetna,Commercial,,2393.60,29.8,29.8% of Medicare Base rate X weight,2393.60,80.32,957.44,Fee Schedule,29.8
SKIN SPLT GRFT T/A/L,15100,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
SKN SPLT GRF T/A/L EA,15101,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
EPIDRM AUTOGRFT T/A/L,15110,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
EPIDR AUTGF T/A/L EA,15111,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
EPIDR AGRFT F/N/H/G,15115,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
EPI AGRFT F/N/HF/G ADL,15116,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
SKN SPLT AGRFT F/N/H/G,15120,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,13673.04,29.8,29.8% of Medicare Base rate X weight,13673.04,458.83,5469.22,Fee Schedule,29.8
SKN SPLT AGRF F/N/H/G ADD,15121,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,13673.04,29.8,29.8% of Medicare Base rate X weight,13673.04,458.83,5469.22,Fee Schedule,29.8
DERM AUTOGRAF T/A/L,15130,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
DERM AGRAF T/A/L ADL,15131,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
DERM AGRF F/N/H/G,15135,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,13673.04,29.8,29.8% of Medicare Base rate X weight,13673.04,458.83,5469.22,Fee Schedule,29.8
DERM AGRF F/N/H/G ADD,15136,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,13673.04,29.8,29.8% of Medicare Base rate X weight,13673.04,458.83,5469.22,Fee Schedule,29.8
CULT SKN GRF T/A/L,15150,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
CUL SKN GRF T/A/L A,15151,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
CUL SKN GRF T/A/L +%,15152,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
CUL SKN GRF F/N/H/G,15155,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,13673.04,29.8,29.8% of Medicare Base rate X weight,13673.04,458.83,5469.22,Fee Schedule,29.8
CUL SKN GRF F/N/H/G ADD,15156,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,13673.04,29.8,29.8% of Medicare Base rate X weight,13673.04,458.83,5469.22,Fee Schedule,29.8
CUL EPIDR GRF F/N/HFG +%,15157,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,13673.04,29.8,29.8% of Medicare Base rate X weight,13673.04,458.83,5469.22,Fee Schedule,29.8
FTH GRF TRNK 20SQ/<,15200,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
FTH GRF FR TRNK EA AD,15201,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
FTH GF S/A/L 20 SQ/<,15220,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
FTH GF S/A/L 20 SQ E A,15221,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
FTH GR F/C/C/M/N/AX/G/H/F,15240,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
FTH GR F/C/C/M/N/AX/G/H/F EA,15241,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
FTH GR FR N/E/E/L 20SQ/<,15260,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
FTH GR FR N/E/E/L E A,15261,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
SKN SUB GRAFT T/A/L,15271,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
SKN SUB GRFT ADDL,15272,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
SKN S GRFT >100SQ,15273,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,13673.04,29.8,29.8% of Medicare Base rate X weight,13673.04,458.83,5469.22,Fee Schedule,29.8
SKN S GR ADD 100SQ,15274,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,13673.04,29.8,29.8% of Medicare Base rate X weight,13673.04,458.83,5469.22,Fee Schedule,29.8
SKN S GR F/NK/HF/G 25SQCM,15275,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
SKN S GR F/N/HF/G ADL,15276,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
SKN S GR F/N/HF/G CH,15277,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
SKN S GR F/N/HF/G CH ADD,15278,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
INIT TX 1ST DEG BURN,16000,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
DRS DEB PTHICK BRN S,16020,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
DRS DEB PTHICK BRN M,16025,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
DRS DEB PTHICK BRN L,16030,CPT,,,,,both,, ,1519.68,911.80,Aetna,Commercial,,1519.68,29.8,29.8% of Medicare Base rate X weight,1519.68,51.00,607.87,Fee Schedule,29.8
DESTRCT PREMAL LES,17000,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
DESTRCT PREMAL 2-14,17003,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
DESTRCT PREMAL 15+,17004,CPT,,,,,both,, ,1519.68,911.80,Aetna,Commercial,,1519.68,29.8,29.8% of Medicare Base rate X weight,1519.68,51.00,607.87,Fee Schedule,29.8
DESTR CV LES <=10 SQ,17106,CPT,,,,,both,, ,1519.68,911.80,Aetna,Commercial,,1519.68,29.8,29.8% of Medicare Base rate X weight,1519.68,51.00,607.87,Fee Schedule,29.8
DESTR CV LES 10-50 SQ,17107,CPT,,,,,both,, ,2393.60,1436.16,Aetna,Commercial,,2393.60,29.8,29.8% of Medicare Base rate X weight,2393.60,80.32,957.44,Fee Schedule,29.8
DESTR CV LES > 50 SQ,17108,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,233.23,2780.05,Fee Schedule,29.8
DESTRUCT B9 LES 1-14,17110,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
CHEM CAUT GRANL TISS,17250,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
UNLISTD PROCEDURE,17999,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,25.60,305.2,Fee Schedule,29.8
S-BRST DUCTOGRM INJ,19030,CPT,,,,,both,, ,289.43,173.65,Aetna,Commercial,,289.43,29.8,29.8% of Medicare Base rate X weight,289.43,9.71,115.77,Fee Schedule,29.8
BX OF BREAST OPEN,19101,CPT,,,,,both,, ,14527.16,8716.29,Aetna,Commercial,,14527.16,29.8,29.8% of Medicare Base rate X weight,14527.16,487.49,5810.86,Fee Schedule,29.8
EXPL P WND EXTREM,20103,CPT,,,,,both,, ,6179.00,3707.40,Aetna,Commercial,,6179.00,29.8,29.8% of Medicare Base rate X weight,6179.00,207.35,2471.6,Fee Schedule,29.8
NJ TENDON SHEATH/LIG,20550,CPT,,,,,both,, ,1128.80,677.28,Aetna,Commercial,,1128.80,29.8,29.8% of Medicare Base rate X weight,1128.80,37.88,451.52,Fee Schedule,29.8
S-JOINT ASP-INJ SM,20600,CPT,,,,,both,, ,487.45,292.47,Aetna,Commercial,,487.45,29.8,29.8% of Medicare Base rate X weight,487.45,16.36,194.98,Fee Schedule,29.8
US-DRN INJ SMAL JT W,20604,CPT,,,,,both,, ,726.15,435.69,Aetna,Commercial,,726.15,29.8,29.8% of Medicare Base rate X weight,726.15,24.37,290.46,Fee Schedule,29.8
S-JOINT ASP-INJ IM,20605,CPT,,,,,both,, ,700.66,420.39,Aetna,Commercial,,700.66,29.8,29.8% of Medicare Base rate X weight,700.66,23.51,280.26,Fee Schedule,29.8
US-DRN INJ INTM JT W,20606,CPT,,,,,both,, ,1594.18,956.50,Aetna,Commercial,,1594.18,29.8,29.8% of Medicare Base rate X weight,1594.18,53.50,637.67,Fee Schedule,29.8
US-DRN INJ MAJR JT W,20611,CPT,,,,,both,, ,726.15,435.69,Aetna,Commercial,,726.15,29.8,29.8% of Medicare Base rate X weight,726.15,24.37,290.46,Fee Schedule,29.8
S-INJ TMJ ARTHROGRAM,21116,CPT,,,,,both,, ,289.43,173.65,Aetna,Commercial,,289.43,29.8,29.8% of Medicare Base rate X weight,289.43,9.71,115.77,Fee Schedule,29.8
S-INJ SHOULDER ARTH,23350,CPT,,,,,both,, ,289.43,173.65,Aetna,Commercial,,289.43,29.8,29.8% of Medicare Base rate X weight,289.43,9.71,115.77,Fee Schedule,29.8
S-INJ ELBOW ARTHRO,24220,CPT,,,,,both,, ,289.43,173.65,Aetna,Commercial,,289.43,29.8,29.8% of Medicare Base rate X weight,289.43,9.71,115.77,Fee Schedule,29.8
S-INJ WRIST ARTHRO,25246,CPT,,,,,both,, ,289.43,173.65,Aetna,Commercial,,289.43,29.8,29.8% of Medicare Base rate X weight,289.43,9.71,115.77,Fee Schedule,29.8
S-INJ HIP ARTHRO,27093,CPT,,,,,both,, ,289.43,173.65,Aetna,Commercial,,289.43,29.8,29.8% of Medicare Base rate X weight,289.43,9.71,115.77,Fee Schedule,29.8
S-INJ KNEE ARTHRO,27369,CPT,,,,,both,, ,289.43,173.65,Aetna,Commercial,,289.43,29.8,29.8% of Medicare Base rate X weight,289.43,9.71,115.77,Fee Schedule,29.8
S-INJ ANKLE ARTHRO,27648,CPT,,,,,both,, ,289.43,173.65,Aetna,Commercial,,289.43,29.8,29.8% of Medicare Base rate X weight,289.43,9.71,115.77,Fee Schedule,29.8
EXPLORE FOOT JOINT,28022,CPT,,,,,both,, ,12336.12,7401.67,Aetna,Commercial,,12336.12,29.8,29.8% of Medicare Base rate X weight,12336.12,413.96,4934.45,Fee Schedule,29.8
AMPUT TOE & METATRSL,28810,CPT,,,,,both,, ,12336.12,7401.67,Aetna,Commercial,,12336.12,29.8,29.8% of Medicare Base rate X weight,12336.12,413.96,4934.45,Fee Schedule,29.8
AMPUTATE TOE,28820,CPT,,,,,both,, ,12336.12,7401.67,Aetna,Commercial,,12336.12,29.8,29.8% of Medicare Base rate X weight,12336.12,413.96,4934.45,Fee Schedule,29.8
SPLNT LNG ARM SH PTA,29105,CPT,,,,,both,, ,1281.32,768.79,Aetna,Commercial,,1281.32,29.8,29.8% of Medicare Base rate X weight,1281.32,43.00,512.53,Fee Schedule,29.8
SPLNT LNG ARM SH PTA,29105,CPT,,,,,both,, ,1281.32,768.79,Aetna,Commercial,,1281.32,29.8,29.8% of Medicare Base rate X weight,1281.32,43.00,512.53,Fee Schedule,29.8
SPLNT LNGARM SH COTA,29105,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,11.46,136.58,Fee Schedule,29.8
SPLNT LNGARM SH COTA,29105,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,11.46,136.58,Fee Schedule,29.8
SPLNT LNGARM SH COTA,29105,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,11.46,136.58,Fee Schedule,29.8
SPLNT LNGARM SH COTA,29105,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,11.46,136.58,Fee Schedule,29.8
SPLNT LNGARM SH COTA,29105,CPT,,,,,both,, ,1388.96,833.37,Aetna,Commercial,,1388.96,29.8,29.8% of Medicare Base rate X weight,1388.96,46.61,555.58,Fee Schedule,29.8
SPLNT LNGARM SH COTA,29105,CPT,,,,,both,, ,1388.96,833.37,Aetna,Commercial,,1388.96,29.8,29.8% of Medicare Base rate X weight,1388.96,46.61,555.58,Fee Schedule,29.8
SPLNT LONG ARM S-H,29105,CPT,,,,,both,, ,1196.17,717.70,Aetna,Commercial,,1196.17,29.8,29.8% of Medicare Base rate X weight,1196.17,40.14,478.47,Fee Schedule,29.8
SPLNT LONG ARM S-H,29105,CPT,,,,,both,, ,1296.73,778.03,Aetna,Commercial,,1296.73,29.8,29.8% of Medicare Base rate X weight,1296.73,43.51,518.69,Fee Schedule,29.8
SPLNT SHRT ARM STATC,29125,CPT,,,,,both,, ,909.80,545.88,Aetna,Commercial,,909.80,29.8,29.8% of Medicare Base rate X weight,909.80,30.53,363.92,Fee Schedule,29.8
SPLNT SHRT ARM STATC,29125,CPT,,,,,both,, ,986.30,591.78,Aetna,Commercial,,986.30,29.8,29.8% of Medicare Base rate X weight,986.30,33.10,394.52,Fee Schedule,29.8
SPLT SHRT ARM ST PTA,29125,CPT,,,,,both,, ,974.64,584.78,Aetna,Commercial,,974.64,29.8,29.8% of Medicare Base rate X weight,974.64,32.71,389.86,Fee Schedule,29.8
SPLT SHRT ARM ST PTA,29125,CPT,,,,,both,, ,974.64,584.78,Aetna,Commercial,,974.64,29.8,29.8% of Medicare Base rate X weight,974.64,32.71,389.86,Fee Schedule,29.8
SPLT SHRTARM ST COTA,29125,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,270.12,29.8,29.8% of Medicare Base rate X weight,270.12,9.06,108.05,Fee Schedule,29.8
SPLT SHRTARM ST COTA,29125,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,270.12,29.8,29.8% of Medicare Base rate X weight,270.12,9.06,108.05,Fee Schedule,29.8
SPLT SHRTARM ST COTA,29125,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,270.12,29.8,29.8% of Medicare Base rate X weight,270.12,9.06,108.05,Fee Schedule,29.8
SPLT SHRTARM ST COTA,29125,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,270.12,29.8,29.8% of Medicare Base rate X weight,270.12,9.06,108.05,Fee Schedule,29.8
SPLT SHRTARM ST COTA,29125,CPT,,,,,both,, ,1056.52,633.91,Aetna,Commercial,,1056.52,29.8,29.8% of Medicare Base rate X weight,1056.52,35.45,422.61,Fee Schedule,29.8
SPLT SHRTARM ST COTA,29125,CPT,,,,,both,, ,1056.52,633.91,Aetna,Commercial,,1056.52,29.8,29.8% of Medicare Base rate X weight,1056.52,35.45,422.61,Fee Schedule,29.8
SPLN SHRT ARM DY PTA,29126,CPT,,,,,both,, ,1486.29,891.77,Aetna,Commercial,,1486.29,29.8,29.8% of Medicare Base rate X weight,1486.29,49.88,594.52,Fee Schedule,29.8
SPLN SHRT ARM DY PTA,29126,CPT,,,,,both,, ,1486.29,891.77,Aetna,Commercial,,1486.29,29.8,29.8% of Medicare Base rate X weight,1486.29,49.88,594.52,Fee Schedule,29.8
SPLNT SHRT ARM DYNAM,29126,CPT,,,,,both,, ,1387.43,832.45,Aetna,Commercial,,1387.43,29.8,29.8% of Medicare Base rate X weight,1387.43,46.56,554.97,Fee Schedule,29.8
SPLNT SHRT ARM DYNAM,29126,CPT,,,,,both,, ,1504.12,902.47,Aetna,Commercial,,1504.12,29.8,29.8% of Medicare Base rate X weight,1504.12,50.47,601.65,Fee Schedule,29.8
SPLT SHRTARM DY COTA,29126,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,270.12,29.8,29.8% of Medicare Base rate X weight,270.12,9.06,108.05,Fee Schedule,29.8
SPLT SHRTARM DY COTA,29126,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,270.12,29.8,29.8% of Medicare Base rate X weight,270.12,9.06,108.05,Fee Schedule,29.8
SPLT SHRTARM DY COTA,29126,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,270.12,29.8,29.8% of Medicare Base rate X weight,270.12,9.06,108.05,Fee Schedule,29.8
SPLT SHRTARM DY COTA,29126,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,270.12,29.8,29.8% of Medicare Base rate X weight,270.12,9.06,108.05,Fee Schedule,29.8
SPLT SHRTARM DY COTA,29126,CPT,,,,,both,, ,1611.18,966.70,Aetna,Commercial,,1611.18,29.8,29.8% of Medicare Base rate X weight,1611.18,54.07,644.47,Fee Schedule,29.8
SPLT SHRTARM DY COTA,29126,CPT,,,,,both,, ,1611.18,966.70,Aetna,Commercial,,1611.18,29.8,29.8% of Medicare Base rate X weight,1611.18,54.07,644.47,Fee Schedule,29.8
SPLNT FINGER STATIC,29130,CPT,,,,,both,, ,299.22,179.53,Aetna,Commercial,,299.22,29.8,29.8% of Medicare Base rate X weight,299.22,10.04,119.69,Fee Schedule,29.8
SPLNT FINGER STATIC,29130,CPT,,,,,both,, ,324.42,194.65,Aetna,Commercial,,324.42,29.8,29.8% of Medicare Base rate X weight,324.42,10.89,129.77,Fee Schedule,29.8
SPLNT FNGR STAT COTA,29130,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,141.88,29.8,29.8% of Medicare Base rate X weight,141.88,4.76,56.75,Fee Schedule,29.8
SPLNT FNGR STAT COTA,29130,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,141.88,29.8,29.8% of Medicare Base rate X weight,141.88,4.76,56.75,Fee Schedule,29.8
SPLNT FNGR STAT COTA,29130,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,141.88,29.8,29.8% of Medicare Base rate X weight,141.88,4.76,56.75,Fee Schedule,29.8
SPLNT FNGR STAT COTA,29130,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,141.88,29.8,29.8% of Medicare Base rate X weight,141.88,4.76,56.75,Fee Schedule,29.8
SPLNT FNGR STAT COTA,29130,CPT,,,,,both,, ,347.63,208.57,Aetna,Commercial,,347.63,29.8,29.8% of Medicare Base rate X weight,347.63,11.67,139.05,Fee Schedule,29.8
SPLNT FNGR STAT COTA,29130,CPT,,,,,both,, ,347.63,208.57,Aetna,Commercial,,347.63,29.8,29.8% of Medicare Base rate X weight,347.63,11.67,139.05,Fee Schedule,29.8
SPLNT FNGR STATC PTA,29130,CPT,,,,,both,, ,320.59,192.35,Aetna,Commercial,,320.59,29.8,29.8% of Medicare Base rate X weight,320.59,10.76,128.24,Fee Schedule,29.8
SPLNT FNGR STATC PTA,29130,CPT,,,,,both,, ,320.59,192.35,Aetna,Commercial,,320.59,29.8,29.8% of Medicare Base rate X weight,320.59,10.76,128.24,Fee Schedule,29.8
SPLNT FINGER DYNAM,29131,CPT,,,,,both,, ,453.68,272.20,Aetna,Commercial,,453.68,29.8,29.8% of Medicare Base rate X weight,453.68,15.22,181.47,Fee Schedule,29.8
SPLNT FINGER DYNAM,29131,CPT,,,,,both,, ,491.82,295.09,Aetna,Commercial,,491.82,29.8,29.8% of Medicare Base rate X weight,491.82,16.50,196.73,Fee Schedule,29.8
SPLNT FINGR DYNA PTA,29131,CPT,,,,,both,, ,485.90,291.54,Aetna,Commercial,,485.90,29.8,29.8% of Medicare Base rate X weight,485.90,16.31,194.36,Fee Schedule,29.8
SPLNT FINGR DYNA PTA,29131,CPT,,,,,both,, ,485.90,291.54,Aetna,Commercial,,485.90,29.8,29.8% of Medicare Base rate X weight,485.90,16.31,194.36,Fee Schedule,29.8
SPLNT FNGR DYNA COTA,29131,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,141.88,29.8,29.8% of Medicare Base rate X weight,141.88,4.76,56.75,Fee Schedule,29.8
SPLNT FNGR DYNA COTA,29131,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,141.88,29.8,29.8% of Medicare Base rate X weight,141.88,4.76,56.75,Fee Schedule,29.8
SPLNT FNGR DYNA COTA,29131,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,141.88,29.8,29.8% of Medicare Base rate X weight,141.88,4.76,56.75,Fee Schedule,29.8
SPLNT FNGR DYNA COTA,29131,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,141.88,29.8,29.8% of Medicare Base rate X weight,141.88,4.76,56.75,Fee Schedule,29.8
SPLNT FNGR DYNA COTA,29131,CPT,,,,,both,, ,526.85,316.11,Aetna,Commercial,,526.85,29.8,29.8% of Medicare Base rate X weight,526.85,17.68,210.74,Fee Schedule,29.8
SPLNT FNGR DYNA COTA,29131,CPT,,,,,both,, ,526.85,316.11,Aetna,Commercial,,526.85,29.8,29.8% of Medicare Base rate X weight,526.85,17.68,210.74,Fee Schedule,29.8
STRAPPING THORAX,29200,CPT,,,,,both,, ,377.17,226.30,Aetna,Commercial,,377.17,29.8,29.8% of Medicare Base rate X weight,377.17,12.66,150.87,Fee Schedule,29.8
STRAPPING THORAX PTA,29200,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,404.02,29.8,29.8% of Medicare Base rate X weight,404.02,13.56,161.61,Fee Schedule,29.8
STRAPPING THORAX PTA,29200,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,404.02,29.8,29.8% of Medicare Base rate X weight,404.02,13.56,161.61,Fee Schedule,29.8
STRAPPING THORX COTA,29200,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,11.46,136.58,Fee Schedule,29.8
STRAPPING THORX COTA,29200,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,11.46,136.58,Fee Schedule,29.8
STRAPPING THORX COTA,29200,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,11.46,136.58,Fee Schedule,29.8
STRAPPING THORX COTA,29200,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,11.46,136.58,Fee Schedule,29.8
STRAPPING SHOULD PTA,29240,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,270.12,29.8,29.8% of Medicare Base rate X weight,270.12,9.06,108.05,Fee Schedule,29.8
STRAPPING SHOULD PTA,29240,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,270.12,29.8,29.8% of Medicare Base rate X weight,270.12,9.06,108.05,Fee Schedule,29.8
STRAPPING SHOULD PTA,29240,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,404.02,29.8,29.8% of Medicare Base rate X weight,404.02,13.56,161.61,Fee Schedule,29.8
STRAPPING SHOULD PTA,29240,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,404.02,29.8,29.8% of Medicare Base rate X weight,404.02,13.56,161.61,Fee Schedule,29.8
STRAPPING SHOULDER,29240,CPT,,,,,both,, ,377.17,226.30,Aetna,Commercial,,377.17,29.8,29.8% of Medicare Base rate X weight,377.17,12.66,150.87,Fee Schedule,29.8
STRAPPING SHOULDER,29240,CPT,,,,,both,, ,408.86,245.31,Aetna,Commercial,,408.86,29.8,29.8% of Medicare Base rate X weight,408.86,13.72,163.54,Fee Schedule,29.8
STRAPPNG SHOULD COTA,29240,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,81.37,29.8,29.8% of Medicare Base rate X weight,81.37,2.73,32.55,Fee Schedule,29.8
STRAPPNG SHOULD COTA,29240,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,81.37,29.8,29.8% of Medicare Base rate X weight,81.37,2.73,32.55,Fee Schedule,29.8
STRAPPNG SHOULD COTA,29240,CPT,,,,,both,, ,438.01,262.80,Aetna,Commercial,,438.01,29.8,29.8% of Medicare Base rate X weight,438.01,14.70,175.2,Fee Schedule,29.8
STRAPPNG SHOULD COTA,29240,CPT,,,,,both,, ,438.01,262.80,Aetna,Commercial,,438.01,29.8,29.8% of Medicare Base rate X weight,438.01,14.70,175.2,Fee Schedule,29.8
STRAPPING ELBO-WRIST,29260,CPT,,,,,both,, ,377.17,226.30,Aetna,Commercial,,377.17,29.8,29.8% of Medicare Base rate X weight,377.17,12.66,150.87,Fee Schedule,29.8
STRAPPING ELBO-WRIST,29260,CPT,,,,,both,, ,408.86,245.31,Aetna,Commercial,,408.86,29.8,29.8% of Medicare Base rate X weight,408.86,13.72,163.54,Fee Schedule,29.8
STRPNG ELBO-WRST PTA,29260,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,404.02,29.8,29.8% of Medicare Base rate X weight,404.02,13.56,161.61,Fee Schedule,29.8
STRPNG ELBO-WRST PTA,29260,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,404.02,29.8,29.8% of Medicare Base rate X weight,404.02,13.56,161.61,Fee Schedule,29.8
STRPNG ELB-WRST COTA,29260,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,81.37,29.8,29.8% of Medicare Base rate X weight,81.37,2.73,32.55,Fee Schedule,29.8
STRPNG ELB-WRST COTA,29260,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,81.37,29.8,29.8% of Medicare Base rate X weight,81.37,2.73,32.55,Fee Schedule,29.8
STRPNG ELB-WRST COTA,29260,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,81.37,29.8,29.8% of Medicare Base rate X weight,81.37,2.73,32.55,Fee Schedule,29.8
STRPNG ELB-WRST COTA,29260,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,81.37,29.8,29.8% of Medicare Base rate X weight,81.37,2.73,32.55,Fee Schedule,29.8
STRPNG ELB-WRST COTA,29260,CPT,,,,,both,, ,438.01,262.80,Aetna,Commercial,,438.01,29.8,29.8% of Medicare Base rate X weight,438.01,14.70,175.2,Fee Schedule,29.8
STRPNG ELB-WRST COTA,29260,CPT,,,,,both,, ,438.01,262.80,Aetna,Commercial,,438.01,29.8,29.8% of Medicare Base rate X weight,438.01,14.70,175.2,Fee Schedule,29.8
STRAPPING HAND-FING,29280,CPT,,,,,both,, ,377.17,226.30,Aetna,Commercial,,377.17,29.8,29.8% of Medicare Base rate X weight,377.17,12.66,150.87,Fee Schedule,29.8
STRAPPING HAND-FING,29280,CPT,,,,,both,, ,408.86,245.31,Aetna,Commercial,,408.86,29.8,29.8% of Medicare Base rate X weight,408.86,13.72,163.54,Fee Schedule,29.8
STRPNG HND-FING COTA,29280,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,81.37,29.8,29.8% of Medicare Base rate X weight,81.37,2.73,32.55,Fee Schedule,29.8
STRPNG HND-FING COTA,29280,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,81.37,29.8,29.8% of Medicare Base rate X weight,81.37,2.73,32.55,Fee Schedule,29.8
STRPNG HND-FING COTA,29280,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,81.37,29.8,29.8% of Medicare Base rate X weight,81.37,2.73,32.55,Fee Schedule,29.8
STRPNG HND-FING COTA,29280,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,81.37,29.8,29.8% of Medicare Base rate X weight,81.37,2.73,32.55,Fee Schedule,29.8
STRPNG HND-FING COTA,29280,CPT,,,,,both,, ,438.01,262.80,Aetna,Commercial,,438.01,29.8,29.8% of Medicare Base rate X weight,438.01,14.70,175.2,Fee Schedule,29.8
STRPNG HND-FING COTA,29280,CPT,,,,,both,, ,438.01,262.80,Aetna,Commercial,,438.01,29.8,29.8% of Medicare Base rate X weight,438.01,14.70,175.2,Fee Schedule,29.8
STRPPNG HND-FING PTA,29280,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,404.02,29.8,29.8% of Medicare Base rate X weight,404.02,13.56,161.61,Fee Schedule,29.8
STRPPNG HND-FING PTA,29280,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,404.02,29.8,29.8% of Medicare Base rate X weight,404.02,13.56,161.61,Fee Schedule,29.8
APPLY RIGID LEG CAST,29445,CPT,,,,,both,, ,1023.52,614.11,Aetna,Commercial,,1023.52,29.8,29.8% of Medicare Base rate X weight,1023.52,34.35,409.41,Fee Schedule,29.8
AP LNG LEG SPLNT PTA,29505,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,11.46,136.58,Fee Schedule,29.8
AP LNG LEG SPLNT PTA,29505,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,11.46,136.58,Fee Schedule,29.8
AP LNG LEG SPLNT PTA,29505,CPT,,,,,both,, ,1486.29,891.77,Aetna,Commercial,,1486.29,29.8,29.8% of Medicare Base rate X weight,1486.29,49.88,594.52,Fee Schedule,29.8
AP LNG LEG SPLNT PTA,29505,CPT,,,,,both,, ,1486.29,891.77,Aetna,Commercial,,1486.29,29.8,29.8% of Medicare Base rate X weight,1486.29,49.88,594.52,Fee Schedule,29.8
APP LNG LEG SPLINT,29505,CPT,,,,,both,, ,1387.43,832.45,Aetna,Commercial,,1387.43,29.8,29.8% of Medicare Base rate X weight,1387.43,46.56,554.97,Fee Schedule,29.8
APPLY LNG LEG SPLNT,29505,CPT,,,,,both,, ,600.52,360.31,Aetna,Commercial,,600.52,29.8,29.8% of Medicare Base rate X weight,600.52,20.15,240.21,Fee Schedule,29.8
AP SHT LEG SPLNT PTA,29515,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,11.46,136.58,Fee Schedule,29.8
AP SHT LEG SPLNT PTA,29515,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,11.46,136.58,Fee Schedule,29.8
AP SHT LEG SPLNT PTA,29515,CPT,,,,,both,, ,974.64,584.78,Aetna,Commercial,,974.64,29.8,29.8% of Medicare Base rate X weight,974.64,32.71,389.86,Fee Schedule,29.8
AP SHT LEG SPLNT PTA,29515,CPT,,,,,both,, ,974.64,584.78,Aetna,Commercial,,974.64,29.8,29.8% of Medicare Base rate X weight,974.64,32.71,389.86,Fee Schedule,29.8
APP SHORT LEG SPLINT,29515,CPT,,,,,both,, ,909.80,545.88,Aetna,Commercial,,909.80,29.8,29.8% of Medicare Base rate X weight,909.80,30.53,363.92,Fee Schedule,29.8
APPLY SHRT LEG SPLNT,29515,CPT,,,,,both,, ,600.52,360.31,Aetna,Commercial,,600.52,29.8,29.8% of Medicare Base rate X weight,600.52,20.15,240.21,Fee Schedule,29.8
STRAPPING HIP,29520,CPT,,,,,both,, ,377.17,226.30,Aetna,Commercial,,377.17,29.8,29.8% of Medicare Base rate X weight,377.17,12.66,150.87,Fee Schedule,29.8
STRAPPING HIP PTA,29520,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,141.88,29.8,29.8% of Medicare Base rate X weight,141.88,4.76,56.75,Fee Schedule,29.8
STRAPPING HIP PTA,29520,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,141.88,29.8,29.8% of Medicare Base rate X weight,141.88,4.76,56.75,Fee Schedule,29.8
STRAPPING HIP PTA,29520,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,404.02,29.8,29.8% of Medicare Base rate X weight,404.02,13.56,161.61,Fee Schedule,29.8
STRAPPING HIP PTA,29520,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,404.02,29.8,29.8% of Medicare Base rate X weight,404.02,13.56,161.61,Fee Schedule,29.8
STRAPPING KNEE,29530,CPT,,,,,both,, ,377.17,226.30,Aetna,Commercial,,377.17,29.8,29.8% of Medicare Base rate X weight,377.17,12.66,150.87,Fee Schedule,29.8
STRAPPING KNEE PTA,29530,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,270.12,29.8,29.8% of Medicare Base rate X weight,270.12,9.06,108.05,Fee Schedule,29.8
STRAPPING KNEE PTA,29530,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,270.12,29.8,29.8% of Medicare Base rate X weight,270.12,9.06,108.05,Fee Schedule,29.8
STRAPPING KNEE PTA,29530,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,404.02,29.8,29.8% of Medicare Base rate X weight,404.02,13.56,161.61,Fee Schedule,29.8
STRAPPING KNEE PTA,29530,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,404.02,29.8,29.8% of Medicare Base rate X weight,404.02,13.56,161.61,Fee Schedule,29.8
STRAPPING ANKLE-FOOT,29540,CPT,,,,,both,, ,377.17,226.30,Aetna,Commercial,,377.17,29.8,29.8% of Medicare Base rate X weight,377.17,12.66,150.87,Fee Schedule,29.8
STRPPNG ANKLE-FT PTA,29540,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,11.46,136.58,Fee Schedule,29.8
STRPPNG ANKLE-FT PTA,29540,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,11.46,136.58,Fee Schedule,29.8
STRPPNG ANKLE-FT PTA,29540,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,404.02,29.8,29.8% of Medicare Base rate X weight,404.02,13.56,161.61,Fee Schedule,29.8
STRPPNG ANKLE-FT PTA,29540,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,404.02,29.8,29.8% of Medicare Base rate X weight,404.02,13.56,161.61,Fee Schedule,29.8
STRAPPING UNA BOOT,29580,CPT,,,,,both,, ,377.17,226.30,Aetna,Commercial,,377.17,29.8,29.8% of Medicare Base rate X weight,377.17,12.66,150.87,Fee Schedule,29.8
STRPPNG UNA BOOT PTA,29580,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,11.46,136.58,Fee Schedule,29.8
STRPPNG UNA BOOT PTA,29580,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,11.46,136.58,Fee Schedule,29.8
STRPPNG UNA BOOT PTA,29580,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,404.02,29.8,29.8% of Medicare Base rate X weight,404.02,13.56,161.61,Fee Schedule,29.8
STRPPNG UNA BOOT PTA,29580,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,404.02,29.8,29.8% of Medicare Base rate X weight,404.02,13.56,161.61,Fee Schedule,29.8
UNNA BOOT STRAPPING,29580,CPT,,,,,both,, ,600.52,360.31,Aetna,Commercial,,600.52,29.8,29.8% of Medicare Base rate X weight,600.52,20.15,240.21,Fee Schedule,29.8
UNNA WRAP,29580,CPT,,,,,both,, ,19.20,11.52,Aetna,Commercial,,19.20,29.8,29.8% of Medicare Base rate X weight,19.20,0.64,7.68,Fee Schedule,29.8
AP MULTLY COMP LR LEG,29581,CPT,,,,,both,, ,600.52,360.31,Aetna,Commercial,,600.52,29.8,29.8% of Medicare Base rate X weight,600.52,20.15,240.21,Fee Schedule,29.8
STRPPNG LOW BCK COTA,29799,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,270.12,29.8,29.8% of Medicare Base rate X weight,270.12,9.06,108.05,Fee Schedule,29.8
STRPPNG LOW BCK COTA,29799,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,270.12,29.8,29.8% of Medicare Base rate X weight,270.12,9.06,108.05,Fee Schedule,29.8
SUCTION PROC-NASOTRA,31720,CPT,,,,,both,, ,280.42,168.25,Aetna,Commercial,,280.42,29.8,29.8% of Medicare Base rate X weight,280.42,9.41,112.17,Fee Schedule,29.8
CT-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914.00,5948.40,Aetna,Commercial,,9914.00,29.8,29.8% of Medicare Base rate X weight,9914.00,332.68,3965.6,Fee Schedule,29.8
IR-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914.00,5948.40,Aetna,Commercial,,9914.00,29.8,29.8% of Medicare Base rate X weight,9914.00,332.68,3965.6,Fee Schedule,29.8
IR-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914.00,5948.40,Aetna,Commercial,,9914.00,29.8,29.8% of Medicare Base rate X weight,9914.00,332.68,3965.6,Fee Schedule,29.8
US-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,5184.63,3110.77,Aetna,Commercial,,5184.63,29.8,29.8% of Medicare Base rate X weight,5184.63,173.98,2073.85,Fee Schedule,29.8
CC-PERICARDIO W/IMG,33016,CPT,,,,,both,, ,3443.03,2065.81,Aetna,Commercial,,3443.03,29.8,29.8% of Medicare Base rate X weight,3443.03,115.54,1377.21,Fee Schedule,29.8
P-IMPLNT LOOP REC,33285,CPT,,,,,both,, ,27383.32,16429.99,Aetna,Commercial,,27383.32,29.8,29.8% of Medicare Base rate X weight,27383.32,918.90,10953.33,Fee Schedule,29.8
P-REMOV LOOP REC,33286,CPT,,,,,both,, ,5044.68,3026.80,Aetna,Commercial,,5044.68,29.8,29.8% of Medicare Base rate X weight,5044.68,169.28,2017.87,Fee Schedule,29.8
CC-IMP PRESS SEN ANG,33289,CPT,,,,,both,, ,11332.83,6799.69,Aetna,Commercial,,11332.83,29.8,29.8% of Medicare Base rate X weight,11332.83,380.30,4533.13,Fee Schedule,29.8
S-INTRO NDL CATH,36000,CPT,,,,,both,, ,168.75,101.25,Aetna,Commercial,,168.75,29.8,29.8% of Medicare Base rate X weight,168.75,5.66,67.5,Fee Schedule,29.8
S-INTRO NDL CATH VEI,36000,CPT,,,,,both,, ,173.81,104.28,Aetna,Commercial,,173.81,29.8,29.8% of Medicare Base rate X weight,173.81,5.83,69.52,Fee Schedule,29.8
S-INJ VENOGRAPHY,36005,CPT,,,,,both,, ,873.46,524.07,Aetna,Commercial,,873.46,29.8,29.8% of Medicare Base rate X weight,873.46,29.31,349.38,Fee Schedule,29.8
S-INTROCATH SEGPULM,36015,CPT,,,,,both,, ,839.21,503.52,Aetna,Commercial,,839.21,29.8,29.8% of Medicare Base rate X weight,839.21,28.16,335.68,Fee Schedule,29.8
S-CATH CAROTD VERT,36100,CPT,,,,,both,, ,1013.23,607.93,Aetna,Commercial,,1013.23,29.8,29.8% of Medicare Base rate X weight,1013.23,34.00,405.29,Fee Schedule,29.8
S-CATH EXTREM ART,36140,CPT,,,,,both,, ,399.68,239.80,Aetna,Commercial,,399.68,29.8,29.8% of Medicare Base rate X weight,399.68,13.41,159.87,Fee Schedule,29.8
S-THORACIC 1ST ORDER,36215,CPT,,,,,both,, ,1839.26,1103.55,Aetna,Commercial,,1839.26,29.8,29.8% of Medicare Base rate X weight,1839.26,61.72,735.7,Fee Schedule,29.8
IR-ANG EXT CRT NS,36221,CPT,,,,,both,, ,12592.76,7555.65,Aetna,Commercial,,12592.76,29.8,29.8% of Medicare Base rate X weight,12592.76,422.58,5037.1,Fee Schedule,29.8
IR-ANG CRT EXT CC BI,36222,CPT,,,,,both,, ,31881.02,19128.61,Aetna,Commercial,,31881.02,29.8,29.8% of Medicare Base rate X weight,31881.02,1069.83,12752.41,Fee Schedule,29.8
IR-ANG CARTD IPS BI,36223,CPT,,,,,both,, ,45998.14,27598.88,Aetna,Commercial,,45998.14,29.8,29.8% of Medicare Base rate X weight,45998.14,1543.56,18399.26,Fee Schedule,29.8
IR-ANG CARTD IPS UNI,36223,CPT,,,,,both,, ,31746.87,19048.12,Aetna,Commercial,,31746.87,29.8,29.8% of Medicare Base rate X weight,31746.87,1065.33,12698.75,Fee Schedule,29.8
IR-ANG INT CAR IP BI,36224,CPT,,,,,both,, ,51895.68,31137.40,Aetna,Commercial,,51895.68,29.8,29.8% of Medicare Base rate X weight,51895.68,1741.47,20758.27,Fee Schedule,29.8
IR-ANG INT CAR IP UN,36224,CPT,,,,,both,, ,32068.51,19241.10,Aetna,Commercial,,32068.51,29.8,29.8% of Medicare Base rate X weight,32068.51,1076.12,12827.4,Fee Schedule,29.8
IR-ANG SUBCL IPS BI,36225,CPT,,,,,both,, ,24740.10,14844.06,Aetna,Commercial,,24740.10,29.8,29.8% of Medicare Base rate X weight,24740.10,830.20,9896.04,Fee Schedule,29.8
IR-ANG SUBCL IPS UNI,36225,CPT,,,,,both,, ,12369.34,7421.60,Aetna,Commercial,,12369.34,29.8,29.8% of Medicare Base rate X weight,12369.34,415.08,4947.74,Fee Schedule,29.8
CTH PLC EXT CD W-ANG,36227,CPT,,,,,both,, ,9411.59,5646.95,Aetna,Commercial,,9411.59,29.8,29.8% of Medicare Base rate X weight,9411.59,315.83,3764.64,Fee Schedule,29.8
CTH PLC EXT CD W-ANG,36227,CPT,,,,,both,, ,14117.39,8470.43,Aetna,Commercial,,14117.39,29.8,29.8% of Medicare Base rate X weight,14117.39,473.74,5646.96,Fee Schedule,29.8
S-ANG EXT CD IPS BI,36227,CPT,,,,,both,, ,8060.51,4836.30,Aetna,Commercial,,8060.51,29.8,29.8% of Medicare Base rate X weight,8060.51,270.49,3224.2,Fee Schedule,29.8
S-ANG EXT CD IPS BI,36227,CPT,,,,,both,, ,12090.77,7254.46,Aetna,Commercial,,12090.77,29.8,29.8% of Medicare Base rate X weight,12090.77,405.73,4836.31,Fee Schedule,29.8
S-ABDOMEN 1ST ORDER,36245,CPT,,,,,both,, ,1979.03,1187.41,Aetna,Commercial,,1979.03,29.8,29.8% of Medicare Base rate X weight,1979.03,66.41,791.61,Fee Schedule,29.8
S-ABDOMEN 2ND ORDER,36246,CPT,,,,,both,, ,9539.09,5723.45,Aetna,Commercial,,9539.09,29.8,29.8% of Medicare Base rate X weight,9539.09,320.10,3815.64,Fee Schedule,29.8
S-ABDOMEN 3RD ORDER,36247,CPT,,,,,both,, ,16382.99,9829.79,Aetna,Commercial,,16382.99,29.8,29.8% of Medicare Base rate X weight,16382.99,549.76,6553.2,Fee Schedule,29.8
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,,,90.37,90.37,Aetna,Commercial,,90.37,29.8,29.8% of Medicare Base rate X weight,90.37,30.33,269.3,Fee Schedule,29.8
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,, ,90.37,54.22,Aetna,Commercial,,90.37,29.8,29.8% of Medicare Base rate X weight,90.37,30.33,269.3,Fee Schedule,29.8
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,22.73,13.63,Aetna,Commercial,,22.73,29.8,29.8% of Medicare Base rate X weight,22.73,7.63,67.74,Fee Schedule,29.8
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,46.31,27.78,Aetna,Commercial,,46.31,29.8,29.8% of Medicare Base rate X weight,46.31,15.54,138,Fee Schedule,29.8
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,49.96,29.97,Aetna,Commercial,,49.96,29.8,29.8% of Medicare Base rate X weight,49.96,16.77,148.88,Fee Schedule,29.8
BLOOD TRANSF 0 2 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Aetna,Commercial,,2260.55,29.8,29.8% of Medicare Base rate X weight,2260.55,758.57,6736.44,Fee Schedule,29.8
BLOOD TRANSF 2 4 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Aetna,Commercial,,2260.55,29.8,29.8% of Medicare Base rate X weight,2260.55,758.57,6736.44,Fee Schedule,29.8
BLOOD TRANSF 4 6 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Aetna,Commercial,,2260.55,29.8,29.8% of Medicare Base rate X weight,2260.55,758.57,6736.44,Fee Schedule,29.8
BLOOD TRANSF 6 8 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Aetna,Commercial,,2260.55,29.8,29.8% of Medicare Base rate X weight,2260.55,758.57,6736.44,Fee Schedule,29.8
BLOOD TRANSF 8 10 HR,36430,CPT,,,,,both,, ,2260.55,1356.33,Aetna,Commercial,,2260.55,29.8,29.8% of Medicare Base rate X weight,2260.55,758.57,6736.44,Fee Schedule,29.8
BLOOD TRANSFUSION,36430,CPT,,,,,both,, ,3283.64,1970.18,Aetna,Commercial,,3283.64,29.8,29.8% of Medicare Base rate X weight,3283.64,1101.89,9785.25,Fee Schedule,29.8
BLOOD TRANSFUSION,36430,CPT,,,,,both,, ,3579.17,2147.50,Aetna,Commercial,,3579.17,29.8,29.8% of Medicare Base rate X weight,3579.17,1201.06,10665.93,Fee Schedule,29.8
BLOOD PUSH TRAN U2YR,36440,CPT,,,,,both,, ,3579.17,2147.50,Aetna,Commercial,,3579.17,29.8,29.8% of Medicare Base rate X weight,3579.17,1201.06,10665.93,Fee Schedule,29.8
THER APHERESIS WBC,36511,CPT,,,,,both,, ,5560.46,3336.27,Aetna,Commercial,,5560.46,29.8,29.8% of Medicare Base rate X weight,5560.46,1865.93,16570.17,Fee Schedule,29.8
THER APHERESI PLASMA,36514,CPT,,,,,both,, ,5560.46,3336.27,Aetna,Commercial,,5560.46,29.8,29.8% of Medicare Base rate X weight,5560.46,1865.93,16570.17,Fee Schedule,29.8
CC-INS NT CVC GT 5YR,36556,CPT,,,,,both,, ,4017.52,2410.51,Aetna,Commercial,,4017.52,29.8,29.8% of Medicare Base rate X weight,4017.52,1348.16,11972.21,Fee Schedule,29.8
IR-RMV TUN CVC WO SQ,36589,CPT,,,,,both,, ,2370.55,1422.33,Aetna,Commercial,,2370.55,29.8,29.8% of Medicare Base rate X weight,2370.55,795.49,7064.24,Fee Schedule,29.8
BLD COLLECT VAD,36591,CPT,,,,,both,, ,445.15,267.09,Aetna,Commercial,,445.15,29.8,29.8% of Medicare Base rate X weight,445.15,149.38,1326.55,Fee Schedule,29.8
BLD DRAW CENTRAL LN,36592,CPT,,,,,both,, ,388.45,233.07,Aetna,Commercial,,388.45,29.8,29.8% of Medicare Base rate X weight,388.45,130.35,1157.58,Fee Schedule,29.8
IR-INJ W FLUR CV DEV,36598,CPT,,,,,both,, ,467.11,280.26,Aetna,Commercial,,467.11,29.8,29.8% of Medicare Base rate X weight,467.11,156.75,1391.99,Fee Schedule,29.8
ARTERIAL PUNCTURE,36600,CPT,,,,,both,, ,327.26,196.35,Aetna,Commercial,,327.26,29.8,29.8% of Medicare Base rate X weight,327.26,109.82,975.23,Fee Schedule,29.8
S-INS ENDO VENA CAVA,37191,CPT,,,,,both,, ,29440.27,17664.16,Aetna,Commercial,,29440.27,29.8,29.8% of Medicare Base rate X weight,29440.27,9879.29,87732,Fee Schedule,29.8
S-REDO ENDO VENA CAV,37192,CPT,,,,,both,, ,20313.85,12188.31,Aetna,Commercial,,20313.85,29.8,29.8% of Medicare Base rate X weight,20313.85,6816.73,60535.27,Fee Schedule,29.8
S-REM ENDO VENA CAVA,37193,CPT,,,,,both,, ,20313.85,12188.31,Aetna,Commercial,,20313.85,29.8,29.8% of Medicare Base rate X weight,20313.85,6816.73,60535.27,Fee Schedule,29.8
S-THROMBOLYSIS CEREB,37195,CPT,,,,,both,, ,860.31,516.18,Aetna,Commercial,,860.31,29.8,29.8% of Medicare Base rate X weight,860.31,288.69,2563.72,Fee Schedule,29.8
S-ID SENTINEL NODE,38792,CPT,,,,,both,, ,1582.72,949.63,Aetna,Commercial,,1582.72,29.8,29.8% of Medicare Base rate X weight,1582.72,531.11,4716.51,Fee Schedule,29.8
S-BX NDL LIVER,47000,CPT,,,,,both,, ,1102.87,661.72,Aetna,Commercial,,1102.87,29.8,29.8% of Medicare Base rate X weight,1102.87,370.09,3286.55,Fee Schedule,29.8
CT-PERC CHOLECYSTOST,47490,CPT,,,,,both,, ,10295.62,6177.37,Aetna,Commercial,,10295.62,29.8,29.8% of Medicare Base rate X weight,10295.62,3454.91,30680.95,Fee Schedule,29.8
IR-ABD PARACEN W IMG,49083,CPT,,,,,both,, ,3767.78,2260.66,Aetna,Commercial,,3767.78,29.8,29.8% of Medicare Base rate X weight,3767.78,1264.36,11227.98,Fee Schedule,29.8
IR-PERITONEAL LAVAGE,49084,CPT,,,,,both,, ,3767.78,2260.66,Aetna,Commercial,,3767.78,29.8,29.8% of Medicare Base rate X weight,3767.78,1264.36,11227.98,Fee Schedule,29.8
LITHOTRIPSY,50590,CPT,,,,,both,, ,54374.73,32624.83,Aetna,Commercial,,54374.73,29.8,29.8% of Medicare Base rate X weight,54374.73,18246.55,162036.7,Fee Schedule,29.8
S-URETEROGRM INJ,50684,CPT,,,,,both,, ,323.94,194.36,Aetna,Commercial,,323.94,29.8,29.8% of Medicare Base rate X weight,323.94,108.70,965.34,Fee Schedule,29.8
S-INJ ILEAL CONDUIT,50690,CPT,,,,,both,, ,323.94,194.36,Aetna,Commercial,,323.94,29.8,29.8% of Medicare Base rate X weight,323.94,108.70,965.34,Fee Schedule,29.8
S-CORPCAVERNOSGR INJ,54230,CPT,,,,,both,, ,425.39,255.23,Aetna,Commercial,,425.39,29.8,29.8% of Medicare Base rate X weight,425.39,142.75,1267.66,Fee Schedule,29.8
S-INJ CATH HYSTERSO,58340,CPT,,,,,both,, ,336.52,201.91,Aetna,Commercial,,336.52,29.8,29.8% of Medicare Base rate X weight,336.52,112.93,1002.83,Fee Schedule,29.8
FETAL CONTRACTION ST,59020,CPT,,,,,both,, ,2089.10,1253.46,Aetna,Commercial,,2089.10,29.8,29.8% of Medicare Base rate X weight,2089.10,701.04,6225.52,Fee Schedule,29.8
FETAL NON STRESS TES,59025,CPT,,,,,both,, ,1169.57,701.74,Aetna,Commercial,,1169.57,29.8,29.8% of Medicare Base rate X weight,1169.57,392.47,3485.32,Fee Schedule,29.8
EXTERNAL CEPHALIC VE,59412,CPT,,,,,both,, ,5047.77,3028.66,Aetna,Commercial,,5047.77,29.8,29.8% of Medicare Base rate X weight,5047.77,1693.88,15042.35,Fee Schedule,29.8
S-THYROID CORE BX,60100,CPT,,,,,both,, ,630.36,378.21,Aetna,Commercial,,630.36,29.8,29.8% of Medicare Base rate X weight,630.36,211.53,1878.47,Fee Schedule,29.8
S-SPINAL TAP DIAGNST,62270,CPT,,,,,both,, ,1417.54,850.52,Aetna,Commercial,,1417.54,29.8,29.8% of Medicare Base rate X weight,1417.54,475.68,4224.27,Fee Schedule,29.8
S-INJ EPI BLD PATCH,62273,CPT,,,,,both,, ,1368.10,820.86,Aetna,Commercial,,1368.10,29.8,29.8% of Medicare Base rate X weight,1368.10,459.09,4076.94,Fee Schedule,29.8
S-MYELOGRAM INJ,62284,CPT,,,,,both,, ,629.07,377.44,Aetna,Commercial,,629.07,29.8,29.8% of Medicare Base rate X weight,629.07,211.10,1874.63,Fee Schedule,29.8
IR-MYELO CERVICAL,62302,CPT,,,,,both,, ,2078.67,1247.20,Aetna,Commercial,,2078.67,29.8,29.8% of Medicare Base rate X weight,2078.67,697.54,6194.44,Fee Schedule,29.8
IR-MYELO THORACIC,62303,CPT,,,,,both,, ,1934.41,1160.64,Aetna,Commercial,,1934.41,29.8,29.8% of Medicare Base rate X weight,1934.41,649.13,5764.54,Fee Schedule,29.8
IR-MYELO LUMBAR,62304,CPT,,,,,both,, ,1964.44,1178.66,Aetna,Commercial,,1964.44,29.8,29.8% of Medicare Base rate X weight,1964.44,659.21,5854.03,Fee Schedule,29.8
IR-MYELO COMPLETE,62305,CPT,,,,,both,, ,4013.09,2407.85,Aetna,Commercial,,4013.09,29.8,29.8% of Medicare Base rate X weight,4013.09,1346.67,11959.01,Fee Schedule,29.8
Injection of substance into spinal canal of lower back or sacrum using imaging guidance,62323,CPT,,,,,both,,,2450.37,2450.37,Aetna,Commercial,,2450.37,29.8,29.8% of Medicare Base rate X weight,2450.37,822.27,7302.1,Fee Schedule,29.8
IR-DI L-S INJ W IM,62323,CPT,,,,,both,, ,2450.37,1470.22,Aetna,Commercial,,2450.37,29.8,29.8% of Medicare Base rate X weight,2450.37,822.27,7302.1,Fee Schedule,29.8
IR-DI L-S INJ-IN WIM,62327,CPT,,,,,both,, ,2707.10,1624.26,Aetna,Commercial,,2707.10,29.8,29.8% of Medicare Base rate X weight,2707.10,908.42,8067.16,Fee Schedule,29.8
SPINAL TAP DIAG W-IM,62328,CPT,,,,,both,, ,1417.54,850.52,Aetna,Commercial,,1417.54,29.8,29.8% of Medicare Base rate X weight,1417.54,475.68,4224.27,Fee Schedule,29.8
IR-POSTERIOR FOSSA,70010,CPT,,,,,both,, ,2122.18,1273.30,Aetna,Commercial,,2122.18,29.8,29.8% of Medicare Base rate X weight,2122.18,712.14,6324.1,Fee Schedule,29.8
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,1239.46,743.67,Aetna,Commercial,,1239.46,29.8,29.8% of Medicare Base rate X weight,1239.46,415.93,3693.59,Fee Schedule,29.8
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,2479.48,1487.68,Aetna,Commercial,,2479.48,29.8,29.8% of Medicare Base rate X weight,2479.48,832.04,7388.85,Fee Schedule,29.8
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,,,883.84,883.84,Aetna,Commercial,,883.84,29.8,29.8% of Medicare Base rate X weight,883.84,296.59,2633.84,Fee Schedule,29.8
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,883.84,530.30,Aetna,Commercial,,883.84,29.8,29.8% of Medicare Base rate X weight,883.84,296.59,2633.84,Fee Schedule,29.8
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,220.61,29.8,29.8% of Medicare Base rate X weight,220.61,74.03,657.42,Fee Schedule,29.8
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,,,940.82,940.82,Aetna,Commercial,,940.82,29.8,29.8% of Medicare Base rate X weight,940.82,315.71,2803.64,Fee Schedule,29.8
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,940.82,564.49,Aetna,Commercial,,940.82,29.8,29.8% of Medicare Base rate X weight,940.82,315.71,2803.64,Fee Schedule,29.8
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,,,456.37,456.37,Aetna,Commercial,,456.37,29.8,29.8% of Medicare Base rate X weight,456.37,153.14,1359.98,Fee Schedule,29.8
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,456.37,273.82,Aetna,Commercial,,456.37,29.8,29.8% of Medicare Base rate X weight,456.37,153.14,1359.98,Fee Schedule,29.8
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,,,782.23,782.23,Aetna,Commercial,,782.23,29.8,29.8% of Medicare Base rate X weight,782.23,262.49,2331.05,Fee Schedule,29.8
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,782.23,469.33,Aetna,Commercial,,782.23,29.8,29.8% of Medicare Base rate X weight,782.23,262.49,2331.05,Fee Schedule,29.8
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,220.61,29.8,29.8% of Medicare Base rate X weight,220.61,74.03,657.42,Fee Schedule,29.8
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,,,1128.31,1128.31,Aetna,Commercial,,1128.31,29.8,29.8% of Medicare Base rate X weight,1128.31,378.63,3362.36,Fee Schedule,29.8
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,1128.31,676.98,Aetna,Commercial,,1128.31,29.8,29.8% of Medicare Base rate X weight,1128.31,378.63,3362.36,Fee Schedule,29.8
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-NASAL BONES CR,70160,CPT,,,,,both,,,782.23,782.23,Aetna,Commercial,,782.23,29.8,29.8% of Medicare Base rate X weight,782.23,262.49,2331.05,Fee Schedule,29.8
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,782.23,469.33,Aetna,Commercial,,782.23,29.8,29.8% of Medicare Base rate X weight,782.23,262.49,2331.05,Fee Schedule,29.8
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-ORBITS 4V CR,70200,CPT,,,,,both,,,918.37,918.37,Aetna,Commercial,,918.37,29.8,29.8% of Medicare Base rate X weight,918.37,308.18,2736.74,Fee Schedule,29.8
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,918.37,551.02,Aetna,Commercial,,918.37,29.8,29.8% of Medicare Base rate X weight,918.37,308.18,2736.74,Fee Schedule,29.8
HE-SINUSES LTD CR,70210,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-SINUSES LTD CR,70210,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,,,936.33,936.33,Aetna,Commercial,,936.33,29.8,29.8% of Medicare Base rate X weight,936.33,314.20,2790.26,Fee Schedule,29.8
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,936.33,561.79,Aetna,Commercial,,936.33,29.8,29.8% of Medicare Base rate X weight,936.33,314.20,2790.26,Fee Schedule,29.8
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-SKULL LIMITED CR,70250,CPT,,,,,both,,,1151.89,1151.89,Aetna,Commercial,,1151.89,29.8,29.8% of Medicare Base rate X weight,1151.89,386.54,3432.63,Fee Schedule,29.8
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,1151.89,691.13,Aetna,Commercial,,1151.89,29.8,29.8% of Medicare Base rate X weight,1151.89,386.54,3432.63,Fee Schedule,29.8
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,220.61,29.8,29.8% of Medicare Base rate X weight,220.61,74.03,657.42,Fee Schedule,29.8
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,,,1381.48,1381.48,Aetna,Commercial,,1381.48,29.8,29.8% of Medicare Base rate X weight,1381.48,463.58,4116.81,Fee Schedule,29.8
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,1381.48,828.88,Aetna,Commercial,,1381.48,29.8,29.8% of Medicare Base rate X weight,1381.48,463.58,4116.81,Fee Schedule,29.8
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,,,538.05,538.05,Aetna,Commercial,,538.05,29.8,29.8% of Medicare Base rate X weight,538.05,180.55,1603.39,Fee Schedule,29.8
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,538.05,322.83,Aetna,Commercial,,538.05,29.8,29.8% of Medicare Base rate X weight,538.05,180.55,1603.39,Fee Schedule,29.8
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,,,342.70,342.70,Aetna,Commercial,,342.70,29.8,29.8% of Medicare Base rate X weight,342.70,115.00,1021.25,Fee Schedule,29.8
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,342.70,205.62,Aetna,Commercial,,342.70,29.8,29.8% of Medicare Base rate X weight,342.70,115.00,1021.25,Fee Schedule,29.8
IR-ARTHGRM TMJ BI CR,70332,CPT,,,,,both,, ,2353.18,1411.90,Aetna,Commercial,,2353.18,29.8,29.8% of Medicare Base rate X weight,2353.18,789.66,7012.48,Fee Schedule,29.8
IR-ARTHROGRAM TMJ CR,70332,CPT,,,,,both,, ,1176.59,705.95,Aetna,Commercial,,1176.59,29.8,29.8% of Medicare Base rate X weight,1176.59,394.83,3506.24,Fee Schedule,29.8
HE-ORTHOPANTOGRAM CR,70355,CPT,,,,,both,, ,692.14,415.28,Aetna,Commercial,,692.14,29.8,29.8% of Medicare Base rate X weight,692.14,232.26,2062.58,Fee Schedule,29.8
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,,,757.53,757.53,Aetna,Commercial,,757.53,29.8,29.8% of Medicare Base rate X weight,757.53,254.20,2257.44,Fee Schedule,29.8
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,757.53,454.51,Aetna,Commercial,,757.53,29.8,29.8% of Medicare Base rate X weight,757.53,254.20,2257.44,Fee Schedule,29.8
FL-PHX SP EV W CINE,70371,CPT,,,,,both,, ,808.06,484.83,Aetna,Commercial,,808.06,29.8,29.8% of Medicare Base rate X weight,808.06,271.16,2408.02,Fee Schedule,29.8
IR-SIALOGRAM,70390,CPT,,,,,both,, ,1800.52,1080.31,Aetna,Commercial,,1800.52,29.8,29.8% of Medicare Base rate X weight,1800.52,604.20,5365.55,Fee Schedule,29.8
"CT scan, head or brain, without contrast",70450,CPT,,,,,both,,,1576.55,1576.55,Aetna,Commercial,,1576.55,29.8,29.8% of Medicare Base rate X weight,1576.55,529.04,4698.12,Fee Schedule,29.8
CT-HEAD WO,70450,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,307.05,29.8,29.8% of Medicare Base rate X weight,307.05,103.04,915.01,Fee Schedule,29.8
CT-HEAD WO,70450,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,330.63,29.8,29.8% of Medicare Base rate X weight,330.63,110.95,985.28,Fee Schedule,29.8
CT-HEAD WO,70450,CPT,,,,,both,, ,1576.55,945.93,Aetna,Commercial,,1576.55,29.8,29.8% of Medicare Base rate X weight,1576.55,529.04,4698.12,Fee Schedule,29.8
CT-HEAD W,70460,CPT,,,,,both,,,1765.72,1765.72,Aetna,Commercial,,1765.72,29.8,29.8% of Medicare Base rate X weight,1765.72,592.52,5261.85,Fee Schedule,29.8
CT-HEAD W,70460,CPT,,,,,both,, ,1765.72,1059.43,Aetna,Commercial,,1765.72,29.8,29.8% of Medicare Base rate X weight,1765.72,592.52,5261.85,Fee Schedule,29.8
CT-HEAD WWO,70470,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,680.91,29.8,29.8% of Medicare Base rate X weight,680.91,228.49,2029.11,Fee Schedule,29.8
CT-HEAD WWO,70470,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,732.83,29.8,29.8% of Medicare Base rate X weight,732.83,245.92,2183.83,Fee Schedule,29.8
CT-HEAD WWO,70470,CPT,,,,,both,,,3726.80,3726.80,Aetna,Commercial,,3726.80,29.8,29.8% of Medicare Base rate X weight,3726.80,1250.60,11105.86,Fee Schedule,29.8
CT-HEAD WWO,70470,CPT,,,,,both,, ,3726.80,2236.08,Aetna,Commercial,,3726.80,29.8,29.8% of Medicare Base rate X weight,3726.80,1250.60,11105.86,Fee Schedule,29.8
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,307.05,29.8,29.8% of Medicare Base rate X weight,307.05,103.04,915.01,Fee Schedule,29.8
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,330.63,29.8,29.8% of Medicare Base rate X weight,330.63,110.95,985.28,Fee Schedule,29.8
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,2847.17,1708.30,Aetna,Commercial,,2847.17,29.8,29.8% of Medicare Base rate X weight,2847.17,955.43,8484.57,Fee Schedule,29.8
CT-ORBIT EAR W,70481,CPT,,,,,both,, ,556.01,333.60,Aetna,Commercial,,556.01,29.8,29.8% of Medicare Base rate X weight,556.01,186.58,1656.91,Fee Schedule,29.8
CT-ORBIT EAR W,70481,CPT,,,,,both,, ,1643.07,985.84,Aetna,Commercial,,1643.07,29.8,29.8% of Medicare Base rate X weight,1643.07,551.37,4896.35,Fee Schedule,29.8
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,680.91,29.8,29.8% of Medicare Base rate X weight,680.91,228.49,2029.11,Fee Schedule,29.8
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,732.83,29.8,29.8% of Medicare Base rate X weight,732.83,245.92,2183.83,Fee Schedule,29.8
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,4001.30,2400.78,Aetna,Commercial,,4001.30,29.8,29.8% of Medicare Base rate X weight,4001.30,1342.72,11923.87,Fee Schedule,29.8
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,307.05,29.8,29.8% of Medicare Base rate X weight,307.05,103.04,915.01,Fee Schedule,29.8
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,330.63,29.8,29.8% of Medicare Base rate X weight,330.63,110.95,985.28,Fee Schedule,29.8
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,,,2847.17,2847.17,Aetna,Commercial,,2847.17,29.8,29.8% of Medicare Base rate X weight,2847.17,955.43,8484.57,Fee Schedule,29.8
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,2847.17,1708.30,Aetna,Commercial,,2847.17,29.8,29.8% of Medicare Base rate X weight,2847.17,955.43,8484.57,Fee Schedule,29.8
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,604.85,29.8,29.8% of Medicare Base rate X weight,604.85,202.97,1802.45,Fee Schedule,29.8
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,650.88,29.8,29.8% of Medicare Base rate X weight,650.88,218.42,1939.62,Fee Schedule,29.8
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,,,3178.64,3178.64,Aetna,Commercial,,3178.64,29.8,29.8% of Medicare Base rate X weight,3178.64,1066.66,9472.35,Fee Schedule,29.8
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,3178.64,1907.18,Aetna,Commercial,,3178.64,29.8,29.8% of Medicare Base rate X weight,3178.64,1066.66,9472.35,Fee Schedule,29.8
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,680.91,29.8,29.8% of Medicare Base rate X weight,680.91,228.49,2029.11,Fee Schedule,29.8
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,732.83,29.8,29.8% of Medicare Base rate X weight,732.83,245.92,2183.83,Fee Schedule,29.8
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,,,3726.80,3726.80,Aetna,Commercial,,3726.80,29.8,29.8% of Medicare Base rate X weight,3726.80,1250.60,11105.86,Fee Schedule,29.8
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,3726.80,2236.08,Aetna,Commercial,,3726.80,29.8,29.8% of Medicare Base rate X weight,3726.80,1250.60,11105.86,Fee Schedule,29.8
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,307.05,29.8,29.8% of Medicare Base rate X weight,307.05,103.04,915.01,Fee Schedule,29.8
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,330.63,29.8,29.8% of Medicare Base rate X weight,330.63,110.95,985.28,Fee Schedule,29.8
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,,,2737.98,2737.98,Aetna,Commercial,,2737.98,29.8,29.8% of Medicare Base rate X weight,2737.98,918.79,8159.18,Fee Schedule,29.8
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,2737.98,1642.78,Aetna,Commercial,,2737.98,29.8,29.8% of Medicare Base rate X weight,2737.98,918.79,8159.18,Fee Schedule,29.8
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,604.85,29.8,29.8% of Medicare Base rate X weight,604.85,202.97,1802.45,Fee Schedule,29.8
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,650.88,29.8,29.8% of Medicare Base rate X weight,650.88,218.42,1939.62,Fee Schedule,29.8
CT-NECK SOFT TIS W,70491,CPT,,,,,both,,,2743.59,2743.59,Aetna,Commercial,,2743.59,29.8,29.8% of Medicare Base rate X weight,2743.59,920.67,8175.9,Fee Schedule,29.8
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,2743.59,1646.15,Aetna,Commercial,,2743.59,29.8,29.8% of Medicare Base rate X weight,2743.59,920.67,8175.9,Fee Schedule,29.8
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,680.91,29.8,29.8% of Medicare Base rate X weight,680.91,228.49,2029.11,Fee Schedule,29.8
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,732.83,29.8,29.8% of Medicare Base rate X weight,732.83,245.92,2183.83,Fee Schedule,29.8
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,,,4317.62,4317.62,Aetna,Commercial,,4317.62,29.8,29.8% of Medicare Base rate X weight,4317.62,1448.87,12866.51,Fee Schedule,29.8
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,4317.62,2590.57,Aetna,Commercial,,4317.62,29.8,29.8% of Medicare Base rate X weight,4317.62,1448.87,12866.51,Fee Schedule,29.8
CTA-HEAD,70496,CPT,,,,,both,, ,893.10,535.86,Aetna,Commercial,,893.10,29.8,29.8% of Medicare Base rate X weight,893.10,299.70,2661.44,Fee Schedule,29.8
CTA-HEAD,70496,CPT,,,,,both,,,2355.42,2355.42,Aetna,Commercial,,2355.42,29.8,29.8% of Medicare Base rate X weight,2355.42,790.41,7019.15,Fee Schedule,29.8
CTA-HEAD,70496,CPT,,,,,both,, ,2355.42,1413.25,Aetna,Commercial,,2355.42,29.8,29.8% of Medicare Base rate X weight,2355.42,790.41,7019.15,Fee Schedule,29.8
CTA-NECK,70498,CPT,,,,,both,, ,893.10,535.86,Aetna,Commercial,,893.10,29.8,29.8% of Medicare Base rate X weight,893.10,299.70,2661.44,Fee Schedule,29.8
CTA-NECK,70498,CPT,,,,,both,,,2355.42,2355.42,Aetna,Commercial,,2355.42,29.8,29.8% of Medicare Base rate X weight,2355.42,790.41,7019.15,Fee Schedule,29.8
CTA-NECK,70498,CPT,,,,,both,, ,2355.42,1413.25,Aetna,Commercial,,2355.42,29.8,29.8% of Medicare Base rate X weight,2355.42,790.41,7019.15,Fee Schedule,29.8
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,715.99,29.8,29.8% of Medicare Base rate X weight,715.99,240.27,2133.65,Fee Schedule,29.8
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,770.45,29.8,29.8% of Medicare Base rate X weight,770.45,258.54,2295.94,Fee Schedule,29.8
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,4042.84,2425.70,Aetna,Commercial,,4042.84,29.8,29.8% of Medicare Base rate X weight,4042.84,1356.66,12047.66,Fee Schedule,29.8
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,1035.69,29.8,29.8% of Medicare Base rate X weight,1035.69,347.55,3086.36,Fee Schedule,29.8
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,1114.55,29.8,29.8% of Medicare Base rate X weight,1114.55,374.01,3321.36,Fee Schedule,29.8
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,4293.48,2576.08,Aetna,Commercial,,4293.48,29.8,29.8% of Medicare Base rate X weight,4293.48,1440.77,12794.57,Fee Schedule,29.8
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,1197.08,29.8,29.8% of Medicare Base rate X weight,1197.08,401.70,3567.3,Fee Schedule,29.8
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,1288.29,29.8,29.8% of Medicare Base rate X weight,1288.29,432.31,3839.1,Fee Schedule,29.8
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,5197.81,3118.68,Aetna,Commercial,,5197.81,29.8,29.8% of Medicare Base rate X weight,5197.81,1744.23,15489.47,Fee Schedule,29.8
MRA-HEAD WO,70544,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,715.99,29.8,29.8% of Medicare Base rate X weight,715.99,240.27,2133.65,Fee Schedule,29.8
MRA-HEAD WO,70544,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,770.45,29.8,29.8% of Medicare Base rate X weight,770.45,258.54,2295.94,Fee Schedule,29.8
MRA-HEAD WO,70544,CPT,,,,,both,, ,1631.56,978.93,Aetna,Commercial,,1631.56,29.8,29.8% of Medicare Base rate X weight,1631.56,547.50,4862.05,Fee Schedule,29.8
MRA-HEAD W,70545,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,1035.69,29.8,29.8% of Medicare Base rate X weight,1035.69,347.55,3086.36,Fee Schedule,29.8
MRA-HEAD W,70545,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,1114.55,29.8,29.8% of Medicare Base rate X weight,1114.55,374.01,3321.36,Fee Schedule,29.8
MRA-HEAD W,70545,CPT,,,,,both,, ,1938.34,1163.00,Aetna,Commercial,,1938.34,29.8,29.8% of Medicare Base rate X weight,1938.34,650.45,5776.25,Fee Schedule,29.8
MRA-HEAD WWO,70546,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,1197.08,29.8,29.8% of Medicare Base rate X weight,1197.08,401.70,3567.3,Fee Schedule,29.8
MRA-HEAD WWO,70546,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,1288.29,29.8,29.8% of Medicare Base rate X weight,1288.29,432.31,3839.1,Fee Schedule,29.8
MRA-HEAD WWO,70546,CPT,,,,,both,, ,2669.78,1601.86,Aetna,Commercial,,2669.78,29.8,29.8% of Medicare Base rate X weight,2669.78,895.90,7955.94,Fee Schedule,29.8
MRA-NECK WO,70547,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,715.99,29.8,29.8% of Medicare Base rate X weight,715.99,240.27,2133.65,Fee Schedule,29.8
MRA-NECK WO,70547,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,770.45,29.8,29.8% of Medicare Base rate X weight,770.45,258.54,2295.94,Fee Schedule,29.8
MRA-NECK WO,70547,CPT,,,,,both,, ,1334.89,800.93,Aetna,Commercial,,1334.89,29.8,29.8% of Medicare Base rate X weight,1334.89,447.95,3977.97,Fee Schedule,29.8
MRA-NECK W,70548,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,1035.69,29.8,29.8% of Medicare Base rate X weight,1035.69,347.55,3086.36,Fee Schedule,29.8
MRA-NECK W,70548,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,1114.55,29.8,29.8% of Medicare Base rate X weight,1114.55,374.01,3321.36,Fee Schedule,29.8
MRA-NECK W,70548,CPT,,,,,both,, ,1938.34,1163.00,Aetna,Commercial,,1938.34,29.8,29.8% of Medicare Base rate X weight,1938.34,650.45,5776.25,Fee Schedule,29.8
MRA-NECK WWO,70549,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,1197.08,29.8,29.8% of Medicare Base rate X weight,1197.08,401.70,3567.3,Fee Schedule,29.8
MRA-NECK WWO,70549,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,1288.29,29.8,29.8% of Medicare Base rate X weight,1288.29,432.31,3839.1,Fee Schedule,29.8
MRA-NECK WWO,70549,CPT,,,,,both,, ,3263.12,1957.87,Aetna,Commercial,,3263.12,29.8,29.8% of Medicare Base rate X weight,3263.12,1095.01,9724.1,Fee Schedule,29.8
MR-BRAIN WO,70551,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,715.99,29.8,29.8% of Medicare Base rate X weight,715.99,240.27,2133.65,Fee Schedule,29.8
MR-BRAIN WO,70551,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,770.45,29.8,29.8% of Medicare Base rate X weight,770.45,258.54,2295.94,Fee Schedule,29.8
MR-BRAIN WO,70551,CPT,,,,,both,,,4941.28,4941.28,Aetna,Commercial,,4941.28,29.8,29.8% of Medicare Base rate X weight,4941.28,1658.15,14725.01,Fee Schedule,29.8
MR-BRAIN WO,70551,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,4941.28,29.8,29.8% of Medicare Base rate X weight,4941.28,1658.15,14725.01,Fee Schedule,29.8
MR-BRAIN W,70552,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,1035.69,29.8,29.8% of Medicare Base rate X weight,1035.69,347.55,3086.36,Fee Schedule,29.8
MR-BRAIN W,70552,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,1114.55,29.8,29.8% of Medicare Base rate X weight,1114.55,374.01,3321.36,Fee Schedule,29.8
MR-BRAIN W,70552,CPT,,,,,both,,,2352.06,2352.06,Aetna,Commercial,,2352.06,29.8,29.8% of Medicare Base rate X weight,2352.06,789.28,7009.14,Fee Schedule,29.8
MR-BRAIN W,70552,CPT,,,,,both,, ,2352.06,1411.23,Aetna,Commercial,,2352.06,29.8,29.8% of Medicare Base rate X weight,2352.06,789.28,7009.14,Fee Schedule,29.8
MR-BRAIN WWO,70553,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,1197.08,29.8,29.8% of Medicare Base rate X weight,1197.08,401.70,3567.3,Fee Schedule,29.8
MR-BRAIN WWO,70553,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,1288.29,29.8,29.8% of Medicare Base rate X weight,1288.29,432.31,3839.1,Fee Schedule,29.8
MR-BRAIN WWO,70553,CPT,,,,,both,, ,6352.79,3811.67,Aetna,Commercial,,6352.79,29.8,29.8% of Medicare Base rate X weight,6352.79,2131.81,18931.31,Fee Schedule,29.8
MRI scan of brain before and after contrast,70553,CPT,,,,,both,,,6352.79,6352.79,Aetna,Commercial,,6352.79,29.8,29.8% of Medicare Base rate X weight,6352.79,2131.81,18931.31,Fee Schedule,29.8
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-CHEST 1V CR,71045,CPT,,,,,both,,,495.95,495.95,Aetna,Commercial,,495.95,29.8,29.8% of Medicare Base rate X weight,495.95,166.43,1477.93,Fee Schedule,29.8
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,495.95,297.57,Aetna,Commercial,,495.95,29.8,29.8% of Medicare Base rate X weight,495.95,166.43,1477.93,Fee Schedule,29.8
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-CHEST 2V CR,71046,CPT,,,,,both,,,750.52,750.52,Aetna,Commercial,,750.52,29.8,29.8% of Medicare Base rate X weight,750.52,251.85,2236.55,Fee Schedule,29.8
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,750.52,450.31,Aetna,Commercial,,750.52,29.8,29.8% of Medicare Base rate X weight,750.52,251.85,2236.55,Fee Schedule,29.8
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Aetna,Commercial,,143.98,29.8,29.8% of Medicare Base rate X weight,143.98,48.32,429.06,Fee Schedule,29.8
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Aetna,Commercial,,143.98,29.8,29.8% of Medicare Base rate X weight,143.98,48.32,429.06,Fee Schedule,29.8
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Aetna,Commercial,,143.98,29.8,29.8% of Medicare Base rate X weight,143.98,48.32,429.06,Fee Schedule,29.8
CH-CHEST 3V CR,71047,CPT,,,,,both,,,1091.82,1091.82,Aetna,Commercial,,1091.82,29.8,29.8% of Medicare Base rate X weight,1091.82,366.38,3253.62,Fee Schedule,29.8
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,1091.82,655.09,Aetna,Commercial,,1091.82,29.8,29.8% of Medicare Base rate X weight,1091.82,366.38,3253.62,Fee Schedule,29.8
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,143.98,86.38,Aetna,Commercial,,143.98,29.8,29.8% of Medicare Base rate X weight,143.98,48.32,429.06,Fee Schedule,29.8
CH-CHEST 4V CR,71048,CPT,,,,,both,,,1652.05,1652.05,Aetna,Commercial,,1652.05,29.8,29.8% of Medicare Base rate X weight,1652.05,554.38,4923.11,Fee Schedule,29.8
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,1652.05,991.23,Aetna,Commercial,,1652.05,29.8,29.8% of Medicare Base rate X weight,1652.05,554.38,4923.11,Fee Schedule,29.8
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-RIBS UNILAT CR,71100,CPT,,,,,both,,,876.83,876.83,Aetna,Commercial,,876.83,29.8,29.8% of Medicare Base rate X weight,876.83,294.24,2612.95,Fee Schedule,29.8
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,876.83,526.09,Aetna,Commercial,,876.83,29.8,29.8% of Medicare Base rate X weight,876.83,294.24,2612.95,Fee Schedule,29.8
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,220.61,29.8,29.8% of Medicare Base rate X weight,220.61,74.03,657.42,Fee Schedule,29.8
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,260.74,156.44,Aetna,Commercial,,260.74,29.8,29.8% of Medicare Base rate X weight,260.74,87.50,777.01,Fee Schedule,29.8
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,260.74,156.44,Aetna,Commercial,,260.74,29.8,29.8% of Medicare Base rate X weight,260.74,87.50,777.01,Fee Schedule,29.8
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,,,1152.17,1152.17,Aetna,Commercial,,1152.17,29.8,29.8% of Medicare Base rate X weight,1152.17,386.63,3433.47,Fee Schedule,29.8
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,1152.17,691.30,Aetna,Commercial,,1152.17,29.8,29.8% of Medicare Base rate X weight,1152.17,386.63,3433.47,Fee Schedule,29.8
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,220.61,29.8,29.8% of Medicare Base rate X weight,220.61,74.03,657.42,Fee Schedule,29.8
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,,,1381.48,1381.48,Aetna,Commercial,,1381.48,29.8,29.8% of Medicare Base rate X weight,1381.48,463.58,4116.81,Fee Schedule,29.8
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,1381.48,828.88,Aetna,Commercial,,1381.48,29.8,29.8% of Medicare Base rate X weight,1381.48,463.58,4116.81,Fee Schedule,29.8
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,220.61,29.8,29.8% of Medicare Base rate X weight,220.61,74.03,657.42,Fee Schedule,29.8
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,260.74,156.44,Aetna,Commercial,,260.74,29.8,29.8% of Medicare Base rate X weight,260.74,87.50,777.01,Fee Schedule,29.8
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,260.74,156.44,Aetna,Commercial,,260.74,29.8,29.8% of Medicare Base rate X weight,260.74,87.50,777.01,Fee Schedule,29.8
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,,,1877.99,1877.99,Aetna,Commercial,,1877.99,29.8,29.8% of Medicare Base rate X weight,1877.99,630.20,5596.41,Fee Schedule,29.8
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,1877.99,1126.79,Aetna,Commercial,,1877.99,29.8,29.8% of Medicare Base rate X weight,1877.99,630.20,5596.41,Fee Schedule,29.8
CH-STERNUM CR,71120,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-STERNUM CR,71120,CPT,,,,,both,,,947.27,947.27,Aetna,Commercial,,947.27,29.8,29.8% of Medicare Base rate X weight,947.27,317.88,2822.86,Fee Schedule,29.8
CH-STERNUM CR,71120,CPT,,,,,both,, ,947.27,568.36,Aetna,Commercial,,947.27,29.8,29.8% of Medicare Base rate X weight,947.27,317.88,2822.86,Fee Schedule,29.8
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,,,989.38,989.38,Aetna,Commercial,,989.38,29.8,29.8% of Medicare Base rate X weight,989.38,332.01,2948.35,Fee Schedule,29.8
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,989.38,593.62,Aetna,Commercial,,989.38,29.8,29.8% of Medicare Base rate X weight,989.38,332.01,2948.35,Fee Schedule,29.8
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,307.05,29.8,29.8% of Medicare Base rate X weight,307.05,103.04,915.01,Fee Schedule,29.8
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,330.63,29.8,29.8% of Medicare Base rate X weight,330.63,110.95,985.28,Fee Schedule,29.8
CT-CHEST DIAG WO,71250,CPT,,,,,both,,,3833.18,3833.18,Aetna,Commercial,,3833.18,29.8,29.8% of Medicare Base rate X weight,3833.18,1286.30,11422.88,Fee Schedule,29.8
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,3833.18,2299.90,Aetna,Commercial,,3833.18,29.8,29.8% of Medicare Base rate X weight,3833.18,1286.30,11422.88,Fee Schedule,29.8
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,604.85,29.8,29.8% of Medicare Base rate X weight,604.85,202.97,1802.45,Fee Schedule,29.8
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,650.88,29.8,29.8% of Medicare Base rate X weight,650.88,218.42,1939.62,Fee Schedule,29.8
CT-CHEST DIAG W,71260,CPT,,,,,both,,,4107.96,4107.96,Aetna,Commercial,,4107.96,29.8,29.8% of Medicare Base rate X weight,4107.96,1378.51,12241.72,Fee Schedule,29.8
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,4107.96,2464.77,Aetna,Commercial,,4107.96,29.8,29.8% of Medicare Base rate X weight,4107.96,1378.51,12241.72,Fee Schedule,29.8
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,680.91,29.8,29.8% of Medicare Base rate X weight,680.91,228.49,2029.11,Fee Schedule,29.8
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,732.83,29.8,29.8% of Medicare Base rate X weight,732.83,245.92,2183.83,Fee Schedule,29.8
CT-CHEST DIAG WWO,71270,CPT,,,,,both,,,3833.18,3833.18,Aetna,Commercial,,3833.18,29.8,29.8% of Medicare Base rate X weight,3833.18,1286.30,11422.88,Fee Schedule,29.8
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,3833.18,2299.90,Aetna,Commercial,,3833.18,29.8,29.8% of Medicare Base rate X weight,3833.18,1286.30,11422.88,Fee Schedule,29.8
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,, ,273.09,163.85,Aetna,Commercial,,273.09,29.8,29.8% of Medicare Base rate X weight,273.09,91.64,813.81,Fee Schedule,29.8
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,, ,273.09,163.85,Aetna,Commercial,,273.09,29.8,29.8% of Medicare Base rate X weight,273.09,91.64,813.81,Fee Schedule,29.8
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,,,568.92,568.92,Aetna,Commercial,,568.92,29.8,29.8% of Medicare Base rate X weight,568.92,190.91,1695.38,Fee Schedule,29.8
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,, ,568.92,341.35,Aetna,Commercial,,568.92,29.8,29.8% of Medicare Base rate X weight,568.92,190.91,1695.38,Fee Schedule,29.8
CTA-CHEST,71275,CPT,,,,,both,, ,708.98,425.38,Aetna,Commercial,,708.98,29.8,29.8% of Medicare Base rate X weight,708.98,237.91,2112.76,Fee Schedule,29.8
CTA-CHEST,71275,CPT,,,,,both,, ,763.15,457.89,Aetna,Commercial,,763.15,29.8,29.8% of Medicare Base rate X weight,763.15,256.09,2274.19,Fee Schedule,29.8
CTA-CHEST,71275,CPT,,,,,both,,,2355.14,2355.14,Aetna,Commercial,,2355.14,29.8,29.8% of Medicare Base rate X weight,2355.14,790.32,7018.32,Fee Schedule,29.8
CTA-CHEST,71275,CPT,,,,,both,, ,2355.14,1413.08,Aetna,Commercial,,2355.14,29.8,29.8% of Medicare Base rate X weight,2355.14,790.32,7018.32,Fee Schedule,29.8
MR-CHEST WO,71550,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,715.99,29.8,29.8% of Medicare Base rate X weight,715.99,240.27,2133.65,Fee Schedule,29.8
MR-CHEST WO,71550,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,770.45,29.8,29.8% of Medicare Base rate X weight,770.45,258.54,2295.94,Fee Schedule,29.8
MR-CHEST WO,71550,CPT,,,,,both,,,4042.84,4042.84,Aetna,Commercial,,4042.84,29.8,29.8% of Medicare Base rate X weight,4042.84,1356.66,12047.66,Fee Schedule,29.8
MR-CHEST WO,71550,CPT,,,,,both,, ,4042.84,2425.70,Aetna,Commercial,,4042.84,29.8,29.8% of Medicare Base rate X weight,4042.84,1356.66,12047.66,Fee Schedule,29.8
MR-CHEST W,71551,CPT,,,,,both,,,4293.48,4293.48,Aetna,Commercial,,4293.48,29.8,29.8% of Medicare Base rate X weight,4293.48,1440.77,12794.57,Fee Schedule,29.8
MR-CHEST W,71551,CPT,,,,,both,, ,4293.48,2576.08,Aetna,Commercial,,4293.48,29.8,29.8% of Medicare Base rate X weight,4293.48,1440.77,12794.57,Fee Schedule,29.8
MR-CHEST WWO,71552,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,1197.08,29.8,29.8% of Medicare Base rate X weight,1197.08,401.70,3567.3,Fee Schedule,29.8
MR-CHEST WWO,71552,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,1288.29,29.8,29.8% of Medicare Base rate X weight,1288.29,432.31,3839.1,Fee Schedule,29.8
MR-CHEST WWO,71552,CPT,,,,,both,,,5197.81,5197.81,Aetna,Commercial,,5197.81,29.8,29.8% of Medicare Base rate X weight,5197.81,1744.23,15489.47,Fee Schedule,29.8
MR-CHEST WWO,71552,CPT,,,,,both,, ,5197.81,3118.68,Aetna,Commercial,,5197.81,29.8,29.8% of Medicare Base rate X weight,5197.81,1744.23,15489.47,Fee Schedule,29.8
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,,,261.02,261.02,Aetna,Commercial,,261.02,29.8,29.8% of Medicare Base rate X weight,261.02,87.59,777.84,Fee Schedule,29.8
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,261.02,156.61,Aetna,Commercial,,261.02,29.8,29.8% of Medicare Base rate X weight,261.02,87.59,777.84,Fee Schedule,29.8
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,,,1085.36,1085.36,Aetna,Commercial,,1085.36,29.8,29.8% of Medicare Base rate X weight,1085.36,364.21,3234.37,Fee Schedule,29.8
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,1085.36,651.21,Aetna,Commercial,,1085.36,29.8,29.8% of Medicare Base rate X weight,1085.36,364.21,3234.37,Fee Schedule,29.8
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,220.61,29.8,29.8% of Medicare Base rate X weight,220.61,74.03,657.42,Fee Schedule,29.8
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,1112.87,667.72,Aetna,Commercial,,1112.87,29.8,29.8% of Medicare Base rate X weight,1112.87,373.45,3316.35,Fee Schedule,29.8
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,220.61,29.8,29.8% of Medicare Base rate X weight,220.61,74.03,657.42,Fee Schedule,29.8
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,1471.29,882.77,Aetna,Commercial,,1471.29,29.8,29.8% of Medicare Base rate X weight,1471.29,493.72,4384.44,Fee Schedule,29.8
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,,,1181.64,1181.64,Aetna,Commercial,,1181.64,29.8,29.8% of Medicare Base rate X weight,1181.64,396.52,3521.29,Fee Schedule,29.8
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,1181.64,708.98,Aetna,Commercial,,1181.64,29.8,29.8% of Medicare Base rate X weight,1181.64,396.52,3521.29,Fee Schedule,29.8
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,220.61,29.8,29.8% of Medicare Base rate X weight,220.61,74.03,657.42,Fee Schedule,29.8
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,,,1444.63,1444.63,Aetna,Commercial,,1444.63,29.8,29.8% of Medicare Base rate X weight,1444.63,484.78,4305,Fee Schedule,29.8
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,1444.63,866.77,Aetna,Commercial,,1444.63,29.8,29.8% of Medicare Base rate X weight,1444.63,484.78,4305,Fee Schedule,29.8
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,,,1444.63,1444.63,Aetna,Commercial,,1444.63,29.8,29.8% of Medicare Base rate X weight,1444.63,484.78,4305,Fee Schedule,29.8
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,1444.63,866.77,Aetna,Commercial,,1444.63,29.8,29.8% of Medicare Base rate X weight,1444.63,484.78,4305,Fee Schedule,29.8
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,139.77,83.86,Aetna,Commercial,,139.77,29.8,29.8% of Medicare Base rate X weight,139.77,46.90,416.51,Fee Schedule,29.8
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,149.32,89.59,Aetna,Commercial,,149.32,29.8,29.8% of Medicare Base rate X weight,149.32,50.11,444.97,Fee Schedule,29.8
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,1181.91,709.14,Aetna,Commercial,,1181.91,29.8,29.8% of Medicare Base rate X weight,1181.91,396.61,3522.09,Fee Schedule,29.8
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,139.77,83.86,Aetna,Commercial,,139.77,29.8,29.8% of Medicare Base rate X weight,139.77,46.90,416.51,Fee Schedule,29.8
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,149.32,89.59,Aetna,Commercial,,149.32,29.8,29.8% of Medicare Base rate X weight,149.32,50.11,444.97,Fee Schedule,29.8
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,230.71,138.42,Aetna,Commercial,,230.71,29.8,29.8% of Medicare Base rate X weight,230.71,77.42,687.52,Fee Schedule,29.8
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,1181.91,709.14,Aetna,Commercial,,1181.91,29.8,29.8% of Medicare Base rate X weight,1181.91,396.61,3522.09,Fee Schedule,29.8
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,230.71,138.42,Aetna,Commercial,,230.71,29.8,29.8% of Medicare Base rate X weight,230.71,77.42,687.52,Fee Schedule,29.8
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,279.26,167.55,Aetna,Commercial,,279.26,29.8,29.8% of Medicare Base rate X weight,279.26,93.71,832.19,Fee Schedule,29.8
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,298.64,179.18,Aetna,Commercial,,298.64,29.8,29.8% of Medicare Base rate X weight,298.64,100.21,889.95,Fee Schedule,29.8
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,2363.84,1418.30,Aetna,Commercial,,2363.84,29.8,29.8% of Medicare Base rate X weight,2363.84,793.23,7044.24,Fee Schedule,29.8
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,279.26,167.55,Aetna,Commercial,,279.26,29.8,29.8% of Medicare Base rate X weight,279.26,93.71,832.19,Fee Schedule,29.8
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,298.64,179.18,Aetna,Commercial,,298.64,29.8,29.8% of Medicare Base rate X weight,298.64,100.21,889.95,Fee Schedule,29.8
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,2363.84,1418.30,Aetna,Commercial,,2363.84,29.8,29.8% of Medicare Base rate X weight,2363.84,793.23,7044.24,Fee Schedule,29.8
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,,,1504.42,1504.42,Aetna,Commercial,,1504.42,29.8,29.8% of Medicare Base rate X weight,1504.42,504.84,4483.17,Fee Schedule,29.8
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,1504.42,902.65,Aetna,Commercial,,1504.42,29.8,29.8% of Medicare Base rate X weight,1504.42,504.84,4483.17,Fee Schedule,29.8
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,220.61,29.8,29.8% of Medicare Base rate X weight,220.61,74.03,657.42,Fee Schedule,29.8
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,1968.65,1181.19,Aetna,Commercial,,1968.65,29.8,29.8% of Medicare Base rate X weight,1968.65,660.62,5866.58,Fee Schedule,29.8
"X-Ray, lower back, minimum four views",72110,CPT,,,,,both,,,1968.65,1968.65,Aetna,Commercial,,1968.65,29.8,29.8% of Medicare Base rate X weight,1968.65,660.62,5866.58,Fee Schedule,29.8
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,220.61,29.8,29.8% of Medicare Base rate X weight,220.61,74.03,657.42,Fee Schedule,29.8
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
SP-LS SPINE W BND CR,72114,CPT,,,,,both,,,2229.96,2229.96,Aetna,Commercial,,2229.96,29.8,29.8% of Medicare Base rate X weight,2229.96,748.31,6645.28,Fee Schedule,29.8
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,2229.96,1337.97,Aetna,Commercial,,2229.96,29.8,29.8% of Medicare Base rate X weight,2229.96,748.31,6645.28,Fee Schedule,29.8
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,220.61,29.8,29.8% of Medicare Base rate X weight,220.61,74.03,657.42,Fee Schedule,29.8
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
SP-LS SPINE BND CR,72120,CPT,,,,,both,,,1765.44,1765.44,Aetna,Commercial,,1765.44,29.8,29.8% of Medicare Base rate X weight,1765.44,592.43,5261.01,Fee Schedule,29.8
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,1765.44,1059.26,Aetna,Commercial,,1765.44,29.8,29.8% of Medicare Base rate X weight,1765.44,592.43,5261.01,Fee Schedule,29.8
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,307.05,29.8,29.8% of Medicare Base rate X weight,307.05,103.04,915.01,Fee Schedule,29.8
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,330.63,29.8,29.8% of Medicare Base rate X weight,330.63,110.95,985.28,Fee Schedule,29.8
CT-CERV SPINE WO,72125,CPT,,,,,both,,,3833.18,3833.18,Aetna,Commercial,,3833.18,29.8,29.8% of Medicare Base rate X weight,3833.18,1286.30,11422.88,Fee Schedule,29.8
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,3833.18,2299.90,Aetna,Commercial,,3833.18,29.8,29.8% of Medicare Base rate X weight,3833.18,1286.30,11422.88,Fee Schedule,29.8
CT-CERV SPINE W,72126,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,604.85,29.8,29.8% of Medicare Base rate X weight,604.85,202.97,1802.45,Fee Schedule,29.8
CT-CERV SPINE W,72126,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,650.88,29.8,29.8% of Medicare Base rate X weight,650.88,218.42,1939.62,Fee Schedule,29.8
CT-CERV SPINE W,72126,CPT,,,,,both,,,6031.42,6031.42,Aetna,Commercial,,6031.42,29.8,29.8% of Medicare Base rate X weight,6031.42,2023.97,17973.63,Fee Schedule,29.8
CT-CERV SPINE W,72126,CPT,,,,,both,, ,6031.42,3618.85,Aetna,Commercial,,6031.42,29.8,29.8% of Medicare Base rate X weight,6031.42,2023.97,17973.63,Fee Schedule,29.8
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,680.91,29.8,29.8% of Medicare Base rate X weight,680.91,228.49,2029.11,Fee Schedule,29.8
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,732.83,29.8,29.8% of Medicare Base rate X weight,732.83,245.92,2183.83,Fee Schedule,29.8
CT-CERV SPINE WWO,72127,CPT,,,,,both,,,6031.42,6031.42,Aetna,Commercial,,6031.42,29.8,29.8% of Medicare Base rate X weight,6031.42,2023.97,17973.63,Fee Schedule,29.8
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,6031.42,3618.85,Aetna,Commercial,,6031.42,29.8,29.8% of Medicare Base rate X weight,6031.42,2023.97,17973.63,Fee Schedule,29.8
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,307.05,29.8,29.8% of Medicare Base rate X weight,307.05,103.04,915.01,Fee Schedule,29.8
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,330.63,29.8,29.8% of Medicare Base rate X weight,330.63,110.95,985.28,Fee Schedule,29.8
CT-THOR SPINE WO,72128,CPT,,,,,both,,,3833.18,3833.18,Aetna,Commercial,,3833.18,29.8,29.8% of Medicare Base rate X weight,3833.18,1286.30,11422.88,Fee Schedule,29.8
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,3833.18,2299.90,Aetna,Commercial,,3833.18,29.8,29.8% of Medicare Base rate X weight,3833.18,1286.30,11422.88,Fee Schedule,29.8
CT-THOR SPINE W,72129,CPT,,,,,both,, ,534.96,320.97,Aetna,Commercial,,534.96,29.8,29.8% of Medicare Base rate X weight,534.96,179.52,1594.18,Fee Schedule,29.8
CT-THOR SPINE W,72129,CPT,,,,,both,,,1786.22,1786.22,Aetna,Commercial,,1786.22,29.8,29.8% of Medicare Base rate X weight,1786.22,599.40,5322.94,Fee Schedule,29.8
CT-THOR SPINE W,72129,CPT,,,,,both,, ,1786.22,1071.73,Aetna,Commercial,,1786.22,29.8,29.8% of Medicare Base rate X weight,1786.22,599.40,5322.94,Fee Schedule,29.8
CT-THOR SPINE WWO,72130,CPT,,,,,both,,,2407.63,2407.63,Aetna,Commercial,,2407.63,29.8,29.8% of Medicare Base rate X weight,2407.63,807.93,7174.74,Fee Schedule,29.8
CT-THOR SPINE WWO,72130,CPT,,,,,both,, ,2407.63,1444.57,Aetna,Commercial,,2407.63,29.8,29.8% of Medicare Base rate X weight,2407.63,807.93,7174.74,Fee Schedule,29.8
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,307.05,29.8,29.8% of Medicare Base rate X weight,307.05,103.04,915.01,Fee Schedule,29.8
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,330.63,29.8,29.8% of Medicare Base rate X weight,330.63,110.95,985.28,Fee Schedule,29.8
CT-LUMB SPINE WO,72131,CPT,,,,,both,,,534.68,534.68,Aetna,Commercial,,534.68,29.8,29.8% of Medicare Base rate X weight,534.68,179.42,1593.35,Fee Schedule,29.8
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,534.68,320.80,Aetna,Commercial,,534.68,29.8,29.8% of Medicare Base rate X weight,534.68,179.42,1593.35,Fee Schedule,29.8
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,604.85,29.8,29.8% of Medicare Base rate X weight,604.85,202.97,1802.45,Fee Schedule,29.8
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,650.88,29.8,29.8% of Medicare Base rate X weight,650.88,218.42,1939.62,Fee Schedule,29.8
CT-LUMB SPINE W,72132,CPT,,,,,both,,,1653.45,1653.45,Aetna,Commercial,,1653.45,29.8,29.8% of Medicare Base rate X weight,1653.45,554.85,4927.28,Fee Schedule,29.8
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,1653.45,992.07,Aetna,Commercial,,1653.45,29.8,29.8% of Medicare Base rate X weight,1653.45,554.85,4927.28,Fee Schedule,29.8
CT-LUMB SPINE WWO,72133,CPT,,,,,both,, ,446.27,267.76,Aetna,Commercial,,446.27,29.8,29.8% of Medicare Base rate X weight,446.27,149.76,1329.88,Fee Schedule,29.8
CT-LUMB SPINE WWO,72133,CPT,,,,,both,,,1126.62,1126.62,Aetna,Commercial,,1126.62,29.8,29.8% of Medicare Base rate X weight,1126.62,378.06,3357.33,Fee Schedule,29.8
CT-LUMB SPINE WWO,72133,CPT,,,,,both,, ,1126.62,675.97,Aetna,Commercial,,1126.62,29.8,29.8% of Medicare Base rate X weight,1126.62,378.06,3357.33,Fee Schedule,29.8
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,715.99,29.8,29.8% of Medicare Base rate X weight,715.99,240.27,2133.65,Fee Schedule,29.8
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,770.45,29.8,29.8% of Medicare Base rate X weight,770.45,258.54,2295.94,Fee Schedule,29.8
MR-CERV SPINE WO,72141,CPT,,,,,both,,,4941.28,4941.28,Aetna,Commercial,,4941.28,29.8,29.8% of Medicare Base rate X weight,4941.28,1658.15,14725.01,Fee Schedule,29.8
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,4941.28,29.8,29.8% of Medicare Base rate X weight,4941.28,1658.15,14725.01,Fee Schedule,29.8
MR-CERV SPINE W,72142,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,1035.69,29.8,29.8% of Medicare Base rate X weight,1035.69,347.55,3086.36,Fee Schedule,29.8
MR-CERV SPINE W,72142,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,1114.55,29.8,29.8% of Medicare Base rate X weight,1114.55,374.01,3321.36,Fee Schedule,29.8
MR-CERV SPINE W,72142,CPT,,,,,both,,,2352.06,2352.06,Aetna,Commercial,,2352.06,29.8,29.8% of Medicare Base rate X weight,2352.06,789.28,7009.14,Fee Schedule,29.8
MR-CERV SPINE W,72142,CPT,,,,,both,, ,2352.06,1411.23,Aetna,Commercial,,2352.06,29.8,29.8% of Medicare Base rate X weight,2352.06,789.28,7009.14,Fee Schedule,29.8
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,715.99,29.8,29.8% of Medicare Base rate X weight,715.99,240.27,2133.65,Fee Schedule,29.8
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,770.45,29.8,29.8% of Medicare Base rate X weight,770.45,258.54,2295.94,Fee Schedule,29.8
MR-THOR SPINE WO,72146,CPT,,,,,both,,,4941.28,4941.28,Aetna,Commercial,,4941.28,29.8,29.8% of Medicare Base rate X weight,4941.28,1658.15,14725.01,Fee Schedule,29.8
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,4941.28,29.8,29.8% of Medicare Base rate X weight,4941.28,1658.15,14725.01,Fee Schedule,29.8
MR-THOR SPINE W,72147,CPT,,,,,both,, ,1641.24,984.74,Aetna,Commercial,,1641.24,29.8,29.8% of Medicare Base rate X weight,1641.24,550.75,4890.9,Fee Schedule,29.8
MR-THOR SPINE W,72147,CPT,,,,,both,,,2351.49,2351.49,Aetna,Commercial,,2351.49,29.8,29.8% of Medicare Base rate X weight,2351.49,789.09,7007.44,Fee Schedule,29.8
MR-THOR SPINE W,72147,CPT,,,,,both,, ,2351.49,1410.89,Aetna,Commercial,,2351.49,29.8,29.8% of Medicare Base rate X weight,2351.49,789.09,7007.44,Fee Schedule,29.8
MRI scan of lower spinal canal,72148,CPT,,,,,both,,,4941.28,4941.28,Aetna,Commercial,,4941.28,29.8,29.8% of Medicare Base rate X weight,4941.28,1658.15,14725.01,Fee Schedule,29.8
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,715.99,29.8,29.8% of Medicare Base rate X weight,715.99,240.27,2133.65,Fee Schedule,29.8
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,770.45,29.8,29.8% of Medicare Base rate X weight,770.45,258.54,2295.94,Fee Schedule,29.8
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,4941.28,29.8,29.8% of Medicare Base rate X weight,4941.28,1658.15,14725.01,Fee Schedule,29.8
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,1035.69,29.8,29.8% of Medicare Base rate X weight,1035.69,347.55,3086.36,Fee Schedule,29.8
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,1114.55,29.8,29.8% of Medicare Base rate X weight,1114.55,374.01,3321.36,Fee Schedule,29.8
MR-LUMB SPINE W,72149,CPT,,,,,both,,,2352.06,2352.06,Aetna,Commercial,,2352.06,29.8,29.8% of Medicare Base rate X weight,2352.06,789.28,7009.14,Fee Schedule,29.8
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,2352.06,1411.23,Aetna,Commercial,,2352.06,29.8,29.8% of Medicare Base rate X weight,2352.06,789.28,7009.14,Fee Schedule,29.8
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,1197.08,29.8,29.8% of Medicare Base rate X weight,1197.08,401.70,3567.3,Fee Schedule,29.8
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,1288.29,29.8,29.8% of Medicare Base rate X weight,1288.29,432.31,3839.1,Fee Schedule,29.8
MR-CERV SPINE WWO,72156,CPT,,,,,both,,,6352.79,6352.79,Aetna,Commercial,,6352.79,29.8,29.8% of Medicare Base rate X weight,6352.79,2131.81,18931.31,Fee Schedule,29.8
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,6352.79,3811.67,Aetna,Commercial,,6352.79,29.8,29.8% of Medicare Base rate X weight,6352.79,2131.81,18931.31,Fee Schedule,29.8
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,1197.08,29.8,29.8% of Medicare Base rate X weight,1197.08,401.70,3567.3,Fee Schedule,29.8
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,1288.29,29.8,29.8% of Medicare Base rate X weight,1288.29,432.31,3839.1,Fee Schedule,29.8
MR-THOR SPINE WWO,72157,CPT,,,,,both,,,6352.79,6352.79,Aetna,Commercial,,6352.79,29.8,29.8% of Medicare Base rate X weight,6352.79,2131.81,18931.31,Fee Schedule,29.8
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,6352.79,3811.67,Aetna,Commercial,,6352.79,29.8,29.8% of Medicare Base rate X weight,6352.79,2131.81,18931.31,Fee Schedule,29.8
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,1197.08,29.8,29.8% of Medicare Base rate X weight,1197.08,401.70,3567.3,Fee Schedule,29.8
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,1288.29,29.8,29.8% of Medicare Base rate X weight,1288.29,432.31,3839.1,Fee Schedule,29.8
MR-LUMB SPINE WWO,72158,CPT,,,,,both,,,6352.79,6352.79,Aetna,Commercial,,6352.79,29.8,29.8% of Medicare Base rate X weight,6352.79,2131.81,18931.31,Fee Schedule,29.8
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,6352.79,3811.67,Aetna,Commercial,,6352.79,29.8,29.8% of Medicare Base rate X weight,6352.79,2131.81,18931.31,Fee Schedule,29.8
LE-PELVIS CR,72170,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-PELVIS CR,72170,CPT,,,,,both,,,936.33,936.33,Aetna,Commercial,,936.33,29.8,29.8% of Medicare Base rate X weight,936.33,314.20,2790.26,Fee Schedule,29.8
LE-PELVIS CR,72170,CPT,,,,,both,, ,936.33,561.79,Aetna,Commercial,,936.33,29.8,29.8% of Medicare Base rate X weight,936.33,314.20,2790.26,Fee Schedule,29.8
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,,,1774.99,1774.99,Aetna,Commercial,,1774.99,29.8,29.8% of Medicare Base rate X weight,1774.99,595.63,5289.47,Fee Schedule,29.8
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,1774.99,1064.99,Aetna,Commercial,,1774.99,29.8,29.8% of Medicare Base rate X weight,1774.99,595.63,5289.47,Fee Schedule,29.8
CT-PELVIS WO,72192,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,307.05,29.8,29.8% of Medicare Base rate X weight,307.05,103.04,915.01,Fee Schedule,29.8
CT-PELVIS WO,72192,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,330.63,29.8,29.8% of Medicare Base rate X weight,330.63,110.95,985.28,Fee Schedule,29.8
CT-PELVIS WO,72192,CPT,,,,,both,,,3285.58,3285.58,Aetna,Commercial,,3285.58,29.8,29.8% of Medicare Base rate X weight,3285.58,1102.54,9791.03,Fee Schedule,29.8
CT-PELVIS WO,72192,CPT,,,,,both,, ,3285.58,1971.34,Aetna,Commercial,,3285.58,29.8,29.8% of Medicare Base rate X weight,3285.58,1102.54,9791.03,Fee Schedule,29.8
"CT scan, pelvis, with contrast",72193,CPT,,,,,both,,,3726.80,3726.80,Aetna,Commercial,,3726.80,29.8,29.8% of Medicare Base rate X weight,3726.80,1250.60,11105.86,Fee Schedule,29.8
CT-PELVIS W,72193,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,604.85,29.8,29.8% of Medicare Base rate X weight,604.85,202.97,1802.45,Fee Schedule,29.8
CT-PELVIS W,72193,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,650.88,29.8,29.8% of Medicare Base rate X weight,650.88,218.42,1939.62,Fee Schedule,29.8
CT-PELVIS W,72193,CPT,,,,,both,, ,3726.80,2236.08,Aetna,Commercial,,3726.80,29.8,29.8% of Medicare Base rate X weight,3726.80,1250.60,11105.86,Fee Schedule,29.8
CT-PELVIS WWO,72194,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,680.91,29.8,29.8% of Medicare Base rate X weight,680.91,228.49,2029.11,Fee Schedule,29.8
CT-PELVIS WWO,72194,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,732.83,29.8,29.8% of Medicare Base rate X weight,732.83,245.92,2183.83,Fee Schedule,29.8
CT-PELVIS WWO,72194,CPT,,,,,both,,,4047.33,4047.33,Aetna,Commercial,,4047.33,29.8,29.8% of Medicare Base rate X weight,4047.33,1358.16,12061.04,Fee Schedule,29.8
CT-PELVIS WWO,72194,CPT,,,,,both,, ,4047.33,2428.39,Aetna,Commercial,,4047.33,29.8,29.8% of Medicare Base rate X weight,4047.33,1358.16,12061.04,Fee Schedule,29.8
MR-PELVIS WO,72195,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,715.99,29.8,29.8% of Medicare Base rate X weight,715.99,240.27,2133.65,Fee Schedule,29.8
MR-PELVIS WO,72195,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,770.45,29.8,29.8% of Medicare Base rate X weight,770.45,258.54,2295.94,Fee Schedule,29.8
MR-PELVIS WO,72195,CPT,,,,,both,,,4042.84,4042.84,Aetna,Commercial,,4042.84,29.8,29.8% of Medicare Base rate X weight,4042.84,1356.66,12047.66,Fee Schedule,29.8
MR-PELVIS WO,72195,CPT,,,,,both,, ,4042.84,2425.70,Aetna,Commercial,,4042.84,29.8,29.8% of Medicare Base rate X weight,4042.84,1356.66,12047.66,Fee Schedule,29.8
MR-PELVIS W,72196,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,1035.69,29.8,29.8% of Medicare Base rate X weight,1035.69,347.55,3086.36,Fee Schedule,29.8
MR-PELVIS W,72196,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,1114.55,29.8,29.8% of Medicare Base rate X weight,1114.55,374.01,3321.36,Fee Schedule,29.8
MR-PELVIS W,72196,CPT,,,,,both,,,2940.06,2940.06,Aetna,Commercial,,2940.06,29.8,29.8% of Medicare Base rate X weight,2940.06,986.60,8761.38,Fee Schedule,29.8
MR-PELVIS W,72196,CPT,,,,,both,, ,2940.06,1764.03,Aetna,Commercial,,2940.06,29.8,29.8% of Medicare Base rate X weight,2940.06,986.60,8761.38,Fee Schedule,29.8
MR-PELVIS WWO,72197,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,1197.08,29.8,29.8% of Medicare Base rate X weight,1197.08,401.70,3567.3,Fee Schedule,29.8
MR-PELVIS WWO,72197,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,1288.29,29.8,29.8% of Medicare Base rate X weight,1288.29,432.31,3839.1,Fee Schedule,29.8
MR-PELVIS WWO,72197,CPT,,,,,both,,,5197.81,5197.81,Aetna,Commercial,,5197.81,29.8,29.8% of Medicare Base rate X weight,5197.81,1744.23,15489.47,Fee Schedule,29.8
MR-PELVIS WWO,72197,CPT,,,,,both,, ,5197.81,3118.68,Aetna,Commercial,,5197.81,29.8,29.8% of Medicare Base rate X weight,5197.81,1744.23,15489.47,Fee Schedule,29.8
SP-SI JOINTS 2V CR,72200,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-SI JOINTS 2V CR,72200,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,,,757.53,757.53,Aetna,Commercial,,757.53,29.8,29.8% of Medicare Base rate X weight,757.53,254.20,2257.44,Fee Schedule,29.8
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,757.53,454.51,Aetna,Commercial,,757.53,29.8,29.8% of Medicare Base rate X weight,757.53,254.20,2257.44,Fee Schedule,29.8
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,,,989.38,989.38,Aetna,Commercial,,989.38,29.8,29.8% of Medicare Base rate X weight,989.38,332.01,2948.35,Fee Schedule,29.8
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,989.38,593.62,Aetna,Commercial,,989.38,29.8,29.8% of Medicare Base rate X weight,989.38,332.01,2948.35,Fee Schedule,29.8
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,,,721.61,721.61,Aetna,Commercial,,721.61,29.8,29.8% of Medicare Base rate X weight,721.61,242.15,2150.4,Fee Schedule,29.8
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,721.61,432.96,Aetna,Commercial,,721.61,29.8,29.8% of Medicare Base rate X weight,721.61,242.15,2150.4,Fee Schedule,29.8
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-CLAVICLE CR,73000,CPT,,,,,both,,,353.93,353.93,Aetna,Commercial,,353.93,29.8,29.8% of Medicare Base rate X weight,353.93,118.77,1054.71,Fee Schedule,29.8
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,353.93,212.35,Aetna,Commercial,,353.93,29.8,29.8% of Medicare Base rate X weight,353.93,118.77,1054.71,Fee Schedule,29.8
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,273.37,164.02,Aetna,Commercial,,273.37,29.8,29.8% of Medicare Base rate X weight,273.37,91.73,814.64,Fee Schedule,29.8
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,273.37,164.02,Aetna,Commercial,,273.37,29.8,29.8% of Medicare Base rate X weight,273.37,91.73,814.64,Fee Schedule,29.8
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,,,804.69,804.69,Aetna,Commercial,,804.69,29.8,29.8% of Medicare Base rate X weight,804.69,270.03,2397.98,Fee Schedule,29.8
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,804.69,29.8,29.8% of Medicare Base rate X weight,804.69,270.03,2397.98,Fee Schedule,29.8
UE-SCAPULA CR,73010,CPT,,,,,both,, ,136.68,82.00,Aetna,Commercial,,136.68,29.8,29.8% of Medicare Base rate X weight,136.68,45.87,407.31,Fee Schedule,29.8
UE-SCAPULA CR,73010,CPT,,,,,both,, ,136.68,82.00,Aetna,Commercial,,136.68,29.8,29.8% of Medicare Base rate X weight,136.68,45.87,407.31,Fee Schedule,29.8
UE-SCAPULA CR,73010,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-SCAPULA CR,73010,CPT,,,,,both,,,402.20,402.20,Aetna,Commercial,,402.20,29.8,29.8% of Medicare Base rate X weight,402.20,134.97,1198.56,Fee Schedule,29.8
UE-SCAPULA CR,73010,CPT,,,,,both,, ,402.20,241.32,Aetna,Commercial,,402.20,29.8,29.8% of Medicare Base rate X weight,402.20,134.97,1198.56,Fee Schedule,29.8
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,,,978.43,978.43,Aetna,Commercial,,978.43,29.8,29.8% of Medicare Base rate X weight,978.43,328.33,2915.72,Fee Schedule,29.8
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,978.43,587.05,Aetna,Commercial,,978.43,29.8,29.8% of Medicare Base rate X weight,978.43,328.33,2915.72,Fee Schedule,29.8
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-SHOULDER 1V CR,73020,CPT,,,,,both,,,489.50,489.50,Aetna,Commercial,,489.50,29.8,29.8% of Medicare Base rate X weight,489.50,164.26,1458.71,Fee Schedule,29.8
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,489.50,293.70,Aetna,Commercial,,489.50,29.8,29.8% of Medicare Base rate X weight,489.50,164.26,1458.71,Fee Schedule,29.8
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,,,863.36,863.36,Aetna,Commercial,,863.36,29.8,29.8% of Medicare Base rate X weight,863.36,289.72,2572.81,Fee Schedule,29.8
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,863.36,518.01,Aetna,Commercial,,863.36,29.8,29.8% of Medicare Base rate X weight,863.36,289.72,2572.81,Fee Schedule,29.8
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,,,1726.71,1726.71,Aetna,Commercial,,1726.71,29.8,29.8% of Medicare Base rate X weight,1726.71,579.43,5145.6,Fee Schedule,29.8
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,1726.71,1036.02,Aetna,Commercial,,1726.71,29.8,29.8% of Medicare Base rate X weight,1726.71,579.43,5145.6,Fee Schedule,29.8
IR-ARTHROGM SHLDR CR,73040,CPT,,,,,both,, ,3748.70,2249.22,Aetna,Commercial,,3748.70,29.8,29.8% of Medicare Base rate X weight,3748.70,1257.95,11171.13,Fee Schedule,29.8
IR-ATHGRM SHLD BI CR,73040,CPT,,,,,both,, ,7497.39,4498.43,Aetna,Commercial,,7497.39,29.8,29.8% of Medicare Base rate X weight,7497.39,2515.90,22342.22,Fee Schedule,29.8
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-AC JTS BILAT CR,73050,CPT,,,,,both,,,918.37,918.37,Aetna,Commercial,,918.37,29.8,29.8% of Medicare Base rate X weight,918.37,308.18,2736.74,Fee Schedule,29.8
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,918.37,551.02,Aetna,Commercial,,918.37,29.8,29.8% of Medicare Base rate X weight,918.37,308.18,2736.74,Fee Schedule,29.8
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,,,721.61,721.61,Aetna,Commercial,,721.61,29.8,29.8% of Medicare Base rate X weight,721.61,242.15,2150.4,Fee Schedule,29.8
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,721.61,432.96,Aetna,Commercial,,721.61,29.8,29.8% of Medicare Base rate X weight,721.61,242.15,2150.4,Fee Schedule,29.8
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-HUMERUS CR,73060,CPT,,,,,both,,,1442.95,1442.95,Aetna,Commercial,,1442.95,29.8,29.8% of Medicare Base rate X weight,1442.95,484.21,4299.99,Fee Schedule,29.8
UE-HUMERUS CR,73060,CPT,,,,,both,, ,1442.95,865.77,Aetna,Commercial,,1442.95,29.8,29.8% of Medicare Base rate X weight,1442.95,484.21,4299.99,Fee Schedule,29.8
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-ELBOW 2V CR,73070,CPT,,,,,both,,,662.39,662.39,Aetna,Commercial,,662.39,29.8,29.8% of Medicare Base rate X weight,662.39,222.28,1973.92,Fee Schedule,29.8
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,662.39,397.43,Aetna,Commercial,,662.39,29.8,29.8% of Medicare Base rate X weight,662.39,222.28,1973.92,Fee Schedule,29.8
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,,,1325.06,1325.06,Aetna,Commercial,,1325.06,29.8,29.8% of Medicare Base rate X weight,1325.06,444.65,3948.68,Fee Schedule,29.8
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,1325.06,795.03,Aetna,Commercial,,1325.06,29.8,29.8% of Medicare Base rate X weight,1325.06,444.65,3948.68,Fee Schedule,29.8
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-ELBOW 3V CR,73080,CPT,,,,,both,,,804.69,804.69,Aetna,Commercial,,804.69,29.8,29.8% of Medicare Base rate X weight,804.69,270.03,2397.98,Fee Schedule,29.8
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,804.69,29.8,29.8% of Medicare Base rate X weight,804.69,270.03,2397.98,Fee Schedule,29.8
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,,,1609.11,1609.11,Aetna,Commercial,,1609.11,29.8,29.8% of Medicare Base rate X weight,1609.11,539.97,4795.15,Fee Schedule,29.8
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,1609.11,965.46,Aetna,Commercial,,1609.11,29.8,29.8% of Medicare Base rate X weight,1609.11,539.97,4795.15,Fee Schedule,29.8
IR-ARTHRGRM ELBOW BI,73085,CPT,,,,,both,, ,3748.70,2249.22,Aetna,Commercial,,3748.70,29.8,29.8% of Medicare Base rate X weight,3748.70,1257.95,11171.13,Fee Schedule,29.8
IR-ARTHRGRM ELBOW BI,73085,CPT,,,,,both,, ,3748.70,2249.22,Aetna,Commercial,,3748.70,29.8,29.8% of Medicare Base rate X weight,3748.70,1257.95,11171.13,Fee Schedule,29.8
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-FOREARM 2V CR,73090,CPT,,,,,both,,,662.39,662.39,Aetna,Commercial,,662.39,29.8,29.8% of Medicare Base rate X weight,662.39,222.28,1973.92,Fee Schedule,29.8
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,662.39,397.43,Aetna,Commercial,,662.39,29.8,29.8% of Medicare Base rate X weight,662.39,222.28,1973.92,Fee Schedule,29.8
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,,,1325.06,1325.06,Aetna,Commercial,,1325.06,29.8,29.8% of Medicare Base rate X weight,1325.06,444.65,3948.68,Fee Schedule,29.8
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,1325.06,795.03,Aetna,Commercial,,1325.06,29.8,29.8% of Medicare Base rate X weight,1325.06,444.65,3948.68,Fee Schedule,29.8
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,220.61,29.8,29.8% of Medicare Base rate X weight,220.61,74.03,657.42,Fee Schedule,29.8
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
UE-UP EXT INFANT CR,73092,CPT,,,,,both,,,721.61,721.61,Aetna,Commercial,,721.61,29.8,29.8% of Medicare Base rate X weight,721.61,242.15,2150.4,Fee Schedule,29.8
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,721.61,432.96,Aetna,Commercial,,721.61,29.8,29.8% of Medicare Base rate X weight,721.61,242.15,2150.4,Fee Schedule,29.8
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,441.50,264.90,Aetna,Commercial,,441.50,29.8,29.8% of Medicare Base rate X weight,441.50,148.15,1315.67,Fee Schedule,29.8
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,475.18,285.10,Aetna,Commercial,,475.18,29.8,29.8% of Medicare Base rate X weight,475.18,159.46,1416.04,Fee Schedule,29.8
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,,,1444.91,1444.91,Aetna,Commercial,,1444.91,29.8,29.8% of Medicare Base rate X weight,1444.91,484.87,4305.83,Fee Schedule,29.8
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,1444.91,866.94,Aetna,Commercial,,1444.91,29.8,29.8% of Medicare Base rate X weight,1444.91,484.87,4305.83,Fee Schedule,29.8
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-WRIST 2V CR,73100,CPT,,,,,both,,,607.94,607.94,Aetna,Commercial,,607.94,29.8,29.8% of Medicare Base rate X weight,607.94,204.01,1811.66,Fee Schedule,29.8
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,607.94,364.76,Aetna,Commercial,,607.94,29.8,29.8% of Medicare Base rate X weight,607.94,204.01,1811.66,Fee Schedule,29.8
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,,,1216.16,1216.16,Aetna,Commercial,,1216.16,29.8,29.8% of Medicare Base rate X weight,1216.16,408.11,3624.16,Fee Schedule,29.8
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,1216.16,729.69,Aetna,Commercial,,1216.16,29.8,29.8% of Medicare Base rate X weight,1216.16,408.11,3624.16,Fee Schedule,29.8
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,,,662.39,662.39,Aetna,Commercial,,662.39,29.8,29.8% of Medicare Base rate X weight,662.39,222.28,1973.92,Fee Schedule,29.8
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,662.39,397.43,Aetna,Commercial,,662.39,29.8,29.8% of Medicare Base rate X weight,662.39,222.28,1973.92,Fee Schedule,29.8
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,,,1325.06,1325.06,Aetna,Commercial,,1325.06,29.8,29.8% of Medicare Base rate X weight,1325.06,444.65,3948.68,Fee Schedule,29.8
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,1325.06,795.03,Aetna,Commercial,,1325.06,29.8,29.8% of Medicare Base rate X weight,1325.06,444.65,3948.68,Fee Schedule,29.8
IR-ARTHRGRM WRIST BI,73115,CPT,,,,,both,, ,3748.70,2249.22,Aetna,Commercial,,3748.70,29.8,29.8% of Medicare Base rate X weight,3748.70,1257.95,11171.13,Fee Schedule,29.8
IR-ARTHRGRM WRIST BI,73115,CPT,,,,,both,, ,3748.70,2249.22,Aetna,Commercial,,3748.70,29.8,29.8% of Medicare Base rate X weight,3748.70,1257.95,11171.13,Fee Schedule,29.8
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-HAND 2V CR,73120,CPT,,,,,both,,,662.39,662.39,Aetna,Commercial,,662.39,29.8,29.8% of Medicare Base rate X weight,662.39,222.28,1973.92,Fee Schedule,29.8
UE-HAND 2V CR,73120,CPT,,,,,both,, ,662.39,397.43,Aetna,Commercial,,662.39,29.8,29.8% of Medicare Base rate X weight,662.39,222.28,1973.92,Fee Schedule,29.8
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,,,1325.06,1325.06,Aetna,Commercial,,1325.06,29.8,29.8% of Medicare Base rate X weight,1325.06,444.65,3948.68,Fee Schedule,29.8
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,1325.06,795.03,Aetna,Commercial,,1325.06,29.8,29.8% of Medicare Base rate X weight,1325.06,444.65,3948.68,Fee Schedule,29.8
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-HAND 3V CR,73130,CPT,,,,,both,,,804.69,804.69,Aetna,Commercial,,804.69,29.8,29.8% of Medicare Base rate X weight,804.69,270.03,2397.98,Fee Schedule,29.8
UE-HAND 3V CR,73130,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,804.69,29.8,29.8% of Medicare Base rate X weight,804.69,270.03,2397.98,Fee Schedule,29.8
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,,,1609.11,1609.11,Aetna,Commercial,,1609.11,29.8,29.8% of Medicare Base rate X weight,1609.11,539.97,4795.15,Fee Schedule,29.8
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,1609.11,965.46,Aetna,Commercial,,1609.11,29.8,29.8% of Medicare Base rate X weight,1609.11,539.97,4795.15,Fee Schedule,29.8
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,,,1137.30,1137.30,Aetna,Commercial,,1137.30,29.8,29.8% of Medicare Base rate X weight,1137.30,381.64,3389.15,Fee Schedule,29.8
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,1137.30,682.38,Aetna,Commercial,,1137.30,29.8,29.8% of Medicare Base rate X weight,1137.30,381.64,3389.15,Fee Schedule,29.8
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,,,568.64,568.64,Aetna,Commercial,,568.64,29.8,29.8% of Medicare Base rate X weight,568.64,190.82,1694.55,Fee Schedule,29.8
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,568.64,341.18,Aetna,Commercial,,568.64,29.8,29.8% of Medicare Base rate X weight,568.64,190.82,1694.55,Fee Schedule,29.8
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,307.05,29.8,29.8% of Medicare Base rate X weight,307.05,103.04,915.01,Fee Schedule,29.8
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,330.63,29.8,29.8% of Medicare Base rate X weight,330.63,110.95,985.28,Fee Schedule,29.8
CT-UPPER EXT WO,73200,CPT,,,,,both,,,3015.85,3015.85,Aetna,Commercial,,3015.85,29.8,29.8% of Medicare Base rate X weight,3015.85,1012.03,8987.23,Fee Schedule,29.8
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,3015.85,1809.51,Aetna,Commercial,,3015.85,29.8,29.8% of Medicare Base rate X weight,3015.85,1012.03,8987.23,Fee Schedule,29.8
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,614.40,368.64,Aetna,Commercial,,614.40,29.8,29.8% of Medicare Base rate X weight,614.40,206.17,1830.91,Fee Schedule,29.8
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,660.98,396.58,Aetna,Commercial,,660.98,29.8,29.8% of Medicare Base rate X weight,660.98,221.81,1969.72,Fee Schedule,29.8
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,6031.42,3618.85,Aetna,Commercial,,6031.42,29.8,29.8% of Medicare Base rate X weight,6031.42,2023.97,17973.63,Fee Schedule,29.8
CT-UPPER EXT W,73201,CPT,,,,,both,, ,556.01,333.60,Aetna,Commercial,,556.01,29.8,29.8% of Medicare Base rate X weight,556.01,186.58,1656.91,Fee Schedule,29.8
CT-UPPER EXT W,73201,CPT,,,,,both,,,3350.14,3350.14,Aetna,Commercial,,3350.14,29.8,29.8% of Medicare Base rate X weight,3350.14,1124.21,9983.42,Fee Schedule,29.8
CT-UPPER EXT W,73201,CPT,,,,,both,, ,3350.14,2010.08,Aetna,Commercial,,3350.14,29.8,29.8% of Medicare Base rate X weight,3350.14,1124.21,9983.42,Fee Schedule,29.8
CTA-UPPER EXT,73206,CPT,,,,,both,,,1947.60,1947.60,Aetna,Commercial,,1947.60,29.8,29.8% of Medicare Base rate X weight,1947.60,653.56,5803.85,Fee Schedule,29.8
CTA-UPPER EXT,73206,CPT,,,,,both,, ,1947.60,1168.56,Aetna,Commercial,,1947.60,29.8,29.8% of Medicare Base rate X weight,1947.60,653.56,5803.85,Fee Schedule,29.8
CTA-UPPER EXT BI,73206,CPT,,,,,both,, ,3895.20,2337.12,Aetna,Commercial,,3895.20,29.8,29.8% of Medicare Base rate X weight,3895.20,1307.11,11607.7,Fee Schedule,29.8
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,1431.72,859.03,Aetna,Commercial,,1431.72,29.8,29.8% of Medicare Base rate X weight,1431.72,480.44,4266.53,Fee Schedule,29.8
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,1540.90,924.54,Aetna,Commercial,,1540.90,29.8,29.8% of Medicare Base rate X weight,1540.90,517.08,4591.88,Fee Schedule,29.8
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,4042.84,2425.70,Aetna,Commercial,,4042.84,29.8,29.8% of Medicare Base rate X weight,4042.84,1356.66,12047.66,Fee Schedule,29.8
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,715.99,29.8,29.8% of Medicare Base rate X weight,715.99,240.27,2133.65,Fee Schedule,29.8
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,770.45,29.8,29.8% of Medicare Base rate X weight,770.45,258.54,2295.94,Fee Schedule,29.8
MR-UPPER EXT WO,73218,CPT,,,,,both,,,2470.50,2470.50,Aetna,Commercial,,2470.50,29.8,29.8% of Medicare Base rate X weight,2470.50,829.03,7362.09,Fee Schedule,29.8
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,2470.50,1482.30,Aetna,Commercial,,2470.50,29.8,29.8% of Medicare Base rate X weight,2470.50,829.03,7362.09,Fee Schedule,29.8
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,2394.15,1436.49,Aetna,Commercial,,2394.15,29.8,29.8% of Medicare Base rate X weight,2394.15,803.41,7134.57,Fee Schedule,29.8
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,2576.60,1545.96,Aetna,Commercial,,2576.60,29.8,29.8% of Medicare Base rate X weight,2576.60,864.63,7678.27,Fee Schedule,29.8
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,5197.81,3118.68,Aetna,Commercial,,5197.81,29.8,29.8% of Medicare Base rate X weight,5197.81,1744.23,15489.47,Fee Schedule,29.8
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,1197.08,29.8,29.8% of Medicare Base rate X weight,1197.08,401.70,3567.3,Fee Schedule,29.8
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,1288.29,29.8,29.8% of Medicare Base rate X weight,1288.29,432.31,3839.1,Fee Schedule,29.8
MR-UPPER EXT WWO,73220,CPT,,,,,both,,,2598.76,2598.76,Aetna,Commercial,,2598.76,29.8,29.8% of Medicare Base rate X weight,2598.76,872.07,7744.3,Fee Schedule,29.8
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,2598.76,1559.25,Aetna,Commercial,,2598.76,29.8,29.8% of Medicare Base rate X weight,2598.76,872.07,7744.3,Fee Schedule,29.8
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,715.99,29.8,29.8% of Medicare Base rate X weight,715.99,240.27,2133.65,Fee Schedule,29.8
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,770.45,29.8,29.8% of Medicare Base rate X weight,770.45,258.54,2295.94,Fee Schedule,29.8
MR-UPPER JOINT WO,73221,CPT,,,,,both,,,2523.26,2523.26,Aetna,Commercial,,2523.26,29.8,29.8% of Medicare Base rate X weight,2523.26,846.73,7519.31,Fee Schedule,29.8
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,2523.26,1513.95,Aetna,Commercial,,2523.26,29.8,29.8% of Medicare Base rate X weight,2523.26,846.73,7519.31,Fee Schedule,29.8
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,1035.69,29.8,29.8% of Medicare Base rate X weight,1035.69,347.55,3086.36,Fee Schedule,29.8
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,1114.55,29.8,29.8% of Medicare Base rate X weight,1114.55,374.01,3321.36,Fee Schedule,29.8
MR-UPPER JOINT W,73222,CPT,,,,,both,,,4293.48,4293.48,Aetna,Commercial,,4293.48,29.8,29.8% of Medicare Base rate X weight,4293.48,1440.77,12794.57,Fee Schedule,29.8
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,4293.48,2576.08,Aetna,Commercial,,4293.48,29.8,29.8% of Medicare Base rate X weight,4293.48,1440.77,12794.57,Fee Schedule,29.8
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,1197.08,29.8,29.8% of Medicare Base rate X weight,1197.08,401.70,3567.3,Fee Schedule,29.8
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,1288.29,29.8,29.8% of Medicare Base rate X weight,1288.29,432.31,3839.1,Fee Schedule,29.8
MR-UPPER JOINT WWO,73223,CPT,,,,,both,,,4941.28,4941.28,Aetna,Commercial,,4941.28,29.8,29.8% of Medicare Base rate X weight,4941.28,1658.15,14725.01,Fee Schedule,29.8
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,4941.28,29.8,29.8% of Medicare Base rate X weight,4941.28,1658.15,14725.01,Fee Schedule,29.8
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,,,333.44,333.44,Aetna,Commercial,,333.44,29.8,29.8% of Medicare Base rate X weight,333.44,111.89,993.65,Fee Schedule,29.8
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,333.44,200.06,Aetna,Commercial,,333.44,29.8,29.8% of Medicare Base rate X weight,333.44,111.89,993.65,Fee Schedule,29.8
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,139.77,83.86,Aetna,Commercial,,139.77,29.8,29.8% of Medicare Base rate X weight,139.77,46.90,416.51,Fee Schedule,29.8
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Aetna,Commercial,,149.32,29.8,29.8% of Medicare Base rate X weight,149.32,50.11,444.97,Fee Schedule,29.8
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Aetna,Commercial,,149.32,29.8,29.8% of Medicare Base rate X weight,149.32,50.11,444.97,Fee Schedule,29.8
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Aetna,Commercial,,149.32,29.8,29.8% of Medicare Base rate X weight,149.32,50.11,444.97,Fee Schedule,29.8
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,887.49,532.49,Aetna,Commercial,,887.49,29.8,29.8% of Medicare Base rate X weight,887.49,297.82,2644.72,Fee Schedule,29.8
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,209.94,125.96,Aetna,Commercial,,209.94,29.8,29.8% of Medicare Base rate X weight,209.94,70.45,625.62,Fee Schedule,29.8
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Aetna,Commercial,,224.54,29.8,29.8% of Medicare Base rate X weight,224.54,75.35,669.13,Fee Schedule,29.8
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Aetna,Commercial,,224.54,29.8,29.8% of Medicare Base rate X weight,224.54,75.35,669.13,Fee Schedule,29.8
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Aetna,Commercial,,224.54,29.8,29.8% of Medicare Base rate X weight,224.54,75.35,669.13,Fee Schedule,29.8
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,1330.96,798.57,Aetna,Commercial,,1330.96,29.8,29.8% of Medicare Base rate X weight,1330.96,446.63,3966.26,Fee Schedule,29.8
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,220.88,29.8,29.8% of Medicare Base rate X weight,220.88,74.12,658.22,Fee Schedule,29.8
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.80,Aetna,Commercial,,238.01,29.8,29.8% of Medicare Base rate X weight,238.01,79.87,709.27,Fee Schedule,29.8
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.80,Aetna,Commercial,,238.01,29.8,29.8% of Medicare Base rate X weight,238.01,79.87,709.27,Fee Schedule,29.8
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.80,Aetna,Commercial,,238.01,29.8,29.8% of Medicare Base rate X weight,238.01,79.87,709.27,Fee Schedule,29.8
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,,,1774.70,1774.70,Aetna,Commercial,,1774.70,29.8,29.8% of Medicare Base rate X weight,1774.70,595.54,5288.61,Fee Schedule,29.8
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,1774.70,1064.82,Aetna,Commercial,,1774.70,29.8,29.8% of Medicare Base rate X weight,1774.70,595.54,5288.61,Fee Schedule,29.8
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,220.88,29.8,29.8% of Medicare Base rate X weight,220.88,74.12,658.22,Fee Schedule,29.8
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.80,Aetna,Commercial,,238.01,29.8,29.8% of Medicare Base rate X weight,238.01,79.87,709.27,Fee Schedule,29.8
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.80,Aetna,Commercial,,238.01,29.8,29.8% of Medicare Base rate X weight,238.01,79.87,709.27,Fee Schedule,29.8
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.80,Aetna,Commercial,,238.01,29.8,29.8% of Medicare Base rate X weight,238.01,79.87,709.27,Fee Schedule,29.8
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,,,1774.70,1774.70,Aetna,Commercial,,1774.70,29.8,29.8% of Medicare Base rate X weight,1774.70,595.54,5288.61,Fee Schedule,29.8
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,1774.70,1064.82,Aetna,Commercial,,1774.70,29.8,29.8% of Medicare Base rate X weight,1774.70,595.54,5288.61,Fee Schedule,29.8
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,442.06,265.23,Aetna,Commercial,,442.06,29.8,29.8% of Medicare Base rate X weight,442.06,148.34,1317.34,Fee Schedule,29.8
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Aetna,Commercial,,476.02,29.8,29.8% of Medicare Base rate X weight,476.02,159.74,1418.54,Fee Schedule,29.8
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Aetna,Commercial,,476.02,29.8,29.8% of Medicare Base rate X weight,476.02,159.74,1418.54,Fee Schedule,29.8
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Aetna,Commercial,,476.02,29.8,29.8% of Medicare Base rate X weight,476.02,159.74,1418.54,Fee Schedule,29.8
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,,,3549.69,3549.69,Aetna,Commercial,,3549.69,29.8,29.8% of Medicare Base rate X weight,3549.69,1191.17,10578.08,Fee Schedule,29.8
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,3549.69,2129.81,Aetna,Commercial,,3549.69,29.8,29.8% of Medicare Base rate X weight,3549.69,1191.17,10578.08,Fee Schedule,29.8
IR-ARTHGRM BI HIP CR,73525,CPT,,,,,both,, ,3760.20,2256.12,Aetna,Commercial,,3760.20,29.8,29.8% of Medicare Base rate X weight,3760.20,1261.81,11205.4,Fee Schedule,29.8
IR-ARTHGRM BI HIP CR,73525,CPT,,,,,both,, ,3760.20,2256.12,Aetna,Commercial,,3760.20,29.8,29.8% of Medicare Base rate X weight,3760.20,1261.81,11205.4,Fee Schedule,29.8
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.20,88.92,Aetna,Commercial,,148.20,29.8,29.8% of Medicare Base rate X weight,148.20,49.73,441.64,Fee Schedule,29.8
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.20,88.92,Aetna,Commercial,,148.20,29.8,29.8% of Medicare Base rate X weight,148.20,49.73,441.64,Fee Schedule,29.8
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.20,88.92,Aetna,Commercial,,148.20,29.8,29.8% of Medicare Base rate X weight,148.20,49.73,441.64,Fee Schedule,29.8
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.20,88.92,Aetna,Commercial,,148.20,29.8,29.8% of Medicare Base rate X weight,148.20,49.73,441.64,Fee Schedule,29.8
LE-FEMUR 1V CR,73551,CPT,,,,,both,,,307.05,307.05,Aetna,Commercial,,307.05,29.8,29.8% of Medicare Base rate X weight,307.05,103.04,915.01,Fee Schedule,29.8
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,307.05,29.8,29.8% of Medicare Base rate X weight,307.05,103.04,915.01,Fee Schedule,29.8
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-FEMUR 2V CR,73552,CPT,,,,,both,,,782.23,782.23,Aetna,Commercial,,782.23,29.8,29.8% of Medicare Base rate X weight,782.23,262.49,2331.05,Fee Schedule,29.8
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,782.23,469.33,Aetna,Commercial,,782.23,29.8,29.8% of Medicare Base rate X weight,782.23,262.49,2331.05,Fee Schedule,29.8
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,,,1564.76,1564.76,Aetna,Commercial,,1564.76,29.8,29.8% of Medicare Base rate X weight,1564.76,525.09,4662.98,Fee Schedule,29.8
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,1564.76,938.85,Aetna,Commercial,,1564.76,29.8,29.8% of Medicare Base rate X weight,1564.76,525.09,4662.98,Fee Schedule,29.8
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,,,721.61,721.61,Aetna,Commercial,,721.61,29.8,29.8% of Medicare Base rate X weight,721.61,242.15,2150.4,Fee Schedule,29.8
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,721.61,432.96,Aetna,Commercial,,721.61,29.8,29.8% of Medicare Base rate X weight,721.61,242.15,2150.4,Fee Schedule,29.8
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,,,1442.95,1442.95,Aetna,Commercial,,1442.95,29.8,29.8% of Medicare Base rate X weight,1442.95,484.21,4299.99,Fee Schedule,29.8
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,1442.95,865.77,Aetna,Commercial,,1442.95,29.8,29.8% of Medicare Base rate X weight,1442.95,484.21,4299.99,Fee Schedule,29.8
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-KNEE 3V CR,73562,CPT,,,,,both,,,981.24,981.24,Aetna,Commercial,,981.24,29.8,29.8% of Medicare Base rate X weight,981.24,329.28,2924.1,Fee Schedule,29.8
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,981.24,588.74,Aetna,Commercial,,981.24,29.8,29.8% of Medicare Base rate X weight,981.24,329.28,2924.1,Fee Schedule,29.8
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,,,1962.48,1962.48,Aetna,Commercial,,1962.48,29.8,29.8% of Medicare Base rate X weight,1962.48,658.55,5848.19,Fee Schedule,29.8
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,1962.48,1177.48,Aetna,Commercial,,1962.48,29.8,29.8% of Medicare Base rate X weight,1962.48,658.55,5848.19,Fee Schedule,29.8
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,,,1070.49,1070.49,Aetna,Commercial,,1070.49,29.8,29.8% of Medicare Base rate X weight,1070.49,359.22,3190.06,Fee Schedule,29.8
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,1070.49,642.29,Aetna,Commercial,,1070.49,29.8,29.8% of Medicare Base rate X weight,1070.49,359.22,3190.06,Fee Schedule,29.8
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,,,2141.27,2141.27,Aetna,Commercial,,2141.27,29.8,29.8% of Medicare Base rate X weight,2141.27,718.55,6380.98,Fee Schedule,29.8
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,2141.27,1284.76,Aetna,Commercial,,2141.27,29.8,29.8% of Medicare Base rate X weight,2141.27,718.55,6380.98,Fee Schedule,29.8
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,,,721.61,721.61,Aetna,Commercial,,721.61,29.8,29.8% of Medicare Base rate X weight,721.61,242.15,2150.4,Fee Schedule,29.8
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,721.61,432.96,Aetna,Commercial,,721.61,29.8,29.8% of Medicare Base rate X weight,721.61,242.15,2150.4,Fee Schedule,29.8
IR-ARTHRGRM KNEE BI,73580,CPT,,,,,both,, ,7520.68,4512.40,Aetna,Commercial,,7520.68,29.8,29.8% of Medicare Base rate X weight,7520.68,2523.72,22411.63,Fee Schedule,29.8
IR-ARTHROGRAM KNEE,73580,CPT,,,,,both,, ,3760.20,2256.12,Aetna,Commercial,,3760.20,29.8,29.8% of Medicare Base rate X weight,3760.20,1261.81,11205.4,Fee Schedule,29.8
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,,,1442.95,1442.95,Aetna,Commercial,,1442.95,29.8,29.8% of Medicare Base rate X weight,1442.95,484.21,4299.99,Fee Schedule,29.8
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,1442.95,865.77,Aetna,Commercial,,1442.95,29.8,29.8% of Medicare Base rate X weight,1442.95,484.21,4299.99,Fee Schedule,29.8
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-TIB FIB 2V CR,73590,CPT,,,,,both,,,721.61,721.61,Aetna,Commercial,,721.61,29.8,29.8% of Medicare Base rate X weight,721.61,242.15,2150.4,Fee Schedule,29.8
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,721.61,432.96,Aetna,Commercial,,721.61,29.8,29.8% of Medicare Base rate X weight,721.61,242.15,2150.4,Fee Schedule,29.8
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,,,1442.95,1442.95,Aetna,Commercial,,1442.95,29.8,29.8% of Medicare Base rate X weight,1442.95,484.21,4299.99,Fee Schedule,29.8
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,1442.95,865.77,Aetna,Commercial,,1442.95,29.8,29.8% of Medicare Base rate X weight,1442.95,484.21,4299.99,Fee Schedule,29.8
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,,,721.61,721.61,Aetna,Commercial,,721.61,29.8,29.8% of Medicare Base rate X weight,721.61,242.15,2150.4,Fee Schedule,29.8
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,721.61,432.96,Aetna,Commercial,,721.61,29.8,29.8% of Medicare Base rate X weight,721.61,242.15,2150.4,Fee Schedule,29.8
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-ANKLE 2V CR,73600,CPT,,,,,both,,,720.49,720.49,Aetna,Commercial,,720.49,29.8,29.8% of Medicare Base rate X weight,720.49,241.78,2147.06,Fee Schedule,29.8
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,720.49,432.29,Aetna,Commercial,,720.49,29.8,29.8% of Medicare Base rate X weight,720.49,241.78,2147.06,Fee Schedule,29.8
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,,,1107.82,1107.82,Aetna,Commercial,,1107.82,29.8,29.8% of Medicare Base rate X weight,1107.82,371.75,3301.3,Fee Schedule,29.8
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,1107.82,664.69,Aetna,Commercial,,1107.82,29.8,29.8% of Medicare Base rate X weight,1107.82,371.75,3301.3,Fee Schedule,29.8
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,,,804.69,804.69,Aetna,Commercial,,804.69,29.8,29.8% of Medicare Base rate X weight,804.69,270.03,2397.98,Fee Schedule,29.8
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,804.69,29.8,29.8% of Medicare Base rate X weight,804.69,270.03,2397.98,Fee Schedule,29.8
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,,,1609.11,1609.11,Aetna,Commercial,,1609.11,29.8,29.8% of Medicare Base rate X weight,1609.11,539.97,4795.15,Fee Schedule,29.8
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,1609.11,965.46,Aetna,Commercial,,1609.11,29.8,29.8% of Medicare Base rate X weight,1609.11,539.97,4795.15,Fee Schedule,29.8
IR-ARTHRGRM ANKLE BI,73615,CPT,,,,,both,, ,3760.20,2256.12,Aetna,Commercial,,3760.20,29.8,29.8% of Medicare Base rate X weight,3760.20,1261.81,11205.4,Fee Schedule,29.8
IR-ARTHRGRM ANKLE BI,73615,CPT,,,,,both,, ,3760.20,2256.12,Aetna,Commercial,,3760.20,29.8,29.8% of Medicare Base rate X weight,3760.20,1261.81,11205.4,Fee Schedule,29.8
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-FOOT 2V CR,73620,CPT,,,,,both,,,553.77,553.77,Aetna,Commercial,,553.77,29.8,29.8% of Medicare Base rate X weight,553.77,185.83,1650.23,Fee Schedule,29.8
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,553.77,332.26,Aetna,Commercial,,553.77,29.8,29.8% of Medicare Base rate X weight,553.77,185.83,1650.23,Fee Schedule,29.8
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,,,1107.82,1107.82,Aetna,Commercial,,1107.82,29.8,29.8% of Medicare Base rate X weight,1107.82,371.75,3301.3,Fee Schedule,29.8
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,1107.82,664.69,Aetna,Commercial,,1107.82,29.8,29.8% of Medicare Base rate X weight,1107.82,371.75,3301.3,Fee Schedule,29.8
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,,,662.39,662.39,Aetna,Commercial,,662.39,29.8,29.8% of Medicare Base rate X weight,662.39,222.28,1973.92,Fee Schedule,29.8
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,662.39,397.43,Aetna,Commercial,,662.39,29.8,29.8% of Medicare Base rate X weight,662.39,222.28,1973.92,Fee Schedule,29.8
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,,,1250.97,1250.97,Aetna,Commercial,,1250.97,29.8,29.8% of Medicare Base rate X weight,1250.97,419.79,3727.89,Fee Schedule,29.8
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,1250.97,750.58,Aetna,Commercial,,1250.97,29.8,29.8% of Medicare Base rate X weight,1250.97,419.79,3727.89,Fee Schedule,29.8
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,,,353.93,353.93,Aetna,Commercial,,353.93,29.8,29.8% of Medicare Base rate X weight,353.93,118.77,1054.71,Fee Schedule,29.8
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,353.93,212.35,Aetna,Commercial,,353.93,29.8,29.8% of Medicare Base rate X weight,353.93,118.77,1054.71,Fee Schedule,29.8
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,,,662.39,662.39,Aetna,Commercial,,662.39,29.8,29.8% of Medicare Base rate X weight,662.39,222.28,1973.92,Fee Schedule,29.8
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,662.39,397.43,Aetna,Commercial,,662.39,29.8,29.8% of Medicare Base rate X weight,662.39,222.28,1973.92,Fee Schedule,29.8
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,,,568.64,568.64,Aetna,Commercial,,568.64,29.8,29.8% of Medicare Base rate X weight,568.64,190.82,1694.55,Fee Schedule,29.8
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,568.64,341.18,Aetna,Commercial,,568.64,29.8,29.8% of Medicare Base rate X weight,568.64,190.82,1694.55,Fee Schedule,29.8
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,278.43,29.8,29.8% of Medicare Base rate X weight,278.43,93.43,829.72,Fee Schedule,29.8
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,299.76,29.8,29.8% of Medicare Base rate X weight,299.76,100.59,893.28,Fee Schedule,29.8
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,,,1137.30,1137.30,Aetna,Commercial,,1137.30,29.8,29.8% of Medicare Base rate X weight,1137.30,381.64,3389.15,Fee Schedule,29.8
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,1137.30,682.38,Aetna,Commercial,,1137.30,29.8,29.8% of Medicare Base rate X weight,1137.30,381.64,3389.15,Fee Schedule,29.8
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,307.05,29.8,29.8% of Medicare Base rate X weight,307.05,103.04,915.01,Fee Schedule,29.8
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,330.63,29.8,29.8% of Medicare Base rate X weight,330.63,110.95,985.28,Fee Schedule,29.8
CT-LOWER EXT WO,73700,CPT,,,,,both,,,3013.04,3013.04,Aetna,Commercial,,3013.04,29.8,29.8% of Medicare Base rate X weight,3013.04,1011.09,8978.86,Fee Schedule,29.8
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,3013.04,1807.82,Aetna,Commercial,,3013.04,29.8,29.8% of Medicare Base rate X weight,3013.04,1011.09,8978.86,Fee Schedule,29.8
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,614.40,368.64,Aetna,Commercial,,614.40,29.8,29.8% of Medicare Base rate X weight,614.40,206.17,1830.91,Fee Schedule,29.8
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,660.98,396.58,Aetna,Commercial,,660.98,29.8,29.8% of Medicare Base rate X weight,660.98,221.81,1969.72,Fee Schedule,29.8
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,4941.28,29.8,29.8% of Medicare Base rate X weight,4941.28,1658.15,14725.01,Fee Schedule,29.8
CT-LOWER EXT W,73701,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,604.85,29.8,29.8% of Medicare Base rate X weight,604.85,202.97,1802.45,Fee Schedule,29.8
CT-LOWER EXT W,73701,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,604.85,29.8,29.8% of Medicare Base rate X weight,604.85,202.97,1802.45,Fee Schedule,29.8
CT-LOWER EXT W,73701,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,650.88,29.8,29.8% of Medicare Base rate X weight,650.88,218.42,1939.62,Fee Schedule,29.8
CT-LOWER EXT W,73701,CPT,,,,,both,,,3013.04,3013.04,Aetna,Commercial,,3013.04,29.8,29.8% of Medicare Base rate X weight,3013.04,1011.09,8978.86,Fee Schedule,29.8
CT-LOWER EXT W,73701,CPT,,,,,both,, ,3013.04,1807.82,Aetna,Commercial,,3013.04,29.8,29.8% of Medicare Base rate X weight,3013.04,1011.09,8978.86,Fee Schedule,29.8
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,680.91,29.8,29.8% of Medicare Base rate X weight,680.91,228.49,2029.11,Fee Schedule,29.8
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,732.83,29.8,29.8% of Medicare Base rate X weight,732.83,245.92,2183.83,Fee Schedule,29.8
CT-LOWER EXT WWO,73702,CPT,,,,,both,,,3013.04,3013.04,Aetna,Commercial,,3013.04,29.8,29.8% of Medicare Base rate X weight,3013.04,1011.09,8978.86,Fee Schedule,29.8
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,3013.04,1807.82,Aetna,Commercial,,3013.04,29.8,29.8% of Medicare Base rate X weight,3013.04,1011.09,8978.86,Fee Schedule,29.8
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,1361.84,817.10,Aetna,Commercial,,1361.84,29.8,29.8% of Medicare Base rate X weight,1361.84,456.99,4058.28,Fee Schedule,29.8
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,1465.68,879.40,Aetna,Commercial,,1465.68,29.8,29.8% of Medicare Base rate X weight,1465.68,491.84,4367.73,Fee Schedule,29.8
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,4941.28,29.8,29.8% of Medicare Base rate X weight,4941.28,1658.15,14725.01,Fee Schedule,29.8
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,1540.90,924.54,Aetna,Commercial,,1540.90,29.8,29.8% of Medicare Base rate X weight,1540.90,517.08,4591.88,Fee Schedule,29.8
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,4941.28,29.8,29.8% of Medicare Base rate X weight,4941.28,1658.15,14725.01,Fee Schedule,29.8
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,715.99,29.8,29.8% of Medicare Base rate X weight,715.99,240.27,2133.65,Fee Schedule,29.8
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,715.99,29.8,29.8% of Medicare Base rate X weight,715.99,240.27,2133.65,Fee Schedule,29.8
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,770.45,29.8,29.8% of Medicare Base rate X weight,770.45,258.54,2295.94,Fee Schedule,29.8
MR-LOWER EXTR WO,73718,CPT,,,,,both,,,2470.50,2470.50,Aetna,Commercial,,2470.50,29.8,29.8% of Medicare Base rate X weight,2470.50,829.03,7362.09,Fee Schedule,29.8
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,2470.50,1482.30,Aetna,Commercial,,2470.50,29.8,29.8% of Medicare Base rate X weight,2470.50,829.03,7362.09,Fee Schedule,29.8
MR-LOWER EXTR W,73719,CPT,,,,,both,,,832.76,832.76,Aetna,Commercial,,832.76,29.8,29.8% of Medicare Base rate X weight,832.76,279.45,2481.62,Fee Schedule,29.8
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,832.76,499.65,Aetna,Commercial,,832.76,29.8,29.8% of Medicare Base rate X weight,832.76,279.45,2481.62,Fee Schedule,29.8
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,1035.69,29.8,29.8% of Medicare Base rate X weight,1035.69,347.55,3086.36,Fee Schedule,29.8
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,1114.55,29.8,29.8% of Medicare Base rate X weight,1114.55,374.01,3321.36,Fee Schedule,29.8
MR-LOWER EXTR BI WWO,73720,CPT,,,,,both,, ,2394.15,1436.49,Aetna,Commercial,,2394.15,29.8,29.8% of Medicare Base rate X weight,2394.15,803.41,7134.57,Fee Schedule,29.8
MR-LOWER EXTR BI WWO,73720,CPT,,,,,both,, ,2576.60,1545.96,Aetna,Commercial,,2576.60,29.8,29.8% of Medicare Base rate X weight,2576.60,864.63,7678.27,Fee Schedule,29.8
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,1197.08,29.8,29.8% of Medicare Base rate X weight,1197.08,401.70,3567.3,Fee Schedule,29.8
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,1288.29,29.8,29.8% of Medicare Base rate X weight,1288.29,432.31,3839.1,Fee Schedule,29.8
MR-LOWER EXTR WWO,73720,CPT,,,,,both,,,3084.06,3084.06,Aetna,Commercial,,3084.06,29.8,29.8% of Medicare Base rate X weight,3084.06,1034.92,9190.5,Fee Schedule,29.8
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,3084.06,1850.43,Aetna,Commercial,,3084.06,29.8,29.8% of Medicare Base rate X weight,3084.06,1034.92,9190.5,Fee Schedule,29.8
MRI scan of leg joint,73721,CPT,,,,,both,,,4941.28,4941.28,Aetna,Commercial,,4941.28,29.8,29.8% of Medicare Base rate X weight,4941.28,1658.15,14725.01,Fee Schedule,29.8
MR-LW JOINT WO,73721,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,715.99,29.8,29.8% of Medicare Base rate X weight,715.99,240.27,2133.65,Fee Schedule,29.8
MR-LW JOINT WO,73721,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,770.45,29.8,29.8% of Medicare Base rate X weight,770.45,258.54,2295.94,Fee Schedule,29.8
MR-LW JOINT WO,73721,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,4941.28,29.8,29.8% of Medicare Base rate X weight,4941.28,1658.15,14725.01,Fee Schedule,29.8
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,1431.72,859.03,Aetna,Commercial,,1431.72,29.8,29.8% of Medicare Base rate X weight,1431.72,480.44,4266.53,Fee Schedule,29.8
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,1540.90,924.54,Aetna,Commercial,,1540.90,29.8,29.8% of Medicare Base rate X weight,1540.90,517.08,4591.88,Fee Schedule,29.8
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,9881.44,5928.86,Aetna,Commercial,,9881.44,29.8,29.8% of Medicare Base rate X weight,9881.44,3315.92,29446.69,Fee Schedule,29.8
MR-LW JOINT W,73722,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,1035.69,29.8,29.8% of Medicare Base rate X weight,1035.69,347.55,3086.36,Fee Schedule,29.8
MR-LW JOINT W,73722,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,1114.55,29.8,29.8% of Medicare Base rate X weight,1114.55,374.01,3321.36,Fee Schedule,29.8
MR-LW JOINT W,73722,CPT,,,,,both,,,4293.48,4293.48,Aetna,Commercial,,4293.48,29.8,29.8% of Medicare Base rate X weight,4293.48,1440.77,12794.57,Fee Schedule,29.8
MR-LW JOINT W,73722,CPT,,,,,both,, ,4293.48,2576.08,Aetna,Commercial,,4293.48,29.8,29.8% of Medicare Base rate X weight,4293.48,1440.77,12794.57,Fee Schedule,29.8
MR-LW JOINT W BI,73722,CPT,,,,,both,, ,7641.10,4584.66,Aetna,Commercial,,7641.10,29.8,29.8% of Medicare Base rate X weight,7641.10,2564.13,22770.48,Fee Schedule,29.8
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,1197.08,29.8,29.8% of Medicare Base rate X weight,1197.08,401.70,3567.3,Fee Schedule,29.8
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,1288.29,29.8,29.8% of Medicare Base rate X weight,1288.29,432.31,3839.1,Fee Schedule,29.8
MR-LW JOINT WWO,73723,CPT,,,,,both,,,5197.81,5197.81,Aetna,Commercial,,5197.81,29.8,29.8% of Medicare Base rate X weight,5197.81,1744.23,15489.47,Fee Schedule,29.8
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,5197.81,3118.68,Aetna,Commercial,,5197.81,29.8,29.8% of Medicare Base rate X weight,5197.81,1744.23,15489.47,Fee Schedule,29.8
MR-LW JOINT WWO BI,73723,CPT,,,,,both,, ,10395.64,6237.38,Aetna,Commercial,,10395.64,29.8,29.8% of Medicare Base rate X weight,10395.64,3488.47,30979.01,Fee Schedule,29.8
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,,,694.38,694.38,Aetna,Commercial,,694.38,29.8,29.8% of Medicare Base rate X weight,694.38,233.01,2069.25,Fee Schedule,29.8
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,694.38,416.62,Aetna,Commercial,,694.38,29.8,29.8% of Medicare Base rate X weight,694.38,233.01,2069.25,Fee Schedule,29.8
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,,,1144.03,1144.03,Aetna,Commercial,,1144.03,29.8,29.8% of Medicare Base rate X weight,1144.03,383.90,3409.21,Fee Schedule,29.8
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,1144.03,686.41,Aetna,Commercial,,1144.03,29.8,29.8% of Medicare Base rate X weight,1144.03,383.90,3409.21,Fee Schedule,29.8
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,,,868.40,868.40,Aetna,Commercial,,868.40,29.8,29.8% of Medicare Base rate X weight,868.40,291.41,2587.83,Fee Schedule,29.8
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,868.40,521.04,Aetna,Commercial,,868.40,29.8,29.8% of Medicare Base rate X weight,868.40,291.41,2587.83,Fee Schedule,29.8
CH-ABD SER PA CXR CR,74022,CPT,,,,,both,,,970.85,970.85,Aetna,Commercial,,970.85,29.8,29.8% of Medicare Base rate X weight,970.85,325.79,2893.13,Fee Schedule,29.8
CH-ABD SER PA CXR CR,74022,CPT,,,,,both,, ,970.85,582.51,Aetna,Commercial,,970.85,29.8,29.8% of Medicare Base rate X weight,970.85,325.79,2893.13,Fee Schedule,29.8
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,307.05,29.8,29.8% of Medicare Base rate X weight,307.05,103.04,915.01,Fee Schedule,29.8
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,330.63,29.8,29.8% of Medicare Base rate X weight,330.63,110.95,985.28,Fee Schedule,29.8
CT-ABDOMEN WO,74150,CPT,,,,,both,,,3285.58,3285.58,Aetna,Commercial,,3285.58,29.8,29.8% of Medicare Base rate X weight,3285.58,1102.54,9791.03,Fee Schedule,29.8
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,3285.58,1971.34,Aetna,Commercial,,3285.58,29.8,29.8% of Medicare Base rate X weight,3285.58,1102.54,9791.03,Fee Schedule,29.8
CT-ABDOMEN W,74160,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,604.85,29.8,29.8% of Medicare Base rate X weight,604.85,202.97,1802.45,Fee Schedule,29.8
CT-ABDOMEN W,74160,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,650.88,29.8,29.8% of Medicare Base rate X weight,650.88,218.42,1939.62,Fee Schedule,29.8
CT-ABDOMEN W,74160,CPT,,,,,both,,,3726.80,3726.80,Aetna,Commercial,,3726.80,29.8,29.8% of Medicare Base rate X weight,3726.80,1250.60,11105.86,Fee Schedule,29.8
CT-ABDOMEN W,74160,CPT,,,,,both,, ,3726.80,2236.08,Aetna,Commercial,,3726.80,29.8,29.8% of Medicare Base rate X weight,3726.80,1250.60,11105.86,Fee Schedule,29.8
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,680.91,29.8,29.8% of Medicare Base rate X weight,680.91,228.49,2029.11,Fee Schedule,29.8
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,732.83,29.8,29.8% of Medicare Base rate X weight,732.83,245.92,2183.83,Fee Schedule,29.8
CT-ABDOMEN WWO,74170,CPT,,,,,both,,,4317.62,4317.62,Aetna,Commercial,,4317.62,29.8,29.8% of Medicare Base rate X weight,4317.62,1448.87,12866.51,Fee Schedule,29.8
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,4317.62,2590.57,Aetna,Commercial,,4317.62,29.8,29.8% of Medicare Base rate X weight,4317.62,1448.87,12866.51,Fee Schedule,29.8
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,893.10,535.86,Aetna,Commercial,,893.10,29.8,29.8% of Medicare Base rate X weight,893.10,299.70,2661.44,Fee Schedule,29.8
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,893.10,535.86,Aetna,Commercial,,893.10,29.8,29.8% of Medicare Base rate X weight,893.10,299.70,2661.44,Fee Schedule,29.8
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,,,1894.27,1894.27,Aetna,Commercial,,1894.27,29.8,29.8% of Medicare Base rate X weight,1894.27,635.66,5644.92,Fee Schedule,29.8
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,1894.27,1136.56,Aetna,Commercial,,1894.27,29.8,29.8% of Medicare Base rate X weight,1894.27,635.66,5644.92,Fee Schedule,29.8
CTA-ABDOMEN,74175,CPT,,,,,both,, ,893.10,535.86,Aetna,Commercial,,893.10,29.8,29.8% of Medicare Base rate X weight,893.10,299.70,2661.44,Fee Schedule,29.8
CTA-ABDOMEN,74175,CPT,,,,,both,,,1894.27,1894.27,Aetna,Commercial,,1894.27,29.8,29.8% of Medicare Base rate X weight,1894.27,635.66,5644.92,Fee Schedule,29.8
CTA-ABDOMEN,74175,CPT,,,,,both,, ,1894.27,1136.56,Aetna,Commercial,,1894.27,29.8,29.8% of Medicare Base rate X weight,1894.27,635.66,5644.92,Fee Schedule,29.8
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,587.17,352.30,Aetna,Commercial,,587.17,29.8,29.8% of Medicare Base rate X weight,587.17,197.04,1749.77,Fee Schedule,29.8
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,632.08,379.24,Aetna,Commercial,,632.08,29.8,29.8% of Medicare Base rate X weight,632.08,212.11,1883.6,Fee Schedule,29.8
CT-ABD PELVIS WO,74176,CPT,,,,,both,,,6571.44,6571.44,Aetna,Commercial,,6571.44,29.8,29.8% of Medicare Base rate X weight,6571.44,2205.18,19582.89,Fee Schedule,29.8
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,6571.44,3942.86,Aetna,Commercial,,6571.44,29.8,29.8% of Medicare Base rate X weight,6571.44,2205.18,19582.89,Fee Schedule,29.8
CT scan of abdomen and pelvis with contrast,74177,CPT,,,,,both,,,7453.61,7453.61,Aetna,Commercial,,7453.61,29.8,29.8% of Medicare Base rate X weight,7453.61,2501.21,22211.76,Fee Schedule,29.8
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,947.56,568.53,Aetna,Commercial,,947.56,29.8,29.8% of Medicare Base rate X weight,947.56,317.97,2823.73,Fee Schedule,29.8
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,1019.69,611.81,Aetna,Commercial,,1019.69,29.8,29.8% of Medicare Base rate X weight,1019.69,342.18,3038.68,Fee Schedule,29.8
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,7453.61,4472.16,Aetna,Commercial,,7453.61,29.8,29.8% of Medicare Base rate X weight,7453.61,2501.21,22211.76,Fee Schedule,29.8
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,947.56,568.53,Aetna,Commercial,,947.56,29.8,29.8% of Medicare Base rate X weight,947.56,317.97,2823.73,Fee Schedule,29.8
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,1019.69,611.81,Aetna,Commercial,,1019.69,29.8,29.8% of Medicare Base rate X weight,1019.69,342.18,3038.68,Fee Schedule,29.8
CT-ABD PELVIS WWO,74178,CPT,,,,,both,,,8364.95,8364.95,Aetna,Commercial,,8364.95,29.8,29.8% of Medicare Base rate X weight,8364.95,2807.03,24927.55,Fee Schedule,29.8
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,8364.95,5018.97,Aetna,Commercial,,8364.95,29.8,29.8% of Medicare Base rate X weight,8364.95,2807.03,24927.55,Fee Schedule,29.8
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,715.99,29.8,29.8% of Medicare Base rate X weight,715.99,240.27,2133.65,Fee Schedule,29.8
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,770.45,29.8,29.8% of Medicare Base rate X weight,770.45,258.54,2295.94,Fee Schedule,29.8
MR-ABDOMEN WO,74181,CPT,,,,,both,,,4042.84,4042.84,Aetna,Commercial,,4042.84,29.8,29.8% of Medicare Base rate X weight,4042.84,1356.66,12047.66,Fee Schedule,29.8
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,4042.84,2425.70,Aetna,Commercial,,4042.84,29.8,29.8% of Medicare Base rate X weight,4042.84,1356.66,12047.66,Fee Schedule,29.8
MR-ABDOMEN W,74182,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,1035.69,29.8,29.8% of Medicare Base rate X weight,1035.69,347.55,3086.36,Fee Schedule,29.8
MR-ABDOMEN W,74182,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,1114.55,29.8,29.8% of Medicare Base rate X weight,1114.55,374.01,3321.36,Fee Schedule,29.8
MR-ABDOMEN W,74182,CPT,,,,,both,,,4293.48,4293.48,Aetna,Commercial,,4293.48,29.8,29.8% of Medicare Base rate X weight,4293.48,1440.77,12794.57,Fee Schedule,29.8
MR-ABDOMEN W,74182,CPT,,,,,both,, ,4293.48,2576.08,Aetna,Commercial,,4293.48,29.8,29.8% of Medicare Base rate X weight,4293.48,1440.77,12794.57,Fee Schedule,29.8
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,1197.08,29.8,29.8% of Medicare Base rate X weight,1197.08,401.70,3567.3,Fee Schedule,29.8
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,1288.29,29.8,29.8% of Medicare Base rate X weight,1288.29,432.31,3839.1,Fee Schedule,29.8
MR-ABDOMEN WWO,74183,CPT,,,,,both,,,5197.81,5197.81,Aetna,Commercial,,5197.81,29.8,29.8% of Medicare Base rate X weight,5197.81,1744.23,15489.47,Fee Schedule,29.8
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,5197.81,3118.68,Aetna,Commercial,,5197.81,29.8,29.8% of Medicare Base rate X weight,5197.81,1744.23,15489.47,Fee Schedule,29.8
FL-ESOPHAGUS,74220,CPT,,,,,both,, ,1227.11,736.26,Aetna,Commercial,,1227.11,29.8,29.8% of Medicare Base rate X weight,1227.11,411.78,3656.79,Fee Schedule,29.8
FL-MOD BA SWALLOW,74230,CPT,,,,,both,, ,391.26,234.75,Aetna,Commercial,,391.26,29.8,29.8% of Medicare Base rate X weight,391.26,131.30,1165.95,Fee Schedule,29.8
FL-GI SERIES,74240,CPT,,,,,both,, ,1557.58,934.54,Aetna,Commercial,,1557.58,29.8,29.8% of Medicare Base rate X weight,1557.58,522.68,4641.59,Fee Schedule,29.8
FL-UPPER GI SINGLE,74240,CPT,,,,,both,, ,1818.77,1091.26,Aetna,Commercial,,1818.77,29.8,29.8% of Medicare Base rate X weight,1818.77,610.33,5419.93,Fee Schedule,29.8
FL-GI SERIES AIR,74246,CPT,,,,,both,, ,1500.93,900.55,Aetna,Commercial,,1500.93,29.8,29.8% of Medicare Base rate X weight,1500.93,503.67,4472.77,Fee Schedule,29.8
FL-UPPER GI DOUBLE,74246,CPT,,,,,both,, ,1752.53,1051.51,Aetna,Commercial,,1752.53,29.8,29.8% of Medicare Base rate X weight,1752.53,588.10,5222.54,Fee Schedule,29.8
FL-LOWER GI FOLLOW,74248,CPT,,,,,both,, ,3343.68,2006.20,Aetna,Commercial,,3343.68,29.8,29.8% of Medicare Base rate X weight,3343.68,1122.04,9964.17,Fee Schedule,29.8
FL-SMALL BOWEL CR,74250,CPT,,,,,both,, ,2123.58,1274.14,Aetna,Commercial,,2123.58,29.8,29.8% of Medicare Base rate X weight,2123.58,712.61,6328.27,Fee Schedule,29.8
FL-SM BWL ENT TBE CR,74251,CPT,,,,,both,, ,2123.58,1274.14,Aetna,Commercial,,2123.58,29.8,29.8% of Medicare Base rate X weight,2123.58,712.61,6328.27,Fee Schedule,29.8
FL-BARIUM ENEMA,74270,CPT,,,,,both,, ,1890.90,1134.54,Aetna,Commercial,,1890.90,29.8,29.8% of Medicare Base rate X weight,1890.90,634.53,5634.88,Fee Schedule,29.8
FL-BARIUM ENEMA AIR,74280,CPT,,,,,both,, ,2333.25,1399.95,Aetna,Commercial,,2333.25,29.8,29.8% of Medicare Base rate X weight,2333.25,782.97,6953.09,Fee Schedule,29.8
SU-CHOLE W GRAMS DR,74300,CPT,,,,,both,, ,1968.65,1181.19,Aetna,Commercial,,1968.65,29.8,29.8% of Medicare Base rate X weight,1968.65,660.62,5866.58,Fee Schedule,29.8
FL-ENDO BILIARY,74328,CPT,,,,,both,, ,3722.58,2233.54,Aetna,Commercial,,3722.58,29.8,29.8% of Medicare Base rate X weight,3722.58,1249.19,11093.29,Fee Schedule,29.8
FL-ENDO PANCREATIC,74329,CPT,,,,,both,, ,1034.01,620.40,Aetna,Commercial,,1034.01,29.8,29.8% of Medicare Base rate X weight,1034.01,346.98,3081.35,Fee Schedule,29.8
FL-ENDO BIL PANC,74330,CPT,,,,,both,, ,1304.29,782.57,Aetna,Commercial,,1304.29,29.8,29.8% of Medicare Base rate X weight,1304.29,437.68,3886.78,Fee Schedule,29.8
FL-LONG GI TUBE PLC,74340,CPT,,,,,both,, ,1359.02,815.41,Aetna,Commercial,,1359.02,29.8,29.8% of Medicare Base rate X weight,1359.02,456.05,4049.88,Fee Schedule,29.8
FL-ENTEROCLYSIS PLAC,74355,CPT,,,,,both,, ,932.40,559.44,Aetna,Commercial,,932.40,29.8,29.8% of Medicare Base rate X weight,932.40,312.89,2778.55,Fee Schedule,29.8
FL-IVP CR,74400,CPT,,,,,both,, ,1836.17,1101.70,Aetna,Commercial,,1836.17,29.8,29.8% of Medicare Base rate X weight,1836.17,616.16,5471.79,Fee Schedule,29.8
FL-UROGRAPH RETRO CR,74420,CPT,,,,,both,, ,2105.34,1263.20,Aetna,Commercial,,2105.34,29.8,29.8% of Medicare Base rate X weight,2105.34,706.49,6273.91,Fee Schedule,29.8
FL-UROGRAPHY ANTE CR,74425,CPT,,,,,both,, ,2165.12,1299.07,Aetna,Commercial,,2165.12,29.8,29.8% of Medicare Base rate X weight,2165.12,726.55,6452.06,Fee Schedule,29.8
FL-CYSTOGRM 3VPLS CR,74430,CPT,,,,,both,, ,1407.87,844.72,Aetna,Commercial,,1407.87,29.8,29.8% of Medicare Base rate X weight,1407.87,472.44,4195.45,Fee Schedule,29.8
FL-CAVERNOSOGRAPH CR,74445,CPT,,,,,both,, ,698.32,418.99,Aetna,Commercial,,698.32,29.8,29.8% of Medicare Base rate X weight,698.32,234.34,2080.99,Fee Schedule,29.8
FL-UCG RETRO CR,74450,CPT,,,,,both,, ,1357.62,814.57,Aetna,Commercial,,1357.62,29.8,29.8% of Medicare Base rate X weight,1357.62,455.58,4045.71,Fee Schedule,29.8
FL-UCG VOIDING,74455,CPT,,,,,both,, ,1357.62,814.57,Aetna,Commercial,,1357.62,29.8,29.8% of Medicare Base rate X weight,1357.62,455.58,4045.71,Fee Schedule,29.8
FL-UCG VOIDING CR,74455,CPT,,,,,both,, ,1162.77,697.66,Aetna,Commercial,,1162.77,29.8,29.8% of Medicare Base rate X weight,1162.77,390.19,3465.05,Fee Schedule,29.8
IR-DILATION GU,74485,CPT,,,,,both,, ,976.75,586.05,Aetna,Commercial,,976.75,29.8,29.8% of Medicare Base rate X weight,976.75,327.77,2910.72,Fee Schedule,29.8
IR-HYSTERSALPINGO CR,74740,CPT,,,,,both,,,1704.21,1704.21,Aetna,Commercial,,1704.21,29.8,29.8% of Medicare Base rate X weight,1704.21,571.88,5078.55,Fee Schedule,29.8
IR-HYSTERSALPINGO CR,74740,CPT,,,,,both,, ,1704.21,1022.52,Aetna,Commercial,,1704.21,29.8,29.8% of Medicare Base rate X weight,1704.21,571.88,5078.55,Fee Schedule,29.8
IR-HYSTERSALPINGOGRM,74740,CPT,,,,,both,,,1989.98,1989.98,Aetna,Commercial,,1989.98,29.8,29.8% of Medicare Base rate X weight,1989.98,667.78,5930.14,Fee Schedule,29.8
IR-HYSTERSALPINGOGRM,74740,CPT,,,,,both,, ,1989.98,1193.98,Aetna,Commercial,,1989.98,29.8,29.8% of Medicare Base rate X weight,1989.98,667.78,5930.14,Fee Schedule,29.8
IR-PERINEOGRAM CR,74775,CPT,,,,,both,, ,1991.67,1195.00,Aetna,Commercial,,1991.67,29.8,29.8% of Medicare Base rate X weight,1991.67,668.35,5935.18,Fee Schedule,29.8
CT-HT ACC LV RV W,75573,CPT,,,,,both,, ,580.15,348.09,Aetna,Commercial,,580.15,29.8,29.8% of Medicare Base rate X weight,580.15,194.68,1728.85,Fee Schedule,29.8
CT-HT ACC LV RV W,75573,CPT,,,,,both,, ,1696.40,1017.84,Aetna,Commercial,,1696.40,29.8,29.8% of Medicare Base rate X weight,1696.40,569.26,5055.27,Fee Schedule,29.8
CT-HT CARD FUNC W,75574,CPT,,,,,both,, ,580.15,348.09,Aetna,Commercial,,580.15,29.8,29.8% of Medicare Base rate X weight,580.15,194.68,1728.85,Fee Schedule,29.8
CT-HT CARD FUNC W,75574,CPT,,,,,both,, ,1696.40,1017.84,Aetna,Commercial,,1696.40,29.8,29.8% of Medicare Base rate X weight,1696.40,569.26,5055.27,Fee Schedule,29.8
CATH-ABD AORTA SERIAL,75625,CPT,,,,,both,, ,8483.00,5089.80,Aetna,Commercial,,8483.00,29.8,29.8% of Medicare Base rate X weight,8483.00,2846.64,25279.34,Fee Schedule,29.8
IR-ABD AORTA SERIAL,75625,CPT,,,,,both,, ,9523.86,5714.31,Aetna,Commercial,,9523.86,29.8,29.8% of Medicare Base rate X weight,9523.86,3195.93,28381.1,Fee Schedule,29.8
CATH-AABF SERIAL     ,75630,CPT,,,,,both,, ,11199.75,6719.85,Aetna,Commercial,,11199.75,29.8,29.8% of Medicare Base rate X weight,11199.75,3758.31,33375.26,Fee Schedule,29.8
IR-AABF SERIAL,75630,CPT,,,,,both,, ,12573.95,7544.37,Aetna,Commercial,,12573.95,29.8,29.8% of Medicare Base rate X weight,12573.95,4219.45,37470.37,Fee Schedule,29.8
CTA-ABD ART W RUNOFF,75635,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,650.88,29.8,29.8% of Medicare Base rate X weight,650.88,218.42,1939.62,Fee Schedule,29.8
CTA-ABD ART W RUNOFF,75635,CPT,,,,,both,, ,2355.42,1413.25,Aetna,Commercial,,2355.42,29.8,29.8% of Medicare Base rate X weight,2355.42,790.41,7019.15,Fee Schedule,29.8
CATH-ANGIO EXTREM UNI,75710,CPT,,,,,both,, ,7520.75,4512.45,Aetna,Commercial,,7520.75,29.8,29.8% of Medicare Base rate X weight,7520.75,2523.74,22411.84,Fee Schedule,29.8
IR-ANGIO EXTREM UNI,75710,CPT,,,,,both,, ,8443.54,5066.12,Aetna,Commercial,,8443.54,29.8,29.8% of Medicare Base rate X weight,8443.54,2833.40,25161.75,Fee Schedule,29.8
CATH-ANGIO EXTREM BI ,75716,CPT,,,,,both,, ,7520.75,4512.45,Aetna,Commercial,,7520.75,29.8,29.8% of Medicare Base rate X weight,7520.75,2523.74,22411.84,Fee Schedule,29.8
IR-ANGIO EXTREM BI,75716,CPT,,,,,both,, ,8423.33,5053.99,Aetna,Commercial,,8423.33,29.8,29.8% of Medicare Base rate X weight,8423.33,2826.62,25101.52,Fee Schedule,29.8
IR-ANGIO VISCERAL SE,75726,CPT,,,,,both,, ,13364.62,8018.77,Aetna,Commercial,,13364.62,29.8,29.8% of Medicare Base rate X weight,13364.62,4484.77,39826.57,Fee Schedule,29.8
IR-ANG PULMONARY UNI,75741,CPT,,,,,both,, ,4237.35,2542.41,Aetna,Commercial,,4237.35,29.8,29.8% of Medicare Base rate X weight,4237.35,1421.93,12627.3,Fee Schedule,29.8
IR-ANG PULMONARY BI,75743,CPT,,,,,both,, ,12357.84,7414.70,Aetna,Commercial,,12357.84,29.8,29.8% of Medicare Base rate X weight,12357.84,4146.93,36826.36,Fee Schedule,29.8
IR-SHUNTOGRAM,75809,CPT,,,,,both,, ,386.21,231.72,Aetna,Commercial,,386.21,29.8,29.8% of Medicare Base rate X weight,386.21,129.60,1150.91,Fee Schedule,29.8
CATH-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,7641.75,4585.05,Aetna,Commercial,,7641.75,29.8,29.8% of Medicare Base rate X weight,7641.75,2564.35,22772.42,Fee Schedule,29.8
IR-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,8579.39,5147.63,Aetna,Commercial,,8579.39,29.8,29.8% of Medicare Base rate X weight,8579.39,2878.99,25566.58,Fee Schedule,29.8
IR-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,8579.39,5147.63,Aetna,Commercial,,8579.39,29.8,29.8% of Medicare Base rate X weight,8579.39,2878.99,25566.58,Fee Schedule,29.8
CATH-VENOGRAM EXT BI ,75822,CPT,,,,,both,, ,3510.00,2106.00,Aetna,Commercial,,3510.00,29.8,29.8% of Medicare Base rate X weight,3510.00,1177.85,10459.8,Fee Schedule,29.8
IR-VENOGRAM EXT BI,75822,CPT,,,,,both,, ,3940.68,2364.40,Aetna,Commercial,,3940.68,29.8,29.8% of Medicare Base rate X weight,3940.68,1322.38,11743.23,Fee Schedule,29.8
IR-VENACAVAGRAM INF,75825,CPT,,,,,both,, ,8923.22,5353.93,Aetna,Commercial,,8923.22,29.8,29.8% of Medicare Base rate X weight,8923.22,2994.37,26591.2,Fee Schedule,29.8
IR-VENOUS SAMPL CATH,75893,CPT,,,,,both,, ,3915.41,2349.24,Aetna,Commercial,,3915.41,29.8,29.8% of Medicare Base rate X weight,3915.41,1313.90,11667.92,Fee Schedule,29.8
IR-ANGIO EXIST CATH,75898,CPT,,,,,both,, ,513.35,308.01,Aetna,Commercial,,513.35,29.8,29.8% of Medicare Base rate X weight,513.35,172.27,1529.78,Fee Schedule,29.8
IR-DRAIN TUBE CHANGE,75984,CPT,,,,,both,, ,2098.33,1258.99,Aetna,Commercial,,2098.33,29.8,29.8% of Medicare Base rate X weight,2098.33,704.14,6253.02,Fee Schedule,29.8
CT-ABSC DRN CATH PLA,75989,CPT,,,,,both,, ,2649.01,1589.40,Aetna,Commercial,,2649.01,29.8,29.8% of Medicare Base rate X weight,2649.01,888.93,7894.05,Fee Schedule,29.8
US-ABSC DRN CATH PLA,75989,CPT,,,,,both,, ,1120.45,672.27,Aetna,Commercial,,1120.45,29.8,29.8% of Medicare Base rate X weight,1120.45,375.99,3338.94,Fee Schedule,29.8
FL-FLUORO 1 HOUR,76000,CPT,,,,,both,, ,553.77,332.26,Aetna,Commercial,,553.77,29.8,29.8% of Medicare Base rate X weight,553.77,185.83,1650.23,Fee Schedule,29.8
FL-FLUORO 1 HOUR CR,76000,CPT,,,,,both,, ,474.31,284.58,Aetna,Commercial,,474.31,29.8,29.8% of Medicare Base rate X weight,474.31,159.16,1413.44,Fee Schedule,29.8
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,756.41,453.84,Aetna,Commercial,,756.41,29.8,29.8% of Medicare Base rate X weight,756.41,253.83,2254.1,Fee Schedule,29.8
IR-FISTULOGRAM CR,76080,CPT,,,,,both,, ,758.66,455.19,Aetna,Commercial,,758.66,29.8,29.8% of Medicare Base rate X weight,758.66,254.58,2260.81,Fee Schedule,29.8
EXAM SURG SPECMN CR,76098,CPT,,,,,both,, ,1190.34,714.20,Aetna,Commercial,,1190.34,29.8,29.8% of Medicare Base rate X weight,1190.34,399.44,3547.21,Fee Schedule,29.8
TOMOGRAM ONE PLNE CR,76100,CPT,,,,,both,, ,2030.12,1218.07,Aetna,Commercial,,2030.12,29.8,29.8% of Medicare Base rate X weight,2030.12,681.25,6049.76,Fee Schedule,29.8
CT-3D W POSTPROCESS,76377,CPT,,,,,both,, ,528.50,317.10,Aetna,Commercial,,528.50,29.8,29.8% of Medicare Base rate X weight,528.50,177.35,1574.93,Fee Schedule,29.8
CT-3D W POSTPROCESS,76377,CPT,,,,,both,, ,536.93,322.15,Aetna,Commercial,,536.93,29.8,29.8% of Medicare Base rate X weight,536.93,180.18,1600.05,Fee Schedule,29.8
MR-3D W POSTPROCESS,76377,CPT,,,,,both,, ,491.18,294.70,Aetna,Commercial,,491.18,29.8,29.8% of Medicare Base rate X weight,491.18,164.83,1463.72,Fee Schedule,29.8
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,193.10,115.86,Aetna,Commercial,,193.10,29.8,29.8% of Medicare Base rate X weight,193.10,64.80,575.44,Fee Schedule,29.8
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,207.98,124.78,Aetna,Commercial,,207.98,29.8,29.8% of Medicare Base rate X weight,207.98,69.79,619.78,Fee Schedule,29.8
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,724.14,434.48,Aetna,Commercial,,724.14,29.8,29.8% of Medicare Base rate X weight,724.14,243.00,2157.94,Fee Schedule,29.8
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,,,2030.68,2030.68,Aetna,Commercial,,2030.68,29.8,29.8% of Medicare Base rate X weight,2030.68,681.44,6051.43,Fee Schedule,29.8
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,2030.68,1218.40,Aetna,Commercial,,2030.68,29.8,29.8% of Medicare Base rate X weight,2030.68,681.44,6051.43,Fee Schedule,29.8
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,1602.93,961.75,Aetna,Commercial,,1602.93,29.8,29.8% of Medicare Base rate X weight,1602.93,537.90,4776.73,Fee Schedule,29.8
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,218.64,131.18,Aetna,Commercial,,218.64,29.8,29.8% of Medicare Base rate X weight,218.64,73.37,651.55,Fee Schedule,29.8
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,218.64,131.18,Aetna,Commercial,,218.64,29.8,29.8% of Medicare Base rate X weight,218.64,73.37,651.55,Fee Schedule,29.8
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,1680.12,1008.07,Aetna,Commercial,,1680.12,29.8,29.8% of Medicare Base rate X weight,1680.12,563.80,5006.76,Fee Schedule,29.8
US-BREAST LIMITED,76642,CPT,,,,,both,, ,218.64,131.18,Aetna,Commercial,,218.64,29.8,29.8% of Medicare Base rate X weight,218.64,73.37,651.55,Fee Schedule,29.8
US-BREAST LIMITED,76642,CPT,,,,,both,, ,218.64,131.18,Aetna,Commercial,,218.64,29.8,29.8% of Medicare Base rate X weight,218.64,73.37,651.55,Fee Schedule,29.8
US-BREAST LIMITED,76642,CPT,,,,,both,,,1680.12,1680.12,Aetna,Commercial,,1680.12,29.8,29.8% of Medicare Base rate X weight,1680.12,563.80,5006.76,Fee Schedule,29.8
US-BREAST LIMITED,76642,CPT,,,,,both,, ,1680.12,1008.07,Aetna,Commercial,,1680.12,29.8,29.8% of Medicare Base rate X weight,1680.12,563.80,5006.76,Fee Schedule,29.8
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,437.29,262.37,Aetna,Commercial,,437.29,29.8,29.8% of Medicare Base rate X weight,437.29,146.74,1303.12,Fee Schedule,29.8
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,437.29,262.37,Aetna,Commercial,,437.29,29.8,29.8% of Medicare Base rate X weight,437.29,146.74,1303.12,Fee Schedule,29.8
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,3359.95,2015.97,Aetna,Commercial,,3359.95,29.8,29.8% of Medicare Base rate X weight,3359.95,1127.50,10012.65,Fee Schedule,29.8
Ultrasound of abdomen,76700,CPT,,,,,both,,,2330.73,2330.73,Aetna,Commercial,,2330.73,29.8,29.8% of Medicare Base rate X weight,2330.73,782.12,6945.58,Fee Schedule,29.8
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,2330.73,1398.43,Aetna,Commercial,,2330.73,29.8,29.8% of Medicare Base rate X weight,2330.73,782.12,6945.58,Fee Schedule,29.8
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-ABDOMEN LTD WO,76705,CPT,,,,,both,,,1908.87,1908.87,Aetna,Commercial,,1908.87,29.8,29.8% of Medicare Base rate X weight,1908.87,640.56,5688.43,Fee Schedule,29.8
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,1908.87,1145.32,Aetna,Commercial,,1908.87,29.8,29.8% of Medicare Base rate X weight,1908.87,640.56,5688.43,Fee Schedule,29.8
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-ABDOMEN RETROPER,76770,CPT,,,,,both,,,2030.68,2030.68,Aetna,Commercial,,2030.68,29.8,29.8% of Medicare Base rate X weight,2030.68,681.44,6051.43,Fee Schedule,29.8
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,2030.68,1218.40,Aetna,Commercial,,2030.68,29.8,29.8% of Medicare Base rate X weight,2030.68,681.44,6051.43,Fee Schedule,29.8
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,,,1965.00,1965.00,Aetna,Commercial,,1965.00,29.8,29.8% of Medicare Base rate X weight,1965.00,659.40,5855.7,Fee Schedule,29.8
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,1965.00,1179.00,Aetna,Commercial,,1965.00,29.8,29.8% of Medicare Base rate X weight,1965.00,659.40,5855.7,Fee Schedule,29.8
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-PELV PREG 14 WKS,76801,CPT,,,,,both,,,813.67,813.67,Aetna,Commercial,,813.67,29.8,29.8% of Medicare Base rate X weight,813.67,273.04,2424.74,Fee Schedule,29.8
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,813.67,488.20,Aetna,Commercial,,813.67,29.8,29.8% of Medicare Base rate X weight,813.67,273.04,2424.74,Fee Schedule,29.8
US-PLV PRG 14 WKS AD,76802,CPT,,,,,both,, ,329.51,197.70,Aetna,Commercial,,329.51,29.8,29.8% of Medicare Base rate X weight,329.51,110.57,981.94,Fee Schedule,29.8
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,76805,CPT,,,,,both,,,1931.60,1931.60,Aetna,Commercial,,1931.60,29.8,29.8% of Medicare Base rate X weight,1931.60,648.19,5756.17,Fee Schedule,29.8
US-PELVIS PREG,76805,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
US-PELVIS PREG,76805,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-PELVIS PREG,76805,CPT,,,,,both,, ,1931.60,1158.96,Aetna,Commercial,,1931.60,29.8,29.8% of Medicare Base rate X weight,1931.60,648.19,5756.17,Fee Schedule,29.8
US-PELVS PREG GESADD,76810,CPT,,,,,both,, ,329.51,197.70,Aetna,Commercial,,329.51,29.8,29.8% of Medicare Base rate X weight,329.51,110.57,981.94,Fee Schedule,29.8
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,577.00,346.20,Aetna,Commercial,,577.00,29.8,29.8% of Medicare Base rate X weight,577.00,193.62,1719.46,Fee Schedule,29.8
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,647.80,388.68,Aetna,Commercial,,647.80,29.8,29.8% of Medicare Base rate X weight,647.80,217.38,1930.44,Fee Schedule,29.8
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,218.64,131.18,Aetna,Commercial,,218.64,29.8,29.8% of Medicare Base rate X weight,218.64,73.37,651.55,Fee Schedule,29.8
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,235.48,141.28,Aetna,Commercial,,235.48,29.8,29.8% of Medicare Base rate X weight,235.48,79.02,701.73,Fee Schedule,29.8
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,647.80,388.68,Aetna,Commercial,,647.80,29.8,29.8% of Medicare Base rate X weight,647.80,217.38,1930.44,Fee Schedule,29.8
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-PLV PRG TRNSV,76817,CPT,,,,,both,,,655.09,655.09,Aetna,Commercial,,655.09,29.8,29.8% of Medicare Base rate X weight,655.09,219.83,1952.17,Fee Schedule,29.8
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,655.09,393.05,Aetna,Commercial,,655.09,29.8,29.8% of Medicare Base rate X weight,655.09,219.83,1952.17,Fee Schedule,29.8
US-FETAL BIO W NST,76818,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-FETAL BIO W NST,76818,CPT,,,,,both,, ,1198.20,718.92,Aetna,Commercial,,1198.20,29.8,29.8% of Medicare Base rate X weight,1198.20,402.08,3570.64,Fee Schedule,29.8
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,793.18,475.90,Aetna,Commercial,,793.18,29.8,29.8% of Medicare Base rate X weight,793.18,266.17,2363.68,Fee Schedule,29.8
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,218.64,131.18,Aetna,Commercial,,218.64,29.8,29.8% of Medicare Base rate X weight,218.64,73.37,651.55,Fee Schedule,29.8
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,235.48,141.28,Aetna,Commercial,,235.48,29.8,29.8% of Medicare Base rate X weight,235.48,79.02,701.73,Fee Schedule,29.8
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,780.55,468.33,Aetna,Commercial,,780.55,29.8,29.8% of Medicare Base rate X weight,780.55,261.93,2326.04,Fee Schedule,29.8
Ultrasound pelvis through vagina,76830,CPT,,,,,both,,,689.62,689.62,Aetna,Commercial,,689.62,29.8,29.8% of Medicare Base rate X weight,689.62,231.42,2055.07,Fee Schedule,29.8
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,689.62,413.77,Aetna,Commercial,,689.62,29.8,29.8% of Medicare Base rate X weight,689.62,231.42,2055.07,Fee Schedule,29.8
US-PELVIS NON OB,76856,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
US-PELVIS NON OB,76856,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-PELVIS NON OB,76856,CPT,,,,,both,,,1931.60,1931.60,Aetna,Commercial,,1931.60,29.8,29.8% of Medicare Base rate X weight,1931.60,648.19,5756.17,Fee Schedule,29.8
US-PELVIS NON OB,76856,CPT,,,,,both,, ,1931.60,1158.96,Aetna,Commercial,,1931.60,29.8,29.8% of Medicare Base rate X weight,1931.60,648.19,5756.17,Fee Schedule,29.8
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,209.94,125.96,Aetna,Commercial,,209.94,29.8,29.8% of Medicare Base rate X weight,209.94,70.45,625.62,Fee Schedule,29.8
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,209.94,125.96,Aetna,Commercial,,209.94,29.8,29.8% of Medicare Base rate X weight,209.94,70.45,625.62,Fee Schedule,29.8
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,437.29,262.37,Aetna,Commercial,,437.29,29.8,29.8% of Medicare Base rate X weight,437.29,146.74,1303.12,Fee Schedule,29.8
US-SCROTUM,76870,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
US-SCROTUM,76870,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-SCROTUM,76870,CPT,,,,,both,,,2005.70,2005.70,Aetna,Commercial,,2005.70,29.8,29.8% of Medicare Base rate X weight,2005.70,673.05,5976.99,Fee Schedule,29.8
US-SCROTUM,76870,CPT,,,,,both,, ,2005.70,1203.42,Aetna,Commercial,,2005.70,29.8,29.8% of Medicare Base rate X weight,2005.70,673.05,5976.99,Fee Schedule,29.8
US-TRANSRECTAL,76872,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
US-TRANSRECTAL,76872,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-TRANSRECTAL,76872,CPT,,,,,both,, ,1300.09,780.05,Aetna,Commercial,,1300.09,29.8,29.8% of Medicare Base rate X weight,1300.09,436.27,3874.27,Fee Schedule,29.8
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,378.35,227.01,Aetna,Commercial,,378.35,29.8,29.8% of Medicare Base rate X weight,378.35,126.96,1127.48,Fee Schedule,29.8
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,189.17,113.50,Aetna,Commercial,,189.17,29.8,29.8% of Medicare Base rate X weight,189.17,63.48,563.73,Fee Schedule,29.8
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,218.64,131.18,Aetna,Commercial,,218.64,29.8,29.8% of Medicare Base rate X weight,218.64,73.37,651.55,Fee Schedule,29.8
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,235.48,141.28,Aetna,Commercial,,235.48,29.8,29.8% of Medicare Base rate X weight,235.48,79.02,701.73,Fee Schedule,29.8
NI-VAS ACCSS SITES,76937,CPT,,,,,both,, ,797.67,478.60,Aetna,Commercial,,797.67,29.8,29.8% of Medicare Base rate X weight,797.67,267.67,2377.06,Fee Schedule,29.8
NI-VAS ACCSS SITES ,76937,CPT,,,,,both,, ,710.50,426.30,Aetna,Commercial,,710.50,29.8,29.8% of Medicare Base rate X weight,710.50,238.42,2117.29,Fee Schedule,29.8
US-GUIDE NEEDLE PLAC,76942,CPT,,,,,both,, ,2221.26,1332.75,Aetna,Commercial,,2221.26,29.8,29.8% of Medicare Base rate X weight,2221.26,745.39,6619.35,Fee Schedule,29.8
US-GUIDE AMNIOCENT,76946,CPT,,,,,both,, ,2221.26,1332.75,Aetna,Commercial,,2221.26,29.8,29.8% of Medicare Base rate X weight,2221.26,745.39,6619.35,Fee Schedule,29.8
US-GUIDE INTRAOPERAT,76998,CPT,,,,,both,, ,604.57,362.74,Aetna,Commercial,,604.57,29.8,29.8% of Medicare Base rate X weight,604.57,202.88,1801.62,Fee Schedule,29.8
FL-FLUORO CVAD ANY,77001,CPT,,,,,both,, ,1968.65,1181.19,Aetna,Commercial,,1968.65,29.8,29.8% of Medicare Base rate X weight,1968.65,660.62,5866.58,Fee Schedule,29.8
FL-NEDL GUIDE FLUORO,77002,CPT,,,,,both,, ,521.21,312.72,Aetna,Commercial,,521.21,29.8,29.8% of Medicare Base rate X weight,521.21,174.90,1553.21,Fee Schedule,29.8
FL-FLUORO GUIDE SPIN,77003,CPT,,,,,both,, ,553.77,332.26,Aetna,Commercial,,553.77,29.8,29.8% of Medicare Base rate X weight,553.77,185.83,1650.23,Fee Schedule,29.8
CT-GUIDE NEEDLE BX,77012,CPT,,,,,both,, ,2649.01,1589.40,Aetna,Commercial,,2649.01,29.8,29.8% of Medicare Base rate X weight,2649.01,888.93,7894.05,Fee Schedule,29.8
CT-GUIDE TISSUE ABLA,77013,CPT,,,,,both,, ,3157.31,1894.38,Aetna,Commercial,,3157.31,29.8,29.8% of Medicare Base rate X weight,3157.31,1059.50,9408.78,Fee Schedule,29.8
MR-BREAST UNI WO,77046,CPT,,,,,both,, ,674.73,404.83,Aetna,Commercial,,674.73,29.8,29.8% of Medicare Base rate X weight,674.73,226.42,2010.7,Fee Schedule,29.8
MR-BREAST BIL WO,77047,CPT,,,,,both,, ,674.73,404.83,Aetna,Commercial,,674.73,29.8,29.8% of Medicare Base rate X weight,674.73,226.42,2010.7,Fee Schedule,29.8
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,772.13,463.27,Aetna,Commercial,,772.13,29.8,29.8% of Medicare Base rate X weight,772.13,259.10,2300.95,Fee Schedule,29.8
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,830.80,498.48,Aetna,Commercial,,830.80,29.8,29.8% of Medicare Base rate X weight,830.80,278.79,2475.78,Fee Schedule,29.8
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,1469.05,881.43,Aetna,Commercial,,1469.05,29.8,29.8% of Medicare Base rate X weight,1469.05,492.97,4377.77,Fee Schedule,29.8
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,772.13,463.27,Aetna,Commercial,,772.13,29.8,29.8% of Medicare Base rate X weight,772.13,259.10,2300.95,Fee Schedule,29.8
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,830.80,498.48,Aetna,Commercial,,830.80,29.8,29.8% of Medicare Base rate X weight,830.80,278.79,2475.78,Fee Schedule,29.8
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,1889.78,1133.86,Aetna,Commercial,,1889.78,29.8,29.8% of Medicare Base rate X weight,1889.78,634.15,5631.54,Fee Schedule,29.8
BR-TOMO MAMM SCR BI,77063,CPT,,,,,both,,,107.12,107.12,Aetna,Commercial,,107.12,29.8,29.8% of Medicare Base rate X weight,107.12,35.95,319.22,Fee Schedule,29.8
BR-TOMO MAMM SCR BI,77063,CPT,,,,,both,, ,107.12,64.27,Aetna,Commercial,,107.12,29.8,29.8% of Medicare Base rate X weight,107.12,35.95,319.22,Fee Schedule,29.8
BR-TOMO MAMM SCR UNI,77063,CPT,,,,,both,, ,80.34,48.20,Aetna,Commercial,,80.34,29.8,29.8% of Medicare Base rate X weight,80.34,26.96,239.41,Fee Schedule,29.8
BR-TOMOSYN SCR AD BI,77063,CPT,,,,,both,, ,100.00,60.00,Aetna,Commercial,,100.00,29.8,29.8% of Medicare Base rate X weight,100.00,33.56,298,Fee Schedule,29.8
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,411.49,246.89,Aetna,Commercial,,411.49,29.8,29.8% of Medicare Base rate X weight,411.49,138.08,1226.24,Fee Schedule,29.8
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,411.49,246.89,Aetna,Commercial,,411.49,29.8,29.8% of Medicare Base rate X weight,411.49,138.08,1226.24,Fee Schedule,29.8
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,439.55,263.73,Aetna,Commercial,,439.55,29.8,29.8% of Medicare Base rate X weight,439.55,147.50,1309.86,Fee Schedule,29.8
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,448.82,269.29,Aetna,Commercial,,448.82,29.8,29.8% of Medicare Base rate X weight,448.82,150.61,1337.48,Fee Schedule,29.8
Mammography of one breast,77065,CPT,,,,,both,,,448.82,448.82,Aetna,Commercial,,448.82,29.8,29.8% of Medicare Base rate X weight,448.82,150.61,1337.48,Fee Schedule,29.8
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,411.49,246.89,Aetna,Commercial,,411.49,29.8,29.8% of Medicare Base rate X weight,411.49,138.08,1226.24,Fee Schedule,29.8
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,411.49,246.89,Aetna,Commercial,,411.49,29.8,29.8% of Medicare Base rate X weight,411.49,138.08,1226.24,Fee Schedule,29.8
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,439.55,263.73,Aetna,Commercial,,439.55,29.8,29.8% of Medicare Base rate X weight,439.55,147.50,1309.86,Fee Schedule,29.8
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,556.97,334.18,Aetna,Commercial,,556.97,29.8,29.8% of Medicare Base rate X weight,556.97,186.90,1659.77,Fee Schedule,29.8
Mammography of both breasts,77066,CPT,,,,,both,,,556.97,556.97,Aetna,Commercial,,556.97,29.8,29.8% of Medicare Base rate X weight,556.97,186.90,1659.77,Fee Schedule,29.8
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,345.31,207.18,Aetna,Commercial,,345.31,29.8,29.8% of Medicare Base rate X weight,345.31,115.88,1029.02,Fee Schedule,29.8
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,345.31,207.18,Aetna,Commercial,,345.31,29.8,29.8% of Medicare Base rate X weight,345.31,115.88,1029.02,Fee Schedule,29.8
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,368.23,220.93,Aetna,Commercial,,368.23,29.8,29.8% of Medicare Base rate X weight,368.23,123.57,1097.33,Fee Schedule,29.8
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,488.99,293.39,Aetna,Commercial,,488.99,29.8,29.8% of Medicare Base rate X weight,488.99,164.09,1457.19,Fee Schedule,29.8
BR-DIG MAMMO SCRN UN,77067,CPT,,,,,both,, ,366.68,220.00,Aetna,Commercial,,366.68,29.8,29.8% of Medicare Base rate X weight,366.68,123.05,1092.71,Fee Schedule,29.8
"Mammography, screening, bilateral",77067,CPT,,,,,both,,,488.99,488.99,Aetna,Commercial,,488.99,29.8,29.8% of Medicare Base rate X weight,488.99,164.09,1457.19,Fee Schedule,29.8
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
BONE AGE STUDY CR,77072,CPT,,,,,both,,,721.61,721.61,Aetna,Commercial,,721.61,29.8,29.8% of Medicare Base rate X weight,721.61,242.15,2150.4,Fee Schedule,29.8
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,721.61,432.96,Aetna,Commercial,,721.61,29.8,29.8% of Medicare Base rate X weight,721.61,242.15,2150.4,Fee Schedule,29.8
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
BONE LENGTH STUDY CR,77073,CPT,,,,,both,,,1904.10,1904.10,Aetna,Commercial,,1904.10,29.8,29.8% of Medicare Base rate X weight,1904.10,638.96,5674.22,Fee Schedule,29.8
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,1904.10,1142.46,Aetna,Commercial,,1904.10,29.8,29.8% of Medicare Base rate X weight,1904.10,638.96,5674.22,Fee Schedule,29.8
BNE SRVY LTD METS CR,77074,CPT,,,,,both,,,523.46,523.46,Aetna,Commercial,,523.46,29.8,29.8% of Medicare Base rate X weight,523.46,175.66,1559.91,Fee Schedule,29.8
BNE SRVY LTD METS CR,77074,CPT,,,,,both,, ,523.46,314.07,Aetna,Commercial,,523.46,29.8,29.8% of Medicare Base rate X weight,523.46,175.66,1559.91,Fee Schedule,29.8
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,220.61,29.8,29.8% of Medicare Base rate X weight,220.61,74.03,657.42,Fee Schedule,29.8
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
BNE SRVY CMP METS CR,77075,CPT,,,,,both,,,418.20,418.20,Aetna,Commercial,,418.20,29.8,29.8% of Medicare Base rate X weight,418.20,140.34,1246.24,Fee Schedule,29.8
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,418.20,250.92,Aetna,Commercial,,418.20,29.8,29.8% of Medicare Base rate X weight,418.20,140.34,1246.24,Fee Schedule,29.8
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,220.61,29.8,29.8% of Medicare Base rate X weight,220.61,74.03,657.42,Fee Schedule,29.8
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,237.45,29.8,29.8% of Medicare Base rate X weight,237.45,79.68,707.6,Fee Schedule,29.8
BONE SRVY INFANT CR,77076,CPT,,,,,both,,,833.32,833.32,Aetna,Commercial,,833.32,29.8,29.8% of Medicare Base rate X weight,833.32,279.64,2483.29,Fee Schedule,29.8
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,833.32,499.99,Aetna,Commercial,,833.32,29.8,29.8% of Medicare Base rate X weight,833.32,279.64,2483.29,Fee Schedule,29.8
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
JOINT SURVEY 1V CR,77077,CPT,,,,,both,,,1387.37,1387.37,Aetna,Commercial,,1387.37,29.8,29.8% of Medicare Base rate X weight,1387.37,465.56,4134.36,Fee Schedule,29.8
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,1387.37,832.42,Aetna,Commercial,,1387.37,29.8,29.8% of Medicare Base rate X weight,1387.37,465.56,4134.36,Fee Schedule,29.8
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,218.93,131.35,Aetna,Commercial,,218.93,29.8,29.8% of Medicare Base rate X weight,218.93,73.47,652.41,Fee Schedule,29.8
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,235.77,141.46,Aetna,Commercial,,235.77,29.8,29.8% of Medicare Base rate X weight,235.77,79.12,702.59,Fee Schedule,29.8
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,613.55,368.13,Aetna,Commercial,,613.55,29.8,29.8% of Medicare Base rate X weight,613.55,205.89,1828.38,Fee Schedule,29.8
DEXA AXIAL,77080,CPT,,,,,both,, ,218.93,131.35,Aetna,Commercial,,218.93,29.8,29.8% of Medicare Base rate X weight,218.93,73.47,652.41,Fee Schedule,29.8
DEXA AXIAL,77080,CPT,,,,,both,, ,235.77,141.46,Aetna,Commercial,,235.77,29.8,29.8% of Medicare Base rate X weight,235.77,79.12,702.59,Fee Schedule,29.8
DEXA AXIAL,77080,CPT,,,,,both,,,430.83,430.83,Aetna,Commercial,,430.83,29.8,29.8% of Medicare Base rate X weight,430.83,144.57,1283.87,Fee Schedule,29.8
DEXA AXIAL,77080,CPT,,,,,both,, ,430.83,258.49,Aetna,Commercial,,430.83,29.8,29.8% of Medicare Base rate X weight,430.83,144.57,1283.87,Fee Schedule,29.8
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,139.21,29.8,29.8% of Medicare Base rate X weight,139.21,46.71,414.85,Fee Schedule,29.8
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,149.88,29.8,29.8% of Medicare Base rate X weight,149.88,50.30,446.64,Fee Schedule,29.8
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,266.91,160.14,Aetna,Commercial,,266.91,29.8,29.8% of Medicare Base rate X weight,266.91,89.57,795.39,Fee Schedule,29.8
NM-THYR UPT S-M-SUPP,78012,CPT,,,,,both,, ,1025.37,615.22,Aetna,Commercial,,1025.37,29.8,29.8% of Medicare Base rate X weight,1025.37,344.08,3055.6,Fee Schedule,29.8
NM-THYROID IMG W-BF,78013,CPT,,,,,both,, ,1365.27,819.16,Aetna,Commercial,,1365.27,29.8,29.8% of Medicare Base rate X weight,1365.27,458.14,4068.5,Fee Schedule,29.8
NM-THY UPT IMG W-BF,78014,CPT,,,,,both,, ,1719.59,1031.75,Aetna,Commercial,,1719.59,29.8,29.8% of Medicare Base rate X weight,1719.59,577.04,5124.38,Fee Schedule,29.8
NM-PAR PLAN THY IMG,78070,CPT,,,,,both,, ,1365.27,819.16,Aetna,Commercial,,1365.27,29.8,29.8% of Medicare Base rate X weight,1365.27,458.14,4068.5,Fee Schedule,29.8
NM-PARA PLN IMG SPEC,78071,CPT,,,,,both,, ,1884.64,1130.78,Aetna,Commercial,,1884.64,29.8,29.8% of Medicare Base rate X weight,1884.64,632.43,5616.23,Fee Schedule,29.8
NM-PAR PL IMG SPE CT,78072,CPT,,,,,both,, ,1884.64,1130.78,Aetna,Commercial,,1884.64,29.8,29.8% of Medicare Base rate X weight,1884.64,632.43,5616.23,Fee Schedule,29.8
NM-ADRENAL IMAGING,78075,CPT,,,,,both,, ,5329.74,3197.84,Aetna,Commercial,,5329.74,29.8,29.8% of Medicare Base rate X weight,5329.74,1788.50,15882.63,Fee Schedule,29.8
NM-BONE MARROW LMTD,78102,CPT,,,,,both,, ,1409.30,845.58,Aetna,Commercial,,1409.30,29.8,29.8% of Medicare Base rate X weight,1409.30,472.92,4199.71,Fee Schedule,29.8
NM-BONE MARROW MULT,78103,CPT,,,,,both,, ,1409.30,845.58,Aetna,Commercial,,1409.30,29.8,29.8% of Medicare Base rate X weight,1409.30,472.92,4199.71,Fee Schedule,29.8
NM-BONE MARROW BODY,78104,CPT,,,,,both,, ,1409.30,845.58,Aetna,Commercial,,1409.30,29.8,29.8% of Medicare Base rate X weight,1409.30,472.92,4199.71,Fee Schedule,29.8
NM-LYMPHATICS NODES,78195,CPT,,,,,both,, ,4917.74,2950.64,Aetna,Commercial,,4917.74,29.8,29.8% of Medicare Base rate X weight,4917.74,1650.25,14654.87,Fee Schedule,29.8
NM-LIVER,78201,CPT,,,,,both,, ,3830.06,2298.03,Aetna,Commercial,,3830.06,29.8,29.8% of Medicare Base rate X weight,3830.06,1285.26,11413.58,Fee Schedule,29.8
NM-LIVER AND SPLEEN,78215,CPT,,,,,both,, ,3830.06,2298.03,Aetna,Commercial,,3830.06,29.8,29.8% of Medicare Base rate X weight,3830.06,1285.26,11413.58,Fee Schedule,29.8
NM-HEPATOBILIARY SYS,78226,CPT,,,,,both,, ,4088.59,2453.15,Aetna,Commercial,,4088.59,29.8,29.8% of Medicare Base rate X weight,4088.59,1372.01,12184,Fee Schedule,29.8
NM-HEPATOBIL W PHARM,78227,CPT,,,,,both,,,4088.59,4088.59,Aetna,Commercial,,4088.59,29.8,29.8% of Medicare Base rate X weight,4088.59,1372.01,12184,Fee Schedule,29.8
NM-HEPATOBIL W PHARM,78227,CPT,,,,,both,, ,4088.59,2453.15,Aetna,Commercial,,4088.59,29.8,29.8% of Medicare Base rate X weight,4088.59,1372.01,12184,Fee Schedule,29.8
NM-GI REFLUX,78262,CPT,,,,,both,, ,3415.74,2049.44,Aetna,Commercial,,3415.74,29.8,29.8% of Medicare Base rate X weight,3415.74,1146.22,10178.91,Fee Schedule,29.8
NM-GASTRIC EMPTYING,78264,CPT,,,,,both,,,3415.74,3415.74,Aetna,Commercial,,3415.74,29.8,29.8% of Medicare Base rate X weight,3415.74,1146.22,10178.91,Fee Schedule,29.8
NM-GASTRIC EMPTYING,78264,CPT,,,,,both,, ,3415.74,2049.44,Aetna,Commercial,,3415.74,29.8,29.8% of Medicare Base rate X weight,3415.74,1146.22,10178.91,Fee Schedule,29.8
NM-GAST EMPT SM BWL,78265,CPT,,,,,both,, ,1543.71,926.22,Aetna,Commercial,,1543.71,29.8,29.8% of Medicare Base rate X weight,1543.71,518.02,4600.26,Fee Schedule,29.8
NM-GE SM BWL CLN MUL,78266,CPT,,,,,both,, ,2046.87,1228.12,Aetna,Commercial,,2046.87,29.8,29.8% of Medicare Base rate X weight,2046.87,686.87,6099.67,Fee Schedule,29.8
NM-GI BLOOD LOSS,78278,CPT,,,,,both,, ,3415.74,2049.44,Aetna,Commercial,,3415.74,29.8,29.8% of Medicare Base rate X weight,3415.74,1146.22,10178.91,Fee Schedule,29.8
NM-MECKELS SCAN,78290,CPT,,,,,both,, ,3576.68,2146.00,Aetna,Commercial,,3576.68,29.8,29.8% of Medicare Base rate X weight,3576.68,1200.23,10658.51,Fee Schedule,29.8
NM-BONE SCAN LMTD,78300,CPT,,,,,both,, ,2526.59,1515.95,Aetna,Commercial,,2526.59,29.8,29.8% of Medicare Base rate X weight,2526.59,847.85,7529.24,Fee Schedule,29.8
NM-BONE SCAN MULTI,78305,CPT,,,,,both,, ,2526.59,1515.95,Aetna,Commercial,,2526.59,29.8,29.8% of Medicare Base rate X weight,2526.59,847.85,7529.24,Fee Schedule,29.8
NM-BONE SCAN BODY,78306,CPT,,,,,both,,,3512.04,3512.04,Aetna,Commercial,,3512.04,29.8,29.8% of Medicare Base rate X weight,3512.04,1178.54,10465.88,Fee Schedule,29.8
NM-BONE SCAN BODY,78306,CPT,,,,,both,, ,3512.04,2107.22,Aetna,Commercial,,3512.04,29.8,29.8% of Medicare Base rate X weight,3512.04,1178.54,10465.88,Fee Schedule,29.8
NM-BONE SCAN 3 PHASE,78315,CPT,,,,,both,,,2911.81,2911.81,Aetna,Commercial,,2911.81,29.8,29.8% of Medicare Base rate X weight,2911.81,977.12,8677.19,Fee Schedule,29.8
NM-BONE SCAN 3 PHASE,78315,CPT,,,,,both,, ,2911.81,1747.08,Aetna,Commercial,,2911.81,29.8,29.8% of Medicare Base rate X weight,2911.81,977.12,8677.19,Fee Schedule,29.8
NM-VASCULAR FLOW,78445,CPT,,,,,both,, ,1719.84,1031.90,Aetna,Commercial,,1719.84,29.8,29.8% of Medicare Base rate X weight,1719.84,577.13,5125.12,Fee Schedule,29.8
NM-MYOCRD SPECT SNGL,78451,CPT,,,,,both,, ,3741.73,2245.03,Aetna,Commercial,,3741.73,29.8,29.8% of Medicare Base rate X weight,3741.73,1255.61,11150.36,Fee Schedule,29.8
NM-MYOCRD SPECT MULT,78452,CPT,,,,,both,,,7071.47,7071.47,Aetna,Commercial,,7071.47,29.8,29.8% of Medicare Base rate X weight,7071.47,2372.98,21072.98,Fee Schedule,29.8
NM-MYOCRD SPECT MULT,78452,CPT,,,,,both,, ,7071.47,4242.88,Aetna,Commercial,,7071.47,29.8,29.8% of Medicare Base rate X weight,7071.47,2372.98,21072.98,Fee Schedule,29.8
NM-MYOCARD SINGLE,78453,CPT,,,,,both,, ,4803.15,2881.89,Aetna,Commercial,,4803.15,29.8,29.8% of Medicare Base rate X weight,4803.15,1611.80,14313.39,Fee Schedule,29.8
NM-MYOCARD INFARCT,78466,CPT,,,,,both,, ,3415.74,2049.44,Aetna,Commercial,,3415.74,29.8,29.8% of Medicare Base rate X weight,3415.74,1146.22,10178.91,Fee Schedule,29.8
NM-MYOCARD INF SPECT,78469,CPT,,,,,both,, ,3184.50,1910.70,Aetna,Commercial,,3184.50,29.8,29.8% of Medicare Base rate X weight,3184.50,1068.62,9489.81,Fee Schedule,29.8
NM-GATED BLD POOL SN,78472,CPT,,,,,both,, ,3415.74,2049.44,Aetna,Commercial,,3415.74,29.8,29.8% of Medicare Base rate X weight,3415.74,1146.22,10178.91,Fee Schedule,29.8
NM-LUNG VENT IMAGING,78579,CPT,,,,,both,,,4088.59,4088.59,Aetna,Commercial,,4088.59,29.8,29.8% of Medicare Base rate X weight,4088.59,1372.01,12184,Fee Schedule,29.8
NM-LUNG VENT IMAGING,78579,CPT,,,,,both,, ,4088.59,2453.15,Aetna,Commercial,,4088.59,29.8,29.8% of Medicare Base rate X weight,4088.59,1372.01,12184,Fee Schedule,29.8
NM-LUNG PERF PARTICU,78580,CPT,,,,,both,, ,3590.32,2154.19,Aetna,Commercial,,3590.32,29.8,29.8% of Medicare Base rate X weight,3590.32,1204.81,10699.15,Fee Schedule,29.8
NM-LUNG VENT PERFUS,78582,CPT,,,,,both,,,6243.60,6243.60,Aetna,Commercial,,6243.60,29.8,29.8% of Medicare Base rate X weight,6243.60,2095.17,18605.93,Fee Schedule,29.8
NM-LUNG VENT PERFUS,78582,CPT,,,,,both,, ,6243.60,3746.16,Aetna,Commercial,,6243.60,29.8,29.8% of Medicare Base rate X weight,6243.60,2095.17,18605.93,Fee Schedule,29.8
NM-LUNG PERFVENT DIF,78598,CPT,,,,,both,, ,8897.66,5338.59,Aetna,Commercial,,8897.66,29.8,29.8% of Medicare Base rate X weight,8897.66,2985.79,26515.03,Fee Schedule,29.8
NM-BRAIN CSF CISTERN,78630,CPT,,,,,both,, ,1616.07,969.64,Aetna,Commercial,,1616.07,29.8,29.8% of Medicare Base rate X weight,1616.07,542.31,4815.89,Fee Schedule,29.8
NM-KIDNEY STATIC,78700,CPT,,,,,both,, ,3590.32,2154.19,Aetna,Commercial,,3590.32,29.8,29.8% of Medicare Base rate X weight,3590.32,1204.81,10699.15,Fee Schedule,29.8
NM-KIDNEY STATIC FLO,78701,CPT,,,,,both,, ,4802.63,2881.57,Aetna,Commercial,,4802.63,29.8,29.8% of Medicare Base rate X weight,4802.63,1611.62,14311.84,Fee Schedule,29.8
NM-KIDNEY VF NO PHRM,78707,CPT,,,,,both,, ,4802.63,2881.57,Aetna,Commercial,,4802.63,29.8,29.8% of Medicare Base rate X weight,4802.63,1611.62,14311.84,Fee Schedule,29.8
NM-KID VF PHRM SNGL,78708,CPT,,,,,both,, ,4802.63,2881.57,Aetna,Commercial,,4802.63,29.8,29.8% of Medicare Base rate X weight,4802.63,1611.62,14311.84,Fee Schedule,29.8
NM-KIDNEY FUNCTION,78725,CPT,,,,,both,, ,617.74,370.64,Aetna,Commercial,,617.74,29.8,29.8% of Medicare Base rate X weight,617.74,207.30,1840.87,Fee Schedule,29.8
NM-URIN BLDDR REFLUX,78740,CPT,,,,,both,, ,3590.32,2154.19,Aetna,Commercial,,3590.32,29.8,29.8% of Medicare Base rate X weight,3590.32,1204.81,10699.15,Fee Schedule,29.8
NM-TUMOR LOC LMTD,78800,CPT,,,,,both,, ,4590.83,2754.49,Aetna,Commercial,,4590.83,29.8,29.8% of Medicare Base rate X weight,4590.83,1540.55,13680.67,Fee Schedule,29.8
NM-TUMOR LOC LMTD 1D,78800,CPT,,,,,both,, ,4917.74,2950.64,Aetna,Commercial,,4917.74,29.8,29.8% of Medicare Base rate X weight,4917.74,1650.25,14654.87,Fee Schedule,29.8
NM-TUMOR LOC MULTI,78801,CPT,,,,,both,, ,4917.74,2950.64,Aetna,Commercial,,4917.74,29.8,29.8% of Medicare Base rate X weight,4917.74,1650.25,14654.87,Fee Schedule,29.8
NM-TUMOR LOC BDY 1D,78802,CPT,,,,,both,, ,6129.79,3677.87,Aetna,Commercial,,6129.79,29.8,29.8% of Medicare Base rate X weight,6129.79,2056.98,18266.77,Fee Schedule,29.8
NM-TUMOR LOC BODY,78802,CPT,,,,,both,, ,4590.83,2754.49,Aetna,Commercial,,4590.83,29.8,29.8% of Medicare Base rate X weight,4590.83,1540.55,13680.67,Fee Schedule,29.8
NM-TUMR LOC SPECT 1D,78803,CPT,,,,,both,, ,5042.88,3025.72,Aetna,Commercial,,5042.88,29.8,29.8% of Medicare Base rate X weight,5042.88,1692.24,15027.78,Fee Schedule,29.8
NM-TUMR LOC BDY >1D,78804,CPT,,,,,both,, ,5251.46,3150.87,Aetna,Commercial,,5251.46,29.8,29.8% of Medicare Base rate X weight,5251.46,1762.23,15649.35,Fee Schedule,29.8
NM-UNLISTED MISC,78999,CPT,,,,,both,, ,593.54,356.12,Aetna,Commercial,,593.54,29.8,29.8% of Medicare Base rate X weight,593.54,199.17,1768.75,Fee Schedule,29.8
NUCLEAR RX IV ADMIN,79101,CPT,,,,,both,, ,1716.50,1029.90,Aetna,Commercial,,1716.50,29.8,29.8% of Medicare Base rate X weight,1716.50,576.01,5115.17,Fee Schedule,29.8
BASIC META W-ION CA,80047,CPT,,,,,both,, ,29.19,17.51,Aetna,Commercial,,29.19,29.8,29.8% of Medicare Base rate X weight,29.19,9.80,86.99,Fee Schedule,29.8
BASIC META W-ION CA,80047,CPT,,,,,both,, ,163.63,98.17,Aetna,Commercial,,163.63,29.8,29.8% of Medicare Base rate X weight,163.63,54.91,487.62,Fee Schedule,29.8
BASIC METABO CA TOTA,80048,CPT,,,,,both,, ,89.53,53.71,Aetna,Commercial,,89.53,29.8,29.8% of Medicare Base rate X weight,89.53,30.04,266.8,Fee Schedule,29.8
BASIC METABO CA TOTA,80048,CPT,,,,,both,, ,510.83,306.49,Aetna,Commercial,,510.83,29.8,29.8% of Medicare Base rate X weight,510.83,171.42,1522.27,Fee Schedule,29.8
Basic metabolic panel,80048,CPT,,,,,both,,,510.83,510.83,Aetna,Commercial,,510.83,29.8,29.8% of Medicare Base rate X weight,510.83,171.42,1522.27,Fee Schedule,29.8
GENERAL HEALTH PANEL,80050,CPT,,,,,both,,,1796.88,1796.88,Aetna,Commercial,,1796.88,29.8,29.8% of Medicare Base rate X weight,1796.88,602.98,5354.7,Fee Schedule,29.8
GENERAL HEALTH PANEL,80050,CPT,,,,,both,, ,1796.88,1078.12,Aetna,Commercial,,1796.88,29.8,29.8% of Medicare Base rate X weight,1796.88,602.98,5354.7,Fee Schedule,29.8
ELECTROLYTE PANEL,80051,CPT,,,,,both,, ,74.10,44.46,Aetna,Commercial,,74.10,29.8,29.8% of Medicare Base rate X weight,74.10,24.87,220.82,Fee Schedule,29.8
ELECTROLYTE PANEL,80051,CPT,,,,,both,, ,390.41,234.24,Aetna,Commercial,,390.41,29.8,29.8% of Medicare Base rate X weight,390.41,131.01,1163.42,Fee Schedule,29.8
"Blood test, comprehensive group of blood chemicals",80053,CPT,,,,,both,,,630.96,630.96,Aetna,Commercial,,630.96,29.8,29.8% of Medicare Base rate X weight,630.96,211.73,1880.26,Fee Schedule,29.8
COMP METAB PANEL,80053,CPT,,,,,both,, ,111.70,67.02,Aetna,Commercial,,111.70,29.8,29.8% of Medicare Base rate X weight,111.70,37.48,332.87,Fee Schedule,29.8
COMP METAB PANEL,80053,CPT,,,,,both,, ,630.96,378.57,Aetna,Commercial,,630.96,29.8,29.8% of Medicare Base rate X weight,630.96,211.73,1880.26,Fee Schedule,29.8
Obstetric blood test panel,80055,CPT,,,,,both,,,1727.55,1727.55,Aetna,Commercial,,1727.55,29.8,29.8% of Medicare Base rate X weight,1727.55,579.71,5148.1,Fee Schedule,29.8
OBSTETRIC PANEL,80055,CPT,,,,,both,, ,350.84,210.50,Aetna,Commercial,,350.84,29.8,29.8% of Medicare Base rate X weight,350.84,117.73,1045.5,Fee Schedule,29.8
OBSTETRIC PANEL,80055,CPT,,,,,both,, ,1727.55,1036.53,Aetna,Commercial,,1727.55,29.8,29.8% of Medicare Base rate X weight,1727.55,579.71,5148.1,Fee Schedule,29.8
"Blood test, lipids (cholesterol and triglycerides)",80061,CPT,,,,,both,,,565.84,565.84,Aetna,Commercial,,565.84,29.8,29.8% of Medicare Base rate X weight,565.84,189.88,1686.2,Fee Schedule,29.8
LIPID PANEL,80061,CPT,,,,,both,, ,86.73,52.03,Aetna,Commercial,,86.73,29.8,29.8% of Medicare Base rate X weight,86.73,29.10,258.46,Fee Schedule,29.8
Q92145 LIPID PANEL,80061,CPT,,,,,both,, ,565.84,339.50,Aetna,Commercial,,565.84,29.8,29.8% of Medicare Base rate X weight,565.84,189.88,1686.2,Fee Schedule,29.8
Q92145 LIPID PANEL,80061,CPT,,,,,both,, ,565.84,339.50,Aetna,Commercial,,565.84,29.8,29.8% of Medicare Base rate X weight,565.84,189.88,1686.2,Fee Schedule,29.8
Kidney function panel test,80069,CPT,,,,,both,,,570.89,570.89,Aetna,Commercial,,570.89,29.8,29.8% of Medicare Base rate X weight,570.89,191.57,1701.25,Fee Schedule,29.8
RENAL FUNCTION PANEL,80069,CPT,,,,,both,, ,91.77,55.06,Aetna,Commercial,,91.77,29.8,29.8% of Medicare Base rate X weight,91.77,30.80,273.47,Fee Schedule,29.8
RENAL FUNCTION PANEL,80069,CPT,,,,,both,, ,570.89,342.53,Aetna,Commercial,,570.89,29.8,29.8% of Medicare Base rate X weight,570.89,191.57,1701.25,Fee Schedule,29.8
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,, ,282.08,169.24,Aetna,Commercial,,282.08,29.8,29.8% of Medicare Base rate X weight,282.08,94.66,840.6,Fee Schedule,29.8
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,,,3484.29,3484.29,Aetna,Commercial,,3484.29,29.8,29.8% of Medicare Base rate X weight,3484.29,1169.22,10383.18,Fee Schedule,29.8
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,, ,3484.29,2090.57,Aetna,Commercial,,3484.29,29.8,29.8% of Medicare Base rate X weight,3484.29,1169.22,10383.18,Fee Schedule,29.8
HEPATIC FUNCTION PAN,80076,CPT,,,,,both,, ,86.45,51.87,Aetna,Commercial,,86.45,29.8,29.8% of Medicare Base rate X weight,86.45,29.01,257.62,Fee Schedule,29.8
HEPATIC FUNCTION PAN,80076,CPT,,,,,both,, ,450.48,270.28,Aetna,Commercial,,450.48,29.8,29.8% of Medicare Base rate X weight,450.48,151.17,1342.43,Fee Schedule,29.8
Liver function blood test panel,80076,CPT,,,,,both,,,450.48,450.48,Aetna,Commercial,,450.48,29.8,29.8% of Medicare Base rate X weight,450.48,151.17,1342.43,Fee Schedule,29.8
OBSTETRIC PNL W HIV,80081,CPT,,,,,both,, ,1883.60,1130.16,Aetna,Commercial,,1883.60,29.8,29.8% of Medicare Base rate X weight,1883.60,632.08,5613.13,Fee Schedule,29.8
ACETAMINOPHEN QT,80143,CPT,,,,,both,, ,186.06,111.63,Aetna,Commercial,,186.06,29.8,29.8% of Medicare Base rate X weight,186.06,62.44,554.46,Fee Schedule,29.8
Q36298 ADM LEV IBD,80145,CPT,,,,,both,, ,174.02,104.41,Aetna,Commercial,,174.02,29.8,29.8% of Medicare Base rate X weight,174.02,58.40,518.58,Fee Schedule,29.8
AMIKACIN,80150,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q36721 AMIOD HPLC/LC,80151,CPT,,,,,both,, ,546.19,327.71,Aetna,Commercial,,546.19,29.8,29.8% of Medicare Base rate X weight,546.19,183.29,1627.65,Fee Schedule,29.8
CARBAMAZEPINE TOTAL,80156,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
Q18948 CBZ FREE LCMS,80157,CPT,,,,,both,, ,88.40,53.04,Aetna,Commercial,,88.40,29.8,29.8% of Medicare Base rate X weight,88.40,29.66,263.43,Fee Schedule,29.8
CYCLOSPORINE,80158,CPT,,,,,both,, ,91.49,54.89,Aetna,Commercial,,91.49,29.8,29.8% of Medicare Base rate X weight,91.49,30.70,272.64,Fee Schedule,29.8
CYCLOSPORINE,80158,CPT,,,,,both,, ,1555.50,933.30,Aetna,Commercial,,1555.50,29.8,29.8% of Medicare Base rate X weight,1555.50,521.98,4635.39,Fee Schedule,29.8
Q15220CYC A BL LCMSM,80158,CPT,,,,,both,, ,1555.50,933.30,Aetna,Commercial,,1555.50,29.8,29.8% of Medicare Base rate X weight,1555.50,521.98,4635.39,Fee Schedule,29.8
Q8812 CYA TRGH BL IA,80158,CPT,,,,,both,, ,1555.50,933.30,Aetna,Commercial,,1555.50,29.8,29.8% of Medicare Base rate X weight,1555.50,521.98,4635.39,Fee Schedule,29.8
Q1769 CLOZAP LCMSMS,80159,CPT,,,,,both,, ,95.43,57.25,Aetna,Commercial,,95.43,29.8,29.8% of Medicare Base rate X weight,95.43,32.02,284.38,Fee Schedule,29.8
Q1769 CLOZAP LCMSMS,80159,CPT,,,,,both,, ,95.43,57.25,Aetna,Commercial,,95.43,29.8,29.8% of Medicare Base rate X weight,95.43,32.02,284.38,Fee Schedule,29.8
DIGOXIN TOTAL,80162,CPT,,,,,both,, ,130.23,78.13,Aetna,Commercial,,130.23,29.8,29.8% of Medicare Base rate X weight,130.23,43.70,388.09,Fee Schedule,29.8
DIGOXIN TOTAL,80162,CPT,,,,,both,, ,787.57,472.54,Aetna,Commercial,,787.57,29.8,29.8% of Medicare Base rate X weight,787.57,264.29,2346.96,Fee Schedule,29.8
DIGOXIN FREE,80163,CPT,,,,,both,, ,130.23,78.13,Aetna,Commercial,,130.23,29.8,29.8% of Medicare Base rate X weight,130.23,43.70,388.09,Fee Schedule,29.8
Q6651 VALP ACID TOT,80164,CPT,,,,,both,, ,691.06,414.63,Aetna,Commercial,,691.06,29.8,29.8% of Medicare Base rate X weight,691.06,231.90,2059.36,Fee Schedule,29.8
VALPROIC ACID TOTAL,80164,CPT,,,,,both,, ,132.76,79.65,Aetna,Commercial,,132.76,29.8,29.8% of Medicare Base rate X weight,132.76,44.55,395.62,Fee Schedule,29.8
VALPROIC ACID TOTAL,80164,CPT,,,,,both,,,711.79,711.79,Aetna,Commercial,,711.79,29.8,29.8% of Medicare Base rate X weight,711.79,238.86,2121.13,Fee Schedule,29.8
VALPROIC ACID TOTAL,80164,CPT,,,,,both,, ,711.79,427.07,Aetna,Commercial,,711.79,29.8,29.8% of Medicare Base rate X weight,711.79,238.86,2121.13,Fee Schedule,29.8
Q6651 VALP ACID FREE,80165,CPT,,,,,both,, ,691.06,414.63,Aetna,Commercial,,691.06,29.8,29.8% of Medicare Base rate X weight,691.06,231.90,2059.36,Fee Schedule,29.8
VALPROIC ACID FREE,80165,CPT,,,,,both,, ,132.76,79.65,Aetna,Commercial,,132.76,29.8,29.8% of Medicare Base rate X weight,132.76,44.55,395.62,Fee Schedule,29.8
VALPROIC ACID FREE,80165,CPT,,,,,both,, ,711.79,427.07,Aetna,Commercial,,711.79,29.8,29.8% of Medicare Base rate X weight,711.79,238.86,2121.13,Fee Schedule,29.8
Q3081 FELBAMATE MS,80167,CPT,,,,,both,, ,191.99,115.19,Aetna,Commercial,,191.99,29.8,29.8% of Medicare Base rate X weight,191.99,64.43,572.13,Fee Schedule,29.8
ETHOSUXIMIDE,80168,CPT,,,,,both,, ,864.19,518.51,Aetna,Commercial,,864.19,29.8,29.8% of Medicare Base rate X weight,864.19,290.00,2575.29,Fee Schedule,29.8
Q18883 EVEROLI LM/MS,80169,CPT,,,,,both,, ,106.93,64.15,Aetna,Commercial,,106.93,29.8,29.8% of Medicare Base rate X weight,106.93,35.88,318.65,Fee Schedule,29.8
GENTAMICIN,80170,CPT,,,,,both,, ,900.96,540.57,Aetna,Commercial,,900.96,29.8,29.8% of Medicare Base rate X weight,900.96,302.34,2684.86,Fee Schedule,29.8
GABAPENTIN QT,80171,CPT,,,,,both,, ,105.53,63.31,Aetna,Commercial,,105.53,29.8,29.8% of Medicare Base rate X weight,105.53,35.41,314.48,Fee Schedule,29.8
L716811 GABAP LCMSMS,80171,CPT,,,,,both,, ,102.46,61.47,Aetna,Commercial,,102.46,29.8,29.8% of Medicare Base rate X weight,102.46,34.38,305.33,Fee Schedule,29.8
HALOPERIDOL,80173,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,871.22,29.8,29.8% of Medicare Base rate X weight,871.22,292.36,2596.24,Fee Schedule,29.8
Q22060 LAMOTR LCMSMS,80175,CPT,,,,,both,, ,105.53,63.31,Aetna,Commercial,,105.53,29.8,29.8% of Medicare Base rate X weight,105.53,35.41,314.48,Fee Schedule,29.8
Q22060 LAMOTR LCMSMS,80175,CPT,,,,,both,, ,105.53,63.31,Aetna,Commercial,,105.53,29.8,29.8% of Medicare Base rate X weight,105.53,35.41,314.48,Fee Schedule,29.8
Q605 LIDOCAINE IA,80176,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,871.22,29.8,29.8% of Medicare Base rate X weight,871.22,292.36,2596.24,Fee Schedule,29.8
Q605 LIDOCAINE IA,80176,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,871.22,29.8,29.8% of Medicare Base rate X weight,871.22,292.36,2596.24,Fee Schedule,29.8
Q15142 LEVE LC/MS/MS,80177,CPT,,,,,both,, ,105.53,63.31,Aetna,Commercial,,105.53,29.8,29.8% of Medicare Base rate X weight,105.53,35.41,314.48,Fee Schedule,29.8
Lithium,80178,CPT,,,,,both,,,420.72,420.72,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
LITHIUM,80178,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
SALICYLATE QT,80179,CPT,,,,,both,, ,191.99,115.19,Aetna,Commercial,,191.99,29.8,29.8% of Medicare Base rate X weight,191.99,64.43,572.13,Fee Schedule,29.8
Q10662 MPA LC/MS/MS,80180,CPT,,,,,both,, ,143.71,86.22,Aetna,Commercial,,143.71,29.8,29.8% of Medicare Base rate X weight,143.71,48.22,428.26,Fee Schedule,29.8
Q36637 OCBZ LC/MS/MS,80183,CPT,,,,,both,, ,122.37,73.42,Aetna,Commercial,,122.37,29.8,29.8% of Medicare Base rate X weight,122.37,41.06,364.66,Fee Schedule,29.8
Q36637 OCBZ LC/MS/MS,80183,CPT,,,,,both,, ,122.37,73.42,Aetna,Commercial,,122.37,29.8,29.8% of Medicare Base rate X weight,122.37,41.06,364.66,Fee Schedule,29.8
PHENOBARBITAL,80184,CPT,,,,,both,, ,120.96,72.57,Aetna,Commercial,,120.96,29.8,29.8% of Medicare Base rate X weight,120.96,40.59,360.46,Fee Schedule,29.8
Q751 PHENOBARBITAL,80184,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,871.22,29.8,29.8% of Medicare Base rate X weight,871.22,292.36,2596.24,Fee Schedule,29.8
Q751 PHENOBARBITAL,80184,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,871.22,29.8,29.8% of Medicare Base rate X weight,871.22,292.36,2596.24,Fee Schedule,29.8
L70706 PHENYTOIN TOT,80185,CPT,,,,,both,, ,847.64,508.58,Aetna,Commercial,,847.64,29.8,29.8% of Medicare Base rate X weight,847.64,284.44,2525.97,Fee Schedule,29.8
L70706 PHENYTOIN TOT,80185,CPT,,,,,both,, ,847.64,508.58,Aetna,Commercial,,847.64,29.8,29.8% of Medicare Base rate X weight,847.64,284.44,2525.97,Fee Schedule,29.8
PHENYTOIN TOTAL,80185,CPT,,,,,both,, ,140.05,84.03,Aetna,Commercial,,140.05,29.8,29.8% of Medicare Base rate X weight,140.05,47.00,417.35,Fee Schedule,29.8
L70706PHENYTOIN FREE,80186,CPT,,,,,both,, ,91.77,55.06,Aetna,Commercial,,91.77,29.8,29.8% of Medicare Base rate X weight,91.77,30.80,273.47,Fee Schedule,29.8
L70706PHENYTOIN FREE,80186,CPT,,,,,both,, ,91.77,55.06,Aetna,Commercial,,91.77,29.8,29.8% of Medicare Base rate X weight,91.77,30.80,273.47,Fee Schedule,29.8
PRIMIDONE,80188,CPT,,,,,both,, ,1757.58,1054.54,Aetna,Commercial,,1757.58,29.8,29.8% of Medicare Base rate X weight,1757.58,589.79,5237.59,Fee Schedule,29.8
Q751 PRIMIDONE,80188,CPT,,,,,both,, ,878.79,527.27,Aetna,Commercial,,878.79,29.8,29.8% of Medicare Base rate X weight,878.79,294.90,2618.79,Fee Schedule,29.8
PROCAINAMIDE+NAPA,80192,CPT,,,,,both,, ,900.96,540.57,Aetna,Commercial,,900.96,29.8,29.8% of Medicare Base rate X weight,900.96,302.34,2684.86,Fee Schedule,29.8
QUINIDINE,80194,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,765.96,29.8,29.8% of Medicare Base rate X weight,765.96,257.03,2282.56,Fee Schedule,29.8
SIROLIMUS,80195,CPT,,,,,both,, ,257.10,154.26,Aetna,Commercial,,257.10,29.8,29.8% of Medicare Base rate X weight,257.10,86.28,766.16,Fee Schedule,29.8
SIROLIMUS,80195,CPT,,,,,both,, ,257.10,154.26,Aetna,Commercial,,257.10,29.8,29.8% of Medicare Base rate X weight,257.10,86.28,766.16,Fee Schedule,29.8
Q70007 TAC HS LCMSMS,80197,CPT,,,,,both,, ,822.37,493.42,Aetna,Commercial,,822.37,29.8,29.8% of Medicare Base rate X weight,822.37,275.96,2450.66,Fee Schedule,29.8
Q70007 TAC HS LCMSMS,80197,CPT,,,,,both,, ,822.37,493.42,Aetna,Commercial,,822.37,29.8,29.8% of Medicare Base rate X weight,822.37,275.96,2450.66,Fee Schedule,29.8
THEOPHYLLINE,80198,CPT,,,,,both,, ,781.11,468.66,Aetna,Commercial,,781.11,29.8,29.8% of Medicare Base rate X weight,781.11,262.12,2327.71,Fee Schedule,29.8
"THEOPHYLLINE, SERUM",80198,CPT,,,,,both,, ,149.60,89.76,Aetna,Commercial,,149.60,29.8,29.8% of Medicare Base rate X weight,149.60,50.20,445.81,Fee Schedule,29.8
"THEOPHYLLINE, SERUM",80198,CPT,,,,,both,, ,149.60,89.76,Aetna,Commercial,,149.60,29.8,29.8% of Medicare Base rate X weight,149.60,50.20,445.81,Fee Schedule,29.8
TIAGABINE QT,80199,CPT,,,,,both,, ,143.71,86.22,Aetna,Commercial,,143.71,29.8,29.8% of Medicare Base rate X weight,143.71,48.22,428.26,Fee Schedule,29.8
TOBRAMYCIN,80200,CPT,,,,,both,, ,75.50,45.30,Aetna,Commercial,,75.50,29.8,29.8% of Medicare Base rate X weight,75.50,25.34,224.99,Fee Schedule,29.8
TOPIRAMATE,80201,CPT,,,,,both,, ,445.71,267.42,Aetna,Commercial,,445.71,29.8,29.8% of Medicare Base rate X weight,445.71,149.57,1328.22,Fee Schedule,29.8
VANCOMYCIN,80202,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,765.96,29.8,29.8% of Medicare Base rate X weight,765.96,257.03,2282.56,Fee Schedule,29.8
ZONISAMIDE,80203,CPT,,,,,both,, ,105.53,63.31,Aetna,Commercial,,105.53,29.8,29.8% of Medicare Base rate X weight,105.53,35.41,314.48,Fee Schedule,29.8
ZONISAMIDE,80203,CPT,,,,,both,, ,105.53,63.31,Aetna,Commercial,,105.53,29.8,29.8% of Medicare Base rate X weight,105.53,35.41,314.48,Fee Schedule,29.8
Q648 METHOTREXATE IA,80204,CPT,,,,,both,, ,501.10,300.66,Aetna,Commercial,,501.10,29.8,29.8% of Medicare Base rate X weight,501.10,168.15,1493.28,Fee Schedule,29.8
L503870 INFLIXIMAB,80230,CPT,,,,,both,, ,159.65,95.79,Aetna,Commercial,,159.65,29.8,29.8% of Medicare Base rate X weight,159.65,53.57,475.76,Fee Schedule,29.8
L504567 VEDOLIZUMAB,80280,CPT,,,,,both,, ,198.79,119.27,Aetna,Commercial,,198.79,29.8,29.8% of Medicare Base rate X weight,198.79,66.71,592.39,Fee Schedule,29.8
DRUG UNSPEC QUANT,80299,CPT,,,,,both,, ,873.46,524.07,Aetna,Commercial,,873.46,29.8,29.8% of Medicare Base rate X weight,873.46,293.11,2602.91,Fee Schedule,29.8
L7609 DOXEPIN LCMSMS,80299,CPT,,,,,both,, ,148.40,89.04,Aetna,Commercial,,148.40,29.8,29.8% of Medicare Base rate X weight,148.40,49.80,442.23,Fee Schedule,29.8
Q2548 DRUG UNSPEC QT,80299,CPT,,,,,both,, ,546.19,327.71,Aetna,Commercial,,546.19,29.8,29.8% of Medicare Base rate X weight,546.19,183.29,1627.65,Fee Schedule,29.8
Q2548 DRUG UNSPEC QT,80299,CPT,,,,,both,, ,546.19,327.71,Aetna,Commercial,,546.19,29.8,29.8% of Medicare Base rate X weight,546.19,183.29,1627.65,Fee Schedule,29.8
Q29391DEXAMET LCMSMS,80299,CPT,,,,,both,, ,342.00,205.20,Aetna,Commercial,,342.00,29.8,29.8% of Medicare Base rate X weight,342.00,114.77,1019.16,Fee Schedule,29.8
Q8389 FLUOXET LCMSMS,80299,CPT,,,,,both,, ,811.42,486.85,Aetna,Commercial,,811.42,29.8,29.8% of Medicare Base rate X weight,811.42,272.29,2418.03,Fee Schedule,29.8
PRS DRG IA VIS,80305,CPT,,,,,both,, ,137.80,82.68,Aetna,Commercial,,137.80,29.8,29.8% of Medicare Base rate X weight,137.80,46.24,410.64,Fee Schedule,29.8
PRS DRG IA MET,80306,CPT,,,,,both,, ,137.80,82.68,Aetna,Commercial,,137.80,29.8,29.8% of Medicare Base rate X weight,137.80,46.24,410.64,Fee Schedule,29.8
733726 URINE DRUG PROFILE 14/MEDWATCH,80307,CPT,,,,,both,, ,360.00,216.00,Aetna,Commercial,,360.00,29.8,29.8% of Medicare Base rate X weight,360.00,120.81,1072.8,Fee Schedule,29.8
DRUGPROF ORAL FLD,80307,CPT,,,,,both,, ,116.00,69.60,Aetna,Commercial,,116.00,29.8,29.8% of Medicare Base rate X weight,116.00,38.93,345.68,Fee Schedule,29.8
L074401 AMPH UR SCRN,80307,CPT,,,,,both,, ,60.00,36.00,Aetna,Commercial,,60.00,29.8,29.8% of Medicare Base rate X weight,60.00,20.13,178.8,Fee Schedule,29.8
L074401 AMPH UR SCRN,80307,CPT,,,,,both,, ,60.00,36.00,Aetna,Commercial,,60.00,29.8,29.8% of Medicare Base rate X weight,60.00,20.13,178.8,Fee Schedule,29.8
L733740 ULTRM SCR UR,80307,CPT,,,,,both,, ,200.00,120.00,Aetna,Commercial,,200.00,29.8,29.8% of Medicare Base rate X weight,200.00,67.11,596,Fee Schedule,29.8
L790600 DAB SCN PRES,80307,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
L790600 DAB SCN PRES,80307,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
PRS DRG IA ANAZ,80307,CPT,,,,,both,,,1174.34,1174.34,Aetna,Commercial,,1174.34,29.8,29.8% of Medicare Base rate X weight,1174.34,394.07,3499.53,Fee Schedule,29.8
Q19027 CONF DRUG 1 U,80307,CPT,,,,,both,, ,1174.34,704.60,Aetna,Commercial,,1174.34,29.8,29.8% of Medicare Base rate X weight,1174.34,394.07,3499.53,Fee Schedule,29.8
Q19027 CONF DRUG 1 U,80307,CPT,,,,,both,, ,1174.34,704.60,Aetna,Commercial,,1174.34,29.8,29.8% of Medicare Base rate X weight,1174.34,394.07,3499.53,Fee Schedule,29.8
Q643 METHYL ALC BL C,80320,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,728.07,29.8,29.8% of Medicare Base rate X weight,728.07,244.32,2169.65,Fee Schedule,29.8
ALKALOIDS NOS MS,80323,CPT,,,,,both,, ,713.47,428.08,Aetna,Commercial,,713.47,29.8,29.8% of Medicare Base rate X weight,713.47,239.42,2126.14,Fee Schedule,29.8
Q90642NIC&COT S LCMS,80323,CPT,,,,,both,, ,713.47,428.08,Aetna,Commercial,,713.47,29.8,29.8% of Medicare Base rate X weight,713.47,239.42,2126.14,Fee Schedule,29.8
Q90646NIC&COT U LCMS,80323,CPT,,,,,both,, ,713.47,428.08,Aetna,Commercial,,713.47,29.8,29.8% of Medicare Base rate X weight,713.47,239.42,2126.14,Fee Schedule,29.8
Q241Z AMPHET U GC/MS,80324,CPT,,,,,both,, ,184.68,110.80,Aetna,Commercial,,184.68,29.8,29.8% of Medicare Base rate X weight,184.68,61.97,550.35,Fee Schedule,29.8
Q241Z AMPHET U GC/MS,80324,CPT,,,,,both,, ,184.68,110.80,Aetna,Commercial,,184.68,29.8,29.8% of Medicare Base rate X weight,184.68,61.97,550.35,Fee Schedule,29.8
L790600 AMPH MS 5P,80326,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
ANABOLC STRD MS 1-2,80327,CPT,,,,,both,, ,269.16,161.49,Aetna,Commercial,,269.16,29.8,29.8% of Medicare Base rate X weight,269.16,90.32,802.1,Fee Schedule,29.8
L790600 ANLGNO MS 6P,80331,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
ANTIDPRS SERO MS 3-5,80333,CPT,,,,,both,, ,771.01,462.60,Aetna,Commercial,,771.01,29.8,29.8% of Medicare Base rate X weight,771.01,258.73,2297.61,Fee Schedule,29.8
L790600 AD MS 6PL,80334,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
Q272 NORTRI LC/MS/MS,80335,CPT,,,,,both,, ,826.59,495.95,Aetna,Commercial,,826.59,29.8,29.8% of Medicare Base rate X weight,826.59,277.38,2463.24,Fee Schedule,29.8
Q272 NORTRI LC/MS/MS,80335,CPT,,,,,both,, ,826.59,495.95,Aetna,Commercial,,826.59,29.8,29.8% of Medicare Base rate X weight,826.59,277.38,2463.24,Fee Schedule,29.8
Q412 DESIPRAM LCMSMS,80335,CPT,,,,,both,, ,826.59,495.95,Aetna,Commercial,,826.59,29.8,29.8% of Medicare Base rate X weight,826.59,277.38,2463.24,Fee Schedule,29.8
Q412 DESIPRAM LCMSMS,80335,CPT,,,,,both,, ,826.59,495.95,Aetna,Commercial,,826.59,29.8,29.8% of Medicare Base rate X weight,826.59,277.38,2463.24,Fee Schedule,29.8
Q887 IMIPRAM LCMSMS,80335,CPT,,,,,both,, ,826.59,495.95,Aetna,Commercial,,826.59,29.8,29.8% of Medicare Base rate X weight,826.59,277.38,2463.24,Fee Schedule,29.8
Q887 IMIPRAM LCMSMS,80335,CPT,,,,,both,, ,826.59,495.95,Aetna,Commercial,,826.59,29.8,29.8% of Medicare Base rate X weight,826.59,277.38,2463.24,Fee Schedule,29.8
ANTIDPRS TRIC MS 3-5,80336,CPT,,,,,both,, ,571.45,342.87,Aetna,Commercial,,571.45,29.8,29.8% of Medicare Base rate X weight,571.45,191.76,1702.92,Fee Schedule,29.8
L790600 ADEP TRI 6PL,80337,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
ANTIDPRS NOS MS,80338,CPT,,,,,both,, ,928.18,556.90,Aetna,Commercial,,928.18,29.8,29.8% of Medicare Base rate X weight,928.18,311.47,2765.98,Fee Schedule,29.8
L790600 AD NOS MS,80338,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
L790600 AED MS 7P,80341,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
ANTIPSYCH NOS MS 1-3,80342,CPT,,,,,both,, ,811.42,486.85,Aetna,Commercial,,811.42,29.8,29.8% of Medicare Base rate X weight,811.42,272.29,2418.03,Fee Schedule,29.8
L790600 APD MS 7P,80344,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
L809630 FLTZP MS,80346,CPT,,,,,both,, ,600.00,360.00,Aetna,Commercial,,600.00,29.8,29.8% of Medicare Base rate X weight,600.00,201.34,1788,Fee Schedule,29.8
Q340 CLONAZEP LCMSMS,80346,CPT,,,,,both,, ,814.24,488.54,Aetna,Commercial,,814.24,29.8,29.8% of Medicare Base rate X weight,814.24,273.23,2426.44,Fee Schedule,29.8
Q340 CLONAZEP LCMSMS,80346,CPT,,,,,both,, ,814.24,488.54,Aetna,Commercial,,814.24,29.8,29.8% of Medicare Base rate X weight,814.24,273.23,2426.44,Fee Schedule,29.8
L790600 BZD MS 13P,80347,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
L790600 BUP MS,80348,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
L790600 BUP MS,80348,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
Q93031 BUPRENOPHINE & METABOLITIES LC/MS,80348,CPT,,,,,both,, ,119.25,71.55,Aetna,Commercial,,119.25,29.8,29.8% of Medicare Base rate X weight,119.25,40.02,355.37,Fee Schedule,29.8
CANNABINDS NATUR MS,80349,CPT,,,,,both,, ,147.91,88.74,Aetna,Commercial,,147.91,29.8,29.8% of Medicare Base rate X weight,147.91,49.63,440.77,Fee Schedule,29.8
L790697 SYNCBD WB MS,80352,CPT,,,,,both,, ,300.00,180.00,Aetna,Commercial,,300.00,29.8,29.8% of Medicare Base rate X weight,300.00,100.67,894,Fee Schedule,29.8
L790600 COCAINE MS,80353,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
FENTANYL MS,80354,CPT,,,,,both,, ,534.41,320.64,Aetna,Commercial,,534.41,29.8,29.8% of Medicare Base rate X weight,534.41,179.33,1592.54,Fee Schedule,29.8
L790600 FENT MET MS,80354,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
GABAPENTIN NONBLD MS,80355,CPT,,,,,both,, ,534.41,320.64,Aetna,Commercial,,534.41,29.8,29.8% of Medicare Base rate X weight,534.41,179.33,1592.54,Fee Schedule,29.8
L790600 GPT NBLD MS,80355,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
HEROIN METABOLITE MS,80356,CPT,,,,,both,, ,227.91,136.74,Aetna,Commercial,,227.91,29.8,29.8% of Medicare Base rate X weight,227.91,76.48,679.17,Fee Schedule,29.8
L790600 KET NKET MS,80357,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
L790600 MTD MS,80358,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
METHADONE MS,80358,CPT,,,,,both,, ,327.54,196.52,Aetna,Commercial,,327.54,29.8,29.8% of Medicare Base rate X weight,327.54,109.91,976.07,Fee Schedule,29.8
L791194 MDMA MS,80359,CPT,,,,,both,, ,133.38,80.02,Aetna,Commercial,,133.38,29.8,29.8% of Medicare Base rate X weight,133.38,44.76,397.47,Fee Schedule,29.8
Q84578 MDMA MS,80359,CPT,,,,,both,, ,404.17,242.50,Aetna,Commercial,,404.17,29.8,29.8% of Medicare Base rate X weight,404.17,135.63,1204.43,Fee Schedule,29.8
Q84578 MDMA MS,80359,CPT,,,,,both,, ,404.17,242.50,Aetna,Commercial,,404.17,29.8,29.8% of Medicare Base rate X weight,404.17,135.63,1204.43,Fee Schedule,29.8
L790600 MPH MS,80360,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
L790600 OPI MS 1P,80361,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
OPIATES MS 1 PL,80361,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
Q20907 OPI MS,80361,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
L790600 OPD OPI MS5P,80364,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
L790600 OXY MS,80365,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
Q20907 OXY MS,80365,CPT,,,,,both,, ,428.58,257.14,Aetna,Commercial,,428.58,29.8,29.8% of Medicare Base rate X weight,428.58,143.82,1277.17,Fee Schedule,29.8
Q20907 OXY MS,80365,CPT,,,,,both,, ,428.58,257.14,Aetna,Commercial,,428.58,29.8,29.8% of Medicare Base rate X weight,428.58,143.82,1277.17,Fee Schedule,29.8
L790600 PGB MS,80366,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
PREGABALIN MS,80366,CPT,,,,,both,, ,811.42,486.85,Aetna,Commercial,,811.42,29.8,29.8% of Medicare Base rate X weight,811.42,272.29,2418.03,Fee Schedule,29.8
L790600 PPX MS,80367,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
L790600 SED HYP MS,80368,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
L790600 SM RLX MS3PL,80370,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
L790600 STIM SYN MS,80371,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
L790600 TAPENTADL MS,80372,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
L761019TRAMADOL CONF,80373,CPT,,,,,both,, ,412.00,247.20,Aetna,Commercial,,412.00,29.8,29.8% of Medicare Base rate X weight,412.00,138.26,1227.76,Fee Schedule,29.8
L790600 TRA MS,80373,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
DEF DRUG NOS MS 1-3,80375,CPT,,,,,both,, ,546.19,327.71,Aetna,Commercial,,546.19,29.8,29.8% of Medicare Base rate X weight,546.19,183.29,1627.65,Fee Schedule,29.8
DEF DRUG NOS MS 7PL,80377,CPT,,,,,both,, ,571.45,342.87,Aetna,Commercial,,571.45,29.8,29.8% of Medicare Base rate X weight,571.45,191.76,1702.92,Fee Schedule,29.8
L790600 DRGNOS MS 7P,80377,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
Manual urinalysis test with examination using microscope,81001,CPT,,,,,both,,,240.26,240.26,Aetna,Commercial,,240.26,29.8,29.8% of Medicare Base rate X weight,240.26,80.62,715.97,Fee Schedule,29.8
"UA, AUTO W-SCOPE",81001,CPT,,,,,both,, ,33.39,20.03,Aetna,Commercial,,33.39,29.8,29.8% of Medicare Base rate X weight,33.39,11.20,99.5,Fee Schedule,29.8
"UA, AUTO W-SCOPE",81001,CPT,,,,,both,, ,240.26,144.15,Aetna,Commercial,,240.26,29.8,29.8% of Medicare Base rate X weight,240.26,80.62,715.97,Fee Schedule,29.8
Automated urinalysis test,81003,CPT,,,,,both,,,210.50,210.50,Aetna,Commercial,,210.50,29.8,29.8% of Medicare Base rate X weight,210.50,70.64,627.29,Fee Schedule,29.8
"UA, AUTO, W-O SCOPE",81003,CPT,,,,,both,, ,23.85,14.31,Aetna,Commercial,,23.85,29.8,29.8% of Medicare Base rate X weight,23.85,8.00,71.07,Fee Schedule,29.8
"UA, AUTO, W-O SCOPE",81003,CPT,,,,,both,, ,210.50,126.30,Aetna,Commercial,,210.50,29.8,29.8% of Medicare Base rate X weight,210.50,70.64,627.29,Fee Schedule,29.8
URINALYSIS,81005,CPT,,,,,both,, ,180.19,108.11,Aetna,Commercial,,180.19,29.8,29.8% of Medicare Base rate X weight,180.19,60.47,536.97,Fee Schedule,29.8
MICROSCOPIC EX OF UR,81015,CPT,,,,,both,, ,10.55,6.33,Aetna,Commercial,,10.55,29.8,29.8% of Medicare Base rate X weight,10.55,3.54,31.44,Fee Schedule,29.8
MICROSCOPIC EX OF UR,81015,CPT,,,,,both,, ,180.19,108.11,Aetna,Commercial,,180.19,29.8,29.8% of Medicare Base rate X weight,180.19,60.47,536.97,Fee Schedule,29.8
URINE PREG TEST QL,81025,CPT,,,,,both,, ,23.58,14.14,Aetna,Commercial,,23.58,29.8,29.8% of Medicare Base rate X weight,23.58,7.91,70.27,Fee Schedule,29.8
URINE PREG TEST QL,81025,CPT,,,,,both,,,420.72,420.72,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
URINE PREG TEST QL,81025,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
"L910235 URINE VOLUME, TIMED",81050,CPT,,,,,both,, ,30.64,18.38,Aetna,Commercial,,30.64,29.8,29.8% of Medicare Base rate X weight,30.64,10.28,91.31,Fee Schedule,29.8
Q91863 BRCADVAN COMP,81162,CPT,,,,,both,, ,5261.25,3156.75,Aetna,Commercial,,5261.25,29.8,29.8% of Medicare Base rate X weight,5261.25,1765.52,15678.53,Fee Schedule,29.8
L480510 BCRABL1 KDMA,81170,CPT,,,,,both,, ,1792.00,1075.20,Aetna,Commercial,,1792.00,29.8,29.8% of Medicare Base rate X weight,1792.00,601.34,5340.16,Fee Schedule,29.8
Q91065 P210 BCRABL1,81206,CPT,,,,,both,, ,552.22,331.33,Aetna,Commercial,,552.22,29.8,29.8% of Medicare Base rate X weight,552.22,185.31,1645.62,Fee Schedule,29.8
Q91065 P190 BCRABL1,81207,CPT,,,,,both,, ,487.83,292.69,Aetna,Commercial,,487.83,29.8,29.8% of Medicare Base rate X weight,487.83,163.70,1453.73,Fee Schedule,29.8
BRAF GENE ANALY V600,81210,CPT,,,,,both,, ,393.84,236.30,Aetna,Commercial,,393.84,29.8,29.8% of Medicare Base rate X weight,393.84,132.16,1173.64,Fee Schedule,29.8
L489450 CALR MA,81219,CPT,,,,,both,, ,675.00,405.00,Aetna,Commercial,,675.00,29.8,29.8% of Medicare Base rate X weight,675.00,226.51,2011.5,Fee Schedule,29.8
Q10458 CFSCN OLA-PCR,81220,CPT,,,,,both,, ,1100.00,660.00,Aetna,Commercial,,1100.00,29.8,29.8% of Medicare Base rate X weight,1100.00,369.13,3278,Fee Schedule,29.8
L252900 CF CFTR DD,81222,CPT,,,,,both,, ,930.00,558.00,Aetna,Commercial,,930.00,29.8,29.8% of Medicare Base rate X weight,930.00,312.08,2771.4,Fee Schedule,29.8
L511230 CYT P450 2D6,81226,CPT,,,,,both,, ,600.00,360.00,Aetna,Commercial,,600.00,29.8,29.8% of Medicare Base rate X weight,600.00,201.34,1788,Fee Schedule,29.8
Q161608 CYP2C9 GN AN,81227,CPT,,,,,both,, ,610.00,366.00,Aetna,Commercial,,610.00,29.8,29.8% of Medicare Base rate X weight,610.00,204.70,1817.8,Fee Schedule,29.8
EGFR GENE COM VAR,81235,CPT,,,,,both,, ,963.55,578.13,Aetna,Commercial,,963.55,29.8,29.8% of Medicare Base rate X weight,963.55,323.34,2871.38,Fee Schedule,29.8
F2 GEN ANALY 20210GA,81240,CPT,,,,,both,, ,2183.65,1310.19,Aetna,Commercial,,2183.65,29.8,29.8% of Medicare Base rate X weight,2183.65,732.77,6507.28,Fee Schedule,29.8
Q17909 PGM HYBEACONS,81240,CPT,,,,,both,, ,1091.82,655.09,Aetna,Commercial,,1091.82,29.8,29.8% of Medicare Base rate X weight,1091.82,366.38,3253.62,Fee Schedule,29.8
Q17900 FVLM HYBEACON,81241,CPT,,,,,both,, ,2183.65,1310.19,Aetna,Commercial,,2183.65,29.8,29.8% of Medicare Base rate X weight,2183.65,732.77,6507.28,Fee Schedule,29.8
Q17900 FVLM HYBEACON,81241,CPT,,,,,both,, ,2183.65,1310.19,Aetna,Commercial,,2183.65,29.8,29.8% of Medicare Base rate X weight,2183.65,732.77,6507.28,Fee Schedule,29.8
FMR1 GENE ANALY AB,81243,CPT,,,,,both,, ,1863.12,1117.87,Aetna,Commercial,,1863.12,29.8,29.8% of Medicare Base rate X weight,1863.12,625.21,5552.1,Fee Schedule,29.8
Q35079 HHC FRFLP-PCR,81256,CPT,,,,,both,, ,3396.72,2038.03,Aetna,Commercial,,3396.72,29.8,29.8% of Medicare Base rate X weight,3396.72,1139.84,10122.23,Fee Schedule,29.8
Q35079 HHC FRFLP-PCR,81256,CPT,,,,,both,, ,3396.72,2038.03,Aetna,Commercial,,3396.72,29.8,29.8% of Medicare Base rate X weight,3396.72,1139.84,10122.23,Fee Schedule,29.8
Q11175AGLOB MUT PCR,81257,CPT,,,,,both,, ,477.70,286.62,Aetna,Commercial,,477.70,29.8,29.8% of Medicare Base rate X weight,477.70,160.30,1423.55,Fee Schedule,29.8
L489421 JAK2V617F QL,81270,CPT,,,,,both,, ,1306.56,783.93,Aetna,Commercial,,1306.56,29.8,29.8% of Medicare Base rate X weight,1306.56,438.44,3893.55,Fee Schedule,29.8
Q16539 JAK2 V617F QL,81270,CPT,,,,,both,, ,1424.14,854.48,Aetna,Commercial,,1424.14,29.8,29.8% of Medicare Base rate X weight,1424.14,477.90,4243.94,Fee Schedule,29.8
Q16539 JAK2 V617F QL,81270,CPT,,,,,both,, ,1424.14,854.48,Aetna,Commercial,,1424.14,29.8,29.8% of Medicare Base rate X weight,1424.14,477.90,4243.94,Fee Schedule,29.8
L511040 CHRO ANA CMA,81277,CPT,,,,,both,, ,2260.00,1356.00,Aetna,Commercial,,2260.00,29.8,29.8% of Medicare Base rate X weight,2260.00,758.39,6734.8,Fee Schedule,29.8
L115101 JAK2 EX12-15,81279,CPT,,,,,both,, ,865.04,519.02,Aetna,Commercial,,865.04,29.8,29.8% of Medicare Base rate X weight,865.04,290.28,2577.82,Fee Schedule,29.8
Q90251 IL28B RT-PCR,81283,CPT,,,,,both,, ,352.24,211.34,Aetna,Commercial,,352.24,29.8,29.8% of Medicare Base rate X weight,352.24,118.20,1049.68,Fee Schedule,29.8
Q17911 MTHFR DNA HYB,81291,CPT,,,,,both,, ,3892.40,2335.44,Aetna,Commercial,,3892.40,29.8,29.8% of Medicare Base rate X weight,3892.40,1306.17,11599.35,Fee Schedule,29.8
Q17911 MTHFR DNA HYB,81291,CPT,,,,,both,, ,3892.40,2335.44,Aetna,Commercial,,3892.40,29.8,29.8% of Medicare Base rate X weight,3892.40,1306.17,11599.35,Fee Schedule,29.8
MICROSAT INSTAB VAR,81301,CPT,,,,,both,, ,960.19,576.11,Aetna,Commercial,,960.19,29.8,29.8% of Medicare Base rate X weight,960.19,322.21,2861.37,Fee Schedule,29.8
PCA3 KLK3 RATIO,81313,CPT,,,,,both,, ,636.57,381.94,Aetna,Commercial,,636.57,29.8,29.8% of Medicare Base rate X weight,636.57,213.61,1896.98,Fee Schedule,29.8
Q18041 SMA CAR SCN,81329,CPT,,,,,both,, ,685.00,411.00,Aetna,Commercial,,685.00,29.8,29.8% of Medicare Base rate X weight,685.00,229.87,2041.3,Fee Schedule,29.8
Q15340 ALPHA-1 ANTITRYPSIN (AAT) MUTATIO,81332,CPT,,,,,both,, ,3025.50,1815.30,Aetna,Commercial,,3025.50,29.8,29.8% of Medicare Base rate X weight,3025.50,1015.27,9015.99,Fee Schedule,29.8
SERPINA1 GENE ANA CV,81332,CPT,,,,,both,, ,3396.72,2038.03,Aetna,Commercial,,3396.72,29.8,29.8% of Medicare Base rate X weight,3396.72,1139.84,10122.23,Fee Schedule,29.8
L489150 MPL MUT AN,81338,CPT,,,,,both,, ,675.00,405.00,Aetna,Commercial,,675.00,29.8,29.8% of Medicare Base rate X weight,675.00,226.51,2011.5,Fee Schedule,29.8
Q92476 MPL MA QL,81339,CPT,,,,,both,, ,701.97,421.18,Aetna,Commercial,,701.97,29.8,29.8% of Medicare Base rate X weight,701.97,235.56,2091.87,Fee Schedule,29.8
CSI153 UGTIA1 GEN AN,81350,CPT,,,,,both,, ,819.57,491.74,Aetna,Commercial,,819.57,29.8,29.8% of Medicare Base rate X weight,819.57,275.02,2442.32,Fee Schedule,29.8
Q15584 HLA-B27 DETER,81374,CPT,,,,,both,, ,250.36,150.21,Aetna,Commercial,,250.36,29.8,29.8% of Medicare Base rate X weight,250.36,84.01,746.07,Fee Schedule,29.8
Q17135 HLA2 TYP LR 1,81376,CPT,,,,,both,, ,610.75,366.45,Aetna,Commercial,,610.75,29.8,29.8% of Medicare Base rate X weight,610.75,204.95,1820.04,Fee Schedule,29.8
L167082 HLA2 LR1 AG,81377,CPT,,,,,both,, ,235.10,141.06,Aetna,Commercial,,235.10,29.8,29.8% of Medicare Base rate X weight,235.10,78.89,700.6,Fee Schedule,29.8
HLA1 TYP HR 1 AL EA,81381,CPT,,,,,both,, ,724.42,434.65,Aetna,Commercial,,724.42,29.8,29.8% of Medicare Base rate X weight,724.42,243.09,2158.77,Fee Schedule,29.8
Q17135 HLA2 TYP HR 1,81382,CPT,,,,,both,, ,618.04,370.82,Aetna,Commercial,,618.04,29.8,29.8% of Medicare Base rate X weight,618.04,207.40,1841.76,Fee Schedule,29.8
L167082 HLA2 HR1 AL,81383,CPT,,,,,both,, ,334.75,200.85,Aetna,Commercial,,334.75,29.8,29.8% of Medicare Base rate X weight,334.75,112.33,997.56,Fee Schedule,29.8
Q90808 MP L2,81401,CPT,,,,,both,, ,1062.07,637.24,Aetna,Commercial,,1062.07,29.8,29.8% of Medicare Base rate X weight,1062.07,356.40,3164.97,Fee Schedule,29.8
Q90808 MP L2,81401,CPT,,,,,both,, ,1062.07,637.24,Aetna,Commercial,,1062.07,29.8,29.8% of Medicare Base rate X weight,1062.07,356.40,3164.97,Fee Schedule,29.8
O51115 RHD GENOTYPE,81403,CPT,,,,,both,, ,865.04,519.02,Aetna,Commercial,,865.04,29.8,29.8% of Medicare Base rate X weight,865.04,290.28,2577.82,Fee Schedule,29.8
O51115 RHD GENOTYPE,81403,CPT,,,,,both,, ,865.04,519.02,Aetna,Commercial,,865.04,29.8,29.8% of Medicare Base rate X weight,865.04,290.28,2577.82,Fee Schedule,29.8
L630540 THRB,81405,CPT,,,,,both,, ,4320.00,2592.00,Aetna,Commercial,,4320.00,29.8,29.8% of Medicare Base rate X weight,4320.00,1449.66,12873.6,Fee Schedule,29.8
B5306-6 ACGH MOL KAR,81406,CPT,,,,,both,, ,2000.00,1200.00,Aetna,Commercial,,2000.00,29.8,29.8% of Medicare Base rate X weight,2000.00,671.14,5960,Fee Schedule,29.8
BB893-9 UNL MOL PTH,81479,CPT,,,,,both,, ,618.00,370.80,Aetna,Commercial,,618.00,29.8,29.8% of Medicare Base rate X weight,618.00,207.38,1841.64,Fee Schedule,29.8
NBS SCID,81479,CPT,,,,,both,, ,109.46,65.67,Aetna,Commercial,,109.46,29.8,29.8% of Medicare Base rate X weight,109.46,36.73,326.19,Fee Schedule,29.8
UNLIST MOLEC PATH,81479,CPT,,,,,both,, ,1145.43,687.25,Aetna,Commercial,,1145.43,29.8,29.8% of Medicare Base rate X weight,1145.43,384.37,3413.38,Fee Schedule,29.8
L140045 OVARIAN MALIGNANCY RISK - ROMA,81500,CPT,,,,,both,, ,600.00,360.00,Aetna,Commercial,,600.00,29.8,29.8% of Medicare Base rate X weight,600.00,201.34,1788,Fee Schedule,29.8
FTL CGEN ABN 4 ANAL,81511,CPT,,,,,both,, ,466.48,279.88,Aetna,Commercial,,466.48,29.8,29.8% of Medicare Base rate X weight,466.48,156.54,1390.11,Fee Schedule,29.8
Q30294 QUAD SCREEN,81511,CPT,,,,,both,, ,415.50,249.30,Aetna,Commercial,,415.50,29.8,29.8% of Medicare Base rate X weight,415.50,139.43,1238.19,Fee Schedule,29.8
FTL CGEN ABN 5 ANAL,81512,CPT,,,,,both,, ,791.78,475.06,Aetna,Commercial,,791.78,29.8,29.8% of Medicare Base rate X weight,791.78,265.70,2359.5,Fee Schedule,29.8
L550659 LIVR BIOMRKR,81517,CPT,,,,,both,, ,1143.00,685.80,Aetna,Commercial,,1143.00,29.8,29.8% of Medicare Base rate X weight,1143.00,383.56,3406.14,Fee Schedule,29.8
Q92688 LIVER FIBROS,81596,CPT,,,,,both,, ,337.09,202.25,Aetna,Commercial,,337.09,29.8,29.8% of Medicare Base rate X weight,337.09,113.12,1004.53,Fee Schedule,29.8
ACETON-KETON SERM QL,82009,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
ACETON-KETON SERM QT,82010,CPT,,,,,both,, ,80.55,48.33,Aetna,Commercial,,80.55,29.8,29.8% of Medicare Base rate X weight,80.55,27.03,240.04,Fee Schedule,29.8
ACETON-KETON SERM QT,82010,CPT,,,,,both,, ,341.30,204.78,Aetna,Commercial,,341.30,29.8,29.8% of Medicare Base rate X weight,341.30,114.53,1017.07,Fee Schedule,29.8
NBS ACYLCARNITINE QL,82016,CPT,,,,,both,, ,82.79,49.67,Aetna,Commercial,,82.79,29.8,29.8% of Medicare Base rate X weight,82.79,27.78,246.71,Fee Schedule,29.8
ADRENOCORT ACTH,82024,CPT,,,,,both,, ,2343.07,1405.84,Aetna,Commercial,,2343.07,29.8,29.8% of Medicare Base rate X weight,2343.07,786.27,6982.35,Fee Schedule,29.8
Q211 ACTH PL IA,82024,CPT,,,,,both,, ,334.00,200.40,Aetna,Commercial,,334.00,29.8,29.8% of Medicare Base rate X weight,334.00,112.08,995.32,Fee Schedule,29.8
ALBUMIN SERUM,82040,CPT,,,,,both,, ,35.08,21.04,Aetna,Commercial,,35.08,29.8,29.8% of Medicare Base rate X weight,35.08,11.77,104.54,Fee Schedule,29.8
ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
Q14966 ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
Q70858 ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
Q70858 ALBUMIN FLUID,82042,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
Q70858 ALBUMIN FLUID,82042,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
MICROALB QNT,82043,CPT,,,,,both,, ,77.74,46.64,Aetna,Commercial,,77.74,29.8,29.8% of Medicare Base rate X weight,77.74,26.09,231.67,Fee Schedule,29.8
MICROALB QNT,82043,CPT,,,,,both,,,660.98,660.98,Aetna,Commercial,,660.98,29.8,29.8% of Medicare Base rate X weight,660.98,221.81,1969.72,Fee Schedule,29.8
MICROALB QNT,82043,CPT,,,,,both,, ,660.98,396.58,Aetna,Commercial,,660.98,29.8,29.8% of Medicare Base rate X weight,660.98,221.81,1969.72,Fee Schedule,29.8
ETHANOL IA,82077,CPT,,,,,both,, ,177.88,106.72,Aetna,Commercial,,177.88,29.8,29.8% of Medicare Base rate X weight,177.88,59.69,530.08,Fee Schedule,29.8
Q227 ALDOLASE ENZEMA,82085,CPT,,,,,both,, ,648.35,389.01,Aetna,Commercial,,648.35,29.8,29.8% of Medicare Base rate X weight,648.35,217.57,1932.08,Fee Schedule,29.8
Q227 ALDOLASE ENZEMA,82085,CPT,,,,,both,, ,648.35,389.01,Aetna,Commercial,,648.35,29.8,29.8% of Medicare Base rate X weight,648.35,217.57,1932.08,Fee Schedule,29.8
ALDOSTERONE,82088,CPT,,,,,both,, ,2366.36,1419.81,Aetna,Commercial,,2366.36,29.8,29.8% of Medicare Base rate X weight,2366.36,794.08,7051.75,Fee Schedule,29.8
Q16845 ALDOSTERONE,82088,CPT,,,,,both,, ,587.45,352.47,Aetna,Commercial,,587.45,29.8,29.8% of Medicare Base rate X weight,587.45,197.13,1750.6,Fee Schedule,29.8
Q17181 ALDOST LCMSMS,82088,CPT,,,,,both,, ,587.45,352.47,Aetna,Commercial,,587.45,29.8,29.8% of Medicare Base rate X weight,587.45,197.13,1750.6,Fee Schedule,29.8
Q229 ALDOSTERONE U24,82088,CPT,,,,,both,, ,587.45,352.47,Aetna,Commercial,,587.45,29.8,29.8% of Medicare Base rate X weight,587.45,197.13,1750.6,Fee Schedule,29.8
Q235 A1A QT NEPH,82103,CPT,,,,,both,, ,969.17,581.50,Aetna,Commercial,,969.17,29.8,29.8% of Medicare Base rate X weight,969.17,325.22,2888.13,Fee Schedule,29.8
Q235 A1A QT NEPH,82103,CPT,,,,,both,, ,969.17,581.50,Aetna,Commercial,,969.17,29.8,29.8% of Medicare Base rate X weight,969.17,325.22,2888.13,Fee Schedule,29.8
Q853 A1AT PHENO IEF,82104,CPT,,,,,both,, ,1051.68,631.00,Aetna,Commercial,,1051.68,29.8,29.8% of Medicare Base rate X weight,1051.68,352.91,3134.01,Fee Schedule,29.8
Q853 A1AT PHENO IEF,82104,CPT,,,,,both,, ,1051.68,631.00,Aetna,Commercial,,1051.68,29.8,29.8% of Medicare Base rate X weight,1051.68,352.91,3134.01,Fee Schedule,29.8
AFP SERUM,82105,CPT,,,,,both,, ,1142.06,685.23,Aetna,Commercial,,1142.06,29.8,29.8% of Medicare Base rate X weight,1142.06,383.24,3403.34,Fee Schedule,29.8
Q237 AFP TUMR MRK IA,82105,CPT,,,,,both,, ,1142.06,685.23,Aetna,Commercial,,1142.06,29.8,29.8% of Medicare Base rate X weight,1142.06,383.24,3403.34,Fee Schedule,29.8
Q5059 MAT SER AFP IA,82105,CPT,,,,,both,, ,1142.06,685.23,Aetna,Commercial,,1142.06,29.8,29.8% of Medicare Base rate X weight,1142.06,383.24,3403.34,Fee Schedule,29.8
AFP AMNIOTIC FLD,82106,CPT,,,,,both,, ,705.89,423.53,Aetna,Commercial,,705.89,29.8,29.8% of Medicare Base rate X weight,705.89,236.88,2103.55,Fee Schedule,29.8
Q19529 AFP/L3 LIBASY,82107,CPT,,,,,both,, ,530.47,318.28,Aetna,Commercial,,530.47,29.8,29.8% of Medicare Base rate X weight,530.47,178.01,1580.8,Fee Schedule,29.8
Q19529 AFP/L3 LIBASY,82107,CPT,,,,,both,, ,530.47,318.28,Aetna,Commercial,,530.47,29.8,29.8% of Medicare Base rate X weight,530.47,178.01,1580.8,Fee Schedule,29.8
ALUMINUM,82108,CPT,,,,,both,, ,265.51,159.30,Aetna,Commercial,,265.51,29.8,29.8% of Medicare Base rate X weight,265.51,89.10,791.22,Fee Schedule,29.8
NBS AMINO ACD MUL QL,82128,CPT,,,,,both,, ,82.79,49.67,Aetna,Commercial,,82.79,29.8,29.8% of Medicare Base rate X weight,82.79,27.78,246.71,Fee Schedule,29.8
Q10947CYSTN U24 LCMS,82131,CPT,,,,,both,, ,175.98,105.58,Aetna,Commercial,,175.98,29.8,29.8% of Medicare Base rate X weight,175.98,59.05,524.42,Fee Schedule,29.8
AMINO ACID QUAN 6+,82139,CPT,,,,,both,, ,873.74,524.24,Aetna,Commercial,,873.74,29.8,29.8% of Medicare Base rate X weight,873.74,293.20,2603.75,Fee Schedule,29.8
AMMONIA,82140,CPT,,,,,both,, ,154.09,92.45,Aetna,Commercial,,154.09,29.8,29.8% of Medicare Base rate X weight,154.09,51.71,459.19,Fee Schedule,29.8
AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
L910235 AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q442 AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
AMYLASE,82150,CPT,,,,,both,, ,68.48,41.08,Aetna,Commercial,,68.48,29.8,29.8% of Medicare Base rate X weight,68.48,22.98,204.07,Fee Schedule,29.8
Q845 AMYLASE,82150,CPT,,,,,both,, ,518.69,311.21,Aetna,Commercial,,518.69,29.8,29.8% of Medicare Base rate X weight,518.69,174.06,1545.7,Fee Schedule,29.8
Q845 AMYLASE,82150,CPT,,,,,both,, ,518.69,311.21,Aetna,Commercial,,518.69,29.8,29.8% of Medicare Base rate X weight,518.69,174.06,1545.7,Fee Schedule,29.8
"ANDROSTENEDIONE, LCMS",82157,CPT,,,,,both,, ,769.33,461.59,Aetna,Commercial,,769.33,29.8,29.8% of Medicare Base rate X weight,769.33,258.16,2292.6,Fee Schedule,29.8
"ANDROSTENEDIONE, LCMS",82157,CPT,,,,,both,, ,769.33,461.59,Aetna,Commercial,,769.33,29.8,29.8% of Medicare Base rate X weight,769.33,258.16,2292.6,Fee Schedule,29.8
ANGIOTENSIN CONV ENZ,82164,CPT,,,,,both,, ,143.71,86.22,Aetna,Commercial,,143.71,29.8,29.8% of Medicare Base rate X weight,143.71,48.22,428.26,Fee Schedule,29.8
ANGIOTENSIN CONV ENZ,82164,CPT,,,,,both,, ,1081.72,649.03,Aetna,Commercial,,1081.72,29.8,29.8% of Medicare Base rate X weight,1081.72,362.99,3223.53,Fee Schedule,29.8
Q34692 ACE CSF KINET,82164,CPT,,,,,both,, ,1081.72,649.03,Aetna,Commercial,,1081.72,29.8,29.8% of Medicare Base rate X weight,1081.72,362.99,3223.53,Fee Schedule,29.8
Q683 ACE SP,82164,CPT,,,,,both,, ,1081.72,649.03,Aetna,Commercial,,1081.72,29.8,29.8% of Medicare Base rate X weight,1081.72,362.99,3223.53,Fee Schedule,29.8
ANTI-MULLERIAN HORM,82166,CPT,,,,,both,, ,116.00,69.60,Aetna,Commercial,,116.00,29.8,29.8% of Medicare Base rate X weight,116.00,38.93,345.68,Fee Schedule,29.8
Q92145 APOLIPOPROTEI,82172,CPT,,,,,both,, ,467.04,280.22,Aetna,Commercial,,467.04,29.8,29.8% of Medicare Base rate X weight,467.04,156.72,1391.78,Fee Schedule,29.8
Q92145 APOLIPOPROTEI,82172,CPT,,,,,both,, ,467.04,280.22,Aetna,Commercial,,467.04,29.8,29.8% of Medicare Base rate X weight,467.04,156.72,1391.78,Fee Schedule,29.8
ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,751.36,29.8,29.8% of Medicare Base rate X weight,751.36,252.13,2239.05,Fee Schedule,29.8
Q269 AS BL ICP/MS,82175,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,751.36,29.8,29.8% of Medicare Base rate X weight,751.36,252.13,2239.05,Fee Schedule,29.8
Q36438 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,751.36,29.8,29.8% of Medicare Base rate X weight,751.36,252.13,2239.05,Fee Schedule,29.8
Q7507 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,751.36,29.8,29.8% of Medicare Base rate X weight,751.36,252.13,2239.05,Fee Schedule,29.8
Q7655 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,751.36,29.8,29.8% of Medicare Base rate X weight,751.36,252.13,2239.05,Fee Schedule,29.8
Q929 VIT C LC/MS/MS,82180,CPT,,,,,both,, ,67.92,40.75,Aetna,Commercial,,67.92,29.8,29.8% of Medicare Base rate X weight,67.92,22.79,202.4,Fee Schedule,29.8
Q852 B2M SERUM NEPH,82232,CPT,,,,,both,, ,936.89,562.13,Aetna,Commercial,,936.89,29.8,29.8% of Medicare Base rate X weight,936.89,314.39,2791.93,Fee Schedule,29.8
Q852 B2M SERUM NEPH,82232,CPT,,,,,both,, ,936.89,562.13,Aetna,Commercial,,936.89,29.8,29.8% of Medicare Base rate X weight,936.89,314.39,2791.93,Fee Schedule,29.8
Q14801 BILE AC ENZ,82239,CPT,,,,,both,, ,274.77,164.86,Aetna,Commercial,,274.77,29.8,29.8% of Medicare Base rate X weight,274.77,92.20,818.81,Fee Schedule,29.8
BILIRUBIN TOTAL,82247,CPT,,,,,both,, ,53.05,31.83,Aetna,Commercial,,53.05,29.8,29.8% of Medicare Base rate X weight,53.05,17.80,158.09,Fee Schedule,29.8
BILIRUBIN TOTAL,82247,CPT,,,,,both,, ,282.92,169.75,Aetna,Commercial,,282.92,29.8,29.8% of Medicare Base rate X weight,282.92,94.94,843.1,Fee Schedule,29.8
BILIRUBIN DIRECT,82248,CPT,,,,,both,, ,53.05,31.83,Aetna,Commercial,,53.05,29.8,29.8% of Medicare Base rate X weight,53.05,17.80,158.09,Fee Schedule,29.8
BILIRUBIN DIRECT,82248,CPT,,,,,both,, ,282.92,169.75,Aetna,Commercial,,282.92,29.8,29.8% of Medicare Base rate X weight,282.92,94.94,843.1,Fee Schedule,29.8
NBS BIOTINIDASE,82261,CPT,,,,,both,, ,100.75,60.45,Aetna,Commercial,,100.75,29.8,29.8% of Medicare Base rate X weight,100.75,33.81,300.24,Fee Schedule,29.8
BLD OCCULT FECES 1-3,82270,CPT,,,,,both,, ,31.99,19.19,Aetna,Commercial,,31.99,29.8,29.8% of Medicare Base rate X weight,31.99,10.73,95.33,Fee Schedule,29.8
BLD OCCULT FECES 1-3,82270,CPT,,,,,both,, ,210.50,126.30,Aetna,Commercial,,210.50,29.8,29.8% of Medicare Base rate X weight,210.50,70.64,627.29,Fee Schedule,29.8
BLD OCCULT OTHER SRC,82271,CPT,,,,,both,, ,277.59,166.55,Aetna,Commercial,,277.59,29.8,29.8% of Medicare Base rate X weight,277.59,93.15,827.22,Fee Schedule,29.8
BLD OCC NON CA SCREE,82272,CPT,,,,,both,, ,210.50,126.30,Aetna,Commercial,,210.50,29.8,29.8% of Medicare Base rate X weight,210.50,70.64,627.29,Fee Schedule,29.8
BLD OCCULT FECES EIA,82274,CPT,,,,,both,, ,165.87,99.52,Aetna,Commercial,,165.87,29.8,29.8% of Medicare Base rate X weight,165.87,55.66,494.29,Fee Schedule,29.8
Q299CADMIUM BL ICPMS,82300,CPT,,,,,both,, ,536.08,321.64,Aetna,Commercial,,536.08,29.8,29.8% of Medicare Base rate X weight,536.08,179.89,1597.52,Fee Schedule,29.8
Q299CADMIUM BL ICPMS,82300,CPT,,,,,both,, ,536.08,321.64,Aetna,Commercial,,536.08,29.8,29.8% of Medicare Base rate X weight,536.08,179.89,1597.52,Fee Schedule,29.8
Q672 CADMIUM,82300,CPT,,,,,both,, ,125.00,75.00,Aetna,Commercial,,125.00,29.8,29.8% of Medicare Base rate X weight,125.00,41.95,372.5,Fee Schedule,29.8
L504115VITD 25-OH LC,82306,CPT,,,,,both,, ,651.73,391.03,Aetna,Commercial,,651.73,29.8,29.8% of Medicare Base rate X weight,651.73,218.70,1942.16,Fee Schedule,29.8
VITAMIN D 25OH,82306,CPT,,,,,both,, ,279.26,167.55,Aetna,Commercial,,279.26,29.8,29.8% of Medicare Base rate X weight,279.26,93.71,832.19,Fee Schedule,29.8
VITAMIN D 25OH,82306,CPT,,,,,both,,,710.38,710.38,Aetna,Commercial,,710.38,29.8,29.8% of Medicare Base rate X weight,710.38,238.38,2116.93,Fee Schedule,29.8
VITAMIN D 25OH,82306,CPT,,,,,both,, ,710.38,426.22,Aetna,Commercial,,710.38,29.8,29.8% of Medicare Base rate X weight,710.38,238.38,2116.93,Fee Schedule,29.8
CALCITONIN,82308,CPT,,,,,both,, ,297.79,178.67,Aetna,Commercial,,297.79,29.8,29.8% of Medicare Base rate X weight,297.79,99.93,887.41,Fee Schedule,29.8
Q30742 CALCITONIN IA,82308,CPT,,,,,both,, ,796.27,477.76,Aetna,Commercial,,796.27,29.8,29.8% of Medicare Base rate X weight,796.27,267.20,2372.88,Fee Schedule,29.8
CALCIUM TOTAL,82310,CPT,,,,,both,, ,54.45,32.67,Aetna,Commercial,,54.45,29.8,29.8% of Medicare Base rate X weight,54.45,18.27,162.26,Fee Schedule,29.8
L54601 CALCIUM TOTAL,82310,CPT,,,,,both,, ,315.48,189.28,Aetna,Commercial,,315.48,29.8,29.8% of Medicare Base rate X weight,315.48,105.87,940.13,Fee Schedule,29.8
L54601 CALCIUM TOTAL,82310,CPT,,,,,both,, ,315.48,189.28,Aetna,Commercial,,315.48,29.8,29.8% of Medicare Base rate X weight,315.48,105.87,940.13,Fee Schedule,29.8
CALCIUM IONIZED,82330,CPT,,,,,both,, ,35.36,21.21,Aetna,Commercial,,35.36,29.8,29.8% of Medicare Base rate X weight,35.36,11.87,105.37,Fee Schedule,29.8
CALCIUM IONIZED,82330,CPT,,,,,both,,,796.27,796.27,Aetna,Commercial,,796.27,29.8,29.8% of Medicare Base rate X weight,796.27,267.20,2372.88,Fee Schedule,29.8
Q306 ICA ISE,82330,CPT,,,,,both,, ,796.27,477.76,Aetna,Commercial,,796.27,29.8,29.8% of Medicare Base rate X weight,796.27,267.20,2372.88,Fee Schedule,29.8
Q306 ICA ISE,82330,CPT,,,,,both,, ,796.27,477.76,Aetna,Commercial,,796.27,29.8,29.8% of Medicare Base rate X weight,796.27,267.20,2372.88,Fee Schedule,29.8
CALCIUM URI QN TIMED,82340,CPT,,,,,both,,,412.87,412.87,Aetna,Commercial,,412.87,29.8,29.8% of Medicare Base rate X weight,412.87,138.55,1230.35,Fee Schedule,29.8
CALCIUM URI QN TIMED,82340,CPT,,,,,both,, ,412.87,247.72,Aetna,Commercial,,412.87,29.8,29.8% of Medicare Base rate X weight,412.87,138.55,1230.35,Fee Schedule,29.8
"L910235 CALCIUM, URINE",82340,CPT,,,,,both,, ,412.87,247.72,Aetna,Commercial,,412.87,29.8,29.8% of Medicare Base rate X weight,412.87,138.55,1230.35,Fee Schedule,29.8
Q442 CALCIUM URI QN,82340,CPT,,,,,both,, ,412.87,247.72,Aetna,Commercial,,412.87,29.8,29.8% of Medicare Base rate X weight,412.87,138.55,1230.35,Fee Schedule,29.8
Q30260 STN ANAL NID,82365,CPT,,,,,both,, ,1187.82,712.69,Aetna,Commercial,,1187.82,29.8,29.8% of Medicare Base rate X weight,1187.82,398.60,3539.7,Fee Schedule,29.8
Q30260 STN ANAL NID,82365,CPT,,,,,both,, ,1187.82,712.69,Aetna,Commercial,,1187.82,29.8,29.8% of Medicare Base rate X weight,1187.82,398.60,3539.7,Fee Schedule,29.8
CARBON DIOXIDE CO2,82374,CPT,,,,,both,, ,47.99,28.79,Aetna,Commercial,,47.99,29.8,29.8% of Medicare Base rate X weight,47.99,16.10,143.01,Fee Schedule,29.8
CARBON DIOXIDE CO2,82374,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
CARBON MONOXIDE QUAN,82375,CPT,,,,,both,, ,203.49,122.09,Aetna,Commercial,,203.49,29.8,29.8% of Medicare Base rate X weight,203.49,68.29,606.4,Fee Schedule,29.8
CARBON MONOXIDE QUAN,82375,CPT,,,,,both,, ,203.49,122.09,Aetna,Commercial,,203.49,29.8,29.8% of Medicare Base rate X weight,203.49,68.29,606.4,Fee Schedule,29.8
CARCINOEMBRYONIC AG,82378,CPT,,,,,both,, ,121.53,72.91,Aetna,Commercial,,121.53,29.8,29.8% of Medicare Base rate X weight,121.53,40.78,362.16,Fee Schedule,29.8
L480095 CEA SM,82378,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,526.26,29.8,29.8% of Medicare Base rate X weight,526.26,176.60,1568.25,Fee Schedule,29.8
L480095 CEA SM,82378,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,526.26,29.8,29.8% of Medicare Base rate X weight,526.26,176.60,1568.25,Fee Schedule,29.8
CAROTENE,82380,CPT,,,,,both,, ,1171.81,703.08,Aetna,Commercial,,1171.81,29.8,29.8% of Medicare Base rate X weight,1171.81,393.22,3491.99,Fee Schedule,29.8
L1529 CAROTENE HPLC,82380,CPT,,,,,both,, ,75.20,45.12,Aetna,Commercial,,75.20,29.8,29.8% of Medicare Base rate X weight,75.20,25.23,224.1,Fee Schedule,29.8
Q5244 CAT FR UR,82384,CPT,,,,,both,, ,263.27,157.96,Aetna,Commercial,,263.27,29.8,29.8% of Medicare Base rate X weight,263.27,88.35,784.54,Fee Schedule,29.8
Q5244 CAT FR UR,82384,CPT,,,,,both,, ,263.27,157.96,Aetna,Commercial,,263.27,29.8,29.8% of Medicare Base rate X weight,263.27,88.35,784.54,Fee Schedule,29.8
Q5244 CAT FR UR,82384,CPT,,,,,both,, ,263.27,157.96,Aetna,Commercial,,263.27,29.8,29.8% of Medicare Base rate X weight,263.27,88.35,784.54,Fee Schedule,29.8
Q5244 CAT FR UR,82384,CPT,,,,,both,, ,263.27,157.96,Aetna,Commercial,,263.27,29.8,29.8% of Medicare Base rate X weight,263.27,88.35,784.54,Fee Schedule,29.8
Q326 CERULOP NEPHELO,82390,CPT,,,,,both,, ,859.70,515.82,Aetna,Commercial,,859.70,29.8,29.8% of Medicare Base rate X weight,859.70,288.49,2561.91,Fee Schedule,29.8
Q326 CERULOP NEPHELO,82390,CPT,,,,,both,, ,859.70,515.82,Aetna,Commercial,,859.70,29.8,29.8% of Medicare Base rate X weight,859.70,288.49,2561.91,Fee Schedule,29.8
CHEMILUM ASSAY NOS,82397,CPT,,,,,both,, ,444.59,266.75,Aetna,Commercial,,444.59,29.8,29.8% of Medicare Base rate X weight,444.59,149.19,1324.88,Fee Schedule,29.8
L503870 CHEM ASY NOS,82397,CPT,,,,,both,, ,444.59,266.75,Aetna,Commercial,,444.59,29.8,29.8% of Medicare Base rate X weight,444.59,149.19,1324.88,Fee Schedule,29.8
L504567 CHEM ASY NOS,82397,CPT,,,,,both,, ,407.88,244.72,Aetna,Commercial,,407.88,29.8,29.8% of Medicare Base rate X weight,407.88,136.87,1215.48,Fee Schedule,29.8
Q34445 INHIBIN B CL,82397,CPT,,,,,both,, ,444.59,266.75,Aetna,Commercial,,444.59,29.8,29.8% of Medicare Base rate X weight,444.59,149.19,1324.88,Fee Schedule,29.8
Q37227 ANTI-MULLERIAN HORMONE(AMH)FEMALE,82397,CPT,,,,,both,, ,396.00,237.60,Aetna,Commercial,,396.00,29.8,29.8% of Medicare Base rate X weight,396.00,132.89,1180.08,Fee Schedule,29.8
Q37227 ANTI-MULLERIAN HORMONE(AMH)FEMALE,82397,CPT,,,,,both,, ,396.00,237.60,Aetna,Commercial,,396.00,29.8,29.8% of Medicare Base rate X weight,396.00,132.89,1180.08,Fee Schedule,29.8
CHLORIDE BLOOD,82435,CPT,,,,,both,, ,38.73,23.23,Aetna,Commercial,,38.73,29.8,29.8% of Medicare Base rate X weight,38.73,13.00,115.42,Fee Schedule,29.8
CHLORIDE BLOOD,82435,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"L910235 CHLORIDE, URINE",82436,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"L910235 CHLORIDE, URINE",82436,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
CHLORIDES OTHER FLD,82438,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
CHOLESTEROL TOTAL,82465,CPT,,,,,both,, ,49.68,29.80,Aetna,Commercial,,49.68,29.8,29.8% of Medicare Base rate X weight,49.68,16.67,148.05,Fee Schedule,29.8
CHOLESTEROL TOTAL,82465,CPT,,,,,both,, ,315.48,189.28,Aetna,Commercial,,315.48,29.8,29.8% of Medicare Base rate X weight,315.48,105.87,940.13,Fee Schedule,29.8
CHOLINESTERASE SERUM,82480,CPT,,,,,both,, ,563.60,338.16,Aetna,Commercial,,563.60,29.8,29.8% of Medicare Base rate X weight,563.60,189.13,1679.53,Fee Schedule,29.8
Q338 CHOLINEST SER,82480,CPT,,,,,both,, ,563.60,338.16,Aetna,Commercial,,563.60,29.8,29.8% of Medicare Base rate X weight,563.60,189.13,1679.53,Fee Schedule,29.8
Q7961 CHOLINEST SER,82480,CPT,,,,,both,, ,563.60,338.16,Aetna,Commercial,,563.60,29.8,29.8% of Medicare Base rate X weight,563.60,189.13,1679.53,Fee Schedule,29.8
Q338 CHOLINEST RBC,82482,CPT,,,,,both,, ,676.14,405.68,Aetna,Commercial,,676.14,29.8,29.8% of Medicare Base rate X weight,676.14,226.89,2014.9,Fee Schedule,29.8
Q338 CHOLINEST RBC,82482,CPT,,,,,both,, ,676.14,405.68,Aetna,Commercial,,676.14,29.8,29.8% of Medicare Base rate X weight,676.14,226.89,2014.9,Fee Schedule,29.8
CHROMIUM,82495,CPT,,,,,both,, ,242.50,145.50,Aetna,Commercial,,242.50,29.8,29.8% of Medicare Base rate X weight,242.50,81.38,722.65,Fee Schedule,29.8
CHROMIUM U,82495,CPT,,,,,both,, ,202.80,121.68,Aetna,Commercial,,202.80,29.8,29.8% of Medicare Base rate X weight,202.80,68.05,604.34,Fee Schedule,29.8
"L910235 CITRATE, URINE",82507,CPT,,,,,both,, ,242.50,145.50,Aetna,Commercial,,242.50,29.8,29.8% of Medicare Base rate X weight,242.50,81.38,722.65,Fee Schedule,29.8
Q11315 CIT AC U24 SP,82507,CPT,,,,,both,, ,242.50,145.50,Aetna,Commercial,,242.50,29.8,29.8% of Medicare Base rate X weight,242.50,81.38,722.65,Fee Schedule,29.8
Q442 CITRATE,82507,CPT,,,,,both,, ,242.50,145.50,Aetna,Commercial,,242.50,29.8,29.8% of Medicare Base rate X weight,242.50,81.38,722.65,Fee Schedule,29.8
COLLAGEN CROSSLINKS,82523,CPT,,,,,both,, ,280.11,168.06,Aetna,Commercial,,280.11,29.8,29.8% of Medicare Base rate X weight,280.11,94.00,834.73,Fee Schedule,29.8
L500089 C-TELO ELISA,82523,CPT,,,,,both,, ,529.20,317.52,Aetna,Commercial,,529.20,29.8,29.8% of Medicare Base rate X weight,529.20,177.58,1577.02,Fee Schedule,29.8
"N-TELOPEP (NTX), UR",82523,CPT,,,,,both,, ,186.80,112.08,Aetna,Commercial,,186.80,29.8,29.8% of Medicare Base rate X weight,186.80,62.68,556.66,Fee Schedule,29.8
Q365 CU U24 ICP/MS,82525,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
Q365 CU U24 ICP/MS,82525,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
Q365 CU U24 ICP/MS,82525,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
Q365 CU U24 ICP/MS,82525,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
Q198978CORTIS LCMSMS,82530,CPT,,,,,both,, ,938.86,563.31,Aetna,Commercial,,938.86,29.8,29.8% of Medicare Base rate X weight,938.86,315.05,2797.8,Fee Schedule,29.8
Q198978CORTIS LCMSMS,82530,CPT,,,,,both,, ,938.86,563.31,Aetna,Commercial,,938.86,29.8,29.8% of Medicare Base rate X weight,938.86,315.05,2797.8,Fee Schedule,29.8
Q36423 CORT FR LCMSM,82530,CPT,,,,,both,, ,939.13,563.47,Aetna,Commercial,,939.13,29.8,29.8% of Medicare Base rate X weight,939.13,315.14,2798.61,Fee Schedule,29.8
CORTISOL TOTAL,82533,CPT,,,,,both,, ,132.19,79.31,Aetna,Commercial,,132.19,29.8,29.8% of Medicare Base rate X weight,132.19,44.36,393.93,Fee Schedule,29.8
CORTISOL TOTAL,82533,CPT,,,,,both,,,1343.58,1343.58,Aetna,Commercial,,1343.58,29.8,29.8% of Medicare Base rate X weight,1343.58,450.87,4003.87,Fee Schedule,29.8
CORTISOL TOTAL,82533,CPT,,,,,both,, ,1343.58,806.14,Aetna,Commercial,,1343.58,29.8,29.8% of Medicare Base rate X weight,1343.58,450.87,4003.87,Fee Schedule,29.8
L500179SALIV CORT MS,82533,CPT,,,,,both,, ,335.78,201.46,Aetna,Commercial,,335.78,29.8,29.8% of Medicare Base rate X weight,335.78,112.68,1000.62,Fee Schedule,29.8
L500440 CORTISOL TOT,82533,CPT,,,,,both,, ,163.00,97.80,Aetna,Commercial,,163.00,29.8,29.8% of Medicare Base rate X weight,163.00,54.70,485.74,Fee Schedule,29.8
CREATINE,82540,CPT,,,,,both,, ,38.73,23.23,Aetna,Commercial,,38.73,29.8,29.8% of Medicare Base rate X weight,38.73,13.00,115.42,Fee Schedule,29.8
L823430 OMEGACHECK (EPA+DPA+DHA),82542,CPT,,,,,both,, ,430.00,258.00,Aetna,Commercial,,430.00,29.8,29.8% of Medicare Base rate X weight,430.00,144.30,1281.4,Fee Schedule,29.8
N-METHLHIST 24H UR,82542,CPT,,,,,both,, ,600.00,360.00,Aetna,Commercial,,600.00,29.8,29.8% of Medicare Base rate X weight,600.00,201.34,1788,Fee Schedule,29.8
Q198268 CO-Q10 HPLC,82542,CPT,,,,,both,, ,320.53,192.31,Aetna,Commercial,,320.53,29.8,29.8% of Medicare Base rate X weight,320.53,107.56,955.18,Fee Schedule,29.8
Q198268 CO-Q10 HPLC,82542,CPT,,,,,both,, ,320.53,192.31,Aetna,Commercial,,320.53,29.8,29.8% of Medicare Base rate X weight,320.53,107.56,955.18,Fee Schedule,29.8
Q198268 CO-Q10 HPLC,82542,CPT,,,,,both,, ,320.53,192.31,Aetna,Commercial,,320.53,29.8,29.8% of Medicare Base rate X weight,320.53,107.56,955.18,Fee Schedule,29.8
Q198268 CO-Q10 HPLC,82542,CPT,,,,,both,, ,320.53,192.31,Aetna,Commercial,,320.53,29.8,29.8% of Medicare Base rate X weight,320.53,107.56,955.18,Fee Schedule,29.8
CPK TOTAL,82550,CPT,,,,,both,, ,64.27,38.56,Aetna,Commercial,,64.27,29.8,29.8% of Medicare Base rate X weight,64.27,21.57,191.52,Fee Schedule,29.8
CPK TOTAL,82550,CPT,,,,,both,,,282.92,282.92,Aetna,Commercial,,282.92,29.8,29.8% of Medicare Base rate X weight,282.92,94.94,843.1,Fee Schedule,29.8
Q6422 CPK TOTAL,82550,CPT,,,,,both,, ,282.92,169.75,Aetna,Commercial,,282.92,29.8,29.8% of Medicare Base rate X weight,282.92,94.94,843.1,Fee Schedule,29.8
Q6422 CPK TOTAL,82550,CPT,,,,,both,, ,282.92,169.75,Aetna,Commercial,,282.92,29.8,29.8% of Medicare Base rate X weight,282.92,94.94,843.1,Fee Schedule,29.8
Q6422 CPK ISOENZYMES,82552,CPT,,,,,both,, ,626.18,375.70,Aetna,Commercial,,626.18,29.8,29.8% of Medicare Base rate X weight,626.18,210.13,1866.02,Fee Schedule,29.8
Q6422 CPK ISOENZYMES,82552,CPT,,,,,both,, ,626.18,375.70,Aetna,Commercial,,626.18,29.8,29.8% of Medicare Base rate X weight,626.18,210.13,1866.02,Fee Schedule,29.8
CPK MB FRACTION,82553,CPT,,,,,both,, ,113.67,68.20,Aetna,Commercial,,113.67,29.8,29.8% of Medicare Base rate X weight,113.67,38.14,338.74,Fee Schedule,29.8
CPK MB FRACTION,82553,CPT,,,,,both,, ,620.56,372.33,Aetna,Commercial,,620.56,29.8,29.8% of Medicare Base rate X weight,620.56,208.24,1849.27,Fee Schedule,29.8
CREATININE BLOOD,82565,CPT,,,,,both,, ,19.09,11.45,Aetna,Commercial,,19.09,29.8,29.8% of Medicare Base rate X weight,19.09,6.41,56.89,Fee Schedule,29.8
CREATININE BLOOD,82565,CPT,,,,,both,,,285.17,285.17,Aetna,Commercial,,285.17,29.8,29.8% of Medicare Base rate X weight,285.17,95.69,849.81,Fee Schedule,29.8
CREATININE BLOOD,82565,CPT,,,,,both,, ,285.17,171.10,Aetna,Commercial,,285.17,29.8,29.8% of Medicare Base rate X weight,285.17,95.69,849.81,Fee Schedule,29.8
CREATININE UR-OTHER,82570,CPT,,,,,both,, ,32.84,19.70,Aetna,Commercial,,32.84,29.8,29.8% of Medicare Base rate X weight,32.84,11.02,97.86,Fee Schedule,29.8
CREATININE UR-OTHER,82570,CPT,,,,,both,,,285.17,285.17,Aetna,Commercial,,285.17,29.8,29.8% of Medicare Base rate X weight,285.17,95.69,849.81,Fee Schedule,29.8
CREATININE UR-OTHER,82570,CPT,,,,,both,, ,285.17,171.10,Aetna,Commercial,,285.17,29.8,29.8% of Medicare Base rate X weight,285.17,95.69,849.81,Fee Schedule,29.8
Q1648 CREATININE UR-,82570,CPT,,,,,both,, ,285.17,171.10,Aetna,Commercial,,285.17,29.8,29.8% of Medicare Base rate X weight,285.17,95.69,849.81,Fee Schedule,29.8
Q17422 CREATIN PTF C,82570,CPT,,,,,both,, ,285.17,171.10,Aetna,Commercial,,285.17,29.8,29.8% of Medicare Base rate X weight,285.17,95.69,849.81,Fee Schedule,29.8
Q442 CREATININE UR-O,82570,CPT,,,,,both,, ,285.17,171.10,Aetna,Commercial,,285.17,29.8,29.8% of Medicare Base rate X weight,285.17,95.69,849.81,Fee Schedule,29.8
Q5244 CREAT UR,82570,CPT,,,,,both,, ,261.87,157.12,Aetna,Commercial,,261.87,29.8,29.8% of Medicare Base rate X weight,261.87,87.88,780.37,Fee Schedule,29.8
Q5244 CREAT UR,82570,CPT,,,,,both,, ,261.87,157.12,Aetna,Commercial,,261.87,29.8,29.8% of Medicare Base rate X weight,261.87,87.88,780.37,Fee Schedule,29.8
Q682 CREATININE UR-O,82570,CPT,,,,,both,, ,285.17,171.10,Aetna,Commercial,,285.17,29.8,29.8% of Medicare Base rate X weight,285.17,95.69,849.81,Fee Schedule,29.8
Q7507 CREATIN UR-OTH,82570,CPT,,,,,both,, ,285.17,171.10,Aetna,Commercial,,285.17,29.8,29.8% of Medicare Base rate X weight,285.17,95.69,849.81,Fee Schedule,29.8
Q8525 CREATININE UR-,82570,CPT,,,,,both,, ,285.17,171.10,Aetna,Commercial,,285.17,29.8,29.8% of Medicare Base rate X weight,285.17,95.69,849.81,Fee Schedule,29.8
CREATININE CLEARANCE,82575,CPT,,,,,both,,,555.45,555.45,Aetna,Commercial,,555.45,29.8,29.8% of Medicare Base rate X weight,555.45,186.39,1655.24,Fee Schedule,29.8
CREATININE CLEARANCE,82575,CPT,,,,,both,, ,555.45,333.27,Aetna,Commercial,,555.45,29.8,29.8% of Medicare Base rate X weight,555.45,186.39,1655.24,Fee Schedule,29.8
Q36562 C-GLOB SER VI,82595,CPT,,,,,both,, ,968.60,581.16,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
Q36562 C-GLOB SER VI,82595,CPT,,,,,both,, ,968.60,581.16,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
VITAMIN B-12,82607,CPT,,,,,both,, ,111.43,66.85,Aetna,Commercial,,111.43,29.8,29.8% of Medicare Base rate X weight,111.43,37.39,332.06,Fee Schedule,29.8
VITAMIN B-12,82607,CPT,,,,,both,,,641.06,641.06,Aetna,Commercial,,641.06,29.8,29.8% of Medicare Base rate X weight,641.06,215.12,1910.36,Fee Schedule,29.8
VITAMIN B-12,82607,CPT,,,,,both,, ,641.06,384.63,Aetna,Commercial,,641.06,29.8,29.8% of Medicare Base rate X weight,641.06,215.12,1910.36,Fee Schedule,29.8
VITAMIN B-12 BINDING,82608,CPT,,,,,both,, ,183.56,110.13,Aetna,Commercial,,183.56,29.8,29.8% of Medicare Base rate X weight,183.56,61.60,547.01,Fee Schedule,29.8
Q10570 CYSTAT C NEPH,82610,CPT,,,,,both,, ,121.25,72.75,Aetna,Commercial,,121.25,29.8,29.8% of Medicare Base rate X weight,121.25,40.69,361.33,Fee Schedule,29.8
"L910235 CREATININE, URINE",82615,CPT,,,,,both,, ,285.17,171.10,Aetna,Commercial,,285.17,29.8,29.8% of Medicare Base rate X weight,285.17,95.69,849.81,Fee Schedule,29.8
L910235 CYSTINE/HOMOCYSTINE UR,82615,CPT,,,,,both,, ,50.00,30.00,Aetna,Commercial,,50.00,29.8,29.8% of Medicare Base rate X weight,50.00,16.78,149,Fee Schedule,29.8
Q19894DHEA UN LCMSMS,82626,CPT,,,,,both,, ,263.55,158.13,Aetna,Commercial,,263.55,29.8,29.8% of Medicare Base rate X weight,263.55,88.44,785.38,Fee Schedule,29.8
Q19894DHEA UN LCMSMS,82626,CPT,,,,,both,, ,263.55,158.13,Aetna,Commercial,,263.55,29.8,29.8% of Medicare Base rate X weight,263.55,88.44,785.38,Fee Schedule,29.8
Q402 DHEA SULFATE IA,82627,CPT,,,,,both,, ,664.35,398.61,Aetna,Commercial,,664.35,29.8,29.8% of Medicare Base rate X weight,664.35,222.94,1979.76,Fee Schedule,29.8
Q402 DHEA SULFATE IA,82627,CPT,,,,,both,, ,664.35,398.61,Aetna,Commercial,,664.35,29.8,29.8% of Medicare Base rate X weight,664.35,222.94,1979.76,Fee Schedule,29.8
DEOXYCORTISOL,82634,CPT,,,,,both,, ,177.39,106.43,Aetna,Commercial,,177.39,29.8,29.8% of Medicare Base rate X weight,177.39,59.53,528.62,Fee Schedule,29.8
Q7961 DIBUCAINE NUMB,82638,CPT,,,,,both,, ,270.28,162.16,Aetna,Commercial,,270.28,29.8,29.8% of Medicare Base rate X weight,270.28,90.70,805.43,Fee Schedule,29.8
Q7961 DIBUCAINE NUMB,82638,CPT,,,,,both,, ,270.28,162.16,Aetna,Commercial,,270.28,29.8,29.8% of Medicare Base rate X weight,270.28,90.70,805.43,Fee Schedule,29.8
DIHYDROTESTOST (DHT),82642,CPT,,,,,both,, ,151.84,91.10,Aetna,Commercial,,151.84,29.8,29.8% of Medicare Base rate X weight,151.84,50.95,452.48,Fee Schedule,29.8
DIHYDROXY VITAMIN D,82652,CPT,,,,,both,, ,379.18,227.50,Aetna,Commercial,,379.18,29.8,29.8% of Medicare Base rate X weight,379.18,127.24,1129.96,Fee Schedule,29.8
DIHYDROXY VITAMIN D,82652,CPT,,,,,both,, ,1307.38,784.42,Aetna,Commercial,,1307.38,29.8,29.8% of Medicare Base rate X weight,1307.38,438.72,3895.99,Fee Schedule,29.8
Q16558 VITD LCMSMS,82652,CPT,,,,,both,, ,554.89,332.93,Aetna,Commercial,,554.89,29.8,29.8% of Medicare Base rate X weight,554.89,186.20,1653.57,Fee Schedule,29.8
L123234 PE FEC ELISA,82653,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,414.83,29.8,29.8% of Medicare Base rate X weight,414.83,139.20,1236.19,Fee Schedule,29.8
L123234 PE FEC ELISA,82653,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,414.83,29.8,29.8% of Medicare Base rate X weight,414.83,139.20,1236.19,Fee Schedule,29.8
Q14693 PE-1 IA,82656,CPT,,,,,both,, ,228.97,137.38,Aetna,Commercial,,228.97,29.8,29.8% of Medicare Base rate X weight,228.97,76.84,682.33,Fee Schedule,29.8
Q146938 PE-1 FEC,82656,CPT,,,,,both,, ,267.48,160.48,Aetna,Commercial,,267.48,29.8,29.8% of Medicare Base rate X weight,267.48,89.76,797.09,Fee Schedule,29.8
Q146938 PE-1 FEC,82656,CPT,,,,,both,, ,267.48,160.48,Aetna,Commercial,,267.48,29.8,29.8% of Medicare Base rate X weight,267.48,89.76,797.09,Fee Schedule,29.8
Q427 ERYTHROPOIET IA,82668,CPT,,,,,both,, ,1449.41,869.64,Aetna,Commercial,,1449.41,29.8,29.8% of Medicare Base rate X weight,1449.41,486.38,4319.24,Fee Schedule,29.8
Q427 ERYTHROPOIET IA,82668,CPT,,,,,both,, ,1449.41,869.64,Aetna,Commercial,,1449.41,29.8,29.8% of Medicare Base rate X weight,1449.41,486.38,4319.24,Fee Schedule,29.8
ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Aetna,Commercial,,976.46,29.8,29.8% of Medicare Base rate X weight,976.46,327.67,2909.85,Fee Schedule,29.8
L500649 ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Aetna,Commercial,,976.46,29.8,29.8% of Medicare Base rate X weight,976.46,327.67,2909.85,Fee Schedule,29.8
Q30289 ESTRADIOL US,82670,CPT,,,,,both,, ,976.46,585.87,Aetna,Commercial,,976.46,29.8,29.8% of Medicare Base rate X weight,976.46,327.67,2909.85,Fee Schedule,29.8
Q36169 ESTRA FR DIR,82670,CPT,,,,,both,, ,895.84,537.50,Aetna,Commercial,,895.84,29.8,29.8% of Medicare Base rate X weight,895.84,300.62,2669.6,Fee Schedule,29.8
Q36169 ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Aetna,Commercial,,976.46,29.8,29.8% of Medicare Base rate X weight,976.46,327.67,2909.85,Fee Schedule,29.8
Q4021 ESTRADIOL IA,82670,CPT,,,,,both,, ,976.46,585.87,Aetna,Commercial,,976.46,29.8,29.8% of Medicare Base rate X weight,976.46,327.67,2909.85,Fee Schedule,29.8
Q36742 EST FR LCMSMS,82671,CPT,,,,,both,, ,170.36,102.21,Aetna,Commercial,,170.36,29.8,29.8% of Medicare Base rate X weight,170.36,57.17,507.67,Fee Schedule,29.8
ESTROGEN TOTAL,82672,CPT,,,,,both,, ,1727.55,1036.53,Aetna,Commercial,,1727.55,29.8,29.8% of Medicare Base rate X weight,1727.55,579.71,5148.1,Fee Schedule,29.8
Q439 ESTROG TOT RIA,82672,CPT,,,,,both,, ,304.53,182.71,Aetna,Commercial,,304.53,29.8,29.8% of Medicare Base rate X weight,304.53,102.19,907.5,Fee Schedule,29.8
Q34883 ESTRIO LCMSMS,82677,CPT,,,,,both,, ,317.44,190.46,Aetna,Commercial,,317.44,29.8,29.8% of Medicare Base rate X weight,317.44,106.52,945.97,Fee Schedule,29.8
Q34883 ESTRIO LCMSMS,82677,CPT,,,,,both,, ,317.44,190.46,Aetna,Commercial,,317.44,29.8,29.8% of Medicare Base rate X weight,317.44,106.52,945.97,Fee Schedule,29.8
Q23244 ESTRON LCMSMS,82679,CPT,,,,,both,, ,116.47,69.88,Aetna,Commercial,,116.47,29.8,29.8% of Medicare Base rate X weight,116.47,39.08,347.08,Fee Schedule,29.8
Q23244 ESTRON LCMSMS,82679,CPT,,,,,both,, ,116.47,69.88,Aetna,Commercial,,116.47,29.8,29.8% of Medicare Base rate X weight,116.47,39.08,347.08,Fee Schedule,29.8
L500649 ESTRA FR DIR,82681,CPT,,,,,both,, ,251.84,151.10,Aetna,Commercial,,251.84,29.8,29.8% of Medicare Base rate X weight,251.84,84.51,750.48,Fee Schedule,29.8
ETHYLENE GLYCOL,82693,CPT,,,,,both,,,1577.11,1577.11,Aetna,Commercial,,1577.11,29.8,29.8% of Medicare Base rate X weight,1577.11,529.23,4699.79,Fee Schedule,29.8
ETHYLENE GLYCOL,82693,CPT,,,,,both,, ,1577.11,946.26,Aetna,Commercial,,1577.11,29.8,29.8% of Medicare Base rate X weight,1577.11,529.23,4699.79,Fee Schedule,29.8
Q801 ETHYL GLY CHRMT,82693,CPT,,,,,both,, ,935.21,561.12,Aetna,Commercial,,935.21,29.8,29.8% of Medicare Base rate X weight,935.21,313.83,2786.93,Fee Schedule,29.8
Q3967 FEC FT QL MIC,82705,CPT,,,,,both,, ,600.92,360.55,Aetna,Commercial,,600.92,29.8,29.8% of Medicare Base rate X weight,600.92,201.65,1790.74,Fee Schedule,29.8
Q3967 FEC FT QL MIC,82705,CPT,,,,,both,, ,600.92,360.55,Aetna,Commercial,,600.92,29.8,29.8% of Medicare Base rate X weight,600.92,201.65,1790.74,Fee Schedule,29.8
FECAL FAT QUANT 72HR,82710,CPT,,,,,both,, ,122.20,73.32,Aetna,Commercial,,122.20,29.8,29.8% of Medicare Base rate X weight,122.20,41.01,364.16,Fee Schedule,29.8
Q455 FEC FT QT NMR,82710,CPT,,,,,both,, ,768.20,460.92,Aetna,Commercial,,768.20,29.8,29.8% of Medicare Base rate X weight,768.20,257.79,2289.24,Fee Schedule,29.8
Q455 FEC FT QT NMR,82710,CPT,,,,,both,, ,768.20,460.92,Aetna,Commercial,,768.20,29.8,29.8% of Medicare Base rate X weight,768.20,257.79,2289.24,Fee Schedule,29.8
Q90559 VLCFA,82726,CPT,,,,,both,, ,88.69,53.21,Aetna,Commercial,,88.69,29.8,29.8% of Medicare Base rate X weight,88.69,29.76,264.3,Fee Schedule,29.8
FERRITIN,82728,CPT,,,,,both,, ,100.75,60.45,Aetna,Commercial,,100.75,29.8,29.8% of Medicare Base rate X weight,100.75,33.81,300.24,Fee Schedule,29.8
FERRITIN,82728,CPT,,,,,both,,,864.19,864.19,Aetna,Commercial,,864.19,29.8,29.8% of Medicare Base rate X weight,864.19,290.00,2575.29,Fee Schedule,29.8
FERRITIN,82728,CPT,,,,,both,, ,864.19,518.51,Aetna,Commercial,,864.19,29.8,29.8% of Medicare Base rate X weight,864.19,290.00,2575.29,Fee Schedule,29.8
FETAL FIBRONECTIN,82731,CPT,,,,,both,, ,701.69,421.01,Aetna,Commercial,,701.69,29.8,29.8% of Medicare Base rate X weight,701.69,235.47,2091.04,Fee Schedule,29.8
FOLIC ACID SERUM,82746,CPT,,,,,both,, ,108.61,65.16,Aetna,Commercial,,108.61,29.8,29.8% of Medicare Base rate X weight,108.61,36.45,323.66,Fee Schedule,29.8
FOLIC ACID SERUM,82746,CPT,,,,,both,,,735.65,735.65,Aetna,Commercial,,735.65,29.8,29.8% of Medicare Base rate X weight,735.65,246.86,2192.24,Fee Schedule,29.8
FOLIC ACID SERUM,82746,CPT,,,,,both,, ,735.65,441.39,Aetna,Commercial,,735.65,29.8,29.8% of Medicare Base rate X weight,735.65,246.86,2192.24,Fee Schedule,29.8
Q467 FOLATE RBC IA,82747,CPT,,,,,both,, ,627.30,376.38,Aetna,Commercial,,627.30,29.8,29.8% of Medicare Base rate X weight,627.30,210.50,1869.35,Fee Schedule,29.8
Q467 FOLATE RBC IA,82747,CPT,,,,,both,, ,627.30,376.38,Aetna,Commercial,,627.30,29.8,29.8% of Medicare Base rate X weight,627.30,210.50,1869.35,Fee Schedule,29.8
NBS GALACTOSE,82760,CPT,,,,,both,, ,66.80,40.08,Aetna,Commercial,,66.80,29.8,29.8% of Medicare Base rate X weight,66.80,22.42,199.06,Fee Schedule,29.8
NBS GALACTOSE TRANS,82776,CPT,,,,,both,, ,49.96,29.97,Aetna,Commercial,,49.96,29.8,29.8% of Medicare Base rate X weight,49.96,16.77,148.88,Fee Schedule,29.8
L165126 GAMMGLB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,220.88,29.8,29.8% of Medicare Base rate X weight,220.88,74.12,658.22,Fee Schedule,29.8
L165126 GAMMGLB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,220.88,29.8,29.8% of Medicare Base rate X weight,220.88,74.12,658.22,Fee Schedule,29.8
L165126 GAMMGLB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,220.88,29.8,29.8% of Medicare Base rate X weight,220.88,74.12,658.22,Fee Schedule,29.8
L165126 GAMMGLB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,220.88,29.8,29.8% of Medicare Base rate X weight,220.88,74.12,658.22,Fee Schedule,29.8
Q38940 GAMMAGLOB M G A D,82784,CPT,,,,,both,, ,196.75,118.05,Aetna,Commercial,,196.75,29.8,29.8% of Medicare Base rate X weight,196.75,66.02,586.32,Fee Schedule,29.8
Q545 IGM ITA,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,220.88,29.8,29.8% of Medicare Base rate X weight,220.88,74.12,658.22,Fee Schedule,29.8
Q545 IGM ITA,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,220.88,29.8,29.8% of Medicare Base rate X weight,220.88,74.12,658.22,Fee Schedule,29.8
Q545 IGM ITA,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,220.88,29.8,29.8% of Medicare Base rate X weight,220.88,74.12,658.22,Fee Schedule,29.8
Q545 IGM ITA,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,220.88,29.8,29.8% of Medicare Base rate X weight,220.88,74.12,658.22,Fee Schedule,29.8
Q7903 GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,220.88,29.8,29.8% of Medicare Base rate X weight,220.88,74.12,658.22,Fee Schedule,29.8
Q7903 GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,220.88,29.8,29.8% of Medicare Base rate X weight,220.88,74.12,658.22,Fee Schedule,29.8
Q7903 GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,220.88,29.8,29.8% of Medicare Base rate X weight,220.88,74.12,658.22,Fee Schedule,29.8
Q7903 GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,220.88,29.8,29.8% of Medicare Base rate X weight,220.88,74.12,658.22,Fee Schedule,29.8
GAMMAGLOBULIN IGE,82785,CPT,,,,,both,, ,127.14,76.28,Aetna,Commercial,,127.14,29.8,29.8% of Medicare Base rate X weight,127.14,42.66,378.88,Fee Schedule,29.8
GAMMAGLOBULIN IGE,82785,CPT,,,,,both,, ,906.30,543.78,Aetna,Commercial,,906.30,29.8,29.8% of Medicare Base rate X weight,906.30,304.13,2700.77,Fee Schedule,29.8
L602635 - GAMMAGLB IGE,82785,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,148.75,29.8,29.8% of Medicare Base rate X weight,148.75,49.92,443.28,Fee Schedule,29.8
L602635 - GAMMAGLB IGE,82785,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,148.75,29.8,29.8% of Medicare Base rate X weight,148.75,49.92,443.28,Fee Schedule,29.8
L602635 - GAMMAGLB IGE,82785,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,148.75,29.8,29.8% of Medicare Base rate X weight,148.75,49.92,443.28,Fee Schedule,29.8
L602635 - GAMMAGLB IGE,82785,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,148.75,29.8,29.8% of Medicare Base rate X weight,148.75,49.92,443.28,Fee Schedule,29.8
"IGG SUB 1,2,3 OR 4",82787,CPT,,,,,both,, ,389.01,233.40,Aetna,Commercial,,389.01,29.8,29.8% of Medicare Base rate X weight,389.01,130.54,1159.25,Fee Schedule,29.8
Q143422 IGG SUB4 NEP,82787,CPT,,,,,both,, ,389.01,233.40,Aetna,Commercial,,389.01,29.8,29.8% of Medicare Base rate X weight,389.01,130.54,1159.25,Fee Schedule,29.8
"Q7903IGG SUB 1,2,3,4",82787,CPT,,,,,both,, ,389.01,233.40,Aetna,Commercial,,389.01,29.8,29.8% of Medicare Base rate X weight,389.01,130.54,1159.25,Fee Schedule,29.8
BLOOD PH,82800,CPT,,,,,both,, ,618.04,370.82,Aetna,Commercial,,618.04,29.8,29.8% of Medicare Base rate X weight,618.04,207.40,1841.76,Fee Schedule,29.8
BLD GAS W-O2 SAT DIR,82805,CPT,,,,,both,, ,1760.39,1056.23,Aetna,Commercial,,1760.39,29.8,29.8% of Medicare Base rate X weight,1760.39,590.73,5245.96,Fee Schedule,29.8
BLD GAS POC/O2 SAT,82810,CPT,,,,,both,, ,100.63,60.37,Aetna,Commercial,,100.63,29.8,29.8% of Medicare Base rate X weight,100.63,33.77,299.88,Fee Schedule,29.8
BLD GAS POC/O2 SAT,82810,CPT,,,,,both,, ,100.63,60.37,Aetna,Commercial,,100.63,29.8,29.8% of Medicare Base rate X weight,100.63,33.77,299.88,Fee Schedule,29.8
Q478 GASTRIN IA,82941,CPT,,,,,both,, ,863.91,518.34,Aetna,Commercial,,863.91,29.8,29.8% of Medicare Base rate X weight,863.91,289.90,2574.45,Fee Schedule,29.8
Q478 GASTRIN IA,82941,CPT,,,,,both,, ,863.91,518.34,Aetna,Commercial,,863.91,29.8,29.8% of Medicare Base rate X weight,863.91,289.90,2574.45,Fee Schedule,29.8
Q519 GLUCAG EXT-RIA,82943,CPT,,,,,both,, ,82.51,49.50,Aetna,Commercial,,82.51,29.8,29.8% of Medicare Base rate X weight,82.51,27.69,245.88,Fee Schedule,29.8
GLUCOSE BODY FLUID,82945,CPT,,,,,both,, ,412.87,247.72,Aetna,Commercial,,412.87,29.8,29.8% of Medicare Base rate X weight,412.87,138.55,1230.35,Fee Schedule,29.8
"GLUCOSE, QUANT",82947,CPT,,,,,both,, ,21.89,13.13,Aetna,Commercial,,21.89,29.8,29.8% of Medicare Base rate X weight,21.89,7.35,65.23,Fee Schedule,29.8
"GLUCOSE, QUANT",82947,CPT,,,,,both,,,240.26,240.26,Aetna,Commercial,,240.26,29.8,29.8% of Medicare Base rate X weight,240.26,80.62,715.97,Fee Schedule,29.8
"GLUCOSE, QUANT",82947,CPT,,,,,both,, ,240.26,144.15,Aetna,Commercial,,240.26,29.8,29.8% of Medicare Base rate X weight,240.26,80.62,715.97,Fee Schedule,29.8
"GLUCOSE, POST DOSE",82950,CPT,,,,,both,,,450.48,450.48,Aetna,Commercial,,450.48,29.8,29.8% of Medicare Base rate X weight,450.48,151.17,1342.43,Fee Schedule,29.8
"GLUCOSE, POST DOSE",82950,CPT,,,,,both,, ,450.48,270.28,Aetna,Commercial,,450.48,29.8,29.8% of Medicare Base rate X weight,450.48,151.17,1342.43,Fee Schedule,29.8
GTT 3 SPEC,82951,CPT,,,,,both,, ,758.95,455.37,Aetna,Commercial,,758.95,29.8,29.8% of Medicare Base rate X weight,758.95,254.68,2261.67,Fee Schedule,29.8
GTT ADD SP,82952,CPT,,,,,both,, ,188.05,112.83,Aetna,Commercial,,188.05,29.8,29.8% of Medicare Base rate X weight,188.05,63.10,560.39,Fee Schedule,29.8
"G6PD, QUANT",82955,CPT,,,,,both,, ,1026.43,615.85,Aetna,Commercial,,1026.43,29.8,29.8% of Medicare Base rate X weight,1026.43,344.44,3058.76,Fee Schedule,29.8
"L121003 G6PD, QUANT",82955,CPT,,,,,both,, ,60.00,36.00,Aetna,Commercial,,60.00,29.8,29.8% of Medicare Base rate X weight,60.00,20.13,178.8,Fee Schedule,29.8
"GLU,HOME USE DIAGNOS",82962,CPT,,,,,both,, ,8.76,5.25,Aetna,Commercial,,8.76,29.8,29.8% of Medicare Base rate X weight,8.76,2.94,26.1,Fee Schedule,29.8
"GLU,HOME USE DIAGNOS",82962,CPT,,,,,both,, ,99.35,59.61,Aetna,Commercial,,99.35,29.8,29.8% of Medicare Base rate X weight,99.35,33.34,296.06,Fee Schedule,29.8
GGT,82977,CPT,,,,,both,, ,71.01,42.60,Aetna,Commercial,,71.01,29.8,29.8% of Medicare Base rate X weight,71.01,23.83,211.61,Fee Schedule,29.8
GGT,82977,CPT,,,,,both,, ,412.87,247.72,Aetna,Commercial,,412.87,29.8,29.8% of Medicare Base rate X weight,412.87,138.55,1230.35,Fee Schedule,29.8
L7700 GSH TOT,82978,CPT,,,,,both,, ,61.00,36.60,Aetna,Commercial,,61.00,29.8,29.8% of Medicare Base rate X weight,61.00,20.47,181.78,Fee Schedule,29.8
GLYCATED PROTEIN,82985,CPT,,,,,both,, ,263.83,158.29,Aetna,Commercial,,263.83,29.8,29.8% of Medicare Base rate X weight,263.83,88.53,786.21,Fee Schedule,29.8
Q8340 FRUCTOSAMINE C,82985,CPT,,,,,both,, ,298.92,179.35,Aetna,Commercial,,298.92,29.8,29.8% of Medicare Base rate X weight,298.92,100.31,890.78,Fee Schedule,29.8
FOLLICLE STIM HORM,83001,CPT,,,,,both,, ,137.25,82.35,Aetna,Commercial,,137.25,29.8,29.8% of Medicare Base rate X weight,137.25,46.06,409.01,Fee Schedule,29.8
L4309 FSH ECLIA,83001,CPT,,,,,both,, ,812.55,487.53,Aetna,Commercial,,812.55,29.8,29.8% of Medicare Base rate X weight,812.55,272.67,2421.4,Fee Schedule,29.8
L4309 FSH ECLIA,83001,CPT,,,,,both,, ,812.55,487.53,Aetna,Commercial,,812.55,29.8,29.8% of Medicare Base rate X weight,812.55,272.67,2421.4,Fee Schedule,29.8
L4283 LH ECLIA,83002,CPT,,,,,both,, ,812.55,487.53,Aetna,Commercial,,812.55,29.8,29.8% of Medicare Base rate X weight,812.55,272.67,2421.4,Fee Schedule,29.8
L4283 LH ECLIA,83002,CPT,,,,,both,, ,812.55,487.53,Aetna,Commercial,,812.55,29.8,29.8% of Medicare Base rate X weight,812.55,272.67,2421.4,Fee Schedule,29.8
LEUTEINIZING HORMONE,83002,CPT,,,,,both,, ,136.97,82.18,Aetna,Commercial,,136.97,29.8,29.8% of Medicare Base rate X weight,136.97,45.96,408.17,Fee Schedule,29.8
GROWTH HORMONE,83003,CPT,,,,,both,, ,1201.85,721.11,Aetna,Commercial,,1201.85,29.8,29.8% of Medicare Base rate X weight,1201.85,403.31,3581.51,Fee Schedule,29.8
Q521 GH IA,83003,CPT,,,,,both,, ,74.86,44.91,Aetna,Commercial,,74.86,29.8,29.8% of Medicare Base rate X weight,74.86,25.12,223.08,Fee Schedule,29.8
Q91823 GRTH STM GN 2,83006,CPT,,,,,both,, ,189.00,113.40,Aetna,Commercial,,189.00,29.8,29.8% of Medicare Base rate X weight,189.00,63.42,563.22,Fee Schedule,29.8
L1628 HAPTOGLOB IMM,83010,CPT,,,,,both,, ,1109.23,665.53,Aetna,Commercial,,1109.23,29.8,29.8% of Medicare Base rate X weight,1109.23,372.22,3305.51,Fee Schedule,29.8
L1628 HAPTOGLOB IMM,83010,CPT,,,,,both,, ,1109.23,665.53,Aetna,Commercial,,1109.23,29.8,29.8% of Medicare Base rate X weight,1109.23,372.22,3305.51,Fee Schedule,29.8
Q14839H.PYLO UREA IR,83013,CPT,,,,,both,, ,623.38,374.02,Aetna,Commercial,,623.38,29.8,29.8% of Medicare Base rate X weight,623.38,209.19,1857.67,Fee Schedule,29.8
"HEAVY METALS, QUANT",83018,CPT,,,,,both,, ,175.14,105.08,Aetna,Commercial,,175.14,29.8,29.8% of Medicare Base rate X weight,175.14,58.77,521.92,Fee Schedule,29.8
L121690 - HEMOGLOBIN ELECTRO,83020,CPT,,,,,both,, ,108.15,64.89,Aetna,Commercial,,108.15,29.8,29.8% of Medicare Base rate X weight,108.15,36.29,322.29,Fee Schedule,29.8
NBS HGB ELECTRO,83020,CPT,,,,,both,, ,76.90,46.14,Aetna,Commercial,,76.90,29.8,29.8% of Medicare Base rate X weight,76.90,25.81,229.16,Fee Schedule,29.8
Q35489 HEMOGLO CHROM,83021,CPT,,,,,both,, ,180.60,108.36,Aetna,Commercial,,180.60,29.8,29.8% of Medicare Base rate X weight,180.60,60.60,538.19,Fee Schedule,29.8
Q35489 HEMOGLO CHROM,83021,CPT,,,,,both,, ,180.60,108.36,Aetna,Commercial,,180.60,29.8,29.8% of Medicare Base rate X weight,180.60,60.60,538.19,Fee Schedule,29.8
"HEMOGLOB,FETGAL,QUAL",83033,CPT,,,,,both,, ,354.77,212.86,Aetna,Commercial,,354.77,29.8,29.8% of Medicare Base rate X weight,354.77,119.05,1057.21,Fee Schedule,29.8
HEMOGLOBIN A1C,83036,CPT,,,,,both,, ,95.71,57.42,Aetna,Commercial,,95.71,29.8,29.8% of Medicare Base rate X weight,95.71,32.12,285.22,Fee Schedule,29.8
HEMOGLOBIN A1C,83036,CPT,,,,,both,,,454.97,454.97,Aetna,Commercial,,454.97,29.8,29.8% of Medicare Base rate X weight,454.97,152.67,1355.81,Fee Schedule,29.8
Q496 HEMOGLO A1C ITA,83036,CPT,,,,,both,, ,454.97,272.98,Aetna,Commercial,,454.97,29.8,29.8% of Medicare Base rate X weight,454.97,152.67,1355.81,Fee Schedule,29.8
Q496 HEMOGLO A1C ITA,83036,CPT,,,,,both,, ,454.97,272.98,Aetna,Commercial,,454.97,29.8,29.8% of Medicare Base rate X weight,454.97,152.67,1355.81,Fee Schedule,29.8
"METHEMOGLOBIN,QUAN",83050,CPT,,,,,both,, ,122.09,73.25,Aetna,Commercial,,122.09,29.8,29.8% of Medicare Base rate X weight,122.09,40.97,363.83,Fee Schedule,29.8
"HEMOGLOBIN, PLASMA",83051,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
"HEMOSIDERIN, QUAL",83070,CPT,,,,,both,, ,373.57,224.14,Aetna,Commercial,,373.57,29.8,29.8% of Medicare Base rate X weight,373.57,125.36,1113.24,Fee Schedule,29.8
HISTAMINE,83088,CPT,,,,,both,, ,385.09,231.05,Aetna,Commercial,,385.09,29.8,29.8% of Medicare Base rate X weight,385.09,129.22,1147.57,Fee Schedule,29.8
Q36586 HISTAM PL RIA,83088,CPT,,,,,both,, ,385.09,231.05,Aetna,Commercial,,385.09,29.8,29.8% of Medicare Base rate X weight,385.09,129.22,1147.57,Fee Schedule,29.8
Q4946 HISTAM U24 IA,83088,CPT,,,,,both,, ,385.09,231.05,Aetna,Commercial,,385.09,29.8,29.8% of Medicare Base rate X weight,385.09,129.22,1147.57,Fee Schedule,29.8
Q31789 HCYSTEINE ENZ,83090,CPT,,,,,both,, ,227.91,136.74,Aetna,Commercial,,227.91,29.8,29.8% of Medicare Base rate X weight,227.91,76.48,679.17,Fee Schedule,29.8
Q31789 HCYSTEINE ENZ,83090,CPT,,,,,both,, ,227.91,136.74,Aetna,Commercial,,227.91,29.8,29.8% of Medicare Base rate X weight,227.91,76.48,679.17,Fee Schedule,29.8
CORTICOSTEROIDS,83491,CPT,,,,,both,, ,1217.28,730.36,Aetna,Commercial,,1217.28,29.8,29.8% of Medicare Base rate X weight,1217.28,408.48,3627.49,Fee Schedule,29.8
5-HIAA,83497,CPT,,,,,both,, ,976.46,585.87,Aetna,Commercial,,976.46,29.8,29.8% of Medicare Base rate X weight,976.46,327.67,2909.85,Fee Schedule,29.8
Q1648 5-HIAA,83497,CPT,,,,,both,, ,976.46,585.87,Aetna,Commercial,,976.46,29.8,29.8% of Medicare Base rate X weight,976.46,327.67,2909.85,Fee Schedule,29.8
Q523 5-HIAA U24 HPLC,83497,CPT,,,,,both,, ,976.46,585.87,Aetna,Commercial,,976.46,29.8,29.8% of Medicare Base rate X weight,976.46,327.67,2909.85,Fee Schedule,29.8
HYDROXYPROGES 17-D,83498,CPT,,,,,both,, ,600.92,360.55,Aetna,Commercial,,600.92,29.8,29.8% of Medicare Base rate X weight,600.92,201.65,1790.74,Fee Schedule,29.8
NBS HYDROXYPROG 17-D,83498,CPT,,,,,both,, ,162.23,97.33,Aetna,Commercial,,162.23,29.8,29.8% of Medicare Base rate X weight,162.23,54.44,483.45,Fee Schedule,29.8
Q17180 17-OHP LCMSMS,83498,CPT,,,,,both,, ,601.20,360.72,Aetna,Commercial,,601.20,29.8,29.8% of Medicare Base rate X weight,601.20,201.74,1791.58,Fee Schedule,29.8
"IMMUNOASSAY, OTHER",83516,CPT,,,,,both,,,765.96,765.96,Aetna,Commercial,,765.96,29.8,29.8% of Medicare Base rate X weight,765.96,257.03,2282.56,Fee Schedule,29.8
"IMMUNOASSAY, OTHER",83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,765.96,29.8,29.8% of Medicare Base rate X weight,765.96,257.03,2282.56,Fee Schedule,29.8
L162045 IA OTH,83516,CPT,,,,,both,, ,702.72,421.63,Aetna,Commercial,,702.72,29.8,29.8% of Medicare Base rate X weight,702.72,235.81,2094.11,Fee Schedule,29.8
L163061 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,765.96,29.8,29.8% of Medicare Base rate X weight,765.96,257.03,2282.56,Fee Schedule,29.8
L165126 IA OTH,83516,CPT,,,,,both,, ,702.72,421.63,Aetna,Commercial,,702.72,29.8,29.8% of Medicare Base rate X weight,702.72,235.81,2094.11,Fee Schedule,29.8
L341142 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,765.96,29.8,29.8% of Medicare Base rate X weight,765.96,257.03,2282.56,Fee Schedule,29.8
L520057 ANTI-HMGCR,83516,CPT,,,,,both,, ,630.00,378.00,Aetna,Commercial,,630.00,29.8,29.8% of Medicare Base rate X weight,630.00,211.41,1877.4,Fee Schedule,29.8
L520085 IA OTHER,83516,CPT,,,,,both,, ,702.72,421.63,Aetna,Commercial,,702.72,29.8,29.8% of Medicare Base rate X weight,702.72,235.81,2094.11,Fee Schedule,29.8
L520139 ANTI-GP210AB,83516,CPT,,,,,both,, ,300.00,180.00,Aetna,Commercial,,300.00,29.8,29.8% of Medicare Base rate X weight,300.00,100.67,894,Fee Schedule,29.8
L520311 CARP AB,83516,CPT,,,,,both,, ,520.00,312.00,Aetna,Commercial,,520.00,29.8,29.8% of Medicare Base rate X weight,520.00,174.50,1549.6,Fee Schedule,29.8
L6486PARIET AB ELISA,83516,CPT,,,,,both,, ,81.50,48.90,Aetna,Commercial,,81.50,29.8,29.8% of Medicare Base rate X weight,81.50,27.35,242.87,Fee Schedule,29.8
Q15114PARCL AB ELISA,83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,765.96,29.8,29.8% of Medicare Base rate X weight,765.96,257.03,2282.56,Fee Schedule,29.8
Q18855 KU AUTOANTIBODIES,83516,CPT,,,,,both,, ,682.25,409.35,Aetna,Commercial,,682.25,29.8,29.8% of Medicare Base rate X weight,682.25,228.94,2033.11,Fee Schedule,29.8
Q19899RNA P-III ELIS,83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,765.96,29.8,29.8% of Medicare Base rate X weight,765.96,257.03,2282.56,Fee Schedule,29.8
Q34283 RIBO P AB IA,83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,765.96,29.8,29.8% of Medicare Base rate X weight,765.96,257.03,2282.56,Fee Schedule,29.8
Q36336 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,765.96,29.8,29.8% of Medicare Base rate X weight,765.96,257.03,2282.56,Fee Schedule,29.8
Q37056 HISTON AB EIA,83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,765.96,29.8,29.8% of Medicare Base rate X weight,765.96,257.03,2282.56,Fee Schedule,29.8
Q39226  21OH AB,83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,765.96,29.8,29.8% of Medicare Base rate X weight,765.96,257.03,2282.56,Fee Schedule,29.8
L086007 IMMUNOASSAY,83519,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,728.07,29.8,29.8% of Medicare Base rate X weight,728.07,244.32,2169.65,Fee Schedule,29.8
L086007 IMMUNOASSAY,83519,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,728.07,29.8,29.8% of Medicare Base rate X weight,728.07,244.32,2169.65,Fee Schedule,29.8
L086007 IMMUNOASSAY,83519,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,728.07,29.8,29.8% of Medicare Base rate X weight,728.07,244.32,2169.65,Fee Schedule,29.8
L086007 IMMUNOASSAY,83519,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,728.07,29.8,29.8% of Medicare Base rate X weight,728.07,244.32,2169.65,Fee Schedule,29.8
L10421 MSH,83519,CPT,,,,,both,, ,184.00,110.40,Aetna,Commercial,,184.00,29.8,29.8% of Medicare Base rate X weight,184.00,61.74,548.32,Fee Schedule,29.8
L504600 MUSCLE SPECIFIC KINASE,83519,CPT,,,,,both,, ,1200.00,720.00,Aetna,Commercial,,1200.00,29.8,29.8% of Medicare Base rate X weight,1200.00,402.68,3576,Fee Schedule,29.8
Q34459 ACHR BLKAB IA,83519,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,728.07,29.8,29.8% of Medicare Base rate X weight,728.07,244.32,2169.65,Fee Schedule,29.8
Q34459 ACHR BLKAB IA,83519,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,728.07,29.8,29.8% of Medicare Base rate X weight,728.07,244.32,2169.65,Fee Schedule,29.8
Q34459 ACHR BLKAB IA,83519,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,728.07,29.8,29.8% of Medicare Base rate X weight,728.07,244.32,2169.65,Fee Schedule,29.8
Q34459 ACHR BLKAB IA,83519,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,728.07,29.8,29.8% of Medicare Base rate X weight,728.07,244.32,2169.65,Fee Schedule,29.8
L117021 VEGF SER,83520,CPT,,,,,both,, ,175.00,105.00,Aetna,Commercial,,175.00,29.8,29.8% of Medicare Base rate X weight,175.00,58.72,521.5,Fee Schedule,29.8
L146712 LEPTIN S EIA,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,414.83,29.8,29.8% of Medicare Base rate X weight,414.83,139.20,1236.19,Fee Schedule,29.8
L146712 LEPTIN S EIA,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,414.83,29.8,29.8% of Medicare Base rate X weight,414.83,139.20,1236.19,Fee Schedule,29.8
L146795INHIBIN B EIA,83520,CPT,,,,,both,, ,380.59,228.35,Aetna,Commercial,,380.59,29.8,29.8% of Medicare Base rate X weight,380.59,127.71,1134.16,Fee Schedule,29.8
L500016PROTHR FR 1+2,83520,CPT,,,,,both,, ,172.70,103.62,Aetna,Commercial,,172.70,29.8,29.8% of Medicare Base rate X weight,172.70,57.95,514.65,Fee Schedule,29.8
L500124 MMP9,83520,CPT,,,,,both,, ,170.00,102.00,Aetna,Commercial,,170.00,29.8,29.8% of Medicare Base rate X weight,170.00,57.05,506.6,Fee Schedule,29.8
NBS IMMUNOASSAY NOS,83520,CPT,,,,,both,, ,77.47,46.48,Aetna,Commercial,,77.47,29.8,29.8% of Medicare Base rate X weight,77.47,26.00,230.86,Fee Schedule,29.8
Q16039 MBL ELISA,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,414.83,29.8,29.8% of Medicare Base rate X weight,414.83,139.20,1236.19,Fee Schedule,29.8
Q16039 MBL ELISA,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,414.83,29.8,29.8% of Medicare Base rate X weight,414.83,139.20,1236.19,Fee Schedule,29.8
Q19509 INTERFERON-BETA (IGG) MAID,83520,CPT,,,,,both,, ,369.50,221.70,Aetna,Commercial,,369.50,29.8,29.8% of Medicare Base rate X weight,369.50,123.99,1101.11,Fee Schedule,29.8
Q19509 INTERFERON-BETA (IGG) MAID,83520,CPT,,,,,both,, ,369.50,221.70,Aetna,Commercial,,369.50,29.8,29.8% of Medicare Base rate X weight,369.50,123.99,1101.11,Fee Schedule,29.8
Q19509 INTERFERON-BETA (IGG) MAID,83520,CPT,,,,,both,, ,369.50,221.70,Aetna,Commercial,,369.50,29.8,29.8% of Medicare Base rate X weight,369.50,123.99,1101.11,Fee Schedule,29.8
Q19509 INTERFERON-BETA (IGG) MAID,83520,CPT,,,,,both,, ,369.50,221.70,Aetna,Commercial,,369.50,29.8,29.8% of Medicare Base rate X weight,369.50,123.99,1101.11,Fee Schedule,29.8
Q257 GBM AB IGG IA,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,414.83,29.8,29.8% of Medicare Base rate X weight,414.83,139.20,1236.19,Fee Schedule,29.8
Q257 GBM AB IGG IA,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,414.83,29.8,29.8% of Medicare Base rate X weight,414.83,139.20,1236.19,Fee Schedule,29.8
Q8658 ALPH SUB ECLIA,83520,CPT,,,,,both,, ,444.59,266.75,Aetna,Commercial,,444.59,29.8,29.8% of Medicare Base rate X weight,444.59,149.19,1324.88,Fee Schedule,29.8
Q8658 ALPH SUB ECLIA,83520,CPT,,,,,both,, ,444.59,266.75,Aetna,Commercial,,444.59,29.8,29.8% of Medicare Base rate X weight,444.59,149.19,1324.88,Fee Schedule,29.8
Q90123 IA NOS,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,414.83,29.8,29.8% of Medicare Base rate X weight,414.83,139.20,1236.19,Fee Schedule,29.8
Q90123 IA NOS,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,414.83,29.8,29.8% of Medicare Base rate X weight,414.83,139.20,1236.19,Fee Schedule,29.8
Q91455 14-3-3 ETA PR,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,414.83,29.8,29.8% of Medicare Base rate X weight,414.83,139.20,1236.19,Fee Schedule,29.8
Q91455 14-3-3 ETA PR,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,414.83,29.8,29.8% of Medicare Base rate X weight,414.83,139.20,1236.19,Fee Schedule,29.8
L121137 LTCHN KAPLAM,83521,CPT,,,,,both,, ,103.62,62.17,Aetna,Commercial,,103.62,29.8,29.8% of Medicare Base rate X weight,103.62,34.77,308.79,Fee Schedule,29.8
L121137 LTCHN KAPLAM,83521,CPT,,,,,both,, ,103.62,62.17,Aetna,Commercial,,103.62,29.8,29.8% of Medicare Base rate X weight,103.62,34.77,308.79,Fee Schedule,29.8
Q11233 LTCHN KAP LAM,83521,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
Q11233 LTCHN KAP LAM,83521,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
"INSULIN, TOTAL",83525,CPT,,,,,both,, ,53.89,32.33,Aetna,Commercial,,53.89,29.8,29.8% of Medicare Base rate X weight,53.89,18.08,160.59,Fee Schedule,29.8
"INSULIN, TOTAL",83525,CPT,,,,,both,, ,600.92,360.55,Aetna,Commercial,,600.92,29.8,29.8% of Medicare Base rate X weight,600.92,201.65,1790.74,Fee Schedule,29.8
Q561 INSULIN IA,83525,CPT,,,,,both,, ,632.36,379.41,Aetna,Commercial,,632.36,29.8,29.8% of Medicare Base rate X weight,632.36,212.20,1884.43,Fee Schedule,29.8
"INSULIN, FREE",83527,CPT,,,,,both,, ,193.94,116.36,Aetna,Commercial,,193.94,29.8,29.8% of Medicare Base rate X weight,193.94,65.08,577.94,Fee Schedule,29.8
L501561 INSULIN FREE,83527,CPT,,,,,both,, ,193.94,116.36,Aetna,Commercial,,193.94,29.8,29.8% of Medicare Base rate X weight,193.94,65.08,577.94,Fee Schedule,29.8
Q36700 INSULIN FR IA,83527,CPT,,,,,both,, ,193.94,116.36,Aetna,Commercial,,193.94,29.8,29.8% of Medicare Base rate X weight,193.94,65.08,577.94,Fee Schedule,29.8
IRON,83540,CPT,,,,,both,, ,63.99,38.39,Aetna,Commercial,,63.99,29.8,29.8% of Medicare Base rate X weight,63.99,21.47,190.69,Fee Schedule,29.8
IRON,83540,CPT,,,,,both,,,345.79,345.79,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
IRON,83540,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
IRON BINDING CAPACIT,83550,CPT,,,,,both,, ,86.16,51.69,Aetna,Commercial,,86.16,29.8,29.8% of Medicare Base rate X weight,86.16,28.91,256.76,Fee Schedule,29.8
IRON BINDING CAPACIT,83550,CPT,,,,,both,,,526.26,526.26,Aetna,Commercial,,526.26,29.8,29.8% of Medicare Base rate X weight,526.26,176.60,1568.25,Fee Schedule,29.8
IRON BINDING CAPACIT,83550,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,526.26,29.8,29.8% of Medicare Base rate X weight,526.26,176.60,1568.25,Fee Schedule,29.8
"17-KETOSTEROIDS, TOT",83586,CPT,,,,,both,, ,164.19,98.51,Aetna,Commercial,,164.19,29.8,29.8% of Medicare Base rate X weight,164.19,55.10,489.29,Fee Schedule,29.8
LACTIC ACID,83605,CPT,,,,,both,, ,105.25,63.15,Aetna,Commercial,,105.25,29.8,29.8% of Medicare Base rate X weight,105.25,35.32,313.65,Fee Schedule,29.8
LACTIC ACID,83605,CPT,,,,,both,,,691.29,691.29,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
LACTIC ACID,83605,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
LACTATE DEHYDROGENASE LDH FLUID,83615,CPT,,,,,both,, ,600.92,360.55,Aetna,Commercial,,600.92,29.8,29.8% of Medicare Base rate X weight,600.92,201.65,1790.74,Fee Schedule,29.8
LACTATE DEHYDROGENASE LDH FLUID,83615,CPT,,,,,both,, ,600.92,360.55,Aetna,Commercial,,600.92,29.8,29.8% of Medicare Base rate X weight,600.92,201.65,1790.74,Fee Schedule,29.8
LACTATE DEHYDROLDH,83615,CPT,,,,,both,, ,59.50,35.70,Aetna,Commercial,,59.50,29.8,29.8% of Medicare Base rate X weight,59.50,19.97,177.31,Fee Schedule,29.8
LDH ISOENZYMES,83625,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q10156 LACTOFER IA,83630,CPT,,,,,both,, ,267.48,160.48,Aetna,Commercial,,267.48,29.8,29.8% of Medicare Base rate X weight,267.48,89.76,797.09,Fee Schedule,29.8
LEAD,83655,CPT,,,,,both,, ,56.97,34.18,Aetna,Commercial,,56.97,29.8,29.8% of Medicare Base rate X weight,56.97,19.12,169.77,Fee Schedule,29.8
LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
"Q3058 LEAD, BLOOD (OSHA)",83655,CPT,,,,,both,, ,615.75,369.45,Aetna,Commercial,,615.75,29.8,29.8% of Medicare Base rate X weight,615.75,206.63,1834.94,Fee Schedule,29.8
"Q3058 LEAD, BLOOD (OSHA)",83655,CPT,,,,,both,, ,615.75,369.45,Aetna,Commercial,,615.75,29.8,29.8% of Medicare Base rate X weight,615.75,206.63,1834.94,Fee Schedule,29.8
Q36438 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q36440LEAD U24 ICPMS,83655,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q599 PB BL ICP/MS,83655,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q601 PB U ICP/MS,83655,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q7507 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q7655 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
"FETAL LUNG,L-S RATIO",83661,CPT,,,,,both,, ,175.14,105.08,Aetna,Commercial,,175.14,29.8,29.8% of Medicare Base rate X weight,175.14,58.77,521.92,Fee Schedule,29.8
"FETAL LUNG, FPIA",83663,CPT,,,,,both,, ,863.91,518.34,Aetna,Commercial,,863.91,29.8,29.8% of Medicare Base rate X weight,863.91,289.90,2574.45,Fee Schedule,29.8
LIPASE,83690,CPT,,,,,both,, ,67.92,40.75,Aetna,Commercial,,67.92,29.8,29.8% of Medicare Base rate X weight,67.92,22.79,202.4,Fee Schedule,29.8
LIPASE,83690,CPT,,,,,both,,,420.72,420.72,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
LIPASE,83690,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
Q34604 LIPOPRT A ITA,83695,CPT,,,,,both,, ,467.04,280.22,Aetna,Commercial,,467.04,29.8,29.8% of Medicare Base rate X weight,467.04,156.72,1391.78,Fee Schedule,29.8
Q92145 LIPOPROTEIN,83695,CPT,,,,,both,, ,112.27,67.36,Aetna,Commercial,,112.27,29.8,29.8% of Medicare Base rate X weight,112.27,37.67,334.56,Fee Schedule,29.8
Q92145 LIPOPROTEIN,83695,CPT,,,,,both,, ,112.27,67.36,Aetna,Commercial,,112.27,29.8,29.8% of Medicare Base rate X weight,112.27,37.67,334.56,Fee Schedule,29.8
Q94220 LP-PLA2,83698,CPT,,,,,both,, ,216.39,129.83,Aetna,Commercial,,216.39,29.8,29.8% of Medicare Base rate X weight,216.39,72.61,644.84,Fee Schedule,29.8
Q92145 LIPOPROT BLD,83704,CPT,,,,,both,, ,374.69,224.81,Aetna,Commercial,,374.69,29.8,29.8% of Medicare Base rate X weight,374.69,125.73,1116.58,Fee Schedule,29.8
Q92145 LIPOPROT BLD,83704,CPT,,,,,both,, ,374.69,224.81,Aetna,Commercial,,374.69,29.8,29.8% of Medicare Base rate X weight,374.69,125.73,1116.58,Fee Schedule,29.8
"LIPOPROTEIN, HDL",83718,CPT,,,,,both,, ,60.63,36.37,Aetna,Commercial,,60.63,29.8,29.8% of Medicare Base rate X weight,60.63,20.35,180.68,Fee Schedule,29.8
"LIPOPROTEIN, HDL",83718,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,480.79,29.8,29.8% of Medicare Base rate X weight,480.79,161.34,1432.75,Fee Schedule,29.8
"LIPOPROTEIN, LDL",83721,CPT,,,,,both,, ,570.89,342.53,Aetna,Commercial,,570.89,29.8,29.8% of Medicare Base rate X weight,570.89,191.57,1701.25,Fee Schedule,29.8
L80283 MG RBC AAS-IC,83735,CPT,,,,,both,, ,67.00,40.20,Aetna,Commercial,,67.00,29.8,29.8% of Medicare Base rate X weight,67.00,22.48,199.66,Fee Schedule,29.8
L80283 MG RBC AAS-IC,83735,CPT,,,,,both,, ,67.00,40.20,Aetna,Commercial,,67.00,29.8,29.8% of Medicare Base rate X weight,67.00,22.48,199.66,Fee Schedule,29.8
MAGNESIUM,83735,CPT,,,,,both,, ,49.68,29.80,Aetna,Commercial,,49.68,29.8,29.8% of Medicare Base rate X weight,49.68,16.67,148.05,Fee Schedule,29.8
MAGNESIUM,83735,CPT,,,,,both,,,344.10,344.10,Aetna,Commercial,,344.10,29.8,29.8% of Medicare Base rate X weight,344.10,115.47,1025.42,Fee Schedule,29.8
Q442 MAGNESIUM,83735,CPT,,,,,both,, ,344.10,206.46,Aetna,Commercial,,344.10,29.8,29.8% of Medicare Base rate X weight,344.10,115.47,1025.42,Fee Schedule,29.8
Q442 MAGNESIUM,83735,CPT,,,,,both,, ,344.10,206.46,Aetna,Commercial,,344.10,29.8,29.8% of Medicare Base rate X weight,344.10,115.47,1025.42,Fee Schedule,29.8
MANGANESE WHOLE BLOOD,83785,CPT,,,,,both,, ,133.00,79.80,Aetna,Commercial,,133.00,29.8,29.8% of Medicare Base rate X weight,133.00,44.63,396.34,Fee Schedule,29.8
L70034 I S/P ICP/MS,83789,CPT,,,,,both,, ,315.00,189.00,Aetna,Commercial,,315.00,29.8,29.8% of Medicare Base rate X weight,315.00,105.70,938.7,Fee Schedule,29.8
L70222 I U ICP/MS,83789,CPT,,,,,both,, ,390.49,234.29,Aetna,Commercial,,390.49,29.8,29.8% of Medicare Base rate X weight,390.49,131.04,1163.66,Fee Schedule,29.8
Q91745THIOPUR LCMSMS,83789,CPT,,,,,both,, ,402.20,241.32,Aetna,Commercial,,402.20,29.8,29.8% of Medicare Base rate X weight,402.20,134.97,1198.56,Fee Schedule,29.8
Q91745THIOPUR LCMSMS,83789,CPT,,,,,both,, ,402.20,241.32,Aetna,Commercial,,402.20,29.8,29.8% of Medicare Base rate X weight,402.20,134.97,1198.56,Fee Schedule,29.8
MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,751.36,29.8,29.8% of Medicare Base rate X weight,751.36,252.13,2239.05,Fee Schedule,29.8
Q36438 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,751.36,29.8,29.8% of Medicare Base rate X weight,751.36,252.13,2239.05,Fee Schedule,29.8
Q636 HG BL ICP/MS,83825,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,751.36,29.8,29.8% of Medicare Base rate X weight,751.36,252.13,2239.05,Fee Schedule,29.8
Q7507 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,751.36,29.8,29.8% of Medicare Base rate X weight,751.36,252.13,2239.05,Fee Schedule,29.8
Q7655 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,751.36,29.8,29.8% of Medicare Base rate X weight,751.36,252.13,2239.05,Fee Schedule,29.8
METANEPHRINES,83835,CPT,,,,,both,, ,2599.05,1559.43,Aetna,Commercial,,2599.05,29.8,29.8% of Medicare Base rate X weight,2599.05,872.16,7745.17,Fee Schedule,29.8
Q14961 METANEPHRINES,83835,CPT,,,,,both,, ,488.65,293.19,Aetna,Commercial,,488.65,29.8,29.8% of Medicare Base rate X weight,488.65,163.98,1456.18,Fee Schedule,29.8
Q14962MNFR U24 LCMSM,83835,CPT,,,,,both,, ,488.65,293.19,Aetna,Commercial,,488.65,29.8,29.8% of Medicare Base rate X weight,488.65,163.98,1456.18,Fee Schedule,29.8
Q19548 MN FRC LCMSMS,83835,CPT,,,,,both,, ,488.65,293.19,Aetna,Commercial,,488.65,29.8,29.8% of Medicare Base rate X weight,488.65,163.98,1456.18,Fee Schedule,29.8
Q70858 MYELIN BASIC,83873,CPT,,,,,both,, ,509.14,305.48,Aetna,Commercial,,509.14,29.8,29.8% of Medicare Base rate X weight,509.14,170.85,1517.24,Fee Schedule,29.8
Q70858 MYELIN BASIC,83873,CPT,,,,,both,, ,509.14,305.48,Aetna,Commercial,,509.14,29.8,29.8% of Medicare Base rate X weight,509.14,170.85,1517.24,Fee Schedule,29.8
L3079MYOGL QT U ICMA,83874,CPT,,,,,both,, ,627.30,376.38,Aetna,Commercial,,627.30,29.8,29.8% of Medicare Base rate X weight,627.30,210.50,1869.35,Fee Schedule,29.8
L3079MYOGL QT U ICMA,83874,CPT,,,,,both,, ,627.30,376.38,Aetna,Commercial,,627.30,29.8,29.8% of Medicare Base rate X weight,627.30,210.50,1869.35,Fee Schedule,29.8
L143000 NT-PROBNP,83880,CPT,,,,,both,, ,450.00,270.00,Aetna,Commercial,,450.00,29.8,29.8% of Medicare Base rate X weight,450.00,151.01,1341,Fee Schedule,29.8
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,, ,279.55,167.73,Aetna,Commercial,,279.55,29.8,29.8% of Medicare Base rate X weight,279.55,93.81,833.06,Fee Schedule,29.8
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,,,1229.07,1229.07,Aetna,Commercial,,1229.07,29.8,29.8% of Medicare Base rate X weight,1229.07,412.44,3662.63,Fee Schedule,29.8
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,, ,1229.07,737.44,Aetna,Commercial,,1229.07,29.8,29.8% of Medicare Base rate X weight,1229.07,412.44,3662.63,Fee Schedule,29.8
Q37863 NEPHELOM NOS,83883,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
Q37863 NEPHELOM NOS,83883,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
Q38940 NEPHELOMETRY NOS,83883,CPT,,,,,both,, ,374.75,224.85,Aetna,Commercial,,374.75,29.8,29.8% of Medicare Base rate X weight,374.75,125.76,1116.76,Fee Schedule,29.8
NICKEL,83885,CPT,,,,,both,, ,934.09,560.45,Aetna,Commercial,,934.09,29.8,29.8% of Medicare Base rate X weight,934.09,313.45,2783.59,Fee Schedule,29.8
Q14624 5'NUCLEO C-KN,83915,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,871.22,29.8,29.8% of Medicare Base rate X weight,871.22,292.36,2596.24,Fee Schedule,29.8
Q14624 5'NUCLEO C-KN,83915,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,871.22,29.8,29.8% of Medicare Base rate X weight,871.22,292.36,2596.24,Fee Schedule,29.8
Q70858 OLIGOCLONAL B,83916,CPT,,,,,both,, ,530.75,318.45,Aetna,Commercial,,530.75,29.8,29.8% of Medicare Base rate X weight,530.75,178.10,1581.64,Fee Schedule,29.8
Q70858 OLIGOCLONAL B,83916,CPT,,,,,both,, ,530.75,318.45,Aetna,Commercial,,530.75,29.8,29.8% of Medicare Base rate X weight,530.75,178.10,1581.64,Fee Schedule,29.8
Q34879 MMA MS/MS,83921,CPT,,,,,both,, ,396.02,237.61,Aetna,Commercial,,396.02,29.8,29.8% of Medicare Base rate X weight,396.02,132.89,1180.14,Fee Schedule,29.8
Q34879 MMA MS/MS,83921,CPT,,,,,both,, ,396.02,237.61,Aetna,Commercial,,396.02,29.8,29.8% of Medicare Base rate X weight,396.02,132.89,1180.14,Fee Schedule,29.8
L2071 OSMALALITY FPD,83930,CPT,,,,,both,, ,40.89,24.53,Aetna,Commercial,,40.89,29.8,29.8% of Medicare Base rate X weight,40.89,13.72,121.85,Fee Schedule,29.8
"OSMOLALITY, BLOOD",83930,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
L3442 OSMOLALI U FPD,83935,CPT,,,,,both,, ,50.90,30.54,Aetna,Commercial,,50.90,29.8,29.8% of Medicare Base rate X weight,50.90,17.08,151.68,Fee Schedule,29.8
"OSMOLALITY,URINE",83935,CPT,,,,,both,, ,67.07,40.24,Aetna,Commercial,,67.07,29.8,29.8% of Medicare Base rate X weight,67.07,22.51,199.87,Fee Schedule,29.8
"OSMOLALITY,URINE",83935,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
L10249 OSTREOC ELISA,83937,CPT,,,,,both,, ,203.60,122.16,Aetna,Commercial,,203.60,29.8,29.8% of Medicare Base rate X weight,203.60,68.32,606.73,Fee Schedule,29.8
OSTEOCALCIN,83937,CPT,,,,,both,, ,447.39,268.43,Aetna,Commercial,,447.39,29.8,29.8% of Medicare Base rate X weight,447.39,150.13,1333.22,Fee Schedule,29.8
LC833603 OXALATE S/P,83945,CPT,,,,,both,, ,660.98,396.58,Aetna,Commercial,,660.98,29.8,29.8% of Medicare Base rate X weight,660.98,221.81,1969.72,Fee Schedule,29.8
LC833603 OXALATE S/P,83945,CPT,,,,,both,, ,660.98,396.58,Aetna,Commercial,,660.98,29.8,29.8% of Medicare Base rate X weight,660.98,221.81,1969.72,Fee Schedule,29.8
LC833603 OXALATE S/P,83945,CPT,,,,,both,, ,660.98,396.58,Aetna,Commercial,,660.98,29.8,29.8% of Medicare Base rate X weight,660.98,221.81,1969.72,Fee Schedule,29.8
LC833603 OXALATE S/P,83945,CPT,,,,,both,, ,660.98,396.58,Aetna,Commercial,,660.98,29.8,29.8% of Medicare Base rate X weight,660.98,221.81,1969.72,Fee Schedule,29.8
L15610 PTH INT ECLIA,83970,CPT,,,,,both,, ,420.49,252.29,Aetna,Commercial,,420.49,29.8,29.8% of Medicare Base rate X weight,420.49,141.10,1253.06,Fee Schedule,29.8
PARATHORMONE PTH,83970,CPT,,,,,both,, ,160.55,96.33,Aetna,Commercial,,160.55,29.8,29.8% of Medicare Base rate X weight,160.55,53.88,478.44,Fee Schedule,29.8
PARATHORMONE PTH,83970,CPT,,,,,both,, ,1420.49,852.29,Aetna,Commercial,,1420.49,29.8,29.8% of Medicare Base rate X weight,1420.49,476.67,4233.06,Fee Schedule,29.8
"L910235 PH FLUID, NOS",83986,CPT,,,,,both,, ,240.26,144.15,Aetna,Commercial,,240.26,29.8,29.8% of Medicare Base rate X weight,240.26,80.62,715.97,Fee Schedule,29.8
"PH FLUID,NOS",83986,CPT,,,,,both,, ,240.26,144.15,Aetna,Commercial,,240.26,29.8,29.8% of Medicare Base rate X weight,240.26,80.62,715.97,Fee Schedule,29.8
"Q442 PH FLUID,NOS",83986,CPT,,,,,both,, ,240.26,144.15,Aetna,Commercial,,240.26,29.8,29.8% of Medicare Base rate X weight,240.26,80.62,715.97,Fee Schedule,29.8
L790600 PCP MS,83992,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
Q16796 CALPRO STL IA,83993,CPT,,,,,both,, ,395.75,237.45,Aetna,Commercial,,395.75,29.8,29.8% of Medicare Base rate X weight,395.75,132.80,1179.34,Fee Schedule,29.8
Q16796 CALPRO STL IA,83993,CPT,,,,,both,, ,395.75,237.45,Aetna,Commercial,,395.75,29.8,29.8% of Medicare Base rate X weight,395.75,132.80,1179.34,Fee Schedule,29.8
Q37356 PNENYLAL HPLC,84030,CPT,,,,,both,, ,32.84,19.70,Aetna,Commercial,,32.84,29.8,29.8% of Medicare Base rate X weight,32.84,11.02,97.86,Fee Schedule,29.8
Q37356 PNENYLAL HPLC,84030,CPT,,,,,both,, ,32.84,19.70,Aetna,Commercial,,32.84,29.8,29.8% of Medicare Base rate X weight,32.84,11.02,97.86,Fee Schedule,29.8
"PHOSPHATASE, PROSTAT",84066,CPT,,,,,both,, ,540.85,324.51,Aetna,Commercial,,540.85,29.8,29.8% of Medicare Base rate X weight,540.85,181.49,1611.73,Fee Schedule,29.8
"PHOSPHATASE,ALKALINE",84075,CPT,,,,,both,, ,51.08,30.64,Aetna,Commercial,,51.08,29.8,29.8% of Medicare Base rate X weight,51.08,17.14,152.22,Fee Schedule,29.8
Q6432 PHOSPHATAS ALK,84075,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
Q6432 PHOSPHATAS ALK,84075,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
Q6432 PHOSPH ALK ISO,84080,CPT,,,,,both,, ,637.41,382.44,Aetna,Commercial,,637.41,29.8,29.8% of Medicare Base rate X weight,637.41,213.90,1899.48,Fee Schedule,29.8
Q6432 PHOSPH ALK ISO,84080,CPT,,,,,both,, ,637.41,382.44,Aetna,Commercial,,637.41,29.8,29.8% of Medicare Base rate X weight,637.41,213.90,1899.48,Fee Schedule,29.8
PHOSPHATIDYLGLYCEROL,84081,CPT,,,,,both,, ,389.01,233.40,Aetna,Commercial,,389.01,29.8,29.8% of Medicare Base rate X weight,389.01,130.54,1159.25,Fee Schedule,29.8
"PHOSPHORUS, BLOOD",84100,CPT,,,,,both,, ,46.87,28.12,Aetna,Commercial,,46.87,29.8,29.8% of Medicare Base rate X weight,46.87,15.73,139.67,Fee Schedule,29.8
"PHOSPHORUS, BLOOD",84100,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"L910235 PHOSPHORUS, URINE",84105,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"PHOSPHORUS, URINE",84105,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"Q442 PHOSPHORUS, URI",84105,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"PORPHOBILINOGEN,QUAN",84110,CPT,,,,,both,, ,630.96,378.57,Aetna,Commercial,,630.96,29.8,29.8% of Medicare Base rate X weight,630.96,211.73,1880.26,Fee Schedule,29.8
PAMG-1 QUALITATIVE,84112,CPT,,,,,both,, ,488.09,292.85,Aetna,Commercial,,488.09,29.8,29.8% of Medicare Base rate X weight,488.09,163.79,1454.51,Fee Schedule,29.8
L3194 PORPH QT U24,84120,CPT,,,,,both,, ,811.43,486.85,Aetna,Commercial,,811.43,29.8,29.8% of Medicare Base rate X weight,811.43,272.29,2418.06,Fee Schedule,29.8
"PORPHYRINS,UR,QUAN",84120,CPT,,,,,both,, ,811.42,486.85,Aetna,Commercial,,811.42,29.8,29.8% of Medicare Base rate X weight,811.42,272.29,2418.03,Fee Schedule,29.8
POTASSIUM SER PL WB,84132,CPT,,,,,both,, ,47.15,28.29,Aetna,Commercial,,47.15,29.8,29.8% of Medicare Base rate X weight,47.15,15.82,140.51,Fee Schedule,29.8
POTASSIUM SER PL WB,84132,CPT,,,,,both,,,240.26,240.26,Aetna,Commercial,,240.26,29.8,29.8% of Medicare Base rate X weight,240.26,80.62,715.97,Fee Schedule,29.8
POTASSIUM SER PL WB,84132,CPT,,,,,both,, ,240.26,144.15,Aetna,Commercial,,240.26,29.8,29.8% of Medicare Base rate X weight,240.26,80.62,715.97,Fee Schedule,29.8
"L910235 POTASSIUM, URINE",84133,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"POTASSIUM, URINE",84133,CPT,,,,,both,,,345.79,345.79,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"POTASSIUM, URINE",84133,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"Q442 POTASSIUM, URIN",84133,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
PREALBUMIN,84134,CPT,,,,,both,, ,105.25,63.15,Aetna,Commercial,,105.25,29.8,29.8% of Medicare Base rate X weight,105.25,35.32,313.65,Fee Schedule,29.8
PREALBUMIN,84134,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
PREGNENOLONE MS,84140,CPT,,,,,both,, ,164.75,98.85,Aetna,Commercial,,164.75,29.8,29.8% of Medicare Base rate X weight,164.75,55.29,490.96,Fee Schedule,29.8
PREGNENOLONE MS,84140,CPT,,,,,both,, ,164.75,98.85,Aetna,Commercial,,164.75,29.8,29.8% of Medicare Base rate X weight,164.75,55.29,490.96,Fee Schedule,29.8
"PREGNENOLONE,17-OH",84143,CPT,,,,,both,, ,387.89,232.73,Aetna,Commercial,,387.89,29.8,29.8% of Medicare Base rate X weight,387.89,130.16,1155.91,Fee Schedule,29.8
L4317 PROGESTE ECLIA,84144,CPT,,,,,both,, ,1217.28,730.36,Aetna,Commercial,,1217.28,29.8,29.8% of Medicare Base rate X weight,1217.28,408.48,3627.49,Fee Schedule,29.8
L4317 PROGESTE ECLIA,84144,CPT,,,,,both,, ,1217.28,730.36,Aetna,Commercial,,1217.28,29.8,29.8% of Medicare Base rate X weight,1217.28,408.48,3627.49,Fee Schedule,29.8
PROGESTERONE,84144,CPT,,,,,both,, ,62.58,37.54,Aetna,Commercial,,62.58,29.8,29.8% of Medicare Base rate X weight,62.58,21.00,186.49,Fee Schedule,29.8
Q16265 PROCALCIT IFA,84145,CPT,,,,,both,, ,232.11,139.26,Aetna,Commercial,,232.11,29.8,29.8% of Medicare Base rate X weight,232.11,77.89,691.69,Fee Schedule,29.8
Q16265 PROCALCIT IFA,84145,CPT,,,,,both,, ,232.11,139.26,Aetna,Commercial,,232.11,29.8,29.8% of Medicare Base rate X weight,232.11,77.89,691.69,Fee Schedule,29.8
L4465 PROLACTI ECLIA,84146,CPT,,,,,both,, ,628.30,376.98,Aetna,Commercial,,628.30,29.8,29.8% of Medicare Base rate X weight,628.30,210.84,1872.33,Fee Schedule,29.8
PROLACTIN,84146,CPT,,,,,both,, ,143.14,85.88,Aetna,Commercial,,143.14,29.8,29.8% of Medicare Base rate X weight,143.14,48.03,426.56,Fee Schedule,29.8
PROLACTIN,84146,CPT,,,,,both,, ,1077.50,646.50,Aetna,Commercial,,1077.50,29.8,29.8% of Medicare Base rate X weight,1077.50,361.58,3210.95,Fee Schedule,29.8
Q16122 PROLACTIN,84146,CPT,,,,,both,, ,959.75,575.85,Aetna,Commercial,,959.75,29.8,29.8% of Medicare Base rate X weight,959.75,322.06,2860.06,Fee Schedule,29.8
Q16122 PROLACTIN,84146,CPT,,,,,both,, ,959.75,575.85,Aetna,Commercial,,959.75,29.8,29.8% of Medicare Base rate X weight,959.75,322.06,2860.06,Fee Schedule,29.8
Q93958 23BPG UR,84150,CPT,,,,,both,, ,390.13,234.07,Aetna,Commercial,,390.13,29.8,29.8% of Medicare Base rate X weight,390.13,130.92,1162.59,Fee Schedule,29.8
PSA (prostate specific antigen),84153,CPT,,,,,both,,,1036.25,1036.25,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
"PSA, TOTAL",84153,CPT,,,,,both,, ,135.85,81.51,Aetna,Commercial,,135.85,29.8,29.8% of Medicare Base rate X weight,135.85,45.59,404.83,Fee Schedule,29.8
"Q31348 PSA, TOTAL",84153,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
"Q31348 PSA, TOTAL",84153,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
PSA (prostate specific antigen),84154,CPT,,,,,both,,,1036.25,1036.25,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
"PSA, FREE",84154,CPT,,,,,both,, ,135.85,81.51,Aetna,Commercial,,135.85,29.8,29.8% of Medicare Base rate X weight,135.85,45.59,404.83,Fee Schedule,29.8
"Q31348 PSA, FREE",84154,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
"Q31348 PSA, FREE",84154,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
L121210 PROT TOT SER,84155,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
L121210 PROT TOT SER,84155,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
L121210 PROT TOT SER,84155,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
L121210 PROT TOT SER,84155,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,35.93,21.55,Aetna,Commercial,,35.93,29.8,29.8% of Medicare Base rate X weight,35.93,12.06,107.07,Fee Schedule,29.8
Q38940 PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,374.75,224.85,Aetna,Commercial,,374.75,29.8,29.8% of Medicare Base rate X weight,374.75,125.76,1116.76,Fee Schedule,29.8
PROT TOTL RANDOM URI,84156,CPT,,,,,both,,,420.72,420.72,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
Q8525 PROT TOTL RAND,84156,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
Q8525 PROT TOTL RAND,84156,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
PROTEIN TOT OTHR SRC,84157,CPT,,,,,both,, ,35.93,21.55,Aetna,Commercial,,35.93,29.8,29.8% of Medicare Base rate X weight,35.93,12.06,107.07,Fee Schedule,29.8
Q749 PROT TOT OTH SR,84157,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
L121210 SPE FR QT,84165,CPT,,,,,both,, ,609.34,365.60,Aetna,Commercial,,609.34,29.8,29.8% of Medicare Base rate X weight,609.34,204.48,1815.83,Fee Schedule,29.8
L121210 SPE FR QT,84165,CPT,,,,,both,, ,609.34,365.60,Aetna,Commercial,,609.34,29.8,29.8% of Medicare Base rate X weight,609.34,204.48,1815.83,Fee Schedule,29.8
L121210 SPE FR QT,84165,CPT,,,,,both,, ,609.34,365.60,Aetna,Commercial,,609.34,29.8,29.8% of Medicare Base rate X weight,609.34,204.48,1815.83,Fee Schedule,29.8
L121210 SPE FR QT,84165,CPT,,,,,both,, ,609.34,365.60,Aetna,Commercial,,609.34,29.8,29.8% of Medicare Base rate X weight,609.34,204.48,1815.83,Fee Schedule,29.8
PROTEINELECTR FR-QNT,84165,CPT,,,,,both,, ,105.81,63.48,Aetna,Commercial,,105.81,29.8,29.8% of Medicare Base rate X weight,105.81,35.51,315.31,Fee Schedule,29.8
Q38940 PROTEINELECTR FR QNT,84165,CPT,,,,,both,, ,542.75,325.65,Aetna,Commercial,,542.75,29.8,29.8% of Medicare Base rate X weight,542.75,182.13,1617.4,Fee Schedule,29.8
PROT E-PHOR-URIN-CSF,84166,CPT,,,,,both,, ,429.71,257.82,Aetna,Commercial,,429.71,29.8,29.8% of Medicare Base rate X weight,429.71,144.20,1280.54,Fee Schedule,29.8
Q749 PROT E-PHOR-URI,84166,CPT,,,,,both,, ,429.71,257.82,Aetna,Commercial,,429.71,29.8,29.8% of Medicare Base rate X weight,429.71,144.20,1280.54,Fee Schedule,29.8
Q8525 PROT E-PHOR-UR,84166,CPT,,,,,both,, ,429.71,257.82,Aetna,Commercial,,429.71,29.8,29.8% of Medicare Base rate X weight,429.71,144.20,1280.54,Fee Schedule,29.8
Q94777 WEST BLOT PRB,84182,CPT,,,,,both,, ,136.40,81.84,Aetna,Commercial,,136.40,29.8,29.8% of Medicare Base rate X weight,136.40,45.77,406.47,Fee Schedule,29.8
Q94777 WEST BLOT PRB,84182,CPT,,,,,both,, ,136.40,81.84,Aetna,Commercial,,136.40,29.8,29.8% of Medicare Base rate X weight,136.40,45.77,406.47,Fee Schedule,29.8
Q22996 PROTOPORPH RBC QUAN,84202,CPT,,,,,both,, ,177.50,106.50,Aetna,Commercial,,177.50,29.8,29.8% of Medicare Base rate X weight,177.50,59.56,528.95,Fee Schedule,29.8
Q948 ZPP HEMATOFLUOR,84202,CPT,,,,,both,, ,199.27,119.56,Aetna,Commercial,,199.27,29.8,29.8% of Medicare Base rate X weight,199.27,66.87,593.82,Fee Schedule,29.8
Q948 ZPP HEMATOFLUOR,84202,CPT,,,,,both,, ,199.27,119.56,Aetna,Commercial,,199.27,29.8,29.8% of Medicare Base rate X weight,199.27,66.87,593.82,Fee Schedule,29.8
PROINSULIN,84206,CPT,,,,,both,, ,266.91,160.14,Aetna,Commercial,,266.91,29.8,29.8% of Medicare Base rate X weight,266.91,89.57,795.39,Fee Schedule,29.8
Q760 PROINSULIN IA,84206,CPT,,,,,both,, ,337.09,202.25,Aetna,Commercial,,337.09,29.8,29.8% of Medicare Base rate X weight,337.09,113.12,1004.53,Fee Schedule,29.8
Q926 B6 PL LC/MS/MS,84207,CPT,,,,,both,, ,738.17,442.90,Aetna,Commercial,,738.17,29.8,29.8% of Medicare Base rate X weight,738.17,247.71,2199.75,Fee Schedule,29.8
Q926 B6 PL LC/MS/MS,84207,CPT,,,,,both,, ,738.17,442.90,Aetna,Commercial,,738.17,29.8,29.8% of Medicare Base rate X weight,738.17,247.71,2199.75,Fee Schedule,29.8
PYRUVATE,84210,CPT,,,,,both,, ,1066.84,640.10,Aetna,Commercial,,1066.84,29.8,29.8% of Medicare Base rate X weight,1066.84,358.00,3179.18,Fee Schedule,29.8
Q91031 STFR NEPHELOM,84238,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
Q91031 STFR NEPHELOM,84238,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,326.71,29.8,29.8% of Medicare Base rate X weight,326.71,109.63,973.6,Fee Schedule,29.8
Q16845 RENIN,84244,CPT,,,,,both,, ,475.46,285.27,Aetna,Commercial,,475.46,29.8,29.8% of Medicare Base rate X weight,475.46,159.55,1416.87,Fee Schedule,29.8
Q16845 RENIN,84244,CPT,,,,,both,, ,475.46,285.27,Aetna,Commercial,,475.46,29.8,29.8% of Medicare Base rate X weight,475.46,159.55,1416.87,Fee Schedule,29.8
RENIN,84244,CPT,,,,,both,, ,1487.01,892.20,Aetna,Commercial,,1487.01,29.8,29.8% of Medicare Base rate X weight,1487.01,499.00,4431.29,Fee Schedule,29.8
VITAMIN B-2,84252,CPT,,,,,both,, ,180.75,108.45,Aetna,Commercial,,180.75,29.8,29.8% of Medicare Base rate X weight,180.75,60.65,538.64,Fee Schedule,29.8
Q5507 SELENIUM AS,84255,CPT,,,,,both,, ,409.50,245.70,Aetna,Commercial,,409.50,29.8,29.8% of Medicare Base rate X weight,409.50,137.42,1220.31,Fee Schedule,29.8
Q5507 SELENIUM AS,84255,CPT,,,,,both,, ,409.50,245.70,Aetna,Commercial,,409.50,29.8,29.8% of Medicare Base rate X weight,409.50,137.42,1220.31,Fee Schedule,29.8
SEROTONIN,84260,CPT,,,,,both,, ,94.58,56.74,Aetna,Commercial,,94.58,29.8,29.8% of Medicare Base rate X weight,94.58,31.74,281.85,Fee Schedule,29.8
Q14966 SEX HORM BIND,84270,CPT,,,,,both,, ,288.25,172.95,Aetna,Commercial,,288.25,29.8,29.8% of Medicare Base rate X weight,288.25,96.73,858.99,Fee Schedule,29.8
Q30740 SHBG IA,84270,CPT,,,,,both,, ,288.25,172.95,Aetna,Commercial,,288.25,29.8,29.8% of Medicare Base rate X weight,288.25,96.73,858.99,Fee Schedule,29.8
SEX HORM BIND GLOB,84270,CPT,,,,,both,, ,288.25,172.95,Aetna,Commercial,,288.25,29.8,29.8% of Medicare Base rate X weight,288.25,96.73,858.99,Fee Schedule,29.8
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,, ,47.43,28.45,Aetna,Commercial,,47.43,29.8,29.8% of Medicare Base rate X weight,47.43,15.92,141.34,Fee Schedule,29.8
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,,,345.79,345.79,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"L910235 SODIUM, URINE",84300,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"Q442 SODIUM, URINE R",84300,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,, ,47.99,28.79,Aetna,Commercial,,47.99,29.8,29.8% of Medicare Base rate X weight,47.99,16.10,143.01,Fee Schedule,29.8
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,,,345.79,345.79,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
SODIUM OTHER SOURCE,84302,CPT,,,,,both,, ,82.51,49.50,Aetna,Commercial,,82.51,29.8,29.8% of Medicare Base rate X weight,82.51,27.69,245.88,Fee Schedule,29.8
Q16293 IGF-I LC/MS,84305,CPT,,,,,both,, ,870.37,522.22,Aetna,Commercial,,870.37,29.8,29.8% of Medicare Base rate X weight,870.37,292.07,2593.7,Fee Schedule,29.8
Q16293 IGF-I LC/MS,84305,CPT,,,,,both,, ,870.37,522.22,Aetna,Commercial,,870.37,29.8,29.8% of Medicare Base rate X weight,870.37,292.07,2593.7,Fee Schedule,29.8
ADENO DEAMNASE BFLD,84311,CPT,,,,,both,, ,93.74,56.24,Aetna,Commercial,,93.74,29.8,29.8% of Medicare Base rate X weight,93.74,31.46,279.35,Fee Schedule,29.8
Q175858 CHOLEST PF C,84311,CPT,,,,,both,, ,93.74,56.24,Aetna,Commercial,,93.74,29.8,29.8% of Medicare Base rate X weight,93.74,31.46,279.35,Fee Schedule,29.8
"SPECTROPHOTO, NOS",84311,CPT,,,,,both,, ,93.74,56.24,Aetna,Commercial,,93.74,29.8,29.8% of Medicare Base rate X weight,93.74,31.46,279.35,Fee Schedule,29.8
SPECIFIC GRAVITY,84315,CPT,,,,,both,, ,210.50,126.30,Aetna,Commercial,,210.50,29.8,29.8% of Medicare Base rate X weight,210.50,70.64,627.29,Fee Schedule,29.8
"SUGARS, SING, QUAL",84376,CPT,,,,,both,, ,93.74,56.24,Aetna,Commercial,,93.74,29.8,29.8% of Medicare Base rate X weight,93.74,31.46,279.35,Fee Schedule,29.8
GLYCOMARK,84378,CPT,,,,,both,, ,224.00,134.40,Aetna,Commercial,,224.00,29.8,29.8% of Medicare Base rate X weight,224.00,75.17,667.52,Fee Schedule,29.8
"Q442 SULFATE, URINE",84392,CPT,,,,,both,, ,31.71,19.02,Aetna,Commercial,,31.71,29.8,29.8% of Medicare Base rate X weight,31.71,10.64,94.5,Fee Schedule,29.8
"Q442 SULFATE, URINE",84392,CPT,,,,,both,, ,31.71,19.02,Aetna,Commercial,,31.71,29.8,29.8% of Medicare Base rate X weight,31.71,10.64,94.5,Fee Schedule,29.8
Q18944 TST FREE,84402,CPT,,,,,both,, ,1017.17,610.30,Aetna,Commercial,,1017.17,29.8,29.8% of Medicare Base rate X weight,1017.17,341.33,3031.17,Fee Schedule,29.8
Q36170 TESTOST FREE,84402,CPT,,,,,both,,,1017.17,1017.17,Aetna,Commercial,,1017.17,29.8,29.8% of Medicare Base rate X weight,1017.17,341.33,3031.17,Fee Schedule,29.8
Q36170 TESTOST FREE,84402,CPT,,,,,both,, ,1017.17,610.30,Aetna,Commercial,,1017.17,29.8,29.8% of Medicare Base rate X weight,1017.17,341.33,3031.17,Fee Schedule,29.8
"TESTOSTERONE, FREE",84402,CPT,,,,,both,, ,1017.17,610.30,Aetna,Commercial,,1017.17,29.8,29.8% of Medicare Base rate X weight,1017.17,341.33,3031.17,Fee Schedule,29.8
Q14966 TESTOST TOTAL,84403,CPT,,,,,both,, ,968.60,581.16,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
Q36170 TESTOST TOTAL,84403,CPT,,,,,both,,,968.60,968.60,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
Q36170 TESTOST TOTAL,84403,CPT,,,,,both,, ,968.60,581.16,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
"TESTOSTERONE, TOTAL",84403,CPT,,,,,both,, ,190.86,114.51,Aetna,Commercial,,190.86,29.8,29.8% of Medicare Base rate X weight,190.86,64.05,568.76,Fee Schedule,29.8
"TESTOSTERONE, TOTAL",84403,CPT,,,,,both,, ,968.60,581.16,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
L70282 TEST FR WB T,84410,CPT,,,,,both,, ,211.15,126.69,Aetna,Commercial,,211.15,29.8,29.8% of Medicare Base rate X weight,211.15,70.86,629.23,Fee Schedule,29.8
L121186VITB1 BL HPLC,84425,CPT,,,,,both,, ,1318.66,791.19,Aetna,Commercial,,1318.66,29.8,29.8% of Medicare Base rate X weight,1318.66,442.50,3929.61,Fee Schedule,29.8
Q5042 B1 BL LC/MS/MS,84425,CPT,,,,,both,, ,269.16,161.49,Aetna,Commercial,,269.16,29.8,29.8% of Medicare Base rate X weight,269.16,90.32,802.1,Fee Schedule,29.8
Q90353 VIT B1 LCMSMS,84425,CPT,,,,,both,, ,303.69,182.21,Aetna,Commercial,,303.69,29.8,29.8% of Medicare Base rate X weight,303.69,101.91,905,Fee Schedule,29.8
VITAMIN B-1,84425,CPT,,,,,both,, ,156.89,94.13,Aetna,Commercial,,156.89,29.8,29.8% of Medicare Base rate X weight,156.89,52.65,467.53,Fee Schedule,29.8
VITAMIN B-1,84425,CPT,,,,,both,, ,1437.33,862.39,Aetna,Commercial,,1437.33,29.8,29.8% of Medicare Base rate X weight,1437.33,482.33,4283.24,Fee Schedule,29.8
THIOCYANATE,84430,CPT,,,,,both,, ,174.57,104.74,Aetna,Commercial,,174.57,29.8,29.8% of Medicare Base rate X weight,174.57,58.58,520.22,Fee Schedule,29.8
Q30278 THYROGLOBULIN,84432,CPT,,,,,both,, ,255.13,153.07,Aetna,Commercial,,255.13,29.8,29.8% of Medicare Base rate X weight,255.13,85.61,760.29,Fee Schedule,29.8
Q30278 THYROGLOBULIN,84432,CPT,,,,,both,, ,255.13,153.07,Aetna,Commercial,,255.13,29.8,29.8% of Medicare Base rate X weight,255.13,85.61,760.29,Fee Schedule,29.8
"THYROXINE T4,TOTAL",84436,CPT,,,,,both,, ,38.73,23.23,Aetna,Commercial,,38.73,29.8,29.8% of Medicare Base rate X weight,38.73,13.00,115.42,Fee Schedule,29.8
"THYROXINE T4,TOTAL",84436,CPT,,,,,both,, ,405.57,243.34,Aetna,Commercial,,405.57,29.8,29.8% of Medicare Base rate X weight,405.57,136.10,1208.6,Fee Schedule,29.8
Q35167 T4FREE DED-IA,84439,CPT,,,,,both,, ,620.56,372.33,Aetna,Commercial,,620.56,29.8,29.8% of Medicare Base rate X weight,620.56,208.24,1849.27,Fee Schedule,29.8
Q35167 T4FREE DED-IA,84439,CPT,,,,,both,, ,620.56,372.33,Aetna,Commercial,,620.56,29.8,29.8% of Medicare Base rate X weight,620.56,208.24,1849.27,Fee Schedule,29.8
"THYROXINE T4, FREE",84439,CPT,,,,,both,, ,66.52,39.91,Aetna,Commercial,,66.52,29.8,29.8% of Medicare Base rate X weight,66.52,22.32,198.23,Fee Schedule,29.8
"THYROXINE T4, FREE",84439,CPT,,,,,both,,,620.56,620.56,Aetna,Commercial,,620.56,29.8,29.8% of Medicare Base rate X weight,620.56,208.24,1849.27,Fee Schedule,29.8
L1735 TBG SER ICMA,84442,CPT,,,,,both,, ,195.70,117.42,Aetna,Commercial,,195.70,29.8,29.8% of Medicare Base rate X weight,195.70,65.67,583.19,Fee Schedule,29.8
THYROXINE BIND GLOB,84442,CPT,,,,,both,, ,213.31,127.98,Aetna,Commercial,,213.31,29.8,29.8% of Medicare Base rate X weight,213.31,71.58,635.66,Fee Schedule,29.8
"Blood test, thyroid stimulating hormone (TSH)",84443,CPT,,,,,both,,,737.61,737.61,Aetna,Commercial,,737.61,29.8,29.8% of Medicare Base rate X weight,737.61,247.52,2198.08,Fee Schedule,29.8
Q90123 TSH,84443,CPT,,,,,both,, ,737.61,442.56,Aetna,Commercial,,737.61,29.8,29.8% of Medicare Base rate X weight,737.61,247.52,2198.08,Fee Schedule,29.8
Q90123 TSH,84443,CPT,,,,,both,, ,737.61,442.56,Aetna,Commercial,,737.61,29.8,29.8% of Medicare Base rate X weight,737.61,247.52,2198.08,Fee Schedule,29.8
THYROID STIM TSH,84443,CPT,,,,,both,, ,124.05,74.43,Aetna,Commercial,,124.05,29.8,29.8% of Medicare Base rate X weight,124.05,41.63,369.67,Fee Schedule,29.8
Q30551 TSI IA,84445,CPT,,,,,both,, ,733.12,439.87,Aetna,Commercial,,733.12,29.8,29.8% of Medicare Base rate X weight,733.12,246.01,2184.7,Fee Schedule,29.8
THYROID STIM IMMUNO,84445,CPT,,,,,both,, ,1178.27,706.96,Aetna,Commercial,,1178.27,29.8,29.8% of Medicare Base rate X weight,1178.27,395.39,3511.24,Fee Schedule,29.8
Q931 VIT E HPLC,84446,CPT,,,,,both,, ,227.62,136.57,Aetna,Commercial,,227.62,29.8,29.8% of Medicare Base rate X weight,227.62,76.38,678.31,Fee Schedule,29.8
Q931 VIT E HPLC,84446,CPT,,,,,both,, ,227.62,136.57,Aetna,Commercial,,227.62,29.8,29.8% of Medicare Base rate X weight,227.62,76.38,678.31,Fee Schedule,29.8
L500440 TRANSCORTIN,84449,CPT,,,,,both,, ,180.00,108.00,Aetna,Commercial,,180.00,29.8,29.8% of Medicare Base rate X weight,180.00,60.40,536.4,Fee Schedule,29.8
TRANSFERASE AST,84450,CPT,,,,,both,, ,38.17,22.90,Aetna,Commercial,,38.17,29.8,29.8% of Medicare Base rate X weight,38.17,12.81,113.75,Fee Schedule,29.8
TRANSFERASE AST,84450,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
TRANSFERASE ALT,84460,CPT,,,,,both,, ,39.29,23.57,Aetna,Commercial,,39.29,29.8,29.8% of Medicare Base rate X weight,39.29,13.18,117.08,Fee Schedule,29.8
TRANSFERASE ALT,84460,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
Q891 TRANSFERRI NEPH,84466,CPT,,,,,both,, ,796.55,477.93,Aetna,Commercial,,796.55,29.8,29.8% of Medicare Base rate X weight,796.55,267.30,2373.72,Fee Schedule,29.8
Q891 TRANSFERRI NEPH,84466,CPT,,,,,both,, ,796.55,477.93,Aetna,Commercial,,796.55,29.8,29.8% of Medicare Base rate X weight,796.55,267.30,2373.72,Fee Schedule,29.8
TRANSFERRIN,84466,CPT,,,,,both,, ,94.31,56.58,Aetna,Commercial,,94.31,29.8,29.8% of Medicare Base rate X weight,94.31,31.65,281.04,Fee Schedule,29.8
TRIGLYCERIDES,84478,CPT,,,,,both,, ,39.29,23.57,Aetna,Commercial,,39.29,29.8,29.8% of Medicare Base rate X weight,39.29,13.18,117.08,Fee Schedule,29.8
TRIGLYCERIDES,84478,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
T3-T4 UPTAKE,84479,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,526.26,29.8,29.8% of Medicare Base rate X weight,526.26,176.60,1568.25,Fee Schedule,29.8
"T3,TOTAL",84480,CPT,,,,,both,, ,1039.33,623.59,Aetna,Commercial,,1039.33,29.8,29.8% of Medicare Base rate X weight,1039.33,348.77,3097.2,Fee Schedule,29.8
"T3,FREE",84481,CPT,,,,,both,, ,858.30,514.98,Aetna,Commercial,,858.30,29.8,29.8% of Medicare Base rate X weight,858.30,288.02,2557.73,Fee Schedule,29.8
Q90963 T3 REV LCMSMS,84482,CPT,,,,,both,, ,858.30,514.98,Aetna,Commercial,,858.30,29.8,29.8% of Medicare Base rate X weight,858.30,288.02,2557.73,Fee Schedule,29.8
"T3,REVERSE",84482,CPT,,,,,both,, ,219.20,131.52,Aetna,Commercial,,219.20,29.8,29.8% of Medicare Base rate X weight,219.20,73.56,653.22,Fee Schedule,29.8
"TROPONIN,QNT",84484,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,133.88,29.8,29.8% of Medicare Base rate X weight,133.88,44.93,398.96,Fee Schedule,29.8
"TROPONIN,QNT",84484,CPT,,,,,both,,,713.19,713.19,Aetna,Commercial,,713.19,29.8,29.8% of Medicare Base rate X weight,713.19,239.33,2125.31,Fee Schedule,29.8
"TROPONIN,QNT",84484,CPT,,,,,both,, ,713.19,427.91,Aetna,Commercial,,713.19,29.8,29.8% of Medicare Base rate X weight,713.19,239.33,2125.31,Fee Schedule,29.8
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,, ,29.19,17.51,Aetna,Commercial,,29.19,29.8,29.8% of Medicare Base rate X weight,29.19,9.80,86.99,Fee Schedule,29.8
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,,,277.59,277.59,Aetna,Commercial,,277.59,29.8,29.8% of Medicare Base rate X weight,277.59,93.15,827.22,Fee Schedule,29.8
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,, ,277.59,166.55,Aetna,Commercial,,277.59,29.8,29.8% of Medicare Base rate X weight,277.59,93.15,827.22,Fee Schedule,29.8
"L910235 UREA NITROGEN, URINE",84540,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"L910235 UREA NITROGEN, URINE",84540,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"UREA NITROGEN,URINE",84540,CPT,,,,,both,,,345.79,345.79,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"URIC ACID, BLOOD",84550,CPT,,,,,both,, ,44.34,26.60,Aetna,Commercial,,44.34,29.8,29.8% of Medicare Base rate X weight,44.34,14.88,132.13,Fee Schedule,29.8
"URIC ACID, BLOOD",84550,CPT,,,,,both,,,285.17,285.17,Aetna,Commercial,,285.17,29.8,29.8% of Medicare Base rate X weight,285.17,95.69,849.81,Fee Schedule,29.8
"URIC ACID, BLOOD",84550,CPT,,,,,both,, ,285.17,171.10,Aetna,Commercial,,285.17,29.8,29.8% of Medicare Base rate X weight,285.17,95.69,849.81,Fee Schedule,29.8
"L910235 URIC ACID, URINE",84560,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"Q442 URIC ACID,URINE",84560,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"URIC ACID,URINE RAND",84560,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
L4143 VMA U24 LCMSMS,84585,CPT,,,,,both,, ,355.05,213.03,Aetna,Commercial,,355.05,29.8,29.8% of Medicare Base rate X weight,355.05,119.14,1058.05,Fee Schedule,29.8
L4143 VMA U24 LCMSMS,84585,CPT,,,,,both,, ,355.05,213.03,Aetna,Commercial,,355.05,29.8,29.8% of Medicare Base rate X weight,355.05,119.14,1058.05,Fee Schedule,29.8
VANILLYLMANDELIC ACID (VMA) SERUM,84585,CPT,,,,,both,, ,116.70,70.02,Aetna,Commercial,,116.70,29.8,29.8% of Medicare Base rate X weight,116.70,39.16,347.77,Fee Schedule,29.8
L10397 VIP PL RIA,84586,CPT,,,,,both,, ,338.36,203.01,Aetna,Commercial,,338.36,29.8,29.8% of Medicare Base rate X weight,338.36,113.54,1008.31,Fee Schedule,29.8
VASOINTESTINAL PEP,84586,CPT,,,,,both,, ,368.80,221.28,Aetna,Commercial,,368.80,29.8,29.8% of Medicare Base rate X weight,368.80,123.76,1099.02,Fee Schedule,29.8
Q252 AVP ADH EXT-RIA,84588,CPT,,,,,both,, ,295.83,177.49,Aetna,Commercial,,295.83,29.8,29.8% of Medicare Base rate X weight,295.83,99.27,881.57,Fee Schedule,29.8
Q252 AVP ADH EXT-RIA,84588,CPT,,,,,both,, ,295.83,177.49,Aetna,Commercial,,295.83,29.8,29.8% of Medicare Base rate X weight,295.83,99.27,881.57,Fee Schedule,29.8
Q921 VIT A HPLC,84590,CPT,,,,,both,, ,186.08,111.64,Aetna,Commercial,,186.08,29.8,29.8% of Medicare Base rate X weight,186.08,62.44,554.52,Fee Schedule,29.8
Q921 VIT A HPLC,84590,CPT,,,,,both,, ,186.08,111.64,Aetna,Commercial,,186.08,29.8,29.8% of Medicare Base rate X weight,186.08,62.44,554.52,Fee Schedule,29.8
"VITAMIN ASSAY, NOS",84591,CPT,,,,,both,, ,197.03,118.21,Aetna,Commercial,,197.03,29.8,29.8% of Medicare Base rate X weight,197.03,66.12,587.15,Fee Schedule,29.8
Q36585 VITAM K HPLC,84597,CPT,,,,,both,, ,188.89,113.33,Aetna,Commercial,,188.89,29.8,29.8% of Medicare Base rate X weight,188.89,63.39,562.89,Fee Schedule,29.8
Q36585 VITAM K HPLC,84597,CPT,,,,,both,, ,188.89,113.33,Aetna,Commercial,,188.89,29.8,29.8% of Medicare Base rate X weight,188.89,63.39,562.89,Fee Schedule,29.8
VOLATILES,84600,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,728.07,29.8,29.8% of Medicare Base rate X weight,728.07,244.32,2169.65,Fee Schedule,29.8
XYLOSE ABSORPTION,84620,CPT,,,,,both,, ,1111.47,666.88,Aetna,Commercial,,1111.47,29.8,29.8% of Medicare Base rate X weight,1111.47,372.98,3312.18,Fee Schedule,29.8
Q945 ZN ICP/MS AS,84630,CPT,,,,,both,, ,1081.72,649.03,Aetna,Commercial,,1081.72,29.8,29.8% of Medicare Base rate X weight,1081.72,362.99,3223.53,Fee Schedule,29.8
Q945 ZN ICP/MS AS,84630,CPT,,,,,both,, ,1081.72,649.03,Aetna,Commercial,,1081.72,29.8,29.8% of Medicare Base rate X weight,1081.72,362.99,3223.53,Fee Schedule,29.8
ZINC WHOLE BLOOD,84630,CPT,,,,,both,, ,80.00,48.00,Aetna,Commercial,,80.00,29.8,29.8% of Medicare Base rate X weight,80.00,26.85,238.4,Fee Schedule,29.8
Q372 C-PEPTIDE IA,84681,CPT,,,,,both,, ,898.44,539.06,Aetna,Commercial,,898.44,29.8,29.8% of Medicare Base rate X weight,898.44,301.49,2677.35,Fee Schedule,29.8
Q372 C-PEPTIDE IA,84681,CPT,,,,,both,, ,898.44,539.06,Aetna,Commercial,,898.44,29.8,29.8% of Medicare Base rate X weight,898.44,301.49,2677.35,Fee Schedule,29.8
HCG QUANT,84702,CPT,,,,,both,, ,148.47,89.08,Aetna,Commercial,,148.47,29.8,29.8% of Medicare Base rate X weight,148.47,49.82,442.44,Fee Schedule,29.8
L140450 HCG TUMOR MK,84702,CPT,,,,,both,, ,758.66,455.19,Aetna,Commercial,,758.66,29.8,29.8% of Medicare Base rate X weight,758.66,254.58,2260.81,Fee Schedule,29.8
L140450 HCG TUMOR MK,84702,CPT,,,,,both,, ,758.66,455.19,Aetna,Commercial,,758.66,29.8,29.8% of Medicare Base rate X weight,758.66,254.58,2260.81,Fee Schedule,29.8
"HCG, QUAL",84703,CPT,,,,,both,, ,74.10,44.46,Aetna,Commercial,,74.10,29.8,29.8% of Medicare Base rate X weight,74.10,24.87,220.82,Fee Schedule,29.8
"HCG, QUAL",84703,CPT,,,,,both,,,420.72,420.72,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
"HCG, QUAL",84703,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
CLIN CHEM TEST NOS,84999,CPT,,,,,both,, ,274.50,164.70,Aetna,Commercial,,274.50,29.8,29.8% of Medicare Base rate X weight,274.50,92.11,818.01,Fee Schedule,29.8
L820610Z K FEC,84999,CPT,,,,,both,, ,225.00,135.00,Aetna,Commercial,,225.00,29.8,29.8% of Medicare Base rate X weight,225.00,75.50,670.5,Fee Schedule,29.8
L820610Z K FEC,84999,CPT,,,,,both,, ,225.00,135.00,Aetna,Commercial,,225.00,29.8,29.8% of Medicare Base rate X weight,225.00,75.50,670.5,Fee Schedule,29.8
BLEEDING TIME,85002,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
AUTO DIFF WBC COUNT,85004,CPT,,,,,both,, ,47.99,28.79,Aetna,Commercial,,47.99,29.8,29.8% of Medicare Base rate X weight,47.99,16.10,143.01,Fee Schedule,29.8
AUTO DIFF WBC COUNT,85004,CPT,,,,,both,, ,103.00,61.80,Aetna,Commercial,,103.00,29.8,29.8% of Medicare Base rate X weight,103.00,34.56,306.94,Fee Schedule,29.8
"WBC DIFF, MAN",85007,CPT,,,,,both,, ,33.96,20.37,Aetna,Commercial,,33.96,29.8,29.8% of Medicare Base rate X weight,33.96,11.40,101.2,Fee Schedule,29.8
"WBC DIFF, MAN",85007,CPT,,,,,both,, ,188.33,112.99,Aetna,Commercial,,188.33,29.8,29.8% of Medicare Base rate X weight,188.33,63.20,561.22,Fee Schedule,29.8
BLOOD SMEAR SCAN,85008,CPT,,,,,both,, ,112.55,67.53,Aetna,Commercial,,112.55,29.8,29.8% of Medicare Base rate X weight,112.55,37.77,335.4,Fee Schedule,29.8
"HEMATOCRIT, SPUN",85013,CPT,,,,,both,, ,32.84,19.70,Aetna,Commercial,,32.84,29.8,29.8% of Medicare Base rate X weight,32.84,11.02,97.86,Fee Schedule,29.8
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,, ,13.18,7.90,Aetna,Commercial,,13.18,29.8,29.8% of Medicare Base rate X weight,13.18,4.42,39.28,Fee Schedule,29.8
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,,,262.99,262.99,Aetna,Commercial,,262.99,29.8,29.8% of Medicare Base rate X weight,262.99,88.25,783.71,Fee Schedule,29.8
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,, ,262.99,157.79,Aetna,Commercial,,262.99,29.8,29.8% of Medicare Base rate X weight,262.99,88.25,783.71,Fee Schedule,29.8
HEMOGLOBIN,85018,CPT,,,,,both,, ,13.18,7.90,Aetna,Commercial,,13.18,29.8,29.8% of Medicare Base rate X weight,13.18,4.42,39.28,Fee Schedule,29.8
HEMOGLOBIN,85018,CPT,,,,,both,,,262.99,262.99,Aetna,Commercial,,262.99,29.8,29.8% of Medicare Base rate X weight,262.99,88.25,783.71,Fee Schedule,29.8
HEMOGLOBIN,85018,CPT,,,,,both,, ,262.99,157.79,Aetna,Commercial,,262.99,29.8,29.8% of Medicare Base rate X weight,262.99,88.25,783.71,Fee Schedule,29.8
HEMOGLOBIN,85018,CPT,,,,,both,, ,262.99,157.79,Aetna,Commercial,,262.99,29.8,29.8% of Medicare Base rate X weight,262.99,88.25,783.71,Fee Schedule,29.8
L121003 HEMOGLOBIN,85018,CPT,,,,,both,, ,10.00,6.00,Aetna,Commercial,,10.00,29.8,29.8% of Medicare Base rate X weight,10.00,3.36,29.8,Fee Schedule,29.8
CBC W-PLT AUTO COMPD,85025,CPT,,,,,both,, ,28.90,17.34,Aetna,Commercial,,28.90,29.8,29.8% of Medicare Base rate X weight,28.90,9.70,86.12,Fee Schedule,29.8
CBC W-PLT AUTO COMPD,85025,CPT,,,,,both,, ,428.30,256.98,Aetna,Commercial,,428.30,29.8,29.8% of Medicare Base rate X weight,428.30,143.72,1276.33,Fee Schedule,29.8
"Complete blood cell count, with differential white blood cells, automated",85025,CPT,,,,,both,,,428.30,428.30,Aetna,Commercial,,428.30,29.8,29.8% of Medicare Base rate X weight,428.30,143.72,1276.33,Fee Schedule,29.8
CBC W-PLT,85027,CPT,,,,,both,, ,24.13,14.47,Aetna,Commercial,,24.13,29.8,29.8% of Medicare Base rate X weight,24.13,8.10,71.91,Fee Schedule,29.8
CBC W-PLT,85027,CPT,,,,,both,, ,412.87,247.72,Aetna,Commercial,,412.87,29.8,29.8% of Medicare Base rate X weight,412.87,138.55,1230.35,Fee Schedule,29.8
"Complete blood count, automated",85027,CPT,,,,,both,,,412.87,412.87,Aetna,Commercial,,412.87,29.8,29.8% of Medicare Base rate X weight,412.87,138.55,1230.35,Fee Schedule,29.8
MAN CELL CT ELP,85032,CPT,,,,,both,, ,466.48,279.88,Aetna,Commercial,,466.48,29.8,29.8% of Medicare Base rate X weight,466.48,156.54,1390.11,Fee Schedule,29.8
L1917 RBC COUNT,85041,CPT,,,,,both,, ,6.06,3.63,Aetna,Commercial,,6.06,29.8,29.8% of Medicare Base rate X weight,6.06,2.03,18.06,Fee Schedule,29.8
"RETIC COUNT, MANUAL",85044,CPT,,,,,both,, ,489.78,293.86,Aetna,Commercial,,489.78,29.8,29.8% of Medicare Base rate X weight,489.78,164.36,1459.54,Fee Schedule,29.8
"RETIC COUNT, FLOW",85045,CPT,,,,,both,, ,39.29,23.57,Aetna,Commercial,,39.29,29.8,29.8% of Medicare Base rate X weight,39.29,13.18,117.08,Fee Schedule,29.8
"RETIC COUNT, FLOW",85045,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
WBC COUNT,85048,CPT,,,,,both,, ,16.55,9.93,Aetna,Commercial,,16.55,29.8,29.8% of Medicare Base rate X weight,16.55,5.55,49.32,Fee Schedule,29.8
WBC COUNT,85048,CPT,,,,,both,, ,285.17,171.10,Aetna,Commercial,,285.17,29.8,29.8% of Medicare Base rate X weight,285.17,95.69,849.81,Fee Schedule,29.8
CBC-PLT AUTORP CDM,85049,CPT,,,,,both,, ,16.55,9.93,Aetna,Commercial,,16.55,29.8,29.8% of Medicare Base rate X weight,16.55,5.55,49.32,Fee Schedule,29.8
CBC-PLT AUTORP CDM,85049,CPT,,,,,both,, ,285.17,171.10,Aetna,Commercial,,285.17,29.8,29.8% of Medicare Base rate X weight,285.17,95.69,849.81,Fee Schedule,29.8
BONE MARROW INTERPRE,85097,CPT,,,,,both,, ,237.17,142.30,Aetna,Commercial,,237.17,29.8,29.8% of Medicare Base rate X weight,237.17,79.59,706.77,Fee Schedule,29.8
APIXABAN ANTI-XA,85130,CPT,,,,,both,, ,250.00,150.00,Aetna,Commercial,,250.00,29.8,29.8% of Medicare Base rate X weight,250.00,83.89,745,Fee Schedule,29.8
Q331 FACT II ACT PCD,85210,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,74.93,29.8,29.8% of Medicare Base rate X weight,74.93,25.14,223.29,Fee Schedule,29.8
FACTOR V ASSAY,85220,CPT,,,,,both,, ,121.53,72.91,Aetna,Commercial,,121.53,29.8,29.8% of Medicare Base rate X weight,121.53,40.78,362.16,Fee Schedule,29.8
L86249 FACT V ACT CD,85220,CPT,,,,,both,, ,121.53,72.91,Aetna,Commercial,,121.53,29.8,29.8% of Medicare Base rate X weight,121.53,40.78,362.16,Fee Schedule,29.8
Q344 FACT V CLOT PCD,85220,CPT,,,,,both,, ,121.53,72.91,Aetna,Commercial,,121.53,29.8,29.8% of Medicare Base rate X weight,121.53,40.78,362.16,Fee Schedule,29.8
L800599FACTVII ACT C,85230,CPT,,,,,both,, ,335.69,201.41,Aetna,Commercial,,335.69,29.8,29.8% of Medicare Base rate X weight,335.69,112.65,1000.36,Fee Schedule,29.8
L800599FACTVII ACT C,85230,CPT,,,,,both,, ,335.69,201.41,Aetna,Commercial,,335.69,29.8,29.8% of Medicare Base rate X weight,335.69,112.65,1000.36,Fee Schedule,29.8
"FACTOR VIII, AHG",85240,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,728.07,29.8,29.8% of Medicare Base rate X weight,728.07,244.32,2169.65,Fee Schedule,29.8
L503333 FAC8 AHG,85240,CPT,,,,,both,, ,706.86,424.11,Aetna,Commercial,,706.86,29.8,29.8% of Medicare Base rate X weight,706.86,237.20,2106.44,Fee Schedule,29.8
FACTOR VIII RISTOCET,85245,CPT,,,,,both,, ,1352.01,811.20,Aetna,Commercial,,1352.01,29.8,29.8% of Medicare Base rate X weight,1352.01,453.69,4028.99,Fee Schedule,29.8
L164509 VWF ACTIV PA,85245,CPT,,,,,both,, ,412.00,247.20,Aetna,Commercial,,412.00,29.8,29.8% of Medicare Base rate X weight,412.00,138.26,1227.76,Fee Schedule,29.8
Q4919 VWF AG ITA,85246,CPT,,,,,both,, ,1164.52,698.71,Aetna,Commercial,,1164.52,29.8,29.8% of Medicare Base rate X weight,1164.52,390.78,3470.27,Fee Schedule,29.8
Q4919 VWF AG ITA,85246,CPT,,,,,both,, ,1164.52,698.71,Aetna,Commercial,,1164.52,29.8,29.8% of Medicare Base rate X weight,1164.52,390.78,3470.27,Fee Schedule,29.8
"FACT VIII,VW,MULTIME",85247,CPT,,,,,both,, ,181.59,108.95,Aetna,Commercial,,181.59,29.8,29.8% of Medicare Base rate X weight,181.59,60.94,541.14,Fee Schedule,29.8
FACTOR IX,85250,CPT,,,,,both,, ,151.56,90.93,Aetna,Commercial,,151.56,29.8,29.8% of Medicare Base rate X weight,151.56,50.86,451.65,Fee Schedule,29.8
FACTOR X,85260,CPT,,,,,both,, ,142.58,85.54,Aetna,Commercial,,142.58,29.8,29.8% of Medicare Base rate X weight,142.58,47.85,424.89,Fee Schedule,29.8
FACTOR XI,85270,CPT,,,,,both,, ,142.58,85.54,Aetna,Commercial,,142.58,29.8,29.8% of Medicare Base rate X weight,142.58,47.85,424.89,Fee Schedule,29.8
ANTITHROMBIN IIIACTI,85300,CPT,,,,,both,, ,1930.76,1158.45,Aetna,Commercial,,1930.76,29.8,29.8% of Medicare Base rate X weight,1930.76,647.91,5753.66,Fee Schedule,29.8
L015040 ANTITHROMBIN ACTIVITY,85300,CPT,,,,,both,, ,965.23,579.13,Aetna,Commercial,,965.23,29.8,29.8% of Medicare Base rate X weight,965.23,323.90,2876.39,Fee Schedule,29.8
Q5158 ATIII AG FRNEP,85301,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,72.13,29.8,29.8% of Medicare Base rate X weight,72.13,24.20,214.95,Fee Schedule,29.8
"PROTEIN C, AG",85302,CPT,,,,,both,, ,1907.47,1144.48,Aetna,Commercial,,1907.47,29.8,29.8% of Medicare Base rate X weight,1907.47,640.09,5684.26,Fee Schedule,29.8
Q4948 PROT C AG IA,85302,CPT,,,,,both,, ,1942.55,1165.53,Aetna,Commercial,,1942.55,29.8,29.8% of Medicare Base rate X weight,1942.55,651.86,5788.8,Fee Schedule,29.8
Q1777 PROT C ACT,85303,CPT,,,,,both,, ,1261.35,756.81,Aetna,Commercial,,1261.35,29.8,29.8% of Medicare Base rate X weight,1261.35,423.27,3758.82,Fee Schedule,29.8
Q1777 PROT C ACT,85303,CPT,,,,,both,, ,1261.35,756.81,Aetna,Commercial,,1261.35,29.8,29.8% of Medicare Base rate X weight,1261.35,423.27,3758.82,Fee Schedule,29.8
"Q7942 PROTEIN C, ACT",85303,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
L117754 PROT S TOT,85305,CPT,,,,,both,, ,116.10,69.66,Aetna,Commercial,,116.10,29.8,29.8% of Medicare Base rate X weight,116.10,38.96,345.98,Fee Schedule,29.8
Q5165 PROT S AG ITA,85305,CPT,,,,,both,, ,1261.35,756.81,Aetna,Commercial,,1261.35,29.8,29.8% of Medicare Base rate X weight,1261.35,423.27,3758.82,Fee Schedule,29.8
Q5165 PROT S AG ITA,85305,CPT,,,,,both,, ,1261.35,756.81,Aetna,Commercial,,1261.35,29.8,29.8% of Medicare Base rate X weight,1261.35,423.27,3758.82,Fee Schedule,29.8
L117754 PROT S FREE,85306,CPT,,,,,both,, ,153.20,91.92,Aetna,Commercial,,153.20,29.8,29.8% of Medicare Base rate X weight,153.20,51.41,456.54,Fee Schedule,29.8
"PROTEIN S, FREE",85306,CPT,,,,,both,, ,151.00,90.60,Aetna,Commercial,,151.00,29.8,29.8% of Medicare Base rate X weight,151.00,50.67,449.98,Fee Schedule,29.8
"PROTEIN S, FREE",85306,CPT,,,,,both,, ,939.98,563.98,Aetna,Commercial,,939.98,29.8,29.8% of Medicare Base rate X weight,939.98,315.43,2801.14,Fee Schedule,29.8
Q10170 PROT S AG ITA,85306,CPT,,,,,both,, ,939.98,563.98,Aetna,Commercial,,939.98,29.8,29.8% of Medicare Base rate X weight,939.98,315.43,2801.14,Fee Schedule,29.8
Q1779 PROT S ACT,85306,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
"Q7942 PROTEIN S, FRE",85306,CPT,,,,,both,, ,939.98,563.98,Aetna,Commercial,,939.98,29.8,29.8% of Medicare Base rate X weight,939.98,315.43,2801.14,Fee Schedule,29.8
PROTEIN C ACTIVATED,85307,CPT,,,,,both,, ,239.69,143.81,Aetna,Commercial,,239.69,29.8,29.8% of Medicare Base rate X weight,239.69,80.43,714.28,Fee Schedule,29.8
Q22 APCR RVVT-BSE AS,85307,CPT,,,,,both,, ,596.43,357.85,Aetna,Commercial,,596.43,29.8,29.8% of Medicare Base rate X weight,596.43,200.14,1777.36,Fee Schedule,29.8
SOLUB LIV AG AB(RDL),85316,CPT,,,,,both,, ,567.00,340.20,Aetna,Commercial,,567.00,29.8,29.8% of Medicare Base rate X weight,567.00,190.27,1689.66,Fee Schedule,29.8
COAG TIME ACTIVATED,85347,CPT,,,,,both,, ,167.84,100.70,Aetna,Commercial,,167.84,29.8,29.8% of Medicare Base rate X weight,167.84,56.32,500.16,Fee Schedule,29.8
FDP-FSP AGG SLIDE,85362,CPT,,,,,both,, ,691.58,414.94,Aetna,Commercial,,691.58,29.8,29.8% of Medicare Base rate X weight,691.58,232.07,2060.91,Fee Schedule,29.8
"D-DIMER, QUANT",85379,CPT,,,,,both,, ,100.48,60.28,Aetna,Commercial,,100.48,29.8,29.8% of Medicare Base rate X weight,100.48,33.72,299.43,Fee Schedule,29.8
"D-DIMER, QUANT",85379,CPT,,,,,both,,,886.09,886.09,Aetna,Commercial,,886.09,29.8,29.8% of Medicare Base rate X weight,886.09,297.35,2640.55,Fee Schedule,29.8
"D-DIMER, QUANT",85379,CPT,,,,,both,, ,886.09,531.65,Aetna,Commercial,,886.09,29.8,29.8% of Medicare Base rate X weight,886.09,297.35,2640.55,Fee Schedule,29.8
FIBRINOGEN ACTIVITY,85384,CPT,,,,,both,, ,83.64,50.18,Aetna,Commercial,,83.64,29.8,29.8% of Medicare Base rate X weight,83.64,28.07,249.25,Fee Schedule,29.8
FIBRINOGEN ACTIVITY,85384,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
Q14532 ADAMTS13 IA,85397,CPT,,,,,both,, ,188.05,112.83,Aetna,Commercial,,188.05,29.8,29.8% of Medicare Base rate X weight,188.05,63.10,560.39,Fee Schedule,29.8
Q36555 PAI-1 IA,85415,CPT,,,,,both,, ,222.01,133.20,Aetna,Commercial,,222.01,29.8,29.8% of Medicare Base rate X weight,222.01,74.50,661.59,Fee Schedule,29.8
LSKBFHS FET HGB ST,85460,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,526.26,29.8,29.8% of Medicare Base rate X weight,526.26,176.60,1568.25,Fee Schedule,29.8
LSKBFHS FET HGB ST,85460,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,526.26,29.8,29.8% of Medicare Base rate X weight,526.26,176.60,1568.25,Fee Schedule,29.8
"FETAL HGB, ROSETTE",85461,CPT,,,,,both,, ,349.72,209.83,Aetna,Commercial,,349.72,29.8,29.8% of Medicare Base rate X weight,349.72,117.36,1042.17,Fee Schedule,29.8
HEPARIN ASSAY,85520,CPT,,,,,both,, ,1274.26,764.55,Aetna,Commercial,,1274.26,29.8,29.8% of Medicare Base rate X weight,1274.26,427.60,3797.29,Fee Schedule,29.8
L117101 HEPARIN A-XA,85520,CPT,,,,,both,, ,139.05,83.43,Aetna,Commercial,,139.05,29.8,29.8% of Medicare Base rate X weight,139.05,46.66,414.37,Fee Schedule,29.8
MURAMIDASE,85549,CPT,,,,,both,, ,261.02,156.61,Aetna,Commercial,,261.02,29.8,29.8% of Medicare Base rate X weight,261.02,87.59,777.84,Fee Schedule,29.8
RBC OSMOTIC FRAGW-IN,85557,CPT,,,,,both,, ,450.48,270.28,Aetna,Commercial,,450.48,29.8,29.8% of Medicare Base rate X weight,450.48,151.17,1342.43,Fee Schedule,29.8
PLATELET AGGREGATION,85576,CPT,,,,,both,, ,344.67,206.80,Aetna,Commercial,,344.67,29.8,29.8% of Medicare Base rate X weight,344.67,115.66,1027.12,Fee Schedule,29.8
QRX143590 DRVVT CONF,85597,CPT,,,,,both,, ,160.55,96.33,Aetna,Commercial,,160.55,29.8,29.8% of Medicare Base rate X weight,160.55,53.88,478.44,Fee Schedule,29.8
QRX143590 DRVVT CONF,85597,CPT,,,,,both,, ,160.55,96.33,Aetna,Commercial,,160.55,29.8,29.8% of Medicare Base rate X weight,160.55,53.88,478.44,Fee Schedule,29.8
L117079 HEX PHOS,85598,CPT,,,,,both,, ,179.80,107.88,Aetna,Commercial,,179.80,29.8,29.8% of Medicare Base rate X weight,179.80,60.34,535.8,Fee Schedule,29.8
Q143583HEXA PHSE CD,85598,CPT,,,,,both,, ,153.52,92.11,Aetna,Commercial,,153.52,29.8,29.8% of Medicare Base rate X weight,153.52,51.52,457.49,Fee Schedule,29.8
Q143583HEXA PHSE CD,85598,CPT,,,,,both,, ,153.52,92.11,Aetna,Commercial,,153.52,29.8,29.8% of Medicare Base rate X weight,153.52,51.52,457.49,Fee Schedule,29.8
"Blood test, clotting time",85610,CPT,,,,,both,,,430.27,430.27,Aetna,Commercial,,430.27,29.8,29.8% of Medicare Base rate X weight,430.27,144.39,1282.2,Fee Schedule,29.8
PROTHROMBIN TIME,85610,CPT,,,,,both,, ,14.60,8.76,Aetna,Commercial,,14.60,29.8,29.8% of Medicare Base rate X weight,14.60,4.90,43.51,Fee Schedule,29.8
PROTHROMBIN TIME,85610,CPT,,,,,both,, ,430.27,258.16,Aetna,Commercial,,430.27,29.8,29.8% of Medicare Base rate X weight,430.27,144.39,1282.2,Fee Schedule,29.8
"PROTHROMBIN, SUBSTIT",85611,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,728.07,29.8,29.8% of Medicare Base rate X weight,728.07,244.32,2169.65,Fee Schedule,29.8
Q7079 RUSSELL VIPER,85613,CPT,,,,,both,, ,364.88,218.92,Aetna,Commercial,,364.88,29.8,29.8% of Medicare Base rate X weight,364.88,122.44,1087.34,Fee Schedule,29.8
Q7079 RUSSELL VIPER,85613,CPT,,,,,both,, ,364.88,218.92,Aetna,Commercial,,364.88,29.8,29.8% of Medicare Base rate X weight,364.88,122.44,1087.34,Fee Schedule,29.8
"SED RATE, AUTOMATED",85652,CPT,,,,,both,, ,26.66,15.99,Aetna,Commercial,,26.66,29.8,29.8% of Medicare Base rate X weight,26.66,8.95,79.45,Fee Schedule,29.8
"SED RATE, AUTOMATED",85652,CPT,,,,,both,,,345.79,345.79,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
"SED RATE, AUTOMATED",85652,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
O51226 SICKLE C  SCR,85660,CPT,,,,,both,, ,385.99,231.59,Aetna,Commercial,,385.99,29.8,29.8% of Medicare Base rate X weight,385.99,129.53,1150.25,Fee Schedule,29.8
Q37679 SICKLE CELL SCRN WITH REFLEX HEMO,85660,CPT,,,,,both,, ,374.75,224.85,Aetna,Commercial,,374.75,29.8,29.8% of Medicare Base rate X weight,374.75,125.76,1116.76,Fee Schedule,29.8
Q825 SICKL CL HS SOL,85660,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
Q825 SICKL CL HS SOL,85660,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
Q883 THROMB CLT BCS,85670,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,526.26,29.8,29.8% of Medicare Base rate X weight,526.26,176.60,1568.25,Fee Schedule,29.8
Q883 THROMB CLT BCS,85670,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,526.26,29.8,29.8% of Medicare Base rate X weight,526.26,176.60,1568.25,Fee Schedule,29.8
Coagulation assessment blood test,85730,CPT,,,,,both,,,480.79,480.79,Aetna,Commercial,,480.79,29.8,29.8% of Medicare Base rate X weight,480.79,161.34,1432.75,Fee Schedule,29.8
Q7079 THROMBOPLAST T,85730,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,480.79,29.8,29.8% of Medicare Base rate X weight,480.79,161.34,1432.75,Fee Schedule,29.8
Q7079 THROMBOPLAST T,85730,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,480.79,29.8,29.8% of Medicare Base rate X weight,480.79,161.34,1432.75,Fee Schedule,29.8
THROMBOPLAST TIMEPTT,85730,CPT,,,,,both,, ,58.94,35.36,Aetna,Commercial,,58.94,29.8,29.8% of Medicare Base rate X weight,58.94,19.78,175.64,Fee Schedule,29.8
PTT-LA MIX,85732,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,480.79,29.8,29.8% of Medicare Base rate X weight,480.79,161.34,1432.75,Fee Schedule,29.8
PTT-LA MIX,85732,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,480.79,29.8,29.8% of Medicare Base rate X weight,480.79,161.34,1432.75,Fee Schedule,29.8
VISCOSITY EXAM,85810,CPT,,,,,both,, ,80.27,48.16,Aetna,Commercial,,80.27,29.8,29.8% of Medicare Base rate X weight,80.27,26.94,239.2,Fee Schedule,29.8
Q94609 ALG IGG QT,86001,CPT,,,,,both,, ,66.24,39.74,Aetna,Commercial,,66.24,29.8,29.8% of Medicare Base rate X weight,66.24,22.23,197.4,Fee Schedule,29.8
Q94609 ALG IGG QT,86001,CPT,,,,,both,, ,66.24,39.74,Aetna,Commercial,,66.24,29.8,29.8% of Medicare Base rate X weight,66.24,22.23,197.4,Fee Schedule,29.8
ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,51.36,30.81,Aetna,Commercial,,51.36,29.8,29.8% of Medicare Base rate X weight,51.36,17.23,153.05,Fee Schedule,29.8
ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,148.75,29.8,29.8% of Medicare Base rate X weight,148.75,49.92,443.28,Fee Schedule,29.8
L602635 - ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,148.75,29.8,29.8% of Medicare Base rate X weight,148.75,49.92,443.28,Fee Schedule,29.8
Q10643 ALG IGE QT,86003,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,148.75,29.8,29.8% of Medicare Base rate X weight,148.75,49.92,443.28,Fee Schedule,29.8
Q10659 ALLERGEN IGE,86003,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,148.75,29.8,29.8% of Medicare Base rate X weight,148.75,49.92,443.28,Fee Schedule,29.8
Q10715 ALLERGEN IGE,86003,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,148.75,29.8,29.8% of Medicare Base rate X weight,148.75,49.92,443.28,Fee Schedule,29.8
Q91681 ALLERGEN IGE,86008,CPT,,,,,both,, ,103.29,61.97,Aetna,Commercial,,103.29,29.8,29.8% of Medicare Base rate X weight,103.29,34.66,307.8,Fee Schedule,29.8
Q91681 ALLERGEN IGE,86008,CPT,,,,,both,, ,103.29,61.97,Aetna,Commercial,,103.29,29.8,29.8% of Medicare Base rate X weight,103.29,34.66,307.8,Fee Schedule,29.8
L6643 ASMA ELISA,86015,CPT,,,,,both,, ,702.72,421.63,Aetna,Commercial,,702.72,29.8,29.8% of Medicare Base rate X weight,702.72,235.81,2094.11,Fee Schedule,29.8
Q15043 ACTIN AB EA,86015,CPT,,,,,both,, ,514.48,308.68,Aetna,Commercial,,514.48,29.8,29.8% of Medicare Base rate X weight,514.48,172.64,1533.15,Fee Schedule,29.8
Q36733 WBC AB IDENT,86021,CPT,,,,,both,, ,500.72,300.43,Aetna,Commercial,,500.72,29.8,29.8% of Medicare Base rate X weight,500.72,168.03,1492.15,Fee Schedule,29.8
Q36733 WBC AB IDENT,86021,CPT,,,,,both,, ,500.72,300.43,Aetna,Commercial,,500.72,29.8,29.8% of Medicare Base rate X weight,500.72,168.03,1492.15,Fee Schedule,29.8
Q36733 WBC AB IDENT,86021,CPT,,,,,both,, ,500.72,300.43,Aetna,Commercial,,500.72,29.8,29.8% of Medicare Base rate X weight,500.72,168.03,1492.15,Fee Schedule,29.8
Q36733 WBC AB IDENT,86021,CPT,,,,,both,, ,500.72,300.43,Aetna,Commercial,,500.72,29.8,29.8% of Medicare Base rate X weight,500.72,168.03,1492.15,Fee Schedule,29.8
PLATELET AB,86022,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,871.22,29.8,29.8% of Medicare Base rate X weight,871.22,292.36,2596.24,Fee Schedule,29.8
Q14627SRA UNF RB-14C,86022,CPT,,,,,both,, ,467.88,280.72,Aetna,Commercial,,467.88,29.8,29.8% of Medicare Base rate X weight,467.88,157.01,1394.28,Fee Schedule,29.8
Q14874 PLATELET AB,86022,CPT,,,,,both,, ,467.88,280.72,Aetna,Commercial,,467.88,29.8,29.8% of Medicare Base rate X weight,467.88,157.01,1394.28,Fee Schedule,29.8
Q414 HEP-IND PLAT AB,86022,CPT,,,,,both,, ,467.88,280.72,Aetna,Commercial,,467.88,29.8,29.8% of Medicare Base rate X weight,467.88,157.01,1394.28,Fee Schedule,29.8
Q91740PLATELT IGG FC,86023,CPT,,,,,both,, ,83.08,49.84,Aetna,Commercial,,83.08,29.8,29.8% of Medicare Base rate X weight,83.08,27.88,247.58,Fee Schedule,29.8
L162045 FLUORS AB SC,86036,CPT,,,,,both,, ,486.16,291.69,Aetna,Commercial,,486.16,29.8,29.8% of Medicare Base rate X weight,486.16,163.14,1448.76,Fee Schedule,29.8
Q70171 ANCA SCN IA,86036,CPT,,,,,both,, ,500.72,300.43,Aetna,Commercial,,500.72,29.8,29.8% of Medicare Base rate X weight,500.72,168.03,1492.15,Fee Schedule,29.8
L163061 ANCA TITER,86037,CPT,,,,,both,, ,120.50,72.30,Aetna,Commercial,,120.50,29.8,29.8% of Medicare Base rate X weight,120.50,40.44,359.09,Fee Schedule,29.8
ANA,86038,CPT,,,,,both,, ,91.77,55.06,Aetna,Commercial,,91.77,29.8,29.8% of Medicare Base rate X weight,91.77,30.80,273.47,Fee Schedule,29.8
ANA,86038,CPT,,,,,both,, ,898.44,539.06,Aetna,Commercial,,898.44,29.8,29.8% of Medicare Base rate X weight,898.44,301.49,2677.35,Fee Schedule,29.8
L164947 ANA IFA,86038,CPT,,,,,both,, ,824.26,494.55,Aetna,Commercial,,824.26,29.8,29.8% of Medicare Base rate X weight,824.26,276.60,2456.29,Fee Schedule,29.8
Q16814 ANA IFA REFIA,86038,CPT,,,,,both,,,898.44,898.44,Aetna,Commercial,,898.44,29.8,29.8% of Medicare Base rate X weight,898.44,301.49,2677.35,Fee Schedule,29.8
Q16814 ANA IFA REFIA,86038,CPT,,,,,both,, ,898.44,539.06,Aetna,Commercial,,898.44,29.8,29.8% of Medicare Base rate X weight,898.44,301.49,2677.35,Fee Schedule,29.8
Q249 ANA SCRN IFA,86038,CPT,,,,,both,, ,898.44,539.06,Aetna,Commercial,,898.44,29.8,29.8% of Medicare Base rate X weight,898.44,301.49,2677.35,Fee Schedule,29.8
"ANA,TITER",86039,CPT,,,,,both,, ,93.46,56.07,Aetna,Commercial,,93.46,29.8,29.8% of Medicare Base rate X weight,93.46,31.36,278.51,Fee Schedule,29.8
QRX ANA TITER PATTRN,86039,CPT,,,,,both,, ,547.31,328.38,Aetna,Commercial,,547.31,29.8,29.8% of Medicare Base rate X weight,547.31,183.66,1630.98,Fee Schedule,29.8
QRX ANA TITER PATTRN,86039,CPT,,,,,both,, ,547.31,328.38,Aetna,Commercial,,547.31,29.8,29.8% of Medicare Base rate X weight,547.31,183.66,1630.98,Fee Schedule,29.8
ACETYLCH RCPT BND AB,86041,CPT,,,,,both,, ,55.20,33.12,Aetna,Commercial,,55.20,29.8,29.8% of Medicare Base rate X weight,55.20,18.52,164.5,Fee Schedule,29.8
ACETYLC RCPT BLCK AB,86042,CPT,,,,,both,, ,55.20,33.12,Aetna,Commercial,,55.20,29.8,29.8% of Medicare Base rate X weight,55.20,18.52,164.5,Fee Schedule,29.8
ACTYLC RCPT MODL AB,86043,CPT,,,,,both,, ,55.20,33.12,Aetna,Commercial,,55.20,29.8,29.8% of Medicare Base rate X weight,55.20,18.52,164.5,Fee Schedule,29.8
Q38321 AQP4 NMOIGG,86052,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,529.91,29.8,29.8% of Medicare Base rate X weight,529.91,177.82,1579.13,Fee Schedule,29.8
"ASO,TITER",86060,CPT,,,,,both,, ,71.85,43.11,Aetna,Commercial,,71.85,29.8,29.8% of Medicare Base rate X weight,71.85,24.11,214.11,Fee Schedule,29.8
"ASO,TITER",86060,CPT,,,,,both,, ,539.45,323.67,Aetna,Commercial,,539.45,29.8,29.8% of Medicare Base rate X weight,539.45,181.02,1607.56,Fee Schedule,29.8
Q265 ASO AB ITA,86060,CPT,,,,,both,, ,189.17,113.50,Aetna,Commercial,,189.17,29.8,29.8% of Medicare Base rate X weight,189.17,63.48,563.73,Fee Schedule,29.8
PHYS BB SERV TRAN RE,86078,CPT,,,,,both,, ,165.59,99.35,Aetna,Commercial,,165.59,29.8,29.8% of Medicare Base rate X weight,165.59,55.57,493.46,Fee Schedule,29.8
C-REACTIVE PROTEIN,86140,CPT,,,,,both,, ,51.08,30.64,Aetna,Commercial,,51.08,29.8,29.8% of Medicare Base rate X weight,51.08,17.14,152.22,Fee Schedule,29.8
C-REACTIVE PROTEIN,86140,CPT,,,,,both,, ,518.69,311.21,Aetna,Commercial,,518.69,29.8,29.8% of Medicare Base rate X weight,518.69,174.06,1545.7,Fee Schedule,29.8
Q10124 HS-CRP NEPHEL,86141,CPT,,,,,both,, ,999.76,599.85,Aetna,Commercial,,999.76,29.8,29.8% of Medicare Base rate X weight,999.76,335.49,2979.28,Fee Schedule,29.8
Q30340 BETA-2 GLYCOP,86146,CPT,,,,,both,, ,252.04,151.22,Aetna,Commercial,,252.04,29.8,29.8% of Medicare Base rate X weight,252.04,84.58,751.08,Fee Schedule,29.8
Q30340 BETA-2 GLYCOP,86146,CPT,,,,,both,, ,252.04,151.22,Aetna,Commercial,,252.04,29.8,29.8% of Medicare Base rate X weight,252.04,84.58,751.08,Fee Schedule,29.8
Q36552 B2-GPIAB IGA,86146,CPT,,,,,both,, ,252.04,151.22,Aetna,Commercial,,252.04,29.8,29.8% of Medicare Base rate X weight,252.04,84.58,751.08,Fee Schedule,29.8
Q36552 B2-GPIAB IGA,86146,CPT,,,,,both,, ,252.04,151.22,Aetna,Commercial,,252.04,29.8,29.8% of Medicare Base rate X weight,252.04,84.58,751.08,Fee Schedule,29.8
Q36554B-2-GP1 IGG IA,86146,CPT,,,,,both,, ,252.04,151.22,Aetna,Commercial,,252.04,29.8,29.8% of Medicare Base rate X weight,252.04,84.58,751.08,Fee Schedule,29.8
Q36554B-2-GP1 IGG IA,86146,CPT,,,,,both,, ,252.04,151.22,Aetna,Commercial,,252.04,29.8,29.8% of Medicare Base rate X weight,252.04,84.58,751.08,Fee Schedule,29.8
L161950CARDIOLIPIN A,86147,CPT,,,,,both,, ,429.43,257.65,Aetna,Commercial,,429.43,29.8,29.8% of Medicare Base rate X weight,429.43,144.10,1279.7,Fee Schedule,29.8
L161950CARDIOLIPIN A,86147,CPT,,,,,both,, ,429.43,257.65,Aetna,Commercial,,429.43,29.8,29.8% of Medicare Base rate X weight,429.43,144.10,1279.7,Fee Schedule,29.8
Q4661 C-LIPIN AB IGA,86147,CPT,,,,,both,, ,429.43,257.65,Aetna,Commercial,,429.43,29.8,29.8% of Medicare Base rate X weight,429.43,144.10,1279.7,Fee Schedule,29.8
Q4661 C-LIPIN AB IGA,86147,CPT,,,,,both,, ,429.43,257.65,Aetna,Commercial,,429.43,29.8,29.8% of Medicare Base rate X weight,429.43,144.10,1279.7,Fee Schedule,29.8
Q4663 C-LIPIN AB IGM,86147,CPT,,,,,both,, ,429.43,257.65,Aetna,Commercial,,429.43,29.8,29.8% of Medicare Base rate X weight,429.43,144.10,1279.7,Fee Schedule,29.8
Q4663 C-LIPIN AB IGM,86147,CPT,,,,,both,, ,429.43,257.65,Aetna,Commercial,,429.43,29.8,29.8% of Medicare Base rate X weight,429.43,144.10,1279.7,Fee Schedule,29.8
PHOSPHATIDYLSERIN AB,86148,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,141.46,29.8,29.8% of Medicare Base rate X weight,141.46,47.47,421.55,Fee Schedule,29.8
PHOSPHOLIPID AB,86148,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,141.46,29.8,29.8% of Medicare Base rate X weight,141.46,47.47,421.55,Fee Schedule,29.8
Q14890 PHOSPHOLIPID,86148,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,141.46,29.8,29.8% of Medicare Base rate X weight,141.46,47.47,421.55,Fee Schedule,29.8
CELL ENUM IS AND ID,86152,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,72.13,29.8,29.8% of Medicare Base rate X weight,72.13,24.20,214.95,Fee Schedule,29.8
"COLD AGG, TITER",86157,CPT,,,,,both,, ,247.83,148.69,Aetna,Commercial,,247.83,29.8,29.8% of Medicare Base rate X weight,247.83,83.16,738.53,Fee Schedule,29.8
L6353COLD HEMAGGL QT,86157,CPT,,,,,both,, ,40.70,24.42,Aetna,Commercial,,40.70,29.8,29.8% of Medicare Base rate X weight,40.70,13.66,121.29,Fee Schedule,29.8
"COMPLEMENT AG, EA",86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q19882 COMP AG,86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q34888 COMPLE C7 RID,86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q34889 COMPLE C8 RID,86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q351 C3 COMPL ITA,86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q353 C4C COMP ITA,86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q354 COMPLEM C5 RID,86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q433 COMPL CP C2 RID,86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q981 COMPL C C1Q RID,86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q297 C1 INH FUNC IA,86161,CPT,,,,,both,, ,79.99,47.99,Aetna,Commercial,,79.99,29.8,29.8% of Medicare Base rate X weight,79.99,26.84,238.37,Fee Schedule,29.8
Q618 COMPL CH50 LIPO,86162,CPT,,,,,both,, ,984.32,590.59,Aetna,Commercial,,984.32,29.8,29.8% of Medicare Base rate X weight,984.32,330.31,2933.27,Fee Schedule,29.8
Q618 COMPL CH50 LIPO,86162,CPT,,,,,both,, ,984.32,590.59,Aetna,Commercial,,984.32,29.8,29.8% of Medicare Base rate X weight,984.32,330.31,2933.27,Fee Schedule,29.8
Q11173 CCP AB IGG IA,86200,CPT,,,,,both,, ,242.50,145.50,Aetna,Commercial,,242.50,29.8,29.8% of Medicare Base rate X weight,242.50,81.38,722.65,Fee Schedule,29.8
L96286 ADNASE-B NEPH,86215,CPT,,,,,both,, ,198.72,119.23,Aetna,Commercial,,198.72,29.8,29.8% of Medicare Base rate X weight,198.72,66.68,592.19,Fee Schedule,29.8
L96286 ADNASE-B NEPH,86215,CPT,,,,,both,, ,198.72,119.23,Aetna,Commercial,,198.72,29.8,29.8% of Medicare Base rate X weight,198.72,66.68,592.19,Fee Schedule,29.8
"DNA AB,NATIVE-DOUBL",86225,CPT,,,,,both,, ,1077.50,646.50,Aetna,Commercial,,1077.50,29.8,29.8% of Medicare Base rate X weight,1077.50,361.58,3210.95,Fee Schedule,29.8
L165092 DNA DS AB,86225,CPT,,,,,both,, ,486.16,291.69,Aetna,Commercial,,486.16,29.8,29.8% of Medicare Base rate X weight,486.16,163.14,1448.76,Fee Schedule,29.8
L96346 DSDNA AB IA,86225,CPT,,,,,both,, ,219.10,131.46,Aetna,Commercial,,219.10,29.8,29.8% of Medicare Base rate X weight,219.10,73.52,652.92,Fee Schedule,29.8
Q19882 DNA DS AB,86225,CPT,,,,,both,, ,1077.50,646.50,Aetna,Commercial,,1077.50,29.8,29.8% of Medicare Base rate X weight,1077.50,361.58,3210.95,Fee Schedule,29.8
Q255 DNA DS AB IA,86225,CPT,,,,,both,, ,1077.50,646.50,Aetna,Commercial,,1077.50,29.8,29.8% of Medicare Base rate X weight,1077.50,361.58,3210.95,Fee Schedule,29.8
Q14857 SSDNA ANTIBODY (IGG),86226,CPT,,,,,both,, ,923.00,553.80,Aetna,Commercial,,923.00,29.8,29.8% of Medicare Base rate X weight,923.00,309.73,2750.54,Fee Schedule,29.8
Q45972 SSDNA IGG EIA,86226,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
Q45972 SSDNA IGG EIA,86226,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
L165126 ENDMYS AB IG,86231,CPT,,,,,both,, ,60.05,36.03,Aetna,Commercial,,60.05,29.8,29.8% of Medicare Base rate X weight,60.05,20.15,178.95,Fee Schedule,29.8
Q15064 ENDOMYS AB IG,86231,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,529.91,29.8,29.8% of Medicare Base rate X weight,529.91,177.82,1579.13,Fee Schedule,29.8
Q19955 ENDOMYS AB IG,86231,CPT,,,,,both,, ,743.65,446.19,Aetna,Commercial,,743.65,29.8,29.8% of Medicare Base rate X weight,743.65,249.55,2216.08,Fee Schedule,29.8
ANTI-ENA,86235,CPT,,,,,both,, ,174.85,104.91,Aetna,Commercial,,174.85,29.8,29.8% of Medicare Base rate X weight,174.85,58.67,521.05,Fee Schedule,29.8
ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,274.22,29.8,29.8% of Medicare Base rate X weight,274.22,92.02,817.18,Fee Schedule,29.8
L165092 ANTI-ENA,86235,CPT,,,,,both,, ,251.58,150.94,Aetna,Commercial,,251.58,29.8,29.8% of Medicare Base rate X weight,251.58,84.42,749.71,Fee Schedule,29.8
L520085 ANTI-ENS,86235,CPT,,,,,both,, ,548.71,329.22,Aetna,Commercial,,548.71,29.8,29.8% of Medicare Base rate X weight,548.71,184.13,1635.16,Fee Schedule,29.8
L520085 ANTI-ENS,86235,CPT,,,,,both,, ,548.71,329.22,Aetna,Commercial,,548.71,29.8,29.8% of Medicare Base rate X weight,548.71,184.13,1635.16,Fee Schedule,29.8
Q16088 CENTR B AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,274.22,29.8,29.8% of Medicare Base rate X weight,274.22,92.02,817.18,Fee Schedule,29.8
Q171728MI-2 AAB RIPA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,274.22,29.8,29.8% of Medicare Base rate X weight,274.22,92.02,817.18,Fee Schedule,29.8
Q19882 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,274.22,29.8,29.8% of Medicare Base rate X weight,274.22,92.02,817.18,Fee Schedule,29.8
Q19887 RNP AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,274.22,29.8,29.8% of Medicare Base rate X weight,274.22,92.02,817.18,Fee Schedule,29.8
Q34088 CHROMAT AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,274.22,29.8,29.8% of Medicare Base rate X weight,274.22,92.02,817.18,Fee Schedule,29.8
Q37923 SM AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,274.22,29.8,29.8% of Medicare Base rate X weight,274.22,92.02,817.18,Fee Schedule,29.8
Q38568 SS-A IA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,274.22,29.8,29.8% of Medicare Base rate X weight,274.22,92.02,817.18,Fee Schedule,29.8
Q38569 SS-B IA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,274.22,29.8,29.8% of Medicare Base rate X weight,274.22,92.02,817.18,Fee Schedule,29.8
Q4942 SCLEROD AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,274.22,29.8,29.8% of Medicare Base rate X weight,274.22,92.02,817.18,Fee Schedule,29.8
Q5810 JO-1 AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,274.22,29.8,29.8% of Medicare Base rate X weight,274.22,92.02,817.18,Fee Schedule,29.8
Q7448 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,274.22,29.8,29.8% of Medicare Base rate X weight,274.22,92.02,817.18,Fee Schedule,29.8
Q94025 PM-SCL AB EIA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,274.22,29.8,29.8% of Medicare Base rate X weight,274.22,92.02,817.18,Fee Schedule,29.8
Q94685 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,274.22,29.8,29.8% of Medicare Base rate X weight,274.22,92.02,817.18,Fee Schedule,29.8
Q94777 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,274.22,29.8,29.8% of Medicare Base rate X weight,274.22,92.02,817.18,Fee Schedule,29.8
L165126 FLUORS AB SC,86255,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,529.91,29.8,29.8% of Medicare Base rate X weight,529.91,177.82,1579.13,Fee Schedule,29.8
L165126 FLUORS AB SC,86255,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,529.91,29.8,29.8% of Medicare Base rate X weight,529.91,177.82,1579.13,Fee Schedule,29.8
L165126 FLUORS AB SC,86255,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,529.91,29.8,29.8% of Medicare Base rate X weight,529.91,177.82,1579.13,Fee Schedule,29.8
L165126 FLUORS AB SC,86255,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,529.91,29.8,29.8% of Medicare Base rate X weight,529.91,177.82,1579.13,Fee Schedule,29.8
L165620 STRIATIONAL ANTIBODIES,86255,CPT,,,,,both,, ,89.90,53.94,Aetna,Commercial,,89.90,29.8,29.8% of Medicare Base rate X weight,89.90,30.17,267.9,Fee Schedule,29.8
LC505225 ACETYLCHOLINE RECEPT-MODULAT AB,86255,CPT,,,,,both,, ,260.64,156.38,Aetna,Commercial,,260.64,29.8,29.8% of Medicare Base rate X weight,260.64,87.46,776.71,Fee Schedule,29.8
Q37520 RETICU IGA IA,86255,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,529.91,29.8,29.8% of Medicare Base rate X weight,529.91,177.82,1579.13,Fee Schedule,29.8
Q37520 RETICU IGA IA,86255,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,529.91,29.8,29.8% of Medicare Base rate X weight,529.91,177.82,1579.13,Fee Schedule,29.8
Q37520 RETICU IGA IA,86255,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,529.91,29.8,29.8% of Medicare Base rate X weight,529.91,177.82,1579.13,Fee Schedule,29.8
Q37520 RETICU IGA IA,86255,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,529.91,29.8,29.8% of Medicare Base rate X weight,529.91,177.82,1579.13,Fee Schedule,29.8
Q91985 ENDOMYSIAL(IGG)ANTIBODY SCRN TITR,86255,CPT,,,,,both,, ,472.00,283.20,Aetna,Commercial,,472.00,29.8,29.8% of Medicare Base rate X weight,472.00,158.39,1406.56,Fee Schedule,29.8
"FLUORESCENT AB,TITER",86256,CPT,,,,,both,, ,1217.28,730.36,Aetna,Commercial,,1217.28,29.8,29.8% of Medicare Base rate X weight,1217.28,408.48,3627.49,Fee Schedule,29.8
L831723 FLUOR AB TIT,86256,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,529.91,29.8,29.8% of Medicare Base rate X weight,529.91,177.82,1579.13,Fee Schedule,29.8
L831723 FLUOR AB TIT,86256,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,529.91,29.8,29.8% of Medicare Base rate X weight,529.91,177.82,1579.13,Fee Schedule,29.8
L165126 GLIA AB IGA,86258,CPT,,,,,both,, ,57.65,34.59,Aetna,Commercial,,57.65,29.8,29.8% of Medicare Base rate X weight,57.65,19.35,171.8,Fee Schedule,29.8
Q8889 GLIA AB IGG IA,86258,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,765.96,29.8,29.8% of Medicare Base rate X weight,765.96,257.03,2282.56,Fee Schedule,29.8
Q8889 GLIA AB IGG IA,86258,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,765.96,29.8,29.8% of Medicare Base rate X weight,765.96,257.03,2282.56,Fee Schedule,29.8
L143404 CA15-3 ECLIA,86300,CPT,,,,,both,, ,442.13,265.27,Aetna,Commercial,,442.13,29.8,29.8% of Medicare Base rate X weight,442.13,148.37,1317.55,Fee Schedule,29.8
Q29493 CA 27.29 IA,86300,CPT,,,,,both,, ,481.92,289.15,Aetna,Commercial,,481.92,29.8,29.8% of Medicare Base rate X weight,481.92,161.72,1436.12,Fee Schedule,29.8
TUMR AG CA15-3 27-29,86300,CPT,,,,,both,, ,109.46,65.67,Aetna,Commercial,,109.46,29.8,29.8% of Medicare Base rate X weight,109.46,36.73,326.19,Fee Schedule,29.8
Q17638 CA 19-9 PERITONEAL FLUID,86301,CPT,,,,,both,, ,716.75,430.05,Aetna,Commercial,,716.75,29.8,29.8% of Medicare Base rate X weight,716.75,240.52,2135.92,Fee Schedule,29.8
Q4698 CA 19-9 IA,86301,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,804.69,29.8,29.8% of Medicare Base rate X weight,804.69,270.03,2397.98,Fee Schedule,29.8
Q4698 CA 19-9 IA,86301,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,804.69,29.8,29.8% of Medicare Base rate X weight,804.69,270.03,2397.98,Fee Schedule,29.8
Q29256 CA 125 IA,86304,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,804.69,29.8,29.8% of Medicare Base rate X weight,804.69,270.03,2397.98,Fee Schedule,29.8
Q91155 TUMR AG CA125,86304,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,804.69,29.8,29.8% of Medicare Base rate X weight,804.69,270.03,2397.98,Fee Schedule,29.8
TUMOR AG CA 125,86304,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,804.69,29.8,29.8% of Medicare Base rate X weight,804.69,270.03,2397.98,Fee Schedule,29.8
Q91155 HE4,86305,CPT,,,,,both,, ,138.65,83.19,Aetna,Commercial,,138.65,29.8,29.8% of Medicare Base rate X weight,138.65,46.53,413.18,Fee Schedule,29.8
HETEROPHILE AB SCREE,86308,CPT,,,,,both,, ,19.09,11.45,Aetna,Commercial,,19.09,29.8,29.8% of Medicare Base rate X weight,19.09,6.41,56.89,Fee Schedule,29.8
HETEROPHILE AB SCREE,86308,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,480.79,29.8,29.8% of Medicare Base rate X weight,480.79,161.34,1432.75,Fee Schedule,29.8
Q16379 CGA ECLIA,86316,CPT,,,,,both,, ,481.92,289.15,Aetna,Commercial,,481.92,29.8,29.8% of Medicare Base rate X weight,481.92,161.72,1436.12,Fee Schedule,29.8
Q16379 CGA ECLIA,86316,CPT,,,,,both,, ,481.92,289.15,Aetna,Commercial,,481.92,29.8,29.8% of Medicare Base rate X weight,481.92,161.72,1436.12,Fee Schedule,29.8
Q17410 ALPHA-FETOPROTEIN PERITONEAL FLUI,86316,CPT,,,,,both,, ,429.25,257.55,Aetna,Commercial,,429.25,29.8,29.8% of Medicare Base rate X weight,429.25,144.04,1279.17,Fee Schedule,29.8
Q16963 INF AGENT IMM,86317,CPT,,,,,both,, ,217.52,130.51,Aetna,Commercial,,217.52,29.8,29.8% of Medicare Base rate X weight,217.52,72.99,648.21,Fee Schedule,29.8
Q16963 INF AGENT IMM,86317,CPT,,,,,both,, ,217.52,130.51,Aetna,Commercial,,217.52,29.8,29.8% of Medicare Base rate X weight,217.52,72.99,648.21,Fee Schedule,29.8
TETANUS/DIPTHERIA AB,86317,CPT,,,,,both,, ,70.00,42.00,Aetna,Commercial,,70.00,29.8,29.8% of Medicare Base rate X weight,70.00,23.49,208.6,Fee Schedule,29.8
Q15914 C4 BND PL RID,86329,CPT,,,,,both,, ,81.11,48.66,Aetna,Commercial,,81.11,29.8,29.8% of Medicare Base rate X weight,81.11,27.22,241.71,Fee Schedule,29.8
Q14978 IMMUNODI OUCN,86331,CPT,,,,,both,, ,69.04,41.42,Aetna,Commercial,,69.04,29.8,29.8% of Medicare Base rate X weight,69.04,23.17,205.74,Fee Schedule,29.8
Q38940 IMMUNOFIXATION ELECT,86334,CPT,,,,,both,, ,909.75,545.85,Aetna,Commercial,,909.75,29.8,29.8% of Medicare Base rate X weight,909.75,305.29,2711.06,Fee Schedule,29.8
Q549 IFE SERUM,86334,CPT,,,,,both,, ,1021.37,612.82,Aetna,Commercial,,1021.37,29.8,29.8% of Medicare Base rate X weight,1021.37,342.74,3043.68,Fee Schedule,29.8
Q549 IFE SERUM,86334,CPT,,,,,both,, ,1021.37,612.82,Aetna,Commercial,,1021.37,29.8,29.8% of Medicare Base rate X weight,1021.37,342.74,3043.68,Fee Schedule,29.8
IMM E-PHORS-URIN-CSF,86335,CPT,,,,,both,, ,680.07,408.04,Aetna,Commercial,,680.07,29.8,29.8% of Medicare Base rate X weight,680.07,228.21,2026.61,Fee Schedule,29.8
Q10640 B2TF EL-IF,86335,CPT,,,,,both,, ,680.07,408.04,Aetna,Commercial,,680.07,29.8,29.8% of Medicare Base rate X weight,680.07,228.21,2026.61,Fee Schedule,29.8
Q213 IFE U,86335,CPT,,,,,both,, ,680.07,408.04,Aetna,Commercial,,680.07,29.8,29.8% of Medicare Base rate X weight,680.07,228.21,2026.61,Fee Schedule,29.8
INHIBIN A,86336,CPT,,,,,both,, ,145.66,87.39,Aetna,Commercial,,145.66,29.8,29.8% of Medicare Base rate X weight,145.66,48.88,434.07,Fee Schedule,29.8
Q36178 INSUL AAB RBA,86337,CPT,,,,,both,, ,207.41,124.44,Aetna,Commercial,,207.41,29.8,29.8% of Medicare Base rate X weight,207.41,69.60,618.08,Fee Schedule,29.8
Q36178 INSUL AAB RBA,86337,CPT,,,,,both,, ,207.41,124.44,Aetna,Commercial,,207.41,29.8,29.8% of Medicare Base rate X weight,207.41,69.60,618.08,Fee Schedule,29.8
INTRINSIC FACTOR AB,86340,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
L10413 IFB AB ICMA,86340,CPT,,,,,both,, ,50.00,30.00,Aetna,Commercial,,50.00,29.8,29.8% of Medicare Base rate X weight,50.00,16.78,149,Fee Schedule,29.8
ISLET CELL AB,86341,CPT,,,,,both,, ,296.67,178.00,Aetna,Commercial,,296.67,29.8,29.8% of Medicare Base rate X weight,296.67,99.55,884.08,Fee Schedule,29.8
Q34878 GAD-65 AB RBA,86341,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,728.07,29.8,29.8% of Medicare Base rate X weight,728.07,244.32,2169.65,Fee Schedule,29.8
Q36177 IA2 AB,86341,CPT,,,,,both,, ,296.67,178.00,Aetna,Commercial,,296.67,29.8,29.8% of Medicare Base rate X weight,296.67,99.55,884.08,Fee Schedule,29.8
Q36741 ISL CL AB IFA,86341,CPT,,,,,both,, ,296.67,178.00,Aetna,Commercial,,296.67,29.8,29.8% of Medicare Base rate X weight,296.67,99.55,884.08,Fee Schedule,29.8
Q93022 ZINC TRANSPORTER 8 (ZNT8)ANTIBODY,86341,CPT,,,,,both,, ,264.25,158.55,Aetna,Commercial,,264.25,29.8,29.8% of Medicare Base rate X weight,264.25,88.67,787.47,Fee Schedule,29.8
Q90123 LEUK HIST REL,86343,CPT,,,,,both,, ,55.95,33.57,Aetna,Commercial,,55.95,29.8,29.8% of Medicare Base rate X weight,55.95,18.78,166.73,Fee Schedule,29.8
L820022 CHRN URTICAR,86352,CPT,,,,,both,, ,422.30,253.38,Aetna,Commercial,,422.30,29.8,29.8% of Medicare Base rate X weight,422.30,141.71,1258.45,Fee Schedule,29.8
"Q39588 B CELLS, TOTA",86355,CPT,,,,,both,, ,217.52,130.51,Aetna,Commercial,,217.52,29.8,29.8% of Medicare Base rate X weight,217.52,72.99,648.21,Fee Schedule,29.8
Q10981 RITXN SN CD20,86356,CPT,,,,,both,, ,308.74,185.24,Aetna,Commercial,,308.74,29.8,29.8% of Medicare Base rate X weight,308.74,103.60,920.05,Fee Schedule,29.8
Q10981 RITXN SN CD20,86356,CPT,,,,,both,, ,308.74,185.24,Aetna,Commercial,,308.74,29.8,29.8% of Medicare Base rate X weight,308.74,103.60,920.05,Fee Schedule,29.8
Q37088 NK CELLS CF,86357,CPT,,,,,both,, ,217.52,130.51,Aetna,Commercial,,217.52,29.8,29.8% of Medicare Base rate X weight,217.52,72.99,648.21,Fee Schedule,29.8
"Q39588 T CELLS, TOTA",86359,CPT,,,,,both,, ,217.52,130.51,Aetna,Commercial,,217.52,29.8,29.8% of Medicare Base rate X weight,217.52,72.99,648.21,Fee Schedule,29.8
Q7924 LYMPH SUBP4 FC,86360,CPT,,,,,both,, ,1515.65,909.39,Aetna,Commercial,,1515.65,29.8,29.8% of Medicare Base rate X weight,1515.65,508.61,4516.64,Fee Schedule,29.8
Q7924 LYMPH SUBP4 FC,86360,CPT,,,,,both,, ,1515.65,909.39,Aetna,Commercial,,1515.65,29.8,29.8% of Medicare Base rate X weight,1515.65,508.61,4516.64,Fee Schedule,29.8
Q8360 LYMP SUB P5 FC,86361,CPT,,,,,both,, ,822.94,493.76,Aetna,Commercial,,822.94,29.8,29.8% of Medicare Base rate X weight,822.94,276.15,2452.36,Fee Schedule,29.8
"T CELL, ABSO CD4",86361,CPT,,,,,both,, ,878.79,527.27,Aetna,Commercial,,878.79,29.8,29.8% of Medicare Base rate X weight,878.79,294.90,2618.79,Fee Schedule,29.8
Q36952 MOG AB,86362,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,529.91,29.8,29.8% of Medicare Base rate X weight,529.91,177.82,1579.13,Fee Schedule,29.8
L165126TTG AB IGG IA,86364,CPT,,,,,both,, ,57.65,34.59,Aetna,Commercial,,57.65,29.8,29.8% of Medicare Base rate X weight,57.65,19.35,171.8,Fee Schedule,29.8
Q11070 TTG AB IGG IA,86364,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,765.96,29.8,29.8% of Medicare Base rate X weight,765.96,257.03,2282.56,Fee Schedule,29.8
Q11070 TTG AB IGG IA,86364,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,765.96,29.8,29.8% of Medicare Base rate X weight,765.96,257.03,2282.56,Fee Schedule,29.8
L504600 MSCLSPECKINAB,86366,CPT,,,,,both,, ,180.40,108.24,Aetna,Commercial,,180.40,29.8,29.8% of Medicare Base rate X weight,180.40,60.54,537.59,Fee Schedule,29.8
Q90123 MICROSOMAL AB,86376,CPT,,,,,both,, ,682.88,409.72,Aetna,Commercial,,682.88,29.8,29.8% of Medicare Base rate X weight,682.88,229.15,2034.98,Fee Schedule,29.8
Q90123 MICROSOMAL AB,86376,CPT,,,,,both,, ,682.88,409.72,Aetna,Commercial,,682.88,29.8,29.8% of Medicare Base rate X weight,682.88,229.15,2034.98,Fee Schedule,29.8
Q90123 MICROSOMAL AB,86376,CPT,,,,,both,, ,682.88,409.72,Aetna,Commercial,,682.88,29.8,29.8% of Medicare Base rate X weight,682.88,229.15,2034.98,Fee Schedule,29.8
Q90123 MICROSOMAL AB,86376,CPT,,,,,both,, ,682.88,409.72,Aetna,Commercial,,682.88,29.8,29.8% of Medicare Base rate X weight,682.88,229.15,2034.98,Fee Schedule,29.8
Q259 MITO AB IA,86381,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,529.91,29.8,29.8% of Medicare Base rate X weight,529.91,177.82,1579.13,Fee Schedule,29.8
Q30321 MM2AB IGG EIA,86381,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,414.83,29.8,29.8% of Medicare Base rate X weight,414.83,139.20,1236.19,Fee Schedule,29.8
Q94106 NEUT TST VIR,86382,CPT,,,,,both,, ,224.54,134.72,Aetna,Commercial,,224.54,29.8,29.8% of Medicare Base rate X weight,224.54,75.35,669.13,Fee Schedule,29.8
Q94106 NEUT TST VIR,86382,CPT,,,,,both,, ,224.54,134.72,Aetna,Commercial,,224.54,29.8,29.8% of Medicare Base rate X weight,224.54,75.35,669.13,Fee Schedule,29.8
PART AGGLUT.SCREEN,86403,CPT,,,,,both,, ,547.31,328.38,Aetna,Commercial,,547.31,29.8,29.8% of Medicare Base rate X weight,547.31,183.66,1630.98,Fee Schedule,29.8
Q16786 S.PN AG U LA,86403,CPT,,,,,both,, ,172.90,103.74,Aetna,Commercial,,172.90,29.8,29.8% of Medicare Base rate X weight,172.90,58.02,515.24,Fee Schedule,29.8
Q16786 S.PN AG U LA,86403,CPT,,,,,both,, ,172.90,103.74,Aetna,Commercial,,172.90,29.8,29.8% of Medicare Base rate X weight,172.90,58.02,515.24,Fee Schedule,29.8
PART AGGLUT. TITER,86406,CPT,,,,,both,, ,147.91,88.74,Aetna,Commercial,,147.91,29.8,29.8% of Medicare Base rate X weight,147.91,49.63,440.77,Fee Schedule,29.8
Q37521 RA FACT QT,86431,CPT,,,,,both,, ,401.19,240.71,Aetna,Commercial,,401.19,29.8,29.8% of Medicare Base rate X weight,401.19,134.63,1195.55,Fee Schedule,29.8
RHEUMATOID FACT QUAN,86431,CPT,,,,,both,, ,55.85,33.51,Aetna,Commercial,,55.85,29.8,29.8% of Medicare Base rate X weight,55.85,18.74,166.43,Fee Schedule,29.8
RHEUMATOID FACT QUAN,86431,CPT,,,,,both,, ,437.29,262.37,Aetna,Commercial,,437.29,29.8,29.8% of Medicare Base rate X weight,437.29,146.74,1303.12,Fee Schedule,29.8
LRX182877 QTFERON TU,86480,CPT,,,,,both,, ,369.77,221.86,Aetna,Commercial,,369.77,29.8,29.8% of Medicare Base rate X weight,369.77,124.08,1101.91,Fee Schedule,29.8
Q19453 TB GOLD BIO A,86480,CPT,,,,,both,,,403.05,403.05,Aetna,Commercial,,403.05,29.8,29.8% of Medicare Base rate X weight,403.05,135.25,1201.09,Fee Schedule,29.8
Q19453 TB GOLD BIO A,86480,CPT,,,,,both,, ,403.05,241.83,Aetna,Commercial,,403.05,29.8,29.8% of Medicare Base rate X weight,403.05,135.25,1201.09,Fee Schedule,29.8
Q19453 TB GOLD BIO A,86480,CPT,,,,,both,, ,403.05,241.83,Aetna,Commercial,,403.05,29.8,29.8% of Medicare Base rate X weight,403.05,135.25,1201.09,Fee Schedule,29.8
L006099 RFLX RPR,86592,CPT,,,,,both,, ,48.90,29.34,Aetna,Commercial,,48.90,29.8,29.8% of Medicare Base rate X weight,48.90,16.41,145.72,Fee Schedule,29.8
L12005 RPR CHAR FLOC,86592,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
L12005 RPR CHAR FLOC,86592,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
"SYPHILIS TEST, QUAL",86592,CPT,,,,,both,, ,42.10,25.26,Aetna,Commercial,,42.10,29.8,29.8% of Medicare Base rate X weight,42.10,14.13,125.46,Fee Schedule,29.8
L6460 RPR QT CHAR FL,86593,CPT,,,,,both,, ,412.88,247.72,Aetna,Commercial,,412.88,29.8,29.8% of Medicare Base rate X weight,412.88,138.55,1230.38,Fee Schedule,29.8
"SYPHILIS TEST, QUANT",86593,CPT,,,,,both,, ,43.50,26.10,Aetna,Commercial,,43.50,29.8,29.8% of Medicare Base rate X weight,43.50,14.60,129.63,Fee Schedule,29.8
"SYPHILIS TEST, QUANT",86593,CPT,,,,,both,, ,412.87,247.72,Aetna,Commercial,,412.87,29.8,29.8% of Medicare Base rate X weight,412.87,138.55,1230.35,Fee Schedule,29.8
VOLT-GTD CA CHNL AB,86596,CPT,,,,,both,, ,120.50,72.30,Aetna,Commercial,,120.50,29.8,29.8% of Medicare Base rate X weight,120.50,40.44,359.09,Fee Schedule,29.8
Q94609 ASP AB,86606,CPT,,,,,both,, ,145.95,87.57,Aetna,Commercial,,145.95,29.8,29.8% of Medicare Base rate X weight,145.95,48.98,434.93,Fee Schedule,29.8
Q94609 ASP AB,86606,CPT,,,,,both,, ,145.95,87.57,Aetna,Commercial,,145.95,29.8,29.8% of Medicare Base rate X weight,145.95,48.98,434.93,Fee Schedule,29.8
Q34329 LISTERI AB CF,86609,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,770.45,29.8,29.8% of Medicare Base rate X weight,770.45,258.54,2295.94,Fee Schedule,29.8
Q94609 BACTERUIM AB,86609,CPT,,,,,both,, ,154.09,92.45,Aetna,Commercial,,154.09,29.8,29.8% of Medicare Base rate X weight,154.09,51.71,459.19,Fee Schedule,29.8
Q94609 BACTERUIM AB,86609,CPT,,,,,both,, ,154.09,92.45,Aetna,Commercial,,154.09,29.8,29.8% of Medicare Base rate X weight,154.09,51.71,459.19,Fee Schedule,29.8
BARTONELLA AB,86611,CPT,,,,,both,, ,348.32,208.99,Aetna,Commercial,,348.32,29.8,29.8% of Medicare Base rate X weight,348.32,116.89,1037.99,Fee Schedule,29.8
Q34251 BARTONELLA AB,86611,CPT,,,,,both,, ,264.11,158.46,Aetna,Commercial,,264.11,29.8,29.8% of Medicare Base rate X weight,264.11,88.63,787.05,Fee Schedule,29.8
Q932 BLASTOM AB ID S,86612,CPT,,,,,both,, ,600.92,360.55,Aetna,Commercial,,600.92,29.8,29.8% of Medicare Base rate X weight,600.92,201.65,1790.74,Fee Schedule,29.8
Q932 BLASTOM AB ID S,86612,CPT,,,,,both,, ,600.92,360.55,Aetna,Commercial,,600.92,29.8,29.8% of Medicare Base rate X weight,600.92,201.65,1790.74,Fee Schedule,29.8
Q37294 B PERTUS AB,86615,CPT,,,,,both,, ,134.44,80.66,Aetna,Commercial,,134.44,29.8,29.8% of Medicare Base rate X weight,134.44,45.11,400.63,Fee Schedule,29.8
Q37294 B PERTUS AB,86615,CPT,,,,,both,, ,134.44,80.66,Aetna,Commercial,,134.44,29.8,29.8% of Medicare Base rate X weight,134.44,45.11,400.63,Fee Schedule,29.8
Q8593 BORRELIA BURG.,86617,CPT,,,,,both,, ,232.11,139.26,Aetna,Commercial,,232.11,29.8,29.8% of Medicare Base rate X weight,232.11,77.89,691.69,Fee Schedule,29.8
Q8593 BORRELIA BURG.,86617,CPT,,,,,both,, ,232.11,139.26,Aetna,Commercial,,232.11,29.8,29.8% of Medicare Base rate X weight,232.11,77.89,691.69,Fee Schedule,29.8
LYME DISEASE AB,86618,CPT,,,,,both,, ,167.84,100.70,Aetna,Commercial,,167.84,29.8,29.8% of Medicare Base rate X weight,167.84,56.32,500.16,Fee Schedule,29.8
Q6646 LYM AB IGG/IGM,86618,CPT,,,,,both,, ,573.13,343.87,Aetna,Commercial,,573.13,29.8,29.8% of Medicare Base rate X weight,573.13,192.33,1707.93,Fee Schedule,29.8
Q6646 LYM AB IGG/IGM,86618,CPT,,,,,both,, ,573.13,343.87,Aetna,Commercial,,573.13,29.8,29.8% of Medicare Base rate X weight,573.13,192.33,1707.93,Fee Schedule,29.8
BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Aetna,Commercial,,405.29,29.8,29.8% of Medicare Base rate X weight,405.29,136.00,1207.76,Fee Schedule,29.8
Q91068 BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Aetna,Commercial,,405.29,29.8,29.8% of Medicare Base rate X weight,405.29,136.00,1207.76,Fee Schedule,29.8
Q91121 BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Aetna,Commercial,,405.29,29.8,29.8% of Medicare Base rate X weight,405.29,136.00,1207.76,Fee Schedule,29.8
CANDIDA AB,86628,CPT,,,,,both,, ,157.18,94.30,Aetna,Commercial,,157.18,29.8,29.8% of Medicare Base rate X weight,157.18,52.74,468.4,Fee Schedule,29.8
CHLAMYDIA AB,86631,CPT,,,,,both,, ,275.62,165.37,Aetna,Commercial,,275.62,29.8,29.8% of Medicare Base rate X weight,275.62,92.49,821.35,Fee Schedule,29.8
Q38481 C.PNEU AB IGM,86632,CPT,,,,,both,, ,743.51,446.10,Aetna,Commercial,,743.51,29.8,29.8% of Medicare Base rate X weight,743.51,249.50,2215.66,Fee Schedule,29.8
Q5157 C.TRACH AB IGM,86632,CPT,,,,,both,, ,286.57,171.94,Aetna,Commercial,,286.57,29.8,29.8% of Medicare Base rate X weight,286.57,96.16,853.98,Fee Schedule,29.8
Q5157 C.TRACH AB IGM,86632,CPT,,,,,both,, ,286.57,171.94,Aetna,Commercial,,286.57,29.8,29.8% of Medicare Base rate X weight,286.57,96.16,853.98,Fee Schedule,29.8
Q906 COCCIDIO AB CF,86635,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
Q906 COCCIDIO AB CF,86635,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
L806606 Q FEV,86638,CPT,,,,,both,, ,120.00,72.00,Aetna,Commercial,,120.00,29.8,29.8% of Medicare Base rate X weight,120.00,40.27,357.6,Fee Schedule,29.8
Q37071 COXIELLA BRUN,86638,CPT,,,,,both,, ,69.89,41.93,Aetna,Commercial,,69.89,29.8,29.8% of Medicare Base rate X weight,69.89,23.45,208.27,Fee Schedule,29.8
Q30430 CRYPTO AB IFA,86641,CPT,,,,,both,, ,74.65,44.79,Aetna,Commercial,,74.65,29.8,29.8% of Medicare Base rate X weight,74.65,25.05,222.46,Fee Schedule,29.8
L6494 CMV IGG CLIA,86644,CPT,,,,,both,, ,1021.50,612.90,Aetna,Commercial,,1021.50,29.8,29.8% of Medicare Base rate X weight,1021.50,342.79,3044.07,Fee Schedule,29.8
Q403 CMV AB IGG IA,86644,CPT,,,,,both,, ,1113.43,668.05,Aetna,Commercial,,1113.43,29.8,29.8% of Medicare Base rate X weight,1113.43,373.63,3318.02,Fee Schedule,29.8
Q403 CMV AB IGG IA,86644,CPT,,,,,both,, ,1113.43,668.05,Aetna,Commercial,,1113.43,29.8,29.8% of Medicare Base rate X weight,1113.43,373.63,3318.02,Fee Schedule,29.8
"CMV AB, IGM",86645,CPT,,,,,both,, ,1277.07,766.24,Aetna,Commercial,,1277.07,29.8,29.8% of Medicare Base rate X weight,1277.07,428.55,3805.67,Fee Schedule,29.8
Q8503 CMV AB IGM IA,86645,CPT,,,,,both,, ,485.84,291.50,Aetna,Commercial,,485.84,29.8,29.8% of Medicare Base rate X weight,485.84,163.03,1447.8,Fee Schedule,29.8
Q37512 DIPTHTHER AB,86648,CPT,,,,,both,, ,101.32,60.79,Aetna,Commercial,,101.32,29.8,29.8% of Medicare Base rate X weight,101.32,34.00,301.93,Fee Schedule,29.8
ENTEROVIRUS AB,86658,CPT,,,,,both,, ,375.82,225.49,Aetna,Commercial,,375.82,29.8,29.8% of Medicare Base rate X weight,375.82,126.11,1119.94,Fee Schedule,29.8
L830764 ENTEROVIR AB,86658,CPT,,,,,both,, ,212.00,127.20,Aetna,Commercial,,212.00,29.8,29.8% of Medicare Base rate X weight,212.00,71.14,631.76,Fee Schedule,29.8
EBV IGG TO EAD,86663,CPT,,,,,both,, ,210.50,126.30,Aetna,Commercial,,210.50,29.8,29.8% of Medicare Base rate X weight,210.50,70.64,627.29,Fee Schedule,29.8
EBV IGG TO EAD,86663,CPT,,,,,both,, ,210.50,126.30,Aetna,Commercial,,210.50,29.8,29.8% of Medicare Base rate X weight,210.50,70.64,627.29,Fee Schedule,29.8
"Q6421EPST-BARR, EBNA",86664,CPT,,,,,both,, ,362.91,217.74,Aetna,Commercial,,362.91,29.8,29.8% of Medicare Base rate X weight,362.91,121.78,1081.47,Fee Schedule,29.8
"Q6421EPST-BARR, EBNA",86664,CPT,,,,,both,, ,362.91,217.74,Aetna,Commercial,,362.91,29.8,29.8% of Medicare Base rate X weight,362.91,121.78,1081.47,Fee Schedule,29.8
"Q6421EPSTE-BARR, VCA",86665,CPT,,,,,both,, ,362.91,217.74,Aetna,Commercial,,362.91,29.8,29.8% of Medicare Base rate X weight,362.91,121.78,1081.47,Fee Schedule,29.8
"Q6421EPSTE-BARR, VCA",86665,CPT,,,,,both,, ,362.91,217.74,Aetna,Commercial,,362.91,29.8,29.8% of Medicare Base rate X weight,362.91,121.78,1081.47,Fee Schedule,29.8
Q8474 EBV VCA IGG IA,86665,CPT,,,,,both,, ,210.50,126.30,Aetna,Commercial,,210.50,29.8,29.8% of Medicare Base rate X weight,210.50,70.64,627.29,Fee Schedule,29.8
Q8474 EBV VCA IGG IA,86665,CPT,,,,,both,, ,210.50,126.30,Aetna,Commercial,,210.50,29.8,29.8% of Medicare Base rate X weight,210.50,70.64,627.29,Fee Schedule,29.8
Q34271 EHRLICHIA AB,86666,CPT,,,,,both,, ,511.95,307.17,Aetna,Commercial,,511.95,29.8,29.8% of Medicare Base rate X weight,511.95,171.80,1525.61,Fee Schedule,29.8
Q34464 EHRLICHIA AB,86666,CPT,,,,,both,, ,255.98,153.58,Aetna,Commercial,,255.98,29.8,29.8% of Medicare Base rate X weight,255.98,85.90,762.82,Fee Schedule,29.8
Q34464 EHRLICHIA AB,86666,CPT,,,,,both,, ,255.98,153.58,Aetna,Commercial,,255.98,29.8,29.8% of Medicare Base rate X weight,255.98,85.90,762.82,Fee Schedule,29.8
FRANCISELLA TULARENS,86668,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
"FUNGUS AB, NOS",86671,CPT,,,,,both,, ,284.32,170.59,Aetna,Commercial,,284.32,29.8,29.8% of Medicare Base rate X weight,284.32,95.41,847.27,Fee Schedule,29.8
L162045 FUNG AB NOS,86671,CPT,,,,,both,, ,260.85,156.51,Aetna,Commercial,,260.85,29.8,29.8% of Medicare Base rate X weight,260.85,87.53,777.33,Fee Schedule,29.8
Q10295 SCAB IGA IA,86671,CPT,,,,,both,, ,568.64,341.18,Aetna,Commercial,,568.64,29.8,29.8% of Medicare Base rate X weight,568.64,190.82,1694.55,Fee Schedule,29.8
Q10295 SCAB IGA IA,86671,CPT,,,,,both,, ,568.64,341.18,Aetna,Commercial,,568.64,29.8,29.8% of Medicare Base rate X weight,568.64,190.82,1694.55,Fee Schedule,29.8
Q37695 H PYLORI AB Q,86677,CPT,,,,,both,, ,56.69,34.01,Aetna,Commercial,,56.69,29.8,29.8% of Medicare Base rate X weight,56.69,19.02,168.94,Fee Schedule,29.8
L809958 SCHISTO AB G,86682,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,74.93,29.8,29.8% of Medicare Base rate X weight,74.93,25.14,223.29,Fee Schedule,29.8
L809958 SCHISTO AB G,86682,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,74.93,29.8,29.8% of Medicare Base rate X weight,74.93,25.14,223.29,Fee Schedule,29.8
L809958 SCHISTO AB G,86682,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,74.93,29.8,29.8% of Medicare Base rate X weight,74.93,25.14,223.29,Fee Schedule,29.8
L809958 SCHISTO AB G,86682,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,74.93,29.8,29.8% of Medicare Base rate X weight,74.93,25.14,223.29,Fee Schedule,29.8
"HEPATITIS, DELTA AGE",86692,CPT,,,,,both,, ,1381.76,829.05,Aetna,Commercial,,1381.76,29.8,29.8% of Medicare Base rate X weight,1381.76,463.68,4117.64,Fee Schedule,29.8
Q4990 HEP D AB TOTAL,86692,CPT,,,,,both,, ,725.82,435.49,Aetna,Commercial,,725.82,29.8,29.8% of Medicare Base rate X weight,725.82,243.56,2162.94,Fee Schedule,29.8
HERPES SIMP NON-SPEC,86694,CPT,,,,,both,, ,338.21,202.92,Aetna,Commercial,,338.21,29.8,29.8% of Medicare Base rate X weight,338.21,113.49,1007.87,Fee Schedule,29.8
L164806 HSV1/2 IGM,86694,CPT,,,,,both,, ,50.70,30.42,Aetna,Commercial,,50.70,29.8,29.8% of Medicare Base rate X weight,50.70,17.01,151.09,Fee Schedule,29.8
HERPES SIMP TYPE 1,86695,CPT,,,,,both,, ,129.94,77.96,Aetna,Commercial,,129.94,29.8,29.8% of Medicare Base rate X weight,129.94,43.60,387.22,Fee Schedule,29.8
Q90849HERPES SMP TP1,86695,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
Q90849HERPES SMP TP1,86695,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
Q90849HERPES SMP TP1,86695,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
Q90849HERPES SMP TP1,86695,CPT,,,,,both,, ,351.68,211.00,Aetna,Commercial,,351.68,29.8,29.8% of Medicare Base rate X weight,351.68,118.01,1048.01,Fee Schedule,29.8
HERPES SIMP TYPE 2,86696,CPT,,,,,both,, ,190.86,114.51,Aetna,Commercial,,190.86,29.8,29.8% of Medicare Base rate X weight,190.86,64.05,568.76,Fee Schedule,29.8
L163006 HSV2 AB IG,86696,CPT,,,,,both,, ,300.00,180.00,Aetna,Commercial,,300.00,29.8,29.8% of Medicare Base rate X weight,300.00,100.67,894,Fee Schedule,29.8
Q17170 HERPES SIMPLEX VIRUS 2 (IGG),86696,CPT,,,,,both,, ,230.25,138.15,Aetna,Commercial,,230.25,29.8,29.8% of Medicare Base rate X weight,230.25,77.27,686.15,Fee Schedule,29.8
Q90849HERPES SMP TP2,86696,CPT,,,,,both,, ,258.50,155.10,Aetna,Commercial,,258.50,29.8,29.8% of Medicare Base rate X weight,258.50,86.74,770.33,Fee Schedule,29.8
Q90849HERPES SMP TP2,86696,CPT,,,,,both,, ,258.50,155.10,Aetna,Commercial,,258.50,29.8,29.8% of Medicare Base rate X weight,258.50,86.74,770.33,Fee Schedule,29.8
Q90849HERPES SMP TP2,86696,CPT,,,,,both,, ,258.50,155.10,Aetna,Commercial,,258.50,29.8,29.8% of Medicare Base rate X weight,258.50,86.74,770.33,Fee Schedule,29.8
Q90849HERPES SMP TP2,86696,CPT,,,,,both,, ,258.50,155.10,Aetna,Commercial,,258.50,29.8,29.8% of Medicare Base rate X weight,258.50,86.74,770.33,Fee Schedule,29.8
Q938 HISTOPLASMA,86698,CPT,,,,,both,, ,450.48,270.28,Aetna,Commercial,,450.48,29.8,29.8% of Medicare Base rate X weight,450.48,151.17,1342.43,Fee Schedule,29.8
Q938 HISTOPLASMA,86698,CPT,,,,,both,, ,450.48,270.28,Aetna,Commercial,,450.48,29.8,29.8% of Medicare Base rate X weight,450.48,151.17,1342.43,Fee Schedule,29.8
Q501 HBC AB TOT IA,86704,CPT,,,,,both,, ,898.44,539.06,Aetna,Commercial,,898.44,29.8,29.8% of Medicare Base rate X weight,898.44,301.49,2677.35,Fee Schedule,29.8
Q501 HBC AB TOT IA,86704,CPT,,,,,both,, ,898.44,539.06,Aetna,Commercial,,898.44,29.8,29.8% of Medicare Base rate X weight,898.44,301.49,2677.35,Fee Schedule,29.8
"HEP B CORE AB, IGM",86705,CPT,,,,,both,,,1047.19,1047.19,Aetna,Commercial,,1047.19,29.8,29.8% of Medicare Base rate X weight,1047.19,351.41,3120.63,Fee Schedule,29.8
"HEP B CORE AB, IGM",86705,CPT,,,,,both,, ,1047.19,628.31,Aetna,Commercial,,1047.19,29.8,29.8% of Medicare Base rate X weight,1047.19,351.41,3120.63,Fee Schedule,29.8
L16881 HBC IGM ICMA,86705,CPT,,,,,both,, ,70.33,42.19,Aetna,Commercial,,70.33,29.8,29.8% of Medicare Base rate X weight,70.33,23.60,209.58,Fee Schedule,29.8
Q556 HBEAB IA,86707,CPT,,,,,both,, ,999.76,599.85,Aetna,Commercial,,999.76,29.8,29.8% of Medicare Base rate X weight,999.76,335.49,2979.28,Fee Schedule,29.8
Q556 HBEAB IA,86707,CPT,,,,,both,, ,999.76,599.85,Aetna,Commercial,,999.76,29.8,29.8% of Medicare Base rate X weight,999.76,335.49,2979.28,Fee Schedule,29.8
"HEP A AB, TOTAL",86708,CPT,,,,,both,, ,547.88,328.72,Aetna,Commercial,,547.88,29.8,29.8% of Medicare Base rate X weight,547.88,183.85,1632.68,Fee Schedule,29.8
L6726HEPA AB TOT ICM,86708,CPT,,,,,both,, ,547.88,328.72,Aetna,Commercial,,547.88,29.8,29.8% of Medicare Base rate X weight,547.88,183.85,1632.68,Fee Schedule,29.8
Q36504 HEPA AB IGM I,86708,CPT,,,,,both,, ,547.88,328.72,Aetna,Commercial,,547.88,29.8,29.8% of Medicare Base rate X weight,547.88,183.85,1632.68,Fee Schedule,29.8
"HEP A AB, IGM",86709,CPT,,,,,both,,,725.82,725.82,Aetna,Commercial,,725.82,29.8,29.8% of Medicare Base rate X weight,725.82,243.56,2162.94,Fee Schedule,29.8
"HEP A AB, IGM",86709,CPT,,,,,both,, ,725.82,435.49,Aetna,Commercial,,725.82,29.8,29.8% of Medicare Base rate X weight,725.82,243.56,2162.94,Fee Schedule,29.8
L28928 HEP A AB IGM,86709,CPT,,,,,both,, ,70.00,42.00,Aetna,Commercial,,70.00,29.8,29.8% of Medicare Base rate X weight,70.00,23.49,208.6,Fee Schedule,29.8
L28928 HEP A AB IGM,86709,CPT,,,,,both,, ,70.00,42.00,Aetna,Commercial,,70.00,29.8,29.8% of Medicare Base rate X weight,70.00,23.49,208.6,Fee Schedule,29.8
Q7250 INFLUENZA VIRU,86710,CPT,,,,,both,, ,295.83,177.49,Aetna,Commercial,,295.83,29.8,29.8% of Medicare Base rate X weight,295.83,99.27,881.57,Fee Schedule,29.8
Q7250 INFLUENZA VIRU,86710,CPT,,,,,both,, ,295.83,177.49,Aetna,Commercial,,295.83,29.8,29.8% of Medicare Base rate X weight,295.83,99.27,881.57,Fee Schedule,29.8
Q91665 STRAT JCV AB,86711,CPT,,,,,both,, ,156.06,93.63,Aetna,Commercial,,156.06,29.8,29.8% of Medicare Base rate X weight,156.06,52.37,465.06,Fee Schedule,29.8
L164616 LEGIONELL AB,86713,CPT,,,,,both,, ,781.12,468.67,Aetna,Commercial,,781.12,29.8,29.8% of Medicare Base rate X weight,781.12,262.12,2327.74,Fee Schedule,29.8
L819877 LEGIONELL AB,86713,CPT,,,,,both,, ,781.11,468.66,Aetna,Commercial,,781.11,29.8,29.8% of Medicare Base rate X weight,781.11,262.12,2327.71,Fee Schedule,29.8
L819877 LEGIONELL AB,86713,CPT,,,,,both,, ,781.11,468.66,Aetna,Commercial,,781.11,29.8,29.8% of Medicare Base rate X weight,781.11,262.12,2327.71,Fee Schedule,29.8
LEPTOSPIRA AB,86720,CPT,,,,,both,, ,329.51,197.70,Aetna,Commercial,,329.51,29.8,29.8% of Medicare Base rate X weight,329.51,110.57,981.94,Fee Schedule,29.8
L96552MUMPS IGG CLIA,86735,CPT,,,,,both,, ,540.24,324.14,Aetna,Commercial,,540.24,29.8,29.8% of Medicare Base rate X weight,540.24,181.29,1609.92,Fee Schedule,29.8
MUMPS AB,86735,CPT,,,,,both,, ,96.55,57.93,Aetna,Commercial,,96.55,29.8,29.8% of Medicare Base rate X weight,96.55,32.40,287.72,Fee Schedule,29.8
MUMPS AB,86735,CPT,,,,,both,, ,588.85,353.31,Aetna,Commercial,,588.85,29.8,29.8% of Medicare Base rate X weight,588.85,197.60,1754.77,Fee Schedule,29.8
Q36565 MUMPS IGM IFA,86735,CPT,,,,,both,, ,588.85,353.31,Aetna,Commercial,,588.85,29.8,29.8% of Medicare Base rate X weight,588.85,197.60,1754.77,Fee Schedule,29.8
Q8624 MUMPSAB IGG IA,86735,CPT,,,,,both,, ,588.85,353.31,Aetna,Commercial,,588.85,29.8,29.8% of Medicare Base rate X weight,588.85,197.60,1754.77,Fee Schedule,29.8
Q34127 MYCOPLASMA AB,86738,CPT,,,,,both,, ,566.12,339.67,Aetna,Commercial,,566.12,29.8,29.8% of Medicare Base rate X weight,566.12,189.97,1687.04,Fee Schedule,29.8
Q34127 MYCOPLASMA AB,86738,CPT,,,,,both,, ,566.12,339.67,Aetna,Commercial,,566.12,29.8,29.8% of Medicare Base rate X weight,566.12,189.97,1687.04,Fee Schedule,29.8
Q34127 MYCOPLASMA AB,86738,CPT,,,,,both,, ,566.12,339.67,Aetna,Commercial,,566.12,29.8,29.8% of Medicare Base rate X weight,566.12,189.97,1687.04,Fee Schedule,29.8
Q34127 MYCOPLASMA AB,86738,CPT,,,,,both,, ,566.12,339.67,Aetna,Commercial,,566.12,29.8,29.8% of Medicare Base rate X weight,566.12,189.97,1687.04,Fee Schedule,29.8
Q8946 PARVOVIRUS AB,86747,CPT,,,,,both,, ,242.50,145.50,Aetna,Commercial,,242.50,29.8,29.8% of Medicare Base rate X weight,242.50,81.38,722.65,Fee Schedule,29.8
Q8946 PARVOVIRUS AB,86747,CPT,,,,,both,, ,242.50,145.50,Aetna,Commercial,,242.50,29.8,29.8% of Medicare Base rate X weight,242.50,81.38,722.65,Fee Schedule,29.8
Q8946 PARVOVIRUS AB,86747,CPT,,,,,both,, ,242.50,145.50,Aetna,Commercial,,242.50,29.8,29.8% of Medicare Base rate X weight,242.50,81.38,722.65,Fee Schedule,29.8
Q8946 PARVOVIRUS AB,86747,CPT,,,,,both,, ,242.50,145.50,Aetna,Commercial,,242.50,29.8,29.8% of Medicare Base rate X weight,242.50,81.38,722.65,Fee Schedule,29.8
Q34278 ENTAB IGG ELI,86753,CPT,,,,,both,, ,64.27,38.56,Aetna,Commercial,,64.27,29.8,29.8% of Medicare Base rate X weight,64.27,21.57,191.52,Fee Schedule,29.8
Q34300 PROTOZ AB NOS,86753,CPT,,,,,both,, ,64.27,38.56,Aetna,Commercial,,64.27,29.8,29.8% of Medicare Base rate X weight,64.27,21.57,191.52,Fee Schedule,29.8
Q90827 T CRUZI AB IA,86753,CPT,,,,,both,, ,64.27,38.56,Aetna,Commercial,,64.27,29.8,29.8% of Medicare Base rate X weight,64.27,21.57,191.52,Fee Schedule,29.8
L96131 RSV AB QT,86756,CPT,,,,,both,, ,95.00,57.00,Aetna,Commercial,,95.00,29.8,29.8% of Medicare Base rate X weight,95.00,31.88,283.1,Fee Schedule,29.8
Q91121 RICKETTSIA AB,86757,CPT,,,,,both,, ,242.50,145.50,Aetna,Commercial,,242.50,29.8,29.8% of Medicare Base rate X weight,242.50,81.38,722.65,Fee Schedule,29.8
Q91121 RICKETTSIA AB,86757,CPT,,,,,both,, ,242.50,145.50,Aetna,Commercial,,242.50,29.8,29.8% of Medicare Base rate X weight,242.50,81.38,722.65,Fee Schedule,29.8
Q91121 RICKETTSIA AB,86757,CPT,,,,,both,, ,242.50,145.50,Aetna,Commercial,,242.50,29.8,29.8% of Medicare Base rate X weight,242.50,81.38,722.65,Fee Schedule,29.8
Q91121 RICKETTSIA AB,86757,CPT,,,,,both,, ,242.50,145.50,Aetna,Commercial,,242.50,29.8,29.8% of Medicare Base rate X weight,242.50,81.38,722.65,Fee Schedule,29.8
RUBELLA AB,86762,CPT,,,,,both,, ,88.69,53.21,Aetna,Commercial,,88.69,29.8,29.8% of Medicare Base rate X weight,88.69,29.76,264.3,Fee Schedule,29.8
RUBELLA AB,86762,CPT,,,,,both,, ,906.30,543.78,Aetna,Commercial,,906.30,29.8,29.8% of Medicare Base rate X weight,906.30,304.13,2700.77,Fee Schedule,29.8
Q34256 MEASAB IGMIA,86765,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,871.22,29.8,29.8% of Medicare Base rate X weight,871.22,292.36,2596.24,Fee Schedule,29.8
Q964 MEAS AB IGG IA,86765,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,871.22,29.8,29.8% of Medicare Base rate X weight,871.22,292.36,2596.24,Fee Schedule,29.8
RUBEOLA AB,86765,CPT,,,,,both,, ,111.15,66.69,Aetna,Commercial,,111.15,29.8,29.8% of Medicare Base rate X weight,111.15,37.30,331.23,Fee Schedule,29.8
RUBEOLA AB,86765,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,871.22,29.8,29.8% of Medicare Base rate X weight,871.22,292.36,2596.24,Fee Schedule,29.8
Q91121 SALMONELLA AB,86768,CPT,,,,,both,, ,127.70,76.62,Aetna,Commercial,,127.70,29.8,29.8% of Medicare Base rate X weight,127.70,42.85,380.55,Fee Schedule,29.8
Q91121 SALMONELLA AB,86768,CPT,,,,,both,, ,127.70,76.62,Aetna,Commercial,,127.70,29.8,29.8% of Medicare Base rate X weight,127.70,42.85,380.55,Fee Schedule,29.8
L164055 COVID19ABIGG,86769,CPT,,,,,both,, ,206.00,123.60,Aetna,Commercial,,206.00,29.8,29.8% of Medicare Base rate X weight,206.00,69.13,613.88,Fee Schedule,29.8
Q39504 COVID19 ABIGG,86769,CPT,,,,,both,, ,224.54,134.72,Aetna,Commercial,,224.54,29.8,29.8% of Medicare Base rate X weight,224.54,75.35,669.13,Fee Schedule,29.8
Q39504 COVID19 ABIGG,86769,CPT,,,,,both,, ,224.54,134.72,Aetna,Commercial,,224.54,29.8,29.8% of Medicare Base rate X weight,224.54,75.35,669.13,Fee Schedule,29.8
Q4862 TET ATOX ELISA,86774,CPT,,,,,both,, ,98.51,59.10,Aetna,Commercial,,98.51,29.8,29.8% of Medicare Base rate X weight,98.51,33.06,293.56,Fee Schedule,29.8
Q3679 TOXOPLAS AB IA,86777,CPT,,,,,both,, ,247.83,148.69,Aetna,Commercial,,247.83,29.8,29.8% of Medicare Base rate X weight,247.83,83.16,738.53,Fee Schedule,29.8
Q8636 TOXOPLASMA AB,86777,CPT,,,,,both,, ,247.83,148.69,Aetna,Commercial,,247.83,29.8,29.8% of Medicare Base rate X weight,247.83,83.16,738.53,Fee Schedule,29.8
TOXOPLASMA AB,86777,CPT,,,,,both,, ,247.83,148.69,Aetna,Commercial,,247.83,29.8,29.8% of Medicare Base rate X weight,247.83,83.16,738.53,Fee Schedule,29.8
Q8636 TOXOPL AB IGM,86778,CPT,,,,,both,, ,247.83,148.69,Aetna,Commercial,,247.83,29.8,29.8% of Medicare Base rate X weight,247.83,83.16,738.53,Fee Schedule,29.8
Q8636 TOXOPL AB IGM,86778,CPT,,,,,both,, ,247.83,148.69,Aetna,Commercial,,247.83,29.8,29.8% of Medicare Base rate X weight,247.83,83.16,738.53,Fee Schedule,29.8
L082370 TREP AB IA,86780,CPT,,,,,both,, ,132.40,79.44,Aetna,Commercial,,132.40,29.8,29.8% of Medicare Base rate X weight,132.40,44.43,394.55,Fee Schedule,29.8
Q4112 FTA-ABS IFA,86780,CPT,,,,,both,, ,172.90,103.74,Aetna,Commercial,,172.90,29.8,29.8% of Medicare Base rate X weight,172.90,58.02,515.24,Fee Schedule,29.8
Q4112 FTA-ABS IFA,86780,CPT,,,,,both,, ,172.90,103.74,Aetna,Commercial,,172.90,29.8,29.8% of Medicare Base rate X weight,172.90,58.02,515.24,Fee Schedule,29.8
TREPONEMAL AB,86780,CPT,,,,,both,, ,48.90,29.34,Aetna,Commercial,,48.90,29.8,29.8% of Medicare Base rate X weight,48.90,16.41,145.72,Fee Schedule,29.8
L96206 VZV IGG CLIA,86787,CPT,,,,,both,, ,831.47,498.88,Aetna,Commercial,,831.47,29.8,29.8% of Medicare Base rate X weight,831.47,279.02,2477.78,Fee Schedule,29.8
Q4439 VZV AB IGG IA,86787,CPT,,,,,both,, ,906.30,543.78,Aetna,Commercial,,906.30,29.8,29.8% of Medicare Base rate X weight,906.30,304.13,2700.77,Fee Schedule,29.8
Q8683 VZV AB IGM IA,86787,CPT,,,,,both,, ,906.30,543.78,Aetna,Commercial,,906.30,29.8,29.8% of Medicare Base rate X weight,906.30,304.13,2700.77,Fee Schedule,29.8
VARICELLA-ZOSTER AB,86787,CPT,,,,,both,, ,111.15,66.69,Aetna,Commercial,,111.15,29.8,29.8% of Medicare Base rate X weight,111.15,37.30,331.23,Fee Schedule,29.8
VARICELLA-ZOSTER AB,86787,CPT,,,,,both,, ,906.30,543.78,Aetna,Commercial,,906.30,29.8,29.8% of Medicare Base rate X weight,906.30,304.13,2700.77,Fee Schedule,29.8
Q16012 WNVAB IGM EIA,86788,CPT,,,,,both,, ,252.61,151.56,Aetna,Commercial,,252.61,29.8,29.8% of Medicare Base rate X weight,252.61,84.77,752.78,Fee Schedule,29.8
Q36596 WEST NILE VIR,86788,CPT,,,,,both,, ,252.61,151.56,Aetna,Commercial,,252.61,29.8,29.8% of Medicare Base rate X weight,252.61,84.77,752.78,Fee Schedule,29.8
WEST NILE VIR AB IGM,86788,CPT,,,,,both,, ,252.61,151.56,Aetna,Commercial,,252.61,29.8,29.8% of Medicare Base rate X weight,252.61,84.77,752.78,Fee Schedule,29.8
Q36596 WEST NILE VIR,86789,CPT,,,,,both,, ,219.20,131.52,Aetna,Commercial,,219.20,29.8,29.8% of Medicare Base rate X weight,219.20,73.56,653.22,Fee Schedule,29.8
WEST NILE VIR AB,86789,CPT,,,,,both,, ,215.84,129.50,Aetna,Commercial,,215.84,29.8,29.8% of Medicare Base rate X weight,215.84,72.43,643.2,Fee Schedule,29.8
L878033 HHV-7 IGM IF,86790,CPT,,,,,both,, ,615.00,369.00,Aetna,Commercial,,615.00,29.8,29.8% of Medicare Base rate X weight,615.00,206.38,1832.7,Fee Schedule,29.8
"Q15085 VIRUS AB, NOS",86790,CPT,,,,,both,, ,124.90,74.94,Aetna,Commercial,,124.90,29.8,29.8% of Medicare Base rate X weight,124.90,41.91,372.2,Fee Schedule,29.8
"Q15085 VIRUS AB, NOS",86790,CPT,,,,,both,, ,124.90,74.94,Aetna,Commercial,,124.90,29.8,29.8% of Medicare Base rate X weight,124.90,41.91,372.2,Fee Schedule,29.8
Q94264 ZIKA AB IGM,86794,CPT,,,,,both,, ,97.11,58.26,Aetna,Commercial,,97.11,29.8,29.8% of Medicare Base rate X weight,97.11,32.59,289.39,Fee Schedule,29.8
Q90123 TG AB,86800,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,751.36,29.8,29.8% of Medicare Base rate X weight,751.36,252.13,2239.05,Fee Schedule,29.8
Q90123 TG AB,86800,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,751.36,29.8,29.8% of Medicare Base rate X weight,751.36,252.13,2239.05,Fee Schedule,29.8
Q90123 TG AB,86800,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,751.36,29.8,29.8% of Medicare Base rate X weight,751.36,252.13,2239.05,Fee Schedule,29.8
Q90123 TG AB,86800,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,751.36,29.8,29.8% of Medicare Base rate X weight,751.36,252.13,2239.05,Fee Schedule,29.8
Q90814 THYROID CANCER (THYROGLOBULIN)MON,86800,CPT,,,,,both,, ,669.25,401.55,Aetna,Commercial,,669.25,29.8,29.8% of Medicare Base rate X weight,669.25,224.58,1994.37,Fee Schedule,29.8
HEPATITIS C AB TEST,86803,CPT,,,,,both,, ,698.32,418.99,Aetna,Commercial,,698.32,29.8,29.8% of Medicare Base rate X weight,698.32,234.34,2080.99,Fee Schedule,29.8
"HEP C AB TEST,CONFIR",86804,CPT,,,,,both,, ,358.42,215.05,Aetna,Commercial,,358.42,29.8,29.8% of Medicare Base rate X weight,358.42,120.28,1068.09,Fee Schedule,29.8
CYTOTOXIC REACTIVE AB SCREEN/STANDARD,86807,CPT,,,,,both,, ,87.00,52.20,Aetna,Commercial,,87.00,29.8,29.8% of Medicare Base rate X weight,87.00,29.19,259.26,Fee Schedule,29.8
Q528 HLA-B27 AG FC,86812,CPT,,,,,both,, ,1449.41,869.64,Aetna,Commercial,,1449.41,29.8,29.8% of Medicare Base rate X weight,1449.41,486.38,4319.24,Fee Schedule,29.8
Q528 HLA-B27 AG FC,86812,CPT,,,,,both,, ,1449.41,869.64,Aetna,Commercial,,1449.41,29.8,29.8% of Medicare Base rate X weight,1449.41,486.38,4319.24,Fee Schedule,29.8
HLA SOLID PHASE/CALSS I&II AB QUAL,86828,CPT,,,,,both,, ,70.00,42.00,Aetna,Commercial,,70.00,29.8,29.8% of Medicare Base rate X weight,70.00,23.49,208.6,Fee Schedule,29.8
HLA SOLID PHASE/CLASS 1 AB QUAL HIGHDEF,86832,CPT,,,,,both,, ,356.00,213.60,Aetna,Commercial,,356.00,29.8,29.8% of Medicare Base rate X weight,356.00,119.46,1060.88,Fee Schedule,29.8
L117065 PROTH AB IGG,86849,CPT,,,,,both,, ,157.00,94.20,Aetna,Commercial,,157.00,29.8,29.8% of Medicare Base rate X weight,157.00,52.68,467.86,Fee Schedule,29.8
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,, ,61.75,37.05,Aetna,Commercial,,61.75,29.8,29.8% of Medicare Base rate X weight,61.75,20.72,184.02,Fee Schedule,29.8
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,,,318.00,318.00,Aetna,Commercial,,318.00,29.8,29.8% of Medicare Base rate X weight,318.00,106.71,947.64,Fee Schedule,29.8
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,, ,318.00,190.80,Aetna,Commercial,,318.00,29.8,29.8% of Medicare Base rate X weight,318.00,106.71,947.64,Fee Schedule,29.8
O51200 AB SCRN,86850,CPT,,,,,both,, ,291.75,175.05,Aetna,Commercial,,291.75,29.8,29.8% of Medicare Base rate X weight,291.75,97.90,869.42,Fee Schedule,29.8
O51128 AB ELUTION,86860,CPT,,,,,both,, ,174.30,104.58,Aetna,Commercial,,174.30,29.8,29.8% of Medicare Base rate X weight,174.30,58.49,519.41,Fee Schedule,29.8
O51128 AB ELUTION,86860,CPT,,,,,both,, ,174.30,104.58,Aetna,Commercial,,174.30,29.8,29.8% of Medicare Base rate X weight,174.30,58.49,519.41,Fee Schedule,29.8
"ANTIBODY ID,EA PANEL",86870,CPT,,,,,both,, ,488.65,293.19,Aetna,Commercial,,488.65,29.8,29.8% of Medicare Base rate X weight,488.65,163.98,1456.18,Fee Schedule,29.8
O51108 AB ID EA PNL,86870,CPT,,,,,both,, ,475.18,285.10,Aetna,Commercial,,475.18,29.8,29.8% of Medicare Base rate X weight,475.18,159.46,1416.04,Fee Schedule,29.8
O51612 DAT,86880,CPT,,,,,both,, ,250.64,150.38,Aetna,Commercial,,250.64,29.8,29.8% of Medicare Base rate X weight,250.64,84.11,746.91,Fee Schedule,29.8
O51612 DAT,86880,CPT,,,,,both,, ,250.64,150.38,Aetna,Commercial,,250.64,29.8,29.8% of Medicare Base rate X weight,250.64,84.11,746.91,Fee Schedule,29.8
IDAT QUAL EA RGT RBC,86885,CPT,,,,,both,, ,39.57,23.74,Aetna,Commercial,,39.57,29.8,29.8% of Medicare Base rate X weight,39.57,13.28,117.92,Fee Schedule,29.8
IDAT EACH AB TITER,86886,CPT,,,,,both,, ,326.14,195.68,Aetna,Commercial,,326.14,29.8,29.8% of Medicare Base rate X weight,326.14,109.44,971.9,Fee Schedule,29.8
"AUTO COMPONENT,PROCS",86890,CPT,,,,,both,, ,756.41,453.84,Aetna,Commercial,,756.41,29.8,29.8% of Medicare Base rate X weight,756.41,253.83,2254.1,Fee Schedule,29.8
AUTOL BID OP SALV,86891,CPT,,,,,both,, ,3941.23,2364.73,Aetna,Commercial,,3941.23,29.8,29.8% of Medicare Base rate X weight,3941.23,1322.56,11744.87,Fee Schedule,29.8
BLOOD TYPING ABO,86900,CPT,,,,,both,, ,38.73,23.23,Aetna,Commercial,,38.73,29.8,29.8% of Medicare Base rate X weight,38.73,13.00,115.42,Fee Schedule,29.8
BLOOD TYPING ABO,86900,CPT,,,,,both,,,97.39,97.39,Aetna,Commercial,,97.39,29.8,29.8% of Medicare Base rate X weight,97.39,32.68,290.22,Fee Schedule,29.8
REF  BLD TYPING ABO,86900,CPT,,,,,both,, ,97.39,58.43,Aetna,Commercial,,97.39,29.8,29.8% of Medicare Base rate X weight,97.39,32.68,290.22,Fee Schedule,29.8
REF  BLD TYPING ABO,86900,CPT,,,,,both,, ,97.39,58.43,Aetna,Commercial,,97.39,29.8,29.8% of Medicare Base rate X weight,97.39,32.68,290.22,Fee Schedule,29.8
BLOOD TYPING RH D,86901,CPT,,,,,both,, ,38.73,23.23,Aetna,Commercial,,38.73,29.8,29.8% of Medicare Base rate X weight,38.73,13.00,115.42,Fee Schedule,29.8
BLOOD TYPING RH D,86901,CPT,,,,,both,,,97.39,97.39,Aetna,Commercial,,97.39,29.8,29.8% of Medicare Base rate X weight,97.39,32.68,290.22,Fee Schedule,29.8
REF  BLD TYPING RH D,86901,CPT,,,,,both,, ,97.39,58.43,Aetna,Commercial,,97.39,29.8,29.8% of Medicare Base rate X weight,97.39,32.68,290.22,Fee Schedule,29.8
REF  BLD TYPING RH D,86901,CPT,,,,,both,, ,97.39,58.43,Aetna,Commercial,,97.39,29.8,29.8% of Medicare Base rate X weight,97.39,32.68,290.22,Fee Schedule,29.8
BLD TYPE DONOR EA AG,86902,CPT,,,,,both,, ,277.86,166.71,Aetna,Commercial,,277.86,29.8,29.8% of Medicare Base rate X weight,277.86,93.24,828.02,Fee Schedule,29.8
BLD TYPING OTHER AG,86905,CPT,,,,,both,,,217.52,217.52,Aetna,Commercial,,217.52,29.8,29.8% of Medicare Base rate X weight,217.52,72.99,648.21,Fee Schedule,29.8
O51232 RBC AG TYP,86905,CPT,,,,,both,, ,217.52,130.51,Aetna,Commercial,,217.52,29.8,29.8% of Medicare Base rate X weight,217.52,72.99,648.21,Fee Schedule,29.8
O51232 RBC AG TYP,86905,CPT,,,,,both,, ,217.52,130.51,Aetna,Commercial,,217.52,29.8,29.8% of Medicare Base rate X weight,217.52,72.99,648.21,Fee Schedule,29.8
O51920 RH PHENO,86906,CPT,,,,,both,, ,224.00,134.40,Aetna,Commercial,,224.00,29.8,29.8% of Medicare Base rate X weight,224.00,75.17,667.52,Fee Schedule,29.8
COMPATIB TEST IS,86920,CPT,,,,,both,,,275.62,275.62,Aetna,Commercial,,275.62,29.8,29.8% of Medicare Base rate X weight,275.62,92.49,821.35,Fee Schedule,29.8
COMPATIB TEST IS,86920,CPT,,,,,both,, ,275.62,165.37,Aetna,Commercial,,275.62,29.8,29.8% of Medicare Base rate X weight,275.62,92.49,821.35,Fee Schedule,29.8
COMPATIB TEST INCUB,86921,CPT,,,,,both,,,103.00,103.00,Aetna,Commercial,,103.00,29.8,29.8% of Medicare Base rate X weight,103.00,34.56,306.94,Fee Schedule,29.8
COMPATIB TEST INCUB,86921,CPT,,,,,both,, ,103.00,61.80,Aetna,Commercial,,103.00,29.8,29.8% of Medicare Base rate X weight,103.00,34.56,306.94,Fee Schedule,29.8
COMPATIB TEST AHG,86922,CPT,,,,,both,,,250.07,250.07,Aetna,Commercial,,250.07,29.8,29.8% of Medicare Base rate X weight,250.07,83.92,745.21,Fee Schedule,29.8
COMPATIB TEST AHG,86922,CPT,,,,,both,, ,250.07,150.04,Aetna,Commercial,,250.07,29.8,29.8% of Medicare Base rate X weight,250.07,83.92,745.21,Fee Schedule,29.8
FFP THAWING,86927,CPT,,,,,both,, ,233.80,140.28,Aetna,Commercial,,233.80,29.8,29.8% of Medicare Base rate X weight,233.80,78.46,696.72,Fee Schedule,29.8
PLATELETS POOLING,86965,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,141.46,29.8,29.8% of Medicare Base rate X weight,141.46,47.47,421.55,Fee Schedule,29.8
O51010 CHEM TREATMNT,86970,CPT,,,,,both,, ,212.44,127.46,Aetna,Commercial,,212.44,29.8,29.8% of Medicare Base rate X weight,212.44,71.29,633.07,Fee Schedule,29.8
RBC PRETREAT CHEM,86970,CPT,,,,,both,, ,231.55,138.93,Aetna,Commercial,,231.55,29.8,29.8% of Medicare Base rate X weight,231.55,77.70,690.02,Fee Schedule,29.8
O51701 ENZYME TREAT,86971,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,141.46,29.8,29.8% of Medicare Base rate X weight,141.46,47.47,421.55,Fee Schedule,29.8
O51701 ENZYME TREAT,86971,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,141.46,29.8,29.8% of Medicare Base rate X weight,141.46,47.47,421.55,Fee Schedule,29.8
O51122 RBC CELL SEP,86972,CPT,,,,,both,, ,246.99,148.19,Aetna,Commercial,,246.99,29.8,29.8% of Medicare Base rate X weight,246.99,82.88,736.03,Fee Schedule,29.8
"RBC PRETREAT,SER,INC",86975,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,141.46,29.8,29.8% of Medicare Base rate X weight,141.46,47.47,421.55,Fee Schedule,29.8
"RBC PRETREAT,SER DIL",86976,CPT,,,,,both,, ,61.80,37.08,Aetna,Commercial,,61.80,29.8,29.8% of Medicare Base rate X weight,61.80,20.74,184.16,Fee Schedule,29.8
RBC PRETREAT W-INHIB,86977,CPT,,,,,both,, ,218.64,131.18,Aetna,Commercial,,218.64,29.8,29.8% of Medicare Base rate X weight,218.64,73.37,651.55,Fee Schedule,29.8
O51234 ADSORPTION,86978,CPT,,,,,both,, ,149.35,89.61,Aetna,Commercial,,149.35,29.8,29.8% of Medicare Base rate X weight,149.35,50.12,445.06,Fee Schedule,29.8
RBC PRETREAT DIFF EA,86978,CPT,,,,,both,, ,162.79,97.67,Aetna,Commercial,,162.79,29.8,29.8% of Medicare Base rate X weight,162.79,54.63,485.11,Fee Schedule,29.8
SPLIT BLOOD OR PROD,86985,CPT,,,,,both,, ,546.75,328.05,Aetna,Commercial,,546.75,29.8,29.8% of Medicare Base rate X weight,546.75,183.47,1629.32,Fee Schedule,29.8
Q34286 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Aetna,Commercial,,177.39,29.8,29.8% of Medicare Base rate X weight,177.39,59.53,528.62,Fee Schedule,29.8
Q37213 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Aetna,Commercial,,177.39,29.8,29.8% of Medicare Base rate X weight,177.39,59.53,528.62,Fee Schedule,29.8
Q39480 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Aetna,Commercial,,177.39,29.8,29.8% of Medicare Base rate X weight,177.39,59.53,528.62,Fee Schedule,29.8
Q4554 SPECIMEN CONCE,87015,CPT,,,,,both,, ,177.39,106.43,Aetna,Commercial,,177.39,29.8,29.8% of Medicare Base rate X weight,177.39,59.53,528.62,Fee Schedule,29.8
SPECIMEN CONCENTRATI,87015,CPT,,,,,both,, ,177.39,106.43,Aetna,Commercial,,177.39,29.8,29.8% of Medicare Base rate X weight,177.39,59.53,528.62,Fee Schedule,29.8
CULTURE BLOOD BACTER,87040,CPT,,,,,both,,,691.29,691.29,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
CULTURE BLOOD BACTER,87040,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
CULT STL BACT W-ISOL,87045,CPT,,,,,both,, ,92.90,55.74,Aetna,Commercial,,92.90,29.8,29.8% of Medicare Base rate X weight,92.90,31.17,276.84,Fee Schedule,29.8
CULT STL BACT W-ISOL,87045,CPT,,,,,both,,,301.72,301.72,Aetna,Commercial,,301.72,29.8,29.8% of Medicare Base rate X weight,301.72,101.25,899.13,Fee Schedule,29.8
CULT STL BACT W-ISOL,87045,CPT,,,,,both,, ,301.72,181.03,Aetna,Commercial,,301.72,29.8,29.8% of Medicare Base rate X weight,301.72,101.25,899.13,Fee Schedule,29.8
CULT STL BACT EA ADD,87046,CPT,,,,,both,, ,92.90,55.74,Aetna,Commercial,,92.90,29.8,29.8% of Medicare Base rate X weight,92.90,31.17,276.84,Fee Schedule,29.8
CULT STL BACT EA ADD,87046,CPT,,,,,both,, ,94.58,56.74,Aetna,Commercial,,94.58,29.8,29.8% of Medicare Base rate X weight,94.58,31.74,281.85,Fee Schedule,29.8
CULTURE BACTERIA OTH,87070,CPT,,,,,both,, ,84.76,50.85,Aetna,Commercial,,84.76,29.8,29.8% of Medicare Base rate X weight,84.76,28.44,252.58,Fee Schedule,29.8
CULTURE BACTERIA OTH,87070,CPT,,,,,both,,,998.91,998.91,Aetna,Commercial,,998.91,29.8,29.8% of Medicare Base rate X weight,998.91,335.20,2976.75,Fee Schedule,29.8
CULTURE BACTERIA OTH,87070,CPT,,,,,both,, ,998.91,599.34,Aetna,Commercial,,998.91,29.8,29.8% of Medicare Base rate X weight,998.91,335.20,2976.75,Fee Schedule,29.8
L188227 CULTURE BACT,87070,CPT,,,,,both,, ,86.20,51.72,Aetna,Commercial,,86.20,29.8,29.8% of Medicare Base rate X weight,86.20,28.93,256.88,Fee Schedule,29.8
CULT BAC AEROB OT QT,87071,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
CULT BACT ANA ANY SO,87075,CPT,,,,,both,,,623.38,623.38,Aetna,Commercial,,623.38,29.8,29.8% of Medicare Base rate X weight,623.38,209.19,1857.67,Fee Schedule,29.8
L8904 ANAEROBIC CULT,87075,CPT,,,,,both,, ,623.38,374.02,Aetna,Commercial,,623.38,29.8,29.8% of Medicare Base rate X weight,623.38,209.19,1857.67,Fee Schedule,29.8
L8904 ANAEROBIC CULT,87075,CPT,,,,,both,, ,623.38,374.02,Aetna,Commercial,,623.38,29.8,29.8% of Medicare Base rate X weight,623.38,209.19,1857.67,Fee Schedule,29.8
CULT ANAERO IDENT EA,87076,CPT,,,,,both,, ,412.87,247.72,Aetna,Commercial,,412.87,29.8,29.8% of Medicare Base rate X weight,412.87,138.55,1230.35,Fee Schedule,29.8
L182345 ORG ID ANAER,87076,CPT,,,,,both,, ,244.44,146.66,Aetna,Commercial,,244.44,29.8,29.8% of Medicare Base rate X weight,244.44,82.03,728.43,Fee Schedule,29.8
CULT AEROBIC ID REF,87077,CPT,,,,,both,, ,389.01,233.40,Aetna,Commercial,,389.01,29.8,29.8% of Medicare Base rate X weight,389.01,130.54,1159.25,Fee Schedule,29.8
CULT AEROBIC ID REF,87077,CPT,,,,,both,, ,389.01,233.40,Aetna,Commercial,,389.01,29.8,29.8% of Medicare Base rate X weight,389.01,130.54,1159.25,Fee Schedule,29.8
CULTURE SCREEN ONLY,87081,CPT,,,,,both,, ,65.39,39.23,Aetna,Commercial,,65.39,29.8,29.8% of Medicare Base rate X weight,65.39,21.94,194.86,Fee Schedule,29.8
CULTURE SCREEN ONLY,87081,CPT,,,,,both,,,420.72,420.72,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
CULTURE SCREEN ONLY,87081,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
CULT URINE-COLONY CT,87086,CPT,,,,,both,, ,59.78,35.86,Aetna,Commercial,,59.78,29.8,29.8% of Medicare Base rate X weight,59.78,20.06,178.14,Fee Schedule,29.8
CULT URINE-COLONY CT,87086,CPT,,,,,both,,,495.95,495.95,Aetna,Commercial,,495.95,29.8,29.8% of Medicare Base rate X weight,495.95,166.43,1477.93,Fee Schedule,29.8
CULT URINE-COLONY CT,87086,CPT,,,,,both,, ,495.95,297.57,Aetna,Commercial,,495.95,29.8,29.8% of Medicare Base rate X weight,495.95,166.43,1477.93,Fee Schedule,29.8
CULT URINE W-P ID,87088,CPT,,,,,both,, ,42.37,25.42,Aetna,Commercial,,42.37,29.8,29.8% of Medicare Base rate X weight,42.37,14.22,126.26,Fee Schedule,29.8
L188243CUL SKIN FUNG,87101,CPT,,,,,both,, ,349.99,209.99,Aetna,Commercial,,349.99,29.8,29.8% of Medicare Base rate X weight,349.99,117.45,1042.97,Fee Schedule,29.8
L188243CUL SKIN FUNG,87101,CPT,,,,,both,, ,349.99,209.99,Aetna,Commercial,,349.99,29.8,29.8% of Medicare Base rate X weight,349.99,117.45,1042.97,Fee Schedule,29.8
CULT FUNGUS ISOLATIO,87102,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
Q4553 CULT FUNGUS IS,87102,CPT,,,,,both,, ,525.70,315.42,Aetna,Commercial,,525.70,29.8,29.8% of Medicare Base rate X weight,525.70,176.41,1566.59,Fee Schedule,29.8
CULTURE FUNGUS BLOOD,87103,CPT,,,,,both,, ,518.69,311.21,Aetna,Commercial,,518.69,29.8,29.8% of Medicare Base rate X weight,518.69,174.06,1545.7,Fee Schedule,29.8
Q4606 FUNGUS CULT BL,87103,CPT,,,,,both,, ,478.95,287.37,Aetna,Commercial,,478.95,29.8,29.8% of Medicare Base rate X weight,478.95,160.72,1427.27,Fee Schedule,29.8
Q575 FUNGAL ID EXAM,87106,CPT,,,,,both,, ,123.21,73.92,Aetna,Commercial,,123.21,29.8,29.8% of Medicare Base rate X weight,123.21,41.35,367.17,Fee Schedule,29.8
Q575 FUNGAL ID EXAM,87106,CPT,,,,,both,, ,123.21,73.92,Aetna,Commercial,,123.21,29.8,29.8% of Medicare Base rate X weight,123.21,41.35,367.17,Fee Schedule,29.8
L8474 MOLD IDENTIF,87107,CPT,,,,,both,, ,123.21,73.92,Aetna,Commercial,,123.21,29.8,29.8% of Medicare Base rate X weight,123.21,41.35,367.17,Fee Schedule,29.8
L8474 MOLD IDENTIF,87107,CPT,,,,,both,, ,123.21,73.92,Aetna,Commercial,,123.21,29.8,29.8% of Medicare Base rate X weight,123.21,41.35,367.17,Fee Schedule,29.8
CULT MYCOPLASMA,87109,CPT,,,,,both,, ,1404.50,842.70,Aetna,Commercial,,1404.50,29.8,29.8% of Medicare Base rate X weight,1404.50,471.31,4185.41,Fee Schedule,29.8
UREA-MYCOPLS HOM CULT,87109,CPT,,,,,both,, ,153.90,92.34,Aetna,Commercial,,153.90,29.8,29.8% of Medicare Base rate X weight,153.90,51.64,458.62,Fee Schedule,29.8
Q690 CULTURE CHLAMYD,87110,CPT,,,,,both,, ,1104.45,662.67,Aetna,Commercial,,1104.45,29.8,29.8% of Medicare Base rate X weight,1104.45,370.62,3291.26,Fee Schedule,29.8
Q690 CULTURE CHLAMYD,87110,CPT,,,,,both,, ,1104.45,662.67,Aetna,Commercial,,1104.45,29.8,29.8% of Medicare Base rate X weight,1104.45,370.62,3291.26,Fee Schedule,29.8
CULT MYCOBACTERIA,87116,CPT,,,,,both,,,827.43,827.43,Aetna,Commercial,,827.43,29.8,29.8% of Medicare Base rate X weight,827.43,277.66,2465.74,Fee Schedule,29.8
CULT MYCOBACTERIA,87116,CPT,,,,,both,, ,827.43,496.45,Aetna,Commercial,,827.43,29.8,29.8% of Medicare Base rate X weight,827.43,277.66,2465.74,Fee Schedule,29.8
Q10526MBAC BL CMBCS,87116,CPT,,,,,both,, ,827.43,496.45,Aetna,Commercial,,827.43,29.8,29.8% of Medicare Base rate X weight,827.43,277.66,2465.74,Fee Schedule,29.8
Q4554 CULT MYCOBACTE,87116,CPT,,,,,both,, ,827.43,496.45,Aetna,Commercial,,827.43,29.8,29.8% of Medicare Base rate X weight,827.43,277.66,2465.74,Fee Schedule,29.8
Q690 CULT TYPE IMMUN,87140,CPT,,,,,both,, ,323.34,194.00,Aetna,Commercial,,323.34,29.8,29.8% of Medicare Base rate X weight,323.34,108.50,963.55,Fee Schedule,29.8
Q690 CULT TYPE IMMUN,87140,CPT,,,,,both,, ,323.34,194.00,Aetna,Commercial,,323.34,29.8,29.8% of Medicare Base rate X weight,323.34,108.50,963.55,Fee Schedule,29.8
"CULT TYPE,IMMUNOLOGI",87147,CPT,,,,,both,, ,547.31,328.38,Aetna,Commercial,,547.31,29.8,29.8% of Medicare Base rate X weight,547.31,183.66,1630.98,Fee Schedule,29.8
"CULT TYPE,NUCLEIC AC",87149,CPT,,,,,both,, ,239.97,143.98,Aetna,Commercial,,239.97,29.8,29.8% of Medicare Base rate X weight,239.97,80.53,715.11,Fee Schedule,29.8
LRX183755 AFB ID PB,87149,CPT,,,,,both,, ,239.99,143.99,Aetna,Commercial,,239.99,29.8,29.8% of Medicare Base rate X weight,239.99,80.53,715.17,Fee Schedule,29.8
DNA-RNA AMPLI PROBE,87150,CPT,,,,,both,, ,339.33,203.59,Aetna,Commercial,,339.33,29.8,29.8% of Medicare Base rate X weight,339.33,113.87,1011.2,Fee Schedule,29.8
LRX183327 MOLD ID,87153,CPT,,,,,both,, ,239.99,143.99,Aetna,Commercial,,239.99,29.8,29.8% of Medicare Base rate X weight,239.99,80.53,715.17,Fee Schedule,29.8
QRX9000010 AFB ID,87153,CPT,,,,,both,, ,388.45,233.07,Aetna,Commercial,,388.45,29.8,29.8% of Medicare Base rate X weight,388.45,130.35,1157.58,Fee Schedule,29.8
MACRO EXAM ARTHROPOD,87168,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,480.79,29.8,29.8% of Medicare Base rate X weight,480.79,161.34,1432.75,Fee Schedule,29.8
MACRO EXAM PARASITE,87169,CPT,,,,,both,, ,207.70,124.62,Aetna,Commercial,,207.70,29.8,29.8% of Medicare Base rate X weight,207.70,69.70,618.95,Fee Schedule,29.8
PINWORM EXAM,87172,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,480.79,29.8,29.8% of Medicare Base rate X weight,480.79,161.34,1432.75,Fee Schedule,29.8
TISSUE HOMOGENIZ CUL,87176,CPT,,,,,both,, ,300.60,180.36,Aetna,Commercial,,300.60,29.8,29.8% of Medicare Base rate X weight,300.60,100.87,895.79,Fee Schedule,29.8
OVA-PARASITES SMEARS,87177,CPT,,,,,both,, ,107.21,64.32,Aetna,Commercial,,107.21,29.8,29.8% of Medicare Base rate X weight,107.21,35.98,319.49,Fee Schedule,29.8
Q681 OVA-PARASITES S,87177,CPT,,,,,both,, ,320.25,192.15,Aetna,Commercial,,320.25,29.8,29.8% of Medicare Base rate X weight,320.25,107.47,954.35,Fee Schedule,29.8
Q681 OVA-PARASITES S,87177,CPT,,,,,both,, ,320.25,192.15,Aetna,Commercial,,320.25,29.8,29.8% of Medicare Base rate X weight,320.25,107.47,954.35,Fee Schedule,29.8
MICROB SUSCEP DIFFUS,87181,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,141.46,29.8,29.8% of Medicare Base rate X weight,141.46,47.47,421.55,Fee Schedule,29.8
Q18869 MOD HODGE DD,87184,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,141.46,29.8,29.8% of Medicare Base rate X weight,141.46,47.47,421.55,Fee Schedule,29.8
Q18869 MOD HODGE DD,87184,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,141.46,29.8,29.8% of Medicare Base rate X weight,141.46,47.47,421.55,Fee Schedule,29.8
MICROB SUSCEP ENZYME,87185,CPT,,,,,both,, ,180.19,108.11,Aetna,Commercial,,180.19,29.8,29.8% of Medicare Base rate X weight,180.19,60.47,536.97,Fee Schedule,29.8
MICROBE SUSCEPT REF,87186,CPT,,,,,both,, ,586.05,351.63,Aetna,Commercial,,586.05,29.8,29.8% of Medicare Base rate X weight,586.05,196.66,1746.43,Fee Schedule,29.8
MICROBE SUSCEPT REF,87186,CPT,,,,,both,, ,586.05,351.63,Aetna,Commercial,,586.05,29.8,29.8% of Medicare Base rate X weight,586.05,196.66,1746.43,Fee Schedule,29.8
"SMEAR,GRAM STAIN",87205,CPT,,,,,both,, ,42.10,25.26,Aetna,Commercial,,42.10,29.8,29.8% of Medicare Base rate X weight,42.10,14.13,125.46,Fee Schedule,29.8
"SMEAR,GRAM STAIN",87205,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
L188243SMR FLUO-AC S,87206,CPT,,,,,both,, ,507.74,304.64,Aetna,Commercial,,507.74,29.8,29.8% of Medicare Base rate X weight,507.74,170.38,1513.07,Fee Schedule,29.8
L188243SMR FLUO-AC S,87206,CPT,,,,,both,, ,507.74,304.64,Aetna,Commercial,,507.74,29.8,29.8% of Medicare Base rate X weight,507.74,170.38,1513.07,Fee Schedule,29.8
L188243SMR FLUO-AC S,87206,CPT,,,,,both,, ,507.74,304.64,Aetna,Commercial,,507.74,29.8,29.8% of Medicare Base rate X weight,507.74,170.38,1513.07,Fee Schedule,29.8
L188243SMR FLUO-AC S,87206,CPT,,,,,both,, ,507.74,304.64,Aetna,Commercial,,507.74,29.8,29.8% of Medicare Base rate X weight,507.74,170.38,1513.07,Fee Schedule,29.8
"SMEAR,SPECIAL STAIN",87207,CPT,,,,,both,, ,555.45,333.27,Aetna,Commercial,,555.45,29.8,29.8% of Medicare Base rate X weight,555.45,186.39,1655.24,Fee Schedule,29.8
Q681 SMEAR COMPLEX S,87209,CPT,,,,,both,, ,190.86,114.51,Aetna,Commercial,,190.86,29.8,29.8% of Medicare Base rate X weight,190.86,64.05,568.76,Fee Schedule,29.8
Q681 SMEAR COMPLEX S,87209,CPT,,,,,both,, ,190.86,114.51,Aetna,Commercial,,190.86,29.8,29.8% of Medicare Base rate X weight,190.86,64.05,568.76,Fee Schedule,29.8
SMEARWET MOUNT SAL-I,87210,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,420.72,29.8,29.8% of Medicare Base rate X weight,420.72,141.18,1253.75,Fee Schedule,29.8
Q8628 SCABIES MIC EX,87220,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,480.79,29.8,29.8% of Medicare Base rate X weight,480.79,161.34,1432.75,Fee Schedule,29.8
Q8628 SCABIES MIC EX,87220,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,480.79,29.8,29.8% of Medicare Base rate X weight,480.79,161.34,1432.75,Fee Schedule,29.8
Q689 VIR CULT IFA-TC,87252,CPT,,,,,both,, ,929.87,557.92,Aetna,Commercial,,929.87,29.8,29.8% of Medicare Base rate X weight,929.87,312.04,2771.01,Fee Schedule,29.8
Q689 VIR CULT IFA-TC,87252,CPT,,,,,both,, ,929.87,557.92,Aetna,Commercial,,929.87,29.8,29.8% of Medicare Base rate X weight,929.87,312.04,2771.01,Fee Schedule,29.8
L186015 VIR INOC SHL,87254,CPT,,,,,both,, ,415.68,249.40,Aetna,Commercial,,415.68,29.8,29.8% of Medicare Base rate X weight,415.68,139.49,1238.73,Fee Schedule,29.8
Q17495VIRUS INOCU SH,87254,CPT,,,,,both,, ,415.68,249.40,Aetna,Commercial,,415.68,29.8,29.8% of Medicare Base rate X weight,415.68,139.49,1238.73,Fee Schedule,29.8
VIRUS INOCU SHELL VI,87254,CPT,,,,,both,, ,415.68,249.40,Aetna,Commercial,,415.68,29.8,29.8% of Medicare Base rate X weight,415.68,139.49,1238.73,Fee Schedule,29.8
Q2649 HSV CULT WREF,87255,CPT,,,,,both,, ,470.69,282.41,Aetna,Commercial,,470.69,29.8,29.8% of Medicare Base rate X weight,470.69,157.95,1402.66,Fee Schedule,29.8
Q841 HSV CULT HS,87255,CPT,,,,,both,, ,470.69,282.41,Aetna,Commercial,,470.69,29.8,29.8% of Medicare Base rate X weight,470.69,157.95,1402.66,Fee Schedule,29.8
VIRUS ISOLATION GEN,87255,CPT,,,,,both,, ,470.69,282.41,Aetna,Commercial,,470.69,29.8,29.8% of Medicare Base rate X weight,470.69,157.95,1402.66,Fee Schedule,29.8
"Q34966 PERTUSSIS AG,",87265,CPT,,,,,both,, ,531.32,318.79,Aetna,Commercial,,531.32,29.8,29.8% of Medicare Base rate X weight,531.32,178.30,1583.33,Fee Schedule,29.8
"Q34966 PERTUSSIS AG,",87265,CPT,,,,,both,, ,531.32,318.79,Aetna,Commercial,,531.32,29.8,29.8% of Medicare Base rate X weight,531.32,178.30,1583.33,Fee Schedule,29.8
INFAGT DT QLSQT CRYP,87272,CPT,,,,,both,, ,525.70,315.42,Aetna,Commercial,,525.70,29.8,29.8% of Medicare Base rate X weight,525.70,176.41,1566.59,Fee Schedule,29.8
Q37213 INFAGT DT QLS,87272,CPT,,,,,both,, ,525.70,315.42,Aetna,Commercial,,525.70,29.8,29.8% of Medicare Base rate X weight,525.70,176.41,1566.59,Fee Schedule,29.8
Q39480 INFAGT DT QLS,87272,CPT,,,,,both,, ,525.70,315.42,Aetna,Commercial,,525.70,29.8,29.8% of Medicare Base rate X weight,525.70,176.41,1566.59,Fee Schedule,29.8
L188227 LEGION PNEUM,87278,CPT,,,,,both,, ,156.00,93.60,Aetna,Commercial,,156.00,29.8,29.8% of Medicare Base rate X weight,156.00,52.35,464.88,Fee Schedule,29.8
Q34475 LEGPNE AG DFA,87278,CPT,,,,,both,, ,277.86,166.71,Aetna,Commercial,,277.86,29.8,29.8% of Medicare Base rate X weight,277.86,93.24,828.02,Fee Schedule,29.8
Q34475 LEGPNE AG DFA,87278,CPT,,,,,both,, ,277.86,166.71,Aetna,Commercial,,277.86,29.8,29.8% of Medicare Base rate X weight,277.86,93.24,828.02,Fee Schedule,29.8
Q34286 PNEUMOCYSTIS,87281,CPT,,,,,both,, ,371.89,223.13,Aetna,Commercial,,371.89,29.8,29.8% of Medicare Base rate X weight,371.89,124.80,1108.23,Fee Schedule,29.8
Q34286 PNEUMOCYSTIS,87281,CPT,,,,,both,, ,371.89,223.13,Aetna,Commercial,,371.89,29.8,29.8% of Medicare Base rate X weight,371.89,124.80,1108.23,Fee Schedule,29.8
VARICELLA ZOSTER AGI,87290,CPT,,,,,both,, ,518.69,311.21,Aetna,Commercial,,518.69,29.8,29.8% of Medicare Base rate X weight,518.69,174.06,1545.7,Fee Schedule,29.8
"ANTIB DETECT NOS, IF",87299,CPT,,,,,both,, ,159.14,95.48,Aetna,Commercial,,159.14,29.8,29.8% of Medicare Base rate X weight,159.14,53.40,474.24,Fee Schedule,29.8
AG DETECT POLYVAL IF,87300,CPT,,,,,both,, ,122.09,73.25,Aetna,Commercial,,122.09,29.8,29.8% of Medicare Base rate X weight,122.09,40.97,363.83,Fee Schedule,29.8
L185041 ADV 40/41 IA,87301,CPT,,,,,both,, ,123.60,74.16,Aetna,Commercial,,123.60,29.8,29.8% of Medicare Base rate X weight,123.60,41.48,368.33,Fee Schedule,29.8
Q14950ASPE AG EIA IA,87305,CPT,,,,,both,, ,111.70,67.02,Aetna,Commercial,,111.70,29.8,29.8% of Medicare Base rate X weight,111.70,37.48,332.87,Fee Schedule,29.8
CLOSTRIDIUM DIF TOXN,87324,CPT,,,,,both,, ,118.16,70.89,Aetna,Commercial,,118.16,29.8,29.8% of Medicare Base rate X weight,118.16,39.65,352.12,Fee Schedule,29.8
CLOSTRIDIUM DIF TOXN,87324,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
CRYPTOCOCCUS NEOF AG,87327,CPT,,,,,both,, ,1321.42,792.85,Aetna,Commercial,,1321.42,29.8,29.8% of Medicare Base rate X weight,1321.42,443.43,3937.83,Fee Schedule,29.8
"CRYPTOSPOR AG,EIA",87328,CPT,,,,,both,, ,64.55,38.73,Aetna,Commercial,,64.55,29.8,29.8% of Medicare Base rate X weight,64.55,21.66,192.36,Fee Schedule,29.8
Q39480 INFAGT DT QLS,87329,CPT,,,,,both,, ,200.12,120.07,Aetna,Commercial,,200.12,29.8,29.8% of Medicare Base rate X weight,200.12,67.15,596.36,Fee Schedule,29.8
Q39480 INFAGT DT QLS,87329,CPT,,,,,both,, ,200.12,120.07,Aetna,Commercial,,200.12,29.8,29.8% of Medicare Base rate X weight,200.12,67.15,596.36,Fee Schedule,29.8
Q8625 GIARDAG EIA IA,87329,CPT,,,,,both,, ,192.49,115.49,Aetna,Commercial,,192.49,29.8,29.8% of Medicare Base rate X weight,192.49,64.59,573.62,Fee Schedule,29.8
Q34838 HPYLAG EIA IA,87338,CPT,,,,,both,, ,183.56,110.13,Aetna,Commercial,,183.56,29.8,29.8% of Medicare Base rate X weight,183.56,61.60,547.01,Fee Schedule,29.8
Q34838 HPYLAG EIA IA,87338,CPT,,,,,both,, ,183.56,110.13,Aetna,Commercial,,183.56,29.8,29.8% of Medicare Base rate X weight,183.56,61.60,547.01,Fee Schedule,29.8
HBSAG,87340,CPT,,,,,both,,,570.04,570.04,Aetna,Commercial,,570.04,29.8,29.8% of Medicare Base rate X weight,570.04,191.29,1698.72,Fee Schedule,29.8
HBSAG,87340,CPT,,,,,both,, ,570.04,342.02,Aetna,Commercial,,570.04,29.8,29.8% of Medicare Base rate X weight,570.04,191.29,1698.72,Fee Schedule,29.8
Q555 HBEAG IA,87350,CPT,,,,,both,, ,1003.97,602.38,Aetna,Commercial,,1003.97,29.8,29.8% of Medicare Base rate X weight,1003.97,336.90,2991.83,Fee Schedule,29.8
Q555 HBEAG IA,87350,CPT,,,,,both,, ,1003.97,602.38,Aetna,Commercial,,1003.97,29.8,29.8% of Medicare Base rate X weight,1003.97,336.90,2991.83,Fee Schedule,29.8
Q91212H.GALA AG U IA,87385,CPT,,,,,both,, ,322.49,193.49,Aetna,Commercial,,322.49,29.8,29.8% of Medicare Base rate X weight,322.49,108.22,961.02,Fee Schedule,29.8
Q91212H.GALA AG U IA,87385,CPT,,,,,both,, ,322.49,193.49,Aetna,Commercial,,322.49,29.8,29.8% of Medicare Base rate X weight,322.49,108.22,961.02,Fee Schedule,29.8
"INFLUENZA A AG,EIA",87400,CPT,,,,,both,, ,118.16,70.89,Aetna,Commercial,,118.16,29.8,29.8% of Medicare Base rate X weight,118.16,39.65,352.12,Fee Schedule,29.8
"INFLUENZA A AG,EIA",87400,CPT,,,,,both,, ,959.34,575.60,Aetna,Commercial,,959.34,29.8,29.8% of Medicare Base rate X weight,959.34,321.93,2858.83,Fee Schedule,29.8
L6866 ROTAVIRUS DDIA,87425,CPT,,,,,both,, ,123.60,74.16,Aetna,Commercial,,123.60,29.8,29.8% of Medicare Base rate X weight,123.60,41.48,368.33,Fee Schedule,29.8
"ROTAVIRUS AG,EIA",87425,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
COVID19 AG EIA,87426,CPT,,,,,both,, ,84.20,50.52,Aetna,Commercial,,84.20,29.8,29.8% of Medicare Base rate X weight,84.20,28.26,250.92,Fee Schedule,29.8
COVID19 AG EIA,87426,CPT,,,,,both,, ,88.35,53.01,Aetna,Commercial,,88.35,29.8,29.8% of Medicare Base rate X weight,88.35,29.65,263.28,Fee Schedule,29.8
"SHIGA-LIKE TOX AG,EI",87427,CPT,,,,,both,, ,113.10,67.86,Aetna,Commercial,,113.10,29.8,29.8% of Medicare Base rate X weight,113.10,37.95,337.04,Fee Schedule,29.8
"SHIGA-LIKE TOX AG,EI",87427,CPT,,,,,both,, ,156.33,93.79,Aetna,Commercial,,156.33,29.8,29.8% of Medicare Base rate X weight,156.33,52.46,465.86,Fee Schedule,29.8
COVID19AG FLUAB SOF2,87428,CPT,,,,,both,, ,159.00,95.40,Aetna,Commercial,,159.00,29.8,29.8% of Medicare Base rate X weight,159.00,53.36,473.82,Fee Schedule,29.8
"AG DETEC NOS,EIA MUL",87449,CPT,,,,,both,, ,886.09,531.65,Aetna,Commercial,,886.09,29.8,29.8% of Medicare Base rate X weight,886.09,297.35,2640.55,Fee Schedule,29.8
FUNGITELL SERUM,87449,CPT,,,,,both,, ,121.98,73.18,Aetna,Commercial,,121.98,29.8,29.8% of Medicare Base rate X weight,121.98,40.93,363.5,Fee Schedule,29.8
FUNGITELL SERUM,87449,CPT,,,,,both,, ,121.98,73.18,Aetna,Commercial,,121.98,29.8,29.8% of Medicare Base rate X weight,121.98,40.93,363.5,Fee Schedule,29.8
Q15544 NOROV EIA IA,87449,CPT,,,,,both,, ,886.09,531.65,Aetna,Commercial,,886.09,29.8,29.8% of Medicare Base rate X weight,886.09,297.35,2640.55,Fee Schedule,29.8
Q8856 LEGIO AG U IA,87449,CPT,,,,,both,, ,886.09,531.65,Aetna,Commercial,,886.09,29.8,29.8% of Medicare Base rate X weight,886.09,297.35,2640.55,Fee Schedule,29.8
CANDIDA DNA AMP PROB,87481,CPT,,,,,both,, ,281.80,169.08,Aetna,Commercial,,281.80,29.8,29.8% of Medicare Base rate X weight,281.80,94.56,839.76,Fee Schedule,29.8
L183410 M ENCEPH CSF,87483,CPT,,,,,both,, ,1650.00,990.00,Aetna,Commercial,,1650.00,29.8,29.8% of Medicare Base rate X weight,1650.00,553.69,4917,Fee Schedule,29.8
L139650 CPNEU DNA,87486,CPT,,,,,both,, ,175.00,105.00,Aetna,Commercial,,175.00,29.8,29.8% of Medicare Base rate X weight,175.00,58.72,521.5,Fee Schedule,29.8
Q37444 C PNEUMO PCR,87486,CPT,,,,,both,, ,105.27,63.16,Aetna,Commercial,,105.27,29.8,29.8% of Medicare Base rate X weight,105.27,35.33,313.7,Fee Schedule,29.8
CHLMYD TRACH DNA AMP,87491,CPT,,,,,both,,,968.60,968.60,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
L180021 CTRACH AMPPR,87491,CPT,,,,,both,, ,888.63,533.17,Aetna,Commercial,,888.63,29.8,29.8% of Medicare Base rate X weight,888.63,298.20,2648.12,Fee Schedule,29.8
Q70051 CHLMYD TRACH,87491,CPT,,,,,both,, ,968.60,581.16,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
Q70051 CHLMYD TRACH,87491,CPT,,,,,both,, ,968.60,581.16,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
Q70051 CHLMYD TRACH,87491,CPT,,,,,both,, ,968.60,581.16,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
Q70051 CHLMYD TRACH,87491,CPT,,,,,both,, ,968.60,581.16,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
C DIFF AMPLI PROBE,87493,CPT,,,,,both,, ,313.51,188.10,Aetna,Commercial,,313.51,29.8,29.8% of Medicare Base rate X weight,313.51,105.20,934.26,Fee Schedule,29.8
Q10601 CMV QL RT-PCR,87496,CPT,,,,,both,, ,1051.68,631.00,Aetna,Commercial,,1051.68,29.8,29.8% of Medicare Base rate X weight,1051.68,352.91,3134.01,Fee Schedule,29.8
Q10600 CMV QT RT-PCR,87497,CPT,,,,,both,, ,889.73,533.83,Aetna,Commercial,,889.73,29.8,29.8% of Medicare Base rate X weight,889.73,298.57,2651.4,Fee Schedule,29.8
Q15082EVRNA QL RTPCR,87498,CPT,,,,,both,, ,437.85,262.71,Aetna,Commercial,,437.85,29.8,29.8% of Medicare Base rate X weight,437.85,146.93,1304.79,Fee Schedule,29.8
INFLU DNA AMP PROBE,87502,CPT,,,,,both,, ,215.11,129.06,Aetna,Commercial,,215.11,29.8,29.8% of Medicare Base rate X weight,215.11,72.18,641.03,Fee Schedule,29.8
INFLU DNA AMP PROBE,87502,CPT,,,,,both,,,887.49,887.49,Aetna,Commercial,,887.49,29.8,29.8% of Medicare Base rate X weight,887.49,297.82,2644.72,Fee Schedule,29.8
INFLU DNA AMP PROBE,87502,CPT,,,,,both,, ,887.49,532.49,Aetna,Commercial,,887.49,29.8,29.8% of Medicare Base rate X weight,887.49,297.82,2644.72,Fee Schedule,29.8
L183480 GI PRO STOOL,87507,CPT,,,,,both,, ,1090.20,654.12,Aetna,Commercial,,1090.20,29.8,29.8% of Medicare Base rate X weight,1090.20,365.84,3248.8,Fee Schedule,29.8
GARDNER VAG DNA QUAN,87512,CPT,,,,,both,, ,335.12,201.07,Aetna,Commercial,,335.12,29.8,29.8% of Medicare Base rate X weight,335.12,112.46,998.66,Fee Schedule,29.8
Q8369 HBV QT RT-PCR,87517,CPT,,,,,both,, ,1011.26,606.75,Aetna,Commercial,,1011.26,29.8,29.8% of Medicare Base rate X weight,1011.26,339.35,3013.55,Fee Schedule,29.8
Q8369 HBV QT RT-PCR,87517,CPT,,,,,both,, ,1011.26,606.75,Aetna,Commercial,,1011.26,29.8,29.8% of Medicare Base rate X weight,1011.26,339.35,3013.55,Fee Schedule,29.8
Q37273 HCVRNA QL TMA,87521,CPT,,,,,both,, ,728.91,437.34,Aetna,Commercial,,728.91,29.8,29.8% of Medicare Base rate X weight,728.91,244.60,2172.15,Fee Schedule,29.8
Q37273 HCVRNA QL TMA,87521,CPT,,,,,both,, ,728.91,437.34,Aetna,Commercial,,728.91,29.8,29.8% of Medicare Base rate X weight,728.91,244.60,2172.15,Fee Schedule,29.8
Q11348 HCV QT RT-PCR,87522,CPT,,,,,both,, ,1066.84,640.10,Aetna,Commercial,,1066.84,29.8,29.8% of Medicare Base rate X weight,1066.84,358.00,3179.18,Fee Schedule,29.8
Q35645 HCV RNAQT RT-,87522,CPT,,,,,both,, ,2133.69,1280.21,Aetna,Commercial,,2133.69,29.8,29.8% of Medicare Base rate X weight,2133.69,716.00,6358.4,Fee Schedule,29.8
Q35645 HCV RNAQT RT-,87522,CPT,,,,,both,, ,2133.69,1280.21,Aetna,Commercial,,2133.69,29.8,29.8% of Medicare Base rate X weight,2133.69,716.00,6358.4,Fee Schedule,29.8
"HSV, DNA, AMP PROBE",87529,CPT,,,,,both,, ,3455.10,2073.06,Aetna,Commercial,,3455.10,29.8,29.8% of Medicare Base rate X weight,3455.10,1159.43,10296.2,Fee Schedule,29.8
"Q34257 HSV, DNA, AMP",87529,CPT,,,,,both,, ,968.60,581.16,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
"Q34257 HSV, DNA, AMP",87529,CPT,,,,,both,, ,968.60,581.16,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
"Q19502 HSV, DNA, QUA",87530,CPT,,,,,both,, ,512.23,307.33,Aetna,Commercial,,512.23,29.8,29.8% of Medicare Base rate X weight,512.23,171.89,1526.45,Fee Schedule,29.8
"Q19502 HSV, DNA, QUA",87530,CPT,,,,,both,, ,512.23,307.33,Aetna,Commercial,,512.23,29.8,29.8% of Medicare Base rate X weight,512.23,171.89,1526.45,Fee Schedule,29.8
"HIV-1, DNA,AMP PROBE",87535,CPT,,,,,both,, ,1718.85,1031.31,Aetna,Commercial,,1718.85,29.8,29.8% of Medicare Base rate X weight,1718.85,576.80,5122.17,Fee Schedule,29.8
Q40085 HIV1RNA RTPCR,87536,CPT,,,,,both,, ,1804.46,1082.67,Aetna,Commercial,,1804.46,29.8,29.8% of Medicare Base rate X weight,1804.46,605.52,5377.29,Fee Schedule,29.8
Q40085 HIV1RNA RTPCR,87536,CPT,,,,,both,, ,1804.46,1082.67,Aetna,Commercial,,1804.46,29.8,29.8% of Medicare Base rate X weight,1804.46,605.52,5377.29,Fee Schedule,29.8
"Q15062 LEGION PNEU,D",87541,CPT,,,,,both,, ,196.98,118.18,Aetna,Commercial,,196.98,29.8,29.8% of Medicare Base rate X weight,196.98,66.10,587,Fee Schedule,29.8
Q30298MTB COMP RTPCR,87556,CPT,,,,,both,, ,815.91,489.54,Aetna,Commercial,,815.91,29.8,29.8% of Medicare Base rate X weight,815.91,273.80,2431.41,Fee Schedule,29.8
Q30298MTB COMP RTPCR,87556,CPT,,,,,both,, ,815.91,489.54,Aetna,Commercial,,815.91,29.8,29.8% of Medicare Base rate X weight,815.91,273.80,2431.41,Fee Schedule,29.8
"Q16064 M.AVIUM-INTR,",87561,CPT,,,,,both,, ,372.45,223.47,Aetna,Commercial,,372.45,29.8,29.8% of Medicare Base rate X weight,372.45,124.98,1109.9,Fee Schedule,29.8
"Q16064 M.AVIUM-INTR,",87561,CPT,,,,,both,, ,372.45,223.47,Aetna,Commercial,,372.45,29.8,29.8% of Medicare Base rate X weight,372.45,124.98,1109.9,Fee Schedule,29.8
L180076 M GENT NAA,87563,CPT,,,,,both,, ,180.00,108.00,Aetna,Commercial,,180.00,29.8,29.8% of Medicare Base rate X weight,180.00,60.40,536.4,Fee Schedule,29.8
L139650 MPNEU DNA,87581,CPT,,,,,both,, ,197.03,118.21,Aetna,Commercial,,197.03,29.8,29.8% of Medicare Base rate X weight,197.03,66.12,587.15,Fee Schedule,29.8
L139650 MPNEU DNA,87581,CPT,,,,,both,, ,197.03,118.21,Aetna,Commercial,,197.03,29.8,29.8% of Medicare Base rate X weight,197.03,66.12,587.15,Fee Schedule,29.8
Q37444 MP QL RT-PCR,87581,CPT,,,,,both,, ,175.50,105.30,Aetna,Commercial,,175.50,29.8,29.8% of Medicare Base rate X weight,175.50,58.89,522.99,Fee Schedule,29.8
L180021 NG AMP PRB,87591,CPT,,,,,both,, ,888.63,533.17,Aetna,Commercial,,888.63,29.8,29.8% of Medicare Base rate X weight,888.63,298.20,2648.12,Fee Schedule,29.8
"Q70051 N.GONORRHO,DN",87591,CPT,,,,,both,, ,968.60,581.16,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
"Q70051 N.GONORRHO,DN",87591,CPT,,,,,both,, ,968.60,581.16,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
"Q70051 N.GONORRHO,DN",87591,CPT,,,,,both,, ,968.60,581.16,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
"Q70051 N.GONORRHO,DN",87591,CPT,,,,,both,, ,968.60,581.16,Aetna,Commercial,,968.60,29.8,29.8% of Medicare Base rate X weight,968.60,325.03,2886.43,Fee Schedule,29.8
L140230 ORTHOPOX VRS,87593,CPT,,,,,both,, ,308.00,184.80,Aetna,Commercial,,308.00,29.8,29.8% of Medicare Base rate X weight,308.00,103.36,917.84,Fee Schedule,29.8
HPV HIGH RISK TYPES,87624,CPT,,,,,both,, ,241.38,144.82,Aetna,Commercial,,241.38,29.8,29.8% of Medicare Base rate X weight,241.38,81.00,719.31,Fee Schedule,29.8
L199305 HPV HR,87624,CPT,,,,,both,, ,221.45,132.87,Aetna,Commercial,,221.45,29.8,29.8% of Medicare Base rate X weight,221.45,74.31,659.92,Fee Schedule,29.8
Q92090 HPV HIGH RISK,87624,CPT,,,,,both,, ,215.00,129.00,Aetna,Commercial,,215.00,29.8,29.8% of Medicare Base rate X weight,215.00,72.15,640.7,Fee Schedule,29.8
L507460 HPV GEN16 18,87625,CPT,,,,,both,, ,164.80,98.88,Aetna,Commercial,,164.80,29.8,29.8% of Medicare Base rate X weight,164.80,55.30,491.1,Fee Schedule,29.8
RESP VIRUS 3-5 TARG,87631,CPT,,,,,both,, ,570.52,342.31,Aetna,Commercial,,570.52,29.8,29.8% of Medicare Base rate X weight,570.52,191.45,1700.15,Fee Schedule,29.8
L139650 RES V 12-25,87633,CPT,,,,,both,, ,175.00,105.00,Aetna,Commercial,,175.00,29.8,29.8% of Medicare Base rate X weight,175.00,58.72,521.5,Fee Schedule,29.8
L139650 RES V 12-25,87633,CPT,,,,,both,, ,175.00,105.00,Aetna,Commercial,,175.00,29.8,29.8% of Medicare Base rate X weight,175.00,58.72,521.5,Fee Schedule,29.8
Q37444 RESP VIR PCR,87633,CPT,,,,,both,, ,1250.34,750.20,Aetna,Commercial,,1250.34,29.8,29.8% of Medicare Base rate X weight,1250.34,419.58,3726.01,Fee Schedule,29.8
RSV DNA/ MA AMP PROB,87634,CPT,,,,,both,, ,157.62,94.57,Aetna,Commercial,,157.62,29.8,29.8% of Medicare Base rate X weight,157.62,52.89,469.71,Fee Schedule,29.8
RSV DNA/ MA AMP PROB,87634,CPT,,,,,both,, ,236.44,141.86,Aetna,Commercial,,236.44,29.8,29.8% of Medicare Base rate X weight,236.44,79.34,704.59,Fee Schedule,29.8
COVID19 PRB,87635,CPT,,,,,both,, ,113.30,67.98,Aetna,Commercial,,113.30,29.8,29.8% of Medicare Base rate X weight,113.30,38.02,337.63,Fee Schedule,29.8
COVID19 PRB,87635,CPT,,,,,both,, ,336.81,202.08,Aetna,Commercial,,336.81,29.8,29.8% of Medicare Base rate X weight,336.81,113.02,1003.69,Fee Schedule,29.8
"STAPH A,DNA,PROBE",87640,CPT,,,,,both,, ,118.16,70.89,Aetna,Commercial,,118.16,29.8,29.8% of Medicare Base rate X weight,118.16,39.65,352.12,Fee Schedule,29.8
"MR-STAPH,DNA,PROBE",87641,CPT,,,,,both,, ,118.16,70.89,Aetna,Commercial,,118.16,29.8,29.8% of Medicare Base rate X weight,118.16,39.65,352.12,Fee Schedule,29.8
"STREP A,DNA,AMP PROB",87651,CPT,,,,,both,, ,78.78,47.26,Aetna,Commercial,,78.78,29.8,29.8% of Medicare Base rate X weight,78.78,26.44,234.76,Fee Schedule,29.8
"STREP A,DNA,AMP PROB",87651,CPT,,,,,both,, ,118.18,70.90,Aetna,Commercial,,118.18,29.8,29.8% of Medicare Base rate X weight,118.18,39.66,352.18,Fee Schedule,29.8
L180021 TVAG AMP PRB,87661,CPT,,,,,both,, ,279.55,167.73,Aetna,Commercial,,279.55,29.8,29.8% of Medicare Base rate X weight,279.55,93.81,833.06,Fee Schedule,29.8
L180021 TVAG AMP PRB,87661,CPT,,,,,both,, ,279.55,167.73,Aetna,Commercial,,279.55,29.8,29.8% of Medicare Base rate X weight,279.55,93.81,833.06,Fee Schedule,29.8
L180021 TVAG AMP PRB,87661,CPT,,,,,both,, ,279.55,167.73,Aetna,Commercial,,279.55,29.8,29.8% of Medicare Base rate X weight,279.55,93.81,833.06,Fee Schedule,29.8
L180021 TVAG AMP PRB,87661,CPT,,,,,both,, ,279.55,167.73,Aetna,Commercial,,279.55,29.8,29.8% of Medicare Base rate X weight,279.55,93.81,833.06,Fee Schedule,29.8
T VAGINALIS AMP,87661,CPT,,,,,both,,,279.55,279.55,Aetna,Commercial,,279.55,29.8,29.8% of Medicare Base rate X weight,279.55,93.81,833.06,Fee Schedule,29.8
Q93870 ZIKA RNA QL,87662,CPT,,,,,both,, ,295.83,177.49,Aetna,Commercial,,295.83,29.8,29.8% of Medicare Base rate X weight,295.83,99.27,881.57,Fee Schedule,29.8
L139650 DET AGNT DNA,87798,CPT,,,,,both,, ,175.00,105.00,Aetna,Commercial,,175.00,29.8,29.8% of Medicare Base rate X weight,175.00,58.72,521.5,Fee Schedule,29.8
L180040 DET AGT NOS,87798,CPT,,,,,both,, ,180.00,108.00,Aetna,Commercial,,180.00,29.8,29.8% of Medicare Base rate X weight,180.00,60.40,536.4,Fee Schedule,29.8
L180060 DET AGT NOS,87798,CPT,,,,,both,, ,696.28,417.76,Aetna,Commercial,,696.28,29.8,29.8% of Medicare Base rate X weight,696.28,233.65,2074.91,Fee Schedule,29.8
L180060 DET AGT NOS,87798,CPT,,,,,both,, ,696.28,417.76,Aetna,Commercial,,696.28,29.8,29.8% of Medicare Base rate X weight,696.28,233.65,2074.91,Fee Schedule,29.8
Q11068DET AGNT DNAAM,87798,CPT,,,,,both,, ,2478.63,1487.17,Aetna,Commercial,,2478.63,29.8,29.8% of Medicare Base rate X weight,2478.63,831.76,7386.32,Fee Schedule,29.8
Q11068DET AGNT DNAAM,87798,CPT,,,,,both,, ,2478.63,1487.17,Aetna,Commercial,,2478.63,29.8,29.8% of Medicare Base rate X weight,2478.63,831.76,7386.32,Fee Schedule,29.8
Q11190 WNVR CSF RT-P,87798,CPT,,,,,both,, ,1011.83,607.09,Aetna,Commercial,,1011.83,29.8,29.8% of Medicare Base rate X weight,1011.83,339.54,3015.25,Fee Schedule,29.8
Q11190 WNVR CSF RT-P,87798,CPT,,,,,both,, ,1011.83,607.09,Aetna,Commercial,,1011.83,29.8,29.8% of Medicare Base rate X weight,1011.83,339.54,3015.25,Fee Schedule,29.8
Q11365DET AGNT DNAAM,87798,CPT,,,,,both,, ,758.95,455.37,Aetna,Commercial,,758.95,29.8,29.8% of Medicare Base rate X weight,758.95,254.68,2261.67,Fee Schedule,29.8
Q15062DET AGNT DNAAM,87798,CPT,,,,,both,, ,1011.83,607.09,Aetna,Commercial,,1011.83,29.8,29.8% of Medicare Base rate X weight,1011.83,339.54,3015.25,Fee Schedule,29.8
Q15062DET AGNT DNAAM,87798,CPT,,,,,both,, ,1011.83,607.09,Aetna,Commercial,,1011.83,29.8,29.8% of Medicare Base rate X weight,1011.83,339.54,3015.25,Fee Schedule,29.8
Q18835 P.JIRO QL PCR,87798,CPT,,,,,both,, ,1011.83,607.09,Aetna,Commercial,,1011.83,29.8,29.8% of Medicare Base rate X weight,1011.83,339.54,3015.25,Fee Schedule,29.8
Q18835 P.JIRO QL PCR,87798,CPT,,,,,both,, ,1011.83,607.09,Aetna,Commercial,,1011.83,29.8,29.8% of Medicare Base rate X weight,1011.83,339.54,3015.25,Fee Schedule,29.8
Q91475 SURESWAB MYCOPLASMA GENITALIUMPCR,87798,CPT,,,,,both,, ,901.25,540.75,Aetna,Commercial,,901.25,29.8,29.8% of Medicare Base rate X weight,901.25,302.43,2685.73,Fee Schedule,29.8
"DETECT AGNT NOS,DNAQ",87799,CPT,,,,,both,, ,454.41,272.64,Aetna,Commercial,,454.41,29.8,29.8% of Medicare Base rate X weight,454.41,152.49,1354.14,Fee Schedule,29.8
Q10186 EBV QT RT-PCR,87799,CPT,,,,,both,, ,454.41,272.64,Aetna,Commercial,,454.41,29.8,29.8% of Medicare Base rate X weight,454.41,152.49,1354.14,Fee Schedule,29.8
Q11274 BKV QT RT-PCR,87799,CPT,,,,,both,, ,454.41,272.64,Aetna,Commercial,,454.41,29.8,29.8% of Medicare Base rate X weight,454.41,152.49,1354.14,Fee Schedule,29.8
"DETECT AGT MULT,DNAA",87801,CPT,,,,,both,, ,715.16,429.09,Aetna,Commercial,,715.16,29.8,29.8% of Medicare Base rate X weight,715.16,239.99,2131.18,Fee Schedule,29.8
L180021 DET AGT MULT,87801,CPT,,,,,both,, ,656.11,393.66,Aetna,Commercial,,656.11,29.8,29.8% of Medicare Base rate X weight,656.11,220.17,1955.21,Fee Schedule,29.8
Q15564LYME RT-PCR SF,87801,CPT,,,,,both,, ,715.16,429.09,Aetna,Commercial,,715.16,29.8,29.8% of Medicare Base rate X weight,715.16,239.99,2131.18,Fee Schedule,29.8
Q15777LYM QL BL RTPC,87801,CPT,,,,,both,, ,715.16,429.09,Aetna,Commercial,,715.16,29.8,29.8% of Medicare Base rate X weight,715.16,239.99,2131.18,Fee Schedule,29.8
INFLUENZA ASSAY W-OP,87804,CPT,,,,,both,, ,30.87,18.52,Aetna,Commercial,,30.87,29.8,29.8% of Medicare Base rate X weight,30.87,10.36,91.99,Fee Schedule,29.8
INFLUENZA ASSAY W-OP,87804,CPT,,,,,both,, ,104.12,62.47,Aetna,Commercial,,104.12,29.8,29.8% of Medicare Base rate X weight,104.12,34.94,310.28,Fee Schedule,29.8
RSV ASSAY W-OPTIC,87807,CPT,,,,,both,, ,44.62,26.77,Aetna,Commercial,,44.62,29.8,29.8% of Medicare Base rate X weight,44.62,14.97,132.97,Fee Schedule,29.8
RSV ASSAY W-OPTIC,87807,CPT,,,,,both,, ,277.86,166.71,Aetna,Commercial,,277.86,29.8,29.8% of Medicare Base rate X weight,277.86,93.24,828.02,Fee Schedule,29.8
STREP A ASSAY W-OPTI,87880,CPT,,,,,both,, ,41.25,24.75,Aetna,Commercial,,41.25,29.8,29.8% of Medicare Base rate X weight,41.25,13.84,122.93,Fee Schedule,29.8
STREP A ASSAY W-OPTI,87880,CPT,,,,,both,, ,285.17,171.10,Aetna,Commercial,,285.17,29.8,29.8% of Medicare Base rate X weight,285.17,95.69,849.81,Fee Schedule,29.8
AGENT NOS ASSAY W-OP,87899,CPT,,,,,both,, ,172.90,103.74,Aetna,Commercial,,172.90,29.8,29.8% of Medicare Base rate X weight,172.90,58.02,515.24,Fee Schedule,29.8
L183009 SPNEU AG U C,87899,CPT,,,,,both,, ,158.62,95.17,Aetna,Commercial,,158.62,29.8,29.8% of Medicare Base rate X weight,158.62,53.23,472.69,Fee Schedule,29.8
L183009 SPNEU AG U C,87899,CPT,,,,,both,, ,158.62,95.17,Aetna,Commercial,,158.62,29.8,29.8% of Medicare Base rate X weight,158.62,53.23,472.69,Fee Schedule,29.8
Q34949 PHENO INF DRG,87900,CPT,,,,,both,, ,773.54,464.12,Aetna,Commercial,,773.54,29.8,29.8% of Medicare Base rate X weight,773.54,259.58,2305.15,Fee Schedule,29.8
Q34949 GENO DNA HIV,87901,CPT,,,,,both,, ,1819.90,1091.94,Aetna,Commercial,,1819.90,29.8,29.8% of Medicare Base rate X weight,1819.90,610.70,5423.3,Fee Schedule,29.8
Q34949 GENO DNA HIV,87901,CPT,,,,,both,, ,1819.90,1091.94,Aetna,Commercial,,1819.90,29.8,29.8% of Medicare Base rate X weight,1819.90,610.70,5423.3,Fee Schedule,29.8
"GENOTYPE,DNA,HEPAT C",87902,CPT,,,,,both,, ,1611.91,967.14,Aetna,Commercial,,1611.91,29.8,29.8% of Medicare Base rate X weight,1611.91,540.91,4803.49,Fee Schedule,29.8
Q37811 HCVRNA GN MPR,87902,CPT,,,,,both,, ,1611.91,967.14,Aetna,Commercial,,1611.91,29.8,29.8% of Medicare Base rate X weight,1611.91,540.91,4803.49,Fee Schedule,29.8
Q92447 HCVG1 NS5A DR,87902,CPT,,,,,both,, ,1611.91,967.14,Aetna,Commercial,,1611.91,29.8,29.8% of Medicare Base rate X weight,1611.91,540.91,4803.49,Fee Schedule,29.8
L551690PHENO DNA HIV,87903,CPT,,,,,both,, ,1465.00,879.00,Aetna,Commercial,,1465.00,29.8,29.8% of Medicare Base rate X weight,1465.00,491.61,4365.7,Fee Schedule,29.8
L551690PHENO DNA HIV,87904,CPT,,,,,both,, ,104.00,62.40,Aetna,Commercial,,104.00,29.8,29.8% of Medicare Base rate X weight,104.00,34.90,309.92,Fee Schedule,29.8
HIV GEN DNA REV OTH,87906,CPT,,,,,both,, ,856.62,513.97,Aetna,Commercial,,856.62,29.8,29.8% of Medicare Base rate X weight,856.62,287.46,2552.73,Fee Schedule,29.8
AUTOPSY COMPL WO-CNS,88020,CPT,,,,,both,, ,3310.55,1986.33,Aetna,Commercial,,3310.55,29.8,29.8% of Medicare Base rate X weight,3310.55,1110.92,9865.44,Fee Schedule,29.8
CYTOPATH FLD NOT V-C,88104,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,109.74,29.8,29.8% of Medicare Base rate X weight,109.74,36.83,327.03,Fee Schedule,29.8
CYTOPATH FLD FTRW-IN,88106,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,109.74,29.8,29.8% of Medicare Base rate X weight,109.74,36.83,327.03,Fee Schedule,29.8
CYTOPATH CONCENT TEC,88108,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,109.74,29.8,29.8% of Medicare Base rate X weight,109.74,36.83,327.03,Fee Schedule,29.8
CYTOCELL ENH X CR-VG,88112,CPT,,,,,both,, ,237.17,142.30,Aetna,Commercial,,237.17,29.8,29.8% of Medicare Base rate X weight,237.17,79.59,706.77,Fee Schedule,29.8
CYTO UR 3-5PROB EA S,88120,CPT,,,,,both,, ,368.80,221.28,Aetna,Commercial,,368.80,29.8,29.8% of Medicare Base rate X weight,368.80,123.76,1099.02,Fee Schedule,29.8
CYTO UR 3-5 PROB CMP,88121,CPT,,,,,both,, ,368.80,221.28,Aetna,Commercial,,368.80,29.8,29.8% of Medicare Base rate X weight,368.80,123.76,1099.02,Fee Schedule,29.8
FORENSIC CYTOPATHOLO,88125,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,109.74,29.8,29.8% of Medicare Base rate X weight,109.74,36.83,327.03,Fee Schedule,29.8
SEX CHROMATIN ID BAR,88130,CPT,,,,,both,, ,144.83,86.89,Aetna,Commercial,,144.83,29.8,29.8% of Medicare Base rate X weight,144.83,48.60,431.59,Fee Schedule,29.8
SEX CHROM ID POLYMOR,88140,CPT,,,,,both,, ,76.90,46.14,Aetna,Commercial,,76.90,29.8,29.8% of Medicare Base rate X weight,76.90,25.81,229.16,Fee Schedule,29.8
L192555 PAP LB,88142,CPT,,,,,both,, ,234.07,140.44,Aetna,Commercial,,234.07,29.8,29.8% of Medicare Base rate X weight,234.07,78.55,697.53,Fee Schedule,29.8
PAP THINLAY LIQ DIAG,88142,CPT,,,,,both,, ,189.74,113.84,Aetna,Commercial,,189.74,29.8,29.8% of Medicare Base rate X weight,189.74,63.67,565.43,Fee Schedule,29.8
CYTOPATH C-V THNLYRE,88143,CPT,,,,,both,, ,189.74,113.84,Aetna,Commercial,,189.74,29.8,29.8% of Medicare Base rate X weight,189.74,63.67,565.43,Fee Schedule,29.8
CYTOP C-V AUTOMATED,88147,CPT,,,,,both,, ,101.60,60.96,Aetna,Commercial,,101.60,29.8,29.8% of Medicare Base rate X weight,101.60,34.09,302.77,Fee Schedule,29.8
CYTOP C-V AUTO RESCR,88148,CPT,,,,,both,, ,101.60,60.96,Aetna,Commercial,,101.60,29.8,29.8% of Medicare Base rate X weight,101.60,34.09,302.77,Fee Schedule,29.8
CYTOPATH C-V MANUAL,88150,CPT,,,,,both,, ,101.60,60.96,Aetna,Commercial,,101.60,29.8,29.8% of Medicare Base rate X weight,101.60,34.09,302.77,Fee Schedule,29.8
CYTOP C-V AUTO REDO,88152,CPT,,,,,both,, ,101.60,60.96,Aetna,Commercial,,101.60,29.8,29.8% of Medicare Base rate X weight,101.60,34.09,302.77,Fee Schedule,29.8
CYTOPATH C-V REDO,88153,CPT,,,,,both,, ,101.60,60.96,Aetna,Commercial,,101.60,29.8,29.8% of Medicare Base rate X weight,101.60,34.09,302.77,Fee Schedule,29.8
CYTOP C-V INDX ADDON,88155,CPT,,,,,both,, ,57.81,34.68,Aetna,Commercial,,57.81,29.8,29.8% of Medicare Base rate X weight,57.81,19.40,172.27,Fee Schedule,29.8
CYTOP SMR OTHR SOURC,88160,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,109.74,29.8,29.8% of Medicare Base rate X weight,109.74,36.83,327.03,Fee Schedule,29.8
CYTOP SMR OTH PRE-SC,88161,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,109.74,29.8,29.8% of Medicare Base rate X weight,109.74,36.83,327.03,Fee Schedule,29.8
CYTOP SMR OTH S5SLID,88162,CPT,,,,,both,, ,237.17,142.30,Aetna,Commercial,,237.17,29.8,29.8% of Medicare Base rate X weight,237.17,79.59,706.77,Fee Schedule,29.8
"CYTOP TBS,C-V,MANUAL",88164,CPT,,,,,both,, ,101.60,60.96,Aetna,Commercial,,101.60,29.8,29.8% of Medicare Base rate X weight,101.60,34.09,302.77,Fee Schedule,29.8
"CYTOP TBS,C-V,REDO",88165,CPT,,,,,both,, ,101.60,60.96,Aetna,Commercial,,101.60,29.8,29.8% of Medicare Base rate X weight,101.60,34.09,302.77,Fee Schedule,29.8
"CYTOP TBS,C-V AUTORE",88166,CPT,,,,,both,, ,101.60,60.96,Aetna,Commercial,,101.60,29.8,29.8% of Medicare Base rate X weight,101.60,34.09,302.77,Fee Schedule,29.8
"CYTOP TBS,C-C,SELECT",88167,CPT,,,,,both,, ,101.60,60.96,Aetna,Commercial,,101.60,29.8,29.8% of Medicare Base rate X weight,101.60,34.09,302.77,Fee Schedule,29.8
CYTOPATH EVAL OF FNA,88172,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,109.74,29.8,29.8% of Medicare Base rate X weight,109.74,36.83,327.03,Fee Schedule,29.8
"CYTOP EVAL,FNA,REPOR",88173,CPT,,,,,both,, ,237.17,142.30,Aetna,Commercial,,237.17,29.8,29.8% of Medicare Base rate X weight,237.17,79.59,706.77,Fee Schedule,29.8
CYTO-CERVICALRP CDM,88174,CPT,,,,,both,, ,205.45,123.27,Aetna,Commercial,,205.45,29.8,29.8% of Medicare Base rate X weight,205.45,68.94,612.24,Fee Schedule,29.8
L199305 PAP AU MN RS,88175,CPT,,,,,both,, ,234.07,140.44,Aetna,Commercial,,234.07,29.8,29.8% of Medicare Base rate X weight,234.07,78.55,697.53,Fee Schedule,29.8
PAP DIAG AUTO MAN RS,88175,CPT,,,,,both,, ,255.13,153.07,Aetna,Commercial,,255.13,29.8,29.8% of Medicare Base rate X weight,255.13,85.61,760.29,Fee Schedule,29.8
Q92090 PAP DIAG AUTO,88175,CPT,,,,,both,, ,227.25,136.35,Aetna,Commercial,,227.25,29.8,29.8% of Medicare Base rate X weight,227.25,76.26,677.21,Fee Schedule,29.8
CYTO EVAL FNA ADD,88177,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,72.13,29.8,29.8% of Medicare Base rate X weight,72.13,24.20,214.95,Fee Schedule,29.8
CELL MRK STDY CY-DNA,88182,CPT,,,,,both,, ,69.89,41.93,Aetna,Commercial,,69.89,29.8,29.8% of Medicare Base rate X weight,69.89,23.45,208.27,Fee Schedule,29.8
Q35080FLOWCY-TC 1MRK,88184,CPT,,,,,both,, ,203.21,121.92,Aetna,Commercial,,203.21,29.8,29.8% of Medicare Base rate X weight,203.21,68.19,605.57,Fee Schedule,29.8
Q35080FLOWCY-TC 1MRK,88184,CPT,,,,,both,, ,203.21,121.92,Aetna,Commercial,,203.21,29.8,29.8% of Medicare Base rate X weight,203.21,68.19,605.57,Fee Schedule,29.8
"FLOWCYTOMETRY-TC,ADD",88185,CPT,,,,,both,, ,195.35,117.21,Aetna,Commercial,,195.35,29.8,29.8% of Medicare Base rate X weight,195.35,65.55,582.14,Fee Schedule,29.8
Q35080 FLOWCY-TC ADD,88185,CPT,,,,,both,, ,60.00,36.00,Aetna,Commercial,,60.00,29.8,29.8% of Medicare Base rate X weight,60.00,20.13,178.8,Fee Schedule,29.8
A3001780 FLWCY 16MRK,88189,CPT,,,,,both,, ,360.00,216.00,Aetna,Commercial,,360.00,29.8,29.8% of Medicare Base rate X weight,360.00,120.81,1072.8,Fee Schedule,29.8
CYTOPATHOLOGY PROCED,88199,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,72.13,29.8,29.8% of Medicare Base rate X weight,72.13,24.20,214.95,Fee Schedule,29.8
Q14596 TISSUE CULT L,88230,CPT,,,,,both,, ,3469.98,2081.98,Aetna,Commercial,,3469.98,29.8,29.8% of Medicare Base rate X weight,3469.98,1164.42,10340.54,Fee Schedule,29.8
Q14596 TISSUE CULT L,88230,CPT,,,,,both,, ,3469.98,2081.98,Aetna,Commercial,,3469.98,29.8,29.8% of Medicare Base rate X weight,3469.98,1164.42,10340.54,Fee Schedule,29.8
TISSUE CULT SKIN/BIO,88233,CPT,,,,,both,, ,1353.98,812.38,Aetna,Commercial,,1353.98,29.8,29.8% of Medicare Base rate X weight,1353.98,454.36,4034.86,Fee Schedule,29.8
"TISSUE CULT, PLACENT",88235,CPT,,,,,both,, ,1416.56,849.93,Aetna,Commercial,,1416.56,29.8,29.8% of Medicare Base rate X weight,1416.56,475.36,4221.35,Fee Schedule,29.8
Q14600 TIS CUL BM,88237,CPT,,,,,both,, ,849.04,509.42,Aetna,Commercial,,849.04,29.8,29.8% of Medicare Base rate X weight,849.04,284.91,2530.14,Fee Schedule,29.8
Q14600 TIS CUL BM,88237,CPT,,,,,both,, ,849.04,509.42,Aetna,Commercial,,849.04,29.8,29.8% of Medicare Base rate X weight,849.04,284.91,2530.14,Fee Schedule,29.8
TISSUE CULTURE TUMOR,88239,CPT,,,,,both,, ,1419.09,851.45,Aetna,Commercial,,1419.09,29.8,29.8% of Medicare Base rate X weight,1419.09,476.20,4228.89,Fee Schedule,29.8
CELL CRYOPRESERV-STO,88240,CPT,,,,,both,, ,97.11,58.26,Aetna,Commercial,,97.11,29.8,29.8% of Medicare Base rate X weight,97.11,32.59,289.39,Fee Schedule,29.8
FROZEN CELL PREPARAT,88241,CPT,,,,,both,, ,97.11,58.26,Aetna,Commercial,,97.11,29.8,29.8% of Medicare Base rate X weight,97.11,32.59,289.39,Fee Schedule,29.8
CHROMOSOME ANAL20-25,88245,CPT,,,,,both,, ,1397.47,838.48,Aetna,Commercial,,1397.47,29.8,29.8% of Medicare Base rate X weight,1397.47,468.95,4164.46,Fee Schedule,29.8
CHROMOSOM ANAL50-100,88248,CPT,,,,,both,, ,1666.09,999.65,Aetna,Commercial,,1666.09,29.8,29.8% of Medicare Base rate X weight,1666.09,559.09,4964.95,Fee Schedule,29.8
CHROMOSOME ANALYS100,88249,CPT,,,,,both,, ,1666.09,999.65,Aetna,Commercial,,1666.09,29.8,29.8% of Medicare Base rate X weight,1666.09,559.09,4964.95,Fee Schedule,29.8
CHROMOSOME ANALYS  5,88261,CPT,,,,,both,, ,1700.32,1020.19,Aetna,Commercial,,1700.32,29.8,29.8% of Medicare Base rate X weight,1700.32,570.58,5066.95,Fee Schedule,29.8
CHROMOSOME ANAL15-20,88262,CPT,,,,,both,, ,4292.64,2575.58,Aetna,Commercial,,4292.64,29.8,29.8% of Medicare Base rate X weight,4292.64,1440.48,12792.07,Fee Schedule,29.8
Q14596 CHR AN 15-20,88262,CPT,,,,,both,, ,1010.00,606.00,Aetna,Commercial,,1010.00,29.8,29.8% of Medicare Base rate X weight,1010.00,338.93,3009.8,Fee Schedule,29.8
CHROMOSOME ANALYS 45,88263,CPT,,,,,both,, ,1445.75,867.45,Aetna,Commercial,,1445.75,29.8,29.8% of Medicare Base rate X weight,1445.75,485.15,4308.34,Fee Schedule,29.8
Q14600 CHRM AN 20-25,88264,CPT,,,,,both,, ,2107.59,1264.55,Aetna,Commercial,,2107.59,29.8,29.8% of Medicare Base rate X weight,2107.59,707.24,6280.62,Fee Schedule,29.8
Q14600 CHRM AN 20-25,88264,CPT,,,,,both,, ,2107.59,1264.55,Aetna,Commercial,,2107.59,29.8,29.8% of Medicare Base rate X weight,2107.59,707.24,6280.62,Fee Schedule,29.8
CHROMOSOME ANAL-PLAC,88267,CPT,,,,,both,, ,1729.51,1037.70,Aetna,Commercial,,1729.51,29.8,29.8% of Medicare Base rate X weight,1729.51,580.37,5153.94,Fee Schedule,29.8
CHROMOSOM ANAL AMNIO,88269,CPT,,,,,both,, ,1600.13,960.07,Aetna,Commercial,,1600.13,29.8,29.8% of Medicare Base rate X weight,1600.13,536.96,4768.39,Fee Schedule,29.8
Q12070 CYTOGEN PRO,88271,CPT,,,,,both,, ,525.70,315.42,Aetna,Commercial,,525.70,29.8,29.8% of Medicare Base rate X weight,525.70,176.41,1566.59,Fee Schedule,29.8
Q12070 CYTOGEN PRO,88271,CPT,,,,,both,, ,525.70,315.42,Aetna,Commercial,,525.70,29.8,29.8% of Medicare Base rate X weight,525.70,176.41,1566.59,Fee Schedule,29.8
CYTOGENETICS 3-5,88272,CPT,,,,,both,, ,243.63,146.17,Aetna,Commercial,,243.63,29.8,29.8% of Medicare Base rate X weight,243.63,81.76,726.02,Fee Schedule,29.8
CYTOGENETICS 25-99,88274,CPT,,,,,both,, ,336.52,201.91,Aetna,Commercial,,336.52,29.8,29.8% of Medicare Base rate X weight,336.52,112.93,1002.83,Fee Schedule,29.8
Q12070CYTOGN 100-300,88275,CPT,,,,,both,, ,1078.63,647.17,Aetna,Commercial,,1078.63,29.8,29.8% of Medicare Base rate X weight,1078.63,361.96,3214.32,Fee Schedule,29.8
Q12070CYTOGN 100-300,88275,CPT,,,,,both,, ,1078.63,647.17,Aetna,Commercial,,1078.63,29.8,29.8% of Medicare Base rate X weight,1078.63,361.96,3214.32,Fee Schedule,29.8
CHROMOSOME KARYOT ST,88280,CPT,,,,,both,, ,962.71,577.62,Aetna,Commercial,,962.71,29.8,29.8% of Medicare Base rate X weight,962.71,323.06,2868.88,Fee Schedule,29.8
CHROMOSOM BANDINGSTU,88283,CPT,,,,,both,, ,375.26,225.15,Aetna,Commercial,,375.26,29.8,29.8% of Medicare Base rate X weight,375.26,125.93,1118.27,Fee Schedule,29.8
CHROMOSOME CT ADDITI,88285,CPT,,,,,both,, ,182.71,109.62,Aetna,Commercial,,182.71,29.8,29.8% of Medicare Base rate X weight,182.71,61.31,544.48,Fee Schedule,29.8
CHROMOS STDY ADD HIG,88289,CPT,,,,,both,, ,284.04,170.42,Aetna,Commercial,,284.04,29.8,29.8% of Medicare Base rate X weight,284.04,95.32,846.44,Fee Schedule,29.8
CYTOGENETIC STUDY,88299,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,72.13,29.8,29.8% of Medicare Base rate X weight,72.13,24.20,214.95,Fee Schedule,29.8
SURG PATH GROSS LVL1,88300,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,72.13,29.8,29.8% of Medicare Base rate X weight,72.13,24.20,214.95,Fee Schedule,29.8
SURG PATH GROSS LVL2,88302,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,109.74,29.8,29.8% of Medicare Base rate X weight,109.74,36.83,327.03,Fee Schedule,29.8
SURG PATH GROSS LVL3,88304,CPT,,,,,both,, ,237.17,142.30,Aetna,Commercial,,237.17,29.8,29.8% of Medicare Base rate X weight,237.17,79.59,706.77,Fee Schedule,29.8
SURG PATH GROSS LVL4,88305,CPT,,,,,both,, ,398.27,238.96,Aetna,Commercial,,398.27,29.8,29.8% of Medicare Base rate X weight,398.27,133.65,1186.84,Fee Schedule,29.8
SURG PATH GROSS LVL5,88307,CPT,,,,,both,, ,368.80,221.28,Aetna,Commercial,,368.80,29.8,29.8% of Medicare Base rate X weight,368.80,123.76,1099.02,Fee Schedule,29.8
SURG PATH GROSS LVL6,88309,CPT,,,,,both,, ,368.80,221.28,Aetna,Commercial,,368.80,29.8,29.8% of Medicare Base rate X weight,368.80,123.76,1099.02,Fee Schedule,29.8
DECALCIFY TISSUE,88311,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,72.13,29.8,29.8% of Medicare Base rate X weight,72.13,24.20,214.95,Fee Schedule,29.8
SPECIAL STAINS GRP 1,88312,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,109.74,29.8,29.8% of Medicare Base rate X weight,109.74,36.83,327.03,Fee Schedule,29.8
SPECIAL STAINS GRP 2,88313,CPT,,,,,both,, ,33.68,20.20,Aetna,Commercial,,33.68,29.8,29.8% of Medicare Base rate X weight,33.68,11.30,100.37,Fee Schedule,29.8
SPECIAL STAINS GRP 2,88313,CPT,,,,,both,, ,241.94,145.16,Aetna,Commercial,,241.94,29.8,29.8% of Medicare Base rate X weight,241.94,81.19,720.98,Fee Schedule,29.8
HISTOCHEMICAL STAIN,88314,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,109.74,29.8,29.8% of Medicare Base rate X weight,109.74,36.83,327.03,Fee Schedule,29.8
ENZYME HISTOCHEMISTR,88319,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,109.74,29.8,29.8% of Medicare Base rate X weight,109.74,36.83,327.03,Fee Schedule,29.8
MICROSLIDE-CONSULN-P,88321,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,109.74,29.8,29.8% of Medicare Base rate X weight,109.74,36.83,327.03,Fee Schedule,29.8
MICROSLID CONSUL-W-P,88323,CPT,,,,,both,, ,237.17,142.30,Aetna,Commercial,,237.17,29.8,29.8% of Medicare Base rate X weight,237.17,79.59,706.77,Fee Schedule,29.8
COMPRE REVIEW OFDATA,88325,CPT,,,,,both,, ,368.80,221.28,Aetna,Commercial,,368.80,29.8,29.8% of Medicare Base rate X weight,368.80,123.76,1099.02,Fee Schedule,29.8
PATH CONSULT INTROP,88329,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,109.74,29.8,29.8% of Medicare Base rate X weight,109.74,36.83,327.03,Fee Schedule,29.8
PATH CONSULT INT-1BL,88331,CPT,,,,,both,, ,237.17,142.30,Aetna,Commercial,,237.17,29.8,29.8% of Medicare Base rate X weight,237.17,79.59,706.77,Fee Schedule,29.8
PATH CONSULT-INTRADD,88332,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,72.13,29.8,29.8% of Medicare Base rate X weight,72.13,24.20,214.95,Fee Schedule,29.8
INOP CYTOPAT CNSLT 1,88333,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,109.74,29.8,29.8% of Medicare Base rate X weight,109.74,36.83,327.03,Fee Schedule,29.8
INOP CYTOPAT CNSLT 2,88334,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,109.74,29.8,29.8% of Medicare Base rate X weight,109.74,36.83,327.03,Fee Schedule,29.8
ICC ADD AB PER SLIDE,88341,CPT,,,,,both,, ,238.01,142.80,Aetna,Commercial,,238.01,29.8,29.8% of Medicare Base rate X weight,238.01,79.87,709.27,Fee Schedule,29.8
1ST SEP ID AB,88342,CPT,,,,,both,, ,238.01,142.80,Aetna,Commercial,,238.01,29.8,29.8% of Medicare Base rate X weight,238.01,79.87,709.27,Fee Schedule,29.8
ICC MLTPX AB ST,88344,CPT,,,,,both,, ,221.17,132.70,Aetna,Commercial,,221.17,29.8,29.8% of Medicare Base rate X weight,221.17,74.22,659.09,Fee Schedule,29.8
IMF SPEC 1ST AB ST,88346,CPT,,,,,both,, ,270.57,162.34,Aetna,Commercial,,270.57,29.8,29.8% of Medicare Base rate X weight,270.57,90.80,806.3,Fee Schedule,29.8
ELECTRON MICROSCOPY,88348,CPT,,,,,both,, ,2028.15,1216.89,Aetna,Commercial,,2028.15,29.8,29.8% of Medicare Base rate X weight,2028.15,680.59,6043.89,Fee Schedule,29.8
IMF/SPEC ADD AB ST,88350,CPT,,,,,both,, ,270.57,162.34,Aetna,Commercial,,270.57,29.8,29.8% of Medicare Base rate X weight,270.57,90.80,806.3,Fee Schedule,29.8
ANALYSIS SKELET MUSC,88355,CPT,,,,,both,, ,237.17,142.30,Aetna,Commercial,,237.17,29.8,29.8% of Medicare Base rate X weight,237.17,79.59,706.77,Fee Schedule,29.8
ANALYSIS NERVE,88356,CPT,,,,,both,, ,368.80,221.28,Aetna,Commercial,,368.80,29.8,29.8% of Medicare Base rate X weight,368.80,123.76,1099.02,Fee Schedule,29.8
ANALYSIS TUMOR,88358,CPT,,,,,both,, ,237.17,142.30,Aetna,Commercial,,237.17,29.8,29.8% of Medicare Base rate X weight,237.17,79.59,706.77,Fee Schedule,29.8
TUMOR IHC QT MAN,88360,CPT,,,,,both,, ,1468.77,881.26,Aetna,Commercial,,1468.77,29.8,29.8% of Medicare Base rate X weight,1468.77,492.88,4376.93,Fee Schedule,29.8
TUMOR IHC QT UTO,88361,CPT,,,,,both,, ,1468.77,881.26,Aetna,Commercial,,1468.77,29.8,29.8% of Medicare Base rate X weight,1468.77,492.88,4376.93,Fee Schedule,29.8
NERVE TEASING PREPAR,88362,CPT,,,,,both,, ,368.80,221.28,Aetna,Commercial,,368.80,29.8,29.8% of Medicare Base rate X weight,368.80,123.76,1099.02,Fee Schedule,29.8
XM ARCHIVE TIS MOLEC,88363,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,72.13,29.8,29.8% of Medicare Base rate X weight,72.13,24.20,214.95,Fee Schedule,29.8
TIS HYBRD AD SNG PRB,88364,CPT,,,,,both,, ,230.71,138.42,Aetna,Commercial,,230.71,29.8,29.8% of Medicare Base rate X weight,230.71,77.42,687.52,Fee Schedule,29.8
TIS HYBRD SPEC INIT,88365,CPT,,,,,both,, ,304.81,182.88,Aetna,Commercial,,304.81,29.8,29.8% of Medicare Base rate X weight,304.81,102.29,908.33,Fee Schedule,29.8
INS HYBR AUT SP INIT,88367,CPT,,,,,both,, ,220.05,132.03,Aetna,Commercial,,220.05,29.8,29.8% of Medicare Base rate X weight,220.05,73.84,655.75,Fee Schedule,29.8
INS HYBRD MAN SP INI,88368,CPT,,,,,both,, ,342.70,205.62,Aetna,Commercial,,342.70,29.8,29.8% of Medicare Base rate X weight,342.70,115.00,1021.25,Fee Schedule,29.8
INS HYBRD MAN SNG PR,88369,CPT,,,,,both,, ,342.70,205.62,Aetna,Commercial,,342.70,29.8,29.8% of Medicare Base rate X weight,342.70,115.00,1021.25,Fee Schedule,29.8
PROTEIN-WEST BLOTTIS,88371,CPT,,,,,both,, ,209.38,125.62,Aetna,Commercial,,209.38,29.8,29.8% of Medicare Base rate X weight,209.38,70.26,623.95,Fee Schedule,29.8
PROTEIN ANALYSW/PROB,88372,CPT,,,,,both,, ,218.93,131.35,Aetna,Commercial,,218.93,29.8,29.8% of Medicare Base rate X weight,218.93,73.47,652.41,Fee Schedule,29.8
INS HYBR AUT SNG PR,88373,CPT,,,,,both,, ,220.05,132.03,Aetna,Commercial,,220.05,29.8,29.8% of Medicare Base rate X weight,220.05,73.84,655.75,Fee Schedule,29.8
INS HYBR AUT MUL PR,88374,CPT,,,,,both,, ,220.05,132.03,Aetna,Commercial,,220.05,29.8,29.8% of Medicare Base rate X weight,220.05,73.84,655.75,Fee Schedule,29.8
INS HYBR MAN MUL PR,88377,CPT,,,,,both,, ,342.70,205.62,Aetna,Commercial,,342.70,29.8,29.8% of Medicare Base rate X weight,342.70,115.00,1021.25,Fee Schedule,29.8
MICRODISSECTION MANU,88381,CPT,,,,,both,, ,424.38,254.62,Aetna,Commercial,,424.38,29.8,29.8% of Medicare Base rate X weight,424.38,142.41,1264.65,Fee Schedule,29.8
SURGICAL PATH PROCED,88399,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,72.13,29.8,29.8% of Medicare Base rate X weight,72.13,24.20,214.95,Fee Schedule,29.8
BILIRUBIN TOT TRANS,88720,CPT,,,,,both,, ,75.22,45.13,Aetna,Commercial,,75.22,29.8,29.8% of Medicare Base rate X weight,75.22,25.24,224.16,Fee Schedule,29.8
CELL CTW-DIF BODYFLU,89051,CPT,,,,,both,, ,54.17,32.50,Aetna,Commercial,,54.17,29.8,29.8% of Medicare Base rate X weight,54.17,18.18,161.43,Fee Schedule,29.8
CELL CTW-DIF BODYFLU,89051,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,691.29,29.8,29.8% of Medicare Base rate X weight,691.29,231.98,2060.04,Fee Schedule,29.8
LEUKOCY ASSES FEC QL,89055,CPT,,,,,both,, ,109.46,65.67,Aetna,Commercial,,109.46,29.8,29.8% of Medicare Base rate X weight,109.46,36.73,326.19,Fee Schedule,29.8
CRYSTALS SYNOVIAL FLD,89060,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
CRYSTALS SYNOVIAL FLD,89060,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,345.79,29.8,29.8% of Medicare Base rate X weight,345.79,116.04,1030.45,Fee Schedule,29.8
NASAL SMEAR-EOSINOPH,89190,CPT,,,,,both,, ,518.69,311.21,Aetna,Commercial,,518.69,29.8,29.8% of Medicare Base rate X weight,518.69,174.06,1545.7,Fee Schedule,29.8
UNL MISC PATH TEST,89240,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,72.13,29.8,29.8% of Medicare Base rate X weight,72.13,24.20,214.95,Fee Schedule,29.8
SEMEN ANYL PRES-M-S,89321,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,526.26,29.8,29.8% of Medicare Base rate X weight,526.26,176.60,1568.25,Fee Schedule,29.8
HEPATITIS B GLOB IM,90371,CPT,,,,,both,, ,679.03,407.41,Aetna,Commercial,,679.03,29.8,29.8% of Medicare Base rate X weight,679.03,227.86,2023.51,Fee Schedule,29.8
HEPATITIS B GLOB IM,90371,CPT,,,,,both,1,ML,953.00,571.80,Aetna,Commercial,,953.00,29.8,29.8% of Medicare Base rate X weight,953.00,319.80,2839.94,Fee Schedule,29.8
RABIES IG IM/SC 150U,90375,CPT,,,,,both,3,ML,414.33,248.59,Aetna,Commercial,,414.33,29.8,29.8% of Medicare Base rate X weight,414.33,139.04,1234.7,Fee Schedule,29.8
RABIES IG IM/SC 150U,90375,CPT,,,,,both,, ,1385.09,831.05,Aetna,Commercial,,1385.09,29.8,29.8% of Medicare Base rate X weight,1385.09,464.80,4127.57,Fee Schedule,29.8
RABIES IG IM/SC 150U,90375,CPT,,,,,both,, ,1428.35,857.01,Aetna,Commercial,,1428.35,29.8,29.8% of Medicare Base rate X weight,1428.35,479.31,4256.48,Fee Schedule,29.8
RABIES IG IM/SC 150U,90375,HCPCS,,,,,both,5,ML,1867.13,1120.27,Aetna,Commercial,,1867.13,29.8,29.8% of Medicare Base rate X weight,1867.13,626.55,5564.05,Fee Schedule,29.8
RABIES IG IM/SC 150U,90375,HCPCS,,,,,both,1,ML,2044.81,1226.88,Aetna,Commercial,,2044.81,29.8,29.8% of Medicare Base rate X weight,2044.81,686.18,6093.53,Fee Schedule,29.8
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,143.69,86.21,Aetna,Commercial,,143.69,29.8,29.8% of Medicare Base rate X weight,143.69,48.22,428.2,Fee Schedule,29.8
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,230.72,138.43,Aetna,Commercial,,230.72,29.8,29.8% of Medicare Base rate X weight,230.72,77.42,687.55,Fee Schedule,29.8
IMM ADM INJ SINGLE,90471,CPT,,,,,both,, ,162.25,97.35,Aetna,Commercial,,162.25,29.8,29.8% of Medicare Base rate X weight,162.25,54.45,483.51,Fee Schedule,29.8
IMM ADM INJ SINGLE,90471,CPT,,,,,both,, ,162.25,97.35,Aetna,Commercial,,162.25,29.8,29.8% of Medicare Base rate X weight,162.25,54.45,483.51,Fee Schedule,29.8
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,119.22,71.53,Aetna,Commercial,,119.22,29.8,29.8% of Medicare Base rate X weight,119.22,40.01,355.28,Fee Schedule,29.8
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,119.22,71.53,Aetna,Commercial,,119.22,29.8,29.8% of Medicare Base rate X weight,119.22,40.01,355.28,Fee Schedule,29.8
IMM ADM INJ EA ADD,90472,CPT,,,,,both,, ,48.75,29.25,Aetna,Commercial,,48.75,29.8,29.8% of Medicare Base rate X weight,48.75,16.36,145.28,Fee Schedule,29.8
IMM ADM INJ EA ADD,90472,CPT,,,,,both,, ,48.75,29.25,Aetna,Commercial,,48.75,29.8,29.8% of Medicare Base rate X weight,48.75,16.36,145.28,Fee Schedule,29.8
HAEMOPH B TETAN INJ,90648,CPT,,,,,both,, ,131.84,79.10,Aetna,Commercial,,131.84,29.8,29.8% of Medicare Base rate X weight,131.84,44.24,392.88,Fee Schedule,29.8
FLU VAC NOPRSV ANTIG,90662,CPT,,,,,both,0.7,ML,434.66,260.79,Aetna,Commercial,,434.66,29.8,29.8% of Medicare Base rate X weight,434.66,145.86,1295.29,Fee Schedule,29.8
PNEUMOCOC 13-VAL IM,90670,CPT,,,,,both,0.5,ML,871.90,523.14,Aetna,Commercial,,871.90,29.8,29.8% of Medicare Base rate X weight,871.90,292.58,2598.26,Fee Schedule,29.8
FLU VAC CCIIV4 PF&AB,90674,CPT,,,,,both,0.5,ML,208.06,124.83,Aetna,Commercial,,208.06,29.8,29.8% of Medicare Base rate X weight,208.06,69.82,620.02,Fee Schedule,29.8
RABIES VAC IM,90675,CPT,,,,,both,1,EA,1856.32,1113.79,Aetna,Commercial,,1856.32,29.8,29.8% of Medicare Base rate X weight,1856.32,622.93,5531.83,Fee Schedule,29.8
RABIES VAC IM,90675,CPT,,,,,both,, ,1941.04,1164.62,Aetna,Commercial,,1941.04,29.8,29.8% of Medicare Base rate X weight,1941.04,651.36,5784.3,Fee Schedule,29.8
FLU VAC QUAD DNA HA,90682,CPT,,,,,both,, ,383.75,230.25,Aetna,Commercial,,383.75,29.8,29.8% of Medicare Base rate X weight,383.75,128.78,1143.58,Fee Schedule,29.8
FLU VACIIV4 PF .5ML,90686,CPT,,,,,both,, ,145.23,87.13,Aetna,Commercial,,145.23,29.8,29.8% of Medicare Base rate X weight,145.23,48.73,432.79,Fee Schedule,29.8
FLU VAC IIV4 .25ML,90687,CPT,,,,,both,, ,135.45,81.27,Aetna,Commercial,,135.45,29.8,29.8% of Medicare Base rate X weight,135.45,45.45,403.64,Fee Schedule,29.8
M-M-R II INJ,90707,CPT,,,,,both,1,EA,471.23,282.73,Aetna,Commercial,,471.23,29.8,29.8% of Medicare Base rate X weight,471.23,158.13,1404.27,Fee Schedule,29.8
TD IM NO PRSRV GE 7Y,90714,CPT,,,,,both,0.5,ML,210.12,126.07,Aetna,Commercial,,210.12,29.8,29.8% of Medicare Base rate X weight,210.12,70.51,626.16,Fee Schedule,29.8
DIPH/TET/ACPERT .5ML,90715,CPT,,,,,both,0.5,ML,350.20,210.12,Aetna,Commercial,,350.20,29.8,29.8% of Medicare Base rate X weight,350.20,117.52,1043.6,Fee Schedule,29.8
DIPH/TET/ACPERT .5ML,90715,CPT,,,,,both,0.5,ML,370.54,222.32,Aetna,Commercial,,370.54,29.8,29.8% of Medicare Base rate X weight,370.54,124.34,1104.21,Fee Schedule,29.8
VARICELLA VIR VAC SC,90716,CPT,,,,,both,1,EA,611.56,366.93,Aetna,Commercial,,611.56,29.8,29.8% of Medicare Base rate X weight,611.56,205.22,1822.45,Fee Schedule,29.8
PNEUMO-VAC 2YR-ADULT,90732,CPT,,,,,both,0.5,ML,544.10,326.46,Aetna,Commercial,,544.10,29.8,29.8% of Medicare Base rate X weight,544.10,182.58,1621.42,Fee Schedule,29.8
HEP B VAC PED,90744,CPT,,,,,both,, ,194.93,116.95,Aetna,Commercial,,194.93,29.8,29.8% of Medicare Base rate X weight,194.93,65.41,580.89,Fee Schedule,29.8
HEP B VAC PED,90744,CPT,,,,,both,0.5,ML,204.97,122.98,Aetna,Commercial,,204.97,29.8,29.8% of Medicare Base rate X weight,204.97,68.78,610.81,Fee Schedule,29.8
INTERACTIVE ADD-ON,90785,CPT,,,,,both,, ,310.80,186.48,Aetna,Commercial,,310.80,29.8,29.8% of Medicare Base rate X weight,310.80,104.30,926.18,Fee Schedule,29.8
PSYCH DIAG EVAL,90791,CPT,,,,,both,, ,249.78,149.86,Aetna,Commercial,,249.78,29.8,29.8% of Medicare Base rate X weight,249.78,83.82,744.34,Fee Schedule,29.8
PSYCH DIAG EVAL,90791,CPT,,,,,both,, ,757.82,454.69,Aetna,Commercial,,757.82,29.8,29.8% of Medicare Base rate X weight,757.82,254.30,2258.3,Fee Schedule,29.8
PSYCHOTHERAPY 30 MIN,90832,CPT,,,,,both,, ,238.96,143.37,Aetna,Commercial,,238.96,29.8,29.8% of Medicare Base rate X weight,238.96,80.19,712.1,Fee Schedule,29.8
"Psychotherapy, 30 min",90832,CPT,,,,,both,,,238.96,238.96,Aetna,Commercial,,238.96,29.8,29.8% of Medicare Base rate X weight,238.96,80.19,712.1,Fee Schedule,29.8
PSYCHOTHER 30M W/E&M,90833,CPT,,,,,both,, ,301.75,181.05,Aetna,Commercial,,301.75,29.8,29.8% of Medicare Base rate X weight,301.75,101.26,899.22,Fee Schedule,29.8
PSYCHOTHERAPY 45 MIN,90834,CPT,,,,,both,, ,299.73,179.83,Aetna,Commercial,,299.73,29.8,29.8% of Medicare Base rate X weight,299.73,100.58,893.2,Fee Schedule,29.8
"Psychotherapy, 45 min",90834,CPT,,,,,both,,,299.73,299.73,Aetna,Commercial,,299.73,29.8,29.8% of Medicare Base rate X weight,299.73,100.58,893.2,Fee Schedule,29.8
PSYCHOTHER 45M W/E&M,90836,CPT,,,,,both,, ,312.25,187.35,Aetna,Commercial,,312.25,29.8,29.8% of Medicare Base rate X weight,312.25,104.78,930.51,Fee Schedule,29.8
PSYCHOTHERAPY 60 MIN,90837,CPT,,,,,both,, ,359.73,215.83,Aetna,Commercial,,359.73,29.8,29.8% of Medicare Base rate X weight,359.73,120.71,1072,Fee Schedule,29.8
"Psychotherapy, 60 min",90837,CPT,,,,,both,,,359.73,359.73,Aetna,Commercial,,359.73,29.8,29.8% of Medicare Base rate X weight,359.73,120.71,1072,Fee Schedule,29.8
PSYCHOTHER 60M W/E&M,90838,CPT,,,,,both,, ,323.75,194.25,Aetna,Commercial,,323.75,29.8,29.8% of Medicare Base rate X weight,323.75,108.64,964.78,Fee Schedule,29.8
FAM THERAPY W/PATIEN,90847,CPT,,,,,both,, ,842.03,505.21,Aetna,Commercial,,842.03,29.8,29.8% of Medicare Base rate X weight,842.03,282.56,2509.25,Fee Schedule,29.8
"Family psychotherapy, including patient, 50 min",90847,CPT,,,,,both,,,842.03,842.03,Aetna,Commercial,,842.03,29.8,29.8% of Medicare Base rate X weight,842.03,282.56,2509.25,Fee Schedule,29.8
MULTI-FAM GRP PSYCH,90849,CPT,,,,,both,, ,396.04,237.62,Aetna,Commercial,,396.04,29.8,29.8% of Medicare Base rate X weight,396.04,132.90,1180.2,Fee Schedule,29.8
Group psychotherapy,90853,CPT,,,,,both,,,220.94,220.94,Aetna,Commercial,,220.94,29.8,29.8% of Medicare Base rate X weight,220.94,74.14,658.4,Fee Schedule,29.8
PSYCH GROUP THERAPY,90853,CPT,,,,,both,, ,220.94,132.56,Aetna,Commercial,,220.94,29.8,29.8% of Medicare Base rate X weight,220.94,74.14,658.4,Fee Schedule,29.8
PSYCH GROUP THERAPY,90853,CPT,,,,,both,, ,689.33,413.59,Aetna,Commercial,,689.33,29.8,29.8% of Medicare Base rate X weight,689.33,231.32,2054.2,Fee Schedule,29.8
MEDICATION MGMT,90863,CPT,,,,,both,, ,294.25,176.55,Aetna,Commercial,,294.25,29.8,29.8% of Medicare Base rate X weight,294.25,98.74,876.87,Fee Schedule,29.8
TMS INITIAL & 1ST TX,90867,CPT,,,,,both,, ,955.84,573.50,Aetna,Commercial,,955.84,29.8,29.8% of Medicare Base rate X weight,955.84,320.75,2848.4,Fee Schedule,29.8
TMS SUBSEQUENT TX,90868,CPT,,,,,both,, ,515.04,309.02,Aetna,Commercial,,515.04,29.8,29.8% of Medicare Base rate X weight,515.04,172.83,1534.82,Fee Schedule,29.8
TMS REMAPPING & TX,90869,CPT,,,,,both,, ,515.04,309.02,Aetna,Commercial,,515.04,29.8,29.8% of Medicare Base rate X weight,515.04,172.83,1534.82,Fee Schedule,29.8
HEMODIALY SING EVAL,90935,CPT,,,,,both,, ,9908.09,5944.85,Aetna,Commercial,,9908.09,29.8,29.8% of Medicare Base rate X weight,9908.09,3324.86,29526.11,Fee Schedule,29.8
OTH DIALY SING EVAL,90945,CPT,,,,,both,, ,4956.88,2974.12,Aetna,Commercial,,4956.88,29.8,29.8% of Medicare Base rate X weight,4956.88,1663.38,14771.5,Fee Schedule,29.8
SP AR MCD TRMT 15MIN,92507,CPT,,,,,both,, ,182.25,109.35,Aetna,Commercial,,182.25,29.8,29.8% of Medicare Base rate X weight,182.25,61.16,543.11,Fee Schedule,29.8
SP-HEAR-TX-INDI VIST,92507,CPT,,,,,both,, ,705.29,423.17,Aetna,Commercial,,705.29,29.8,29.8% of Medicare Base rate X weight,705.29,236.67,2101.76,Fee Schedule,29.8
SP-HEAR-GROUP-VISIT,92508,CPT,,,,,both,, ,324.19,194.51,Aetna,Commercial,,324.19,29.8,29.8% of Medicare Base rate X weight,324.19,108.79,966.09,Fee Schedule,29.8
EV SP FLUENCY 15,92521,CPT,,,,,both,, ,135.50,81.30,Aetna,Commercial,,135.50,29.8,29.8% of Medicare Base rate X weight,135.50,45.47,403.79,Fee Schedule,29.8
EVAL SPEECH FLUENCY,92521,CPT,,,,,both,, ,814.22,488.53,Aetna,Commercial,,814.22,29.8,29.8% of Medicare Base rate X weight,814.22,273.23,2426.38,Fee Schedule,29.8
EV SP PROD 15,92522,CPT,,,,,both,, ,182.25,109.35,Aetna,Commercial,,182.25,29.8,29.8% of Medicare Base rate X weight,182.25,61.16,543.11,Fee Schedule,29.8
EVAL SPEECH SND PROD,92522,CPT,,,,,both,, ,814.22,488.53,Aetna,Commercial,,814.22,29.8,29.8% of Medicare Base rate X weight,814.22,273.23,2426.38,Fee Schedule,29.8
EVAL SP SND PROD CMP,92523,CPT,,,,,both,, ,814.22,488.53,Aetna,Commercial,,814.22,29.8,29.8% of Medicare Base rate X weight,814.22,273.23,2426.38,Fee Schedule,29.8
SP SOUND LANG CMP 15,92523,CPT,,,,,both,, ,182.25,109.35,Aetna,Commercial,,182.25,29.8,29.8% of Medicare Base rate X weight,182.25,61.16,543.11,Fee Schedule,29.8
BEH QL ANAL VOICE 15,92524,CPT,,,,,both,, ,182.25,109.35,Aetna,Commercial,,182.25,29.8,29.8% of Medicare Base rate X weight,182.25,61.16,543.11,Fee Schedule,29.8
BEHAV QL ANAL VOICE,92524,CPT,,,,,both,, ,814.22,488.53,Aetna,Commercial,,814.22,29.8,29.8% of Medicare Base rate X weight,814.22,273.23,2426.38,Fee Schedule,29.8
ORAL FUNC TX-VIS,92526,CPT,,,,,both,, ,705.29,423.17,Aetna,Commercial,,705.29,29.8,29.8% of Medicare Base rate X weight,705.29,236.67,2101.76,Fee Schedule,29.8
EVAL VOICE PROS DEV,92597,CPT,,,,,both,, ,390.11,234.06,Aetna,Commercial,,390.11,29.8,29.8% of Medicare Base rate X weight,390.11,130.91,1162.53,Fee Schedule,29.8
COCHLE IMP INTIL LT7,92601,CPT,,,,,both,, ,854.90,512.94,Aetna,Commercial,,854.90,29.8,29.8% of Medicare Base rate X weight,854.90,286.88,2547.6,Fee Schedule,29.8
SP-EVAL NSG DEV 1STH,92605,CPT,,,,,both,, ,813.70,488.22,Aetna,Commercial,,813.70,29.8,29.8% of Medicare Base rate X weight,813.70,273.05,2424.83,Fee Schedule,29.8
SP-EVAL SP DEV 1STHR,92607,CPT,,,,,both,, ,813.70,488.22,Aetna,Commercial,,813.70,29.8,29.8% of Medicare Base rate X weight,813.70,273.05,2424.83,Fee Schedule,29.8
SP-EVAL SP DEV AD30M,92608,CPT,,,,,both,, ,763.23,457.93,Aetna,Commercial,,763.23,29.8,29.8% of Medicare Base rate X weight,763.23,256.12,2274.43,Fee Schedule,29.8
SP-THER SVC SPCH DEV,92609,CPT,,,,,both,, ,705.29,423.17,Aetna,Commercial,,705.29,29.8,29.8% of Medicare Base rate X weight,705.29,236.67,2101.76,Fee Schedule,29.8
SP-EVAL SWL WO RADOP,92610,CPT,,,,,both,, ,758.08,454.84,Aetna,Commercial,,758.08,29.8,29.8% of Medicare Base rate X weight,758.08,254.39,2259.08,Fee Schedule,29.8
SP-EVAL SWL W-RADOPQ,92611,CPT,,,,,both,, ,862.63,517.57,Aetna,Commercial,,862.63,29.8,29.8% of Medicare Base rate X weight,862.63,289.47,2570.64,Fee Schedule,29.8
AUD EVOKE HR BRD STM,92651,CPT,,,,,both,, ,567.79,340.67,Aetna,Commercial,,567.79,29.8,29.8% of Medicare Base rate X weight,567.79,190.53,1692.01,Fee Schedule,29.8
"IC-PTCA, SINGLE",92920,CPT,,,,,both,, ,65091.11,39054.66,Aetna,Commercial,,65091.11,29.8,29.8% of Medicare Base rate X weight,65091.11,21842.65,193971.51,Fee Schedule,29.8
"IC-PTCA, ADDL",92921,CPT,,,,,both,, ,65091.11,39054.66,Aetna,Commercial,,65091.11,29.8,29.8% of Medicare Base rate X weight,65091.11,21842.65,193971.51,Fee Schedule,29.8
IC-PRQ CRD STN W-ANG,92928,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,88719.05,29.8,29.8% of Medicare Base rate X weight,88719.05,29771.49,264382.77,Fee Schedule,29.8
IC-PRQ STNT W-ANG EA,92929,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,88719.05,29.8,29.8% of Medicare Base rate X weight,88719.05,29771.49,264382.77,Fee Schedule,29.8
IC-PRQ CRD ST-AT-ANG,92933,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,88719.05,29.8,29.8% of Medicare Base rate X weight,88719.05,29771.49,264382.77,Fee Schedule,29.8
IC-PRQ ST-AT-ANG EA,92934,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,88719.05,29.8,29.8% of Medicare Base rate X weight,88719.05,29771.49,264382.77,Fee Schedule,29.8
IC-PRQ RV BYP GRF IN,92937,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,88719.05,29.8,29.8% of Medicare Base rate X weight,88719.05,29771.49,264382.77,Fee Schedule,29.8
IC-PRQ RV BYP GRF AD,92938,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,88719.05,29.8,29.8% of Medicare Base rate X weight,88719.05,29771.49,264382.77,Fee Schedule,29.8
IC-PRQ CARD REV 1 VS,92941,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,88719.05,29.8,29.8% of Medicare Base rate X weight,88719.05,29771.49,264382.77,Fee Schedule,29.8
IC-PRQ REVSC CHR 1VS,92943,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,88719.05,29.8,29.8% of Medicare Base rate X weight,88719.05,29771.49,264382.77,Fee Schedule,29.8
IC-PRQ REVSC CHR ADD,92944,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,88719.05,29.8,29.8% of Medicare Base rate X weight,88719.05,29771.49,264382.77,Fee Schedule,29.8
CPR,92950,CPT,,,,,both,, ,382.90,229.74,Aetna,Commercial,,382.90,29.8,29.8% of Medicare Base rate X weight,382.90,128.49,1141.04,Fee Schedule,29.8
CPR,92950,CPT,,,,,both,, ,382.90,229.74,Aetna,Commercial,,382.90,29.8,29.8% of Medicare Base rate X weight,382.90,128.49,1141.04,Fee Schedule,29.8
CPR,92950,CPT,,,,,both,, ,6031.42,3618.85,Aetna,Commercial,,6031.42,29.8,29.8% of Medicare Base rate X weight,6031.42,2023.97,17973.63,Fee Schedule,29.8
CPR ASSIST (NON ER),92950,CPT,,,,,both,, ,5533.42,3320.05,Aetna,Commercial,,5533.42,29.8,29.8% of Medicare Base rate X weight,5533.42,1856.85,16489.59,Fee Schedule,29.8
NI-TEMP EXT PACE,92953,CPT,,,,,both,, ,4462.48,2677.48,Aetna,Commercial,,4462.48,29.8,29.8% of Medicare Base rate X weight,4462.48,1497.48,13298.19,Fee Schedule,29.8
NI-TEMP EXT PACE,92953,CPT,,,,,both,, ,4864.09,2918.45,Aetna,Commercial,,4864.09,29.8,29.8% of Medicare Base rate X weight,4864.09,1632.24,14494.99,Fee Schedule,29.8
NI-CARDIOVERSION,92960,CPT,,,,,both,, ,4603.59,2762.15,Aetna,Commercial,,4603.59,29.8,29.8% of Medicare Base rate X weight,4603.59,1544.83,13718.7,Fee Schedule,29.8
NI-CARDIOVERSION,92960,CPT,,,,,both,, ,5017.90,3010.74,Aetna,Commercial,,5017.90,29.8,29.8% of Medicare Base rate X weight,5017.90,1683.86,14953.34,Fee Schedule,29.8
"EP-CARDIOVER,INTERN",92961,CPT,,,,,both,, ,2378.01,1426.80,Aetna,Commercial,,2378.01,29.8,29.8% of Medicare Base rate X weight,2378.01,797.99,7086.47,Fee Schedule,29.8
IC-COR THROMBECTOMY,92973,CPT,,,,,both,, ,29086.43,17451.85,Aetna,Commercial,,29086.43,29.8,29.8% of Medicare Base rate X weight,29086.43,9760.55,86677.56,Fee Schedule,29.8
IC-INTRCOR THROMBOL,92975,CPT,,,,,both,, ,18741.62,11244.97,Aetna,Commercial,,18741.62,29.8,29.8% of Medicare Base rate X weight,18741.62,6289.13,55850.03,Fee Schedule,29.8
IC-INTRCOR THROMBOL,92975,CPT,,,,,both,, ,18741.62,11244.97,Aetna,Commercial,,18741.62,29.8,29.8% of Medicare Base rate X weight,18741.62,6289.13,55850.03,Fee Schedule,29.8
"THROMBOLY,CORONRY,IV",92977,CPT,,,,,both,, ,4033.02,2419.81,Aetna,Commercial,,4033.02,29.8,29.8% of Medicare Base rate X weight,4033.02,1353.36,12018.4,Fee Schedule,29.8
"IC-IVUS, INIT",92978,CPT,,,,,both,, ,537.92,322.75,Aetna,Commercial,,537.92,29.8,29.8% of Medicare Base rate X weight,537.92,180.51,1603,Fee Schedule,29.8
"IC-IVUS, ADDL",92979,CPT,,,,,both,, ,433.89,260.33,Aetna,Commercial,,433.89,29.8,29.8% of Medicare Base rate X weight,433.89,145.60,1292.99,Fee Schedule,29.8
EKG 12 LEAD ED STAFF,93005,CPT,,,,,both,, ,1530.84,918.50,Aetna,Commercial,,1530.84,29.8,29.8% of Medicare Base rate X weight,1530.84,513.70,4561.9,Fee Schedule,29.8
EKG 12 LEAD UC STAFF,93005,CPT,,,,,both,, ,65.15,39.09,Aetna,Commercial,,65.15,29.8,29.8% of Medicare Base rate X weight,65.15,21.86,194.15,Fee Schedule,29.8
EKG 12 LEAD UC STAFF,93005,CPT,,,,,both,, ,65.15,39.09,Aetna,Commercial,,65.15,29.8,29.8% of Medicare Base rate X weight,65.15,21.86,194.15,Fee Schedule,29.8
"NI-EKG, 12 LEADS",93005,CPT,,,,,both,, ,714.82,428.89,Aetna,Commercial,,714.82,29.8,29.8% of Medicare Base rate X weight,714.82,239.87,2130.16,Fee Schedule,29.8
NI-STRESS TEST,93017,CPT,,,,,both,, ,5189.40,3113.64,Aetna,Commercial,,5189.40,29.8,29.8% of Medicare Base rate X weight,5189.40,1741.41,15464.41,Fee Schedule,29.8
EP-MICROVOLT T,93025,CPT,,,,,both,, ,1128.62,677.17,Aetna,Commercial,,1128.62,29.8,29.8% of Medicare Base rate X weight,1128.62,378.73,3363.29,Fee Schedule,29.8
"NI-EKG, 1-3 LEADS",93041,CPT,,,,,both,, ,1999.49,1199.69,Aetna,Commercial,,1999.49,29.8,29.8% of Medicare Base rate X weight,1999.49,670.97,5958.48,Fee Schedule,29.8
NI-HOLT RECRD TO48HR,93225,CPT,,,,,both,, ,9701.06,5820.63,Aetna,Commercial,,9701.06,29.8,29.8% of Medicare Base rate X weight,9701.06,3255.39,28909.16,Fee Schedule,29.8
NI-HOLT WSCAN TO48HR,93226,CPT,,,,,both,, ,1596.24,957.74,Aetna,Commercial,,1596.24,29.8,29.8% of Medicare Base rate X weight,1596.24,535.65,4756.8,Fee Schedule,29.8
NI-TTE 2D W DOPP,93306,CPT,,,,,both,, ,12135.98,7281.58,Aetna,Commercial,,12135.98,29.8,29.8% of Medicare Base rate X weight,12135.98,4072.48,36165.22,Fee Schedule,29.8
NI-TTE 2D MM COMP WO,93307,CPT,,,,,both,, ,8910.27,5346.16,Aetna,Commercial,,8910.27,29.8,29.8% of Medicare Base rate X weight,8910.27,2990.02,26552.6,Fee Schedule,29.8
NI-TTE 2D MM LTD WO,93308,CPT,,,,,both,, ,4522.73,2713.63,Aetna,Commercial,,4522.73,29.8,29.8% of Medicare Base rate X weight,4522.73,1517.69,13477.74,Fee Schedule,29.8
NI-TEE COMP 2D MM WO,93312,CPT,,,,,both,, ,9011.21,5406.72,Aetna,Commercial,,9011.21,29.8,29.8% of Medicare Base rate X weight,9011.21,3023.90,26853.41,Fee Schedule,29.8
US-ECHO DOPP COMP AD,93320,CPT,,,,,both,, ,1635.90,981.54,Aetna,Commercial,,1635.90,29.8,29.8% of Medicare Base rate X weight,1635.90,548.96,4874.98,Fee Schedule,29.8
NI-ECHO DOP LTD,93321,CPT,,,,,both,, ,541.78,325.06,Aetna,Commercial,,541.78,29.8,29.8% of Medicare Base rate X weight,541.78,181.81,1614.5,Fee Schedule,29.8
US-ECHO DOP CO FL AD,93325,CPT,,,,,both,, ,616.46,369.87,Aetna,Commercial,,616.46,29.8,29.8% of Medicare Base rate X weight,616.46,206.87,1837.05,Fee Schedule,29.8
US-TTE STRESS WO,93350,CPT,,,,,both,, ,6350.21,3810.12,Aetna,Commercial,,6350.21,29.8,29.8% of Medicare Base rate X weight,6350.21,2130.94,18923.63,Fee Schedule,29.8
CC-RHC,93451,CPT,,,,,both,, ,39597.32,23758.39,Aetna,Commercial,,39597.32,29.8,29.8% of Medicare Base rate X weight,39597.32,13287.69,118000.01,Fee Schedule,29.8
CC-LHC VENT PUNC,93452,CPT,,,,,both,, ,43345.75,26007.45,Aetna,Commercial,,43345.75,29.8,29.8% of Medicare Base rate X weight,43345.75,14545.55,129170.34,Fee Schedule,29.8
Insertion of catheter into left heart for diagnosis,93452,CPT,,,,,both,,,43345.75,43345.75,Aetna,Commercial,,43345.75,29.8,29.8% of Medicare Base rate X weight,43345.75,14545.55,129170.34,Fee Schedule,29.8
CC-R-L CATH LV PUNC,93453,CPT,,,,,both,, ,43345.75,26007.45,Aetna,Commercial,,43345.75,29.8,29.8% of Medicare Base rate X weight,43345.75,14545.55,129170.34,Fee Schedule,29.8
CC-ANGIO CORON ONLY,93454,CPT,,,,,both,, ,34667.23,20800.33,Aetna,Commercial,,34667.23,29.8,29.8% of Medicare Base rate X weight,34667.23,11633.30,103308.35,Fee Schedule,29.8
CC-S-I VNT ATR ANGIO,93455,CPT,,,,,both,, ,36140.38,21684.22,Aetna,Commercial,,36140.38,29.8,29.8% of Medicare Base rate X weight,36140.38,12127.64,107698.33,Fee Schedule,29.8
CC-R HRT CORONRY ART,93456,CPT,,,,,both,, ,74264.29,44558.57,Aetna,Commercial,,74264.29,29.8,29.8% of Medicare Base rate X weight,74264.29,24920.90,221307.58,Fee Schedule,29.8
CC-R HRT ART-GRF ANG,93457,CPT,,,,,both,, ,75737.70,45442.62,Aetna,Commercial,,75737.70,29.8,29.8% of Medicare Base rate X weight,75737.70,25415.34,225698.35,Fee Schedule,29.8
CC-L HRT ARTERY-VENT,93458,CPT,,,,,both,, ,49262.84,29557.70,Aetna,Commercial,,49262.84,29.8,29.8% of Medicare Base rate X weight,49262.84,16531.15,146803.26,Fee Schedule,29.8
CC-L HRT ART-GRF ANG,93459,CPT,,,,,both,, ,50736.00,30441.60,Aetna,Commercial,,50736.00,29.8,29.8% of Medicare Base rate X weight,50736.00,17025.50,151193.28,Fee Schedule,29.8
CC-R-L HRT ART-VENT,93460,CPT,,,,,both,, ,49262.84,29557.70,Aetna,Commercial,,49262.84,29.8,29.8% of Medicare Base rate X weight,49262.84,16531.15,146803.26,Fee Schedule,29.8
CC-R-L HRT ART-ANGIO,93461,CPT,,,,,both,, ,50736.00,30441.60,Aetna,Commercial,,50736.00,29.8,29.8% of Medicare Base rate X weight,50736.00,17025.50,151193.28,Fee Schedule,29.8
CC-DRUM ADM-HEMODYNC,93463,CPT,,,,,both,, ,451.91,271.14,Aetna,Commercial,,451.91,29.8,29.8% of Medicare Base rate X weight,451.91,151.65,1346.69,Fee Schedule,29.8
INSERTION FLOW CATH,93503,CPT,,,,,both,, ,13163.66,7898.19,Aetna,Commercial,,13163.66,29.8,29.8% of Medicare Base rate X weight,13163.66,4417.34,39227.71,Fee Schedule,29.8
CC-INJ L VENT-ATRIAL,93565,CPT,,,,,both,, ,3748.43,2249.05,Aetna,Commercial,,3748.43,29.8,29.8% of Medicare Base rate X weight,3748.43,1257.86,11170.32,Fee Schedule,29.8
CC-INJ R VENT-ATRIAL,93566,CPT,,,,,both,, ,3252.48,1951.48,Aetna,Commercial,,3252.48,29.8,29.8% of Medicare Base rate X weight,3252.48,1091.44,9692.39,Fee Schedule,29.8
CC-INJ SUPRV AORTOGR,93567,CPT,,,,,both,, ,5119.62,3071.77,Aetna,Commercial,,5119.62,29.8,29.8% of Medicare Base rate X weight,5119.62,1717.99,15256.47,Fee Schedule,29.8
CC-INJ PULM ART HRTC,93568,CPT,,,,,both,, ,5119.62,3071.77,Aetna,Commercial,,5119.62,29.8,29.8% of Medicare Base rate X weight,5119.62,1717.99,15256.47,Fee Schedule,29.8
HEART FLOW MEASURE,93571,CPT,,,,,both,, ,709.67,425.80,Aetna,Commercial,,709.67,29.8,29.8% of Medicare Base rate X weight,709.67,238.14,2114.82,Fee Schedule,29.8
HEART FLOW MEAS ADD,93572,CPT,,,,,both,, ,709.67,425.80,Aetna,Commercial,,709.67,29.8,29.8% of Medicare Base rate X weight,709.67,238.14,2114.82,Fee Schedule,29.8
CC-PDA CLOSE PERC,93582,CPT,,,,,both,, ,68501.18,41100.70,Aetna,Commercial,,68501.18,29.8,29.8% of Medicare Base rate X weight,68501.18,22986.97,204133.52,Fee Schedule,29.8
EP-HIS BUNDLE REC,93600,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,4670.54,29.8,29.8% of Medicare Base rate X weight,4670.54,1567.30,13918.21,Fee Schedule,29.8
EP-INTRAATRIAL REC,93602,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,4670.54,29.8,29.8% of Medicare Base rate X weight,4670.54,1567.30,13918.21,Fee Schedule,29.8
EP-RV RECORD,93603,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,4670.54,29.8,29.8% of Medicare Base rate X weight,4670.54,1567.30,13918.21,Fee Schedule,29.8
EP-MAP TACHY,93609,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,4670.54,29.8,29.8% of Medicare Base rate X weight,4670.54,1567.30,13918.21,Fee Schedule,29.8
EP-INTRAATRIAL PAC,93610,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,4670.54,29.8,29.8% of Medicare Base rate X weight,4670.54,1567.30,13918.21,Fee Schedule,29.8
EP-INTRAVENT PAC,93612,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,4670.54,29.8,29.8% of Medicare Base rate X weight,4670.54,1567.30,13918.21,Fee Schedule,29.8
EP-MAP ADD,93613,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,4670.54,29.8,29.8% of Medicare Base rate X weight,4670.54,1567.30,13918.21,Fee Schedule,29.8
EP-ATRI RECORD ESO,93615,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,4670.54,29.8,29.8% of Medicare Base rate X weight,4670.54,1567.30,13918.21,Fee Schedule,29.8
EP-ATRI REC-PAC ESO,93616,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,4670.54,29.8,29.8% of Medicare Base rate X weight,4670.54,1567.30,13918.21,Fee Schedule,29.8
EP-INDUC ARRY PAC,93618,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,4670.54,29.8,29.8% of Medicare Base rate X weight,4670.54,1567.30,13918.21,Fee Schedule,29.8
EP-COMP EP W-O ARRY,93619,CPT,,,,,both,, ,22625.50,13575.30,Aetna,Commercial,,22625.50,29.8,29.8% of Medicare Base rate X weight,22625.50,7592.45,67423.99,Fee Schedule,29.8
EP-COMP EP W- ARRY,93620,CPT,,,,,both,, ,22625.50,13575.30,Aetna,Commercial,,22625.50,29.8,29.8% of Medicare Base rate X weight,22625.50,7592.45,67423.99,Fee Schedule,29.8
"EP-LA PACING, ADD",93621,CPT,,,,,both,, ,22625.50,13575.30,Aetna,Commercial,,22625.50,29.8,29.8% of Medicare Base rate X weight,22625.50,7592.45,67423.99,Fee Schedule,29.8
"EP-LV PACING, ADD",93622,CPT,,,,,both,, ,22625.50,13575.30,Aetna,Commercial,,22625.50,29.8,29.8% of Medicare Base rate X weight,22625.50,7592.45,67423.99,Fee Schedule,29.8
EP-PROG STIM IV DRUG,93623,CPT,,,,,both,, ,22625.50,13575.30,Aetna,Commercial,,22625.50,29.8,29.8% of Medicare Base rate X weight,22625.50,7592.45,67423.99,Fee Schedule,29.8
EP-F-U EPW-ARRY IND,93624,CPT,,,,,both,, ,22625.50,13575.30,Aetna,Commercial,,22625.50,29.8,29.8% of Medicare Base rate X weight,22625.50,7592.45,67423.99,Fee Schedule,29.8
EP-INTRA OP MAPPNG,93631,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,4670.54,29.8,29.8% of Medicare Base rate X weight,4670.54,1567.30,13918.21,Fee Schedule,29.8
"EP-EVAL LEAD,INDUC",93640,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,4670.54,29.8,29.8% of Medicare Base rate X weight,4670.54,1567.30,13918.21,Fee Schedule,29.8
"EP-EVAL GEN, INDUC",93641,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,4670.54,29.8,29.8% of Medicare Base rate X weight,4670.54,1567.30,13918.21,Fee Schedule,29.8
EP-EVAL PREV DEVICE,93642,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,4670.54,29.8,29.8% of Medicare Base rate X weight,4670.54,1567.30,13918.21,Fee Schedule,29.8
EP-ABLATE AV NODE,93650,CPT,,,,,both,, ,22625.50,13575.30,Aetna,Commercial,,22625.50,29.8,29.8% of Medicare Base rate X weight,22625.50,7592.45,67423.99,Fee Schedule,29.8
EP-ABLATE SPRVNT ART,93653,CPT,,,,,both,, ,46220.99,27732.59,Aetna,Commercial,,46220.99,29.8,29.8% of Medicare Base rate X weight,46220.99,15510.40,137738.55,Fee Schedule,29.8
EP-ABLATE VENT TACY,93654,CPT,,,,,both,, ,46220.99,27732.59,Aetna,Commercial,,46220.99,29.8,29.8% of Medicare Base rate X weight,46220.99,15510.40,137738.55,Fee Schedule,29.8
EP-ATR FIB PULM VN I,93656,CPT,,,,,both,, ,46220.99,27732.59,Aetna,Commercial,,46220.99,29.8,29.8% of Medicare Base rate X weight,46220.99,15510.40,137738.55,Fee Schedule,29.8
EP-INTCRD ECHO INTER,93662,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,4670.54,29.8,29.8% of Medicare Base rate X weight,4670.54,1567.30,13918.21,Fee Schedule,29.8
PAD REHB PER SESSION,93668,CPT,,,,,both,, ,169.18,101.50,Aetna,Commercial,,169.18,29.8,29.8% of Medicare Base rate X weight,169.18,56.77,504.16,Fee Schedule,29.8
NI-CARD REHAB W-O MO,93797,CPT,,,,,both,, ,193.64,116.18,Aetna,Commercial,,193.64,29.8,29.8% of Medicare Base rate X weight,193.64,64.98,577.05,Fee Schedule,29.8
NI-CARDI REHAB W- MO,93798,CPT,,,,,both,, ,296.38,177.82,Aetna,Commercial,,296.38,29.8,29.8% of Medicare Base rate X weight,296.38,99.46,883.21,Fee Schedule,29.8
US-CAROTID DPLX SCAN,93880,CPT,,,,,both,, ,425.13,255.07,Aetna,Commercial,,425.13,29.8,29.8% of Medicare Base rate X weight,425.13,142.66,1266.89,Fee Schedule,29.8
US-CAROTID DPLX SCAN,93880,CPT,,,,,both,, ,457.58,274.54,Aetna,Commercial,,457.58,29.8,29.8% of Medicare Base rate X weight,457.58,153.55,1363.59,Fee Schedule,29.8
US-CRAN DPLX SCN BIL,93880,CPT,,,,,both,, ,12714.32,7628.59,Aetna,Commercial,,12714.32,29.8,29.8% of Medicare Base rate X weight,12714.32,4266.55,37888.67,Fee Schedule,29.8
US-CAROTID DUP DOPLR,93882,CPT,,,,,both,, ,425.13,255.07,Aetna,Commercial,,425.13,29.8,29.8% of Medicare Base rate X weight,425.13,142.66,1266.89,Fee Schedule,29.8
US-CAROTID DUP DOPLR,93882,CPT,,,,,both,, ,457.58,274.54,Aetna,Commercial,,457.58,29.8,29.8% of Medicare Base rate X weight,457.58,153.55,1363.59,Fee Schedule,29.8
NI-EXT ARTERIAL LTD,93922,CPT,,,,,both,, ,2456.29,1473.77,Aetna,Commercial,,2456.29,29.8,29.8% of Medicare Base rate X weight,2456.29,824.26,7319.74,Fee Schedule,29.8
US-EXT ARTERIAL LTD,93922,CPT,,,,,both,, ,167.38,100.42,Aetna,Commercial,,167.38,29.8,29.8% of Medicare Base rate X weight,167.38,56.17,498.79,Fee Schedule,29.8
NI-EXT ARTERIAL COMP,93923,CPT,,,,,both,, ,3819.24,2291.54,Aetna,Commercial,,3819.24,29.8,29.8% of Medicare Base rate X weight,3819.24,1281.62,11381.34,Fee Schedule,29.8
US-NON INV ARTER EXT,93923,CPT,,,,,both,, ,268.32,160.99,Aetna,Commercial,,268.32,29.8,29.8% of Medicare Base rate X weight,268.32,90.04,799.59,Fee Schedule,29.8
NI-STD LE STRS REST,93924,CPT,,,,,both,, ,5693.84,3416.30,Aetna,Commercial,,5693.84,29.8,29.8% of Medicare Base rate X weight,5693.84,1910.68,16967.64,Fee Schedule,29.8
NI-LW EXT DPX ART BI,93925,CPT,,,,,both,, ,5086.40,3051.84,Aetna,Commercial,,5086.40,29.8,29.8% of Medicare Base rate X weight,5086.40,1706.85,15157.47,Fee Schedule,29.8
NI-LW EXT DPX ART UN,93926,CPT,,,,,both,, ,2541.53,1524.91,Aetna,Commercial,,2541.53,29.8,29.8% of Medicare Base rate X weight,2541.53,852.86,7573.76,Fee Schedule,29.8
US-LW EXT DPX ART UN,93926,CPT,,,,,both,, ,1560.19,936.11,Aetna,Commercial,,1560.19,29.8,29.8% of Medicare Base rate X weight,1560.19,523.55,4649.37,Fee Schedule,29.8
NI-UP EXT DPX ART BI,93930,CPT,,,,,both,, ,5083.05,3049.83,Aetna,Commercial,,5083.05,29.8,29.8% of Medicare Base rate X weight,5083.05,1705.72,15147.49,Fee Schedule,29.8
NI-UP EXT DPX ART UN,93931,CPT,,,,,both,, ,2541.53,1524.91,Aetna,Commercial,,2541.53,29.8,29.8% of Medicare Base rate X weight,2541.53,852.86,7573.76,Fee Schedule,29.8
US-UP EXT DPX ART UN,93931,CPT,,,,,both,, ,2026.01,1215.60,Aetna,Commercial,,2026.01,29.8,29.8% of Medicare Base rate X weight,2026.01,679.87,6037.51,Fee Schedule,29.8
NI-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,5086.40,3051.84,Aetna,Commercial,,5086.40,29.8,29.8% of Medicare Base rate X weight,5086.40,1706.85,15157.47,Fee Schedule,29.8
US-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,425.13,255.07,Aetna,Commercial,,425.13,29.8,29.8% of Medicare Base rate X weight,425.13,142.66,1266.89,Fee Schedule,29.8
US-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,457.58,274.54,Aetna,Commercial,,457.58,29.8,29.8% of Medicare Base rate X weight,457.58,153.55,1363.59,Fee Schedule,29.8
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,299.73,179.83,Aetna,Commercial,,299.73,29.8,29.8% of Medicare Base rate X weight,299.73,100.58,893.2,Fee Schedule,29.8
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,322.65,193.59,Aetna,Commercial,,322.65,29.8,29.8% of Medicare Base rate X weight,322.65,108.27,961.5,Fee Schedule,29.8
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,2541.53,1524.91,Aetna,Commercial,,2541.53,29.8,29.8% of Medicare Base rate X weight,2541.53,852.86,7573.76,Fee Schedule,29.8
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,425.13,255.07,Aetna,Commercial,,425.13,29.8,29.8% of Medicare Base rate X weight,425.13,142.66,1266.89,Fee Schedule,29.8
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,457.58,274.54,Aetna,Commercial,,457.58,29.8,29.8% of Medicare Base rate X weight,457.58,153.55,1363.59,Fee Schedule,29.8
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,823.23,493.93,Aetna,Commercial,,823.23,29.8,29.8% of Medicare Base rate X weight,823.23,276.25,2453.23,Fee Schedule,29.8
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,425.13,255.07,Aetna,Commercial,,425.13,29.8,29.8% of Medicare Base rate X weight,425.13,142.66,1266.89,Fee Schedule,29.8
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,457.58,274.54,Aetna,Commercial,,457.58,29.8,29.8% of Medicare Base rate X weight,457.58,153.55,1363.59,Fee Schedule,29.8
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,828.89,497.33,Aetna,Commercial,,828.89,29.8,29.8% of Medicare Base rate X weight,828.89,278.15,2470.09,Fee Schedule,29.8
US-DPLXSCN GRFT ARTA,93978,CPT,,,,,both,, ,1665.51,999.30,Aetna,Commercial,,1665.51,29.8,29.8% of Medicare Base rate X weight,1665.51,558.90,4963.22,Fee Schedule,29.8
NI-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,1292.14,775.28,Aetna,Commercial,,1292.14,29.8,29.8% of Medicare Base rate X weight,1292.14,433.60,3850.58,Fee Schedule,29.8
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,425.13,255.07,Aetna,Commercial,,425.13,29.8,29.8% of Medicare Base rate X weight,425.13,142.66,1266.89,Fee Schedule,29.8
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,457.58,274.54,Aetna,Commercial,,457.58,29.8,29.8% of Medicare Base rate X weight,457.58,153.55,1363.59,Fee Schedule,29.8
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,841.51,504.90,Aetna,Commercial,,841.51,29.8,29.8% of Medicare Base rate X weight,841.51,282.39,2507.7,Fee Schedule,29.8
VESS MAP HEMO ACC BI,93985,CPT,,,,,both,, ,977.58,586.54,Aetna,Commercial,,977.58,29.8,29.8% of Medicare Base rate X weight,977.58,328.05,2913.19,Fee Schedule,29.8
VESS MAP HEMO ACC UN,93986,CPT,,,,,both,, ,977.58,586.54,Aetna,Commercial,,977.58,29.8,29.8% of Medicare Base rate X weight,977.58,328.05,2913.19,Fee Schedule,29.8
NI-DUPSCN HEMODIAL,93990,CPT,,,,,both,, ,4623.93,2774.35,Aetna,Commercial,,4623.93,29.8,29.8% of Medicare Base rate X weight,4623.93,1551.65,13779.31,Fee Schedule,29.8
MECH VENT INITIAL,94002,CPT,,,,,both,, ,4971.30,2982.78,Aetna,Commercial,,4971.30,29.8,29.8% of Medicare Base rate X weight,4971.30,1668.22,14814.47,Fee Schedule,29.8
MECH VENT DAILY SUBS,94003,CPT,,,,,both,, ,4971.30,2982.78,Aetna,Commercial,,4971.30,29.8,29.8% of Medicare Base rate X weight,4971.30,1668.22,14814.47,Fee Schedule,29.8
SPIROMETRY,94010,CPT,,,,,both,, ,530.45,318.27,Aetna,Commercial,,530.45,29.8,29.8% of Medicare Base rate X weight,530.45,178.00,1580.74,Fee Schedule,29.8
BRONCHO EVAL PRE/PST,94060,CPT,,,,,both,, ,2361.28,1416.76,Aetna,Commercial,,2361.28,29.8,29.8% of Medicare Base rate X weight,2361.28,792.38,7036.61,Fee Schedule,29.8
METHACHOLINE CHALLEN,94070,CPT,,,,,both,, ,961.51,576.90,Aetna,Commercial,,961.51,29.8,29.8% of Medicare Base rate X weight,961.51,322.65,2865.3,Fee Schedule,29.8
MAXIMUM VOLUNTARY VE,94200,CPT,,,,,both,, ,306.94,184.16,Aetna,Commercial,,306.94,29.8,29.8% of Medicare Base rate X weight,306.94,103.00,914.68,Fee Schedule,29.8
HAST WITH 02 TITRATE,94453,CPT,,,,,both,, ,1089.74,653.84,Aetna,Commercial,,1089.74,29.8,29.8% of Medicare Base rate X weight,1089.74,365.68,3247.43,Fee Schedule,29.8
PULM STRESS SIMPLE,94618,CPT,,,,,both,, ,459.12,275.47,Aetna,Commercial,,459.12,29.8,29.8% of Medicare Base rate X weight,459.12,154.07,1368.18,Fee Schedule,29.8
PULM REHAB WO OXIMET,94625,CPT,,,,,both,, ,227.40,136.44,Aetna,Commercial,,227.40,29.8,29.8% of Medicare Base rate X weight,227.40,76.31,677.65,Fee Schedule,29.8
PULM REHAB W OXIMET,94626,CPT,,,,,both,, ,227.40,136.44,Aetna,Commercial,,227.40,29.8,29.8% of Medicare Base rate X weight,227.40,76.31,677.65,Fee Schedule,29.8
INHALATION TRTMT INI,94640,CPT,,,,,both,, ,569.50,341.70,Aetna,Commercial,,569.50,29.8,29.8% of Medicare Base rate X weight,569.50,191.11,1697.11,Fee Schedule,29.8
INHALATION TRTMT INI,94640,CPT,,,,,both,, ,586.59,351.95,Aetna,Commercial,,586.59,29.8,29.8% of Medicare Base rate X weight,586.59,196.84,1748.04,Fee Schedule,29.8
INHALATION TRTMT SUB,94640,CPT,,,,,both,, ,691.75,415.05,Aetna,Commercial,,691.75,29.8,29.8% of Medicare Base rate X weight,691.75,232.13,2061.42,Fee Schedule,29.8
INHALATION TRTMT SUB,94640,CPT,,,,,both,, ,712.50,427.50,Aetna,Commercial,,712.50,29.8,29.8% of Medicare Base rate X weight,712.50,239.09,2123.25,Fee Schedule,29.8
PENTAMIDINE ARSL INH,94642,CPT,,,,,both,, ,1061.67,637.00,Aetna,Commercial,,1061.67,29.8,29.8% of Medicare Base rate X weight,1061.67,356.27,3163.78,Fee Schedule,29.8
AEROSOL OBSTRUCT 1HR,94644,CPT,,,,,both,, ,719.71,431.82,Aetna,Commercial,,719.71,29.8,29.8% of Medicare Base rate X weight,719.71,241.51,2144.74,Fee Schedule,29.8
CONT INH TX ED 1HR,94644,CPT,,,,,both,, ,698.75,419.25,Aetna,Commercial,,698.75,29.8,29.8% of Medicare Base rate X weight,698.75,234.48,2082.28,Fee Schedule,29.8
AEROSOL OBSTR ADD HR,94645,CPT,,,,,both,, ,719.71,431.82,Aetna,Commercial,,719.71,29.8,29.8% of Medicare Base rate X weight,719.71,241.51,2144.74,Fee Schedule,29.8
CONT INH TX ED AD HR,94645,CPT,,,,,both,, ,698.75,419.25,Aetna,Commercial,,698.75,29.8,29.8% of Medicare Base rate X weight,698.75,234.48,2082.28,Fee Schedule,29.8
BIPAP/CPAP,94660,CPT,,,,,both,, ,2771.47,1662.88,Aetna,Commercial,,2771.47,29.8,29.8% of Medicare Base rate X weight,2771.47,930.02,8258.98,Fee Schedule,29.8
EVAL-DEMO INHL DEVCE,94664,CPT,,,,,both,, ,342.73,205.63,Aetna,Commercial,,342.73,29.8,29.8% of Medicare Base rate X weight,342.73,115.01,1021.34,Fee Schedule,29.8
MANIP CHST WALL INIT,94667,CPT,,,,,both,, ,1191.45,714.87,Aetna,Commercial,,1191.45,29.8,29.8% of Medicare Base rate X weight,1191.45,399.82,3550.52,Fee Schedule,29.8
MANIP CHST WALL SBSQ,94668,CPT,,,,,both,, ,975.15,585.09,Aetna,Commercial,,975.15,29.8,29.8% of Medicare Base rate X weight,975.15,327.23,2905.95,Fee Schedule,29.8
MECHAN CHST WALL OSC,94669,CPT,,,,,both,, ,210.89,126.53,Aetna,Commercial,,210.89,29.8,29.8% of Medicare Base rate X weight,210.89,70.77,628.45,Fee Schedule,29.8
PF TST PLETHYSMOGRA,94726,CPT,,,,,both,, ,548.73,329.23,Aetna,Commercial,,548.73,29.8,29.8% of Medicare Base rate X weight,548.73,184.14,1635.22,Fee Schedule,29.8
PF TEST BY GAS,94727,CPT,,,,,both,, ,548.73,329.23,Aetna,Commercial,,548.73,29.8,29.8% of Medicare Base rate X weight,548.73,184.14,1635.22,Fee Schedule,29.8
PF TEST OSCILLOMETRY,94728,CPT,,,,,both,, ,548.73,329.23,Aetna,Commercial,,548.73,29.8,29.8% of Medicare Base rate X weight,548.73,184.14,1635.22,Fee Schedule,29.8
CO2-MEMBANE DIFF CAP,94729,CPT,,,,,both,, ,2800.31,1680.18,Aetna,Commercial,,2800.31,29.8,29.8% of Medicare Base rate X weight,2800.31,939.70,8344.92,Fee Schedule,29.8
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309.00,185.40,Aetna,Commercial,,309.00,29.8,29.8% of Medicare Base rate X weight,309.00,103.69,920.82,Fee Schedule,29.8
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309.00,185.40,Aetna,Commercial,,309.00,29.8,29.8% of Medicare Base rate X weight,309.00,103.69,920.82,Fee Schedule,29.8
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309.00,185.40,Aetna,Commercial,,309.00,29.8,29.8% of Medicare Base rate X weight,309.00,103.69,920.82,Fee Schedule,29.8
PULSE OX NWBRN MULTI,94761,CPT,,,,,both,, ,797.48,478.48,Aetna,Commercial,,797.48,29.8,29.8% of Medicare Base rate X weight,797.48,267.61,2376.49,Fee Schedule,29.8
PULSE OX NWBRN MULTI,94761,CPT,,,,,both,, ,797.48,478.48,Aetna,Commercial,,797.48,29.8,29.8% of Medicare Base rate X weight,797.48,267.61,2376.49,Fee Schedule,29.8
PULSE OX CONTINUOS,94762,CPT,,,,,both,, ,388.00,232.80,Aetna,Commercial,,388.00,29.8,29.8% of Medicare Base rate X weight,388.00,130.20,1156.24,Fee Schedule,29.8
PULSE OX CONTINUOS,94762,CPT,,,,,both,, ,468.91,281.34,Aetna,Commercial,,468.91,29.8,29.8% of Medicare Base rate X weight,468.91,157.35,1397.35,Fee Schedule,29.8
PULSE OX CONTINUOS,94762,CPT,,,,,both,, ,468.91,281.34,Aetna,Commercial,,468.91,29.8,29.8% of Medicare Base rate X weight,468.91,157.35,1397.35,Fee Schedule,29.8
CAR SEAT BED TST 60M,94780,CPT,,,,,both,, ,118.19,70.91,Aetna,Commercial,,118.19,29.8,29.8% of Medicare Base rate X weight,118.19,39.66,352.21,Fee Schedule,29.8
CAR SE-BED TST AD 30,94781,CPT,,,,,both,, ,58.97,35.38,Aetna,Commercial,,58.97,29.8,29.8% of Medicare Base rate X weight,58.97,19.79,175.73,Fee Schedule,29.8
ALLERGY INJ SIM,95115,CPT,,,,,both,, ,70.56,42.33,Aetna,Commercial,,70.56,29.8,29.8% of Medicare Base rate X weight,70.56,23.68,210.27,Fee Schedule,29.8
ALLERGY INJ SIM,95115,CPT,,,,,both,, ,70.81,42.48,Aetna,Commercial,,70.81,29.8,29.8% of Medicare Base rate X weight,70.81,23.76,211.01,Fee Schedule,29.8
ALLERGY INJ MUL,95117,CPT,,,,,both,, ,70.56,42.33,Aetna,Commercial,,70.56,29.8,29.8% of Medicare Base rate X weight,70.56,23.68,210.27,Fee Schedule,29.8
ALLERGY INJ MUL,95117,CPT,,,,,both,, ,70.81,42.48,Aetna,Commercial,,70.81,29.8,29.8% of Medicare Base rate X weight,70.81,23.76,211.01,Fee Schedule,29.8
POLYSOMNO GT4 LT6YO,95782,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,2570.88,29.8,29.8% of Medicare Base rate X weight,2570.88,862.71,7661.22,Fee Schedule,29.8
POLYSOMNO GT4 LT6YO,95782,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,2570.88,29.8,29.8% of Medicare Base rate X weight,2570.88,862.71,7661.22,Fee Schedule,29.8
POLYS-CPAP GT4 LT6YO,95783,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,2570.88,29.8,29.8% of Medicare Base rate X weight,2570.88,862.71,7661.22,Fee Schedule,29.8
POLYS-CPAP GT4 LT6YO,95783,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,2570.88,29.8,29.8% of Medicare Base rate X weight,2570.88,862.71,7661.22,Fee Schedule,29.8
SLPSTDY UNATT AN-ST,95800,CPT,,,,,both,, ,428.48,257.08,Aetna,Commercial,,428.48,29.8,29.8% of Medicare Base rate X weight,428.48,143.79,1276.87,Fee Schedule,29.8
SLPSTDY UNATT AN-ST,95800,CPT,,,,,both,, ,625.00,375.00,Aetna,Commercial,,625.00,29.8,29.8% of Medicare Base rate X weight,625.00,209.73,1862.5,Fee Schedule,29.8
MULTI SLEEP LAT,95805,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,2570.88,29.8,29.8% of Medicare Base rate X weight,2570.88,862.71,7661.22,Fee Schedule,29.8
MULTI SLEEP LAT,95805,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,2570.88,29.8,29.8% of Medicare Base rate X weight,2570.88,862.71,7661.22,Fee Schedule,29.8
SLPSTDY UNATT RS EFF,95806,CPT,,,,,both,, ,428.48,257.08,Aetna,Commercial,,428.48,29.8,29.8% of Medicare Base rate X weight,428.48,143.79,1276.87,Fee Schedule,29.8
SLPSTDY UNATT RS EFF,95806,CPT,,,,,both,, ,625.00,375.00,Aetna,Commercial,,625.00,29.8,29.8% of Medicare Base rate X weight,625.00,209.73,1862.5,Fee Schedule,29.8
POLYSOMNO GT4 GE6YO,95810,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,2570.88,29.8,29.8% of Medicare Base rate X weight,2570.88,862.71,7661.22,Fee Schedule,29.8
POLYSOMNO GT4 GE6YO,95810,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,2570.88,29.8,29.8% of Medicare Base rate X weight,2570.88,862.71,7661.22,Fee Schedule,29.8
Sleep study,95810,CPT,,,,,both,,,2570.88,2570.88,Aetna,Commercial,,2570.88,29.8,29.8% of Medicare Base rate X weight,2570.88,862.71,7661.22,Fee Schedule,29.8
POLYS-CPAP GT4 GE6YO,95811,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,2570.88,29.8,29.8% of Medicare Base rate X weight,2570.88,862.71,7661.22,Fee Schedule,29.8
POLYS-CPAP GT4 GE6YO,95811,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,2570.88,29.8,29.8% of Medicare Base rate X weight,2570.88,862.71,7661.22,Fee Schedule,29.8
EEG 41-60 MIN,95812,CPT,,,,,both,, ,1075.58,645.34,Aetna,Commercial,,1075.58,29.8,29.8% of Medicare Base rate X weight,1075.58,360.93,3205.23,Fee Schedule,29.8
EEG GT 1 HOUR,95813,CPT,,,,,both,, ,1044.25,626.55,Aetna,Commercial,,1044.25,29.8,29.8% of Medicare Base rate X weight,1044.25,350.42,3111.87,Fee Schedule,29.8
EEG AWAKE DROWSY,95816,CPT,,,,,both,, ,1075.58,645.34,Aetna,Commercial,,1075.58,29.8,29.8% of Medicare Base rate X weight,1075.58,360.93,3205.23,Fee Schedule,29.8
EEG AWAKE ASLEEP,95819,CPT,,,,,both,, ,3362.50,2017.50,Aetna,Commercial,,3362.50,29.8,29.8% of Medicare Base rate X weight,3362.50,1128.36,10020.25,Fee Schedule,29.8
EEG ASLEEP,95822,CPT,,,,,both,, ,4457.07,2674.24,Aetna,Commercial,,4457.07,29.8,29.8% of Medicare Base rate X weight,4457.07,1495.66,13282.07,Fee Schedule,29.8
ROM WR EA EXTRK COTA,95851,CPT,,,,,both,, ,21.12,12.67,Aetna,Commercial,,21.12,29.8,29.8% of Medicare Base rate X weight,21.12,7.09,62.94,Fee Schedule,29.8
ROM WR EA EXTRK COTA,95851,CPT,,,,,both,, ,21.12,12.67,Aetna,Commercial,,21.12,29.8,29.8% of Medicare Base rate X weight,21.12,7.09,62.94,Fee Schedule,29.8
ROM WR EA EXTRK COTA,95851,CPT,,,,,both,, ,21.12,12.67,Aetna,Commercial,,21.12,29.8,29.8% of Medicare Base rate X weight,21.12,7.09,62.94,Fee Schedule,29.8
ROM WR EA EXTRK COTA,95851,CPT,,,,,both,, ,21.12,12.67,Aetna,Commercial,,21.12,29.8,29.8% of Medicare Base rate X weight,21.12,7.09,62.94,Fee Schedule,29.8
ROM WR EA EXTRK COTA,95851,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,486.42,29.8,29.8% of Medicare Base rate X weight,486.42,163.23,1449.53,Fee Schedule,29.8
ROM WR EA EXTRK COTA,95851,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,486.42,29.8,29.8% of Medicare Base rate X weight,486.42,163.23,1449.53,Fee Schedule,29.8
ROM WR EA EXTRNK PTA,95851,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,448.57,29.8,29.8% of Medicare Base rate X weight,448.57,150.53,1336.74,Fee Schedule,29.8
ROM WR EA EXTRNK PTA,95851,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,448.57,29.8,29.8% of Medicare Base rate X weight,448.57,150.53,1336.74,Fee Schedule,29.8
ROM W-R EA EXT-TRNK,95851,CPT,,,,,both,, ,418.86,251.31,Aetna,Commercial,,418.86,29.8,29.8% of Medicare Base rate X weight,418.86,140.56,1248.2,Fee Schedule,29.8
ROM W-R EA EXT-TRNK,95851,CPT,,,,,both,, ,454.13,272.47,Aetna,Commercial,,454.13,29.8,29.8% of Medicare Base rate X weight,454.13,152.39,1353.31,Fee Schedule,29.8
ROM W-R HND W-WO COM,95852,CPT,,,,,both,, ,418.86,251.31,Aetna,Commercial,,418.86,29.8,29.8% of Medicare Base rate X weight,418.86,140.56,1248.2,Fee Schedule,29.8
ROM W-R HND W-WO COM,95852,CPT,,,,,both,, ,454.13,272.47,Aetna,Commercial,,454.13,29.8,29.8% of Medicare Base rate X weight,454.13,152.39,1353.31,Fee Schedule,29.8
ROM WR HND W-WO COTA,95852,CPT,,,,,both,, ,16.22,9.73,Aetna,Commercial,,16.22,29.8,29.8% of Medicare Base rate X weight,16.22,5.44,48.34,Fee Schedule,29.8
ROM WR HND W-WO COTA,95852,CPT,,,,,both,, ,16.22,9.73,Aetna,Commercial,,16.22,29.8,29.8% of Medicare Base rate X weight,16.22,5.44,48.34,Fee Schedule,29.8
ROM WR HND W-WO COTA,95852,CPT,,,,,both,, ,16.22,9.73,Aetna,Commercial,,16.22,29.8,29.8% of Medicare Base rate X weight,16.22,5.44,48.34,Fee Schedule,29.8
ROM WR HND W-WO COTA,95852,CPT,,,,,both,, ,16.22,9.73,Aetna,Commercial,,16.22,29.8,29.8% of Medicare Base rate X weight,16.22,5.44,48.34,Fee Schedule,29.8
ROM WR HND W-WO COTA,95852,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,486.42,29.8,29.8% of Medicare Base rate X weight,486.42,163.23,1449.53,Fee Schedule,29.8
ROM WR HND W-WO COTA,95852,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,486.42,29.8,29.8% of Medicare Base rate X weight,486.42,163.23,1449.53,Fee Schedule,29.8
ROM W-R HND W-WO PTA,95852,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,448.57,29.8,29.8% of Medicare Base rate X weight,448.57,150.53,1336.74,Fee Schedule,29.8
ROM W-R HND W-WO PTA,95852,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,448.57,29.8,29.8% of Medicare Base rate X weight,448.57,150.53,1336.74,Fee Schedule,29.8
"EMG, 1 EXTREM",95860,CPT,,,,,both,, ,3272.05,1963.23,Aetna,Commercial,,3272.05,29.8,29.8% of Medicare Base rate X weight,3272.05,1098.00,9750.71,Fee Schedule,29.8
"EMG, 2 EXTREM",95861,CPT,,,,,both,, ,5586.46,3351.87,Aetna,Commercial,,5586.46,29.8,29.8% of Medicare Base rate X weight,5586.46,1874.65,16647.65,Fee Schedule,29.8
"EMG, 3 EXTREM",95863,CPT,,,,,both,, ,7162.62,4297.57,Aetna,Commercial,,7162.62,29.8,29.8% of Medicare Base rate X weight,7162.62,2403.56,21344.61,Fee Schedule,29.8
"EMG, 4 EXTREM",95864,CPT,,,,,both,, ,8764.27,5258.56,Aetna,Commercial,,8764.27,29.8,29.8% of Medicare Base rate X weight,8764.27,2941.03,26117.52,Fee Schedule,29.8
"EMG, W-NERVE TEST",95885,CPT,,,,,both,, ,458.87,275.32,Aetna,Commercial,,458.87,29.8,29.8% of Medicare Base rate X weight,458.87,153.98,1367.43,Fee Schedule,29.8
EMG W-NRV TST COM,95886,CPT,,,,,both,, ,458.87,275.32,Aetna,Commercial,,458.87,29.8,29.8% of Medicare Base rate X weight,458.87,153.98,1367.43,Fee Schedule,29.8
EMG W-NRV TST NON,95887,CPT,,,,,both,, ,242.57,145.54,Aetna,Commercial,,242.57,29.8,29.8% of Medicare Base rate X weight,242.57,81.40,722.86,Fee Schedule,29.8
MTR-SENS 1-2 NRV TST,95907,CPT,,,,,both,, ,821.43,492.85,Aetna,Commercial,,821.43,29.8,29.8% of Medicare Base rate X weight,821.43,275.65,2447.86,Fee Schedule,29.8
MTR-SENS 3-4 NRV TST,95908,CPT,,,,,both,, ,821.43,492.85,Aetna,Commercial,,821.43,29.8,29.8% of Medicare Base rate X weight,821.43,275.65,2447.86,Fee Schedule,29.8
MTR-SENS 5-6 NRV TST,95909,CPT,,,,,both,, ,821.43,492.85,Aetna,Commercial,,821.43,29.8,29.8% of Medicare Base rate X weight,821.43,275.65,2447.86,Fee Schedule,29.8
MTR-SENS 7-8 NRV TST,95910,CPT,,,,,both,, ,821.43,492.85,Aetna,Commercial,,821.43,29.8,29.8% of Medicare Base rate X weight,821.43,275.65,2447.86,Fee Schedule,29.8
MTR-SES 9-10 NRV TST,95911,CPT,,,,,both,, ,821.43,492.85,Aetna,Commercial,,821.43,29.8,29.8% of Medicare Base rate X weight,821.43,275.65,2447.86,Fee Schedule,29.8
MTR-SES 11-12 NRV TS,95912,CPT,,,,,both,, ,1518.74,911.24,Aetna,Commercial,,1518.74,29.8,29.8% of Medicare Base rate X weight,1518.74,509.64,4525.85,Fee Schedule,29.8
MTR-SNS 13 OR MORE,95913,CPT,,,,,both,, ,1518.74,911.24,Aetna,Commercial,,1518.74,29.8,29.8% of Medicare Base rate X weight,1518.74,509.64,4525.85,Fee Schedule,29.8
PARASYMP-SYMP HRT RT,95924,CPT,,,,,both,, ,461.44,276.86,Aetna,Commercial,,461.44,29.8,29.8% of Medicare Base rate X weight,461.44,154.85,1375.09,Fee Schedule,29.8
VISUAL EVOK POTENT,95930,CPT,,,,,both,, ,3397.20,2038.32,Aetna,Commercial,,3397.20,29.8,29.8% of Medicare Base rate X weight,3397.20,1140.00,10123.66,Fee Schedule,29.8
"REPETIT STIM, EA NE",95937,CPT,,,,,both,, ,3199.95,1919.97,Aetna,Commercial,,3199.95,29.8,29.8% of Medicare Base rate X weight,3199.95,1073.81,9535.85,Fee Schedule,29.8
CANALITH PER DAY,95992,CPT,,,,,both,, ,158.07,94.84,Aetna,Commercial,,158.07,29.8,29.8% of Medicare Base rate X weight,158.07,53.04,471.05,Fee Schedule,29.8
CANALITH PER DAY PTA,95992,CPT,,,,,both,, ,101.97,61.18,Aetna,Commercial,,101.97,29.8,29.8% of Medicare Base rate X weight,101.97,34.22,303.87,Fee Schedule,29.8
CANALITH PER DAY PTA,95992,CPT,,,,,both,, ,101.97,61.18,Aetna,Commercial,,101.97,29.8,29.8% of Medicare Base rate X weight,101.97,34.22,303.87,Fee Schedule,29.8
CANALITH PER DAY PTA,95992,CPT,,,,,both,, ,169.44,101.66,Aetna,Commercial,,169.44,29.8,29.8% of Medicare Base rate X weight,169.44,56.86,504.93,Fee Schedule,29.8
CANALITH PER DAY PTA,95992,CPT,,,,,both,, ,169.44,101.66,Aetna,Commercial,,169.44,29.8,29.8% of Medicare Base rate X weight,169.44,56.86,504.93,Fee Schedule,29.8
APHASIA ASSESS 1HOUR,96105,CPT,,,,,both,, ,813.70,488.22,Aetna,Commercial,,813.70,29.8,29.8% of Medicare Base rate X weight,813.70,273.05,2424.83,Fee Schedule,29.8
DEV TEST 1ST HR,96112,CPT,,,,,both,, ,813.70,488.22,Aetna,Commercial,,813.70,29.8,29.8% of Medicare Base rate X weight,813.70,273.05,2424.83,Fee Schedule,29.8
DEV TEST ADD 30M,96113,CPT,,,,,both,, ,763.23,457.93,Aetna,Commercial,,763.23,29.8,29.8% of Medicare Base rate X weight,763.23,256.12,2274.43,Fee Schedule,29.8
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,253.90,152.34,Aetna,Commercial,,253.90,29.8,29.8% of Medicare Base rate X weight,253.90,85.20,756.62,Fee Schedule,29.8
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,253.90,152.34,Aetna,Commercial,,253.90,29.8,29.8% of Medicare Base rate X weight,253.90,85.20,756.62,Fee Schedule,29.8
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,487.00,292.20,Aetna,Commercial,,487.00,29.8,29.8% of Medicare Base rate X weight,487.00,163.42,1451.26,Fee Schedule,29.8
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,487.00,292.20,Aetna,Commercial,,487.00,29.8,29.8% of Medicare Base rate X weight,487.00,163.42,1451.26,Fee Schedule,29.8
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,501.61,300.96,Aetna,Commercial,,501.61,29.8,29.8% of Medicare Base rate X weight,501.61,168.33,1494.8,Fee Schedule,29.8
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,501.61,300.96,Aetna,Commercial,,501.61,29.8,29.8% of Medicare Base rate X weight,501.61,168.33,1494.8,Fee Schedule,29.8
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,1841.23,1104.73,Aetna,Commercial,,1841.23,29.8,29.8% of Medicare Base rate X weight,1841.23,617.86,5486.87,Fee Schedule,29.8
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,70.81,42.48,Aetna,Commercial,,70.81,29.8,29.8% of Medicare Base rate X weight,70.81,23.76,211.01,Fee Schedule,29.8
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,70.81,42.48,Aetna,Commercial,,70.81,29.8,29.8% of Medicare Base rate X weight,70.81,23.76,211.01,Fee Schedule,29.8
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,135.75,81.45,Aetna,Commercial,,135.75,29.8,29.8% of Medicare Base rate X weight,135.75,45.55,404.54,Fee Schedule,29.8
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,135.75,81.45,Aetna,Commercial,,135.75,29.8,29.8% of Medicare Base rate X weight,135.75,45.55,404.54,Fee Schedule,29.8
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,139.82,83.89,Aetna,Commercial,,139.82,29.8,29.8% of Medicare Base rate X weight,139.82,46.92,416.66,Fee Schedule,29.8
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,139.82,83.89,Aetna,Commercial,,139.82,29.8,29.8% of Medicare Base rate X weight,139.82,46.92,416.66,Fee Schedule,29.8
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,1841.23,1104.73,Aetna,Commercial,,1841.23,29.8,29.8% of Medicare Base rate X weight,1841.23,617.86,5486.87,Fee Schedule,29.8
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,412.77,247.66,Aetna,Commercial,,412.77,29.8,29.8% of Medicare Base rate X weight,412.77,138.51,1230.05,Fee Schedule,29.8
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,412.77,247.66,Aetna,Commercial,,412.77,29.8,29.8% of Medicare Base rate X weight,412.77,138.51,1230.05,Fee Schedule,29.8
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,928.18,556.90,Aetna,Commercial,,928.18,29.8,29.8% of Medicare Base rate X weight,928.18,311.47,2765.98,Fee Schedule,29.8
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1301.75,781.05,Aetna,Commercial,,1301.75,29.8,29.8% of Medicare Base rate X weight,1301.75,436.83,3879.22,Fee Schedule,29.8
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1301.75,781.05,Aetna,Commercial,,1301.75,29.8,29.8% of Medicare Base rate X weight,1301.75,436.83,3879.22,Fee Schedule,29.8
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1340.80,804.48,Aetna,Commercial,,1340.80,29.8,29.8% of Medicare Base rate X weight,1340.80,449.93,3995.58,Fee Schedule,29.8
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1340.80,804.48,Aetna,Commercial,,1340.80,29.8,29.8% of Medicare Base rate X weight,1340.80,449.93,3995.58,Fee Schedule,29.8
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,70.81,42.48,Aetna,Commercial,,70.81,29.8,29.8% of Medicare Base rate X weight,70.81,23.76,211.01,Fee Schedule,29.8
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,70.81,42.48,Aetna,Commercial,,70.81,29.8,29.8% of Medicare Base rate X weight,70.81,23.76,211.01,Fee Schedule,29.8
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,928.18,556.90,Aetna,Commercial,,928.18,29.8,29.8% of Medicare Base rate X weight,928.18,311.47,2765.98,Fee Schedule,29.8
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1301.75,781.05,Aetna,Commercial,,1301.75,29.8,29.8% of Medicare Base rate X weight,1301.75,436.83,3879.22,Fee Schedule,29.8
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1301.75,781.05,Aetna,Commercial,,1301.75,29.8,29.8% of Medicare Base rate X weight,1301.75,436.83,3879.22,Fee Schedule,29.8
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1340.80,804.48,Aetna,Commercial,,1340.80,29.8,29.8% of Medicare Base rate X weight,1340.80,449.93,3995.58,Fee Schedule,29.8
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1340.80,804.48,Aetna,Commercial,,1340.80,29.8,29.8% of Medicare Base rate X weight,1340.80,449.93,3995.58,Fee Schedule,29.8
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,201.25,120.75,Aetna,Commercial,,201.25,29.8,29.8% of Medicare Base rate X weight,201.25,67.53,599.73,Fee Schedule,29.8
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,201.25,120.75,Aetna,Commercial,,201.25,29.8,29.8% of Medicare Base rate X weight,201.25,67.53,599.73,Fee Schedule,29.8
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,207.29,124.37,Aetna,Commercial,,207.29,29.8,29.8% of Medicare Base rate X weight,207.29,69.56,617.72,Fee Schedule,29.8
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,207.29,124.37,Aetna,Commercial,,207.29,29.8,29.8% of Medicare Base rate X weight,207.29,69.56,617.72,Fee Schedule,29.8
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,928.18,556.90,Aetna,Commercial,,928.18,29.8,29.8% of Medicare Base rate X weight,928.18,311.47,2765.98,Fee Schedule,29.8
CONCURRENT IV THER,96368,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
CONCURRENT IV THER,96368,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
CONCURRENT IV THER,96368,CPT,,,,,both,, ,791.25,474.75,Aetna,Commercial,,791.25,29.8,29.8% of Medicare Base rate X weight,791.25,265.52,2357.93,Fee Schedule,29.8
CONCURRENT IV THER,96368,CPT,,,,,both,, ,791.25,474.75,Aetna,Commercial,,791.25,29.8,29.8% of Medicare Base rate X weight,791.25,265.52,2357.93,Fee Schedule,29.8
CONCURRENT IV THER,96368,CPT,,,,,both,, ,814.99,488.99,Aetna,Commercial,,814.99,29.8,29.8% of Medicare Base rate X weight,814.99,273.49,2428.67,Fee Schedule,29.8
CONCURRENT IV THER,96368,CPT,,,,,both,, ,814.99,488.99,Aetna,Commercial,,814.99,29.8,29.8% of Medicare Base rate X weight,814.99,273.49,2428.67,Fee Schedule,29.8
CONCURRENT IV THER,96368,CPT,,,,,both,, ,928.18,556.90,Aetna,Commercial,,928.18,29.8,29.8% of Medicare Base rate X weight,928.18,311.47,2765.98,Fee Schedule,29.8
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,201.25,120.75,Aetna,Commercial,,201.25,29.8,29.8% of Medicare Base rate X weight,201.25,67.53,599.73,Fee Schedule,29.8
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,201.25,120.75,Aetna,Commercial,,201.25,29.8,29.8% of Medicare Base rate X weight,201.25,67.53,599.73,Fee Schedule,29.8
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,207.29,124.37,Aetna,Commercial,,207.29,29.8,29.8% of Medicare Base rate X weight,207.29,69.56,617.72,Fee Schedule,29.8
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,207.29,124.37,Aetna,Commercial,,207.29,29.8,29.8% of Medicare Base rate X weight,207.29,69.56,617.72,Fee Schedule,29.8
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,301.16,180.69,Aetna,Commercial,,301.16,29.8,29.8% of Medicare Base rate X weight,301.16,101.06,897.46,Fee Schedule,29.8
S-INJ NON CHEMO IA,96373,CPT,,,,,both,, ,1355.48,813.28,Aetna,Commercial,,1355.48,29.8,29.8% of Medicare Base rate X weight,1355.48,454.86,4039.33,Fee Schedule,29.8
INJECTION IV PUSH,96374,CPT,,,,,both,, ,1477.47,886.48,Aetna,Commercial,,1477.47,29.8,29.8% of Medicare Base rate X weight,1477.47,495.80,4402.86,Fee Schedule,29.8
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,201.25,120.75,Aetna,Commercial,,201.25,29.8,29.8% of Medicare Base rate X weight,201.25,67.53,599.73,Fee Schedule,29.8
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,201.25,120.75,Aetna,Commercial,,201.25,29.8,29.8% of Medicare Base rate X weight,201.25,67.53,599.73,Fee Schedule,29.8
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,207.29,124.37,Aetna,Commercial,,207.29,29.8,29.8% of Medicare Base rate X weight,207.29,69.56,617.72,Fee Schedule,29.8
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,253.90,152.34,Aetna,Commercial,,253.90,29.8,29.8% of Medicare Base rate X weight,253.90,85.20,756.62,Fee Schedule,29.8
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,253.90,152.34,Aetna,Commercial,,253.90,29.8,29.8% of Medicare Base rate X weight,253.90,85.20,756.62,Fee Schedule,29.8
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,501.61,300.96,Aetna,Commercial,,501.61,29.8,29.8% of Medicare Base rate X weight,501.61,168.33,1494.8,Fee Schedule,29.8
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,1355.48,813.28,Aetna,Commercial,,1355.48,29.8,29.8% of Medicare Base rate X weight,1355.48,454.86,4039.33,Fee Schedule,29.8
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,201.25,120.75,Aetna,Commercial,,201.25,29.8,29.8% of Medicare Base rate X weight,201.25,67.53,599.73,Fee Schedule,29.8
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,201.25,120.75,Aetna,Commercial,,201.25,29.8,29.8% of Medicare Base rate X weight,201.25,67.53,599.73,Fee Schedule,29.8
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,207.29,124.37,Aetna,Commercial,,207.29,29.8,29.8% of Medicare Base rate X weight,207.29,69.56,617.72,Fee Schedule,29.8
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,207.29,124.37,Aetna,Commercial,,207.29,29.8,29.8% of Medicare Base rate X weight,207.29,69.56,617.72,Fee Schedule,29.8
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,668.99,401.39,Aetna,Commercial,,668.99,29.8,29.8% of Medicare Base rate X weight,668.99,224.49,1993.59,Fee Schedule,29.8
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,729.19,437.51,Aetna,Commercial,,729.19,29.8,29.8% of Medicare Base rate X weight,729.19,244.69,2172.99,Fee Schedule,29.8
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,98.50,59.10,Aetna,Commercial,,98.50,29.8,29.8% of Medicare Base rate X weight,98.50,33.05,293.53,Fee Schedule,29.8
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,98.50,59.10,Aetna,Commercial,,98.50,29.8,29.8% of Medicare Base rate X weight,98.50,33.05,293.53,Fee Schedule,29.8
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,101.46,60.87,Aetna,Commercial,,101.46,29.8,29.8% of Medicare Base rate X weight,101.46,34.05,302.35,Fee Schedule,29.8
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,101.46,60.87,Aetna,Commercial,,101.46,29.8,29.8% of Medicare Base rate X weight,101.46,34.05,302.35,Fee Schedule,29.8
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,729.19,437.51,Aetna,Commercial,,729.19,29.8,29.8% of Medicare Base rate X weight,729.19,244.69,2172.99,Fee Schedule,29.8
CHEMO NON HORM IM SC,96401,CPT,,,,,both,, ,476.63,285.97,Aetna,Commercial,,476.63,29.8,29.8% of Medicare Base rate X weight,476.63,159.94,1420.36,Fee Schedule,29.8
CHEMO HORMONAL IM SC,96402,CPT,,,,,both,, ,235.36,141.21,Aetna,Commercial,,235.36,29.8,29.8% of Medicare Base rate X weight,235.36,78.98,701.37,Fee Schedule,29.8
CHEMO IV PUSH,96409,CPT,,,,,both,, ,382.65,229.59,Aetna,Commercial,,382.65,29.8,29.8% of Medicare Base rate X weight,382.65,128.41,1140.3,Fee Schedule,29.8
CHEMO EA AD IV PUSH,96411,CPT,,,,,both,, ,117.16,70.29,Aetna,Commercial,,117.16,29.8,29.8% of Medicare Base rate X weight,117.16,39.32,349.14,Fee Schedule,29.8
CHEMO IV INFU 1ST HR,96413,CPT,,,,,both,, ,1377.11,826.26,Aetna,Commercial,,1377.11,29.8,29.8% of Medicare Base rate X weight,1377.11,462.12,4103.79,Fee Schedule,29.8
CHEMO IV IN EA AD HR,96415,CPT,,,,,both,, ,234.58,140.74,Aetna,Commercial,,234.58,29.8,29.8% of Medicare Base rate X weight,234.58,78.72,699.05,Fee Schedule,29.8
CHEMO IV EA SEQ INF,96417,CPT,,,,,both,, ,126.18,75.70,Aetna,Commercial,,126.18,29.8,29.8% of Medicare Base rate X weight,126.18,42.34,376.02,Fee Schedule,29.8
IR-IRR PORT DRUG DEL,96523,CPT,,,,,both,, ,383.16,229.89,Aetna,Commercial,,383.16,29.8,29.8% of Medicare Base rate X weight,383.16,128.58,1141.82,Fee Schedule,29.8
HOT-COLD PACKS,97010,CPT,,,,,both,, ,239.27,143.56,Aetna,Commercial,,239.27,29.8,29.8% of Medicare Base rate X weight,239.27,80.29,713.02,Fee Schedule,29.8
HOT-COLD PACKS,97010,CPT,,,,,both,, ,259.41,155.64,Aetna,Commercial,,259.41,29.8,29.8% of Medicare Base rate X weight,259.41,87.05,773.04,Fee Schedule,29.8
HOT-COLD PACKS COTA,97010,CPT,,,,,both,, ,41.20,24.72,Aetna,Commercial,,41.20,29.8,29.8% of Medicare Base rate X weight,41.20,13.83,122.78,Fee Schedule,29.8
HOT-COLD PACKS COTA,97010,CPT,,,,,both,, ,41.20,24.72,Aetna,Commercial,,41.20,29.8,29.8% of Medicare Base rate X weight,41.20,13.83,122.78,Fee Schedule,29.8
HOT-COLD PACKS COTA,97010,CPT,,,,,both,, ,41.20,24.72,Aetna,Commercial,,41.20,29.8,29.8% of Medicare Base rate X weight,41.20,13.83,122.78,Fee Schedule,29.8
HOT-COLD PACKS COTA,97010,CPT,,,,,both,, ,41.20,24.72,Aetna,Commercial,,41.20,29.8,29.8% of Medicare Base rate X weight,41.20,13.83,122.78,Fee Schedule,29.8
HOT-COLD PACKS COTA,97010,CPT,,,,,both,, ,277.84,166.70,Aetna,Commercial,,277.84,29.8,29.8% of Medicare Base rate X weight,277.84,93.23,827.96,Fee Schedule,29.8
HOT-COLD PACKS COTA,97010,CPT,,,,,both,, ,277.84,166.70,Aetna,Commercial,,277.84,29.8,29.8% of Medicare Base rate X weight,277.84,93.23,827.96,Fee Schedule,29.8
HOT-COLD PACKS PTA,97010,CPT,,,,,both,, ,256.21,153.72,Aetna,Commercial,,256.21,29.8,29.8% of Medicare Base rate X weight,256.21,85.98,763.51,Fee Schedule,29.8
HOT-COLD PACKS PTA,97010,CPT,,,,,both,, ,256.21,153.72,Aetna,Commercial,,256.21,29.8,29.8% of Medicare Base rate X weight,256.21,85.98,763.51,Fee Schedule,29.8
MECH TRACTION-VISIT,97012,CPT,,,,,both,, ,485.24,291.14,Aetna,Commercial,,485.24,29.8,29.8% of Medicare Base rate X weight,485.24,162.83,1446.02,Fee Schedule,29.8
MECH TRACTN-VST PTA,97012,CPT,,,,,both,, ,39.40,23.64,Aetna,Commercial,,39.40,29.8,29.8% of Medicare Base rate X weight,39.40,13.22,117.41,Fee Schedule,29.8
MECH TRACTN-VST PTA,97012,CPT,,,,,both,, ,39.40,23.64,Aetna,Commercial,,39.40,29.8,29.8% of Medicare Base rate X weight,39.40,13.22,117.41,Fee Schedule,29.8
MECH TRACTN-VST PTA,97012,CPT,,,,,both,, ,519.89,311.93,Aetna,Commercial,,519.89,29.8,29.8% of Medicare Base rate X weight,519.89,174.46,1549.27,Fee Schedule,29.8
MECH TRACTN-VST PTA,97012,CPT,,,,,both,, ,519.89,311.93,Aetna,Commercial,,519.89,29.8,29.8% of Medicare Base rate X weight,519.89,174.46,1549.27,Fee Schedule,29.8
PARAF BATH-VISIT PTA,97018,CPT,,,,,both,, ,18.54,11.12,Aetna,Commercial,,18.54,29.8,29.8% of Medicare Base rate X weight,18.54,6.22,55.25,Fee Schedule,29.8
PARAF BATH-VISIT PTA,97018,CPT,,,,,both,, ,18.54,11.12,Aetna,Commercial,,18.54,29.8,29.8% of Medicare Base rate X weight,18.54,6.22,55.25,Fee Schedule,29.8
PARAF BATH-VISIT PTA,97018,CPT,,,,,both,, ,320.85,192.51,Aetna,Commercial,,320.85,29.8,29.8% of Medicare Base rate X weight,320.85,107.67,956.13,Fee Schedule,29.8
PARAF BATH-VISIT PTA,97018,CPT,,,,,both,, ,320.85,192.51,Aetna,Commercial,,320.85,29.8,29.8% of Medicare Base rate X weight,320.85,107.67,956.13,Fee Schedule,29.8
PARAF BTH-VISIT COTA,97018,CPT,,,,,both,, ,41.20,24.72,Aetna,Commercial,,41.20,29.8,29.8% of Medicare Base rate X weight,41.20,13.83,122.78,Fee Schedule,29.8
PARAF BTH-VISIT COTA,97018,CPT,,,,,both,, ,41.20,24.72,Aetna,Commercial,,41.20,29.8,29.8% of Medicare Base rate X weight,41.20,13.83,122.78,Fee Schedule,29.8
PARAF BTH-VISIT COTA,97018,CPT,,,,,both,, ,347.88,208.72,Aetna,Commercial,,347.88,29.8,29.8% of Medicare Base rate X weight,347.88,116.74,1036.68,Fee Schedule,29.8
PARAF BTH-VISIT COTA,97018,CPT,,,,,both,, ,347.88,208.72,Aetna,Commercial,,347.88,29.8,29.8% of Medicare Base rate X weight,347.88,116.74,1036.68,Fee Schedule,29.8
PARAFFIN BATH-VISIT,97018,CPT,,,,,both,, ,299.53,179.71,Aetna,Commercial,,299.53,29.8,29.8% of Medicare Base rate X weight,299.53,100.51,892.6,Fee Schedule,29.8
PARAFFIN BATH-VISIT,97018,CPT,,,,,both,, ,324.73,194.83,Aetna,Commercial,,324.73,29.8,29.8% of Medicare Base rate X weight,324.73,108.97,967.7,Fee Schedule,29.8
WHIRLPOOL THRPY-VIST,97022,CPT,,,,,both,, ,652.70,391.62,Aetna,Commercial,,652.70,29.8,29.8% of Medicare Base rate X weight,652.70,219.03,1945.05,Fee Schedule,29.8
WHIRLPOOL THRPY-VIST,97022,CPT,,,,,both,, ,707.58,424.54,Aetna,Commercial,,707.58,29.8,29.8% of Medicare Base rate X weight,707.58,237.44,2108.59,Fee Schedule,29.8
WHRLPL THPY-VST COTA,97022,CPT,,,,,both,, ,46.87,28.12,Aetna,Commercial,,46.87,29.8,29.8% of Medicare Base rate X weight,46.87,15.73,139.67,Fee Schedule,29.8
WHRLPL THPY-VST COTA,97022,CPT,,,,,both,, ,46.87,28.12,Aetna,Commercial,,46.87,29.8,29.8% of Medicare Base rate X weight,46.87,15.73,139.67,Fee Schedule,29.8
WHRLPL THPY-VST COTA,97022,CPT,,,,,both,, ,46.87,28.12,Aetna,Commercial,,46.87,29.8,29.8% of Medicare Base rate X weight,46.87,15.73,139.67,Fee Schedule,29.8
WHRLPL THPY-VST COTA,97022,CPT,,,,,both,, ,46.87,28.12,Aetna,Commercial,,46.87,29.8,29.8% of Medicare Base rate X weight,46.87,15.73,139.67,Fee Schedule,29.8
WHRLPL THPY-VST COTA,97022,CPT,,,,,both,, ,758.08,454.84,Aetna,Commercial,,758.08,29.8,29.8% of Medicare Base rate X weight,758.08,254.39,2259.08,Fee Schedule,29.8
WHRLPL THPY-VST COTA,97022,CPT,,,,,both,, ,758.08,454.84,Aetna,Commercial,,758.08,29.8,29.8% of Medicare Base rate X weight,758.08,254.39,2259.08,Fee Schedule,29.8
WHRLPL THRPY-VST PTA,97022,CPT,,,,,both,, ,699.11,419.46,Aetna,Commercial,,699.11,29.8,29.8% of Medicare Base rate X weight,699.11,234.60,2083.35,Fee Schedule,29.8
WHRLPL THRPY-VST PTA,97022,CPT,,,,,both,, ,699.11,419.46,Aetna,Commercial,,699.11,29.8,29.8% of Medicare Base rate X weight,699.11,234.60,2083.35,Fee Schedule,29.8
ELE STM-MN-15MN COTA,97032,CPT,,,,,both,, ,39.40,23.64,Aetna,Commercial,,39.40,29.8,29.8% of Medicare Base rate X weight,39.40,13.22,117.41,Fee Schedule,29.8
ELE STM-MN-15MN COTA,97032,CPT,,,,,both,, ,39.40,23.64,Aetna,Commercial,,39.40,29.8,29.8% of Medicare Base rate X weight,39.40,13.22,117.41,Fee Schedule,29.8
ELE STM-MN-15MN COTA,97032,CPT,,,,,both,, ,39.40,23.64,Aetna,Commercial,,39.40,29.8,29.8% of Medicare Base rate X weight,39.40,13.22,117.41,Fee Schedule,29.8
ELE STM-MN-15MN COTA,97032,CPT,,,,,both,, ,39.40,23.64,Aetna,Commercial,,39.40,29.8,29.8% of Medicare Base rate X weight,39.40,13.22,117.41,Fee Schedule,29.8
ELE STM-MN-15MN COTA,97032,CPT,,,,,both,, ,541.52,324.91,Aetna,Commercial,,541.52,29.8,29.8% of Medicare Base rate X weight,541.52,181.72,1613.73,Fee Schedule,29.8
ELE STM-MN-15MN COTA,97032,CPT,,,,,both,, ,541.52,324.91,Aetna,Commercial,,541.52,29.8,29.8% of Medicare Base rate X weight,541.52,181.72,1613.73,Fee Schedule,29.8
ELEC STIM-MAN-15 MIN,97032,CPT,,,,,both,, ,466.32,279.79,Aetna,Commercial,,466.32,29.8,29.8% of Medicare Base rate X weight,466.32,156.48,1389.63,Fee Schedule,29.8
ELEC STIM-MAN-15 MIN,97032,CPT,,,,,both,, ,505.50,303.30,Aetna,Commercial,,505.50,29.8,29.8% of Medicare Base rate X weight,505.50,169.63,1506.39,Fee Schedule,29.8
ELEC STM-MN-15MN PTA,97032,CPT,,,,,both,, ,499.55,299.73,Aetna,Commercial,,499.55,29.8,29.8% of Medicare Base rate X weight,499.55,167.63,1488.66,Fee Schedule,29.8
ELEC STM-MN-15MN PTA,97032,CPT,,,,,both,, ,499.55,299.73,Aetna,Commercial,,499.55,29.8,29.8% of Medicare Base rate X weight,499.55,167.63,1488.66,Fee Schedule,29.8
IONTOPHO-15 MIN COTA,97033,CPT,,,,,both,, ,54.59,32.75,Aetna,Commercial,,54.59,29.8,29.8% of Medicare Base rate X weight,54.59,18.32,162.68,Fee Schedule,29.8
IONTOPHO-15 MIN COTA,97033,CPT,,,,,both,, ,54.59,32.75,Aetna,Commercial,,54.59,29.8,29.8% of Medicare Base rate X weight,54.59,18.32,162.68,Fee Schedule,29.8
IONTOPHO-15 MIN COTA,97033,CPT,,,,,both,, ,54.59,32.75,Aetna,Commercial,,54.59,29.8,29.8% of Medicare Base rate X weight,54.59,18.32,162.68,Fee Schedule,29.8
IONTOPHO-15 MIN COTA,97033,CPT,,,,,both,, ,54.59,32.75,Aetna,Commercial,,54.59,29.8,29.8% of Medicare Base rate X weight,54.59,18.32,162.68,Fee Schedule,29.8
IONTOPHO-15 MIN COTA,97033,CPT,,,,,both,, ,764.52,458.71,Aetna,Commercial,,764.52,29.8,29.8% of Medicare Base rate X weight,764.52,256.55,2278.27,Fee Schedule,29.8
IONTOPHO-15 MIN COTA,97033,CPT,,,,,both,, ,764.52,458.71,Aetna,Commercial,,764.52,29.8,29.8% of Medicare Base rate X weight,764.52,256.55,2278.27,Fee Schedule,29.8
IONTOPHOR-15 MIN PTA,97033,CPT,,,,,both,, ,705.04,423.02,Aetna,Commercial,,705.04,29.8,29.8% of Medicare Base rate X weight,705.04,236.59,2101.02,Fee Schedule,29.8
IONTOPHOR-15 MIN PTA,97033,CPT,,,,,both,, ,705.04,423.02,Aetna,Commercial,,705.04,29.8,29.8% of Medicare Base rate X weight,705.04,236.59,2101.02,Fee Schedule,29.8
IONTOPHORESIS-15 MIN,97033,CPT,,,,,both,, ,658.28,394.96,Aetna,Commercial,,658.28,29.8,29.8% of Medicare Base rate X weight,658.28,220.90,1961.67,Fee Schedule,29.8
IONTOPHORESIS-15 MIN,97033,CPT,,,,,both,, ,713.65,428.19,Aetna,Commercial,,713.65,29.8,29.8% of Medicare Base rate X weight,713.65,239.48,2126.68,Fee Schedule,29.8
CNTRST BTH-15MIN PTA,97034,CPT,,,,,both,, ,474.83,284.89,Aetna,Commercial,,474.83,29.8,29.8% of Medicare Base rate X weight,474.83,159.34,1414.99,Fee Schedule,29.8
CNTRST BTH-15MIN PTA,97034,CPT,,,,,both,, ,474.83,284.89,Aetna,Commercial,,474.83,29.8,29.8% of Medicare Base rate X weight,474.83,159.34,1414.99,Fee Schedule,29.8
CNTRST BTH-15MN COTA,97034,CPT,,,,,both,, ,40.17,24.10,Aetna,Commercial,,40.17,29.8,29.8% of Medicare Base rate X weight,40.17,13.48,119.71,Fee Schedule,29.8
CNTRST BTH-15MN COTA,97034,CPT,,,,,both,, ,40.17,24.10,Aetna,Commercial,,40.17,29.8,29.8% of Medicare Base rate X weight,40.17,13.48,119.71,Fee Schedule,29.8
CNTRST BTH-15MN COTA,97034,CPT,,,,,both,, ,40.17,24.10,Aetna,Commercial,,40.17,29.8,29.8% of Medicare Base rate X weight,40.17,13.48,119.71,Fee Schedule,29.8
CNTRST BTH-15MN COTA,97034,CPT,,,,,both,, ,40.17,24.10,Aetna,Commercial,,40.17,29.8,29.8% of Medicare Base rate X weight,40.17,13.48,119.71,Fee Schedule,29.8
CNTRST BTH-15MN COTA,97034,CPT,,,,,both,, ,514.74,308.84,Aetna,Commercial,,514.74,29.8,29.8% of Medicare Base rate X weight,514.74,172.73,1533.93,Fee Schedule,29.8
CNTRST BTH-15MN COTA,97034,CPT,,,,,both,, ,514.74,308.84,Aetna,Commercial,,514.74,29.8,29.8% of Medicare Base rate X weight,514.74,172.73,1533.93,Fee Schedule,29.8
CONTRAST BATH-15 MIN,97034,CPT,,,,,both,, ,443.25,265.95,Aetna,Commercial,,443.25,29.8,29.8% of Medicare Base rate X weight,443.25,148.74,1320.89,Fee Schedule,29.8
CONTRAST BATH-15 MIN,97034,CPT,,,,,both,, ,480.51,288.30,Aetna,Commercial,,480.51,29.8,29.8% of Medicare Base rate X weight,480.51,161.24,1431.92,Fee Schedule,29.8
ULTRASND-15 MIN COTA,97035,CPT,,,,,both,, ,36.57,21.94,Aetna,Commercial,,36.57,29.8,29.8% of Medicare Base rate X weight,36.57,12.27,108.98,Fee Schedule,29.8
ULTRASND-15 MIN COTA,97035,CPT,,,,,both,, ,36.57,21.94,Aetna,Commercial,,36.57,29.8,29.8% of Medicare Base rate X weight,36.57,12.27,108.98,Fee Schedule,29.8
ULTRASND-15 MIN COTA,97035,CPT,,,,,both,, ,36.57,21.94,Aetna,Commercial,,36.57,29.8,29.8% of Medicare Base rate X weight,36.57,12.27,108.98,Fee Schedule,29.8
ULTRASND-15 MIN COTA,97035,CPT,,,,,both,, ,36.57,21.94,Aetna,Commercial,,36.57,29.8,29.8% of Medicare Base rate X weight,36.57,12.27,108.98,Fee Schedule,29.8
ULTRASND-15 MIN COTA,97035,CPT,,,,,both,, ,611.56,366.93,Aetna,Commercial,,611.56,29.8,29.8% of Medicare Base rate X weight,611.56,205.22,1822.45,Fee Schedule,29.8
ULTRASND-15 MIN COTA,97035,CPT,,,,,both,, ,611.56,366.93,Aetna,Commercial,,611.56,29.8,29.8% of Medicare Base rate X weight,611.56,205.22,1822.45,Fee Schedule,29.8
ULTRASND-15 MIN PTA,97035,CPT,,,,,both,, ,564.18,338.50,Aetna,Commercial,,564.18,29.8,29.8% of Medicare Base rate X weight,564.18,189.32,1681.26,Fee Schedule,29.8
ULTRASND-15 MIN PTA,97035,CPT,,,,,both,, ,564.18,338.50,Aetna,Commercial,,564.18,29.8,29.8% of Medicare Base rate X weight,564.18,189.32,1681.26,Fee Schedule,29.8
ULTRASOUND-15 MIN,97035,CPT,,,,,both,, ,526.62,315.97,Aetna,Commercial,,526.62,29.8,29.8% of Medicare Base rate X weight,526.62,176.72,1569.33,Fee Schedule,29.8
ULTRASOUND-15 MIN,97035,CPT,,,,,both,, ,570.95,342.57,Aetna,Commercial,,570.95,29.8,29.8% of Medicare Base rate X weight,570.95,191.59,1701.43,Fee Schedule,29.8
"Physical therapy, therapeutic exercise .",97110,CPT,,,,,both,,,342.72,342.72,Aetna,Commercial,,342.72,29.8,29.8% of Medicare Base rate X weight,342.72,115.01,1021.31,Fee Schedule,29.8
THER EXRCS-15MIN PTA,97110,CPT,,,,,both,, ,367.20,220.32,Aetna,Commercial,,367.20,29.8,29.8% of Medicare Base rate X weight,367.20,123.22,1094.26,Fee Schedule,29.8
THER EXRCS-15MIN PTA,97110,CPT,,,,,both,, ,367.20,220.32,Aetna,Commercial,,367.20,29.8,29.8% of Medicare Base rate X weight,367.20,123.22,1094.26,Fee Schedule,29.8
THER EXRCS-15MN COTA,97110,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,81.37,29.8,29.8% of Medicare Base rate X weight,81.37,27.31,242.48,Fee Schedule,29.8
THER EXRCS-15MN COTA,97110,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,81.37,29.8,29.8% of Medicare Base rate X weight,81.37,27.31,242.48,Fee Schedule,29.8
THER EXRCS-15MN COTA,97110,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,81.37,29.8,29.8% of Medicare Base rate X weight,81.37,27.31,242.48,Fee Schedule,29.8
THER EXRCS-15MN COTA,97110,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,81.37,29.8,29.8% of Medicare Base rate X weight,81.37,27.31,242.48,Fee Schedule,29.8
THER EXRCS-15MN COTA,97110,CPT,,,,,both,, ,398.10,238.86,Aetna,Commercial,,398.10,29.8,29.8% of Medicare Base rate X weight,398.10,133.59,1186.34,Fee Schedule,29.8
THER EXRCS-15MN COTA,97110,CPT,,,,,both,, ,398.10,238.86,Aetna,Commercial,,398.10,29.8,29.8% of Medicare Base rate X weight,398.10,133.59,1186.34,Fee Schedule,29.8
THERAP EXERCS-15 MIN,97110,CPT,,,,,both,, ,342.72,205.63,Aetna,Commercial,,342.72,29.8,29.8% of Medicare Base rate X weight,342.72,115.01,1021.31,Fee Schedule,29.8
THERAP EXERCS-15 MIN,97110,CPT,,,,,both,, ,371.55,222.93,Aetna,Commercial,,371.55,29.8,29.8% of Medicare Base rate X weight,371.55,124.68,1107.22,Fee Schedule,29.8
NEUR RE-ED-15MIN PTA,97112,CPT,,,,,both,, ,367.20,220.32,Aetna,Commercial,,367.20,29.8,29.8% of Medicare Base rate X weight,367.20,123.22,1094.26,Fee Schedule,29.8
NEUR RE-ED-15MIN PTA,97112,CPT,,,,,both,, ,367.20,220.32,Aetna,Commercial,,367.20,29.8,29.8% of Medicare Base rate X weight,367.20,123.22,1094.26,Fee Schedule,29.8
NEUR RE-ED-15MN COTA,97112,CPT,,,,,both,, ,92.19,55.31,Aetna,Commercial,,92.19,29.8,29.8% of Medicare Base rate X weight,92.19,30.94,274.73,Fee Schedule,29.8
NEUR RE-ED-15MN COTA,97112,CPT,,,,,both,, ,92.19,55.31,Aetna,Commercial,,92.19,29.8,29.8% of Medicare Base rate X weight,92.19,30.94,274.73,Fee Schedule,29.8
NEUR RE-ED-15MN COTA,97112,CPT,,,,,both,, ,92.19,55.31,Aetna,Commercial,,92.19,29.8,29.8% of Medicare Base rate X weight,92.19,30.94,274.73,Fee Schedule,29.8
NEUR RE-ED-15MN COTA,97112,CPT,,,,,both,, ,92.19,55.31,Aetna,Commercial,,92.19,29.8,29.8% of Medicare Base rate X weight,92.19,30.94,274.73,Fee Schedule,29.8
NEUR RE-ED-15MN COTA,97112,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,486.42,29.8,29.8% of Medicare Base rate X weight,486.42,163.23,1449.53,Fee Schedule,29.8
NEUR RE-ED-15MN COTA,97112,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,486.42,29.8,29.8% of Medicare Base rate X weight,486.42,163.23,1449.53,Fee Schedule,29.8
NEURO RE-ED-15 MIN,97112,CPT,,,,,both,, ,342.72,205.63,Aetna,Commercial,,342.72,29.8,29.8% of Medicare Base rate X weight,342.72,115.01,1021.31,Fee Schedule,29.8
NEURO RE-ED-15 MIN,97112,CPT,,,,,both,, ,454.13,272.47,Aetna,Commercial,,454.13,29.8,29.8% of Medicare Base rate X weight,454.13,152.39,1353.31,Fee Schedule,29.8
GAIT TRAINING-15 MIN,97116,CPT,,,,,both,, ,342.72,205.63,Aetna,Commercial,,342.72,29.8,29.8% of Medicare Base rate X weight,342.72,115.01,1021.31,Fee Schedule,29.8
GAIT TRAINING-15 MIN,97116,CPT,,,,,both,, ,454.13,272.47,Aetna,Commercial,,454.13,29.8,29.8% of Medicare Base rate X weight,454.13,152.39,1353.31,Fee Schedule,29.8
GAIT TRNG-15MIN COTA,97116,CPT,,,,,both,, ,80.34,48.20,Aetna,Commercial,,80.34,29.8,29.8% of Medicare Base rate X weight,80.34,26.96,239.41,Fee Schedule,29.8
GAIT TRNG-15MIN COTA,97116,CPT,,,,,both,, ,80.34,48.20,Aetna,Commercial,,80.34,29.8,29.8% of Medicare Base rate X weight,80.34,26.96,239.41,Fee Schedule,29.8
GAIT TRNG-15MIN COTA,97116,CPT,,,,,both,, ,80.34,48.20,Aetna,Commercial,,80.34,29.8,29.8% of Medicare Base rate X weight,80.34,26.96,239.41,Fee Schedule,29.8
GAIT TRNG-15MIN COTA,97116,CPT,,,,,both,, ,80.34,48.20,Aetna,Commercial,,80.34,29.8,29.8% of Medicare Base rate X weight,80.34,26.96,239.41,Fee Schedule,29.8
GAIT TRNG-15MIN COTA,97116,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,486.42,29.8,29.8% of Medicare Base rate X weight,486.42,163.23,1449.53,Fee Schedule,29.8
GAIT TRNG-15MIN COTA,97116,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,486.42,29.8,29.8% of Medicare Base rate X weight,486.42,163.23,1449.53,Fee Schedule,29.8
GAIT TRNNG-15MIN PTA,97116,CPT,,,,,both,, ,367.20,220.32,Aetna,Commercial,,367.20,29.8,29.8% of Medicare Base rate X weight,367.20,123.22,1094.26,Fee Schedule,29.8
GAIT TRNNG-15MIN PTA,97116,CPT,,,,,both,, ,367.20,220.32,Aetna,Commercial,,367.20,29.8,29.8% of Medicare Base rate X weight,367.20,123.22,1094.26,Fee Schedule,29.8
MASSAGE THRPY-15 MIN,97124,CPT,,,,,both,, ,294.09,176.45,Aetna,Commercial,,294.09,29.8,29.8% of Medicare Base rate X weight,294.09,98.69,876.39,Fee Schedule,29.8
MASSAGE THRPY-15 MIN,97124,CPT,,,,,both,, ,318.84,191.30,Aetna,Commercial,,318.84,29.8,29.8% of Medicare Base rate X weight,318.84,106.99,950.14,Fee Schedule,29.8
MASSG THRP-15MN COTA,97124,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,74.93,29.8,29.8% of Medicare Base rate X weight,74.93,25.14,223.29,Fee Schedule,29.8
MASSG THRP-15MN COTA,97124,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,74.93,29.8,29.8% of Medicare Base rate X weight,74.93,25.14,223.29,Fee Schedule,29.8
MASSG THRP-15MN COTA,97124,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,74.93,29.8,29.8% of Medicare Base rate X weight,74.93,25.14,223.29,Fee Schedule,29.8
MASSG THRP-15MN COTA,97124,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,74.93,29.8,29.8% of Medicare Base rate X weight,74.93,25.14,223.29,Fee Schedule,29.8
MASSG THRP-15MN COTA,97124,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,114.58,1017.52,Fee Schedule,29.8
MASSG THRP-15MN COTA,97124,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,341.45,29.8,29.8% of Medicare Base rate X weight,341.45,114.58,1017.52,Fee Schedule,29.8
MASSG THRPY-15MN PTA,97124,CPT,,,,,both,, ,314.92,188.95,Aetna,Commercial,,314.92,29.8,29.8% of Medicare Base rate X weight,314.92,105.68,938.46,Fee Schedule,29.8
MASSG THRPY-15MN PTA,97124,CPT,,,,,both,, ,314.92,188.95,Aetna,Commercial,,314.92,29.8,29.8% of Medicare Base rate X weight,314.92,105.68,938.46,Fee Schedule,29.8
COG SKL DV IN15 COTA,97129,CPT,,,,,both,, ,84.46,50.67,Aetna,Commercial,,84.46,29.8,29.8% of Medicare Base rate X weight,84.46,28.34,251.69,Fee Schedule,29.8
COG SKL DV IN15 COTA,97129,CPT,,,,,both,, ,84.46,50.67,Aetna,Commercial,,84.46,29.8,29.8% of Medicare Base rate X weight,84.46,28.34,251.69,Fee Schedule,29.8
COG SKL DV IN15 COTA,97129,CPT,,,,,both,, ,84.46,50.67,Aetna,Commercial,,84.46,29.8,29.8% of Medicare Base rate X weight,84.46,28.34,251.69,Fee Schedule,29.8
COG SKL DV IN15 COTA,97129,CPT,,,,,both,, ,84.46,50.67,Aetna,Commercial,,84.46,29.8,29.8% of Medicare Base rate X weight,84.46,28.34,251.69,Fee Schedule,29.8
COG SKL DV IN15 COTA,97129,CPT,,,,,both,, ,398.10,238.86,Aetna,Commercial,,398.10,29.8,29.8% of Medicare Base rate X weight,398.10,133.59,1186.34,Fee Schedule,29.8
COG SKL DV INI15 OT,97129,CPT,,,,,both,, ,398.10,238.86,Aetna,Commercial,,398.10,29.8,29.8% of Medicare Base rate X weight,398.10,133.59,1186.34,Fee Schedule,29.8
COG SKL DV INI15 PTA,97129,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,448.57,29.8,29.8% of Medicare Base rate X weight,448.57,150.53,1336.74,Fee Schedule,29.8
COG SKL DV INI15 PTA,97129,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,448.57,29.8,29.8% of Medicare Base rate X weight,448.57,150.53,1336.74,Fee Schedule,29.8
COG SKL DV INI15 SP,97129,CPT,,,,,both,, ,398.10,238.86,Aetna,Commercial,,398.10,29.8,29.8% of Medicare Base rate X weight,398.10,133.59,1186.34,Fee Schedule,29.8
COG SKL DV AD15 COTA,97130,CPT,,,,,both,, ,84.46,50.67,Aetna,Commercial,,84.46,29.8,29.8% of Medicare Base rate X weight,84.46,28.34,251.69,Fee Schedule,29.8
COG SKL DV AD15 COTA,97130,CPT,,,,,both,, ,84.46,50.67,Aetna,Commercial,,84.46,29.8,29.8% of Medicare Base rate X weight,84.46,28.34,251.69,Fee Schedule,29.8
COG SKL DV AD15 COTA,97130,CPT,,,,,both,, ,84.46,50.67,Aetna,Commercial,,84.46,29.8,29.8% of Medicare Base rate X weight,84.46,28.34,251.69,Fee Schedule,29.8
COG SKL DV AD15 COTA,97130,CPT,,,,,both,, ,84.46,50.67,Aetna,Commercial,,84.46,29.8,29.8% of Medicare Base rate X weight,84.46,28.34,251.69,Fee Schedule,29.8
COG SKL DV AD15 COTA,97130,CPT,,,,,both,, ,398.10,238.86,Aetna,Commercial,,398.10,29.8,29.8% of Medicare Base rate X weight,398.10,133.59,1186.34,Fee Schedule,29.8
COG SKL DV ADD15 OT,97130,CPT,,,,,both,, ,398.10,238.86,Aetna,Commercial,,398.10,29.8,29.8% of Medicare Base rate X weight,398.10,133.59,1186.34,Fee Schedule,29.8
COG SKL DV ADD15 PTA,97130,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,448.57,29.8,29.8% of Medicare Base rate X weight,448.57,150.53,1336.74,Fee Schedule,29.8
COG SKL DV ADD15 PTA,97130,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,448.57,29.8,29.8% of Medicare Base rate X weight,448.57,150.53,1336.74,Fee Schedule,29.8
COG SKL DV ADD15 SP,97130,CPT,,,,,both,, ,398.10,238.86,Aetna,Commercial,,398.10,29.8,29.8% of Medicare Base rate X weight,398.10,133.59,1186.34,Fee Schedule,29.8
MANUAL THRPY-15 MIN,97140,CPT,,,,,both,, ,342.72,205.63,Aetna,Commercial,,342.72,29.8,29.8% of Medicare Base rate X weight,342.72,115.01,1021.31,Fee Schedule,29.8
MANUAL THRPY-15 MIN,97140,CPT,,,,,both,, ,454.13,272.47,Aetna,Commercial,,454.13,29.8,29.8% of Medicare Base rate X weight,454.13,152.39,1353.31,Fee Schedule,29.8
MNL THRPY-15 MIN PTA,97140,CPT,,,,,both,, ,367.20,220.32,Aetna,Commercial,,367.20,29.8,29.8% of Medicare Base rate X weight,367.20,123.22,1094.26,Fee Schedule,29.8
MNL THRPY-15 MIN PTA,97140,CPT,,,,,both,, ,367.20,220.32,Aetna,Commercial,,367.20,29.8,29.8% of Medicare Base rate X weight,367.20,123.22,1094.26,Fee Schedule,29.8
MNL THRPY-15MIN COTA,97140,CPT,,,,,both,, ,73.65,44.19,Aetna,Commercial,,73.65,29.8,29.8% of Medicare Base rate X weight,73.65,24.71,219.48,Fee Schedule,29.8
MNL THRPY-15MIN COTA,97140,CPT,,,,,both,, ,73.65,44.19,Aetna,Commercial,,73.65,29.8,29.8% of Medicare Base rate X weight,73.65,24.71,219.48,Fee Schedule,29.8
MNL THRPY-15MIN COTA,97140,CPT,,,,,both,, ,73.65,44.19,Aetna,Commercial,,73.65,29.8,29.8% of Medicare Base rate X weight,73.65,24.71,219.48,Fee Schedule,29.8
MNL THRPY-15MIN COTA,97140,CPT,,,,,both,, ,73.65,44.19,Aetna,Commercial,,73.65,29.8,29.8% of Medicare Base rate X weight,73.65,24.71,219.48,Fee Schedule,29.8
MNL THRPY-15MIN COTA,97140,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,486.42,29.8,29.8% of Medicare Base rate X weight,486.42,163.23,1449.53,Fee Schedule,29.8
MNL THRPY-15MIN COTA,97140,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,486.42,29.8,29.8% of Medicare Base rate X weight,486.42,163.23,1449.53,Fee Schedule,29.8
GROUP THRP PROC-VIST,97150,CPT,,,,,both,, ,341.23,204.73,Aetna,Commercial,,341.23,29.8,29.8% of Medicare Base rate X weight,341.23,114.51,1016.87,Fee Schedule,29.8
GROUP THRP PROC-VIST,97150,CPT,,,,,both,, ,369.92,221.95,Aetna,Commercial,,369.92,29.8,29.8% of Medicare Base rate X weight,369.92,124.13,1102.36,Fee Schedule,29.8
GRP THR PRC-VST COTA,97150,CPT,,,,,both,, ,48.67,29.20,Aetna,Commercial,,48.67,29.8,29.8% of Medicare Base rate X weight,48.67,16.33,145.04,Fee Schedule,29.8
GRP THR PRC-VST COTA,97150,CPT,,,,,both,, ,48.67,29.20,Aetna,Commercial,,48.67,29.8,29.8% of Medicare Base rate X weight,48.67,16.33,145.04,Fee Schedule,29.8
GRP THR PRC-VST COTA,97150,CPT,,,,,both,, ,48.67,29.20,Aetna,Commercial,,48.67,29.8,29.8% of Medicare Base rate X weight,48.67,16.33,145.04,Fee Schedule,29.8
GRP THR PRC-VST COTA,97150,CPT,,,,,both,, ,48.67,29.20,Aetna,Commercial,,48.67,29.8,29.8% of Medicare Base rate X weight,48.67,16.33,145.04,Fee Schedule,29.8
GRP THR PRC-VST COTA,97150,CPT,,,,,both,, ,396.29,237.77,Aetna,Commercial,,396.29,29.8,29.8% of Medicare Base rate X weight,396.29,132.98,1180.94,Fee Schedule,29.8
GRP THR PRC-VST COTA,97150,CPT,,,,,both,, ,396.29,237.77,Aetna,Commercial,,396.29,29.8,29.8% of Medicare Base rate X weight,396.29,132.98,1180.94,Fee Schedule,29.8
GRP THRP PRC-VST PTA,97150,CPT,,,,,both,, ,365.65,219.39,Aetna,Commercial,,365.65,29.8,29.8% of Medicare Base rate X weight,365.65,122.70,1089.64,Fee Schedule,29.8
GRP THRP PRC-VST PTA,97150,CPT,,,,,both,, ,365.65,219.39,Aetna,Commercial,,365.65,29.8,29.8% of Medicare Base rate X weight,365.65,122.70,1089.64,Fee Schedule,29.8
PT EVAL- LOW CMP PTA,97161,CPT,,,,,both,, ,223.77,134.26,Aetna,Commercial,,223.77,29.8,29.8% of Medicare Base rate X weight,223.77,75.09,666.83,Fee Schedule,29.8
PT EVAL- LOW CMP PTA,97161,CPT,,,,,both,, ,223.77,134.26,Aetna,Commercial,,223.77,29.8,29.8% of Medicare Base rate X weight,223.77,75.09,666.83,Fee Schedule,29.8
PT EVAL- LOW CMP PTA,97161,CPT,,,,,both,, ,721.00,432.60,Aetna,Commercial,,721.00,29.8,29.8% of Medicare Base rate X weight,721.00,241.95,2148.58,Fee Schedule,29.8
PT EVAL- LOW CMP PTA,97161,CPT,,,,,both,, ,721.00,432.60,Aetna,Commercial,,721.00,29.8,29.8% of Medicare Base rate X weight,721.00,241.95,2148.58,Fee Schedule,29.8
PT EVAL- LOW COMP,97161,CPT,,,,,both,, ,673.18,403.90,Aetna,Commercial,,673.18,29.8,29.8% of Medicare Base rate X weight,673.18,225.90,2006.08,Fee Schedule,29.8
PT-EVAL LOW 15M MCD,97161,CPT,,,,,both,, ,700.00,420.00,Aetna,Commercial,,700.00,29.8,29.8% of Medicare Base rate X weight,700.00,234.90,2086,Fee Schedule,29.8
PT EVAL- MOD CMP PTA,97162,CPT,,,,,both,, ,223.77,134.26,Aetna,Commercial,,223.77,29.8,29.8% of Medicare Base rate X weight,223.77,75.09,666.83,Fee Schedule,29.8
PT EVAL- MOD CMP PTA,97162,CPT,,,,,both,, ,223.77,134.26,Aetna,Commercial,,223.77,29.8,29.8% of Medicare Base rate X weight,223.77,75.09,666.83,Fee Schedule,29.8
PT EVAL- MOD CMP PTA,97162,CPT,,,,,both,, ,360.50,216.30,Aetna,Commercial,,360.50,29.8,29.8% of Medicare Base rate X weight,360.50,120.97,1074.29,Fee Schedule,29.8
PT EVAL- MOD CMP PTA,97162,CPT,,,,,both,, ,360.50,216.30,Aetna,Commercial,,360.50,29.8,29.8% of Medicare Base rate X weight,360.50,120.97,1074.29,Fee Schedule,29.8
PT EVAL- MOD COMP,97162,CPT,,,,,both,, ,673.18,403.90,Aetna,Commercial,,673.18,29.8,29.8% of Medicare Base rate X weight,673.18,225.90,2006.08,Fee Schedule,29.8
PT-EVAL MOD 15M MCD,97162,CPT,,,,,both,, ,350.00,210.00,Aetna,Commercial,,350.00,29.8,29.8% of Medicare Base rate X weight,350.00,117.45,1043,Fee Schedule,29.8
PT EVAL- HGH CMP PTA,97163,CPT,,,,,both,, ,224.03,134.41,Aetna,Commercial,,224.03,29.8,29.8% of Medicare Base rate X weight,224.03,75.18,667.61,Fee Schedule,29.8
PT EVAL- HGH CMP PTA,97163,CPT,,,,,both,, ,224.03,134.41,Aetna,Commercial,,224.03,29.8,29.8% of Medicare Base rate X weight,224.03,75.18,667.61,Fee Schedule,29.8
PT EVAL- HGH CMP PTA,97163,CPT,,,,,both,, ,721.00,432.60,Aetna,Commercial,,721.00,29.8,29.8% of Medicare Base rate X weight,721.00,241.95,2148.58,Fee Schedule,29.8
PT EVAL- HGH CMP PTA,97163,CPT,,,,,both,, ,721.00,432.60,Aetna,Commercial,,721.00,29.8,29.8% of Medicare Base rate X weight,721.00,241.95,2148.58,Fee Schedule,29.8
PT EVAL- HGH COMP,97163,CPT,,,,,both,, ,673.18,403.90,Aetna,Commercial,,673.18,29.8,29.8% of Medicare Base rate X weight,673.18,225.90,2006.08,Fee Schedule,29.8
PT-EVAL HGH 15M MCD,97163,CPT,,,,,both,, ,233.25,139.95,Aetna,Commercial,,233.25,29.8,29.8% of Medicare Base rate X weight,233.25,78.27,695.09,Fee Schedule,29.8
PT RE-EVAL-VISIT,97164,CPT,,,,,both,, ,437.36,262.41,Aetna,Commercial,,437.36,29.8,29.8% of Medicare Base rate X weight,437.36,146.77,1303.33,Fee Schedule,29.8
PT RE-EVAL-VISIT PTA,97164,CPT,,,,,both,, ,151.41,90.84,Aetna,Commercial,,151.41,29.8,29.8% of Medicare Base rate X weight,151.41,50.81,451.2,Fee Schedule,29.8
PT RE-EVAL-VISIT PTA,97164,CPT,,,,,both,, ,151.41,90.84,Aetna,Commercial,,151.41,29.8,29.8% of Medicare Base rate X weight,151.41,50.81,451.2,Fee Schedule,29.8
PT RE-EVAL-VISIT PTA,97164,CPT,,,,,both,, ,468.39,281.03,Aetna,Commercial,,468.39,29.8,29.8% of Medicare Base rate X weight,468.39,157.18,1395.8,Fee Schedule,29.8
PT RE-EVAL-VISIT PTA,97164,CPT,,,,,both,, ,468.39,281.03,Aetna,Commercial,,468.39,29.8,29.8% of Medicare Base rate X weight,468.39,157.18,1395.8,Fee Schedule,29.8
OT EVAL- LOW CMP OT,97165,CPT,,,,,both,, ,223.77,134.26,Aetna,Commercial,,223.77,29.8,29.8% of Medicare Base rate X weight,223.77,75.09,666.83,Fee Schedule,29.8
OT EVAL- LOW COMP,97165,CPT,,,,,both,, ,729.80,437.88,Aetna,Commercial,,729.80,29.8,29.8% of Medicare Base rate X weight,729.80,244.90,2174.8,Fee Schedule,29.8
OT EVAL-LOW CMP COTA,97165,CPT,,,,,both,, ,781.77,469.06,Aetna,Commercial,,781.77,29.8,29.8% of Medicare Base rate X weight,781.77,262.34,2329.67,Fee Schedule,29.8
OT EVAL-LOW CMP COTA,97165,CPT,,,,,both,, ,781.77,469.06,Aetna,Commercial,,781.77,29.8,29.8% of Medicare Base rate X weight,781.77,262.34,2329.67,Fee Schedule,29.8
OT-EVAL LOW 15M MCD,97165,CPT,,,,,both,, ,100.00,60.00,Aetna,Commercial,,100.00,29.8,29.8% of Medicare Base rate X weight,100.00,33.56,298,Fee Schedule,29.8
OT-EVAL LOW 15M MCD,97165,CPT,,,,,both,, ,759.00,455.40,Aetna,Commercial,,759.00,29.8,29.8% of Medicare Base rate X weight,759.00,254.70,2261.82,Fee Schedule,29.8
OT EVAL- MOD CMP OT,97166,CPT,,,,,both,, ,223.77,134.26,Aetna,Commercial,,223.77,29.8,29.8% of Medicare Base rate X weight,223.77,75.09,666.83,Fee Schedule,29.8
OT EVAL- MOD COMP,97166,CPT,,,,,both,, ,729.80,437.88,Aetna,Commercial,,729.80,29.8,29.8% of Medicare Base rate X weight,729.80,244.90,2174.8,Fee Schedule,29.8
OT EVAL-MOD CMP COTA,97166,CPT,,,,,both,, ,390.89,234.53,Aetna,Commercial,,390.89,29.8,29.8% of Medicare Base rate X weight,390.89,131.17,1164.85,Fee Schedule,29.8
OT EVAL-MOD CMP COTA,97166,CPT,,,,,both,, ,390.89,234.53,Aetna,Commercial,,390.89,29.8,29.8% of Medicare Base rate X weight,390.89,131.17,1164.85,Fee Schedule,29.8
OT-EVAL MOD 15M MCD,97166,CPT,,,,,both,, ,100.00,60.00,Aetna,Commercial,,100.00,29.8,29.8% of Medicare Base rate X weight,100.00,33.56,298,Fee Schedule,29.8
OT-EVAL MOD 15M MCD,97166,CPT,,,,,both,, ,379.50,227.70,Aetna,Commercial,,379.50,29.8,29.8% of Medicare Base rate X weight,379.50,127.35,1130.91,Fee Schedule,29.8
OT EVAL- HGH CMP OT,97167,CPT,,,,,both,, ,223.77,134.26,Aetna,Commercial,,223.77,29.8,29.8% of Medicare Base rate X weight,223.77,75.09,666.83,Fee Schedule,29.8
OT EVAL- HGH COMP,97167,CPT,,,,,both,, ,729.80,437.88,Aetna,Commercial,,729.80,29.8,29.8% of Medicare Base rate X weight,729.80,244.90,2174.8,Fee Schedule,29.8
OT EVAL-HGH CMP COTA,97167,CPT,,,,,both,, ,781.77,469.06,Aetna,Commercial,,781.77,29.8,29.8% of Medicare Base rate X weight,781.77,262.34,2329.67,Fee Schedule,29.8
OT EVAL-HGH CMP COTA,97167,CPT,,,,,both,, ,781.77,469.06,Aetna,Commercial,,781.77,29.8,29.8% of Medicare Base rate X weight,781.77,262.34,2329.67,Fee Schedule,29.8
OT-EVAL HGH 15M MCD,97167,CPT,,,,,both,, ,100.00,60.00,Aetna,Commercial,,100.00,29.8,29.8% of Medicare Base rate X weight,100.00,33.56,298,Fee Schedule,29.8
OT-EVAL HGH 15M MCD,97167,CPT,,,,,both,, ,253.00,151.80,Aetna,Commercial,,253.00,29.8,29.8% of Medicare Base rate X weight,253.00,84.90,753.94,Fee Schedule,29.8
OT RE-EVAL VIST COTA,97168,CPT,,,,,both,, ,151.41,90.84,Aetna,Commercial,,151.41,29.8,29.8% of Medicare Base rate X weight,151.41,50.81,451.2,Fee Schedule,29.8
OT RE-EVAL VIST COTA,97168,CPT,,,,,both,, ,151.41,90.84,Aetna,Commercial,,151.41,29.8,29.8% of Medicare Base rate X weight,151.41,50.81,451.2,Fee Schedule,29.8
OT RE-EVAL VIST COTA,97168,CPT,,,,,both,, ,507.79,304.67,Aetna,Commercial,,507.79,29.8,29.8% of Medicare Base rate X weight,507.79,170.40,1513.21,Fee Schedule,29.8
OT RE-EVAL VIST COTA,97168,CPT,,,,,both,, ,507.79,304.67,Aetna,Commercial,,507.79,29.8,29.8% of Medicare Base rate X weight,507.79,170.40,1513.21,Fee Schedule,29.8
OT RE-EVAL-VISIT,97168,CPT,,,,,both,, ,474.13,284.47,Aetna,Commercial,,474.13,29.8,29.8% of Medicare Base rate X weight,474.13,159.10,1412.91,Fee Schedule,29.8
THER ACTV-15MIN COTA,97530,CPT,,,,,both,, ,104.29,62.57,Aetna,Commercial,,104.29,29.8,29.8% of Medicare Base rate X weight,104.29,35.00,310.78,Fee Schedule,29.8
THER ACTV-15MIN COTA,97530,CPT,,,,,both,, ,104.29,62.57,Aetna,Commercial,,104.29,29.8,29.8% of Medicare Base rate X weight,104.29,35.00,310.78,Fee Schedule,29.8
THER ACTV-15MIN COTA,97530,CPT,,,,,both,, ,104.29,62.57,Aetna,Commercial,,104.29,29.8,29.8% of Medicare Base rate X weight,104.29,35.00,310.78,Fee Schedule,29.8
THER ACTV-15MIN COTA,97530,CPT,,,,,both,, ,104.29,62.57,Aetna,Commercial,,104.29,29.8,29.8% of Medicare Base rate X weight,104.29,35.00,310.78,Fee Schedule,29.8
THER ACTV-15MIN COTA,97530,CPT,,,,,both,, ,398.10,238.86,Aetna,Commercial,,398.10,29.8,29.8% of Medicare Base rate X weight,398.10,133.59,1186.34,Fee Schedule,29.8
THER ACTV-15MIN COTA,97530,CPT,,,,,both,, ,398.10,238.86,Aetna,Commercial,,398.10,29.8,29.8% of Medicare Base rate X weight,398.10,133.59,1186.34,Fee Schedule,29.8
THER ACTVT-15MIN PTA,97530,CPT,,,,,both,, ,367.20,220.32,Aetna,Commercial,,367.20,29.8,29.8% of Medicare Base rate X weight,367.20,123.22,1094.26,Fee Schedule,29.8
THER ACTVT-15MIN PTA,97530,CPT,,,,,both,, ,367.20,220.32,Aetna,Commercial,,367.20,29.8,29.8% of Medicare Base rate X weight,367.20,123.22,1094.26,Fee Schedule,29.8
THERAP ACTVTS-15 MIN,97530,CPT,,,,,both,, ,342.72,205.63,Aetna,Commercial,,342.72,29.8,29.8% of Medicare Base rate X weight,342.72,115.01,1021.31,Fee Schedule,29.8
THERAP ACTVTS-15 MIN,97530,CPT,,,,,both,, ,371.55,222.93,Aetna,Commercial,,371.55,29.8,29.8% of Medicare Base rate X weight,371.55,124.68,1107.22,Fee Schedule,29.8
SENS INTG-15 MIN,97533,CPT,,,,,both,, ,167.89,100.73,Aetna,Commercial,,167.89,29.8,29.8% of Medicare Base rate X weight,167.89,56.34,500.31,Fee Schedule,29.8
SENS INTG-15MIN COTA,97533,CPT,,,,,both,, ,90.13,54.07,Aetna,Commercial,,90.13,29.8,29.8% of Medicare Base rate X weight,90.13,30.24,268.59,Fee Schedule,29.8
SENS INTG-15MIN COTA,97533,CPT,,,,,both,, ,90.13,54.07,Aetna,Commercial,,90.13,29.8,29.8% of Medicare Base rate X weight,90.13,30.24,268.59,Fee Schedule,29.8
SENS INTG-15MIN COTA,97533,CPT,,,,,both,, ,687.27,412.36,Aetna,Commercial,,687.27,29.8,29.8% of Medicare Base rate X weight,687.27,230.63,2048.06,Fee Schedule,29.8
SENS INTG-15MIN COTA,97533,CPT,,,,,both,, ,687.27,412.36,Aetna,Commercial,,687.27,29.8,29.8% of Medicare Base rate X weight,687.27,230.63,2048.06,Fee Schedule,29.8
SENSORY INTEG-15 MIN,97533,CPT,,,,,both,, ,641.59,384.95,Aetna,Commercial,,641.59,29.8,29.8% of Medicare Base rate X weight,641.59,215.30,1911.94,Fee Schedule,29.8
SELF CARE MGT-15 MIN,97535,CPT,,,,,both,, ,342.72,205.63,Aetna,Commercial,,342.72,29.8,29.8% of Medicare Base rate X weight,342.72,115.01,1021.31,Fee Schedule,29.8
SELF CARE MGT-15 MIN,97535,CPT,,,,,both,, ,371.55,222.93,Aetna,Commercial,,371.55,29.8,29.8% of Medicare Base rate X weight,371.55,124.68,1107.22,Fee Schedule,29.8
SLF CR MGT-15MN COTA,97535,CPT,,,,,both,, ,90.13,54.07,Aetna,Commercial,,90.13,29.8,29.8% of Medicare Base rate X weight,90.13,30.24,268.59,Fee Schedule,29.8
SLF CR MGT-15MN COTA,97535,CPT,,,,,both,, ,90.13,54.07,Aetna,Commercial,,90.13,29.8,29.8% of Medicare Base rate X weight,90.13,30.24,268.59,Fee Schedule,29.8
SLF CR MGT-15MN COTA,97535,CPT,,,,,both,, ,90.13,54.07,Aetna,Commercial,,90.13,29.8,29.8% of Medicare Base rate X weight,90.13,30.24,268.59,Fee Schedule,29.8
SLF CR MGT-15MN COTA,97535,CPT,,,,,both,, ,90.13,54.07,Aetna,Commercial,,90.13,29.8,29.8% of Medicare Base rate X weight,90.13,30.24,268.59,Fee Schedule,29.8
SLF CR MGT-15MN COTA,97535,CPT,,,,,both,, ,398.10,238.86,Aetna,Commercial,,398.10,29.8,29.8% of Medicare Base rate X weight,398.10,133.59,1186.34,Fee Schedule,29.8
SLF CR MGT-15MN COTA,97535,CPT,,,,,both,, ,398.10,238.86,Aetna,Commercial,,398.10,29.8,29.8% of Medicare Base rate X weight,398.10,133.59,1186.34,Fee Schedule,29.8
SLF CRE MGT-15MN PTA,97535,CPT,,,,,both,, ,367.20,220.32,Aetna,Commercial,,367.20,29.8,29.8% of Medicare Base rate X weight,367.20,123.22,1094.26,Fee Schedule,29.8
SLF CRE MGT-15MN PTA,97535,CPT,,,,,both,, ,367.20,220.32,Aetna,Commercial,,367.20,29.8,29.8% of Medicare Base rate X weight,367.20,123.22,1094.26,Fee Schedule,29.8
CM-WK REIN-15MN COTA,97537,CPT,,,,,both,, ,86.78,52.06,Aetna,Commercial,,86.78,29.8,29.8% of Medicare Base rate X weight,86.78,29.12,258.6,Fee Schedule,29.8
CM-WK REIN-15MN COTA,97537,CPT,,,,,both,, ,86.78,52.06,Aetna,Commercial,,86.78,29.8,29.8% of Medicare Base rate X weight,86.78,29.12,258.6,Fee Schedule,29.8
CM-WK REIN-15MN COTA,97537,CPT,,,,,both,, ,86.78,52.06,Aetna,Commercial,,86.78,29.8,29.8% of Medicare Base rate X weight,86.78,29.12,258.6,Fee Schedule,29.8
CM-WK REIN-15MN COTA,97537,CPT,,,,,both,, ,86.78,52.06,Aetna,Commercial,,86.78,29.8,29.8% of Medicare Base rate X weight,86.78,29.12,258.6,Fee Schedule,29.8
CM-WK REIN-15MN COTA,97537,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,486.42,29.8,29.8% of Medicare Base rate X weight,486.42,163.23,1449.53,Fee Schedule,29.8
CM-WK REIN-15MN COTA,97537,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,486.42,29.8,29.8% of Medicare Base rate X weight,486.42,163.23,1449.53,Fee Schedule,29.8
COM-WK REIN-15MN PTA,97537,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,448.57,29.8,29.8% of Medicare Base rate X weight,448.57,150.53,1336.74,Fee Schedule,29.8
COM-WK REIN-15MN PTA,97537,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,448.57,29.8,29.8% of Medicare Base rate X weight,448.57,150.53,1336.74,Fee Schedule,29.8
COM-WRK REINT-15 MIN,97537,CPT,,,,,both,, ,418.86,251.31,Aetna,Commercial,,418.86,29.8,29.8% of Medicare Base rate X weight,418.86,140.56,1248.2,Fee Schedule,29.8
COM-WRK REINT-15 MIN,97537,CPT,,,,,both,, ,454.13,272.47,Aetna,Commercial,,454.13,29.8,29.8% of Medicare Base rate X weight,454.13,152.39,1353.31,Fee Schedule,29.8
WHEELCHR MGT-15 MIN,97542,CPT,,,,,both,, ,418.86,251.31,Aetna,Commercial,,418.86,29.8,29.8% of Medicare Base rate X weight,418.86,140.56,1248.2,Fee Schedule,29.8
WHEELCHR MGT-15 MIN,97542,CPT,,,,,both,, ,454.13,272.47,Aetna,Commercial,,454.13,29.8,29.8% of Medicare Base rate X weight,454.13,152.39,1353.31,Fee Schedule,29.8
WHLCHR MGT-15MIN PTA,97542,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,448.57,29.8,29.8% of Medicare Base rate X weight,448.57,150.53,1336.74,Fee Schedule,29.8
WHLCHR MGT-15MIN PTA,97542,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,448.57,29.8,29.8% of Medicare Base rate X weight,448.57,150.53,1336.74,Fee Schedule,29.8
WHLCHR MGT-15MN COTA,97542,CPT,,,,,both,, ,87.55,52.53,Aetna,Commercial,,87.55,29.8,29.8% of Medicare Base rate X weight,87.55,29.38,260.9,Fee Schedule,29.8
WHLCHR MGT-15MN COTA,97542,CPT,,,,,both,, ,87.55,52.53,Aetna,Commercial,,87.55,29.8,29.8% of Medicare Base rate X weight,87.55,29.38,260.9,Fee Schedule,29.8
WHLCHR MGT-15MN COTA,97542,CPT,,,,,both,, ,87.55,52.53,Aetna,Commercial,,87.55,29.8,29.8% of Medicare Base rate X weight,87.55,29.38,260.9,Fee Schedule,29.8
WHLCHR MGT-15MN COTA,97542,CPT,,,,,both,, ,87.55,52.53,Aetna,Commercial,,87.55,29.8,29.8% of Medicare Base rate X weight,87.55,29.38,260.9,Fee Schedule,29.8
WHLCHR MGT-15MN COTA,97542,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,486.42,29.8,29.8% of Medicare Base rate X weight,486.42,163.23,1449.53,Fee Schedule,29.8
WHLCHR MGT-15MN COTA,97542,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,486.42,29.8,29.8% of Medicare Base rate X weight,486.42,163.23,1449.53,Fee Schedule,29.8
WK HR-CD 1ST 2HR PTA,97545,CPT,,,,,both,, ,206.00,123.60,Aetna,Commercial,,206.00,29.8,29.8% of Medicare Base rate X weight,206.00,69.13,613.88,Fee Schedule,29.8
WK HR-CD 1ST 2HR PTA,97545,CPT,,,,,both,, ,206.00,123.60,Aetna,Commercial,,206.00,29.8,29.8% of Medicare Base rate X weight,206.00,69.13,613.88,Fee Schedule,29.8
WK HR-CD IN 2HR COTA,97545,CPT,,,,,both,, ,1121.67,673.00,Aetna,Commercial,,1121.67,29.8,29.8% of Medicare Base rate X weight,1121.67,376.40,3342.58,Fee Schedule,29.8
WK HR-CD IN 2HR COTA,97545,CPT,,,,,both,, ,1121.67,673.00,Aetna,Commercial,,1121.67,29.8,29.8% of Medicare Base rate X weight,1121.67,376.40,3342.58,Fee Schedule,29.8
WK HR-CD IN 2HR COTA,97545,CPT,,,,,both,, ,1121.67,673.00,Aetna,Commercial,,1121.67,29.8,29.8% of Medicare Base rate X weight,1121.67,376.40,3342.58,Fee Schedule,29.8
WK HR-CD IN 2HR COTA,97545,CPT,,,,,both,, ,1121.67,673.00,Aetna,Commercial,,1121.67,29.8,29.8% of Medicare Base rate X weight,1121.67,376.40,3342.58,Fee Schedule,29.8
WK HR-CD IN 2HR COTA,97545,CPT,,,,,both,, ,1215.92,729.55,Aetna,Commercial,,1215.92,29.8,29.8% of Medicare Base rate X weight,1215.92,408.03,3623.44,Fee Schedule,29.8
WK HR-CD IN 2HR COTA,97545,CPT,,,,,both,, ,1215.92,729.55,Aetna,Commercial,,1215.92,29.8,29.8% of Medicare Base rate X weight,1215.92,408.03,3623.44,Fee Schedule,29.8
WRK HAR-CND 1ST 2HRS,97545,CPT,,,,,both,, ,1047.07,628.24,Aetna,Commercial,,1047.07,29.8,29.8% of Medicare Base rate X weight,1047.07,351.37,3120.27,Fee Schedule,29.8
WRK HAR-CND 1ST 2HRS,97545,CPT,,,,,both,, ,1135.14,681.08,Aetna,Commercial,,1135.14,29.8,29.8% of Medicare Base rate X weight,1135.14,380.92,3382.72,Fee Schedule,29.8
WK HAR-CND-ADHR COTA,97546,CPT,,,,,both,, ,103.00,61.80,Aetna,Commercial,,103.00,29.8,29.8% of Medicare Base rate X weight,103.00,34.56,306.94,Fee Schedule,29.8
WK HAR-CND-ADHR COTA,97546,CPT,,,,,both,, ,103.00,61.80,Aetna,Commercial,,103.00,29.8,29.8% of Medicare Base rate X weight,103.00,34.56,306.94,Fee Schedule,29.8
WK HAR-CND-ADHR COTA,97546,CPT,,,,,both,, ,103.00,61.80,Aetna,Commercial,,103.00,29.8,29.8% of Medicare Base rate X weight,103.00,34.56,306.94,Fee Schedule,29.8
WK HAR-CND-ADHR COTA,97546,CPT,,,,,both,, ,103.00,61.80,Aetna,Commercial,,103.00,29.8,29.8% of Medicare Base rate X weight,103.00,34.56,306.94,Fee Schedule,29.8
WK HAR-CND-ADHR COTA,97546,CPT,,,,,both,, ,607.96,364.77,Aetna,Commercial,,607.96,29.8,29.8% of Medicare Base rate X weight,607.96,204.01,1811.72,Fee Schedule,29.8
WK HAR-CND-ADHR COTA,97546,CPT,,,,,both,, ,607.96,364.77,Aetna,Commercial,,607.96,29.8,29.8% of Medicare Base rate X weight,607.96,204.01,1811.72,Fee Schedule,29.8
WRK HAR-CND-ADD HR,97546,CPT,,,,,both,, ,460.55,276.33,Aetna,Commercial,,460.55,29.8,29.8% of Medicare Base rate X weight,460.55,154.55,1372.44,Fee Schedule,29.8
WRK HAR-CND-ADD HR,97546,CPT,,,,,both,, ,567.57,340.54,Aetna,Commercial,,567.57,29.8,29.8% of Medicare Base rate X weight,567.57,190.46,1691.36,Fee Schedule,29.8
WRK HAR-CND-ADHR PTA,97546,CPT,,,,,both,, ,493.37,296.02,Aetna,Commercial,,493.37,29.8,29.8% of Medicare Base rate X weight,493.37,165.56,1470.24,Fee Schedule,29.8
WRK HAR-CND-ADHR PTA,97546,CPT,,,,,both,, ,493.37,296.02,Aetna,Commercial,,493.37,29.8,29.8% of Medicare Base rate X weight,493.37,165.56,1470.24,Fee Schedule,29.8
DEBRD LE 20SQCM COTA,97597,CPT,,,,,both,, ,447.54,268.52,Aetna,Commercial,,447.54,29.8,29.8% of Medicare Base rate X weight,447.54,150.18,1333.67,Fee Schedule,29.8
DEBRD LE 20SQCM COTA,97597,CPT,,,,,both,, ,447.54,268.52,Aetna,Commercial,,447.54,29.8,29.8% of Medicare Base rate X weight,447.54,150.18,1333.67,Fee Schedule,29.8
DEBRD LE 20SQCM COTA,97597,CPT,,,,,both,, ,447.54,268.52,Aetna,Commercial,,447.54,29.8,29.8% of Medicare Base rate X weight,447.54,150.18,1333.67,Fee Schedule,29.8
DEBRD LE 20SQCM COTA,97597,CPT,,,,,both,, ,447.54,268.52,Aetna,Commercial,,447.54,29.8,29.8% of Medicare Base rate X weight,447.54,150.18,1333.67,Fee Schedule,29.8
DEBRD LE 20SQCM COTA,97597,CPT,,,,,both,, ,731.82,439.09,Aetna,Commercial,,731.82,29.8,29.8% of Medicare Base rate X weight,731.82,245.58,2180.82,Fee Schedule,29.8
DEBRD LE 20SQCM COTA,97597,CPT,,,,,both,, ,731.82,439.09,Aetna,Commercial,,731.82,29.8,29.8% of Medicare Base rate X weight,731.82,245.58,2180.82,Fee Schedule,29.8
DEBRDE LE 20SQCM PTA,97597,CPT,,,,,both,, ,675.17,405.10,Aetna,Commercial,,675.17,29.8,29.8% of Medicare Base rate X weight,675.17,226.57,2012.01,Fee Schedule,29.8
DEBRDE LE 20SQCM PTA,97597,CPT,,,,,both,, ,675.17,405.10,Aetna,Commercial,,675.17,29.8,29.8% of Medicare Base rate X weight,675.17,226.57,2012.01,Fee Schedule,29.8
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,252.25,151.35,Aetna,Commercial,,252.25,29.8,29.8% of Medicare Base rate X weight,252.25,84.65,751.71,Fee Schedule,29.8
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,259.82,155.89,Aetna,Commercial,,259.82,29.8,29.8% of Medicare Base rate X weight,259.82,87.19,774.26,Fee Schedule,29.8
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,259.82,155.89,Aetna,Commercial,,259.82,29.8,29.8% of Medicare Base rate X weight,259.82,87.19,774.26,Fee Schedule,29.8
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,630.26,378.15,Aetna,Commercial,,630.26,29.8,29.8% of Medicare Base rate X weight,630.26,211.50,1878.17,Fee Schedule,29.8
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,683.29,409.97,Aetna,Commercial,,683.29,29.8,29.8% of Medicare Base rate X weight,683.29,229.29,2036.2,Fee Schedule,29.8
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,861.67,517.00,Aetna,Commercial,,861.67,29.8,29.8% of Medicare Base rate X weight,861.67,289.15,2567.78,Fee Schedule,29.8
SLCTV WND DEB =<20CM,97597,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,256.04,2273.74,Fee Schedule,29.8
DEBRD EA AD20CM COTA,97598,CPT,,,,,both,, ,450.63,270.37,Aetna,Commercial,,450.63,29.8,29.8% of Medicare Base rate X weight,450.63,151.22,1342.88,Fee Schedule,29.8
DEBRD EA AD20CM COTA,97598,CPT,,,,,both,, ,450.63,270.37,Aetna,Commercial,,450.63,29.8,29.8% of Medicare Base rate X weight,450.63,151.22,1342.88,Fee Schedule,29.8
DEBRD EA AD20CM COTA,97598,CPT,,,,,both,, ,488.48,293.08,Aetna,Commercial,,488.48,29.8,29.8% of Medicare Base rate X weight,488.48,163.92,1455.67,Fee Schedule,29.8
DEBRD EA AD20CM COTA,97598,CPT,,,,,both,, ,488.48,293.08,Aetna,Commercial,,488.48,29.8,29.8% of Medicare Base rate X weight,488.48,163.92,1455.67,Fee Schedule,29.8
DEBRDE EA AD20CM PTA,97598,CPT,,,,,both,, ,450.63,270.37,Aetna,Commercial,,450.63,29.8,29.8% of Medicare Base rate X weight,450.63,151.22,1342.88,Fee Schedule,29.8
DEBRDE EA AD20CM PTA,97598,CPT,,,,,both,, ,450.63,270.37,Aetna,Commercial,,450.63,29.8,29.8% of Medicare Base rate X weight,450.63,151.22,1342.88,Fee Schedule,29.8
DEBRDE EA AD20CM PTA,97598,CPT,,,,,both,, ,450.63,270.37,Aetna,Commercial,,450.63,29.8,29.8% of Medicare Base rate X weight,450.63,151.22,1342.88,Fee Schedule,29.8
DEBRDE EA AD20CM PTA,97598,CPT,,,,,both,, ,450.63,270.37,Aetna,Commercial,,450.63,29.8,29.8% of Medicare Base rate X weight,450.63,151.22,1342.88,Fee Schedule,29.8
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,252.25,151.35,Aetna,Commercial,,252.25,29.8,29.8% of Medicare Base rate X weight,252.25,84.65,751.71,Fee Schedule,29.8
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,252.25,151.35,Aetna,Commercial,,252.25,29.8,29.8% of Medicare Base rate X weight,252.25,84.65,751.71,Fee Schedule,29.8
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,259.82,155.89,Aetna,Commercial,,259.82,29.8,29.8% of Medicare Base rate X weight,259.82,87.19,774.26,Fee Schedule,29.8
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,259.82,155.89,Aetna,Commercial,,259.82,29.8,29.8% of Medicare Base rate X weight,259.82,87.19,774.26,Fee Schedule,29.8
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,420.57,252.34,Aetna,Commercial,,420.57,29.8,29.8% of Medicare Base rate X weight,420.57,141.13,1253.3,Fee Schedule,29.8
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,455.94,273.56,Aetna,Commercial,,455.94,29.8,29.8% of Medicare Base rate X weight,455.94,153.00,1358.7,Fee Schedule,29.8
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,575.10,345.06,Aetna,Commercial,,575.10,29.8,29.8% of Medicare Base rate X weight,575.10,192.99,1713.8,Fee Schedule,29.8
SLCTV WND DEB >20 CM,97598,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,256.04,2273.74,Fee Schedule,29.8
DBRD NONSEL-VIS COTA,97602,CPT,,,,,both,, ,447.54,268.52,Aetna,Commercial,,447.54,29.8,29.8% of Medicare Base rate X weight,447.54,150.18,1333.67,Fee Schedule,29.8
DBRD NONSEL-VIS COTA,97602,CPT,,,,,both,, ,447.54,268.52,Aetna,Commercial,,447.54,29.8,29.8% of Medicare Base rate X weight,447.54,150.18,1333.67,Fee Schedule,29.8
DBRD NONSEL-VIS COTA,97602,CPT,,,,,both,, ,447.54,268.52,Aetna,Commercial,,447.54,29.8,29.8% of Medicare Base rate X weight,447.54,150.18,1333.67,Fee Schedule,29.8
DBRD NONSEL-VIS COTA,97602,CPT,,,,,both,, ,447.54,268.52,Aetna,Commercial,,447.54,29.8,29.8% of Medicare Base rate X weight,447.54,150.18,1333.67,Fee Schedule,29.8
DBRD NONSEL-VIS COTA,97602,CPT,,,,,both,, ,521.70,313.02,Aetna,Commercial,,521.70,29.8,29.8% of Medicare Base rate X weight,521.70,175.07,1554.67,Fee Schedule,29.8
DBRD NONSEL-VIS COTA,97602,CPT,,,,,both,, ,521.70,313.02,Aetna,Commercial,,521.70,29.8,29.8% of Medicare Base rate X weight,521.70,175.07,1554.67,Fee Schedule,29.8
DBRD NON-SEL-VIS PTA,97602,CPT,,,,,both,, ,481.27,288.76,Aetna,Commercial,,481.27,29.8,29.8% of Medicare Base rate X weight,481.27,161.50,1434.18,Fee Schedule,29.8
DBRD NON-SEL-VIS PTA,97602,CPT,,,,,both,, ,481.27,288.76,Aetna,Commercial,,481.27,29.8,29.8% of Medicare Base rate X weight,481.27,161.50,1434.18,Fee Schedule,29.8
DEBRIDE NON-SELC-VIS,97602,CPT,,,,,both,, ,449.32,269.59,Aetna,Commercial,,449.32,29.8,29.8% of Medicare Base rate X weight,449.32,150.78,1338.97,Fee Schedule,29.8
DEBRIDE NON-SELC-VIS,97602,CPT,,,,,both,, ,487.13,292.27,Aetna,Commercial,,487.13,29.8,29.8% of Medicare Base rate X weight,487.13,163.47,1451.65,Fee Schedule,29.8
NON SELECTIVE DEBRID,97602,CPT,,,,,both,, ,158.11,94.86,Aetna,Commercial,,158.11,29.8,29.8% of Medicare Base rate X weight,158.11,53.06,471.17,Fee Schedule,29.8
NON SELECTIVE DEBRID,97602,CPT,,,,,both,, ,158.11,94.86,Aetna,Commercial,,158.11,29.8,29.8% of Medicare Base rate X weight,158.11,53.06,471.17,Fee Schedule,29.8
NSW DEB WO A/SESSION,97602,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,256.04,2273.74,Fee Schedule,29.8
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,146.78,88.06,Aetna,Commercial,,146.78,29.8,29.8% of Medicare Base rate X weight,146.78,49.26,437.4,Fee Schedule,29.8
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,158.11,94.86,Aetna,Commercial,,158.11,29.8,29.8% of Medicare Base rate X weight,158.11,53.06,471.17,Fee Schedule,29.8
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,158.11,94.86,Aetna,Commercial,,158.11,29.8,29.8% of Medicare Base rate X weight,158.11,53.06,471.17,Fee Schedule,29.8
NEG PRESS WND TX <50,97605,CPT,,,,,both,, ,763.00,457.80,Aetna,Commercial,,763.00,29.8,29.8% of Medicare Base rate X weight,763.00,256.04,2273.74,Fee Schedule,29.8
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,241.28,144.76,Aetna,Commercial,,241.28,29.8,29.8% of Medicare Base rate X weight,241.28,80.97,719.01,Fee Schedule,29.8
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,259.82,155.89,Aetna,Commercial,,259.82,29.8,29.8% of Medicare Base rate X weight,259.82,87.19,774.26,Fee Schedule,29.8
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,259.82,155.89,Aetna,Commercial,,259.82,29.8,29.8% of Medicare Base rate X weight,259.82,87.19,774.26,Fee Schedule,29.8
NEG PRESS WND TX >50,97606,CPT,,,,,both,, ,1520.00,912.00,Aetna,Commercial,,1520.00,29.8,29.8% of Medicare Base rate X weight,1520.00,510.07,4529.6,Fee Schedule,29.8
NEG PR WN MD LT 50CM,97607,CPT,,,,,both,, ,463.24,277.94,Aetna,Commercial,,463.24,29.8,29.8% of Medicare Base rate X weight,463.24,155.45,1380.46,Fee Schedule,29.8
NEG PR WN MD LT 50CM,97607,CPT,,,,,both,, ,463.24,277.94,Aetna,Commercial,,463.24,29.8,29.8% of Medicare Base rate X weight,463.24,155.45,1380.46,Fee Schedule,29.8
NEG PRES WND TX <=50,97607,CPT,,,,,both,, ,1520.00,912.00,Aetna,Commercial,,1520.00,29.8,29.8% of Medicare Base rate X weight,1520.00,510.07,4529.6,Fee Schedule,29.8
NEG PR WN MD GT 50CM,97608,CPT,,,,,both,, ,919.79,551.87,Aetna,Commercial,,919.79,29.8,29.8% of Medicare Base rate X weight,919.79,308.65,2740.97,Fee Schedule,29.8
PHYS PERF-15 MIN PTA,97750,CPT,,,,,both,, ,936.01,561.60,Aetna,Commercial,,936.01,29.8,29.8% of Medicare Base rate X weight,936.01,314.10,2789.31,Fee Schedule,29.8
PHYS PERF-15 MIN PTA,97750,CPT,,,,,both,, ,936.01,561.60,Aetna,Commercial,,936.01,29.8,29.8% of Medicare Base rate X weight,936.01,314.10,2789.31,Fee Schedule,29.8
PHYS PERF-15MIN COTA,97750,CPT,,,,,both,, ,91.93,55.15,Aetna,Commercial,,91.93,29.8,29.8% of Medicare Base rate X weight,91.93,30.85,273.95,Fee Schedule,29.8
PHYS PERF-15MIN COTA,97750,CPT,,,,,both,, ,91.93,55.15,Aetna,Commercial,,91.93,29.8,29.8% of Medicare Base rate X weight,91.93,30.85,273.95,Fee Schedule,29.8
PHYS PERF-15MIN COTA,97750,CPT,,,,,both,, ,91.93,55.15,Aetna,Commercial,,91.93,29.8,29.8% of Medicare Base rate X weight,91.93,30.85,273.95,Fee Schedule,29.8
PHYS PERF-15MIN COTA,97750,CPT,,,,,both,, ,91.93,55.15,Aetna,Commercial,,91.93,29.8,29.8% of Medicare Base rate X weight,91.93,30.85,273.95,Fee Schedule,29.8
PHYS PERF-15MIN COTA,97750,CPT,,,,,both,, ,1014.55,608.73,Aetna,Commercial,,1014.55,29.8,29.8% of Medicare Base rate X weight,1014.55,340.45,3023.36,Fee Schedule,29.8
PHYS PERF-15MIN COTA,97750,CPT,,,,,both,, ,1014.55,608.73,Aetna,Commercial,,1014.55,29.8,29.8% of Medicare Base rate X weight,1014.55,340.45,3023.36,Fee Schedule,29.8
PHYSICAL PERF-15 MIN,97750,CPT,,,,,both,, ,873.68,524.20,Aetna,Commercial,,873.68,29.8,29.8% of Medicare Base rate X weight,873.68,293.18,2603.57,Fee Schedule,29.8
PHYSICAL PERF-15 MIN,97750,CPT,,,,,both,, ,947.11,568.26,Aetna,Commercial,,947.11,29.8,29.8% of Medicare Base rate X weight,947.11,317.82,2822.39,Fee Schedule,29.8
ORTH TRAIN INI-15 MI,97760,CPT,,,,,both,, ,342.72,205.63,Aetna,Commercial,,342.72,29.8,29.8% of Medicare Base rate X weight,342.72,115.01,1021.31,Fee Schedule,29.8
ORTH TRAIN INI-15 MI,97760,CPT,,,,,both,, ,371.55,222.93,Aetna,Commercial,,371.55,29.8,29.8% of Medicare Base rate X weight,371.55,124.68,1107.22,Fee Schedule,29.8
ORTH TRN IN15MI COTA,97760,CPT,,,,,both,, ,124.12,74.47,Aetna,Commercial,,124.12,29.8,29.8% of Medicare Base rate X weight,124.12,41.65,369.88,Fee Schedule,29.8
ORTH TRN IN15MI COTA,97760,CPT,,,,,both,, ,124.12,74.47,Aetna,Commercial,,124.12,29.8,29.8% of Medicare Base rate X weight,124.12,41.65,369.88,Fee Schedule,29.8
ORTH TRN IN15MI COTA,97760,CPT,,,,,both,, ,124.12,74.47,Aetna,Commercial,,124.12,29.8,29.8% of Medicare Base rate X weight,124.12,41.65,369.88,Fee Schedule,29.8
ORTH TRN IN15MI COTA,97760,CPT,,,,,both,, ,124.12,74.47,Aetna,Commercial,,124.12,29.8,29.8% of Medicare Base rate X weight,124.12,41.65,369.88,Fee Schedule,29.8
ORTH TRN IN15MI COTA,97760,CPT,,,,,both,, ,398.10,238.86,Aetna,Commercial,,398.10,29.8,29.8% of Medicare Base rate X weight,398.10,133.59,1186.34,Fee Schedule,29.8
ORTH TRN IN15MI COTA,97760,CPT,,,,,both,, ,398.10,238.86,Aetna,Commercial,,398.10,29.8,29.8% of Medicare Base rate X weight,398.10,133.59,1186.34,Fee Schedule,29.8
ORTH TRN INI15MI PTA,97760,CPT,,,,,both,, ,367.20,220.32,Aetna,Commercial,,367.20,29.8,29.8% of Medicare Base rate X weight,367.20,123.22,1094.26,Fee Schedule,29.8
ORTH TRN INI15MI PTA,97760,CPT,,,,,both,, ,367.20,220.32,Aetna,Commercial,,367.20,29.8,29.8% of Medicare Base rate X weight,367.20,123.22,1094.26,Fee Schedule,29.8
PROS TRAIN INI-15 MI,97761,CPT,,,,,both,, ,342.72,205.63,Aetna,Commercial,,342.72,29.8,29.8% of Medicare Base rate X weight,342.72,115.01,1021.31,Fee Schedule,29.8
PROS TRAIN INI-15 MI,97761,CPT,,,,,both,, ,371.55,222.93,Aetna,Commercial,,371.55,29.8,29.8% of Medicare Base rate X weight,371.55,124.68,1107.22,Fee Schedule,29.8
PROS TRN IN15MI COTA,97761,CPT,,,,,both,, ,107.38,64.42,Aetna,Commercial,,107.38,29.8,29.8% of Medicare Base rate X weight,107.38,36.03,319.99,Fee Schedule,29.8
PROS TRN IN15MI COTA,97761,CPT,,,,,both,, ,107.38,64.42,Aetna,Commercial,,107.38,29.8,29.8% of Medicare Base rate X weight,107.38,36.03,319.99,Fee Schedule,29.8
PROS TRN IN15MI COTA,97761,CPT,,,,,both,, ,107.38,64.42,Aetna,Commercial,,107.38,29.8,29.8% of Medicare Base rate X weight,107.38,36.03,319.99,Fee Schedule,29.8
PROS TRN IN15MI COTA,97761,CPT,,,,,both,, ,107.38,64.42,Aetna,Commercial,,107.38,29.8,29.8% of Medicare Base rate X weight,107.38,36.03,319.99,Fee Schedule,29.8
PROS TRN IN15MI COTA,97761,CPT,,,,,both,, ,398.10,238.86,Aetna,Commercial,,398.10,29.8,29.8% of Medicare Base rate X weight,398.10,133.59,1186.34,Fee Schedule,29.8
PROS TRN IN15MI COTA,97761,CPT,,,,,both,, ,398.10,238.86,Aetna,Commercial,,398.10,29.8,29.8% of Medicare Base rate X weight,398.10,133.59,1186.34,Fee Schedule,29.8
PROS TRN INI15MI PTA,97761,CPT,,,,,both,, ,367.20,220.32,Aetna,Commercial,,367.20,29.8,29.8% of Medicare Base rate X weight,367.20,123.22,1094.26,Fee Schedule,29.8
PROS TRN INI15MI PTA,97761,CPT,,,,,both,, ,367.20,220.32,Aetna,Commercial,,367.20,29.8,29.8% of Medicare Base rate X weight,367.20,123.22,1094.26,Fee Schedule,29.8
PROS-ORTH SUB-15 MIN,97763,CPT,,,,,both,, ,318.29,190.97,Aetna,Commercial,,318.29,29.8,29.8% of Medicare Base rate X weight,318.29,106.81,948.5,Fee Schedule,29.8
PROS-ORTH SUB-15 MIN,97763,CPT,,,,,both,, ,358.85,215.31,Aetna,Commercial,,358.85,29.8,29.8% of Medicare Base rate X weight,358.85,120.42,1069.37,Fee Schedule,29.8
PRS-ORT SUB15MN COTA,97763,CPT,,,,,both,, ,131.07,78.64,Aetna,Commercial,,131.07,29.8,29.8% of Medicare Base rate X weight,131.07,43.98,390.59,Fee Schedule,29.8
PRS-ORT SUB15MN COTA,97763,CPT,,,,,both,, ,131.07,78.64,Aetna,Commercial,,131.07,29.8,29.8% of Medicare Base rate X weight,131.07,43.98,390.59,Fee Schedule,29.8
PRS-ORT SUB15MN COTA,97763,CPT,,,,,both,, ,131.07,78.64,Aetna,Commercial,,131.07,29.8,29.8% of Medicare Base rate X weight,131.07,43.98,390.59,Fee Schedule,29.8
PRS-ORT SUB15MN COTA,97763,CPT,,,,,both,, ,131.07,78.64,Aetna,Commercial,,131.07,29.8,29.8% of Medicare Base rate X weight,131.07,43.98,390.59,Fee Schedule,29.8
PRS-ORT SUB15MN COTA,97763,CPT,,,,,both,, ,340.93,204.55,Aetna,Commercial,,340.93,29.8,29.8% of Medicare Base rate X weight,340.93,114.41,1015.97,Fee Schedule,29.8
PRS-ORT SUB15MN COTA,97763,CPT,,,,,both,, ,340.93,204.55,Aetna,Commercial,,340.93,29.8,29.8% of Medicare Base rate X weight,340.93,114.41,1015.97,Fee Schedule,29.8
PRS-ORT SUB-15MN PTA,97763,CPT,,,,,both,, ,384.45,230.67,Aetna,Commercial,,384.45,29.8,29.8% of Medicare Base rate X weight,384.45,129.01,1145.66,Fee Schedule,29.8
PRS-ORT SUB-15MN PTA,97763,CPT,,,,,both,, ,384.45,230.67,Aetna,Commercial,,384.45,29.8,29.8% of Medicare Base rate X weight,384.45,129.01,1145.66,Fee Schedule,29.8
MNT INITIAL EA 15 MN,97802,CPT,,,,,both,, ,194.41,116.64,Aetna,Commercial,,194.41,29.8,29.8% of Medicare Base rate X weight,194.41,65.24,579.34,Fee Schedule,29.8
MNT REASSES EA 15 MN,97803,CPT,,,,,both,, ,101.46,60.87,Aetna,Commercial,,101.46,29.8,29.8% of Medicare Base rate X weight,101.46,34.05,302.35,Fee Schedule,29.8
MNT GROUP EA 30 MIN,97804,CPT,,,,,both,, ,223.25,133.95,Aetna,Commercial,,223.25,29.8,29.8% of Medicare Base rate X weight,223.25,74.92,665.29,Fee Schedule,29.8
LAB COLLECTION,99000,CPT,,,,,both,, ,70.00,42.00,Aetna,Commercial,,70.00,29.8,29.8% of Medicare Base rate X weight,70.00,23.49,208.6,Fee Schedule,29.8
SPEC CHAIN CUSTODY,99001,CPT,,,,,both,, ,21.33,12.79,Aetna,Commercial,,21.33,29.8,29.8% of Medicare Base rate X weight,21.33,7.16,63.56,Fee Schedule,29.8
MSED SAMEGT5 1ST15,99152,CPT,,,,,both,, ,313.38,188.02,Aetna,Commercial,,313.38,29.8,29.8% of Medicare Base rate X weight,313.38,105.16,933.87,Fee Schedule,29.8
MODSED SAME ADD15MIN,99153,CPT,,,,,both,, ,417.92,250.75,Aetna,Commercial,,417.92,29.8,29.8% of Medicare Base rate X weight,417.92,140.24,1245.4,Fee Schedule,29.8
HBO COMM PER SESSION,99183,CPT,,,,,both,, ,990.13,594.07,Aetna,Commercial,,990.13,29.8,29.8% of Medicare Base rate X weight,990.13,332.26,2950.59,Fee Schedule,29.8
PHLEBOTOMY THERAPEUT,99195,CPT,,,,,both,, ,266.77,160.06,Aetna,Commercial,,266.77,29.8,29.8% of Medicare Base rate X weight,266.77,89.52,794.97,Fee Schedule,29.8
SUTURE REMOVAL/RECHE,99281,CPT,,,,,Outpatient,, ,1098.28,658.96,Aetna,Commercial,,1098.28,29.8,29.8% of Medicare Base rate X weight,1098.28,368.55,3272.87,Fee Schedule,29.8
SUTURE REMOVAL/RECHE,99281,CPT,,,,,Outpatient,, ,1098.28,658.96,Aetna,Commercial,,1098.28,29.8,29.8% of Medicare Base rate X weight,1098.28,368.55,3272.87,Fee Schedule,29.8
LIMITED ED VISIT,99282,CPT,,,,,Outpatient,, ,1925.14,1155.08,Aetna,Commercial,,1925.14,29.8,29.8% of Medicare Base rate X weight,1925.14,646.02,5736.92,Fee Schedule,29.8
INTERMEDIATE ED VIST,99283,CPT,,,,,Outpatient,, ,3494.12,2096.47,Aetna,Commercial,,3494.12,29.8,29.8% of Medicare Base rate X weight,3494.12,1172.52,10412.48,Fee Schedule,29.8
EXTENDED ED VISIT,99284,CPT,,,,,Outpatient,, ,6509.13,3905.47,Aetna,Commercial,,6509.13,29.8,29.8% of Medicare Base rate X weight,6509.13,2184.27,19397.21,Fee Schedule,29.8
COMPREHENSIVE ED VST,99285,CPT,,,,,Outpatient,, ,8592.58,5155.54,Aetna,Commercial,,8592.58,29.8,29.8% of Medicare Base rate X weight,8592.58,2883.42,25605.89,Fee Schedule,29.8
CRITICAL CARE LT 74M,99291,CPT,,,,,both,, ,12285.42,7371.25,Aetna,Commercial,,12285.42,29.8,29.8% of Medicare Base rate X weight,12285.42,4122.62,36610.55,Fee Schedule,29.8
CRIT CARE EA 30 MIN,99292,CPT,,,,,both,, ,4418.38,2651.02,Aetna,Commercial,,4418.38,29.8,29.8% of Medicare Base rate X weight,4418.38,1482.68,13166.77,Fee Schedule,29.8
BEHAV CHG SMOKE U 10,99406,CPT,,,,,both,, ,127.46,76.47,Aetna,Commercial,,127.46,29.8,29.8% of Medicare Base rate X weight,127.46,42.77,379.83,Fee Schedule,29.8
BEHAV CHG SMOKE GR10,99407,CPT,,,,,both,, ,127.46,76.47,Aetna,Commercial,,127.46,29.8,29.8% of Medicare Base rate X weight,127.46,42.77,379.83,Fee Schedule,29.8
NEWBORN RESUCITATION,99465,CPT,,,,,both,, ,2447.28,1468.36,Aetna,Commercial,,2447.28,29.8,29.8% of Medicare Base rate X weight,2447.28,821.23,7292.89,Fee Schedule,29.8
RESPIRATORY PANEL PCR,0202U,HCPCS,,,,,both,, ,500.00,300.00,Aetna,Commercial,,500.00,29.8,29.8% of Medicare Base rate X weight,500.00,167.79,1490,Fee Schedule,29.8
COV19 FLUAB CEPHEID,0240U,CPT,,,,,both,, ,568.00,340.80,Aetna,Commercial,,568.00,29.8,29.8% of Medicare Base rate X weight,568.00,190.60,1692.64,Fee Schedule,29.8
COV19 FLUAB RSV CEPH,0241U,CPT,,,,,both,, ,570.52,342.31,Aetna,Commercial,,570.52,29.8,29.8% of Medicare Base rate X weight,570.52,191.45,1700.15,Fee Schedule,29.8
MVP MULTIPLEX VAGINAL DNA PROBE,0352U,HCPCS,,,,,both,, ,570.52,342.31,Aetna,Commercial,,570.52,29.8,29.8% of Medicare Base rate X weight,570.52,191.45,1700.15,Fee Schedule,29.8
INTRATUBAL OCCLU DEV,A4264,HCPCS,,,,,both,, ,8176.40,4905.84,Aetna,Commercial,,8176.40,29.8,29.8% of Medicare Base rate X weight,8176.40,2743.76,24365.67,Fee Schedule,29.8
TISSUE MARKR IMPLT 1,A4648,HCPCS,,,,,both,, ,179.22,107.53,Aetna,Commercial,,179.22,29.8,29.8% of Medicare Base rate X weight,179.22,60.14,534.08,Fee Schedule,29.8
TISSUE MARKR IMPLT 2,A4648,HCPCS,,,,,both,, ,1195.32,717.19,Aetna,Commercial,,1195.32,29.8,29.8% of Medicare Base rate X weight,1195.32,401.11,3562.05,Fee Schedule,29.8
TISSUE MARKR IMPLT 3,A4648,HCPCS,,,,,both,, ,2390.63,1434.37,Aetna,Commercial,,2390.63,29.8,29.8% of Medicare Base rate X weight,2390.63,802.22,7124.08,Fee Schedule,29.8
COLLAGEN WITH SILVER (PUROCOL),A6022,HCPCS,,,,,both,, ,28.28,16.96,Aetna,Commercial,,28.28,29.8,29.8% of Medicare Base rate X weight,28.28,9.49,84.27,Fee Schedule,29.8
ENDOFORM ANTIMICROBIAL,A6022,HCPCS,,,,,both,, ,41.56,24.93,Aetna,Commercial,,41.56,29.8,29.8% of Medicare Base rate X weight,41.56,13.95,123.85,Fee Schedule,29.8
COLLAGEN (PUROCOL),A6023,HCPCS,,,,,both,, ,19.80,11.88,Aetna,Commercial,,19.80,29.8,29.8% of Medicare Base rate X weight,19.80,6.64,59,Fee Schedule,29.8
CONVAMAX PAD 4X4,A6196,HCPCS,,,,,both,, ,7.68,4.60,Aetna,Commercial,,7.68,29.8,29.8% of Medicare Base rate X weight,7.68,2.58,22.89,Fee Schedule,29.8
CONVAMAX PAD 4X8,A6197,HCPCS,,,,,both,, ,8.88,5.32,Aetna,Commercial,,8.88,29.8,29.8% of Medicare Base rate X weight,8.88,2.98,26.46,Fee Schedule,29.8
CONVAMAX PAD 6X8,A6197,HCPCS,,,,,both,, ,11.76,7.05,Aetna,Commercial,,11.76,29.8,29.8% of Medicare Base rate X weight,11.76,3.95,35.04,Fee Schedule,29.8
DRSG GRMCDL 45X2CM AQCL AG MIC,A6197,HCPCS,,,,,both,, ,36.48,21.88,Aetna,Commercial,,36.48,29.8,29.8% of Medicare Base rate X weight,36.48,12.24,108.71,Fee Schedule,29.8
DRSG GRMCDL 4X5IN AQCL AG,A6197,HCPCS,,,,,both,, ,31.04,18.62,Aetna,Commercial,,31.04,29.8,29.8% of Medicare Base rate X weight,31.04,10.42,92.5,Fee Schedule,29.8
DRSG WND 5X4IN SQ AQCL X HDRFB,A6198,HCPCS,,,,,both,, ,11.16,6.69,Aetna,Commercial,,11.16,29.8,29.8% of Medicare Base rate X weight,11.16,3.74,33.26,Fee Schedule,29.8
DRSG ALG 18X.75IN AQCL HDRFB,A6199,HCPCS,,,,,both,, ,14.12,8.47,Aetna,Commercial,,14.12,29.8,29.8% of Medicare Base rate X weight,14.12,4.74,42.08,Fee Schedule,29.8
HYDROFERA BLUE TRANSFER 5X4,A6210,HCPCS,,,,,both,, ,24.12,14.47,Aetna,Commercial,,24.12,29.8,29.8% of Medicare Base rate X weight,24.12,8.09,71.88,Fee Schedule,29.8
4X4 AQUACEL FOAM NO ADHESIVE,A6211,HCPCS,,,,,both,, ,7.48,4.48,Aetna,Commercial,,7.48,29.8,29.8% of Medicare Base rate X weight,7.48,2.51,22.29,Fee Schedule,29.8
"DRESSING,ALLEVYN,SACRUM,SMALL",A6212,HCPCS,,,,,both,, ,21.96,13.17,Aetna,Commercial,,21.96,29.8,29.8% of Medicare Base rate X weight,21.96,7.37,65.44,Fee Schedule,29.8
DRSG LG QUADRILOBE 6 1/16INX6,A6212,HCPCS,,,,,both,, ,11.48,6.88,Aetna,Commercial,,11.48,29.8,29.8% of Medicare Base rate X weight,11.48,3.85,34.21,Fee Schedule,29.8
"HEEL,LIFE,ALLEVYN",A6212,HCPCS,,,,,both,, ,29.16,17.49,Aetna,Commercial,,29.16,29.8,29.8% of Medicare Base rate X weight,29.16,9.79,86.9,Fee Schedule,29.8
DRSG MED QUADRILOBE 5 1/16INX5,A6213,HCPCS,,,,,both,, ,9.80,5.88,Aetna,Commercial,,9.80,29.8,29.8% of Medicare Base rate X weight,9.80,3.29,29.2,Fee Schedule,29.8
SACRAL AQUACEL FOAM WITH ADHESIVE,A6213,HCPCS,,,,,both,, ,17.32,10.39,Aetna,Commercial,,17.32,29.8,29.8% of Medicare Base rate X weight,17.32,5.81,51.61,Fee Schedule,29.8
4X4 AQUACEL FOAM WITH ADHESIVE,A6214,HCPCS,,,,,both,, ,8.12,4.87,Aetna,Commercial,,8.12,29.8,29.8% of Medicare Base rate X weight,8.12,2.72,24.2,Fee Schedule,29.8
DUODERM THIN 4X2,A6237,HCPCS,,,,,both,, ,4.80,2.88,Aetna,Commercial,,4.80,29.8,29.8% of Medicare Base rate X weight,4.80,1.61,14.3,Fee Schedule,29.8
DUODERM THIN 4X4,A6238,HCPCS,,,,,both,, ,4.12,2.47,Aetna,Commercial,,4.12,29.8,29.8% of Medicare Base rate X weight,4.12,1.38,12.28,Fee Schedule,29.8
TRIAD CREAM 2.5 OUNCES,A6240,HCPCS,,,,,both,, ,3.64,2.18,Aetna,Commercial,,3.64,29.8,29.8% of Medicare Base rate X weight,3.64,1.22,10.85,Fee Schedule,29.8
HYDROGEL,A6248,HCPCS,,,,,both,, ,16.76,10.05,Aetna,Commercial,,16.76,29.8,29.8% of Medicare Base rate X weight,16.76,5.62,49.94,Fee Schedule,29.8
NO-RINSE FOAM CLEANSER,A6250,HCPCS,,,,,both,, ,7.96,4.77,Aetna,Commercial,,7.96,29.8,29.8% of Medicare Base rate X weight,7.96,2.67,23.72,Fee Schedule,29.8
ABD PADS 5X9,A6252,HCPCS,,,,,both,, ,0.32,0.19,Aetna,Commercial,,0.32,29.8,29.8% of Medicare Base rate X weight,0.32,0.11,0.95,Fee Schedule,29.8
ABD PADS 8X10,A6253,HCPCS,,,,,both,, ,0.48,0.28,Aetna,Commercial,,0.48,29.8,29.8% of Medicare Base rate X weight,0.48,0.16,1.43,Fee Schedule,29.8
IODOFORM PACKING 1 INCH,A6266,HCPCS,,,,,both,, ,8.76,5.25,Aetna,Commercial,,8.76,29.8,29.8% of Medicare Base rate X weight,8.76,2.94,26.1,Fee Schedule,29.8
IODOFORM PACKING 1/2 INCH,A6266,HCPCS,,,,,both,, ,6.84,4.10,Aetna,Commercial,,6.84,29.8,29.8% of Medicare Base rate X weight,6.84,2.30,20.38,Fee Schedule,29.8
IODOFORM PACKING 1/4 INCH,A6266,HCPCS,,,,,both,, ,6.56,3.93,Aetna,Commercial,,6.56,29.8,29.8% of Medicare Base rate X weight,6.56,2.20,19.55,Fee Schedule,29.8
STERILE 2X2 GAUZE,A6402,HCPCS,,,,,both,, ,0.08,0.04,Aetna,Commercial,,0.08,29.8,29.8% of Medicare Base rate X weight,0.08,0.03,0.24,Fee Schedule,29.8
STERILE 4X4 GAUZE,A6402,HCPCS,,,,,both,, ,0.16,0.09,Aetna,Commercial,,0.16,29.8,29.8% of Medicare Base rate X weight,0.16,0.05,0.48,Fee Schedule,29.8
PLAIN PACKING 1 INCH,A6407,HCPCS,,,,,both,, ,6.88,4.12,Aetna,Commercial,,6.88,29.8,29.8% of Medicare Base rate X weight,6.88,2.31,20.5,Fee Schedule,29.8
PLAIN PACKING 1/2 INCH,A6407,HCPCS,,,,,both,, ,6.28,3.76,Aetna,Commercial,,6.28,29.8,29.8% of Medicare Base rate X weight,6.28,2.11,18.71,Fee Schedule,29.8
PLAIN PACKING 1/4 INCH,A6407,HCPCS,,,,,both,, ,6.40,3.84,Aetna,Commercial,,6.40,29.8,29.8% of Medicare Base rate X weight,6.40,2.15,19.07,Fee Schedule,29.8
ACE WRAP 4 INCH,A6449,HCPCS,,,,,both,, ,1.64,0.98,Aetna,Commercial,,1.64,29.8,29.8% of Medicare Base rate X weight,1.64,0.55,4.89,Fee Schedule,29.8
ACE WRAP 6 INCH,A6450,HCPCS,,,,,both,, ,2.40,1.44,Aetna,Commercial,,2.40,29.8,29.8% of Medicare Base rate X weight,2.40,0.81,7.15,Fee Schedule,29.8
ZINC PASTE TUBES,A6456,HCPCS,,,,,both,, ,8.44,5.06,Aetna,Commercial,,8.44,29.8,29.8% of Medicare Base rate X weight,8.44,2.83,25.15,Fee Schedule,29.8
PICO DRESSING KIT,A9272,HCPCS,,,,,both,, ,3547.64,2128.58,Aetna,Commercial,,3547.64,29.8,29.8% of Medicare Base rate X weight,3547.64,1190.48,10571.97,Fee Schedule,29.8
TC-99M SESTA / DOSE,A9500,HCPCS,,,,,both,, ,551.05,330.63,Aetna,Commercial,,551.05,29.8,29.8% of Medicare Base rate X weight,551.05,184.92,1642.13,Fee Schedule,29.8
TC-99M TETRO/UNITDOS,A9502,HCPCS,,,,,both,, ,347.11,208.26,Aetna,Commercial,,347.11,29.8,29.8% of Medicare Base rate X weight,347.11,116.48,1034.39,Fee Schedule,29.8
TC99M MEDRO TO 30MCI,A9503,HCPCS,,,,,both,, ,69.78,41.86,Aetna,Commercial,,69.78,29.8,29.8% of Medicare Base rate X weight,69.78,23.42,207.94,Fee Schedule,29.8
"TL-201, PER MCI",A9505,HCPCS,,,,,both,, ,95.53,57.31,Aetna,Commercial,,95.53,29.8,29.8% of Medicare Base rate X weight,95.53,32.06,284.68,Fee Schedule,29.8
TC99M PERTECHNET/MCI,A9512,HCPCS,,,,,both,, ,81.89,49.13,Aetna,Commercial,,81.89,29.8,29.8% of Medicare Base rate X weight,81.89,27.48,244.03,Fee Schedule,29.8
"I123 CAP,DX /100UCI",A9516,HCPCS,,,,,both,, ,312.35,187.41,Aetna,Commercial,,312.35,29.8,29.8% of Medicare Base rate X weight,312.35,104.82,930.8,Fee Schedule,29.8
TC99 TILMAN DX .5MCI,A9520,HCPCS,,,,,both,, ,2305.66,1383.39,Aetna,Commercial,,2305.66,29.8,29.8% of Medicare Base rate X weight,2305.66,773.71,6870.87,Fee Schedule,29.8
TC99M EXAME / DOSE,A9521,HCPCS,,,,,both,, ,17205.64,10323.38,Aetna,Commercial,,17205.64,29.8,29.8% of Medicare Base rate X weight,17205.64,5773.70,51272.81,Fee Schedule,29.8
TC99M MEBROF /15MCI,A9537,HCPCS,,,,,both,, ,170.47,102.28,Aetna,Commercial,,170.47,29.8,29.8% of Medicare Base rate X weight,170.47,57.20,508,Fee Schedule,29.8
TC99M PYROPHOS/25MCI,A9538,HCPCS,,,,,both,, ,235.61,141.36,Aetna,Commercial,,235.61,29.8,29.8% of Medicare Base rate X weight,235.61,79.06,702.12,Fee Schedule,29.8
TC99M PENTETAT/25MCI,A9539,HCPCS,,,,,both,, ,69.78,41.86,Aetna,Commercial,,69.78,29.8,29.8% of Medicare Base rate X weight,69.78,23.42,207.94,Fee Schedule,29.8
TC99M MAA/10MCI,A9540,HCPCS,,,,,both,, ,62.83,37.69,Aetna,Commercial,,62.83,29.8,29.8% of Medicare Base rate X weight,62.83,21.08,187.23,Fee Schedule,29.8
TC99M SULF COL/20MCI,A9541,HCPCS,,,,,both,, ,83.17,49.90,Aetna,Commercial,,83.17,29.8,29.8% of Medicare Base rate X weight,83.17,27.91,247.85,Fee Schedule,29.8
TC99M SULFCOL2/20MCI,A9541,HCPCS,,,,,both,, ,529.68,317.80,Aetna,Commercial,,529.68,29.8,29.8% of Medicare Base rate X weight,529.68,177.74,1578.45,Fee Schedule,29.8
IN111 PENTETAT/.5MCI,A9548,HCPCS,,,,,both,, ,12525.06,7515.03,Aetna,Commercial,,12525.06,29.8,29.8% of Medicare Base rate X weight,12525.06,4203.04,37324.68,Fee Schedule,29.8
GA67 GALLIUM/MCI,A9556,HCPCS,,,,,both,, ,102.23,61.33,Aetna,Commercial,,102.23,29.8,29.8% of Medicare Base rate X weight,102.23,34.31,304.65,Fee Schedule,29.8
XE133 XENON 10MCI,A9558,HCPCS,,,,,both,, ,264.20,158.52,Aetna,Commercial,,264.20,29.8,29.8% of Medicare Base rate X weight,264.20,88.66,787.32,Fee Schedule,29.8
TC99M LABL RBC/30MCI,A9560,HCPCS,,,,,both,, ,69.78,41.86,Aetna,Commercial,,69.78,29.8,29.8% of Medicare Base rate X weight,69.78,23.42,207.94,Fee Schedule,29.8
TC99M OXIDRONA/30MCI,A9561,HCPCS,,,,,both,, ,148.84,89.30,Aetna,Commercial,,148.84,29.8,29.8% of Medicare Base rate X weight,148.84,49.95,443.54,Fee Schedule,29.8
TC99M MERTIATI/15MCI,A9562,HCPCS,,,,,both,, ,938.33,562.99,Aetna,Commercial,,938.33,29.8,29.8% of Medicare Base rate X weight,938.33,314.88,2796.22,Fee Schedule,29.8
TC99M AEROSOL 75 MCI,A9567,HCPCS,,,,,both,, ,69.78,41.86,Aetna,Commercial,,69.78,29.8,29.8% of Medicare Base rate X weight,69.78,23.42,207.94,Fee Schedule,29.8
IN-111 PENTETRE/6MCI,A9572,HCPCS,,,,,both,, ,14752.18,8851.30,Aetna,Commercial,,14752.18,29.8,29.8% of Medicare Base rate X weight,14752.18,4950.40,43961.5,Fee Schedule,29.8
INJ GADO DIMEG ML 15,A9577,HCPCS,,,,,both,15,ML,13.75,8.25,Aetna,Commercial,,13.75,29.8,29.8% of Medicare Base rate X weight,13.75,4.61,40.98,Fee Schedule,29.8
INJ GADO DIMEG ML 20,A9577,HCPCS,,,,,both,20,ML,13.75,8.25,Aetna,Commercial,,13.75,29.8,29.8% of Medicare Base rate X weight,13.75,4.61,40.98,Fee Schedule,29.8
INJ MULTIHANCE /ML,A9577,HCPCS,,,,,both,, ,14.16,8.49,Aetna,Commercial,,14.16,29.8,29.8% of Medicare Base rate X weight,14.16,4.75,42.2,Fee Schedule,29.8
INJ MULTIHANCE/ ML,A9577,HCPCS,,,,,both,, ,13.75,8.25,Aetna,Commercial,,13.75,29.8,29.8% of Medicare Base rate X weight,13.75,4.61,40.98,Fee Schedule,29.8
INJ GAD-MR1 CONTR ML,A9579,HCPCS,,,,,both,, ,37.60,22.56,Aetna,Commercial,,37.60,29.8,29.8% of Medicare Base rate X weight,37.60,12.62,112.05,Fee Schedule,29.8
INJ GAD-MR2 CONTR ML,A9579,HCPCS,,,,,both,, ,47.90,28.74,Aetna,Commercial,,47.90,29.8,29.8% of Medicare Base rate X weight,47.90,16.07,142.74,Fee Schedule,29.8
INJ GAD-MR3 CONTR ML,A9579,HCPCS,,,,,both,, ,40.94,24.56,Aetna,Commercial,,40.94,29.8,29.8% of Medicare Base rate X weight,40.94,13.74,122,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 1,C1713,HCPCS,,,,,both,, ,129.01,77.40,Aetna,Commercial,,129.01,29.8,29.8% of Medicare Base rate X weight,129.01,43.29,384.45,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 10,C1713,HCPCS,,,,,both,, ,2873.70,1724.22,Aetna,Commercial,,2873.70,29.8,29.8% of Medicare Base rate X weight,2873.70,964.33,8563.63,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 11,C1713,HCPCS,,,,,both,, ,4069.02,2441.41,Aetna,Commercial,,4069.02,29.8,29.8% of Medicare Base rate X weight,4069.02,1365.44,12125.68,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 12,C1713,HCPCS,,,,,both,, ,4786.15,2871.69,Aetna,Commercial,,4786.15,29.8,29.8% of Medicare Base rate X weight,4786.15,1606.09,14262.73,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 13,C1713,HCPCS,,,,,both,, ,6684.19,4010.51,Aetna,Commercial,,6684.19,29.8,29.8% of Medicare Base rate X weight,6684.19,2243.02,19918.89,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 14,C1713,HCPCS,,,,,both,, ,9567.67,5740.60,Aetna,Commercial,,9567.67,29.8,29.8% of Medicare Base rate X weight,9567.67,3210.63,28511.66,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 15,C1713,HCPCS,,,,,both,, ,14349.19,8609.51,Aetna,Commercial,,14349.19,29.8,29.8% of Medicare Base rate X weight,14349.19,4815.16,42760.59,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 16,C1713,HCPCS,,,,,both,, ,19130.71,11478.42,Aetna,Commercial,,19130.71,29.8,29.8% of Medicare Base rate X weight,19130.71,6419.70,57009.52,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 17,C1713,HCPCS,,,,,both,, ,23912.22,14347.33,Aetna,Commercial,,23912.22,29.8,29.8% of Medicare Base rate X weight,23912.22,8024.23,71258.42,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 18,C1713,HCPCS,,,,,both,, ,31084.37,18650.62,Aetna,Commercial,,31084.37,29.8,29.8% of Medicare Base rate X weight,31084.37,10431.00,92631.42,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 19,C1713,HCPCS,,,,,both,, ,38256.78,22954.06,Aetna,Commercial,,38256.78,29.8,29.8% of Medicare Base rate X weight,38256.78,12837.85,114005.2,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 2,C1713,HCPCS,,,,,both,, ,172.01,103.20,Aetna,Commercial,,172.01,29.8,29.8% of Medicare Base rate X weight,172.01,57.72,512.59,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 20,C1713,HCPCS,,,,,both,, ,47814.92,28688.95,Aetna,Commercial,,47814.92,29.8,29.8% of Medicare Base rate X weight,47814.92,16045.28,142488.46,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 21,C1713,HCPCS,,,,,both,, ,57377.95,34426.77,Aetna,Commercial,,57377.95,29.8,29.8% of Medicare Base rate X weight,57377.95,19254.35,170986.29,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 3,C1713,HCPCS,,,,,both,, ,243.85,146.31,Aetna,Commercial,,243.85,29.8,29.8% of Medicare Base rate X weight,243.85,81.83,726.67,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 4,C1713,HCPCS,,,,,both,, ,411.23,246.73,Aetna,Commercial,,411.23,29.8,29.8% of Medicare Base rate X weight,411.23,138.00,1225.47,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 5,C1713,HCPCS,,,,,both,, ,602.55,361.53,Aetna,Commercial,,602.55,29.8,29.8% of Medicare Base rate X weight,602.55,202.20,1795.6,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 6,C1713,HCPCS,,,,,both,, ,841.51,504.90,Aetna,Commercial,,841.51,29.8,29.8% of Medicare Base rate X weight,841.51,282.39,2507.7,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 7,C1713,HCPCS,,,,,both,, ,1200.21,720.12,Aetna,Commercial,,1200.21,29.8,29.8% of Medicare Base rate X weight,1200.21,402.76,3576.63,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 8,C1713,HCPCS,,,,,both,, ,1678.39,1007.03,Aetna,Commercial,,1678.39,29.8,29.8% of Medicare Base rate X weight,1678.39,563.22,5001.6,Fee Schedule,29.8
ANCHOR/SCRW LEVEL 9,C1713,HCPCS,,,,,both,, ,2156.56,1293.93,Aetna,Commercial,,2156.56,29.8,29.8% of Medicare Base rate X weight,2156.56,723.68,6426.55,Fee Schedule,29.8
BONE CEMENT 1,C1713,HCPCS,,,,,both,, ,884.51,530.70,Aetna,Commercial,,884.51,29.8,29.8% of Medicare Base rate X weight,884.51,296.82,2635.84,Fee Schedule,29.8
BONE CEMENT 2,C1713,HCPCS,,,,,both,, ,2467.37,1480.42,Aetna,Commercial,,2467.37,29.8,29.8% of Medicare Base rate X weight,2467.37,827.98,7352.76,Fee Schedule,29.8
CATH TRNS ARTHR DIR1,C1714,HCPCS,,,,,both,, ,5379.18,3227.50,Aetna,Commercial,,5379.18,29.8,29.8% of Medicare Base rate X weight,5379.18,1805.09,16029.96,Fee Schedule,29.8
CATH TRNS ARTHR DIR2,C1714,HCPCS,,,,,both,, ,8391.41,5034.84,Aetna,Commercial,,8391.41,29.8,29.8% of Medicare Base rate X weight,8391.41,2815.91,25006.4,Fee Schedule,29.8
AICD DUAL CHAMBER L1,C1721,HCPCS,,,,,both,, ,93836.86,56302.11,Aetna,Commercial,,93836.86,29.8,29.8% of Medicare Base rate X weight,93836.86,31488.88,279633.84,Fee Schedule,29.8
AICD SINGLE CHAMBER1,C1722,HCPCS,,,,,both,, ,99999.00,59999.40,Aetna,Commercial,,99999.00,29.8,29.8% of Medicare Base rate X weight,99999.00,33556.71,297997.02,Fee Schedule,29.8
CATH TRNS ARTHR ROT1,C1724,HCPCS,,,,,both,, ,5379.18,3227.50,Aetna,Commercial,,5379.18,29.8,29.8% of Medicare Base rate X weight,5379.18,1805.09,16029.96,Fee Schedule,29.8
CATH TRNS ARTHR ROT2,C1724,HCPCS,,,,,both,, ,16735.18,10041.10,Aetna,Commercial,,16735.18,29.8,29.8% of Medicare Base rate X weight,16735.18,5615.83,49870.84,Fee Schedule,29.8
CATH-ANGIO LEVEL 1,C1725,HCPCS,,,,,both,, ,855.42,513.25,Aetna,Commercial,,855.42,29.8,29.8% of Medicare Base rate X weight,855.42,287.05,2549.15,Fee Schedule,29.8
CATH-ANGIO LEVEL 2,C1725,HCPCS,,,,,both,, ,1728.86,1037.31,Aetna,Commercial,,1728.86,29.8,29.8% of Medicare Base rate X weight,1728.86,580.15,5152,Fee Schedule,29.8
CATH-ANGIO LEVEL 3,C1725,HCPCS,,,,,both,, ,2726.15,1635.69,Aetna,Commercial,,2726.15,29.8,29.8% of Medicare Base rate X weight,2726.15,914.82,8123.93,Fee Schedule,29.8
CATH-ANGIO LEVEL 4,C1725,HCPCS,,,,,both,, ,4234.59,2540.75,Aetna,Commercial,,4234.59,29.8,29.8% of Medicare Base rate X weight,4234.59,1421.00,12619.08,Fee Schedule,29.8
CATH-ANGIO LEVEL 5,C1725,HCPCS,,,,,both,, ,6331.93,3799.15,Aetna,Commercial,,6331.93,29.8,29.8% of Medicare Base rate X weight,6331.93,2124.81,18869.15,Fee Schedule,29.8
CATH BAL DIL NONVAS1,C1726,HCPCS,,,,,both,, ,1434.53,860.71,Aetna,Commercial,,1434.53,29.8,29.8% of Medicare Base rate X weight,1434.53,481.39,4274.9,Fee Schedule,29.8
CATH BAL DIL NONVAS2,C1726,HCPCS,,,,,both,, ,2390.63,1434.37,Aetna,Commercial,,2390.63,29.8,29.8% of Medicare Base rate X weight,2390.63,802.22,7124.08,Fee Schedule,29.8
CATH BRACHY SEED AD1,C1728,HCPCS,,,,,both,, ,717.14,430.28,Aetna,Commercial,,717.14,29.8,29.8% of Medicare Base rate X weight,717.14,240.65,2137.08,Fee Schedule,29.8
CATH BRACHY SEED AD2,C1728,HCPCS,,,,,both,, ,956.36,573.81,Aetna,Commercial,,956.36,29.8,29.8% of Medicare Base rate X weight,956.36,320.93,2849.95,Fee Schedule,29.8
CATH DRAINAG LEVEL11,C1729,HCPCS,,,,,both,, ,11958.56,7175.13,Aetna,Commercial,,11958.56,29.8,29.8% of Medicare Base rate X weight,11958.56,4012.94,35636.51,Fee Schedule,29.8
CATH-DRAINAG LEVEL 1,C1729,HCPCS,,,,,both,, ,84.20,50.52,Aetna,Commercial,,84.20,29.8,29.8% of Medicare Base rate X weight,84.20,28.26,250.92,Fee Schedule,29.8
CATH-DRAINAG LEVEL 2,C1729,HCPCS,,,,,both,, ,247.72,148.63,Aetna,Commercial,,247.72,29.8,29.8% of Medicare Base rate X weight,247.72,83.13,738.21,Fee Schedule,29.8
CATH-DRAINAG LEVEL 3,C1729,HCPCS,,,,,both,, ,727.18,436.30,Aetna,Commercial,,727.18,29.8,29.8% of Medicare Base rate X weight,727.18,244.02,2167,Fee Schedule,29.8
CATH-DRAINAG LEVEL 4,C1729,HCPCS,,,,,both,, ,1200.21,720.12,Aetna,Commercial,,1200.21,29.8,29.8% of Medicare Base rate X weight,1200.21,402.76,3576.63,Fee Schedule,29.8
CATH-DRAINAG LEVEL 5,C1729,HCPCS,,,,,both,, ,1917.35,1150.41,Aetna,Commercial,,1917.35,29.8,29.8% of Medicare Base rate X weight,1917.35,643.41,5713.7,Fee Schedule,29.8
CATH-DRAINAG LEVEL 6,C1729,HCPCS,,,,,both,, ,2634.48,1580.68,Aetna,Commercial,,2634.48,29.8,29.8% of Medicare Base rate X weight,2634.48,884.05,7850.75,Fee Schedule,29.8
CATH-DRAINAG LEVEL 7,C1729,HCPCS,,,,,both,, ,3351.88,2011.12,Aetna,Commercial,,3351.88,29.8,29.8% of Medicare Base rate X weight,3351.88,1124.79,9988.6,Fee Schedule,29.8
CATH-DRAINAG LEVEL 8,C1729,HCPCS,,,,,both,, ,4786.15,2871.69,Aetna,Commercial,,4786.15,29.8,29.8% of Medicare Base rate X weight,4786.15,1606.09,14262.73,Fee Schedule,29.8
CATH-DRAINAG LEVEL 9,C1729,HCPCS,,,,,both,, ,7177.04,4306.22,Aetna,Commercial,,7177.04,29.8,29.8% of Medicare Base rate X weight,7177.04,2408.40,21387.58,Fee Schedule,29.8
CATH-DRAINAG LEVEL10,C1729,HCPCS,,,,,both,, ,9567.67,5740.60,Aetna,Commercial,,9567.67,29.8,29.8% of Medicare Base rate X weight,9567.67,3210.63,28511.66,Fee Schedule,29.8
CATH-DRAINAG LEVEL12,C1729,HCPCS,,,,,both,, ,14344.55,8606.73,Aetna,Commercial,,14344.55,29.8,29.8% of Medicare Base rate X weight,14344.55,4813.61,42746.76,Fee Schedule,29.8
CATH EP 19 OR FEW 1,C1730,HCPCS,,,,,both,, ,554.66,332.79,Aetna,Commercial,,554.66,29.8,29.8% of Medicare Base rate X weight,554.66,186.13,1652.89,Fee Schedule,29.8
CATH EP 19 OR FEW 2,C1730,HCPCS,,,,,both,, ,1807.39,1084.43,Aetna,Commercial,,1807.39,29.8,29.8% of Medicare Base rate X weight,1807.39,606.51,5386.02,Fee Schedule,29.8
CATH EP 20 OR MORE 1,C1731,HCPCS,,,,,both,, ,6185.15,3711.09,Aetna,Commercial,,6185.15,29.8,29.8% of Medicare Base rate X weight,6185.15,2075.55,18431.75,Fee Schedule,29.8
CATH EP DIG/ABL 3D 1,C1732,HCPCS,,,,,both,, ,7172.15,4303.29,Aetna,Commercial,,7172.15,29.8,29.8% of Medicare Base rate X weight,7172.15,2406.76,21373.01,Fee Schedule,29.8
CATH EP DIG/ABL 3D 2,C1732,HCPCS,,,,,both,, ,15395.93,9237.55,Aetna,Commercial,,15395.93,29.8,29.8% of Medicare Base rate X weight,15395.93,5166.42,45879.87,Fee Schedule,29.8
CATH HEMODIAL LT 1,C1750,HCPCS,,,,,both,, ,1434.53,860.71,Aetna,Commercial,,1434.53,29.8,29.8% of Medicare Base rate X weight,1434.53,481.39,4274.9,Fee Schedule,29.8
CATH HEMODIAL LT 2,C1750,HCPCS,,,,,both,, ,1912.71,1147.62,Aetna,Commercial,,1912.71,29.8,29.8% of Medicare Base rate X weight,1912.71,641.85,5699.88,Fee Schedule,29.8
CATH-INFUS PERIF 1,C1751,HCPCS,,,,,both,, ,89.61,53.76,Aetna,Commercial,,89.61,29.8,29.8% of Medicare Base rate X weight,89.61,30.07,267.04,Fee Schedule,29.8
CATH-INFUS PERIF 10,C1751,HCPCS,,,,,both,, ,2395.52,1437.31,Aetna,Commercial,,2395.52,29.8,29.8% of Medicare Base rate X weight,2395.52,803.87,7138.65,Fee Schedule,29.8
CATH-INFUS PERIF 11,C1751,HCPCS,,,,,both,, ,3351.88,2011.12,Aetna,Commercial,,3351.88,29.8,29.8% of Medicare Base rate X weight,3351.88,1124.79,9988.6,Fee Schedule,29.8
CATH-INFUS PERIF 12,C1751,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,4781.52,29.8,29.8% of Medicare Base rate X weight,4781.52,1604.54,14248.93,Fee Schedule,29.8
CATH-INFUS PERIF 2,C1751,HCPCS,,,,,both,, ,124.37,74.62,Aetna,Commercial,,124.37,29.8,29.8% of Medicare Base rate X weight,124.37,41.73,370.62,Fee Schedule,29.8
CATH-INFUS PERIF 3,C1751,HCPCS,,,,,both,, ,243.85,146.31,Aetna,Commercial,,243.85,29.8,29.8% of Medicare Base rate X weight,243.85,81.83,726.67,Fee Schedule,29.8
CATH-INFUS PERIF 4,C1751,HCPCS,,,,,both,, ,722.03,433.21,Aetna,Commercial,,722.03,29.8,29.8% of Medicare Base rate X weight,722.03,242.29,2151.65,Fee Schedule,29.8
CATH-INFUS PERIF 6,C1751,HCPCS,,,,,both,, ,960.99,576.59,Aetna,Commercial,,960.99,29.8,29.8% of Medicare Base rate X weight,960.99,322.48,2863.75,Fee Schedule,29.8
CATH-INFUS PERIF 6,C1751,HCPCS,,,,,both,, ,960.99,576.59,Aetna,Commercial,,960.99,29.8,29.8% of Medicare Base rate X weight,960.99,322.48,2863.75,Fee Schedule,29.8
CATH-INFUS PERIF 7,C1751,HCPCS,,,,,both,, ,1200.21,720.12,Aetna,Commercial,,1200.21,29.8,29.8% of Medicare Base rate X weight,1200.21,402.76,3576.63,Fee Schedule,29.8
CATH-INFUS PERIF 8,C1751,HCPCS,,,,,both,, ,1439.17,863.50,Aetna,Commercial,,1439.17,29.8,29.8% of Medicare Base rate X weight,1439.17,482.94,4288.73,Fee Schedule,29.8
CATH-INFUS PERIF 9,C1751,HCPCS,,,,,both,, ,1673.49,1004.09,Aetna,Commercial,,1673.49,29.8,29.8% of Medicare Base rate X weight,1673.49,561.57,4987,Fee Schedule,29.8
CATH HEMODIAL ST 1,C1752,HCPCS,,,,,both,, ,358.70,215.22,Aetna,Commercial,,358.70,29.8,29.8% of Medicare Base rate X weight,358.70,120.37,1068.93,Fee Schedule,29.8
CATH HEMODIAL ST 2,C1752,HCPCS,,,,,both,, ,478.18,286.90,Aetna,Commercial,,478.18,29.8,29.8% of Medicare Base rate X weight,478.18,160.46,1424.98,Fee Schedule,29.8
CATH INTRAVAS ULTRA1,C1753,HCPCS,,,,,both,, ,3586.20,2151.72,Aetna,Commercial,,3586.20,29.8,29.8% of Medicare Base rate X weight,3586.20,1203.42,10686.88,Fee Schedule,29.8
CATH INTRAVAS ULTRA2,C1753,HCPCS,,,,,both,, ,14344.55,8606.73,Aetna,Commercial,,14344.55,29.8,29.8% of Medicare Base rate X weight,14344.55,4813.61,42746.76,Fee Schedule,29.8
CATHETER INTRASPINAL,C1755,HCPCS,,,,,both,, ,5259.70,3155.82,Aetna,Commercial,,5259.70,29.8,29.8% of Medicare Base rate X weight,5259.70,1765.00,15673.91,Fee Schedule,29.8
CATH THRMB/EMBOL 1,C1757,HCPCS,,,,,both,, ,238.96,143.37,Aetna,Commercial,,238.96,29.8,29.8% of Medicare Base rate X weight,238.96,80.19,712.1,Fee Schedule,29.8
CATH THRMB/EMBOL 2,C1757,HCPCS,,,,,both,, ,1792.97,1075.78,Aetna,Commercial,,1792.97,29.8,29.8% of Medicare Base rate X weight,1792.97,601.67,5343.05,Fee Schedule,29.8
CATH THRMB/EMBOL 3,C1757,HCPCS,,,,,both,, ,2395.52,1437.31,Aetna,Commercial,,2395.52,29.8,29.8% of Medicare Base rate X weight,2395.52,803.87,7138.65,Fee Schedule,29.8
CATH THRMB/EMBOL 4,C1757,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,4781.52,29.8,29.8% of Medicare Base rate X weight,4781.52,1604.54,14248.93,Fee Schedule,29.8
CATH URETERAL 1,C1758,HCPCS,,,,,both,, ,478.18,286.90,Aetna,Commercial,,478.18,29.8,29.8% of Medicare Base rate X weight,478.18,160.46,1424.98,Fee Schedule,29.8
CATH URETERAL 2,C1758,HCPCS,,,,,both,, ,717.14,430.28,Aetna,Commercial,,717.14,29.8,29.8% of Medicare Base rate X weight,717.14,240.65,2137.08,Fee Schedule,29.8
CATH URETERAL 3,C1758,HCPCS,,,,,both,, ,956.36,573.81,Aetna,Commercial,,956.36,29.8,29.8% of Medicare Base rate X weight,956.36,320.93,2849.95,Fee Schedule,29.8
CATH INTRA ECHOCARD1,C1759,HCPCS,,,,,both,, ,7172.15,4303.29,Aetna,Commercial,,7172.15,29.8,29.8% of Medicare Base rate X weight,7172.15,2406.76,21373.01,Fee Schedule,29.8
CATH INTRA ECHOCARD2,C1759,HCPCS,,,,,both,, ,9563.04,5737.82,Aetna,Commercial,,9563.04,29.8,29.8% of Medicare Base rate X weight,9563.04,3209.07,28497.86,Fee Schedule,29.8
CLOSURE DEVIC VASC 1,C1760,HCPCS,,,,,both,, ,1634.61,980.76,Aetna,Commercial,,1634.61,29.8,29.8% of Medicare Base rate X weight,1634.61,548.53,4871.14,Fee Schedule,29.8
CLOSURE DEVIC VASC 2,C1760,HCPCS,,,,,both,, ,2504.70,1502.82,Aetna,Commercial,,2504.70,29.8,29.8% of Medicare Base rate X weight,2504.70,840.50,7464.01,Fee Schedule,29.8
CONN TISSUE HUMAN 1,C1762,HCPCS,,,,,both,, ,1438.14,862.88,Aetna,Commercial,,1438.14,29.8,29.8% of Medicare Base rate X weight,1438.14,482.60,4285.66,Fee Schedule,29.8
CONN TISSUE HUMAN 10,C1762,HCPCS,,,,,both,, ,57377.95,34426.77,Aetna,Commercial,,57377.95,29.8,29.8% of Medicare Base rate X weight,57377.95,19254.35,170986.29,Fee Schedule,29.8
CONN TISSUE HUMAN 2,C1762,HCPCS,,,,,both,, ,1917.35,1150.41,Aetna,Commercial,,1917.35,29.8,29.8% of Medicare Base rate X weight,1917.35,643.41,5713.7,Fee Schedule,29.8
CONN TISSUE HUMAN 3,C1762,HCPCS,,,,,both,, ,5742.51,3445.50,Aetna,Commercial,,5742.51,29.8,29.8% of Medicare Base rate X weight,5742.51,1927.02,17112.68,Fee Schedule,29.8
CONN TISSUE HUMAN 4,C1762,HCPCS,,,,,both,, ,9567.67,5740.60,Aetna,Commercial,,9567.67,29.8,29.8% of Medicare Base rate X weight,9567.67,3210.63,28511.66,Fee Schedule,29.8
CONN TISSUE HUMAN 5,C1762,HCPCS,,,,,both,, ,13393.09,8035.85,Aetna,Commercial,,13393.09,29.8,29.8% of Medicare Base rate X weight,13393.09,4494.33,39911.41,Fee Schedule,29.8
CONN TISSUE HUMAN 6,C1762,HCPCS,,,,,both,, ,17218.25,10330.95,Aetna,Commercial,,17218.25,29.8,29.8% of Medicare Base rate X weight,17218.25,5777.94,51310.39,Fee Schedule,29.8
CONN TISSUE HUMAN 7,C1762,HCPCS,,,,,both,, ,23907.59,14344.55,Aetna,Commercial,,23907.59,29.8,29.8% of Medicare Base rate X weight,23907.59,8022.68,71244.62,Fee Schedule,29.8
CONN TISSUE HUMAN 8,C1762,HCPCS,,,,,both,, ,33475.26,20085.15,Aetna,Commercial,,33475.26,29.8,29.8% of Medicare Base rate X weight,33475.26,11233.31,99756.27,Fee Schedule,29.8
CONN TISSUE HUMAN 9,C1762,HCPCS,,,,,both,, ,43033.40,25820.04,Aetna,Commercial,,43033.40,29.8,29.8% of Medicare Base rate X weight,43033.40,14440.74,128239.53,Fee Schedule,29.8
TISSUE NON-HUMAN 1,C1763,HCPCS,,,,,both,, ,1796.58,1077.94,Aetna,Commercial,,1796.58,29.8,29.8% of Medicare Base rate X weight,1796.58,602.88,5353.81,Fee Schedule,29.8
TISSUE NON-HUMAN 10,C1763,HCPCS,,,,,both,, ,43033.40,25820.04,Aetna,Commercial,,43033.40,29.8,29.8% of Medicare Base rate X weight,43033.40,14440.74,128239.53,Fee Schedule,29.8
TISSUE NON-HUMAN 11,C1763,HCPCS,,,,,both,, ,57377.95,34426.77,Aetna,Commercial,,57377.95,29.8,29.8% of Medicare Base rate X weight,57377.95,19254.35,170986.29,Fee Schedule,29.8
TISSUE NON-HUMAN 2,C1763,HCPCS,,,,,both,, ,2395.52,1437.31,Aetna,Commercial,,2395.52,29.8,29.8% of Medicare Base rate X weight,2395.52,803.87,7138.65,Fee Schedule,29.8
TISSUE NON-HUMAN 3,C1763,HCPCS,,,,,both,, ,4786.15,2871.69,Aetna,Commercial,,4786.15,29.8,29.8% of Medicare Base rate X weight,4786.15,1606.09,14262.73,Fee Schedule,29.8
TISSUE NON-HUMAN 4,C1763,HCPCS,,,,,both,, ,8611.57,5166.94,Aetna,Commercial,,8611.57,29.8,29.8% of Medicare Base rate X weight,8611.57,2889.79,25662.48,Fee Schedule,29.8
TISSUE NON-HUMAN 5,C1763,HCPCS,,,,,both,, ,12436.74,7462.04,Aetna,Commercial,,12436.74,29.8,29.8% of Medicare Base rate X weight,12436.74,4173.40,37061.49,Fee Schedule,29.8
TISSUE NON-HUMAN 6,C1763,HCPCS,,,,,both,, ,15305.54,9183.32,Aetna,Commercial,,15305.54,29.8,29.8% of Medicare Base rate X weight,15305.54,5136.09,45610.51,Fee Schedule,29.8
TISSUE NON-HUMAN 7,C1763,HCPCS,,,,,both,, ,19130.71,11478.42,Aetna,Commercial,,19130.71,29.8,29.8% of Medicare Base rate X weight,19130.71,6419.70,57009.52,Fee Schedule,29.8
TISSUE NON-HUMAN 8,C1763,HCPCS,,,,,both,, ,23912.22,14347.33,Aetna,Commercial,,23912.22,29.8,29.8% of Medicare Base rate X weight,23912.22,8024.23,71258.42,Fee Schedule,29.8
TISSUE NON-HUMAN 9,C1763,HCPCS,,,,,both,, ,33475.26,20085.15,Aetna,Commercial,,33475.26,29.8,29.8% of Medicare Base rate X weight,33475.26,11233.31,99756.27,Fee Schedule,29.8
EVENT RECRDR CARDIAC,C1764,HCPCS,,,,,both,, ,21590.35,12954.21,Aetna,Commercial,,21590.35,29.8,29.8% of Medicare Base rate X weight,21590.35,7245.08,64339.24,Fee Schedule,29.8
ADHESION BARRIER1,C1765,HCPCS,,,,,both,, ,717.14,430.28,Aetna,Commercial,,717.14,29.8,29.8% of Medicare Base rate X weight,717.14,240.65,2137.08,Fee Schedule,29.8
ADHESION BARRIER2,C1765,HCPCS,,,,,both,, ,956.36,573.81,Aetna,Commercial,,956.36,29.8,29.8% of Medicare Base rate X weight,956.36,320.93,2849.95,Fee Schedule,29.8
ADHESION BARRIER3,C1765,HCPCS,,,,,both,, ,8466.86,5080.11,Aetna,Commercial,,8466.86,29.8,29.8% of Medicare Base rate X weight,8466.86,2841.23,25231.24,Fee Schedule,29.8
ADHESION BARRIER4,C1765,HCPCS,,,,,both,, ,4456.30,2673.78,Aetna,Commercial,,4456.30,29.8,29.8% of Medicare Base rate X weight,4456.30,1495.40,13279.77,Fee Schedule,29.8
GENRATR NEUROSTM 1,C1767,HCPCS,,,,,both,, ,35861.25,21516.75,Aetna,Commercial,,35861.25,29.8,29.8% of Medicare Base rate X weight,35861.25,12033.98,106866.53,Fee Schedule,29.8
GENRATR NEUROSTM 2,C1767,HCPCS,,,,,both,, ,71722.51,43033.50,Aetna,Commercial,,71722.51,29.8,29.8% of Medicare Base rate X weight,71722.51,24067.96,213733.08,Fee Schedule,29.8
GRAFT VASCULAR 1,C1768,HCPCS,,,,,both,, ,1796.58,1077.94,Aetna,Commercial,,1796.58,29.8,29.8% of Medicare Base rate X weight,1796.58,602.88,5353.81,Fee Schedule,29.8
GRAFT VASCULAR 2,C1768,HCPCS,,,,,both,, ,2395.52,1437.31,Aetna,Commercial,,2395.52,29.8,29.8% of Medicare Base rate X weight,2395.52,803.87,7138.65,Fee Schedule,29.8
GRAFT VASCULAR 3,C1768,HCPCS,,,,,both,, ,4786.15,2871.69,Aetna,Commercial,,4786.15,29.8,29.8% of Medicare Base rate X weight,4786.15,1606.09,14262.73,Fee Schedule,29.8
GRAFT VASCULAR 4,C1768,HCPCS,,,,,both,, ,9567.67,5740.60,Aetna,Commercial,,9567.67,29.8,29.8% of Medicare Base rate X weight,9567.67,3210.63,28511.66,Fee Schedule,29.8
GRAFT VASCULAR 5,C1768,HCPCS,,,,,both,, ,14349.19,8609.51,Aetna,Commercial,,14349.19,29.8,29.8% of Medicare Base rate X weight,14349.19,4815.16,42760.59,Fee Schedule,29.8
GRAFT VASCULAR 6,C1768,HCPCS,,,,,both,, ,19130.71,11478.42,Aetna,Commercial,,19130.71,29.8,29.8% of Medicare Base rate X weight,19130.71,6419.70,57009.52,Fee Schedule,29.8
GRAFT VASCULAR 7,C1768,HCPCS,,,,,both,, ,23912.22,14347.33,Aetna,Commercial,,23912.22,29.8,29.8% of Medicare Base rate X weight,23912.22,8024.23,71258.42,Fee Schedule,29.8
GRAFT VASCULAR 8,C1768,HCPCS,,,,,both,, ,28688.85,17213.31,Aetna,Commercial,,28688.85,29.8,29.8% of Medicare Base rate X weight,28688.85,9627.13,85492.77,Fee Schedule,29.8
GUIDEWIRE LEVEL 1,C1769,HCPCS,,,,,both,, ,182.83,109.69,Aetna,Commercial,,182.83,29.8,29.8% of Medicare Base rate X weight,182.83,61.35,544.83,Fee Schedule,29.8
GUIDEWIRE LEVEL 10,C1769,HCPCS,,,,,both,, ,3830.06,2298.03,Aetna,Commercial,,3830.06,29.8,29.8% of Medicare Base rate X weight,3830.06,1285.26,11413.58,Fee Schedule,29.8
GUIDEWIRE LEVEL 11,C1769,HCPCS,,,,,both,, ,4308.23,2584.93,Aetna,Commercial,,4308.23,29.8,29.8% of Medicare Base rate X weight,4308.23,1445.71,12838.53,Fee Schedule,29.8
GUIDEWIRE LEVEL 12,C1769,HCPCS,,,,,both,, ,4786.15,2871.69,Aetna,Commercial,,4786.15,29.8,29.8% of Medicare Base rate X weight,4786.15,1606.09,14262.73,Fee Schedule,29.8
GUIDEWIRE LEVEL 13,C1769,HCPCS,,,,,both,, ,7177.04,4306.22,Aetna,Commercial,,7177.04,29.8,29.8% of Medicare Base rate X weight,7177.04,2408.40,21387.58,Fee Schedule,29.8
GUIDEWIRE LEVEL 14,C1769,HCPCS,,,,,both,, ,9567.67,5740.60,Aetna,Commercial,,9567.67,29.8,29.8% of Medicare Base rate X weight,9567.67,3210.63,28511.66,Fee Schedule,29.8
GUIDEWIRE LEVEL 15,C1769,HCPCS,,,,,both,, ,14349.19,8609.51,Aetna,Commercial,,14349.19,29.8,29.8% of Medicare Base rate X weight,14349.19,4815.16,42760.59,Fee Schedule,29.8
GUIDEWIRE LEVEL 16,C1769,HCPCS,,,,,both,, ,19130.71,11478.42,Aetna,Commercial,,19130.71,29.8,29.8% of Medicare Base rate X weight,19130.71,6419.70,57009.52,Fee Schedule,29.8
GUIDEWIRE LEVEL 17,C1769,HCPCS,,,,,both,, ,23912.22,14347.33,Aetna,Commercial,,23912.22,29.8,29.8% of Medicare Base rate X weight,23912.22,8024.23,71258.42,Fee Schedule,29.8
GUIDEWIRE LEVEL 18,C1769,HCPCS,,,,,both,, ,31084.37,18650.62,Aetna,Commercial,,31084.37,29.8,29.8% of Medicare Base rate X weight,31084.37,10431.00,92631.42,Fee Schedule,29.8
GUIDEWIRE LEVEL 19,C1769,HCPCS,,,,,both,, ,38256.78,22954.06,Aetna,Commercial,,38256.78,29.8,29.8% of Medicare Base rate X weight,38256.78,12837.85,114005.2,Fee Schedule,29.8
GUIDEWIRE LEVEL 2,C1769,HCPCS,,,,,both,, ,243.85,146.31,Aetna,Commercial,,243.85,29.8,29.8% of Medicare Base rate X weight,243.85,81.83,726.67,Fee Schedule,29.8
GUIDEWIRE LEVEL 20,C1769,HCPCS,,,,,both,, ,47814.92,28688.95,Aetna,Commercial,,47814.92,29.8,29.8% of Medicare Base rate X weight,47814.92,16045.28,142488.46,Fee Schedule,29.8
GUIDEWIRE LEVEL 3,C1769,HCPCS,,,,,both,, ,482.81,289.68,Aetna,Commercial,,482.81,29.8,29.8% of Medicare Base rate X weight,482.81,162.02,1438.77,Fee Schedule,29.8
GUIDEWIRE LEVEL 4,C1769,HCPCS,,,,,both,, ,960.99,576.59,Aetna,Commercial,,960.99,29.8,29.8% of Medicare Base rate X weight,960.99,322.48,2863.75,Fee Schedule,29.8
GUIDEWIRE LEVEL 5,C1769,HCPCS,,,,,both,, ,1439.17,863.50,Aetna,Commercial,,1439.17,29.8,29.8% of Medicare Base rate X weight,1439.17,482.94,4288.73,Fee Schedule,29.8
GUIDEWIRE LEVEL 6,C1769,HCPCS,,,,,both,, ,1917.35,1150.41,Aetna,Commercial,,1917.35,29.8,29.8% of Medicare Base rate X weight,1917.35,643.41,5713.7,Fee Schedule,29.8
GUIDEWIRE LEVEL 7,C1769,HCPCS,,,,,both,, ,2395.52,1437.31,Aetna,Commercial,,2395.52,29.8,29.8% of Medicare Base rate X weight,2395.52,803.87,7138.65,Fee Schedule,29.8
GUIDEWIRE LEVEL 9,C1769,HCPCS,,,,,both,, ,3351.88,2011.12,Aetna,Commercial,,3351.88,29.8,29.8% of Medicare Base rate X weight,3351.88,1124.79,9988.6,Fee Schedule,29.8
GUIDEWIRE LEVEL 9,C1769,HCPCS,,,,,both,, ,3351.88,2011.12,Aetna,Commercial,,3351.88,29.8,29.8% of Medicare Base rate X weight,3351.88,1124.79,9988.6,Fee Schedule,29.8
REP DEV URINRY W/SL1,C1771,HCPCS,,,,,both,, ,2868.81,1721.28,Aetna,Commercial,,2868.81,29.8,29.8% of Medicare Base rate X weight,2868.81,962.69,8549.05,Fee Schedule,29.8
REP DEV URINRY W/SL2,C1771,HCPCS,,,,,both,, ,3825.16,2295.09,Aetna,Commercial,,3825.16,29.8,29.8% of Medicare Base rate X weight,3825.16,1283.61,11398.98,Fee Schedule,29.8
REP DEV URINRY W/SL3,C1771,HCPCS,,,,,both,, ,14344.55,8606.73,Aetna,Commercial,,14344.55,29.8,29.8% of Medicare Base rate X weight,14344.55,4813.61,42746.76,Fee Schedule,29.8
INF PUMP PROGRAM LV1,C1772,HCPCS,,,,,both,, ,2774.56,1664.73,Aetna,Commercial,,2774.56,29.8,29.8% of Medicare Base rate X weight,2774.56,931.06,8268.19,Fee Schedule,29.8
INF PUMP PROGRAM LV3,C1772,HCPCS,,,,,both,, ,53552.79,32131.67,Aetna,Commercial,,53552.79,29.8,29.8% of Medicare Base rate X weight,53552.79,17970.73,159587.31,Fee Schedule,29.8
CATH-RETRIEVAL 1,C1773,HCPCS,,,,,both,, ,1338.74,803.24,Aetna,Commercial,,1338.74,29.8,29.8% of Medicare Base rate X weight,1338.74,449.24,3989.45,Fee Schedule,29.8
CATH-RETRIEVAL 2,C1773,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,4781.52,29.8,29.8% of Medicare Base rate X weight,4781.52,1604.54,14248.93,Fee Schedule,29.8
JOINT DEVICE IMPLT 1,C1776,HCPCS,,,,,both,, ,3586.20,2151.72,Aetna,Commercial,,3586.20,29.8,29.8% of Medicare Base rate X weight,3586.20,1203.42,10686.88,Fee Schedule,29.8
JOINT DEVICE IMPLT 2,C1776,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,4781.52,29.8,29.8% of Medicare Base rate X weight,4781.52,1604.54,14248.93,Fee Schedule,29.8
JOINT DEVICE IMPLT 3,C1776,HCPCS,,,,,both,, ,9567.67,5740.60,Aetna,Commercial,,9567.67,29.8,29.8% of Medicare Base rate X weight,9567.67,3210.63,28511.66,Fee Schedule,29.8
JOINT DEVICE IMPLT 4,C1776,HCPCS,,,,,both,, ,11958.56,7175.13,Aetna,Commercial,,11958.56,29.8,29.8% of Medicare Base rate X weight,11958.56,4012.94,35636.51,Fee Schedule,29.8
JOINT DEVICE IMPLT 5,C1776,HCPCS,,,,,both,, ,19130.71,11478.42,Aetna,Commercial,,19130.71,29.8,29.8% of Medicare Base rate X weight,19130.71,6419.70,57009.52,Fee Schedule,29.8
JOINT DEVICE IMPLT 6,C1776,HCPCS,,,,,both,, ,23912.22,14347.33,Aetna,Commercial,,23912.22,29.8,29.8% of Medicare Base rate X weight,23912.22,8024.23,71258.42,Fee Schedule,29.8
JOINT DEVICE IMPLT 7,C1776,HCPCS,,,,,both,, ,31084.37,18650.62,Aetna,Commercial,,31084.37,29.8,29.8% of Medicare Base rate X weight,31084.37,10431.00,92631.42,Fee Schedule,29.8
JOINT DEVICE IMPLT 8,C1776,HCPCS,,,,,both,, ,38256.78,22954.06,Aetna,Commercial,,38256.78,29.8,29.8% of Medicare Base rate X weight,38256.78,12837.85,114005.2,Fee Schedule,29.8
JOINT DEVICE IMPLT 9,C1776,HCPCS,,,,,both,, ,47819.81,28691.88,Aetna,Commercial,,47819.81,29.8,29.8% of Medicare Base rate X weight,47819.81,16046.92,142503.03,Fee Schedule,29.8
JOINT DEVICE IMPLT10,C1776,HCPCS,,,,,both,, ,71727.14,43036.28,Aetna,Commercial,,71727.14,29.8,29.8% of Medicare Base rate X weight,71727.14,24069.51,213746.88,Fee Schedule,29.8
JOINT DEVICE IMPLT11,C1776,HCPCS,,,,,both,, ,95629.84,57377.90,Aetna,Commercial,,95629.84,29.8,29.8% of Medicare Base rate X weight,95629.84,32090.55,284976.92,Fee Schedule,29.8
JOINT DEVICE IMPLT12,C1776,HCPCS,,,,,both,, ,99999.00,59999.40,Aetna,Commercial,,99999.00,29.8,29.8% of Medicare Base rate X weight,99999.00,33556.71,297997.02,Fee Schedule,29.8
LEAD AICD ENDO SN L1,C1777,HCPCS,,,,,both,, ,23599.62,14159.77,Aetna,Commercial,,23599.62,29.8,29.8% of Medicare Base rate X weight,23599.62,7919.34,70326.87,Fee Schedule,29.8
LEAD NEUROSTIMULAT 1,C1778,HCPCS,,,,,both,, ,9563.04,5737.82,Aetna,Commercial,,9563.04,29.8,29.8% of Medicare Base rate X weight,9563.04,3209.07,28497.86,Fee Schedule,29.8
LEAD NEUROSTIMULAT 2,C1778,HCPCS,,,,,both,, ,3586.20,2151.72,Aetna,Commercial,,3586.20,29.8,29.8% of Medicare Base rate X weight,3586.20,1203.42,10686.88,Fee Schedule,29.8
LEAD NEUROSTIMULAT 3,C1778,HCPCS,,,,,both,, ,14344.55,8606.73,Aetna,Commercial,,14344.55,29.8,29.8% of Medicare Base rate X weight,14344.55,4813.61,42746.76,Fee Schedule,29.8
LEAD NEUROSTIMULAT 4,C1778,HCPCS,,,,,both,, ,23907.59,14344.55,Aetna,Commercial,,23907.59,29.8,29.8% of Medicare Base rate X weight,23907.59,8022.68,71244.62,Fee Schedule,29.8
LEAD PMKR TRNSV VDD1,C1779,HCPCS,,,,,both,, ,9194.30,5516.58,Aetna,Commercial,,9194.30,29.8,29.8% of Medicare Base rate X weight,9194.30,3085.34,27399.01,Fee Schedule,29.8
MESH IMPLANTABLE 1,C1781,HCPCS,,,,,both,, ,717.14,430.28,Aetna,Commercial,,717.14,29.8,29.8% of Medicare Base rate X weight,717.14,240.65,2137.08,Fee Schedule,29.8
MESH IMPLANTABLE 10,C1781,HCPCS,,,,,both,, ,11958.56,7175.13,Aetna,Commercial,,11958.56,29.8,29.8% of Medicare Base rate X weight,11958.56,4012.94,35636.51,Fee Schedule,29.8
MESH IMPLANTABLE 11,C1781,HCPCS,,,,,both,, ,14349.19,8609.51,Aetna,Commercial,,14349.19,29.8,29.8% of Medicare Base rate X weight,14349.19,4815.16,42760.59,Fee Schedule,29.8
MESH IMPLANTABLE 12,C1781,HCPCS,,,,,both,, ,19130.71,11478.42,Aetna,Commercial,,19130.71,29.8,29.8% of Medicare Base rate X weight,19130.71,6419.70,57009.52,Fee Schedule,29.8
MESH IMPLANTABLE 13,C1781,HCPCS,,,,,both,, ,28693.74,17216.24,Aetna,Commercial,,28693.74,29.8,29.8% of Medicare Base rate X weight,28693.74,9628.77,85507.35,Fee Schedule,29.8
MESH IMPLANTABLE 14,C1781,HCPCS,,,,,both,, ,43038.29,25822.97,Aetna,Commercial,,43038.29,29.8,29.8% of Medicare Base rate X weight,43038.29,14442.38,128254.1,Fee Schedule,29.8
MESH IMPLANTABLE 2,C1781,HCPCS,,,,,both,, ,960.99,576.59,Aetna,Commercial,,960.99,29.8,29.8% of Medicare Base rate X weight,960.99,322.48,2863.75,Fee Schedule,29.8
MESH IMPLANTABLE 3,C1781,HCPCS,,,,,both,, ,1917.35,1150.41,Aetna,Commercial,,1917.35,29.8,29.8% of Medicare Base rate X weight,1917.35,643.41,5713.7,Fee Schedule,29.8
MESH IMPLANTABLE 4,C1781,HCPCS,,,,,both,, ,2873.70,1724.22,Aetna,Commercial,,2873.70,29.8,29.8% of Medicare Base rate X weight,2873.70,964.33,8563.63,Fee Schedule,29.8
MESH IMPLANTABLE 6,C1781,HCPCS,,,,,both,, ,3830.06,2298.03,Aetna,Commercial,,3830.06,29.8,29.8% of Medicare Base rate X weight,3830.06,1285.26,11413.58,Fee Schedule,29.8
MESH IMPLANTABLE 6,C1781,HCPCS,,,,,both,, ,3830.06,2298.03,Aetna,Commercial,,3830.06,29.8,29.8% of Medicare Base rate X weight,3830.06,1285.26,11413.58,Fee Schedule,29.8
MESH IMPLANTABLE 7,C1781,HCPCS,,,,,both,, ,6220.69,3732.41,Aetna,Commercial,,6220.69,29.8,29.8% of Medicare Base rate X weight,6220.69,2087.48,18537.66,Fee Schedule,29.8
MESH IMPLANTABLE 8,C1781,HCPCS,,,,,both,, ,7655.22,4593.13,Aetna,Commercial,,7655.22,29.8,29.8% of Medicare Base rate X weight,7655.22,2568.87,22812.56,Fee Schedule,29.8
MESH IMPLANTABLE 9,C1781,HCPCS,,,,,both,, ,9567.67,5740.60,Aetna,Commercial,,9567.67,29.8,29.8% of Medicare Base rate X weight,9567.67,3210.63,28511.66,Fee Schedule,29.8
MORCELLATOR 1,C1782,HCPCS,,,,,both,, ,1792.97,1075.78,Aetna,Commercial,,1792.97,29.8,29.8% of Medicare Base rate X weight,1792.97,601.67,5343.05,Fee Schedule,29.8
MORCELLATOR 2,C1782,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,4781.52,29.8,29.8% of Medicare Base rate X weight,4781.52,1604.54,14248.93,Fee Schedule,29.8
MORCELLATOR 3,C1782,HCPCS,,,,,both,, ,9563.04,5737.82,Aetna,Commercial,,9563.04,29.8,29.8% of Medicare Base rate X weight,9563.04,3209.07,28497.86,Fee Schedule,29.8
OCLR DEV INTROP DTR1,C1784,HCPCS,,,,,both,, ,15780.63,9468.37,Aetna,Commercial,,15780.63,29.8,29.8% of Medicare Base rate X weight,15780.63,5295.51,47026.28,Fee Schedule,29.8
PMKR DUAL RATE-RS L1,C1785,HCPCS,,,,,both,, ,84273.06,50563.83,Aetna,Commercial,,84273.06,29.8,29.8% of Medicare Base rate X weight,84273.06,28279.55,251133.72,Fee Schedule,29.8
PMKR DUAL RATE-RS L2,C1785,HCPCS,,,,,both,, ,28809.36,17285.61,Aetna,Commercial,,28809.36,29.8,29.8% of Medicare Base rate X weight,28809.36,9667.57,85851.89,Fee Schedule,29.8
PMKR SINGL RATE-RSL1,C1786,HCPCS,,,,,both,, ,62664.69,37598.81,Aetna,Commercial,,62664.69,29.8,29.8% of Medicare Base rate X weight,62664.69,21028.42,186740.78,Fee Schedule,29.8
PATIENT PROGR NEURO1,C1787,HCPCS,,,,,both,, ,5302.96,3181.77,Aetna,Commercial,,5302.96,29.8,29.8% of Medicare Base rate X weight,5302.96,1779.52,15802.82,Fee Schedule,29.8
PORT 1,C1788,HCPCS,,,,,both,, ,720.74,432.44,Aetna,Commercial,,720.74,29.8,29.8% of Medicare Base rate X weight,720.74,241.86,2147.81,Fee Schedule,29.8
PORT 2,C1788,HCPCS,,,,,both,, ,960.99,576.59,Aetna,Commercial,,960.99,29.8,29.8% of Medicare Base rate X weight,960.99,322.48,2863.75,Fee Schedule,29.8
PORT 3,C1788,HCPCS,,,,,both,, ,1912.71,1147.62,Aetna,Commercial,,1912.71,29.8,29.8% of Medicare Base rate X weight,1912.71,641.85,5699.88,Fee Schedule,29.8
BREAST IMPLANT 1,C1789,HCPCS,,,,,both,, ,7833.15,4699.89,Aetna,Commercial,,7833.15,29.8,29.8% of Medicare Base rate X weight,7833.15,2628.57,23342.79,Fee Schedule,29.8
PRSTHS PENILE INFL 1,C1813,HCPCS,,,,,both,, ,3586.20,2151.72,Aetna,Commercial,,3586.20,29.8,29.8% of Medicare Base rate X weight,3586.20,1203.42,10686.88,Fee Schedule,29.8
PRSTHS PENILE INFL 2,C1813,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,4781.52,29.8,29.8% of Medicare Base rate X weight,4781.52,1604.54,14248.93,Fee Schedule,29.8
PRSTHS PENILE INFL 3,C1813,HCPCS,,,,,both,, ,14344.55,8606.73,Aetna,Commercial,,14344.55,29.8,29.8% of Medicare Base rate X weight,14344.55,4813.61,42746.76,Fee Schedule,29.8
PRSTHS PENILE INFL 4,C1813,HCPCS,,,,,both,, ,23907.59,14344.55,Aetna,Commercial,,23907.59,29.8,29.8% of Medicare Base rate X weight,23907.59,8022.68,71244.62,Fee Schedule,29.8
TISSUE LOCALZ EXCISI,C1819,HCPCS,,,,,both,, ,1000.00,600.00,Aetna,Commercial,,1000.00,29.8,29.8% of Medicare Base rate X weight,1000.00,335.57,2980,Fee Schedule,29.8
GENRATE NEURO RECHR,C1820,HCPCS,,,,,both,, ,38545.95,23127.57,Aetna,Commercial,,38545.95,29.8,29.8% of Medicare Base rate X weight,38545.95,12934.88,114866.93,Fee Schedule,29.8
INTERSPINOUS IMPL L1,C1821,HCPCS,,,,,both,, ,31193.29,18715.97,Aetna,Commercial,,31193.29,29.8,29.8% of Medicare Base rate X weight,31193.29,10467.55,92956,Fee Schedule,29.8
INTERSPINOUS IMPL L2,C1821,HCPCS,,,,,both,, ,44561.92,26737.15,Aetna,Commercial,,44561.92,29.8,29.8% of Medicare Base rate X weight,44561.92,14953.66,132794.52,Fee Schedule,29.8
STNT COAT/COV W/DEL1,C1874,HCPCS,,,,,both,, ,3586.20,2151.72,Aetna,Commercial,,3586.20,29.8,29.8% of Medicare Base rate X weight,3586.20,1203.42,10686.88,Fee Schedule,29.8
STNT COAT/COV W/DEL2,C1874,HCPCS,,,,,both,, ,7172.15,4303.29,Aetna,Commercial,,7172.15,29.8,29.8% of Medicare Base rate X weight,7172.15,2406.76,21373.01,Fee Schedule,29.8
STNT COAT/COV W/DEL3,C1874,HCPCS,,,,,both,, ,14344.55,8606.73,Aetna,Commercial,,14344.55,29.8,29.8% of Medicare Base rate X weight,14344.55,4813.61,42746.76,Fee Schedule,29.8
STNT COAT/COV W/DEL4,C1874,HCPCS,,,,,both,, ,23907.59,14344.55,Aetna,Commercial,,23907.59,29.8,29.8% of Medicare Base rate X weight,23907.59,8022.68,71244.62,Fee Schedule,29.8
STNT NO COCV W/DEL 1,C1876,HCPCS,,,,,both,, ,3589.81,2153.88,Aetna,Commercial,,3589.81,29.8,29.8% of Medicare Base rate X weight,3589.81,1204.63,10697.63,Fee Schedule,29.8
STNT NO COCV W/DEL 2,C1876,HCPCS,,,,,both,, ,4786.15,2871.69,Aetna,Commercial,,4786.15,29.8,29.8% of Medicare Base rate X weight,4786.15,1606.09,14262.73,Fee Schedule,29.8
STNT NO COCV W/DEL 3,C1876,HCPCS,,,,,both,, ,9567.67,5740.60,Aetna,Commercial,,9567.67,29.8,29.8% of Medicare Base rate X weight,9567.67,3210.63,28511.66,Fee Schedule,29.8
STNT NO COCV W/DEL 4,C1876,HCPCS,,,,,both,, ,14344.55,8606.73,Aetna,Commercial,,14344.55,29.8,29.8% of Medicare Base rate X weight,14344.55,4813.61,42746.76,Fee Schedule,29.8
STNT NO-COA/COV W/O1,C1877,HCPCS,,,,,both,, ,3586.20,2151.72,Aetna,Commercial,,3586.20,29.8,29.8% of Medicare Base rate X weight,3586.20,1203.42,10686.88,Fee Schedule,29.8
STNT NO-COA/COV W/O2,C1877,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,4781.52,29.8,29.8% of Medicare Base rate X weight,4781.52,1604.54,14248.93,Fee Schedule,29.8
VENA CAVA FILTER 1,C1880,HCPCS,,,,,both,, ,3586.20,2151.72,Aetna,Commercial,,3586.20,29.8,29.8% of Medicare Base rate X weight,3586.20,1203.42,10686.88,Fee Schedule,29.8
VENA CAVA FILTER 2,C1880,HCPCS,,,,,both,, ,7172.15,4303.29,Aetna,Commercial,,7172.15,29.8,29.8% of Medicare Base rate X weight,7172.15,2406.76,21373.01,Fee Schedule,29.8
AICD OHR THN SGL/DU1,C1882,HCPCS,,,,,both,, ,99999.00,59999.40,Aetna,Commercial,,99999.00,29.8,29.8% of Medicare Base rate X weight,99999.00,33556.71,297997.02,Fee Schedule,29.8
EMBOLIZ PROTECT SYS1,C1884,HCPCS,,,,,both,, ,6144.21,3686.52,Aetna,Commercial,,6144.21,29.8,29.8% of Medicare Base rate X weight,6144.21,2061.82,18309.75,Fee Schedule,29.8
EMBOLIZ PROTECT SYS2,C1884,HCPCS,,,,,both,, ,7172.15,4303.29,Aetna,Commercial,,7172.15,29.8,29.8% of Medicare Base rate X weight,7172.15,2406.76,21373.01,Fee Schedule,29.8
CATH TRNSLUM ANG LA1,C1885,HCPCS,,,,,both,, ,7172.15,4303.29,Aetna,Commercial,,7172.15,29.8,29.8% of Medicare Base rate X weight,7172.15,2406.76,21373.01,Fee Schedule,29.8
CATH TRNSLUM ANG LA2,C1885,HCPCS,,,,,both,, ,9563.04,5737.82,Aetna,Commercial,,9563.04,29.8,29.8% of Medicare Base rate X weight,9563.04,3209.07,28497.86,Fee Schedule,29.8
CATHETER GUIDING 1,C1887,HCPCS,,,,,both,, ,358.70,215.22,Aetna,Commercial,,358.70,29.8,29.8% of Medicare Base rate X weight,358.70,120.37,1068.93,Fee Schedule,29.8
CATHETER GUIDING 2,C1887,HCPCS,,,,,both,, ,1195.32,717.19,Aetna,Commercial,,1195.32,29.8,29.8% of Medicare Base rate X weight,1195.32,401.11,3562.05,Fee Schedule,29.8
CATHETER GUIDING 3,C1887,HCPCS,,,,,both,, ,1912.71,1147.62,Aetna,Commercial,,1912.71,29.8,29.8% of Medicare Base rate X weight,1912.71,641.85,5699.88,Fee Schedule,29.8
CATH ABLTN NOCRD ED1,C1888,HCPCS,,,,,both,, ,896.62,537.97,Aetna,Commercial,,896.62,29.8,29.8% of Medicare Base rate X weight,896.62,300.88,2671.93,Fee Schedule,29.8
CATH ABLTN NOCRD ED2,C1888,HCPCS,,,,,both,, ,1195.32,717.19,Aetna,Commercial,,1195.32,29.8,29.8% of Medicare Base rate X weight,1195.32,401.11,3562.05,Fee Schedule,29.8
EAR TUBES DRAINAGE 1,C1889,HCPCS,,,,,both,, ,113.04,67.82,Aetna,Commercial,,113.04,29.8,29.8% of Medicare Base rate X weight,113.04,37.93,336.86,Fee Schedule,29.8
TISSUE EXP NONBREAST,C1889,HCPCS,,,,,both,, ,570.11,342.06,Aetna,Commercial,,570.11,29.8,29.8% of Medicare Base rate X weight,570.11,191.31,1698.93,Fee Schedule,29.8
INF PMP NON-PROG LV1,C1891,HCPCS,,,,,both,, ,10237.17,6142.30,Aetna,Commercial,,10237.17,29.8,29.8% of Medicare Base rate X weight,10237.17,3435.29,30506.77,Fee Schedule,29.8
PEEL-AWAY SHEATH 1,C1892,HCPCS,,,,,both,, ,179.22,107.53,Aetna,Commercial,,179.22,29.8,29.8% of Medicare Base rate X weight,179.22,60.14,534.08,Fee Schedule,29.8
PEEL-AWAY SHEATH 2,C1892,HCPCS,,,,,both,, ,478.18,286.90,Aetna,Commercial,,478.18,29.8,29.8% of Medicare Base rate X weight,478.18,160.46,1424.98,Fee Schedule,29.8
PEEL-AWAY SHEATH 3,C1892,HCPCS,,,,,both,, ,1434.53,860.71,Aetna,Commercial,,1434.53,29.8,29.8% of Medicare Base rate X weight,1434.53,481.39,4274.9,Fee Schedule,29.8
INT SHTH FIX NO-PL 1,C1893,HCPCS,,,,,both,, ,611.31,366.78,Aetna,Commercial,,611.31,29.8,29.8% of Medicare Base rate X weight,611.31,205.14,1821.7,Fee Schedule,29.8
INT SHTH FIX NO-PL 2,C1893,HCPCS,,,,,both,, ,3048.29,1828.97,Aetna,Commercial,,3048.29,29.8,29.8% of Medicare Base rate X weight,3048.29,1022.92,9083.9,Fee Schedule,29.8
SHEATH NON-LASR 1,C1894,HCPCS,,,,,both,, ,717.14,430.28,Aetna,Commercial,,717.14,29.8,29.8% of Medicare Base rate X weight,717.14,240.65,2137.08,Fee Schedule,29.8
SHEATH NON-LASR 2,C1894,HCPCS,,,,,both,, ,1434.53,860.71,Aetna,Commercial,,1434.53,29.8,29.8% of Medicare Base rate X weight,1434.53,481.39,4274.9,Fee Schedule,29.8
SHEATH NON-LASR 3,C1894,HCPCS,,,,,both,, ,2390.63,1434.37,Aetna,Commercial,,2390.63,29.8,29.8% of Medicare Base rate X weight,2390.63,802.22,7124.08,Fee Schedule,29.8
SHEATH NON-LASR 4,C1894,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,4781.52,29.8,29.8% of Medicare Base rate X weight,4781.52,1604.54,14248.93,Fee Schedule,29.8
SHEATH NON-LASR 5,C1894,HCPCS,,,,,both,, ,7172.15,4303.29,Aetna,Commercial,,7172.15,29.8,29.8% of Medicare Base rate X weight,7172.15,2406.76,21373.01,Fee Schedule,29.8
SHEATH NON-LASR 6,C1894,HCPCS,,,,,both,, ,9563.04,5737.82,Aetna,Commercial,,9563.04,29.8,29.8% of Medicare Base rate X weight,9563.04,3209.07,28497.86,Fee Schedule,29.8
SHEATH NON-LASR 7,C1894,HCPCS,,,,,both,, ,14344.55,8606.73,Aetna,Commercial,,14344.55,29.8,29.8% of Medicare Base rate X weight,14344.55,4813.61,42746.76,Fee Schedule,29.8
SHEATH NON-LASR 8,C1894,HCPCS,,,,,both,, ,19126.07,11475.64,Aetna,Commercial,,19126.07,29.8,29.8% of Medicare Base rate X weight,19126.07,6418.14,56995.69,Fee Schedule,29.8
LEAD AICD END DUL L1,C1895,HCPCS,,,,,both,, ,76277.94,45766.76,Aetna,Commercial,,76277.94,29.8,29.8% of Medicare Base rate X weight,76277.94,25596.62,227308.26,Fee Schedule,29.8
LEAD AICD END DUL L2,C1895,HCPCS,,,,,both,, ,16735.18,10041.10,Aetna,Commercial,,16735.18,29.8,29.8% of Medicare Base rate X weight,16735.18,5615.83,49870.84,Fee Schedule,29.8
LEAD AICD NO-SING L1,C1896,HCPCS,,,,,both,, ,16206.54,9723.92,Aetna,Commercial,,16206.54,29.8,29.8% of Medicare Base rate X weight,16206.54,5438.44,48295.49,Fee Schedule,29.8
LEAD NEUROSTM TST K1,C1897,HCPCS,,,,,both,, ,3586.20,2151.72,Aetna,Commercial,,3586.20,29.8,29.8% of Medicare Base rate X weight,3586.20,1203.42,10686.88,Fee Schedule,29.8
LEAD NEUROSTM TST K2,C1897,HCPCS,,,,,both,, ,6646.33,3987.79,Aetna,Commercial,,6646.33,29.8,29.8% of Medicare Base rate X weight,6646.33,2230.31,19806.06,Fee Schedule,29.8
LEAD PMKR NON-TRN L1,C1898,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,4781.52,29.8,29.8% of Medicare Base rate X weight,4781.52,1604.54,14248.93,Fee Schedule,29.8
LEAD PMKR/AICD CMBL1,C1899,HCPCS,,,,,both,, ,41218.03,24730.81,Aetna,Commercial,,41218.03,29.8,29.8% of Medicare Base rate X weight,41218.03,13831.55,122829.73,Fee Schedule,29.8
LEAD LT VENT COR LV1,C1900,HCPCS,,,,,both,, ,20278.38,12167.02,Aetna,Commercial,,20278.38,29.8,29.8% of Medicare Base rate X weight,20278.38,6804.83,60429.57,Fee Schedule,29.8
SEALANT PULMNRY LIQD,C2615,HCPCS,,,,,both,, ,5932.54,3559.52,Aetna,Commercial,,5932.54,29.8,29.8% of Medicare Base rate X weight,5932.54,1990.79,17678.97,Fee Schedule,29.8
STNT NONCOR TM W/O 1,C2617,HCPCS,,,,,both,, ,2963.83,1778.29,Aetna,Commercial,,2963.83,29.8,29.8% of Medicare Base rate X weight,2963.83,994.57,8832.21,Fee Schedule,29.8
PROBE CRYOABLATION 1,C2618,HCPCS,,,,,both,, ,3586.20,2151.72,Aetna,Commercial,,3586.20,29.8,29.8% of Medicare Base rate X weight,3586.20,1203.42,10686.88,Fee Schedule,29.8
PROBE CRYOABLATION 2,C2618,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,4781.52,29.8,29.8% of Medicare Base rate X weight,4781.52,1604.54,14248.93,Fee Schedule,29.8
PROBE CRYOABLATION 3,C2618,HCPCS,,,,,both,, ,9563.04,5737.82,Aetna,Commercial,,9563.04,29.8,29.8% of Medicare Base rate X weight,9563.04,3209.07,28497.86,Fee Schedule,29.8
PROBE CRYOABLATION 4,C2618,HCPCS,,,,,both,, ,16735.18,10041.10,Aetna,Commercial,,16735.18,29.8,29.8% of Medicare Base rate X weight,16735.18,5615.83,49870.84,Fee Schedule,29.8
PMKR DUL NON RAT LV1,C2619,HCPCS,,,,,both,, ,73166.31,43899.78,Aetna,Commercial,,73166.31,29.8,29.8% of Medicare Base rate X weight,73166.31,24552.45,218035.6,Fee Schedule,29.8
PMKR SNGL NON RTE-RE,C2620,HCPCS,,,,,both,, ,45918.17,27550.90,Aetna,Commercial,,45918.17,29.8,29.8% of Medicare Base rate X weight,45918.17,15408.78,136836.15,Fee Schedule,29.8
PMKR OTHR TH SNGL L1,C2621,HCPCS,,,,,both,, ,99999.00,59999.40,Aetna,Commercial,,99999.00,29.8,29.8% of Medicare Base rate X weight,99999.00,33556.71,297997.02,Fee Schedule,29.8
PRSTHS PENILE NNINF1,C2622,HCPCS,,,,,both,, ,38894.09,23336.45,Aetna,Commercial,,38894.09,29.8,29.8% of Medicare Base rate X weight,38894.09,13051.71,115904.39,Fee Schedule,29.8
WIRELESS PRESS SENS,C2624,HCPCS,,,,,both,, ,99999.00,59999.40,Aetna,Commercial,,99999.00,29.8,29.8% of Medicare Base rate X weight,99999.00,33556.71,297997.02,Fee Schedule,29.8
STNT NON-COR TM DL 1,C2625,HCPCS,,,,,both,, ,541.52,324.91,Aetna,Commercial,,541.52,29.8,29.8% of Medicare Base rate X weight,541.52,181.72,1613.73,Fee Schedule,29.8
STNT NON-COR TM DL 2,C2625,HCPCS,,,,,both,, ,722.03,433.21,Aetna,Commercial,,722.03,29.8,29.8% of Medicare Base rate X weight,722.03,242.29,2151.65,Fee Schedule,29.8
STNT NON-COR TM DL 3,C2625,HCPCS,,,,,both,, ,3787.83,2272.69,Aetna,Commercial,,3787.83,29.8,29.8% of Medicare Base rate X weight,3787.83,1271.08,11287.73,Fee Schedule,29.8
INF PMP NON-PROG LV1,C2626,HCPCS,,,,,both,, ,545.13,327.07,Aetna,Commercial,,545.13,29.8,29.8% of Medicare Base rate X weight,545.13,182.93,1624.49,Fee Schedule,29.8
CATH SUPRPUBC-CYSTO1,C2627,HCPCS,,,,,both,, ,172.01,103.20,Aetna,Commercial,,172.01,29.8,29.8% of Medicare Base rate X weight,172.01,57.72,512.59,Fee Schedule,29.8
CATH SUPRPUBC-CYSTO2,C2627,HCPCS,,,,,both,, ,1075.84,645.50,Aetna,Commercial,,1075.84,29.8,29.8% of Medicare Base rate X weight,1075.84,361.02,3206,Fee Schedule,29.8
CATH OCCLUSION 1,C2628,HCPCS,,,,,both,, ,717.14,430.28,Aetna,Commercial,,717.14,29.8,29.8% of Medicare Base rate X weight,717.14,240.65,2137.08,Fee Schedule,29.8
CATH OCCLUSION 2,C2628,HCPCS,,,,,both,, ,1434.53,860.71,Aetna,Commercial,,1434.53,29.8,29.8% of Medicare Base rate X weight,1434.53,481.39,4274.9,Fee Schedule,29.8
CATH OCCLUSION 3,C2628,HCPCS,,,,,both,, ,2390.63,1434.37,Aetna,Commercial,,2390.63,29.8,29.8% of Medicare Base rate X weight,2390.63,802.22,7124.08,Fee Schedule,29.8
INTRO/SHEATH LASER 1,C2629,HCPCS,,,,,both,, ,5379.18,3227.50,Aetna,Commercial,,5379.18,29.8,29.8% of Medicare Base rate X weight,5379.18,1805.09,16029.96,Fee Schedule,29.8
INTRO/SHEATH LASER 2,C2629,HCPCS,,,,,both,, ,7172.15,4303.29,Aetna,Commercial,,7172.15,29.8,29.8% of Medicare Base rate X weight,7172.15,2406.76,21373.01,Fee Schedule,29.8
REP DEV URNRY WO SL1,C2631,HCPCS,,,,,both,, ,8266.27,4959.76,Aetna,Commercial,,8266.27,29.8,29.8% of Medicare Base rate X weight,8266.27,2773.92,24633.48,Fee Schedule,29.8
LC S SUB T/A/L 25S,C5271,HCPCS,,,,,both,, ,2393.60,1436.16,Aetna,Commercial,,2393.60,29.8,29.8% of Medicare Base rate X weight,2393.60,803.22,7132.93,Fee Schedule,29.8
LC S SUB T/A/L ADL,C5272,HCPCS,,,,,both,, ,2393.60,1436.16,Aetna,Commercial,,2393.60,29.8,29.8% of Medicare Base rate X weight,2393.60,803.22,7132.93,Fee Schedule,29.8
LC S SUB T/A/L 100SQ,C5273,HCPCS,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,2332.26,20711.36,Fee Schedule,29.8
LC S SUB T/A/L ADL,C5274,HCPCS,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,6950.12,29.8,29.8% of Medicare Base rate X weight,6950.12,2332.26,20711.36,Fee Schedule,29.8
LC S SUB F/NK/HF/G,C5275,HCPCS,,,,,both,, ,2393.60,1436.16,Aetna,Commercial,,2393.60,29.8,29.8% of Medicare Base rate X weight,2393.60,803.22,7132.93,Fee Schedule,29.8
LC S SUB F/NK/HF/G EA,C5276,HCPCS,,,,,both,, ,2393.60,1436.16,Aetna,Commercial,,2393.60,29.8,29.8% of Medicare Base rate X weight,2393.60,803.22,7132.93,Fee Schedule,29.8
LC S SUB F/NK/HF/G 100SQ,C5277,HCPCS,,,,,both,, ,2393.60,1436.16,Aetna,Commercial,,2393.60,29.8,29.8% of Medicare Base rate X weight,2393.60,803.22,7132.93,Fee Schedule,29.8
LC S SUB F/NK/HF/G EA,C5278,HCPCS,,,,,both,, ,2393.60,1436.16,Aetna,Commercial,,2393.60,29.8,29.8% of Medicare Base rate X weight,2393.60,803.22,7132.93,Fee Schedule,29.8
MRA-ABDOMEN W,C8900,HCPCS,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,1035.69,29.8,29.8% of Medicare Base rate X weight,1035.69,347.55,3086.36,Fee Schedule,29.8
MRA-ABDOMEN W,C8900,HCPCS,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,1114.55,29.8,29.8% of Medicare Base rate X weight,1114.55,374.01,3321.36,Fee Schedule,29.8
MRA-ABDOMEN WO,C8901,HCPCS,,,,,both,, ,715.99,429.59,Aetna,Commercial,,715.99,29.8,29.8% of Medicare Base rate X weight,715.99,240.27,2133.65,Fee Schedule,29.8
MRA-ABDOMEN WO,C8901,HCPCS,,,,,both,, ,770.45,462.27,Aetna,Commercial,,770.45,29.8,29.8% of Medicare Base rate X weight,770.45,258.54,2295.94,Fee Schedule,29.8
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,1197.08,29.8,29.8% of Medicare Base rate X weight,1197.08,401.70,3567.3,Fee Schedule,29.8
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,1288.29,29.8,29.8% of Medicare Base rate X weight,1288.29,432.31,3839.1,Fee Schedule,29.8
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,2669.78,1601.86,Aetna,Commercial,,2669.78,29.8,29.8% of Medicare Base rate X weight,2669.78,895.90,7955.94,Fee Schedule,29.8
MR-BREAST UNI WWO,C8905,HCPCS,,,,,both,, ,3114.65,1868.79,Aetna,Commercial,,3114.65,29.8,29.8% of Medicare Base rate X weight,3114.65,1045.18,9281.66,Fee Schedule,29.8
MR-BREAST BI WWO,C8908,HCPCS,,,,,both,, ,3115.20,1869.12,Aetna,Commercial,,3115.20,29.8,29.8% of Medicare Base rate X weight,3115.20,1045.37,9283.3,Fee Schedule,29.8
MRA-LW EXTR WWO,C8914,HCPCS,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,1197.08,29.8,29.8% of Medicare Base rate X weight,1197.08,401.70,3567.3,Fee Schedule,29.8
MRA-LW EXTR WWO,C8914,HCPCS,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,1288.29,29.8,29.8% of Medicare Base rate X weight,1288.29,432.31,3839.1,Fee Schedule,29.8
MRA-LW EXTR WWO BI,C8914,HCPCS,,,,,both,, ,2394.15,1436.49,Aetna,Commercial,,2394.15,29.8,29.8% of Medicare Base rate X weight,2394.15,803.41,7134.57,Fee Schedule,29.8
MRA-LW EXTR WWO BI,C8914,CPT,,,,,both,, ,2576.60,1545.96,Aetna,Commercial,,2576.60,29.8,29.8% of Medicare Base rate X weight,2576.60,864.63,7678.27,Fee Schedule,29.8
BR-CAD MRI LESION,C8937,HCPCS,,,,,both,, ,50.52,30.31,Aetna,Commercial,,50.52,29.8,29.8% of Medicare Base rate X weight,50.52,16.95,150.55,Fee Schedule,29.8
COCAINE HCL NASL 1MG,C9046,HCPCS,,,,,both,4,ML,8.00,4.80,Aetna,Commercial,,8.00,29.8,29.8% of Medicare Base rate X weight,8.00,2.68,23.84,Fee Schedule,29.8
IDARUCIZU 2.5GM/50ML,C9399,HCPCS,,,,,both,50,ML,10077.78,6046.66,Aetna,Commercial,,10077.78,29.8,29.8% of Medicare Base rate X weight,10077.78,3381.81,30031.78,Fee Schedule,29.8
REMDESIV 5MG/ML 20ML,C9399,HCPCS,,,,,both,, ,2878.85,1727.31,Aetna,Commercial,,2878.85,29.8,29.8% of Medicare Base rate X weight,2878.85,966.06,8578.97,Fee Schedule,29.8
IC-PRQ DE COR STNT,C9600,CPT,,,,,both,, ,42411.02,25446.61,Aetna,Commercial,,42411.02,29.8,29.8% of Medicare Base rate X weight,42411.02,14231.89,126384.84,Fee Schedule,29.8
IC-PRQ DE CR REV CAB,C9604,CPT,,,,,both,, ,29428.39,17657.03,Aetna,Commercial,,29428.39,29.8,29.8% of Medicare Base rate X weight,29428.39,9875.30,87696.6,Fee Schedule,29.8
ADMIN FLU VACCINE,G0008,HCPCS,,,,,both,, ,106.25,63.75,Aetna,Commercial,,106.25,29.8,29.8% of Medicare Base rate X weight,106.25,35.65,316.63,Fee Schedule,29.8
ADMIN FLU VACCINE,G0008,HCPCS,,,,,both,, ,106.25,63.75,Aetna,Commercial,,106.25,29.8,29.8% of Medicare Base rate X weight,106.25,35.65,316.63,Fee Schedule,29.8
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,70.81,42.48,Aetna,Commercial,,70.81,29.8,29.8% of Medicare Base rate X weight,70.81,23.76,211.01,Fee Schedule,29.8
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,70.81,42.48,Aetna,Commercial,,70.81,29.8,29.8% of Medicare Base rate X weight,70.81,23.76,211.01,Fee Schedule,29.8
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,109.18,65.50,Aetna,Commercial,,109.18,29.8,29.8% of Medicare Base rate X weight,109.18,36.64,325.36,Fee Schedule,29.8
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,143.69,86.21,Aetna,Commercial,,143.69,29.8,29.8% of Medicare Base rate X weight,143.69,48.22,428.2,Fee Schedule,29.8
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,184.63,110.77,Aetna,Commercial,,184.63,29.8,29.8% of Medicare Base rate X weight,184.63,61.96,550.2,Fee Schedule,29.8
ADMIN PNEU VACCINE,G0009,HCPCS,,,,,both,, ,106.25,63.75,Aetna,Commercial,,106.25,29.8,29.8% of Medicare Base rate X weight,106.25,35.65,316.63,Fee Schedule,29.8
ADMIN PNEU VACCINE,G0009,HCPCS,,,,,both,, ,106.25,63.75,Aetna,Commercial,,106.25,29.8,29.8% of Medicare Base rate X weight,106.25,35.65,316.63,Fee Schedule,29.8
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,109.18,65.50,Aetna,Commercial,,109.18,29.8,29.8% of Medicare Base rate X weight,109.18,36.64,325.36,Fee Schedule,29.8
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,143.69,86.21,Aetna,Commercial,,143.69,29.8,29.8% of Medicare Base rate X weight,143.69,48.22,428.2,Fee Schedule,29.8
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,184.63,110.77,Aetna,Commercial,,184.63,29.8,29.8% of Medicare Base rate X weight,184.63,61.96,550.2,Fee Schedule,29.8
HEP B VACCINE ADMIN,G0010,HCPCS,,,,,both,, ,106.25,63.75,Aetna,Commercial,,106.25,29.8,29.8% of Medicare Base rate X weight,106.25,35.65,316.63,Fee Schedule,29.8
HEP B VACCINE ADMIN,G0010,HCPCS,,,,,both,, ,106.25,63.75,Aetna,Commercial,,106.25,29.8,29.8% of Medicare Base rate X weight,106.25,35.65,316.63,Fee Schedule,29.8
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,105.06,63.03,Aetna,Commercial,,105.06,29.8,29.8% of Medicare Base rate X weight,105.06,35.26,313.08,Fee Schedule,29.8
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,109.44,65.66,Aetna,Commercial,,109.44,29.8,29.8% of Medicare Base rate X weight,109.44,36.72,326.13,Fee Schedule,29.8
PSA SCRN TO LABCORP,G0103,HCPCS,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
PSA SCRN TO LABCORP,G0103,HCPCS,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
"PSA, SCREENING",G0103,HCPCS,,,,,both,, ,135.85,81.51,Aetna,Commercial,,135.85,29.8,29.8% of Medicare Base rate X weight,135.85,45.59,404.83,Fee Schedule,29.8
"PSA, SCREENING",G0103,HCPCS,,,,,both,,,1036.25,1036.25,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
DSMT INDIVIDUAL 30M,G0108,HCPCS,,,,,both,, ,261.62,156.97,Aetna,Commercial,,261.62,29.8,29.8% of Medicare Base rate X weight,261.62,87.79,779.63,Fee Schedule,29.8
PAP THINLAY LIQ SCRN,G0123,HCPCS,,,,,both,, ,195.06,117.03,Aetna,Commercial,,195.06,29.8,29.8% of Medicare Base rate X weight,195.06,65.46,581.28,Fee Schedule,29.8
STRNGTH TRN SLG 15MI,G0237,HCPCS,,,,,both,, ,177.16,106.29,Aetna,Commercial,,177.16,29.8,29.8% of Medicare Base rate X weight,177.16,59.45,527.94,Fee Schedule,29.8
RESP FX TRN SGL 15MN,G0238,HCPCS,,,,,both,, ,177.16,106.29,Aetna,Commercial,,177.16,29.8,29.8% of Medicare Base rate X weight,177.16,59.45,527.94,Fee Schedule,29.8
RESP FX TRAIN GROUP,G0239,HCPCS,,,,,both,, ,177.16,106.29,Aetna,Commercial,,177.16,29.8,29.8% of Medicare Base rate X weight,177.16,59.45,527.94,Fee Schedule,29.8
DIALYSIS  EMERGENT,G0257,HCPCS,,,,,both,, ,9908.34,5945.00,Aetna,Commercial,,9908.34,29.8,29.8% of Medicare Base rate X weight,9908.34,3324.95,29526.85,Fee Schedule,29.8
IR-ARTHROGRAM SI JTS,G0260,HCPCS,,,,,both,, ,2101.41,1260.84,Aetna,Commercial,,2101.41,29.8,29.8% of Medicare Base rate X weight,2101.41,705.17,6262.2,Fee Schedule,29.8
CC-PLACE CLOS DEV,G0269,HCPCS,,,,,both,, ,22097.11,13258.26,Aetna,Commercial,,22097.11,29.8,29.8% of Medicare Base rate X weight,22097.11,7415.14,65849.39,Fee Schedule,29.8
HBO FB 30MN,G0277,HCPCS,,,,,both,, ,265.23,159.13,Aetna,Commercial,,265.23,29.8,29.8% of Medicare Base rate X weight,265.23,89.00,790.39,Fee Schedule,29.8
BR-TOMO MAMMO BI,G0279,HCPCS,,,,,both,,,160.68,160.68,Aetna,Commercial,,160.68,29.8,29.8% of Medicare Base rate X weight,160.68,53.92,478.83,Fee Schedule,29.8
BR-TOMO MAMMO BI,G0279,HCPCS,,,,,both,, ,160.68,96.40,Aetna,Commercial,,160.68,29.8,29.8% of Medicare Base rate X weight,160.68,53.92,478.83,Fee Schedule,29.8
BR-TOMO MAMMO UNI,G0279,HCPCS,,,,,both,,,133.90,133.90,Aetna,Commercial,,133.90,29.8,29.8% of Medicare Base rate X weight,133.90,44.93,399.02,Fee Schedule,29.8
BR-TOMO MAMMO UNI,G0279,HCPCS,,,,,both,, ,133.90,80.34,Aetna,Commercial,,133.90,29.8,29.8% of Medicare Base rate X weight,133.90,44.93,399.02,Fee Schedule,29.8
ELEC STIM-UNATTND-VI,G0283,HCPCS,,,,,both,, ,443.37,266.02,Aetna,Commercial,,443.37,29.8,29.8% of Medicare Base rate X weight,443.37,148.78,1321.24,Fee Schedule,29.8
ELEC STIM-UNATTND-VI,G0283,HCPCS,,,,,both,, ,480.68,288.40,Aetna,Commercial,,480.68,29.8,29.8% of Medicare Base rate X weight,480.68,161.30,1432.43,Fee Schedule,29.8
ELEC STM-UNATVI COTA,G0283,HCPCS,,,,,both,, ,37.08,22.24,Aetna,Commercial,,37.08,29.8,29.8% of Medicare Base rate X weight,37.08,12.44,110.5,Fee Schedule,29.8
ELEC STM-UNATVI COTA,G0283,HCPCS,,,,,both,, ,37.08,22.24,Aetna,Commercial,,37.08,29.8,29.8% of Medicare Base rate X weight,37.08,12.44,110.5,Fee Schedule,29.8
ELEC STM-UNATVI COTA,G0283,HCPCS,,,,,both,, ,37.08,22.24,Aetna,Commercial,,37.08,29.8,29.8% of Medicare Base rate X weight,37.08,12.44,110.5,Fee Schedule,29.8
ELEC STM-UNATVI COTA,G0283,HCPCS,,,,,both,, ,37.08,22.24,Aetna,Commercial,,37.08,29.8,29.8% of Medicare Base rate X weight,37.08,12.44,110.5,Fee Schedule,29.8
ELEC STM-UNATVI COTA,G0283,HCPCS,,,,,both,, ,515.00,309.00,Aetna,Commercial,,515.00,29.8,29.8% of Medicare Base rate X weight,515.00,172.82,1534.7,Fee Schedule,29.8
ELEC STM-UNATVI COTA,G0283,HCPCS,,,,,both,, ,515.00,309.00,Aetna,Commercial,,515.00,29.8,29.8% of Medicare Base rate X weight,515.00,172.82,1534.7,Fee Schedule,29.8
ELEC STM-UNAT-VI PTA,G0283,HCPCS,,,,,both,, ,474.83,284.89,Aetna,Commercial,,474.83,29.8,29.8% of Medicare Base rate X weight,474.83,159.34,1414.99,Fee Schedule,29.8
ELEC STM-UNAT-VI PTA,G0283,HCPCS,,,,,both,, ,474.83,284.89,Aetna,Commercial,,474.83,29.8,29.8% of Medicare Base rate X weight,474.83,159.34,1414.99,Fee Schedule,29.8
SCR FECAL OC BLD 1-3,G0328,HCPCS,,,,,both,, ,159.42,95.65,Aetna,Commercial,,159.42,29.8,29.8% of Medicare Base rate X weight,159.42,53.50,475.07,Fee Schedule,29.8
L&D OBSERV 1ST HOUR,G0378,CPT,,,,,both,, ,1189.39,713.63,Aetna,Commercial,,1189.39,29.8,29.8% of Medicare Base rate X weight,1189.39,399.12,3544.38,Fee Schedule,29.8
L&D OBSERV 1ST HOUR,G0378,CPT,,,,,both,, ,1189.39,713.63,Aetna,Commercial,,1189.39,29.8,29.8% of Medicare Base rate X weight,1189.39,399.12,3544.38,Fee Schedule,29.8
L&D OBSERV ADDL HOUR,G0378,CPT,,,,,both,, ,151.15,90.69,Aetna,Commercial,,151.15,29.8,29.8% of Medicare Base rate X weight,151.15,50.72,450.43,Fee Schedule,29.8
L&D OBSERV ADDL HOUR,G0378,CPT,,,,,both,, ,151.15,90.69,Aetna,Commercial,,151.15,29.8,29.8% of Medicare Base rate X weight,151.15,50.72,450.43,Fee Schedule,29.8
OBSRVATION ADDL HOUR,G0378,HCPCS,,,,,both,, ,141.21,84.72,Aetna,Commercial,,141.21,29.8,29.8% of Medicare Base rate X weight,141.21,47.39,420.81,Fee Schedule,29.8
DIRECT ADMIT TO OBS,G0379,HCPCS,,,,,both,, ,610.15,366.09,Aetna,Commercial,,610.15,29.8,29.8% of Medicare Base rate X weight,610.15,204.75,1818.25,Fee Schedule,29.8
L&D DIRECT ADMIT OBS,G0379,HCPCS,,,,,both,, ,653.54,392.12,Aetna,Commercial,,653.54,29.8,29.8% of Medicare Base rate X weight,653.54,219.31,1947.55,Fee Schedule,29.8
L&D DIRECT ADMIT OBS,G0379,HCPCS,,,,,both,, ,653.54,392.12,Aetna,Commercial,,653.54,29.8,29.8% of Medicare Base rate X weight,653.54,219.31,1947.55,Fee Schedule,29.8
HOME SLEEP TYPE 3,G0399,HCPCS,,,,,both,, ,428.48,257.08,Aetna,Commercial,,428.48,29.8,29.8% of Medicare Base rate X weight,428.48,143.79,1276.87,Fee Schedule,29.8
HOME SLEEP TYPE 3,G0399,HCPCS,,,,,both,, ,428.48,257.08,Aetna,Commercial,,428.48,29.8,29.8% of Medicare Base rate X weight,428.48,143.79,1276.87,Fee Schedule,29.8
PROSTATE NDL BX ANY,G0416,HCPCS,,,,,both,, ,1059.54,635.72,Aetna,Commercial,,1059.54,29.8,29.8% of Medicare Base rate X weight,1059.54,355.55,3157.43,Fee Schedule,29.8
HIV-1 AB EIA,G0432,HCPCS,,,,,both,, ,113.39,68.03,Aetna,Commercial,,113.39,29.8,29.8% of Medicare Base rate X weight,113.39,38.05,337.9,Fee Schedule,29.8
HIV1 AG HIV1 HIV2 AB,G0433,CPT,,,,,both,, ,165.59,99.35,Aetna,Commercial,,165.59,29.8,29.8% of Medicare Base rate X weight,165.59,55.57,493.46,Fee Schedule,29.8
HIV1-HIV2 AB SNG RES,G0435,CPT,,,,,both,, ,42.66,25.59,Aetna,Commercial,,42.66,29.8,29.8% of Medicare Base rate X weight,42.66,14.32,127.13,Fee Schedule,29.8
HIV1-HIV2 AB SNG RES,G0435,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,1036.25,29.8,29.8% of Medicare Base rate X weight,1036.25,347.73,3088.03,Fee Schedule,29.8
EVAL & MGMT LEVEL 3,G0463,HCPCS,,,,,both,, ,215.75,129.45,Aetna,Commercial,,215.75,29.8,29.8% of Medicare Base rate X weight,215.75,72.40,642.94,Fee Schedule,29.8
EVAL & MGMT LEVEL 5,G0463,HCPCS,,,,,both,, ,261.00,156.60,Aetna,Commercial,,261.00,29.8,29.8% of Medicare Base rate X weight,261.00,87.58,777.78,Fee Schedule,29.8
HOSPITAL OUTPT VISIT,G0463,HCPCS,,,,,both,, ,520.00,312.00,Aetna,Commercial,,520.00,29.8,29.8% of Medicare Base rate X weight,520.00,174.50,1549.6,Fee Schedule,29.8
LEVEL 1 EP,G0463,HCPCS,,,,,both,, ,249.52,149.71,Aetna,Commercial,,249.52,29.8,29.8% of Medicare Base rate X weight,249.52,83.73,743.57,Fee Schedule,29.8
LEVEL 2 EP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Aetna,Commercial,,188.75,29.8,29.8% of Medicare Base rate X weight,188.75,63.34,562.48,Fee Schedule,29.8
LEVEL 2 NP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Aetna,Commercial,,188.75,29.8,29.8% of Medicare Base rate X weight,188.75,63.34,562.48,Fee Schedule,29.8
LEVEL 3 NP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Aetna,Commercial,,188.75,29.8,29.8% of Medicare Base rate X weight,188.75,63.34,562.48,Fee Schedule,29.8
LEVEL 4 NP,G0463,HCPCS,,,,,both,, ,251.84,151.10,Aetna,Commercial,,251.84,29.8,29.8% of Medicare Base rate X weight,251.84,84.51,750.48,Fee Schedule,29.8
LEVEL 4 NP,G0463,HCPCS,,,,,both,, ,251.84,151.10,Aetna,Commercial,,251.84,29.8,29.8% of Medicare Base rate X weight,251.84,84.51,750.48,Fee Schedule,29.8
LEVEL 4 NP,G0463,HCPCS,,,,,both,, ,251.84,151.10,Aetna,Commercial,,251.84,29.8,29.8% of Medicare Base rate X weight,251.84,84.51,750.48,Fee Schedule,29.8
LEVEL 4 NP,G0463,HCPCS,,,,,both,, ,251.84,151.10,Aetna,Commercial,,251.84,29.8,29.8% of Medicare Base rate X weight,251.84,84.51,750.48,Fee Schedule,29.8
LEVEL 5 EP,G0463,HCPCS,,,,,both,, ,425.91,255.54,Aetna,Commercial,,425.91,29.8,29.8% of Medicare Base rate X weight,425.91,142.92,1269.21,Fee Schedule,29.8
LEVEL 5 NP,G0463,HCPCS,,,,,both,, ,324.19,194.51,Aetna,Commercial,,324.19,29.8,29.8% of Medicare Base rate X weight,324.19,108.79,966.09,Fee Schedule,29.8
LEVEL 5 NP,G0463,HCPCS,,,,,both,, ,324.19,194.51,Aetna,Commercial,,324.19,29.8,29.8% of Medicare Base rate X weight,324.19,108.79,966.09,Fee Schedule,29.8
OB TRIAGE LVL 1 EP,G0463,HCPCS,,,,,both,, ,700.40,420.24,Aetna,Commercial,,700.40,29.8,29.8% of Medicare Base rate X weight,700.40,235.03,2087.19,Fee Schedule,29.8
PAT EVAL/MGM LEVEL 2,G0463,HCPCS,,,,,both,, ,325.25,195.15,Aetna,Commercial,,325.25,29.8,29.8% of Medicare Base rate X weight,325.25,109.14,969.25,Fee Schedule,29.8
PAT EVAL/MGM LEVEL 3,G0463,HCPCS,,,,,both,, ,379.50,227.70,Aetna,Commercial,,379.50,29.8,29.8% of Medicare Base rate X weight,379.50,127.35,1130.91,Fee Schedule,29.8
PAT EVAL/MGM LEVEL 4,G0463,HCPCS,,,,,both,, ,433.50,260.10,Aetna,Commercial,,433.50,29.8,29.8% of Medicare Base rate X weight,433.50,145.47,1291.83,Fee Schedule,29.8
PAT EVAL/MGM LEVEL 5,G0463,HCPCS,,,,,both,, ,487.50,292.50,Aetna,Commercial,,487.50,29.8,29.8% of Medicare Base rate X weight,487.50,163.59,1452.75,Fee Schedule,29.8
PHYSICAL-EMPLOYMENT,G0463,HCPCS,,,,,both,, ,55.62,33.37,Aetna,Commercial,,55.62,29.8,29.8% of Medicare Base rate X weight,55.62,18.66,165.75,Fee Schedule,29.8
PHYSICAL-EMPLOYMENT,G0463,HCPCS,,,,,both,, ,55.62,33.37,Aetna,Commercial,,55.62,29.8,29.8% of Medicare Base rate X weight,55.62,18.66,165.75,Fee Schedule,29.8
PHYSICAL-SCHOOL,G0463,HCPCS,,,,,both,, ,66.95,40.17,Aetna,Commercial,,66.95,29.8,29.8% of Medicare Base rate X weight,66.95,22.47,199.51,Fee Schedule,29.8
PHYSICAL-SCHOOL,G0463,HCPCS,,,,,both,, ,66.95,40.17,Aetna,Commercial,,66.95,29.8,29.8% of Medicare Base rate X weight,66.95,22.47,199.51,Fee Schedule,29.8
PSYCH CLINIC TYPE A,G0463,HCPCS,,,,,both,, ,294.25,176.55,Aetna,Commercial,,294.25,29.8,29.8% of Medicare Base rate X weight,294.25,98.74,876.87,Fee Schedule,29.8
SUTURE REMOVAL,G0463,HCPCS,,,,,both,, ,132.61,79.56,Aetna,Commercial,,132.61,29.8,29.8% of Medicare Base rate X weight,132.61,44.50,395.18,Fee Schedule,29.8
SUTURE REMOVAL,G0463,HCPCS,,,,,both,, ,132.61,79.56,Aetna,Commercial,,132.61,29.8,29.8% of Medicare Base rate X weight,132.61,44.50,395.18,Fee Schedule,29.8
URG CARE L1 EP PROF,G0463,HCPCS,,,,,both,, ,60.50,36.30,Aetna,Commercial,,60.50,29.8,29.8% of Medicare Base rate X weight,60.50,20.30,180.29,Fee Schedule,29.8
URG CARE L2 EP PROF,G0463,HCPCS,,,,,both,, ,123.25,73.95,Aetna,Commercial,,123.25,29.8,29.8% of Medicare Base rate X weight,123.25,41.36,367.29,Fee Schedule,29.8
URG CARE L2 EP PROF,G0463,HCPCS,,,,,both,, ,123.25,73.95,Aetna,Commercial,,123.25,29.8,29.8% of Medicare Base rate X weight,123.25,41.36,367.29,Fee Schedule,29.8
URG CARE L2 NP PROF,G0463,HCPCS,,,,,both,, ,213.00,127.80,Aetna,Commercial,,213.00,29.8,29.8% of Medicare Base rate X weight,213.00,71.48,634.74,Fee Schedule,29.8
URG CARE L3 EP PROF,G0463,HCPCS,,,,,both,, ,209.75,125.85,Aetna,Commercial,,209.75,29.8,29.8% of Medicare Base rate X weight,209.75,70.39,625.06,Fee Schedule,29.8
URG CARE L3 NP PROF,G0463,HCPCS,,,,,both,, ,312.50,187.50,Aetna,Commercial,,312.50,29.8,29.8% of Medicare Base rate X weight,312.50,104.87,931.25,Fee Schedule,29.8
URG CARE L4 EP PROF,G0463,HCPCS,,,,,both,, ,309.25,185.55,Aetna,Commercial,,309.25,29.8,29.8% of Medicare Base rate X weight,309.25,103.78,921.57,Fee Schedule,29.8
URG CARE L4 NP PROF,G0463,HCPCS,,,,,both,, ,483.50,290.10,Aetna,Commercial,,483.50,29.8,29.8% of Medicare Base rate X weight,483.50,162.25,1440.83,Fee Schedule,29.8
URG CARE L5 EP PROF,G0463,HCPCS,,,,,both,, ,414.25,248.55,Aetna,Commercial,,414.25,29.8,29.8% of Medicare Base rate X weight,414.25,139.01,1234.47,Fee Schedule,29.8
URG CARE L5 NP PROF,G0463,HCPCS,,,,,both,, ,602.50,361.50,Aetna,Commercial,,602.50,29.8,29.8% of Medicare Base rate X weight,602.50,202.18,1795.45,Fee Schedule,29.8
URGENT CARE LVL 2 NP,G0463,HCPCS,,,,,both,, ,234.07,140.44,Aetna,Commercial,,234.07,29.8,29.8% of Medicare Base rate X weight,234.07,78.55,697.53,Fee Schedule,29.8
URGENT CARE LVL 2 NP,G0463,HCPCS,,,,,both,, ,234.07,140.44,Aetna,Commercial,,234.07,29.8,29.8% of Medicare Base rate X weight,234.07,78.55,697.53,Fee Schedule,29.8
URGENT CARE LVL 3 EP,G0463,HCPCS,,,,,both,, ,281.71,169.02,Aetna,Commercial,,281.71,29.8,29.8% of Medicare Base rate X weight,281.71,94.53,839.5,Fee Schedule,29.8
URGENT CARE LVL 3 EP,G0463,HCPCS,,,,,both,, ,281.71,169.02,Aetna,Commercial,,281.71,29.8,29.8% of Medicare Base rate X weight,281.71,94.53,839.5,Fee Schedule,29.8
URGENT CARE LVL 3 NP,G0463,HCPCS,,,,,both,, ,261.88,157.12,Aetna,Commercial,,261.88,29.8,29.8% of Medicare Base rate X weight,261.88,87.88,780.4,Fee Schedule,29.8
URGENT CARE LVL 3 NP,G0463,HCPCS,,,,,both,, ,261.88,157.12,Aetna,Commercial,,261.88,29.8,29.8% of Medicare Base rate X weight,261.88,87.88,780.4,Fee Schedule,29.8
URGENT CARE LVL 4 EP,G0463,HCPCS,,,,,both,, ,311.83,187.09,Aetna,Commercial,,311.83,29.8,29.8% of Medicare Base rate X weight,311.83,104.64,929.25,Fee Schedule,29.8
URGENT CARE LVL 4 EP,G0463,HCPCS,,,,,both,, ,311.83,187.09,Aetna,Commercial,,311.83,29.8,29.8% of Medicare Base rate X weight,311.83,104.64,929.25,Fee Schedule,29.8
URGENT CARE LVL 4 NP,G0463,HCPCS,,,,,both,, ,289.69,173.81,Aetna,Commercial,,289.69,29.8,29.8% of Medicare Base rate X weight,289.69,97.21,863.28,Fee Schedule,29.8
URGENT CARE LVL 4 NP,G0463,HCPCS,,,,,both,, ,289.69,173.81,Aetna,Commercial,,289.69,29.8,29.8% of Medicare Base rate X weight,289.69,97.21,863.28,Fee Schedule,29.8
URGENT CARE LVL 5 NP,G0463,HCPCS,,,,,both,, ,317.50,190.50,Aetna,Commercial,,317.50,29.8,29.8% of Medicare Base rate X weight,317.50,106.54,946.15,Fee Schedule,29.8
URGENT CARE LVL 5 NP,G0463,HCPCS,,,,,both,, ,317.50,190.50,Aetna,Commercial,,317.50,29.8,29.8% of Medicare Base rate X weight,317.50,106.54,946.15,Fee Schedule,29.8
URGENT CARE LVL 5 NP,G0463,HCPCS,,,,,both,, ,317.50,190.50,Aetna,Commercial,,317.50,29.8,29.8% of Medicare Base rate X weight,317.50,106.54,946.15,Fee Schedule,29.8
URGENT CARE LVL 5 NP,G0463,HCPCS,,,,,both,, ,317.50,190.50,Aetna,Commercial,,317.50,29.8,29.8% of Medicare Base rate X weight,317.50,106.54,946.15,Fee Schedule,29.8
URGENT CARE- SUT REM,G0463,HCPCS,,,,,both,, ,239.73,143.83,Aetna,Commercial,,239.73,29.8,29.8% of Medicare Base rate X weight,239.73,80.45,714.4,Fee Schedule,29.8
URGENT CARE- SUT REM,G0463,HCPCS,,,,,both,, ,239.73,143.83,Aetna,Commercial,,239.73,29.8,29.8% of Medicare Base rate X weight,239.73,80.45,714.4,Fee Schedule,29.8
URGENT CARE- SUT REM,G0463,HCPCS,,,,,both,, ,239.73,143.83,Aetna,Commercial,,239.73,29.8,29.8% of Medicare Base rate X weight,239.73,80.45,714.4,Fee Schedule,29.8
URGENT CARE- SUT REM,G0463,HCPCS,,,,,both,, ,239.73,143.83,Aetna,Commercial,,239.73,29.8,29.8% of Medicare Base rate X weight,239.73,80.45,714.4,Fee Schedule,29.8
EVAL & MGMT LEVEL 4,G0463,HCPCS,,,,,Outpatient,, ,237.25,142.35,Aetna,Commercial,,237.25,29.8,29.8% of Medicare Base rate X weight,237.25,79.61,707.01,Fee Schedule,29.8
"New patient office of other outpatient visit, typically 60 min",G0463,HCPCS,,,,,Outpatient,,,317.50,317.50,Aetna,Commercial,,317.50,29.8,29.8% of Medicare Base rate X weight,317.50,106.54,946.15,Fee Schedule,29.8
"New patient office of other outpatient visit, typically 45 min",G0463,HCPCS,,,,,Outpatient,,,289.69,289.69,Aetna,Commercial,,289.69,29.8,29.8% of Medicare Base rate X weight,289.69,97.21,863.28,Fee Schedule,29.8
"New patient office or other outpatient visit, typically 30 min",G0463,HCPCS,,,,,Outpatient,,,261.88,261.88,Aetna,Commercial,,261.88,29.8,29.8% of Medicare Base rate X weight,261.88,87.88,780.4,Fee Schedule,29.8
HIV1 AG W HIV 1 2 AB,G0475,HCPCS,,,,,both,, ,166.16,99.69,Aetna,Commercial,,166.16,29.8,29.8% of Medicare Base rate X weight,166.16,55.76,495.16,Fee Schedule,29.8
HEPB SCR HI RSK NPRG,G0499,HCPCS,,,,,both,, ,570.04,342.02,Aetna,Commercial,,570.04,29.8,29.8% of Medicare Base rate X weight,570.04,191.29,1698.72,Fee Schedule,29.8
ABCIXIMAB 10MG,J0130,HCPCS,,,,,both,, ,4719.72,2831.83,Aetna,Commercial,,4719.72,29.8,29.8% of Medicare Base rate X weight,4719.72,1583.80,14064.77,Fee Schedule,29.8
ACETAMINO 10MG INJ,J0131,HCPCS,,,,,both,100,ML,3.00,1.80,Aetna,Commercial,,3.00,29.8,29.8% of Medicare Base rate X weight,3.00,1.01,8.94,Fee Schedule,29.8
ACTYLCYSTN INJ 100MG,J0132,HCPCS,,,,,both,30,ML,17.77,10.66,Aetna,Commercial,,17.77,29.8,29.8% of Medicare Base rate X weight,17.77,5.96,52.95,Fee Schedule,29.8
ACYCLOVIR 5MG INJ,J0133,HCPCS,,,,,both,, ,0.31,0.18,Aetna,Commercial,,0.31,29.8,29.8% of Medicare Base rate X weight,0.31,0.10,0.92,Fee Schedule,29.8
ACYCLOVIR 5MG INJ,J0133,HCPCS,,,,,both,10,ML,1.03,0.61,Aetna,Commercial,,1.03,29.8,29.8% of Medicare Base rate X weight,1.03,0.35,3.07,Fee Schedule,29.8
ADENOSINE 1MG INJ,J0153,HCPCS,,,,,both,4,ML,15.45,9.27,Aetna,Commercial,,15.45,29.8,29.8% of Medicare Base rate X weight,15.45,5.18,46.04,Fee Schedule,29.8
ADENOSINE 1MG INJ,J0153,HCPCS,,,,,both,4,ML,15.45,9.27,Aetna,Commercial,,15.45,29.8,29.8% of Medicare Base rate X weight,15.45,5.18,46.04,Fee Schedule,29.8
ADRENL/EPINEP 0.1MG,J0171,HCPCS,,,,,both,1,ML,2.68,1.60,Aetna,Commercial,,2.68,29.8,29.8% of Medicare Base rate X weight,2.68,0.90,7.99,Fee Schedule,29.8
ADRENL/EPINEP 0.1MG,J0171,HCPCS,,,,,both,10,ML,8.65,5.19,Aetna,Commercial,,8.65,29.8,29.8% of Medicare Base rate X weight,8.65,2.90,25.78,Fee Schedule,29.8
EPINEPHRINE INJ 30MG/30ML (1 MG/ML),J0171,HCPCS,,,,,both,30,ML,4.00,2.40,Aetna,Commercial,,4.00,29.8,29.8% of Medicare Base rate X weight,4.00,1.34,11.92,Fee Schedule,29.8
REMDESIVIR 1MG INJ,J0248,HCPCS,,,,,both,1,EA,28.00,16.80,Aetna,Commercial,,28.00,29.8,29.8% of Medicare Base rate X weight,28.00,9.40,83.44,Fee Schedule,29.8
AMKCN SULF INJ 100MG,J0278,HCPCS,,,,,both,2,ML,5.56,3.33,Aetna,Commercial,,5.56,29.8,29.8% of Medicare Base rate X weight,5.56,1.87,16.57,Fee Schedule,29.8
AMINOPHYLL 250MG INJ,J0280,HCPCS,,,,,both,20,ML,58.97,35.38,Aetna,Commercial,,58.97,29.8,29.8% of Medicare Base rate X weight,58.97,19.79,175.73,Fee Schedule,29.8
AMINOPHYLL 250MG INJ,J0280,HCPCS,,,,,both,10,ML,96.31,57.78,Aetna,Commercial,,96.31,29.8,29.8% of Medicare Base rate X weight,96.31,32.32,287,Fee Schedule,29.8
AMIODARONE 30MG INJ,J0282,HCPCS,,,,,both,18,ML,5.15,3.09,Aetna,Commercial,,5.15,29.8,29.8% of Medicare Base rate X weight,5.15,1.73,15.35,Fee Schedule,29.8
AMIODARONE 30MG INJ,J0282,HCPCS,,,,,both,3,ML,6.39,3.83,Aetna,Commercial,,6.39,29.8,29.8% of Medicare Base rate X weight,6.39,2.14,19.04,Fee Schedule,29.8
AMPHOTER B 50MG INJ,J0285,HCPCS,,,,,both,, ,321.36,192.81,Aetna,Commercial,,321.36,29.8,29.8% of Medicare Base rate X weight,321.36,107.84,957.65,Fee Schedule,29.8
AMPHOTER B LIPO 10MG,J0289,HCPCS,,,,,both,1,EA,211.15,126.69,Aetna,Commercial,,211.15,29.8,29.8% of Medicare Base rate X weight,211.15,70.86,629.23,Fee Schedule,29.8
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,17.00,10.20,Aetna,Commercial,,17.00,29.8,29.8% of Medicare Base rate X weight,17.00,5.70,50.66,Fee Schedule,29.8
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,26.78,16.06,Aetna,Commercial,,26.78,29.8,29.8% of Medicare Base rate X weight,26.78,8.99,79.8,Fee Schedule,29.8
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,26.78,16.06,Aetna,Commercial,,26.78,29.8,29.8% of Medicare Base rate X weight,26.78,8.99,79.8,Fee Schedule,29.8
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,57.94,34.76,Aetna,Commercial,,57.94,29.8,29.8% of Medicare Base rate X weight,57.94,19.44,172.66,Fee Schedule,29.8
AMPICILLIN/SUB 1.5GM,J0295,HCPCS,,,,,both,1,EA,23.69,14.21,Aetna,Commercial,,23.69,29.8,29.8% of Medicare Base rate X weight,23.69,7.95,70.6,Fee Schedule,29.8
AMPICILLIN/SUB 1.5GM,J0295,HCPCS,,,,,both,, ,63.09,37.85,Aetna,Commercial,,63.09,29.8,29.8% of Medicare Base rate X weight,63.09,21.17,188.01,Fee Schedule,29.8
SUCCINYLCHN 20MG INJ,J0330,HCPCS,,,,,both,10,ML,13.00,7.80,Aetna,Commercial,,13.00,29.8,29.8% of Medicare Base rate X weight,13.00,4.36,38.74,Fee Schedule,29.8
SUCCINYLCHN 20MG INJ,J0330,HCPCS,,,,,both,, ,20.34,12.20,Aetna,Commercial,,20.34,29.8,29.8% of Medicare Base rate X weight,20.34,6.83,60.61,Fee Schedule,29.8
HYDRALAZINE 20MG INJ,J0360,HCPCS,,,,,both,1,ML,101.71,61.02,Aetna,Commercial,,101.71,29.8,29.8% of Medicare Base rate X weight,101.71,34.13,303.1,Fee Schedule,29.8
AZITHROMYC 500MG INJ,J0456,HCPCS,,,,,both,1,EA,40.69,24.41,Aetna,Commercial,,40.69,29.8,29.8% of Medicare Base rate X weight,40.69,13.65,121.26,Fee Schedule,29.8
ATROPINE 0.01 MG INJ,J0461,HCPCS,,,,,both,1,ML,2.00,1.20,Aetna,Commercial,,2.00,29.8,29.8% of Medicare Base rate X weight,2.00,0.67,5.96,Fee Schedule,29.8
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,, ,0.03,0.01,Aetna,Commercial,,0.03,29.8,29.8% of Medicare Base rate X weight,0.03,0.01,0.09,Fee Schedule,29.8
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,, ,0.62,0.37,Aetna,Commercial,,0.62,29.8,29.8% of Medicare Base rate X weight,0.62,0.21,1.85,Fee Schedule,29.8
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,10,ML,1.03,0.61,Aetna,Commercial,,1.03,29.8,29.8% of Medicare Base rate X weight,1.03,0.35,3.07,Fee Schedule,29.8
DIMERCAPRO 100MG INJ,J0470,HCPCS,,,,,both,, ,198.28,118.96,Aetna,Commercial,,198.28,29.8,29.8% of Medicare Base rate X weight,198.28,66.54,590.87,Fee Schedule,29.8
DICYCLOMINE 20MG INJ,J0500,HCPCS,,,,,both,2,ML,307.46,184.47,Aetna,Commercial,,307.46,29.8,29.8% of Medicare Base rate X weight,307.46,103.17,916.23,Fee Schedule,29.8
BENZTROPN MES 1MGINJ,J0515,HCPCS,,,,,both,2,ML,263.42,158.05,Aetna,Commercial,,263.42,29.8,29.8% of Medicare Base rate X weight,263.42,88.40,784.99,Fee Schedule,29.8
PCN G BENZ/PROC 100K,J0558,HCPCS,,,,,both,, ,34.25,20.55,Aetna,Commercial,,34.25,29.8,29.8% of Medicare Base rate X weight,34.25,11.49,102.07,Fee Schedule,29.8
PCN G BENZ/PROC 100K,J0558,HCPCS,,,,,both,, ,35.54,21.32,Aetna,Commercial,,35.54,29.8,29.8% of Medicare Base rate X weight,35.54,11.93,105.91,Fee Schedule,29.8
PEN G BENZ INJ 100K,J0561,HCPCS,,,,,both,2,ML,43.00,25.80,Aetna,Commercial,,43.00,29.8,29.8% of Medicare Base rate X weight,43.00,14.43,128.14,Fee Schedule,29.8
BIVALIRUDIN 1MG INJ,J0583,HCPCS,,,,,both,1,EA,18.28,10.96,Aetna,Commercial,,18.28,29.8,29.8% of Medicare Base rate X weight,18.28,6.13,54.47,Fee Schedule,29.8
BOTULINUM TOXI A 1U,J0585,HCPCS,,,,,both,1,EA,33.48,20.08,Aetna,Commercial,,33.48,29.8,29.8% of Medicare Base rate X weight,33.48,11.23,99.77,Fee Schedule,29.8
BUTORPHANOL 1MG INJ,J0595,HCPCS,,,,,both,1,ML,17.77,10.66,Aetna,Commercial,,17.77,29.8,29.8% of Medicare Base rate X weight,17.77,5.96,52.95,Fee Schedule,29.8
CINACALC 1MG PO ESRD,J0604,HCPCS,,,,,both,, ,6.18,3.70,Aetna,Commercial,,6.18,29.8,29.8% of Medicare Base rate X weight,6.18,2.07,18.42,Fee Schedule,29.8
CALCITRIOL .1MCG INJ,J0636,HCPCS,,,,,both,, ,4.33,2.59,Aetna,Commercial,,4.33,29.8,29.8% of Medicare Base rate X weight,4.33,1.45,12.9,Fee Schedule,29.8
LEUCOVORIN 50MG INJ,J0640,HCPCS,,,,,both,1,EA,84.46,50.67,Aetna,Commercial,,84.46,29.8,29.8% of Medicare Base rate X weight,84.46,28.34,251.69,Fee Schedule,29.8
MEPIVACAINE 10ML INJ,J0670,HCPCS,,,,,both,30,ML,19.31,11.58,Aetna,Commercial,,19.31,29.8,29.8% of Medicare Base rate X weight,19.31,6.48,57.54,Fee Schedule,29.8
MEPIVACAINE 10ML INJ,J0670,HCPCS,,,,,both,20,ML,21.89,13.13,Aetna,Commercial,,21.89,29.8,29.8% of Medicare Base rate X weight,21.89,7.35,65.23,Fee Schedule,29.8
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,12.88,7.72,Aetna,Commercial,,12.88,29.8,29.8% of Medicare Base rate X weight,12.88,4.32,38.38,Fee Schedule,29.8
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,12.88,7.72,Aetna,Commercial,,12.88,29.8,29.8% of Medicare Base rate X weight,12.88,4.32,38.38,Fee Schedule,29.8
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,, ,14.94,8.96,Aetna,Commercial,,14.94,29.8,29.8% of Medicare Base rate X weight,14.94,5.01,44.52,Fee Schedule,29.8
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,, ,14.94,8.96,Aetna,Commercial,,14.94,29.8,29.8% of Medicare Base rate X weight,14.94,5.01,44.52,Fee Schedule,29.8
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,22.40,13.44,Aetna,Commercial,,22.40,29.8,29.8% of Medicare Base rate X weight,22.40,7.52,66.75,Fee Schedule,29.8
CEFEPIME 500 MG INJ,J0692,CPT,,,,,both,1,EA,9.00,5.40,Aetna,Commercial,,9.00,29.8,29.8% of Medicare Base rate X weight,9.00,3.02,26.82,Fee Schedule,29.8
CEFEPIME 500MG INJ,J0692,HCPCS,,,,,both,, ,19.06,11.43,Aetna,Commercial,,19.06,29.8,29.8% of Medicare Base rate X weight,19.06,6.40,56.8,Fee Schedule,29.8
CEFEPIME 500MG INJ,J0692,HCPCS,,,,,both,1,EA,24.72,14.83,Aetna,Commercial,,24.72,29.8,29.8% of Medicare Base rate X weight,24.72,8.30,73.67,Fee Schedule,29.8
CEFOXITIN 1GM INJ,J0694,HCPCS,,,,,both,1,EA,53.82,32.29,Aetna,Commercial,,53.82,29.8,29.8% of Medicare Base rate X weight,53.82,18.06,160.38,Fee Schedule,29.8
CEFTO50-TAZO25MG INJ,J0695,HCPCS,,,,,both,1,EA,28.84,17.30,Aetna,Commercial,,28.84,29.8,29.8% of Medicare Base rate X weight,28.84,9.68,85.94,Fee Schedule,29.8
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,8.03,4.81,Aetna,Commercial,,8.03,29.8,29.8% of Medicare Base rate X weight,8.03,2.69,23.93,Fee Schedule,29.8
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,11.59,6.95,Aetna,Commercial,,11.59,29.8,29.8% of Medicare Base rate X weight,11.59,3.89,34.54,Fee Schedule,29.8
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,12.88,7.72,Aetna,Commercial,,12.88,29.8,29.8% of Medicare Base rate X weight,12.88,4.32,38.38,Fee Schedule,29.8
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,24.72,14.83,Aetna,Commercial,,24.72,29.8,29.8% of Medicare Base rate X weight,24.72,8.30,73.67,Fee Schedule,29.8
CEFUROXIME 750MG INJ,J0697,HCPCS,,,,,both,, ,23.69,14.21,Aetna,Commercial,,23.69,29.8,29.8% of Medicare Base rate X weight,23.69,7.95,70.6,Fee Schedule,29.8
CEFUROXIME 750MG INJ,J0697,HCPCS,,,,,both,, ,45.06,27.03,Aetna,Commercial,,45.06,29.8,29.8% of Medicare Base rate X weight,45.06,15.12,134.28,Fee Schedule,29.8
BETAM ACE/SOD PHO3MG,J0702,HCPCS,,,,,both,5,ML,56.14,33.68,Aetna,Commercial,,56.14,29.8,29.8% of Medicare Base rate X weight,56.14,18.84,167.3,Fee Schedule,29.8
CEFTAROLIN 10MG INJ,J0712,HCPCS,,,,,both,, ,16.48,9.88,Aetna,Commercial,,16.48,29.8,29.8% of Medicare Base rate X weight,16.48,5.53,49.11,Fee Schedule,29.8
CEFTAROLIN 10MG INJ,J0712,HCPCS,,,,,both,, ,24.72,14.83,Aetna,Commercial,,24.72,29.8,29.8% of Medicare Base rate X weight,24.72,8.30,73.67,Fee Schedule,29.8
COLISTIME UP TO 150M,J0770,CPT,,,,,both,1,EA,236.64,141.98,Aetna,Commercial,,236.64,29.8,29.8% of Medicare Base rate X weight,236.64,79.41,705.19,Fee Schedule,29.8
PROCHLORPE UPTO 10MG,J0780,HCPCS,,,,,both,, ,39.66,23.79,Aetna,Commercial,,39.66,29.8,29.8% of Medicare Base rate X weight,39.66,13.31,118.19,Fee Schedule,29.8
COSYNTROPN .25MG INJ,J0834,HCPCS,,,,,both,1,EA,687.78,412.66,Aetna,Commercial,,687.78,29.8,29.8% of Medicare Base rate X weight,687.78,230.80,2049.58,Fee Schedule,29.8
DALBAVANCIN 5MG INJ,J0875,HCPCS,,,,,both,, ,85.75,51.45,Aetna,Commercial,,85.75,29.8,29.8% of Medicare Base rate X weight,85.75,28.78,255.54,Fee Schedule,29.8
DAPTOMYCIN 1 MG INJ,J0878,HCPCS,,,,,both,1,EA,3.50,2.10,Aetna,Commercial,,3.50,29.8,29.8% of Medicare Base rate X weight,3.50,1.17,10.43,Fee Schedule,29.8
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,38.88,23.32,Aetna,Commercial,,38.88,29.8,29.8% of Medicare Base rate X weight,38.88,13.05,115.86,Fee Schedule,29.8
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,38.88,23.32,Aetna,Commercial,,38.88,29.8,29.8% of Medicare Base rate X weight,38.88,13.05,115.86,Fee Schedule,29.8
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Aetna,Commercial,,42.75,29.8,29.8% of Medicare Base rate X weight,42.75,14.35,127.4,Fee Schedule,29.8
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Aetna,Commercial,,42.75,29.8,29.8% of Medicare Base rate X weight,42.75,14.35,127.4,Fee Schedule,29.8
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Aetna,Commercial,,42.75,29.8,29.8% of Medicare Base rate X weight,42.75,14.35,127.4,Fee Schedule,29.8
ARGATROBAN 1MG NESRD,J0883,HCPCS,,,,,both,2.5,ML,18.80,11.28,Aetna,Commercial,,18.80,29.8,29.8% of Medicare Base rate X weight,18.80,6.31,56.02,Fee Schedule,29.8
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,111.50,66.90,Aetna,Commercial,,111.50,29.8,29.8% of Medicare Base rate X weight,111.50,37.42,332.27,Fee Schedule,29.8
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,111.50,66.90,Aetna,Commercial,,111.50,29.8,29.8% of Medicare Base rate X weight,111.50,37.42,332.27,Fee Schedule,29.8
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,124.37,74.62,Aetna,Commercial,,124.37,29.8,29.8% of Medicare Base rate X weight,124.37,41.73,370.62,Fee Schedule,29.8
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Aetna,Commercial,,162.74,29.8,29.8% of Medicare Base rate X weight,162.74,54.61,484.97,Fee Schedule,29.8
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Aetna,Commercial,,162.74,29.8,29.8% of Medicare Base rate X weight,162.74,54.61,484.97,Fee Schedule,29.8
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Aetna,Commercial,,162.74,29.8,29.8% of Medicare Base rate X weight,162.74,54.61,484.97,Fee Schedule,29.8
DEFEROXAMIN 500MGINJ,J0895,HCPCS,,,,,both,1,EA,66.44,39.86,Aetna,Commercial,,66.44,29.8,29.8% of Medicare Base rate X weight,66.44,22.30,197.99,Fee Schedule,29.8
DEFEROXAMIN 500MGINJ,J0895,HCPCS,,,,,both,, ,132.87,79.72,Aetna,Commercial,,132.87,29.8,29.8% of Medicare Base rate X weight,132.87,44.59,395.95,Fee Schedule,29.8
DENOSUMAB 1MG INJ,J0897,HCPCS,,,,,both,1,ML,96.31,57.78,Aetna,Commercial,,96.31,29.8,29.8% of Medicare Base rate X weight,96.31,32.32,287,Fee Schedule,29.8
MEDROXYPROG 1MG INJ,J1050,HCPCS,,,,,both,1,ML,4.43,2.65,Aetna,Commercial,,4.43,29.8,29.8% of Medicare Base rate X weight,4.43,1.49,13.2,Fee Schedule,29.8
TESTOSTER CYPION 1MG,J1071,HCPCS,,,,,both,, ,0.93,0.55,Aetna,Commercial,,0.93,29.8,29.8% of Medicare Base rate X weight,0.93,0.31,2.77,Fee Schedule,29.8
TESTOSTER CYPION 1MG,J1071,HCPCS,,,,,both,, ,593.28,355.96,Aetna,Commercial,,593.28,29.8,29.8% of Medicare Base rate X weight,593.28,199.09,1767.97,Fee Schedule,29.8
DEXAMETH NA 1MG INJ,J1100,HCPCS,,,,,both,1,ML,6.39,3.83,Aetna,Commercial,,6.39,29.8,29.8% of Medicare Base rate X weight,6.39,2.14,19.04,Fee Schedule,29.8
ACETAZOLAMI 500MGINJ,J1120,HCPCS,,,,,both,1,EA,308.49,185.09,Aetna,Commercial,,308.49,29.8,29.8% of Medicare Base rate X weight,308.49,103.52,919.3,Fee Schedule,29.8
DIGOXIN 0.5MG INJ,J1160,HCPCS,,,,,both,2,ML,47.12,28.27,Aetna,Commercial,,47.12,29.8,29.8% of Medicare Base rate X weight,47.12,15.81,140.42,Fee Schedule,29.8
DIGOXIN IMMUNE FAB,J1162,HCPCS,,,,,both,1,EA,6881.43,4128.85,Aetna,Commercial,,6881.43,29.8,29.8% of Medicare Base rate X weight,6881.43,2309.20,20506.66,Fee Schedule,29.8
PHENYTOIN NA 50MGINJ,J1165,HCPCS,,,,,both,5,ML,5.36,3.21,Aetna,Commercial,,5.36,29.8,29.8% of Medicare Base rate X weight,5.36,1.80,15.97,Fee Schedule,29.8
PHENYTOIN NA 50MGINJ,J1165,HCPCS,,,,,both,2,ML,12.88,7.72,Aetna,Commercial,,12.88,29.8,29.8% of Medicare Base rate X weight,12.88,4.32,38.38,Fee Schedule,29.8
DEXRAZOXANE 25OMG IJ,J1190,HCPCS,,,,,both,, ,1352.91,811.74,Aetna,Commercial,,1352.91,29.8,29.8% of Medicare Base rate X weight,1352.91,454.00,4031.67,Fee Schedule,29.8
DIPHENHYDRAM 50MGINJ,J1200,HCPCS,,,,,both,1,ML,13.91,8.34,Aetna,Commercial,,13.91,29.8,29.8% of Medicare Base rate X weight,13.91,4.67,41.45,Fee Schedule,29.8
DIPYRIDAMOLE 10MGINJ,J1245,HCPCS,,,,,both,, ,26.78,16.06,Aetna,Commercial,,26.78,29.8,29.8% of Medicare Base rate X weight,26.78,8.99,79.8,Fee Schedule,29.8
DOBUTAMINE 250MG INJ,J1250,HCPCS,,,,,both,20,ML,28.84,17.30,Aetna,Commercial,,28.84,29.8,29.8% of Medicare Base rate X weight,28.84,9.68,85.94,Fee Schedule,29.8
DOBUTAMINE 250MG INJ,J1250,HCPCS,,,,,both,250,ML,78.28,46.96,Aetna,Commercial,,78.28,29.8,29.8% of Medicare Base rate X weight,78.28,26.27,233.27,Fee Schedule,29.8
DOPAMIN HCL 40MG INJ,J1265,HCPCS,,,,,both,250,ML,8.55,5.13,Aetna,Commercial,,8.55,29.8,29.8% of Medicare Base rate X weight,8.55,2.87,25.48,Fee Schedule,29.8
EPTIFABITIDE 5MG IJ,J1327,HCPCS,,,,,both,, ,164.80,98.88,Aetna,Commercial,,164.80,29.8,29.8% of Medicare Base rate X weight,164.80,55.30,491.1,Fee Schedule,29.8
ERTAPENEM SOD/500MG,J1335,HCPCS,,,,,both,1,EA,298.96,179.37,Aetna,Commercial,,298.96,29.8,29.8% of Medicare Base rate X weight,298.96,100.32,890.9,Fee Schedule,29.8
ERYTHROMYC 500MG INJ,J1364,HCPCS,,,,,both,1,EA,196.99,118.19,Aetna,Commercial,,196.99,29.8,29.8% of Medicare Base rate X weight,196.99,66.10,587.03,Fee Schedule,29.8
ESTROGEN CNJ 25MGINJ,J1410,HCPCS,,,,,both,, ,1016.61,609.96,Aetna,Commercial,,1016.61,29.8,29.8% of Medicare Base rate X weight,1016.61,341.14,3029.5,Fee Schedule,29.8
FER CARBOXYM 1MG INJ,J1439,HCPCS,,,,,both,15,ML,7.00,4.20,Aetna,Commercial,,7.00,29.8,29.8% of Medicare Base rate X weight,7.00,2.35,20.86,Fee Schedule,29.8
TBO-FILGRASTIM 1MCG,J1447,HCPCS,,,,,both,0.8,ML,4.53,2.71,Aetna,Commercial,,4.53,29.8,29.8% of Medicare Base rate X weight,4.53,1.52,13.5,Fee Schedule,29.8
TBO-FILGRASTIM 1MCG,J1447,HCPCS,,,,,both,0.8,ML,4.53,2.71,Aetna,Commercial,,4.53,29.8,29.8% of Medicare Base rate X weight,4.53,1.52,13.5,Fee Schedule,29.8
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,200,ML,32.19,19.31,Aetna,Commercial,,32.19,29.8,29.8% of Medicare Base rate X weight,32.19,10.80,95.93,Fee Schedule,29.8
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,50,ML,84.72,50.83,Aetna,Commercial,,84.72,29.8,29.8% of Medicare Base rate X weight,84.72,28.43,252.47,Fee Schedule,29.8
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,100,ML,144.72,86.83,Aetna,Commercial,,144.72,29.8,29.8% of Medicare Base rate X weight,144.72,48.56,431.27,Fee Schedule,29.8
"FOMEPIZOLE, 15 MG",J1451,HCPCS,,,,,both,1.5,ML,43.52,26.11,Aetna,Commercial,,43.52,29.8,29.8% of Medicare Base rate X weight,43.52,14.60,129.69,Fee Schedule,29.8
FOSAPREPITANT 1MG IJ,J1453,HCPCS,,,,,both,1,EA,10.82,6.49,Aetna,Commercial,,10.82,29.8,29.8% of Medicare Base rate X weight,10.82,3.63,32.24,Fee Schedule,29.8
IVIG (PRIVIGEN)500MG,J1459,HCPCS,,,,,both,200,ML,390.89,234.53,Aetna,Commercial,,390.89,29.8,29.8% of Medicare Base rate X weight,390.89,131.17,1164.85,Fee Schedule,29.8
IVIG (PRIVIGEN)500MG,J1459,HCPCS,,,,,both,200,ML,390.89,234.53,Aetna,Commercial,,390.89,29.8,29.8% of Medicare Base rate X weight,390.89,131.17,1164.85,Fee Schedule,29.8
IMMU GLOB LYO 500MG,J1566,HCPCS,,,,,both,, ,270.89,162.53,Aetna,Commercial,,270.89,29.8,29.8% of Medicare Base rate X weight,270.89,90.90,807.25,Fee Schedule,29.8
IMMU GLOB LYO 500MG,J1566,HCPCS,,,,,both,, ,270.89,162.53,Aetna,Commercial,,270.89,29.8,29.8% of Medicare Base rate X weight,270.89,90.90,807.25,Fee Schedule,29.8
IVIG (OCTAGAM) 500MG,J1568,HCPCS,,,,,both,100,ML,319.82,191.89,Aetna,Commercial,,319.82,29.8,29.8% of Medicare Base rate X weight,319.82,107.32,953.06,Fee Schedule,29.8
IVIG (OCTAGAM) 500MG,J1568,HCPCS,,,,,both,100,ML,319.82,191.89,Aetna,Commercial,,319.82,29.8,29.8% of Medicare Base rate X weight,319.82,107.32,953.06,Fee Schedule,29.8
GANCICLOVI SOD 500MG,J1570,HCPCS,,,,,both,1,EA,615.94,369.56,Aetna,Commercial,,615.94,29.8,29.8% of Medicare Base rate X weight,615.94,206.69,1835.5,Fee Schedule,29.8
IVIG (FLEBOGAM)500MG,J1572,HCPCS,,,,,both,200,ML,256.99,154.19,Aetna,Commercial,,256.99,29.8,29.8% of Medicare Base rate X weight,256.99,86.24,765.83,Fee Schedule,29.8
IVIG (FLEBOGAM)500MG,J1572,HCPCS,,,,,both,200,ML,256.99,154.19,Aetna,Commercial,,256.99,29.8,29.8% of Medicare Base rate X weight,256.99,86.24,765.83,Fee Schedule,29.8
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,2,ML,24.72,14.83,Aetna,Commercial,,24.72,29.8,29.8% of Medicare Base rate X weight,24.72,8.30,73.67,Fee Schedule,29.8
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,, ,27.81,16.68,Aetna,Commercial,,27.81,29.8,29.8% of Medicare Base rate X weight,27.81,9.33,82.87,Fee Schedule,29.8
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,2,ML,28.84,17.30,Aetna,Commercial,,28.84,29.8,29.8% of Medicare Base rate X weight,28.84,9.68,85.94,Fee Schedule,29.8
GLUCAGON 1MG INJ,J1610,HCPCS,,,,,both,, ,710.19,426.11,Aetna,Commercial,,710.19,29.8,29.8% of Medicare Base rate X weight,710.19,238.32,2116.37,Fee Schedule,29.8
GLUCAGON 1MG INJ,J1610,HCPCS,,,,,both,1,EA,1505.00,903.00,Aetna,Commercial,,1505.00,29.8,29.8% of Medicare Base rate X weight,1505.00,505.03,4484.9,Fee Schedule,29.8
HALOPERIDOL 5MG INJ,J1630,HCPCS,,,,,both,1,ML,68.50,41.10,Aetna,Commercial,,68.50,29.8,29.8% of Medicare Base rate X weight,68.50,22.99,204.13,Fee Schedule,29.8
HALOPER DEC 50MGINJ,J1631,HCPCS,,,,,both,1,ML,183.08,109.84,Aetna,Commercial,,183.08,29.8,29.8% of Medicare Base rate X weight,183.08,61.44,545.58,Fee Schedule,29.8
HALOPER DEC 50MGINJ,J1631,HCPCS,,,,,both,1,ML,217.33,130.39,Aetna,Commercial,,217.33,29.8,29.8% of Medicare Base rate X weight,217.33,72.93,647.64,Fee Schedule,29.8
HEPARIN NA 10U FLUSH,J1642,HCPCS,,,,,both,5,ML,0.52,0.31,Aetna,Commercial,,0.52,29.8,29.8% of Medicare Base rate X weight,0.52,0.17,1.55,Fee Schedule,29.8
HEPARIN NA 10U FLUSH,J1642,HCPCS,,,,,both,3,ML,0.93,0.55,Aetna,Commercial,,0.93,29.8,29.8% of Medicare Base rate X weight,0.93,0.31,2.77,Fee Schedule,29.8
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,2.16,1.29,Aetna,Commercial,,2.16,29.8,29.8% of Medicare Base rate X weight,2.16,0.72,6.44,Fee Schedule,29.8
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,5.67,3.40,Aetna,Commercial,,5.67,29.8,29.8% of Medicare Base rate X weight,5.67,1.90,16.9,Fee Schedule,29.8
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,6.39,3.83,Aetna,Commercial,,6.39,29.8,29.8% of Medicare Base rate X weight,6.39,2.14,19.04,Fee Schedule,29.8
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,19.57,11.74,Aetna,Commercial,,19.57,29.8,29.8% of Medicare Base rate X weight,19.57,6.57,58.32,Fee Schedule,29.8
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,500,ML,27.81,16.68,Aetna,Commercial,,27.81,29.8,29.8% of Medicare Base rate X weight,27.81,9.33,82.87,Fee Schedule,29.8
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,28.84,17.30,Aetna,Commercial,,28.84,29.8,29.8% of Medicare Base rate X weight,28.84,9.68,85.94,Fee Schedule,29.8
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,41.72,25.03,Aetna,Commercial,,41.72,29.8,29.8% of Medicare Base rate X weight,41.72,14.00,124.33,Fee Schedule,29.8
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,250,ML,76.00,45.60,Aetna,Commercial,,76.00,29.8,29.8% of Medicare Base rate X weight,76.00,25.50,226.48,Fee Schedule,29.8
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.8,ML,57.17,34.30,Aetna,Commercial,,57.17,29.8,29.8% of Medicare Base rate X weight,57.17,19.18,170.37,Fee Schedule,29.8
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.6,ML,57.17,34.30,Aetna,Commercial,,57.17,29.8,29.8% of Medicare Base rate X weight,57.17,19.18,170.37,Fee Schedule,29.8
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.4,ML,57.17,34.30,Aetna,Commercial,,57.17,29.8,29.8% of Medicare Base rate X weight,57.17,19.18,170.37,Fee Schedule,29.8
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.3,ML,57.17,34.30,Aetna,Commercial,,57.17,29.8,29.8% of Medicare Base rate X weight,57.17,19.18,170.37,Fee Schedule,29.8
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,1,ML,57.17,34.30,Aetna,Commercial,,57.17,29.8,29.8% of Medicare Base rate X weight,57.17,19.18,170.37,Fee Schedule,29.8
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,38.37,23.02,Aetna,Commercial,,38.37,29.8,29.8% of Medicare Base rate X weight,38.37,12.88,114.34,Fee Schedule,29.8
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,51.24,30.74,Aetna,Commercial,,51.24,29.8,29.8% of Medicare Base rate X weight,51.24,17.19,152.7,Fee Schedule,29.8
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,76.74,46.04,Aetna,Commercial,,76.74,29.8,29.8% of Medicare Base rate X weight,76.74,25.75,228.69,Fee Schedule,29.8
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,85.49,51.29,Aetna,Commercial,,85.49,29.8,29.8% of Medicare Base rate X weight,85.49,28.69,254.76,Fee Schedule,29.8
TETANUS IG HUM 250U,J1670,HCPCS,,,,,both,1,ML,1976.31,1185.78,Aetna,Commercial,,1976.31,29.8,29.8% of Medicare Base rate X weight,1976.31,663.19,5889.4,Fee Schedule,29.8
HYDROCORTIS 100MGINJ,J1720,HCPCS,,,,,both,1,EA,48.15,28.89,Aetna,Commercial,,48.15,29.8,29.8% of Medicare Base rate X weight,48.15,16.16,143.49,Fee Schedule,29.8
MELOXICAM 1MG INJ,J1738,HCPCS,,,,,both,1,ML,566.00,339.60,Aetna,Commercial,,566.00,29.8,29.8% of Medicare Base rate X weight,566.00,189.93,1686.68,Fee Schedule,29.8
IBUTILIDE 1MG INJ,J1742,HCPCS,,,,,both,, ,1612.21,967.32,Aetna,Commercial,,1612.21,29.8,29.8% of Medicare Base rate X weight,1612.21,541.01,4804.39,Fee Schedule,29.8
INFLIXIMAB 10 MG INJ,J1745,HCPCS,,,,,both,1,EA,560.84,336.50,Aetna,Commercial,,560.84,29.8,29.8% of Medicare Base rate X weight,560.84,188.20,1671.3,Fee Schedule,29.8
IRON DEX165 INJ 50MG,J1750,HCPCS,,,,,both,, ,132.87,79.72,Aetna,Commercial,,132.87,29.8,29.8% of Medicare Base rate X weight,132.87,44.59,395.95,Fee Schedule,29.8
IRON SUCROSE 1MG INJ,J1756,HCPCS,,,,,both,, ,4.22,2.53,Aetna,Commercial,,4.22,29.8,29.8% of Medicare Base rate X weight,4.22,1.42,12.58,Fee Schedule,29.8
DROPERIDOL UP TO 5MG,J1790,HCPCS,,,,,both,2,ML,27.81,16.68,Aetna,Commercial,,27.81,29.8,29.8% of Medicare Base rate X weight,27.81,9.33,82.87,Fee Schedule,29.8
INSULIN 1 UNT INJ,J1815,CPT,,,,,both,10,ML,1.00,0.60,Aetna,Commercial,,1.00,29.8,29.8% of Medicare Base rate X weight,1.00,0.34,2.98,Fee Schedule,29.8
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,, ,6.39,3.83,Aetna,Commercial,,6.39,29.8,29.8% of Medicare Base rate X weight,6.39,2.14,19.04,Fee Schedule,29.8
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,1,ML,12.88,7.72,Aetna,Commercial,,12.88,29.8,29.8% of Medicare Base rate X weight,12.88,4.32,38.38,Fee Schedule,29.8
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,1,ML,25.75,15.45,Aetna,Commercial,,25.75,29.8,29.8% of Medicare Base rate X weight,25.75,8.64,76.74,Fee Schedule,29.8
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,10,ML,5.67,3.40,Aetna,Commercial,,5.67,29.8,29.8% of Medicare Base rate X weight,5.67,1.90,16.9,Fee Schedule,29.8
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,4,ML,12.88,7.72,Aetna,Commercial,,12.88,29.8,29.8% of Medicare Base rate X weight,12.88,4.32,38.38,Fee Schedule,29.8
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,2,ML,25.75,15.45,Aetna,Commercial,,25.75,29.8,29.8% of Medicare Base rate X weight,25.75,8.64,76.74,Fee Schedule,29.8
LUPR 3.75FEMALE/PEDS,J1950,HCPCS,,,,,both,1,EA,6029.88,3617.92,Aetna,Commercial,,6029.88,29.8,29.8% of Medicare Base rate X weight,6029.88,2023.45,17969.04,Fee Schedule,29.8
LEVETIRACET 10MG INJ,J1953,HCPCS,,,,,both,5,ML,1.18,0.70,Aetna,Commercial,,1.18,29.8,29.8% of Medicare Base rate X weight,1.18,0.40,3.52,Fee Schedule,29.8
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,100,ML,58.45,35.07,Aetna,Commercial,,58.45,29.8,29.8% of Medicare Base rate X weight,58.45,19.61,174.18,Fee Schedule,29.8
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,150,ML,68.24,40.94,Aetna,Commercial,,68.24,29.8,29.8% of Medicare Base rate X weight,68.24,22.90,203.36,Fee Schedule,29.8
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,50,ML,78.28,46.96,Aetna,Commercial,,78.28,29.8,29.8% of Medicare Base rate X weight,78.28,26.27,233.27,Fee Schedule,29.8
LINEZOLID 200 MG,J2020,HCPCS,,,,,both,300,ML,225.31,135.18,Aetna,Commercial,,225.31,29.8,29.8% of Medicare Base rate X weight,225.31,75.61,671.42,Fee Schedule,29.8
LINEZOLID 200 MG,J2020,HCPCS,,,,,both,, ,258.79,155.27,Aetna,Commercial,,258.79,29.8,29.8% of Medicare Base rate X weight,258.79,86.84,771.19,Fee Schedule,29.8
LORAZEPAM 2MG INJ,J2060,HCPCS,,,,,both,1,ML,19.57,11.74,Aetna,Commercial,,19.57,29.8,29.8% of Medicare Base rate X weight,19.57,6.57,58.32,Fee Schedule,29.8
LORAZEPAM INJ 2MG/ML 10 ML MDV,J2060,HCPCS,,,,,both,, ,15.14,9.08,Aetna,Commercial,,15.14,29.8,29.8% of Medicare Base rate X weight,15.14,5.08,45.12,Fee Schedule,29.8
MANNITOL 25% 50MLINJ,J2150,HCPCS,,,,,both,50,ML,24.72,14.83,Aetna,Commercial,,24.72,29.8,29.8% of Medicare Base rate X weight,24.72,8.30,73.67,Fee Schedule,29.8
MEPERID HCL 100MGINJ,J2175,HCPCS,,,,,both,1,ML,16.48,9.88,Aetna,Commercial,,16.48,29.8,29.8% of Medicare Base rate X weight,16.48,5.53,49.11,Fee Schedule,29.8
MEROPENEMBR 100MGINJ,J2184,HCPCS,,,,,both,, ,18.28,10.96,Aetna,Commercial,,18.28,29.8,29.8% of Medicare Base rate X weight,18.28,6.13,54.47,Fee Schedule,29.8
MEROPENEM 100MG INJ,J2185,HCPCS,,,,,both,1,EA,8.96,5.37,Aetna,Commercial,,8.96,29.8,29.8% of Medicare Base rate X weight,8.96,3.01,26.7,Fee Schedule,29.8
MEROPENEM 100MG INJ,J2185,HCPCS,,,,,both,1,EA,8.96,5.37,Aetna,Commercial,,8.96,29.8,29.8% of Medicare Base rate X weight,8.96,3.01,26.7,Fee Schedule,29.8
METHYLERGONV .2MGINJ,J2210,HCPCS,,,,,both,1,ML,47.12,28.27,Aetna,Commercial,,47.12,29.8,29.8% of Medicare Base rate X weight,47.12,15.81,140.42,Fee Schedule,29.8
METHYLNALTR .1MG INJ,J2212,HCPCS,,,,,both,, ,4.33,2.59,Aetna,Commercial,,4.33,29.8,29.8% of Medicare Base rate X weight,4.33,1.45,12.9,Fee Schedule,29.8
MICAFUNGIN 1MG INJ,J2248,HCPCS,,,,,both,1,EA,11.59,6.95,Aetna,Commercial,,11.59,29.8,29.8% of Medicare Base rate X weight,11.59,3.89,34.54,Fee Schedule,29.8
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,10,ML,1.03,0.61,Aetna,Commercial,,1.03,29.8,29.8% of Medicare Base rate X weight,1.03,0.35,3.07,Fee Schedule,29.8
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,5,ML,3.09,1.85,Aetna,Commercial,,3.09,29.8,29.8% of Medicare Base rate X weight,3.09,1.04,9.21,Fee Schedule,29.8
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,2,ML,7.00,4.20,Aetna,Commercial,,7.00,29.8,29.8% of Medicare Base rate X weight,7.00,2.35,20.86,Fee Schedule,29.8
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,, ,8.34,5.00,Aetna,Commercial,,8.34,29.8,29.8% of Medicare Base rate X weight,8.34,2.80,24.85,Fee Schedule,29.8
MIDAZOL HCL WG 1MG,J2251,HCPCS,,,,,both,50,ML,3.25,1.95,Aetna,Commercial,,3.25,29.8,29.8% of Medicare Base rate X weight,3.25,1.09,9.69,Fee Schedule,29.8
MILRINONE 5MG INJ,J2260,HCPCS,,,,,both,100,ML,32.19,19.31,Aetna,Commercial,,32.19,29.8,29.8% of Medicare Base rate X weight,32.19,10.80,95.93,Fee Schedule,29.8
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,1.03,0.61,Aetna,Commercial,,1.03,29.8,29.8% of Medicare Base rate X weight,1.03,0.35,3.07,Fee Schedule,29.8
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,5.15,3.09,Aetna,Commercial,,5.15,29.8,29.8% of Medicare Base rate X weight,5.15,1.73,15.35,Fee Schedule,29.8
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Aetna,Commercial,,14.94,29.8,29.8% of Medicare Base rate X weight,14.94,5.01,44.52,Fee Schedule,29.8
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Aetna,Commercial,,14.94,29.8,29.8% of Medicare Base rate X weight,14.94,5.01,44.52,Fee Schedule,29.8
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Aetna,Commercial,,14.94,29.8,29.8% of Medicare Base rate X weight,14.94,5.01,44.52,Fee Schedule,29.8
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,14.75,8.85,Aetna,Commercial,,14.75,29.8,29.8% of Medicare Base rate X weight,14.75,4.95,43.96,Fee Schedule,29.8
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,14.94,8.96,Aetna,Commercial,,14.94,29.8,29.8% of Medicare Base rate X weight,14.94,5.01,44.52,Fee Schedule,29.8
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,16.00,9.60,Aetna,Commercial,,16.00,29.8,29.8% of Medicare Base rate X weight,16.00,5.37,47.68,Fee Schedule,29.8
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,, ,86.78,52.06,Aetna,Commercial,,86.78,29.8,29.8% of Medicare Base rate X weight,86.78,29.12,258.6,Fee Schedule,29.8
NALBUPHINE 10MG INJ,J2300,HCPCS,,,,,both,1,ML,25.75,15.45,Aetna,Commercial,,25.75,29.8,29.8% of Medicare Base rate X weight,25.75,8.64,76.74,Fee Schedule,29.8
NALOXONE HCL 1MG INJ,J2310,HCPCS,,,,,both,1,ML,133.90,80.34,Aetna,Commercial,,133.90,29.8,29.8% of Medicare Base rate X weight,133.90,44.93,399.02,Fee Schedule,29.8
NALOXONE HCL 1MG INJ,J2310,HCPCS,,,,,both,2,ML,139.31,83.58,Aetna,Commercial,,139.31,29.8,29.8% of Medicare Base rate X weight,139.31,46.75,415.14,Fee Schedule,29.8
OCRELIZUMAB 1MG INJ,J2350,HCPCS,,,,,both,10,ML,133.90,80.34,Aetna,Commercial,,133.90,29.8,29.8% of Medicare Base rate X weight,133.90,44.93,399.02,Fee Schedule,29.8
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,1,ML,21.37,12.82,Aetna,Commercial,,21.37,29.8,29.8% of Medicare Base rate X weight,21.37,7.17,63.68,Fee Schedule,29.8
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,1,ML,42.23,25.33,Aetna,Commercial,,42.23,29.8,29.8% of Medicare Base rate X weight,42.23,14.17,125.85,Fee Schedule,29.8
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,, ,280.16,168.09,Aetna,Commercial,,280.16,29.8,29.8% of Medicare Base rate X weight,280.16,94.01,834.88,Fee Schedule,29.8
ORPHENADR UP TO 60MG,J2360,HCPCS,,,,,both,2,ML,156.30,93.78,Aetna,Commercial,,156.30,29.8,29.8% of Medicare Base rate X weight,156.30,52.45,465.77,Fee Schedule,29.8
CHLOROPR HCL INJ 1MG,J2401,HCPCS,,,,,both,20,ML,0.30,0.18,Aetna,Commercial,,0.30,29.8,29.8% of Medicare Base rate X weight,0.30,0.10,0.89,Fee Schedule,29.8
ONDANSETRON 1MG INJ,J2405,HCPCS,,,,,both,2,ML,42.23,25.33,Aetna,Commercial,,42.23,29.8,29.8% of Medicare Base rate X weight,42.23,14.17,125.85,Fee Schedule,29.8
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.75,ML,42.23,25.33,Aetna,Commercial,,42.23,29.8,29.8% of Medicare Base rate X weight,42.23,14.17,125.85,Fee Schedule,29.8
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.25,ML,58.97,35.38,Aetna,Commercial,,58.97,29.8,29.8% of Medicare Base rate X weight,58.97,19.79,175.73,Fee Schedule,29.8
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,1,ML,58.97,35.38,Aetna,Commercial,,58.97,29.8,29.8% of Medicare Base rate X weight,58.97,19.79,175.73,Fee Schedule,29.8
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,1.5,ML,58.97,35.38,Aetna,Commercial,,58.97,29.8,29.8% of Medicare Base rate X weight,58.97,19.79,175.73,Fee Schedule,29.8
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.5,ML,61.03,36.61,Aetna,Commercial,,61.03,29.8,29.8% of Medicare Base rate X weight,61.03,20.48,181.87,Fee Schedule,29.8
PAMIDRONATE 30MG IJ,J2430,HCPCS,,,,,both,10,ML,193.64,116.18,Aetna,Commercial,,193.64,29.8,29.8% of Medicare Base rate X weight,193.64,64.98,577.05,Fee Schedule,29.8
PAMIDRONATE 30MG IJ,J2430,HCPCS,,,,,both,, ,1208.71,725.22,Aetna,Commercial,,1208.71,29.8,29.8% of Medicare Base rate X weight,1208.71,405.61,3601.96,Fee Schedule,29.8
PAPAVERINE UPTO 60MG,J2440,HCPCS,,,,,both,, ,302.05,181.23,Aetna,Commercial,,302.05,29.8,29.8% of Medicare Base rate X weight,302.05,101.36,900.11,Fee Schedule,29.8
PALONOSETRON 25MCG,J2469,HCPCS,,,,,both,, ,250.55,150.33,Aetna,Commercial,,250.55,29.8,29.8% of Medicare Base rate X weight,250.55,84.08,746.64,Fee Schedule,29.8
PANTOPRAZOLE SOD VL,J2470,HCPCS,,,,,both,1,EA,41.72,25.03,Aetna,Commercial,,41.72,29.8,29.8% of Medicare Base rate X weight,41.72,14.00,124.33,Fee Schedule,29.8
PARICALCITOL 1MCGINJ,J2501,HCPCS,,,,,both,1,ML,25.75,15.45,Aetna,Commercial,,25.75,29.8,29.8% of Medicare Base rate X weight,25.75,8.64,76.74,Fee Schedule,29.8
PENICI G POT .6MUINJ,J2540,HCPCS,,,,,both,, ,11.33,6.79,Aetna,Commercial,,11.33,29.8,29.8% of Medicare Base rate X weight,11.33,3.80,33.76,Fee Schedule,29.8
PENICI G POT .6MUINJ,J2540,HCPCS,,,,,both,1,EA,11.59,6.95,Aetna,Commercial,,11.59,29.8,29.8% of Medicare Base rate X weight,11.59,3.89,34.54,Fee Schedule,29.8
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,41.97,25.18,Aetna,Commercial,,41.97,29.8,29.8% of Medicare Base rate X weight,41.97,14.08,125.07,Fee Schedule,29.8
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,44.55,26.73,Aetna,Commercial,,44.55,29.8,29.8% of Medicare Base rate X weight,44.55,14.95,132.76,Fee Schedule,29.8
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,48.15,28.89,Aetna,Commercial,,48.15,29.8,29.8% of Medicare Base rate X weight,48.15,16.16,143.49,Fee Schedule,29.8
PROMETHAZI UPTO 50MG,J2550,HCPCS,,,,,both,1,ML,24.72,14.83,Aetna,Commercial,,24.72,29.8,29.8% of Medicare Base rate X weight,24.72,8.30,73.67,Fee Schedule,29.8
PHENOBARB 120MG INJ,J2560,HCPCS,,,,,both,1,ML,167.89,100.73,Aetna,Commercial,,167.89,29.8,29.8% of Medicare Base rate X weight,167.89,56.34,500.31,Fee Schedule,29.8
PHENOBARB 120MG INJ,J2560,HCPCS,,,,,both,, ,232.78,139.66,Aetna,Commercial,,232.78,29.8,29.8% of Medicare Base rate X weight,232.78,78.11,693.68,Fee Schedule,29.8
OXYTOCIN UP TO 10UN,J2590,HCPCS,,,,,both,1,ML,27.81,16.68,Aetna,Commercial,,27.81,29.8,29.8% of Medicare Base rate X weight,27.81,9.33,82.87,Fee Schedule,29.8
DESMOPRESSIN 1MCGINJ,J2597,HCPCS,,,,,both,1,ML,13.91,8.34,Aetna,Commercial,,13.91,29.8,29.8% of Medicare Base rate X weight,13.91,4.67,41.45,Fee Schedule,29.8
FLUPHENZI UP TO 25MG,J2680,HCPCS,,,,,both,5,ML,139.05,83.43,Aetna,Commercial,,139.05,29.8,29.8% of Medicare Base rate X weight,139.05,46.66,414.37,Fee Schedule,29.8
PROCAINAMID UPTO 1GM,J2690,HCPCS,,,,,both,2,ML,95.79,57.47,Aetna,Commercial,,95.79,29.8,29.8% of Medicare Base rate X weight,95.79,32.14,285.45,Fee Schedule,29.8
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,20,ML,1.44,0.86,Aetna,Commercial,,1.44,29.8,29.8% of Medicare Base rate X weight,1.44,0.48,4.29,Fee Schedule,29.8
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,100,ML,2.68,1.60,Aetna,Commercial,,2.68,29.8,29.8% of Medicare Base rate X weight,2.68,0.90,7.99,Fee Schedule,29.8
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,100,ML,2.68,1.60,Aetna,Commercial,,2.68,29.8,29.8% of Medicare Base rate X weight,2.68,0.90,7.99,Fee Schedule,29.8
NEOSTIGMINE .5MG INJ,J2710,HCPCS,,,,,both,10,ML,13.91,8.34,Aetna,Commercial,,13.91,29.8,29.8% of Medicare Base rate X weight,13.91,4.67,41.45,Fee Schedule,29.8
NEOSTIGMINE .5MG INJ,J2710,HCPCS,,,,,both,5,ML,19.57,11.74,Aetna,Commercial,,19.57,29.8,29.8% of Medicare Base rate X weight,19.57,6.57,58.32,Fee Schedule,29.8
PROTAMINE 10MG INJ,J2720,HCPCS,,,,,both,5,ML,12.88,7.72,Aetna,Commercial,,12.88,29.8,29.8% of Medicare Base rate X weight,12.88,4.32,38.38,Fee Schedule,29.8
PHENTOLAMINE 5MG INJ,J2760,HCPCS,,,,,both,1,EA,968.46,581.07,Aetna,Commercial,,968.46,29.8,29.8% of Medicare Base rate X weight,968.46,324.99,2886.01,Fee Schedule,29.8
METOCLOPRAM 10MG INJ,J2765,HCPCS,,,,,both,2,ML,24.72,14.83,Aetna,Commercial,,24.72,29.8,29.8% of Medicare Base rate X weight,24.72,8.30,73.67,Fee Schedule,29.8
REGADENOSON 0.1MG IJ,J2785,HCPCS,,,,,both,5,ML,335.01,201.00,Aetna,Commercial,,335.01,29.8,29.8% of Medicare Base rate X weight,335.01,112.42,998.33,Fee Schedule,29.8
RHOPHYLAC 100UNT,J2791,HCPCS,,,,,both,2,ML,62.83,37.69,Aetna,Commercial,,62.83,29.8,29.8% of Medicare Base rate X weight,62.83,21.08,187.23,Fee Schedule,29.8
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,28.33,16.99,Aetna,Commercial,,28.33,29.8,29.8% of Medicare Base rate X weight,28.33,9.51,84.42,Fee Schedule,29.8
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,34.25,20.55,Aetna,Commercial,,34.25,29.8,29.8% of Medicare Base rate X weight,34.25,11.49,102.07,Fee Schedule,29.8
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,37.08,22.24,Aetna,Commercial,,37.08,29.8,29.8% of Medicare Base rate X weight,37.08,12.44,110.5,Fee Schedule,29.8
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,20,ML,1.03,0.61,Aetna,Commercial,,1.03,29.8,29.8% of Medicare Base rate X weight,1.03,0.35,3.07,Fee Schedule,29.8
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,20,ML,1.03,0.61,Aetna,Commercial,,1.03,29.8,29.8% of Medicare Base rate X weight,1.03,0.35,3.07,Fee Schedule,29.8
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,30,ML,1.03,0.61,Aetna,Commercial,,1.03,29.8,29.8% of Medicare Base rate X weight,1.03,0.35,3.07,Fee Schedule,29.8
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,, ,1.65,0.99,Aetna,Commercial,,1.65,29.8,29.8% of Medicare Base rate X weight,1.65,0.55,4.92,Fee Schedule,29.8
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,100,ML,1.96,1.17,Aetna,Commercial,,1.96,29.8,29.8% of Medicare Base rate X weight,1.96,0.66,5.84,Fee Schedule,29.8
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,10,ML,2.16,1.29,Aetna,Commercial,,2.16,29.8,29.8% of Medicare Base rate X weight,2.16,0.72,6.44,Fee Schedule,29.8
SINCALIDE INJ 5MCG,J2805,HCPCS,,,,,both,1,EA,670.53,402.31,Aetna,Commercial,,670.53,29.8,29.8% of Medicare Base rate X weight,670.53,225.01,1998.18,Fee Schedule,29.8
SOD FERRIC 12.5MGINJ,J2916,HCPCS,,,,,both,5,ML,53.56,32.13,Aetna,Commercial,,53.56,29.8,29.8% of Medicare Base rate X weight,53.56,17.97,159.61,Fee Schedule,29.8
RETEPLASE 18.1MG IJ,J2993,HCPCS,,,,,both,, ,7366.00,4419.60,Aetna,Commercial,,7366.00,29.8,29.8% of Medicare Base rate X weight,7366.00,2471.81,21950.68,Fee Schedule,29.8
ALTEPLASE RECOM 1MG,J2997,HCPCS,,,,,both,1,EA,347.11,208.26,Aetna,Commercial,,347.11,29.8,29.8% of Medicare Base rate X weight,347.11,116.48,1034.39,Fee Schedule,29.8
ALTEPLASE RECOM 1MG,J2997,HCPCS,,,,,both,1,EA,353.55,212.13,Aetna,Commercial,,353.55,29.8,29.8% of Medicare Base rate X weight,353.55,118.64,1053.58,Fee Schedule,29.8
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,5,ML,6.59,3.95,Aetna,Commercial,,6.59,29.8,29.8% of Medicare Base rate X weight,6.59,2.21,19.64,Fee Schedule,29.8
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,2,ML,14.42,8.65,Aetna,Commercial,,14.42,29.8,29.8% of Medicare Base rate X weight,14.42,4.84,42.97,Fee Schedule,29.8
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,1,ML,17.25,10.35,Aetna,Commercial,,17.25,29.8,29.8% of Medicare Base rate X weight,17.25,5.79,51.41,Fee Schedule,29.8
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,100,ML,20.25,12.15,Aetna,Commercial,,20.25,29.8,29.8% of Medicare Base rate X weight,20.25,6.80,60.35,Fee Schedule,29.8
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,20,ML,49.44,29.66,Aetna,Commercial,,49.44,29.8,29.8% of Medicare Base rate X weight,49.44,16.59,147.33,Fee Schedule,29.8
SUMATRIPTAN 6MG INJ,J3030,HCPCS,,,,,both,0.5,ML,631.91,379.14,Aetna,Commercial,,631.91,29.8,29.8% of Medicare Base rate X weight,631.91,212.05,1883.09,Fee Schedule,29.8
TENECTEPLASE 1MG INJ,J3101,HCPCS,,,,,both,1,EA,402.47,241.48,Aetna,Commercial,,402.47,29.8,29.8% of Medicare Base rate X weight,402.47,135.06,1199.36,Fee Schedule,29.8
TERBUTALINE 1MG INJ,J3105,HCPCS,,,,,both,1,ML,28.84,17.30,Aetna,Commercial,,28.84,29.8,29.8% of Medicare Base rate X weight,28.84,9.68,85.94,Fee Schedule,29.8
CHLORPROM UP TO 50MG,J3230,HCPCS,,,,,both,, ,161.71,97.02,Aetna,Commercial,,161.71,29.8,29.8% of Medicare Base rate X weight,161.71,54.27,481.9,Fee Schedule,29.8
CHLORPROM UP TO 50MG,J3230,HCPCS,,,,,both,2,ML,185.40,111.24,Aetna,Commercial,,185.40,29.8,29.8% of Medicare Base rate X weight,185.40,62.21,552.49,Fee Schedule,29.8
TIGECYCLINE 1 MG INJ,J3243,HCPCS,,,,,both,, ,11.33,6.79,Aetna,Commercial,,11.33,29.8,29.8% of Medicare Base rate X weight,11.33,3.80,33.76,Fee Schedule,29.8
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,250,ML,60.00,36.00,Aetna,Commercial,,60.00,29.8,29.8% of Medicare Base rate X weight,60.00,20.13,178.8,Fee Schedule,29.8
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,100,ML,75.71,45.42,Aetna,Commercial,,75.71,29.8,29.8% of Medicare Base rate X weight,75.71,25.41,225.62,Fee Schedule,29.8
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,15,ML,91.16,54.69,Aetna,Commercial,,91.16,29.8,29.8% of Medicare Base rate X weight,91.16,30.59,271.66,Fee Schedule,29.8
TRIMETHOBEN 200MGINJ,J3250,HCPCS,,,,,both,, ,26.78,16.06,Aetna,Commercial,,26.78,29.8,29.8% of Medicare Base rate X weight,26.78,8.99,79.8,Fee Schedule,29.8
TOBRAMYCIN UPTO 80MG,J3260,HCPCS,,,,,both,1,EA,71.84,43.10,Aetna,Commercial,,71.84,29.8,29.8% of Medicare Base rate X weight,71.84,24.11,214.08,Fee Schedule,29.8
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,4,ML,28.58,17.14,Aetna,Commercial,,28.58,29.8,29.8% of Medicare Base rate X weight,28.58,9.59,85.17,Fee Schedule,29.8
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,20,ML,28.58,17.14,Aetna,Commercial,,28.58,29.8,29.8% of Medicare Base rate X weight,28.58,9.59,85.17,Fee Schedule,29.8
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,10,ML,28.58,17.14,Aetna,Commercial,,28.58,29.8,29.8% of Medicare Base rate X weight,28.58,9.59,85.17,Fee Schedule,29.8
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,, ,18.28,10.96,Aetna,Commercial,,18.28,29.8,29.8% of Medicare Base rate X weight,18.28,6.13,54.47,Fee Schedule,29.8
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,, ,18.28,10.96,Aetna,Commercial,,18.28,29.8,29.8% of Medicare Base rate X weight,18.28,6.13,54.47,Fee Schedule,29.8
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,, ,18.54,11.12,Aetna,Commercial,,18.54,29.8,29.8% of Medicare Base rate X weight,18.54,6.22,55.25,Fee Schedule,29.8
DIAZEPAM 5MG INJ,J3360,HCPCS,,,,,both,2,ML,100.94,60.56,Aetna,Commercial,,100.94,29.8,29.8% of Medicare Base rate X weight,100.94,33.87,300.8,Fee Schedule,29.8
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,1,EA,58.97,35.38,Aetna,Commercial,,58.97,29.8,29.8% of Medicare Base rate X weight,58.97,19.79,175.73,Fee Schedule,29.8
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,1,EA,58.97,35.38,Aetna,Commercial,,58.97,29.8,29.8% of Medicare Base rate X weight,58.97,19.79,175.73,Fee Schedule,29.8
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,, ,62.32,37.39,Aetna,Commercial,,62.32,29.8,29.8% of Medicare Base rate X weight,62.32,20.91,185.71,Fee Schedule,29.8
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,300,ML,60.00,36.00,Aetna,Commercial,,60.00,29.8,29.8% of Medicare Base rate X weight,60.00,20.13,178.8,Fee Schedule,29.8
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,350,ML,68.00,40.80,Aetna,Commercial,,68.00,29.8,29.8% of Medicare Base rate X weight,68.00,22.82,202.64,Fee Schedule,29.8
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,250,ML,75.00,45.00,Aetna,Commercial,,75.00,29.8,29.8% of Medicare Base rate X weight,75.00,25.17,223.5,Fee Schedule,29.8
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,150,ML,95.00,57.00,Aetna,Commercial,,95.00,29.8,29.8% of Medicare Base rate X weight,95.00,31.88,283.1,Fee Schedule,29.8
VEDOLIZUMAB 1MG INJ,J3380,HCPCS,,,,,both,1,EA,96.31,57.78,Aetna,Commercial,,96.31,29.8,29.8% of Medicare Base rate X weight,96.31,32.32,287,Fee Schedule,29.8
HYDROXYZI UP TO 25MG,J3410,HCPCS,,,,,both,, ,13.91,8.34,Aetna,Commercial,,13.91,29.8,29.8% of Medicare Base rate X weight,13.91,4.67,41.45,Fee Schedule,29.8
THIAMINE 100MG INJ,J3411,HCPCS,,,,,both,2,ML,44.03,26.41,Aetna,Commercial,,44.03,29.8,29.8% of Medicare Base rate X weight,44.03,14.78,131.21,Fee Schedule,29.8
PYRIDOXINE 100MG INJ,J3415,HCPCS,,,,,both,1,ML,79.31,47.58,Aetna,Commercial,,79.31,29.8,29.8% of Medicare Base rate X weight,79.31,26.61,236.34,Fee Schedule,29.8
VIT B12 CYAN 1000MCG,J3420,HCPCS,,,,,both,1,ML,84.72,50.83,Aetna,Commercial,,84.72,29.8,29.8% of Medicare Base rate X weight,84.72,28.43,252.47,Fee Schedule,29.8
PHYTONADIONE 1MG INJ,J3430,HCPCS,,,,,both,0.5,ML,27.81,16.68,Aetna,Commercial,,27.81,29.8,29.8% of Medicare Base rate X weight,27.81,9.33,82.87,Fee Schedule,29.8
PHYTONADIONE 1MG INJ,J3430,HCPCS,,,,,both,1,ML,31.93,19.15,Aetna,Commercial,,31.93,29.8,29.8% of Medicare Base rate X weight,31.93,10.71,95.15,Fee Schedule,29.8
HYALURONID RECOM 1UN,J3473,HCPCS,,,,,both,1,ML,3.19,1.91,Aetna,Commercial,,3.19,29.8,29.8% of Medicare Base rate X weight,3.19,1.07,9.51,Fee Schedule,29.8
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,500,ML,1.13,0.67,Aetna,Commercial,,1.13,29.8,29.8% of Medicare Base rate X weight,1.13,0.38,3.37,Fee Schedule,29.8
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,20,ML,2.99,1.79,Aetna,Commercial,,2.99,29.8,29.8% of Medicare Base rate X weight,2.99,1.00,8.91,Fee Schedule,29.8
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,2,ML,12.88,7.72,Aetna,Commercial,,12.88,29.8,29.8% of Medicare Base rate X weight,12.88,4.32,38.38,Fee Schedule,29.8
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,, ,13.91,8.34,Aetna,Commercial,,13.91,29.8,29.8% of Medicare Base rate X weight,13.91,4.67,41.45,Fee Schedule,29.8
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,50,ML,14.94,8.96,Aetna,Commercial,,14.94,29.8,29.8% of Medicare Base rate X weight,14.94,5.01,44.52,Fee Schedule,29.8
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,100,ML,1.03,0.61,Aetna,Commercial,,1.03,29.8,29.8% of Medicare Base rate X weight,1.03,0.35,3.07,Fee Schedule,29.8
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,100,ML,1.03,0.61,Aetna,Commercial,,1.03,29.8,29.8% of Medicare Base rate X weight,1.03,0.35,3.07,Fee Schedule,29.8
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,, ,2.68,1.60,Aetna,Commercial,,2.68,29.8,29.8% of Medicare Base rate X weight,2.68,0.90,7.99,Fee Schedule,29.8
ZIDOVUDINE 10MG INJ,J3485,HCPCS,,,,,both,, ,12.36,7.41,Aetna,Commercial,,12.36,29.8,29.8% of Medicare Base rate X weight,12.36,4.15,36.83,Fee Schedule,29.8
ZIPRSIDNE MESYL 10MG,J3486,HCPCS,,,,,both,1,EA,77.77,46.66,Aetna,Commercial,,77.77,29.8,29.8% of Medicare Base rate X weight,77.77,26.10,231.75,Fee Schedule,29.8
ZOLEDRONIC ACID 1MG,J3489,HCPCS,,,,,both,100,ML,332.69,199.61,Aetna,Commercial,,332.69,29.8,29.8% of Medicare Base rate X weight,332.69,111.64,991.42,Fee Schedule,29.8
ZOLEDRONIC ACID 1MG,J3489,HCPCS,,,,,both,5,ML,1005.80,603.48,Aetna,Commercial,,1005.80,29.8,29.8% of Medicare Base rate X weight,1005.80,337.52,2997.28,Fee Schedule,29.8
BRIVARACETAM 50MG TB,J3490,HCPCS,,,,,both,60,EA,172.75,103.65,Aetna,Commercial,,172.75,29.8,29.8% of Medicare Base rate X weight,172.75,57.97,514.8,Fee Schedule,29.8
NORM SALIN 1000ML IV,J7030,HCPCS,,,,,both,1000,ML,25.75,15.45,Aetna,Commercial,,25.75,29.8,29.8% of Medicare Base rate X weight,25.75,8.64,76.74,Fee Schedule,29.8
NORM SAL STER500MLIV,J7040,HCPCS,,,,,both,500,ML,25.75,15.45,Aetna,Commercial,,25.75,29.8,29.8% of Medicare Base rate X weight,25.75,8.64,76.74,Fee Schedule,29.8
D5W/SOD CHL.9% 500ML,J7042,HCPCS,,,,,both,1000,ML,12.88,7.72,Aetna,Commercial,,12.88,29.8,29.8% of Medicare Base rate X weight,12.88,4.32,38.38,Fee Schedule,29.8
NORM SALINE 250ML IV,J7050,HCPCS,,,,,both,250,ML,26.78,16.06,Aetna,Commercial,,26.78,29.8,29.8% of Medicare Base rate X weight,26.78,8.99,79.8,Fee Schedule,29.8
SOD CHLOR .9% 100ML,J7050,HCPCS,,,,,both,100,ML,25.75,15.45,Aetna,Commercial,,25.75,29.8,29.8% of Medicare Base rate X weight,25.75,8.64,76.74,Fee Schedule,29.8
SOD CHLOR .9% 100ML,J7050,HCPCS,,,,,both,100,ML,68.50,41.10,Aetna,Commercial,,68.50,29.8,29.8% of Medicare Base rate X weight,68.50,22.99,204.13,Fee Schedule,29.8
SOD CHLOR .9% 150ML,J7050,HCPCS,,,,,both,150,ML,25.75,15.45,Aetna,Commercial,,25.75,29.8,29.8% of Medicare Base rate X weight,25.75,8.64,76.74,Fee Schedule,29.8
SOD CHLOR .9% 50ML,J7050,HCPCS,,,,,both,50,ML,25.75,15.45,Aetna,Commercial,,25.75,29.8,29.8% of Medicare Base rate X weight,25.75,8.64,76.74,Fee Schedule,29.8
SOD CHLOR .9% 50ML,J7050,HCPCS,,,,,both,50,ML,41.72,25.03,Aetna,Commercial,,41.72,29.8,29.8% of Medicare Base rate X weight,41.72,14.00,124.33,Fee Schedule,29.8
DEX 5%/WATER 500ML,J7060,HCPCS,,,,,both,, ,24.72,14.83,Aetna,Commercial,,24.72,29.8,29.8% of Medicare Base rate X weight,24.72,8.30,73.67,Fee Schedule,29.8
DEX 5%/WATER 500ML,J7060,HCPCS,,,,,both,500,ML,25.75,15.45,Aetna,Commercial,,25.75,29.8,29.8% of Medicare Base rate X weight,25.75,8.64,76.74,Fee Schedule,29.8
DEX 5%/WATER 1000ML,J7070,HCPCS,,,,,both,1000,ML,25.75,15.45,Aetna,Commercial,,25.75,29.8,29.8% of Medicare Base rate X weight,25.75,8.64,76.74,Fee Schedule,29.8
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,1000,ML,24.72,14.83,Aetna,Commercial,,24.72,29.8,29.8% of Medicare Base rate X weight,24.72,8.30,73.67,Fee Schedule,29.8
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,500,ML,25.75,15.45,Aetna,Commercial,,25.75,29.8,29.8% of Medicare Base rate X weight,25.75,8.64,76.74,Fee Schedule,29.8
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,, ,28.84,17.30,Aetna,Commercial,,28.84,29.8,29.8% of Medicare Base rate X weight,28.84,9.68,85.94,Fee Schedule,29.8
D5LR UP TO 1000ML,J7121,HCPCS,,,,,both,1000,ML,25.75,15.45,Aetna,Commercial,,25.75,29.8,29.8% of Medicare Base rate X weight,25.75,8.64,76.74,Fee Schedule,29.8
PROTHROMB COM 1UN IX,J7168,HCPCS,,,,,both,1,EA,12.25,7.35,Aetna,Commercial,,12.25,29.8,29.8% of Medicare Base rate X weight,12.25,4.11,36.51,Fee Schedule,29.8
PROTHROMB COM 1UN IX,J7168,CPT,,,,,both,1,EA,12.62,7.57,Aetna,Commercial,,12.62,29.8,29.8% of Medicare Base rate X weight,12.62,4.23,37.61,Fee Schedule,29.8
MOMETA SIN IMP 10MCG,J7402,HCPCS,,,,,both,, ,54.59,32.75,Aetna,Commercial,,54.59,29.8,29.8% of Medicare Base rate X weight,54.59,18.32,162.68,Fee Schedule,29.8
AZATHIOPRINE 50MG TB,J7500,HCPCS,,,,,both,100,EA,20.34,12.20,Aetna,Commercial,,20.34,29.8,29.8% of Medicare Base rate X weight,20.34,6.83,60.61,Fee Schedule,29.8
CYCLOSPORNE 100MG PO,J7502,HCPCS,,,,,both,, ,41.20,24.72,Aetna,Commercial,,41.20,29.8,29.8% of Medicare Base rate X weight,41.20,13.83,122.78,Fee Schedule,29.8
TACROLIMUS 1MG PO,J7507,HCPCS,,,,,both,100,EA,27.30,16.38,Aetna,Commercial,,27.30,29.8,29.8% of Medicare Base rate X weight,27.30,9.16,81.35,Fee Schedule,29.8
METHYLPREDNIS 4MG PO,J7509,HCPCS,,,,,both,, ,8.55,5.13,Aetna,Commercial,,8.55,29.8,29.8% of Medicare Base rate X weight,8.55,2.87,25.48,Fee Schedule,29.8
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.10,0.06,Aetna,Commercial,,0.10,29.8,29.8% of Medicare Base rate X weight,0.10,0.03,0.3,Fee Schedule,29.8
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.31,0.18,Aetna,Commercial,,0.31,29.8,29.8% of Medicare Base rate X weight,0.31,0.10,0.92,Fee Schedule,29.8
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.72,0.43,Aetna,Commercial,,0.72,29.8,29.8% of Medicare Base rate X weight,0.72,0.24,2.15,Fee Schedule,29.8
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,1.34,0.80,Aetna,Commercial,,1.34,29.8,29.8% of Medicare Base rate X weight,1.34,0.45,3.99,Fee Schedule,29.8
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,, ,7.00,4.20,Aetna,Commercial,,7.00,29.8,29.8% of Medicare Base rate X weight,7.00,2.35,20.86,Fee Schedule,29.8
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,, ,107.38,64.42,Aetna,Commercial,,107.38,29.8,29.8% of Medicare Base rate X weight,107.38,36.03,319.99,Fee Schedule,29.8
CYCLOSPORINE 25MG PO,J7515,HCPCS,,,,,both,, ,19.31,11.58,Aetna,Commercial,,19.31,29.8,29.8% of Medicare Base rate X weight,19.31,6.48,57.54,Fee Schedule,29.8
CYCLOSPOR PAREN250MG,J7516,HCPCS,,,,,both,, ,191.84,115.10,Aetna,Commercial,,191.84,29.8,29.8% of Medicare Base rate X weight,191.84,64.38,571.68,Fee Schedule,29.8
MYCOPHE MOF 250MG PO,J7517,HCPCS,,,,,both,100,EA,41.46,24.87,Aetna,Commercial,,41.46,29.8,29.8% of Medicare Base rate X weight,41.46,13.91,123.55,Fee Schedule,29.8
METHACHOL 1MGINH NEB,J7674,HCPCS,,,,,both,1,EA,4.84,2.90,Aetna,Commercial,,4.84,29.8,29.8% of Medicare Base rate X weight,4.84,1.62,14.42,Fee Schedule,29.8
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,, ,13.39,8.03,Aetna,Commercial,,13.39,29.8,29.8% of Medicare Base rate X weight,13.39,4.49,39.9,Fee Schedule,29.8
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,, ,49.18,29.50,Aetna,Commercial,,49.18,29.8,29.8% of Medicare Base rate X weight,49.18,16.50,146.56,Fee Schedule,29.8
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,100,EA,53.56,32.13,Aetna,Commercial,,53.56,29.8,29.8% of Medicare Base rate X weight,53.56,17.97,159.61,Fee Schedule,29.8
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,, ,0.52,0.31,Aetna,Commercial,,0.52,29.8,29.8% of Medicare Base rate X weight,0.52,0.17,1.55,Fee Schedule,29.8
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,100,EA,1.34,0.80,Aetna,Commercial,,1.34,29.8,29.8% of Medicare Base rate X weight,1.34,0.45,3.99,Fee Schedule,29.8
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,, ,3.50,2.10,Aetna,Commercial,,3.50,29.8,29.8% of Medicare Base rate X weight,3.50,1.17,10.43,Fee Schedule,29.8
METHOTREXATE 2.5MGPO,J8610,HCPCS,,,,,both,100,EA,20.34,12.20,Aetna,Commercial,,20.34,29.8,29.8% of Medicare Base rate X weight,20.34,6.83,60.61,Fee Schedule,29.8
LEUCOVOR CAL 25MG TB,J8999,HCPCS,,,,,both,20,EA,78.54,47.12,Aetna,Commercial,,78.54,29.8,29.8% of Medicare Base rate X weight,78.54,26.36,234.05,Fee Schedule,29.8
BENDAMUSTINE 1MG INJ,J9033,HCPCS,,,,,both,, ,147.81,88.68,Aetna,Commercial,,147.81,29.8,29.8% of Medicare Base rate X weight,147.81,49.60,440.47,Fee Schedule,29.8
BENDAMUSTINE 1MG INJ,J9033,HCPCS,,,,,both,, ,147.81,88.68,Aetna,Commercial,,147.81,29.8,29.8% of Medicare Base rate X weight,147.81,49.60,440.47,Fee Schedule,29.8
BORTEZOMIB .1MG INJ,J9041,HCPCS,,,,,both,, ,265.74,159.44,Aetna,Commercial,,265.74,29.8,29.8% of Medicare Base rate X weight,265.74,89.17,791.91,Fee Schedule,29.8
CARBOPLATIN 50MG INJ,J9045,HCPCS,,,,,both,45,ML,61.03,36.61,Aetna,Commercial,,61.03,29.8,29.8% of Medicare Base rate X weight,61.03,20.48,181.87,Fee Schedule,29.8
CISPLAT POW/SOL 10MG,J9060,HCPCS,,,,,both,50,ML,5.36,3.21,Aetna,Commercial,,5.36,29.8,29.8% of Medicare Base rate X weight,5.36,1.80,15.97,Fee Schedule,29.8
DOCETAXEL 1MG INJ,J9171,HCPCS,,,,,both,, ,87.81,52.68,Aetna,Commercial,,87.81,29.8,29.8% of Medicare Base rate X weight,87.81,29.47,261.67,Fee Schedule,29.8
FLUOROURACIL 500MG,J9190,HCPCS,,,,,both,, ,25.75,15.45,Aetna,Commercial,,25.75,29.8,29.8% of Medicare Base rate X weight,25.75,8.64,76.74,Fee Schedule,29.8
GEMCITABIN 200MG INJ,J9201,HCPCS,,,,,both,1,EA,616.97,370.18,Aetna,Commercial,,616.97,29.8,29.8% of Medicare Base rate X weight,616.97,207.04,1838.57,Fee Schedule,29.8
GEMCITABIN 200MG INJ,J9201,HCPCS,,,,,both,, ,690.87,414.52,Aetna,Commercial,,690.87,29.8,29.8% of Medicare Base rate X weight,690.87,231.84,2058.79,Fee Schedule,29.8
IPILIMUMAB 1MG INJ,J9228,HCPCS,,,,,both,40,ML,777.65,466.59,Aetna,Commercial,,777.65,29.8,29.8% of Medicare Base rate X weight,777.65,260.96,2317.4,Fee Schedule,29.8
OXALIPLATIN .5MG INJ,J9263,HCPCS,,,,,both,10,ML,6.39,3.83,Aetna,Commercial,,6.39,29.8,29.8% of Medicare Base rate X weight,6.39,2.14,19.04,Fee Schedule,29.8
PACLITAXEL 1MG INJ,J9267,HCPCS,,,,,both,, ,3.71,2.22,Aetna,Commercial,,3.71,29.8,29.8% of Medicare Base rate X weight,3.71,1.24,11.06,Fee Schedule,29.8
PERTUZUMAB 1MG INJ,J9306,HCPCS,,,,,both,14,ML,61.03,36.61,Aetna,Commercial,,61.03,29.8,29.8% of Medicare Base rate X weight,61.03,20.48,181.87,Fee Schedule,29.8
TRASTUZUMAB 10MG INJ,J9355,HCPCS,,,,,both,, ,531.22,318.73,Aetna,Commercial,,531.22,29.8,29.8% of Medicare Base rate X weight,531.22,178.26,1583.04,Fee Schedule,29.8
POST OP SHOES,L3260,HCPCS,,,,,both,, ,12.00,7.20,Aetna,Commercial,,12.00,29.8,29.8% of Medicare Base rate X weight,12.00,4.03,35.76,Fee Schedule,29.8
ADM IV INF CASI IMDV,M0243,HCPCS,,,,,both,, ,851.55,510.93,Aetna,Commercial,,851.55,29.8,29.8% of Medicare Base rate X weight,851.55,285.76,2537.62,Fee Schedule,29.8
ADM IV INF CASI IMDV,M0243,HCPCS,,,,,both,, ,1340.29,804.17,Aetna,Commercial,,1340.29,29.8,29.8% of Medicare Base rate X weight,1340.29,449.76,3994.06,Fee Schedule,29.8
ADM IV INF BAM ETES,M0245,HCPCS,,,,,both,, ,1301.25,780.75,Aetna,Commercial,,1301.25,29.8,29.8% of Medicare Base rate X weight,1301.25,436.66,3877.73,Fee Schedule,29.8
ADM IV INF SOTROVIM,M0247,HCPCS,,,,,both,, ,1301.25,780.75,Aetna,Commercial,,1301.25,29.8,29.8% of Medicare Base rate X weight,1301.25,436.66,3877.73,Fee Schedule,29.8
"PAP SMEAR, SCREEN",P3000,HCPCS,,,,,both,, ,101.60,60.96,Aetna,Commercial,,101.60,29.8,29.8% of Medicare Base rate X weight,101.60,34.09,302.77,Fee Schedule,29.8
S-H CRYO EACH UNIT,P9012,HCPCS,,,,,both,, ,283.48,170.08,Aetna,Commercial,,283.48,29.8,29.8% of Medicare Base rate X weight,283.48,95.13,844.77,Fee Schedule,29.8
S-H RBC LEUKO REDU,P9016,HCPCS,,,,,both,, ,884.69,530.81,Aetna,Commercial,,884.69,29.8,29.8% of Medicare Base rate X weight,884.69,296.88,2636.38,Fee Schedule,29.8
S-H 1 DONOR FFP,P9017,HCPCS,,,,,both,, ,638.53,383.11,Aetna,Commercial,,638.53,29.8,29.8% of Medicare Base rate X weight,638.53,214.27,1902.82,Fee Schedule,29.8
S-H RED BLD-UNIT,P9021,HCPCS,,,,,both,, ,737.05,442.23,Aetna,Commercial,,737.05,29.8,29.8% of Medicare Base rate X weight,737.05,247.33,2196.41,Fee Schedule,29.8
S-H PLAT PHERE L-R,P9035,HCPCS,,,,,both,, ,2646.20,1587.72,Aetna,Commercial,,2646.20,29.8,29.8% of Medicare Base rate X weight,2646.20,887.99,7885.68,Fee Schedule,29.8
S-H PLAT A-P L-R IRR,P9037,HCPCS,,,,,both,, ,2796.36,1677.81,Aetna,Commercial,,2796.36,29.8,29.8% of Medicare Base rate X weight,2796.36,938.38,8333.15,Fee Schedule,29.8
S-H RBC IRRAD,P9038,HCPCS,,,,,both,, ,1013.80,608.28,Aetna,Commercial,,1013.80,29.8,29.8% of Medicare Base rate X weight,1013.80,340.20,3021.12,Fee Schedule,29.8
S-H RBC L-R IRRAD,P9040,HCPCS,,,,,both,, ,1025.03,615.01,Aetna,Commercial,,1025.03,29.8,29.8% of Medicare Base rate X weight,1025.03,343.97,3054.59,Fee Schedule,29.8
S-H CRYOPRE REDU PLS,P9044,HCPCS,,,,,both,, ,614.12,368.47,Aetna,Commercial,,614.12,29.8,29.8% of Medicare Base rate X weight,614.12,206.08,1830.08,Fee Schedule,29.8
ALBUMIN 5% 250ML IV,P9045,HCPCS,,,,,both,250,ML,528.13,316.87,Aetna,Commercial,,528.13,29.8,29.8% of Medicare Base rate X weight,528.13,177.22,1573.83,Fee Schedule,29.8
ALBUMIN 25% 50ML IV,P9047,HCPCS,,,,,both,100,ML,408.14,244.88,Aetna,Commercial,,408.14,29.8,29.8% of Medicare Base rate X weight,408.14,136.96,1216.26,Fee Schedule,29.8
ALBUMIN 25% 50ML IV,P9047,HCPCS,,,,,both,50,ML,623.92,374.35,Aetna,Commercial,,623.92,29.8,29.8% of Medicare Base rate X weight,623.92,209.37,1859.28,Fee Schedule,29.8
S-H BLD L-R CMV- EA,P9051,HCPCS,,,,,both,, ,1025.03,615.01,Aetna,Commercial,,1025.03,29.8,29.8% of Medicare Base rate X weight,1025.03,343.97,3054.59,Fee Schedule,29.8
S-H FFP BTWN8-24HREA,P9059,HCPCS,,,,,both,, ,634.60,380.76,Aetna,Commercial,,634.60,29.8,29.8% of Medicare Base rate X weight,634.60,212.95,1891.11,Fee Schedule,29.8
FERUMOXYTOL1MG NESRD,Q0138,HCPCS,,,,,both,17,ML,9.68,5.80,Aetna,Commercial,,9.68,29.8,29.8% of Medicare Base rate X weight,9.68,3.25,28.85,Fee Schedule,29.8
CHLORPROMAZIN 5MG PO,Q0161,HCPCS,,,,,both,1,EA,4.12,2.47,Aetna,Commercial,,4.12,29.8,29.8% of Medicare Base rate X weight,4.12,1.38,12.28,Fee Schedule,29.8
CHLORPROMAZIN 5MG PO,Q0161,HCPCS,,,,,both,, ,7.52,4.51,Aetna,Commercial,,7.52,29.8,29.8% of Medicare Base rate X weight,7.52,2.52,22.41,Fee Schedule,29.8
ONDANSETRON 1MG PO,Q0162,HCPCS,,,,,both,, ,33.73,20.23,Aetna,Commercial,,33.73,29.8,29.8% of Medicare Base rate X weight,33.73,11.32,100.52,Fee Schedule,29.8
ONDANSETRON 1MG PO,Q0162,HCPCS,,,,,both,50,ML,34.25,20.55,Aetna,Commercial,,34.25,29.8,29.8% of Medicare Base rate X weight,34.25,11.49,102.07,Fee Schedule,29.8
TELEHEALTH IP NEURO,Q3014,HCPCS,,,,,both,, ,83.25,49.95,Aetna,Commercial,,83.25,29.8,29.8% of Medicare Base rate X weight,83.25,27.94,248.09,Fee Schedule,29.8
TOTAL CONTACT CAST 3 INCH,Q4038,HCPCS,,,,,both,, ,456.00,273.60,Aetna,Commercial,,456.00,29.8,29.8% of Medicare Base rate X weight,456.00,153.02,1358.88,Fee Schedule,29.8
TOTAL CONTACT CAST 4 INCH,Q4038,HCPCS,,,,,both,, ,469.68,281.80,Aetna,Commercial,,469.68,29.8,29.8% of Medicare Base rate X weight,469.68,157.61,1399.65,Fee Schedule,29.8
TOTAL CONTACT CAST BOOT LARGE,Q4038,HCPCS,,,,,both,, ,307.80,184.68,Aetna,Commercial,,307.80,29.8,29.8% of Medicare Base rate X weight,307.80,103.29,917.24,Fee Schedule,29.8
TOTAL CONTACT CAST BOOT X-LARGE,Q4038,HCPCS,,,,,both,, ,323.00,193.80,Aetna,Commercial,,323.00,29.8,29.8% of Medicare Base rate X weight,323.00,108.39,962.54,Fee Schedule,29.8
OASIS WOUND MAT SQCM,Q4102,HCPCS,,,,,both,, ,10.82,6.49,Aetna,Commercial,,10.82,29.8,29.8% of Medicare Base rate X weight,10.82,3.63,32.24,Fee Schedule,29.8
INTEGRA BMWD SQ CM,Q4104,HCPCS,,,,,both,, ,599.72,359.83,Aetna,Commercial,,599.72,29.8,29.8% of Medicare Base rate X weight,599.72,201.25,1787.17,Fee Schedule,29.8
INTEGRA SKIN SUB 5X5CM,Q4108,HCPCS,,,,,both,, ,4404.00,2642.40,Aetna,Commercial,,4404.00,29.8,29.8% of Medicare Base rate X weight,4404.00,1477.85,13123.92,Fee Schedule,29.8
DERMACELL SQ CM,Q4122,HCPCS,,,,,both,, ,166.86,100.11,Aetna,Commercial,,166.86,29.8,29.8% of Medicare Base rate X weight,166.86,55.99,497.24,Fee Schedule,29.8
OASIS ULTRA TRI SQCM,Q4124,HCPCS,,,,,both,, ,31.93,19.15,Aetna,Commercial,,31.93,29.8,29.8% of Medicare Base rate X weight,31.93,10.71,95.15,Fee Schedule,29.8
ACELL DERM MAT 1SQCM,Q4126,HCPCS,,,,,both,, ,133.90,80.34,Aetna,Commercial,,133.90,29.8,29.8% of Medicare Base rate X weight,133.90,44.93,399.02,Fee Schedule,29.8
1AMNIOEXCEL SKIN 1.5X1.5CM,Q4137,HCPCS,,,,,both,, ,2544.00,1526.40,Aetna,Commercial,,2544.00,29.8,29.8% of Medicare Base rate X weight,2544.00,853.69,7581.12,Fee Schedule,29.8
AMNIOEXCEL SKIN 2X3CM,Q4137,HCPCS,,,,,both,, ,3469.00,2081.40,Aetna,Commercial,,3469.00,29.8,29.8% of Medicare Base rate X weight,3469.00,1164.09,10337.62,Fee Schedule,29.8
AMNIOEXCEL SKIN 3.5X3.5CM,Q4137,HCPCS,,,,,both,, ,3745.00,2247.00,Aetna,Commercial,,3745.00,29.8,29.8% of Medicare Base rate X weight,3745.00,1256.71,11160.1,Fee Schedule,29.8
AMNIOEXCEL SKIN 4X4CM,Q4137,HCPCS,,,,,both,, ,3928.00,2356.80,Aetna,Commercial,,3928.00,29.8,29.8% of Medicare Base rate X weight,3928.00,1318.12,11705.44,Fee Schedule,29.8
ALLOWRAP DS/DRY SQCM,Q4150,HCPCS,,,,,both,, ,347.63,208.57,Aetna,Commercial,,347.63,29.8,29.8% of Medicare Base rate X weight,347.63,116.65,1035.94,Fee Schedule,29.8
ALLOWRAP DS/DRY SQCM,Q4150,HCPCS,,,,,both,, ,506.25,303.75,Aetna,Commercial,,506.25,29.8,29.8% of Medicare Base rate X weight,506.25,169.88,1508.63,Fee Schedule,29.8
HELICOLL (PER SQ CM),Q4164,HCPCS,,,,,both,, ,6211.00,3726.60,Aetna,Commercial,,6211.00,29.8,29.8% of Medicare Base rate X weight,6211.00,2084.23,18508.78,Fee Schedule,29.8
EPIFIX SQ CM,Q4186,HCPCS,,,,,both,, ,570.11,342.06,Aetna,Commercial,,570.11,29.8,29.8% of Medicare Base rate X weight,570.11,191.31,1698.93,Fee Schedule,29.8
MEMBRANE GRAFT/WRAP (PER SQ CM),Q4205,HCPCS,,,,,both,, ,5236.00,3141.60,Aetna,Commercial,,5236.00,29.8,29.8% of Medicare Base rate X weight,5236.00,1757.05,15603.28,Fee Schedule,29.8
DERM-MAXX (PER SQ CM),Q4238,HCPCS,,,,,both,, ,3534.00,2120.40,Aetna,Commercial,,3534.00,29.8,29.8% of Medicare Base rate X weight,3534.00,1185.91,10531.32,Fee Schedule,29.8
AMNIO-MAX (PER SQ CM),Q4239,HCPCS,,,,,both,, ,9540.00,5724.00,Aetna,Commercial,,9540.00,29.8,29.8% of Medicare Base rate X weight,9540.00,3201.34,28429.2,Fee Schedule,29.8
INFLIXIMAB-DYYB 10MG,Q5103,HCPCS,,,,,both,1,EA,545.13,327.07,Aetna,Commercial,,545.13,29.8,29.8% of Medicare Base rate X weight,545.13,182.93,1624.49,Fee Schedule,29.8
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,1,ML,70.81,42.48,Aetna,Commercial,,70.81,29.8,29.8% of Medicare Base rate X weight,70.81,23.76,211.01,Fee Schedule,29.8
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,1,ML,93.22,55.93,Aetna,Commercial,,93.22,29.8,29.8% of Medicare Base rate X weight,93.22,31.28,277.8,Fee Schedule,29.8
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,, ,93.22,55.93,Aetna,Commercial,,93.22,29.8,29.8% of Medicare Base rate X weight,93.22,31.28,277.8,Fee Schedule,29.8
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,, ,93.22,55.93,Aetna,Commercial,,93.22,29.8,29.8% of Medicare Base rate X weight,93.22,31.28,277.8,Fee Schedule,29.8
INJ PERFLUTRN LIP ML,Q9957,HCPCS,,,,,both,, ,1184.50,710.70,Aetna,Commercial,,1184.50,29.8,29.8% of Medicare Base rate X weight,1184.50,397.48,3529.81,Fee Schedule,29.8
HOCM2 250-299MGML ML,Q9961,HCPCS,,,,,both,, ,1.65,0.99,Aetna,Commercial,,1.65,29.8,29.8% of Medicare Base rate X weight,1.65,0.55,4.92,Fee Schedule,29.8
HOCM 350 MG ML 30ML,Q9963,HCPCS,,,,,both,30,ML,49.50,29.70,Aetna,Commercial,,49.50,29.8,29.8% of Medicare Base rate X weight,49.50,16.61,147.51,Fee Schedule,29.8
HOCM 350-399MGML IOD,Q9963,HCPCS,,,,,both,, ,1.65,0.99,Aetna,Commercial,,1.65,29.8,29.8% of Medicare Base rate X weight,1.65,0.55,4.92,Fee Schedule,29.8
LOC2 200-299MG/ML ML,Q9966,HCPCS,,,,,both,, ,27.81,16.68,Aetna,Commercial,,27.81,29.8,29.8% of Medicare Base rate X weight,27.81,9.33,82.87,Fee Schedule,29.8
LOCM 240MG 100ML,Q9966,HCPCS,,,,,both,100,ML,6.00,3.60,Aetna,Commercial,,6.00,29.8,29.8% of Medicare Base rate X weight,6.00,2.01,17.88,Fee Schedule,29.8
LOCM 240MG 50ML,Q9966,HCPCS,,,,,both,50,ML,6.00,3.60,Aetna,Commercial,,6.00,29.8,29.8% of Medicare Base rate X weight,6.00,2.01,17.88,Fee Schedule,29.8
LOCM 270MG 150ML,Q9966,HCPCS,,,,,both,150,ML,6.00,3.60,Aetna,Commercial,,6.00,29.8,29.8% of Medicare Base rate X weight,6.00,2.01,17.88,Fee Schedule,29.8
LOCM200MG/ML 41% 200,Q9966,HCPCS,,,,,both,200,ML,4.00,2.40,Aetna,Commercial,,4.00,29.8,29.8% of Medicare Base rate X weight,4.00,1.34,11.92,Fee Schedule,29.8
LOCM200MG/ML M41% 10,Q9966,HCPCS,,,,,both,20,ML,36.82,22.09,Aetna,Commercial,,36.82,29.8,29.8% of Medicare Base rate X weight,36.82,12.36,109.72,Fee Schedule,29.8
LOCM200MG/ML M41% 10,Q9966,HCPCS,,,,,both,20,ML,36.82,22.09,Aetna,Commercial,,36.82,29.8,29.8% of Medicare Base rate X weight,36.82,12.36,109.72,Fee Schedule,29.8
LOC2 300-399MG/ML ML,Q9967,HCPCS,,,,,both,150,ML,1337.97,802.78,Aetna,Commercial,,1337.97,29.8,29.8% of Medicare Base rate X weight,1337.97,448.98,3987.15,Fee Schedule,29.8
LOC3 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,60.50,36.30,Aetna,Commercial,,60.50,29.8,29.8% of Medicare Base rate X weight,60.50,20.30,180.29,Fee Schedule,29.8
LOC3 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,60.50,36.30,Aetna,Commercial,,60.50,29.8,29.8% of Medicare Base rate X weight,60.50,20.30,180.29,Fee Schedule,29.8
LOC4 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,7.40,4.44,Aetna,Commercial,,7.40,29.8,29.8% of Medicare Base rate X weight,7.40,2.48,22.05,Fee Schedule,29.8
LOC4 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,7.40,4.44,Aetna,Commercial,,7.40,29.8,29.8% of Medicare Base rate X weight,7.40,2.48,22.05,Fee Schedule,29.8
LOC4 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,7.40,4.44,Aetna,Commercial,,7.40,29.8,29.8% of Medicare Base rate X weight,7.40,2.48,22.05,Fee Schedule,29.8
LOC4 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,7.40,4.44,Aetna,Commercial,,7.40,29.8,29.8% of Medicare Base rate X weight,7.40,2.48,22.05,Fee Schedule,29.8
LOC5 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,0.70,0.42,Aetna,Commercial,,0.70,29.8,29.8% of Medicare Base rate X weight,0.70,0.23,2.09,Fee Schedule,29.8
LOC5 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,0.70,0.42,Aetna,Commercial,,0.70,29.8,29.8% of Medicare Base rate X weight,0.70,0.23,2.09,Fee Schedule,29.8
LOC6 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,0.60,0.36,Aetna,Commercial,,0.60,29.8,29.8% of Medicare Base rate X weight,0.60,0.20,1.79,Fee Schedule,29.8
LOC6 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,0.60,0.36,Aetna,Commercial,,0.60,29.8,29.8% of Medicare Base rate X weight,0.60,0.20,1.79,Fee Schedule,29.8
LOCM 300-399MG/ML ML,Q9967,HCPCS,,,,,both,50,ML,12.62,7.57,Aetna,Commercial,,12.62,29.8,29.8% of Medicare Base rate X weight,12.62,4.23,37.61,Fee Schedule,29.8
LOCM 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,1178.84,707.30,Aetna,Commercial,,1178.84,29.8,29.8% of Medicare Base rate X weight,1178.84,395.58,3512.94,Fee Schedule,29.8
LOCM300MG/ML 76% 125,Q9967,HCPCS,,,,,both,125,ML,4.00,2.40,Aetna,Commercial,,4.00,29.8,29.8% of Medicare Base rate X weight,4.00,1.34,11.92,Fee Schedule,29.8
LOCM300MG/ML 76% 200,Q9967,HCPCS,,,,,both,200,ML,11.07,6.64,Aetna,Commercial,,11.07,29.8,29.8% of Medicare Base rate X weight,11.07,3.71,32.99,Fee Schedule,29.8
LOCM300MG/ML 76% 200,Q9967,HCPCS,,,,,both,200,ML,11.07,6.64,Aetna,Commercial,,11.07,29.8,29.8% of Medicare Base rate X weight,11.07,3.71,32.99,Fee Schedule,29.8
LOCM300MG/ML 76% 200,Q9967,HCPCS,,,,,both,200,ML,11.07,6.64,Aetna,Commercial,,11.07,29.8,29.8% of Medicare Base rate X weight,11.07,3.71,32.99,Fee Schedule,29.8
LOCM300MG/ML 76% 200,Q9967,HCPCS,,,,,both,200,ML,11.07,6.64,Aetna,Commercial,,11.07,29.8,29.8% of Medicare Base rate X weight,11.07,3.71,32.99,Fee Schedule,29.8
LACTATION CONSULT,S9443,HCPCS,,,,,both,, ,115.88,69.52,Aetna,Commercial,,115.88,29.8,29.8% of Medicare Base rate X weight,115.88,38.89,345.32,Fee Schedule,29.8
NI-CARD REHAB PH 3,S9472,HCPCS,,,,,both,, ,2.58,1.54,Aetna,Commercial,,2.58,29.8,29.8% of Medicare Base rate X weight,2.58,0.87,7.69,Fee Schedule,29.8
NI-PULM REHAB PH 3,S9473,HCPCS,,,,,both,, ,2.58,1.54,Aetna,Commercial,,2.58,29.8,29.8% of Medicare Base rate X weight,2.58,0.87,7.69,Fee Schedule,29.8
IOP PSYCH PER DIEM,S9480,HCPCS,,,,,both,, ,872.41,523.44,Aetna,Commercial,,872.41,29.8,29.8% of Medicare Base rate X weight,872.41,292.76,2599.78,Fee Schedule,29.8
CDC COVID19,U0001,HCPCS,,,,,both,, ,120.97,72.58,Aetna,Commercial,,120.97,29.8,29.8% of Medicare Base rate X weight,120.97,40.59,360.49,Fee Schedule,29.8
STATE COVID19,U0002,HCPCS,,,,,both,, ,172.81,103.68,Aetna,Commercial,,172.81,29.8,29.8% of Medicare Base rate X weight,172.81,57.99,514.97,Fee Schedule,29.8
Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC),470,MS-DRG,,,,,Inpatient,,,13886.51,13886.51,Blue Cross and Blue Shield,Traditional,,12497.86,29.8,29.8% of Medicare Base rate X weight,13886.51,13886.51,13886.51,percent of total billed charges,38.7
CT-CATH FLUID DRAIN,10030,CPT,,,,,both,, ,1071.33,1071.33,Blue Cross and Blue Shield,Traditional,,414.60,38.7,percent of total billed charges,1071.33,41.78,546.38,percent of total billed charges,38.7
I&D ABSCS SMPL/SGL,10060,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
I&D ABSCS COMP/MULTI,10061,CPT,,,,,both,, ,1519.68,1519.68,Blue Cross and Blue Shield,Traditional,,588.12,38.7,percent of total billed charges,1519.68,59.27,775.04,percent of total billed charges,38.7
INC & REM FB SQ SMPL,10120,CPT,,,,,both,, ,1519.68,1519.68,Blue Cross and Blue Shield,Traditional,,588.12,38.7,percent of total billed charges,1519.68,59.27,775.04,percent of total billed charges,38.7
INC & REM FB SQ COMP,10121,CPT,,,,,both,, ,6179.00,6179.00,Blue Cross and Blue Shield,Traditional,,2391.27,38.7,percent of total billed charges,6179.00,240.98,3151.29,percent of total billed charges,38.7
I&D HEMATOMA/FLUID,10140,CPT,,,,,both,, ,6179.00,6179.00,Blue Cross and Blue Shield,Traditional,,2391.27,38.7,percent of total billed charges,6179.00,240.98,3151.29,percent of total billed charges,38.7
PNXR ASP ABS HEM CYT,10160,CPT,,,,,both,, ,1519.68,1519.68,Blue Cross and Blue Shield,Traditional,,588.12,38.7,percent of total billed charges,1519.68,59.27,775.04,percent of total billed charges,38.7
I&D CPLX PO WND INF,10180,CPT,,,,,both,, ,10829.40,10829.40,Blue Cross and Blue Shield,Traditional,,4190.98,38.7,percent of total billed charges,10829.40,422.35,5522.99,percent of total billed charges,38.7
DEBR EXZ/INF SKN <10%,11000,CPT,,,,,both,, ,2393.60,2393.60,Blue Cross and Blue Shield,Traditional,,926.32,38.7,percent of total billed charges,2393.60,93.35,1220.74,percent of total billed charges,38.7
DEBR EXZ/INF SKN E A,11001,CPT,,,,,both,, ,2393.60,2393.60,Blue Cross and Blue Shield,Traditional,,926.32,38.7,percent of total billed charges,2393.60,93.35,1220.74,percent of total billed charges,38.7
DEB SKN BONE FX SITE,11012,CPT,,,,,both,, ,10829.40,10829.40,Blue Cross and Blue Shield,Traditional,,4190.98,38.7,percent of total billed charges,10829.40,422.35,5522.99,percent of total billed charges,38.7
DEB SUB TIS 20 SQ CM<,11042,CPT,,,,,both,, ,1519.68,1519.68,Blue Cross and Blue Shield,Traditional,,588.12,38.7,percent of total billed charges,1519.68,59.27,775.04,percent of total billed charges,38.7
DEB MUSC/FSCA <20 SQ,11043,CPT,,,,,both,, ,2393.60,2393.60,Blue Cross and Blue Shield,Traditional,,926.32,38.7,percent of total billed charges,2393.60,93.35,1220.74,percent of total billed charges,38.7
DEB BONE 20 SQ CM/<,11044,CPT,,,,,both,, ,6179.00,6179.00,Blue Cross and Blue Shield,Traditional,,2391.27,38.7,percent of total billed charges,6179.00,240.98,3151.29,percent of total billed charges,38.7
DEB SUB TISS EA ADDL,11045,CPT,,,,,both,, ,6179.00,6179.00,Blue Cross and Blue Shield,Traditional,,2391.27,38.7,percent of total billed charges,6179.00,240.98,3151.29,percent of total billed charges,38.7
DEB MUSC/FSCA EA ADL,11046,CPT,,,,,both,, ,6179.00,6179.00,Blue Cross and Blue Shield,Traditional,,2391.27,38.7,percent of total billed charges,6179.00,240.98,3151.29,percent of total billed charges,38.7
DEB BONE EA ADDL,11047,CPT,,,,,both,, ,6179.00,6179.00,Blue Cross and Blue Shield,Traditional,,2391.27,38.7,percent of total billed charges,6179.00,240.98,3151.29,percent of total billed charges,38.7
PARG/CUTG B9 SGL LES,11055,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
TRIM SKIN LESION 2-4,11056,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
TRIM SKIN LESIONS >4,11057,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
TNGNTL BX SKN SGL LES,11102,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
TNGNTL BX SKN EA ADD,11103,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
PUNCH BX SKN SGL LES,11104,CPT,,,,,both,, ,1519.68,1519.68,Blue Cross and Blue Shield,Traditional,,588.12,38.7,percent of total billed charges,1519.68,59.27,775.04,percent of total billed charges,38.7
PUNCH BX SKN EA ADDL,11105,CPT,,,,,both,, ,1519.68,1519.68,Blue Cross and Blue Shield,Traditional,,588.12,38.7,percent of total billed charges,1519.68,59.27,775.04,percent of total billed charges,38.7
INCIS BX SKN SGL LES,11106,CPT,,,,,both,, ,2393.60,2393.60,Blue Cross and Blue Shield,Traditional,,926.32,38.7,percent of total billed charges,2393.60,93.35,1220.74,percent of total billed charges,38.7
INCAL BX SKN EA ADDL,11107,CPT,,,,,both,, ,2393.60,2393.60,Blue Cross and Blue Shield,Traditional,,926.32,38.7,percent of total billed charges,2393.60,93.35,1220.74,percent of total billed charges,38.7
RMV SKN TAGS<=15 LES,11200,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
RMV SKN TAGS EA ADDL,11201,CPT,,,,,both,, ,233.12,233.12,Blue Cross and Blue Shield,Traditional,,90.22,38.7,percent of total billed charges,233.12,9.09,118.89,percent of total billed charges,38.7
DEBRIDEMENT NAIL 1-5,11720,CPT,,,,,both,, ,233.12,233.12,Blue Cross and Blue Shield,Traditional,,90.22,38.7,percent of total billed charges,233.12,9.09,118.89,percent of total billed charges,38.7
DEBRIDEMENT NAIL >6,11721,CPT,,,,,both,, ,233.12,233.12,Blue Cross and Blue Shield,Traditional,,90.22,38.7,percent of total billed charges,233.12,9.09,118.89,percent of total billed charges,38.7
RMV NAIL PLATE SGL,11730,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
RMV NAIL PLATE E ADD,11732,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
EVAC SU HEMATOMA,11740,CPT,,,,,both,, ,486.84,486.84,Blue Cross and Blue Shield,Traditional,,188.41,38.7,percent of total billed charges,486.84,18.99,248.29,percent of total billed charges,38.7
TT F/C/M/N/A/G/H/F,14040,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
TT F/C/M/N/A/G/H/F AD,14041,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
WND PR T/A/L 100SQCM,15002,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
WND PR ADL 100 SQCM,15003,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
WND PREP F/N/HF/G,15004,CPT,,,,,both,, ,2393.60,2393.60,Blue Cross and Blue Shield,Traditional,,926.32,38.7,percent of total billed charges,2393.60,93.35,1220.74,percent of total billed charges,38.7
WND PREP F/N/HF/G ADL,15005,CPT,,,,,both,, ,2393.60,2393.60,Blue Cross and Blue Shield,Traditional,,926.32,38.7,percent of total billed charges,2393.60,93.35,1220.74,percent of total billed charges,38.7
PINCH GRFT UP TO 2CM,15050,CPT,,,,,both,, ,2393.60,2393.60,Blue Cross and Blue Shield,Traditional,,926.32,38.7,percent of total billed charges,2393.60,93.35,1220.74,percent of total billed charges,38.7
SKIN SPLT GRFT T/A/L,15100,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
SKN SPLT GRF T/A/L EA,15101,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
EPIDRM AUTOGRFT T/A/L,15110,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
EPIDR AUTGF T/A/L EA,15111,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
EPIDR AGRFT F/N/H/G,15115,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
EPI AGRFT F/N/HF/G ADL,15116,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
SKN SPLT AGRFT F/N/H/G,15120,CPT,,,,,both,, ,13673.04,13673.04,Blue Cross and Blue Shield,Traditional,,5291.47,38.7,percent of total billed charges,13673.04,533.25,6973.25,percent of total billed charges,38.7
SKN SPLT AGRF F/N/H/G ADD,15121,CPT,,,,,both,, ,13673.04,13673.04,Blue Cross and Blue Shield,Traditional,,5291.47,38.7,percent of total billed charges,13673.04,533.25,6973.25,percent of total billed charges,38.7
DERM AUTOGRAF T/A/L,15130,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
DERM AGRAF T/A/L ADL,15131,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
DERM AGRF F/N/H/G,15135,CPT,,,,,both,, ,13673.04,13673.04,Blue Cross and Blue Shield,Traditional,,5291.47,38.7,percent of total billed charges,13673.04,533.25,6973.25,percent of total billed charges,38.7
DERM AGRF F/N/H/G ADD,15136,CPT,,,,,both,, ,13673.04,13673.04,Blue Cross and Blue Shield,Traditional,,5291.47,38.7,percent of total billed charges,13673.04,533.25,6973.25,percent of total billed charges,38.7
CULT SKN GRF T/A/L,15150,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
CUL SKN GRF T/A/L A,15151,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
CUL SKN GRF T/A/L +%,15152,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
CUL SKN GRF F/N/H/G,15155,CPT,,,,,both,, ,13673.04,13673.04,Blue Cross and Blue Shield,Traditional,,5291.47,38.7,percent of total billed charges,13673.04,533.25,6973.25,percent of total billed charges,38.7
CUL SKN GRF F/N/H/G ADD,15156,CPT,,,,,both,, ,13673.04,13673.04,Blue Cross and Blue Shield,Traditional,,5291.47,38.7,percent of total billed charges,13673.04,533.25,6973.25,percent of total billed charges,38.7
CUL EPIDR GRF F/N/HFG +%,15157,CPT,,,,,both,, ,13673.04,13673.04,Blue Cross and Blue Shield,Traditional,,5291.47,38.7,percent of total billed charges,13673.04,533.25,6973.25,percent of total billed charges,38.7
FTH GRF TRNK 20SQ/<,15200,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
FTH GRF FR TRNK EA AD,15201,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
FTH GF S/A/L 20 SQ/<,15220,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
FTH GF S/A/L 20 SQ E A,15221,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
FTH GR F/C/C/M/N/AX/G/H/F,15240,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
FTH GR F/C/C/M/N/AX/G/H/F EA,15241,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
FTH GR FR N/E/E/L 20SQ/<,15260,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
FTH GR FR N/E/E/L E A,15261,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
SKN SUB GRAFT T/A/L,15271,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
SKN SUB GRFT ADDL,15272,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
SKN S GRFT >100SQ,15273,CPT,,,,,both,, ,13673.04,13673.04,Blue Cross and Blue Shield,Traditional,,5291.47,38.7,percent of total billed charges,13673.04,533.25,6973.25,percent of total billed charges,38.7
SKN S GR ADD 100SQ,15274,CPT,,,,,both,, ,13673.04,13673.04,Blue Cross and Blue Shield,Traditional,,5291.47,38.7,percent of total billed charges,13673.04,533.25,6973.25,percent of total billed charges,38.7
SKN S GR F/NK/HF/G 25SQCM,15275,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
SKN S GR F/N/HF/G ADL,15276,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
SKN S GR F/N/HF/G CH,15277,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
SKN S GR F/N/HF/G CH ADD,15278,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
INIT TX 1ST DEG BURN,16000,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
DRS DEB PTHICK BRN S,16020,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
DRS DEB PTHICK BRN M,16025,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
DRS DEB PTHICK BRN L,16030,CPT,,,,,both,, ,1519.68,1519.68,Blue Cross and Blue Shield,Traditional,,588.12,38.7,percent of total billed charges,1519.68,59.27,775.04,percent of total billed charges,38.7
DESTRCT PREMAL LES,17000,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
DESTRCT PREMAL 2-14,17003,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
DESTRCT PREMAL 15+,17004,CPT,,,,,both,, ,1519.68,1519.68,Blue Cross and Blue Shield,Traditional,,588.12,38.7,percent of total billed charges,1519.68,59.27,775.04,percent of total billed charges,38.7
DESTR CV LES <=10 SQ,17106,CPT,,,,,both,, ,1519.68,1519.68,Blue Cross and Blue Shield,Traditional,,588.12,38.7,percent of total billed charges,1519.68,59.27,775.04,percent of total billed charges,38.7
DESTR CV LES 10-50 SQ,17107,CPT,,,,,both,, ,2393.60,2393.60,Blue Cross and Blue Shield,Traditional,,926.32,38.7,percent of total billed charges,2393.60,93.35,1220.74,percent of total billed charges,38.7
DESTR CV LES > 50 SQ,17108,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,271.05,3544.56,percent of total billed charges,38.7
DESTRUCT B9 LES 1-14,17110,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
CHEM CAUT GRANL TISS,17250,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
UNLISTD PROCEDURE,17999,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,29.76,389.13,percent of total billed charges,38.7
S-BRST DUCTOGRM INJ,19030,CPT,,,,,both,, ,289.43,289.43,Blue Cross and Blue Shield,Traditional,,112.01,38.7,percent of total billed charges,289.43,11.29,147.61,percent of total billed charges,38.7
BX OF BREAST OPEN,19101,CPT,,,,,both,, ,14527.16,14527.16,Blue Cross and Blue Shield,Traditional,,5622.01,38.7,percent of total billed charges,14527.16,566.56,7408.85,percent of total billed charges,38.7
EXPL P WND EXTREM,20103,CPT,,,,,both,, ,6179.00,6179.00,Blue Cross and Blue Shield,Traditional,,2391.27,38.7,percent of total billed charges,6179.00,240.98,3151.29,percent of total billed charges,38.7
NJ TENDON SHEATH/LIG,20550,CPT,,,,,both,, ,1128.80,1128.80,Blue Cross and Blue Shield,Traditional,,436.85,38.7,percent of total billed charges,1128.80,44.02,575.69,percent of total billed charges,38.7
S-JOINT ASP-INJ SM,20600,CPT,,,,,both,, ,487.45,487.45,Blue Cross and Blue Shield,Traditional,,188.64,38.7,percent of total billed charges,487.45,19.01,248.6,percent of total billed charges,38.7
US-DRN INJ SMAL JT W,20604,CPT,,,,,both,, ,726.15,726.15,Blue Cross and Blue Shield,Traditional,,281.02,38.7,percent of total billed charges,726.15,28.32,370.34,percent of total billed charges,38.7
S-JOINT ASP-INJ IM,20605,CPT,,,,,both,, ,700.66,700.66,Blue Cross and Blue Shield,Traditional,,271.16,38.7,percent of total billed charges,700.66,27.33,357.34,percent of total billed charges,38.7
US-DRN INJ INTM JT W,20606,CPT,,,,,both,, ,1594.18,1594.18,Blue Cross and Blue Shield,Traditional,,616.95,38.7,percent of total billed charges,1594.18,62.17,813.03,percent of total billed charges,38.7
US-DRN INJ MAJR JT W,20611,CPT,,,,,both,, ,726.15,726.15,Blue Cross and Blue Shield,Traditional,,281.02,38.7,percent of total billed charges,726.15,28.32,370.34,percent of total billed charges,38.7
S-INJ TMJ ARTHROGRAM,21116,CPT,,,,,both,, ,289.43,289.43,Blue Cross and Blue Shield,Traditional,,112.01,38.7,percent of total billed charges,289.43,11.29,147.61,percent of total billed charges,38.7
S-INJ SHOULDER ARTH,23350,CPT,,,,,both,, ,289.43,289.43,Blue Cross and Blue Shield,Traditional,,112.01,38.7,percent of total billed charges,289.43,11.29,147.61,percent of total billed charges,38.7
S-INJ ELBOW ARTHRO,24220,CPT,,,,,both,, ,289.43,289.43,Blue Cross and Blue Shield,Traditional,,112.01,38.7,percent of total billed charges,289.43,11.29,147.61,percent of total billed charges,38.7
S-INJ WRIST ARTHRO,25246,CPT,,,,,both,, ,289.43,289.43,Blue Cross and Blue Shield,Traditional,,112.01,38.7,percent of total billed charges,289.43,11.29,147.61,percent of total billed charges,38.7
S-INJ HIP ARTHRO,27093,CPT,,,,,both,, ,289.43,289.43,Blue Cross and Blue Shield,Traditional,,112.01,38.7,percent of total billed charges,289.43,11.29,147.61,percent of total billed charges,38.7
S-INJ KNEE ARTHRO,27369,CPT,,,,,both,, ,289.43,289.43,Blue Cross and Blue Shield,Traditional,,112.01,38.7,percent of total billed charges,289.43,11.29,147.61,percent of total billed charges,38.7
S-INJ ANKLE ARTHRO,27648,CPT,,,,,both,, ,289.43,289.43,Blue Cross and Blue Shield,Traditional,,112.01,38.7,percent of total billed charges,289.43,11.29,147.61,percent of total billed charges,38.7
EXPLORE FOOT JOINT,28022,CPT,,,,,both,, ,12336.12,12336.12,Blue Cross and Blue Shield,Traditional,,4774.08,38.7,percent of total billed charges,12336.12,481.11,6291.42,percent of total billed charges,38.7
AMPUT TOE & METATRSL,28810,CPT,,,,,both,, ,12336.12,12336.12,Blue Cross and Blue Shield,Traditional,,4774.08,38.7,percent of total billed charges,12336.12,481.11,6291.42,percent of total billed charges,38.7
AMPUTATE TOE,28820,CPT,,,,,both,, ,12336.12,12336.12,Blue Cross and Blue Shield,Traditional,,4774.08,38.7,percent of total billed charges,12336.12,481.11,6291.42,percent of total billed charges,38.7
SPLNT LNG ARM S-H OT,29105,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,13.32,174.14,percent of total billed charges,38.7
SPLNT LNG ARM S-H OT,29105,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,13.32,174.14,percent of total billed charges,38.7
SPLNT LNG ARM S-H OT,29105,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,13.32,174.14,percent of total billed charges,38.7
SPLNT LNG ARM S-H OT,29105,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,13.32,174.14,percent of total billed charges,38.7
SPLNT LNG ARM S-H OT,29105,CPT,,,,,both,, ,1388.96,1388.96,Blue Cross and Blue Shield,Traditional,,537.53,38.7,percent of total billed charges,1388.96,54.17,708.37,percent of total billed charges,38.7
SPLNT LNG ARM S-H OT,29105,CPT,,,,,both,, ,1388.96,1388.96,Blue Cross and Blue Shield,Traditional,,537.53,38.7,percent of total billed charges,1388.96,54.17,708.37,percent of total billed charges,38.7
SPLNT LNG ARM S-H PT,29105,CPT,,,,,both,, ,1281.32,1281.32,Blue Cross and Blue Shield,Traditional,,495.87,38.7,percent of total billed charges,1281.32,49.97,653.47,percent of total billed charges,38.7
SPLNT LNG ARM S-H PT,29105,CPT,,,,,both,, ,1281.32,1281.32,Blue Cross and Blue Shield,Traditional,,495.87,38.7,percent of total billed charges,1281.32,49.97,653.47,percent of total billed charges,38.7
SPLNT LONG ARM S-H,29105,CPT,,,,,both,, ,1196.17,1196.17,Blue Cross and Blue Shield,Traditional,,462.92,38.7,percent of total billed charges,1196.17,46.65,610.05,percent of total billed charges,38.7
SPLNT LONG ARM S-H,29105,CPT,,,,,both,, ,1296.73,1296.73,Blue Cross and Blue Shield,Traditional,,501.83,38.7,percent of total billed charges,1296.73,50.57,661.33,percent of total billed charges,38.7
SPLNT SHRT ARM STATC,29125,CPT,,,,,both,, ,909.80,909.80,Blue Cross and Blue Shield,Traditional,,352.09,38.7,percent of total billed charges,909.80,35.48,464,percent of total billed charges,38.7
SPLNT SHRT ARM STATC,29125,CPT,,,,,both,, ,986.30,986.30,Blue Cross and Blue Shield,Traditional,,381.70,38.7,percent of total billed charges,986.30,38.47,503.01,percent of total billed charges,38.7
SPLT SHRT ARM ST OT,29125,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,percent of total billed charges,270.12,10.53,137.76,percent of total billed charges,38.7
SPLT SHRT ARM ST OT,29125,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,percent of total billed charges,270.12,10.53,137.76,percent of total billed charges,38.7
SPLT SHRT ARM ST OT,29125,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,percent of total billed charges,270.12,10.53,137.76,percent of total billed charges,38.7
SPLT SHRT ARM ST OT,29125,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,percent of total billed charges,270.12,10.53,137.76,percent of total billed charges,38.7
SPLT SHRT ARM ST OT,29125,CPT,,,,,both,, ,1056.52,1056.52,Blue Cross and Blue Shield,Traditional,,408.87,38.7,percent of total billed charges,1056.52,41.20,538.83,percent of total billed charges,38.7
SPLT SHRT ARM ST OT,29125,CPT,,,,,both,, ,1056.52,1056.52,Blue Cross and Blue Shield,Traditional,,408.87,38.7,percent of total billed charges,1056.52,41.20,538.83,percent of total billed charges,38.7
SPLT SHRT ARM ST PT,29125,CPT,,,,,both,, ,974.64,974.64,Blue Cross and Blue Shield,Traditional,,377.19,38.7,percent of total billed charges,974.64,38.01,497.07,percent of total billed charges,38.7
SPLT SHRT ARM ST PT,29125,CPT,,,,,both,, ,974.64,974.64,Blue Cross and Blue Shield,Traditional,,377.19,38.7,percent of total billed charges,974.64,38.01,497.07,percent of total billed charges,38.7
SPLN SHRT ARM DY OT,29126,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,percent of total billed charges,270.12,10.53,137.76,percent of total billed charges,38.7
SPLN SHRT ARM DY OT,29126,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,percent of total billed charges,270.12,10.53,137.76,percent of total billed charges,38.7
SPLN SHRT ARM DY OT,29126,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,percent of total billed charges,270.12,10.53,137.76,percent of total billed charges,38.7
SPLN SHRT ARM DY OT,29126,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,percent of total billed charges,270.12,10.53,137.76,percent of total billed charges,38.7
SPLN SHRT ARM DY OT,29126,CPT,,,,,both,, ,1611.18,1611.18,Blue Cross and Blue Shield,Traditional,,623.53,38.7,percent of total billed charges,1611.18,62.84,821.7,percent of total billed charges,38.7
SPLN SHRT ARM DY OT,29126,CPT,,,,,both,, ,1611.18,1611.18,Blue Cross and Blue Shield,Traditional,,623.53,38.7,percent of total billed charges,1611.18,62.84,821.7,percent of total billed charges,38.7
SPLN SHRT ARM DY PT,29126,CPT,,,,,both,, ,1486.29,1486.29,Blue Cross and Blue Shield,Traditional,,575.19,38.7,percent of total billed charges,1486.29,57.97,758.01,percent of total billed charges,38.7
SPLN SHRT ARM DY PT,29126,CPT,,,,,both,, ,1486.29,1486.29,Blue Cross and Blue Shield,Traditional,,575.19,38.7,percent of total billed charges,1486.29,57.97,758.01,percent of total billed charges,38.7
SPLNT SHRT ARM DYNAM,29126,CPT,,,,,both,, ,1387.43,1387.43,Blue Cross and Blue Shield,Traditional,,536.94,38.7,percent of total billed charges,1387.43,54.11,707.59,percent of total billed charges,38.7
SPLNT SHRT ARM DYNAM,29126,CPT,,,,,both,, ,1504.12,1504.12,Blue Cross and Blue Shield,Traditional,,582.09,38.7,percent of total billed charges,1504.12,58.66,767.1,percent of total billed charges,38.7
SPLNT FINGER STATIC,29130,CPT,,,,,both,, ,299.22,299.22,Blue Cross and Blue Shield,Traditional,,115.80,38.7,percent of total billed charges,299.22,11.67,152.6,percent of total billed charges,38.7
SPLNT FINGER STATIC,29130,CPT,,,,,both,, ,324.42,324.42,Blue Cross and Blue Shield,Traditional,,125.55,38.7,percent of total billed charges,324.42,12.65,165.45,percent of total billed charges,38.7
SPLNT FNGR STATC OT,29130,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,percent of total billed charges,141.88,5.53,72.36,percent of total billed charges,38.7
SPLNT FNGR STATC OT,29130,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,percent of total billed charges,141.88,5.53,72.36,percent of total billed charges,38.7
SPLNT FNGR STATC OT,29130,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,percent of total billed charges,141.88,5.53,72.36,percent of total billed charges,38.7
SPLNT FNGR STATC OT,29130,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,percent of total billed charges,141.88,5.53,72.36,percent of total billed charges,38.7
SPLNT FNGR STATC OT,29130,CPT,,,,,both,, ,347.63,347.63,Blue Cross and Blue Shield,Traditional,,134.53,38.7,percent of total billed charges,347.63,13.56,177.29,percent of total billed charges,38.7
SPLNT FNGR STATC OT,29130,CPT,,,,,both,, ,347.63,347.63,Blue Cross and Blue Shield,Traditional,,134.53,38.7,percent of total billed charges,347.63,13.56,177.29,percent of total billed charges,38.7
SPLNT FNGR STATC PT,29130,CPT,,,,,both,, ,320.59,320.59,Blue Cross and Blue Shield,Traditional,,124.07,38.7,percent of total billed charges,320.59,12.50,163.5,percent of total billed charges,38.7
SPLNT FNGR STATC PT,29130,CPT,,,,,both,, ,320.59,320.59,Blue Cross and Blue Shield,Traditional,,124.07,38.7,percent of total billed charges,320.59,12.50,163.5,percent of total billed charges,38.7
SPLNT FINGER DYNAM,29131,CPT,,,,,both,, ,453.68,453.68,Blue Cross and Blue Shield,Traditional,,175.57,38.7,percent of total billed charges,453.68,17.69,231.38,percent of total billed charges,38.7
SPLNT FINGER DYNAM,29131,CPT,,,,,both,, ,491.82,491.82,Blue Cross and Blue Shield,Traditional,,190.33,38.7,percent of total billed charges,491.82,19.18,250.83,percent of total billed charges,38.7
SPLNT FINGR DYNA OT,29131,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,percent of total billed charges,141.88,5.53,72.36,percent of total billed charges,38.7
SPLNT FINGR DYNA OT,29131,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,percent of total billed charges,141.88,5.53,72.36,percent of total billed charges,38.7
SPLNT FINGR DYNA OT,29131,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,percent of total billed charges,141.88,5.53,72.36,percent of total billed charges,38.7
SPLNT FINGR DYNA OT,29131,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,percent of total billed charges,141.88,5.53,72.36,percent of total billed charges,38.7
SPLNT FINGR DYNA OT,29131,CPT,,,,,both,, ,526.85,526.85,Blue Cross and Blue Shield,Traditional,,203.89,38.7,percent of total billed charges,526.85,20.55,268.69,percent of total billed charges,38.7
SPLNT FINGR DYNA OT,29131,CPT,,,,,both,, ,526.85,526.85,Blue Cross and Blue Shield,Traditional,,203.89,38.7,percent of total billed charges,526.85,20.55,268.69,percent of total billed charges,38.7
SPLNT FINGR DYNA PT,29131,CPT,,,,,both,, ,485.90,485.90,Blue Cross and Blue Shield,Traditional,,188.04,38.7,percent of total billed charges,485.90,18.95,247.81,percent of total billed charges,38.7
SPLNT FINGR DYNA PT,29131,CPT,,,,,both,, ,485.90,485.90,Blue Cross and Blue Shield,Traditional,,188.04,38.7,percent of total billed charges,485.90,18.95,247.81,percent of total billed charges,38.7
STRAPPING THORAX,29200,CPT,,,,,both,, ,377.17,377.17,Blue Cross and Blue Shield,Traditional,,145.96,38.7,percent of total billed charges,377.17,14.71,192.36,percent of total billed charges,38.7
STRAPPING THORAX OT,29200,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,13.32,174.14,percent of total billed charges,38.7
STRAPPING THORAX OT,29200,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,13.32,174.14,percent of total billed charges,38.7
STRAPPING THORAX OT,29200,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,13.32,174.14,percent of total billed charges,38.7
STRAPPING THORAX OT,29200,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,13.32,174.14,percent of total billed charges,38.7
STRAPPING THORAX PT,29200,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,percent of total billed charges,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING THORAX PT,29200,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,percent of total billed charges,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING SHOULD OT,29240,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,percent of total billed charges,81.37,3.17,41.5,percent of total billed charges,38.7
STRAPPING SHOULD OT,29240,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,percent of total billed charges,81.37,3.17,41.5,percent of total billed charges,38.7
STRAPPING SHOULD OT,29240,CPT,,,,,both,, ,438.01,438.01,Blue Cross and Blue Shield,Traditional,,169.51,38.7,percent of total billed charges,438.01,17.08,223.39,percent of total billed charges,38.7
STRAPPING SHOULD OT,29240,CPT,,,,,both,, ,438.01,438.01,Blue Cross and Blue Shield,Traditional,,169.51,38.7,percent of total billed charges,438.01,17.08,223.39,percent of total billed charges,38.7
STRAPPING SHOULD PT,29240,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,percent of total billed charges,270.12,10.53,137.76,percent of total billed charges,38.7
STRAPPING SHOULD PT,29240,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,percent of total billed charges,270.12,10.53,137.76,percent of total billed charges,38.7
STRAPPING SHOULD PT,29240,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,percent of total billed charges,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING SHOULD PT,29240,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,percent of total billed charges,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING SHOULDER,29240,CPT,,,,,both,, ,377.17,377.17,Blue Cross and Blue Shield,Traditional,,145.96,38.7,percent of total billed charges,377.17,14.71,192.36,percent of total billed charges,38.7
STRAPPING SHOULDER,29240,CPT,,,,,both,, ,408.86,408.86,Blue Cross and Blue Shield,Traditional,,158.23,38.7,percent of total billed charges,408.86,15.95,208.52,percent of total billed charges,38.7
STRAPPING ELBO-WRIST,29260,CPT,,,,,both,, ,377.17,377.17,Blue Cross and Blue Shield,Traditional,,145.96,38.7,percent of total billed charges,377.17,14.71,192.36,percent of total billed charges,38.7
STRAPPING ELBO-WRIST,29260,CPT,,,,,both,, ,408.86,408.86,Blue Cross and Blue Shield,Traditional,,158.23,38.7,percent of total billed charges,408.86,15.95,208.52,percent of total billed charges,38.7
STRPNG ELBO-WRST OT,29260,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,percent of total billed charges,81.37,3.17,41.5,percent of total billed charges,38.7
STRPNG ELBO-WRST OT,29260,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,percent of total billed charges,81.37,3.17,41.5,percent of total billed charges,38.7
STRPNG ELBO-WRST OT,29260,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,percent of total billed charges,81.37,3.17,41.5,percent of total billed charges,38.7
STRPNG ELBO-WRST OT,29260,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,percent of total billed charges,81.37,3.17,41.5,percent of total billed charges,38.7
STRPNG ELBO-WRST OT,29260,CPT,,,,,both,, ,438.01,438.01,Blue Cross and Blue Shield,Traditional,,169.51,38.7,percent of total billed charges,438.01,17.08,223.39,percent of total billed charges,38.7
STRPNG ELBO-WRST OT,29260,CPT,,,,,both,, ,438.01,438.01,Blue Cross and Blue Shield,Traditional,,169.51,38.7,percent of total billed charges,438.01,17.08,223.39,percent of total billed charges,38.7
STRPNG ELBO-WRST PT,29260,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,percent of total billed charges,404.02,15.76,206.05,percent of total billed charges,38.7
STRPNG ELBO-WRST PT,29260,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,percent of total billed charges,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING HAND-FING,29280,CPT,,,,,both,, ,377.17,377.17,Blue Cross and Blue Shield,Traditional,,145.96,38.7,percent of total billed charges,377.17,14.71,192.36,percent of total billed charges,38.7
STRAPPING HAND-FING,29280,CPT,,,,,both,, ,408.86,408.86,Blue Cross and Blue Shield,Traditional,,158.23,38.7,percent of total billed charges,408.86,15.95,208.52,percent of total billed charges,38.7
STRPPNG HND-FING OT,29280,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,percent of total billed charges,81.37,3.17,41.5,percent of total billed charges,38.7
STRPPNG HND-FING OT,29280,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,percent of total billed charges,81.37,3.17,41.5,percent of total billed charges,38.7
STRPPNG HND-FING OT,29280,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,percent of total billed charges,81.37,3.17,41.5,percent of total billed charges,38.7
STRPPNG HND-FING OT,29280,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,percent of total billed charges,81.37,3.17,41.5,percent of total billed charges,38.7
STRPPNG HND-FING OT,29280,CPT,,,,,both,, ,438.01,438.01,Blue Cross and Blue Shield,Traditional,,169.51,38.7,percent of total billed charges,438.01,17.08,223.39,percent of total billed charges,38.7
STRPPNG HND-FING OT,29280,CPT,,,,,both,, ,438.01,438.01,Blue Cross and Blue Shield,Traditional,,169.51,38.7,percent of total billed charges,438.01,17.08,223.39,percent of total billed charges,38.7
STRPPNG HND-FING PT,29280,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,percent of total billed charges,404.02,15.76,206.05,percent of total billed charges,38.7
STRPPNG HND-FING PT,29280,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,percent of total billed charges,404.02,15.76,206.05,percent of total billed charges,38.7
APPLY RIGID LEG CAST,29445,CPT,,,,,both,, ,1023.52,1023.52,Blue Cross and Blue Shield,Traditional,,396.10,38.7,percent of total billed charges,1023.52,39.92,522,percent of total billed charges,38.7
AP LNG LEG SPLNT PT,29505,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,13.32,174.14,percent of total billed charges,38.7
AP LNG LEG SPLNT PT,29505,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,13.32,174.14,percent of total billed charges,38.7
AP LNG LEG SPLNT PT,29505,CPT,,,,,both,, ,1486.29,1486.29,Blue Cross and Blue Shield,Traditional,,575.19,38.7,percent of total billed charges,1486.29,57.97,758.01,percent of total billed charges,38.7
AP LNG LEG SPLNT PT,29505,CPT,,,,,both,, ,1486.29,1486.29,Blue Cross and Blue Shield,Traditional,,575.19,38.7,percent of total billed charges,1486.29,57.97,758.01,percent of total billed charges,38.7
APP LNG LEG SPLINT,29505,CPT,,,,,both,, ,1387.43,1387.43,Blue Cross and Blue Shield,Traditional,,536.94,38.7,percent of total billed charges,1387.43,54.11,707.59,percent of total billed charges,38.7
APPLY LNG LEG SPLNT,29505,CPT,,,,,both,, ,600.52,600.52,Blue Cross and Blue Shield,Traditional,,232.40,38.7,percent of total billed charges,600.52,23.42,306.27,percent of total billed charges,38.7
AP SHT LEG SPLNT PT,29515,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,13.32,174.14,percent of total billed charges,38.7
AP SHT LEG SPLNT PT,29515,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,13.32,174.14,percent of total billed charges,38.7
AP SHT LEG SPLNT PT,29515,CPT,,,,,both,, ,974.64,974.64,Blue Cross and Blue Shield,Traditional,,377.19,38.7,percent of total billed charges,974.64,38.01,497.07,percent of total billed charges,38.7
AP SHT LEG SPLNT PT,29515,CPT,,,,,both,, ,974.64,974.64,Blue Cross and Blue Shield,Traditional,,377.19,38.7,percent of total billed charges,974.64,38.01,497.07,percent of total billed charges,38.7
APP SHORT LEG SPLINT,29515,CPT,,,,,both,, ,909.80,909.80,Blue Cross and Blue Shield,Traditional,,352.09,38.7,percent of total billed charges,909.80,35.48,464,percent of total billed charges,38.7
APPLY SHRT LEG SPLNT,29515,CPT,,,,,both,, ,600.52,600.52,Blue Cross and Blue Shield,Traditional,,232.40,38.7,percent of total billed charges,600.52,23.42,306.27,percent of total billed charges,38.7
STRAPPING HIP,29520,CPT,,,,,both,, ,377.17,377.17,Blue Cross and Blue Shield,Traditional,,145.96,38.7,percent of total billed charges,377.17,14.71,192.36,percent of total billed charges,38.7
STRAPPING HIP PT,29520,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,percent of total billed charges,141.88,5.53,72.36,percent of total billed charges,38.7
STRAPPING HIP PT,29520,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,percent of total billed charges,141.88,5.53,72.36,percent of total billed charges,38.7
STRAPPING HIP PT,29520,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,percent of total billed charges,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING HIP PT,29520,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,percent of total billed charges,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING KNEE,29530,CPT,,,,,both,, ,377.17,377.17,Blue Cross and Blue Shield,Traditional,,145.96,38.7,percent of total billed charges,377.17,14.71,192.36,percent of total billed charges,38.7
STRAPPING KNEE PT,29530,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,percent of total billed charges,270.12,10.53,137.76,percent of total billed charges,38.7
STRAPPING KNEE PT,29530,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,percent of total billed charges,270.12,10.53,137.76,percent of total billed charges,38.7
STRAPPING KNEE PT,29530,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,percent of total billed charges,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING KNEE PT,29530,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,percent of total billed charges,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING ANKLE-FOOT,29540,CPT,,,,,both,, ,377.17,377.17,Blue Cross and Blue Shield,Traditional,,145.96,38.7,percent of total billed charges,377.17,14.71,192.36,percent of total billed charges,38.7
STRPPNG ANKLE-FT PT,29540,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,13.32,174.14,percent of total billed charges,38.7
STRPPNG ANKLE-FT PT,29540,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,13.32,174.14,percent of total billed charges,38.7
STRPPNG ANKLE-FT PT,29540,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,percent of total billed charges,404.02,15.76,206.05,percent of total billed charges,38.7
STRPPNG ANKLE-FT PT,29540,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,percent of total billed charges,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING UNA BOOT,29580,CPT,,,,,both,, ,377.17,377.17,Blue Cross and Blue Shield,Traditional,,145.96,38.7,percent of total billed charges,377.17,14.71,192.36,percent of total billed charges,38.7
STRPPNG UNA BOOT PT,29580,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,13.32,174.14,percent of total billed charges,38.7
STRPPNG UNA BOOT PT,29580,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,13.32,174.14,percent of total billed charges,38.7
STRPPNG UNA BOOT PT,29580,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,percent of total billed charges,404.02,15.76,206.05,percent of total billed charges,38.7
STRPPNG UNA BOOT PT,29580,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,percent of total billed charges,404.02,15.76,206.05,percent of total billed charges,38.7
UNNA BOOT STRAPPING,29580,CPT,,,,,both,, ,600.52,600.52,Blue Cross and Blue Shield,Traditional,,232.40,38.7,percent of total billed charges,600.52,23.42,306.27,percent of total billed charges,38.7
UNNA WRAP,29580,CPT,,,,,both,, ,19.20,19.20,Blue Cross and Blue Shield,Traditional,,7.43,38.7,percent of total billed charges,19.20,0.75,9.79,percent of total billed charges,38.7
AP MULTLY COMP LR LEG,29581,CPT,,,,,both,, ,600.52,600.52,Blue Cross and Blue Shield,Traditional,,232.40,38.7,percent of total billed charges,600.52,23.42,306.27,percent of total billed charges,38.7
STRPPNG LOW BACK OT,29799,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,percent of total billed charges,270.12,10.53,137.76,percent of total billed charges,38.7
STRPPNG LOW BACK OT,29799,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,percent of total billed charges,270.12,10.53,137.76,percent of total billed charges,38.7
SUCTION PROC-NASOTRA,31720,CPT,,,,,both,, ,280.42,280.42,Blue Cross and Blue Shield,Traditional,,108.52,38.7,percent of total billed charges,280.42,10.94,143.01,percent of total billed charges,38.7
CT-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914.00,9914.00,Blue Cross and Blue Shield,Traditional,,3836.72,38.7,percent of total billed charges,9914.00,386.65,5056.14,percent of total billed charges,38.7
IR-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914.00,9914.00,Blue Cross and Blue Shield,Traditional,,3836.72,38.7,percent of total billed charges,9914.00,386.65,5056.14,percent of total billed charges,38.7
IR-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914.00,9914.00,Blue Cross and Blue Shield,Traditional,,3836.72,38.7,percent of total billed charges,9914.00,386.65,5056.14,percent of total billed charges,38.7
US-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,5184.63,5184.63,Blue Cross and Blue Shield,Traditional,,2006.45,38.7,percent of total billed charges,5184.63,202.20,2644.16,percent of total billed charges,38.7
CC-PERICARDIO W/IMG,33016,CPT,,,,,both,, ,3443.03,3443.03,Blue Cross and Blue Shield,Traditional,,1332.45,38.7,percent of total billed charges,3443.03,134.28,1755.95,percent of total billed charges,38.7
P-IMPLNT LOOP REC,33285,CPT,,,,,both,, ,27383.32,27383.32,Blue Cross and Blue Shield,Traditional,,10597.34,38.7,percent of total billed charges,27383.32,1067.95,13965.49,percent of total billed charges,38.7
P-REMOV LOOP REC,33286,CPT,,,,,both,, ,5044.68,5044.68,Blue Cross and Blue Shield,Traditional,,1952.29,38.7,percent of total billed charges,5044.68,196.74,2572.79,percent of total billed charges,38.7
CC-IMP PRESS SEN ANG,33289,CPT,,,,,both,, ,11332.83,11332.83,Blue Cross and Blue Shield,Traditional,,4385.81,38.7,percent of total billed charges,11332.83,441.98,5779.74,percent of total billed charges,38.7
S-INTRO NDL CATH,36000,CPT,,,,,both,, ,168.75,168.75,Blue Cross and Blue Shield,Traditional,,65.31,38.7,percent of total billed charges,168.75,6.58,86.06,percent of total billed charges,38.7
S-INTRO NDL CATH VEI,36000,CPT,,,,,both,, ,173.81,173.81,Blue Cross and Blue Shield,Traditional,,67.26,38.7,percent of total billed charges,173.81,6.78,88.64,percent of total billed charges,38.7
S-INJ VENOGRAPHY,36005,CPT,,,,,both,, ,873.46,873.46,Blue Cross and Blue Shield,Traditional,,338.03,38.7,percent of total billed charges,873.46,34.06,445.46,percent of total billed charges,38.7
S-INTROCATH SEGPULM,36015,CPT,,,,,both,, ,839.21,839.21,Blue Cross and Blue Shield,Traditional,,324.77,38.7,percent of total billed charges,839.21,32.73,428,percent of total billed charges,38.7
S-CATH CAROTD VERT,36100,CPT,,,,,both,, ,1013.23,1013.23,Blue Cross and Blue Shield,Traditional,,392.12,38.7,percent of total billed charges,1013.23,39.52,516.75,percent of total billed charges,38.7
S-CATH EXTREM ART,36140,CPT,,,,,both,, ,399.68,399.68,Blue Cross and Blue Shield,Traditional,,154.68,38.7,percent of total billed charges,399.68,15.59,203.84,percent of total billed charges,38.7
S-THORACIC 1ST ORDER,36215,CPT,,,,,both,, ,1839.26,1839.26,Blue Cross and Blue Shield,Traditional,,711.79,38.7,percent of total billed charges,1839.26,71.73,938.02,percent of total billed charges,38.7
IR-ANG EXT CRT NS,36221,CPT,,,,,both,, ,12592.76,12592.76,Blue Cross and Blue Shield,Traditional,,4873.40,38.7,percent of total billed charges,12592.76,491.12,6422.31,percent of total billed charges,38.7
IR-ANG CRT EXT CC BI,36222,CPT,,,,,both,, ,31881.02,31881.02,Blue Cross and Blue Shield,Traditional,,12337.95,38.7,percent of total billed charges,31881.02,1243.36,16259.32,percent of total billed charges,38.7
IR-ANG CARTD IPS BI,36223,CPT,,,,,both,, ,45998.14,45998.14,Blue Cross and Blue Shield,Traditional,,17801.28,38.7,percent of total billed charges,45998.14,1793.93,23459.05,percent of total billed charges,38.7
IR-ANG CARTD IPS UNI,36223,CPT,,,,,both,, ,31746.87,31746.87,Blue Cross and Blue Shield,Traditional,,12286.04,38.7,percent of total billed charges,31746.87,1238.13,16190.9,percent of total billed charges,38.7
IR-ANG INT CAR IP BI,36224,CPT,,,,,both,, ,51895.68,51895.68,Blue Cross and Blue Shield,Traditional,,20083.63,38.7,percent of total billed charges,51895.68,2023.93,26466.8,percent of total billed charges,38.7
IR-ANG INT CAR IP UN,36224,CPT,,,,,both,, ,32068.51,32068.51,Blue Cross and Blue Shield,Traditional,,12410.51,38.7,percent of total billed charges,32068.51,1250.67,16354.94,percent of total billed charges,38.7
IR-ANG SUBCL IPS BI,36225,CPT,,,,,both,, ,24740.10,24740.10,Blue Cross and Blue Shield,Traditional,,9574.42,38.7,percent of total billed charges,24740.10,964.86,12617.45,percent of total billed charges,38.7
IR-ANG SUBCL IPS UNI,36225,CPT,,,,,both,, ,12369.34,12369.34,Blue Cross and Blue Shield,Traditional,,4786.93,38.7,percent of total billed charges,12369.34,482.40,6308.36,percent of total billed charges,38.7
CTH PLC EXT CD W-ANG,36227,CPT,,,,,both,, ,9411.59,9411.59,Blue Cross and Blue Shield,Traditional,,3642.29,38.7,percent of total billed charges,9411.59,367.05,4799.91,percent of total billed charges,38.7
CTH PLC EXT CD W-ANG,36227,CPT,,,,,both,, ,14117.39,14117.39,Blue Cross and Blue Shield,Traditional,,5463.43,38.7,percent of total billed charges,14117.39,550.58,7199.87,percent of total billed charges,38.7
S-ANG EXT CD IPS BI,36227,CPT,,,,,both,, ,8060.51,8060.51,Blue Cross and Blue Shield,Traditional,,3119.42,38.7,percent of total billed charges,8060.51,314.36,4110.86,percent of total billed charges,38.7
S-ANG EXT CD IPS BI,36227,CPT,,,,,both,, ,12090.77,12090.77,Blue Cross and Blue Shield,Traditional,,4679.13,38.7,percent of total billed charges,12090.77,471.54,6166.29,percent of total billed charges,38.7
S-ABDOMEN 1ST ORDER,36245,CPT,,,,,both,, ,1979.03,1979.03,Blue Cross and Blue Shield,Traditional,,765.88,38.7,percent of total billed charges,1979.03,77.18,1009.31,percent of total billed charges,38.7
S-ABDOMEN 2ND ORDER,36246,CPT,,,,,both,, ,9539.09,9539.09,Blue Cross and Blue Shield,Traditional,,3691.63,38.7,percent of total billed charges,9539.09,372.02,4864.94,percent of total billed charges,38.7
S-ABDOMEN 3RD ORDER,36247,CPT,,,,,both,, ,16382.99,16382.99,Blue Cross and Blue Shield,Traditional,,6340.22,38.7,percent of total billed charges,16382.99,638.94,8355.32,percent of total billed charges,38.7
DNA SPECIMEN COLLECTION VENI,36415,CPT,,,,,both,, ,70.00,70.00,Blue Cross and Blue Shield,Traditional,,27.09,38.7,percent of total billed charges,70.00,2.73,35.7,percent of total billed charges,38.7
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,, ,8.19,8.19,Blue Cross and Blue Shield,Traditional,,3.17,38.7,percent of total billed charges,8.19,0.32,4.18,percent of total billed charges,38.7
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,,,90.37,90.37,Blue Cross and Blue Shield,Traditional,,34.97,38.7,percent of total billed charges,90.37,3.52,46.09,percent of total billed charges,38.7
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,, ,90.37,90.37,Blue Cross and Blue Shield,Traditional,,34.97,38.7,percent of total billed charges,90.37,3.52,46.09,percent of total billed charges,38.7
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,22.73,22.73,Blue Cross and Blue Shield,Traditional,,8.80,38.7,percent of total billed charges,22.73,0.89,11.59,percent of total billed charges,38.7
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,46.31,46.31,Blue Cross and Blue Shield,Traditional,,17.92,38.7,percent of total billed charges,46.31,1.81,23.62,percent of total billed charges,38.7
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,49.96,49.96,Blue Cross and Blue Shield,Traditional,,19.33,38.7,percent of total billed charges,49.96,1.95,25.48,percent of total billed charges,38.7
BLOOD TRANSF 0 2 HRS,36430,CPT,,,,,both,, ,2260.55,2260.55,Blue Cross and Blue Shield,Traditional,,874.83,38.7,percent of total billed charges,2260.55,88.16,1152.88,percent of total billed charges,38.7
BLOOD TRANSF 2 4 HRS,36430,CPT,,,,,both,, ,2260.55,2260.55,Blue Cross and Blue Shield,Traditional,,874.83,38.7,percent of total billed charges,2260.55,88.16,1152.88,percent of total billed charges,38.7
BLOOD TRANSF 4 6 HRS,36430,CPT,,,,,both,, ,2260.55,2260.55,Blue Cross and Blue Shield,Traditional,,874.83,38.7,percent of total billed charges,2260.55,88.16,1152.88,percent of total billed charges,38.7
BLOOD TRANSF 6 8 HRS,36430,CPT,,,,,both,, ,2260.55,2260.55,Blue Cross and Blue Shield,Traditional,,874.83,38.7,percent of total billed charges,2260.55,88.16,1152.88,percent of total billed charges,38.7
BLOOD TRANSF 8 10 HR,36430,CPT,,,,,both,, ,2260.55,2260.55,Blue Cross and Blue Shield,Traditional,,874.83,38.7,percent of total billed charges,2260.55,88.16,1152.88,percent of total billed charges,38.7
BLOOD TRANSFUSION,36430,CPT,,,,,both,, ,3283.64,3283.64,Blue Cross and Blue Shield,Traditional,,1270.77,38.7,percent of total billed charges,3283.64,128.06,1674.66,percent of total billed charges,38.7
BLOOD TRANSFUSION,36430,CPT,,,,,both,, ,3579.17,3579.17,Blue Cross and Blue Shield,Traditional,,1385.14,38.7,percent of total billed charges,3579.17,139.59,1825.38,percent of total billed charges,38.7
BLOOD PUSH TRAN U2YR,36440,CPT,,,,,both,, ,3579.17,3579.17,Blue Cross and Blue Shield,Traditional,,1385.14,38.7,percent of total billed charges,3579.17,139.59,1825.38,percent of total billed charges,38.7
THER APHERESIS WBC,36511,CPT,,,,,both,, ,5560.46,5560.46,Blue Cross and Blue Shield,Traditional,,2151.90,38.7,percent of total billed charges,5560.46,216.86,2835.83,percent of total billed charges,38.7
THER APHERESI PLASMA,36514,CPT,,,,,both,, ,5560.46,5560.46,Blue Cross and Blue Shield,Traditional,,2151.90,38.7,percent of total billed charges,5560.46,216.86,2835.83,percent of total billed charges,38.7
CC-INS NT CVC GT 5YR,36556,CPT,,,,,both,, ,4017.52,4017.52,Blue Cross and Blue Shield,Traditional,,1554.78,38.7,percent of total billed charges,4017.52,156.68,2048.94,percent of total billed charges,38.7
IR-RMV TUN CVC WO SQ,36589,CPT,,,,,both,, ,2370.55,2370.55,Blue Cross and Blue Shield,Traditional,,917.40,38.7,percent of total billed charges,2370.55,92.45,1208.98,percent of total billed charges,38.7
BLD COLLECT VAD,36591,CPT,,,,,both,, ,445.15,445.15,Blue Cross and Blue Shield,Traditional,,172.27,38.7,percent of total billed charges,445.15,17.36,227.03,percent of total billed charges,38.7
BLD DRAW CENTRAL LN,36592,CPT,,,,,both,, ,388.45,388.45,Blue Cross and Blue Shield,Traditional,,150.33,38.7,percent of total billed charges,388.45,15.15,198.11,percent of total billed charges,38.7
IR-INJ W FLUR CV DEV,36598,CPT,,,,,both,, ,467.11,467.11,Blue Cross and Blue Shield,Traditional,,180.77,38.7,percent of total billed charges,467.11,18.22,238.23,percent of total billed charges,38.7
ARTERIAL PUNCTURE,36600,CPT,,,,,both,, ,327.26,327.26,Blue Cross and Blue Shield,Traditional,,126.65,38.7,percent of total billed charges,327.26,12.76,166.9,percent of total billed charges,38.7
S-INS ENDO VENA CAVA,37191,CPT,,,,,both,, ,29440.27,29440.27,Blue Cross and Blue Shield,Traditional,,11393.38,38.7,percent of total billed charges,29440.27,1148.17,15014.54,percent of total billed charges,38.7
S-REDO ENDO VENA CAV,37192,CPT,,,,,both,, ,20313.85,20313.85,Blue Cross and Blue Shield,Traditional,,7861.46,38.7,percent of total billed charges,20313.85,792.24,10360.06,percent of total billed charges,38.7
S-REM ENDO VENA CAVA,37193,CPT,,,,,both,, ,20313.85,20313.85,Blue Cross and Blue Shield,Traditional,,7861.46,38.7,percent of total billed charges,20313.85,792.24,10360.06,percent of total billed charges,38.7
S-THROMBOLYSIS CEREB,37195,CPT,,,,,both,, ,860.31,860.31,Blue Cross and Blue Shield,Traditional,,332.94,38.7,percent of total billed charges,860.31,33.55,438.76,percent of total billed charges,38.7
S-ID SENTINEL NODE,38792,CPT,,,,,both,, ,1582.72,1582.72,Blue Cross and Blue Shield,Traditional,,612.51,38.7,percent of total billed charges,1582.72,61.73,807.19,percent of total billed charges,38.7
S-BX NDL LIVER,47000,CPT,,,,,both,, ,1102.87,1102.87,Blue Cross and Blue Shield,Traditional,,426.81,38.7,percent of total billed charges,1102.87,43.01,562.46,percent of total billed charges,38.7
CT-PERC CHOLECYSTOST,47490,CPT,,,,,both,, ,10295.62,10295.62,Blue Cross and Blue Shield,Traditional,,3984.40,38.7,percent of total billed charges,10295.62,401.53,5250.77,percent of total billed charges,38.7
IR-ABD PARACEN W IMG,49083,CPT,,,,,both,, ,3767.78,3767.78,Blue Cross and Blue Shield,Traditional,,1458.13,38.7,percent of total billed charges,3767.78,146.94,1921.57,percent of total billed charges,38.7
IR-PERITONEAL LAVAGE,49084,CPT,,,,,both,, ,3767.78,3767.78,Blue Cross and Blue Shield,Traditional,,1458.13,38.7,percent of total billed charges,3767.78,146.94,1921.57,percent of total billed charges,38.7
LITHOTRIPSY,50590,CPT,,,,,both,, ,54374.73,54374.73,Blue Cross and Blue Shield,Traditional,,21043.02,38.7,percent of total billed charges,54374.73,2120.61,27731.11,percent of total billed charges,38.7
S-URETEROGRM INJ,50684,CPT,,,,,both,, ,323.94,323.94,Blue Cross and Blue Shield,Traditional,,125.36,38.7,percent of total billed charges,323.94,12.63,165.21,percent of total billed charges,38.7
S-INJ ILEAL CONDUIT,50690,CPT,,,,,both,, ,323.94,323.94,Blue Cross and Blue Shield,Traditional,,125.36,38.7,percent of total billed charges,323.94,12.63,165.21,percent of total billed charges,38.7
S-CORPCAVERNOSGR INJ,54230,CPT,,,,,both,, ,425.39,425.39,Blue Cross and Blue Shield,Traditional,,164.63,38.7,percent of total billed charges,425.39,16.59,216.95,percent of total billed charges,38.7
S-INJ CATH HYSTERSO,58340,CPT,,,,,both,, ,336.52,336.52,Blue Cross and Blue Shield,Traditional,,130.23,38.7,percent of total billed charges,336.52,13.12,171.63,percent of total billed charges,38.7
FETAL CONTRACTION ST,59020,CPT,,,,,both,, ,2089.10,2089.10,Blue Cross and Blue Shield,Traditional,,808.48,38.7,percent of total billed charges,2089.10,81.47,1065.44,percent of total billed charges,38.7
FETAL NON STRESS TES,59025,CPT,,,,,both,, ,1169.57,1169.57,Blue Cross and Blue Shield,Traditional,,452.62,38.7,percent of total billed charges,1169.57,45.61,596.48,percent of total billed charges,38.7
EXTERNAL CEPHALIC VE,59412,CPT,,,,,both,, ,5047.77,5047.77,Blue Cross and Blue Shield,Traditional,,1953.49,38.7,percent of total billed charges,5047.77,196.86,2574.36,percent of total billed charges,38.7
S-THYROID CORE BX,60100,CPT,,,,,both,, ,630.36,630.36,Blue Cross and Blue Shield,Traditional,,243.95,38.7,percent of total billed charges,630.36,24.58,321.48,percent of total billed charges,38.7
S-SPINAL TAP DIAGNST,62270,CPT,,,,,both,, ,1417.54,1417.54,Blue Cross and Blue Shield,Traditional,,548.59,38.7,percent of total billed charges,1417.54,55.28,722.95,percent of total billed charges,38.7
S-INJ EPI BLD PATCH,62273,CPT,,,,,both,, ,1368.10,1368.10,Blue Cross and Blue Shield,Traditional,,529.45,38.7,percent of total billed charges,1368.10,53.36,697.73,percent of total billed charges,38.7
S-MYELOGRAM INJ,62284,CPT,,,,,both,, ,629.07,629.07,Blue Cross and Blue Shield,Traditional,,243.45,38.7,percent of total billed charges,629.07,24.53,320.83,percent of total billed charges,38.7
IR-MYELO CERVICAL,62302,CPT,,,,,both,, ,2078.67,2078.67,Blue Cross and Blue Shield,Traditional,,804.45,38.7,percent of total billed charges,2078.67,81.07,1060.12,percent of total billed charges,38.7
IR-MYELO THORACIC,62303,CPT,,,,,both,, ,1934.41,1934.41,Blue Cross and Blue Shield,Traditional,,748.62,38.7,percent of total billed charges,1934.41,75.44,986.55,percent of total billed charges,38.7
IR-MYELO LUMBAR,62304,CPT,,,,,both,, ,1964.44,1964.44,Blue Cross and Blue Shield,Traditional,,760.24,38.7,percent of total billed charges,1964.44,76.61,1001.86,percent of total billed charges,38.7
IR-MYELO COMPLETE,62305,CPT,,,,,both,, ,4013.09,4013.09,Blue Cross and Blue Shield,Traditional,,1553.07,38.7,percent of total billed charges,4013.09,156.51,2046.68,percent of total billed charges,38.7
Injection of substance into spinal canal of lower back or sacrum using imaging guidance,62323,CPT,,,,,both,,,2450.37,2450.37,Blue Cross and Blue Shield,Traditional,,948.29,38.7,percent of total billed charges,2450.37,95.56,1249.69,percent of total billed charges,38.7
IR-DI L-S INJ W IM,62323,CPT,,,,,both,, ,2450.37,2450.37,Blue Cross and Blue Shield,Traditional,,948.29,38.7,percent of total billed charges,2450.37,95.56,1249.69,percent of total billed charges,38.7
IR-DI L-S INJ-IN WIM,62327,CPT,,,,,both,, ,2707.10,2707.10,Blue Cross and Blue Shield,Traditional,,1047.65,38.7,percent of total billed charges,2707.10,105.58,1380.62,percent of total billed charges,38.7
SPINAL TAP DIAG W-IM,62328,CPT,,,,,both,, ,1417.54,1417.54,Blue Cross and Blue Shield,Traditional,,548.59,38.7,percent of total billed charges,1417.54,55.28,722.95,percent of total billed charges,38.7
IR-POSTERIOR FOSSA,70010,CPT,,,,,both,, ,2122.18,2122.18,Blue Cross and Blue Shield,Traditional,,821.28,38.7,percent of total billed charges,2122.18,82.77,1082.31,percent of total billed charges,38.7
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,1239.46,1239.46,Blue Cross and Blue Shield,Traditional,,479.67,38.7,percent of total billed charges,1239.46,48.34,632.12,percent of total billed charges,38.7
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,2479.48,2479.48,Blue Cross and Blue Shield,Traditional,,959.56,38.7,percent of total billed charges,2479.48,96.70,1264.53,percent of total billed charges,38.7
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,,,883.84,883.84,Blue Cross and Blue Shield,Traditional,,342.05,38.7,percent of total billed charges,883.84,34.47,450.76,percent of total billed charges,38.7
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,883.84,883.84,Blue Cross and Blue Shield,Traditional,,342.05,38.7,percent of total billed charges,883.84,34.47,450.76,percent of total billed charges,38.7
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,percent of total billed charges,220.61,8.60,112.51,percent of total billed charges,38.7
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,,,940.82,940.82,Blue Cross and Blue Shield,Traditional,,364.10,38.7,percent of total billed charges,940.82,36.69,479.82,percent of total billed charges,38.7
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,940.82,940.82,Blue Cross and Blue Shield,Traditional,,364.10,38.7,percent of total billed charges,940.82,36.69,479.82,percent of total billed charges,38.7
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,,,456.37,456.37,Blue Cross and Blue Shield,Traditional,,176.62,38.7,percent of total billed charges,456.37,17.80,232.75,percent of total billed charges,38.7
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,456.37,456.37,Blue Cross and Blue Shield,Traditional,,176.62,38.7,percent of total billed charges,456.37,17.80,232.75,percent of total billed charges,38.7
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,,,782.23,782.23,Blue Cross and Blue Shield,Traditional,,302.72,38.7,percent of total billed charges,782.23,30.51,398.94,percent of total billed charges,38.7
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,782.23,782.23,Blue Cross and Blue Shield,Traditional,,302.72,38.7,percent of total billed charges,782.23,30.51,398.94,percent of total billed charges,38.7
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,percent of total billed charges,220.61,8.60,112.51,percent of total billed charges,38.7
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,,,1128.31,1128.31,Blue Cross and Blue Shield,Traditional,,436.66,38.7,percent of total billed charges,1128.31,44.00,575.44,percent of total billed charges,38.7
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,1128.31,1128.31,Blue Cross and Blue Shield,Traditional,,436.66,38.7,percent of total billed charges,1128.31,44.00,575.44,percent of total billed charges,38.7
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-NASAL BONES CR,70160,CPT,,,,,both,,,782.23,782.23,Blue Cross and Blue Shield,Traditional,,302.72,38.7,percent of total billed charges,782.23,30.51,398.94,percent of total billed charges,38.7
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,782.23,782.23,Blue Cross and Blue Shield,Traditional,,302.72,38.7,percent of total billed charges,782.23,30.51,398.94,percent of total billed charges,38.7
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-ORBITS 4V CR,70200,CPT,,,,,both,,,918.37,918.37,Blue Cross and Blue Shield,Traditional,,355.41,38.7,percent of total billed charges,918.37,35.82,468.37,percent of total billed charges,38.7
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,918.37,918.37,Blue Cross and Blue Shield,Traditional,,355.41,38.7,percent of total billed charges,918.37,35.82,468.37,percent of total billed charges,38.7
HE-SINUSES LTD CR,70210,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-SINUSES LTD CR,70210,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,,,936.33,936.33,Blue Cross and Blue Shield,Traditional,,362.36,38.7,percent of total billed charges,936.33,36.52,477.53,percent of total billed charges,38.7
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,936.33,936.33,Blue Cross and Blue Shield,Traditional,,362.36,38.7,percent of total billed charges,936.33,36.52,477.53,percent of total billed charges,38.7
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-SKULL LIMITED CR,70250,CPT,,,,,both,,,1151.89,1151.89,Blue Cross and Blue Shield,Traditional,,445.78,38.7,percent of total billed charges,1151.89,44.92,587.46,percent of total billed charges,38.7
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,1151.89,1151.89,Blue Cross and Blue Shield,Traditional,,445.78,38.7,percent of total billed charges,1151.89,44.92,587.46,percent of total billed charges,38.7
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,percent of total billed charges,220.61,8.60,112.51,percent of total billed charges,38.7
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,,,1381.48,1381.48,Blue Cross and Blue Shield,Traditional,,534.63,38.7,percent of total billed charges,1381.48,53.88,704.55,percent of total billed charges,38.7
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,1381.48,1381.48,Blue Cross and Blue Shield,Traditional,,534.63,38.7,percent of total billed charges,1381.48,53.88,704.55,percent of total billed charges,38.7
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,,,538.05,538.05,Blue Cross and Blue Shield,Traditional,,208.23,38.7,percent of total billed charges,538.05,20.98,274.41,percent of total billed charges,38.7
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,538.05,538.05,Blue Cross and Blue Shield,Traditional,,208.23,38.7,percent of total billed charges,538.05,20.98,274.41,percent of total billed charges,38.7
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,,,342.70,342.70,Blue Cross and Blue Shield,Traditional,,132.62,38.7,percent of total billed charges,342.70,13.37,174.78,percent of total billed charges,38.7
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,342.70,342.70,Blue Cross and Blue Shield,Traditional,,132.62,38.7,percent of total billed charges,342.70,13.37,174.78,percent of total billed charges,38.7
IR-ARTHGRM TMJ BI CR,70332,CPT,,,,,both,, ,2353.18,2353.18,Blue Cross and Blue Shield,Traditional,,910.68,38.7,percent of total billed charges,2353.18,91.77,1200.12,percent of total billed charges,38.7
IR-ARTHROGRAM TMJ CR,70332,CPT,,,,,both,, ,1176.59,1176.59,Blue Cross and Blue Shield,Traditional,,455.34,38.7,percent of total billed charges,1176.59,45.89,600.06,percent of total billed charges,38.7
HE-ORTHOPANTOGRAM CR,70355,CPT,,,,,both,, ,692.14,692.14,Blue Cross and Blue Shield,Traditional,,267.86,38.7,percent of total billed charges,692.14,26.99,352.99,percent of total billed charges,38.7
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,,,757.53,757.53,Blue Cross and Blue Shield,Traditional,,293.16,38.7,percent of total billed charges,757.53,29.54,386.34,percent of total billed charges,38.7
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,757.53,757.53,Blue Cross and Blue Shield,Traditional,,293.16,38.7,percent of total billed charges,757.53,29.54,386.34,percent of total billed charges,38.7
FL-PHX SP EV W CINE,70371,CPT,,,,,both,, ,808.06,808.06,Blue Cross and Blue Shield,Traditional,,312.72,38.7,percent of total billed charges,808.06,31.51,412.11,percent of total billed charges,38.7
IR-SIALOGRAM,70390,CPT,,,,,both,, ,1800.52,1800.52,Blue Cross and Blue Shield,Traditional,,696.80,38.7,percent of total billed charges,1800.52,70.22,918.27,percent of total billed charges,38.7
"CT scan, head or brain, without contrast",70450,CPT,,,,,both,,,1576.55,1576.55,Blue Cross and Blue Shield,Traditional,,610.12,38.7,percent of total billed charges,1576.55,61.49,804.04,percent of total billed charges,38.7
CT-HEAD WO,70450,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,percent of total billed charges,307.05,11.97,156.6,percent of total billed charges,38.7
CT-HEAD WO,70450,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,percent of total billed charges,330.63,12.89,168.62,percent of total billed charges,38.7
CT-HEAD WO,70450,CPT,,,,,both,, ,1576.55,1576.55,Blue Cross and Blue Shield,Traditional,,610.12,38.7,percent of total billed charges,1576.55,61.49,804.04,percent of total billed charges,38.7
CT-HEAD W,70460,CPT,,,,,both,,,1765.72,1765.72,Blue Cross and Blue Shield,Traditional,,683.33,38.7,percent of total billed charges,1765.72,68.86,900.52,percent of total billed charges,38.7
CT-HEAD W,70460,CPT,,,,,both,, ,1765.72,1765.72,Blue Cross and Blue Shield,Traditional,,683.33,38.7,percent of total billed charges,1765.72,68.86,900.52,percent of total billed charges,38.7
CT-HEAD WWO,70470,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,percent of total billed charges,680.91,26.56,347.26,percent of total billed charges,38.7
CT-HEAD WWO,70470,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,percent of total billed charges,732.83,28.58,373.74,percent of total billed charges,38.7
CT-HEAD WWO,70470,CPT,,,,,both,,,3726.80,3726.80,Blue Cross and Blue Shield,Traditional,,1442.27,38.7,percent of total billed charges,3726.80,145.35,1900.67,percent of total billed charges,38.7
CT-HEAD WWO,70470,CPT,,,,,both,, ,3726.80,3726.80,Blue Cross and Blue Shield,Traditional,,1442.27,38.7,percent of total billed charges,3726.80,145.35,1900.67,percent of total billed charges,38.7
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,percent of total billed charges,307.05,11.97,156.6,percent of total billed charges,38.7
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,percent of total billed charges,330.63,12.89,168.62,percent of total billed charges,38.7
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,2847.17,2847.17,Blue Cross and Blue Shield,Traditional,,1101.85,38.7,percent of total billed charges,2847.17,111.04,1452.06,percent of total billed charges,38.7
CT-ORBIT EAR W,70481,CPT,,,,,both,, ,556.01,556.01,Blue Cross and Blue Shield,Traditional,,215.18,38.7,percent of total billed charges,556.01,21.68,283.57,percent of total billed charges,38.7
CT-ORBIT EAR W,70481,CPT,,,,,both,, ,1643.07,1643.07,Blue Cross and Blue Shield,Traditional,,635.87,38.7,percent of total billed charges,1643.07,64.08,837.97,percent of total billed charges,38.7
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,percent of total billed charges,680.91,26.56,347.26,percent of total billed charges,38.7
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,percent of total billed charges,732.83,28.58,373.74,percent of total billed charges,38.7
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,4001.30,4001.30,Blue Cross and Blue Shield,Traditional,,1548.50,38.7,percent of total billed charges,4001.30,156.05,2040.66,percent of total billed charges,38.7
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,percent of total billed charges,307.05,11.97,156.6,percent of total billed charges,38.7
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,percent of total billed charges,330.63,12.89,168.62,percent of total billed charges,38.7
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,,,2847.17,2847.17,Blue Cross and Blue Shield,Traditional,,1101.85,38.7,percent of total billed charges,2847.17,111.04,1452.06,percent of total billed charges,38.7
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,2847.17,2847.17,Blue Cross and Blue Shield,Traditional,,1101.85,38.7,percent of total billed charges,2847.17,111.04,1452.06,percent of total billed charges,38.7
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,604.85,604.85,Blue Cross and Blue Shield,Traditional,,234.08,38.7,percent of total billed charges,604.85,23.59,308.47,percent of total billed charges,38.7
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,650.88,650.88,Blue Cross and Blue Shield,Traditional,,251.89,38.7,percent of total billed charges,650.88,25.38,331.95,percent of total billed charges,38.7
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,,,3178.64,3178.64,Blue Cross and Blue Shield,Traditional,,1230.13,38.7,percent of total billed charges,3178.64,123.97,1621.11,percent of total billed charges,38.7
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,3178.64,3178.64,Blue Cross and Blue Shield,Traditional,,1230.13,38.7,percent of total billed charges,3178.64,123.97,1621.11,percent of total billed charges,38.7
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,percent of total billed charges,680.91,26.56,347.26,percent of total billed charges,38.7
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,percent of total billed charges,732.83,28.58,373.74,percent of total billed charges,38.7
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,,,3726.80,3726.80,Blue Cross and Blue Shield,Traditional,,1442.27,38.7,percent of total billed charges,3726.80,145.35,1900.67,percent of total billed charges,38.7
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,3726.80,3726.80,Blue Cross and Blue Shield,Traditional,,1442.27,38.7,percent of total billed charges,3726.80,145.35,1900.67,percent of total billed charges,38.7
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,percent of total billed charges,307.05,11.97,156.6,percent of total billed charges,38.7
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,percent of total billed charges,330.63,12.89,168.62,percent of total billed charges,38.7
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,,,2737.98,2737.98,Blue Cross and Blue Shield,Traditional,,1059.60,38.7,percent of total billed charges,2737.98,106.78,1396.37,percent of total billed charges,38.7
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,2737.98,2737.98,Blue Cross and Blue Shield,Traditional,,1059.60,38.7,percent of total billed charges,2737.98,106.78,1396.37,percent of total billed charges,38.7
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,604.85,604.85,Blue Cross and Blue Shield,Traditional,,234.08,38.7,percent of total billed charges,604.85,23.59,308.47,percent of total billed charges,38.7
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,650.88,650.88,Blue Cross and Blue Shield,Traditional,,251.89,38.7,percent of total billed charges,650.88,25.38,331.95,percent of total billed charges,38.7
CT-NECK SOFT TIS W,70491,CPT,,,,,both,,,2743.59,2743.59,Blue Cross and Blue Shield,Traditional,,1061.77,38.7,percent of total billed charges,2743.59,107.00,1399.23,percent of total billed charges,38.7
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,2743.59,2743.59,Blue Cross and Blue Shield,Traditional,,1061.77,38.7,percent of total billed charges,2743.59,107.00,1399.23,percent of total billed charges,38.7
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,percent of total billed charges,680.91,26.56,347.26,percent of total billed charges,38.7
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,percent of total billed charges,732.83,28.58,373.74,percent of total billed charges,38.7
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,,,4317.62,4317.62,Blue Cross and Blue Shield,Traditional,,1670.92,38.7,percent of total billed charges,4317.62,168.39,2201.99,percent of total billed charges,38.7
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,4317.62,4317.62,Blue Cross and Blue Shield,Traditional,,1670.92,38.7,percent of total billed charges,4317.62,168.39,2201.99,percent of total billed charges,38.7
CTA-HEAD,70496,CPT,,,,,both,, ,893.10,893.10,Blue Cross and Blue Shield,Traditional,,345.63,38.7,percent of total billed charges,893.10,34.83,455.48,percent of total billed charges,38.7
CTA-HEAD,70496,CPT,,,,,both,,,2355.42,2355.42,Blue Cross and Blue Shield,Traditional,,911.55,38.7,percent of total billed charges,2355.42,91.86,1201.26,percent of total billed charges,38.7
CTA-HEAD,70496,CPT,,,,,both,, ,2355.42,2355.42,Blue Cross and Blue Shield,Traditional,,911.55,38.7,percent of total billed charges,2355.42,91.86,1201.26,percent of total billed charges,38.7
CTA-NECK,70498,CPT,,,,,both,, ,893.10,893.10,Blue Cross and Blue Shield,Traditional,,345.63,38.7,percent of total billed charges,893.10,34.83,455.48,percent of total billed charges,38.7
CTA-NECK,70498,CPT,,,,,both,,,2355.42,2355.42,Blue Cross and Blue Shield,Traditional,,911.55,38.7,percent of total billed charges,2355.42,91.86,1201.26,percent of total billed charges,38.7
CTA-NECK,70498,CPT,,,,,both,, ,2355.42,2355.42,Blue Cross and Blue Shield,Traditional,,911.55,38.7,percent of total billed charges,2355.42,91.86,1201.26,percent of total billed charges,38.7
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,percent of total billed charges,715.99,27.92,365.15,percent of total billed charges,38.7
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,percent of total billed charges,770.45,30.05,392.93,percent of total billed charges,38.7
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,4042.84,4042.84,Blue Cross and Blue Shield,Traditional,,1564.58,38.7,percent of total billed charges,4042.84,157.67,2061.85,percent of total billed charges,38.7
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,percent of total billed charges,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,percent of total billed charges,1114.55,43.47,568.42,percent of total billed charges,38.7
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,percent of total billed charges,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,percent of total billed charges,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,percent of total billed charges,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,percent of total billed charges,5197.81,202.71,2650.88,percent of total billed charges,38.7
MRA-HEAD WO,70544,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,percent of total billed charges,715.99,27.92,365.15,percent of total billed charges,38.7
MRA-HEAD WO,70544,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,percent of total billed charges,770.45,30.05,392.93,percent of total billed charges,38.7
MRA-HEAD WO,70544,CPT,,,,,both,, ,1631.56,1631.56,Blue Cross and Blue Shield,Traditional,,631.41,38.7,percent of total billed charges,1631.56,63.63,832.1,percent of total billed charges,38.7
MRA-HEAD W,70545,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,percent of total billed charges,1035.69,40.39,528.2,percent of total billed charges,38.7
MRA-HEAD W,70545,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,percent of total billed charges,1114.55,43.47,568.42,percent of total billed charges,38.7
MRA-HEAD W,70545,CPT,,,,,both,, ,1938.34,1938.34,Blue Cross and Blue Shield,Traditional,,750.14,38.7,percent of total billed charges,1938.34,75.60,988.55,percent of total billed charges,38.7
MRA-HEAD WWO,70546,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,percent of total billed charges,1197.08,46.69,610.51,percent of total billed charges,38.7
MRA-HEAD WWO,70546,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,percent of total billed charges,1288.29,50.24,657.03,percent of total billed charges,38.7
MRA-HEAD WWO,70546,CPT,,,,,both,, ,2669.78,2669.78,Blue Cross and Blue Shield,Traditional,,1033.20,38.7,percent of total billed charges,2669.78,104.12,1361.59,percent of total billed charges,38.7
MRA-NECK WO,70547,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,percent of total billed charges,715.99,27.92,365.15,percent of total billed charges,38.7
MRA-NECK WO,70547,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,percent of total billed charges,770.45,30.05,392.93,percent of total billed charges,38.7
MRA-NECK WO,70547,CPT,,,,,both,, ,1334.89,1334.89,Blue Cross and Blue Shield,Traditional,,516.60,38.7,percent of total billed charges,1334.89,52.06,680.79,percent of total billed charges,38.7
MRA-NECK W,70548,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,percent of total billed charges,1035.69,40.39,528.2,percent of total billed charges,38.7
MRA-NECK W,70548,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,percent of total billed charges,1114.55,43.47,568.42,percent of total billed charges,38.7
MRA-NECK W,70548,CPT,,,,,both,, ,1938.34,1938.34,Blue Cross and Blue Shield,Traditional,,750.14,38.7,percent of total billed charges,1938.34,75.60,988.55,percent of total billed charges,38.7
MRA-NECK WWO,70549,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,percent of total billed charges,1197.08,46.69,610.51,percent of total billed charges,38.7
MRA-NECK WWO,70549,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,percent of total billed charges,1288.29,50.24,657.03,percent of total billed charges,38.7
MRA-NECK WWO,70549,CPT,,,,,both,, ,3263.12,3263.12,Blue Cross and Blue Shield,Traditional,,1262.83,38.7,percent of total billed charges,3263.12,127.26,1664.19,percent of total billed charges,38.7
MR-BRAIN WO,70551,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,percent of total billed charges,715.99,27.92,365.15,percent of total billed charges,38.7
MR-BRAIN WO,70551,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,percent of total billed charges,770.45,30.05,392.93,percent of total billed charges,38.7
MR-BRAIN WO,70551,CPT,,,,,both,,,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,percent of total billed charges,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-BRAIN WO,70551,CPT,,,,,both,, ,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,percent of total billed charges,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-BRAIN W,70552,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,percent of total billed charges,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-BRAIN W,70552,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,percent of total billed charges,1114.55,43.47,568.42,percent of total billed charges,38.7
MR-BRAIN W,70552,CPT,,,,,both,,,2352.06,2352.06,Blue Cross and Blue Shield,Traditional,,910.25,38.7,percent of total billed charges,2352.06,91.73,1199.55,percent of total billed charges,38.7
MR-BRAIN W,70552,CPT,,,,,both,, ,2352.06,2352.06,Blue Cross and Blue Shield,Traditional,,910.25,38.7,percent of total billed charges,2352.06,91.73,1199.55,percent of total billed charges,38.7
MR-BRAIN WWO,70553,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,percent of total billed charges,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-BRAIN WWO,70553,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,percent of total billed charges,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-BRAIN WWO,70553,CPT,,,,,both,, ,6352.79,6352.79,Blue Cross and Blue Shield,Traditional,,2458.53,38.7,percent of total billed charges,6352.79,247.76,3239.92,percent of total billed charges,38.7
MRI scan of brain before and after contrast,70553,CPT,,,,,both,,,6352.79,6352.79,Blue Cross and Blue Shield,Traditional,,2458.53,38.7,percent of total billed charges,6352.79,247.76,3239.92,percent of total billed charges,38.7
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-CHEST 1V CR,71045,CPT,,,,,both,,,495.95,495.95,Blue Cross and Blue Shield,Traditional,,191.93,38.7,percent of total billed charges,495.95,19.34,252.93,percent of total billed charges,38.7
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,495.95,495.95,Blue Cross and Blue Shield,Traditional,,191.93,38.7,percent of total billed charges,495.95,19.34,252.93,percent of total billed charges,38.7
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-CHEST 2V CR,71046,CPT,,,,,both,,,750.52,750.52,Blue Cross and Blue Shield,Traditional,,290.45,38.7,percent of total billed charges,750.52,29.27,382.77,percent of total billed charges,38.7
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,750.52,750.52,Blue Cross and Blue Shield,Traditional,,290.45,38.7,percent of total billed charges,750.52,29.27,382.77,percent of total billed charges,38.7
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,143.98,Blue Cross and Blue Shield,Traditional,,55.72,38.7,percent of total billed charges,143.98,5.62,73.43,percent of total billed charges,38.7
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,143.98,Blue Cross and Blue Shield,Traditional,,55.72,38.7,percent of total billed charges,143.98,5.62,73.43,percent of total billed charges,38.7
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,143.98,Blue Cross and Blue Shield,Traditional,,55.72,38.7,percent of total billed charges,143.98,5.62,73.43,percent of total billed charges,38.7
CH-CHEST 3V CR,71047,CPT,,,,,both,,,1091.82,1091.82,Blue Cross and Blue Shield,Traditional,,422.53,38.7,percent of total billed charges,1091.82,42.58,556.83,percent of total billed charges,38.7
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,1091.82,1091.82,Blue Cross and Blue Shield,Traditional,,422.53,38.7,percent of total billed charges,1091.82,42.58,556.83,percent of total billed charges,38.7
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,143.98,143.98,Blue Cross and Blue Shield,Traditional,,55.72,38.7,percent of total billed charges,143.98,5.62,73.43,percent of total billed charges,38.7
CH-CHEST 4V CR,71048,CPT,,,,,both,,,1652.05,1652.05,Blue Cross and Blue Shield,Traditional,,639.34,38.7,percent of total billed charges,1652.05,64.43,842.55,percent of total billed charges,38.7
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,1652.05,1652.05,Blue Cross and Blue Shield,Traditional,,639.34,38.7,percent of total billed charges,1652.05,64.43,842.55,percent of total billed charges,38.7
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-RIBS UNILAT CR,71100,CPT,,,,,both,,,876.83,876.83,Blue Cross and Blue Shield,Traditional,,339.33,38.7,percent of total billed charges,876.83,34.20,447.18,percent of total billed charges,38.7
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,876.83,876.83,Blue Cross and Blue Shield,Traditional,,339.33,38.7,percent of total billed charges,876.83,34.20,447.18,percent of total billed charges,38.7
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,percent of total billed charges,220.61,8.60,112.51,percent of total billed charges,38.7
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,260.74,260.74,Blue Cross and Blue Shield,Traditional,,100.91,38.7,percent of total billed charges,260.74,10.17,132.98,percent of total billed charges,38.7
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,260.74,260.74,Blue Cross and Blue Shield,Traditional,,100.91,38.7,percent of total billed charges,260.74,10.17,132.98,percent of total billed charges,38.7
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,,,1152.17,1152.17,Blue Cross and Blue Shield,Traditional,,445.89,38.7,percent of total billed charges,1152.17,44.93,587.61,percent of total billed charges,38.7
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,1152.17,1152.17,Blue Cross and Blue Shield,Traditional,,445.89,38.7,percent of total billed charges,1152.17,44.93,587.61,percent of total billed charges,38.7
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,percent of total billed charges,220.61,8.60,112.51,percent of total billed charges,38.7
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,,,1381.48,1381.48,Blue Cross and Blue Shield,Traditional,,534.63,38.7,percent of total billed charges,1381.48,53.88,704.55,percent of total billed charges,38.7
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,1381.48,1381.48,Blue Cross and Blue Shield,Traditional,,534.63,38.7,percent of total billed charges,1381.48,53.88,704.55,percent of total billed charges,38.7
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,percent of total billed charges,220.61,8.60,112.51,percent of total billed charges,38.7
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,260.74,260.74,Blue Cross and Blue Shield,Traditional,,100.91,38.7,percent of total billed charges,260.74,10.17,132.98,percent of total billed charges,38.7
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,260.74,260.74,Blue Cross and Blue Shield,Traditional,,100.91,38.7,percent of total billed charges,260.74,10.17,132.98,percent of total billed charges,38.7
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,,,1877.99,1877.99,Blue Cross and Blue Shield,Traditional,,726.78,38.7,percent of total billed charges,1877.99,73.24,957.77,percent of total billed charges,38.7
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,1877.99,1877.99,Blue Cross and Blue Shield,Traditional,,726.78,38.7,percent of total billed charges,1877.99,73.24,957.77,percent of total billed charges,38.7
CH-STERNUM CR,71120,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-STERNUM CR,71120,CPT,,,,,both,,,947.27,947.27,Blue Cross and Blue Shield,Traditional,,366.59,38.7,percent of total billed charges,947.27,36.94,483.11,percent of total billed charges,38.7
CH-STERNUM CR,71120,CPT,,,,,both,, ,947.27,947.27,Blue Cross and Blue Shield,Traditional,,366.59,38.7,percent of total billed charges,947.27,36.94,483.11,percent of total billed charges,38.7
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,,,989.38,989.38,Blue Cross and Blue Shield,Traditional,,382.89,38.7,percent of total billed charges,989.38,38.59,504.58,percent of total billed charges,38.7
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,989.38,989.38,Blue Cross and Blue Shield,Traditional,,382.89,38.7,percent of total billed charges,989.38,38.59,504.58,percent of total billed charges,38.7
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,percent of total billed charges,307.05,11.97,156.6,percent of total billed charges,38.7
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,percent of total billed charges,330.63,12.89,168.62,percent of total billed charges,38.7
CT-CHEST DIAG WO,71250,CPT,,,,,both,,,3833.18,3833.18,Blue Cross and Blue Shield,Traditional,,1483.44,38.7,percent of total billed charges,3833.18,149.49,1954.92,percent of total billed charges,38.7
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,3833.18,3833.18,Blue Cross and Blue Shield,Traditional,,1483.44,38.7,percent of total billed charges,3833.18,149.49,1954.92,percent of total billed charges,38.7
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,604.85,604.85,Blue Cross and Blue Shield,Traditional,,234.08,38.7,percent of total billed charges,604.85,23.59,308.47,percent of total billed charges,38.7
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,650.88,650.88,Blue Cross and Blue Shield,Traditional,,251.89,38.7,percent of total billed charges,650.88,25.38,331.95,percent of total billed charges,38.7
CT-CHEST DIAG W,71260,CPT,,,,,both,,,4107.96,4107.96,Blue Cross and Blue Shield,Traditional,,1589.78,38.7,percent of total billed charges,4107.96,160.21,2095.06,percent of total billed charges,38.7
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,4107.96,4107.96,Blue Cross and Blue Shield,Traditional,,1589.78,38.7,percent of total billed charges,4107.96,160.21,2095.06,percent of total billed charges,38.7
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,percent of total billed charges,680.91,26.56,347.26,percent of total billed charges,38.7
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,percent of total billed charges,732.83,28.58,373.74,percent of total billed charges,38.7
CT-CHEST DIAG WWO,71270,CPT,,,,,both,,,3833.18,3833.18,Blue Cross and Blue Shield,Traditional,,1483.44,38.7,percent of total billed charges,3833.18,149.49,1954.92,percent of total billed charges,38.7
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,3833.18,3833.18,Blue Cross and Blue Shield,Traditional,,1483.44,38.7,percent of total billed charges,3833.18,149.49,1954.92,percent of total billed charges,38.7
CT-LOW DOSE CNCR SCR,71271,CPT,,,,,both,, ,273.09,273.09,Blue Cross and Blue Shield,Traditional,,105.69,38.7,percent of total billed charges,273.09,10.65,139.28,percent of total billed charges,38.7
CT-LOW DOSE CNCR SCR,71271,CPT,,,,,both,, ,273.09,273.09,Blue Cross and Blue Shield,Traditional,,105.69,38.7,percent of total billed charges,273.09,10.65,139.28,percent of total billed charges,38.7
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,,,568.92,568.92,Blue Cross and Blue Shield,Traditional,,220.17,38.7,percent of total billed charges,568.92,22.19,290.15,percent of total billed charges,38.7
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,, ,568.92,568.92,Blue Cross and Blue Shield,Traditional,,220.17,38.7,percent of total billed charges,568.92,22.19,290.15,percent of total billed charges,38.7
CTA-CHEST,71275,CPT,,,,,both,, ,708.98,708.98,Blue Cross and Blue Shield,Traditional,,274.38,38.7,percent of total billed charges,708.98,27.65,361.58,percent of total billed charges,38.7
CTA-CHEST,71275,CPT,,,,,both,, ,763.15,763.15,Blue Cross and Blue Shield,Traditional,,295.34,38.7,percent of total billed charges,763.15,29.76,389.21,percent of total billed charges,38.7
CTA-CHEST,71275,CPT,,,,,both,,,2355.14,2355.14,Blue Cross and Blue Shield,Traditional,,911.44,38.7,percent of total billed charges,2355.14,91.85,1201.12,percent of total billed charges,38.7
CTA-CHEST,71275,CPT,,,,,both,, ,2355.14,2355.14,Blue Cross and Blue Shield,Traditional,,911.44,38.7,percent of total billed charges,2355.14,91.85,1201.12,percent of total billed charges,38.7
MR-CHEST WO,71550,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,percent of total billed charges,715.99,27.92,365.15,percent of total billed charges,38.7
MR-CHEST WO,71550,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,percent of total billed charges,770.45,30.05,392.93,percent of total billed charges,38.7
MR-CHEST WO,71550,CPT,,,,,both,,,4042.84,4042.84,Blue Cross and Blue Shield,Traditional,,1564.58,38.7,percent of total billed charges,4042.84,157.67,2061.85,percent of total billed charges,38.7
MR-CHEST WO,71550,CPT,,,,,both,, ,4042.84,4042.84,Blue Cross and Blue Shield,Traditional,,1564.58,38.7,percent of total billed charges,4042.84,157.67,2061.85,percent of total billed charges,38.7
MR-CHEST W,71551,CPT,,,,,both,,,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,percent of total billed charges,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-CHEST W,71551,CPT,,,,,both,, ,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,percent of total billed charges,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-CHEST WWO,71552,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,percent of total billed charges,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-CHEST WWO,71552,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,percent of total billed charges,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-CHEST WWO,71552,CPT,,,,,both,,,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,percent of total billed charges,5197.81,202.71,2650.88,percent of total billed charges,38.7
MR-CHEST WWO,71552,CPT,,,,,both,, ,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,percent of total billed charges,5197.81,202.71,2650.88,percent of total billed charges,38.7
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,,,261.02,261.02,Blue Cross and Blue Shield,Traditional,,101.01,38.7,percent of total billed charges,261.02,10.18,133.12,percent of total billed charges,38.7
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,261.02,261.02,Blue Cross and Blue Shield,Traditional,,101.01,38.7,percent of total billed charges,261.02,10.18,133.12,percent of total billed charges,38.7
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,,,1085.36,1085.36,Blue Cross and Blue Shield,Traditional,,420.03,38.7,percent of total billed charges,1085.36,42.33,553.53,percent of total billed charges,38.7
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,1085.36,1085.36,Blue Cross and Blue Shield,Traditional,,420.03,38.7,percent of total billed charges,1085.36,42.33,553.53,percent of total billed charges,38.7
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,percent of total billed charges,220.61,8.60,112.51,percent of total billed charges,38.7
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,1112.87,1112.87,Blue Cross and Blue Shield,Traditional,,430.68,38.7,percent of total billed charges,1112.87,43.40,567.56,percent of total billed charges,38.7
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,percent of total billed charges,220.61,8.60,112.51,percent of total billed charges,38.7
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,1471.29,1471.29,Blue Cross and Blue Shield,Traditional,,569.39,38.7,percent of total billed charges,1471.29,57.38,750.36,percent of total billed charges,38.7
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,,,1181.64,1181.64,Blue Cross and Blue Shield,Traditional,,457.29,38.7,percent of total billed charges,1181.64,46.08,602.64,percent of total billed charges,38.7
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,1181.64,1181.64,Blue Cross and Blue Shield,Traditional,,457.29,38.7,percent of total billed charges,1181.64,46.08,602.64,percent of total billed charges,38.7
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,percent of total billed charges,220.61,8.60,112.51,percent of total billed charges,38.7
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,,,1444.63,1444.63,Blue Cross and Blue Shield,Traditional,,559.07,38.7,percent of total billed charges,1444.63,56.34,736.76,percent of total billed charges,38.7
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,1444.63,1444.63,Blue Cross and Blue Shield,Traditional,,559.07,38.7,percent of total billed charges,1444.63,56.34,736.76,percent of total billed charges,38.7
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,,,1444.63,1444.63,Blue Cross and Blue Shield,Traditional,,559.07,38.7,percent of total billed charges,1444.63,56.34,736.76,percent of total billed charges,38.7
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,1444.63,1444.63,Blue Cross and Blue Shield,Traditional,,559.07,38.7,percent of total billed charges,1444.63,56.34,736.76,percent of total billed charges,38.7
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,139.77,139.77,Blue Cross and Blue Shield,Traditional,,54.09,38.7,percent of total billed charges,139.77,5.45,71.28,percent of total billed charges,38.7
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,149.32,149.32,Blue Cross and Blue Shield,Traditional,,57.79,38.7,percent of total billed charges,149.32,5.82,76.15,percent of total billed charges,38.7
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,1181.91,1181.91,Blue Cross and Blue Shield,Traditional,,457.40,38.7,percent of total billed charges,1181.91,46.09,602.77,percent of total billed charges,38.7
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,139.77,139.77,Blue Cross and Blue Shield,Traditional,,54.09,38.7,percent of total billed charges,139.77,5.45,71.28,percent of total billed charges,38.7
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,149.32,149.32,Blue Cross and Blue Shield,Traditional,,57.79,38.7,percent of total billed charges,149.32,5.82,76.15,percent of total billed charges,38.7
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,230.71,230.71,Blue Cross and Blue Shield,Traditional,,89.28,38.7,percent of total billed charges,230.71,9.00,117.66,percent of total billed charges,38.7
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,1181.91,1181.91,Blue Cross and Blue Shield,Traditional,,457.40,38.7,percent of total billed charges,1181.91,46.09,602.77,percent of total billed charges,38.7
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,230.71,230.71,Blue Cross and Blue Shield,Traditional,,89.28,38.7,percent of total billed charges,230.71,9.00,117.66,percent of total billed charges,38.7
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,279.26,279.26,Blue Cross and Blue Shield,Traditional,,108.07,38.7,percent of total billed charges,279.26,10.89,142.42,percent of total billed charges,38.7
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,298.64,298.64,Blue Cross and Blue Shield,Traditional,,115.57,38.7,percent of total billed charges,298.64,11.65,152.31,percent of total billed charges,38.7
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,2363.84,2363.84,Blue Cross and Blue Shield,Traditional,,914.81,38.7,percent of total billed charges,2363.84,92.19,1205.56,percent of total billed charges,38.7
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,279.26,279.26,Blue Cross and Blue Shield,Traditional,,108.07,38.7,percent of total billed charges,279.26,10.89,142.42,percent of total billed charges,38.7
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,298.64,298.64,Blue Cross and Blue Shield,Traditional,,115.57,38.7,percent of total billed charges,298.64,11.65,152.31,percent of total billed charges,38.7
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,2363.84,2363.84,Blue Cross and Blue Shield,Traditional,,914.81,38.7,percent of total billed charges,2363.84,92.19,1205.56,percent of total billed charges,38.7
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,,,1504.42,1504.42,Blue Cross and Blue Shield,Traditional,,582.21,38.7,percent of total billed charges,1504.42,58.67,767.25,percent of total billed charges,38.7
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,1504.42,1504.42,Blue Cross and Blue Shield,Traditional,,582.21,38.7,percent of total billed charges,1504.42,58.67,767.25,percent of total billed charges,38.7
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,percent of total billed charges,220.61,8.60,112.51,percent of total billed charges,38.7
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,1968.65,1968.65,Blue Cross and Blue Shield,Traditional,,761.87,38.7,percent of total billed charges,1968.65,76.78,1004.01,percent of total billed charges,38.7
"X-Ray, lower back, minimum four views",72110,CPT,,,,,both,,,1968.65,1968.65,Blue Cross and Blue Shield,Traditional,,761.87,38.7,percent of total billed charges,1968.65,76.78,1004.01,percent of total billed charges,38.7
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,percent of total billed charges,220.61,8.60,112.51,percent of total billed charges,38.7
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
SP-LS SPINE W BND CR,72114,CPT,,,,,both,,,2229.96,2229.96,Blue Cross and Blue Shield,Traditional,,862.99,38.7,percent of total billed charges,2229.96,86.97,1137.28,percent of total billed charges,38.7
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,2229.96,2229.96,Blue Cross and Blue Shield,Traditional,,862.99,38.7,percent of total billed charges,2229.96,86.97,1137.28,percent of total billed charges,38.7
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,percent of total billed charges,220.61,8.60,112.51,percent of total billed charges,38.7
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
SP-LS SPINE BND CR,72120,CPT,,,,,both,,,1765.44,1765.44,Blue Cross and Blue Shield,Traditional,,683.23,38.7,percent of total billed charges,1765.44,68.85,900.37,percent of total billed charges,38.7
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,1765.44,1765.44,Blue Cross and Blue Shield,Traditional,,683.23,38.7,percent of total billed charges,1765.44,68.85,900.37,percent of total billed charges,38.7
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,percent of total billed charges,307.05,11.97,156.6,percent of total billed charges,38.7
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,percent of total billed charges,330.63,12.89,168.62,percent of total billed charges,38.7
CT-CERV SPINE WO,72125,CPT,,,,,both,,,3833.18,3833.18,Blue Cross and Blue Shield,Traditional,,1483.44,38.7,percent of total billed charges,3833.18,149.49,1954.92,percent of total billed charges,38.7
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,3833.18,3833.18,Blue Cross and Blue Shield,Traditional,,1483.44,38.7,percent of total billed charges,3833.18,149.49,1954.92,percent of total billed charges,38.7
CT-CERV SPINE W,72126,CPT,,,,,both,, ,604.85,604.85,Blue Cross and Blue Shield,Traditional,,234.08,38.7,percent of total billed charges,604.85,23.59,308.47,percent of total billed charges,38.7
CT-CERV SPINE W,72126,CPT,,,,,both,, ,650.88,650.88,Blue Cross and Blue Shield,Traditional,,251.89,38.7,percent of total billed charges,650.88,25.38,331.95,percent of total billed charges,38.7
CT-CERV SPINE W,72126,CPT,,,,,both,,,6031.42,6031.42,Blue Cross and Blue Shield,Traditional,,2334.16,38.7,percent of total billed charges,6031.42,235.23,3076.02,percent of total billed charges,38.7
CT-CERV SPINE W,72126,CPT,,,,,both,, ,6031.42,6031.42,Blue Cross and Blue Shield,Traditional,,2334.16,38.7,percent of total billed charges,6031.42,235.23,3076.02,percent of total billed charges,38.7
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,percent of total billed charges,680.91,26.56,347.26,percent of total billed charges,38.7
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,percent of total billed charges,732.83,28.58,373.74,percent of total billed charges,38.7
CT-CERV SPINE WWO,72127,CPT,,,,,both,,,6031.42,6031.42,Blue Cross and Blue Shield,Traditional,,2334.16,38.7,percent of total billed charges,6031.42,235.23,3076.02,percent of total billed charges,38.7
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,6031.42,6031.42,Blue Cross and Blue Shield,Traditional,,2334.16,38.7,percent of total billed charges,6031.42,235.23,3076.02,percent of total billed charges,38.7
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,percent of total billed charges,307.05,11.97,156.6,percent of total billed charges,38.7
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,percent of total billed charges,330.63,12.89,168.62,percent of total billed charges,38.7
CT-THOR SPINE WO,72128,CPT,,,,,both,,,3833.18,3833.18,Blue Cross and Blue Shield,Traditional,,1483.44,38.7,percent of total billed charges,3833.18,149.49,1954.92,percent of total billed charges,38.7
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,3833.18,3833.18,Blue Cross and Blue Shield,Traditional,,1483.44,38.7,percent of total billed charges,3833.18,149.49,1954.92,percent of total billed charges,38.7
CT-THOR SPINE W,72129,CPT,,,,,both,, ,534.96,534.96,Blue Cross and Blue Shield,Traditional,,207.03,38.7,percent of total billed charges,534.96,20.86,272.83,percent of total billed charges,38.7
CT-THOR SPINE W,72129,CPT,,,,,both,,,1786.22,1786.22,Blue Cross and Blue Shield,Traditional,,691.27,38.7,percent of total billed charges,1786.22,69.66,910.97,percent of total billed charges,38.7
CT-THOR SPINE W,72129,CPT,,,,,both,, ,1786.22,1786.22,Blue Cross and Blue Shield,Traditional,,691.27,38.7,percent of total billed charges,1786.22,69.66,910.97,percent of total billed charges,38.7
CT-THOR SPINE WWO,72130,CPT,,,,,both,,,2407.63,2407.63,Blue Cross and Blue Shield,Traditional,,931.75,38.7,percent of total billed charges,2407.63,93.90,1227.89,percent of total billed charges,38.7
CT-THOR SPINE WWO,72130,CPT,,,,,both,, ,2407.63,2407.63,Blue Cross and Blue Shield,Traditional,,931.75,38.7,percent of total billed charges,2407.63,93.90,1227.89,percent of total billed charges,38.7
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,percent of total billed charges,307.05,11.97,156.6,percent of total billed charges,38.7
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,percent of total billed charges,330.63,12.89,168.62,percent of total billed charges,38.7
CT-LUMB SPINE WO,72131,CPT,,,,,both,,,534.68,534.68,Blue Cross and Blue Shield,Traditional,,206.92,38.7,percent of total billed charges,534.68,20.85,272.69,percent of total billed charges,38.7
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,534.68,534.68,Blue Cross and Blue Shield,Traditional,,206.92,38.7,percent of total billed charges,534.68,20.85,272.69,percent of total billed charges,38.7
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,604.85,604.85,Blue Cross and Blue Shield,Traditional,,234.08,38.7,percent of total billed charges,604.85,23.59,308.47,percent of total billed charges,38.7
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,650.88,650.88,Blue Cross and Blue Shield,Traditional,,251.89,38.7,percent of total billed charges,650.88,25.38,331.95,percent of total billed charges,38.7
CT-LUMB SPINE W,72132,CPT,,,,,both,,,1653.45,1653.45,Blue Cross and Blue Shield,Traditional,,639.89,38.7,percent of total billed charges,1653.45,64.48,843.26,percent of total billed charges,38.7
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,1653.45,1653.45,Blue Cross and Blue Shield,Traditional,,639.89,38.7,percent of total billed charges,1653.45,64.48,843.26,percent of total billed charges,38.7
CT-LUMB SPINE WWO,72133,CPT,,,,,both,, ,446.27,446.27,Blue Cross and Blue Shield,Traditional,,172.71,38.7,percent of total billed charges,446.27,17.40,227.6,percent of total billed charges,38.7
CT-LUMB SPINE WWO,72133,CPT,,,,,both,,,1126.62,1126.62,Blue Cross and Blue Shield,Traditional,,436.00,38.7,percent of total billed charges,1126.62,43.94,574.58,percent of total billed charges,38.7
CT-LUMB SPINE WWO,72133,CPT,,,,,both,, ,1126.62,1126.62,Blue Cross and Blue Shield,Traditional,,436.00,38.7,percent of total billed charges,1126.62,43.94,574.58,percent of total billed charges,38.7
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,percent of total billed charges,715.99,27.92,365.15,percent of total billed charges,38.7
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,percent of total billed charges,770.45,30.05,392.93,percent of total billed charges,38.7
MR-CERV SPINE WO,72141,CPT,,,,,both,,,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,percent of total billed charges,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,percent of total billed charges,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-CERV SPINE W,72142,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,percent of total billed charges,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-CERV SPINE W,72142,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,percent of total billed charges,1114.55,43.47,568.42,percent of total billed charges,38.7
MR-CERV SPINE W,72142,CPT,,,,,both,,,2352.06,2352.06,Blue Cross and Blue Shield,Traditional,,910.25,38.7,percent of total billed charges,2352.06,91.73,1199.55,percent of total billed charges,38.7
MR-CERV SPINE W,72142,CPT,,,,,both,, ,2352.06,2352.06,Blue Cross and Blue Shield,Traditional,,910.25,38.7,percent of total billed charges,2352.06,91.73,1199.55,percent of total billed charges,38.7
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,percent of total billed charges,715.99,27.92,365.15,percent of total billed charges,38.7
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,percent of total billed charges,770.45,30.05,392.93,percent of total billed charges,38.7
MR-THOR SPINE WO,72146,CPT,,,,,both,,,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,percent of total billed charges,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,percent of total billed charges,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-THOR SPINE W,72147,CPT,,,,,both,, ,1641.24,1641.24,Blue Cross and Blue Shield,Traditional,,635.16,38.7,percent of total billed charges,1641.24,64.01,837.03,percent of total billed charges,38.7
MR-THOR SPINE W,72147,CPT,,,,,both,,,2351.49,2351.49,Blue Cross and Blue Shield,Traditional,,910.03,38.7,percent of total billed charges,2351.49,91.71,1199.26,percent of total billed charges,38.7
MR-THOR SPINE W,72147,CPT,,,,,both,, ,2351.49,2351.49,Blue Cross and Blue Shield,Traditional,,910.03,38.7,percent of total billed charges,2351.49,91.71,1199.26,percent of total billed charges,38.7
MRI scan of lower spinal canal,72148,CPT,,,,,both,,,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,percent of total billed charges,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,percent of total billed charges,715.99,27.92,365.15,percent of total billed charges,38.7
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,percent of total billed charges,770.45,30.05,392.93,percent of total billed charges,38.7
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,percent of total billed charges,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,percent of total billed charges,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,percent of total billed charges,1114.55,43.47,568.42,percent of total billed charges,38.7
MR-LUMB SPINE W,72149,CPT,,,,,both,,,2352.06,2352.06,Blue Cross and Blue Shield,Traditional,,910.25,38.7,percent of total billed charges,2352.06,91.73,1199.55,percent of total billed charges,38.7
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,2352.06,2352.06,Blue Cross and Blue Shield,Traditional,,910.25,38.7,percent of total billed charges,2352.06,91.73,1199.55,percent of total billed charges,38.7
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,percent of total billed charges,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,percent of total billed charges,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-CERV SPINE WWO,72156,CPT,,,,,both,,,6352.79,6352.79,Blue Cross and Blue Shield,Traditional,,2458.53,38.7,percent of total billed charges,6352.79,247.76,3239.92,percent of total billed charges,38.7
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,6352.79,6352.79,Blue Cross and Blue Shield,Traditional,,2458.53,38.7,percent of total billed charges,6352.79,247.76,3239.92,percent of total billed charges,38.7
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,percent of total billed charges,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,percent of total billed charges,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-THOR SPINE WWO,72157,CPT,,,,,both,,,6352.79,6352.79,Blue Cross and Blue Shield,Traditional,,2458.53,38.7,percent of total billed charges,6352.79,247.76,3239.92,percent of total billed charges,38.7
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,6352.79,6352.79,Blue Cross and Blue Shield,Traditional,,2458.53,38.7,percent of total billed charges,6352.79,247.76,3239.92,percent of total billed charges,38.7
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,percent of total billed charges,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,percent of total billed charges,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-LUMB SPINE WWO,72158,CPT,,,,,both,,,6352.79,6352.79,Blue Cross and Blue Shield,Traditional,,2458.53,38.7,percent of total billed charges,6352.79,247.76,3239.92,percent of total billed charges,38.7
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,6352.79,6352.79,Blue Cross and Blue Shield,Traditional,,2458.53,38.7,percent of total billed charges,6352.79,247.76,3239.92,percent of total billed charges,38.7
LE-PELVIS CR,72170,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-PELVIS CR,72170,CPT,,,,,both,,,936.33,936.33,Blue Cross and Blue Shield,Traditional,,362.36,38.7,percent of total billed charges,936.33,36.52,477.53,percent of total billed charges,38.7
LE-PELVIS CR,72170,CPT,,,,,both,, ,936.33,936.33,Blue Cross and Blue Shield,Traditional,,362.36,38.7,percent of total billed charges,936.33,36.52,477.53,percent of total billed charges,38.7
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,,,1774.99,1774.99,Blue Cross and Blue Shield,Traditional,,686.92,38.7,percent of total billed charges,1774.99,69.22,905.24,percent of total billed charges,38.7
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,1774.99,1774.99,Blue Cross and Blue Shield,Traditional,,686.92,38.7,percent of total billed charges,1774.99,69.22,905.24,percent of total billed charges,38.7
CT-PELVIS WO,72192,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,percent of total billed charges,307.05,11.97,156.6,percent of total billed charges,38.7
CT-PELVIS WO,72192,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,percent of total billed charges,330.63,12.89,168.62,percent of total billed charges,38.7
CT-PELVIS WO,72192,CPT,,,,,both,,,3285.58,3285.58,Blue Cross and Blue Shield,Traditional,,1271.52,38.7,percent of total billed charges,3285.58,128.14,1675.65,percent of total billed charges,38.7
CT-PELVIS WO,72192,CPT,,,,,both,, ,3285.58,3285.58,Blue Cross and Blue Shield,Traditional,,1271.52,38.7,percent of total billed charges,3285.58,128.14,1675.65,percent of total billed charges,38.7
"CT scan, pelvis, with contrast",72193,CPT,,,,,both,,,3726.80,3726.80,Blue Cross and Blue Shield,Traditional,,1442.27,38.7,percent of total billed charges,3726.80,145.35,1900.67,percent of total billed charges,38.7
CT-PELVIS W,72193,CPT,,,,,both,, ,604.85,604.85,Blue Cross and Blue Shield,Traditional,,234.08,38.7,percent of total billed charges,604.85,23.59,308.47,percent of total billed charges,38.7
CT-PELVIS W,72193,CPT,,,,,both,, ,650.88,650.88,Blue Cross and Blue Shield,Traditional,,251.89,38.7,percent of total billed charges,650.88,25.38,331.95,percent of total billed charges,38.7
CT-PELVIS W,72193,CPT,,,,,both,, ,3726.80,3726.80,Blue Cross and Blue Shield,Traditional,,1442.27,38.7,percent of total billed charges,3726.80,145.35,1900.67,percent of total billed charges,38.7
CT-PELVIS WWO,72194,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,percent of total billed charges,680.91,26.56,347.26,percent of total billed charges,38.7
CT-PELVIS WWO,72194,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,percent of total billed charges,732.83,28.58,373.74,percent of total billed charges,38.7
CT-PELVIS WWO,72194,CPT,,,,,both,,,4047.33,4047.33,Blue Cross and Blue Shield,Traditional,,1566.32,38.7,percent of total billed charges,4047.33,157.85,2064.14,percent of total billed charges,38.7
CT-PELVIS WWO,72194,CPT,,,,,both,, ,4047.33,4047.33,Blue Cross and Blue Shield,Traditional,,1566.32,38.7,percent of total billed charges,4047.33,157.85,2064.14,percent of total billed charges,38.7
MR-PELVIS WO,72195,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,percent of total billed charges,715.99,27.92,365.15,percent of total billed charges,38.7
MR-PELVIS WO,72195,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,percent of total billed charges,770.45,30.05,392.93,percent of total billed charges,38.7
MR-PELVIS WO,72195,CPT,,,,,both,,,4042.84,4042.84,Blue Cross and Blue Shield,Traditional,,1564.58,38.7,percent of total billed charges,4042.84,157.67,2061.85,percent of total billed charges,38.7
MR-PELVIS WO,72195,CPT,,,,,both,, ,4042.84,4042.84,Blue Cross and Blue Shield,Traditional,,1564.58,38.7,percent of total billed charges,4042.84,157.67,2061.85,percent of total billed charges,38.7
MR-PELVIS W,72196,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,percent of total billed charges,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-PELVIS W,72196,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,percent of total billed charges,1114.55,43.47,568.42,percent of total billed charges,38.7
MR-PELVIS W,72196,CPT,,,,,both,,,2940.06,2940.06,Blue Cross and Blue Shield,Traditional,,1137.80,38.7,percent of total billed charges,2940.06,114.66,1499.43,percent of total billed charges,38.7
MR-PELVIS W,72196,CPT,,,,,both,, ,2940.06,2940.06,Blue Cross and Blue Shield,Traditional,,1137.80,38.7,percent of total billed charges,2940.06,114.66,1499.43,percent of total billed charges,38.7
MR-PELVIS WWO,72197,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,percent of total billed charges,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-PELVIS WWO,72197,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,percent of total billed charges,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-PELVIS WWO,72197,CPT,,,,,both,,,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,percent of total billed charges,5197.81,202.71,2650.88,percent of total billed charges,38.7
MR-PELVIS WWO,72197,CPT,,,,,both,, ,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,percent of total billed charges,5197.81,202.71,2650.88,percent of total billed charges,38.7
SP-SI JOINTS 2V CR,72200,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-SI JOINTS 2V CR,72200,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,,,757.53,757.53,Blue Cross and Blue Shield,Traditional,,293.16,38.7,percent of total billed charges,757.53,29.54,386.34,percent of total billed charges,38.7
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,757.53,757.53,Blue Cross and Blue Shield,Traditional,,293.16,38.7,percent of total billed charges,757.53,29.54,386.34,percent of total billed charges,38.7
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,,,989.38,989.38,Blue Cross and Blue Shield,Traditional,,382.89,38.7,percent of total billed charges,989.38,38.59,504.58,percent of total billed charges,38.7
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,989.38,989.38,Blue Cross and Blue Shield,Traditional,,382.89,38.7,percent of total billed charges,989.38,38.59,504.58,percent of total billed charges,38.7
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,,,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,percent of total billed charges,721.61,28.14,368.02,percent of total billed charges,38.7
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,percent of total billed charges,721.61,28.14,368.02,percent of total billed charges,38.7
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-CLAVICLE CR,73000,CPT,,,,,both,,,353.93,353.93,Blue Cross and Blue Shield,Traditional,,136.97,38.7,percent of total billed charges,353.93,13.80,180.5,percent of total billed charges,38.7
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,353.93,353.93,Blue Cross and Blue Shield,Traditional,,136.97,38.7,percent of total billed charges,353.93,13.80,180.5,percent of total billed charges,38.7
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,273.37,273.37,Blue Cross and Blue Shield,Traditional,,105.79,38.7,percent of total billed charges,273.37,10.66,139.42,percent of total billed charges,38.7
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,273.37,273.37,Blue Cross and Blue Shield,Traditional,,105.79,38.7,percent of total billed charges,273.37,10.66,139.42,percent of total billed charges,38.7
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,,,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,percent of total billed charges,804.69,31.38,410.39,percent of total billed charges,38.7
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,percent of total billed charges,804.69,31.38,410.39,percent of total billed charges,38.7
UE-SCAPULA CR,73010,CPT,,,,,both,, ,136.68,136.68,Blue Cross and Blue Shield,Traditional,,52.90,38.7,percent of total billed charges,136.68,5.33,69.71,percent of total billed charges,38.7
UE-SCAPULA CR,73010,CPT,,,,,both,, ,136.68,136.68,Blue Cross and Blue Shield,Traditional,,52.90,38.7,percent of total billed charges,136.68,5.33,69.71,percent of total billed charges,38.7
UE-SCAPULA CR,73010,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-SCAPULA CR,73010,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-SCAPULA CR,73010,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-SCAPULA CR,73010,CPT,,,,,both,,,402.20,402.20,Blue Cross and Blue Shield,Traditional,,155.65,38.7,percent of total billed charges,402.20,15.69,205.12,percent of total billed charges,38.7
UE-SCAPULA CR,73010,CPT,,,,,both,, ,402.20,402.20,Blue Cross and Blue Shield,Traditional,,155.65,38.7,percent of total billed charges,402.20,15.69,205.12,percent of total billed charges,38.7
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,,,978.43,978.43,Blue Cross and Blue Shield,Traditional,,378.65,38.7,percent of total billed charges,978.43,38.16,499,percent of total billed charges,38.7
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,978.43,978.43,Blue Cross and Blue Shield,Traditional,,378.65,38.7,percent of total billed charges,978.43,38.16,499,percent of total billed charges,38.7
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-SHOULDER 1V CR,73020,CPT,,,,,both,,,489.50,489.50,Blue Cross and Blue Shield,Traditional,,189.44,38.7,percent of total billed charges,489.50,19.09,249.65,percent of total billed charges,38.7
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,489.50,489.50,Blue Cross and Blue Shield,Traditional,,189.44,38.7,percent of total billed charges,489.50,19.09,249.65,percent of total billed charges,38.7
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,,,863.36,863.36,Blue Cross and Blue Shield,Traditional,,334.12,38.7,percent of total billed charges,863.36,33.67,440.31,percent of total billed charges,38.7
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,863.36,863.36,Blue Cross and Blue Shield,Traditional,,334.12,38.7,percent of total billed charges,863.36,33.67,440.31,percent of total billed charges,38.7
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,,,1726.71,1726.71,Blue Cross and Blue Shield,Traditional,,668.24,38.7,percent of total billed charges,1726.71,67.34,880.62,percent of total billed charges,38.7
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,1726.71,1726.71,Blue Cross and Blue Shield,Traditional,,668.24,38.7,percent of total billed charges,1726.71,67.34,880.62,percent of total billed charges,38.7
IR-ARTHROGM SHLDR CR,73040,CPT,,,,,both,, ,3748.70,3748.70,Blue Cross and Blue Shield,Traditional,,1450.75,38.7,percent of total billed charges,3748.70,146.20,1911.84,percent of total billed charges,38.7
IR-ATHGRM SHLD BI CR,73040,CPT,,,,,both,, ,7497.39,7497.39,Blue Cross and Blue Shield,Traditional,,2901.49,38.7,percent of total billed charges,7497.39,292.40,3823.67,percent of total billed charges,38.7
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-AC JTS BILAT CR,73050,CPT,,,,,both,,,918.37,918.37,Blue Cross and Blue Shield,Traditional,,355.41,38.7,percent of total billed charges,918.37,35.82,468.37,percent of total billed charges,38.7
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,918.37,918.37,Blue Cross and Blue Shield,Traditional,,355.41,38.7,percent of total billed charges,918.37,35.82,468.37,percent of total billed charges,38.7
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,,,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,percent of total billed charges,721.61,28.14,368.02,percent of total billed charges,38.7
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,percent of total billed charges,721.61,28.14,368.02,percent of total billed charges,38.7
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HUMERUS CR,73060,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-HUMERUS CR,73060,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-HUMERUS CR,73060,CPT,,,,,both,,,1442.95,1442.95,Blue Cross and Blue Shield,Traditional,,558.42,38.7,percent of total billed charges,1442.95,56.28,735.9,percent of total billed charges,38.7
UE-HUMERUS CR,73060,CPT,,,,,both,, ,1442.95,1442.95,Blue Cross and Blue Shield,Traditional,,558.42,38.7,percent of total billed charges,1442.95,56.28,735.9,percent of total billed charges,38.7
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-ELBOW 2V CR,73070,CPT,,,,,both,,,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,percent of total billed charges,662.39,25.83,337.82,percent of total billed charges,38.7
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,percent of total billed charges,662.39,25.83,337.82,percent of total billed charges,38.7
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,,,1325.06,1325.06,Blue Cross and Blue Shield,Traditional,,512.80,38.7,percent of total billed charges,1325.06,51.68,675.78,percent of total billed charges,38.7
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,1325.06,1325.06,Blue Cross and Blue Shield,Traditional,,512.80,38.7,percent of total billed charges,1325.06,51.68,675.78,percent of total billed charges,38.7
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-ELBOW 3V CR,73080,CPT,,,,,both,,,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,percent of total billed charges,804.69,31.38,410.39,percent of total billed charges,38.7
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,percent of total billed charges,804.69,31.38,410.39,percent of total billed charges,38.7
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,,,1609.11,1609.11,Blue Cross and Blue Shield,Traditional,,622.73,38.7,percent of total billed charges,1609.11,62.76,820.65,percent of total billed charges,38.7
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,1609.11,1609.11,Blue Cross and Blue Shield,Traditional,,622.73,38.7,percent of total billed charges,1609.11,62.76,820.65,percent of total billed charges,38.7
IR-ARTHROGRAM ELBOW,73085,CPT,,,,,both,, ,3748.70,3748.70,Blue Cross and Blue Shield,Traditional,,1450.75,38.7,percent of total billed charges,3748.70,146.20,1911.84,percent of total billed charges,38.7
IR-ARTHROGRAM ELBOW,73085,CPT,,,,,both,, ,3748.70,3748.70,Blue Cross and Blue Shield,Traditional,,1450.75,38.7,percent of total billed charges,3748.70,146.20,1911.84,percent of total billed charges,38.7
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-FOREARM 2V CR,73090,CPT,,,,,both,,,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,percent of total billed charges,662.39,25.83,337.82,percent of total billed charges,38.7
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,percent of total billed charges,662.39,25.83,337.82,percent of total billed charges,38.7
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,,,1325.06,1325.06,Blue Cross and Blue Shield,Traditional,,512.80,38.7,percent of total billed charges,1325.06,51.68,675.78,percent of total billed charges,38.7
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,1325.06,1325.06,Blue Cross and Blue Shield,Traditional,,512.80,38.7,percent of total billed charges,1325.06,51.68,675.78,percent of total billed charges,38.7
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,percent of total billed charges,220.61,8.60,112.51,percent of total billed charges,38.7
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
UE-UP EXT INFANT CR,73092,CPT,,,,,both,,,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,percent of total billed charges,721.61,28.14,368.02,percent of total billed charges,38.7
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,percent of total billed charges,721.61,28.14,368.02,percent of total billed charges,38.7
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,441.50,441.50,Blue Cross and Blue Shield,Traditional,,170.86,38.7,percent of total billed charges,441.50,17.22,225.17,percent of total billed charges,38.7
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,475.18,475.18,Blue Cross and Blue Shield,Traditional,,183.89,38.7,percent of total billed charges,475.18,18.53,242.34,percent of total billed charges,38.7
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,,,1444.91,1444.91,Blue Cross and Blue Shield,Traditional,,559.18,38.7,percent of total billed charges,1444.91,56.35,736.9,percent of total billed charges,38.7
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,1444.91,1444.91,Blue Cross and Blue Shield,Traditional,,559.18,38.7,percent of total billed charges,1444.91,56.35,736.9,percent of total billed charges,38.7
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-WRIST 2V CR,73100,CPT,,,,,both,,,607.94,607.94,Blue Cross and Blue Shield,Traditional,,235.27,38.7,percent of total billed charges,607.94,23.71,310.05,percent of total billed charges,38.7
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,607.94,607.94,Blue Cross and Blue Shield,Traditional,,235.27,38.7,percent of total billed charges,607.94,23.71,310.05,percent of total billed charges,38.7
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,,,1216.16,1216.16,Blue Cross and Blue Shield,Traditional,,470.65,38.7,percent of total billed charges,1216.16,47.43,620.24,percent of total billed charges,38.7
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,1216.16,1216.16,Blue Cross and Blue Shield,Traditional,,470.65,38.7,percent of total billed charges,1216.16,47.43,620.24,percent of total billed charges,38.7
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,,,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,percent of total billed charges,662.39,25.83,337.82,percent of total billed charges,38.7
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,percent of total billed charges,662.39,25.83,337.82,percent of total billed charges,38.7
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,,,1325.06,1325.06,Blue Cross and Blue Shield,Traditional,,512.80,38.7,percent of total billed charges,1325.06,51.68,675.78,percent of total billed charges,38.7
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,1325.06,1325.06,Blue Cross and Blue Shield,Traditional,,512.80,38.7,percent of total billed charges,1325.06,51.68,675.78,percent of total billed charges,38.7
IR-ARTHROGRAM WRIST,73115,CPT,,,,,both,, ,3748.70,3748.70,Blue Cross and Blue Shield,Traditional,,1450.75,38.7,percent of total billed charges,3748.70,146.20,1911.84,percent of total billed charges,38.7
IR-ARTHROGRAM WRIST,73115,CPT,,,,,both,, ,3748.70,3748.70,Blue Cross and Blue Shield,Traditional,,1450.75,38.7,percent of total billed charges,3748.70,146.20,1911.84,percent of total billed charges,38.7
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HAND 2V CR,73120,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-HAND 2V CR,73120,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-HAND 2V CR,73120,CPT,,,,,both,,,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,percent of total billed charges,662.39,25.83,337.82,percent of total billed charges,38.7
UE-HAND 2V CR,73120,CPT,,,,,both,, ,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,percent of total billed charges,662.39,25.83,337.82,percent of total billed charges,38.7
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,,,1325.06,1325.06,Blue Cross and Blue Shield,Traditional,,512.80,38.7,percent of total billed charges,1325.06,51.68,675.78,percent of total billed charges,38.7
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,1325.06,1325.06,Blue Cross and Blue Shield,Traditional,,512.80,38.7,percent of total billed charges,1325.06,51.68,675.78,percent of total billed charges,38.7
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HAND 3V CR,73130,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-HAND 3V CR,73130,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-HAND 3V CR,73130,CPT,,,,,both,,,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,percent of total billed charges,804.69,31.38,410.39,percent of total billed charges,38.7
UE-HAND 3V CR,73130,CPT,,,,,both,, ,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,percent of total billed charges,804.69,31.38,410.39,percent of total billed charges,38.7
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,,,1609.11,1609.11,Blue Cross and Blue Shield,Traditional,,622.73,38.7,percent of total billed charges,1609.11,62.76,820.65,percent of total billed charges,38.7
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,1609.11,1609.11,Blue Cross and Blue Shield,Traditional,,622.73,38.7,percent of total billed charges,1609.11,62.76,820.65,percent of total billed charges,38.7
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,,,1137.30,1137.30,Blue Cross and Blue Shield,Traditional,,440.14,38.7,percent of total billed charges,1137.30,44.35,580.02,percent of total billed charges,38.7
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,1137.30,1137.30,Blue Cross and Blue Shield,Traditional,,440.14,38.7,percent of total billed charges,1137.30,44.35,580.02,percent of total billed charges,38.7
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,,,568.64,568.64,Blue Cross and Blue Shield,Traditional,,220.06,38.7,percent of total billed charges,568.64,22.18,290.01,percent of total billed charges,38.7
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,568.64,568.64,Blue Cross and Blue Shield,Traditional,,220.06,38.7,percent of total billed charges,568.64,22.18,290.01,percent of total billed charges,38.7
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,percent of total billed charges,307.05,11.97,156.6,percent of total billed charges,38.7
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,percent of total billed charges,330.63,12.89,168.62,percent of total billed charges,38.7
CT-UPPER EXT WO,73200,CPT,,,,,both,,,3015.85,3015.85,Blue Cross and Blue Shield,Traditional,,1167.13,38.7,percent of total billed charges,3015.85,117.62,1538.08,percent of total billed charges,38.7
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,3015.85,3015.85,Blue Cross and Blue Shield,Traditional,,1167.13,38.7,percent of total billed charges,3015.85,117.62,1538.08,percent of total billed charges,38.7
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,614.40,614.40,Blue Cross and Blue Shield,Traditional,,237.77,38.7,percent of total billed charges,614.40,23.96,313.34,percent of total billed charges,38.7
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,660.98,660.98,Blue Cross and Blue Shield,Traditional,,255.80,38.7,percent of total billed charges,660.98,25.78,337.1,percent of total billed charges,38.7
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,6031.42,6031.42,Blue Cross and Blue Shield,Traditional,,2334.16,38.7,percent of total billed charges,6031.42,235.23,3076.02,percent of total billed charges,38.7
CT-UPPER EXT W,73201,CPT,,,,,both,, ,556.01,556.01,Blue Cross and Blue Shield,Traditional,,215.18,38.7,percent of total billed charges,556.01,21.68,283.57,percent of total billed charges,38.7
CT-UPPER EXT W,73201,CPT,,,,,both,,,3350.14,3350.14,Blue Cross and Blue Shield,Traditional,,1296.50,38.7,percent of total billed charges,3350.14,130.66,1708.57,percent of total billed charges,38.7
CT-UPPER EXT W,73201,CPT,,,,,both,, ,3350.14,3350.14,Blue Cross and Blue Shield,Traditional,,1296.50,38.7,percent of total billed charges,3350.14,130.66,1708.57,percent of total billed charges,38.7
CTA-UPPER EXT,73206,CPT,,,,,both,,,1947.60,1947.60,Blue Cross and Blue Shield,Traditional,,753.72,38.7,percent of total billed charges,1947.60,75.96,993.28,percent of total billed charges,38.7
CTA-UPPER EXT,73206,CPT,,,,,both,, ,1947.60,1947.60,Blue Cross and Blue Shield,Traditional,,753.72,38.7,percent of total billed charges,1947.60,75.96,993.28,percent of total billed charges,38.7
CTA-UPPER EXT BI,73206,CPT,,,,,both,, ,3895.20,3895.20,Blue Cross and Blue Shield,Traditional,,1507.44,38.7,percent of total billed charges,3895.20,151.91,1986.55,percent of total billed charges,38.7
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,1431.72,1431.72,Blue Cross and Blue Shield,Traditional,,554.08,38.7,percent of total billed charges,1431.72,55.84,730.18,percent of total billed charges,38.7
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,1540.90,1540.90,Blue Cross and Blue Shield,Traditional,,596.33,38.7,percent of total billed charges,1540.90,60.10,785.86,percent of total billed charges,38.7
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,4042.84,4042.84,Blue Cross and Blue Shield,Traditional,,1564.58,38.7,percent of total billed charges,4042.84,157.67,2061.85,percent of total billed charges,38.7
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,percent of total billed charges,715.99,27.92,365.15,percent of total billed charges,38.7
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,percent of total billed charges,770.45,30.05,392.93,percent of total billed charges,38.7
MR-UPPER EXT WO,73218,CPT,,,,,both,,,2470.50,2470.50,Blue Cross and Blue Shield,Traditional,,956.08,38.7,percent of total billed charges,2470.50,96.35,1259.96,percent of total billed charges,38.7
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,2470.50,2470.50,Blue Cross and Blue Shield,Traditional,,956.08,38.7,percent of total billed charges,2470.50,96.35,1259.96,percent of total billed charges,38.7
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,2394.15,2394.15,Blue Cross and Blue Shield,Traditional,,926.54,38.7,percent of total billed charges,2394.15,93.37,1221.02,percent of total billed charges,38.7
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,2576.60,2576.60,Blue Cross and Blue Shield,Traditional,,997.14,38.7,percent of total billed charges,2576.60,100.49,1314.07,percent of total billed charges,38.7
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,percent of total billed charges,5197.81,202.71,2650.88,percent of total billed charges,38.7
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,percent of total billed charges,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,percent of total billed charges,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-UPPER EXT WWO,73220,CPT,,,,,both,,,2598.76,2598.76,Blue Cross and Blue Shield,Traditional,,1005.72,38.7,percent of total billed charges,2598.76,101.35,1325.37,percent of total billed charges,38.7
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,2598.76,2598.76,Blue Cross and Blue Shield,Traditional,,1005.72,38.7,percent of total billed charges,2598.76,101.35,1325.37,percent of total billed charges,38.7
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,percent of total billed charges,715.99,27.92,365.15,percent of total billed charges,38.7
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,percent of total billed charges,770.45,30.05,392.93,percent of total billed charges,38.7
MR-UPPER JOINT WO,73221,CPT,,,,,both,,,2523.26,2523.26,Blue Cross and Blue Shield,Traditional,,976.50,38.7,percent of total billed charges,2523.26,98.41,1286.86,percent of total billed charges,38.7
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,2523.26,2523.26,Blue Cross and Blue Shield,Traditional,,976.50,38.7,percent of total billed charges,2523.26,98.41,1286.86,percent of total billed charges,38.7
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,percent of total billed charges,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,percent of total billed charges,1114.55,43.47,568.42,percent of total billed charges,38.7
MR-UPPER JOINT W,73222,CPT,,,,,both,,,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,percent of total billed charges,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,percent of total billed charges,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,percent of total billed charges,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,percent of total billed charges,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-UPPER JOINT WWO,73223,CPT,,,,,both,,,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,percent of total billed charges,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,percent of total billed charges,4941.28,192.71,2520.05,percent of total billed charges,38.7
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,,,333.44,333.44,Blue Cross and Blue Shield,Traditional,,129.04,38.7,percent of total billed charges,333.44,13.00,170.05,percent of total billed charges,38.7
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,333.44,333.44,Blue Cross and Blue Shield,Traditional,,129.04,38.7,percent of total billed charges,333.44,13.00,170.05,percent of total billed charges,38.7
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,139.77,139.77,Blue Cross and Blue Shield,Traditional,,54.09,38.7,percent of total billed charges,139.77,5.45,71.28,percent of total billed charges,38.7
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,149.32,Blue Cross and Blue Shield,Traditional,,57.79,38.7,percent of total billed charges,149.32,5.82,76.15,percent of total billed charges,38.7
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,149.32,Blue Cross and Blue Shield,Traditional,,57.79,38.7,percent of total billed charges,149.32,5.82,76.15,percent of total billed charges,38.7
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,149.32,Blue Cross and Blue Shield,Traditional,,57.79,38.7,percent of total billed charges,149.32,5.82,76.15,percent of total billed charges,38.7
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,887.49,887.49,Blue Cross and Blue Shield,Traditional,,343.46,38.7,percent of total billed charges,887.49,34.61,452.62,percent of total billed charges,38.7
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,209.94,209.94,Blue Cross and Blue Shield,Traditional,,81.25,38.7,percent of total billed charges,209.94,8.19,107.07,percent of total billed charges,38.7
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,224.54,Blue Cross and Blue Shield,Traditional,,86.90,38.7,percent of total billed charges,224.54,8.76,114.52,percent of total billed charges,38.7
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,224.54,Blue Cross and Blue Shield,Traditional,,86.90,38.7,percent of total billed charges,224.54,8.76,114.52,percent of total billed charges,38.7
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,224.54,Blue Cross and Blue Shield,Traditional,,86.90,38.7,percent of total billed charges,224.54,8.76,114.52,percent of total billed charges,38.7
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,1330.96,1330.96,Blue Cross and Blue Shield,Traditional,,515.08,38.7,percent of total billed charges,1330.96,51.91,678.79,percent of total billed charges,38.7
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,percent of total billed charges,220.88,8.61,112.65,percent of total billed charges,38.7
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,238.01,Blue Cross and Blue Shield,Traditional,,92.11,38.7,percent of total billed charges,238.01,9.28,121.39,percent of total billed charges,38.7
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,238.01,Blue Cross and Blue Shield,Traditional,,92.11,38.7,percent of total billed charges,238.01,9.28,121.39,percent of total billed charges,38.7
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,238.01,Blue Cross and Blue Shield,Traditional,,92.11,38.7,percent of total billed charges,238.01,9.28,121.39,percent of total billed charges,38.7
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,,,1774.70,1774.70,Blue Cross and Blue Shield,Traditional,,686.81,38.7,percent of total billed charges,1774.70,69.21,905.1,percent of total billed charges,38.7
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,1774.70,1774.70,Blue Cross and Blue Shield,Traditional,,686.81,38.7,percent of total billed charges,1774.70,69.21,905.1,percent of total billed charges,38.7
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,percent of total billed charges,220.88,8.61,112.65,percent of total billed charges,38.7
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,238.01,Blue Cross and Blue Shield,Traditional,,92.11,38.7,percent of total billed charges,238.01,9.28,121.39,percent of total billed charges,38.7
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,238.01,Blue Cross and Blue Shield,Traditional,,92.11,38.7,percent of total billed charges,238.01,9.28,121.39,percent of total billed charges,38.7
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,238.01,Blue Cross and Blue Shield,Traditional,,92.11,38.7,percent of total billed charges,238.01,9.28,121.39,percent of total billed charges,38.7
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,,,1774.70,1774.70,Blue Cross and Blue Shield,Traditional,,686.81,38.7,percent of total billed charges,1774.70,69.21,905.1,percent of total billed charges,38.7
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,1774.70,1774.70,Blue Cross and Blue Shield,Traditional,,686.81,38.7,percent of total billed charges,1774.70,69.21,905.1,percent of total billed charges,38.7
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,442.06,442.06,Blue Cross and Blue Shield,Traditional,,171.08,38.7,percent of total billed charges,442.06,17.24,225.45,percent of total billed charges,38.7
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,476.02,Blue Cross and Blue Shield,Traditional,,184.22,38.7,percent of total billed charges,476.02,18.56,242.77,percent of total billed charges,38.7
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,476.02,Blue Cross and Blue Shield,Traditional,,184.22,38.7,percent of total billed charges,476.02,18.56,242.77,percent of total billed charges,38.7
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,476.02,Blue Cross and Blue Shield,Traditional,,184.22,38.7,percent of total billed charges,476.02,18.56,242.77,percent of total billed charges,38.7
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,,,3549.69,3549.69,Blue Cross and Blue Shield,Traditional,,1373.73,38.7,percent of total billed charges,3549.69,138.44,1810.34,percent of total billed charges,38.7
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,3549.69,3549.69,Blue Cross and Blue Shield,Traditional,,1373.73,38.7,percent of total billed charges,3549.69,138.44,1810.34,percent of total billed charges,38.7
IR-ARTHROGRAM HIP CR,73525,CPT,,,,,both,, ,3760.20,3760.20,Blue Cross and Blue Shield,Traditional,,1455.20,38.7,percent of total billed charges,3760.20,146.65,1917.7,percent of total billed charges,38.7
IR-ARTHROGRAM HIP CR,73525,CPT,,,,,both,, ,3760.20,3760.20,Blue Cross and Blue Shield,Traditional,,1455.20,38.7,percent of total billed charges,3760.20,146.65,1917.7,percent of total billed charges,38.7
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.20,148.20,Blue Cross and Blue Shield,Traditional,,57.35,38.7,percent of total billed charges,148.20,5.78,75.58,percent of total billed charges,38.7
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.20,148.20,Blue Cross and Blue Shield,Traditional,,57.35,38.7,percent of total billed charges,148.20,5.78,75.58,percent of total billed charges,38.7
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.20,148.20,Blue Cross and Blue Shield,Traditional,,57.35,38.7,percent of total billed charges,148.20,5.78,75.58,percent of total billed charges,38.7
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.20,148.20,Blue Cross and Blue Shield,Traditional,,57.35,38.7,percent of total billed charges,148.20,5.78,75.58,percent of total billed charges,38.7
LE-FEMUR 1V CR,73551,CPT,,,,,both,,,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,percent of total billed charges,307.05,11.97,156.6,percent of total billed charges,38.7
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,percent of total billed charges,307.05,11.97,156.6,percent of total billed charges,38.7
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-FEMUR 2V CR,73552,CPT,,,,,both,,,782.23,782.23,Blue Cross and Blue Shield,Traditional,,302.72,38.7,percent of total billed charges,782.23,30.51,398.94,percent of total billed charges,38.7
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,782.23,782.23,Blue Cross and Blue Shield,Traditional,,302.72,38.7,percent of total billed charges,782.23,30.51,398.94,percent of total billed charges,38.7
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,,,1564.76,1564.76,Blue Cross and Blue Shield,Traditional,,605.56,38.7,percent of total billed charges,1564.76,61.03,798.03,percent of total billed charges,38.7
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,1564.76,1564.76,Blue Cross and Blue Shield,Traditional,,605.56,38.7,percent of total billed charges,1564.76,61.03,798.03,percent of total billed charges,38.7
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,,,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,percent of total billed charges,721.61,28.14,368.02,percent of total billed charges,38.7
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,percent of total billed charges,721.61,28.14,368.02,percent of total billed charges,38.7
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,,,1442.95,1442.95,Blue Cross and Blue Shield,Traditional,,558.42,38.7,percent of total billed charges,1442.95,56.28,735.9,percent of total billed charges,38.7
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,1442.95,1442.95,Blue Cross and Blue Shield,Traditional,,558.42,38.7,percent of total billed charges,1442.95,56.28,735.9,percent of total billed charges,38.7
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-KNEE 3V CR,73562,CPT,,,,,both,,,981.24,981.24,Blue Cross and Blue Shield,Traditional,,379.74,38.7,percent of total billed charges,981.24,38.27,500.43,percent of total billed charges,38.7
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,981.24,981.24,Blue Cross and Blue Shield,Traditional,,379.74,38.7,percent of total billed charges,981.24,38.27,500.43,percent of total billed charges,38.7
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,,,1962.48,1962.48,Blue Cross and Blue Shield,Traditional,,759.48,38.7,percent of total billed charges,1962.48,76.54,1000.86,percent of total billed charges,38.7
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,1962.48,1962.48,Blue Cross and Blue Shield,Traditional,,759.48,38.7,percent of total billed charges,1962.48,76.54,1000.86,percent of total billed charges,38.7
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,,,1070.49,1070.49,Blue Cross and Blue Shield,Traditional,,414.28,38.7,percent of total billed charges,1070.49,41.75,545.95,percent of total billed charges,38.7
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,1070.49,1070.49,Blue Cross and Blue Shield,Traditional,,414.28,38.7,percent of total billed charges,1070.49,41.75,545.95,percent of total billed charges,38.7
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,,,2141.27,2141.27,Blue Cross and Blue Shield,Traditional,,828.67,38.7,percent of total billed charges,2141.27,83.51,1092.05,percent of total billed charges,38.7
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,2141.27,2141.27,Blue Cross and Blue Shield,Traditional,,828.67,38.7,percent of total billed charges,2141.27,83.51,1092.05,percent of total billed charges,38.7
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,,,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,percent of total billed charges,721.61,28.14,368.02,percent of total billed charges,38.7
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,percent of total billed charges,721.61,28.14,368.02,percent of total billed charges,38.7
IR-ARTHRGRM KNEE BI,73580,CPT,,,,,both,, ,7520.68,7520.68,Blue Cross and Blue Shield,Traditional,,2910.50,38.7,percent of total billed charges,7520.68,293.31,3835.55,percent of total billed charges,38.7
IR-ARTHROGRAM KNEE,73580,CPT,,,,,both,, ,3760.20,3760.20,Blue Cross and Blue Shield,Traditional,,1455.20,38.7,percent of total billed charges,3760.20,146.65,1917.7,percent of total billed charges,38.7
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,,,1442.95,1442.95,Blue Cross and Blue Shield,Traditional,,558.42,38.7,percent of total billed charges,1442.95,56.28,735.9,percent of total billed charges,38.7
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,1442.95,1442.95,Blue Cross and Blue Shield,Traditional,,558.42,38.7,percent of total billed charges,1442.95,56.28,735.9,percent of total billed charges,38.7
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-TIB FIB 2V CR,73590,CPT,,,,,both,,,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,percent of total billed charges,721.61,28.14,368.02,percent of total billed charges,38.7
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,percent of total billed charges,721.61,28.14,368.02,percent of total billed charges,38.7
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,,,1442.95,1442.95,Blue Cross and Blue Shield,Traditional,,558.42,38.7,percent of total billed charges,1442.95,56.28,735.9,percent of total billed charges,38.7
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,1442.95,1442.95,Blue Cross and Blue Shield,Traditional,,558.42,38.7,percent of total billed charges,1442.95,56.28,735.9,percent of total billed charges,38.7
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,,,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,percent of total billed charges,721.61,28.14,368.02,percent of total billed charges,38.7
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,percent of total billed charges,721.61,28.14,368.02,percent of total billed charges,38.7
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-ANKLE 2V CR,73600,CPT,,,,,both,,,720.49,720.49,Blue Cross and Blue Shield,Traditional,,278.83,38.7,percent of total billed charges,720.49,28.10,367.45,percent of total billed charges,38.7
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,720.49,720.49,Blue Cross and Blue Shield,Traditional,,278.83,38.7,percent of total billed charges,720.49,28.10,367.45,percent of total billed charges,38.7
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,,,1107.82,1107.82,Blue Cross and Blue Shield,Traditional,,428.73,38.7,percent of total billed charges,1107.82,43.20,564.99,percent of total billed charges,38.7
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,1107.82,1107.82,Blue Cross and Blue Shield,Traditional,,428.73,38.7,percent of total billed charges,1107.82,43.20,564.99,percent of total billed charges,38.7
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,,,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,percent of total billed charges,804.69,31.38,410.39,percent of total billed charges,38.7
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,percent of total billed charges,804.69,31.38,410.39,percent of total billed charges,38.7
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,,,1609.11,1609.11,Blue Cross and Blue Shield,Traditional,,622.73,38.7,percent of total billed charges,1609.11,62.76,820.65,percent of total billed charges,38.7
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,1609.11,1609.11,Blue Cross and Blue Shield,Traditional,,622.73,38.7,percent of total billed charges,1609.11,62.76,820.65,percent of total billed charges,38.7
IR-ARTHROGRAM ANKLE,73615,CPT,,,,,both,, ,3760.20,3760.20,Blue Cross and Blue Shield,Traditional,,1455.20,38.7,percent of total billed charges,3760.20,146.65,1917.7,percent of total billed charges,38.7
IR-ARTHROGRAM ANKLE,73615,CPT,,,,,both,, ,3760.20,3760.20,Blue Cross and Blue Shield,Traditional,,1455.20,38.7,percent of total billed charges,3760.20,146.65,1917.7,percent of total billed charges,38.7
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-FOOT 2V CR,73620,CPT,,,,,both,,,553.77,553.77,Blue Cross and Blue Shield,Traditional,,214.31,38.7,percent of total billed charges,553.77,21.60,282.42,percent of total billed charges,38.7
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,553.77,553.77,Blue Cross and Blue Shield,Traditional,,214.31,38.7,percent of total billed charges,553.77,21.60,282.42,percent of total billed charges,38.7
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,,,1107.82,1107.82,Blue Cross and Blue Shield,Traditional,,428.73,38.7,percent of total billed charges,1107.82,43.20,564.99,percent of total billed charges,38.7
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,1107.82,1107.82,Blue Cross and Blue Shield,Traditional,,428.73,38.7,percent of total billed charges,1107.82,43.20,564.99,percent of total billed charges,38.7
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,,,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,percent of total billed charges,662.39,25.83,337.82,percent of total billed charges,38.7
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,percent of total billed charges,662.39,25.83,337.82,percent of total billed charges,38.7
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,,,1250.97,1250.97,Blue Cross and Blue Shield,Traditional,,484.13,38.7,percent of total billed charges,1250.97,48.79,637.99,percent of total billed charges,38.7
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,1250.97,1250.97,Blue Cross and Blue Shield,Traditional,,484.13,38.7,percent of total billed charges,1250.97,48.79,637.99,percent of total billed charges,38.7
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,,,353.93,353.93,Blue Cross and Blue Shield,Traditional,,136.97,38.7,percent of total billed charges,353.93,13.80,180.5,percent of total billed charges,38.7
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,353.93,353.93,Blue Cross and Blue Shield,Traditional,,136.97,38.7,percent of total billed charges,353.93,13.80,180.5,percent of total billed charges,38.7
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,,,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,percent of total billed charges,662.39,25.83,337.82,percent of total billed charges,38.7
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,percent of total billed charges,662.39,25.83,337.82,percent of total billed charges,38.7
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,percent of total billed charges,278.43,10.86,142,percent of total billed charges,38.7
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,,,568.64,568.64,Blue Cross and Blue Shield,Traditional,,220.06,38.7,percent of total billed charges,568.64,22.18,290.01,percent of total billed charges,38.7
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,568.64,568.64,Blue Cross and Blue Shield,Traditional,,220.06,38.7,percent of total billed charges,568.64,22.18,290.01,percent of total billed charges,38.7
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,percent of total billed charges,299.76,11.69,152.88,percent of total billed charges,38.7
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,,,1137.30,1137.30,Blue Cross and Blue Shield,Traditional,,440.14,38.7,percent of total billed charges,1137.30,44.35,580.02,percent of total billed charges,38.7
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,1137.30,1137.30,Blue Cross and Blue Shield,Traditional,,440.14,38.7,percent of total billed charges,1137.30,44.35,580.02,percent of total billed charges,38.7
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,percent of total billed charges,307.05,11.97,156.6,percent of total billed charges,38.7
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,percent of total billed charges,330.63,12.89,168.62,percent of total billed charges,38.7
CT-LOWER EXT WO,73700,CPT,,,,,both,,,3013.04,3013.04,Blue Cross and Blue Shield,Traditional,,1166.05,38.7,percent of total billed charges,3013.04,117.51,1536.65,percent of total billed charges,38.7
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,3013.04,3013.04,Blue Cross and Blue Shield,Traditional,,1166.05,38.7,percent of total billed charges,3013.04,117.51,1536.65,percent of total billed charges,38.7
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,614.40,614.40,Blue Cross and Blue Shield,Traditional,,237.77,38.7,percent of total billed charges,614.40,23.96,313.34,percent of total billed charges,38.7
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,660.98,660.98,Blue Cross and Blue Shield,Traditional,,255.80,38.7,percent of total billed charges,660.98,25.78,337.1,percent of total billed charges,38.7
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,percent of total billed charges,4941.28,192.71,2520.05,percent of total billed charges,38.7
CT-LOWER EXT W,73701,CPT,,,,,both,, ,650.88,650.88,Blue Cross and Blue Shield,Traditional,,251.89,38.7,percent of total billed charges,650.88,25.38,331.95,percent of total billed charges,38.7
CT-LOWER EXT W,73701,CPT,,,,,both,,,3013.04,3013.04,Blue Cross and Blue Shield,Traditional,,1166.05,38.7,percent of total billed charges,3013.04,117.51,1536.65,percent of total billed charges,38.7
CT-LOWER EXT W,73701,CPT,,,,,both,, ,3013.04,3013.04,Blue Cross and Blue Shield,Traditional,,1166.05,38.7,percent of total billed charges,3013.04,117.51,1536.65,percent of total billed charges,38.7
CT-LOWER EXT W BI,73701,CPT,,,,,both,, ,604.85,604.85,Blue Cross and Blue Shield,Traditional,,234.08,38.7,percent of total billed charges,604.85,23.59,308.47,percent of total billed charges,38.7
CT-LOWER EXT W BI,73701,CPT,,,,,both,, ,604.85,604.85,Blue Cross and Blue Shield,Traditional,,234.08,38.7,percent of total billed charges,604.85,23.59,308.47,percent of total billed charges,38.7
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,percent of total billed charges,680.91,26.56,347.26,percent of total billed charges,38.7
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,percent of total billed charges,732.83,28.58,373.74,percent of total billed charges,38.7
CT-LOWER EXT WWO,73702,CPT,,,,,both,,,3013.04,3013.04,Blue Cross and Blue Shield,Traditional,,1166.05,38.7,percent of total billed charges,3013.04,117.51,1536.65,percent of total billed charges,38.7
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,3013.04,3013.04,Blue Cross and Blue Shield,Traditional,,1166.05,38.7,percent of total billed charges,3013.04,117.51,1536.65,percent of total billed charges,38.7
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,1361.84,1361.84,Blue Cross and Blue Shield,Traditional,,527.03,38.7,percent of total billed charges,1361.84,53.11,694.54,percent of total billed charges,38.7
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,1465.68,1465.68,Blue Cross and Blue Shield,Traditional,,567.22,38.7,percent of total billed charges,1465.68,57.16,747.5,percent of total billed charges,38.7
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,percent of total billed charges,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,percent of total billed charges,715.99,27.92,365.15,percent of total billed charges,38.7
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,percent of total billed charges,715.99,27.92,365.15,percent of total billed charges,38.7
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,1540.90,1540.90,Blue Cross and Blue Shield,Traditional,,596.33,38.7,percent of total billed charges,1540.90,60.10,785.86,percent of total billed charges,38.7
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,percent of total billed charges,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,percent of total billed charges,770.45,30.05,392.93,percent of total billed charges,38.7
MR-LOWER EXTR WO,73718,CPT,,,,,both,,,2470.50,2470.50,Blue Cross and Blue Shield,Traditional,,956.08,38.7,percent of total billed charges,2470.50,96.35,1259.96,percent of total billed charges,38.7
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,2470.50,2470.50,Blue Cross and Blue Shield,Traditional,,956.08,38.7,percent of total billed charges,2470.50,96.35,1259.96,percent of total billed charges,38.7
MR-LOWER EXTR W,73719,CPT,,,,,both,,,832.76,832.76,Blue Cross and Blue Shield,Traditional,,322.28,38.7,percent of total billed charges,832.76,32.48,424.71,percent of total billed charges,38.7
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,832.76,832.76,Blue Cross and Blue Shield,Traditional,,322.28,38.7,percent of total billed charges,832.76,32.48,424.71,percent of total billed charges,38.7
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,percent of total billed charges,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,percent of total billed charges,1114.55,43.47,568.42,percent of total billed charges,38.7
MR-LOWER EXTR BI WWO,73720,CPT,,,,,both,, ,2394.15,2394.15,Blue Cross and Blue Shield,Traditional,,926.54,38.7,percent of total billed charges,2394.15,93.37,1221.02,percent of total billed charges,38.7
MR-LOWER EXTR BI WWO,73720,CPT,,,,,both,, ,2576.60,2576.60,Blue Cross and Blue Shield,Traditional,,997.14,38.7,percent of total billed charges,2576.60,100.49,1314.07,percent of total billed charges,38.7
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,percent of total billed charges,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,percent of total billed charges,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-LOWER EXTR WWO,73720,CPT,,,,,both,,,3084.06,3084.06,Blue Cross and Blue Shield,Traditional,,1193.53,38.7,percent of total billed charges,3084.06,120.28,1572.87,percent of total billed charges,38.7
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,3084.06,3084.06,Blue Cross and Blue Shield,Traditional,,1193.53,38.7,percent of total billed charges,3084.06,120.28,1572.87,percent of total billed charges,38.7
MRI scan of leg joint,73721,CPT,,,,,both,,,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,percent of total billed charges,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-LW JOINT WO,73721,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,percent of total billed charges,715.99,27.92,365.15,percent of total billed charges,38.7
MR-LW JOINT WO,73721,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,percent of total billed charges,770.45,30.05,392.93,percent of total billed charges,38.7
MR-LW JOINT WO,73721,CPT,,,,,both,, ,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,percent of total billed charges,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,1431.72,1431.72,Blue Cross and Blue Shield,Traditional,,554.08,38.7,percent of total billed charges,1431.72,55.84,730.18,percent of total billed charges,38.7
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,1540.90,1540.90,Blue Cross and Blue Shield,Traditional,,596.33,38.7,percent of total billed charges,1540.90,60.10,785.86,percent of total billed charges,38.7
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,9881.44,9881.44,Blue Cross and Blue Shield,Traditional,,3824.12,38.7,percent of total billed charges,9881.44,385.38,5039.53,percent of total billed charges,38.7
MR-LW JOINT W,73722,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,percent of total billed charges,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-LW JOINT W,73722,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,percent of total billed charges,1114.55,43.47,568.42,percent of total billed charges,38.7
MR-LW JOINT W,73722,CPT,,,,,both,,,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,percent of total billed charges,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-LW JOINT W,73722,CPT,,,,,both,, ,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,percent of total billed charges,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-LW JOINT W BI,73722,CPT,,,,,both,, ,7641.10,7641.10,Blue Cross and Blue Shield,Traditional,,2957.11,38.7,percent of total billed charges,7641.10,298.00,3896.96,percent of total billed charges,38.7
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,percent of total billed charges,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,percent of total billed charges,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-LW JOINT WWO,73723,CPT,,,,,both,,,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,percent of total billed charges,5197.81,202.71,2650.88,percent of total billed charges,38.7
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,percent of total billed charges,5197.81,202.71,2650.88,percent of total billed charges,38.7
MR-LW JOINT WWO BI,73723,CPT,,,,,both,, ,10395.64,10395.64,Blue Cross and Blue Shield,Traditional,,4023.11,38.7,percent of total billed charges,10395.64,405.43,5301.78,percent of total billed charges,38.7
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,,,694.38,694.38,Blue Cross and Blue Shield,Traditional,,268.73,38.7,percent of total billed charges,694.38,27.08,354.13,percent of total billed charges,38.7
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,694.38,694.38,Blue Cross and Blue Shield,Traditional,,268.73,38.7,percent of total billed charges,694.38,27.08,354.13,percent of total billed charges,38.7
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,,,1144.03,1144.03,Blue Cross and Blue Shield,Traditional,,442.74,38.7,percent of total billed charges,1144.03,44.62,583.46,percent of total billed charges,38.7
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,1144.03,1144.03,Blue Cross and Blue Shield,Traditional,,442.74,38.7,percent of total billed charges,1144.03,44.62,583.46,percent of total billed charges,38.7
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,,,868.40,868.40,Blue Cross and Blue Shield,Traditional,,336.07,38.7,percent of total billed charges,868.40,33.87,442.88,percent of total billed charges,38.7
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,868.40,868.40,Blue Cross and Blue Shield,Traditional,,336.07,38.7,percent of total billed charges,868.40,33.87,442.88,percent of total billed charges,38.7
CH-ABD SER PA CXR CR,74022,CPT,,,,,both,,,970.85,970.85,Blue Cross and Blue Shield,Traditional,,375.72,38.7,percent of total billed charges,970.85,37.86,495.13,percent of total billed charges,38.7
CH-ABD SER PA CXR CR,74022,CPT,,,,,both,, ,970.85,970.85,Blue Cross and Blue Shield,Traditional,,375.72,38.7,percent of total billed charges,970.85,37.86,495.13,percent of total billed charges,38.7
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,percent of total billed charges,307.05,11.97,156.6,percent of total billed charges,38.7
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,percent of total billed charges,330.63,12.89,168.62,percent of total billed charges,38.7
CT-ABDOMEN WO,74150,CPT,,,,,both,,,3285.58,3285.58,Blue Cross and Blue Shield,Traditional,,1271.52,38.7,percent of total billed charges,3285.58,128.14,1675.65,percent of total billed charges,38.7
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,3285.58,3285.58,Blue Cross and Blue Shield,Traditional,,1271.52,38.7,percent of total billed charges,3285.58,128.14,1675.65,percent of total billed charges,38.7
CT-ABDOMEN W,74160,CPT,,,,,both,, ,604.85,604.85,Blue Cross and Blue Shield,Traditional,,234.08,38.7,percent of total billed charges,604.85,23.59,308.47,percent of total billed charges,38.7
CT-ABDOMEN W,74160,CPT,,,,,both,, ,650.88,650.88,Blue Cross and Blue Shield,Traditional,,251.89,38.7,percent of total billed charges,650.88,25.38,331.95,percent of total billed charges,38.7
CT-ABDOMEN W,74160,CPT,,,,,both,,,3726.80,3726.80,Blue Cross and Blue Shield,Traditional,,1442.27,38.7,percent of total billed charges,3726.80,145.35,1900.67,percent of total billed charges,38.7
CT-ABDOMEN W,74160,CPT,,,,,both,, ,3726.80,3726.80,Blue Cross and Blue Shield,Traditional,,1442.27,38.7,percent of total billed charges,3726.80,145.35,1900.67,percent of total billed charges,38.7
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,percent of total billed charges,680.91,26.56,347.26,percent of total billed charges,38.7
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,percent of total billed charges,732.83,28.58,373.74,percent of total billed charges,38.7
CT-ABDOMEN WWO,74170,CPT,,,,,both,,,4317.62,4317.62,Blue Cross and Blue Shield,Traditional,,1670.92,38.7,percent of total billed charges,4317.62,168.39,2201.99,percent of total billed charges,38.7
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,4317.62,4317.62,Blue Cross and Blue Shield,Traditional,,1670.92,38.7,percent of total billed charges,4317.62,168.39,2201.99,percent of total billed charges,38.7
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,893.10,893.10,Blue Cross and Blue Shield,Traditional,,345.63,38.7,percent of total billed charges,893.10,34.83,455.48,percent of total billed charges,38.7
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,893.10,893.10,Blue Cross and Blue Shield,Traditional,,345.63,38.7,percent of total billed charges,893.10,34.83,455.48,percent of total billed charges,38.7
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,,,1894.27,1894.27,Blue Cross and Blue Shield,Traditional,,733.08,38.7,percent of total billed charges,1894.27,73.88,966.08,percent of total billed charges,38.7
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,1894.27,1894.27,Blue Cross and Blue Shield,Traditional,,733.08,38.7,percent of total billed charges,1894.27,73.88,966.08,percent of total billed charges,38.7
CTA-ABDOMEN,74175,CPT,,,,,both,, ,893.10,893.10,Blue Cross and Blue Shield,Traditional,,345.63,38.7,percent of total billed charges,893.10,34.83,455.48,percent of total billed charges,38.7
CTA-ABDOMEN,74175,CPT,,,,,both,,,1894.27,1894.27,Blue Cross and Blue Shield,Traditional,,733.08,38.7,percent of total billed charges,1894.27,73.88,966.08,percent of total billed charges,38.7
CTA-ABDOMEN,74175,CPT,,,,,both,, ,1894.27,1894.27,Blue Cross and Blue Shield,Traditional,,733.08,38.7,percent of total billed charges,1894.27,73.88,966.08,percent of total billed charges,38.7
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,587.17,587.17,Blue Cross and Blue Shield,Traditional,,227.23,38.7,percent of total billed charges,587.17,22.90,299.46,percent of total billed charges,38.7
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,632.08,632.08,Blue Cross and Blue Shield,Traditional,,244.61,38.7,percent of total billed charges,632.08,24.65,322.36,percent of total billed charges,38.7
CT-ABD PELVIS WO,74176,CPT,,,,,both,,,6571.44,6571.44,Blue Cross and Blue Shield,Traditional,,2543.15,38.7,percent of total billed charges,6571.44,256.29,3351.43,percent of total billed charges,38.7
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,6571.44,6571.44,Blue Cross and Blue Shield,Traditional,,2543.15,38.7,percent of total billed charges,6571.44,256.29,3351.43,percent of total billed charges,38.7
CT scan of abdomen and pelvis with contrast,74177,CPT,,,,,both,,,7453.61,7453.61,Blue Cross and Blue Shield,Traditional,,2884.55,38.7,percent of total billed charges,7453.61,290.69,3801.34,percent of total billed charges,38.7
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,947.56,947.56,Blue Cross and Blue Shield,Traditional,,366.71,38.7,percent of total billed charges,947.56,36.95,483.26,percent of total billed charges,38.7
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,1019.69,1019.69,Blue Cross and Blue Shield,Traditional,,394.62,38.7,percent of total billed charges,1019.69,39.77,520.04,percent of total billed charges,38.7
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,7453.61,7453.61,Blue Cross and Blue Shield,Traditional,,2884.55,38.7,percent of total billed charges,7453.61,290.69,3801.34,percent of total billed charges,38.7
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,947.56,947.56,Blue Cross and Blue Shield,Traditional,,366.71,38.7,percent of total billed charges,947.56,36.95,483.26,percent of total billed charges,38.7
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,1019.69,1019.69,Blue Cross and Blue Shield,Traditional,,394.62,38.7,percent of total billed charges,1019.69,39.77,520.04,percent of total billed charges,38.7
CT-ABD PELVIS WWO,74178,CPT,,,,,both,,,8364.95,8364.95,Blue Cross and Blue Shield,Traditional,,3237.24,38.7,percent of total billed charges,8364.95,326.23,4266.12,percent of total billed charges,38.7
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,8364.95,8364.95,Blue Cross and Blue Shield,Traditional,,3237.24,38.7,percent of total billed charges,8364.95,326.23,4266.12,percent of total billed charges,38.7
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,percent of total billed charges,715.99,27.92,365.15,percent of total billed charges,38.7
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,percent of total billed charges,770.45,30.05,392.93,percent of total billed charges,38.7
MR-ABDOMEN WO,74181,CPT,,,,,both,,,4042.84,4042.84,Blue Cross and Blue Shield,Traditional,,1564.58,38.7,percent of total billed charges,4042.84,157.67,2061.85,percent of total billed charges,38.7
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,4042.84,4042.84,Blue Cross and Blue Shield,Traditional,,1564.58,38.7,percent of total billed charges,4042.84,157.67,2061.85,percent of total billed charges,38.7
MR-ABDOMEN W,74182,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,percent of total billed charges,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-ABDOMEN W,74182,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,percent of total billed charges,1114.55,43.47,568.42,percent of total billed charges,38.7
MR-ABDOMEN W,74182,CPT,,,,,both,,,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,percent of total billed charges,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-ABDOMEN W,74182,CPT,,,,,both,, ,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,percent of total billed charges,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,percent of total billed charges,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,percent of total billed charges,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-ABDOMEN WWO,74183,CPT,,,,,both,,,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,percent of total billed charges,5197.81,202.71,2650.88,percent of total billed charges,38.7
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,percent of total billed charges,5197.81,202.71,2650.88,percent of total billed charges,38.7
FL-ESOPHAGUS,74220,CPT,,,,,both,, ,1227.11,1227.11,Blue Cross and Blue Shield,Traditional,,474.89,38.7,percent of total billed charges,1227.11,47.86,625.83,percent of total billed charges,38.7
FL-MOD BA SWALLOW,74230,CPT,,,,,both,, ,391.26,391.26,Blue Cross and Blue Shield,Traditional,,151.42,38.7,percent of total billed charges,391.26,15.26,199.54,percent of total billed charges,38.7
FL-GI SERIES,74240,CPT,,,,,both,, ,1557.58,1557.58,Blue Cross and Blue Shield,Traditional,,602.78,38.7,percent of total billed charges,1557.58,60.75,794.37,percent of total billed charges,38.7
FL-UPPER GI SINGLE,74240,CPT,,,,,both,, ,1818.77,1818.77,Blue Cross and Blue Shield,Traditional,,703.86,38.7,percent of total billed charges,1818.77,70.93,927.57,percent of total billed charges,38.7
FL-GI SERIES AIR,74246,CPT,,,,,both,, ,1500.93,1500.93,Blue Cross and Blue Shield,Traditional,,580.86,38.7,percent of total billed charges,1500.93,58.54,765.47,percent of total billed charges,38.7
FL-UPPER GI DOUBLE,74246,CPT,,,,,both,, ,1752.53,1752.53,Blue Cross and Blue Shield,Traditional,,678.23,38.7,percent of total billed charges,1752.53,68.35,893.79,percent of total billed charges,38.7
FL-LOWER GI FOLLOW,74248,CPT,,,,,both,, ,3343.68,3343.68,Blue Cross and Blue Shield,Traditional,,1294.00,38.7,percent of total billed charges,3343.68,130.40,1705.28,percent of total billed charges,38.7
FL-SMALL BOWEL CR,74250,CPT,,,,,both,, ,2123.58,2123.58,Blue Cross and Blue Shield,Traditional,,821.83,38.7,percent of total billed charges,2123.58,82.82,1083.03,percent of total billed charges,38.7
FL-SM BWL ENT TBE CR,74251,CPT,,,,,both,, ,2123.58,2123.58,Blue Cross and Blue Shield,Traditional,,821.83,38.7,percent of total billed charges,2123.58,82.82,1083.03,percent of total billed charges,38.7
FL-BARIUM ENEMA,74270,CPT,,,,,both,, ,1890.90,1890.90,Blue Cross and Blue Shield,Traditional,,731.78,38.7,percent of total billed charges,1890.90,73.75,964.36,percent of total billed charges,38.7
FL-BARIUM ENEMA AIR,74280,CPT,,,,,both,, ,2333.25,2333.25,Blue Cross and Blue Shield,Traditional,,902.97,38.7,percent of total billed charges,2333.25,91.00,1189.96,percent of total billed charges,38.7
SU-CHOLE W GRAMS DR,74300,CPT,,,,,both,, ,1968.65,1968.65,Blue Cross and Blue Shield,Traditional,,761.87,38.7,percent of total billed charges,1968.65,76.78,1004.01,percent of total billed charges,38.7
FL-ENDO BILIARY,74328,CPT,,,,,both,, ,3722.58,3722.58,Blue Cross and Blue Shield,Traditional,,1440.64,38.7,percent of total billed charges,3722.58,145.18,1898.52,percent of total billed charges,38.7
FL-ENDO PANCREATIC,74329,CPT,,,,,both,, ,1034.01,1034.01,Blue Cross and Blue Shield,Traditional,,400.16,38.7,percent of total billed charges,1034.01,40.33,527.35,percent of total billed charges,38.7
FL-ENDO BIL PANC,74330,CPT,,,,,both,, ,1304.29,1304.29,Blue Cross and Blue Shield,Traditional,,504.76,38.7,percent of total billed charges,1304.29,50.87,665.19,percent of total billed charges,38.7
FL-LONG GI TUBE PLC,74340,CPT,,,,,both,, ,1359.02,1359.02,Blue Cross and Blue Shield,Traditional,,525.94,38.7,percent of total billed charges,1359.02,53.00,693.1,percent of total billed charges,38.7
FL-ENTEROCLYSIS PLAC,74355,CPT,,,,,both,, ,932.40,932.40,Blue Cross and Blue Shield,Traditional,,360.84,38.7,percent of total billed charges,932.40,36.36,475.52,percent of total billed charges,38.7
FL-IVP CR,74400,CPT,,,,,both,, ,1836.17,1836.17,Blue Cross and Blue Shield,Traditional,,710.60,38.7,percent of total billed charges,1836.17,71.61,936.45,percent of total billed charges,38.7
FL-UROGRAPH RETRO CR,74420,CPT,,,,,both,, ,2105.34,2105.34,Blue Cross and Blue Shield,Traditional,,814.77,38.7,percent of total billed charges,2105.34,82.11,1073.72,percent of total billed charges,38.7
FL-UROGRAPHY ANTE CR,74425,CPT,,,,,both,, ,2165.12,2165.12,Blue Cross and Blue Shield,Traditional,,837.90,38.7,percent of total billed charges,2165.12,84.44,1104.21,percent of total billed charges,38.7
FL-CYSTOGRM 3VPLS CR,74430,CPT,,,,,both,, ,1407.87,1407.87,Blue Cross and Blue Shield,Traditional,,544.85,38.7,percent of total billed charges,1407.87,54.91,718.01,percent of total billed charges,38.7
FL-CAVERNOSOGRAPH CR,74445,CPT,,,,,both,, ,698.32,698.32,Blue Cross and Blue Shield,Traditional,,270.25,38.7,percent of total billed charges,698.32,27.23,356.14,percent of total billed charges,38.7
FL-UCG RETRO CR,74450,CPT,,,,,both,, ,1357.62,1357.62,Blue Cross and Blue Shield,Traditional,,525.40,38.7,percent of total billed charges,1357.62,52.95,692.39,percent of total billed charges,38.7
FL-UCG VOIDING,74455,CPT,,,,,both,, ,1357.62,1357.62,Blue Cross and Blue Shield,Traditional,,525.40,38.7,percent of total billed charges,1357.62,52.95,692.39,percent of total billed charges,38.7
FL-UCG VOIDING CR,74455,CPT,,,,,both,, ,1162.77,1162.77,Blue Cross and Blue Shield,Traditional,,449.99,38.7,percent of total billed charges,1162.77,45.35,593.01,percent of total billed charges,38.7
IR-DILATION GU,74485,CPT,,,,,both,, ,976.75,976.75,Blue Cross and Blue Shield,Traditional,,378.00,38.7,percent of total billed charges,976.75,38.09,498.14,percent of total billed charges,38.7
IR-HYSTERSALPINGO CR,74740,CPT,,,,,both,,,1704.21,1704.21,Blue Cross and Blue Shield,Traditional,,659.53,38.7,percent of total billed charges,1704.21,66.46,869.15,percent of total billed charges,38.7
IR-HYSTERSALPINGO CR,74740,CPT,,,,,both,, ,1704.21,1704.21,Blue Cross and Blue Shield,Traditional,,659.53,38.7,percent of total billed charges,1704.21,66.46,869.15,percent of total billed charges,38.7
IR-HYSTERSALPINGOGRM,74740,CPT,,,,,both,,,1989.98,1989.98,Blue Cross and Blue Shield,Traditional,,770.12,38.7,percent of total billed charges,1989.98,77.61,1014.89,percent of total billed charges,38.7
IR-HYSTERSALPINGOGRM,74740,CPT,,,,,both,, ,1989.98,1989.98,Blue Cross and Blue Shield,Traditional,,770.12,38.7,percent of total billed charges,1989.98,77.61,1014.89,percent of total billed charges,38.7
IR-PERINEOGRAM CR,74775,CPT,,,,,both,, ,1991.67,1991.67,Blue Cross and Blue Shield,Traditional,,770.78,38.7,percent of total billed charges,1991.67,77.68,1015.75,percent of total billed charges,38.7
CT-HT ACC LV RV W,75573,CPT,,,,,both,, ,580.15,580.15,Blue Cross and Blue Shield,Traditional,,224.52,38.7,percent of total billed charges,580.15,22.63,295.88,percent of total billed charges,38.7
CT-HT ACC LV RV W,75573,CPT,,,,,both,, ,1696.40,1696.40,Blue Cross and Blue Shield,Traditional,,656.51,38.7,percent of total billed charges,1696.40,66.16,865.16,percent of total billed charges,38.7
CT-HT CARD FUNC W,75574,CPT,,,,,both,, ,580.15,580.15,Blue Cross and Blue Shield,Traditional,,224.52,38.7,percent of total billed charges,580.15,22.63,295.88,percent of total billed charges,38.7
CT-HT CARD FUNC W,75574,CPT,,,,,both,, ,1696.40,1696.40,Blue Cross and Blue Shield,Traditional,,656.51,38.7,percent of total billed charges,1696.40,66.16,865.16,percent of total billed charges,38.7
CATH-ABD AORTA SERIAL,75625,CPT,,,,,both,, ,8483.00,8483.00,Blue Cross and Blue Shield,Traditional,,3282.92,38.7,percent of total billed charges,8483.00,330.84,4326.33,percent of total billed charges,38.7
IR-ABD AORTA SERIAL,75625,CPT,,,,,both,, ,9523.86,9523.86,Blue Cross and Blue Shield,Traditional,,3685.73,38.7,percent of total billed charges,9523.86,371.43,4857.17,percent of total billed charges,38.7
CATH-AABF SERIAL     ,75630,CPT,,,,,both,, ,11199.75,11199.75,Blue Cross and Blue Shield,Traditional,,4334.30,38.7,percent of total billed charges,11199.75,436.79,5711.87,percent of total billed charges,38.7
IR-AABF SERIAL,75630,CPT,,,,,both,, ,12573.95,12573.95,Blue Cross and Blue Shield,Traditional,,4866.12,38.7,percent of total billed charges,12573.95,490.38,6412.71,percent of total billed charges,38.7
CTA-ABD ART W RUNOFF,75635,CPT,,,,,both,, ,650.88,650.88,Blue Cross and Blue Shield,Traditional,,251.89,38.7,percent of total billed charges,650.88,25.38,331.95,percent of total billed charges,38.7
CTA-ABD ART W RUNOFF,75635,CPT,,,,,both,, ,2355.42,2355.42,Blue Cross and Blue Shield,Traditional,,911.55,38.7,percent of total billed charges,2355.42,91.86,1201.26,percent of total billed charges,38.7
CATH-ANGIO EXTREM UNI,75710,CPT,,,,,both,, ,7520.75,7520.75,Blue Cross and Blue Shield,Traditional,,2910.53,38.7,percent of total billed charges,7520.75,293.31,3835.58,percent of total billed charges,38.7
IR-ANGIO EXTREM UNI,75710,CPT,,,,,both,, ,8443.54,8443.54,Blue Cross and Blue Shield,Traditional,,3267.65,38.7,percent of total billed charges,8443.54,329.30,4306.21,percent of total billed charges,38.7
CATH-ANGIO EXTREM BI ,75716,CPT,,,,,both,, ,7520.75,7520.75,Blue Cross and Blue Shield,Traditional,,2910.53,38.7,percent of total billed charges,7520.75,293.31,3835.58,percent of total billed charges,38.7
IR-ANGIO EXTREM BI,75716,CPT,,,,,both,, ,8423.33,8423.33,Blue Cross and Blue Shield,Traditional,,3259.83,38.7,percent of total billed charges,8423.33,328.51,4295.9,percent of total billed charges,38.7
IR-ANGIO VISCERAL SE,75726,CPT,,,,,both,, ,13364.62,13364.62,Blue Cross and Blue Shield,Traditional,,5172.11,38.7,percent of total billed charges,13364.62,521.22,6815.96,percent of total billed charges,38.7
IR-ANG PULMONARY UNI,75741,CPT,,,,,both,, ,4237.35,4237.35,Blue Cross and Blue Shield,Traditional,,1639.85,38.7,percent of total billed charges,4237.35,165.26,2161.05,percent of total billed charges,38.7
IR-ANG PULMONARY BI,75743,CPT,,,,,both,, ,12357.84,12357.84,Blue Cross and Blue Shield,Traditional,,4782.48,38.7,percent of total billed charges,12357.84,481.96,6302.5,percent of total billed charges,38.7
IR-SHUNTOGRAM,75809,CPT,,,,,both,, ,386.21,386.21,Blue Cross and Blue Shield,Traditional,,149.46,38.7,percent of total billed charges,386.21,15.06,196.97,percent of total billed charges,38.7
CATH-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,7641.75,7641.75,Blue Cross and Blue Shield,Traditional,,2957.36,38.7,percent of total billed charges,7641.75,298.03,3897.29,percent of total billed charges,38.7
IR-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,8579.39,8579.39,Blue Cross and Blue Shield,Traditional,,3320.22,38.7,percent of total billed charges,8579.39,334.60,4375.49,percent of total billed charges,38.7
IR-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,8579.39,8579.39,Blue Cross and Blue Shield,Traditional,,3320.22,38.7,percent of total billed charges,8579.39,334.60,4375.49,percent of total billed charges,38.7
CATH-VENOGRAM EXT BI ,75822,CPT,,,,,both,, ,3510.00,3510.00,Blue Cross and Blue Shield,Traditional,,1358.37,38.7,percent of total billed charges,3510.00,136.89,1790.1,percent of total billed charges,38.7
IR-VENOGRAM EXT BI,75822,CPT,,,,,both,, ,3940.68,3940.68,Blue Cross and Blue Shield,Traditional,,1525.04,38.7,percent of total billed charges,3940.68,153.69,2009.75,percent of total billed charges,38.7
IR-VENACAVAGRAM INF,75825,CPT,,,,,both,, ,8923.22,8923.22,Blue Cross and Blue Shield,Traditional,,3453.29,38.7,percent of total billed charges,8923.22,348.01,4550.84,percent of total billed charges,38.7
IR-VENOUS SAMPL CATH,75893,CPT,,,,,both,, ,3915.41,3915.41,Blue Cross and Blue Shield,Traditional,,1515.26,38.7,percent of total billed charges,3915.41,152.70,1996.86,percent of total billed charges,38.7
IR-ANGIO EXIST CATH,75898,CPT,,,,,both,, ,513.35,513.35,Blue Cross and Blue Shield,Traditional,,198.67,38.7,percent of total billed charges,513.35,20.02,261.81,percent of total billed charges,38.7
IR-DRAIN TUBE CHANGE,75984,CPT,,,,,both,, ,2098.33,2098.33,Blue Cross and Blue Shield,Traditional,,812.05,38.7,percent of total billed charges,2098.33,81.83,1070.15,percent of total billed charges,38.7
CT-ABSC DRN CATH PLA,75989,CPT,,,,,both,, ,2649.01,2649.01,Blue Cross and Blue Shield,Traditional,,1025.17,38.7,percent of total billed charges,2649.01,103.31,1351,percent of total billed charges,38.7
US-ABSC DRN CATH PLA,75989,CPT,,,,,both,, ,1120.45,1120.45,Blue Cross and Blue Shield,Traditional,,433.61,38.7,percent of total billed charges,1120.45,43.70,571.43,percent of total billed charges,38.7
FL-FLUORO 1 HOUR,76000,CPT,,,,,both,, ,553.77,553.77,Blue Cross and Blue Shield,Traditional,,214.31,38.7,percent of total billed charges,553.77,21.60,282.42,percent of total billed charges,38.7
FL-FLUORO 1 HOUR CR,76000,CPT,,,,,both,, ,474.31,474.31,Blue Cross and Blue Shield,Traditional,,183.56,38.7,percent of total billed charges,474.31,18.50,241.9,percent of total billed charges,38.7
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,756.41,756.41,Blue Cross and Blue Shield,Traditional,,292.73,38.7,percent of total billed charges,756.41,29.50,385.77,percent of total billed charges,38.7
IR-FISTULOGRAM CR,76080,CPT,,,,,both,, ,758.66,758.66,Blue Cross and Blue Shield,Traditional,,293.60,38.7,percent of total billed charges,758.66,29.59,386.92,percent of total billed charges,38.7
EXAM SURG SPECMN CR,76098,CPT,,,,,both,, ,1190.34,1190.34,Blue Cross and Blue Shield,Traditional,,460.66,38.7,percent of total billed charges,1190.34,46.42,607.07,percent of total billed charges,38.7
TOMOGRAM ONE PLNE CR,76100,CPT,,,,,both,, ,2030.12,2030.12,Blue Cross and Blue Shield,Traditional,,785.66,38.7,percent of total billed charges,2030.12,79.17,1035.36,percent of total billed charges,38.7
CT-3D W POSTPROCESS,76377,CPT,,,,,both,, ,528.50,528.50,Blue Cross and Blue Shield,Traditional,,204.53,38.7,percent of total billed charges,528.50,20.61,269.54,percent of total billed charges,38.7
CT-3D W POSTPROCESS,76377,CPT,,,,,both,, ,536.93,536.93,Blue Cross and Blue Shield,Traditional,,207.79,38.7,percent of total billed charges,536.93,20.94,273.83,percent of total billed charges,38.7
MR-3D W POSTPROCESS,76377,CPT,,,,,both,, ,491.18,491.18,Blue Cross and Blue Shield,Traditional,,190.09,38.7,percent of total billed charges,491.18,19.16,250.5,percent of total billed charges,38.7
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,193.10,193.10,Blue Cross and Blue Shield,Traditional,,74.73,38.7,percent of total billed charges,193.10,7.53,98.48,percent of total billed charges,38.7
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,207.98,207.98,Blue Cross and Blue Shield,Traditional,,80.49,38.7,percent of total billed charges,207.98,8.11,106.07,percent of total billed charges,38.7
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,724.14,724.14,Blue Cross and Blue Shield,Traditional,,280.24,38.7,percent of total billed charges,724.14,28.24,369.31,percent of total billed charges,38.7
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,,,2030.68,2030.68,Blue Cross and Blue Shield,Traditional,,785.87,38.7,percent of total billed charges,2030.68,79.20,1035.65,percent of total billed charges,38.7
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,2030.68,2030.68,Blue Cross and Blue Shield,Traditional,,785.87,38.7,percent of total billed charges,2030.68,79.20,1035.65,percent of total billed charges,38.7
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,1602.93,1602.93,Blue Cross and Blue Shield,Traditional,,620.33,38.7,percent of total billed charges,1602.93,62.51,817.49,percent of total billed charges,38.7
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,218.64,218.64,Blue Cross and Blue Shield,Traditional,,84.61,38.7,percent of total billed charges,218.64,8.53,111.51,percent of total billed charges,38.7
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,218.64,218.64,Blue Cross and Blue Shield,Traditional,,84.61,38.7,percent of total billed charges,218.64,8.53,111.51,percent of total billed charges,38.7
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,1680.12,1680.12,Blue Cross and Blue Shield,Traditional,,650.21,38.7,percent of total billed charges,1680.12,65.52,856.86,percent of total billed charges,38.7
US-BREAST LIMITED,76642,CPT,,,,,both,, ,218.64,218.64,Blue Cross and Blue Shield,Traditional,,84.61,38.7,percent of total billed charges,218.64,8.53,111.51,percent of total billed charges,38.7
US-BREAST LIMITED,76642,CPT,,,,,both,, ,218.64,218.64,Blue Cross and Blue Shield,Traditional,,84.61,38.7,percent of total billed charges,218.64,8.53,111.51,percent of total billed charges,38.7
US-BREAST LIMITED,76642,CPT,,,,,both,,,1680.12,1680.12,Blue Cross and Blue Shield,Traditional,,650.21,38.7,percent of total billed charges,1680.12,65.52,856.86,percent of total billed charges,38.7
US-BREAST LIMITED,76642,CPT,,,,,both,, ,1680.12,1680.12,Blue Cross and Blue Shield,Traditional,,650.21,38.7,percent of total billed charges,1680.12,65.52,856.86,percent of total billed charges,38.7
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,437.29,437.29,Blue Cross and Blue Shield,Traditional,,169.23,38.7,percent of total billed charges,437.29,17.05,223.02,percent of total billed charges,38.7
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,437.29,437.29,Blue Cross and Blue Shield,Traditional,,169.23,38.7,percent of total billed charges,437.29,17.05,223.02,percent of total billed charges,38.7
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,3359.95,3359.95,Blue Cross and Blue Shield,Traditional,,1300.30,38.7,percent of total billed charges,3359.95,131.04,1713.57,percent of total billed charges,38.7
Ultrasound of abdomen,76700,CPT,,,,,both,,,2330.73,2330.73,Blue Cross and Blue Shield,Traditional,,901.99,38.7,percent of total billed charges,2330.73,90.90,1188.67,percent of total billed charges,38.7
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,2330.73,2330.73,Blue Cross and Blue Shield,Traditional,,901.99,38.7,percent of total billed charges,2330.73,90.90,1188.67,percent of total billed charges,38.7
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-ABDOMEN LTD WO,76705,CPT,,,,,both,,,1908.87,1908.87,Blue Cross and Blue Shield,Traditional,,738.73,38.7,percent of total billed charges,1908.87,74.45,973.52,percent of total billed charges,38.7
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,1908.87,1908.87,Blue Cross and Blue Shield,Traditional,,738.73,38.7,percent of total billed charges,1908.87,74.45,973.52,percent of total billed charges,38.7
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-ABDOMEN RETROPER,76770,CPT,,,,,both,,,2030.68,2030.68,Blue Cross and Blue Shield,Traditional,,785.87,38.7,percent of total billed charges,2030.68,79.20,1035.65,percent of total billed charges,38.7
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,2030.68,2030.68,Blue Cross and Blue Shield,Traditional,,785.87,38.7,percent of total billed charges,2030.68,79.20,1035.65,percent of total billed charges,38.7
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,,,1965.00,1965.00,Blue Cross and Blue Shield,Traditional,,760.46,38.7,percent of total billed charges,1965.00,76.64,1002.15,percent of total billed charges,38.7
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,1965.00,1965.00,Blue Cross and Blue Shield,Traditional,,760.46,38.7,percent of total billed charges,1965.00,76.64,1002.15,percent of total billed charges,38.7
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-PELV PREG 14 WKS,76801,CPT,,,,,both,,,813.67,813.67,Blue Cross and Blue Shield,Traditional,,314.89,38.7,percent of total billed charges,813.67,31.73,414.97,percent of total billed charges,38.7
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,813.67,813.67,Blue Cross and Blue Shield,Traditional,,314.89,38.7,percent of total billed charges,813.67,31.73,414.97,percent of total billed charges,38.7
US-PLV PRG 14 WKS AD,76802,CPT,,,,,both,, ,329.51,329.51,Blue Cross and Blue Shield,Traditional,,127.52,38.7,percent of total billed charges,329.51,12.85,168.05,percent of total billed charges,38.7
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,76805,CPT,,,,,both,,,1931.60,1931.60,Blue Cross and Blue Shield,Traditional,,747.53,38.7,percent of total billed charges,1931.60,75.33,985.12,percent of total billed charges,38.7
US-PELVIS PREG,76805,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
US-PELVIS PREG,76805,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-PELVIS PREG,76805,CPT,,,,,both,, ,1931.60,1931.60,Blue Cross and Blue Shield,Traditional,,747.53,38.7,percent of total billed charges,1931.60,75.33,985.12,percent of total billed charges,38.7
US-PELVS PREG GESADD,76810,CPT,,,,,both,, ,329.51,329.51,Blue Cross and Blue Shield,Traditional,,127.52,38.7,percent of total billed charges,329.51,12.85,168.05,percent of total billed charges,38.7
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,577.00,577.00,Blue Cross and Blue Shield,Traditional,,223.30,38.7,percent of total billed charges,577.00,22.50,294.27,percent of total billed charges,38.7
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,647.80,647.80,Blue Cross and Blue Shield,Traditional,,250.70,38.7,percent of total billed charges,647.80,25.26,330.38,percent of total billed charges,38.7
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,218.64,218.64,Blue Cross and Blue Shield,Traditional,,84.61,38.7,percent of total billed charges,218.64,8.53,111.51,percent of total billed charges,38.7
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,235.48,235.48,Blue Cross and Blue Shield,Traditional,,91.13,38.7,percent of total billed charges,235.48,9.18,120.09,percent of total billed charges,38.7
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,647.80,647.80,Blue Cross and Blue Shield,Traditional,,250.70,38.7,percent of total billed charges,647.80,25.26,330.38,percent of total billed charges,38.7
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-PLV PRG TRNSV,76817,CPT,,,,,both,,,655.09,655.09,Blue Cross and Blue Shield,Traditional,,253.52,38.7,percent of total billed charges,655.09,25.55,334.1,percent of total billed charges,38.7
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,655.09,655.09,Blue Cross and Blue Shield,Traditional,,253.52,38.7,percent of total billed charges,655.09,25.55,334.1,percent of total billed charges,38.7
US-FETAL BIO W NST,76818,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-FETAL BIO W NST,76818,CPT,,,,,both,, ,1198.20,1198.20,Blue Cross and Blue Shield,Traditional,,463.70,38.7,percent of total billed charges,1198.20,46.73,611.08,percent of total billed charges,38.7
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,793.18,793.18,Blue Cross and Blue Shield,Traditional,,306.96,38.7,percent of total billed charges,793.18,30.93,404.52,percent of total billed charges,38.7
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,218.64,218.64,Blue Cross and Blue Shield,Traditional,,84.61,38.7,percent of total billed charges,218.64,8.53,111.51,percent of total billed charges,38.7
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,235.48,235.48,Blue Cross and Blue Shield,Traditional,,91.13,38.7,percent of total billed charges,235.48,9.18,120.09,percent of total billed charges,38.7
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,780.55,780.55,Blue Cross and Blue Shield,Traditional,,302.07,38.7,percent of total billed charges,780.55,30.44,398.08,percent of total billed charges,38.7
Ultrasound pelvis through vagina,76830,CPT,,,,,both,,,689.62,689.62,Blue Cross and Blue Shield,Traditional,,266.88,38.7,percent of total billed charges,689.62,26.90,351.71,percent of total billed charges,38.7
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,689.62,689.62,Blue Cross and Blue Shield,Traditional,,266.88,38.7,percent of total billed charges,689.62,26.90,351.71,percent of total billed charges,38.7
US-PELVIS NON OB,76856,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
US-PELVIS NON OB,76856,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-PELVIS NON OB,76856,CPT,,,,,both,,,1931.60,1931.60,Blue Cross and Blue Shield,Traditional,,747.53,38.7,percent of total billed charges,1931.60,75.33,985.12,percent of total billed charges,38.7
US-PELVIS NON OB,76856,CPT,,,,,both,, ,1931.60,1931.60,Blue Cross and Blue Shield,Traditional,,747.53,38.7,percent of total billed charges,1931.60,75.33,985.12,percent of total billed charges,38.7
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,209.94,209.94,Blue Cross and Blue Shield,Traditional,,81.25,38.7,percent of total billed charges,209.94,8.19,107.07,percent of total billed charges,38.7
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,209.94,209.94,Blue Cross and Blue Shield,Traditional,,81.25,38.7,percent of total billed charges,209.94,8.19,107.07,percent of total billed charges,38.7
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,437.29,437.29,Blue Cross and Blue Shield,Traditional,,169.23,38.7,percent of total billed charges,437.29,17.05,223.02,percent of total billed charges,38.7
US-SCROTUM,76870,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
US-SCROTUM,76870,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-SCROTUM,76870,CPT,,,,,both,,,2005.70,2005.70,Blue Cross and Blue Shield,Traditional,,776.21,38.7,percent of total billed charges,2005.70,78.22,1022.91,percent of total billed charges,38.7
US-SCROTUM,76870,CPT,,,,,both,, ,2005.70,2005.70,Blue Cross and Blue Shield,Traditional,,776.21,38.7,percent of total billed charges,2005.70,78.22,1022.91,percent of total billed charges,38.7
US-TRANSRECTAL,76872,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
US-TRANSRECTAL,76872,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-TRANSRECTAL,76872,CPT,,,,,both,, ,1300.09,1300.09,Blue Cross and Blue Shield,Traditional,,503.13,38.7,percent of total billed charges,1300.09,50.70,663.05,percent of total billed charges,38.7
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,378.35,378.35,Blue Cross and Blue Shield,Traditional,,146.42,38.7,percent of total billed charges,378.35,14.76,192.96,percent of total billed charges,38.7
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,189.17,189.17,Blue Cross and Blue Shield,Traditional,,73.21,38.7,percent of total billed charges,189.17,7.38,96.48,percent of total billed charges,38.7
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,218.64,218.64,Blue Cross and Blue Shield,Traditional,,84.61,38.7,percent of total billed charges,218.64,8.53,111.51,percent of total billed charges,38.7
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,235.48,235.48,Blue Cross and Blue Shield,Traditional,,91.13,38.7,percent of total billed charges,235.48,9.18,120.09,percent of total billed charges,38.7
NI-VAS ACCSS SITES,76937,CPT,,,,,both,, ,797.67,797.67,Blue Cross and Blue Shield,Traditional,,308.70,38.7,percent of total billed charges,797.67,31.11,406.81,percent of total billed charges,38.7
NI-VAS ACCSS SITES ,76937,CPT,,,,,both,, ,710.50,710.50,Blue Cross and Blue Shield,Traditional,,274.96,38.7,percent of total billed charges,710.50,27.71,362.36,percent of total billed charges,38.7
US-GUIDE NEEDLE PLAC,76942,CPT,,,,,both,, ,2221.26,2221.26,Blue Cross and Blue Shield,Traditional,,859.63,38.7,percent of total billed charges,2221.26,86.63,1132.84,percent of total billed charges,38.7
US-GUIDE AMNIOCENT,76946,CPT,,,,,both,, ,2221.26,2221.26,Blue Cross and Blue Shield,Traditional,,859.63,38.7,percent of total billed charges,2221.26,86.63,1132.84,percent of total billed charges,38.7
US-GUIDE INTRAOPERAT,76998,CPT,,,,,both,, ,604.57,604.57,Blue Cross and Blue Shield,Traditional,,233.97,38.7,percent of total billed charges,604.57,23.58,308.33,percent of total billed charges,38.7
FL-FLUORO CVAD ANY,77001,CPT,,,,,both,, ,1968.65,1968.65,Blue Cross and Blue Shield,Traditional,,761.87,38.7,percent of total billed charges,1968.65,76.78,1004.01,percent of total billed charges,38.7
FL-NEDL GUIDE FLUORO,77002,CPT,,,,,both,, ,521.21,521.21,Blue Cross and Blue Shield,Traditional,,201.71,38.7,percent of total billed charges,521.21,20.33,265.82,percent of total billed charges,38.7
FL-FLUORO GUIDE SPIN,77003,CPT,,,,,both,, ,553.77,553.77,Blue Cross and Blue Shield,Traditional,,214.31,38.7,percent of total billed charges,553.77,21.60,282.42,percent of total billed charges,38.7
CT-GUIDE NEEDLE BX,77012,CPT,,,,,both,, ,2649.01,2649.01,Blue Cross and Blue Shield,Traditional,,1025.17,38.7,percent of total billed charges,2649.01,103.31,1351,percent of total billed charges,38.7
CT-GUIDE TISSUE ABLA,77013,CPT,,,,,both,, ,3157.31,3157.31,Blue Cross and Blue Shield,Traditional,,1221.88,38.7,percent of total billed charges,3157.31,123.14,1610.23,percent of total billed charges,38.7
MR-BREAST UNI WO,77046,CPT,,,,,both,, ,674.73,674.73,Blue Cross and Blue Shield,Traditional,,261.12,38.7,percent of total billed charges,674.73,26.31,344.11,percent of total billed charges,38.7
MR-BREAST BIL WO,77047,CPT,,,,,both,, ,674.73,674.73,Blue Cross and Blue Shield,Traditional,,261.12,38.7,percent of total billed charges,674.73,26.31,344.11,percent of total billed charges,38.7
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,772.13,772.13,Blue Cross and Blue Shield,Traditional,,298.81,38.7,percent of total billed charges,772.13,30.11,393.79,percent of total billed charges,38.7
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,830.80,830.80,Blue Cross and Blue Shield,Traditional,,321.52,38.7,percent of total billed charges,830.80,32.40,423.71,percent of total billed charges,38.7
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,1469.05,1469.05,Blue Cross and Blue Shield,Traditional,,568.52,38.7,percent of total billed charges,1469.05,57.29,749.22,percent of total billed charges,38.7
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,772.13,772.13,Blue Cross and Blue Shield,Traditional,,298.81,38.7,percent of total billed charges,772.13,30.11,393.79,percent of total billed charges,38.7
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,830.80,830.80,Blue Cross and Blue Shield,Traditional,,321.52,38.7,percent of total billed charges,830.80,32.40,423.71,percent of total billed charges,38.7
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,1889.78,1889.78,Blue Cross and Blue Shield,Traditional,,731.34,38.7,percent of total billed charges,1889.78,73.70,963.79,percent of total billed charges,38.7
BR-TOMO MAMM SCR BI,77063,CPT,,,,,both,,,107.12,107.12,Blue Cross and Blue Shield,Traditional,,41.46,38.7,percent of total billed charges,107.12,4.18,54.63,percent of total billed charges,38.7
BR-TOMO MAMM SCR BI,77063,CPT,,,,,both,, ,107.12,107.12,Blue Cross and Blue Shield,Traditional,,41.46,38.7,percent of total billed charges,107.12,4.18,54.63,percent of total billed charges,38.7
BR-TOMO MAMM SCR UNI,77063,CPT,,,,,both,, ,80.34,80.34,Blue Cross and Blue Shield,Traditional,,31.09,38.7,percent of total billed charges,80.34,3.13,40.97,percent of total billed charges,38.7
BR-TOMOSYN SCR AD BI,77063,CPT,,,,,both,, ,100.00,100.00,Blue Cross and Blue Shield,Traditional,,38.70,38.7,percent of total billed charges,100.00,3.90,51,percent of total billed charges,38.7
BR-DIG MAMMO UNI GG,77065,CPT,,,,,both,, ,411.49,411.49,Blue Cross and Blue Shield,Traditional,,159.25,38.7,percent of total billed charges,411.49,16.05,209.86,percent of total billed charges,38.7
BR-DIG MAMMO UNI GG,77065,CPT,,,,,both,, ,411.49,411.49,Blue Cross and Blue Shield,Traditional,,159.25,38.7,percent of total billed charges,411.49,16.05,209.86,percent of total billed charges,38.7
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,439.55,439.55,Blue Cross and Blue Shield,Traditional,,170.11,38.7,percent of total billed charges,439.55,17.14,224.17,percent of total billed charges,38.7
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,448.82,448.82,Blue Cross and Blue Shield,Traditional,,173.69,38.7,percent of total billed charges,448.82,17.50,228.9,percent of total billed charges,38.7
Mammography of one breast,77065,CPT,,,,,both,,,448.82,448.82,Blue Cross and Blue Shield,Traditional,,173.69,38.7,percent of total billed charges,448.82,17.50,228.9,percent of total billed charges,38.7
BR-DIG MAMMO BI GG,77066,CPT,,,,,both,, ,411.49,411.49,Blue Cross and Blue Shield,Traditional,,159.25,38.7,percent of total billed charges,411.49,16.05,209.86,percent of total billed charges,38.7
BR-DIG MAMMO BI GG,77066,CPT,,,,,both,, ,411.49,411.49,Blue Cross and Blue Shield,Traditional,,159.25,38.7,percent of total billed charges,411.49,16.05,209.86,percent of total billed charges,38.7
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,439.55,439.55,Blue Cross and Blue Shield,Traditional,,170.11,38.7,percent of total billed charges,439.55,17.14,224.17,percent of total billed charges,38.7
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,556.97,556.97,Blue Cross and Blue Shield,Traditional,,215.55,38.7,percent of total billed charges,556.97,21.72,284.05,percent of total billed charges,38.7
Mammography of both breasts,77066,CPT,,,,,both,,,556.97,556.97,Blue Cross and Blue Shield,Traditional,,215.55,38.7,percent of total billed charges,556.97,21.72,284.05,percent of total billed charges,38.7
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,368.23,368.23,Blue Cross and Blue Shield,Traditional,,142.51,38.7,percent of total billed charges,368.23,14.36,187.8,percent of total billed charges,38.7
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,488.99,488.99,Blue Cross and Blue Shield,Traditional,,189.24,38.7,percent of total billed charges,488.99,19.07,249.38,percent of total billed charges,38.7
BR-DIG MAMMO SCRN UN,77067,CPT,,,,,both,, ,345.31,345.31,Blue Cross and Blue Shield,Traditional,,133.63,38.7,percent of total billed charges,345.31,13.47,176.11,percent of total billed charges,38.7
BR-DIG MAMMO SCRN UN,77067,CPT,,,,,both,, ,345.31,345.31,Blue Cross and Blue Shield,Traditional,,133.63,38.7,percent of total billed charges,345.31,13.47,176.11,percent of total billed charges,38.7
BR-DIG MAMMO SCRN UN,77067,CPT,,,,,both,, ,366.68,366.68,Blue Cross and Blue Shield,Traditional,,141.91,38.7,percent of total billed charges,366.68,14.30,187.01,percent of total billed charges,38.7
"Mammography, screening, bilateral",77067,CPT,,,,,both,,,488.99,488.99,Blue Cross and Blue Shield,Traditional,,189.24,38.7,percent of total billed charges,488.99,19.07,249.38,percent of total billed charges,38.7
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
BONE AGE STUDY CR,77072,CPT,,,,,both,,,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,percent of total billed charges,721.61,28.14,368.02,percent of total billed charges,38.7
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,percent of total billed charges,721.61,28.14,368.02,percent of total billed charges,38.7
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
BONE LENGTH STUDY CR,77073,CPT,,,,,both,,,1904.10,1904.10,Blue Cross and Blue Shield,Traditional,,736.89,38.7,percent of total billed charges,1904.10,74.26,971.09,percent of total billed charges,38.7
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,1904.10,1904.10,Blue Cross and Blue Shield,Traditional,,736.89,38.7,percent of total billed charges,1904.10,74.26,971.09,percent of total billed charges,38.7
BNE SRVY LTD METS CR,77074,CPT,,,,,both,,,523.46,523.46,Blue Cross and Blue Shield,Traditional,,202.58,38.7,percent of total billed charges,523.46,20.41,266.96,percent of total billed charges,38.7
BNE SRVY LTD METS CR,77074,CPT,,,,,both,, ,523.46,523.46,Blue Cross and Blue Shield,Traditional,,202.58,38.7,percent of total billed charges,523.46,20.41,266.96,percent of total billed charges,38.7
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,percent of total billed charges,220.61,8.60,112.51,percent of total billed charges,38.7
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
BNE SRVY CMP METS CR,77075,CPT,,,,,both,,,418.20,418.20,Blue Cross and Blue Shield,Traditional,,161.84,38.7,percent of total billed charges,418.20,16.31,213.28,percent of total billed charges,38.7
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,418.20,418.20,Blue Cross and Blue Shield,Traditional,,161.84,38.7,percent of total billed charges,418.20,16.31,213.28,percent of total billed charges,38.7
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,percent of total billed charges,220.61,8.60,112.51,percent of total billed charges,38.7
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,percent of total billed charges,237.45,9.26,121.1,percent of total billed charges,38.7
BONE SRVY INFANT CR,77076,CPT,,,,,both,,,833.32,833.32,Blue Cross and Blue Shield,Traditional,,322.49,38.7,percent of total billed charges,833.32,32.50,424.99,percent of total billed charges,38.7
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,833.32,833.32,Blue Cross and Blue Shield,Traditional,,322.49,38.7,percent of total billed charges,833.32,32.50,424.99,percent of total billed charges,38.7
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
JOINT SURVEY 1V CR,77077,CPT,,,,,both,,,1387.37,1387.37,Blue Cross and Blue Shield,Traditional,,536.91,38.7,percent of total billed charges,1387.37,54.11,707.56,percent of total billed charges,38.7
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,1387.37,1387.37,Blue Cross and Blue Shield,Traditional,,536.91,38.7,percent of total billed charges,1387.37,54.11,707.56,percent of total billed charges,38.7
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,218.93,218.93,Blue Cross and Blue Shield,Traditional,,84.73,38.7,percent of total billed charges,218.93,8.54,111.65,percent of total billed charges,38.7
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,235.77,235.77,Blue Cross and Blue Shield,Traditional,,91.24,38.7,percent of total billed charges,235.77,9.20,120.24,percent of total billed charges,38.7
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,613.55,613.55,Blue Cross and Blue Shield,Traditional,,237.44,38.7,percent of total billed charges,613.55,23.93,312.91,percent of total billed charges,38.7
DEXA AXIAL,77080,CPT,,,,,both,, ,218.93,218.93,Blue Cross and Blue Shield,Traditional,,84.73,38.7,percent of total billed charges,218.93,8.54,111.65,percent of total billed charges,38.7
DEXA AXIAL,77080,CPT,,,,,both,, ,235.77,235.77,Blue Cross and Blue Shield,Traditional,,91.24,38.7,percent of total billed charges,235.77,9.20,120.24,percent of total billed charges,38.7
DEXA AXIAL,77080,CPT,,,,,both,,,430.83,430.83,Blue Cross and Blue Shield,Traditional,,166.73,38.7,percent of total billed charges,430.83,16.80,219.72,percent of total billed charges,38.7
DEXA AXIAL,77080,CPT,,,,,both,, ,430.83,430.83,Blue Cross and Blue Shield,Traditional,,166.73,38.7,percent of total billed charges,430.83,16.80,219.72,percent of total billed charges,38.7
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,percent of total billed charges,139.21,5.43,71,percent of total billed charges,38.7
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58.00,38.7,percent of total billed charges,149.88,5.85,76.44,percent of total billed charges,38.7
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,266.91,266.91,Blue Cross and Blue Shield,Traditional,,103.29,38.7,percent of total billed charges,266.91,10.41,136.12,percent of total billed charges,38.7
NM-THYR UPT S-M-SUPP,78012,CPT,,,,,both,, ,1025.37,1025.37,Blue Cross and Blue Shield,Traditional,,396.82,38.7,percent of total billed charges,1025.37,39.99,522.94,percent of total billed charges,38.7
NM-THYROID IMG W-BF,78013,CPT,,,,,both,, ,1365.27,1365.27,Blue Cross and Blue Shield,Traditional,,528.36,38.7,percent of total billed charges,1365.27,53.25,696.29,percent of total billed charges,38.7
NM-THY UPT IMG W-BF,78014,CPT,,,,,both,, ,1719.59,1719.59,Blue Cross and Blue Shield,Traditional,,665.48,38.7,percent of total billed charges,1719.59,67.06,876.99,percent of total billed charges,38.7
NM-PAR PLAN THY IMG,78070,CPT,,,,,both,, ,1365.27,1365.27,Blue Cross and Blue Shield,Traditional,,528.36,38.7,percent of total billed charges,1365.27,53.25,696.29,percent of total billed charges,38.7
NM-PARA PLN IMG SPEC,78071,CPT,,,,,both,, ,1884.64,1884.64,Blue Cross and Blue Shield,Traditional,,729.36,38.7,percent of total billed charges,1884.64,73.50,961.17,percent of total billed charges,38.7
NM-PAR PL IMG SPE CT,78072,CPT,,,,,both,, ,1884.64,1884.64,Blue Cross and Blue Shield,Traditional,,729.36,38.7,percent of total billed charges,1884.64,73.50,961.17,percent of total billed charges,38.7
NM-ADRENAL IMAGING,78075,CPT,,,,,both,, ,5329.74,5329.74,Blue Cross and Blue Shield,Traditional,,2062.61,38.7,percent of total billed charges,5329.74,207.86,2718.17,percent of total billed charges,38.7
NM-BONE MARROW LMTD,78102,CPT,,,,,both,, ,1409.30,1409.30,Blue Cross and Blue Shield,Traditional,,545.40,38.7,percent of total billed charges,1409.30,54.96,718.74,percent of total billed charges,38.7
NM-BONE MARROW MULT,78103,CPT,,,,,both,, ,1409.30,1409.30,Blue Cross and Blue Shield,Traditional,,545.40,38.7,percent of total billed charges,1409.30,54.96,718.74,percent of total billed charges,38.7
NM-BONE MARROW BODY,78104,CPT,,,,,both,, ,1409.30,1409.30,Blue Cross and Blue Shield,Traditional,,545.40,38.7,percent of total billed charges,1409.30,54.96,718.74,percent of total billed charges,38.7
NM-LYMPHATICS NODES,78195,CPT,,,,,both,, ,4917.74,4917.74,Blue Cross and Blue Shield,Traditional,,1903.17,38.7,percent of total billed charges,4917.74,191.79,2508.05,percent of total billed charges,38.7
NM-LIVER,78201,CPT,,,,,both,, ,3830.06,3830.06,Blue Cross and Blue Shield,Traditional,,1482.23,38.7,percent of total billed charges,3830.06,149.37,1953.33,percent of total billed charges,38.7
NM-LIVER AND SPLEEN,78215,CPT,,,,,both,, ,3830.06,3830.06,Blue Cross and Blue Shield,Traditional,,1482.23,38.7,percent of total billed charges,3830.06,149.37,1953.33,percent of total billed charges,38.7
NM-HEPATOBILIARY SYS,78226,CPT,,,,,both,, ,4088.59,4088.59,Blue Cross and Blue Shield,Traditional,,1582.28,38.7,percent of total billed charges,4088.59,159.46,2085.18,percent of total billed charges,38.7
NM-HEPATOBIL W PHARM,78227,CPT,,,,,both,,,4088.59,4088.59,Blue Cross and Blue Shield,Traditional,,1582.28,38.7,percent of total billed charges,4088.59,159.46,2085.18,percent of total billed charges,38.7
NM-HEPATOBIL W PHARM,78227,CPT,,,,,both,, ,4088.59,4088.59,Blue Cross and Blue Shield,Traditional,,1582.28,38.7,percent of total billed charges,4088.59,159.46,2085.18,percent of total billed charges,38.7
NM-GI REFLUX,78262,CPT,,,,,both,, ,3415.74,3415.74,Blue Cross and Blue Shield,Traditional,,1321.89,38.7,percent of total billed charges,3415.74,133.21,1742.03,percent of total billed charges,38.7
NM-GASTRIC EMPTYING,78264,CPT,,,,,both,,,3415.74,3415.74,Blue Cross and Blue Shield,Traditional,,1321.89,38.7,percent of total billed charges,3415.74,133.21,1742.03,percent of total billed charges,38.7
NM-GASTRIC EMPTYING,78264,CPT,,,,,both,, ,3415.74,3415.74,Blue Cross and Blue Shield,Traditional,,1321.89,38.7,percent of total billed charges,3415.74,133.21,1742.03,percent of total billed charges,38.7
NM-GAST EMPT SM BWL,78265,CPT,,,,,both,, ,1543.71,1543.71,Blue Cross and Blue Shield,Traditional,,597.42,38.7,percent of total billed charges,1543.71,60.20,787.29,percent of total billed charges,38.7
NM-GE SM BWL CLN MUL,78266,CPT,,,,,both,, ,2046.87,2046.87,Blue Cross and Blue Shield,Traditional,,792.14,38.7,percent of total billed charges,2046.87,79.83,1043.9,percent of total billed charges,38.7
NM-GI BLOOD LOSS,78278,CPT,,,,,both,, ,3415.74,3415.74,Blue Cross and Blue Shield,Traditional,,1321.89,38.7,percent of total billed charges,3415.74,133.21,1742.03,percent of total billed charges,38.7
NM-MECKELS SCAN,78290,CPT,,,,,both,, ,3576.68,3576.68,Blue Cross and Blue Shield,Traditional,,1384.18,38.7,percent of total billed charges,3576.68,139.49,1824.11,percent of total billed charges,38.7
NM-BONE SCAN LMTD,78300,CPT,,,,,both,, ,2526.59,2526.59,Blue Cross and Blue Shield,Traditional,,977.79,38.7,percent of total billed charges,2526.59,98.54,1288.56,percent of total billed charges,38.7
NM-BONE SCAN MULTI,78305,CPT,,,,,both,, ,2526.59,2526.59,Blue Cross and Blue Shield,Traditional,,977.79,38.7,percent of total billed charges,2526.59,98.54,1288.56,percent of total billed charges,38.7
NM-BONE SCAN BODY,78306,CPT,,,,,both,,,3512.04,3512.04,Blue Cross and Blue Shield,Traditional,,1359.16,38.7,percent of total billed charges,3512.04,136.97,1791.14,percent of total billed charges,38.7
NM-BONE SCAN BODY,78306,CPT,,,,,both,, ,3512.04,3512.04,Blue Cross and Blue Shield,Traditional,,1359.16,38.7,percent of total billed charges,3512.04,136.97,1791.14,percent of total billed charges,38.7
NM-BONE SCAN 3 PHASE,78315,CPT,,,,,both,,,2911.81,2911.81,Blue Cross and Blue Shield,Traditional,,1126.87,38.7,percent of total billed charges,2911.81,113.56,1485.02,percent of total billed charges,38.7
NM-BONE SCAN 3 PHASE,78315,CPT,,,,,both,, ,2911.81,2911.81,Blue Cross and Blue Shield,Traditional,,1126.87,38.7,percent of total billed charges,2911.81,113.56,1485.02,percent of total billed charges,38.7
NM-VASCULAR FLOW,78445,CPT,,,,,both,, ,1719.84,1719.84,Blue Cross and Blue Shield,Traditional,,665.58,38.7,percent of total billed charges,1719.84,67.07,877.12,percent of total billed charges,38.7
NM-MYOCRD SPECT SNGL,78451,CPT,,,,,both,, ,3741.73,3741.73,Blue Cross and Blue Shield,Traditional,,1448.05,38.7,percent of total billed charges,3741.73,145.93,1908.28,percent of total billed charges,38.7
NM-MYOCRD SPECT MULT,78452,CPT,,,,,both,,,7071.47,7071.47,Blue Cross and Blue Shield,Traditional,,2736.66,38.7,percent of total billed charges,7071.47,275.79,3606.45,percent of total billed charges,38.7
NM-MYOCRD SPECT MULT,78452,CPT,,,,,both,, ,7071.47,7071.47,Blue Cross and Blue Shield,Traditional,,2736.66,38.7,percent of total billed charges,7071.47,275.79,3606.45,percent of total billed charges,38.7
NM-MYOCARD SINGLE,78453,CPT,,,,,both,, ,4803.15,4803.15,Blue Cross and Blue Shield,Traditional,,1858.82,38.7,percent of total billed charges,4803.15,187.32,2449.61,percent of total billed charges,38.7
NM-MYOCARD INFARCT,78466,CPT,,,,,both,, ,3415.74,3415.74,Blue Cross and Blue Shield,Traditional,,1321.89,38.7,percent of total billed charges,3415.74,133.21,1742.03,percent of total billed charges,38.7
NM-MYOCARD INF SPECT,78469,CPT,,,,,both,, ,3184.50,3184.50,Blue Cross and Blue Shield,Traditional,,1232.40,38.7,percent of total billed charges,3184.50,124.20,1624.1,percent of total billed charges,38.7
NM-GATED BLD POOL SN,78472,CPT,,,,,both,, ,3415.74,3415.74,Blue Cross and Blue Shield,Traditional,,1321.89,38.7,percent of total billed charges,3415.74,133.21,1742.03,percent of total billed charges,38.7
NM-LUNG VENT IMAGING,78579,CPT,,,,,both,,,4088.59,4088.59,Blue Cross and Blue Shield,Traditional,,1582.28,38.7,percent of total billed charges,4088.59,159.46,2085.18,percent of total billed charges,38.7
NM-LUNG VENT IMAGING,78579,CPT,,,,,both,, ,4088.59,4088.59,Blue Cross and Blue Shield,Traditional,,1582.28,38.7,percent of total billed charges,4088.59,159.46,2085.18,percent of total billed charges,38.7
NM-LUNG PERF PARTICU,78580,CPT,,,,,both,, ,3590.32,3590.32,Blue Cross and Blue Shield,Traditional,,1389.45,38.7,percent of total billed charges,3590.32,140.02,1831.06,percent of total billed charges,38.7
NM-LUNG VENT PERFUS,78582,CPT,,,,,both,,,6243.60,6243.60,Blue Cross and Blue Shield,Traditional,,2416.27,38.7,percent of total billed charges,6243.60,243.50,3184.24,percent of total billed charges,38.7
NM-LUNG VENT PERFUS,78582,CPT,,,,,both,, ,6243.60,6243.60,Blue Cross and Blue Shield,Traditional,,2416.27,38.7,percent of total billed charges,6243.60,243.50,3184.24,percent of total billed charges,38.7
NM-LUNG PERFVENT DIF,78598,CPT,,,,,both,, ,8897.66,8897.66,Blue Cross and Blue Shield,Traditional,,3443.39,38.7,percent of total billed charges,8897.66,347.01,4537.81,percent of total billed charges,38.7
NM-BRAIN CSF CISTERN,78630,CPT,,,,,both,, ,1616.07,1616.07,Blue Cross and Blue Shield,Traditional,,625.42,38.7,percent of total billed charges,1616.07,63.03,824.2,percent of total billed charges,38.7
NM-KIDNEY STATIC,78700,CPT,,,,,both,, ,3590.32,3590.32,Blue Cross and Blue Shield,Traditional,,1389.45,38.7,percent of total billed charges,3590.32,140.02,1831.06,percent of total billed charges,38.7
NM-KIDNEY STATIC FLO,78701,CPT,,,,,both,, ,4802.63,4802.63,Blue Cross and Blue Shield,Traditional,,1858.62,38.7,percent of total billed charges,4802.63,187.30,2449.34,percent of total billed charges,38.7
NM-KIDNEY VF NO PHRM,78707,CPT,,,,,both,, ,4802.63,4802.63,Blue Cross and Blue Shield,Traditional,,1858.62,38.7,percent of total billed charges,4802.63,187.30,2449.34,percent of total billed charges,38.7
NM-KID VF PHRM SNGL,78708,CPT,,,,,both,, ,4802.63,4802.63,Blue Cross and Blue Shield,Traditional,,1858.62,38.7,percent of total billed charges,4802.63,187.30,2449.34,percent of total billed charges,38.7
NM-KIDNEY FUNCTION,78725,CPT,,,,,both,, ,617.74,617.74,Blue Cross and Blue Shield,Traditional,,239.07,38.7,percent of total billed charges,617.74,24.09,315.05,percent of total billed charges,38.7
NM-URIN BLDDR REFLUX,78740,CPT,,,,,both,, ,3590.32,3590.32,Blue Cross and Blue Shield,Traditional,,1389.45,38.7,percent of total billed charges,3590.32,140.02,1831.06,percent of total billed charges,38.7
NM-TUMOR LOC LMTD,78800,CPT,,,,,both,, ,4590.83,4590.83,Blue Cross and Blue Shield,Traditional,,1776.65,38.7,percent of total billed charges,4590.83,179.04,2341.32,percent of total billed charges,38.7
NM-TUMOR LOC LMTD 1D,78800,CPT,,,,,both,, ,4917.74,4917.74,Blue Cross and Blue Shield,Traditional,,1903.17,38.7,percent of total billed charges,4917.74,191.79,2508.05,percent of total billed charges,38.7
NM-TUMOR LOC MULTI,78801,CPT,,,,,both,, ,4917.74,4917.74,Blue Cross and Blue Shield,Traditional,,1903.17,38.7,percent of total billed charges,4917.74,191.79,2508.05,percent of total billed charges,38.7
NM-TUMOR LOC BDY 1D,78802,CPT,,,,,both,, ,6129.79,6129.79,Blue Cross and Blue Shield,Traditional,,2372.23,38.7,percent of total billed charges,6129.79,239.06,3126.19,percent of total billed charges,38.7
NM-TUMOR LOC BODY,78802,CPT,,,,,both,, ,4590.83,4590.83,Blue Cross and Blue Shield,Traditional,,1776.65,38.7,percent of total billed charges,4590.83,179.04,2341.32,percent of total billed charges,38.7
NM-TUMR LOC SPECT 1D,78803,CPT,,,,,both,, ,5042.88,5042.88,Blue Cross and Blue Shield,Traditional,,1951.59,38.7,percent of total billed charges,5042.88,196.67,2571.87,percent of total billed charges,38.7
NM-TUMR LOC BDY >1D,78804,CPT,,,,,both,, ,5251.46,5251.46,Blue Cross and Blue Shield,Traditional,,2032.32,38.7,percent of total billed charges,5251.46,204.81,2678.24,percent of total billed charges,38.7
NM-UNLISTED MISC,78999,CPT,,,,,both,, ,593.54,593.54,Blue Cross and Blue Shield,Traditional,,229.70,38.7,percent of total billed charges,593.54,23.15,302.71,percent of total billed charges,38.7
NUCLEAR RX IV ADMIN,79101,CPT,,,,,both,, ,1716.50,1716.50,Blue Cross and Blue Shield,Traditional,,664.29,38.7,percent of total billed charges,1716.50,66.94,875.42,percent of total billed charges,38.7
BASIC META W-ION CA,80047,CPT,,,,,both,, ,29.19,29.19,Blue Cross and Blue Shield,Traditional,,11.30,38.7,percent of total billed charges,29.19,1.14,14.89,percent of total billed charges,38.7
BASIC META W-ION CA,80047,CPT,,,,,both,, ,163.63,163.63,Blue Cross and Blue Shield,Traditional,,63.32,38.7,percent of total billed charges,163.63,6.38,83.45,percent of total billed charges,38.7
BASIC METABO CA TOTA,80048,CPT,,,,,both,, ,89.53,89.53,Blue Cross and Blue Shield,Traditional,,34.65,38.7,percent of total billed charges,89.53,3.49,45.66,percent of total billed charges,38.7
BASIC METABO CA TOTA,80048,CPT,,,,,both,, ,510.83,510.83,Blue Cross and Blue Shield,Traditional,,197.69,38.7,percent of total billed charges,510.83,19.92,260.52,percent of total billed charges,38.7
Basic metabolic panel,80048,CPT,,,,,both,,,510.83,510.83,Blue Cross and Blue Shield,Traditional,,197.69,38.7,percent of total billed charges,510.83,19.92,260.52,percent of total billed charges,38.7
GENERAL HEALTH PANEL,80050,CPT,,,,,both,,,1796.88,1796.88,Blue Cross and Blue Shield,Traditional,,695.39,38.7,percent of total billed charges,1796.88,70.08,916.41,percent of total billed charges,38.7
GENERAL HEALTH PANEL,80050,CPT,,,,,both,, ,1796.88,1796.88,Blue Cross and Blue Shield,Traditional,,695.39,38.7,percent of total billed charges,1796.88,70.08,916.41,percent of total billed charges,38.7
ELECTROLYTE PANEL,80051,CPT,,,,,both,, ,74.10,74.10,Blue Cross and Blue Shield,Traditional,,28.68,38.7,percent of total billed charges,74.10,2.89,37.79,percent of total billed charges,38.7
ELECTROLYTE PANEL,80051,CPT,,,,,both,, ,390.41,390.41,Blue Cross and Blue Shield,Traditional,,151.09,38.7,percent of total billed charges,390.41,15.23,199.11,percent of total billed charges,38.7
"Blood test, comprehensive group of blood chemicals",80053,CPT,,,,,both,,,630.96,630.96,Blue Cross and Blue Shield,Traditional,,244.18,38.7,percent of total billed charges,630.96,24.61,321.79,percent of total billed charges,38.7
COMP METAB PANEL,80053,CPT,,,,,both,, ,111.70,111.70,Blue Cross and Blue Shield,Traditional,,43.23,38.7,percent of total billed charges,111.70,4.36,56.97,percent of total billed charges,38.7
COMP METAB PANEL,80053,CPT,,,,,both,, ,630.96,630.96,Blue Cross and Blue Shield,Traditional,,244.18,38.7,percent of total billed charges,630.96,24.61,321.79,percent of total billed charges,38.7
Obstetric blood test panel,80055,CPT,,,,,both,,,1727.55,1727.55,Blue Cross and Blue Shield,Traditional,,668.56,38.7,percent of total billed charges,1727.55,67.37,881.05,percent of total billed charges,38.7
OBSTETRIC PANEL,80055,CPT,,,,,both,, ,350.84,350.84,Blue Cross and Blue Shield,Traditional,,135.78,38.7,percent of total billed charges,350.84,13.68,178.93,percent of total billed charges,38.7
OBSTETRIC PANEL,80055,CPT,,,,,both,, ,1727.55,1727.55,Blue Cross and Blue Shield,Traditional,,668.56,38.7,percent of total billed charges,1727.55,67.37,881.05,percent of total billed charges,38.7
"Blood test, lipids (cholesterol and triglycerides)",80061,CPT,,,,,both,,,565.84,565.84,Blue Cross and Blue Shield,Traditional,,218.98,38.7,percent of total billed charges,565.84,22.07,288.58,percent of total billed charges,38.7
LIPID PANEL,80061,CPT,,,,,both,, ,86.73,86.73,Blue Cross and Blue Shield,Traditional,,33.56,38.7,percent of total billed charges,86.73,3.38,44.23,percent of total billed charges,38.7
LIPID PANEL,80061,CPT,,,,,both,, ,565.84,565.84,Blue Cross and Blue Shield,Traditional,,218.98,38.7,percent of total billed charges,565.84,22.07,288.58,percent of total billed charges,38.7
LIPID PANEL,80061,CPT,,,,,both,, ,565.84,565.84,Blue Cross and Blue Shield,Traditional,,218.98,38.7,percent of total billed charges,565.84,22.07,288.58,percent of total billed charges,38.7
Kidney function panel test,80069,CPT,,,,,both,,,570.89,570.89,Blue Cross and Blue Shield,Traditional,,220.93,38.7,percent of total billed charges,570.89,22.26,291.15,percent of total billed charges,38.7
RENAL FUNCTION PANEL,80069,CPT,,,,,both,, ,91.77,91.77,Blue Cross and Blue Shield,Traditional,,35.51,38.7,percent of total billed charges,91.77,3.58,46.8,percent of total billed charges,38.7
RENAL FUNCTION PANEL,80069,CPT,,,,,both,, ,570.89,570.89,Blue Cross and Blue Shield,Traditional,,220.93,38.7,percent of total billed charges,570.89,22.26,291.15,percent of total billed charges,38.7
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,, ,282.08,282.08,Blue Cross and Blue Shield,Traditional,,109.16,38.7,percent of total billed charges,282.08,11.00,143.86,percent of total billed charges,38.7
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,,,3484.29,3484.29,Blue Cross and Blue Shield,Traditional,,1348.42,38.7,percent of total billed charges,3484.29,135.89,1776.99,percent of total billed charges,38.7
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,, ,3484.29,3484.29,Blue Cross and Blue Shield,Traditional,,1348.42,38.7,percent of total billed charges,3484.29,135.89,1776.99,percent of total billed charges,38.7
HEPATIC FUNCTION PAN,80076,CPT,,,,,both,, ,86.45,86.45,Blue Cross and Blue Shield,Traditional,,33.46,38.7,percent of total billed charges,86.45,3.37,44.09,percent of total billed charges,38.7
HEPATIC FUNCTION PAN,80076,CPT,,,,,both,, ,450.48,450.48,Blue Cross and Blue Shield,Traditional,,174.34,38.7,percent of total billed charges,450.48,17.57,229.74,percent of total billed charges,38.7
Liver function blood test panel,80076,CPT,,,,,both,,,450.48,450.48,Blue Cross and Blue Shield,Traditional,,174.34,38.7,percent of total billed charges,450.48,17.57,229.74,percent of total billed charges,38.7
OBSTETRIC PNL W HIV,80081,CPT,,,,,both,, ,1883.60,1883.60,Blue Cross and Blue Shield,Traditional,,728.95,38.7,percent of total billed charges,1883.60,73.46,960.64,percent of total billed charges,38.7
ACETAMINOPHEN QT,80143,CPT,,,,,both,, ,186.06,186.06,Blue Cross and Blue Shield,Traditional,,72.01,38.7,percent of total billed charges,186.06,7.26,94.89,percent of total billed charges,38.7
Q36298 ADM LEV IBD,80145,CPT,,,,,both,, ,174.02,174.02,Blue Cross and Blue Shield,Traditional,,67.35,38.7,percent of total billed charges,174.02,6.79,88.75,percent of total billed charges,38.7
AMIKACIN,80150,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q36721 AMIOD HPLC/LC,80151,CPT,,,,,both,, ,546.19,546.19,Blue Cross and Blue Shield,Traditional,,211.38,38.7,percent of total billed charges,546.19,21.30,278.56,percent of total billed charges,38.7
CARBAMAZEPINE TOTAL,80156,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,40.41,528.49,percent of total billed charges,38.7
Q18948 CBZ FREE LCMS,80157,CPT,,,,,both,, ,88.40,88.40,Blue Cross and Blue Shield,Traditional,,34.21,38.7,percent of total billed charges,88.40,3.45,45.08,percent of total billed charges,38.7
CYCLOSPORINE,80158,CPT,,,,,both,, ,91.49,91.49,Blue Cross and Blue Shield,Traditional,,35.41,38.7,percent of total billed charges,91.49,3.57,46.66,percent of total billed charges,38.7
CYCLOSPORINE,80158,CPT,,,,,both,, ,1555.50,1555.50,Blue Cross and Blue Shield,Traditional,,601.98,38.7,percent of total billed charges,1555.50,60.66,793.31,percent of total billed charges,38.7
Q15220CYC A BL LCMSM,80158,CPT,,,,,both,, ,1555.50,1555.50,Blue Cross and Blue Shield,Traditional,,601.98,38.7,percent of total billed charges,1555.50,60.66,793.31,percent of total billed charges,38.7
Q8812 CYA TRGH BL IA,80158,CPT,,,,,both,, ,1555.50,1555.50,Blue Cross and Blue Shield,Traditional,,601.98,38.7,percent of total billed charges,1555.50,60.66,793.31,percent of total billed charges,38.7
CLOZAPINE QT,80159,CPT,,,,,both,, ,95.43,95.43,Blue Cross and Blue Shield,Traditional,,36.93,38.7,percent of total billed charges,95.43,3.72,48.67,percent of total billed charges,38.7
CLOZAPINE QT,80159,CPT,,,,,both,, ,95.43,95.43,Blue Cross and Blue Shield,Traditional,,36.93,38.7,percent of total billed charges,95.43,3.72,48.67,percent of total billed charges,38.7
DIGOXIN TOTAL,80162,CPT,,,,,both,, ,130.23,130.23,Blue Cross and Blue Shield,Traditional,,50.40,38.7,percent of total billed charges,130.23,5.08,66.42,percent of total billed charges,38.7
DIGOXIN TOTAL,80162,CPT,,,,,both,, ,787.57,787.57,Blue Cross and Blue Shield,Traditional,,304.79,38.7,percent of total billed charges,787.57,30.72,401.66,percent of total billed charges,38.7
DIGOXIN FREE,80163,CPT,,,,,both,, ,130.23,130.23,Blue Cross and Blue Shield,Traditional,,50.40,38.7,percent of total billed charges,130.23,5.08,66.42,percent of total billed charges,38.7
Q6651 VALP ACID TOT,80164,CPT,,,,,both,, ,691.06,691.06,Blue Cross and Blue Shield,Traditional,,267.44,38.7,percent of total billed charges,691.06,26.95,352.44,percent of total billed charges,38.7
VALPROIC ACID TOTAL,80164,CPT,,,,,both,, ,132.76,132.76,Blue Cross and Blue Shield,Traditional,,51.38,38.7,percent of total billed charges,132.76,5.18,67.71,percent of total billed charges,38.7
VALPROIC ACID TOTAL,80164,CPT,,,,,both,,,711.79,711.79,Blue Cross and Blue Shield,Traditional,,275.46,38.7,percent of total billed charges,711.79,27.76,363.01,percent of total billed charges,38.7
VALPROIC ACID TOTAL,80164,CPT,,,,,both,, ,711.79,711.79,Blue Cross and Blue Shield,Traditional,,275.46,38.7,percent of total billed charges,711.79,27.76,363.01,percent of total billed charges,38.7
Q6651 VALP ACID FREE,80165,CPT,,,,,both,, ,691.06,691.06,Blue Cross and Blue Shield,Traditional,,267.44,38.7,percent of total billed charges,691.06,26.95,352.44,percent of total billed charges,38.7
VALPROIC ACID FREE,80165,CPT,,,,,both,, ,132.76,132.76,Blue Cross and Blue Shield,Traditional,,51.38,38.7,percent of total billed charges,132.76,5.18,67.71,percent of total billed charges,38.7
VALPROIC ACID FREE,80165,CPT,,,,,both,, ,711.79,711.79,Blue Cross and Blue Shield,Traditional,,275.46,38.7,percent of total billed charges,711.79,27.76,363.01,percent of total billed charges,38.7
Q3081 FELBAMATE MS,80167,CPT,,,,,both,, ,191.99,191.99,Blue Cross and Blue Shield,Traditional,,74.30,38.7,percent of total billed charges,191.99,7.49,97.91,percent of total billed charges,38.7
ETHOSUXIMIDE,80168,CPT,,,,,both,, ,864.19,864.19,Blue Cross and Blue Shield,Traditional,,334.44,38.7,percent of total billed charges,864.19,33.70,440.74,percent of total billed charges,38.7
Q18883 EVEROLI LM/MS,80169,CPT,,,,,both,, ,106.93,106.93,Blue Cross and Blue Shield,Traditional,,41.38,38.7,percent of total billed charges,106.93,4.17,54.53,percent of total billed charges,38.7
GENTAMICIN,80170,CPT,,,,,both,, ,900.96,900.96,Blue Cross and Blue Shield,Traditional,,348.67,38.7,percent of total billed charges,900.96,35.14,459.49,percent of total billed charges,38.7
GABAPENTIN QT,80171,CPT,,,,,both,, ,105.53,105.53,Blue Cross and Blue Shield,Traditional,,40.84,38.7,percent of total billed charges,105.53,4.12,53.82,percent of total billed charges,38.7
L716811 GABAP LCMSMS,80171,CPT,,,,,both,, ,102.46,102.46,Blue Cross and Blue Shield,Traditional,,39.65,38.7,percent of total billed charges,102.46,4.00,52.25,percent of total billed charges,38.7
HALOPERIDOL,80173,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,percent of total billed charges,871.22,33.98,444.32,percent of total billed charges,38.7
LAMOTRIGINE QT,80175,CPT,,,,,both,, ,105.53,105.53,Blue Cross and Blue Shield,Traditional,,40.84,38.7,percent of total billed charges,105.53,4.12,53.82,percent of total billed charges,38.7
LAMOTRIGINE QT,80175,CPT,,,,,both,, ,105.53,105.53,Blue Cross and Blue Shield,Traditional,,40.84,38.7,percent of total billed charges,105.53,4.12,53.82,percent of total billed charges,38.7
LIDOCAINE,80176,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,percent of total billed charges,871.22,33.98,444.32,percent of total billed charges,38.7
LIDOCAINE,80176,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,percent of total billed charges,871.22,33.98,444.32,percent of total billed charges,38.7
Q15142 LEVE LC/MS/MS,80177,CPT,,,,,both,, ,105.53,105.53,Blue Cross and Blue Shield,Traditional,,40.84,38.7,percent of total billed charges,105.53,4.12,53.82,percent of total billed charges,38.7
Lithium,80178,CPT,,,,,both,,,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
LITHIUM,80178,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
SALICYLATE QT,80179,CPT,,,,,both,, ,191.99,191.99,Blue Cross and Blue Shield,Traditional,,74.30,38.7,percent of total billed charges,191.99,7.49,97.91,percent of total billed charges,38.7
Q10662 MPA LC/MS/MS,80180,CPT,,,,,both,, ,143.71,143.71,Blue Cross and Blue Shield,Traditional,,55.62,38.7,percent of total billed charges,143.71,5.60,73.29,percent of total billed charges,38.7
OXCARBAEPINE QT,80183,CPT,,,,,both,, ,122.37,122.37,Blue Cross and Blue Shield,Traditional,,47.36,38.7,percent of total billed charges,122.37,4.77,62.41,percent of total billed charges,38.7
OXCARBAEPINE QT,80183,CPT,,,,,both,, ,122.37,122.37,Blue Cross and Blue Shield,Traditional,,47.36,38.7,percent of total billed charges,122.37,4.77,62.41,percent of total billed charges,38.7
PHENOBARBITAL,80184,CPT,,,,,both,, ,120.96,120.96,Blue Cross and Blue Shield,Traditional,,46.81,38.7,percent of total billed charges,120.96,4.72,61.69,percent of total billed charges,38.7
PHENOBARBITAL,80184,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,percent of total billed charges,871.22,33.98,444.32,percent of total billed charges,38.7
PHENOBARBITAL,80184,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,percent of total billed charges,871.22,33.98,444.32,percent of total billed charges,38.7
PHENYTOIN TOTAL,80185,CPT,,,,,both,, ,140.05,140.05,Blue Cross and Blue Shield,Traditional,,54.20,38.7,percent of total billed charges,140.05,5.46,71.43,percent of total billed charges,38.7
PHENYTOIN TOTAL,80185,CPT,,,,,both,, ,847.64,847.64,Blue Cross and Blue Shield,Traditional,,328.04,38.7,percent of total billed charges,847.64,33.06,432.3,percent of total billed charges,38.7
PHENYTOIN TOTAL,80185,CPT,,,,,both,, ,847.64,847.64,Blue Cross and Blue Shield,Traditional,,328.04,38.7,percent of total billed charges,847.64,33.06,432.3,percent of total billed charges,38.7
Q3189 PHENY FR UF-IA,80186,CPT,,,,,both,, ,91.77,91.77,Blue Cross and Blue Shield,Traditional,,35.51,38.7,percent of total billed charges,91.77,3.58,46.8,percent of total billed charges,38.7
Q3189 PHENY FR UF-IA,80186,CPT,,,,,both,, ,91.77,91.77,Blue Cross and Blue Shield,Traditional,,35.51,38.7,percent of total billed charges,91.77,3.58,46.8,percent of total billed charges,38.7
PRIMIDONE,80188,CPT,,,,,both,, ,1757.58,1757.58,Blue Cross and Blue Shield,Traditional,,680.18,38.7,percent of total billed charges,1757.58,68.55,896.37,percent of total billed charges,38.7
Q751 PRIMIDONE,80188,CPT,,,,,both,, ,878.79,878.79,Blue Cross and Blue Shield,Traditional,,340.09,38.7,percent of total billed charges,878.79,34.27,448.18,percent of total billed charges,38.7
PROCAINAMIDE+NAPA,80192,CPT,,,,,both,, ,900.96,900.96,Blue Cross and Blue Shield,Traditional,,348.67,38.7,percent of total billed charges,900.96,35.14,459.49,percent of total billed charges,38.7
QUINIDINE,80194,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,percent of total billed charges,765.96,29.87,390.64,percent of total billed charges,38.7
SIROLIMUS,80195,CPT,,,,,both,, ,257.10,257.10,Blue Cross and Blue Shield,Traditional,,99.50,38.7,percent of total billed charges,257.10,10.03,131.12,percent of total billed charges,38.7
SIROLIMUS,80195,CPT,,,,,both,, ,257.10,257.10,Blue Cross and Blue Shield,Traditional,,99.50,38.7,percent of total billed charges,257.10,10.03,131.12,percent of total billed charges,38.7
TACROLIMUS,80197,CPT,,,,,both,, ,822.37,822.37,Blue Cross and Blue Shield,Traditional,,318.26,38.7,percent of total billed charges,822.37,32.07,419.41,percent of total billed charges,38.7
TACROLIMUS,80197,CPT,,,,,both,, ,822.37,822.37,Blue Cross and Blue Shield,Traditional,,318.26,38.7,percent of total billed charges,822.37,32.07,419.41,percent of total billed charges,38.7
THEOPHYLLINE,80198,CPT,,,,,both,, ,149.60,149.60,Blue Cross and Blue Shield,Traditional,,57.90,38.7,percent of total billed charges,149.60,5.83,76.3,percent of total billed charges,38.7
THEOPHYLLINE,80198,CPT,,,,,both,, ,149.60,149.60,Blue Cross and Blue Shield,Traditional,,57.90,38.7,percent of total billed charges,149.60,5.83,76.3,percent of total billed charges,38.7
THEOPHYLLINE,80198,CPT,,,,,both,, ,781.11,781.11,Blue Cross and Blue Shield,Traditional,,302.29,38.7,percent of total billed charges,781.11,30.46,398.37,percent of total billed charges,38.7
TIAGABINE QT,80199,CPT,,,,,both,, ,143.71,143.71,Blue Cross and Blue Shield,Traditional,,55.62,38.7,percent of total billed charges,143.71,5.60,73.29,percent of total billed charges,38.7
TOBRAMYCIN,80200,CPT,,,,,both,, ,75.50,75.50,Blue Cross and Blue Shield,Traditional,,29.22,38.7,percent of total billed charges,75.50,2.94,38.51,percent of total billed charges,38.7
TOPIRAMATE,80201,CPT,,,,,both,, ,445.71,445.71,Blue Cross and Blue Shield,Traditional,,172.49,38.7,percent of total billed charges,445.71,17.38,227.31,percent of total billed charges,38.7
VANCOMYCIN,80202,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,percent of total billed charges,765.96,29.87,390.64,percent of total billed charges,38.7
ZONISAMIDE QT,80203,CPT,,,,,both,, ,105.53,105.53,Blue Cross and Blue Shield,Traditional,,40.84,38.7,percent of total billed charges,105.53,4.12,53.82,percent of total billed charges,38.7
ZONISAMIDE QT,80203,CPT,,,,,both,, ,105.53,105.53,Blue Cross and Blue Shield,Traditional,,40.84,38.7,percent of total billed charges,105.53,4.12,53.82,percent of total billed charges,38.7
Q648 METHOTREXATE IA,80204,CPT,,,,,both,, ,501.10,501.10,Blue Cross and Blue Shield,Traditional,,193.93,38.7,percent of total billed charges,501.10,19.54,255.56,percent of total billed charges,38.7
L503870 INFLIXIMAB,80230,CPT,,,,,both,, ,159.65,159.65,Blue Cross and Blue Shield,Traditional,,61.78,38.7,percent of total billed charges,159.65,6.23,81.42,percent of total billed charges,38.7
L504567 VEDOLIZUMAB,80280,CPT,,,,,both,, ,198.79,198.79,Blue Cross and Blue Shield,Traditional,,76.93,38.7,percent of total billed charges,198.79,7.75,101.38,percent of total billed charges,38.7
DRUG UNSPEC QUANT,80299,CPT,,,,,both,, ,873.46,873.46,Blue Cross and Blue Shield,Traditional,,338.03,38.7,percent of total billed charges,873.46,34.06,445.46,percent of total billed charges,38.7
L7609 DOXEPIN LCMSMS,80299,CPT,,,,,both,, ,148.40,148.40,Blue Cross and Blue Shield,Traditional,,57.43,38.7,percent of total billed charges,148.40,5.79,75.68,percent of total billed charges,38.7
Q29391DEXAMET LCMSMS,80299,CPT,,,,,both,, ,342.00,342.00,Blue Cross and Blue Shield,Traditional,,132.35,38.7,percent of total billed charges,342.00,13.34,174.42,percent of total billed charges,38.7
Q78222DEXAMET LCMSMS,80299,CPT,,,,,both,, ,546.19,546.19,Blue Cross and Blue Shield,Traditional,,211.38,38.7,percent of total billed charges,546.19,21.30,278.56,percent of total billed charges,38.7
Q78222DEXAMET LCMSMS,80299,CPT,,,,,both,, ,546.19,546.19,Blue Cross and Blue Shield,Traditional,,211.38,38.7,percent of total billed charges,546.19,21.30,278.56,percent of total billed charges,38.7
Q8389 FLUOXET LCMSMS,80299,CPT,,,,,both,, ,811.42,811.42,Blue Cross and Blue Shield,Traditional,,314.02,38.7,percent of total billed charges,811.42,31.65,413.82,percent of total billed charges,38.7
PRS DRG IA VIS,80305,CPT,,,,,both,, ,137.80,137.80,Blue Cross and Blue Shield,Traditional,,53.33,38.7,percent of total billed charges,137.80,5.37,70.28,percent of total billed charges,38.7
PRS DRG IA MET,80306,CPT,,,,,both,, ,137.80,137.80,Blue Cross and Blue Shield,Traditional,,53.33,38.7,percent of total billed charges,137.80,5.37,70.28,percent of total billed charges,38.7
733726 URINE DRUG PROFILE 14/MEDWATCH,80307,CPT,,,,,both,, ,360.00,360.00,Blue Cross and Blue Shield,Traditional,,139.32,38.7,percent of total billed charges,360.00,14.04,183.6,percent of total billed charges,38.7
DRUGPROF ORAL FLD,80307,CPT,,,,,both,, ,116.00,116.00,Blue Cross and Blue Shield,Traditional,,44.89,38.7,percent of total billed charges,116.00,4.52,59.16,percent of total billed charges,38.7
ETHANOL UR QUAL,80307,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
ETHANOL UR QUAL,80307,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
L074401 AMPH UR SCRN,80307,CPT,,,,,both,, ,60.00,60.00,Blue Cross and Blue Shield,Traditional,,23.22,38.7,percent of total billed charges,60.00,2.34,30.6,percent of total billed charges,38.7
L074401 AMPH UR SCRN,80307,CPT,,,,,both,, ,60.00,60.00,Blue Cross and Blue Shield,Traditional,,23.22,38.7,percent of total billed charges,60.00,2.34,30.6,percent of total billed charges,38.7
L733740 ULTRM SCR UR,80307,CPT,,,,,both,, ,200.00,200.00,Blue Cross and Blue Shield,Traditional,,77.40,38.7,percent of total billed charges,200.00,7.80,102,percent of total billed charges,38.7
PRS DRG IA ANAZ,80307,CPT,,,,,both,,,1174.34,1174.34,Blue Cross and Blue Shield,Traditional,,454.47,38.7,percent of total billed charges,1174.34,45.80,598.91,percent of total billed charges,38.7
PRS DRG IA ANAZ,80307,CPT,,,,,both,, ,1174.34,1174.34,Blue Cross and Blue Shield,Traditional,,454.47,38.7,percent of total billed charges,1174.34,45.80,598.91,percent of total billed charges,38.7
PRS DRG IA ANAZ,80307,CPT,,,,,both,, ,1174.34,1174.34,Blue Cross and Blue Shield,Traditional,,454.47,38.7,percent of total billed charges,1174.34,45.80,598.91,percent of total billed charges,38.7
Q643 METHYL ALC BL C,80320,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,percent of total billed charges,728.07,28.39,371.32,percent of total billed charges,38.7
ALKALOIDS NOS MS,80323,CPT,,,,,both,, ,713.47,713.47,Blue Cross and Blue Shield,Traditional,,276.11,38.7,percent of total billed charges,713.47,27.83,363.87,percent of total billed charges,38.7
Q90642NIC&COT S LCMS,80323,CPT,,,,,both,, ,713.47,713.47,Blue Cross and Blue Shield,Traditional,,276.11,38.7,percent of total billed charges,713.47,27.83,363.87,percent of total billed charges,38.7
Q90646NIC&COT U LCMS,80323,CPT,,,,,both,, ,713.47,713.47,Blue Cross and Blue Shield,Traditional,,276.11,38.7,percent of total billed charges,713.47,27.83,363.87,percent of total billed charges,38.7
AMPHETAMINES MS 1-2,80324,CPT,,,,,both,, ,184.68,184.68,Blue Cross and Blue Shield,Traditional,,71.47,38.7,percent of total billed charges,184.68,7.20,94.19,percent of total billed charges,38.7
AMPHETAMINES MS 1-2,80324,CPT,,,,,both,, ,184.68,184.68,Blue Cross and Blue Shield,Traditional,,71.47,38.7,percent of total billed charges,184.68,7.20,94.19,percent of total billed charges,38.7
L790600 AMPH MS 5P,80326,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
ANABOLC STRD MS 1-2,80327,CPT,,,,,both,, ,269.16,269.16,Blue Cross and Blue Shield,Traditional,,104.16,38.7,percent of total billed charges,269.16,10.50,137.27,percent of total billed charges,38.7
L790600 ANLGNO MS 6P,80331,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
ANTIDPRS SERO MS 3-5,80333,CPT,,,,,both,, ,771.01,771.01,Blue Cross and Blue Shield,Traditional,,298.38,38.7,percent of total billed charges,771.01,30.07,393.22,percent of total billed charges,38.7
L790600 AD MS 6PL,80334,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
ANTIDPRS TRIC MS 1-2,80335,CPT,,,,,both,, ,826.59,826.59,Blue Cross and Blue Shield,Traditional,,319.89,38.7,percent of total billed charges,826.59,32.24,421.56,percent of total billed charges,38.7
ANTIDPRS TRIC MS 1-2,80335,CPT,,,,,both,, ,826.59,826.59,Blue Cross and Blue Shield,Traditional,,319.89,38.7,percent of total billed charges,826.59,32.24,421.56,percent of total billed charges,38.7
Q30013 CLOMIPRA LCMS,80335,CPT,,,,,both,, ,826.59,826.59,Blue Cross and Blue Shield,Traditional,,319.89,38.7,percent of total billed charges,826.59,32.24,421.56,percent of total billed charges,38.7
Q30013 CLOMIPRA LCMS,80335,CPT,,,,,both,, ,826.59,826.59,Blue Cross and Blue Shield,Traditional,,319.89,38.7,percent of total billed charges,826.59,32.24,421.56,percent of total billed charges,38.7
Q423AMITRIP HPLC/LCM,80335,CPT,,,,,both,, ,826.59,826.59,Blue Cross and Blue Shield,Traditional,,319.89,38.7,percent of total billed charges,826.59,32.24,421.56,percent of total billed charges,38.7
Q423AMITRIP HPLC/LCM,80335,CPT,,,,,both,, ,826.59,826.59,Blue Cross and Blue Shield,Traditional,,319.89,38.7,percent of total billed charges,826.59,32.24,421.56,percent of total billed charges,38.7
ANTIDPRS TRIC MS 3-5,80336,CPT,,,,,both,, ,571.45,571.45,Blue Cross and Blue Shield,Traditional,,221.15,38.7,percent of total billed charges,571.45,22.29,291.44,percent of total billed charges,38.7
L790600 ADEP TRI 6PL,80337,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
ANTIDPRS NOS MS,80338,CPT,,,,,both,, ,928.18,928.18,Blue Cross and Blue Shield,Traditional,,359.21,38.7,percent of total billed charges,928.18,36.20,473.37,percent of total billed charges,38.7
L790600 AD NOS MS,80338,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 AED MS 7P,80341,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
ANTIPSYCH NOS MS 1-3,80342,CPT,,,,,both,, ,811.42,811.42,Blue Cross and Blue Shield,Traditional,,314.02,38.7,percent of total billed charges,811.42,31.65,413.82,percent of total billed charges,38.7
L790600 APD MS 7P,80344,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
BENZODIAZ MS 1-12,80346,CPT,,,,,both,, ,814.24,814.24,Blue Cross and Blue Shield,Traditional,,315.11,38.7,percent of total billed charges,814.24,31.76,415.26,percent of total billed charges,38.7
BENZODIAZ MS 1-12,80346,CPT,,,,,both,, ,814.24,814.24,Blue Cross and Blue Shield,Traditional,,315.11,38.7,percent of total billed charges,814.24,31.76,415.26,percent of total billed charges,38.7
L809630 FLTZP MS,80346,CPT,,,,,both,, ,600.00,600.00,Blue Cross and Blue Shield,Traditional,,232.20,38.7,percent of total billed charges,600.00,23.40,306,percent of total billed charges,38.7
L790600 BZD MS 13P,80347,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
BUPRENORPHINE MS,80348,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
BUPRENORPHINE MS,80348,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
Q93031 BUPRENOPHINE & METABOLITIES LC/MS,80348,CPT,,,,,both,, ,119.25,119.25,Blue Cross and Blue Shield,Traditional,,46.15,38.7,percent of total billed charges,119.25,4.65,60.82,percent of total billed charges,38.7
CANNABINDS NATUR MS,80349,CPT,,,,,both,, ,147.91,147.91,Blue Cross and Blue Shield,Traditional,,57.24,38.7,percent of total billed charges,147.91,5.77,75.43,percent of total billed charges,38.7
L790697 SYNCBD WB MS,80352,CPT,,,,,both,, ,300.00,300.00,Blue Cross and Blue Shield,Traditional,,116.10,38.7,percent of total billed charges,300.00,11.70,153,percent of total billed charges,38.7
L790600 COCAINE MS,80353,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
FENTANYL MS,80354,CPT,,,,,both,, ,534.41,534.41,Blue Cross and Blue Shield,Traditional,,206.82,38.7,percent of total billed charges,534.41,20.84,272.55,percent of total billed charges,38.7
L790600 FENT MET MS,80354,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
GABAPENTIN NONBLD MS,80355,CPT,,,,,both,, ,534.41,534.41,Blue Cross and Blue Shield,Traditional,,206.82,38.7,percent of total billed charges,534.41,20.84,272.55,percent of total billed charges,38.7
L790600 GPT NBLD MS,80355,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
HEROIN METABOLITE MS,80356,CPT,,,,,both,, ,227.91,227.91,Blue Cross and Blue Shield,Traditional,,88.20,38.7,percent of total billed charges,227.91,8.89,116.23,percent of total billed charges,38.7
L790600 KET NKET MS,80357,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 MTD MS,80358,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
METHADONE MS,80358,CPT,,,,,both,, ,327.54,327.54,Blue Cross and Blue Shield,Traditional,,126.76,38.7,percent of total billed charges,327.54,12.77,167.05,percent of total billed charges,38.7
L791194 MDMA MS,80359,CPT,,,,,both,, ,133.38,133.38,Blue Cross and Blue Shield,Traditional,,51.62,38.7,percent of total billed charges,133.38,5.20,68.02,percent of total billed charges,38.7
MDA MDEA MOMA MS,80359,CPT,,,,,both,, ,404.17,404.17,Blue Cross and Blue Shield,Traditional,,156.41,38.7,percent of total billed charges,404.17,15.76,206.13,percent of total billed charges,38.7
MDA MDEA MOMA MS,80359,CPT,,,,,both,, ,404.17,404.17,Blue Cross and Blue Shield,Traditional,,156.41,38.7,percent of total billed charges,404.17,15.76,206.13,percent of total billed charges,38.7
L790600 MPH MS,80360,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 OPI MS 1P,80361,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
OPIATES MS 1 PL,80361,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
Q20907 OPI MS,80361,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 OPD OPI MS5P,80364,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 OXY MS,80365,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
OXYCODONE MS,80365,CPT,,,,,both,, ,428.58,428.58,Blue Cross and Blue Shield,Traditional,,165.86,38.7,percent of total billed charges,428.58,16.71,218.58,percent of total billed charges,38.7
OXYCODONE MS,80365,CPT,,,,,both,, ,428.58,428.58,Blue Cross and Blue Shield,Traditional,,165.86,38.7,percent of total billed charges,428.58,16.71,218.58,percent of total billed charges,38.7
L790600 PGB MS,80366,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
PREGABALIN MS,80366,CPT,,,,,both,, ,811.42,811.42,Blue Cross and Blue Shield,Traditional,,314.02,38.7,percent of total billed charges,811.42,31.65,413.82,percent of total billed charges,38.7
L790600 PPX MS,80367,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 SED HYP MS,80368,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 SM RLX MS3PL,80370,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 STIM SYN MS,80371,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 TAPENTADL MS,80372,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
L761019TRAMADOL CONF,80373,CPT,,,,,both,, ,412.00,412.00,Blue Cross and Blue Shield,Traditional,,159.44,38.7,percent of total billed charges,412.00,16.07,210.12,percent of total billed charges,38.7
L790600 TRA MS,80373,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
DEF DRUG NOS MS 1-3,80375,CPT,,,,,both,, ,546.19,546.19,Blue Cross and Blue Shield,Traditional,,211.38,38.7,percent of total billed charges,546.19,21.30,278.56,percent of total billed charges,38.7
DEF DRUG NOS MS 7PL,80377,CPT,,,,,both,, ,571.45,571.45,Blue Cross and Blue Shield,Traditional,,221.15,38.7,percent of total billed charges,571.45,22.29,291.44,percent of total billed charges,38.7
L790600 DRGNOS MS 7P,80377,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
Manual urinalysis test with examination using microscope,81001,CPT,,,,,both,,,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,percent of total billed charges,240.26,9.37,122.53,percent of total billed charges,38.7
"UA, AUTO W-SCOPE",81001,CPT,,,,,both,, ,33.39,33.39,Blue Cross and Blue Shield,Traditional,,12.92,38.7,percent of total billed charges,33.39,1.30,17.03,percent of total billed charges,38.7
"UA, AUTO W-SCOPE",81001,CPT,,,,,both,, ,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,percent of total billed charges,240.26,9.37,122.53,percent of total billed charges,38.7
Automated urinalysis test,81003,CPT,,,,,both,,,210.50,210.50,Blue Cross and Blue Shield,Traditional,,81.46,38.7,percent of total billed charges,210.50,8.21,107.36,percent of total billed charges,38.7
"UA, AUTO, W-O SCOPE",81003,CPT,,,,,both,, ,23.85,23.85,Blue Cross and Blue Shield,Traditional,,9.23,38.7,percent of total billed charges,23.85,0.93,12.16,percent of total billed charges,38.7
"UA, AUTO, W-O SCOPE",81003,CPT,,,,,both,, ,210.50,210.50,Blue Cross and Blue Shield,Traditional,,81.46,38.7,percent of total billed charges,210.50,8.21,107.36,percent of total billed charges,38.7
URINALYSIS,81005,CPT,,,,,both,, ,180.19,180.19,Blue Cross and Blue Shield,Traditional,,69.73,38.7,percent of total billed charges,180.19,7.03,91.9,percent of total billed charges,38.7
MICROSCOPIC EX OF UR,81015,CPT,,,,,both,, ,10.55,10.55,Blue Cross and Blue Shield,Traditional,,4.08,38.7,percent of total billed charges,10.55,0.41,5.38,percent of total billed charges,38.7
MICROSCOPIC EX OF UR,81015,CPT,,,,,both,, ,180.19,180.19,Blue Cross and Blue Shield,Traditional,,69.73,38.7,percent of total billed charges,180.19,7.03,91.9,percent of total billed charges,38.7
URINE PREG TEST QL,81025,CPT,,,,,both,, ,23.58,23.58,Blue Cross and Blue Shield,Traditional,,9.13,38.7,percent of total billed charges,23.58,0.92,12.03,percent of total billed charges,38.7
URINE PREG TEST QL,81025,CPT,,,,,both,,,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
URINE PREG TEST QL,81025,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
"L910235 URINE VOLUME, TIMED",81050,CPT,,,,,both,, ,30.64,30.64,Blue Cross and Blue Shield,Traditional,,11.86,38.7,percent of total billed charges,30.64,1.19,15.63,percent of total billed charges,38.7
Q91863 BRCADVAN COMP,81162,CPT,,,,,both,, ,5261.25,5261.25,Blue Cross and Blue Shield,Traditional,,2036.10,38.7,percent of total billed charges,5261.25,205.19,2683.24,percent of total billed charges,38.7
L480510 BCRABL1 KDMA,81170,CPT,,,,,both,, ,1792.00,1792.00,Blue Cross and Blue Shield,Traditional,,693.50,38.7,percent of total billed charges,1792.00,69.89,913.92,percent of total billed charges,38.7
Q91065 P210 BCRABL1,81206,CPT,,,,,both,, ,552.22,552.22,Blue Cross and Blue Shield,Traditional,,213.71,38.7,percent of total billed charges,552.22,21.54,281.63,percent of total billed charges,38.7
Q91065 P190 BCRABL1,81207,CPT,,,,,both,, ,487.83,487.83,Blue Cross and Blue Shield,Traditional,,188.79,38.7,percent of total billed charges,487.83,19.03,248.79,percent of total billed charges,38.7
BRAF GENE ANALY V600,81210,CPT,,,,,both,, ,393.84,393.84,Blue Cross and Blue Shield,Traditional,,152.42,38.7,percent of total billed charges,393.84,15.36,200.86,percent of total billed charges,38.7
L489450 CALR MA,81219,CPT,,,,,both,, ,675.00,675.00,Blue Cross and Blue Shield,Traditional,,261.23,38.7,percent of total billed charges,675.00,26.33,344.25,percent of total billed charges,38.7
Q10458 CFSCN OLA-PCR,81220,CPT,,,,,both,, ,1100.00,1100.00,Blue Cross and Blue Shield,Traditional,,425.70,38.7,percent of total billed charges,1100.00,42.90,561,percent of total billed charges,38.7
L252900 CF CFTR DD,81222,CPT,,,,,both,, ,930.00,930.00,Blue Cross and Blue Shield,Traditional,,359.91,38.7,percent of total billed charges,930.00,36.27,474.3,percent of total billed charges,38.7
L511230 CYT P450 2D6,81226,CPT,,,,,both,, ,600.00,600.00,Blue Cross and Blue Shield,Traditional,,232.20,38.7,percent of total billed charges,600.00,23.40,306,percent of total billed charges,38.7
Q161608 CYP2C9 GN AN,81227,CPT,,,,,both,, ,610.00,610.00,Blue Cross and Blue Shield,Traditional,,236.07,38.7,percent of total billed charges,610.00,23.79,311.1,percent of total billed charges,38.7
EGFR GENE COM VAR,81235,CPT,,,,,both,, ,963.55,963.55,Blue Cross and Blue Shield,Traditional,,372.89,38.7,percent of total billed charges,963.55,37.58,491.41,percent of total billed charges,38.7
F2 GEN ANALY 20210GA,81240,CPT,,,,,both,, ,2183.65,2183.65,Blue Cross and Blue Shield,Traditional,,845.07,38.7,percent of total billed charges,2183.65,85.16,1113.66,percent of total billed charges,38.7
Q17909 PGM HYBEACONS,81240,CPT,,,,,both,, ,1091.82,1091.82,Blue Cross and Blue Shield,Traditional,,422.53,38.7,percent of total billed charges,1091.82,42.58,556.83,percent of total billed charges,38.7
F5 GENE ANALY LEID V,81241,CPT,,,,,both,, ,2183.65,2183.65,Blue Cross and Blue Shield,Traditional,,845.07,38.7,percent of total billed charges,2183.65,85.16,1113.66,percent of total billed charges,38.7
F5 GENE ANALY LEID V,81241,CPT,,,,,both,, ,2183.65,2183.65,Blue Cross and Blue Shield,Traditional,,845.07,38.7,percent of total billed charges,2183.65,85.16,1113.66,percent of total billed charges,38.7
FMR1 GENE ANALY AB,81243,CPT,,,,,both,, ,1863.12,1863.12,Blue Cross and Blue Shield,Traditional,,721.03,38.7,percent of total billed charges,1863.12,72.66,950.19,percent of total billed charges,38.7
HFE GENE ANALY CV,81256,CPT,,,,,both,, ,3396.72,3396.72,Blue Cross and Blue Shield,Traditional,,1314.53,38.7,percent of total billed charges,3396.72,132.47,1732.33,percent of total billed charges,38.7
HFE GENE ANALY CV,81256,CPT,,,,,both,, ,3396.72,3396.72,Blue Cross and Blue Shield,Traditional,,1314.53,38.7,percent of total billed charges,3396.72,132.47,1732.33,percent of total billed charges,38.7
Q11175AGLOB MUT PCR,81257,CPT,,,,,both,, ,477.70,477.70,Blue Cross and Blue Shield,Traditional,,184.87,38.7,percent of total billed charges,477.70,18.63,243.63,percent of total billed charges,38.7
JAK2 GEN ANALY V617F,81270,CPT,,,,,both,, ,1424.14,1424.14,Blue Cross and Blue Shield,Traditional,,551.14,38.7,percent of total billed charges,1424.14,55.54,726.31,percent of total billed charges,38.7
JAK2 GEN ANALY V617F,81270,CPT,,,,,both,, ,1424.14,1424.14,Blue Cross and Blue Shield,Traditional,,551.14,38.7,percent of total billed charges,1424.14,55.54,726.31,percent of total billed charges,38.7
L489421 JAK2V617F QL,81270,CPT,,,,,both,, ,1306.56,1306.56,Blue Cross and Blue Shield,Traditional,,505.64,38.7,percent of total billed charges,1306.56,50.96,666.35,percent of total billed charges,38.7
L511040 CHRO ANA CMA,81277,CPT,,,,,both,, ,2260.00,2260.00,Blue Cross and Blue Shield,Traditional,,874.62,38.7,percent of total billed charges,2260.00,88.14,1152.6,percent of total billed charges,38.7
L115101 JAK2 EX12-15,81279,CPT,,,,,both,, ,865.04,865.04,Blue Cross and Blue Shield,Traditional,,334.77,38.7,percent of total billed charges,865.04,33.74,441.17,percent of total billed charges,38.7
Q90251 IL28B RT-PCR,81283,CPT,,,,,both,, ,352.24,352.24,Blue Cross and Blue Shield,Traditional,,136.32,38.7,percent of total billed charges,352.24,13.74,179.64,percent of total billed charges,38.7
MTHFR GENE ANALY CV,81291,CPT,,,,,both,, ,3892.40,3892.40,Blue Cross and Blue Shield,Traditional,,1506.36,38.7,percent of total billed charges,3892.40,151.80,1985.12,percent of total billed charges,38.7
MTHFR GENE ANALY CV,81291,CPT,,,,,both,, ,3892.40,3892.40,Blue Cross and Blue Shield,Traditional,,1506.36,38.7,percent of total billed charges,3892.40,151.80,1985.12,percent of total billed charges,38.7
MICROSAT INSTAB VAR,81301,CPT,,,,,both,, ,960.19,960.19,Blue Cross and Blue Shield,Traditional,,371.59,38.7,percent of total billed charges,960.19,37.45,489.7,percent of total billed charges,38.7
PCA3 KLK3 RATIO,81313,CPT,,,,,both,, ,636.57,636.57,Blue Cross and Blue Shield,Traditional,,246.35,38.7,percent of total billed charges,636.57,24.83,324.65,percent of total billed charges,38.7
Q18041 SMA CAR SCN,81329,CPT,,,,,both,, ,685.00,685.00,Blue Cross and Blue Shield,Traditional,,265.10,38.7,percent of total billed charges,685.00,26.72,349.35,percent of total billed charges,38.7
Q15340 ALPHA-1 ANTITRYPSIN (AAT) MUTATIO,81332,CPT,,,,,both,, ,3025.50,3025.50,Blue Cross and Blue Shield,Traditional,,1170.87,38.7,percent of total billed charges,3025.50,117.99,1543.01,percent of total billed charges,38.7
SERPINA1 GENE ANA CV,81332,CPT,,,,,both,, ,3396.72,3396.72,Blue Cross and Blue Shield,Traditional,,1314.53,38.7,percent of total billed charges,3396.72,132.47,1732.33,percent of total billed charges,38.7
L489150 MPL MUT AN,81338,CPT,,,,,both,, ,675.00,675.00,Blue Cross and Blue Shield,Traditional,,261.23,38.7,percent of total billed charges,675.00,26.33,344.25,percent of total billed charges,38.7
Q92476 MPL MA QL,81339,CPT,,,,,both,, ,701.97,701.97,Blue Cross and Blue Shield,Traditional,,271.66,38.7,percent of total billed charges,701.97,27.38,358,percent of total billed charges,38.7
CSI153 UGTIA1 GEN AN,81350,CPT,,,,,both,, ,819.57,819.57,Blue Cross and Blue Shield,Traditional,,317.17,38.7,percent of total billed charges,819.57,31.96,417.98,percent of total billed charges,38.7
Q15584 HLA-B27 DETER,81374,CPT,,,,,both,, ,250.36,250.36,Blue Cross and Blue Shield,Traditional,,96.89,38.7,percent of total billed charges,250.36,9.76,127.68,percent of total billed charges,38.7
Q17135 HLA2 TYP LR 1,81376,CPT,,,,,both,, ,610.75,610.75,Blue Cross and Blue Shield,Traditional,,236.36,38.7,percent of total billed charges,610.75,23.82,311.48,percent of total billed charges,38.7
L167082 HLA2 LR1 AG,81377,CPT,,,,,both,, ,235.10,235.10,Blue Cross and Blue Shield,Traditional,,90.98,38.7,percent of total billed charges,235.10,9.17,119.9,percent of total billed charges,38.7
HLA1 TYP HR 1 AL EA,81381,CPT,,,,,both,, ,724.42,724.42,Blue Cross and Blue Shield,Traditional,,280.35,38.7,percent of total billed charges,724.42,28.25,369.45,percent of total billed charges,38.7
Q17135 HLA2 TYP HR 1,81382,CPT,,,,,both,, ,618.04,618.04,Blue Cross and Blue Shield,Traditional,,239.18,38.7,percent of total billed charges,618.04,24.10,315.2,percent of total billed charges,38.7
L167082 HLA2 HR1 AL,81383,CPT,,,,,both,, ,334.75,334.75,Blue Cross and Blue Shield,Traditional,,129.55,38.7,percent of total billed charges,334.75,13.06,170.72,percent of total billed charges,38.7
MOLEC PATH LEV 2,81401,CPT,,,,,both,, ,1062.07,1062.07,Blue Cross and Blue Shield,Traditional,,411.02,38.7,percent of total billed charges,1062.07,41.42,541.66,percent of total billed charges,38.7
MOLEC PATH LEV 2,81401,CPT,,,,,both,, ,1062.07,1062.07,Blue Cross and Blue Shield,Traditional,,411.02,38.7,percent of total billed charges,1062.07,41.42,541.66,percent of total billed charges,38.7
Q16536 JAK2 EX 12&13,81403,CPT,,,,,both,, ,865.04,865.04,Blue Cross and Blue Shield,Traditional,,334.77,38.7,percent of total billed charges,865.04,33.74,441.17,percent of total billed charges,38.7
Q16536 JAK2 EX 12&13,81403,CPT,,,,,both,, ,865.04,865.04,Blue Cross and Blue Shield,Traditional,,334.77,38.7,percent of total billed charges,865.04,33.74,441.17,percent of total billed charges,38.7
L630540 THRB,81405,CPT,,,,,both,, ,4320.00,4320.00,Blue Cross and Blue Shield,Traditional,,1671.84,38.7,percent of total billed charges,4320.00,168.48,2203.2,percent of total billed charges,38.7
B5306-6 ACGH MOL KAR,81406,CPT,,,,,both,, ,2000.00,2000.00,Blue Cross and Blue Shield,Traditional,,774.00,38.7,percent of total billed charges,2000.00,78.00,1020,percent of total billed charges,38.7
BB893-9 UNL MOL PTH,81479,CPT,,,,,both,, ,618.00,618.00,Blue Cross and Blue Shield,Traditional,,239.17,38.7,percent of total billed charges,618.00,24.10,315.18,percent of total billed charges,38.7
NBS SCID,81479,CPT,,,,,both,, ,109.46,109.46,Blue Cross and Blue Shield,Traditional,,42.36,38.7,percent of total billed charges,109.46,4.27,55.82,percent of total billed charges,38.7
UNLIST MOLEC PATH,81479,CPT,,,,,both,, ,1145.43,1145.43,Blue Cross and Blue Shield,Traditional,,443.28,38.7,percent of total billed charges,1145.43,44.67,584.17,percent of total billed charges,38.7
L140045 OVARIAN MALIGNANCY RISK - ROMA,81500,CPT,,,,,both,, ,600.00,600.00,Blue Cross and Blue Shield,Traditional,,232.20,38.7,percent of total billed charges,600.00,23.40,306,percent of total billed charges,38.7
FTL CGEN ABN 4 ANAL,81511,CPT,,,,,both,, ,466.48,466.48,Blue Cross and Blue Shield,Traditional,,180.53,38.7,percent of total billed charges,466.48,18.19,237.9,percent of total billed charges,38.7
Q30294 QUAD SCREEN,81511,CPT,,,,,both,, ,415.50,415.50,Blue Cross and Blue Shield,Traditional,,160.80,38.7,percent of total billed charges,415.50,16.20,211.91,percent of total billed charges,38.7
FTL CGEN ABN 5 ANAL,81512,CPT,,,,,both,, ,791.78,791.78,Blue Cross and Blue Shield,Traditional,,306.42,38.7,percent of total billed charges,791.78,30.88,403.81,percent of total billed charges,38.7
L550659 LIVR BIOMRKR,81517,CPT,,,,,both,, ,1143.00,1143.00,Blue Cross and Blue Shield,Traditional,,442.34,38.7,percent of total billed charges,1143.00,44.58,582.93,percent of total billed charges,38.7
Q92688 LIVER FIBROS,81596,CPT,,,,,both,, ,337.09,337.09,Blue Cross and Blue Shield,Traditional,,130.45,38.7,percent of total billed charges,337.09,13.15,171.92,percent of total billed charges,38.7
ACETON-KETON SERM QL,82009,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
ACETON-KETON SERM QT,82010,CPT,,,,,both,, ,80.55,80.55,Blue Cross and Blue Shield,Traditional,,31.17,38.7,percent of total billed charges,80.55,3.14,41.08,percent of total billed charges,38.7
ACETON-KETON SERM QT,82010,CPT,,,,,both,, ,341.30,341.30,Blue Cross and Blue Shield,Traditional,,132.08,38.7,percent of total billed charges,341.30,13.31,174.06,percent of total billed charges,38.7
NBS ACYLCARNITINE QL,82016,CPT,,,,,both,, ,82.79,82.79,Blue Cross and Blue Shield,Traditional,,32.04,38.7,percent of total billed charges,82.79,3.23,42.22,percent of total billed charges,38.7
ADRENOCORT ACTH,82024,CPT,,,,,both,, ,2343.07,2343.07,Blue Cross and Blue Shield,Traditional,,906.77,38.7,percent of total billed charges,2343.07,91.38,1194.97,percent of total billed charges,38.7
Q211 ACTH PL IA,82024,CPT,,,,,both,, ,334.00,334.00,Blue Cross and Blue Shield,Traditional,,129.26,38.7,percent of total billed charges,334.00,13.03,170.34,percent of total billed charges,38.7
ALBUMIN SERUM,82040,CPT,,,,,both,, ,35.08,35.08,Blue Cross and Blue Shield,Traditional,,13.58,38.7,percent of total billed charges,35.08,1.37,17.89,percent of total billed charges,38.7
ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
Q14966 ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
Q70858 ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
ALBUMIN FLUID,82042,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
ALBUMIN FLUID,82042,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
MICROALB QNT,82043,CPT,,,,,both,, ,77.74,77.74,Blue Cross and Blue Shield,Traditional,,30.09,38.7,percent of total billed charges,77.74,3.03,39.65,percent of total billed charges,38.7
MICROALB QNT,82043,CPT,,,,,both,,,660.98,660.98,Blue Cross and Blue Shield,Traditional,,255.80,38.7,percent of total billed charges,660.98,25.78,337.1,percent of total billed charges,38.7
MICROALB QNT,82043,CPT,,,,,both,, ,660.98,660.98,Blue Cross and Blue Shield,Traditional,,255.80,38.7,percent of total billed charges,660.98,25.78,337.1,percent of total billed charges,38.7
ETHANOL IA,82077,CPT,,,,,both,, ,177.88,177.88,Blue Cross and Blue Shield,Traditional,,68.84,38.7,percent of total billed charges,177.88,6.94,90.72,percent of total billed charges,38.7
ALDOLASE,82085,CPT,,,,,both,, ,648.35,648.35,Blue Cross and Blue Shield,Traditional,,250.91,38.7,percent of total billed charges,648.35,25.29,330.66,percent of total billed charges,38.7
ALDOLASE,82085,CPT,,,,,both,, ,648.35,648.35,Blue Cross and Blue Shield,Traditional,,250.91,38.7,percent of total billed charges,648.35,25.29,330.66,percent of total billed charges,38.7
ALDOSTERONE,82088,CPT,,,,,both,, ,2366.36,2366.36,Blue Cross and Blue Shield,Traditional,,915.78,38.7,percent of total billed charges,2366.36,92.29,1206.84,percent of total billed charges,38.7
Q16845 ALDOSTERONE,82088,CPT,,,,,both,, ,587.45,587.45,Blue Cross and Blue Shield,Traditional,,227.34,38.7,percent of total billed charges,587.45,22.91,299.6,percent of total billed charges,38.7
Q17181 ALDOST LCMSMS,82088,CPT,,,,,both,, ,587.45,587.45,Blue Cross and Blue Shield,Traditional,,227.34,38.7,percent of total billed charges,587.45,22.91,299.6,percent of total billed charges,38.7
Q229 ALDOSTERONE U24,82088,CPT,,,,,both,, ,587.45,587.45,Blue Cross and Blue Shield,Traditional,,227.34,38.7,percent of total billed charges,587.45,22.91,299.6,percent of total billed charges,38.7
ALPHA 1-ANTITRYP TOT,82103,CPT,,,,,both,, ,969.17,969.17,Blue Cross and Blue Shield,Traditional,,375.07,38.7,percent of total billed charges,969.17,37.80,494.28,percent of total billed charges,38.7
ALPHA 1-ANTITRYP TOT,82103,CPT,,,,,both,, ,969.17,969.17,Blue Cross and Blue Shield,Traditional,,375.07,38.7,percent of total billed charges,969.17,37.80,494.28,percent of total billed charges,38.7
ALPHA 1-ANTITRYP PHE,82104,CPT,,,,,both,, ,1051.68,1051.68,Blue Cross and Blue Shield,Traditional,,407.00,38.7,percent of total billed charges,1051.68,41.02,536.36,percent of total billed charges,38.7
ALPHA 1-ANTITRYP PHE,82104,CPT,,,,,both,, ,1051.68,1051.68,Blue Cross and Blue Shield,Traditional,,407.00,38.7,percent of total billed charges,1051.68,41.02,536.36,percent of total billed charges,38.7
AFP SERUM,82105,CPT,,,,,both,, ,1142.06,1142.06,Blue Cross and Blue Shield,Traditional,,441.98,38.7,percent of total billed charges,1142.06,44.54,582.45,percent of total billed charges,38.7
Q237 AFP TUMR MRK IA,82105,CPT,,,,,both,, ,1142.06,1142.06,Blue Cross and Blue Shield,Traditional,,441.98,38.7,percent of total billed charges,1142.06,44.54,582.45,percent of total billed charges,38.7
Q5059 MAT SER AFP IA,82105,CPT,,,,,both,, ,1142.06,1142.06,Blue Cross and Blue Shield,Traditional,,441.98,38.7,percent of total billed charges,1142.06,44.54,582.45,percent of total billed charges,38.7
AFP AMNIOTIC FLD,82106,CPT,,,,,both,, ,705.89,705.89,Blue Cross and Blue Shield,Traditional,,273.18,38.7,percent of total billed charges,705.89,27.53,360,percent of total billed charges,38.7
AFP-L3 AND TOTL AFP,82107,CPT,,,,,both,, ,530.47,530.47,Blue Cross and Blue Shield,Traditional,,205.29,38.7,percent of total billed charges,530.47,20.69,270.54,percent of total billed charges,38.7
AFP-L3 AND TOTL AFP,82107,CPT,,,,,both,, ,530.47,530.47,Blue Cross and Blue Shield,Traditional,,205.29,38.7,percent of total billed charges,530.47,20.69,270.54,percent of total billed charges,38.7
ALUMINUM,82108,CPT,,,,,both,, ,265.51,265.51,Blue Cross and Blue Shield,Traditional,,102.75,38.7,percent of total billed charges,265.51,10.35,135.41,percent of total billed charges,38.7
NBS AMINO ACD MUL QL,82128,CPT,,,,,both,, ,82.79,82.79,Blue Cross and Blue Shield,Traditional,,32.04,38.7,percent of total billed charges,82.79,3.23,42.22,percent of total billed charges,38.7
Q10947CYSTN U24 LCMS,82131,CPT,,,,,both,, ,175.98,175.98,Blue Cross and Blue Shield,Traditional,,68.10,38.7,percent of total billed charges,175.98,6.86,89.75,percent of total billed charges,38.7
AMINO ACID QUAN 6+,82139,CPT,,,,,both,, ,873.74,873.74,Blue Cross and Blue Shield,Traditional,,338.14,38.7,percent of total billed charges,873.74,34.08,445.61,percent of total billed charges,38.7
AMMONIA,82140,CPT,,,,,both,, ,154.09,154.09,Blue Cross and Blue Shield,Traditional,,59.63,38.7,percent of total billed charges,154.09,6.01,78.59,percent of total billed charges,38.7
AMMONIA,82140,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
L910235 AMMONIA,82140,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q442 AMMONIA,82140,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
AMYLASE,82150,CPT,,,,,both,, ,68.48,68.48,Blue Cross and Blue Shield,Traditional,,26.50,38.7,percent of total billed charges,68.48,2.67,34.92,percent of total billed charges,38.7
AMYLASE,82150,CPT,,,,,both,, ,518.69,518.69,Blue Cross and Blue Shield,Traditional,,200.73,38.7,percent of total billed charges,518.69,20.23,264.53,percent of total billed charges,38.7
AMYLASE,82150,CPT,,,,,both,, ,518.69,518.69,Blue Cross and Blue Shield,Traditional,,200.73,38.7,percent of total billed charges,518.69,20.23,264.53,percent of total billed charges,38.7
ANDROSTENEDIONE,82157,CPT,,,,,both,, ,769.33,769.33,Blue Cross and Blue Shield,Traditional,,297.73,38.7,percent of total billed charges,769.33,30.00,392.36,percent of total billed charges,38.7
ANDROSTENEDIONE,82157,CPT,,,,,both,, ,769.33,769.33,Blue Cross and Blue Shield,Traditional,,297.73,38.7,percent of total billed charges,769.33,30.00,392.36,percent of total billed charges,38.7
ANGIOTENSIN CONV ENZ,82164,CPT,,,,,both,, ,143.71,143.71,Blue Cross and Blue Shield,Traditional,,55.62,38.7,percent of total billed charges,143.71,5.60,73.29,percent of total billed charges,38.7
ANGIOTENSIN CONV ENZ,82164,CPT,,,,,both,, ,1081.72,1081.72,Blue Cross and Blue Shield,Traditional,,418.63,38.7,percent of total billed charges,1081.72,42.19,551.68,percent of total billed charges,38.7
Q34692 ACE CSF KINET,82164,CPT,,,,,both,, ,1081.72,1081.72,Blue Cross and Blue Shield,Traditional,,418.63,38.7,percent of total billed charges,1081.72,42.19,551.68,percent of total billed charges,38.7
Q683 ACE SP,82164,CPT,,,,,both,, ,1081.72,1081.72,Blue Cross and Blue Shield,Traditional,,418.63,38.7,percent of total billed charges,1081.72,42.19,551.68,percent of total billed charges,38.7
ANTI-MULLERIAN HORM,82166,CPT,,,,,both,, ,116.00,116.00,Blue Cross and Blue Shield,Traditional,,44.89,38.7,percent of total billed charges,116.00,4.52,59.16,percent of total billed charges,38.7
APOLIPOPROTEIN EACH,82172,CPT,,,,,both,, ,467.04,467.04,Blue Cross and Blue Shield,Traditional,,180.74,38.7,percent of total billed charges,467.04,18.21,238.19,percent of total billed charges,38.7
APOLIPOPROTEIN EACH,82172,CPT,,,,,both,, ,467.04,467.04,Blue Cross and Blue Shield,Traditional,,180.74,38.7,percent of total billed charges,467.04,18.21,238.19,percent of total billed charges,38.7
ARSENIC,82175,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,percent of total billed charges,751.36,29.30,383.19,percent of total billed charges,38.7
Q269 AS BL ICP/MS,82175,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,percent of total billed charges,751.36,29.30,383.19,percent of total billed charges,38.7
Q36438 ARSENIC,82175,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,percent of total billed charges,751.36,29.30,383.19,percent of total billed charges,38.7
Q7507 ARSENIC,82175,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,percent of total billed charges,751.36,29.30,383.19,percent of total billed charges,38.7
Q7655 ARSENIC,82175,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,percent of total billed charges,751.36,29.30,383.19,percent of total billed charges,38.7
Q929 VIT C LC/MS/MS,82180,CPT,,,,,both,, ,67.92,67.92,Blue Cross and Blue Shield,Traditional,,26.29,38.7,percent of total billed charges,67.92,2.65,34.64,percent of total billed charges,38.7
BETA-2 MICROGLOBULIN,82232,CPT,,,,,both,, ,936.89,936.89,Blue Cross and Blue Shield,Traditional,,362.58,38.7,percent of total billed charges,936.89,36.54,477.81,percent of total billed charges,38.7
BETA-2 MICROGLOBULIN,82232,CPT,,,,,both,, ,936.89,936.89,Blue Cross and Blue Shield,Traditional,,362.58,38.7,percent of total billed charges,936.89,36.54,477.81,percent of total billed charges,38.7
Q14801 BILE AC ENZ,82239,CPT,,,,,both,, ,274.77,274.77,Blue Cross and Blue Shield,Traditional,,106.34,38.7,percent of total billed charges,274.77,10.72,140.13,percent of total billed charges,38.7
BILIRUBIN TOTAL,82247,CPT,,,,,both,, ,53.05,53.05,Blue Cross and Blue Shield,Traditional,,20.53,38.7,percent of total billed charges,53.05,2.07,27.06,percent of total billed charges,38.7
BILIRUBIN TOTAL,82247,CPT,,,,,both,, ,282.92,282.92,Blue Cross and Blue Shield,Traditional,,109.49,38.7,percent of total billed charges,282.92,11.03,144.29,percent of total billed charges,38.7
BILIRUBIN DIRECT,82248,CPT,,,,,both,, ,53.05,53.05,Blue Cross and Blue Shield,Traditional,,20.53,38.7,percent of total billed charges,53.05,2.07,27.06,percent of total billed charges,38.7
BILIRUBIN DIRECT,82248,CPT,,,,,both,, ,282.92,282.92,Blue Cross and Blue Shield,Traditional,,109.49,38.7,percent of total billed charges,282.92,11.03,144.29,percent of total billed charges,38.7
NBS BIOTINIDASE,82261,CPT,,,,,both,, ,100.75,100.75,Blue Cross and Blue Shield,Traditional,,38.99,38.7,percent of total billed charges,100.75,3.93,51.38,percent of total billed charges,38.7
BLD OCCULT FECES 1-3,82270,CPT,,,,,both,, ,31.99,31.99,Blue Cross and Blue Shield,Traditional,,12.38,38.7,percent of total billed charges,31.99,1.25,16.31,percent of total billed charges,38.7
BLD OCCULT FECES 1-3,82270,CPT,,,,,both,, ,210.50,210.50,Blue Cross and Blue Shield,Traditional,,81.46,38.7,percent of total billed charges,210.50,8.21,107.36,percent of total billed charges,38.7
BLD OCCULT OTHER SRC,82271,CPT,,,,,both,, ,277.59,277.59,Blue Cross and Blue Shield,Traditional,,107.43,38.7,percent of total billed charges,277.59,10.83,141.57,percent of total billed charges,38.7
BLD OCC NON CA SCREE,82272,CPT,,,,,both,, ,210.50,210.50,Blue Cross and Blue Shield,Traditional,,81.46,38.7,percent of total billed charges,210.50,8.21,107.36,percent of total billed charges,38.7
BLD OCCULT FECES EIA,82274,CPT,,,,,both,, ,165.87,165.87,Blue Cross and Blue Shield,Traditional,,64.19,38.7,percent of total billed charges,165.87,6.47,84.59,percent of total billed charges,38.7
CADMIUM,82300,CPT,,,,,both,, ,536.08,536.08,Blue Cross and Blue Shield,Traditional,,207.46,38.7,percent of total billed charges,536.08,20.91,273.4,percent of total billed charges,38.7
CADMIUM,82300,CPT,,,,,both,, ,536.08,536.08,Blue Cross and Blue Shield,Traditional,,207.46,38.7,percent of total billed charges,536.08,20.91,273.4,percent of total billed charges,38.7
Q672 CADMIUM,82300,CPT,,,,,both,, ,125.00,125.00,Blue Cross and Blue Shield,Traditional,,48.38,38.7,percent of total billed charges,125.00,4.88,63.75,percent of total billed charges,38.7
L504115VITD 25-OH LC,82306,CPT,,,,,both,, ,651.73,651.73,Blue Cross and Blue Shield,Traditional,,252.22,38.7,percent of total billed charges,651.73,25.42,332.38,percent of total billed charges,38.7
VITAMIN D 25OH,82306,CPT,,,,,both,, ,279.26,279.26,Blue Cross and Blue Shield,Traditional,,108.07,38.7,percent of total billed charges,279.26,10.89,142.42,percent of total billed charges,38.7
VITAMIN D 25OH,82306,CPT,,,,,both,,,710.38,710.38,Blue Cross and Blue Shield,Traditional,,274.92,38.7,percent of total billed charges,710.38,27.70,362.29,percent of total billed charges,38.7
VITAMIN D 25OH,82306,CPT,,,,,both,, ,710.38,710.38,Blue Cross and Blue Shield,Traditional,,274.92,38.7,percent of total billed charges,710.38,27.70,362.29,percent of total billed charges,38.7
CALCITONIN,82308,CPT,,,,,both,, ,297.79,297.79,Blue Cross and Blue Shield,Traditional,,115.24,38.7,percent of total billed charges,297.79,11.61,151.87,percent of total billed charges,38.7
Q30742 CALCITONIN IA,82308,CPT,,,,,both,, ,796.27,796.27,Blue Cross and Blue Shield,Traditional,,308.16,38.7,percent of total billed charges,796.27,31.05,406.1,percent of total billed charges,38.7
CALCIUM TOTAL,82310,CPT,,,,,both,, ,54.45,54.45,Blue Cross and Blue Shield,Traditional,,21.07,38.7,percent of total billed charges,54.45,2.12,27.77,percent of total billed charges,38.7
CALCIUM TOTAL,82310,CPT,,,,,both,, ,315.48,315.48,Blue Cross and Blue Shield,Traditional,,122.09,38.7,percent of total billed charges,315.48,12.30,160.89,percent of total billed charges,38.7
CALCIUM TOTAL,82310,CPT,,,,,both,, ,315.48,315.48,Blue Cross and Blue Shield,Traditional,,122.09,38.7,percent of total billed charges,315.48,12.30,160.89,percent of total billed charges,38.7
CALCIUM IONIZED,82330,CPT,,,,,both,, ,35.36,35.36,Blue Cross and Blue Shield,Traditional,,13.68,38.7,percent of total billed charges,35.36,1.38,18.03,percent of total billed charges,38.7
CALCIUM IONIZED,82330,CPT,,,,,both,,,796.27,796.27,Blue Cross and Blue Shield,Traditional,,308.16,38.7,percent of total billed charges,796.27,31.05,406.1,percent of total billed charges,38.7
CALCIUM IONIZED,82330,CPT,,,,,both,, ,796.27,796.27,Blue Cross and Blue Shield,Traditional,,308.16,38.7,percent of total billed charges,796.27,31.05,406.1,percent of total billed charges,38.7
CALCIUM IONIZED,82330,CPT,,,,,both,, ,796.27,796.27,Blue Cross and Blue Shield,Traditional,,308.16,38.7,percent of total billed charges,796.27,31.05,406.1,percent of total billed charges,38.7
CALCIUM URI QN TIMED,82340,CPT,,,,,both,,,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,percent of total billed charges,412.87,16.10,210.56,percent of total billed charges,38.7
CALCIUM URI QN TIMED,82340,CPT,,,,,both,, ,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,percent of total billed charges,412.87,16.10,210.56,percent of total billed charges,38.7
"L910235 CALCIUM, URINE",82340,CPT,,,,,both,, ,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,percent of total billed charges,412.87,16.10,210.56,percent of total billed charges,38.7
Q442 CALCIUM URI QN,82340,CPT,,,,,both,, ,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,percent of total billed charges,412.87,16.10,210.56,percent of total billed charges,38.7
CALCULUS INFRARED,82365,CPT,,,,,both,, ,1187.82,1187.82,Blue Cross and Blue Shield,Traditional,,459.69,38.7,percent of total billed charges,1187.82,46.32,605.79,percent of total billed charges,38.7
CALCULUS INFRARED,82365,CPT,,,,,both,, ,1187.82,1187.82,Blue Cross and Blue Shield,Traditional,,459.69,38.7,percent of total billed charges,1187.82,46.32,605.79,percent of total billed charges,38.7
CARBON DIOXIDE CO2,82374,CPT,,,,,both,, ,47.99,47.99,Blue Cross and Blue Shield,Traditional,,18.57,38.7,percent of total billed charges,47.99,1.87,24.47,percent of total billed charges,38.7
CARBON DIOXIDE CO2,82374,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
CARBON MONOXIDE QUAN,82375,CPT,,,,,both,, ,203.49,203.49,Blue Cross and Blue Shield,Traditional,,78.75,38.7,percent of total billed charges,203.49,7.94,103.78,percent of total billed charges,38.7
CARBON MONOXIDE QUAN,82375,CPT,,,,,both,, ,203.49,203.49,Blue Cross and Blue Shield,Traditional,,78.75,38.7,percent of total billed charges,203.49,7.94,103.78,percent of total billed charges,38.7
CARCINOEMBRYONIC AG,82378,CPT,,,,,both,, ,121.53,121.53,Blue Cross and Blue Shield,Traditional,,47.03,38.7,percent of total billed charges,121.53,4.74,61.98,percent of total billed charges,38.7
CARCINOEMBRYONIC AG,82378,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,percent of total billed charges,526.26,20.52,268.39,percent of total billed charges,38.7
CARCINOEMBRYONIC AG,82378,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,percent of total billed charges,526.26,20.52,268.39,percent of total billed charges,38.7
CAROTENE,82380,CPT,,,,,both,, ,1171.81,1171.81,Blue Cross and Blue Shield,Traditional,,453.49,38.7,percent of total billed charges,1171.81,45.70,597.62,percent of total billed charges,38.7
L1529 CAROTENE HPLC,82380,CPT,,,,,both,, ,75.20,75.20,Blue Cross and Blue Shield,Traditional,,29.10,38.7,percent of total billed charges,75.20,2.93,38.35,percent of total billed charges,38.7
Q314 CAT FR PL,82384,CPT,,,,,both,, ,263.27,263.27,Blue Cross and Blue Shield,Traditional,,101.89,38.7,percent of total billed charges,263.27,10.27,134.27,percent of total billed charges,38.7
Q314 CAT FR PL,82384,CPT,,,,,both,, ,263.27,263.27,Blue Cross and Blue Shield,Traditional,,101.89,38.7,percent of total billed charges,263.27,10.27,134.27,percent of total billed charges,38.7
Q314 CAT FR PL,82384,CPT,,,,,both,, ,263.27,263.27,Blue Cross and Blue Shield,Traditional,,101.89,38.7,percent of total billed charges,263.27,10.27,134.27,percent of total billed charges,38.7
Q314 CAT FR PL,82384,CPT,,,,,both,, ,263.27,263.27,Blue Cross and Blue Shield,Traditional,,101.89,38.7,percent of total billed charges,263.27,10.27,134.27,percent of total billed charges,38.7
CERULOPLASMIN,82390,CPT,,,,,both,, ,859.70,859.70,Blue Cross and Blue Shield,Traditional,,332.70,38.7,percent of total billed charges,859.70,33.53,438.45,percent of total billed charges,38.7
CERULOPLASMIN,82390,CPT,,,,,both,, ,859.70,859.70,Blue Cross and Blue Shield,Traditional,,332.70,38.7,percent of total billed charges,859.70,33.53,438.45,percent of total billed charges,38.7
CHEMILUM ASSAY NOS,82397,CPT,,,,,both,, ,444.59,444.59,Blue Cross and Blue Shield,Traditional,,172.06,38.7,percent of total billed charges,444.59,17.34,226.74,percent of total billed charges,38.7
L503870 CHEM ASY NOS,82397,CPT,,,,,both,, ,444.59,444.59,Blue Cross and Blue Shield,Traditional,,172.06,38.7,percent of total billed charges,444.59,17.34,226.74,percent of total billed charges,38.7
L504567 CHEM ASY NOS,82397,CPT,,,,,both,, ,407.88,407.88,Blue Cross and Blue Shield,Traditional,,157.85,38.7,percent of total billed charges,407.88,15.91,208.02,percent of total billed charges,38.7
Q34445 INHIBIN B CL,82397,CPT,,,,,both,, ,444.59,444.59,Blue Cross and Blue Shield,Traditional,,172.06,38.7,percent of total billed charges,444.59,17.34,226.74,percent of total billed charges,38.7
Q37226 ANTI-MULLERIAN HORMONE (AMH) MALE,82397,CPT,,,,,both,, ,396.00,396.00,Blue Cross and Blue Shield,Traditional,,153.25,38.7,percent of total billed charges,396.00,15.44,201.96,percent of total billed charges,38.7
Q37226 ANTI-MULLERIAN HORMONE (AMH) MALE,82397,CPT,,,,,both,, ,396.00,396.00,Blue Cross and Blue Shield,Traditional,,153.25,38.7,percent of total billed charges,396.00,15.44,201.96,percent of total billed charges,38.7
CHLORIDE BLOOD,82435,CPT,,,,,both,, ,38.73,38.73,Blue Cross and Blue Shield,Traditional,,14.99,38.7,percent of total billed charges,38.73,1.51,19.75,percent of total billed charges,38.7
CHLORIDE BLOOD,82435,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
CHLORIDE URINE RAN,82436,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
CHLORIDE URINE RAN,82436,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
CHLORIDES OTHER FLD,82438,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
CHOLESTEROL TOTAL,82465,CPT,,,,,both,, ,49.68,49.68,Blue Cross and Blue Shield,Traditional,,19.23,38.7,percent of total billed charges,49.68,1.94,25.34,percent of total billed charges,38.7
CHOLESTEROL TOTAL,82465,CPT,,,,,both,, ,315.48,315.48,Blue Cross and Blue Shield,Traditional,,122.09,38.7,percent of total billed charges,315.48,12.30,160.89,percent of total billed charges,38.7
CHOLINESTERASE SERUM,82480,CPT,,,,,both,, ,563.60,563.60,Blue Cross and Blue Shield,Traditional,,218.11,38.7,percent of total billed charges,563.60,21.98,287.44,percent of total billed charges,38.7
Q338 CHOLINEST SER,82480,CPT,,,,,both,, ,563.60,563.60,Blue Cross and Blue Shield,Traditional,,218.11,38.7,percent of total billed charges,563.60,21.98,287.44,percent of total billed charges,38.7
Q7961 CHOLINEST SER,82480,CPT,,,,,both,, ,563.60,563.60,Blue Cross and Blue Shield,Traditional,,218.11,38.7,percent of total billed charges,563.60,21.98,287.44,percent of total billed charges,38.7
CHOLINESTERASE RBC,82482,CPT,,,,,both,, ,676.14,676.14,Blue Cross and Blue Shield,Traditional,,261.67,38.7,percent of total billed charges,676.14,26.37,344.83,percent of total billed charges,38.7
CHOLINESTERASE RBC,82482,CPT,,,,,both,, ,676.14,676.14,Blue Cross and Blue Shield,Traditional,,261.67,38.7,percent of total billed charges,676.14,26.37,344.83,percent of total billed charges,38.7
CHROMIUM,82495,CPT,,,,,both,, ,242.50,242.50,Blue Cross and Blue Shield,Traditional,,93.85,38.7,percent of total billed charges,242.50,9.46,123.68,percent of total billed charges,38.7
CHROMIUM U,82495,CPT,,,,,both,, ,202.80,202.80,Blue Cross and Blue Shield,Traditional,,78.48,38.7,percent of total billed charges,202.80,7.91,103.43,percent of total billed charges,38.7
"L910235 CITRATE, URINE",82507,CPT,,,,,both,, ,242.50,242.50,Blue Cross and Blue Shield,Traditional,,93.85,38.7,percent of total billed charges,242.50,9.46,123.68,percent of total billed charges,38.7
Q11315 CIT AC U24 SP,82507,CPT,,,,,both,, ,242.50,242.50,Blue Cross and Blue Shield,Traditional,,93.85,38.7,percent of total billed charges,242.50,9.46,123.68,percent of total billed charges,38.7
Q442 CITRATE,82507,CPT,,,,,both,, ,242.50,242.50,Blue Cross and Blue Shield,Traditional,,93.85,38.7,percent of total billed charges,242.50,9.46,123.68,percent of total billed charges,38.7
COLLAGEN CROSSLINKS,82523,CPT,,,,,both,, ,280.11,280.11,Blue Cross and Blue Shield,Traditional,,108.40,38.7,percent of total billed charges,280.11,10.92,142.86,percent of total billed charges,38.7
L500089 C-TELO ELISA,82523,CPT,,,,,both,, ,529.20,529.20,Blue Cross and Blue Shield,Traditional,,204.80,38.7,percent of total billed charges,529.20,20.64,269.89,percent of total billed charges,38.7
"N-TELOPEP (NTX), UR",82523,CPT,,,,,both,, ,186.80,186.80,Blue Cross and Blue Shield,Traditional,,72.29,38.7,percent of total billed charges,186.80,7.29,95.27,percent of total billed charges,38.7
Q15319 CU RND U ICPM,82525,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,40.41,528.49,percent of total billed charges,38.7
Q15319 CU RND U ICPM,82525,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,40.41,528.49,percent of total billed charges,38.7
Q15319 CU RND U ICPM,82525,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,40.41,528.49,percent of total billed charges,38.7
Q15319 CU RND U ICPM,82525,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,40.41,528.49,percent of total billed charges,38.7
Q11280CORTU24 LCMSMS,82530,CPT,,,,,both,, ,938.86,938.86,Blue Cross and Blue Shield,Traditional,,363.34,38.7,percent of total billed charges,938.86,36.62,478.82,percent of total billed charges,38.7
Q11280CORTU24 LCMSMS,82530,CPT,,,,,both,, ,938.86,938.86,Blue Cross and Blue Shield,Traditional,,363.34,38.7,percent of total billed charges,938.86,36.62,478.82,percent of total billed charges,38.7
Q36423 CORT FR LCMSM,82530,CPT,,,,,both,, ,939.13,939.13,Blue Cross and Blue Shield,Traditional,,363.44,38.7,percent of total billed charges,939.13,36.63,478.96,percent of total billed charges,38.7
CORTISOL TOTAL,82533,CPT,,,,,both,, ,132.19,132.19,Blue Cross and Blue Shield,Traditional,,51.16,38.7,percent of total billed charges,132.19,5.16,67.42,percent of total billed charges,38.7
CORTISOL TOTAL,82533,CPT,,,,,both,,,1343.58,1343.58,Blue Cross and Blue Shield,Traditional,,519.97,38.7,percent of total billed charges,1343.58,52.40,685.23,percent of total billed charges,38.7
CORTISOL TOTAL,82533,CPT,,,,,both,, ,1343.58,1343.58,Blue Cross and Blue Shield,Traditional,,519.97,38.7,percent of total billed charges,1343.58,52.40,685.23,percent of total billed charges,38.7
L500179SALIV CORT MS,82533,CPT,,,,,both,, ,335.78,335.78,Blue Cross and Blue Shield,Traditional,,129.95,38.7,percent of total billed charges,335.78,13.10,171.25,percent of total billed charges,38.7
L500440 CORTISOL TOT,82533,CPT,,,,,both,, ,163.00,163.00,Blue Cross and Blue Shield,Traditional,,63.08,38.7,percent of total billed charges,163.00,6.36,83.13,percent of total billed charges,38.7
CREATINE,82540,CPT,,,,,both,, ,38.73,38.73,Blue Cross and Blue Shield,Traditional,,14.99,38.7,percent of total billed charges,38.73,1.51,19.75,percent of total billed charges,38.7
L823430 OMEGACHECK (EPA+DPA+DHA),82542,CPT,,,,,both,, ,430.00,430.00,Blue Cross and Blue Shield,Traditional,,166.41,38.7,percent of total billed charges,430.00,16.77,219.3,percent of total billed charges,38.7
N-METHLHIST 24H UR,82542,CPT,,,,,both,, ,600.00,600.00,Blue Cross and Blue Shield,Traditional,,232.20,38.7,percent of total billed charges,600.00,23.40,306,percent of total billed charges,38.7
Q4846 MJ MET U GC/MS,82542,CPT,,,,,both,, ,320.53,320.53,Blue Cross and Blue Shield,Traditional,,124.05,38.7,percent of total billed charges,320.53,12.50,163.47,percent of total billed charges,38.7
Q4846 MJ MET U GC/MS,82542,CPT,,,,,both,, ,320.53,320.53,Blue Cross and Blue Shield,Traditional,,124.05,38.7,percent of total billed charges,320.53,12.50,163.47,percent of total billed charges,38.7
Q4846 MJ MET U GC/MS,82542,CPT,,,,,both,, ,320.53,320.53,Blue Cross and Blue Shield,Traditional,,124.05,38.7,percent of total billed charges,320.53,12.50,163.47,percent of total billed charges,38.7
Q4846 MJ MET U GC/MS,82542,CPT,,,,,both,, ,320.53,320.53,Blue Cross and Blue Shield,Traditional,,124.05,38.7,percent of total billed charges,320.53,12.50,163.47,percent of total billed charges,38.7
CPK TOTAL,82550,CPT,,,,,both,, ,64.27,64.27,Blue Cross and Blue Shield,Traditional,,24.87,38.7,percent of total billed charges,64.27,2.51,32.78,percent of total billed charges,38.7
CPK TOTAL,82550,CPT,,,,,both,,,282.92,282.92,Blue Cross and Blue Shield,Traditional,,109.49,38.7,percent of total billed charges,282.92,11.03,144.29,percent of total billed charges,38.7
CPK TOTAL,82550,CPT,,,,,both,, ,282.92,282.92,Blue Cross and Blue Shield,Traditional,,109.49,38.7,percent of total billed charges,282.92,11.03,144.29,percent of total billed charges,38.7
CPK TOTAL,82550,CPT,,,,,both,, ,282.92,282.92,Blue Cross and Blue Shield,Traditional,,109.49,38.7,percent of total billed charges,282.92,11.03,144.29,percent of total billed charges,38.7
CPK ISOENZYMES,82552,CPT,,,,,both,, ,626.18,626.18,Blue Cross and Blue Shield,Traditional,,242.33,38.7,percent of total billed charges,626.18,24.42,319.35,percent of total billed charges,38.7
CPK ISOENZYMES,82552,CPT,,,,,both,, ,626.18,626.18,Blue Cross and Blue Shield,Traditional,,242.33,38.7,percent of total billed charges,626.18,24.42,319.35,percent of total billed charges,38.7
CPK MB FRACTION,82553,CPT,,,,,both,, ,113.67,113.67,Blue Cross and Blue Shield,Traditional,,43.99,38.7,percent of total billed charges,113.67,4.43,57.97,percent of total billed charges,38.7
CPK MB FRACTION,82553,CPT,,,,,both,, ,620.56,620.56,Blue Cross and Blue Shield,Traditional,,240.16,38.7,percent of total billed charges,620.56,24.20,316.49,percent of total billed charges,38.7
CREATININE BLOOD,82565,CPT,,,,,both,, ,19.09,19.09,Blue Cross and Blue Shield,Traditional,,7.39,38.7,percent of total billed charges,19.09,0.74,9.74,percent of total billed charges,38.7
CREATININE BLOOD,82565,CPT,,,,,both,,,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,percent of total billed charges,285.17,11.12,145.44,percent of total billed charges,38.7
CREATININE BLOOD,82565,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,percent of total billed charges,285.17,11.12,145.44,percent of total billed charges,38.7
CREATININE UR-OTHER,82570,CPT,,,,,both,, ,32.84,32.84,Blue Cross and Blue Shield,Traditional,,12.71,38.7,percent of total billed charges,32.84,1.28,16.75,percent of total billed charges,38.7
CREATININE UR-OTHER,82570,CPT,,,,,both,,,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,percent of total billed charges,285.17,11.12,145.44,percent of total billed charges,38.7
CREATININE UR-OTHER,82570,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,percent of total billed charges,285.17,11.12,145.44,percent of total billed charges,38.7
Q14961 CREATININE UR,82570,CPT,,,,,both,, ,261.87,261.87,Blue Cross and Blue Shield,Traditional,,101.34,38.7,percent of total billed charges,261.87,10.21,133.55,percent of total billed charges,38.7
Q14961 CREATININE UR,82570,CPT,,,,,both,, ,261.87,261.87,Blue Cross and Blue Shield,Traditional,,101.34,38.7,percent of total billed charges,261.87,10.21,133.55,percent of total billed charges,38.7
Q1648 CREATININE UR-,82570,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,percent of total billed charges,285.17,11.12,145.44,percent of total billed charges,38.7
Q17422 CREATIN PTF C,82570,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,percent of total billed charges,285.17,11.12,145.44,percent of total billed charges,38.7
Q442 CREATININE UR-O,82570,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,percent of total billed charges,285.17,11.12,145.44,percent of total billed charges,38.7
Q682 CREATININE UR-O,82570,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,percent of total billed charges,285.17,11.12,145.44,percent of total billed charges,38.7
Q7507 CREATIN UR-OTH,82570,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,percent of total billed charges,285.17,11.12,145.44,percent of total billed charges,38.7
Q8525 CREATININE UR-,82570,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,percent of total billed charges,285.17,11.12,145.44,percent of total billed charges,38.7
CREATININE CLEARANCE,82575,CPT,,,,,both,,,555.45,555.45,Blue Cross and Blue Shield,Traditional,,214.96,38.7,percent of total billed charges,555.45,21.66,283.28,percent of total billed charges,38.7
CREATININE CLEARANCE,82575,CPT,,,,,both,, ,555.45,555.45,Blue Cross and Blue Shield,Traditional,,214.96,38.7,percent of total billed charges,555.45,21.66,283.28,percent of total billed charges,38.7
CRYOGLOBULIN,82595,CPT,,,,,both,, ,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
CRYOGLOBULIN,82595,CPT,,,,,both,, ,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
VITAMIN B-12,82607,CPT,,,,,both,, ,111.43,111.43,Blue Cross and Blue Shield,Traditional,,43.12,38.7,percent of total billed charges,111.43,4.35,56.83,percent of total billed charges,38.7
VITAMIN B-12,82607,CPT,,,,,both,,,641.06,641.06,Blue Cross and Blue Shield,Traditional,,248.09,38.7,percent of total billed charges,641.06,25.00,326.94,percent of total billed charges,38.7
VITAMIN B-12,82607,CPT,,,,,both,, ,641.06,641.06,Blue Cross and Blue Shield,Traditional,,248.09,38.7,percent of total billed charges,641.06,25.00,326.94,percent of total billed charges,38.7
VITAMIN B-12 BINDING,82608,CPT,,,,,both,, ,183.56,183.56,Blue Cross and Blue Shield,Traditional,,71.04,38.7,percent of total billed charges,183.56,7.16,93.62,percent of total billed charges,38.7
Q10570 CYSTAT C NEPH,82610,CPT,,,,,both,, ,121.25,121.25,Blue Cross and Blue Shield,Traditional,,46.92,38.7,percent of total billed charges,121.25,4.73,61.84,percent of total billed charges,38.7
"L910235 CREATININE, URINE",82615,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,percent of total billed charges,285.17,11.12,145.44,percent of total billed charges,38.7
L910235 CYSTINE/HOMOCYSTINE UR,82615,CPT,,,,,both,, ,50.00,50.00,Blue Cross and Blue Shield,Traditional,,19.35,38.7,percent of total billed charges,50.00,1.95,25.5,percent of total billed charges,38.7
DHEA,82626,CPT,,,,,both,, ,263.55,263.55,Blue Cross and Blue Shield,Traditional,,101.99,38.7,percent of total billed charges,263.55,10.28,134.41,percent of total billed charges,38.7
DHEA,82626,CPT,,,,,both,, ,263.55,263.55,Blue Cross and Blue Shield,Traditional,,101.99,38.7,percent of total billed charges,263.55,10.28,134.41,percent of total billed charges,38.7
DHEA-S,82627,CPT,,,,,both,, ,664.35,664.35,Blue Cross and Blue Shield,Traditional,,257.10,38.7,percent of total billed charges,664.35,25.91,338.82,percent of total billed charges,38.7
DHEA-S,82627,CPT,,,,,both,, ,664.35,664.35,Blue Cross and Blue Shield,Traditional,,257.10,38.7,percent of total billed charges,664.35,25.91,338.82,percent of total billed charges,38.7
DEOXYCORTISOL,82634,CPT,,,,,both,, ,177.39,177.39,Blue Cross and Blue Shield,Traditional,,68.65,38.7,percent of total billed charges,177.39,6.92,90.47,percent of total billed charges,38.7
DIBUCAINE NUMBER,82638,CPT,,,,,both,, ,270.28,270.28,Blue Cross and Blue Shield,Traditional,,104.60,38.7,percent of total billed charges,270.28,10.54,137.84,percent of total billed charges,38.7
DIBUCAINE NUMBER,82638,CPT,,,,,both,, ,270.28,270.28,Blue Cross and Blue Shield,Traditional,,104.60,38.7,percent of total billed charges,270.28,10.54,137.84,percent of total billed charges,38.7
DIHYDROTESTOST (DHT),82642,CPT,,,,,both,, ,151.84,151.84,Blue Cross and Blue Shield,Traditional,,58.76,38.7,percent of total billed charges,151.84,5.92,77.44,percent of total billed charges,38.7
DIHYDROXY VITAMIN D,82652,CPT,,,,,both,, ,379.18,379.18,Blue Cross and Blue Shield,Traditional,,146.74,38.7,percent of total billed charges,379.18,14.79,193.38,percent of total billed charges,38.7
DIHYDROXY VITAMIN D,82652,CPT,,,,,both,, ,1307.38,1307.38,Blue Cross and Blue Shield,Traditional,,505.96,38.7,percent of total billed charges,1307.38,50.99,666.76,percent of total billed charges,38.7
Q16558 VITD LCMSMS,82652,CPT,,,,,both,, ,554.89,554.89,Blue Cross and Blue Shield,Traditional,,214.74,38.7,percent of total billed charges,554.89,21.64,282.99,percent of total billed charges,38.7
Q14693 ELAST PANC QT,82653,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,percent of total billed charges,414.83,16.18,211.56,percent of total billed charges,38.7
Q14693 ELAST PANC QT,82653,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,percent of total billed charges,414.83,16.18,211.56,percent of total billed charges,38.7
"PANCREA ELASTAS,FEC",82656,CPT,,,,,both,, ,267.48,267.48,Blue Cross and Blue Shield,Traditional,,103.51,38.7,percent of total billed charges,267.48,10.43,136.41,percent of total billed charges,38.7
"PANCREA ELASTAS,FEC",82656,CPT,,,,,both,, ,267.48,267.48,Blue Cross and Blue Shield,Traditional,,103.51,38.7,percent of total billed charges,267.48,10.43,136.41,percent of total billed charges,38.7
Q14693 PE-1 IA,82656,CPT,,,,,both,, ,228.97,228.97,Blue Cross and Blue Shield,Traditional,,88.61,38.7,percent of total billed charges,228.97,8.93,116.77,percent of total billed charges,38.7
ERYTHROPOIETIN,82668,CPT,,,,,both,, ,1449.41,1449.41,Blue Cross and Blue Shield,Traditional,,560.92,38.7,percent of total billed charges,1449.41,56.53,739.2,percent of total billed charges,38.7
ERYTHROPOIETIN,82668,CPT,,,,,both,, ,1449.41,1449.41,Blue Cross and Blue Shield,Traditional,,560.92,38.7,percent of total billed charges,1449.41,56.53,739.2,percent of total billed charges,38.7
ESTRADIOL,82670,CPT,,,,,both,, ,976.46,976.46,Blue Cross and Blue Shield,Traditional,,377.89,38.7,percent of total billed charges,976.46,38.08,497.99,percent of total billed charges,38.7
L500649 ESTRADIOL,82670,CPT,,,,,both,, ,976.46,976.46,Blue Cross and Blue Shield,Traditional,,377.89,38.7,percent of total billed charges,976.46,38.08,497.99,percent of total billed charges,38.7
Q30289 ESTRADIOL US,82670,CPT,,,,,both,, ,976.46,976.46,Blue Cross and Blue Shield,Traditional,,377.89,38.7,percent of total billed charges,976.46,38.08,497.99,percent of total billed charges,38.7
Q36169 ESTRA FR DIR,82670,CPT,,,,,both,, ,895.84,895.84,Blue Cross and Blue Shield,Traditional,,346.69,38.7,percent of total billed charges,895.84,34.94,456.88,percent of total billed charges,38.7
Q36169 ESTRADIOL,82670,CPT,,,,,both,, ,976.46,976.46,Blue Cross and Blue Shield,Traditional,,377.89,38.7,percent of total billed charges,976.46,38.08,497.99,percent of total billed charges,38.7
Q4021 ESTRADIOL IA,82670,CPT,,,,,both,, ,976.46,976.46,Blue Cross and Blue Shield,Traditional,,377.89,38.7,percent of total billed charges,976.46,38.08,497.99,percent of total billed charges,38.7
Q36742 EST FR LCMSMS,82671,CPT,,,,,both,, ,170.36,170.36,Blue Cross and Blue Shield,Traditional,,65.93,38.7,percent of total billed charges,170.36,6.64,86.88,percent of total billed charges,38.7
ESTROGEN TOTAL,82672,CPT,,,,,both,, ,1727.55,1727.55,Blue Cross and Blue Shield,Traditional,,668.56,38.7,percent of total billed charges,1727.55,67.37,881.05,percent of total billed charges,38.7
Q439 ESTROG TOT RIA,82672,CPT,,,,,both,, ,304.53,304.53,Blue Cross and Blue Shield,Traditional,,117.85,38.7,percent of total billed charges,304.53,11.88,155.31,percent of total billed charges,38.7
ESTRIOL,82677,CPT,,,,,both,, ,317.44,317.44,Blue Cross and Blue Shield,Traditional,,122.85,38.7,percent of total billed charges,317.44,12.38,161.89,percent of total billed charges,38.7
ESTRIOL,82677,CPT,,,,,both,, ,317.44,317.44,Blue Cross and Blue Shield,Traditional,,122.85,38.7,percent of total billed charges,317.44,12.38,161.89,percent of total billed charges,38.7
ESTRONE,82679,CPT,,,,,both,, ,116.47,116.47,Blue Cross and Blue Shield,Traditional,,45.07,38.7,percent of total billed charges,116.47,4.54,59.4,percent of total billed charges,38.7
ESTRONE,82679,CPT,,,,,both,, ,116.47,116.47,Blue Cross and Blue Shield,Traditional,,45.07,38.7,percent of total billed charges,116.47,4.54,59.4,percent of total billed charges,38.7
L500649 ESTRA FR DIR,82681,CPT,,,,,both,, ,251.84,251.84,Blue Cross and Blue Shield,Traditional,,97.46,38.7,percent of total billed charges,251.84,9.82,128.44,percent of total billed charges,38.7
ETHYLENE GLYCOL,82693,CPT,,,,,both,,,1577.11,1577.11,Blue Cross and Blue Shield,Traditional,,610.34,38.7,percent of total billed charges,1577.11,61.51,804.33,percent of total billed charges,38.7
ETHYLENE GLYCOL,82693,CPT,,,,,both,, ,1577.11,1577.11,Blue Cross and Blue Shield,Traditional,,610.34,38.7,percent of total billed charges,1577.11,61.51,804.33,percent of total billed charges,38.7
Q801 ETHYL GLY CHRMT,82693,CPT,,,,,both,, ,935.21,935.21,Blue Cross and Blue Shield,Traditional,,361.93,38.7,percent of total billed charges,935.21,36.47,476.96,percent of total billed charges,38.7
FAT-LIPID FECES QUAL,82705,CPT,,,,,both,, ,600.92,600.92,Blue Cross and Blue Shield,Traditional,,232.56,38.7,percent of total billed charges,600.92,23.44,306.47,percent of total billed charges,38.7
FAT-LIPID FECES QUAL,82705,CPT,,,,,both,, ,600.92,600.92,Blue Cross and Blue Shield,Traditional,,232.56,38.7,percent of total billed charges,600.92,23.44,306.47,percent of total billed charges,38.7
FAT-LIPID FECES QUAN,82710,CPT,,,,,both,, ,768.20,768.20,Blue Cross and Blue Shield,Traditional,,297.29,38.7,percent of total billed charges,768.20,29.96,391.78,percent of total billed charges,38.7
FAT-LIPID FECES QUAN,82710,CPT,,,,,both,, ,768.20,768.20,Blue Cross and Blue Shield,Traditional,,297.29,38.7,percent of total billed charges,768.20,29.96,391.78,percent of total billed charges,38.7
FECAL FAT QUANT 72HR,82710,CPT,,,,,both,, ,122.20,122.20,Blue Cross and Blue Shield,Traditional,,47.29,38.7,percent of total billed charges,122.20,4.77,62.32,percent of total billed charges,38.7
Q90559 VLCFA,82726,CPT,,,,,both,, ,88.69,88.69,Blue Cross and Blue Shield,Traditional,,34.32,38.7,percent of total billed charges,88.69,3.46,45.23,percent of total billed charges,38.7
FERRITIN,82728,CPT,,,,,both,, ,100.75,100.75,Blue Cross and Blue Shield,Traditional,,38.99,38.7,percent of total billed charges,100.75,3.93,51.38,percent of total billed charges,38.7
FERRITIN,82728,CPT,,,,,both,,,864.19,864.19,Blue Cross and Blue Shield,Traditional,,334.44,38.7,percent of total billed charges,864.19,33.70,440.74,percent of total billed charges,38.7
FERRITIN,82728,CPT,,,,,both,, ,864.19,864.19,Blue Cross and Blue Shield,Traditional,,334.44,38.7,percent of total billed charges,864.19,33.70,440.74,percent of total billed charges,38.7
FETAL FIBRONECTIN,82731,CPT,,,,,both,, ,701.69,701.69,Blue Cross and Blue Shield,Traditional,,271.55,38.7,percent of total billed charges,701.69,27.37,357.86,percent of total billed charges,38.7
FOLIC ACID SERUM,82746,CPT,,,,,both,, ,108.61,108.61,Blue Cross and Blue Shield,Traditional,,42.03,38.7,percent of total billed charges,108.61,4.24,55.39,percent of total billed charges,38.7
FOLIC ACID SERUM,82746,CPT,,,,,both,,,735.65,735.65,Blue Cross and Blue Shield,Traditional,,284.70,38.7,percent of total billed charges,735.65,28.69,375.18,percent of total billed charges,38.7
FOLIC ACID SERUM,82746,CPT,,,,,both,, ,735.65,735.65,Blue Cross and Blue Shield,Traditional,,284.70,38.7,percent of total billed charges,735.65,28.69,375.18,percent of total billed charges,38.7
FOLIC ACID RBC,82747,CPT,,,,,both,, ,627.30,627.30,Blue Cross and Blue Shield,Traditional,,242.77,38.7,percent of total billed charges,627.30,24.46,319.92,percent of total billed charges,38.7
FOLIC ACID RBC,82747,CPT,,,,,both,, ,627.30,627.30,Blue Cross and Blue Shield,Traditional,,242.77,38.7,percent of total billed charges,627.30,24.46,319.92,percent of total billed charges,38.7
NBS GALACTOSE,82760,CPT,,,,,both,, ,66.80,66.80,Blue Cross and Blue Shield,Traditional,,25.85,38.7,percent of total billed charges,66.80,2.61,34.07,percent of total billed charges,38.7
NBS GALACTOSE TRANS,82776,CPT,,,,,both,, ,49.96,49.96,Blue Cross and Blue Shield,Traditional,,19.33,38.7,percent of total billed charges,49.96,1.95,25.48,percent of total billed charges,38.7
L341142GAMMAGLO MGAD,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,percent of total billed charges,220.88,8.61,112.65,percent of total billed charges,38.7
L341142GAMMAGLO MGAD,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,percent of total billed charges,220.88,8.61,112.65,percent of total billed charges,38.7
L341142GAMMAGLO MGAD,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,percent of total billed charges,220.88,8.61,112.65,percent of total billed charges,38.7
L341142GAMMAGLO MGAD,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,percent of total billed charges,220.88,8.61,112.65,percent of total billed charges,38.7
Q38940 GAMMAGLOB M G A D,82784,CPT,,,,,both,, ,196.75,196.75,Blue Cross and Blue Shield,Traditional,,76.14,38.7,percent of total billed charges,196.75,7.67,100.34,percent of total billed charges,38.7
Q543 IGG ITA,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,percent of total billed charges,220.88,8.61,112.65,percent of total billed charges,38.7
Q543 IGG ITA,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,percent of total billed charges,220.88,8.61,112.65,percent of total billed charges,38.7
Q543 IGG ITA,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,percent of total billed charges,220.88,8.61,112.65,percent of total billed charges,38.7
Q543 IGG ITA,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,percent of total billed charges,220.88,8.61,112.65,percent of total billed charges,38.7
Q7083GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,percent of total billed charges,220.88,8.61,112.65,percent of total billed charges,38.7
Q7083GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,percent of total billed charges,220.88,8.61,112.65,percent of total billed charges,38.7
Q7083GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,percent of total billed charges,220.88,8.61,112.65,percent of total billed charges,38.7
Q7083GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,percent of total billed charges,220.88,8.61,112.65,percent of total billed charges,38.7
GAMMAGLOBULIN IGE,82785,CPT,,,,,both,, ,127.14,127.14,Blue Cross and Blue Shield,Traditional,,49.20,38.7,percent of total billed charges,127.14,4.96,64.84,percent of total billed charges,38.7
GAMMAGLOBULIN IGE,82785,CPT,,,,,both,, ,906.30,906.30,Blue Cross and Blue Shield,Traditional,,350.74,38.7,percent of total billed charges,906.30,35.35,462.21,percent of total billed charges,38.7
Q10643 GAMMAGLOB IGE,82785,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,percent of total billed charges,148.75,5.80,75.86,percent of total billed charges,38.7
Q10643 GAMMAGLOB IGE,82785,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,percent of total billed charges,148.75,5.80,75.86,percent of total billed charges,38.7
Q10643 GAMMAGLOB IGE,82785,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,percent of total billed charges,148.75,5.80,75.86,percent of total billed charges,38.7
Q10643 GAMMAGLOB IGE,82785,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,percent of total billed charges,148.75,5.80,75.86,percent of total billed charges,38.7
"IGG SUB 1,2,3 OR 4",82787,CPT,,,,,both,, ,389.01,389.01,Blue Cross and Blue Shield,Traditional,,150.55,38.7,percent of total billed charges,389.01,15.17,198.4,percent of total billed charges,38.7
Q143422 IGG SUB4 NEP,82787,CPT,,,,,both,, ,389.01,389.01,Blue Cross and Blue Shield,Traditional,,150.55,38.7,percent of total billed charges,389.01,15.17,198.4,percent of total billed charges,38.7
"Q7903IGG SUB 1,2,3,4",82787,CPT,,,,,both,, ,389.01,389.01,Blue Cross and Blue Shield,Traditional,,150.55,38.7,percent of total billed charges,389.01,15.17,198.4,percent of total billed charges,38.7
BLOOD PH,82800,CPT,,,,,both,, ,618.04,618.04,Blue Cross and Blue Shield,Traditional,,239.18,38.7,percent of total billed charges,618.04,24.10,315.2,percent of total billed charges,38.7
BLD GAS W-O2 SAT DIR,82805,CPT,,,,,both,, ,1760.39,1760.39,Blue Cross and Blue Shield,Traditional,,681.27,38.7,percent of total billed charges,1760.39,68.66,897.8,percent of total billed charges,38.7
"BLD GAS, O2 SAT ONLY",82810,CPT,,,,,both,, ,100.63,100.63,Blue Cross and Blue Shield,Traditional,,38.94,38.7,percent of total billed charges,100.63,3.92,51.32,percent of total billed charges,38.7
"BLD GAS, O2 SAT ONLY",82810,CPT,,,,,both,, ,100.63,100.63,Blue Cross and Blue Shield,Traditional,,38.94,38.7,percent of total billed charges,100.63,3.92,51.32,percent of total billed charges,38.7
GASTRIN,82941,CPT,,,,,both,, ,863.91,863.91,Blue Cross and Blue Shield,Traditional,,334.33,38.7,percent of total billed charges,863.91,33.69,440.59,percent of total billed charges,38.7
GASTRIN,82941,CPT,,,,,both,, ,863.91,863.91,Blue Cross and Blue Shield,Traditional,,334.33,38.7,percent of total billed charges,863.91,33.69,440.59,percent of total billed charges,38.7
Q519 GLUCAG EXT-RIA,82943,CPT,,,,,both,, ,82.51,82.51,Blue Cross and Blue Shield,Traditional,,31.93,38.7,percent of total billed charges,82.51,3.22,42.08,percent of total billed charges,38.7
GLUCOSE BODY FLUID,82945,CPT,,,,,both,, ,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,percent of total billed charges,412.87,16.10,210.56,percent of total billed charges,38.7
"GLUCOSE, QUANT",82947,CPT,,,,,both,, ,21.89,21.89,Blue Cross and Blue Shield,Traditional,,8.47,38.7,percent of total billed charges,21.89,0.85,11.16,percent of total billed charges,38.7
"GLUCOSE, QUANT",82947,CPT,,,,,both,,,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,percent of total billed charges,240.26,9.37,122.53,percent of total billed charges,38.7
"GLUCOSE, QUANT",82947,CPT,,,,,both,, ,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,percent of total billed charges,240.26,9.37,122.53,percent of total billed charges,38.7
"GLUCOSE, POST DOSE",82950,CPT,,,,,both,,,450.48,450.48,Blue Cross and Blue Shield,Traditional,,174.34,38.7,percent of total billed charges,450.48,17.57,229.74,percent of total billed charges,38.7
"GLUCOSE, POST DOSE",82950,CPT,,,,,both,, ,450.48,450.48,Blue Cross and Blue Shield,Traditional,,174.34,38.7,percent of total billed charges,450.48,17.57,229.74,percent of total billed charges,38.7
GTT 3 SPEC,82951,CPT,,,,,both,, ,758.95,758.95,Blue Cross and Blue Shield,Traditional,,293.71,38.7,percent of total billed charges,758.95,29.60,387.06,percent of total billed charges,38.7
GTT ADD SP,82952,CPT,,,,,both,, ,188.05,188.05,Blue Cross and Blue Shield,Traditional,,72.78,38.7,percent of total billed charges,188.05,7.33,95.91,percent of total billed charges,38.7
"G6PD, QUANT",82955,CPT,,,,,both,, ,1026.43,1026.43,Blue Cross and Blue Shield,Traditional,,397.23,38.7,percent of total billed charges,1026.43,40.03,523.48,percent of total billed charges,38.7
"L121003 G6PD, QUANT",82955,CPT,,,,,both,, ,60.00,60.00,Blue Cross and Blue Shield,Traditional,,23.22,38.7,percent of total billed charges,60.00,2.34,30.6,percent of total billed charges,38.7
"GLU,HOME USE DIAGNOS",82962,CPT,,,,,both,, ,8.76,8.76,Blue Cross and Blue Shield,Traditional,,3.39,38.7,percent of total billed charges,8.76,0.34,4.47,percent of total billed charges,38.7
"GLU,HOME USE DIAGNOS",82962,CPT,,,,,both,, ,99.35,99.35,Blue Cross and Blue Shield,Traditional,,38.45,38.7,percent of total billed charges,99.35,3.87,50.67,percent of total billed charges,38.7
GGT,82977,CPT,,,,,both,, ,71.01,71.01,Blue Cross and Blue Shield,Traditional,,27.48,38.7,percent of total billed charges,71.01,2.77,36.22,percent of total billed charges,38.7
GGT,82977,CPT,,,,,both,, ,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,percent of total billed charges,412.87,16.10,210.56,percent of total billed charges,38.7
L7700 GSH TOT,82978,CPT,,,,,both,, ,61.00,61.00,Blue Cross and Blue Shield,Traditional,,23.61,38.7,percent of total billed charges,61.00,2.38,31.11,percent of total billed charges,38.7
GLYCATED PROTEIN,82985,CPT,,,,,both,, ,263.83,263.83,Blue Cross and Blue Shield,Traditional,,102.10,38.7,percent of total billed charges,263.83,10.29,134.55,percent of total billed charges,38.7
Q8340 FRUCTOSAMINE C,82985,CPT,,,,,both,, ,298.92,298.92,Blue Cross and Blue Shield,Traditional,,115.68,38.7,percent of total billed charges,298.92,11.66,152.45,percent of total billed charges,38.7
FOLLICLE STIM HORM,83001,CPT,,,,,both,, ,137.25,137.25,Blue Cross and Blue Shield,Traditional,,53.12,38.7,percent of total billed charges,137.25,5.35,70,percent of total billed charges,38.7
FOLLICLE STIM HORM,83001,CPT,,,,,both,, ,812.55,812.55,Blue Cross and Blue Shield,Traditional,,314.46,38.7,percent of total billed charges,812.55,31.69,414.4,percent of total billed charges,38.7
FOLLICLE STIM HORM,83001,CPT,,,,,both,, ,812.55,812.55,Blue Cross and Blue Shield,Traditional,,314.46,38.7,percent of total billed charges,812.55,31.69,414.4,percent of total billed charges,38.7
LEUTEINIZING HORMONE,83002,CPT,,,,,both,, ,136.97,136.97,Blue Cross and Blue Shield,Traditional,,53.01,38.7,percent of total billed charges,136.97,5.34,69.85,percent of total billed charges,38.7
LEUTEINIZING HORMONE,83002,CPT,,,,,both,, ,812.55,812.55,Blue Cross and Blue Shield,Traditional,,314.46,38.7,percent of total billed charges,812.55,31.69,414.4,percent of total billed charges,38.7
LEUTEINIZING HORMONE,83002,CPT,,,,,both,, ,812.55,812.55,Blue Cross and Blue Shield,Traditional,,314.46,38.7,percent of total billed charges,812.55,31.69,414.4,percent of total billed charges,38.7
GROWTH HORMONE,83003,CPT,,,,,both,, ,1201.85,1201.85,Blue Cross and Blue Shield,Traditional,,465.12,38.7,percent of total billed charges,1201.85,46.87,612.94,percent of total billed charges,38.7
Q521 GH IA,83003,CPT,,,,,both,, ,74.86,74.86,Blue Cross and Blue Shield,Traditional,,28.97,38.7,percent of total billed charges,74.86,2.92,38.18,percent of total billed charges,38.7
Q91823 GRTH STM GN 2,83006,CPT,,,,,both,, ,189.00,189.00,Blue Cross and Blue Shield,Traditional,,73.14,38.7,percent of total billed charges,189.00,7.37,96.39,percent of total billed charges,38.7
"HAPTOGLOBIN, QUANT",83010,CPT,,,,,both,, ,1109.23,1109.23,Blue Cross and Blue Shield,Traditional,,429.27,38.7,percent of total billed charges,1109.23,43.26,565.71,percent of total billed charges,38.7
"HAPTOGLOBIN, QUANT",83010,CPT,,,,,both,, ,1109.23,1109.23,Blue Cross and Blue Shield,Traditional,,429.27,38.7,percent of total billed charges,1109.23,43.26,565.71,percent of total billed charges,38.7
Q14839H.PYLO UREA IR,83013,CPT,,,,,both,, ,623.38,623.38,Blue Cross and Blue Shield,Traditional,,241.25,38.7,percent of total billed charges,623.38,24.31,317.92,percent of total billed charges,38.7
"HEAVY METALS, QUANT",83018,CPT,,,,,both,, ,175.14,175.14,Blue Cross and Blue Shield,Traditional,,67.78,38.7,percent of total billed charges,175.14,6.83,89.32,percent of total billed charges,38.7
L121690 - HEMOGLOBIN ELECTRO,83020,CPT,,,,,both,, ,108.15,108.15,Blue Cross and Blue Shield,Traditional,,41.85,38.7,percent of total billed charges,108.15,4.22,55.16,percent of total billed charges,38.7
NBS HGB ELECTRO,83020,CPT,,,,,both,, ,76.90,76.90,Blue Cross and Blue Shield,Traditional,,29.76,38.7,percent of total billed charges,76.90,3.00,39.22,percent of total billed charges,38.7
"HEMOGLOBIN, CHROMA",83021,CPT,,,,,both,, ,180.60,180.60,Blue Cross and Blue Shield,Traditional,,69.89,38.7,percent of total billed charges,180.60,7.04,92.11,percent of total billed charges,38.7
"HEMOGLOBIN, CHROMA",83021,CPT,,,,,both,, ,180.60,180.60,Blue Cross and Blue Shield,Traditional,,69.89,38.7,percent of total billed charges,180.60,7.04,92.11,percent of total billed charges,38.7
"HEMOGLOB,FETGAL,QUAL",83033,CPT,,,,,both,, ,354.77,354.77,Blue Cross and Blue Shield,Traditional,,137.30,38.7,percent of total billed charges,354.77,13.84,180.93,percent of total billed charges,38.7
HEMOGLOBIN A1C,83036,CPT,,,,,both,, ,95.71,95.71,Blue Cross and Blue Shield,Traditional,,37.04,38.7,percent of total billed charges,95.71,3.73,48.81,percent of total billed charges,38.7
HEMOGLOBIN A1C,83036,CPT,,,,,both,,,454.97,454.97,Blue Cross and Blue Shield,Traditional,,176.07,38.7,percent of total billed charges,454.97,17.74,232.03,percent of total billed charges,38.7
HEMOGLOBIN A1C,83036,CPT,,,,,both,, ,454.97,454.97,Blue Cross and Blue Shield,Traditional,,176.07,38.7,percent of total billed charges,454.97,17.74,232.03,percent of total billed charges,38.7
HEMOGLOBIN A1C,83036,CPT,,,,,both,, ,454.97,454.97,Blue Cross and Blue Shield,Traditional,,176.07,38.7,percent of total billed charges,454.97,17.74,232.03,percent of total billed charges,38.7
"METHEMOGLOBIN,QUAN",83050,CPT,,,,,both,, ,122.09,122.09,Blue Cross and Blue Shield,Traditional,,47.25,38.7,percent of total billed charges,122.09,4.76,62.27,percent of total billed charges,38.7
"HEMOGLOBIN, PLASMA",83051,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
"HEMOSIDERIN, QUAL",83070,CPT,,,,,both,, ,373.57,373.57,Blue Cross and Blue Shield,Traditional,,144.57,38.7,percent of total billed charges,373.57,14.57,190.52,percent of total billed charges,38.7
HISTAMINE,83088,CPT,,,,,both,, ,385.09,385.09,Blue Cross and Blue Shield,Traditional,,149.03,38.7,percent of total billed charges,385.09,15.02,196.4,percent of total billed charges,38.7
Q36586 HISTAM PL RIA,83088,CPT,,,,,both,, ,385.09,385.09,Blue Cross and Blue Shield,Traditional,,149.03,38.7,percent of total billed charges,385.09,15.02,196.4,percent of total billed charges,38.7
Q4946 HISTAM U24 IA,83088,CPT,,,,,both,, ,385.09,385.09,Blue Cross and Blue Shield,Traditional,,149.03,38.7,percent of total billed charges,385.09,15.02,196.4,percent of total billed charges,38.7
HOMOCYSTEINE,83090,CPT,,,,,both,, ,227.91,227.91,Blue Cross and Blue Shield,Traditional,,88.20,38.7,percent of total billed charges,227.91,8.89,116.23,percent of total billed charges,38.7
HOMOCYSTEINE,83090,CPT,,,,,both,, ,227.91,227.91,Blue Cross and Blue Shield,Traditional,,88.20,38.7,percent of total billed charges,227.91,8.89,116.23,percent of total billed charges,38.7
CORTICOSTEROIDS,83491,CPT,,,,,both,, ,1217.28,1217.28,Blue Cross and Blue Shield,Traditional,,471.09,38.7,percent of total billed charges,1217.28,47.47,620.81,percent of total billed charges,38.7
5-HIAA,83497,CPT,,,,,both,, ,976.46,976.46,Blue Cross and Blue Shield,Traditional,,377.89,38.7,percent of total billed charges,976.46,38.08,497.99,percent of total billed charges,38.7
Q1648 5-HIAA,83497,CPT,,,,,both,, ,976.46,976.46,Blue Cross and Blue Shield,Traditional,,377.89,38.7,percent of total billed charges,976.46,38.08,497.99,percent of total billed charges,38.7
Q523 5-HIAA U24 HPLC,83497,CPT,,,,,both,, ,976.46,976.46,Blue Cross and Blue Shield,Traditional,,377.89,38.7,percent of total billed charges,976.46,38.08,497.99,percent of total billed charges,38.7
HYDROXYPROGES 17-D,83498,CPT,,,,,both,, ,600.92,600.92,Blue Cross and Blue Shield,Traditional,,232.56,38.7,percent of total billed charges,600.92,23.44,306.47,percent of total billed charges,38.7
NBS HYDROXYPROG 17-D,83498,CPT,,,,,both,, ,162.23,162.23,Blue Cross and Blue Shield,Traditional,,62.78,38.7,percent of total billed charges,162.23,6.33,82.74,percent of total billed charges,38.7
Q17180 17-OHP LCMSMS,83498,CPT,,,,,both,, ,601.20,601.20,Blue Cross and Blue Shield,Traditional,,232.66,38.7,percent of total billed charges,601.20,23.45,306.61,percent of total billed charges,38.7
"IMMUNOASSAY, OTHER",83516,CPT,,,,,both,,,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,percent of total billed charges,765.96,29.87,390.64,percent of total billed charges,38.7
"IMMUNOASSAY, OTHER",83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,percent of total billed charges,765.96,29.87,390.64,percent of total billed charges,38.7
L162045 IA OTH,83516,CPT,,,,,both,, ,702.72,702.72,Blue Cross and Blue Shield,Traditional,,271.95,38.7,percent of total billed charges,702.72,27.41,358.39,percent of total billed charges,38.7
L163061 IA OTHER,83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,percent of total billed charges,765.96,29.87,390.64,percent of total billed charges,38.7
L165126 IA OTH,83516,CPT,,,,,both,, ,702.72,702.72,Blue Cross and Blue Shield,Traditional,,271.95,38.7,percent of total billed charges,702.72,27.41,358.39,percent of total billed charges,38.7
L341142 IA OTHER,83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,percent of total billed charges,765.96,29.87,390.64,percent of total billed charges,38.7
L520057 ANTI-HMGCR,83516,CPT,,,,,both,, ,630.00,630.00,Blue Cross and Blue Shield,Traditional,,243.81,38.7,percent of total billed charges,630.00,24.57,321.3,percent of total billed charges,38.7
L520085 IA OTHER,83516,CPT,,,,,both,, ,702.72,702.72,Blue Cross and Blue Shield,Traditional,,271.95,38.7,percent of total billed charges,702.72,27.41,358.39,percent of total billed charges,38.7
L520139 ANTI-GP210AB,83516,CPT,,,,,both,, ,300.00,300.00,Blue Cross and Blue Shield,Traditional,,116.10,38.7,percent of total billed charges,300.00,11.70,153,percent of total billed charges,38.7
L520311 CARP AB,83516,CPT,,,,,both,, ,520.00,520.00,Blue Cross and Blue Shield,Traditional,,201.24,38.7,percent of total billed charges,520.00,20.28,265.2,percent of total billed charges,38.7
L6486PARIET AB ELISA,83516,CPT,,,,,both,, ,81.50,81.50,Blue Cross and Blue Shield,Traditional,,31.54,38.7,percent of total billed charges,81.50,3.18,41.57,percent of total billed charges,38.7
Q15114PARCL AB ELISA,83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,percent of total billed charges,765.96,29.87,390.64,percent of total billed charges,38.7
Q18855 KU AUTOANTIBODIES,83516,CPT,,,,,both,, ,682.25,682.25,Blue Cross and Blue Shield,Traditional,,264.03,38.7,percent of total billed charges,682.25,26.61,347.95,percent of total billed charges,38.7
Q19899RNA P-III ELIS,83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,percent of total billed charges,765.96,29.87,390.64,percent of total billed charges,38.7
Q34283 RIBO P AB IA,83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,percent of total billed charges,765.96,29.87,390.64,percent of total billed charges,38.7
Q36336 IA OTHER,83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,percent of total billed charges,765.96,29.87,390.64,percent of total billed charges,38.7
Q37056 HISTON AB EIA,83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,percent of total billed charges,765.96,29.87,390.64,percent of total billed charges,38.7
Q39226  21OH AB,83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,percent of total billed charges,765.96,29.87,390.64,percent of total billed charges,38.7
L10421 MSH,83519,CPT,,,,,both,, ,184.00,184.00,Blue Cross and Blue Shield,Traditional,,71.21,38.7,percent of total billed charges,184.00,7.18,93.84,percent of total billed charges,38.7
L504600 MUSCLE SPECIFIC KINASE,83519,CPT,,,,,both,, ,1200.00,1200.00,Blue Cross and Blue Shield,Traditional,,464.40,38.7,percent of total billed charges,1200.00,46.80,612,percent of total billed charges,38.7
Q26474 ACHRMAB RBA,83519,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,percent of total billed charges,728.07,28.39,371.32,percent of total billed charges,38.7
Q26474 ACHRMAB RBA,83519,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,percent of total billed charges,728.07,28.39,371.32,percent of total billed charges,38.7
Q26474 ACHRMAB RBA,83519,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,percent of total billed charges,728.07,28.39,371.32,percent of total billed charges,38.7
Q26474 ACHRMAB RBA,83519,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,percent of total billed charges,728.07,28.39,371.32,percent of total billed charges,38.7
Q5738 TBII RRA,83519,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,percent of total billed charges,728.07,28.39,371.32,percent of total billed charges,38.7
Q5738 TBII RRA,83519,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,percent of total billed charges,728.07,28.39,371.32,percent of total billed charges,38.7
Q5738 TBII RRA,83519,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,percent of total billed charges,728.07,28.39,371.32,percent of total billed charges,38.7
Q5738 TBII RRA,83519,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,percent of total billed charges,728.07,28.39,371.32,percent of total billed charges,38.7
"IMMUNOASSAY, NOS",83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,percent of total billed charges,414.83,16.18,211.56,percent of total billed charges,38.7
"IMMUNOASSAY, NOS",83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,percent of total billed charges,414.83,16.18,211.56,percent of total billed charges,38.7
L117021 VEGF SER,83520,CPT,,,,,both,, ,175.00,175.00,Blue Cross and Blue Shield,Traditional,,67.73,38.7,percent of total billed charges,175.00,6.83,89.25,percent of total billed charges,38.7
L146795INHIBIN B EIA,83520,CPT,,,,,both,, ,380.59,380.59,Blue Cross and Blue Shield,Traditional,,147.29,38.7,percent of total billed charges,380.59,14.84,194.1,percent of total billed charges,38.7
L500016PROTHR FR 1+2,83520,CPT,,,,,both,, ,172.70,172.70,Blue Cross and Blue Shield,Traditional,,66.83,38.7,percent of total billed charges,172.70,6.74,88.08,percent of total billed charges,38.7
L500124 MMP9,83520,CPT,,,,,both,, ,170.00,170.00,Blue Cross and Blue Shield,Traditional,,65.79,38.7,percent of total billed charges,170.00,6.63,86.7,percent of total billed charges,38.7
L520085 IA NOS,83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,percent of total billed charges,414.83,16.18,211.56,percent of total billed charges,38.7
L520085 IA NOS,83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,percent of total billed charges,414.83,16.18,211.56,percent of total billed charges,38.7
NBS IMMUNOASSAY NOS,83520,CPT,,,,,both,, ,77.47,77.47,Blue Cross and Blue Shield,Traditional,,29.98,38.7,percent of total billed charges,77.47,3.02,39.51,percent of total billed charges,38.7
Q113354 IA NOS,83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,percent of total billed charges,414.83,16.18,211.56,percent of total billed charges,38.7
Q113354 IA NOS,83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,percent of total billed charges,414.83,16.18,211.56,percent of total billed charges,38.7
Q145128 VEGF ELISA,83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,percent of total billed charges,414.83,16.18,211.56,percent of total billed charges,38.7
Q145128 VEGF ELISA,83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,percent of total billed charges,414.83,16.18,211.56,percent of total billed charges,38.7
Q34458 IGFBP-3 IA,83520,CPT,,,,,both,, ,444.59,444.59,Blue Cross and Blue Shield,Traditional,,172.06,38.7,percent of total billed charges,444.59,17.34,226.74,percent of total billed charges,38.7
Q34458 IGFBP-3 IA,83520,CPT,,,,,both,, ,444.59,444.59,Blue Cross and Blue Shield,Traditional,,172.06,38.7,percent of total billed charges,444.59,17.34,226.74,percent of total billed charges,38.7
Q34484 TRYPTASE FIA,83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,percent of total billed charges,414.83,16.18,211.56,percent of total billed charges,38.7
Q34484 TRYPTASE FIA,83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,percent of total billed charges,414.83,16.18,211.56,percent of total billed charges,38.7
Q38928 SOLUBLE LIVER ANTIGEN(SLA) AUTOAN,83520,CPT,,,,,both,, ,369.50,369.50,Blue Cross and Blue Shield,Traditional,,143.00,38.7,percent of total billed charges,369.50,14.41,188.45,percent of total billed charges,38.7
Q38928 SOLUBLE LIVER ANTIGEN(SLA) AUTOAN,83520,CPT,,,,,both,, ,369.50,369.50,Blue Cross and Blue Shield,Traditional,,143.00,38.7,percent of total billed charges,369.50,14.41,188.45,percent of total billed charges,38.7
Q38928 SOLUBLE LIVER ANTIGEN(SLA) AUTOAN,83520,CPT,,,,,both,, ,369.50,369.50,Blue Cross and Blue Shield,Traditional,,143.00,38.7,percent of total billed charges,369.50,14.41,188.45,percent of total billed charges,38.7
Q38928 SOLUBLE LIVER ANTIGEN(SLA) AUTOAN,83520,CPT,,,,,both,, ,369.50,369.50,Blue Cross and Blue Shield,Traditional,,143.00,38.7,percent of total billed charges,369.50,14.41,188.45,percent of total billed charges,38.7
L121210 LTCHN KAPLAM,83521,CPT,,,,,both,, ,103.62,103.62,Blue Cross and Blue Shield,Traditional,,40.10,38.7,percent of total billed charges,103.62,4.04,52.85,percent of total billed charges,38.7
L121210 LTCHN KAPLAM,83521,CPT,,,,,both,, ,103.62,103.62,Blue Cross and Blue Shield,Traditional,,40.10,38.7,percent of total billed charges,103.62,4.04,52.85,percent of total billed charges,38.7
Q11234 LTCHN KAP LAM,83521,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
Q11234 LTCHN KAP LAM,83521,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
"INSULIN, TOTAL",83525,CPT,,,,,both,, ,53.89,53.89,Blue Cross and Blue Shield,Traditional,,20.86,38.7,percent of total billed charges,53.89,2.10,27.48,percent of total billed charges,38.7
"INSULIN, TOTAL",83525,CPT,,,,,both,, ,600.92,600.92,Blue Cross and Blue Shield,Traditional,,232.56,38.7,percent of total billed charges,600.92,23.44,306.47,percent of total billed charges,38.7
Q561 INSULIN IA,83525,CPT,,,,,both,, ,632.36,632.36,Blue Cross and Blue Shield,Traditional,,244.72,38.7,percent of total billed charges,632.36,24.66,322.5,percent of total billed charges,38.7
"INSULIN, FREE",83527,CPT,,,,,both,, ,193.94,193.94,Blue Cross and Blue Shield,Traditional,,75.05,38.7,percent of total billed charges,193.94,7.56,98.91,percent of total billed charges,38.7
L501561 INSULIN FREE,83527,CPT,,,,,both,, ,193.94,193.94,Blue Cross and Blue Shield,Traditional,,75.05,38.7,percent of total billed charges,193.94,7.56,98.91,percent of total billed charges,38.7
Q36700 INSULIN FR IA,83527,CPT,,,,,both,, ,193.94,193.94,Blue Cross and Blue Shield,Traditional,,75.05,38.7,percent of total billed charges,193.94,7.56,98.91,percent of total billed charges,38.7
IRON,83540,CPT,,,,,both,, ,63.99,63.99,Blue Cross and Blue Shield,Traditional,,24.76,38.7,percent of total billed charges,63.99,2.50,32.63,percent of total billed charges,38.7
IRON,83540,CPT,,,,,both,,,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
IRON,83540,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
IRON BINDING CAPACIT,83550,CPT,,,,,both,, ,86.16,86.16,Blue Cross and Blue Shield,Traditional,,33.34,38.7,percent of total billed charges,86.16,3.36,43.94,percent of total billed charges,38.7
IRON BINDING CAPACIT,83550,CPT,,,,,both,,,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,percent of total billed charges,526.26,20.52,268.39,percent of total billed charges,38.7
IRON BINDING CAPACIT,83550,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,percent of total billed charges,526.26,20.52,268.39,percent of total billed charges,38.7
"17-KETOSTEROIDS, TOT",83586,CPT,,,,,both,, ,164.19,164.19,Blue Cross and Blue Shield,Traditional,,63.54,38.7,percent of total billed charges,164.19,6.40,83.74,percent of total billed charges,38.7
LACTIC ACID,83605,CPT,,,,,both,, ,105.25,105.25,Blue Cross and Blue Shield,Traditional,,40.73,38.7,percent of total billed charges,105.25,4.10,53.68,percent of total billed charges,38.7
LACTIC ACID,83605,CPT,,,,,both,,,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
LACTIC ACID,83605,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
LACTATE DEHYDROLDH,83615,CPT,,,,,both,, ,59.50,59.50,Blue Cross and Blue Shield,Traditional,,23.03,38.7,percent of total billed charges,59.50,2.32,30.35,percent of total billed charges,38.7
LACTATE DEHYDROLDH,83615,CPT,,,,,both,, ,600.92,600.92,Blue Cross and Blue Shield,Traditional,,232.56,38.7,percent of total billed charges,600.92,23.44,306.47,percent of total billed charges,38.7
LACTATE DEHYDROLDH,83615,CPT,,,,,both,, ,600.92,600.92,Blue Cross and Blue Shield,Traditional,,232.56,38.7,percent of total billed charges,600.92,23.44,306.47,percent of total billed charges,38.7
LDH ISOENZYMES,83625,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q10156 LACTOFER IA,83630,CPT,,,,,both,, ,267.48,267.48,Blue Cross and Blue Shield,Traditional,,103.51,38.7,percent of total billed charges,267.48,10.43,136.41,percent of total billed charges,38.7
LEAD,83655,CPT,,,,,both,, ,56.97,56.97,Blue Cross and Blue Shield,Traditional,,22.05,38.7,percent of total billed charges,56.97,2.22,29.05,percent of total billed charges,38.7
LEAD,83655,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q22996 LEAD,83655,CPT,,,,,both,, ,615.75,615.75,Blue Cross and Blue Shield,Traditional,,238.30,38.7,percent of total billed charges,615.75,24.01,314.03,percent of total billed charges,38.7
Q22996 LEAD,83655,CPT,,,,,both,, ,615.75,615.75,Blue Cross and Blue Shield,Traditional,,238.30,38.7,percent of total billed charges,615.75,24.01,314.03,percent of total billed charges,38.7
Q36438 LEAD,83655,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q36440LEAD U24 ICPMS,83655,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q599 PB BL ICP/MS,83655,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q601 PB U ICP/MS,83655,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q7507 LEAD,83655,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q7655 LEAD,83655,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
"FETAL LUNG,L-S RATIO",83661,CPT,,,,,both,, ,175.14,175.14,Blue Cross and Blue Shield,Traditional,,67.78,38.7,percent of total billed charges,175.14,6.83,89.32,percent of total billed charges,38.7
"FETAL LUNG, FPIA",83663,CPT,,,,,both,, ,863.91,863.91,Blue Cross and Blue Shield,Traditional,,334.33,38.7,percent of total billed charges,863.91,33.69,440.59,percent of total billed charges,38.7
LIPASE,83690,CPT,,,,,both,, ,67.92,67.92,Blue Cross and Blue Shield,Traditional,,26.29,38.7,percent of total billed charges,67.92,2.65,34.64,percent of total billed charges,38.7
LIPASE,83690,CPT,,,,,both,,,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
LIPASE,83690,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
LIPOPROTEIN A,83695,CPT,,,,,both,, ,112.27,112.27,Blue Cross and Blue Shield,Traditional,,43.45,38.7,percent of total billed charges,112.27,4.38,57.26,percent of total billed charges,38.7
LIPOPROTEIN A,83695,CPT,,,,,both,, ,112.27,112.27,Blue Cross and Blue Shield,Traditional,,43.45,38.7,percent of total billed charges,112.27,4.38,57.26,percent of total billed charges,38.7
Q34604 LIPOPRT A ITA,83695,CPT,,,,,both,, ,467.04,467.04,Blue Cross and Blue Shield,Traditional,,180.74,38.7,percent of total billed charges,467.04,18.21,238.19,percent of total billed charges,38.7
Q94220 LP-PLA2,83698,CPT,,,,,both,, ,216.39,216.39,Blue Cross and Blue Shield,Traditional,,83.74,38.7,percent of total billed charges,216.39,8.44,110.36,percent of total billed charges,38.7
LIPOPROT BLD BY NMR,83704,CPT,,,,,both,, ,374.69,374.69,Blue Cross and Blue Shield,Traditional,,145.01,38.7,percent of total billed charges,374.69,14.61,191.09,percent of total billed charges,38.7
LIPOPROT BLD BY NMR,83704,CPT,,,,,both,, ,374.69,374.69,Blue Cross and Blue Shield,Traditional,,145.01,38.7,percent of total billed charges,374.69,14.61,191.09,percent of total billed charges,38.7
"LIPOPROTEIN, HDL",83718,CPT,,,,,both,, ,60.63,60.63,Blue Cross and Blue Shield,Traditional,,23.46,38.7,percent of total billed charges,60.63,2.36,30.92,percent of total billed charges,38.7
"LIPOPROTEIN, HDL",83718,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,percent of total billed charges,480.79,18.75,245.2,percent of total billed charges,38.7
"LIPOPROTEIN, LDL",83721,CPT,,,,,both,, ,570.89,570.89,Blue Cross and Blue Shield,Traditional,,220.93,38.7,percent of total billed charges,570.89,22.26,291.15,percent of total billed charges,38.7
"L910235 MAGNESIUM, URINE",83735,CPT,,,,,both,, ,67.00,67.00,Blue Cross and Blue Shield,Traditional,,25.93,38.7,percent of total billed charges,67.00,2.61,34.17,percent of total billed charges,38.7
"L910235 MAGNESIUM, URINE",83735,CPT,,,,,both,, ,67.00,67.00,Blue Cross and Blue Shield,Traditional,,25.93,38.7,percent of total billed charges,67.00,2.61,34.17,percent of total billed charges,38.7
MAGNESIUM,83735,CPT,,,,,both,, ,49.68,49.68,Blue Cross and Blue Shield,Traditional,,19.23,38.7,percent of total billed charges,49.68,1.94,25.34,percent of total billed charges,38.7
MAGNESIUM,83735,CPT,,,,,both,,,344.10,344.10,Blue Cross and Blue Shield,Traditional,,133.17,38.7,percent of total billed charges,344.10,13.42,175.49,percent of total billed charges,38.7
MAGNESIUM,83735,CPT,,,,,both,, ,344.10,344.10,Blue Cross and Blue Shield,Traditional,,133.17,38.7,percent of total billed charges,344.10,13.42,175.49,percent of total billed charges,38.7
MAGNESIUM,83735,CPT,,,,,both,, ,344.10,344.10,Blue Cross and Blue Shield,Traditional,,133.17,38.7,percent of total billed charges,344.10,13.42,175.49,percent of total billed charges,38.7
MANGANESE WHOLE BLOOD,83785,CPT,,,,,both,, ,133.00,133.00,Blue Cross and Blue Shield,Traditional,,51.47,38.7,percent of total billed charges,133.00,5.19,67.83,percent of total billed charges,38.7
L70034 I S/P ICP/MS,83789,CPT,,,,,both,, ,315.00,315.00,Blue Cross and Blue Shield,Traditional,,121.91,38.7,percent of total billed charges,315.00,12.29,160.65,percent of total billed charges,38.7
L70222 I U ICP/MS,83789,CPT,,,,,both,, ,390.49,390.49,Blue Cross and Blue Shield,Traditional,,151.12,38.7,percent of total billed charges,390.49,15.23,199.15,percent of total billed charges,38.7
MASS SPECTRO QUANT,83789,CPT,,,,,both,, ,402.20,402.20,Blue Cross and Blue Shield,Traditional,,155.65,38.7,percent of total billed charges,402.20,15.69,205.12,percent of total billed charges,38.7
MASS SPECTRO QUANT,83789,CPT,,,,,both,, ,402.20,402.20,Blue Cross and Blue Shield,Traditional,,155.65,38.7,percent of total billed charges,402.20,15.69,205.12,percent of total billed charges,38.7
MERCURY,83825,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,percent of total billed charges,751.36,29.30,383.19,percent of total billed charges,38.7
Q36438 MERCURY,83825,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,percent of total billed charges,751.36,29.30,383.19,percent of total billed charges,38.7
Q636 HG BL ICP/MS,83825,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,percent of total billed charges,751.36,29.30,383.19,percent of total billed charges,38.7
Q7507 MERCURY,83825,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,percent of total billed charges,751.36,29.30,383.19,percent of total billed charges,38.7
Q7655 MERCURY,83825,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,percent of total billed charges,751.36,29.30,383.19,percent of total billed charges,38.7
METANEPHRINES,83835,CPT,,,,,both,, ,2599.05,2599.05,Blue Cross and Blue Shield,Traditional,,1005.83,38.7,percent of total billed charges,2599.05,101.36,1325.52,percent of total billed charges,38.7
Q14961 METANEPHRINES,83835,CPT,,,,,both,, ,488.65,488.65,Blue Cross and Blue Shield,Traditional,,189.11,38.7,percent of total billed charges,488.65,19.06,249.21,percent of total billed charges,38.7
Q14962MNFR U24 LCMSM,83835,CPT,,,,,both,, ,488.65,488.65,Blue Cross and Blue Shield,Traditional,,189.11,38.7,percent of total billed charges,488.65,19.06,249.21,percent of total billed charges,38.7
Q19548 MN FRC LCMSMS,83835,CPT,,,,,both,, ,488.65,488.65,Blue Cross and Blue Shield,Traditional,,189.11,38.7,percent of total billed charges,488.65,19.06,249.21,percent of total billed charges,38.7
MYELIN BASIC PROTEIN,83873,CPT,,,,,both,, ,509.14,509.14,Blue Cross and Blue Shield,Traditional,,197.04,38.7,percent of total billed charges,509.14,19.86,259.66,percent of total billed charges,38.7
MYELIN BASIC PROTEIN,83873,CPT,,,,,both,, ,509.14,509.14,Blue Cross and Blue Shield,Traditional,,197.04,38.7,percent of total billed charges,509.14,19.86,259.66,percent of total billed charges,38.7
MYOGLOBIN,83874,CPT,,,,,both,, ,627.30,627.30,Blue Cross and Blue Shield,Traditional,,242.77,38.7,percent of total billed charges,627.30,24.46,319.92,percent of total billed charges,38.7
MYOGLOBIN,83874,CPT,,,,,both,, ,627.30,627.30,Blue Cross and Blue Shield,Traditional,,242.77,38.7,percent of total billed charges,627.30,24.46,319.92,percent of total billed charges,38.7
L143000 NT-PROBNP,83880,CPT,,,,,both,, ,450.00,450.00,Blue Cross and Blue Shield,Traditional,,174.15,38.7,percent of total billed charges,450.00,17.55,229.5,percent of total billed charges,38.7
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,, ,279.55,279.55,Blue Cross and Blue Shield,Traditional,,108.19,38.7,percent of total billed charges,279.55,10.90,142.57,percent of total billed charges,38.7
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,,,1229.07,1229.07,Blue Cross and Blue Shield,Traditional,,475.65,38.7,percent of total billed charges,1229.07,47.93,626.83,percent of total billed charges,38.7
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,, ,1229.07,1229.07,Blue Cross and Blue Shield,Traditional,,475.65,38.7,percent of total billed charges,1229.07,47.93,626.83,percent of total billed charges,38.7
"NEPHELOMETRY, NOS",83883,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
"NEPHELOMETRY, NOS",83883,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
Q38940 NEPHELOMETRY NOS,83883,CPT,,,,,both,, ,374.75,374.75,Blue Cross and Blue Shield,Traditional,,145.03,38.7,percent of total billed charges,374.75,14.62,191.12,percent of total billed charges,38.7
NICKEL,83885,CPT,,,,,both,, ,934.09,934.09,Blue Cross and Blue Shield,Traditional,,361.49,38.7,percent of total billed charges,934.09,36.43,476.39,percent of total billed charges,38.7
NUCLEOTIDASE 5',83915,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,percent of total billed charges,871.22,33.98,444.32,percent of total billed charges,38.7
NUCLEOTIDASE 5',83915,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,percent of total billed charges,871.22,33.98,444.32,percent of total billed charges,38.7
OLIGOCLONAL BANDS,83916,CPT,,,,,both,, ,530.75,530.75,Blue Cross and Blue Shield,Traditional,,205.40,38.7,percent of total billed charges,530.75,20.70,270.68,percent of total billed charges,38.7
OLIGOCLONAL BANDS,83916,CPT,,,,,both,, ,530.75,530.75,Blue Cross and Blue Shield,Traditional,,205.40,38.7,percent of total billed charges,530.75,20.70,270.68,percent of total billed charges,38.7
"ORGAN ACID,SIN,QUAN",83921,CPT,,,,,both,, ,396.02,396.02,Blue Cross and Blue Shield,Traditional,,153.26,38.7,percent of total billed charges,396.02,15.44,201.97,percent of total billed charges,38.7
"ORGAN ACID,SIN,QUAN",83921,CPT,,,,,both,, ,396.02,396.02,Blue Cross and Blue Shield,Traditional,,153.26,38.7,percent of total billed charges,396.02,15.44,201.97,percent of total billed charges,38.7
L2071 OSMALALITY FPD,83930,CPT,,,,,both,, ,40.89,40.89,Blue Cross and Blue Shield,Traditional,,15.82,38.7,percent of total billed charges,40.89,1.59,20.85,percent of total billed charges,38.7
"OSMOLALITY, BLOOD",83930,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
L3442 OSMOLALI U FPD,83935,CPT,,,,,both,, ,50.90,50.90,Blue Cross and Blue Shield,Traditional,,19.70,38.7,percent of total billed charges,50.90,1.99,25.96,percent of total billed charges,38.7
"OSMOLALITY,URINE",83935,CPT,,,,,both,, ,67.07,67.07,Blue Cross and Blue Shield,Traditional,,25.96,38.7,percent of total billed charges,67.07,2.62,34.21,percent of total billed charges,38.7
"OSMOLALITY,URINE",83935,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
L10249 OSTREOC ELISA,83937,CPT,,,,,both,, ,203.60,203.60,Blue Cross and Blue Shield,Traditional,,78.79,38.7,percent of total billed charges,203.60,7.94,103.84,percent of total billed charges,38.7
OSTEOCALCIN,83937,CPT,,,,,both,, ,447.39,447.39,Blue Cross and Blue Shield,Traditional,,173.14,38.7,percent of total billed charges,447.39,17.45,228.17,percent of total billed charges,38.7
"L910235 OXALATE, URINE",83945,CPT,,,,,both,, ,660.98,660.98,Blue Cross and Blue Shield,Traditional,,255.80,38.7,percent of total billed charges,660.98,25.78,337.1,percent of total billed charges,38.7
"L910235 OXALATE, URINE",83945,CPT,,,,,both,, ,660.98,660.98,Blue Cross and Blue Shield,Traditional,,255.80,38.7,percent of total billed charges,660.98,25.78,337.1,percent of total billed charges,38.7
"L910235 OXALATE, URINE",83945,CPT,,,,,both,, ,660.98,660.98,Blue Cross and Blue Shield,Traditional,,255.80,38.7,percent of total billed charges,660.98,25.78,337.1,percent of total billed charges,38.7
"L910235 OXALATE, URINE",83945,CPT,,,,,both,, ,660.98,660.98,Blue Cross and Blue Shield,Traditional,,255.80,38.7,percent of total billed charges,660.98,25.78,337.1,percent of total billed charges,38.7
L15610 PTH INT ECLIA,83970,CPT,,,,,both,, ,420.49,420.49,Blue Cross and Blue Shield,Traditional,,162.73,38.7,percent of total billed charges,420.49,16.40,214.45,percent of total billed charges,38.7
PARATHORMONE PTH,83970,CPT,,,,,both,, ,160.55,160.55,Blue Cross and Blue Shield,Traditional,,62.13,38.7,percent of total billed charges,160.55,6.26,81.88,percent of total billed charges,38.7
PARATHORMONE PTH,83970,CPT,,,,,both,, ,1420.49,1420.49,Blue Cross and Blue Shield,Traditional,,549.73,38.7,percent of total billed charges,1420.49,55.40,724.45,percent of total billed charges,38.7
"L910235 PH FLUID, NOS",83986,CPT,,,,,both,, ,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,percent of total billed charges,240.26,9.37,122.53,percent of total billed charges,38.7
"PH FLUID,NOS",83986,CPT,,,,,both,, ,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,percent of total billed charges,240.26,9.37,122.53,percent of total billed charges,38.7
"Q442 PH FLUID,NOS",83986,CPT,,,,,both,, ,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,percent of total billed charges,240.26,9.37,122.53,percent of total billed charges,38.7
L790600 PCP MS,83992,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
CALPROTECTIN FECAL,83993,CPT,,,,,both,, ,395.75,395.75,Blue Cross and Blue Shield,Traditional,,153.16,38.7,percent of total billed charges,395.75,15.43,201.83,percent of total billed charges,38.7
CALPROTECTIN FECAL,83993,CPT,,,,,both,, ,395.75,395.75,Blue Cross and Blue Shield,Traditional,,153.16,38.7,percent of total billed charges,395.75,15.43,201.83,percent of total billed charges,38.7
NBS PHENYLALANINE BL,84030,CPT,,,,,both,, ,32.84,32.84,Blue Cross and Blue Shield,Traditional,,12.71,38.7,percent of total billed charges,32.84,1.28,16.75,percent of total billed charges,38.7
NBS PHENYLALANINE BL,84030,CPT,,,,,both,, ,32.84,32.84,Blue Cross and Blue Shield,Traditional,,12.71,38.7,percent of total billed charges,32.84,1.28,16.75,percent of total billed charges,38.7
"PHOSPHATASE, PROSTAT",84066,CPT,,,,,both,, ,540.85,540.85,Blue Cross and Blue Shield,Traditional,,209.31,38.7,percent of total billed charges,540.85,21.09,275.83,percent of total billed charges,38.7
"PHOSPHATASE,ALKALINE",84075,CPT,,,,,both,, ,51.08,51.08,Blue Cross and Blue Shield,Traditional,,19.77,38.7,percent of total billed charges,51.08,1.99,26.05,percent of total billed charges,38.7
"PHOSPHATASE,ALKALINE",84075,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
"PHOSPHATASE,ALKALINE",84075,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
"PHOSPHATASE,ALK ISO",84080,CPT,,,,,both,, ,637.41,637.41,Blue Cross and Blue Shield,Traditional,,246.68,38.7,percent of total billed charges,637.41,24.86,325.08,percent of total billed charges,38.7
"PHOSPHATASE,ALK ISO",84080,CPT,,,,,both,, ,637.41,637.41,Blue Cross and Blue Shield,Traditional,,246.68,38.7,percent of total billed charges,637.41,24.86,325.08,percent of total billed charges,38.7
PHOSPHATIDYLGLYCEROL,84081,CPT,,,,,both,, ,389.01,389.01,Blue Cross and Blue Shield,Traditional,,150.55,38.7,percent of total billed charges,389.01,15.17,198.4,percent of total billed charges,38.7
"PHOSPHORUS, BLOOD",84100,CPT,,,,,both,, ,46.87,46.87,Blue Cross and Blue Shield,Traditional,,18.14,38.7,percent of total billed charges,46.87,1.83,23.9,percent of total billed charges,38.7
"PHOSPHORUS, BLOOD",84100,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"L910235 PHOSPHORUS, URINE",84105,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"PHOSPHORUS, URINE",84105,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"Q442 PHOSPHORUS, URI",84105,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"PORPHOBILINOGEN,QUAN",84110,CPT,,,,,both,, ,630.96,630.96,Blue Cross and Blue Shield,Traditional,,244.18,38.7,percent of total billed charges,630.96,24.61,321.79,percent of total billed charges,38.7
PAMG-1 QUALITATIVE,84112,CPT,,,,,both,, ,488.09,488.09,Blue Cross and Blue Shield,Traditional,,188.89,38.7,percent of total billed charges,488.09,19.04,248.93,percent of total billed charges,38.7
L3194 PORPH QT U24,84120,CPT,,,,,both,, ,811.43,811.43,Blue Cross and Blue Shield,Traditional,,314.02,38.7,percent of total billed charges,811.43,31.65,413.83,percent of total billed charges,38.7
"PORPHYRINS,UR,QUAN",84120,CPT,,,,,both,, ,811.42,811.42,Blue Cross and Blue Shield,Traditional,,314.02,38.7,percent of total billed charges,811.42,31.65,413.82,percent of total billed charges,38.7
POTASSIUM SER PL WB,84132,CPT,,,,,both,, ,47.15,47.15,Blue Cross and Blue Shield,Traditional,,18.25,38.7,percent of total billed charges,47.15,1.84,24.05,percent of total billed charges,38.7
POTASSIUM SER PL WB,84132,CPT,,,,,both,,,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,percent of total billed charges,240.26,9.37,122.53,percent of total billed charges,38.7
POTASSIUM SER PL WB,84132,CPT,,,,,both,, ,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,percent of total billed charges,240.26,9.37,122.53,percent of total billed charges,38.7
"L910235 POTASSIUM, URINE",84133,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"POTASSIUM, URINE",84133,CPT,,,,,both,,,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"POTASSIUM, URINE",84133,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"Q442 POTASSIUM, URIN",84133,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
PREALBUMIN,84134,CPT,,,,,both,, ,105.25,105.25,Blue Cross and Blue Shield,Traditional,,40.73,38.7,percent of total billed charges,105.25,4.10,53.68,percent of total billed charges,38.7
PREALBUMIN,84134,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,40.41,528.49,percent of total billed charges,38.7
PREGNENOLONE,84140,CPT,,,,,both,, ,164.75,164.75,Blue Cross and Blue Shield,Traditional,,63.76,38.7,percent of total billed charges,164.75,6.43,84.02,percent of total billed charges,38.7
PREGNENOLONE,84140,CPT,,,,,both,, ,164.75,164.75,Blue Cross and Blue Shield,Traditional,,63.76,38.7,percent of total billed charges,164.75,6.43,84.02,percent of total billed charges,38.7
"PREGNENOLONE,17-OH",84143,CPT,,,,,both,, ,387.89,387.89,Blue Cross and Blue Shield,Traditional,,150.11,38.7,percent of total billed charges,387.89,15.13,197.82,percent of total billed charges,38.7
PROGESTERONE,84144,CPT,,,,,both,, ,62.58,62.58,Blue Cross and Blue Shield,Traditional,,24.22,38.7,percent of total billed charges,62.58,2.44,31.92,percent of total billed charges,38.7
PROGESTERONE,84144,CPT,,,,,both,, ,1217.28,1217.28,Blue Cross and Blue Shield,Traditional,,471.09,38.7,percent of total billed charges,1217.28,47.47,620.81,percent of total billed charges,38.7
PROGESTERONE,84144,CPT,,,,,both,, ,1217.28,1217.28,Blue Cross and Blue Shield,Traditional,,471.09,38.7,percent of total billed charges,1217.28,47.47,620.81,percent of total billed charges,38.7
PROCALCITONIN PCT,84145,CPT,,,,,both,, ,232.11,232.11,Blue Cross and Blue Shield,Traditional,,89.83,38.7,percent of total billed charges,232.11,9.05,118.38,percent of total billed charges,38.7
PROCALCITONIN PCT,84145,CPT,,,,,both,, ,232.11,232.11,Blue Cross and Blue Shield,Traditional,,89.83,38.7,percent of total billed charges,232.11,9.05,118.38,percent of total billed charges,38.7
L4465 PROLACTI ECLIA,84146,CPT,,,,,both,, ,628.30,628.30,Blue Cross and Blue Shield,Traditional,,243.15,38.7,percent of total billed charges,628.30,24.50,320.43,percent of total billed charges,38.7
PROLACTIN,84146,CPT,,,,,both,, ,143.14,143.14,Blue Cross and Blue Shield,Traditional,,55.40,38.7,percent of total billed charges,143.14,5.58,73,percent of total billed charges,38.7
PROLACTIN,84146,CPT,,,,,both,, ,1077.50,1077.50,Blue Cross and Blue Shield,Traditional,,416.99,38.7,percent of total billed charges,1077.50,42.02,549.53,percent of total billed charges,38.7
Q40049 PROLACTIN,84146,CPT,,,,,both,, ,959.75,959.75,Blue Cross and Blue Shield,Traditional,,371.42,38.7,percent of total billed charges,959.75,37.43,489.47,percent of total billed charges,38.7
Q40049 PROLACTIN,84146,CPT,,,,,both,, ,959.75,959.75,Blue Cross and Blue Shield,Traditional,,371.42,38.7,percent of total billed charges,959.75,37.43,489.47,percent of total billed charges,38.7
Q93958 23BPG UR,84150,CPT,,,,,both,, ,390.13,390.13,Blue Cross and Blue Shield,Traditional,,150.98,38.7,percent of total billed charges,390.13,15.22,198.97,percent of total billed charges,38.7
PSA (prostate specific antigen),84153,CPT,,,,,both,,,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,40.41,528.49,percent of total billed charges,38.7
"PSA, TOTAL",84153,CPT,,,,,both,, ,135.85,135.85,Blue Cross and Blue Shield,Traditional,,52.57,38.7,percent of total billed charges,135.85,5.30,69.28,percent of total billed charges,38.7
"PSA, TOTAL",84153,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,40.41,528.49,percent of total billed charges,38.7
"PSA, TOTAL",84153,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,40.41,528.49,percent of total billed charges,38.7
PSA (prostate specific antigen),84154,CPT,,,,,both,,,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,40.41,528.49,percent of total billed charges,38.7
"PSA, FREE",84154,CPT,,,,,both,, ,135.85,135.85,Blue Cross and Blue Shield,Traditional,,52.57,38.7,percent of total billed charges,135.85,5.30,69.28,percent of total billed charges,38.7
"PSA, FREE",84154,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,40.41,528.49,percent of total billed charges,38.7
"PSA, FREE",84154,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,40.41,528.49,percent of total billed charges,38.7
PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,35.93,35.93,Blue Cross and Blue Shield,Traditional,,13.90,38.7,percent of total billed charges,35.93,1.40,18.32,percent of total billed charges,38.7
Q10269 PROT TOT SER,84155,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
Q10269 PROT TOT SER,84155,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
Q10269 PROT TOT SER,84155,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
Q10269 PROT TOT SER,84155,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
Q38940 PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,374.75,374.75,Blue Cross and Blue Shield,Traditional,,145.03,38.7,percent of total billed charges,374.75,14.62,191.12,percent of total billed charges,38.7
PROT TOTL RANDOM URI,84156,CPT,,,,,both,,,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
PROT TOTL RANDOM URI,84156,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
PROT TOTL RANDOM URI,84156,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
PROTEIN TOT OTHR SRC,84157,CPT,,,,,both,, ,35.93,35.93,Blue Cross and Blue Shield,Traditional,,13.90,38.7,percent of total billed charges,35.93,1.40,18.32,percent of total billed charges,38.7
Q749 PROT TOT OTH SR,84157,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
PROTEINELECTR FR-QNT,84165,CPT,,,,,both,, ,105.81,105.81,Blue Cross and Blue Shield,Traditional,,40.95,38.7,percent of total billed charges,105.81,4.13,53.96,percent of total billed charges,38.7
Q10269 SPE FR QT,84165,CPT,,,,,both,, ,609.34,609.34,Blue Cross and Blue Shield,Traditional,,235.81,38.7,percent of total billed charges,609.34,23.76,310.76,percent of total billed charges,38.7
Q10269 SPE FR QT,84165,CPT,,,,,both,, ,609.34,609.34,Blue Cross and Blue Shield,Traditional,,235.81,38.7,percent of total billed charges,609.34,23.76,310.76,percent of total billed charges,38.7
Q10269 SPE FR QT,84165,CPT,,,,,both,, ,609.34,609.34,Blue Cross and Blue Shield,Traditional,,235.81,38.7,percent of total billed charges,609.34,23.76,310.76,percent of total billed charges,38.7
Q10269 SPE FR QT,84165,CPT,,,,,both,, ,609.34,609.34,Blue Cross and Blue Shield,Traditional,,235.81,38.7,percent of total billed charges,609.34,23.76,310.76,percent of total billed charges,38.7
Q38940 PROTEINELECTR FR QNT,84165,CPT,,,,,both,, ,542.75,542.75,Blue Cross and Blue Shield,Traditional,,210.04,38.7,percent of total billed charges,542.75,21.17,276.8,percent of total billed charges,38.7
PROT E-PHOR-URIN-CSF,84166,CPT,,,,,both,, ,429.71,429.71,Blue Cross and Blue Shield,Traditional,,166.30,38.7,percent of total billed charges,429.71,16.76,219.15,percent of total billed charges,38.7
Q749 PROT E-PHOR-URI,84166,CPT,,,,,both,, ,429.71,429.71,Blue Cross and Blue Shield,Traditional,,166.30,38.7,percent of total billed charges,429.71,16.76,219.15,percent of total billed charges,38.7
Q8525 PROT E-PHOR-UR,84166,CPT,,,,,both,, ,429.71,429.71,Blue Cross and Blue Shield,Traditional,,166.30,38.7,percent of total billed charges,429.71,16.76,219.15,percent of total billed charges,38.7
Q94685 WEST BLOT PRB,84182,CPT,,,,,both,, ,136.40,136.40,Blue Cross and Blue Shield,Traditional,,52.79,38.7,percent of total billed charges,136.40,5.32,69.56,percent of total billed charges,38.7
Q94685 WEST BLOT PRB,84182,CPT,,,,,both,, ,136.40,136.40,Blue Cross and Blue Shield,Traditional,,52.79,38.7,percent of total billed charges,136.40,5.32,69.56,percent of total billed charges,38.7
"PROTOPORPH,RBC,QUAN",84202,CPT,,,,,both,, ,199.27,199.27,Blue Cross and Blue Shield,Traditional,,77.12,38.7,percent of total billed charges,199.27,7.77,101.63,percent of total billed charges,38.7
"PROTOPORPH,RBC,QUAN",84202,CPT,,,,,both,, ,199.27,199.27,Blue Cross and Blue Shield,Traditional,,77.12,38.7,percent of total billed charges,199.27,7.77,101.63,percent of total billed charges,38.7
Q22996 PROTOPORPH RBC QUAN,84202,CPT,,,,,both,, ,177.50,177.50,Blue Cross and Blue Shield,Traditional,,68.69,38.7,percent of total billed charges,177.50,6.92,90.53,percent of total billed charges,38.7
PROINSULIN,84206,CPT,,,,,both,, ,266.91,266.91,Blue Cross and Blue Shield,Traditional,,103.29,38.7,percent of total billed charges,266.91,10.41,136.12,percent of total billed charges,38.7
Q760 PROINSULIN IA,84206,CPT,,,,,both,, ,337.09,337.09,Blue Cross and Blue Shield,Traditional,,130.45,38.7,percent of total billed charges,337.09,13.15,171.92,percent of total billed charges,38.7
VITAMIN B-6,84207,CPT,,,,,both,, ,738.17,738.17,Blue Cross and Blue Shield,Traditional,,285.67,38.7,percent of total billed charges,738.17,28.79,376.47,percent of total billed charges,38.7
VITAMIN B-6,84207,CPT,,,,,both,, ,738.17,738.17,Blue Cross and Blue Shield,Traditional,,285.67,38.7,percent of total billed charges,738.17,28.79,376.47,percent of total billed charges,38.7
PYRUVATE,84210,CPT,,,,,both,, ,1066.84,1066.84,Blue Cross and Blue Shield,Traditional,,412.87,38.7,percent of total billed charges,1066.84,41.61,544.09,percent of total billed charges,38.7
"RECEPTOR, NON-ENDO",84238,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
"RECEPTOR, NON-ENDO",84238,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,percent of total billed charges,326.71,12.74,166.62,percent of total billed charges,38.7
Q16846 PL REN LCMSMS,84244,CPT,,,,,both,, ,475.46,475.46,Blue Cross and Blue Shield,Traditional,,184.00,38.7,percent of total billed charges,475.46,18.54,242.48,percent of total billed charges,38.7
Q16846 PL REN LCMSMS,84244,CPT,,,,,both,, ,475.46,475.46,Blue Cross and Blue Shield,Traditional,,184.00,38.7,percent of total billed charges,475.46,18.54,242.48,percent of total billed charges,38.7
RENIN,84244,CPT,,,,,both,, ,1487.01,1487.01,Blue Cross and Blue Shield,Traditional,,575.47,38.7,percent of total billed charges,1487.01,57.99,758.38,percent of total billed charges,38.7
VITAMIN B-2,84252,CPT,,,,,both,, ,180.75,180.75,Blue Cross and Blue Shield,Traditional,,69.95,38.7,percent of total billed charges,180.75,7.05,92.18,percent of total billed charges,38.7
SELENIUM,84255,CPT,,,,,both,, ,409.50,409.50,Blue Cross and Blue Shield,Traditional,,158.48,38.7,percent of total billed charges,409.50,15.97,208.85,percent of total billed charges,38.7
SELENIUM,84255,CPT,,,,,both,, ,409.50,409.50,Blue Cross and Blue Shield,Traditional,,158.48,38.7,percent of total billed charges,409.50,15.97,208.85,percent of total billed charges,38.7
SEROTONIN,84260,CPT,,,,,both,, ,94.58,94.58,Blue Cross and Blue Shield,Traditional,,36.60,38.7,percent of total billed charges,94.58,3.69,48.24,percent of total billed charges,38.7
Q14966 SEX HORM BIND,84270,CPT,,,,,both,, ,288.25,288.25,Blue Cross and Blue Shield,Traditional,,111.55,38.7,percent of total billed charges,288.25,11.24,147.01,percent of total billed charges,38.7
Q30740 SHBG IA,84270,CPT,,,,,both,, ,288.25,288.25,Blue Cross and Blue Shield,Traditional,,111.55,38.7,percent of total billed charges,288.25,11.24,147.01,percent of total billed charges,38.7
SEX HORM BIND GLOB,84270,CPT,,,,,both,, ,288.25,288.25,Blue Cross and Blue Shield,Traditional,,111.55,38.7,percent of total billed charges,288.25,11.24,147.01,percent of total billed charges,38.7
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,, ,47.43,47.43,Blue Cross and Blue Shield,Traditional,,18.36,38.7,percent of total billed charges,47.43,1.85,24.19,percent of total billed charges,38.7
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,,,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"L910235 SODIUM, URINE",84300,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"Q442 SODIUM, URINE R",84300,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,, ,47.99,47.99,Blue Cross and Blue Shield,Traditional,,18.57,38.7,percent of total billed charges,47.99,1.87,24.47,percent of total billed charges,38.7
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,,,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
SODIUM OTHER SOURCE,84302,CPT,,,,,both,, ,82.51,82.51,Blue Cross and Blue Shield,Traditional,,31.93,38.7,percent of total billed charges,82.51,3.22,42.08,percent of total billed charges,38.7
SOMATOMEDIN,84305,CPT,,,,,both,, ,870.37,870.37,Blue Cross and Blue Shield,Traditional,,336.83,38.7,percent of total billed charges,870.37,33.94,443.89,percent of total billed charges,38.7
SOMATOMEDIN,84305,CPT,,,,,both,, ,870.37,870.37,Blue Cross and Blue Shield,Traditional,,336.83,38.7,percent of total billed charges,870.37,33.94,443.89,percent of total billed charges,38.7
ADENO DEAMNASE BFLD,84311,CPT,,,,,both,, ,93.74,93.74,Blue Cross and Blue Shield,Traditional,,36.28,38.7,percent of total billed charges,93.74,3.66,47.81,percent of total billed charges,38.7
Q175858 CHOLEST PF C,84311,CPT,,,,,both,, ,93.74,93.74,Blue Cross and Blue Shield,Traditional,,36.28,38.7,percent of total billed charges,93.74,3.66,47.81,percent of total billed charges,38.7
"SPECTROPHOTO, NOS",84311,CPT,,,,,both,, ,93.74,93.74,Blue Cross and Blue Shield,Traditional,,36.28,38.7,percent of total billed charges,93.74,3.66,47.81,percent of total billed charges,38.7
SPECIFIC GRAVITY,84315,CPT,,,,,both,, ,210.50,210.50,Blue Cross and Blue Shield,Traditional,,81.46,38.7,percent of total billed charges,210.50,8.21,107.36,percent of total billed charges,38.7
"SUGARS, SING, QUAL",84376,CPT,,,,,both,, ,93.74,93.74,Blue Cross and Blue Shield,Traditional,,36.28,38.7,percent of total billed charges,93.74,3.66,47.81,percent of total billed charges,38.7
GLYCOMARK,84378,CPT,,,,,both,, ,224.00,224.00,Blue Cross and Blue Shield,Traditional,,86.69,38.7,percent of total billed charges,224.00,8.74,114.24,percent of total billed charges,38.7
"L910235 SULFATE, URINE",84392,CPT,,,,,both,, ,31.71,31.71,Blue Cross and Blue Shield,Traditional,,12.27,38.7,percent of total billed charges,31.71,1.24,16.17,percent of total billed charges,38.7
"L910235 SULFATE, URINE",84392,CPT,,,,,both,, ,31.71,31.71,Blue Cross and Blue Shield,Traditional,,12.27,38.7,percent of total billed charges,31.71,1.24,16.17,percent of total billed charges,38.7
Q18944 TST FREE,84402,CPT,,,,,both,, ,1017.17,1017.17,Blue Cross and Blue Shield,Traditional,,393.64,38.7,percent of total billed charges,1017.17,39.67,518.76,percent of total billed charges,38.7
Q36170 TESTOST FREE,84402,CPT,,,,,both,,,1017.17,1017.17,Blue Cross and Blue Shield,Traditional,,393.64,38.7,percent of total billed charges,1017.17,39.67,518.76,percent of total billed charges,38.7
Q36170 TESTOST FREE,84402,CPT,,,,,both,, ,1017.17,1017.17,Blue Cross and Blue Shield,Traditional,,393.64,38.7,percent of total billed charges,1017.17,39.67,518.76,percent of total billed charges,38.7
"TESTOSTERONE, FREE",84402,CPT,,,,,both,, ,1017.17,1017.17,Blue Cross and Blue Shield,Traditional,,393.64,38.7,percent of total billed charges,1017.17,39.67,518.76,percent of total billed charges,38.7
Q14966 TESTOST TOTAL,84403,CPT,,,,,both,, ,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
Q36170 TESTOST TOTAL,84403,CPT,,,,,both,,,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
Q36170 TESTOST TOTAL,84403,CPT,,,,,both,, ,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
"TESTOSTERONE, TOTAL",84403,CPT,,,,,both,, ,190.86,190.86,Blue Cross and Blue Shield,Traditional,,73.86,38.7,percent of total billed charges,190.86,7.44,97.34,percent of total billed charges,38.7
"TESTOSTERONE, TOTAL",84403,CPT,,,,,both,, ,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
L70282 TEST FR WB T,84410,CPT,,,,,both,, ,211.15,211.15,Blue Cross and Blue Shield,Traditional,,81.72,38.7,percent of total billed charges,211.15,8.23,107.69,percent of total billed charges,38.7
L121186VITB1 BL HPLC,84425,CPT,,,,,both,, ,1318.66,1318.66,Blue Cross and Blue Shield,Traditional,,510.32,38.7,percent of total billed charges,1318.66,51.43,672.52,percent of total billed charges,38.7
Q5042 B1 BL LC/MS/MS,84425,CPT,,,,,both,, ,269.16,269.16,Blue Cross and Blue Shield,Traditional,,104.16,38.7,percent of total billed charges,269.16,10.50,137.27,percent of total billed charges,38.7
Q90353 VIT B1 LCMSMS,84425,CPT,,,,,both,, ,303.69,303.69,Blue Cross and Blue Shield,Traditional,,117.53,38.7,percent of total billed charges,303.69,11.84,154.88,percent of total billed charges,38.7
VITAMIN B-1,84425,CPT,,,,,both,, ,156.89,156.89,Blue Cross and Blue Shield,Traditional,,60.72,38.7,percent of total billed charges,156.89,6.12,80.01,percent of total billed charges,38.7
VITAMIN B-1,84425,CPT,,,,,both,, ,1437.33,1437.33,Blue Cross and Blue Shield,Traditional,,556.25,38.7,percent of total billed charges,1437.33,56.06,733.04,percent of total billed charges,38.7
THIOCYANATE,84430,CPT,,,,,both,, ,174.57,174.57,Blue Cross and Blue Shield,Traditional,,67.56,38.7,percent of total billed charges,174.57,6.81,89.03,percent of total billed charges,38.7
Q15561 QT THYR WO AB,84432,CPT,,,,,both,, ,255.13,255.13,Blue Cross and Blue Shield,Traditional,,98.74,38.7,percent of total billed charges,255.13,9.95,130.12,percent of total billed charges,38.7
Q15561 QT THYR WO AB,84432,CPT,,,,,both,, ,255.13,255.13,Blue Cross and Blue Shield,Traditional,,98.74,38.7,percent of total billed charges,255.13,9.95,130.12,percent of total billed charges,38.7
"THYROXINE T4,TOTAL",84436,CPT,,,,,both,, ,38.73,38.73,Blue Cross and Blue Shield,Traditional,,14.99,38.7,percent of total billed charges,38.73,1.51,19.75,percent of total billed charges,38.7
"THYROXINE T4,TOTAL",84436,CPT,,,,,both,, ,405.57,405.57,Blue Cross and Blue Shield,Traditional,,156.96,38.7,percent of total billed charges,405.57,15.82,206.84,percent of total billed charges,38.7
"THYROXINE T4, FREE",84439,CPT,,,,,both,, ,66.52,66.52,Blue Cross and Blue Shield,Traditional,,25.74,38.7,percent of total billed charges,66.52,2.59,33.93,percent of total billed charges,38.7
"THYROXINE T4, FREE",84439,CPT,,,,,both,,,620.56,620.56,Blue Cross and Blue Shield,Traditional,,240.16,38.7,percent of total billed charges,620.56,24.20,316.49,percent of total billed charges,38.7
"THYROXINE T4, FREE",84439,CPT,,,,,both,, ,620.56,620.56,Blue Cross and Blue Shield,Traditional,,240.16,38.7,percent of total billed charges,620.56,24.20,316.49,percent of total billed charges,38.7
"THYROXINE T4, FREE",84439,CPT,,,,,both,, ,620.56,620.56,Blue Cross and Blue Shield,Traditional,,240.16,38.7,percent of total billed charges,620.56,24.20,316.49,percent of total billed charges,38.7
L1735 TBG SER ICMA,84442,CPT,,,,,both,, ,195.70,195.70,Blue Cross and Blue Shield,Traditional,,75.74,38.7,percent of total billed charges,195.70,7.63,99.81,percent of total billed charges,38.7
THYROXINE BIND GLOB,84442,CPT,,,,,both,, ,213.31,213.31,Blue Cross and Blue Shield,Traditional,,82.55,38.7,percent of total billed charges,213.31,8.32,108.79,percent of total billed charges,38.7
"Blood test, thyroid stimulating hormone (TSH)",84443,CPT,,,,,both,,,737.61,737.61,Blue Cross and Blue Shield,Traditional,,285.46,38.7,percent of total billed charges,737.61,28.77,376.18,percent of total billed charges,38.7
THYROID STIM TSH,84443,CPT,,,,,both,, ,124.05,124.05,Blue Cross and Blue Shield,Traditional,,48.01,38.7,percent of total billed charges,124.05,4.84,63.27,percent of total billed charges,38.7
THYROID STIM TSH,84443,CPT,,,,,both,, ,737.61,737.61,Blue Cross and Blue Shield,Traditional,,285.46,38.7,percent of total billed charges,737.61,28.77,376.18,percent of total billed charges,38.7
THYROID STIM TSH,84443,CPT,,,,,both,, ,737.61,737.61,Blue Cross and Blue Shield,Traditional,,285.46,38.7,percent of total billed charges,737.61,28.77,376.18,percent of total billed charges,38.7
Q30551 TSI IA,84445,CPT,,,,,both,, ,733.12,733.12,Blue Cross and Blue Shield,Traditional,,283.72,38.7,percent of total billed charges,733.12,28.59,373.89,percent of total billed charges,38.7
THYROID STIM IMMUNO,84445,CPT,,,,,both,, ,1178.27,1178.27,Blue Cross and Blue Shield,Traditional,,455.99,38.7,percent of total billed charges,1178.27,45.95,600.92,percent of total billed charges,38.7
VITAMIN E,84446,CPT,,,,,both,, ,227.62,227.62,Blue Cross and Blue Shield,Traditional,,88.09,38.7,percent of total billed charges,227.62,8.88,116.09,percent of total billed charges,38.7
VITAMIN E,84446,CPT,,,,,both,, ,227.62,227.62,Blue Cross and Blue Shield,Traditional,,88.09,38.7,percent of total billed charges,227.62,8.88,116.09,percent of total billed charges,38.7
L500440 TRANSCORTIN,84449,CPT,,,,,both,, ,180.00,180.00,Blue Cross and Blue Shield,Traditional,,69.66,38.7,percent of total billed charges,180.00,7.02,91.8,percent of total billed charges,38.7
TRANSFERASE AST,84450,CPT,,,,,both,, ,38.17,38.17,Blue Cross and Blue Shield,Traditional,,14.77,38.7,percent of total billed charges,38.17,1.49,19.47,percent of total billed charges,38.7
TRANSFERASE AST,84450,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
TRANSFERASE ALT,84460,CPT,,,,,both,, ,39.29,39.29,Blue Cross and Blue Shield,Traditional,,15.21,38.7,percent of total billed charges,39.29,1.53,20.04,percent of total billed charges,38.7
TRANSFERASE ALT,84460,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
TRANSFERRIN,84466,CPT,,,,,both,, ,94.31,94.31,Blue Cross and Blue Shield,Traditional,,36.50,38.7,percent of total billed charges,94.31,3.68,48.1,percent of total billed charges,38.7
TRANSFERRIN,84466,CPT,,,,,both,, ,796.55,796.55,Blue Cross and Blue Shield,Traditional,,308.26,38.7,percent of total billed charges,796.55,31.07,406.24,percent of total billed charges,38.7
TRANSFERRIN,84466,CPT,,,,,both,, ,796.55,796.55,Blue Cross and Blue Shield,Traditional,,308.26,38.7,percent of total billed charges,796.55,31.07,406.24,percent of total billed charges,38.7
TRIGLYCERIDES,84478,CPT,,,,,both,, ,39.29,39.29,Blue Cross and Blue Shield,Traditional,,15.21,38.7,percent of total billed charges,39.29,1.53,20.04,percent of total billed charges,38.7
TRIGLYCERIDES,84478,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
T3-T4 UPTAKE,84479,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,percent of total billed charges,526.26,20.52,268.39,percent of total billed charges,38.7
"T3,TOTAL",84480,CPT,,,,,both,, ,1039.33,1039.33,Blue Cross and Blue Shield,Traditional,,402.22,38.7,percent of total billed charges,1039.33,40.53,530.06,percent of total billed charges,38.7
"T3,FREE",84481,CPT,,,,,both,, ,858.30,858.30,Blue Cross and Blue Shield,Traditional,,332.16,38.7,percent of total billed charges,858.30,33.47,437.73,percent of total billed charges,38.7
Q90963 T3 REV LCMSMS,84482,CPT,,,,,both,, ,858.30,858.30,Blue Cross and Blue Shield,Traditional,,332.16,38.7,percent of total billed charges,858.30,33.47,437.73,percent of total billed charges,38.7
"T3,REVERSE",84482,CPT,,,,,both,, ,219.20,219.20,Blue Cross and Blue Shield,Traditional,,84.83,38.7,percent of total billed charges,219.20,8.55,111.79,percent of total billed charges,38.7
"TROPONIN,QNT",84484,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,percent of total billed charges,133.88,5.22,68.28,percent of total billed charges,38.7
"TROPONIN,QNT",84484,CPT,,,,,both,,,713.19,713.19,Blue Cross and Blue Shield,Traditional,,276.00,38.7,percent of total billed charges,713.19,27.81,363.73,percent of total billed charges,38.7
"TROPONIN,QNT",84484,CPT,,,,,both,, ,713.19,713.19,Blue Cross and Blue Shield,Traditional,,276.00,38.7,percent of total billed charges,713.19,27.81,363.73,percent of total billed charges,38.7
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,, ,29.19,29.19,Blue Cross and Blue Shield,Traditional,,11.30,38.7,percent of total billed charges,29.19,1.14,14.89,percent of total billed charges,38.7
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,,,277.59,277.59,Blue Cross and Blue Shield,Traditional,,107.43,38.7,percent of total billed charges,277.59,10.83,141.57,percent of total billed charges,38.7
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,, ,277.59,277.59,Blue Cross and Blue Shield,Traditional,,107.43,38.7,percent of total billed charges,277.59,10.83,141.57,percent of total billed charges,38.7
"UREA NITROGEN,URINE",84540,CPT,,,,,both,,,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"UREA NITROGEN,URINE",84540,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"UREA NITROGEN,URINE",84540,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"URIC ACID, BLOOD",84550,CPT,,,,,both,, ,44.34,44.34,Blue Cross and Blue Shield,Traditional,,17.16,38.7,percent of total billed charges,44.34,1.73,22.61,percent of total billed charges,38.7
"URIC ACID, BLOOD",84550,CPT,,,,,both,,,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,percent of total billed charges,285.17,11.12,145.44,percent of total billed charges,38.7
"URIC ACID, BLOOD",84550,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,percent of total billed charges,285.17,11.12,145.44,percent of total billed charges,38.7
"L910235 URIC ACID, URINE",84560,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"Q442 URIC ACID,URINE",84560,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"URIC ACID,URINE RAND",84560,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
VANILLYLMANDELIC ACID (VMA) SERUM,84585,CPT,,,,,both,, ,116.70,116.70,Blue Cross and Blue Shield,Traditional,,45.16,38.7,percent of total billed charges,116.70,4.55,59.52,percent of total billed charges,38.7
"VMA, URINE",84585,CPT,,,,,both,, ,355.05,355.05,Blue Cross and Blue Shield,Traditional,,137.40,38.7,percent of total billed charges,355.05,13.85,181.08,percent of total billed charges,38.7
"VMA, URINE",84585,CPT,,,,,both,, ,355.05,355.05,Blue Cross and Blue Shield,Traditional,,137.40,38.7,percent of total billed charges,355.05,13.85,181.08,percent of total billed charges,38.7
L10397 VIP PL RIA,84586,CPT,,,,,both,, ,338.36,338.36,Blue Cross and Blue Shield,Traditional,,130.95,38.7,percent of total billed charges,338.36,13.20,172.56,percent of total billed charges,38.7
VASOINTESTINAL PEP,84586,CPT,,,,,both,, ,368.80,368.80,Blue Cross and Blue Shield,Traditional,,142.73,38.7,percent of total billed charges,368.80,14.38,188.09,percent of total billed charges,38.7
VASOPRESSIN,84588,CPT,,,,,both,, ,295.83,295.83,Blue Cross and Blue Shield,Traditional,,114.49,38.7,percent of total billed charges,295.83,11.54,150.87,percent of total billed charges,38.7
VASOPRESSIN,84588,CPT,,,,,both,, ,295.83,295.83,Blue Cross and Blue Shield,Traditional,,114.49,38.7,percent of total billed charges,295.83,11.54,150.87,percent of total billed charges,38.7
VITAMIN A,84590,CPT,,,,,both,, ,186.08,186.08,Blue Cross and Blue Shield,Traditional,,72.01,38.7,percent of total billed charges,186.08,7.26,94.9,percent of total billed charges,38.7
VITAMIN A,84590,CPT,,,,,both,, ,186.08,186.08,Blue Cross and Blue Shield,Traditional,,72.01,38.7,percent of total billed charges,186.08,7.26,94.9,percent of total billed charges,38.7
"VITAMIN ASSAY, NOS",84591,CPT,,,,,both,, ,197.03,197.03,Blue Cross and Blue Shield,Traditional,,76.25,38.7,percent of total billed charges,197.03,7.68,100.49,percent of total billed charges,38.7
VITAMIN K,84597,CPT,,,,,both,, ,188.89,188.89,Blue Cross and Blue Shield,Traditional,,73.10,38.7,percent of total billed charges,188.89,7.37,96.33,percent of total billed charges,38.7
VITAMIN K,84597,CPT,,,,,both,, ,188.89,188.89,Blue Cross and Blue Shield,Traditional,,73.10,38.7,percent of total billed charges,188.89,7.37,96.33,percent of total billed charges,38.7
VOLATILES,84600,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,percent of total billed charges,728.07,28.39,371.32,percent of total billed charges,38.7
XYLOSE ABSORPTION,84620,CPT,,,,,both,, ,1111.47,1111.47,Blue Cross and Blue Shield,Traditional,,430.14,38.7,percent of total billed charges,1111.47,43.35,566.85,percent of total billed charges,38.7
ZINC,84630,CPT,,,,,both,, ,1081.72,1081.72,Blue Cross and Blue Shield,Traditional,,418.63,38.7,percent of total billed charges,1081.72,42.19,551.68,percent of total billed charges,38.7
ZINC,84630,CPT,,,,,both,, ,1081.72,1081.72,Blue Cross and Blue Shield,Traditional,,418.63,38.7,percent of total billed charges,1081.72,42.19,551.68,percent of total billed charges,38.7
ZINC WHOLE BLOOD,84630,CPT,,,,,both,, ,80.00,80.00,Blue Cross and Blue Shield,Traditional,,30.96,38.7,percent of total billed charges,80.00,3.12,40.8,percent of total billed charges,38.7
C-PEPTIDE,84681,CPT,,,,,both,, ,898.44,898.44,Blue Cross and Blue Shield,Traditional,,347.70,38.7,percent of total billed charges,898.44,35.04,458.2,percent of total billed charges,38.7
C-PEPTIDE,84681,CPT,,,,,both,, ,898.44,898.44,Blue Cross and Blue Shield,Traditional,,347.70,38.7,percent of total billed charges,898.44,35.04,458.2,percent of total billed charges,38.7
HCG QUANT,84702,CPT,,,,,both,, ,148.47,148.47,Blue Cross and Blue Shield,Traditional,,57.46,38.7,percent of total billed charges,148.47,5.79,75.72,percent of total billed charges,38.7
HCG QUANT,84702,CPT,,,,,both,, ,758.66,758.66,Blue Cross and Blue Shield,Traditional,,293.60,38.7,percent of total billed charges,758.66,29.59,386.92,percent of total billed charges,38.7
HCG QUANT,84702,CPT,,,,,both,, ,758.66,758.66,Blue Cross and Blue Shield,Traditional,,293.60,38.7,percent of total billed charges,758.66,29.59,386.92,percent of total billed charges,38.7
"HCG, QUAL",84703,CPT,,,,,both,, ,74.10,74.10,Blue Cross and Blue Shield,Traditional,,28.68,38.7,percent of total billed charges,74.10,2.89,37.79,percent of total billed charges,38.7
"HCG, QUAL",84703,CPT,,,,,both,,,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
"HCG, QUAL",84703,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
CLIN CHEM TEST NOS,84999,CPT,,,,,both,, ,274.50,274.50,Blue Cross and Blue Shield,Traditional,,106.23,38.7,percent of total billed charges,274.50,10.71,140,percent of total billed charges,38.7
L123413 TMAO,84999,CPT,,,,,both,, ,225.00,225.00,Blue Cross and Blue Shield,Traditional,,87.08,38.7,percent of total billed charges,225.00,8.78,114.75,percent of total billed charges,38.7
L123413 TMAO,84999,CPT,,,,,both,, ,225.00,225.00,Blue Cross and Blue Shield,Traditional,,87.08,38.7,percent of total billed charges,225.00,8.78,114.75,percent of total billed charges,38.7
BLEEDING TIME,85002,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
AUTO DIFF WBC COUNT,85004,CPT,,,,,both,, ,47.99,47.99,Blue Cross and Blue Shield,Traditional,,18.57,38.7,percent of total billed charges,47.99,1.87,24.47,percent of total billed charges,38.7
AUTO DIFF WBC COUNT,85004,CPT,,,,,both,, ,103.00,103.00,Blue Cross and Blue Shield,Traditional,,39.86,38.7,percent of total billed charges,103.00,4.02,52.53,percent of total billed charges,38.7
"WBC DIFF, MAN",85007,CPT,,,,,both,, ,33.96,33.96,Blue Cross and Blue Shield,Traditional,,13.14,38.7,percent of total billed charges,33.96,1.32,17.32,percent of total billed charges,38.7
"WBC DIFF, MAN",85007,CPT,,,,,both,, ,188.33,188.33,Blue Cross and Blue Shield,Traditional,,72.88,38.7,percent of total billed charges,188.33,7.34,96.05,percent of total billed charges,38.7
BLOOD SMEAR SCAN,85008,CPT,,,,,both,, ,112.55,112.55,Blue Cross and Blue Shield,Traditional,,43.56,38.7,percent of total billed charges,112.55,4.39,57.4,percent of total billed charges,38.7
"HEMATOCRIT, SPUN",85013,CPT,,,,,both,, ,32.84,32.84,Blue Cross and Blue Shield,Traditional,,12.71,38.7,percent of total billed charges,32.84,1.28,16.75,percent of total billed charges,38.7
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,, ,13.18,13.18,Blue Cross and Blue Shield,Traditional,,5.10,38.7,percent of total billed charges,13.18,0.51,6.72,percent of total billed charges,38.7
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,,,262.99,262.99,Blue Cross and Blue Shield,Traditional,,101.78,38.7,percent of total billed charges,262.99,10.26,134.12,percent of total billed charges,38.7
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,, ,262.99,262.99,Blue Cross and Blue Shield,Traditional,,101.78,38.7,percent of total billed charges,262.99,10.26,134.12,percent of total billed charges,38.7
HEMOGLOBIN,85018,CPT,,,,,both,, ,13.18,13.18,Blue Cross and Blue Shield,Traditional,,5.10,38.7,percent of total billed charges,13.18,0.51,6.72,percent of total billed charges,38.7
HEMOGLOBIN,85018,CPT,,,,,both,,,262.99,262.99,Blue Cross and Blue Shield,Traditional,,101.78,38.7,percent of total billed charges,262.99,10.26,134.12,percent of total billed charges,38.7
HEMOGLOBIN,85018,CPT,,,,,both,, ,262.99,262.99,Blue Cross and Blue Shield,Traditional,,101.78,38.7,percent of total billed charges,262.99,10.26,134.12,percent of total billed charges,38.7
HEMOGLOBIN,85018,CPT,,,,,both,, ,262.99,262.99,Blue Cross and Blue Shield,Traditional,,101.78,38.7,percent of total billed charges,262.99,10.26,134.12,percent of total billed charges,38.7
L121003 HEMOGLOBIN,85018,CPT,,,,,both,, ,10.00,10.00,Blue Cross and Blue Shield,Traditional,,3.87,38.7,percent of total billed charges,10.00,0.39,5.1,percent of total billed charges,38.7
CBC W-PLT AUTO COMPD,85025,CPT,,,,,both,, ,28.90,28.90,Blue Cross and Blue Shield,Traditional,,11.18,38.7,percent of total billed charges,28.90,1.13,14.74,percent of total billed charges,38.7
CBC W-PLT AUTO COMPD,85025,CPT,,,,,both,, ,428.30,428.30,Blue Cross and Blue Shield,Traditional,,165.75,38.7,percent of total billed charges,428.30,16.70,218.43,percent of total billed charges,38.7
"Complete blood cell count, with differential white blood cells, automated",85025,CPT,,,,,both,,,428.30,428.30,Blue Cross and Blue Shield,Traditional,,165.75,38.7,percent of total billed charges,428.30,16.70,218.43,percent of total billed charges,38.7
CBC W-PLT,85027,CPT,,,,,both,, ,24.13,24.13,Blue Cross and Blue Shield,Traditional,,9.34,38.7,percent of total billed charges,24.13,0.94,12.31,percent of total billed charges,38.7
CBC W-PLT,85027,CPT,,,,,both,, ,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,percent of total billed charges,412.87,16.10,210.56,percent of total billed charges,38.7
"Complete blood count, automated",85027,CPT,,,,,both,,,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,percent of total billed charges,412.87,16.10,210.56,percent of total billed charges,38.7
MAN CELL CT ELP,85032,CPT,,,,,both,, ,466.48,466.48,Blue Cross and Blue Shield,Traditional,,180.53,38.7,percent of total billed charges,466.48,18.19,237.9,percent of total billed charges,38.7
L1917 RBC COUNT,85041,CPT,,,,,both,, ,6.06,6.06,Blue Cross and Blue Shield,Traditional,,2.35,38.7,percent of total billed charges,6.06,0.24,3.09,percent of total billed charges,38.7
"RETIC COUNT, MANUAL",85044,CPT,,,,,both,, ,489.78,489.78,Blue Cross and Blue Shield,Traditional,,189.54,38.7,percent of total billed charges,489.78,19.10,249.79,percent of total billed charges,38.7
"RETIC COUNT, FLOW",85045,CPT,,,,,both,, ,39.29,39.29,Blue Cross and Blue Shield,Traditional,,15.21,38.7,percent of total billed charges,39.29,1.53,20.04,percent of total billed charges,38.7
"RETIC COUNT, FLOW",85045,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
WBC COUNT,85048,CPT,,,,,both,, ,16.55,16.55,Blue Cross and Blue Shield,Traditional,,6.40,38.7,percent of total billed charges,16.55,0.65,8.44,percent of total billed charges,38.7
WBC COUNT,85048,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,percent of total billed charges,285.17,11.12,145.44,percent of total billed charges,38.7
CBC-PLT AUTORP CDM,85049,CPT,,,,,both,, ,16.55,16.55,Blue Cross and Blue Shield,Traditional,,6.40,38.7,percent of total billed charges,16.55,0.65,8.44,percent of total billed charges,38.7
CBC-PLT AUTORP CDM,85049,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,percent of total billed charges,285.17,11.12,145.44,percent of total billed charges,38.7
BONE MARROW INTERPRE,85097,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,percent of total billed charges,237.17,9.25,120.96,percent of total billed charges,38.7
APIXABAN ANTI-XA,85130,CPT,,,,,both,, ,250.00,250.00,Blue Cross and Blue Shield,Traditional,,96.75,38.7,percent of total billed charges,250.00,9.75,127.5,percent of total billed charges,38.7
Q331 FACT II ACT PCD,85210,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29.00,38.7,percent of total billed charges,74.93,2.92,38.21,percent of total billed charges,38.7
FACTOR V ASSAY,85220,CPT,,,,,both,, ,121.53,121.53,Blue Cross and Blue Shield,Traditional,,47.03,38.7,percent of total billed charges,121.53,4.74,61.98,percent of total billed charges,38.7
L86249 FACT V ACT CD,85220,CPT,,,,,both,, ,121.53,121.53,Blue Cross and Blue Shield,Traditional,,47.03,38.7,percent of total billed charges,121.53,4.74,61.98,percent of total billed charges,38.7
Q344 FACT V CLOT PCD,85220,CPT,,,,,both,, ,121.53,121.53,Blue Cross and Blue Shield,Traditional,,47.03,38.7,percent of total billed charges,121.53,4.74,61.98,percent of total billed charges,38.7
FACTOR VII ASSAY,85230,CPT,,,,,both,, ,335.69,335.69,Blue Cross and Blue Shield,Traditional,,129.91,38.7,percent of total billed charges,335.69,13.09,171.2,percent of total billed charges,38.7
FACTOR VII ASSAY,85230,CPT,,,,,both,, ,335.69,335.69,Blue Cross and Blue Shield,Traditional,,129.91,38.7,percent of total billed charges,335.69,13.09,171.2,percent of total billed charges,38.7
"FACTOR VIII, AHG",85240,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,percent of total billed charges,728.07,28.39,371.32,percent of total billed charges,38.7
L503333 FAC8 AHG,85240,CPT,,,,,both,, ,706.86,706.86,Blue Cross and Blue Shield,Traditional,,273.55,38.7,percent of total billed charges,706.86,27.57,360.5,percent of total billed charges,38.7
FACTOR VIII RISTOCET,85245,CPT,,,,,both,, ,1352.01,1352.01,Blue Cross and Blue Shield,Traditional,,523.23,38.7,percent of total billed charges,1352.01,52.73,689.53,percent of total billed charges,38.7
L164509 VWF ACTIV PA,85245,CPT,,,,,both,, ,412.00,412.00,Blue Cross and Blue Shield,Traditional,,159.44,38.7,percent of total billed charges,412.00,16.07,210.12,percent of total billed charges,38.7
FACTOR VIII VW AG,85246,CPT,,,,,both,, ,1164.52,1164.52,Blue Cross and Blue Shield,Traditional,,450.67,38.7,percent of total billed charges,1164.52,45.42,593.91,percent of total billed charges,38.7
FACTOR VIII VW AG,85246,CPT,,,,,both,, ,1164.52,1164.52,Blue Cross and Blue Shield,Traditional,,450.67,38.7,percent of total billed charges,1164.52,45.42,593.91,percent of total billed charges,38.7
"FACT VIII,VW,MULTIME",85247,CPT,,,,,both,, ,181.59,181.59,Blue Cross and Blue Shield,Traditional,,70.28,38.7,percent of total billed charges,181.59,7.08,92.61,percent of total billed charges,38.7
FACTOR IX,85250,CPT,,,,,both,, ,151.56,151.56,Blue Cross and Blue Shield,Traditional,,58.65,38.7,percent of total billed charges,151.56,5.91,77.3,percent of total billed charges,38.7
FACTOR X,85260,CPT,,,,,both,, ,142.58,142.58,Blue Cross and Blue Shield,Traditional,,55.18,38.7,percent of total billed charges,142.58,5.56,72.72,percent of total billed charges,38.7
FACTOR XI,85270,CPT,,,,,both,, ,142.58,142.58,Blue Cross and Blue Shield,Traditional,,55.18,38.7,percent of total billed charges,142.58,5.56,72.72,percent of total billed charges,38.7
ANTITHROMBIN IIIACTI,85300,CPT,,,,,both,, ,1930.76,1930.76,Blue Cross and Blue Shield,Traditional,,747.20,38.7,percent of total billed charges,1930.76,75.30,984.69,percent of total billed charges,38.7
L015040 ANTITHROMBIN ACTIVITY,85300,CPT,,,,,both,, ,965.23,965.23,Blue Cross and Blue Shield,Traditional,,373.54,38.7,percent of total billed charges,965.23,37.64,492.27,percent of total billed charges,38.7
Q5158 ATIII AG FRNEP,85301,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,percent of total billed charges,72.13,2.81,36.79,percent of total billed charges,38.7
"PROTEIN C, AG",85302,CPT,,,,,both,, ,1907.47,1907.47,Blue Cross and Blue Shield,Traditional,,738.19,38.7,percent of total billed charges,1907.47,74.39,972.81,percent of total billed charges,38.7
Q4948 PROT C AG IA,85302,CPT,,,,,both,, ,1942.55,1942.55,Blue Cross and Blue Shield,Traditional,,751.77,38.7,percent of total billed charges,1942.55,75.76,990.7,percent of total billed charges,38.7
"PROTEIN C, ACTIVITY",85303,CPT,,,,,both,, ,1261.35,1261.35,Blue Cross and Blue Shield,Traditional,,488.14,38.7,percent of total billed charges,1261.35,49.19,643.29,percent of total billed charges,38.7
"PROTEIN C, ACTIVITY",85303,CPT,,,,,both,, ,1261.35,1261.35,Blue Cross and Blue Shield,Traditional,,488.14,38.7,percent of total billed charges,1261.35,49.19,643.29,percent of total billed charges,38.7
"Q7942 PROTEIN C, ACT",85303,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
L117754 PROT S TOT,85305,CPT,,,,,both,, ,116.10,116.10,Blue Cross and Blue Shield,Traditional,,44.93,38.7,percent of total billed charges,116.10,4.53,59.21,percent of total billed charges,38.7
"PROTEIN S, TOTAL",85305,CPT,,,,,both,, ,1261.35,1261.35,Blue Cross and Blue Shield,Traditional,,488.14,38.7,percent of total billed charges,1261.35,49.19,643.29,percent of total billed charges,38.7
"PROTEIN S, TOTAL",85305,CPT,,,,,both,, ,1261.35,1261.35,Blue Cross and Blue Shield,Traditional,,488.14,38.7,percent of total billed charges,1261.35,49.19,643.29,percent of total billed charges,38.7
L117754 PROT S FREE,85306,CPT,,,,,both,, ,153.20,153.20,Blue Cross and Blue Shield,Traditional,,59.29,38.7,percent of total billed charges,153.20,5.97,78.13,percent of total billed charges,38.7
"PROTEIN S, FREE",85306,CPT,,,,,both,, ,151.00,151.00,Blue Cross and Blue Shield,Traditional,,58.44,38.7,percent of total billed charges,151.00,5.89,77.01,percent of total billed charges,38.7
"PROTEIN S, FREE",85306,CPT,,,,,both,, ,939.98,939.98,Blue Cross and Blue Shield,Traditional,,363.77,38.7,percent of total billed charges,939.98,36.66,479.39,percent of total billed charges,38.7
Q10170 PROT S AG ITA,85306,CPT,,,,,both,, ,939.98,939.98,Blue Cross and Blue Shield,Traditional,,363.77,38.7,percent of total billed charges,939.98,36.66,479.39,percent of total billed charges,38.7
Q1779 PROT S ACT,85306,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
"Q7942 PROTEIN S, FRE",85306,CPT,,,,,both,, ,939.98,939.98,Blue Cross and Blue Shield,Traditional,,363.77,38.7,percent of total billed charges,939.98,36.66,479.39,percent of total billed charges,38.7
PROTEIN C ACTIVATED,85307,CPT,,,,,both,, ,239.69,239.69,Blue Cross and Blue Shield,Traditional,,92.76,38.7,percent of total billed charges,239.69,9.35,122.24,percent of total billed charges,38.7
Q22 APCR RVVT-BSE AS,85307,CPT,,,,,both,, ,596.43,596.43,Blue Cross and Blue Shield,Traditional,,230.82,38.7,percent of total billed charges,596.43,23.26,304.18,percent of total billed charges,38.7
SOLUB LIV AG AB(RDL),85316,CPT,,,,,both,, ,567.00,567.00,Blue Cross and Blue Shield,Traditional,,219.43,38.7,percent of total billed charges,567.00,22.11,289.17,percent of total billed charges,38.7
COAG TIME ACTIVATED,85347,CPT,,,,,both,, ,167.84,167.84,Blue Cross and Blue Shield,Traditional,,64.95,38.7,percent of total billed charges,167.84,6.55,85.6,percent of total billed charges,38.7
FDP-FSP AGG SLIDE,85362,CPT,,,,,both,, ,691.58,691.58,Blue Cross and Blue Shield,Traditional,,267.64,38.7,percent of total billed charges,691.58,26.97,352.71,percent of total billed charges,38.7
"D-DIMER, QUANT",85379,CPT,,,,,both,, ,100.48,100.48,Blue Cross and Blue Shield,Traditional,,38.89,38.7,percent of total billed charges,100.48,3.92,51.24,percent of total billed charges,38.7
"D-DIMER, QUANT",85379,CPT,,,,,both,,,886.09,886.09,Blue Cross and Blue Shield,Traditional,,342.92,38.7,percent of total billed charges,886.09,34.56,451.91,percent of total billed charges,38.7
"D-DIMER, QUANT",85379,CPT,,,,,both,, ,886.09,886.09,Blue Cross and Blue Shield,Traditional,,342.92,38.7,percent of total billed charges,886.09,34.56,451.91,percent of total billed charges,38.7
FIBRINOGEN ACTIVITY,85384,CPT,,,,,both,, ,83.64,83.64,Blue Cross and Blue Shield,Traditional,,32.37,38.7,percent of total billed charges,83.64,3.26,42.66,percent of total billed charges,38.7
FIBRINOGEN ACTIVITY,85384,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,40.41,528.49,percent of total billed charges,38.7
Q14532 ADAMTS13 IA,85397,CPT,,,,,both,, ,188.05,188.05,Blue Cross and Blue Shield,Traditional,,72.78,38.7,percent of total billed charges,188.05,7.33,95.91,percent of total billed charges,38.7
Q36555 PAI-1 IA,85415,CPT,,,,,both,, ,222.01,222.01,Blue Cross and Blue Shield,Traditional,,85.92,38.7,percent of total billed charges,222.01,8.66,113.23,percent of total billed charges,38.7
FETAL HGB KLEIH-BETK,85460,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,percent of total billed charges,526.26,20.52,268.39,percent of total billed charges,38.7
FETAL HGB KLEIH-BETK,85460,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,percent of total billed charges,526.26,20.52,268.39,percent of total billed charges,38.7
"FETAL HGB, ROSETTE",85461,CPT,,,,,both,, ,349.72,349.72,Blue Cross and Blue Shield,Traditional,,135.34,38.7,percent of total billed charges,349.72,13.64,178.36,percent of total billed charges,38.7
HEPARIN ASSAY,85520,CPT,,,,,both,, ,1274.26,1274.26,Blue Cross and Blue Shield,Traditional,,493.14,38.7,percent of total billed charges,1274.26,49.70,649.87,percent of total billed charges,38.7
L117101 HEPARIN A-XA,85520,CPT,,,,,both,, ,139.05,139.05,Blue Cross and Blue Shield,Traditional,,53.81,38.7,percent of total billed charges,139.05,5.42,70.92,percent of total billed charges,38.7
MURAMIDASE,85549,CPT,,,,,both,, ,261.02,261.02,Blue Cross and Blue Shield,Traditional,,101.01,38.7,percent of total billed charges,261.02,10.18,133.12,percent of total billed charges,38.7
RBC OSMOTIC FRAGW-IN,85557,CPT,,,,,both,, ,450.48,450.48,Blue Cross and Blue Shield,Traditional,,174.34,38.7,percent of total billed charges,450.48,17.57,229.74,percent of total billed charges,38.7
PLATELET AGGREGATION,85576,CPT,,,,,both,, ,344.67,344.67,Blue Cross and Blue Shield,Traditional,,133.39,38.7,percent of total billed charges,344.67,13.44,175.78,percent of total billed charges,38.7
PLTT NEUTRALIZATION,85597,CPT,,,,,both,, ,160.55,160.55,Blue Cross and Blue Shield,Traditional,,62.13,38.7,percent of total billed charges,160.55,6.26,81.88,percent of total billed charges,38.7
PLTT NEUTRALIZATION,85597,CPT,,,,,both,, ,160.55,160.55,Blue Cross and Blue Shield,Traditional,,62.13,38.7,percent of total billed charges,160.55,6.26,81.88,percent of total billed charges,38.7
HEXAGONAL PHOSPHOLIP,85598,CPT,,,,,both,, ,153.52,153.52,Blue Cross and Blue Shield,Traditional,,59.41,38.7,percent of total billed charges,153.52,5.99,78.3,percent of total billed charges,38.7
HEXAGONAL PHOSPHOLIP,85598,CPT,,,,,both,, ,153.52,153.52,Blue Cross and Blue Shield,Traditional,,59.41,38.7,percent of total billed charges,153.52,5.99,78.3,percent of total billed charges,38.7
L117079 HEX PHOS,85598,CPT,,,,,both,, ,179.80,179.80,Blue Cross and Blue Shield,Traditional,,69.58,38.7,percent of total billed charges,179.80,7.01,91.7,percent of total billed charges,38.7
"Blood test, clotting time",85610,CPT,,,,,both,,,430.27,430.27,Blue Cross and Blue Shield,Traditional,,166.51,38.7,percent of total billed charges,430.27,16.78,219.44,percent of total billed charges,38.7
PROTHROMBIN TIME,85610,CPT,,,,,both,, ,14.60,14.60,Blue Cross and Blue Shield,Traditional,,5.65,38.7,percent of total billed charges,14.60,0.57,7.45,percent of total billed charges,38.7
PROTHROMBIN TIME,85610,CPT,,,,,both,, ,430.27,430.27,Blue Cross and Blue Shield,Traditional,,166.51,38.7,percent of total billed charges,430.27,16.78,219.44,percent of total billed charges,38.7
"PROTHROMBIN, SUBSTIT",85611,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,percent of total billed charges,728.07,28.39,371.32,percent of total billed charges,38.7
RUSSELL VIPER VEN DI,85613,CPT,,,,,both,, ,364.88,364.88,Blue Cross and Blue Shield,Traditional,,141.21,38.7,percent of total billed charges,364.88,14.23,186.09,percent of total billed charges,38.7
RUSSELL VIPER VEN DI,85613,CPT,,,,,both,, ,364.88,364.88,Blue Cross and Blue Shield,Traditional,,141.21,38.7,percent of total billed charges,364.88,14.23,186.09,percent of total billed charges,38.7
"SED RATE, AUTOMATED",85652,CPT,,,,,both,, ,26.66,26.66,Blue Cross and Blue Shield,Traditional,,10.32,38.7,percent of total billed charges,26.66,1.04,13.6,percent of total billed charges,38.7
"SED RATE, AUTOMATED",85652,CPT,,,,,both,,,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"SED RATE, AUTOMATED",85652,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
O51226 SICKLE C  SCR,85660,CPT,,,,,both,, ,385.99,385.99,Blue Cross and Blue Shield,Traditional,,149.38,38.7,percent of total billed charges,385.99,15.05,196.85,percent of total billed charges,38.7
Q37679 SICKLE CELL SCRN WITH REFLEX HEMO,85660,CPT,,,,,both,, ,374.75,374.75,Blue Cross and Blue Shield,Traditional,,145.03,38.7,percent of total billed charges,374.75,14.62,191.12,percent of total billed charges,38.7
SICKLE CELL TEST RED,85660,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
SICKLE CELL TEST RED,85660,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
THROMBIN TIME,85670,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,percent of total billed charges,526.26,20.52,268.39,percent of total billed charges,38.7
THROMBIN TIME,85670,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,percent of total billed charges,526.26,20.52,268.39,percent of total billed charges,38.7
Coagulation assessment blood test,85730,CPT,,,,,both,,,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,percent of total billed charges,480.79,18.75,245.2,percent of total billed charges,38.7
THROMBOPLAST TIMEPTT,85730,CPT,,,,,both,, ,58.94,58.94,Blue Cross and Blue Shield,Traditional,,22.81,38.7,percent of total billed charges,58.94,2.30,30.06,percent of total billed charges,38.7
THROMBOPLAST TIMEPTT,85730,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,percent of total billed charges,480.79,18.75,245.2,percent of total billed charges,38.7
THROMBOPLAST TIMEPTT,85730,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,percent of total billed charges,480.79,18.75,245.2,percent of total billed charges,38.7
PTT SUBSTITUT,85732,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,percent of total billed charges,480.79,18.75,245.2,percent of total billed charges,38.7
PTT SUBSTITUT,85732,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,percent of total billed charges,480.79,18.75,245.2,percent of total billed charges,38.7
VISCOSITY EXAM,85810,CPT,,,,,both,, ,80.27,80.27,Blue Cross and Blue Shield,Traditional,,31.06,38.7,percent of total billed charges,80.27,3.13,40.94,percent of total billed charges,38.7
ALLERGEN IGG QT,86001,CPT,,,,,both,, ,66.24,66.24,Blue Cross and Blue Shield,Traditional,,25.63,38.7,percent of total billed charges,66.24,2.58,33.78,percent of total billed charges,38.7
ALLERGEN IGG QT,86001,CPT,,,,,both,, ,66.24,66.24,Blue Cross and Blue Shield,Traditional,,25.63,38.7,percent of total billed charges,66.24,2.58,33.78,percent of total billed charges,38.7
ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,51.36,51.36,Blue Cross and Blue Shield,Traditional,,19.88,38.7,percent of total billed charges,51.36,2.00,26.19,percent of total billed charges,38.7
ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,percent of total billed charges,148.75,5.80,75.86,percent of total billed charges,38.7
L602635 - ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,percent of total billed charges,148.75,5.80,75.86,percent of total billed charges,38.7
Q10643 ALG IGE QT,86003,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,percent of total billed charges,148.75,5.80,75.86,percent of total billed charges,38.7
Q10659 ALLERGEN IGE,86003,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,percent of total billed charges,148.75,5.80,75.86,percent of total billed charges,38.7
Q10715 ALLERGEN IGE,86003,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,percent of total billed charges,148.75,5.80,75.86,percent of total billed charges,38.7
ALLG SPEC IGE REC EA,86008,CPT,,,,,both,, ,103.29,103.29,Blue Cross and Blue Shield,Traditional,,39.97,38.7,percent of total billed charges,103.29,4.03,52.68,percent of total billed charges,38.7
ALLG SPEC IGE REC EA,86008,CPT,,,,,both,, ,103.29,103.29,Blue Cross and Blue Shield,Traditional,,39.97,38.7,percent of total billed charges,103.29,4.03,52.68,percent of total billed charges,38.7
L6643 ASMA ELISA,86015,CPT,,,,,both,, ,702.72,702.72,Blue Cross and Blue Shield,Traditional,,271.95,38.7,percent of total billed charges,702.72,27.41,358.39,percent of total billed charges,38.7
Q15043 ACTIN AB EA,86015,CPT,,,,,both,, ,514.48,514.48,Blue Cross and Blue Shield,Traditional,,199.10,38.7,percent of total billed charges,514.48,20.06,262.38,percent of total billed charges,38.7
Q8796 MPO AB IA,86021,CPT,,,,,both,, ,500.72,500.72,Blue Cross and Blue Shield,Traditional,,193.78,38.7,percent of total billed charges,500.72,19.53,255.37,percent of total billed charges,38.7
Q8796 MPO AB IA,86021,CPT,,,,,both,, ,500.72,500.72,Blue Cross and Blue Shield,Traditional,,193.78,38.7,percent of total billed charges,500.72,19.53,255.37,percent of total billed charges,38.7
Q8796 MPO AB IA,86021,CPT,,,,,both,, ,500.72,500.72,Blue Cross and Blue Shield,Traditional,,193.78,38.7,percent of total billed charges,500.72,19.53,255.37,percent of total billed charges,38.7
Q8796 MPO AB IA,86021,CPT,,,,,both,, ,500.72,500.72,Blue Cross and Blue Shield,Traditional,,193.78,38.7,percent of total billed charges,500.72,19.53,255.37,percent of total billed charges,38.7
PLATELET AB,86022,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,percent of total billed charges,871.22,33.98,444.32,percent of total billed charges,38.7
Q14627SRA UNF RB-14C,86022,CPT,,,,,both,, ,467.88,467.88,Blue Cross and Blue Shield,Traditional,,181.07,38.7,percent of total billed charges,467.88,18.25,238.62,percent of total billed charges,38.7
Q14874 PLATELET AB,86022,CPT,,,,,both,, ,467.88,467.88,Blue Cross and Blue Shield,Traditional,,181.07,38.7,percent of total billed charges,467.88,18.25,238.62,percent of total billed charges,38.7
Q414 HEP-IND PLAT AB,86022,CPT,,,,,both,, ,467.88,467.88,Blue Cross and Blue Shield,Traditional,,181.07,38.7,percent of total billed charges,467.88,18.25,238.62,percent of total billed charges,38.7
Q91740PLATELT IGG FC,86023,CPT,,,,,both,, ,83.08,83.08,Blue Cross and Blue Shield,Traditional,,32.15,38.7,percent of total billed charges,83.08,3.24,42.37,percent of total billed charges,38.7
L162045 FLUORS AB SC,86036,CPT,,,,,both,, ,486.16,486.16,Blue Cross and Blue Shield,Traditional,,188.14,38.7,percent of total billed charges,486.16,18.96,247.94,percent of total billed charges,38.7
Q70171 ANCA SCN IA,86036,CPT,,,,,both,, ,500.72,500.72,Blue Cross and Blue Shield,Traditional,,193.78,38.7,percent of total billed charges,500.72,19.53,255.37,percent of total billed charges,38.7
L163061 ANCA TITER,86037,CPT,,,,,both,, ,120.50,120.50,Blue Cross and Blue Shield,Traditional,,46.63,38.7,percent of total billed charges,120.50,4.70,61.46,percent of total billed charges,38.7
ANA,86038,CPT,,,,,both,, ,91.77,91.77,Blue Cross and Blue Shield,Traditional,,35.51,38.7,percent of total billed charges,91.77,3.58,46.8,percent of total billed charges,38.7
ANA,86038,CPT,,,,,both,, ,898.44,898.44,Blue Cross and Blue Shield,Traditional,,347.70,38.7,percent of total billed charges,898.44,35.04,458.2,percent of total billed charges,38.7
L164947 ANA IFA,86038,CPT,,,,,both,, ,824.26,824.26,Blue Cross and Blue Shield,Traditional,,318.99,38.7,percent of total billed charges,824.26,32.15,420.37,percent of total billed charges,38.7
Q16814 ANA IFA REFIA,86038,CPT,,,,,both,,,898.44,898.44,Blue Cross and Blue Shield,Traditional,,347.70,38.7,percent of total billed charges,898.44,35.04,458.2,percent of total billed charges,38.7
Q16814 ANA IFA REFIA,86038,CPT,,,,,both,, ,898.44,898.44,Blue Cross and Blue Shield,Traditional,,347.70,38.7,percent of total billed charges,898.44,35.04,458.2,percent of total billed charges,38.7
Q249 ANA SCRN IFA,86038,CPT,,,,,both,, ,898.44,898.44,Blue Cross and Blue Shield,Traditional,,347.70,38.7,percent of total billed charges,898.44,35.04,458.2,percent of total billed charges,38.7
"ANA,TITER",86039,CPT,,,,,both,, ,93.46,93.46,Blue Cross and Blue Shield,Traditional,,36.17,38.7,percent of total billed charges,93.46,3.64,47.66,percent of total billed charges,38.7
"ANA,TITER",86039,CPT,,,,,both,, ,547.31,547.31,Blue Cross and Blue Shield,Traditional,,211.81,38.7,percent of total billed charges,547.31,21.35,279.13,percent of total billed charges,38.7
"ANA,TITER",86039,CPT,,,,,both,, ,547.31,547.31,Blue Cross and Blue Shield,Traditional,,211.81,38.7,percent of total billed charges,547.31,21.35,279.13,percent of total billed charges,38.7
ACETYLCH RCPT BND AB,86041,CPT,,,,,both,, ,55.20,55.20,Blue Cross and Blue Shield,Traditional,,21.36,38.7,percent of total billed charges,55.20,2.15,28.15,percent of total billed charges,38.7
ACETYLC RCPT BLCK AB,86042,CPT,,,,,both,, ,55.20,55.20,Blue Cross and Blue Shield,Traditional,,21.36,38.7,percent of total billed charges,55.20,2.15,28.15,percent of total billed charges,38.7
ACTYLC RCPT MODL AB,86043,CPT,,,,,both,, ,55.20,55.20,Blue Cross and Blue Shield,Traditional,,21.36,38.7,percent of total billed charges,55.20,2.15,28.15,percent of total billed charges,38.7
Q38321 AQP4 NMOIGG,86052,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,percent of total billed charges,529.91,20.67,270.25,percent of total billed charges,38.7
"ASO,TITER",86060,CPT,,,,,both,, ,71.85,71.85,Blue Cross and Blue Shield,Traditional,,27.81,38.7,percent of total billed charges,71.85,2.80,36.64,percent of total billed charges,38.7
"ASO,TITER",86060,CPT,,,,,both,, ,539.45,539.45,Blue Cross and Blue Shield,Traditional,,208.77,38.7,percent of total billed charges,539.45,21.04,275.12,percent of total billed charges,38.7
Q265 ASO AB ITA,86060,CPT,,,,,both,, ,189.17,189.17,Blue Cross and Blue Shield,Traditional,,73.21,38.7,percent of total billed charges,189.17,7.38,96.48,percent of total billed charges,38.7
PHYS BB SERV TRAN RE,86078,CPT,,,,,both,, ,165.59,165.59,Blue Cross and Blue Shield,Traditional,,64.08,38.7,percent of total billed charges,165.59,6.46,84.45,percent of total billed charges,38.7
C-REACTIVE PROTEIN,86140,CPT,,,,,both,, ,51.08,51.08,Blue Cross and Blue Shield,Traditional,,19.77,38.7,percent of total billed charges,51.08,1.99,26.05,percent of total billed charges,38.7
C-REACTIVE PROTEIN,86140,CPT,,,,,both,, ,518.69,518.69,Blue Cross and Blue Shield,Traditional,,200.73,38.7,percent of total billed charges,518.69,20.23,264.53,percent of total billed charges,38.7
Q10124 HS-CRP NEPHEL,86141,CPT,,,,,both,, ,999.76,999.76,Blue Cross and Blue Shield,Traditional,,386.91,38.7,percent of total billed charges,999.76,38.99,509.88,percent of total billed charges,38.7
BETA-2 GLYCOPROT AB,86146,CPT,,,,,both,, ,252.04,252.04,Blue Cross and Blue Shield,Traditional,,97.54,38.7,percent of total billed charges,252.04,9.83,128.54,percent of total billed charges,38.7
BETA-2 GLYCOPROT AB,86146,CPT,,,,,both,, ,252.04,252.04,Blue Cross and Blue Shield,Traditional,,97.54,38.7,percent of total billed charges,252.04,9.83,128.54,percent of total billed charges,38.7
Q14890 BETA-2 GLYCOP,86146,CPT,,,,,both,, ,252.04,252.04,Blue Cross and Blue Shield,Traditional,,97.54,38.7,percent of total billed charges,252.04,9.83,128.54,percent of total billed charges,38.7
Q14890 BETA-2 GLYCOP,86146,CPT,,,,,both,, ,252.04,252.04,Blue Cross and Blue Shield,Traditional,,97.54,38.7,percent of total billed charges,252.04,9.83,128.54,percent of total billed charges,38.7
Q36553B-2-GP1 IGM IA,86146,CPT,,,,,both,, ,252.04,252.04,Blue Cross and Blue Shield,Traditional,,97.54,38.7,percent of total billed charges,252.04,9.83,128.54,percent of total billed charges,38.7
Q36553B-2-GP1 IGM IA,86146,CPT,,,,,both,, ,252.04,252.04,Blue Cross and Blue Shield,Traditional,,97.54,38.7,percent of total billed charges,252.04,9.83,128.54,percent of total billed charges,38.7
"CARDIOLIPIN AB,IGG",86147,CPT,,,,,both,, ,429.43,429.43,Blue Cross and Blue Shield,Traditional,,166.19,38.7,percent of total billed charges,429.43,16.75,219.01,percent of total billed charges,38.7
"CARDIOLIPIN AB,IGG",86147,CPT,,,,,both,, ,429.43,429.43,Blue Cross and Blue Shield,Traditional,,166.19,38.7,percent of total billed charges,429.43,16.75,219.01,percent of total billed charges,38.7
Q14890 CARDIOLIPIN A,86147,CPT,,,,,both,, ,429.43,429.43,Blue Cross and Blue Shield,Traditional,,166.19,38.7,percent of total billed charges,429.43,16.75,219.01,percent of total billed charges,38.7
Q14890 CARDIOLIPIN A,86147,CPT,,,,,both,, ,429.43,429.43,Blue Cross and Blue Shield,Traditional,,166.19,38.7,percent of total billed charges,429.43,16.75,219.01,percent of total billed charges,38.7
Q4662 C-LIPIN AB IGG,86147,CPT,,,,,both,, ,429.43,429.43,Blue Cross and Blue Shield,Traditional,,166.19,38.7,percent of total billed charges,429.43,16.75,219.01,percent of total billed charges,38.7
Q4662 C-LIPIN AB IGG,86147,CPT,,,,,both,, ,429.43,429.43,Blue Cross and Blue Shield,Traditional,,166.19,38.7,percent of total billed charges,429.43,16.75,219.01,percent of total billed charges,38.7
PHOSPHATIDYLSERIN AB,86148,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,percent of total billed charges,141.46,5.52,72.14,percent of total billed charges,38.7
PHOSPHOLIPID AB,86148,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,percent of total billed charges,141.46,5.52,72.14,percent of total billed charges,38.7
Q14890 PHOSPHOLIPID,86148,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,percent of total billed charges,141.46,5.52,72.14,percent of total billed charges,38.7
CELL ENUM IS AND ID,86152,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,percent of total billed charges,72.13,2.81,36.79,percent of total billed charges,38.7
"COLD AGG, TITER",86157,CPT,,,,,both,, ,247.83,247.83,Blue Cross and Blue Shield,Traditional,,95.91,38.7,percent of total billed charges,247.83,9.67,126.39,percent of total billed charges,38.7
L6353COLD HEMAGGL QT,86157,CPT,,,,,both,, ,40.70,40.70,Blue Cross and Blue Shield,Traditional,,15.75,38.7,percent of total billed charges,40.70,1.59,20.76,percent of total billed charges,38.7
"COMPLEMENT AG, EA",86160,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q19882 COMP AG,86160,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q34888 COMPLE C7 RID,86160,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q34889 COMPLE C8 RID,86160,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q351 C3 COMPL ITA,86160,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q353 C4C COMP ITA,86160,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q354 COMPLEM C5 RID,86160,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q433 COMPL CP C2 RID,86160,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q981 COMPL C C1Q RID,86160,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
Q297 C1 INH FUNC IA,86161,CPT,,,,,both,, ,79.99,79.99,Blue Cross and Blue Shield,Traditional,,30.96,38.7,percent of total billed charges,79.99,3.12,40.79,percent of total billed charges,38.7
"COMP, TOTAL CH50",86162,CPT,,,,,both,, ,984.32,984.32,Blue Cross and Blue Shield,Traditional,,380.93,38.7,percent of total billed charges,984.32,38.39,502,percent of total billed charges,38.7
"COMP, TOTAL CH50",86162,CPT,,,,,both,, ,984.32,984.32,Blue Cross and Blue Shield,Traditional,,380.93,38.7,percent of total billed charges,984.32,38.39,502,percent of total billed charges,38.7
Q11173 CCP AB IGG IA,86200,CPT,,,,,both,, ,242.50,242.50,Blue Cross and Blue Shield,Traditional,,93.85,38.7,percent of total billed charges,242.50,9.46,123.68,percent of total billed charges,38.7
DEOXYRIBONUCLEASE AB,86215,CPT,,,,,both,, ,198.72,198.72,Blue Cross and Blue Shield,Traditional,,76.90,38.7,percent of total billed charges,198.72,7.75,101.35,percent of total billed charges,38.7
DEOXYRIBONUCLEASE AB,86215,CPT,,,,,both,, ,198.72,198.72,Blue Cross and Blue Shield,Traditional,,76.90,38.7,percent of total billed charges,198.72,7.75,101.35,percent of total billed charges,38.7
"DNA AB,NATIVE-DOUBL",86225,CPT,,,,,both,, ,1077.50,1077.50,Blue Cross and Blue Shield,Traditional,,416.99,38.7,percent of total billed charges,1077.50,42.02,549.53,percent of total billed charges,38.7
L165092 DNA DS AB,86225,CPT,,,,,both,, ,486.16,486.16,Blue Cross and Blue Shield,Traditional,,188.14,38.7,percent of total billed charges,486.16,18.96,247.94,percent of total billed charges,38.7
L96346 DSDNA AB IA,86225,CPT,,,,,both,, ,219.10,219.10,Blue Cross and Blue Shield,Traditional,,84.79,38.7,percent of total billed charges,219.10,8.54,111.74,percent of total billed charges,38.7
Q19882 DNA DS AB,86225,CPT,,,,,both,, ,1077.50,1077.50,Blue Cross and Blue Shield,Traditional,,416.99,38.7,percent of total billed charges,1077.50,42.02,549.53,percent of total billed charges,38.7
Q255 DNA DS AB IA,86225,CPT,,,,,both,, ,1077.50,1077.50,Blue Cross and Blue Shield,Traditional,,416.99,38.7,percent of total billed charges,1077.50,42.02,549.53,percent of total billed charges,38.7
DNA AB SINGLE STRAND,86226,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,40.41,528.49,percent of total billed charges,38.7
DNA AB SINGLE STRAND,86226,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,40.41,528.49,percent of total billed charges,38.7
Q14857 SSDNA ANTIBODY (IGG),86226,CPT,,,,,both,, ,923.00,923.00,Blue Cross and Blue Shield,Traditional,,357.20,38.7,percent of total billed charges,923.00,36.00,470.73,percent of total billed charges,38.7
L165126 ENDMYS AB IG,86231,CPT,,,,,both,, ,60.05,60.05,Blue Cross and Blue Shield,Traditional,,23.24,38.7,percent of total billed charges,60.05,2.34,30.63,percent of total billed charges,38.7
Q15064 ENDOMYS AB IG,86231,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,percent of total billed charges,529.91,20.67,270.25,percent of total billed charges,38.7
Q19955 ENDOMYS AB IG,86231,CPT,,,,,both,, ,743.65,743.65,Blue Cross and Blue Shield,Traditional,,287.79,38.7,percent of total billed charges,743.65,29.00,379.26,percent of total billed charges,38.7
ANTI-ENA,86235,CPT,,,,,both,, ,174.85,174.85,Blue Cross and Blue Shield,Traditional,,67.67,38.7,percent of total billed charges,174.85,6.82,89.17,percent of total billed charges,38.7
ANTI-ENA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,percent of total billed charges,274.22,10.69,139.85,percent of total billed charges,38.7
L165092 ANTI-ENA,86235,CPT,,,,,both,, ,251.58,251.58,Blue Cross and Blue Shield,Traditional,,97.36,38.7,percent of total billed charges,251.58,9.81,128.31,percent of total billed charges,38.7
Q16088 CENTR B AB IA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,percent of total billed charges,274.22,10.69,139.85,percent of total billed charges,38.7
Q171728MI-2 AAB RIPA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,percent of total billed charges,274.22,10.69,139.85,percent of total billed charges,38.7
Q19882 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,percent of total billed charges,274.22,10.69,139.85,percent of total billed charges,38.7
Q19887 RNP AB IA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,percent of total billed charges,274.22,10.69,139.85,percent of total billed charges,38.7
Q34088 CHROMAT AB IA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,percent of total billed charges,274.22,10.69,139.85,percent of total billed charges,38.7
Q37923 SM AB IA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,percent of total billed charges,274.22,10.69,139.85,percent of total billed charges,38.7
Q38568 SS-A IA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,percent of total billed charges,274.22,10.69,139.85,percent of total billed charges,38.7
Q38569 SS-B IA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,percent of total billed charges,274.22,10.69,139.85,percent of total billed charges,38.7
Q4942 SCLEROD AB IA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,percent of total billed charges,274.22,10.69,139.85,percent of total billed charges,38.7
Q5810 JO-1 AB IA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,percent of total billed charges,274.22,10.69,139.85,percent of total billed charges,38.7
Q7448 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,percent of total billed charges,274.22,10.69,139.85,percent of total billed charges,38.7
Q7832 ANTI-ENA,86235,CPT,,,,,both,, ,548.71,548.71,Blue Cross and Blue Shield,Traditional,,212.35,38.7,percent of total billed charges,548.71,21.40,279.84,percent of total billed charges,38.7
Q7832 ANTI-ENA,86235,CPT,,,,,both,, ,548.71,548.71,Blue Cross and Blue Shield,Traditional,,212.35,38.7,percent of total billed charges,548.71,21.40,279.84,percent of total billed charges,38.7
Q94025 PM-SCL AB EIA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,percent of total billed charges,274.22,10.69,139.85,percent of total billed charges,38.7
Q94685 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,percent of total billed charges,274.22,10.69,139.85,percent of total billed charges,38.7
Q94777 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,percent of total billed charges,274.22,10.69,139.85,percent of total billed charges,38.7
L165620 STRIATIONAL ANTIBODIES,86255,CPT,,,,,both,, ,89.90,89.90,Blue Cross and Blue Shield,Traditional,,34.79,38.7,percent of total billed charges,89.90,3.51,45.85,percent of total billed charges,38.7
LC505225 ACETYLCHOLINE RECEPT-MODULAT AB,86255,CPT,,,,,both,, ,260.64,260.64,Blue Cross and Blue Shield,Traditional,,100.87,38.7,percent of total billed charges,260.64,10.16,132.93,percent of total billed charges,38.7
Q37097FLUORES AB SCN,86255,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,percent of total billed charges,529.91,20.67,270.25,percent of total billed charges,38.7
Q37097FLUORES AB SCN,86255,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,percent of total billed charges,529.91,20.67,270.25,percent of total billed charges,38.7
Q37097FLUORES AB SCN,86255,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,percent of total billed charges,529.91,20.67,270.25,percent of total billed charges,38.7
Q37097FLUORES AB SCN,86255,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,percent of total billed charges,529.91,20.67,270.25,percent of total billed charges,38.7
Q8292 ANTIADR AB IFA,86255,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,percent of total billed charges,529.91,20.67,270.25,percent of total billed charges,38.7
Q8292 ANTIADR AB IFA,86255,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,percent of total billed charges,529.91,20.67,270.25,percent of total billed charges,38.7
Q8292 ANTIADR AB IFA,86255,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,percent of total billed charges,529.91,20.67,270.25,percent of total billed charges,38.7
Q8292 ANTIADR AB IFA,86255,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,percent of total billed charges,529.91,20.67,270.25,percent of total billed charges,38.7
Q91985 ENDOMYSIAL(IGG)ANTIBODY SCRN TITR,86255,CPT,,,,,both,, ,472.00,472.00,Blue Cross and Blue Shield,Traditional,,182.66,38.7,percent of total billed charges,472.00,18.41,240.72,percent of total billed charges,38.7
"FLUORESCENT AB,TITER",86256,CPT,,,,,both,, ,1217.28,1217.28,Blue Cross and Blue Shield,Traditional,,471.09,38.7,percent of total billed charges,1217.28,47.47,620.81,percent of total billed charges,38.7
"Q261 FLUORES AB, TIT",86256,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,percent of total billed charges,529.91,20.67,270.25,percent of total billed charges,38.7
"Q261 FLUORES AB, TIT",86256,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,percent of total billed charges,529.91,20.67,270.25,percent of total billed charges,38.7
L165126 GLIA AB IGA,86258,CPT,,,,,both,, ,57.65,57.65,Blue Cross and Blue Shield,Traditional,,22.31,38.7,percent of total billed charges,57.65,2.25,29.4,percent of total billed charges,38.7
Q11212GLIA AB IGG IA,86258,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,percent of total billed charges,765.96,29.87,390.64,percent of total billed charges,38.7
Q11212GLIA AB IGG IA,86258,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,percent of total billed charges,765.96,29.87,390.64,percent of total billed charges,38.7
L143404 CA15-3 ECLIA,86300,CPT,,,,,both,, ,442.13,442.13,Blue Cross and Blue Shield,Traditional,,171.10,38.7,percent of total billed charges,442.13,17.24,225.49,percent of total billed charges,38.7
Q29493 CA 27.29 IA,86300,CPT,,,,,both,, ,481.92,481.92,Blue Cross and Blue Shield,Traditional,,186.50,38.7,percent of total billed charges,481.92,18.79,245.78,percent of total billed charges,38.7
TUMR AG CA15-3 27-29,86300,CPT,,,,,both,, ,109.46,109.46,Blue Cross and Blue Shield,Traditional,,42.36,38.7,percent of total billed charges,109.46,4.27,55.82,percent of total billed charges,38.7
Q17638 CA 19-9 PERITONEAL FLUID,86301,CPT,,,,,both,, ,716.75,716.75,Blue Cross and Blue Shield,Traditional,,277.38,38.7,percent of total billed charges,716.75,27.95,365.54,percent of total billed charges,38.7
TUMOR AG CA 19-9,86301,CPT,,,,,both,, ,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,percent of total billed charges,804.69,31.38,410.39,percent of total billed charges,38.7
TUMOR AG CA 19-9,86301,CPT,,,,,both,, ,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,percent of total billed charges,804.69,31.38,410.39,percent of total billed charges,38.7
Q29256 CA 125 IA,86304,CPT,,,,,both,, ,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,percent of total billed charges,804.69,31.38,410.39,percent of total billed charges,38.7
Q91155 TUMR AG CA125,86304,CPT,,,,,both,, ,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,percent of total billed charges,804.69,31.38,410.39,percent of total billed charges,38.7
TUMOR AG CA 125,86304,CPT,,,,,both,, ,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,percent of total billed charges,804.69,31.38,410.39,percent of total billed charges,38.7
Q91155 HE4,86305,CPT,,,,,both,, ,138.65,138.65,Blue Cross and Blue Shield,Traditional,,53.66,38.7,percent of total billed charges,138.65,5.41,70.71,percent of total billed charges,38.7
HETEROPHILE AB SCREE,86308,CPT,,,,,both,, ,19.09,19.09,Blue Cross and Blue Shield,Traditional,,7.39,38.7,percent of total billed charges,19.09,0.74,9.74,percent of total billed charges,38.7
HETEROPHILE AB SCREE,86308,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,percent of total billed charges,480.79,18.75,245.2,percent of total billed charges,38.7
Q17410 ALPHA-FETOPROTEIN PERITONEAL FLUI,86316,CPT,,,,,both,, ,429.25,429.25,Blue Cross and Blue Shield,Traditional,,166.12,38.7,percent of total billed charges,429.25,16.74,218.92,percent of total billed charges,38.7
"TUMOR AG, OTHER",86316,CPT,,,,,both,, ,481.92,481.92,Blue Cross and Blue Shield,Traditional,,186.50,38.7,percent of total billed charges,481.92,18.79,245.78,percent of total billed charges,38.7
"TUMOR AG, OTHER",86316,CPT,,,,,both,, ,481.92,481.92,Blue Cross and Blue Shield,Traditional,,186.50,38.7,percent of total billed charges,481.92,18.79,245.78,percent of total billed charges,38.7
INF AGENT IMMUNO QUA,86317,CPT,,,,,both,, ,217.52,217.52,Blue Cross and Blue Shield,Traditional,,84.18,38.7,percent of total billed charges,217.52,8.48,110.94,percent of total billed charges,38.7
INF AGENT IMMUNO QUA,86317,CPT,,,,,both,, ,217.52,217.52,Blue Cross and Blue Shield,Traditional,,84.18,38.7,percent of total billed charges,217.52,8.48,110.94,percent of total billed charges,38.7
TETANUS/DIPTHERIA AB,86317,CPT,,,,,both,, ,70.00,70.00,Blue Cross and Blue Shield,Traditional,,27.09,38.7,percent of total billed charges,70.00,2.73,35.7,percent of total billed charges,38.7
Q15914 C4 BND PL RID,86329,CPT,,,,,both,, ,81.11,81.11,Blue Cross and Blue Shield,Traditional,,31.39,38.7,percent of total billed charges,81.11,3.16,41.37,percent of total billed charges,38.7
Q14978 IMMUNODI OUCN,86331,CPT,,,,,both,, ,69.04,69.04,Blue Cross and Blue Shield,Traditional,,26.72,38.7,percent of total billed charges,69.04,2.69,35.21,percent of total billed charges,38.7
IMMUNOFIXATION ELECT,86334,CPT,,,,,both,, ,1021.37,1021.37,Blue Cross and Blue Shield,Traditional,,395.27,38.7,percent of total billed charges,1021.37,39.83,520.9,percent of total billed charges,38.7
IMMUNOFIXATION ELECT,86334,CPT,,,,,both,, ,1021.37,1021.37,Blue Cross and Blue Shield,Traditional,,395.27,38.7,percent of total billed charges,1021.37,39.83,520.9,percent of total billed charges,38.7
Q38940 IMMUNOFIXATION ELECT,86334,CPT,,,,,both,, ,909.75,909.75,Blue Cross and Blue Shield,Traditional,,352.07,38.7,percent of total billed charges,909.75,35.48,463.97,percent of total billed charges,38.7
IMM E-PHORS-URIN-CSF,86335,CPT,,,,,both,, ,680.07,680.07,Blue Cross and Blue Shield,Traditional,,263.19,38.7,percent of total billed charges,680.07,26.52,346.84,percent of total billed charges,38.7
Q10640 B2TF EL-IF,86335,CPT,,,,,both,, ,680.07,680.07,Blue Cross and Blue Shield,Traditional,,263.19,38.7,percent of total billed charges,680.07,26.52,346.84,percent of total billed charges,38.7
Q213 IFE U,86335,CPT,,,,,both,, ,680.07,680.07,Blue Cross and Blue Shield,Traditional,,263.19,38.7,percent of total billed charges,680.07,26.52,346.84,percent of total billed charges,38.7
INHIBIN A,86336,CPT,,,,,both,, ,145.66,145.66,Blue Cross and Blue Shield,Traditional,,56.37,38.7,percent of total billed charges,145.66,5.68,74.29,percent of total billed charges,38.7
INSULIN AB,86337,CPT,,,,,both,, ,207.41,207.41,Blue Cross and Blue Shield,Traditional,,80.27,38.7,percent of total billed charges,207.41,8.09,105.78,percent of total billed charges,38.7
INSULIN AB,86337,CPT,,,,,both,, ,207.41,207.41,Blue Cross and Blue Shield,Traditional,,80.27,38.7,percent of total billed charges,207.41,8.09,105.78,percent of total billed charges,38.7
INTRINSIC FACTOR AB,86340,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
L10413 IFB AB ICMA,86340,CPT,,,,,both,, ,50.00,50.00,Blue Cross and Blue Shield,Traditional,,19.35,38.7,percent of total billed charges,50.00,1.95,25.5,percent of total billed charges,38.7
ISLET CELL AB,86341,CPT,,,,,both,, ,296.67,296.67,Blue Cross and Blue Shield,Traditional,,114.81,38.7,percent of total billed charges,296.67,11.57,151.3,percent of total billed charges,38.7
Q34878 GAD-65 AB RBA,86341,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,percent of total billed charges,728.07,28.39,371.32,percent of total billed charges,38.7
Q36177 IA2 AB,86341,CPT,,,,,both,, ,296.67,296.67,Blue Cross and Blue Shield,Traditional,,114.81,38.7,percent of total billed charges,296.67,11.57,151.3,percent of total billed charges,38.7
Q36741 ISL CL AB IFA,86341,CPT,,,,,both,, ,296.67,296.67,Blue Cross and Blue Shield,Traditional,,114.81,38.7,percent of total billed charges,296.67,11.57,151.3,percent of total billed charges,38.7
Q93022 ZINC TRANSPORTER 8 (ZNT8)ANTIBODY,86341,CPT,,,,,both,, ,264.25,264.25,Blue Cross and Blue Shield,Traditional,,102.26,38.7,percent of total billed charges,264.25,10.31,134.77,percent of total billed charges,38.7
Q90123 LEUK HIST REL,86343,CPT,,,,,both,, ,55.95,55.95,Blue Cross and Blue Shield,Traditional,,21.65,38.7,percent of total billed charges,55.95,2.18,28.53,percent of total billed charges,38.7
L820022 CHRN URTICAR,86352,CPT,,,,,both,, ,422.30,422.30,Blue Cross and Blue Shield,Traditional,,163.43,38.7,percent of total billed charges,422.30,16.47,215.37,percent of total billed charges,38.7
"Q39588 B CELLS, TOTA",86355,CPT,,,,,both,, ,217.52,217.52,Blue Cross and Blue Shield,Traditional,,84.18,38.7,percent of total billed charges,217.52,8.48,110.94,percent of total billed charges,38.7
MONONUC CELL AG QT,86356,CPT,,,,,both,, ,308.74,308.74,Blue Cross and Blue Shield,Traditional,,119.48,38.7,percent of total billed charges,308.74,12.04,157.46,percent of total billed charges,38.7
MONONUC CELL AG QT,86356,CPT,,,,,both,, ,308.74,308.74,Blue Cross and Blue Shield,Traditional,,119.48,38.7,percent of total billed charges,308.74,12.04,157.46,percent of total billed charges,38.7
Q37088 NK CELLS CF,86357,CPT,,,,,both,, ,217.52,217.52,Blue Cross and Blue Shield,Traditional,,84.18,38.7,percent of total billed charges,217.52,8.48,110.94,percent of total billed charges,38.7
"Q39588 T CELLS, TOTA",86359,CPT,,,,,both,, ,217.52,217.52,Blue Cross and Blue Shield,Traditional,,84.18,38.7,percent of total billed charges,217.52,8.48,110.94,percent of total billed charges,38.7
"T CELL,ABSO CD4-CD8",86360,CPT,,,,,both,, ,1515.65,1515.65,Blue Cross and Blue Shield,Traditional,,586.56,38.7,percent of total billed charges,1515.65,59.11,772.98,percent of total billed charges,38.7
"T CELL,ABSO CD4-CD8",86360,CPT,,,,,both,, ,1515.65,1515.65,Blue Cross and Blue Shield,Traditional,,586.56,38.7,percent of total billed charges,1515.65,59.11,772.98,percent of total billed charges,38.7
Q8360 LYMP SUB P5 FC,86361,CPT,,,,,both,, ,822.94,822.94,Blue Cross and Blue Shield,Traditional,,318.48,38.7,percent of total billed charges,822.94,32.09,419.7,percent of total billed charges,38.7
"T CELL, ABSO CD4",86361,CPT,,,,,both,, ,878.79,878.79,Blue Cross and Blue Shield,Traditional,,340.09,38.7,percent of total billed charges,878.79,34.27,448.18,percent of total billed charges,38.7
Q36952 MOG AB,86362,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,percent of total billed charges,529.91,20.67,270.25,percent of total billed charges,38.7
L165126TTG AB IGG IA,86364,CPT,,,,,both,, ,57.65,57.65,Blue Cross and Blue Shield,Traditional,,22.31,38.7,percent of total billed charges,57.65,2.25,29.4,percent of total billed charges,38.7
Q8821 TTG AB IGA IA,86364,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,percent of total billed charges,765.96,29.87,390.64,percent of total billed charges,38.7
Q8821 TTG AB IGA IA,86364,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,percent of total billed charges,765.96,29.87,390.64,percent of total billed charges,38.7
L504600 MSCLSPECKINAB,86366,CPT,,,,,both,, ,180.40,180.40,Blue Cross and Blue Shield,Traditional,,69.81,38.7,percent of total billed charges,180.40,7.04,92,percent of total billed charges,38.7
Q5081 TPO AB IA,86376,CPT,,,,,both,, ,682.88,682.88,Blue Cross and Blue Shield,Traditional,,264.27,38.7,percent of total billed charges,682.88,26.63,348.27,percent of total billed charges,38.7
Q5081 TPO AB IA,86376,CPT,,,,,both,, ,682.88,682.88,Blue Cross and Blue Shield,Traditional,,264.27,38.7,percent of total billed charges,682.88,26.63,348.27,percent of total billed charges,38.7
Q5081 TPO AB IA,86376,CPT,,,,,both,, ,682.88,682.88,Blue Cross and Blue Shield,Traditional,,264.27,38.7,percent of total billed charges,682.88,26.63,348.27,percent of total billed charges,38.7
Q5081 TPO AB IA,86376,CPT,,,,,both,, ,682.88,682.88,Blue Cross and Blue Shield,Traditional,,264.27,38.7,percent of total billed charges,682.88,26.63,348.27,percent of total billed charges,38.7
Q259 MITO AB IA,86381,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,percent of total billed charges,529.91,20.67,270.25,percent of total billed charges,38.7
Q30321 MM2AB IGG EIA,86381,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,percent of total billed charges,414.83,16.18,211.56,percent of total billed charges,38.7
"NEUTRALIZ TEST,VIRAL",86382,CPT,,,,,both,, ,224.54,224.54,Blue Cross and Blue Shield,Traditional,,86.90,38.7,percent of total billed charges,224.54,8.76,114.52,percent of total billed charges,38.7
"NEUTRALIZ TEST,VIRAL",86382,CPT,,,,,both,, ,224.54,224.54,Blue Cross and Blue Shield,Traditional,,86.90,38.7,percent of total billed charges,224.54,8.76,114.52,percent of total billed charges,38.7
PART AGGLUT.SCREEN,86403,CPT,,,,,both,, ,547.31,547.31,Blue Cross and Blue Shield,Traditional,,211.81,38.7,percent of total billed charges,547.31,21.35,279.13,percent of total billed charges,38.7
Q11196 CRYPTOC AG LA,86403,CPT,,,,,both,, ,172.90,172.90,Blue Cross and Blue Shield,Traditional,,66.91,38.7,percent of total billed charges,172.90,6.74,88.18,percent of total billed charges,38.7
Q11196 CRYPTOC AG LA,86403,CPT,,,,,both,, ,172.90,172.90,Blue Cross and Blue Shield,Traditional,,66.91,38.7,percent of total billed charges,172.90,6.74,88.18,percent of total billed charges,38.7
PART AGGLUT. TITER,86406,CPT,,,,,both,, ,147.91,147.91,Blue Cross and Blue Shield,Traditional,,57.24,38.7,percent of total billed charges,147.91,5.77,75.43,percent of total billed charges,38.7
Q37521 RA FACT QT,86431,CPT,,,,,both,, ,401.19,401.19,Blue Cross and Blue Shield,Traditional,,155.26,38.7,percent of total billed charges,401.19,15.65,204.61,percent of total billed charges,38.7
RHEUMATOID FACT QUAN,86431,CPT,,,,,both,, ,55.85,55.85,Blue Cross and Blue Shield,Traditional,,21.61,38.7,percent of total billed charges,55.85,2.18,28.48,percent of total billed charges,38.7
RHEUMATOID FACT QUAN,86431,CPT,,,,,both,, ,437.29,437.29,Blue Cross and Blue Shield,Traditional,,169.23,38.7,percent of total billed charges,437.29,17.05,223.02,percent of total billed charges,38.7
LRX182877 QTFERON TU,86480,CPT,,,,,both,, ,369.77,369.77,Blue Cross and Blue Shield,Traditional,,143.10,38.7,percent of total billed charges,369.77,14.42,188.58,percent of total billed charges,38.7
Q19453 TB GOLD BIO A,86480,CPT,,,,,both,,,403.05,403.05,Blue Cross and Blue Shield,Traditional,,155.98,38.7,percent of total billed charges,403.05,15.72,205.56,percent of total billed charges,38.7
TB TEST CELL IM MEAS,86480,CPT,,,,,both,, ,403.05,403.05,Blue Cross and Blue Shield,Traditional,,155.98,38.7,percent of total billed charges,403.05,15.72,205.56,percent of total billed charges,38.7
TB TEST CELL IM MEAS,86480,CPT,,,,,both,, ,403.05,403.05,Blue Cross and Blue Shield,Traditional,,155.98,38.7,percent of total billed charges,403.05,15.72,205.56,percent of total billed charges,38.7
L006099 RFLX RPR,86592,CPT,,,,,both,, ,48.90,48.90,Blue Cross and Blue Shield,Traditional,,18.92,38.7,percent of total billed charges,48.90,1.91,24.94,percent of total billed charges,38.7
"SYPHILIS TEST, QUAL",86592,CPT,,,,,both,, ,42.10,42.10,Blue Cross and Blue Shield,Traditional,,16.29,38.7,percent of total billed charges,42.10,1.64,21.47,percent of total billed charges,38.7
"SYPHILIS TEST, QUAL",86592,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
"SYPHILIS TEST, QUAL",86592,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
L6460 RPR QT CHAR FL,86593,CPT,,,,,both,, ,412.88,412.88,Blue Cross and Blue Shield,Traditional,,159.78,38.7,percent of total billed charges,412.88,16.10,210.57,percent of total billed charges,38.7
"SYPHILIS TEST, QUANT",86593,CPT,,,,,both,, ,43.50,43.50,Blue Cross and Blue Shield,Traditional,,16.83,38.7,percent of total billed charges,43.50,1.70,22.19,percent of total billed charges,38.7
"SYPHILIS TEST, QUANT",86593,CPT,,,,,both,, ,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,percent of total billed charges,412.87,16.10,210.56,percent of total billed charges,38.7
VOLT-GTD CA CHNL AB,86596,CPT,,,,,both,, ,120.50,120.50,Blue Cross and Blue Shield,Traditional,,46.63,38.7,percent of total billed charges,120.50,4.70,61.46,percent of total billed charges,38.7
ASPERGILLUS AB,86606,CPT,,,,,both,, ,145.95,145.95,Blue Cross and Blue Shield,Traditional,,56.48,38.7,percent of total billed charges,145.95,5.69,74.43,percent of total billed charges,38.7
ASPERGILLUS AB,86606,CPT,,,,,both,, ,145.95,145.95,Blue Cross and Blue Shield,Traditional,,56.48,38.7,percent of total billed charges,145.95,5.69,74.43,percent of total billed charges,38.7
"BACTERUIM AB, NOS",86609,CPT,,,,,both,, ,154.09,154.09,Blue Cross and Blue Shield,Traditional,,59.63,38.7,percent of total billed charges,154.09,6.01,78.59,percent of total billed charges,38.7
"BACTERUIM AB, NOS",86609,CPT,,,,,both,, ,154.09,154.09,Blue Cross and Blue Shield,Traditional,,59.63,38.7,percent of total billed charges,154.09,6.01,78.59,percent of total billed charges,38.7
Q34329 LISTERI AB CF,86609,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,percent of total billed charges,770.45,30.05,392.93,percent of total billed charges,38.7
BARTONELLA AB,86611,CPT,,,,,both,, ,348.32,348.32,Blue Cross and Blue Shield,Traditional,,134.80,38.7,percent of total billed charges,348.32,13.58,177.64,percent of total billed charges,38.7
Q34251 BARTONELLA AB,86611,CPT,,,,,both,, ,264.11,264.11,Blue Cross and Blue Shield,Traditional,,102.21,38.7,percent of total billed charges,264.11,10.30,134.7,percent of total billed charges,38.7
BLASTOMYCES AB,86612,CPT,,,,,both,, ,600.92,600.92,Blue Cross and Blue Shield,Traditional,,232.56,38.7,percent of total billed charges,600.92,23.44,306.47,percent of total billed charges,38.7
BLASTOMYCES AB,86612,CPT,,,,,both,, ,600.92,600.92,Blue Cross and Blue Shield,Traditional,,232.56,38.7,percent of total billed charges,600.92,23.44,306.47,percent of total billed charges,38.7
BORDETELLA AB,86615,CPT,,,,,both,, ,134.44,134.44,Blue Cross and Blue Shield,Traditional,,52.03,38.7,percent of total billed charges,134.44,5.24,68.56,percent of total billed charges,38.7
BORDETELLA AB,86615,CPT,,,,,both,, ,134.44,134.44,Blue Cross and Blue Shield,Traditional,,52.03,38.7,percent of total billed charges,134.44,5.24,68.56,percent of total billed charges,38.7
BORRELIA BURG.CONFIR,86617,CPT,,,,,both,, ,232.11,232.11,Blue Cross and Blue Shield,Traditional,,89.83,38.7,percent of total billed charges,232.11,9.05,118.38,percent of total billed charges,38.7
BORRELIA BURG.CONFIR,86617,CPT,,,,,both,, ,232.11,232.11,Blue Cross and Blue Shield,Traditional,,89.83,38.7,percent of total billed charges,232.11,9.05,118.38,percent of total billed charges,38.7
LYME DISEASE AB,86618,CPT,,,,,both,, ,167.84,167.84,Blue Cross and Blue Shield,Traditional,,64.95,38.7,percent of total billed charges,167.84,6.55,85.6,percent of total billed charges,38.7
LYME DISEASE AB,86618,CPT,,,,,both,, ,573.13,573.13,Blue Cross and Blue Shield,Traditional,,221.80,38.7,percent of total billed charges,573.13,22.35,292.3,percent of total billed charges,38.7
LYME DISEASE AB,86618,CPT,,,,,both,, ,573.13,573.13,Blue Cross and Blue Shield,Traditional,,221.80,38.7,percent of total billed charges,573.13,22.35,292.3,percent of total billed charges,38.7
BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,405.29,Blue Cross and Blue Shield,Traditional,,156.85,38.7,percent of total billed charges,405.29,15.81,206.7,percent of total billed charges,38.7
Q91068 BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,405.29,Blue Cross and Blue Shield,Traditional,,156.85,38.7,percent of total billed charges,405.29,15.81,206.7,percent of total billed charges,38.7
Q91121 BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,405.29,Blue Cross and Blue Shield,Traditional,,156.85,38.7,percent of total billed charges,405.29,15.81,206.7,percent of total billed charges,38.7
CANDIDA AB,86628,CPT,,,,,both,, ,157.18,157.18,Blue Cross and Blue Shield,Traditional,,60.83,38.7,percent of total billed charges,157.18,6.13,80.16,percent of total billed charges,38.7
CHLAMYDIA AB,86631,CPT,,,,,both,, ,275.62,275.62,Blue Cross and Blue Shield,Traditional,,106.66,38.7,percent of total billed charges,275.62,10.75,140.57,percent of total billed charges,38.7
CHLAMYDIA IGM AB,86632,CPT,,,,,both,, ,286.57,286.57,Blue Cross and Blue Shield,Traditional,,110.90,38.7,percent of total billed charges,286.57,11.18,146.15,percent of total billed charges,38.7
CHLAMYDIA IGM AB,86632,CPT,,,,,both,, ,286.57,286.57,Blue Cross and Blue Shield,Traditional,,110.90,38.7,percent of total billed charges,286.57,11.18,146.15,percent of total billed charges,38.7
Q38481 C.PNEU AB IGM,86632,CPT,,,,,both,, ,743.51,743.51,Blue Cross and Blue Shield,Traditional,,287.74,38.7,percent of total billed charges,743.51,29.00,379.19,percent of total billed charges,38.7
COCCIDIOIDES AB,86635,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
COCCIDIOIDES AB,86635,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
L806606 Q FEV,86638,CPT,,,,,both,, ,120.00,120.00,Blue Cross and Blue Shield,Traditional,,46.44,38.7,percent of total billed charges,120.00,4.68,61.2,percent of total billed charges,38.7
Q37071 COXIELLA BRUN,86638,CPT,,,,,both,, ,69.89,69.89,Blue Cross and Blue Shield,Traditional,,27.05,38.7,percent of total billed charges,69.89,2.73,35.64,percent of total billed charges,38.7
Q30430 CRYPTO AB IFA,86641,CPT,,,,,both,, ,74.65,74.65,Blue Cross and Blue Shield,Traditional,,28.89,38.7,percent of total billed charges,74.65,2.91,38.07,percent of total billed charges,38.7
CMV AB,86644,CPT,,,,,both,, ,1113.43,1113.43,Blue Cross and Blue Shield,Traditional,,430.90,38.7,percent of total billed charges,1113.43,43.42,567.85,percent of total billed charges,38.7
CMV AB,86644,CPT,,,,,both,, ,1113.43,1113.43,Blue Cross and Blue Shield,Traditional,,430.90,38.7,percent of total billed charges,1113.43,43.42,567.85,percent of total billed charges,38.7
L6494 CMV IGG CLIA,86644,CPT,,,,,both,, ,1021.50,1021.50,Blue Cross and Blue Shield,Traditional,,395.32,38.7,percent of total billed charges,1021.50,39.84,520.97,percent of total billed charges,38.7
"CMV AB, IGM",86645,CPT,,,,,both,, ,1277.07,1277.07,Blue Cross and Blue Shield,Traditional,,494.23,38.7,percent of total billed charges,1277.07,49.81,651.31,percent of total billed charges,38.7
Q8503 CMV AB IGM IA,86645,CPT,,,,,both,, ,485.84,485.84,Blue Cross and Blue Shield,Traditional,,188.02,38.7,percent of total billed charges,485.84,18.95,247.78,percent of total billed charges,38.7
Q37512 DIPTHTHER AB,86648,CPT,,,,,both,, ,101.32,101.32,Blue Cross and Blue Shield,Traditional,,39.21,38.7,percent of total billed charges,101.32,3.95,51.67,percent of total billed charges,38.7
ENTEROVIRUS AB,86658,CPT,,,,,both,, ,375.82,375.82,Blue Cross and Blue Shield,Traditional,,145.44,38.7,percent of total billed charges,375.82,14.66,191.67,percent of total billed charges,38.7
L830764 ENTEROVIR AB,86658,CPT,,,,,both,, ,212.00,212.00,Blue Cross and Blue Shield,Traditional,,82.04,38.7,percent of total billed charges,212.00,8.27,108.12,percent of total billed charges,38.7
"EPSTEIN-BARR AB, EA",86663,CPT,,,,,both,, ,210.50,210.50,Blue Cross and Blue Shield,Traditional,,81.46,38.7,percent of total billed charges,210.50,8.21,107.36,percent of total billed charges,38.7
"EPSTEIN-BARR AB, EA",86663,CPT,,,,,both,, ,210.50,210.50,Blue Cross and Blue Shield,Traditional,,81.46,38.7,percent of total billed charges,210.50,8.21,107.36,percent of total billed charges,38.7
"EPSTEIN-BARR, EBNA",86664,CPT,,,,,both,, ,362.91,362.91,Blue Cross and Blue Shield,Traditional,,140.45,38.7,percent of total billed charges,362.91,14.15,185.08,percent of total billed charges,38.7
"EPSTEIN-BARR, EBNA",86664,CPT,,,,,both,, ,362.91,362.91,Blue Cross and Blue Shield,Traditional,,140.45,38.7,percent of total billed charges,362.91,14.15,185.08,percent of total billed charges,38.7
"EPSTEIN-BARR, VCA",86665,CPT,,,,,both,, ,362.91,362.91,Blue Cross and Blue Shield,Traditional,,140.45,38.7,percent of total billed charges,362.91,14.15,185.08,percent of total billed charges,38.7
"EPSTEIN-BARR, VCA",86665,CPT,,,,,both,, ,362.91,362.91,Blue Cross and Blue Shield,Traditional,,140.45,38.7,percent of total billed charges,362.91,14.15,185.08,percent of total billed charges,38.7
Q8426 EBV VCA IGM IA,86665,CPT,,,,,both,, ,210.50,210.50,Blue Cross and Blue Shield,Traditional,,81.46,38.7,percent of total billed charges,210.50,8.21,107.36,percent of total billed charges,38.7
Q8426 EBV VCA IGM IA,86665,CPT,,,,,both,, ,210.50,210.50,Blue Cross and Blue Shield,Traditional,,81.46,38.7,percent of total billed charges,210.50,8.21,107.36,percent of total billed charges,38.7
EHRLICHIA AB,86666,CPT,,,,,both,, ,255.98,255.98,Blue Cross and Blue Shield,Traditional,,99.06,38.7,percent of total billed charges,255.98,9.98,130.55,percent of total billed charges,38.7
EHRLICHIA AB,86666,CPT,,,,,both,, ,255.98,255.98,Blue Cross and Blue Shield,Traditional,,99.06,38.7,percent of total billed charges,255.98,9.98,130.55,percent of total billed charges,38.7
Q34271 EHRLICHIA AB,86666,CPT,,,,,both,, ,511.95,511.95,Blue Cross and Blue Shield,Traditional,,198.12,38.7,percent of total billed charges,511.95,19.97,261.09,percent of total billed charges,38.7
FRANCISELLA TULARENS,86668,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,40.41,528.49,percent of total billed charges,38.7
"FUNGUS AB, NOS",86671,CPT,,,,,both,, ,284.32,284.32,Blue Cross and Blue Shield,Traditional,,110.03,38.7,percent of total billed charges,284.32,11.09,145,percent of total billed charges,38.7
L162045 FUNG AB NOS,86671,CPT,,,,,both,, ,260.85,260.85,Blue Cross and Blue Shield,Traditional,,100.95,38.7,percent of total billed charges,260.85,10.17,133.03,percent of total billed charges,38.7
Q10294 SCAB IGG IA,86671,CPT,,,,,both,, ,568.64,568.64,Blue Cross and Blue Shield,Traditional,,220.06,38.7,percent of total billed charges,568.64,22.18,290.01,percent of total billed charges,38.7
Q10294 SCAB IGG IA,86671,CPT,,,,,both,, ,568.64,568.64,Blue Cross and Blue Shield,Traditional,,220.06,38.7,percent of total billed charges,568.64,22.18,290.01,percent of total billed charges,38.7
Q37695 H PYLORI AB Q,86677,CPT,,,,,both,, ,56.69,56.69,Blue Cross and Blue Shield,Traditional,,21.94,38.7,percent of total billed charges,56.69,2.21,28.91,percent of total billed charges,38.7
Q34168 FILAR IGG4 EL,86682,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29.00,38.7,percent of total billed charges,74.93,2.92,38.21,percent of total billed charges,38.7
Q34168 FILAR IGG4 EL,86682,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29.00,38.7,percent of total billed charges,74.93,2.92,38.21,percent of total billed charges,38.7
Q34168 FILAR IGG4 EL,86682,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29.00,38.7,percent of total billed charges,74.93,2.92,38.21,percent of total billed charges,38.7
Q34168 FILAR IGG4 EL,86682,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29.00,38.7,percent of total billed charges,74.93,2.92,38.21,percent of total billed charges,38.7
"HEPATITIS, DELTA AGE",86692,CPT,,,,,both,, ,1381.76,1381.76,Blue Cross and Blue Shield,Traditional,,534.74,38.7,percent of total billed charges,1381.76,53.89,704.7,percent of total billed charges,38.7
Q4990 HEP D AB TOTAL,86692,CPT,,,,,both,, ,725.82,725.82,Blue Cross and Blue Shield,Traditional,,280.89,38.7,percent of total billed charges,725.82,28.31,370.17,percent of total billed charges,38.7
HERPES SIMP NON-SPEC,86694,CPT,,,,,both,, ,338.21,338.21,Blue Cross and Blue Shield,Traditional,,130.89,38.7,percent of total billed charges,338.21,13.19,172.49,percent of total billed charges,38.7
L164806 HSV1/2 IGM,86694,CPT,,,,,both,, ,50.70,50.70,Blue Cross and Blue Shield,Traditional,,19.62,38.7,percent of total billed charges,50.70,1.98,25.86,percent of total billed charges,38.7
HERPES SIMP TYPE 1,86695,CPT,,,,,both,, ,129.94,129.94,Blue Cross and Blue Shield,Traditional,,50.29,38.7,percent of total billed charges,129.94,5.07,66.27,percent of total billed charges,38.7
Q6447 HERPES SMP TP1,86695,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
Q6447 HERPES SMP TP1,86695,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
Q6447 HERPES SMP TP1,86695,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
Q6447 HERPES SMP TP1,86695,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.10,38.7,percent of total billed charges,351.68,13.72,179.36,percent of total billed charges,38.7
HERPES SIMP TYPE 2,86696,CPT,,,,,both,, ,190.86,190.86,Blue Cross and Blue Shield,Traditional,,73.86,38.7,percent of total billed charges,190.86,7.44,97.34,percent of total billed charges,38.7
L163006 HSV2 AB IG,86696,CPT,,,,,both,, ,300.00,300.00,Blue Cross and Blue Shield,Traditional,,116.10,38.7,percent of total billed charges,300.00,11.70,153,percent of total billed charges,38.7
Q17170 HERPES SIMPLEX VIRUS 2 (IGG),86696,CPT,,,,,both,, ,230.25,230.25,Blue Cross and Blue Shield,Traditional,,89.11,38.7,percent of total billed charges,230.25,8.98,117.43,percent of total billed charges,38.7
Q6447 HERPES SMP TP2,86696,CPT,,,,,both,, ,258.50,258.50,Blue Cross and Blue Shield,Traditional,,100.04,38.7,percent of total billed charges,258.50,10.08,131.84,percent of total billed charges,38.7
Q6447 HERPES SMP TP2,86696,CPT,,,,,both,, ,258.50,258.50,Blue Cross and Blue Shield,Traditional,,100.04,38.7,percent of total billed charges,258.50,10.08,131.84,percent of total billed charges,38.7
Q6447 HERPES SMP TP2,86696,CPT,,,,,both,, ,258.50,258.50,Blue Cross and Blue Shield,Traditional,,100.04,38.7,percent of total billed charges,258.50,10.08,131.84,percent of total billed charges,38.7
Q6447 HERPES SMP TP2,86696,CPT,,,,,both,, ,258.50,258.50,Blue Cross and Blue Shield,Traditional,,100.04,38.7,percent of total billed charges,258.50,10.08,131.84,percent of total billed charges,38.7
HISTOPLASMA,86698,CPT,,,,,both,, ,450.48,450.48,Blue Cross and Blue Shield,Traditional,,174.34,38.7,percent of total billed charges,450.48,17.57,229.74,percent of total billed charges,38.7
HISTOPLASMA,86698,CPT,,,,,both,, ,450.48,450.48,Blue Cross and Blue Shield,Traditional,,174.34,38.7,percent of total billed charges,450.48,17.57,229.74,percent of total billed charges,38.7
HEP B CORE TOT,86704,CPT,,,,,both,, ,898.44,898.44,Blue Cross and Blue Shield,Traditional,,347.70,38.7,percent of total billed charges,898.44,35.04,458.2,percent of total billed charges,38.7
HEP B CORE TOT,86704,CPT,,,,,both,, ,898.44,898.44,Blue Cross and Blue Shield,Traditional,,347.70,38.7,percent of total billed charges,898.44,35.04,458.2,percent of total billed charges,38.7
"HEP B CORE AB, IGM",86705,CPT,,,,,both,,,1047.19,1047.19,Blue Cross and Blue Shield,Traditional,,405.26,38.7,percent of total billed charges,1047.19,40.84,534.07,percent of total billed charges,38.7
"HEP B CORE AB, IGM",86705,CPT,,,,,both,, ,1047.19,1047.19,Blue Cross and Blue Shield,Traditional,,405.26,38.7,percent of total billed charges,1047.19,40.84,534.07,percent of total billed charges,38.7
L16881 HBC IGM ICMA,86705,CPT,,,,,both,, ,70.33,70.33,Blue Cross and Blue Shield,Traditional,,27.22,38.7,percent of total billed charges,70.33,2.74,35.87,percent of total billed charges,38.7
HEP BE AB,86707,CPT,,,,,both,, ,999.76,999.76,Blue Cross and Blue Shield,Traditional,,386.91,38.7,percent of total billed charges,999.76,38.99,509.88,percent of total billed charges,38.7
HEP BE AB,86707,CPT,,,,,both,, ,999.76,999.76,Blue Cross and Blue Shield,Traditional,,386.91,38.7,percent of total billed charges,999.76,38.99,509.88,percent of total billed charges,38.7
"HEP A AB, TOTAL",86708,CPT,,,,,both,, ,547.88,547.88,Blue Cross and Blue Shield,Traditional,,212.03,38.7,percent of total billed charges,547.88,21.37,279.42,percent of total billed charges,38.7
L6726HEPA AB TOT ICM,86708,CPT,,,,,both,, ,547.88,547.88,Blue Cross and Blue Shield,Traditional,,212.03,38.7,percent of total billed charges,547.88,21.37,279.42,percent of total billed charges,38.7
Q36504 HEPA AB IGM I,86708,CPT,,,,,both,, ,547.88,547.88,Blue Cross and Blue Shield,Traditional,,212.03,38.7,percent of total billed charges,547.88,21.37,279.42,percent of total billed charges,38.7
"HEP A AB, IGM",86709,CPT,,,,,both,,,725.82,725.82,Blue Cross and Blue Shield,Traditional,,280.89,38.7,percent of total billed charges,725.82,28.31,370.17,percent of total billed charges,38.7
"HEP A AB, IGM",86709,CPT,,,,,both,, ,725.82,725.82,Blue Cross and Blue Shield,Traditional,,280.89,38.7,percent of total billed charges,725.82,28.31,370.17,percent of total billed charges,38.7
L6734 HEP A IGM ICMA,86709,CPT,,,,,both,, ,70.00,70.00,Blue Cross and Blue Shield,Traditional,,27.09,38.7,percent of total billed charges,70.00,2.73,35.7,percent of total billed charges,38.7
L6734 HEP A IGM ICMA,86709,CPT,,,,,both,, ,70.00,70.00,Blue Cross and Blue Shield,Traditional,,27.09,38.7,percent of total billed charges,70.00,2.73,35.7,percent of total billed charges,38.7
INFLUENZA VIRUS AB,86710,CPT,,,,,both,, ,295.83,295.83,Blue Cross and Blue Shield,Traditional,,114.49,38.7,percent of total billed charges,295.83,11.54,150.87,percent of total billed charges,38.7
INFLUENZA VIRUS AB,86710,CPT,,,,,both,, ,295.83,295.83,Blue Cross and Blue Shield,Traditional,,114.49,38.7,percent of total billed charges,295.83,11.54,150.87,percent of total billed charges,38.7
Q91665 STRAT JCV AB,86711,CPT,,,,,both,, ,156.06,156.06,Blue Cross and Blue Shield,Traditional,,60.40,38.7,percent of total billed charges,156.06,6.09,79.59,percent of total billed charges,38.7
L164616 LEGIONELL AB,86713,CPT,,,,,both,, ,781.12,781.12,Blue Cross and Blue Shield,Traditional,,302.29,38.7,percent of total billed charges,781.12,30.46,398.37,percent of total billed charges,38.7
LEGIONELLA AB,86713,CPT,,,,,both,, ,781.11,781.11,Blue Cross and Blue Shield,Traditional,,302.29,38.7,percent of total billed charges,781.11,30.46,398.37,percent of total billed charges,38.7
LEGIONELLA AB,86713,CPT,,,,,both,, ,781.11,781.11,Blue Cross and Blue Shield,Traditional,,302.29,38.7,percent of total billed charges,781.11,30.46,398.37,percent of total billed charges,38.7
LEPTOSPIRA AB,86720,CPT,,,,,both,, ,329.51,329.51,Blue Cross and Blue Shield,Traditional,,127.52,38.7,percent of total billed charges,329.51,12.85,168.05,percent of total billed charges,38.7
L96552MUMPS IGG CLIA,86735,CPT,,,,,both,, ,540.24,540.24,Blue Cross and Blue Shield,Traditional,,209.07,38.7,percent of total billed charges,540.24,21.07,275.52,percent of total billed charges,38.7
MUMPS AB,86735,CPT,,,,,both,, ,96.55,96.55,Blue Cross and Blue Shield,Traditional,,37.36,38.7,percent of total billed charges,96.55,3.77,49.24,percent of total billed charges,38.7
MUMPS AB,86735,CPT,,,,,both,, ,588.85,588.85,Blue Cross and Blue Shield,Traditional,,227.88,38.7,percent of total billed charges,588.85,22.97,300.31,percent of total billed charges,38.7
Q36565 MUMPS IGM IFA,86735,CPT,,,,,both,, ,588.85,588.85,Blue Cross and Blue Shield,Traditional,,227.88,38.7,percent of total billed charges,588.85,22.97,300.31,percent of total billed charges,38.7
Q8624 MUMPSAB IGG IA,86735,CPT,,,,,both,, ,588.85,588.85,Blue Cross and Blue Shield,Traditional,,227.88,38.7,percent of total billed charges,588.85,22.97,300.31,percent of total billed charges,38.7
Q21130 MPAB IGM EIA,86738,CPT,,,,,both,, ,566.12,566.12,Blue Cross and Blue Shield,Traditional,,219.09,38.7,percent of total billed charges,566.12,22.08,288.72,percent of total billed charges,38.7
Q21130 MPAB IGM EIA,86738,CPT,,,,,both,, ,566.12,566.12,Blue Cross and Blue Shield,Traditional,,219.09,38.7,percent of total billed charges,566.12,22.08,288.72,percent of total billed charges,38.7
Q21130 MPAB IGM EIA,86738,CPT,,,,,both,, ,566.12,566.12,Blue Cross and Blue Shield,Traditional,,219.09,38.7,percent of total billed charges,566.12,22.08,288.72,percent of total billed charges,38.7
Q21130 MPAB IGM EIA,86738,CPT,,,,,both,, ,566.12,566.12,Blue Cross and Blue Shield,Traditional,,219.09,38.7,percent of total billed charges,566.12,22.08,288.72,percent of total billed charges,38.7
Q8948 PARVO IGM EIA,86747,CPT,,,,,both,, ,242.50,242.50,Blue Cross and Blue Shield,Traditional,,93.85,38.7,percent of total billed charges,242.50,9.46,123.68,percent of total billed charges,38.7
Q8948 PARVO IGM EIA,86747,CPT,,,,,both,, ,242.50,242.50,Blue Cross and Blue Shield,Traditional,,93.85,38.7,percent of total billed charges,242.50,9.46,123.68,percent of total billed charges,38.7
Q8948 PARVO IGM EIA,86747,CPT,,,,,both,, ,242.50,242.50,Blue Cross and Blue Shield,Traditional,,93.85,38.7,percent of total billed charges,242.50,9.46,123.68,percent of total billed charges,38.7
Q8948 PARVO IGM EIA,86747,CPT,,,,,both,, ,242.50,242.50,Blue Cross and Blue Shield,Traditional,,93.85,38.7,percent of total billed charges,242.50,9.46,123.68,percent of total billed charges,38.7
Q34278 ENTAB IGG ELI,86753,CPT,,,,,both,, ,64.27,64.27,Blue Cross and Blue Shield,Traditional,,24.87,38.7,percent of total billed charges,64.27,2.51,32.78,percent of total billed charges,38.7
Q34300 PROTOZ AB NOS,86753,CPT,,,,,both,, ,64.27,64.27,Blue Cross and Blue Shield,Traditional,,24.87,38.7,percent of total billed charges,64.27,2.51,32.78,percent of total billed charges,38.7
Q90827 T CRUZI AB IA,86753,CPT,,,,,both,, ,64.27,64.27,Blue Cross and Blue Shield,Traditional,,24.87,38.7,percent of total billed charges,64.27,2.51,32.78,percent of total billed charges,38.7
L96131 RSV AB QT,86756,CPT,,,,,both,, ,95.00,95.00,Blue Cross and Blue Shield,Traditional,,36.77,38.7,percent of total billed charges,95.00,3.71,48.45,percent of total billed charges,38.7
SPOTTED FEVER IGM,86757,CPT,,,,,both,, ,242.50,242.50,Blue Cross and Blue Shield,Traditional,,93.85,38.7,percent of total billed charges,242.50,9.46,123.68,percent of total billed charges,38.7
SPOTTED FEVER IGM,86757,CPT,,,,,both,, ,242.50,242.50,Blue Cross and Blue Shield,Traditional,,93.85,38.7,percent of total billed charges,242.50,9.46,123.68,percent of total billed charges,38.7
SPOTTED FEVER IGM,86757,CPT,,,,,both,, ,242.50,242.50,Blue Cross and Blue Shield,Traditional,,93.85,38.7,percent of total billed charges,242.50,9.46,123.68,percent of total billed charges,38.7
SPOTTED FEVER IGM,86757,CPT,,,,,both,, ,242.50,242.50,Blue Cross and Blue Shield,Traditional,,93.85,38.7,percent of total billed charges,242.50,9.46,123.68,percent of total billed charges,38.7
RUBELLA AB,86762,CPT,,,,,both,, ,88.69,88.69,Blue Cross and Blue Shield,Traditional,,34.32,38.7,percent of total billed charges,88.69,3.46,45.23,percent of total billed charges,38.7
RUBELLA AB,86762,CPT,,,,,both,, ,906.30,906.30,Blue Cross and Blue Shield,Traditional,,350.74,38.7,percent of total billed charges,906.30,35.35,462.21,percent of total billed charges,38.7
Q34256 MEASAB IGMIA,86765,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,percent of total billed charges,871.22,33.98,444.32,percent of total billed charges,38.7
Q964 MEAS AB IGG IA,86765,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,percent of total billed charges,871.22,33.98,444.32,percent of total billed charges,38.7
RUBEOLA AB,86765,CPT,,,,,both,, ,111.15,111.15,Blue Cross and Blue Shield,Traditional,,43.02,38.7,percent of total billed charges,111.15,4.33,56.69,percent of total billed charges,38.7
RUBEOLA AB,86765,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,percent of total billed charges,871.22,33.98,444.32,percent of total billed charges,38.7
SALMONELLA AB,86768,CPT,,,,,both,, ,127.70,127.70,Blue Cross and Blue Shield,Traditional,,49.42,38.7,percent of total billed charges,127.70,4.98,65.13,percent of total billed charges,38.7
SALMONELLA AB,86768,CPT,,,,,both,, ,127.70,127.70,Blue Cross and Blue Shield,Traditional,,49.42,38.7,percent of total billed charges,127.70,4.98,65.13,percent of total billed charges,38.7
COVID19 AB,86769,CPT,,,,,both,, ,224.54,224.54,Blue Cross and Blue Shield,Traditional,,86.90,38.7,percent of total billed charges,224.54,8.76,114.52,percent of total billed charges,38.7
COVID19 AB,86769,CPT,,,,,both,, ,224.54,224.54,Blue Cross and Blue Shield,Traditional,,86.90,38.7,percent of total billed charges,224.54,8.76,114.52,percent of total billed charges,38.7
L164055 COVID19ABIGG,86769,CPT,,,,,both,, ,206.00,206.00,Blue Cross and Blue Shield,Traditional,,79.72,38.7,percent of total billed charges,206.00,8.03,105.06,percent of total billed charges,38.7
Q4862 TET ATOX ELISA,86774,CPT,,,,,both,, ,98.51,98.51,Blue Cross and Blue Shield,Traditional,,38.12,38.7,percent of total billed charges,98.51,3.84,50.24,percent of total billed charges,38.7
Q3679 TOXOPLAS AB IA,86777,CPT,,,,,both,, ,247.83,247.83,Blue Cross and Blue Shield,Traditional,,95.91,38.7,percent of total billed charges,247.83,9.67,126.39,percent of total billed charges,38.7
Q8636 TOXOPLASMA AB,86777,CPT,,,,,both,, ,247.83,247.83,Blue Cross and Blue Shield,Traditional,,95.91,38.7,percent of total billed charges,247.83,9.67,126.39,percent of total billed charges,38.7
TOXOPLASMA AB,86777,CPT,,,,,both,, ,247.83,247.83,Blue Cross and Blue Shield,Traditional,,95.91,38.7,percent of total billed charges,247.83,9.67,126.39,percent of total billed charges,38.7
"TOXOPLASMA AB, IGM",86778,CPT,,,,,both,, ,247.83,247.83,Blue Cross and Blue Shield,Traditional,,95.91,38.7,percent of total billed charges,247.83,9.67,126.39,percent of total billed charges,38.7
"TOXOPLASMA AB, IGM",86778,CPT,,,,,both,, ,247.83,247.83,Blue Cross and Blue Shield,Traditional,,95.91,38.7,percent of total billed charges,247.83,9.67,126.39,percent of total billed charges,38.7
L082370 TREP AB IA,86780,CPT,,,,,both,, ,132.40,132.40,Blue Cross and Blue Shield,Traditional,,51.24,38.7,percent of total billed charges,132.40,5.16,67.52,percent of total billed charges,38.7
"TREP. PALLIDUM,CONFI",86780,CPT,,,,,both,, ,172.90,172.90,Blue Cross and Blue Shield,Traditional,,66.91,38.7,percent of total billed charges,172.90,6.74,88.18,percent of total billed charges,38.7
"TREP. PALLIDUM,CONFI",86780,CPT,,,,,both,, ,172.90,172.90,Blue Cross and Blue Shield,Traditional,,66.91,38.7,percent of total billed charges,172.90,6.74,88.18,percent of total billed charges,38.7
TREPONEMAL AB,86780,CPT,,,,,both,, ,48.90,48.90,Blue Cross and Blue Shield,Traditional,,18.92,38.7,percent of total billed charges,48.90,1.91,24.94,percent of total billed charges,38.7
L96206 VZV IGG CLIA,86787,CPT,,,,,both,, ,831.47,831.47,Blue Cross and Blue Shield,Traditional,,321.78,38.7,percent of total billed charges,831.47,32.43,424.05,percent of total billed charges,38.7
Q4439 VZV AB IGG IA,86787,CPT,,,,,both,, ,906.30,906.30,Blue Cross and Blue Shield,Traditional,,350.74,38.7,percent of total billed charges,906.30,35.35,462.21,percent of total billed charges,38.7
Q8683 VZV AB IGM IA,86787,CPT,,,,,both,, ,906.30,906.30,Blue Cross and Blue Shield,Traditional,,350.74,38.7,percent of total billed charges,906.30,35.35,462.21,percent of total billed charges,38.7
VARICELLA-ZOSTER AB,86787,CPT,,,,,both,, ,111.15,111.15,Blue Cross and Blue Shield,Traditional,,43.02,38.7,percent of total billed charges,111.15,4.33,56.69,percent of total billed charges,38.7
VARICELLA-ZOSTER AB,86787,CPT,,,,,both,, ,906.30,906.30,Blue Cross and Blue Shield,Traditional,,350.74,38.7,percent of total billed charges,906.30,35.35,462.21,percent of total billed charges,38.7
Q16012 WNVAB IGM EIA,86788,CPT,,,,,both,, ,252.61,252.61,Blue Cross and Blue Shield,Traditional,,97.76,38.7,percent of total billed charges,252.61,9.85,128.83,percent of total billed charges,38.7
Q36596 WEST NILE VIR,86788,CPT,,,,,both,, ,252.61,252.61,Blue Cross and Blue Shield,Traditional,,97.76,38.7,percent of total billed charges,252.61,9.85,128.83,percent of total billed charges,38.7
WEST NILE VIR AB IGM,86788,CPT,,,,,both,, ,252.61,252.61,Blue Cross and Blue Shield,Traditional,,97.76,38.7,percent of total billed charges,252.61,9.85,128.83,percent of total billed charges,38.7
Q36596 WEST NILE VIR,86789,CPT,,,,,both,, ,219.20,219.20,Blue Cross and Blue Shield,Traditional,,84.83,38.7,percent of total billed charges,219.20,8.55,111.79,percent of total billed charges,38.7
WEST NILE VIR AB,86789,CPT,,,,,both,, ,215.84,215.84,Blue Cross and Blue Shield,Traditional,,83.53,38.7,percent of total billed charges,215.84,8.42,110.08,percent of total billed charges,38.7
L878033 HHV-7 IGM IF,86790,CPT,,,,,both,, ,615.00,615.00,Blue Cross and Blue Shield,Traditional,,238.01,38.7,percent of total billed charges,615.00,23.99,313.65,percent of total billed charges,38.7
Q36175HLTV I/II CL-I,86790,CPT,,,,,both,, ,124.90,124.90,Blue Cross and Blue Shield,Traditional,,48.34,38.7,percent of total billed charges,124.90,4.87,63.7,percent of total billed charges,38.7
Q36175HLTV I/II CL-I,86790,CPT,,,,,both,, ,124.90,124.90,Blue Cross and Blue Shield,Traditional,,48.34,38.7,percent of total billed charges,124.90,4.87,63.7,percent of total billed charges,38.7
Q94264 ZIKA AB IGM,86794,CPT,,,,,both,, ,97.11,97.11,Blue Cross and Blue Shield,Traditional,,37.58,38.7,percent of total billed charges,97.11,3.79,49.53,percent of total billed charges,38.7
Q30278 THYROGLOB AB,86800,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,percent of total billed charges,751.36,29.30,383.19,percent of total billed charges,38.7
Q30278 THYROGLOB AB,86800,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,percent of total billed charges,751.36,29.30,383.19,percent of total billed charges,38.7
Q30278 THYROGLOB AB,86800,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,percent of total billed charges,751.36,29.30,383.19,percent of total billed charges,38.7
Q30278 THYROGLOB AB,86800,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,percent of total billed charges,751.36,29.30,383.19,percent of total billed charges,38.7
Q90814 THYROID CANCER (THYROGLOBULIN)MON,86800,CPT,,,,,both,, ,669.25,669.25,Blue Cross and Blue Shield,Traditional,,259.00,38.7,percent of total billed charges,669.25,26.10,341.32,percent of total billed charges,38.7
HEPATITIS C AB TEST,86803,CPT,,,,,both,, ,698.32,698.32,Blue Cross and Blue Shield,Traditional,,270.25,38.7,percent of total billed charges,698.32,27.23,356.14,percent of total billed charges,38.7
"HEP C AB TEST,CONFIR",86804,CPT,,,,,both,, ,358.42,358.42,Blue Cross and Blue Shield,Traditional,,138.71,38.7,percent of total billed charges,358.42,13.98,182.79,percent of total billed charges,38.7
CYTOTOXIC REACTIVE AB SCREEN/STANDARD,86807,CPT,,,,,both,, ,87.00,87.00,Blue Cross and Blue Shield,Traditional,,33.67,38.7,percent of total billed charges,87.00,3.39,44.37,percent of total billed charges,38.7
"HLA  A,B,OR C,SING",86812,CPT,,,,,both,, ,1449.41,1449.41,Blue Cross and Blue Shield,Traditional,,560.92,38.7,percent of total billed charges,1449.41,56.53,739.2,percent of total billed charges,38.7
"HLA  A,B,OR C,SING",86812,CPT,,,,,both,, ,1449.41,1449.41,Blue Cross and Blue Shield,Traditional,,560.92,38.7,percent of total billed charges,1449.41,56.53,739.2,percent of total billed charges,38.7
HLA SOLID PHASE/CALSS I&II AB QUAL,86828,CPT,,,,,both,, ,70.00,70.00,Blue Cross and Blue Shield,Traditional,,27.09,38.7,percent of total billed charges,70.00,2.73,35.7,percent of total billed charges,38.7
HLA SOLID PHASE/CLASS 1 AB QUAL HIGHDEF,86832,CPT,,,,,both,, ,356.00,356.00,Blue Cross and Blue Shield,Traditional,,137.77,38.7,percent of total billed charges,356.00,13.88,181.56,percent of total billed charges,38.7
L117065 PROTH AB IGG,86849,CPT,,,,,both,, ,157.00,157.00,Blue Cross and Blue Shield,Traditional,,60.76,38.7,percent of total billed charges,157.00,6.12,80.07,percent of total billed charges,38.7
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,, ,61.75,61.75,Blue Cross and Blue Shield,Traditional,,23.90,38.7,percent of total billed charges,61.75,2.41,31.49,percent of total billed charges,38.7
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,,,318.00,318.00,Blue Cross and Blue Shield,Traditional,,123.07,38.7,percent of total billed charges,318.00,12.40,162.18,percent of total billed charges,38.7
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,, ,318.00,318.00,Blue Cross and Blue Shield,Traditional,,123.07,38.7,percent of total billed charges,318.00,12.40,162.18,percent of total billed charges,38.7
O51200 AB SCRN,86850,CPT,,,,,both,, ,291.75,291.75,Blue Cross and Blue Shield,Traditional,,112.91,38.7,percent of total billed charges,291.75,11.38,148.79,percent of total billed charges,38.7
"ANTIBODY ELUTION,RBC",86860,CPT,,,,,both,, ,174.30,174.30,Blue Cross and Blue Shield,Traditional,,67.45,38.7,percent of total billed charges,174.30,6.80,88.89,percent of total billed charges,38.7
"ANTIBODY ELUTION,RBC",86860,CPT,,,,,both,, ,174.30,174.30,Blue Cross and Blue Shield,Traditional,,67.45,38.7,percent of total billed charges,174.30,6.80,88.89,percent of total billed charges,38.7
"ANTIBODY ID,EA PANEL",86870,CPT,,,,,both,, ,488.65,488.65,Blue Cross and Blue Shield,Traditional,,189.11,38.7,percent of total billed charges,488.65,19.06,249.21,percent of total billed charges,38.7
O51108 AB ID EA PNL,86870,CPT,,,,,both,, ,475.18,475.18,Blue Cross and Blue Shield,Traditional,,183.89,38.7,percent of total billed charges,475.18,18.53,242.34,percent of total billed charges,38.7
DIRECT COOMBS TEST,86880,CPT,,,,,both,, ,250.64,250.64,Blue Cross and Blue Shield,Traditional,,97.00,38.7,percent of total billed charges,250.64,9.77,127.83,percent of total billed charges,38.7
DIRECT COOMBS TEST,86880,CPT,,,,,both,, ,250.64,250.64,Blue Cross and Blue Shield,Traditional,,97.00,38.7,percent of total billed charges,250.64,9.77,127.83,percent of total billed charges,38.7
IDAT QUAL EA RGT RBC,86885,CPT,,,,,both,, ,39.57,39.57,Blue Cross and Blue Shield,Traditional,,15.31,38.7,percent of total billed charges,39.57,1.54,20.18,percent of total billed charges,38.7
IDAT EACH AB TITER,86886,CPT,,,,,both,, ,326.14,326.14,Blue Cross and Blue Shield,Traditional,,126.22,38.7,percent of total billed charges,326.14,12.72,166.33,percent of total billed charges,38.7
"AUTO COMPONENT,PROCS",86890,CPT,,,,,both,, ,756.41,756.41,Blue Cross and Blue Shield,Traditional,,292.73,38.7,percent of total billed charges,756.41,29.50,385.77,percent of total billed charges,38.7
AUTOL BID OP SALV,86891,CPT,,,,,both,, ,3941.23,3941.23,Blue Cross and Blue Shield,Traditional,,1525.26,38.7,percent of total billed charges,3941.23,153.71,2010.03,percent of total billed charges,38.7
BLOOD TYPING ABO,86900,CPT,,,,,both,, ,38.73,38.73,Blue Cross and Blue Shield,Traditional,,14.99,38.7,percent of total billed charges,38.73,1.51,19.75,percent of total billed charges,38.7
BLOOD TYPING ABO,86900,CPT,,,,,both,,,97.39,97.39,Blue Cross and Blue Shield,Traditional,,37.69,38.7,percent of total billed charges,97.39,3.80,49.67,percent of total billed charges,38.7
BLOOD TYPING ABO,86900,CPT,,,,,both,, ,97.39,97.39,Blue Cross and Blue Shield,Traditional,,37.69,38.7,percent of total billed charges,97.39,3.80,49.67,percent of total billed charges,38.7
BLOOD TYPING ABO,86900,CPT,,,,,both,, ,97.39,97.39,Blue Cross and Blue Shield,Traditional,,37.69,38.7,percent of total billed charges,97.39,3.80,49.67,percent of total billed charges,38.7
BLOOD TYPING RH D,86901,CPT,,,,,both,, ,38.73,38.73,Blue Cross and Blue Shield,Traditional,,14.99,38.7,percent of total billed charges,38.73,1.51,19.75,percent of total billed charges,38.7
BLOOD TYPING RH D,86901,CPT,,,,,both,,,97.39,97.39,Blue Cross and Blue Shield,Traditional,,37.69,38.7,percent of total billed charges,97.39,3.80,49.67,percent of total billed charges,38.7
BLOOD TYPING RH D,86901,CPT,,,,,both,, ,97.39,97.39,Blue Cross and Blue Shield,Traditional,,37.69,38.7,percent of total billed charges,97.39,3.80,49.67,percent of total billed charges,38.7
BLOOD TYPING RH D,86901,CPT,,,,,both,, ,97.39,97.39,Blue Cross and Blue Shield,Traditional,,37.69,38.7,percent of total billed charges,97.39,3.80,49.67,percent of total billed charges,38.7
BLD TYPE DONOR EA AG,86902,CPT,,,,,both,, ,277.86,277.86,Blue Cross and Blue Shield,Traditional,,107.53,38.7,percent of total billed charges,277.86,10.84,141.71,percent of total billed charges,38.7
BLD TYPING OTHER AG,86905,CPT,,,,,both,,,217.52,217.52,Blue Cross and Blue Shield,Traditional,,84.18,38.7,percent of total billed charges,217.52,8.48,110.94,percent of total billed charges,38.7
BLD TYPING OTHER AG,86905,CPT,,,,,both,, ,217.52,217.52,Blue Cross and Blue Shield,Traditional,,84.18,38.7,percent of total billed charges,217.52,8.48,110.94,percent of total billed charges,38.7
BLD TYPING OTHER AG,86905,CPT,,,,,both,, ,217.52,217.52,Blue Cross and Blue Shield,Traditional,,84.18,38.7,percent of total billed charges,217.52,8.48,110.94,percent of total billed charges,38.7
O51920 RH PHENO,86906,CPT,,,,,both,, ,224.00,224.00,Blue Cross and Blue Shield,Traditional,,86.69,38.7,percent of total billed charges,224.00,8.74,114.24,percent of total billed charges,38.7
COMPATIB TEST IS,86920,CPT,,,,,both,,,275.62,275.62,Blue Cross and Blue Shield,Traditional,,106.66,38.7,percent of total billed charges,275.62,10.75,140.57,percent of total billed charges,38.7
COMPATIB TEST IS,86920,CPT,,,,,both,, ,275.62,275.62,Blue Cross and Blue Shield,Traditional,,106.66,38.7,percent of total billed charges,275.62,10.75,140.57,percent of total billed charges,38.7
COMPATIB TEST INCUB,86921,CPT,,,,,both,,,103.00,103.00,Blue Cross and Blue Shield,Traditional,,39.86,38.7,percent of total billed charges,103.00,4.02,52.53,percent of total billed charges,38.7
COMPATIB TEST INCUB,86921,CPT,,,,,both,, ,103.00,103.00,Blue Cross and Blue Shield,Traditional,,39.86,38.7,percent of total billed charges,103.00,4.02,52.53,percent of total billed charges,38.7
COMPATIB TEST AHG,86922,CPT,,,,,both,,,250.07,250.07,Blue Cross and Blue Shield,Traditional,,96.78,38.7,percent of total billed charges,250.07,9.75,127.54,percent of total billed charges,38.7
COMPATIB TEST AHG,86922,CPT,,,,,both,, ,250.07,250.07,Blue Cross and Blue Shield,Traditional,,96.78,38.7,percent of total billed charges,250.07,9.75,127.54,percent of total billed charges,38.7
FFP THAWING,86927,CPT,,,,,both,, ,233.80,233.80,Blue Cross and Blue Shield,Traditional,,90.48,38.7,percent of total billed charges,233.80,9.12,119.24,percent of total billed charges,38.7
PLATELETS POOLING,86965,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,percent of total billed charges,141.46,5.52,72.14,percent of total billed charges,38.7
O51010 CHEM TREATMNT,86970,CPT,,,,,both,, ,212.44,212.44,Blue Cross and Blue Shield,Traditional,,82.21,38.7,percent of total billed charges,212.44,8.29,108.34,percent of total billed charges,38.7
RBC PRETREAT CHEM,86970,CPT,,,,,both,, ,231.55,231.55,Blue Cross and Blue Shield,Traditional,,89.61,38.7,percent of total billed charges,231.55,9.03,118.09,percent of total billed charges,38.7
RBC PRETREAT ENZ,86971,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,percent of total billed charges,141.46,5.52,72.14,percent of total billed charges,38.7
RBC PRETREAT ENZ,86971,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,percent of total billed charges,141.46,5.52,72.14,percent of total billed charges,38.7
O51122 RBC CELL SEP,86972,CPT,,,,,both,, ,246.99,246.99,Blue Cross and Blue Shield,Traditional,,95.59,38.7,percent of total billed charges,246.99,9.63,125.96,percent of total billed charges,38.7
"RBC PRETREAT,SER,INC",86975,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,percent of total billed charges,141.46,5.52,72.14,percent of total billed charges,38.7
"RBC PRETREAT,SER DIL",86976,CPT,,,,,both,, ,61.80,61.80,Blue Cross and Blue Shield,Traditional,,23.92,38.7,percent of total billed charges,61.80,2.41,31.52,percent of total billed charges,38.7
RBC PRETREAT W-INHIB,86977,CPT,,,,,both,, ,218.64,218.64,Blue Cross and Blue Shield,Traditional,,84.61,38.7,percent of total billed charges,218.64,8.53,111.51,percent of total billed charges,38.7
O51234 ADSORPTION,86978,CPT,,,,,both,, ,149.35,149.35,Blue Cross and Blue Shield,Traditional,,57.80,38.7,percent of total billed charges,149.35,5.82,76.17,percent of total billed charges,38.7
RBC PRETREAT DIFF EA,86978,CPT,,,,,both,, ,162.79,162.79,Blue Cross and Blue Shield,Traditional,,63.00,38.7,percent of total billed charges,162.79,6.35,83.02,percent of total billed charges,38.7
SPLIT BLOOD OR PROD,86985,CPT,,,,,both,, ,546.75,546.75,Blue Cross and Blue Shield,Traditional,,211.59,38.7,percent of total billed charges,546.75,21.32,278.84,percent of total billed charges,38.7
Q34286 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,177.39,Blue Cross and Blue Shield,Traditional,,68.65,38.7,percent of total billed charges,177.39,6.92,90.47,percent of total billed charges,38.7
Q37213 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,177.39,Blue Cross and Blue Shield,Traditional,,68.65,38.7,percent of total billed charges,177.39,6.92,90.47,percent of total billed charges,38.7
Q39480 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,177.39,Blue Cross and Blue Shield,Traditional,,68.65,38.7,percent of total billed charges,177.39,6.92,90.47,percent of total billed charges,38.7
Q4554 SPECIMEN CONCE,87015,CPT,,,,,both,, ,177.39,177.39,Blue Cross and Blue Shield,Traditional,,68.65,38.7,percent of total billed charges,177.39,6.92,90.47,percent of total billed charges,38.7
SPECIMEN CONCENTRATI,87015,CPT,,,,,both,, ,177.39,177.39,Blue Cross and Blue Shield,Traditional,,68.65,38.7,percent of total billed charges,177.39,6.92,90.47,percent of total billed charges,38.7
CULTURE BLOOD BACTER,87040,CPT,,,,,both,,,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
CULTURE BLOOD BACTER,87040,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
CULT STL BACT W-ISOL,87045,CPT,,,,,both,, ,92.90,92.90,Blue Cross and Blue Shield,Traditional,,35.95,38.7,percent of total billed charges,92.90,3.62,47.38,percent of total billed charges,38.7
CULT STL BACT W-ISOL,87045,CPT,,,,,both,,,301.72,301.72,Blue Cross and Blue Shield,Traditional,,116.77,38.7,percent of total billed charges,301.72,11.77,153.88,percent of total billed charges,38.7
CULT STL BACT W-ISOL,87045,CPT,,,,,both,, ,301.72,301.72,Blue Cross and Blue Shield,Traditional,,116.77,38.7,percent of total billed charges,301.72,11.77,153.88,percent of total billed charges,38.7
CULT STL BACT EA ADD,87046,CPT,,,,,both,, ,92.90,92.90,Blue Cross and Blue Shield,Traditional,,35.95,38.7,percent of total billed charges,92.90,3.62,47.38,percent of total billed charges,38.7
CULT STL BACT EA ADD,87046,CPT,,,,,both,, ,94.58,94.58,Blue Cross and Blue Shield,Traditional,,36.60,38.7,percent of total billed charges,94.58,3.69,48.24,percent of total billed charges,38.7
CULTURE BACTERIA OTH,87070,CPT,,,,,both,, ,84.76,84.76,Blue Cross and Blue Shield,Traditional,,32.80,38.7,percent of total billed charges,84.76,3.31,43.23,percent of total billed charges,38.7
CULTURE BACTERIA OTH,87070,CPT,,,,,both,,,998.91,998.91,Blue Cross and Blue Shield,Traditional,,386.58,38.7,percent of total billed charges,998.91,38.96,509.44,percent of total billed charges,38.7
CULTURE BACTERIA OTH,87070,CPT,,,,,both,, ,998.91,998.91,Blue Cross and Blue Shield,Traditional,,386.58,38.7,percent of total billed charges,998.91,38.96,509.44,percent of total billed charges,38.7
L188227 CULTURE BACT,87070,CPT,,,,,both,, ,86.20,86.20,Blue Cross and Blue Shield,Traditional,,33.36,38.7,percent of total billed charges,86.20,3.36,43.96,percent of total billed charges,38.7
CULT BAC AEROB OT QT,87071,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
CULT BACT ANA ANY SO,87075,CPT,,,,,both,,,623.38,623.38,Blue Cross and Blue Shield,Traditional,,241.25,38.7,percent of total billed charges,623.38,24.31,317.92,percent of total billed charges,38.7
CULT BACT ANA ANY SO,87075,CPT,,,,,both,, ,623.38,623.38,Blue Cross and Blue Shield,Traditional,,241.25,38.7,percent of total billed charges,623.38,24.31,317.92,percent of total billed charges,38.7
CULT BACT ANA ANY SO,87075,CPT,,,,,both,, ,623.38,623.38,Blue Cross and Blue Shield,Traditional,,241.25,38.7,percent of total billed charges,623.38,24.31,317.92,percent of total billed charges,38.7
CULT ANAERO IDENT EA,87076,CPT,,,,,both,, ,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,percent of total billed charges,412.87,16.10,210.56,percent of total billed charges,38.7
L182345 ORG ID ANAER,87076,CPT,,,,,both,, ,244.44,244.44,Blue Cross and Blue Shield,Traditional,,94.60,38.7,percent of total billed charges,244.44,9.53,124.66,percent of total billed charges,38.7
CULT AEROBIC IDENTIF,87077,CPT,,,,,both,, ,389.01,389.01,Blue Cross and Blue Shield,Traditional,,150.55,38.7,percent of total billed charges,389.01,15.17,198.4,percent of total billed charges,38.7
CULT AEROBIC IDENTIF,87077,CPT,,,,,both,, ,389.01,389.01,Blue Cross and Blue Shield,Traditional,,150.55,38.7,percent of total billed charges,389.01,15.17,198.4,percent of total billed charges,38.7
CULTURE SCREEN ONLY,87081,CPT,,,,,both,, ,65.39,65.39,Blue Cross and Blue Shield,Traditional,,25.31,38.7,percent of total billed charges,65.39,2.55,33.35,percent of total billed charges,38.7
CULTURE SCREEN ONLY,87081,CPT,,,,,both,,,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
CULTURE SCREEN ONLY,87081,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
CULT URINE-COLONY CT,87086,CPT,,,,,both,, ,59.78,59.78,Blue Cross and Blue Shield,Traditional,,23.13,38.7,percent of total billed charges,59.78,2.33,30.49,percent of total billed charges,38.7
CULT URINE-COLONY CT,87086,CPT,,,,,both,,,495.95,495.95,Blue Cross and Blue Shield,Traditional,,191.93,38.7,percent of total billed charges,495.95,19.34,252.93,percent of total billed charges,38.7
CULT URINE-COLONY CT,87086,CPT,,,,,both,, ,495.95,495.95,Blue Cross and Blue Shield,Traditional,,191.93,38.7,percent of total billed charges,495.95,19.34,252.93,percent of total billed charges,38.7
CULT URINE W-P ID,87088,CPT,,,,,both,, ,42.37,42.37,Blue Cross and Blue Shield,Traditional,,16.40,38.7,percent of total billed charges,42.37,1.65,21.61,percent of total billed charges,38.7
CULT SKIN FUNGI,87101,CPT,,,,,both,, ,349.99,349.99,Blue Cross and Blue Shield,Traditional,,135.45,38.7,percent of total billed charges,349.99,13.65,178.49,percent of total billed charges,38.7
CULT SKIN FUNGI,87101,CPT,,,,,both,, ,349.99,349.99,Blue Cross and Blue Shield,Traditional,,135.45,38.7,percent of total billed charges,349.99,13.65,178.49,percent of total billed charges,38.7
CULT FUNGUS ISOLATIO,87102,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
Q4553 CULT FUNGUS IS,87102,CPT,,,,,both,, ,525.70,525.70,Blue Cross and Blue Shield,Traditional,,203.45,38.7,percent of total billed charges,525.70,20.50,268.11,percent of total billed charges,38.7
CULTURE FUNGUS BLOOD,87103,CPT,,,,,both,, ,518.69,518.69,Blue Cross and Blue Shield,Traditional,,200.73,38.7,percent of total billed charges,518.69,20.23,264.53,percent of total billed charges,38.7
Q4606 FUNGUS CULT BL,87103,CPT,,,,,both,, ,478.95,478.95,Blue Cross and Blue Shield,Traditional,,185.35,38.7,percent of total billed charges,478.95,18.68,244.26,percent of total billed charges,38.7
FUNGI IDENTIF YEAST,87106,CPT,,,,,both,, ,123.21,123.21,Blue Cross and Blue Shield,Traditional,,47.68,38.7,percent of total billed charges,123.21,4.81,62.84,percent of total billed charges,38.7
FUNGI IDENTIF YEAST,87106,CPT,,,,,both,, ,123.21,123.21,Blue Cross and Blue Shield,Traditional,,47.68,38.7,percent of total billed charges,123.21,4.81,62.84,percent of total billed charges,38.7
"FUNGI IDENTIF, MOLD",87107,CPT,,,,,both,, ,123.21,123.21,Blue Cross and Blue Shield,Traditional,,47.68,38.7,percent of total billed charges,123.21,4.81,62.84,percent of total billed charges,38.7
"FUNGI IDENTIF, MOLD",87107,CPT,,,,,both,, ,123.21,123.21,Blue Cross and Blue Shield,Traditional,,47.68,38.7,percent of total billed charges,123.21,4.81,62.84,percent of total billed charges,38.7
CULT MYCOPLASMA,87109,CPT,,,,,both,, ,1404.50,1404.50,Blue Cross and Blue Shield,Traditional,,543.54,38.7,percent of total billed charges,1404.50,54.78,716.3,percent of total billed charges,38.7
UREA-MYCOPLS HOM CULT,87109,CPT,,,,,both,, ,153.90,153.90,Blue Cross and Blue Shield,Traditional,,59.56,38.7,percent of total billed charges,153.90,6.00,78.49,percent of total billed charges,38.7
CULTURE CHLAMYDIA,87110,CPT,,,,,both,, ,1104.45,1104.45,Blue Cross and Blue Shield,Traditional,,427.42,38.7,percent of total billed charges,1104.45,43.07,563.27,percent of total billed charges,38.7
CULTURE CHLAMYDIA,87110,CPT,,,,,both,, ,1104.45,1104.45,Blue Cross and Blue Shield,Traditional,,427.42,38.7,percent of total billed charges,1104.45,43.07,563.27,percent of total billed charges,38.7
CULT MYCOBACTERIA,87116,CPT,,,,,both,,,827.43,827.43,Blue Cross and Blue Shield,Traditional,,320.22,38.7,percent of total billed charges,827.43,32.27,421.99,percent of total billed charges,38.7
CULT MYCOBACTERIA,87116,CPT,,,,,both,, ,827.43,827.43,Blue Cross and Blue Shield,Traditional,,320.22,38.7,percent of total billed charges,827.43,32.27,421.99,percent of total billed charges,38.7
Q10526MBAC BL CMBCS,87116,CPT,,,,,both,, ,827.43,827.43,Blue Cross and Blue Shield,Traditional,,320.22,38.7,percent of total billed charges,827.43,32.27,421.99,percent of total billed charges,38.7
Q4554 CULT MYCOBACTE,87116,CPT,,,,,both,, ,827.43,827.43,Blue Cross and Blue Shield,Traditional,,320.22,38.7,percent of total billed charges,827.43,32.27,421.99,percent of total billed charges,38.7
CULT TYPE IMMUNOFLUO,87140,CPT,,,,,both,, ,323.34,323.34,Blue Cross and Blue Shield,Traditional,,125.13,38.7,percent of total billed charges,323.34,12.61,164.9,percent of total billed charges,38.7
CULT TYPE IMMUNOFLUO,87140,CPT,,,,,both,, ,323.34,323.34,Blue Cross and Blue Shield,Traditional,,125.13,38.7,percent of total billed charges,323.34,12.61,164.9,percent of total billed charges,38.7
"CULT TYPE,IMMUNOLOGI",87147,CPT,,,,,both,, ,547.31,547.31,Blue Cross and Blue Shield,Traditional,,211.81,38.7,percent of total billed charges,547.31,21.35,279.13,percent of total billed charges,38.7
"CULT TYPE,NUCLEIC AC",87149,CPT,,,,,both,, ,239.97,239.97,Blue Cross and Blue Shield,Traditional,,92.87,38.7,percent of total billed charges,239.97,9.36,122.38,percent of total billed charges,38.7
LRX183755 AFB ID PB,87149,CPT,,,,,both,, ,239.99,239.99,Blue Cross and Blue Shield,Traditional,,92.88,38.7,percent of total billed charges,239.99,9.36,122.39,percent of total billed charges,38.7
DNA-RNA AMPLI PROBE,87150,CPT,,,,,both,, ,339.33,339.33,Blue Cross and Blue Shield,Traditional,,131.32,38.7,percent of total billed charges,339.33,13.23,173.06,percent of total billed charges,38.7
LRX183327 MOLD ID,87153,CPT,,,,,both,, ,239.99,239.99,Blue Cross and Blue Shield,Traditional,,92.88,38.7,percent of total billed charges,239.99,9.36,122.39,percent of total billed charges,38.7
QRX9000010 AFB ID,87153,CPT,,,,,both,, ,388.45,388.45,Blue Cross and Blue Shield,Traditional,,150.33,38.7,percent of total billed charges,388.45,15.15,198.11,percent of total billed charges,38.7
MACRO EXAM ARTHROPOD,87168,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,percent of total billed charges,480.79,18.75,245.2,percent of total billed charges,38.7
MACRO EXAM PARASITE,87169,CPT,,,,,both,, ,207.70,207.70,Blue Cross and Blue Shield,Traditional,,80.38,38.7,percent of total billed charges,207.70,8.10,105.93,percent of total billed charges,38.7
PINWORM EXAM,87172,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,percent of total billed charges,480.79,18.75,245.2,percent of total billed charges,38.7
TISSUE HOMOGENIZ CUL,87176,CPT,,,,,both,, ,300.60,300.60,Blue Cross and Blue Shield,Traditional,,116.33,38.7,percent of total billed charges,300.60,11.72,153.31,percent of total billed charges,38.7
OVA-PARASITES SMEARS,87177,CPT,,,,,both,, ,107.21,107.21,Blue Cross and Blue Shield,Traditional,,41.49,38.7,percent of total billed charges,107.21,4.18,54.68,percent of total billed charges,38.7
OVA-PARASITES SMEARS,87177,CPT,,,,,both,, ,320.25,320.25,Blue Cross and Blue Shield,Traditional,,123.94,38.7,percent of total billed charges,320.25,12.49,163.33,percent of total billed charges,38.7
OVA-PARASITES SMEARS,87177,CPT,,,,,both,, ,320.25,320.25,Blue Cross and Blue Shield,Traditional,,123.94,38.7,percent of total billed charges,320.25,12.49,163.33,percent of total billed charges,38.7
MICROB SUSCEP DIFFUS,87181,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,percent of total billed charges,141.46,5.52,72.14,percent of total billed charges,38.7
MICROBE SUSCEP DISK,87184,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,percent of total billed charges,141.46,5.52,72.14,percent of total billed charges,38.7
MICROBE SUSCEP DISK,87184,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,percent of total billed charges,141.46,5.52,72.14,percent of total billed charges,38.7
MICROB SUSCEP ENZYME,87185,CPT,,,,,both,, ,180.19,180.19,Blue Cross and Blue Shield,Traditional,,69.73,38.7,percent of total billed charges,180.19,7.03,91.9,percent of total billed charges,38.7
MICROBE SUSCEPT MIC,87186,CPT,,,,,both,, ,586.05,586.05,Blue Cross and Blue Shield,Traditional,,226.80,38.7,percent of total billed charges,586.05,22.86,298.89,percent of total billed charges,38.7
MICROBE SUSCEPT MIC,87186,CPT,,,,,both,, ,586.05,586.05,Blue Cross and Blue Shield,Traditional,,226.80,38.7,percent of total billed charges,586.05,22.86,298.89,percent of total billed charges,38.7
"SMEAR,GRAM STAIN",87205,CPT,,,,,both,, ,42.10,42.10,Blue Cross and Blue Shield,Traditional,,16.29,38.7,percent of total billed charges,42.10,1.64,21.47,percent of total billed charges,38.7
"SMEAR,GRAM STAIN",87205,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
Q4554 SMEAR FLUORES-,87206,CPT,,,,,both,, ,507.74,507.74,Blue Cross and Blue Shield,Traditional,,196.50,38.7,percent of total billed charges,507.74,19.80,258.95,percent of total billed charges,38.7
Q4554 SMEAR FLUORES-,87206,CPT,,,,,both,, ,507.74,507.74,Blue Cross and Blue Shield,Traditional,,196.50,38.7,percent of total billed charges,507.74,19.80,258.95,percent of total billed charges,38.7
Q4554 SMEAR FLUORES-,87206,CPT,,,,,both,, ,507.74,507.74,Blue Cross and Blue Shield,Traditional,,196.50,38.7,percent of total billed charges,507.74,19.80,258.95,percent of total billed charges,38.7
Q4554 SMEAR FLUORES-,87206,CPT,,,,,both,, ,507.74,507.74,Blue Cross and Blue Shield,Traditional,,196.50,38.7,percent of total billed charges,507.74,19.80,258.95,percent of total billed charges,38.7
"SMEAR,SPECIAL STAIN",87207,CPT,,,,,both,, ,555.45,555.45,Blue Cross and Blue Shield,Traditional,,214.96,38.7,percent of total billed charges,555.45,21.66,283.28,percent of total billed charges,38.7
SMEAR COMPLEX STN,87209,CPT,,,,,both,, ,190.86,190.86,Blue Cross and Blue Shield,Traditional,,73.86,38.7,percent of total billed charges,190.86,7.44,97.34,percent of total billed charges,38.7
SMEAR COMPLEX STN,87209,CPT,,,,,both,, ,190.86,190.86,Blue Cross and Blue Shield,Traditional,,73.86,38.7,percent of total billed charges,190.86,7.44,97.34,percent of total billed charges,38.7
SMEARWET MOUNT SAL-I,87210,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,percent of total billed charges,420.72,16.41,214.57,percent of total billed charges,38.7
TISSUE EX FOR FUNGI,87220,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,percent of total billed charges,480.79,18.75,245.2,percent of total billed charges,38.7
TISSUE EX FOR FUNGI,87220,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,percent of total billed charges,480.79,18.75,245.2,percent of total billed charges,38.7
VIRUS INOCULAT TISSU,87252,CPT,,,,,both,, ,929.87,929.87,Blue Cross and Blue Shield,Traditional,,359.86,38.7,percent of total billed charges,929.87,36.26,474.23,percent of total billed charges,38.7
VIRUS INOCULAT TISSU,87252,CPT,,,,,both,, ,929.87,929.87,Blue Cross and Blue Shield,Traditional,,359.86,38.7,percent of total billed charges,929.87,36.26,474.23,percent of total billed charges,38.7
L186015 VIR INOC SHL,87254,CPT,,,,,both,, ,415.68,415.68,Blue Cross and Blue Shield,Traditional,,160.87,38.7,percent of total billed charges,415.68,16.21,212,percent of total billed charges,38.7
Q17495VIRUS INOCU SH,87254,CPT,,,,,both,, ,415.68,415.68,Blue Cross and Blue Shield,Traditional,,160.87,38.7,percent of total billed charges,415.68,16.21,212,percent of total billed charges,38.7
VIRUS INOCU SHELL VI,87254,CPT,,,,,both,, ,415.68,415.68,Blue Cross and Blue Shield,Traditional,,160.87,38.7,percent of total billed charges,415.68,16.21,212,percent of total billed charges,38.7
Q2649 HSV CULT WREF,87255,CPT,,,,,both,, ,470.69,470.69,Blue Cross and Blue Shield,Traditional,,182.16,38.7,percent of total billed charges,470.69,18.36,240.05,percent of total billed charges,38.7
Q841 HSV CULT HS,87255,CPT,,,,,both,, ,470.69,470.69,Blue Cross and Blue Shield,Traditional,,182.16,38.7,percent of total billed charges,470.69,18.36,240.05,percent of total billed charges,38.7
VIRUS ISOLATION GEN,87255,CPT,,,,,both,, ,470.69,470.69,Blue Cross and Blue Shield,Traditional,,182.16,38.7,percent of total billed charges,470.69,18.36,240.05,percent of total billed charges,38.7
"PERTUSSIS AG, IF",87265,CPT,,,,,both,, ,531.32,531.32,Blue Cross and Blue Shield,Traditional,,205.62,38.7,percent of total billed charges,531.32,20.72,270.97,percent of total billed charges,38.7
"PERTUSSIS AG, IF",87265,CPT,,,,,both,, ,531.32,531.32,Blue Cross and Blue Shield,Traditional,,205.62,38.7,percent of total billed charges,531.32,20.72,270.97,percent of total billed charges,38.7
INFAGT DT QLSQT CRYP,87272,CPT,,,,,both,, ,525.70,525.70,Blue Cross and Blue Shield,Traditional,,203.45,38.7,percent of total billed charges,525.70,20.50,268.11,percent of total billed charges,38.7
Q37213 INFAGT DT QLS,87272,CPT,,,,,both,, ,525.70,525.70,Blue Cross and Blue Shield,Traditional,,203.45,38.7,percent of total billed charges,525.70,20.50,268.11,percent of total billed charges,38.7
Q39480 INFAGT DT QLS,87272,CPT,,,,,both,, ,525.70,525.70,Blue Cross and Blue Shield,Traditional,,203.45,38.7,percent of total billed charges,525.70,20.50,268.11,percent of total billed charges,38.7
L188227 LEGION PNEUM,87278,CPT,,,,,both,, ,156.00,156.00,Blue Cross and Blue Shield,Traditional,,60.37,38.7,percent of total billed charges,156.00,6.08,79.56,percent of total billed charges,38.7
"LEGION PNEUMOPH AG,I",87278,CPT,,,,,both,, ,277.86,277.86,Blue Cross and Blue Shield,Traditional,,107.53,38.7,percent of total billed charges,277.86,10.84,141.71,percent of total billed charges,38.7
"LEGION PNEUMOPH AG,I",87278,CPT,,,,,both,, ,277.86,277.86,Blue Cross and Blue Shield,Traditional,,107.53,38.7,percent of total billed charges,277.86,10.84,141.71,percent of total billed charges,38.7
PNEUMOCYSTIS CAR AGI,87281,CPT,,,,,both,, ,371.89,371.89,Blue Cross and Blue Shield,Traditional,,143.92,38.7,percent of total billed charges,371.89,14.50,189.66,percent of total billed charges,38.7
PNEUMOCYSTIS CAR AGI,87281,CPT,,,,,both,, ,371.89,371.89,Blue Cross and Blue Shield,Traditional,,143.92,38.7,percent of total billed charges,371.89,14.50,189.66,percent of total billed charges,38.7
VARICELLA ZOSTER AGI,87290,CPT,,,,,both,, ,518.69,518.69,Blue Cross and Blue Shield,Traditional,,200.73,38.7,percent of total billed charges,518.69,20.23,264.53,percent of total billed charges,38.7
"ANTIB DETECT NOS, IF",87299,CPT,,,,,both,, ,159.14,159.14,Blue Cross and Blue Shield,Traditional,,61.59,38.7,percent of total billed charges,159.14,6.21,81.16,percent of total billed charges,38.7
AG DETECT POLYVAL IF,87300,CPT,,,,,both,, ,122.09,122.09,Blue Cross and Blue Shield,Traditional,,47.25,38.7,percent of total billed charges,122.09,4.76,62.27,percent of total billed charges,38.7
L185041 ADV 40/41 IA,87301,CPT,,,,,both,, ,123.60,123.60,Blue Cross and Blue Shield,Traditional,,47.83,38.7,percent of total billed charges,123.60,4.82,63.04,percent of total billed charges,38.7
Q14950ASPE AG EIA IA,87305,CPT,,,,,both,, ,111.70,111.70,Blue Cross and Blue Shield,Traditional,,43.23,38.7,percent of total billed charges,111.70,4.36,56.97,percent of total billed charges,38.7
CLOSTRIDIUM DIF TOXN,87324,CPT,,,,,both,, ,118.16,118.16,Blue Cross and Blue Shield,Traditional,,45.73,38.7,percent of total billed charges,118.16,4.61,60.26,percent of total billed charges,38.7
CLOSTRIDIUM DIF TOXN,87324,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
CRYPTOCOCCUS NEOF AG,87327,CPT,,,,,both,, ,1321.42,1321.42,Blue Cross and Blue Shield,Traditional,,511.39,38.7,percent of total billed charges,1321.42,51.54,673.92,percent of total billed charges,38.7
"CRYPTOSPOR AG,EIA",87328,CPT,,,,,both,, ,64.55,64.55,Blue Cross and Blue Shield,Traditional,,24.98,38.7,percent of total billed charges,64.55,2.52,32.92,percent of total billed charges,38.7
INFAGT DT QLSQT GIAR,87329,CPT,,,,,both,, ,200.12,200.12,Blue Cross and Blue Shield,Traditional,,77.45,38.7,percent of total billed charges,200.12,7.80,102.06,percent of total billed charges,38.7
INFAGT DT QLSQT GIAR,87329,CPT,,,,,both,, ,200.12,200.12,Blue Cross and Blue Shield,Traditional,,77.45,38.7,percent of total billed charges,200.12,7.80,102.06,percent of total billed charges,38.7
Q8625 GIARDAG EIA IA,87329,CPT,,,,,both,, ,192.49,192.49,Blue Cross and Blue Shield,Traditional,,74.49,38.7,percent of total billed charges,192.49,7.51,98.17,percent of total billed charges,38.7
"HPYLORI,STOOL,EIA",87338,CPT,,,,,both,, ,183.56,183.56,Blue Cross and Blue Shield,Traditional,,71.04,38.7,percent of total billed charges,183.56,7.16,93.62,percent of total billed charges,38.7
"HPYLORI,STOOL,EIA",87338,CPT,,,,,both,, ,183.56,183.56,Blue Cross and Blue Shield,Traditional,,71.04,38.7,percent of total billed charges,183.56,7.16,93.62,percent of total billed charges,38.7
HBSAG,87340,CPT,,,,,both,,,570.04,570.04,Blue Cross and Blue Shield,Traditional,,220.61,38.7,percent of total billed charges,570.04,22.23,290.72,percent of total billed charges,38.7
HBSAG,87340,CPT,,,,,both,, ,570.04,570.04,Blue Cross and Blue Shield,Traditional,,220.61,38.7,percent of total billed charges,570.04,22.23,290.72,percent of total billed charges,38.7
HBEAG,87350,CPT,,,,,both,, ,1003.97,1003.97,Blue Cross and Blue Shield,Traditional,,388.54,38.7,percent of total billed charges,1003.97,39.15,512.02,percent of total billed charges,38.7
HBEAG,87350,CPT,,,,,both,, ,1003.97,1003.97,Blue Cross and Blue Shield,Traditional,,388.54,38.7,percent of total billed charges,1003.97,39.15,512.02,percent of total billed charges,38.7
HISTOPLASM CAPSU AGE,87385,CPT,,,,,both,, ,322.49,322.49,Blue Cross and Blue Shield,Traditional,,124.80,38.7,percent of total billed charges,322.49,12.58,164.47,percent of total billed charges,38.7
HISTOPLASM CAPSU AGE,87385,CPT,,,,,both,, ,322.49,322.49,Blue Cross and Blue Shield,Traditional,,124.80,38.7,percent of total billed charges,322.49,12.58,164.47,percent of total billed charges,38.7
"INFLUENZA A AG,EIA",87400,CPT,,,,,both,, ,118.16,118.16,Blue Cross and Blue Shield,Traditional,,45.73,38.7,percent of total billed charges,118.16,4.61,60.26,percent of total billed charges,38.7
"INFLUENZA A AG,EIA",87400,CPT,,,,,both,, ,959.34,959.34,Blue Cross and Blue Shield,Traditional,,371.26,38.7,percent of total billed charges,959.34,37.41,489.26,percent of total billed charges,38.7
L6866 ROTAVIRUS DDIA,87425,CPT,,,,,both,, ,123.60,123.60,Blue Cross and Blue Shield,Traditional,,47.83,38.7,percent of total billed charges,123.60,4.82,63.04,percent of total billed charges,38.7
"ROTAVIRUS AG,EIA",87425,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
COVID19 AG EIA,87426,CPT,,,,,both,, ,84.20,84.20,Blue Cross and Blue Shield,Traditional,,32.59,38.7,percent of total billed charges,84.20,3.28,42.94,percent of total billed charges,38.7
COVID19 AG EIA,87426,CPT,,,,,both,, ,88.35,88.35,Blue Cross and Blue Shield,Traditional,,34.19,38.7,percent of total billed charges,88.35,3.45,45.06,percent of total billed charges,38.7
"SHIGA-LIKE TOX AG,EI",87427,CPT,,,,,both,, ,113.10,113.10,Blue Cross and Blue Shield,Traditional,,43.77,38.7,percent of total billed charges,113.10,4.41,57.68,percent of total billed charges,38.7
"SHIGA-LIKE TOX AG,EI",87427,CPT,,,,,both,, ,156.33,156.33,Blue Cross and Blue Shield,Traditional,,60.50,38.7,percent of total billed charges,156.33,6.10,79.73,percent of total billed charges,38.7
COVID19AG FLUAB SOF2,87428,CPT,,,,,both,, ,159.00,159.00,Blue Cross and Blue Shield,Traditional,,61.53,38.7,percent of total billed charges,159.00,6.20,81.09,percent of total billed charges,38.7
"AG DETEC NOS,EIA MUL",87449,CPT,,,,,both,, ,886.09,886.09,Blue Cross and Blue Shield,Traditional,,342.92,38.7,percent of total billed charges,886.09,34.56,451.91,percent of total billed charges,38.7
OXOID PBP2 MRSA SCRN,87449,CPT,,,,,both,, ,121.98,121.98,Blue Cross and Blue Shield,Traditional,,47.21,38.7,percent of total billed charges,121.98,4.76,62.21,percent of total billed charges,38.7
OXOID PBP2 MRSA SCRN,87449,CPT,,,,,both,, ,121.98,121.98,Blue Cross and Blue Shield,Traditional,,47.21,38.7,percent of total billed charges,121.98,4.76,62.21,percent of total billed charges,38.7
Q15544 NOROV EIA IA,87449,CPT,,,,,both,, ,886.09,886.09,Blue Cross and Blue Shield,Traditional,,342.92,38.7,percent of total billed charges,886.09,34.56,451.91,percent of total billed charges,38.7
Q8856 LEGIO AG U IA,87449,CPT,,,,,both,, ,886.09,886.09,Blue Cross and Blue Shield,Traditional,,342.92,38.7,percent of total billed charges,886.09,34.56,451.91,percent of total billed charges,38.7
CANDIDA DNA AMP PROB,87481,CPT,,,,,both,, ,281.80,281.80,Blue Cross and Blue Shield,Traditional,,109.06,38.7,percent of total billed charges,281.80,10.99,143.72,percent of total billed charges,38.7
L183410 M ENCEPH CSF,87483,CPT,,,,,both,, ,1650.00,1650.00,Blue Cross and Blue Shield,Traditional,,638.55,38.7,percent of total billed charges,1650.00,64.35,841.5,percent of total billed charges,38.7
L139650 CPNEU DNA,87486,CPT,,,,,both,, ,175.00,175.00,Blue Cross and Blue Shield,Traditional,,67.73,38.7,percent of total billed charges,175.00,6.83,89.25,percent of total billed charges,38.7
Q37444 C PNEUMO PCR,87486,CPT,,,,,both,, ,105.27,105.27,Blue Cross and Blue Shield,Traditional,,40.74,38.7,percent of total billed charges,105.27,4.11,53.69,percent of total billed charges,38.7
CHLMYD TRACH DNA AMP,87491,CPT,,,,,both,,,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
L180021 CTRACH AMPPR,87491,CPT,,,,,both,, ,888.63,888.63,Blue Cross and Blue Shield,Traditional,,343.90,38.7,percent of total billed charges,888.63,34.66,453.2,percent of total billed charges,38.7
Q11363 CHLMYD TRACH,87491,CPT,,,,,both,, ,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
Q11363 CHLMYD TRACH,87491,CPT,,,,,both,, ,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
Q11363 CHLMYD TRACH,87491,CPT,,,,,both,, ,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
Q11363 CHLMYD TRACH,87491,CPT,,,,,both,, ,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
C DIFF AMPLI PROBE,87493,CPT,,,,,both,, ,313.51,313.51,Blue Cross and Blue Shield,Traditional,,121.33,38.7,percent of total billed charges,313.51,12.23,159.89,percent of total billed charges,38.7
Q10601 CMV QL RT-PCR,87496,CPT,,,,,both,, ,1051.68,1051.68,Blue Cross and Blue Shield,Traditional,,407.00,38.7,percent of total billed charges,1051.68,41.02,536.36,percent of total billed charges,38.7
Q10600 CMV QT RT-PCR,87497,CPT,,,,,both,, ,889.73,889.73,Blue Cross and Blue Shield,Traditional,,344.33,38.7,percent of total billed charges,889.73,34.70,453.76,percent of total billed charges,38.7
Q15082EVRNA QL RTPCR,87498,CPT,,,,,both,, ,437.85,437.85,Blue Cross and Blue Shield,Traditional,,169.45,38.7,percent of total billed charges,437.85,17.08,223.3,percent of total billed charges,38.7
INFLU DNA AMP PROBE,87502,CPT,,,,,both,, ,215.11,215.11,Blue Cross and Blue Shield,Traditional,,83.25,38.7,percent of total billed charges,215.11,8.39,109.71,percent of total billed charges,38.7
INFLU DNA AMP PROBE,87502,CPT,,,,,both,,,887.49,887.49,Blue Cross and Blue Shield,Traditional,,343.46,38.7,percent of total billed charges,887.49,34.61,452.62,percent of total billed charges,38.7
INFLU DNA AMP PROBE,87502,CPT,,,,,both,, ,887.49,887.49,Blue Cross and Blue Shield,Traditional,,343.46,38.7,percent of total billed charges,887.49,34.61,452.62,percent of total billed charges,38.7
L183480 GI PRO STOOL,87507,CPT,,,,,both,, ,1090.20,1090.20,Blue Cross and Blue Shield,Traditional,,421.91,38.7,percent of total billed charges,1090.20,42.52,556,percent of total billed charges,38.7
GARDNER VAG DNA QUAN,87512,CPT,,,,,both,, ,335.12,335.12,Blue Cross and Blue Shield,Traditional,,129.69,38.7,percent of total billed charges,335.12,13.07,170.91,percent of total billed charges,38.7
"HEPATITIS B,DNA QNT",87517,CPT,,,,,both,, ,1011.26,1011.26,Blue Cross and Blue Shield,Traditional,,391.36,38.7,percent of total billed charges,1011.26,39.44,515.74,percent of total billed charges,38.7
"HEPATITIS B,DNA QNT",87517,CPT,,,,,both,, ,1011.26,1011.26,Blue Cross and Blue Shield,Traditional,,391.36,38.7,percent of total billed charges,1011.26,39.44,515.74,percent of total billed charges,38.7
"HEPATITIS C,RNA,AMPP",87521,CPT,,,,,both,, ,728.91,728.91,Blue Cross and Blue Shield,Traditional,,282.09,38.7,percent of total billed charges,728.91,28.43,371.74,percent of total billed charges,38.7
"HEPATITIS C,RNA,AMPP",87521,CPT,,,,,both,, ,728.91,728.91,Blue Cross and Blue Shield,Traditional,,282.09,38.7,percent of total billed charges,728.91,28.43,371.74,percent of total billed charges,38.7
"HEPATITIS C,RNA,QUAN",87522,CPT,,,,,both,, ,2133.69,2133.69,Blue Cross and Blue Shield,Traditional,,825.74,38.7,percent of total billed charges,2133.69,83.21,1088.18,percent of total billed charges,38.7
"HEPATITIS C,RNA,QUAN",87522,CPT,,,,,both,, ,2133.69,2133.69,Blue Cross and Blue Shield,Traditional,,825.74,38.7,percent of total billed charges,2133.69,83.21,1088.18,percent of total billed charges,38.7
Q11348 HCV QT RT-PCR,87522,CPT,,,,,both,, ,1066.84,1066.84,Blue Cross and Blue Shield,Traditional,,412.87,38.7,percent of total billed charges,1066.84,41.61,544.09,percent of total billed charges,38.7
"HSV, DNA, AMP PROBE",87529,CPT,,,,,both,, ,3455.10,3455.10,Blue Cross and Blue Shield,Traditional,,1337.12,38.7,percent of total billed charges,3455.10,134.75,1762.1,percent of total billed charges,38.7
"Q90570 HSV, DNA, AMP",87529,CPT,,,,,both,, ,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
"Q90570 HSV, DNA, AMP",87529,CPT,,,,,both,, ,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
"HSV, DNA, QUANT",87530,CPT,,,,,both,, ,512.23,512.23,Blue Cross and Blue Shield,Traditional,,198.23,38.7,percent of total billed charges,512.23,19.98,261.24,percent of total billed charges,38.7
"HSV, DNA, QUANT",87530,CPT,,,,,both,, ,512.23,512.23,Blue Cross and Blue Shield,Traditional,,198.23,38.7,percent of total billed charges,512.23,19.98,261.24,percent of total billed charges,38.7
"HIV-1, DNA,AMP PROBE",87535,CPT,,,,,both,, ,1718.85,1718.85,Blue Cross and Blue Shield,Traditional,,665.19,38.7,percent of total billed charges,1718.85,67.04,876.61,percent of total billed charges,38.7
"HIV-1, DNA, QUANT",87536,CPT,,,,,both,, ,1804.46,1804.46,Blue Cross and Blue Shield,Traditional,,698.33,38.7,percent of total billed charges,1804.46,70.37,920.27,percent of total billed charges,38.7
"HIV-1, DNA, QUANT",87536,CPT,,,,,both,, ,1804.46,1804.46,Blue Cross and Blue Shield,Traditional,,698.33,38.7,percent of total billed charges,1804.46,70.37,920.27,percent of total billed charges,38.7
"Q15062 LEGION PNEU,D",87541,CPT,,,,,both,, ,196.98,196.98,Blue Cross and Blue Shield,Traditional,,76.23,38.7,percent of total billed charges,196.98,7.68,100.46,percent of total billed charges,38.7
"M.TUBERCULO,DNA,AMPP",87556,CPT,,,,,both,, ,815.91,815.91,Blue Cross and Blue Shield,Traditional,,315.76,38.7,percent of total billed charges,815.91,31.82,416.11,percent of total billed charges,38.7
"M.TUBERCULO,DNA,AMPP",87556,CPT,,,,,both,, ,815.91,815.91,Blue Cross and Blue Shield,Traditional,,315.76,38.7,percent of total billed charges,815.91,31.82,416.11,percent of total billed charges,38.7
"M.AVIUM-INTR,DNA,AMP",87561,CPT,,,,,both,, ,372.45,372.45,Blue Cross and Blue Shield,Traditional,,144.14,38.7,percent of total billed charges,372.45,14.53,189.95,percent of total billed charges,38.7
"M.AVIUM-INTR,DNA,AMP",87561,CPT,,,,,both,, ,372.45,372.45,Blue Cross and Blue Shield,Traditional,,144.14,38.7,percent of total billed charges,372.45,14.53,189.95,percent of total billed charges,38.7
L180076 M GENT NAA,87563,CPT,,,,,both,, ,180.00,180.00,Blue Cross and Blue Shield,Traditional,,69.66,38.7,percent of total billed charges,180.00,7.02,91.8,percent of total billed charges,38.7
Q15498 MP QL RT-PCR,87581,CPT,,,,,both,, ,197.03,197.03,Blue Cross and Blue Shield,Traditional,,76.25,38.7,percent of total billed charges,197.03,7.68,100.49,percent of total billed charges,38.7
Q15498 MP QL RT-PCR,87581,CPT,,,,,both,, ,197.03,197.03,Blue Cross and Blue Shield,Traditional,,76.25,38.7,percent of total billed charges,197.03,7.68,100.49,percent of total billed charges,38.7
Q37444 MP QL RT-PCR,87581,CPT,,,,,both,, ,175.50,175.50,Blue Cross and Blue Shield,Traditional,,67.92,38.7,percent of total billed charges,175.50,6.84,89.51,percent of total billed charges,38.7
L180021 NG AMP PRB,87591,CPT,,,,,both,, ,888.63,888.63,Blue Cross and Blue Shield,Traditional,,343.90,38.7,percent of total billed charges,888.63,34.66,453.2,percent of total billed charges,38.7
"Q11363 N.GONORRHO,DN",87591,CPT,,,,,both,, ,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
"Q11363 N.GONORRHO,DN",87591,CPT,,,,,both,, ,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
"Q11363 N.GONORRHO,DN",87591,CPT,,,,,both,, ,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
"Q11363 N.GONORRHO,DN",87591,CPT,,,,,both,, ,968.60,968.60,Blue Cross and Blue Shield,Traditional,,374.85,38.7,percent of total billed charges,968.60,37.78,493.99,percent of total billed charges,38.7
L140230 ORTHOPOX VRS,87593,CPT,,,,,both,, ,308.00,308.00,Blue Cross and Blue Shield,Traditional,,119.20,38.7,percent of total billed charges,308.00,12.01,157.08,percent of total billed charges,38.7
HPV HIGH RISK TYPES,87624,CPT,,,,,both,, ,241.38,241.38,Blue Cross and Blue Shield,Traditional,,93.41,38.7,percent of total billed charges,241.38,9.41,123.1,percent of total billed charges,38.7
L199305 HPV HR,87624,CPT,,,,,both,, ,221.45,221.45,Blue Cross and Blue Shield,Traditional,,85.70,38.7,percent of total billed charges,221.45,8.64,112.94,percent of total billed charges,38.7
Q92090 HPV HIGH RISK,87624,CPT,,,,,both,, ,215.00,215.00,Blue Cross and Blue Shield,Traditional,,83.21,38.7,percent of total billed charges,215.00,8.39,109.65,percent of total billed charges,38.7
L507460 HPV GEN16 18,87625,CPT,,,,,both,, ,164.80,164.80,Blue Cross and Blue Shield,Traditional,,63.78,38.7,percent of total billed charges,164.80,6.43,84.05,percent of total billed charges,38.7
RESP VIRUS 3-5 TARG,87631,CPT,,,,,both,, ,570.52,570.52,Blue Cross and Blue Shield,Traditional,,220.79,38.7,percent of total billed charges,570.52,22.25,290.97,percent of total billed charges,38.7
L139250 RVP PCR,87633,CPT,,,,,both,, ,175.00,175.00,Blue Cross and Blue Shield,Traditional,,67.73,38.7,percent of total billed charges,175.00,6.83,89.25,percent of total billed charges,38.7
L139250 RVP PCR,87633,CPT,,,,,both,, ,175.00,175.00,Blue Cross and Blue Shield,Traditional,,67.73,38.7,percent of total billed charges,175.00,6.83,89.25,percent of total billed charges,38.7
Q37444 RESP VIR PCR,87633,CPT,,,,,both,, ,1250.34,1250.34,Blue Cross and Blue Shield,Traditional,,483.88,38.7,percent of total billed charges,1250.34,48.76,637.67,percent of total billed charges,38.7
RSV DNA/ MA AMP PROB,87634,CPT,,,,,both,, ,157.62,157.62,Blue Cross and Blue Shield,Traditional,,61.00,38.7,percent of total billed charges,157.62,6.15,80.39,percent of total billed charges,38.7
RSV DNA/ MA AMP PROB,87634,CPT,,,,,both,, ,236.44,236.44,Blue Cross and Blue Shield,Traditional,,91.50,38.7,percent of total billed charges,236.44,9.22,120.58,percent of total billed charges,38.7
COVID19 PRB,87635,CPT,,,,,both,, ,113.30,113.30,Blue Cross and Blue Shield,Traditional,,43.85,38.7,percent of total billed charges,113.30,4.42,57.78,percent of total billed charges,38.7
COVID19 PRB,87635,CPT,,,,,both,, ,336.81,336.81,Blue Cross and Blue Shield,Traditional,,130.35,38.7,percent of total billed charges,336.81,13.14,171.77,percent of total billed charges,38.7
"STAPH A,DNA,PROBE",87640,CPT,,,,,both,, ,118.16,118.16,Blue Cross and Blue Shield,Traditional,,45.73,38.7,percent of total billed charges,118.16,4.61,60.26,percent of total billed charges,38.7
"MR-STAPH,DNA,PROBE",87641,CPT,,,,,both,, ,118.16,118.16,Blue Cross and Blue Shield,Traditional,,45.73,38.7,percent of total billed charges,118.16,4.61,60.26,percent of total billed charges,38.7
"STREP A,DNA,AMP PROB",87651,CPT,,,,,both,, ,78.78,78.78,Blue Cross and Blue Shield,Traditional,,30.49,38.7,percent of total billed charges,78.78,3.07,40.18,percent of total billed charges,38.7
"STREP A,DNA,AMP PROB",87651,CPT,,,,,both,, ,118.18,118.18,Blue Cross and Blue Shield,Traditional,,45.74,38.7,percent of total billed charges,118.18,4.61,60.27,percent of total billed charges,38.7
Q90801T.VAGIN QL TMA,87661,CPT,,,,,both,, ,279.55,279.55,Blue Cross and Blue Shield,Traditional,,108.19,38.7,percent of total billed charges,279.55,10.90,142.57,percent of total billed charges,38.7
Q90801T.VAGIN QL TMA,87661,CPT,,,,,both,, ,279.55,279.55,Blue Cross and Blue Shield,Traditional,,108.19,38.7,percent of total billed charges,279.55,10.90,142.57,percent of total billed charges,38.7
Q90801T.VAGIN QL TMA,87661,CPT,,,,,both,, ,279.55,279.55,Blue Cross and Blue Shield,Traditional,,108.19,38.7,percent of total billed charges,279.55,10.90,142.57,percent of total billed charges,38.7
Q90801T.VAGIN QL TMA,87661,CPT,,,,,both,, ,279.55,279.55,Blue Cross and Blue Shield,Traditional,,108.19,38.7,percent of total billed charges,279.55,10.90,142.57,percent of total billed charges,38.7
T VAGINALIS AMP,87661,CPT,,,,,both,,,279.55,279.55,Blue Cross and Blue Shield,Traditional,,108.19,38.7,percent of total billed charges,279.55,10.90,142.57,percent of total billed charges,38.7
Q93870 ZIKA RNA QL,87662,CPT,,,,,both,, ,295.83,295.83,Blue Cross and Blue Shield,Traditional,,114.49,38.7,percent of total billed charges,295.83,11.54,150.87,percent of total billed charges,38.7
"DETECT AGNTNOS,DNAAM",87798,CPT,,,,,both,, ,2478.63,2478.63,Blue Cross and Blue Shield,Traditional,,959.23,38.7,percent of total billed charges,2478.63,96.67,1264.1,percent of total billed charges,38.7
"DETECT AGNTNOS,DNAAM",87798,CPT,,,,,both,, ,2478.63,2478.63,Blue Cross and Blue Shield,Traditional,,959.23,38.7,percent of total billed charges,2478.63,96.67,1264.1,percent of total billed charges,38.7
L139650 DET AGNT DNA,87798,CPT,,,,,both,, ,175.00,175.00,Blue Cross and Blue Shield,Traditional,,67.73,38.7,percent of total billed charges,175.00,6.83,89.25,percent of total billed charges,38.7
L180021 DET AGT NOS,87798,CPT,,,,,both,, ,696.28,696.28,Blue Cross and Blue Shield,Traditional,,269.46,38.7,percent of total billed charges,696.28,27.15,355.1,percent of total billed charges,38.7
L180021 DET AGT NOS,87798,CPT,,,,,both,, ,696.28,696.28,Blue Cross and Blue Shield,Traditional,,269.46,38.7,percent of total billed charges,696.28,27.15,355.1,percent of total billed charges,38.7
L180040 DET AGT NOS,87798,CPT,,,,,both,, ,180.00,180.00,Blue Cross and Blue Shield,Traditional,,69.66,38.7,percent of total billed charges,180.00,7.02,91.8,percent of total billed charges,38.7
Q10992 WNVRNA RT-PCR,87798,CPT,,,,,both,, ,1011.83,1011.83,Blue Cross and Blue Shield,Traditional,,391.58,38.7,percent of total billed charges,1011.83,39.46,516.03,percent of total billed charges,38.7
Q10992 WNVRNA RT-PCR,87798,CPT,,,,,both,, ,1011.83,1011.83,Blue Cross and Blue Shield,Traditional,,391.58,38.7,percent of total billed charges,1011.83,39.46,516.03,percent of total billed charges,38.7
Q11365DET AGNT DNAAM,87798,CPT,,,,,both,, ,758.95,758.95,Blue Cross and Blue Shield,Traditional,,293.71,38.7,percent of total billed charges,758.95,29.60,387.06,percent of total billed charges,38.7
Q17220 JCPV QL RTPCR,87798,CPT,,,,,both,, ,1011.83,1011.83,Blue Cross and Blue Shield,Traditional,,391.58,38.7,percent of total billed charges,1011.83,39.46,516.03,percent of total billed charges,38.7
Q17220 JCPV QL RTPCR,87798,CPT,,,,,both,, ,1011.83,1011.83,Blue Cross and Blue Shield,Traditional,,391.58,38.7,percent of total billed charges,1011.83,39.46,516.03,percent of total billed charges,38.7
Q34296 PARVO B19 QL,87798,CPT,,,,,both,, ,1011.83,1011.83,Blue Cross and Blue Shield,Traditional,,391.58,38.7,percent of total billed charges,1011.83,39.46,516.03,percent of total billed charges,38.7
Q34296 PARVO B19 QL,87798,CPT,,,,,both,, ,1011.83,1011.83,Blue Cross and Blue Shield,Traditional,,391.58,38.7,percent of total billed charges,1011.83,39.46,516.03,percent of total billed charges,38.7
Q91475 SURESWAB MYCOPLASMA GENITALIUMPCR,87798,CPT,,,,,both,, ,901.25,901.25,Blue Cross and Blue Shield,Traditional,,348.78,38.7,percent of total billed charges,901.25,35.15,459.64,percent of total billed charges,38.7
"DETECT AGNT NOS,DNAQ",87799,CPT,,,,,both,, ,454.41,454.41,Blue Cross and Blue Shield,Traditional,,175.86,38.7,percent of total billed charges,454.41,17.72,231.75,percent of total billed charges,38.7
Q10186 EBV QT RT-PCR,87799,CPT,,,,,both,, ,454.41,454.41,Blue Cross and Blue Shield,Traditional,,175.86,38.7,percent of total billed charges,454.41,17.72,231.75,percent of total billed charges,38.7
Q11274 BKV QT RT-PCR,87799,CPT,,,,,both,, ,454.41,454.41,Blue Cross and Blue Shield,Traditional,,175.86,38.7,percent of total billed charges,454.41,17.72,231.75,percent of total billed charges,38.7
"DETECT AGT MULT,DNAA",87801,CPT,,,,,both,, ,715.16,715.16,Blue Cross and Blue Shield,Traditional,,276.77,38.7,percent of total billed charges,715.16,27.89,364.73,percent of total billed charges,38.7
L180021 DET AGT MULT,87801,CPT,,,,,both,, ,656.11,656.11,Blue Cross and Blue Shield,Traditional,,253.91,38.7,percent of total billed charges,656.11,25.59,334.62,percent of total billed charges,38.7
Q15564LYME RT-PCR SF,87801,CPT,,,,,both,, ,715.16,715.16,Blue Cross and Blue Shield,Traditional,,276.77,38.7,percent of total billed charges,715.16,27.89,364.73,percent of total billed charges,38.7
Q15777LYM QL BL RTPC,87801,CPT,,,,,both,, ,715.16,715.16,Blue Cross and Blue Shield,Traditional,,276.77,38.7,percent of total billed charges,715.16,27.89,364.73,percent of total billed charges,38.7
INFLUENZA ASSAY W-OP,87804,CPT,,,,,both,, ,30.87,30.87,Blue Cross and Blue Shield,Traditional,,11.95,38.7,percent of total billed charges,30.87,1.20,15.74,percent of total billed charges,38.7
INFLUENZA ASSAY W-OP,87804,CPT,,,,,both,, ,104.12,104.12,Blue Cross and Blue Shield,Traditional,,40.29,38.7,percent of total billed charges,104.12,4.06,53.1,percent of total billed charges,38.7
RSV ASSAY W-OPTIC,87807,CPT,,,,,both,, ,44.62,44.62,Blue Cross and Blue Shield,Traditional,,17.27,38.7,percent of total billed charges,44.62,1.74,22.76,percent of total billed charges,38.7
RSV ASSAY W-OPTIC,87807,CPT,,,,,both,, ,277.86,277.86,Blue Cross and Blue Shield,Traditional,,107.53,38.7,percent of total billed charges,277.86,10.84,141.71,percent of total billed charges,38.7
STREP A ASSAY W-OPTI,87880,CPT,,,,,both,, ,41.25,41.25,Blue Cross and Blue Shield,Traditional,,15.96,38.7,percent of total billed charges,41.25,1.61,21.04,percent of total billed charges,38.7
STREP A ASSAY W-OPTI,87880,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,percent of total billed charges,285.17,11.12,145.44,percent of total billed charges,38.7
AGENT NOS ASSAY W-OP,87899,CPT,,,,,both,, ,172.90,172.90,Blue Cross and Blue Shield,Traditional,,66.91,38.7,percent of total billed charges,172.90,6.74,88.18,percent of total billed charges,38.7
L183025 CRYPTO AG,87899,CPT,,,,,both,, ,158.62,158.62,Blue Cross and Blue Shield,Traditional,,61.39,38.7,percent of total billed charges,158.62,6.19,80.9,percent of total billed charges,38.7
L183025 CRYPTO AG,87899,CPT,,,,,both,, ,158.62,158.62,Blue Cross and Blue Shield,Traditional,,61.39,38.7,percent of total billed charges,158.62,6.19,80.9,percent of total billed charges,38.7
Q34949 PHENO INF DRG,87900,CPT,,,,,both,, ,773.54,773.54,Blue Cross and Blue Shield,Traditional,,299.36,38.7,percent of total billed charges,773.54,30.17,394.51,percent of total billed charges,38.7
"GENOTYPE,DNA,HIV REV",87901,CPT,,,,,both,, ,1819.90,1819.90,Blue Cross and Blue Shield,Traditional,,704.30,38.7,percent of total billed charges,1819.90,70.98,928.15,percent of total billed charges,38.7
"GENOTYPE,DNA,HIV REV",87901,CPT,,,,,both,, ,1819.90,1819.90,Blue Cross and Blue Shield,Traditional,,704.30,38.7,percent of total billed charges,1819.90,70.98,928.15,percent of total billed charges,38.7
"GENOTYPE,DNA,HEPAT C",87902,CPT,,,,,both,, ,1611.91,1611.91,Blue Cross and Blue Shield,Traditional,,623.81,38.7,percent of total billed charges,1611.91,62.86,822.07,percent of total billed charges,38.7
Q37811 HCVRNA GN MPR,87902,CPT,,,,,both,, ,1611.91,1611.91,Blue Cross and Blue Shield,Traditional,,623.81,38.7,percent of total billed charges,1611.91,62.86,822.07,percent of total billed charges,38.7
Q92447 HCVG1 NS5A DR,87902,CPT,,,,,both,, ,1611.91,1611.91,Blue Cross and Blue Shield,Traditional,,623.81,38.7,percent of total billed charges,1611.91,62.86,822.07,percent of total billed charges,38.7
L551690PHENO DNA HIV,87903,CPT,,,,,both,, ,1465.00,1465.00,Blue Cross and Blue Shield,Traditional,,566.96,38.7,percent of total billed charges,1465.00,57.14,747.15,percent of total billed charges,38.7
L551690PHENO DNA HIV,87904,CPT,,,,,both,, ,104.00,104.00,Blue Cross and Blue Shield,Traditional,,40.25,38.7,percent of total billed charges,104.00,4.06,53.04,percent of total billed charges,38.7
HIV GEN DNA REV OTH,87906,CPT,,,,,both,, ,856.62,856.62,Blue Cross and Blue Shield,Traditional,,331.51,38.7,percent of total billed charges,856.62,33.41,436.88,percent of total billed charges,38.7
AUTOPSY COMPL WO-CNS,88020,CPT,,,,,both,, ,3310.55,3310.55,Blue Cross and Blue Shield,Traditional,,1281.18,38.7,percent of total billed charges,3310.55,129.11,1688.38,percent of total billed charges,38.7
CYTOPATH FLD NOT V-C,88104,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,percent of total billed charges,109.74,4.28,55.97,percent of total billed charges,38.7
CYTOPATH FLD FTRW-IN,88106,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,percent of total billed charges,109.74,4.28,55.97,percent of total billed charges,38.7
CYTOPATH CONCENT TEC,88108,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,percent of total billed charges,109.74,4.28,55.97,percent of total billed charges,38.7
CYTOCELL ENH X CR-VG,88112,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,percent of total billed charges,237.17,9.25,120.96,percent of total billed charges,38.7
CYTO UR 3-5PROB EA S,88120,CPT,,,,,both,, ,368.80,368.80,Blue Cross and Blue Shield,Traditional,,142.73,38.7,percent of total billed charges,368.80,14.38,188.09,percent of total billed charges,38.7
CYTO UR 3-5 PROB CMP,88121,CPT,,,,,both,, ,368.80,368.80,Blue Cross and Blue Shield,Traditional,,142.73,38.7,percent of total billed charges,368.80,14.38,188.09,percent of total billed charges,38.7
FORENSIC CYTOPATHOLO,88125,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,percent of total billed charges,109.74,4.28,55.97,percent of total billed charges,38.7
SEX CHROMATIN ID BAR,88130,CPT,,,,,both,, ,144.83,144.83,Blue Cross and Blue Shield,Traditional,,56.05,38.7,percent of total billed charges,144.83,5.65,73.86,percent of total billed charges,38.7
SEX CHROM ID POLYMOR,88140,CPT,,,,,both,, ,76.90,76.90,Blue Cross and Blue Shield,Traditional,,29.76,38.7,percent of total billed charges,76.90,3.00,39.22,percent of total billed charges,38.7
L192555 PAP LB,88142,CPT,,,,,both,, ,234.07,234.07,Blue Cross and Blue Shield,Traditional,,90.59,38.7,percent of total billed charges,234.07,9.13,119.38,percent of total billed charges,38.7
PAP THINLAY LIQ DIAG,88142,CPT,,,,,both,, ,189.74,189.74,Blue Cross and Blue Shield,Traditional,,73.43,38.7,percent of total billed charges,189.74,7.40,96.77,percent of total billed charges,38.7
CYTOPATH C-V THNLYRE,88143,CPT,,,,,both,, ,189.74,189.74,Blue Cross and Blue Shield,Traditional,,73.43,38.7,percent of total billed charges,189.74,7.40,96.77,percent of total billed charges,38.7
CYTOP C-V AUTOMATED,88147,CPT,,,,,both,, ,101.60,101.60,Blue Cross and Blue Shield,Traditional,,39.32,38.7,percent of total billed charges,101.60,3.96,51.82,percent of total billed charges,38.7
CYTOP C-V AUTO RESCR,88148,CPT,,,,,both,, ,101.60,101.60,Blue Cross and Blue Shield,Traditional,,39.32,38.7,percent of total billed charges,101.60,3.96,51.82,percent of total billed charges,38.7
CYTOPATH C-V MANUAL,88150,CPT,,,,,both,, ,101.60,101.60,Blue Cross and Blue Shield,Traditional,,39.32,38.7,percent of total billed charges,101.60,3.96,51.82,percent of total billed charges,38.7
CYTOP C-V AUTO REDO,88152,CPT,,,,,both,, ,101.60,101.60,Blue Cross and Blue Shield,Traditional,,39.32,38.7,percent of total billed charges,101.60,3.96,51.82,percent of total billed charges,38.7
CYTOPATH C-V REDO,88153,CPT,,,,,both,, ,101.60,101.60,Blue Cross and Blue Shield,Traditional,,39.32,38.7,percent of total billed charges,101.60,3.96,51.82,percent of total billed charges,38.7
CYTOP C-V INDX ADDON,88155,CPT,,,,,both,, ,57.81,57.81,Blue Cross and Blue Shield,Traditional,,22.37,38.7,percent of total billed charges,57.81,2.25,29.48,percent of total billed charges,38.7
CYTOP SMR OTHR SOURC,88160,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,percent of total billed charges,109.74,4.28,55.97,percent of total billed charges,38.7
CYTOP SMR OTH PRE-SC,88161,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,percent of total billed charges,109.74,4.28,55.97,percent of total billed charges,38.7
CYTOP SMR OTH S5SLID,88162,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,percent of total billed charges,237.17,9.25,120.96,percent of total billed charges,38.7
"CYTOP TBS,C-V,MANUAL",88164,CPT,,,,,both,, ,101.60,101.60,Blue Cross and Blue Shield,Traditional,,39.32,38.7,percent of total billed charges,101.60,3.96,51.82,percent of total billed charges,38.7
"CYTOP TBS,C-V,REDO",88165,CPT,,,,,both,, ,101.60,101.60,Blue Cross and Blue Shield,Traditional,,39.32,38.7,percent of total billed charges,101.60,3.96,51.82,percent of total billed charges,38.7
"CYTOP TBS,C-V AUTORE",88166,CPT,,,,,both,, ,101.60,101.60,Blue Cross and Blue Shield,Traditional,,39.32,38.7,percent of total billed charges,101.60,3.96,51.82,percent of total billed charges,38.7
"CYTOP TBS,C-C,SELECT",88167,CPT,,,,,both,, ,101.60,101.60,Blue Cross and Blue Shield,Traditional,,39.32,38.7,percent of total billed charges,101.60,3.96,51.82,percent of total billed charges,38.7
CYTOPATH EVAL OF FNA,88172,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,percent of total billed charges,109.74,4.28,55.97,percent of total billed charges,38.7
"CYTOP EVAL,FNA,REPOR",88173,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,percent of total billed charges,237.17,9.25,120.96,percent of total billed charges,38.7
CYTO-CERVICALRP CDM,88174,CPT,,,,,both,, ,205.45,205.45,Blue Cross and Blue Shield,Traditional,,79.51,38.7,percent of total billed charges,205.45,8.01,104.78,percent of total billed charges,38.7
L199305 PAP AU MN RS,88175,CPT,,,,,both,, ,234.07,234.07,Blue Cross and Blue Shield,Traditional,,90.59,38.7,percent of total billed charges,234.07,9.13,119.38,percent of total billed charges,38.7
PAP DIAG AUTO MAN RS,88175,CPT,,,,,both,, ,255.13,255.13,Blue Cross and Blue Shield,Traditional,,98.74,38.7,percent of total billed charges,255.13,9.95,130.12,percent of total billed charges,38.7
Q92090 PAP DIAG AUTO,88175,CPT,,,,,both,, ,227.25,227.25,Blue Cross and Blue Shield,Traditional,,87.95,38.7,percent of total billed charges,227.25,8.86,115.9,percent of total billed charges,38.7
CYTO EVAL FNA ADD,88177,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,percent of total billed charges,72.13,2.81,36.79,percent of total billed charges,38.7
CELL MRK STDY CY-DNA,88182,CPT,,,,,both,, ,69.89,69.89,Blue Cross and Blue Shield,Traditional,,27.05,38.7,percent of total billed charges,69.89,2.73,35.64,percent of total billed charges,38.7
"FLOWCYTOMET-TC,1 MRK",88184,CPT,,,,,both,, ,203.21,203.21,Blue Cross and Blue Shield,Traditional,,78.64,38.7,percent of total billed charges,203.21,7.93,103.64,percent of total billed charges,38.7
"FLOWCYTOMET-TC,1 MRK",88184,CPT,,,,,both,, ,203.21,203.21,Blue Cross and Blue Shield,Traditional,,78.64,38.7,percent of total billed charges,203.21,7.93,103.64,percent of total billed charges,38.7
"FLOWCYTOMETRY-TC,ADD",88185,CPT,,,,,both,, ,195.35,195.35,Blue Cross and Blue Shield,Traditional,,75.60,38.7,percent of total billed charges,195.35,7.62,99.63,percent of total billed charges,38.7
Q35080 FLOWCY-TC ADD,88185,CPT,,,,,both,, ,60.00,60.00,Blue Cross and Blue Shield,Traditional,,23.22,38.7,percent of total billed charges,60.00,2.34,30.6,percent of total billed charges,38.7
A3001780 FLWCY 16MRK,88189,CPT,,,,,both,, ,360.00,360.00,Blue Cross and Blue Shield,Traditional,,139.32,38.7,percent of total billed charges,360.00,14.04,183.6,percent of total billed charges,38.7
CYTOPATHOLOGY PROCED,88199,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,percent of total billed charges,72.13,2.81,36.79,percent of total billed charges,38.7
TISSUE CULT LYMPHOCY,88230,CPT,,,,,both,, ,3469.98,3469.98,Blue Cross and Blue Shield,Traditional,,1342.88,38.7,percent of total billed charges,3469.98,135.33,1769.69,percent of total billed charges,38.7
TISSUE CULT LYMPHOCY,88230,CPT,,,,,both,, ,3469.98,3469.98,Blue Cross and Blue Shield,Traditional,,1342.88,38.7,percent of total billed charges,3469.98,135.33,1769.69,percent of total billed charges,38.7
TISSUE CULT SKIN/BIO,88233,CPT,,,,,both,, ,1353.98,1353.98,Blue Cross and Blue Shield,Traditional,,523.99,38.7,percent of total billed charges,1353.98,52.81,690.53,percent of total billed charges,38.7
"TISSUE CULT, PLACENT",88235,CPT,,,,,both,, ,1416.56,1416.56,Blue Cross and Blue Shield,Traditional,,548.21,38.7,percent of total billed charges,1416.56,55.25,722.45,percent of total billed charges,38.7
TISSUE CULT BONEMARR,88237,CPT,,,,,both,, ,849.04,849.04,Blue Cross and Blue Shield,Traditional,,328.58,38.7,percent of total billed charges,849.04,33.11,433.01,percent of total billed charges,38.7
TISSUE CULT BONEMARR,88237,CPT,,,,,both,, ,849.04,849.04,Blue Cross and Blue Shield,Traditional,,328.58,38.7,percent of total billed charges,849.04,33.11,433.01,percent of total billed charges,38.7
TISSUE CULTURE TUMOR,88239,CPT,,,,,both,, ,1419.09,1419.09,Blue Cross and Blue Shield,Traditional,,549.19,38.7,percent of total billed charges,1419.09,55.34,723.74,percent of total billed charges,38.7
CELL CRYOPRESERV-STO,88240,CPT,,,,,both,, ,97.11,97.11,Blue Cross and Blue Shield,Traditional,,37.58,38.7,percent of total billed charges,97.11,3.79,49.53,percent of total billed charges,38.7
FROZEN CELL PREPARAT,88241,CPT,,,,,both,, ,97.11,97.11,Blue Cross and Blue Shield,Traditional,,37.58,38.7,percent of total billed charges,97.11,3.79,49.53,percent of total billed charges,38.7
CHROMOSOME ANAL20-25,88245,CPT,,,,,both,, ,1397.47,1397.47,Blue Cross and Blue Shield,Traditional,,540.82,38.7,percent of total billed charges,1397.47,54.50,712.71,percent of total billed charges,38.7
CHROMOSOM ANAL50-100,88248,CPT,,,,,both,, ,1666.09,1666.09,Blue Cross and Blue Shield,Traditional,,644.78,38.7,percent of total billed charges,1666.09,64.98,849.71,percent of total billed charges,38.7
CHROMOSOME ANALYS100,88249,CPT,,,,,both,, ,1666.09,1666.09,Blue Cross and Blue Shield,Traditional,,644.78,38.7,percent of total billed charges,1666.09,64.98,849.71,percent of total billed charges,38.7
CHROMOSOME ANALYS  5,88261,CPT,,,,,both,, ,1700.32,1700.32,Blue Cross and Blue Shield,Traditional,,658.02,38.7,percent of total billed charges,1700.32,66.31,867.16,percent of total billed charges,38.7
CHROMOSOME ANAL15-20,88262,CPT,,,,,both,, ,4292.64,4292.64,Blue Cross and Blue Shield,Traditional,,1661.25,38.7,percent of total billed charges,4292.64,167.41,2189.25,percent of total billed charges,38.7
Q14596 CHR AN 15-20,88262,CPT,,,,,both,, ,1010.00,1010.00,Blue Cross and Blue Shield,Traditional,,390.87,38.7,percent of total billed charges,1010.00,39.39,515.1,percent of total billed charges,38.7
CHROMOSOME ANALYS 45,88263,CPT,,,,,both,, ,1445.75,1445.75,Blue Cross and Blue Shield,Traditional,,559.51,38.7,percent of total billed charges,1445.75,56.38,737.33,percent of total billed charges,38.7
CHROMOSOME ANAL20-25,88264,CPT,,,,,both,, ,2107.59,2107.59,Blue Cross and Blue Shield,Traditional,,815.64,38.7,percent of total billed charges,2107.59,82.20,1074.87,percent of total billed charges,38.7
CHROMOSOME ANAL20-25,88264,CPT,,,,,both,, ,2107.59,2107.59,Blue Cross and Blue Shield,Traditional,,815.64,38.7,percent of total billed charges,2107.59,82.20,1074.87,percent of total billed charges,38.7
CHROMOSOME ANAL-PLAC,88267,CPT,,,,,both,, ,1729.51,1729.51,Blue Cross and Blue Shield,Traditional,,669.32,38.7,percent of total billed charges,1729.51,67.45,882.05,percent of total billed charges,38.7
CHROMOSOM ANAL AMNIO,88269,CPT,,,,,both,, ,1600.13,1600.13,Blue Cross and Blue Shield,Traditional,,619.25,38.7,percent of total billed charges,1600.13,62.41,816.07,percent of total billed charges,38.7
CYTOGENETICS DNA-PRO,88271,CPT,,,,,both,, ,525.70,525.70,Blue Cross and Blue Shield,Traditional,,203.45,38.7,percent of total billed charges,525.70,20.50,268.11,percent of total billed charges,38.7
CYTOGENETICS DNA-PRO,88271,CPT,,,,,both,, ,525.70,525.70,Blue Cross and Blue Shield,Traditional,,203.45,38.7,percent of total billed charges,525.70,20.50,268.11,percent of total billed charges,38.7
CYTOGENETICS 3-5,88272,CPT,,,,,both,, ,243.63,243.63,Blue Cross and Blue Shield,Traditional,,94.28,38.7,percent of total billed charges,243.63,9.50,124.25,percent of total billed charges,38.7
CYTOGENETICS 25-99,88274,CPT,,,,,both,, ,336.52,336.52,Blue Cross and Blue Shield,Traditional,,130.23,38.7,percent of total billed charges,336.52,13.12,171.63,percent of total billed charges,38.7
CYTOGENETICS 100-300,88275,CPT,,,,,both,, ,1078.63,1078.63,Blue Cross and Blue Shield,Traditional,,417.43,38.7,percent of total billed charges,1078.63,42.07,550.1,percent of total billed charges,38.7
CYTOGENETICS 100-300,88275,CPT,,,,,both,, ,1078.63,1078.63,Blue Cross and Blue Shield,Traditional,,417.43,38.7,percent of total billed charges,1078.63,42.07,550.1,percent of total billed charges,38.7
CHROMOSOME KARYOT ST,88280,CPT,,,,,both,, ,962.71,962.71,Blue Cross and Blue Shield,Traditional,,372.57,38.7,percent of total billed charges,962.71,37.55,490.98,percent of total billed charges,38.7
CHROMOSOM BANDINGSTU,88283,CPT,,,,,both,, ,375.26,375.26,Blue Cross and Blue Shield,Traditional,,145.23,38.7,percent of total billed charges,375.26,14.64,191.38,percent of total billed charges,38.7
CHROMOSOME CT ADDITI,88285,CPT,,,,,both,, ,182.71,182.71,Blue Cross and Blue Shield,Traditional,,70.71,38.7,percent of total billed charges,182.71,7.13,93.18,percent of total billed charges,38.7
CHROMOS STDY ADD HIG,88289,CPT,,,,,both,, ,284.04,284.04,Blue Cross and Blue Shield,Traditional,,109.92,38.7,percent of total billed charges,284.04,11.08,144.86,percent of total billed charges,38.7
CYTOGENETIC STUDY,88299,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,percent of total billed charges,72.13,2.81,36.79,percent of total billed charges,38.7
SURG PATH GROSS LVL1,88300,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,percent of total billed charges,72.13,2.81,36.79,percent of total billed charges,38.7
SURG PATH GROSS LVL2,88302,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,percent of total billed charges,109.74,4.28,55.97,percent of total billed charges,38.7
SURG PATH GROSS LVL3,88304,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,percent of total billed charges,237.17,9.25,120.96,percent of total billed charges,38.7
SURG PATH GROSS LVL4,88305,CPT,,,,,both,, ,398.27,398.27,Blue Cross and Blue Shield,Traditional,,154.13,38.7,percent of total billed charges,398.27,15.53,203.12,percent of total billed charges,38.7
SURG PATH GROSS LVL5,88307,CPT,,,,,both,, ,368.80,368.80,Blue Cross and Blue Shield,Traditional,,142.73,38.7,percent of total billed charges,368.80,14.38,188.09,percent of total billed charges,38.7
SURG PATH GROSS LVL6,88309,CPT,,,,,both,, ,368.80,368.80,Blue Cross and Blue Shield,Traditional,,142.73,38.7,percent of total billed charges,368.80,14.38,188.09,percent of total billed charges,38.7
DECALCIFY TISSUE,88311,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,percent of total billed charges,72.13,2.81,36.79,percent of total billed charges,38.7
SPECIAL STAINS GRP 1,88312,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,percent of total billed charges,109.74,4.28,55.97,percent of total billed charges,38.7
SPECIAL STAINS GRP 2,88313,CPT,,,,,both,, ,33.68,33.68,Blue Cross and Blue Shield,Traditional,,13.03,38.7,percent of total billed charges,33.68,1.31,17.18,percent of total billed charges,38.7
SPECIAL STAINS GRP 2,88313,CPT,,,,,both,, ,241.94,241.94,Blue Cross and Blue Shield,Traditional,,93.63,38.7,percent of total billed charges,241.94,9.44,123.39,percent of total billed charges,38.7
HISTOCHEMICAL STAIN,88314,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,percent of total billed charges,109.74,4.28,55.97,percent of total billed charges,38.7
ENZYME HISTOCHEMISTR,88319,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,percent of total billed charges,109.74,4.28,55.97,percent of total billed charges,38.7
MICROSLIDE-CONSULN-P,88321,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,percent of total billed charges,109.74,4.28,55.97,percent of total billed charges,38.7
MICROSLID CONSUL-W-P,88323,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,percent of total billed charges,237.17,9.25,120.96,percent of total billed charges,38.7
COMPRE REVIEW OFDATA,88325,CPT,,,,,both,, ,368.80,368.80,Blue Cross and Blue Shield,Traditional,,142.73,38.7,percent of total billed charges,368.80,14.38,188.09,percent of total billed charges,38.7
PATH CONSULT INTROP,88329,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,percent of total billed charges,109.74,4.28,55.97,percent of total billed charges,38.7
PATH CONSULT INT-1BL,88331,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,percent of total billed charges,237.17,9.25,120.96,percent of total billed charges,38.7
PATH CONSULT-INTRADD,88332,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,percent of total billed charges,72.13,2.81,36.79,percent of total billed charges,38.7
INOP CYTOPAT CNSLT 1,88333,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,percent of total billed charges,109.74,4.28,55.97,percent of total billed charges,38.7
INOP CYTOPAT CNSLT 2,88334,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,percent of total billed charges,109.74,4.28,55.97,percent of total billed charges,38.7
ICC ADD AB PER SLIDE,88341,CPT,,,,,both,, ,238.01,238.01,Blue Cross and Blue Shield,Traditional,,92.11,38.7,percent of total billed charges,238.01,9.28,121.39,percent of total billed charges,38.7
1ST SEP ID AB,88342,CPT,,,,,both,, ,238.01,238.01,Blue Cross and Blue Shield,Traditional,,92.11,38.7,percent of total billed charges,238.01,9.28,121.39,percent of total billed charges,38.7
ICC MLTPX AB ST,88344,CPT,,,,,both,, ,221.17,221.17,Blue Cross and Blue Shield,Traditional,,85.59,38.7,percent of total billed charges,221.17,8.63,112.8,percent of total billed charges,38.7
IMF SPEC 1ST AB ST,88346,CPT,,,,,both,, ,270.57,270.57,Blue Cross and Blue Shield,Traditional,,104.71,38.7,percent of total billed charges,270.57,10.55,137.99,percent of total billed charges,38.7
ELECTRON MICROSCOPY,88348,CPT,,,,,both,, ,2028.15,2028.15,Blue Cross and Blue Shield,Traditional,,784.89,38.7,percent of total billed charges,2028.15,79.10,1034.36,percent of total billed charges,38.7
IMF/SPEC ADD AB ST,88350,CPT,,,,,both,, ,270.57,270.57,Blue Cross and Blue Shield,Traditional,,104.71,38.7,percent of total billed charges,270.57,10.55,137.99,percent of total billed charges,38.7
ANALYSIS SKELET MUSC,88355,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,percent of total billed charges,237.17,9.25,120.96,percent of total billed charges,38.7
ANALYSIS NERVE,88356,CPT,,,,,both,, ,368.80,368.80,Blue Cross and Blue Shield,Traditional,,142.73,38.7,percent of total billed charges,368.80,14.38,188.09,percent of total billed charges,38.7
ANALYSIS TUMOR,88358,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,percent of total billed charges,237.17,9.25,120.96,percent of total billed charges,38.7
TUMOR IHC QT MAN,88360,CPT,,,,,both,, ,1468.77,1468.77,Blue Cross and Blue Shield,Traditional,,568.41,38.7,percent of total billed charges,1468.77,57.28,749.07,percent of total billed charges,38.7
TUMOR IHC QT UTO,88361,CPT,,,,,both,, ,1468.77,1468.77,Blue Cross and Blue Shield,Traditional,,568.41,38.7,percent of total billed charges,1468.77,57.28,749.07,percent of total billed charges,38.7
NERVE TEASING PREPAR,88362,CPT,,,,,both,, ,368.80,368.80,Blue Cross and Blue Shield,Traditional,,142.73,38.7,percent of total billed charges,368.80,14.38,188.09,percent of total billed charges,38.7
XM ARCHIVE TIS MOLEC,88363,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,percent of total billed charges,72.13,2.81,36.79,percent of total billed charges,38.7
TIS HYBRD AD SNG PRB,88364,CPT,,,,,both,, ,230.71,230.71,Blue Cross and Blue Shield,Traditional,,89.28,38.7,percent of total billed charges,230.71,9.00,117.66,percent of total billed charges,38.7
TIS HYBRD SPEC INIT,88365,CPT,,,,,both,, ,304.81,304.81,Blue Cross and Blue Shield,Traditional,,117.96,38.7,percent of total billed charges,304.81,11.89,155.45,percent of total billed charges,38.7
INS HYBR AUT SP INIT,88367,CPT,,,,,both,, ,220.05,220.05,Blue Cross and Blue Shield,Traditional,,85.16,38.7,percent of total billed charges,220.05,8.58,112.23,percent of total billed charges,38.7
INS HYBRD MAN SP INI,88368,CPT,,,,,both,, ,342.70,342.70,Blue Cross and Blue Shield,Traditional,,132.62,38.7,percent of total billed charges,342.70,13.37,174.78,percent of total billed charges,38.7
INS HYBRD MAN SNG PR,88369,CPT,,,,,both,, ,342.70,342.70,Blue Cross and Blue Shield,Traditional,,132.62,38.7,percent of total billed charges,342.70,13.37,174.78,percent of total billed charges,38.7
PROTEIN-WEST BLOTTIS,88371,CPT,,,,,both,, ,209.38,209.38,Blue Cross and Blue Shield,Traditional,,81.03,38.7,percent of total billed charges,209.38,8.17,106.78,percent of total billed charges,38.7
PROTEIN ANALYSW/PROB,88372,CPT,,,,,both,, ,218.93,218.93,Blue Cross and Blue Shield,Traditional,,84.73,38.7,percent of total billed charges,218.93,8.54,111.65,percent of total billed charges,38.7
INS HYBR AUT SNG PR,88373,CPT,,,,,both,, ,220.05,220.05,Blue Cross and Blue Shield,Traditional,,85.16,38.7,percent of total billed charges,220.05,8.58,112.23,percent of total billed charges,38.7
INS HYBR AUT MUL PR,88374,CPT,,,,,both,, ,220.05,220.05,Blue Cross and Blue Shield,Traditional,,85.16,38.7,percent of total billed charges,220.05,8.58,112.23,percent of total billed charges,38.7
INS HYBR MAN MUL PR,88377,CPT,,,,,both,, ,342.70,342.70,Blue Cross and Blue Shield,Traditional,,132.62,38.7,percent of total billed charges,342.70,13.37,174.78,percent of total billed charges,38.7
MICRODISSECTION MANU,88381,CPT,,,,,both,, ,424.38,424.38,Blue Cross and Blue Shield,Traditional,,164.24,38.7,percent of total billed charges,424.38,16.55,216.43,percent of total billed charges,38.7
SURGICAL PATH PROCED,88399,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,percent of total billed charges,72.13,2.81,36.79,percent of total billed charges,38.7
BILIRUBIN TOT TRANS,88720,CPT,,,,,both,, ,75.22,75.22,Blue Cross and Blue Shield,Traditional,,29.11,38.7,percent of total billed charges,75.22,2.93,38.36,percent of total billed charges,38.7
CELL CTW-DIF BODYFLU,89051,CPT,,,,,both,, ,54.17,54.17,Blue Cross and Blue Shield,Traditional,,20.96,38.7,percent of total billed charges,54.17,2.11,27.63,percent of total billed charges,38.7
CELL CTW-DIF BODYFLU,89051,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,percent of total billed charges,691.29,26.96,352.56,percent of total billed charges,38.7
LEUKOCY ASSES FEC QL,89055,CPT,,,,,both,, ,109.46,109.46,Blue Cross and Blue Shield,Traditional,,42.36,38.7,percent of total billed charges,109.46,4.27,55.82,percent of total billed charges,38.7
"CRYSTAL ID,TISSUE,FL",89060,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
"CRYSTAL ID,TISSUE,FL",89060,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,percent of total billed charges,345.79,13.49,176.35,percent of total billed charges,38.7
NASAL SMEAR-EOSINOPH,89190,CPT,,,,,both,, ,518.69,518.69,Blue Cross and Blue Shield,Traditional,,200.73,38.7,percent of total billed charges,518.69,20.23,264.53,percent of total billed charges,38.7
UNL MISC PATH TEST,89240,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,percent of total billed charges,72.13,2.81,36.79,percent of total billed charges,38.7
SEMEN ANYL PRES-M-S,89321,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,percent of total billed charges,526.26,20.52,268.39,percent of total billed charges,38.7
HEPATITIS B GLOB IM,90371,CPT,,,,,both,, ,679.03,679.03,Blue Cross and Blue Shield,Traditional,,262.78,38.7,percent of total billed charges,679.03,26.48,346.31,percent of total billed charges,38.7
HEPATITIS B GLOB IM,90371,CPT,,,,,both,1,ML,953.00,953.00,Blue Cross and Blue Shield,Traditional,,368.81,38.7,percent of total billed charges,953.00,37.17,486.03,percent of total billed charges,38.7
RABIES IG IM/SC 150U,90375,CPT,,,,,both,3,ML,414.33,414.33,Blue Cross and Blue Shield,Traditional,,160.35,38.7,percent of total billed charges,414.33,16.16,211.31,percent of total billed charges,38.7
RABIES IG IM/SC 150U,90375,CPT,,,,,both,, ,1385.09,1385.09,Blue Cross and Blue Shield,Traditional,,536.03,38.7,percent of total billed charges,1385.09,54.02,706.4,percent of total billed charges,38.7
RABIES IG IM/SC 150U,90375,CPT,,,,,both,, ,1428.35,1428.35,Blue Cross and Blue Shield,Traditional,,552.77,38.7,percent of total billed charges,1428.35,55.71,728.46,percent of total billed charges,38.7
RABIES IG IM/SC 150U,90375,HCPCS,,,,,both,5,ML,1867.13,1867.13,Blue Cross and Blue Shield,Traditional,,722.58,38.7,percent of total billed charges,1867.13,72.82,952.24,percent of total billed charges,38.7
RABIES IG IM/SC 150U,90375,HCPCS,,,,,both,1,ML,2044.81,2044.81,Blue Cross and Blue Shield,Traditional,,791.34,38.7,percent of total billed charges,2044.81,79.75,1042.85,percent of total billed charges,38.7
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,4.10,53.58,percent of total billed charges,38.7
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,4.10,53.58,percent of total billed charges,38.7
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,143.69,143.69,Blue Cross and Blue Shield,Traditional,,55.61,38.7,percent of total billed charges,143.69,5.60,73.28,percent of total billed charges,38.7
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,230.72,230.72,Blue Cross and Blue Shield,Traditional,,89.29,38.7,percent of total billed charges,230.72,9.00,117.67,percent of total billed charges,38.7
IMM ADM INJ SINGLE,90471,CPT,,,,,both,, ,162.25,162.25,Blue Cross and Blue Shield,Traditional,,62.79,38.7,percent of total billed charges,162.25,6.33,82.75,percent of total billed charges,38.7
IMM ADM INJ SINGLE,90471,CPT,,,,,both,, ,162.25,162.25,Blue Cross and Blue Shield,Traditional,,62.79,38.7,percent of total billed charges,162.25,6.33,82.75,percent of total billed charges,38.7
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,4.10,53.58,percent of total billed charges,38.7
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,4.10,53.58,percent of total billed charges,38.7
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,119.22,119.22,Blue Cross and Blue Shield,Traditional,,46.14,38.7,percent of total billed charges,119.22,4.65,60.8,percent of total billed charges,38.7
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,119.22,119.22,Blue Cross and Blue Shield,Traditional,,46.14,38.7,percent of total billed charges,119.22,4.65,60.8,percent of total billed charges,38.7
IMM ADM INJ EA ADD,90472,CPT,,,,,both,, ,48.75,48.75,Blue Cross and Blue Shield,Traditional,,18.87,38.7,percent of total billed charges,48.75,1.90,24.86,percent of total billed charges,38.7
IMM ADM INJ EA ADD,90472,CPT,,,,,both,, ,48.75,48.75,Blue Cross and Blue Shield,Traditional,,18.87,38.7,percent of total billed charges,48.75,1.90,24.86,percent of total billed charges,38.7
HAEMOPH B TETAN INJ,90648,CPT,,,,,both,, ,131.84,131.84,Blue Cross and Blue Shield,Traditional,,51.02,38.7,percent of total billed charges,131.84,5.14,67.24,percent of total billed charges,38.7
FLU VAC NOPRSV ANTIG,90662,CPT,,,,,both,0.7,ML,434.66,434.66,Blue Cross and Blue Shield,Traditional,,168.21,38.7,percent of total billed charges,434.66,16.95,221.68,percent of total billed charges,38.7
PNEUMOCOC 13-VAL IM,90670,CPT,,,,,both,0.5,ML,871.90,871.90,Blue Cross and Blue Shield,Traditional,,337.43,38.7,percent of total billed charges,871.90,34.00,444.67,percent of total billed charges,38.7
FLU VAC CCIIV4 PF&AB,90674,CPT,,,,,both,0.5,ML,208.06,208.06,Blue Cross and Blue Shield,Traditional,,80.52,38.7,percent of total billed charges,208.06,8.11,106.11,percent of total billed charges,38.7
RABIES VAC IM,90675,CPT,,,,,both,1,EA,1856.32,1856.32,Blue Cross and Blue Shield,Traditional,,718.40,38.7,percent of total billed charges,1856.32,72.40,946.72,percent of total billed charges,38.7
RABIES VAC IM,90675,CPT,,,,,both,, ,1941.04,1941.04,Blue Cross and Blue Shield,Traditional,,751.18,38.7,percent of total billed charges,1941.04,75.70,989.93,percent of total billed charges,38.7
FLU VAC QUAD DNA HA,90682,CPT,,,,,both,, ,383.75,383.75,Blue Cross and Blue Shield,Traditional,,148.51,38.7,percent of total billed charges,383.75,14.97,195.71,percent of total billed charges,38.7
FLU VACIIV4 PF .5ML,90686,CPT,,,,,both,, ,145.23,145.23,Blue Cross and Blue Shield,Traditional,,56.20,38.7,percent of total billed charges,145.23,5.66,74.07,percent of total billed charges,38.7
FLU VAC IIV4 .25ML,90687,CPT,,,,,both,, ,135.45,135.45,Blue Cross and Blue Shield,Traditional,,52.42,38.7,percent of total billed charges,135.45,5.28,69.08,percent of total billed charges,38.7
M-M-R II INJ,90707,CPT,,,,,both,1,EA,471.23,471.23,Blue Cross and Blue Shield,Traditional,,182.37,38.7,percent of total billed charges,471.23,18.38,240.33,percent of total billed charges,38.7
TD IM NO PRSRV GE 7Y,90714,CPT,,,,,both,0.5,ML,210.12,210.12,Blue Cross and Blue Shield,Traditional,,81.32,38.7,percent of total billed charges,210.12,8.19,107.16,percent of total billed charges,38.7
DIPH/TET/ACPERT .5ML,90715,CPT,,,,,both,0.5,ML,350.20,350.20,Blue Cross and Blue Shield,Traditional,,135.53,38.7,percent of total billed charges,350.20,13.66,178.6,percent of total billed charges,38.7
DIPH/TET/ACPERT .5ML,90715,CPT,,,,,both,0.5,ML,370.54,370.54,Blue Cross and Blue Shield,Traditional,,143.40,38.7,percent of total billed charges,370.54,14.45,188.98,percent of total billed charges,38.7
VARICELLA VIR VAC SC,90716,CPT,,,,,both,1,EA,611.56,611.56,Blue Cross and Blue Shield,Traditional,,236.67,38.7,percent of total billed charges,611.56,23.85,311.9,percent of total billed charges,38.7
PNEUMO-VAC 2YR-ADULT,90732,CPT,,,,,both,0.5,ML,544.10,544.10,Blue Cross and Blue Shield,Traditional,,210.57,38.7,percent of total billed charges,544.10,21.22,277.49,percent of total billed charges,38.7
HEP B VAC PED,90744,CPT,,,,,both,, ,194.93,194.93,Blue Cross and Blue Shield,Traditional,,75.44,38.7,percent of total billed charges,194.93,7.60,99.41,percent of total billed charges,38.7
HEP B VAC PED,90744,CPT,,,,,both,0.5,ML,204.97,204.97,Blue Cross and Blue Shield,Traditional,,79.32,38.7,percent of total billed charges,204.97,7.99,104.53,percent of total billed charges,38.7
INTERACTIVE ADD-ON,90785,CPT,,,,,both,, ,310.80,310.80,Blue Cross and Blue Shield,Traditional,,120.28,38.7,percent of total billed charges,310.80,12.12,158.51,percent of total billed charges,38.7
PSYCH DIAG EVAL,90791,CPT,,,,,both,, ,249.78,249.78,Blue Cross and Blue Shield,Traditional,,96.66,38.7,percent of total billed charges,249.78,9.74,127.39,percent of total billed charges,38.7
PSYCH DIAG EVAL,90791,CPT,,,,,both,, ,757.82,757.82,Blue Cross and Blue Shield,Traditional,,293.28,38.7,percent of total billed charges,757.82,29.55,386.49,percent of total billed charges,38.7
PSYCHOTHERAPY 30 MIN,90832,CPT,,,,,both,, ,238.96,238.96,Blue Cross and Blue Shield,Traditional,,92.48,38.7,percent of total billed charges,238.96,9.32,121.87,percent of total billed charges,38.7
"Psychotherapy, 30 min",90832,CPT,,,,,both,,,238.96,238.96,Blue Cross and Blue Shield,Traditional,,92.48,38.7,percent of total billed charges,238.96,9.32,121.87,percent of total billed charges,38.7
PSYCHOTHER 30M W/E&M,90833,CPT,,,,,both,, ,301.75,301.75,Blue Cross and Blue Shield,Traditional,,116.78,38.7,percent of total billed charges,301.75,11.77,153.89,percent of total billed charges,38.7
PSYCHOTHERAPY 45 MIN,90834,CPT,,,,,both,, ,299.73,299.73,Blue Cross and Blue Shield,Traditional,,116.00,38.7,percent of total billed charges,299.73,11.69,152.86,percent of total billed charges,38.7
"Psychotherapy, 45 min",90834,CPT,,,,,both,,,299.73,299.73,Blue Cross and Blue Shield,Traditional,,116.00,38.7,percent of total billed charges,299.73,11.69,152.86,percent of total billed charges,38.7
PSYCHOTHER 45M W/E&M,90836,CPT,,,,,both,, ,312.25,312.25,Blue Cross and Blue Shield,Traditional,,120.84,38.7,percent of total billed charges,312.25,12.18,159.25,percent of total billed charges,38.7
PSYCHOTHERAPY 60 MIN,90837,CPT,,,,,both,, ,359.73,359.73,Blue Cross and Blue Shield,Traditional,,139.22,38.7,percent of total billed charges,359.73,14.03,183.46,percent of total billed charges,38.7
"Psychotherapy, 60 min",90837,CPT,,,,,both,,,359.73,359.73,Blue Cross and Blue Shield,Traditional,,139.22,38.7,percent of total billed charges,359.73,14.03,183.46,percent of total billed charges,38.7
PSYCHOTHER 60M W/E&M,90838,CPT,,,,,both,, ,323.75,323.75,Blue Cross and Blue Shield,Traditional,,125.29,38.7,percent of total billed charges,323.75,12.63,165.11,percent of total billed charges,38.7
FAM THERAPY W/PATIEN,90847,CPT,,,,,both,, ,842.03,842.03,Blue Cross and Blue Shield,Traditional,,325.87,38.7,percent of total billed charges,842.03,32.84,429.44,percent of total billed charges,38.7
"Family psychotherapy, including patient, 50 min",90847,CPT,,,,,both,,,842.03,842.03,Blue Cross and Blue Shield,Traditional,,325.87,38.7,percent of total billed charges,842.03,32.84,429.44,percent of total billed charges,38.7
MULTI-FAM GRP PSYCH,90849,CPT,,,,,both,, ,396.04,396.04,Blue Cross and Blue Shield,Traditional,,153.27,38.7,percent of total billed charges,396.04,15.45,201.98,percent of total billed charges,38.7
Group psychotherapy,90853,CPT,,,,,both,,,220.94,220.94,Blue Cross and Blue Shield,Traditional,,85.50,38.7,percent of total billed charges,220.94,8.62,112.68,percent of total billed charges,38.7
PSYCH GROUP THERAPY,90853,CPT,,,,,both,, ,220.94,220.94,Blue Cross and Blue Shield,Traditional,,85.50,38.7,percent of total billed charges,220.94,8.62,112.68,percent of total billed charges,38.7
PSYCH GROUP THERAPY,90853,CPT,,,,,both,, ,689.33,689.33,Blue Cross and Blue Shield,Traditional,,266.77,38.7,percent of total billed charges,689.33,26.88,351.56,percent of total billed charges,38.7
MEDICATION MGMT,90863,CPT,,,,,both,, ,294.25,294.25,Blue Cross and Blue Shield,Traditional,,113.87,38.7,percent of total billed charges,294.25,11.48,150.07,percent of total billed charges,38.7
TMS INITIAL & 1ST TX,90867,CPT,,,,,both,, ,955.84,955.84,Blue Cross and Blue Shield,Traditional,,369.91,38.7,percent of total billed charges,955.84,37.28,487.48,percent of total billed charges,38.7
TMS SUBSEQUENT TX,90868,CPT,,,,,both,, ,515.04,515.04,Blue Cross and Blue Shield,Traditional,,199.32,38.7,percent of total billed charges,515.04,20.09,262.67,percent of total billed charges,38.7
TMS REMAPPING & TX,90869,CPT,,,,,both,, ,515.04,515.04,Blue Cross and Blue Shield,Traditional,,199.32,38.7,percent of total billed charges,515.04,20.09,262.67,percent of total billed charges,38.7
HEMODIALY SING EVAL,90935,CPT,,,,,both,, ,9908.09,9908.09,Blue Cross and Blue Shield,Traditional,,3834.43,38.7,percent of total billed charges,9908.09,386.42,5053.13,percent of total billed charges,38.7
OTH DIALY SING EVAL,90945,CPT,,,,,both,, ,4956.88,4956.88,Blue Cross and Blue Shield,Traditional,,1918.31,38.7,percent of total billed charges,4956.88,193.32,2528.01,percent of total billed charges,38.7
SP AR MCD TRMT 15MIN,92507,CPT,,,,,both,, ,182.25,182.25,Blue Cross and Blue Shield,Traditional,,70.53,38.7,percent of total billed charges,182.25,7.11,92.95,percent of total billed charges,38.7
SP-HEAR-TX-INDI VIST,92507,CPT,,,,,both,, ,705.29,705.29,Blue Cross and Blue Shield,Traditional,,272.95,38.7,percent of total billed charges,705.29,27.51,359.7,percent of total billed charges,38.7
SP-HEAR-GROUP-VISIT,92508,CPT,,,,,both,, ,324.19,324.19,Blue Cross and Blue Shield,Traditional,,125.46,38.7,percent of total billed charges,324.19,12.64,165.34,percent of total billed charges,38.7
EV SP FLUENCY 15,92521,CPT,,,,,both,, ,135.50,135.50,Blue Cross and Blue Shield,Traditional,,52.44,38.7,percent of total billed charges,135.50,5.28,69.11,percent of total billed charges,38.7
EVAL SPEECH FLUENCY,92521,CPT,,,,,both,, ,814.22,814.22,Blue Cross and Blue Shield,Traditional,,315.10,38.7,percent of total billed charges,814.22,31.75,415.25,percent of total billed charges,38.7
EV SP PROD 15,92522,CPT,,,,,both,, ,182.25,182.25,Blue Cross and Blue Shield,Traditional,,70.53,38.7,percent of total billed charges,182.25,7.11,92.95,percent of total billed charges,38.7
EVAL SPEECH SND PROD,92522,CPT,,,,,both,, ,814.22,814.22,Blue Cross and Blue Shield,Traditional,,315.10,38.7,percent of total billed charges,814.22,31.75,415.25,percent of total billed charges,38.7
EVAL SP SND PROD CMP,92523,CPT,,,,,both,, ,814.22,814.22,Blue Cross and Blue Shield,Traditional,,315.10,38.7,percent of total billed charges,814.22,31.75,415.25,percent of total billed charges,38.7
SP SOUND LANG CMP 15,92523,CPT,,,,,both,, ,182.25,182.25,Blue Cross and Blue Shield,Traditional,,70.53,38.7,percent of total billed charges,182.25,7.11,92.95,percent of total billed charges,38.7
BEH QL ANAL VOICE 15,92524,CPT,,,,,both,, ,182.25,182.25,Blue Cross and Blue Shield,Traditional,,70.53,38.7,percent of total billed charges,182.25,7.11,92.95,percent of total billed charges,38.7
BEHAV QL ANAL VOICE,92524,CPT,,,,,both,, ,814.22,814.22,Blue Cross and Blue Shield,Traditional,,315.10,38.7,percent of total billed charges,814.22,31.75,415.25,percent of total billed charges,38.7
ORAL FUNC TX-VIS,92526,CPT,,,,,both,, ,705.29,705.29,Blue Cross and Blue Shield,Traditional,,272.95,38.7,percent of total billed charges,705.29,27.51,359.7,percent of total billed charges,38.7
EVAL VOICE PROS DEV,92597,CPT,,,,,both,, ,390.11,390.11,Blue Cross and Blue Shield,Traditional,,150.97,38.7,percent of total billed charges,390.11,15.21,198.96,percent of total billed charges,38.7
COCHLE IMP INTIL LT7,92601,CPT,,,,,both,, ,854.90,854.90,Blue Cross and Blue Shield,Traditional,,330.85,38.7,percent of total billed charges,854.90,33.34,436,percent of total billed charges,38.7
SP-EVAL NSG DEV 1STH,92605,CPT,,,,,both,, ,813.70,813.70,Blue Cross and Blue Shield,Traditional,,314.90,38.7,percent of total billed charges,813.70,31.73,414.99,percent of total billed charges,38.7
SP-EVAL SP DEV 1STHR,92607,CPT,,,,,both,, ,813.70,813.70,Blue Cross and Blue Shield,Traditional,,314.90,38.7,percent of total billed charges,813.70,31.73,414.99,percent of total billed charges,38.7
SP-EVAL SP DEV AD30M,92608,CPT,,,,,both,, ,763.23,763.23,Blue Cross and Blue Shield,Traditional,,295.37,38.7,percent of total billed charges,763.23,29.77,389.25,percent of total billed charges,38.7
SP-THER SVC SPCH DEV,92609,CPT,,,,,both,, ,705.29,705.29,Blue Cross and Blue Shield,Traditional,,272.95,38.7,percent of total billed charges,705.29,27.51,359.7,percent of total billed charges,38.7
SP-EVAL SWL WO RADOP,92610,CPT,,,,,both,, ,758.08,758.08,Blue Cross and Blue Shield,Traditional,,293.38,38.7,percent of total billed charges,758.08,29.57,386.62,percent of total billed charges,38.7
SP-EVAL SWL W-RADOPQ,92611,CPT,,,,,both,, ,862.63,862.63,Blue Cross and Blue Shield,Traditional,,333.84,38.7,percent of total billed charges,862.63,33.64,439.94,percent of total billed charges,38.7
AUD EVOKE HR BRD STM,92651,CPT,,,,,both,, ,567.79,567.79,Blue Cross and Blue Shield,Traditional,,219.73,38.7,percent of total billed charges,567.79,22.14,289.57,percent of total billed charges,38.7
"IC-PTCA, SINGLE",92920,CPT,,,,,both,, ,65091.11,65091.11,Blue Cross and Blue Shield,Traditional,,25190.26,38.7,percent of total billed charges,65091.11,2538.55,33196.47,percent of total billed charges,38.7
"IC-PTCA, ADDL",92921,CPT,,,,,both,, ,65091.11,65091.11,Blue Cross and Blue Shield,Traditional,,25190.26,38.7,percent of total billed charges,65091.11,2538.55,33196.47,percent of total billed charges,38.7
IC-PRQ CRD STN W-ANG,92928,CPT,,,,,both,, ,88719.05,88719.05,Blue Cross and Blue Shield,Traditional,,34334.27,38.7,percent of total billed charges,88719.05,3460.04,45246.72,percent of total billed charges,38.7
IC-PRQ STNT W-ANG EA,92929,CPT,,,,,both,, ,88719.05,88719.05,Blue Cross and Blue Shield,Traditional,,34334.27,38.7,percent of total billed charges,88719.05,3460.04,45246.72,percent of total billed charges,38.7
IC-PRQ CRD ST-AT-ANG,92933,CPT,,,,,both,, ,88719.05,88719.05,Blue Cross and Blue Shield,Traditional,,34334.27,38.7,percent of total billed charges,88719.05,3460.04,45246.72,percent of total billed charges,38.7
IC-PRQ ST-AT-ANG EA,92934,CPT,,,,,both,, ,88719.05,88719.05,Blue Cross and Blue Shield,Traditional,,34334.27,38.7,percent of total billed charges,88719.05,3460.04,45246.72,percent of total billed charges,38.7
IC-PRQ RV BYP GRF IN,92937,CPT,,,,,both,, ,88719.05,88719.05,Blue Cross and Blue Shield,Traditional,,34334.27,38.7,percent of total billed charges,88719.05,3460.04,45246.72,percent of total billed charges,38.7
IC-PRQ RV BYP GRF AD,92938,CPT,,,,,both,, ,88719.05,88719.05,Blue Cross and Blue Shield,Traditional,,34334.27,38.7,percent of total billed charges,88719.05,3460.04,45246.72,percent of total billed charges,38.7
IC-PRQ CARD REV 1 VS,92941,CPT,,,,,both,, ,88719.05,88719.05,Blue Cross and Blue Shield,Traditional,,34334.27,38.7,percent of total billed charges,88719.05,3460.04,45246.72,percent of total billed charges,38.7
IC-PRQ REVSC CHR 1VS,92943,CPT,,,,,both,, ,88719.05,88719.05,Blue Cross and Blue Shield,Traditional,,34334.27,38.7,percent of total billed charges,88719.05,3460.04,45246.72,percent of total billed charges,38.7
IC-PRQ REVSC CHR ADD,92944,CPT,,,,,both,, ,88719.05,88719.05,Blue Cross and Blue Shield,Traditional,,34334.27,38.7,percent of total billed charges,88719.05,3460.04,45246.72,percent of total billed charges,38.7
CPR,92950,CPT,,,,,both,, ,382.90,382.90,Blue Cross and Blue Shield,Traditional,,148.18,38.7,percent of total billed charges,382.90,14.93,195.28,percent of total billed charges,38.7
CPR,92950,CPT,,,,,both,, ,382.90,382.90,Blue Cross and Blue Shield,Traditional,,148.18,38.7,percent of total billed charges,382.90,14.93,195.28,percent of total billed charges,38.7
CPR,92950,CPT,,,,,both,, ,6031.42,6031.42,Blue Cross and Blue Shield,Traditional,,2334.16,38.7,percent of total billed charges,6031.42,235.23,3076.02,percent of total billed charges,38.7
CPR ASSIST (NON ER),92950,CPT,,,,,both,, ,5533.42,5533.42,Blue Cross and Blue Shield,Traditional,,2141.43,38.7,percent of total billed charges,5533.42,215.80,2822.04,percent of total billed charges,38.7
NI-TEMP EXT PACE,92953,CPT,,,,,both,, ,4462.48,4462.48,Blue Cross and Blue Shield,Traditional,,1726.98,38.7,percent of total billed charges,4462.48,174.04,2275.86,percent of total billed charges,38.7
NI-TEMP EXT PACE,92953,CPT,,,,,both,, ,4864.09,4864.09,Blue Cross and Blue Shield,Traditional,,1882.40,38.7,percent of total billed charges,4864.09,189.70,2480.69,percent of total billed charges,38.7
NI-CARDIOVERSION,92960,CPT,,,,,both,, ,4603.59,4603.59,Blue Cross and Blue Shield,Traditional,,1781.59,38.7,percent of total billed charges,4603.59,179.54,2347.83,percent of total billed charges,38.7
NI-CARDIOVERSION,92960,CPT,,,,,both,, ,5017.90,5017.90,Blue Cross and Blue Shield,Traditional,,1941.93,38.7,percent of total billed charges,5017.90,195.70,2559.13,percent of total billed charges,38.7
"EP-CARDIOVER,INTERN",92961,CPT,,,,,both,, ,2378.01,2378.01,Blue Cross and Blue Shield,Traditional,,920.29,38.7,percent of total billed charges,2378.01,92.74,1212.79,percent of total billed charges,38.7
IC-COR THROMBECTOMY,92973,CPT,,,,,both,, ,29086.43,29086.43,Blue Cross and Blue Shield,Traditional,,11256.45,38.7,percent of total billed charges,29086.43,1134.37,14834.08,percent of total billed charges,38.7
CC-INTRACOR THROMBO,92975,CPT,,,,,both,, ,18741.62,18741.62,Blue Cross and Blue Shield,Traditional,,7253.01,38.7,percent of total billed charges,18741.62,730.92,9558.23,percent of total billed charges,38.7
CC-INTRACOR THROMBO,92975,CPT,,,,,both,, ,18741.62,18741.62,Blue Cross and Blue Shield,Traditional,,7253.01,38.7,percent of total billed charges,18741.62,730.92,9558.23,percent of total billed charges,38.7
"THROMBOLY,CORONRY,IV",92977,CPT,,,,,both,, ,4033.02,4033.02,Blue Cross and Blue Shield,Traditional,,1560.78,38.7,percent of total billed charges,4033.02,157.29,2056.84,percent of total billed charges,38.7
"IC-IVUS, INIT",92978,CPT,,,,,both,, ,537.92,537.92,Blue Cross and Blue Shield,Traditional,,208.18,38.7,percent of total billed charges,537.92,20.98,274.34,percent of total billed charges,38.7
"IC-IVUS, ADDL",92979,CPT,,,,,both,, ,433.89,433.89,Blue Cross and Blue Shield,Traditional,,167.92,38.7,percent of total billed charges,433.89,16.92,221.28,percent of total billed charges,38.7
EKG 12 LEAD ED STAFF,93005,CPT,,,,,both,, ,1530.84,1530.84,Blue Cross and Blue Shield,Traditional,,592.44,38.7,percent of total billed charges,1530.84,59.70,780.73,percent of total billed charges,38.7
EKG 12 LEAD UC STAFF,93005,CPT,,,,,both,, ,65.15,65.15,Blue Cross and Blue Shield,Traditional,,25.21,38.7,percent of total billed charges,65.15,2.54,33.23,percent of total billed charges,38.7
EKG 12 LEAD UC STAFF,93005,CPT,,,,,both,, ,65.15,65.15,Blue Cross and Blue Shield,Traditional,,25.21,38.7,percent of total billed charges,65.15,2.54,33.23,percent of total billed charges,38.7
"NI-EKG, 12 LEADS",93005,CPT,,,,,both,, ,714.82,714.82,Blue Cross and Blue Shield,Traditional,,276.64,38.7,percent of total billed charges,714.82,27.88,364.56,percent of total billed charges,38.7
NI-STRESS TEST,93017,CPT,,,,,both,, ,5189.40,5189.40,Blue Cross and Blue Shield,Traditional,,2008.30,38.7,percent of total billed charges,5189.40,202.39,2646.59,percent of total billed charges,38.7
EP-MICROVOLT T,93025,CPT,,,,,both,, ,1128.62,1128.62,Blue Cross and Blue Shield,Traditional,,436.78,38.7,percent of total billed charges,1128.62,44.02,575.6,percent of total billed charges,38.7
"NI-EKG, 1-3 LEADS",93041,CPT,,,,,both,, ,1999.49,1999.49,Blue Cross and Blue Shield,Traditional,,773.80,38.7,percent of total billed charges,1999.49,77.98,1019.74,percent of total billed charges,38.7
NI-HOLT RECRD TO48HR,93225,CPT,,,,,both,, ,9701.06,9701.06,Blue Cross and Blue Shield,Traditional,,3754.31,38.7,percent of total billed charges,9701.06,378.34,4947.54,percent of total billed charges,38.7
NI-HOLT WSCAN TO48HR,93226,CPT,,,,,both,, ,1596.24,1596.24,Blue Cross and Blue Shield,Traditional,,617.74,38.7,percent of total billed charges,1596.24,62.25,814.08,percent of total billed charges,38.7
NI-TTE 2D W DOPP,93306,CPT,,,,,both,, ,12135.98,12135.98,Blue Cross and Blue Shield,Traditional,,4696.62,38.7,percent of total billed charges,12135.98,473.30,6189.35,percent of total billed charges,38.7
NI-TTE 2D MM COMP WO,93307,CPT,,,,,both,, ,8910.27,8910.27,Blue Cross and Blue Shield,Traditional,,3448.27,38.7,percent of total billed charges,8910.27,347.50,4544.24,percent of total billed charges,38.7
NI-TTE 2D MM LTD WO,93308,CPT,,,,,both,, ,4522.73,4522.73,Blue Cross and Blue Shield,Traditional,,1750.30,38.7,percent of total billed charges,4522.73,176.39,2306.59,percent of total billed charges,38.7
NI-TEE COMP 2D MM WO,93312,CPT,,,,,both,, ,9011.21,9011.21,Blue Cross and Blue Shield,Traditional,,3487.34,38.7,percent of total billed charges,9011.21,351.44,4595.72,percent of total billed charges,38.7
US-ECHO DOPP COMP AD,93320,CPT,,,,,both,, ,1635.90,1635.90,Blue Cross and Blue Shield,Traditional,,633.09,38.7,percent of total billed charges,1635.90,63.80,834.31,percent of total billed charges,38.7
NI-ECHO DOP LTD,93321,CPT,,,,,both,, ,541.78,541.78,Blue Cross and Blue Shield,Traditional,,209.67,38.7,percent of total billed charges,541.78,21.13,276.31,percent of total billed charges,38.7
US-ECHO DOP CO FL AD,93325,CPT,,,,,both,, ,616.46,616.46,Blue Cross and Blue Shield,Traditional,,238.57,38.7,percent of total billed charges,616.46,24.04,314.39,percent of total billed charges,38.7
US-TTE STRESS WO,93350,CPT,,,,,both,, ,6350.21,6350.21,Blue Cross and Blue Shield,Traditional,,2457.53,38.7,percent of total billed charges,6350.21,247.66,3238.61,percent of total billed charges,38.7
CC-RHC,93451,CPT,,,,,both,, ,39597.32,39597.32,Blue Cross and Blue Shield,Traditional,,15324.16,38.7,percent of total billed charges,39597.32,1544.30,20194.63,percent of total billed charges,38.7
CC-LHC VENT PUNC,93452,CPT,,,,,both,, ,43345.75,43345.75,Blue Cross and Blue Shield,Traditional,,16774.81,38.7,percent of total billed charges,43345.75,1690.48,22106.33,percent of total billed charges,38.7
Insertion of catheter into left heart for diagnosis,93452,CPT,,,,,both,,,43345.75,43345.75,Blue Cross and Blue Shield,Traditional,,16774.81,38.7,percent of total billed charges,43345.75,1690.48,22106.33,percent of total billed charges,38.7
CC-R-L CATH LV PUNC,93453,CPT,,,,,both,, ,43345.75,43345.75,Blue Cross and Blue Shield,Traditional,,16774.81,38.7,percent of total billed charges,43345.75,1690.48,22106.33,percent of total billed charges,38.7
CC-ANGIO CORON ONLY,93454,CPT,,,,,both,, ,34667.23,34667.23,Blue Cross and Blue Shield,Traditional,,13416.22,38.7,percent of total billed charges,34667.23,1352.02,17680.29,percent of total billed charges,38.7
CC-S-I VNT ATR ANGIO,93455,CPT,,,,,both,, ,36140.38,36140.38,Blue Cross and Blue Shield,Traditional,,13986.33,38.7,percent of total billed charges,36140.38,1409.47,18431.59,percent of total billed charges,38.7
CC-R HRT CORONRY ART,93456,CPT,,,,,both,, ,74264.29,74264.29,Blue Cross and Blue Shield,Traditional,,28740.28,38.7,percent of total billed charges,74264.29,2896.31,37874.79,percent of total billed charges,38.7
CC-R HRT ART-GRF ANG,93457,CPT,,,,,both,, ,75737.70,75737.70,Blue Cross and Blue Shield,Traditional,,29310.49,38.7,percent of total billed charges,75737.70,2953.77,38626.23,percent of total billed charges,38.7
CC-L HRT ARTERY-VENT,93458,CPT,,,,,both,, ,49262.84,49262.84,Blue Cross and Blue Shield,Traditional,,19064.72,38.7,percent of total billed charges,49262.84,1921.25,25124.05,percent of total billed charges,38.7
CC-L HRT ART-GRF ANG,93459,CPT,,,,,both,, ,50736.00,50736.00,Blue Cross and Blue Shield,Traditional,,19634.83,38.7,percent of total billed charges,50736.00,1978.70,25875.36,percent of total billed charges,38.7
CC-R-L HRT ART-VENT,93460,CPT,,,,,both,, ,49262.84,49262.84,Blue Cross and Blue Shield,Traditional,,19064.72,38.7,percent of total billed charges,49262.84,1921.25,25124.05,percent of total billed charges,38.7
CC-R-L HRT ART-ANGIO,93461,CPT,,,,,both,, ,50736.00,50736.00,Blue Cross and Blue Shield,Traditional,,19634.83,38.7,percent of total billed charges,50736.00,1978.70,25875.36,percent of total billed charges,38.7
CC-DRUM ADM-HEMODYNC,93463,CPT,,,,,both,, ,451.91,451.91,Blue Cross and Blue Shield,Traditional,,174.89,38.7,percent of total billed charges,451.91,17.62,230.47,percent of total billed charges,38.7
INSERTION FLOW CATH,93503,CPT,,,,,both,, ,13163.66,13163.66,Blue Cross and Blue Shield,Traditional,,5094.34,38.7,percent of total billed charges,13163.66,513.38,6713.47,percent of total billed charges,38.7
CC-INJ L VENT-ATRIAL,93565,CPT,,,,,both,, ,3748.43,3748.43,Blue Cross and Blue Shield,Traditional,,1450.64,38.7,percent of total billed charges,3748.43,146.19,1911.7,percent of total billed charges,38.7
CC-INJ R VENT-ATRIAL,93566,CPT,,,,,both,, ,3252.48,3252.48,Blue Cross and Blue Shield,Traditional,,1258.71,38.7,percent of total billed charges,3252.48,126.85,1658.76,percent of total billed charges,38.7
CC-INJ SUPRV AORTOGR,93567,CPT,,,,,both,, ,5119.62,5119.62,Blue Cross and Blue Shield,Traditional,,1981.29,38.7,percent of total billed charges,5119.62,199.67,2611.01,percent of total billed charges,38.7
CC-INJ PULM ART HRTC,93568,CPT,,,,,both,, ,5119.62,5119.62,Blue Cross and Blue Shield,Traditional,,1981.29,38.7,percent of total billed charges,5119.62,199.67,2611.01,percent of total billed charges,38.7
HEART FLOW MEASURE,93571,CPT,,,,,both,, ,709.67,709.67,Blue Cross and Blue Shield,Traditional,,274.64,38.7,percent of total billed charges,709.67,27.68,361.93,percent of total billed charges,38.7
HEART FLOW MEAS ADD,93572,CPT,,,,,both,, ,709.67,709.67,Blue Cross and Blue Shield,Traditional,,274.64,38.7,percent of total billed charges,709.67,27.68,361.93,percent of total billed charges,38.7
CC-PDA CLOSE PERC,93582,CPT,,,,,both,, ,68501.18,68501.18,Blue Cross and Blue Shield,Traditional,,26509.96,38.7,percent of total billed charges,68501.18,2671.55,34935.6,percent of total billed charges,38.7
EP-HIS BUNDLE REC,93600,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.50,38.7,percent of total billed charges,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-INTRAATRIAL REC,93602,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.50,38.7,percent of total billed charges,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-RV RECORD,93603,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.50,38.7,percent of total billed charges,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-MAP TACHY,93609,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.50,38.7,percent of total billed charges,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-INTRAATRIAL PAC,93610,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.50,38.7,percent of total billed charges,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-INTRAVENT PAC,93612,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.50,38.7,percent of total billed charges,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-MAP ADD,93613,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.50,38.7,percent of total billed charges,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-ATRI RECORD ESO,93615,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.50,38.7,percent of total billed charges,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-ATRI REC-PAC ESO,93616,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.50,38.7,percent of total billed charges,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-INDUC ARRY PAC,93618,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.50,38.7,percent of total billed charges,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-COMP EP W-O ARRY,93619,CPT,,,,,both,, ,22625.50,22625.50,Blue Cross and Blue Shield,Traditional,,8756.07,38.7,percent of total billed charges,22625.50,882.39,11539.01,percent of total billed charges,38.7
EP-COMP EP W- ARRY,93620,CPT,,,,,both,, ,22625.50,22625.50,Blue Cross and Blue Shield,Traditional,,8756.07,38.7,percent of total billed charges,22625.50,882.39,11539.01,percent of total billed charges,38.7
"EP-LA PACING, ADD",93621,CPT,,,,,both,, ,22625.50,22625.50,Blue Cross and Blue Shield,Traditional,,8756.07,38.7,percent of total billed charges,22625.50,882.39,11539.01,percent of total billed charges,38.7
"EP-LV PACING, ADD",93622,CPT,,,,,both,, ,22625.50,22625.50,Blue Cross and Blue Shield,Traditional,,8756.07,38.7,percent of total billed charges,22625.50,882.39,11539.01,percent of total billed charges,38.7
EP-PROG STIM IV DRUG,93623,CPT,,,,,both,, ,22625.50,22625.50,Blue Cross and Blue Shield,Traditional,,8756.07,38.7,percent of total billed charges,22625.50,882.39,11539.01,percent of total billed charges,38.7
EP-F-U EPW-ARRY IND,93624,CPT,,,,,both,, ,22625.50,22625.50,Blue Cross and Blue Shield,Traditional,,8756.07,38.7,percent of total billed charges,22625.50,882.39,11539.01,percent of total billed charges,38.7
EP-INTRA OP MAPPNG,93631,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.50,38.7,percent of total billed charges,4670.54,182.15,2381.98,percent of total billed charges,38.7
"EP-EVAL LEAD,INDUC",93640,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.50,38.7,percent of total billed charges,4670.54,182.15,2381.98,percent of total billed charges,38.7
"EP-EVAL GEN, INDUC",93641,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.50,38.7,percent of total billed charges,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-EVAL PREV DEVICE,93642,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.50,38.7,percent of total billed charges,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-ABLATE AV NODE,93650,CPT,,,,,both,, ,22625.50,22625.50,Blue Cross and Blue Shield,Traditional,,8756.07,38.7,percent of total billed charges,22625.50,882.39,11539.01,percent of total billed charges,38.7
EP-ABLATE SPRVNT ART,93653,CPT,,,,,both,, ,46220.99,46220.99,Blue Cross and Blue Shield,Traditional,,17887.52,38.7,percent of total billed charges,46220.99,1802.62,23572.7,percent of total billed charges,38.7
EP-ABLATE VENT TACY,93654,CPT,,,,,both,, ,46220.99,46220.99,Blue Cross and Blue Shield,Traditional,,17887.52,38.7,percent of total billed charges,46220.99,1802.62,23572.7,percent of total billed charges,38.7
EP-ATR FIB PULM VN I,93656,CPT,,,,,both,, ,46220.99,46220.99,Blue Cross and Blue Shield,Traditional,,17887.52,38.7,percent of total billed charges,46220.99,1802.62,23572.7,percent of total billed charges,38.7
EP-INTCRD ECHO INTER,93662,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.50,38.7,percent of total billed charges,4670.54,182.15,2381.98,percent of total billed charges,38.7
PAD REHB PER SESSION,93668,CPT,,,,,both,, ,169.18,169.18,Blue Cross and Blue Shield,Traditional,,65.47,38.7,percent of total billed charges,169.18,6.60,86.28,percent of total billed charges,38.7
NI-CARD REHAB W-O MO,93797,CPT,,,,,both,, ,193.64,193.64,Blue Cross and Blue Shield,Traditional,,74.94,38.7,percent of total billed charges,193.64,7.55,98.76,percent of total billed charges,38.7
NI-CARDI REHAB W- MO,93798,CPT,,,,,both,, ,296.38,296.38,Blue Cross and Blue Shield,Traditional,,114.70,38.7,percent of total billed charges,296.38,11.56,151.15,percent of total billed charges,38.7
US-CAROTID DPLX SCAN,93880,CPT,,,,,both,, ,425.13,425.13,Blue Cross and Blue Shield,Traditional,,164.53,38.7,percent of total billed charges,425.13,16.58,216.82,percent of total billed charges,38.7
US-CAROTID DPLX SCAN,93880,CPT,,,,,both,, ,457.58,457.58,Blue Cross and Blue Shield,Traditional,,177.08,38.7,percent of total billed charges,457.58,17.85,233.37,percent of total billed charges,38.7
US-CRAN DPLX SCN BIL,93880,CPT,,,,,both,, ,12714.32,12714.32,Blue Cross and Blue Shield,Traditional,,4920.44,38.7,percent of total billed charges,12714.32,495.86,6484.3,percent of total billed charges,38.7
US-CAROTID DUP DOPLR,93882,CPT,,,,,both,, ,425.13,425.13,Blue Cross and Blue Shield,Traditional,,164.53,38.7,percent of total billed charges,425.13,16.58,216.82,percent of total billed charges,38.7
US-CAROTID DUP DOPLR,93882,CPT,,,,,both,, ,457.58,457.58,Blue Cross and Blue Shield,Traditional,,177.08,38.7,percent of total billed charges,457.58,17.85,233.37,percent of total billed charges,38.7
NI-EXT ARTERIAL LTD,93922,CPT,,,,,both,, ,2456.29,2456.29,Blue Cross and Blue Shield,Traditional,,950.58,38.7,percent of total billed charges,2456.29,95.80,1252.71,percent of total billed charges,38.7
US-EXT ARTERIAL LTD,93922,CPT,,,,,both,, ,167.38,167.38,Blue Cross and Blue Shield,Traditional,,64.78,38.7,percent of total billed charges,167.38,6.53,85.36,percent of total billed charges,38.7
NI-EXT ARTERIAL COMP,93923,CPT,,,,,both,, ,3819.24,3819.24,Blue Cross and Blue Shield,Traditional,,1478.05,38.7,percent of total billed charges,3819.24,148.95,1947.81,percent of total billed charges,38.7
US-NON INV ARTER EXT,93923,CPT,,,,,both,, ,268.32,268.32,Blue Cross and Blue Shield,Traditional,,103.84,38.7,percent of total billed charges,268.32,10.46,136.84,percent of total billed charges,38.7
NI-STD LE STRS REST,93924,CPT,,,,,both,, ,5693.84,5693.84,Blue Cross and Blue Shield,Traditional,,2203.52,38.7,percent of total billed charges,5693.84,222.06,2903.86,percent of total billed charges,38.7
NI-LW EXT DPX ART BI,93925,CPT,,,,,both,, ,5086.40,5086.40,Blue Cross and Blue Shield,Traditional,,1968.44,38.7,percent of total billed charges,5086.40,198.37,2594.06,percent of total billed charges,38.7
NI-LW EXT DPX ART UN,93926,CPT,,,,,both,, ,2541.53,2541.53,Blue Cross and Blue Shield,Traditional,,983.57,38.7,percent of total billed charges,2541.53,99.12,1296.18,percent of total billed charges,38.7
US-LW EXT DPX ART UN,93926,CPT,,,,,both,, ,1560.19,1560.19,Blue Cross and Blue Shield,Traditional,,603.79,38.7,percent of total billed charges,1560.19,60.85,795.7,percent of total billed charges,38.7
NI-UP EXT DPX ART BI,93930,CPT,,,,,both,, ,5083.05,5083.05,Blue Cross and Blue Shield,Traditional,,1967.14,38.7,percent of total billed charges,5083.05,198.24,2592.36,percent of total billed charges,38.7
NI-UP EXT DPX ART UN,93931,CPT,,,,,both,, ,2541.53,2541.53,Blue Cross and Blue Shield,Traditional,,983.57,38.7,percent of total billed charges,2541.53,99.12,1296.18,percent of total billed charges,38.7
US-UP EXT DPX ART UN,93931,CPT,,,,,both,, ,2026.01,2026.01,Blue Cross and Blue Shield,Traditional,,784.07,38.7,percent of total billed charges,2026.01,79.01,1033.27,percent of total billed charges,38.7
NI-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,5086.40,5086.40,Blue Cross and Blue Shield,Traditional,,1968.44,38.7,percent of total billed charges,5086.40,198.37,2594.06,percent of total billed charges,38.7
US-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,425.13,425.13,Blue Cross and Blue Shield,Traditional,,164.53,38.7,percent of total billed charges,425.13,16.58,216.82,percent of total billed charges,38.7
US-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,457.58,457.58,Blue Cross and Blue Shield,Traditional,,177.08,38.7,percent of total billed charges,457.58,17.85,233.37,percent of total billed charges,38.7
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,299.73,299.73,Blue Cross and Blue Shield,Traditional,,116.00,38.7,percent of total billed charges,299.73,11.69,152.86,percent of total billed charges,38.7
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,322.65,322.65,Blue Cross and Blue Shield,Traditional,,124.87,38.7,percent of total billed charges,322.65,12.58,164.55,percent of total billed charges,38.7
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,2541.53,2541.53,Blue Cross and Blue Shield,Traditional,,983.57,38.7,percent of total billed charges,2541.53,99.12,1296.18,percent of total billed charges,38.7
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,425.13,425.13,Blue Cross and Blue Shield,Traditional,,164.53,38.7,percent of total billed charges,425.13,16.58,216.82,percent of total billed charges,38.7
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,457.58,457.58,Blue Cross and Blue Shield,Traditional,,177.08,38.7,percent of total billed charges,457.58,17.85,233.37,percent of total billed charges,38.7
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,823.23,823.23,Blue Cross and Blue Shield,Traditional,,318.59,38.7,percent of total billed charges,823.23,32.11,419.85,percent of total billed charges,38.7
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,425.13,425.13,Blue Cross and Blue Shield,Traditional,,164.53,38.7,percent of total billed charges,425.13,16.58,216.82,percent of total billed charges,38.7
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,457.58,457.58,Blue Cross and Blue Shield,Traditional,,177.08,38.7,percent of total billed charges,457.58,17.85,233.37,percent of total billed charges,38.7
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,828.89,828.89,Blue Cross and Blue Shield,Traditional,,320.78,38.7,percent of total billed charges,828.89,32.33,422.73,percent of total billed charges,38.7
US-DPLXSCN GRFT ARTA,93978,CPT,,,,,both,, ,1665.51,1665.51,Blue Cross and Blue Shield,Traditional,,644.55,38.7,percent of total billed charges,1665.51,64.95,849.41,percent of total billed charges,38.7
NI-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,1292.14,1292.14,Blue Cross and Blue Shield,Traditional,,500.06,38.7,percent of total billed charges,1292.14,50.39,658.99,percent of total billed charges,38.7
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,425.13,425.13,Blue Cross and Blue Shield,Traditional,,164.53,38.7,percent of total billed charges,425.13,16.58,216.82,percent of total billed charges,38.7
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,457.58,457.58,Blue Cross and Blue Shield,Traditional,,177.08,38.7,percent of total billed charges,457.58,17.85,233.37,percent of total billed charges,38.7
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,841.51,841.51,Blue Cross and Blue Shield,Traditional,,325.66,38.7,percent of total billed charges,841.51,32.82,429.17,percent of total billed charges,38.7
VESS MAP HEMO ACC BI,93985,CPT,,,,,both,, ,977.58,977.58,Blue Cross and Blue Shield,Traditional,,378.32,38.7,percent of total billed charges,977.58,38.13,498.57,percent of total billed charges,38.7
VESS MAP HEMO ACC UN,93986,CPT,,,,,both,, ,977.58,977.58,Blue Cross and Blue Shield,Traditional,,378.32,38.7,percent of total billed charges,977.58,38.13,498.57,percent of total billed charges,38.7
NI-DUPSCN HEMODIAL,93990,CPT,,,,,both,, ,4623.93,4623.93,Blue Cross and Blue Shield,Traditional,,1789.46,38.7,percent of total billed charges,4623.93,180.33,2358.2,percent of total billed charges,38.7
MECH VENT INITIAL,94002,CPT,,,,,both,, ,4971.30,4971.30,Blue Cross and Blue Shield,Traditional,,1923.89,38.7,percent of total billed charges,4971.30,193.88,2535.36,percent of total billed charges,38.7
MECH VENT DAILY SUBS,94003,CPT,,,,,both,, ,4971.30,4971.30,Blue Cross and Blue Shield,Traditional,,1923.89,38.7,percent of total billed charges,4971.30,193.88,2535.36,percent of total billed charges,38.7
SPIROMETRY,94010,CPT,,,,,both,, ,530.45,530.45,Blue Cross and Blue Shield,Traditional,,205.28,38.7,percent of total billed charges,530.45,20.69,270.53,percent of total billed charges,38.7
BRONCHO EVAL PRE/PST,94060,CPT,,,,,both,, ,2361.28,2361.28,Blue Cross and Blue Shield,Traditional,,913.82,38.7,percent of total billed charges,2361.28,92.09,1204.25,percent of total billed charges,38.7
METHACHOLINE CHALLEN,94070,CPT,,,,,both,, ,961.51,961.51,Blue Cross and Blue Shield,Traditional,,372.10,38.7,percent of total billed charges,961.51,37.50,490.37,percent of total billed charges,38.7
MAXIMUM VOLUNTARY VE,94200,CPT,,,,,both,, ,306.94,306.94,Blue Cross and Blue Shield,Traditional,,118.79,38.7,percent of total billed charges,306.94,11.97,156.54,percent of total billed charges,38.7
HAST WITH 02 TITRATE,94453,CPT,,,,,both,, ,1089.74,1089.74,Blue Cross and Blue Shield,Traditional,,421.73,38.7,percent of total billed charges,1089.74,42.50,555.77,percent of total billed charges,38.7
PULM STRESS SIMPLE,94618,CPT,,,,,both,, ,459.12,459.12,Blue Cross and Blue Shield,Traditional,,177.68,38.7,percent of total billed charges,459.12,17.91,234.15,percent of total billed charges,38.7
PULM REHAB WO OXIMET,94625,CPT,,,,,both,, ,227.40,227.40,Blue Cross and Blue Shield,Traditional,,88.00,38.7,percent of total billed charges,227.40,8.87,115.97,percent of total billed charges,38.7
PULM REHAB W OXIMET,94626,CPT,,,,,both,, ,227.40,227.40,Blue Cross and Blue Shield,Traditional,,88.00,38.7,percent of total billed charges,227.40,8.87,115.97,percent of total billed charges,38.7
INHALATION TRTMT INI,94640,CPT,,,,,both,, ,569.50,569.50,Blue Cross and Blue Shield,Traditional,,220.40,38.7,percent of total billed charges,569.50,22.21,290.45,percent of total billed charges,38.7
INHALATION TRTMT INI,94640,CPT,,,,,both,, ,586.59,586.59,Blue Cross and Blue Shield,Traditional,,227.01,38.7,percent of total billed charges,586.59,22.88,299.16,percent of total billed charges,38.7
INHALATION TRTMT SUB,94640,CPT,,,,,both,, ,691.75,691.75,Blue Cross and Blue Shield,Traditional,,267.71,38.7,percent of total billed charges,691.75,26.98,352.79,percent of total billed charges,38.7
INHALATION TRTMT SUB,94640,CPT,,,,,both,, ,712.50,712.50,Blue Cross and Blue Shield,Traditional,,275.74,38.7,percent of total billed charges,712.50,27.79,363.38,percent of total billed charges,38.7
PENTAMIDINE ARSL INH,94642,CPT,,,,,both,, ,1061.67,1061.67,Blue Cross and Blue Shield,Traditional,,410.87,38.7,percent of total billed charges,1061.67,41.41,541.45,percent of total billed charges,38.7
AEROSOL OBSTRUCT 1HR,94644,CPT,,,,,both,, ,719.71,719.71,Blue Cross and Blue Shield,Traditional,,278.53,38.7,percent of total billed charges,719.71,28.07,367.05,percent of total billed charges,38.7
CONT INH TX ED 1HR,94644,CPT,,,,,both,, ,698.75,698.75,Blue Cross and Blue Shield,Traditional,,270.42,38.7,percent of total billed charges,698.75,27.25,356.36,percent of total billed charges,38.7
AEROSOL OBSTR ADD HR,94645,CPT,,,,,both,, ,719.71,719.71,Blue Cross and Blue Shield,Traditional,,278.53,38.7,percent of total billed charges,719.71,28.07,367.05,percent of total billed charges,38.7
CONT INH TX ED AD HR,94645,CPT,,,,,both,, ,698.75,698.75,Blue Cross and Blue Shield,Traditional,,270.42,38.7,percent of total billed charges,698.75,27.25,356.36,percent of total billed charges,38.7
BIPAP/CPAP,94660,CPT,,,,,both,, ,2771.47,2771.47,Blue Cross and Blue Shield,Traditional,,1072.56,38.7,percent of total billed charges,2771.47,108.09,1413.45,percent of total billed charges,38.7
EVAL-DEMO INHL DEVCE,94664,CPT,,,,,both,, ,342.73,342.73,Blue Cross and Blue Shield,Traditional,,132.64,38.7,percent of total billed charges,342.73,13.37,174.79,percent of total billed charges,38.7
MANIP CHST WALL INIT,94667,CPT,,,,,both,, ,1191.45,1191.45,Blue Cross and Blue Shield,Traditional,,461.09,38.7,percent of total billed charges,1191.45,46.47,607.64,percent of total billed charges,38.7
MANIP CHST WALL SBSQ,94668,CPT,,,,,both,, ,975.15,975.15,Blue Cross and Blue Shield,Traditional,,377.38,38.7,percent of total billed charges,975.15,38.03,497.33,percent of total billed charges,38.7
MECHAN CHST WALL OSC,94669,CPT,,,,,both,, ,210.89,210.89,Blue Cross and Blue Shield,Traditional,,81.61,38.7,percent of total billed charges,210.89,8.22,107.55,percent of total billed charges,38.7
PF TST PLETHYSMOGRA,94726,CPT,,,,,both,, ,548.73,548.73,Blue Cross and Blue Shield,Traditional,,212.36,38.7,percent of total billed charges,548.73,21.40,279.85,percent of total billed charges,38.7
PF TEST BY GAS,94727,CPT,,,,,both,, ,548.73,548.73,Blue Cross and Blue Shield,Traditional,,212.36,38.7,percent of total billed charges,548.73,21.40,279.85,percent of total billed charges,38.7
PF TEST OSCILLOMETRY,94728,CPT,,,,,both,, ,548.73,548.73,Blue Cross and Blue Shield,Traditional,,212.36,38.7,percent of total billed charges,548.73,21.40,279.85,percent of total billed charges,38.7
CO2-MEMBANE DIFF CAP,94729,CPT,,,,,both,, ,2800.31,2800.31,Blue Cross and Blue Shield,Traditional,,1083.72,38.7,percent of total billed charges,2800.31,109.21,1428.16,percent of total billed charges,38.7
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309.00,309.00,Blue Cross and Blue Shield,Traditional,,119.58,38.7,percent of total billed charges,309.00,12.05,157.59,percent of total billed charges,38.7
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309.00,309.00,Blue Cross and Blue Shield,Traditional,,119.58,38.7,percent of total billed charges,309.00,12.05,157.59,percent of total billed charges,38.7
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309.00,309.00,Blue Cross and Blue Shield,Traditional,,119.58,38.7,percent of total billed charges,309.00,12.05,157.59,percent of total billed charges,38.7
PULSE OX MULTI/EXERC,94761,CPT,,,,,both,, ,797.48,797.48,Blue Cross and Blue Shield,Traditional,,308.62,38.7,percent of total billed charges,797.48,31.10,406.71,percent of total billed charges,38.7
PULSE OX MULTI/EXERC,94761,CPT,,,,,both,, ,797.48,797.48,Blue Cross and Blue Shield,Traditional,,308.62,38.7,percent of total billed charges,797.48,31.10,406.71,percent of total billed charges,38.7
PULSE OX CONTINUOS,94762,CPT,,,,,both,, ,388.00,388.00,Blue Cross and Blue Shield,Traditional,,150.16,38.7,percent of total billed charges,388.00,15.13,197.88,percent of total billed charges,38.7
PULSE OX OVERNIGHT,94762,CPT,,,,,both,, ,468.91,468.91,Blue Cross and Blue Shield,Traditional,,181.47,38.7,percent of total billed charges,468.91,18.29,239.14,percent of total billed charges,38.7
PULSE OX OVERNIGHT,94762,CPT,,,,,both,, ,468.91,468.91,Blue Cross and Blue Shield,Traditional,,181.47,38.7,percent of total billed charges,468.91,18.29,239.14,percent of total billed charges,38.7
CAR SEAT BED TST 60M,94780,CPT,,,,,both,, ,118.19,118.19,Blue Cross and Blue Shield,Traditional,,45.74,38.7,percent of total billed charges,118.19,4.61,60.28,percent of total billed charges,38.7
CAR SE-BED TST AD 30,94781,CPT,,,,,both,, ,58.97,58.97,Blue Cross and Blue Shield,Traditional,,22.82,38.7,percent of total billed charges,58.97,2.30,30.07,percent of total billed charges,38.7
ALLERGY INJ SIM,95115,CPT,,,,,both,, ,70.56,70.56,Blue Cross and Blue Shield,Traditional,,27.31,38.7,percent of total billed charges,70.56,2.75,35.99,percent of total billed charges,38.7
ALLERGY INJ SIM,95115,CPT,,,,,both,, ,70.81,70.81,Blue Cross and Blue Shield,Traditional,,27.40,38.7,percent of total billed charges,70.81,2.76,36.11,percent of total billed charges,38.7
ALLERGY INJ MUL,95117,CPT,,,,,both,, ,70.56,70.56,Blue Cross and Blue Shield,Traditional,,27.31,38.7,percent of total billed charges,70.56,2.75,35.99,percent of total billed charges,38.7
ALLERGY INJ MUL,95117,CPT,,,,,both,, ,70.81,70.81,Blue Cross and Blue Shield,Traditional,,27.40,38.7,percent of total billed charges,70.81,2.76,36.11,percent of total billed charges,38.7
POLYSOMNO GT4 LT6YO,95782,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,percent of total billed charges,2570.88,100.26,1311.15,percent of total billed charges,38.7
POLYSOMNO GT4 LT6YO,95782,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,percent of total billed charges,2570.88,100.26,1311.15,percent of total billed charges,38.7
POLYS-CPAP GT4 LT6YO,95783,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,percent of total billed charges,2570.88,100.26,1311.15,percent of total billed charges,38.7
POLYS-CPAP GT4 LT6YO,95783,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,percent of total billed charges,2570.88,100.26,1311.15,percent of total billed charges,38.7
SLPSTDY UNATT AN-ST,95800,CPT,,,,,both,, ,428.48,428.48,Blue Cross and Blue Shield,Traditional,,165.82,38.7,percent of total billed charges,428.48,16.71,218.52,percent of total billed charges,38.7
SLPSTDY UNATT AN-ST,95800,CPT,,,,,both,, ,625.00,625.00,Blue Cross and Blue Shield,Traditional,,241.88,38.7,percent of total billed charges,625.00,24.38,318.75,percent of total billed charges,38.7
MULTI SLEEP LAT,95805,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,percent of total billed charges,2570.88,100.26,1311.15,percent of total billed charges,38.7
MULTI SLEEP LAT,95805,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,percent of total billed charges,2570.88,100.26,1311.15,percent of total billed charges,38.7
SLPSTDY UNATT RS EFF,95806,CPT,,,,,both,, ,428.48,428.48,Blue Cross and Blue Shield,Traditional,,165.82,38.7,percent of total billed charges,428.48,16.71,218.52,percent of total billed charges,38.7
SLPSTDY UNATT RS EFF,95806,CPT,,,,,both,, ,625.00,625.00,Blue Cross and Blue Shield,Traditional,,241.88,38.7,percent of total billed charges,625.00,24.38,318.75,percent of total billed charges,38.7
POLYSOMNO GT4 GE6YO,95810,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,percent of total billed charges,2570.88,100.26,1311.15,percent of total billed charges,38.7
POLYSOMNO GT4 GE6YO,95810,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,percent of total billed charges,2570.88,100.26,1311.15,percent of total billed charges,38.7
Sleep study,95810,CPT,,,,,both,,,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,percent of total billed charges,2570.88,100.26,1311.15,percent of total billed charges,38.7
POLYS-CPAP GT4 GE6YO,95811,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,percent of total billed charges,2570.88,100.26,1311.15,percent of total billed charges,38.7
POLYS-CPAP GT4 GE6YO,95811,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,percent of total billed charges,2570.88,100.26,1311.15,percent of total billed charges,38.7
EEG 41-60 MIN,95812,CPT,,,,,both,, ,1075.58,1075.58,Blue Cross and Blue Shield,Traditional,,416.25,38.7,percent of total billed charges,1075.58,41.95,548.55,percent of total billed charges,38.7
EEG GT 1 HOUR,95813,CPT,,,,,both,, ,1044.25,1044.25,Blue Cross and Blue Shield,Traditional,,404.12,38.7,percent of total billed charges,1044.25,40.73,532.57,percent of total billed charges,38.7
EEG AWAKE DROWSY,95816,CPT,,,,,both,, ,1075.58,1075.58,Blue Cross and Blue Shield,Traditional,,416.25,38.7,percent of total billed charges,1075.58,41.95,548.55,percent of total billed charges,38.7
EEG AWAKE ASLEEP,95819,CPT,,,,,both,, ,3362.50,3362.50,Blue Cross and Blue Shield,Traditional,,1301.29,38.7,percent of total billed charges,3362.50,131.14,1714.88,percent of total billed charges,38.7
EEG ASLEEP,95822,CPT,,,,,both,, ,4457.07,4457.07,Blue Cross and Blue Shield,Traditional,,1724.89,38.7,percent of total billed charges,4457.07,173.83,2273.11,percent of total billed charges,38.7
ROM WR EA EX-TRNK OT,95851,CPT,,,,,both,, ,21.12,21.12,Blue Cross and Blue Shield,Traditional,,8.17,38.7,percent of total billed charges,21.12,0.82,10.77,percent of total billed charges,38.7
ROM WR EA EX-TRNK OT,95851,CPT,,,,,both,, ,21.12,21.12,Blue Cross and Blue Shield,Traditional,,8.17,38.7,percent of total billed charges,21.12,0.82,10.77,percent of total billed charges,38.7
ROM WR EA EX-TRNK OT,95851,CPT,,,,,both,, ,21.12,21.12,Blue Cross and Blue Shield,Traditional,,8.17,38.7,percent of total billed charges,21.12,0.82,10.77,percent of total billed charges,38.7
ROM WR EA EX-TRNK OT,95851,CPT,,,,,both,, ,21.12,21.12,Blue Cross and Blue Shield,Traditional,,8.17,38.7,percent of total billed charges,21.12,0.82,10.77,percent of total billed charges,38.7
ROM WR EA EX-TRNK OT,95851,CPT,,,,,both,, ,486.42,486.42,Blue Cross and Blue Shield,Traditional,,188.24,38.7,percent of total billed charges,486.42,0.82,248.07,percent of total billed charges,38.7
ROM WR EA EX-TRNK OT,95851,CPT,,,,,both,, ,486.42,486.42,Blue Cross and Blue Shield,Traditional,,188.24,38.7,percent of total billed charges,486.42,0.82,248.07,percent of total billed charges,38.7
ROM WR EA EX-TRNK PT,95851,CPT,,,,,both,, ,448.57,448.57,Blue Cross and Blue Shield,Traditional,,173.60,38.7,percent of total billed charges,448.57,0.82,228.77,percent of total billed charges,38.7
ROM WR EA EX-TRNK PT,95851,CPT,,,,,both,, ,448.57,448.57,Blue Cross and Blue Shield,Traditional,,173.60,38.7,percent of total billed charges,448.57,0.82,228.77,percent of total billed charges,38.7
ROM W-R EA EXT-TRNK,95851,CPT,,,,,both,, ,418.86,418.86,Blue Cross and Blue Shield,Traditional,,162.10,38.7,percent of total billed charges,418.86,0.82,213.62,percent of total billed charges,38.7
ROM W-R EA EXT-TRNK,95851,CPT,,,,,both,, ,454.13,454.13,Blue Cross and Blue Shield,Traditional,,175.75,38.7,percent of total billed charges,454.13,0.82,231.61,percent of total billed charges,38.7
ROM W-R HND W-WO COM,95852,CPT,,,,,both,, ,418.86,418.86,Blue Cross and Blue Shield,Traditional,,162.10,38.7,percent of total billed charges,418.86,0.82,213.62,percent of total billed charges,38.7
ROM W-R HND W-WO COM,95852,CPT,,,,,both,, ,454.13,454.13,Blue Cross and Blue Shield,Traditional,,175.75,38.7,percent of total billed charges,454.13,0.82,231.61,percent of total billed charges,38.7
ROM W-R HND W-WO OT,95852,CPT,,,,,both,, ,16.22,16.22,Blue Cross and Blue Shield,Traditional,,6.28,38.7,percent of total billed charges,16.22,0.82,8.27,percent of total billed charges,38.7
ROM W-R HND W-WO OT,95852,CPT,,,,,both,, ,16.22,16.22,Blue Cross and Blue Shield,Traditional,,6.28,38.7,percent of total billed charges,16.22,0.82,8.27,percent of total billed charges,38.7
ROM W-R HND W-WO OT,95852,CPT,,,,,both,, ,16.22,16.22,Blue Cross and Blue Shield,Traditional,,6.28,38.7,percent of total billed charges,16.22,0.82,8.27,percent of total billed charges,38.7
ROM W-R HND W-WO OT,95852,CPT,,,,,both,, ,16.22,16.22,Blue Cross and Blue Shield,Traditional,,6.28,38.7,percent of total billed charges,16.22,0.82,8.27,percent of total billed charges,38.7
ROM W-R HND W-WO OT,95852,CPT,,,,,both,, ,486.42,486.42,Blue Cross and Blue Shield,Traditional,,188.24,38.7,percent of total billed charges,486.42,0.82,248.07,percent of total billed charges,38.7
ROM W-R HND W-WO OT,95852,CPT,,,,,both,, ,486.42,486.42,Blue Cross and Blue Shield,Traditional,,188.24,38.7,percent of total billed charges,486.42,0.82,248.07,percent of total billed charges,38.7
ROM W-R HND W-WO PT,95852,CPT,,,,,both,, ,448.57,448.57,Blue Cross and Blue Shield,Traditional,,173.60,38.7,percent of total billed charges,448.57,0.82,228.77,percent of total billed charges,38.7
ROM W-R HND W-WO PT,95852,CPT,,,,,both,, ,448.57,448.57,Blue Cross and Blue Shield,Traditional,,173.60,38.7,percent of total billed charges,448.57,0.82,228.77,percent of total billed charges,38.7
"EMG, 1 EXTREM",95860,CPT,,,,,both,, ,3272.05,3272.05,Blue Cross and Blue Shield,Traditional,,1266.28,38.7,percent of total billed charges,3272.05,0.82,1668.75,percent of total billed charges,38.7
"EMG, 2 EXTREM",95861,CPT,,,,,both,, ,5586.46,5586.46,Blue Cross and Blue Shield,Traditional,,2161.96,38.7,percent of total billed charges,5586.46,0.82,2849.09,percent of total billed charges,38.7
"EMG, 3 EXTREM",95863,CPT,,,,,both,, ,7162.62,7162.62,Blue Cross and Blue Shield,Traditional,,2771.93,38.7,percent of total billed charges,7162.62,0.82,3652.94,percent of total billed charges,38.7
"EMG, 4 EXTREM",95864,CPT,,,,,both,, ,8764.27,8764.27,Blue Cross and Blue Shield,Traditional,,3391.77,38.7,percent of total billed charges,8764.27,0.82,4469.78,percent of total billed charges,38.7
"EMG, W-NERVE TEST",95885,CPT,,,,,both,, ,458.87,458.87,Blue Cross and Blue Shield,Traditional,,177.58,38.7,percent of total billed charges,458.87,0.82,234.02,percent of total billed charges,38.7
EMG W-NRV TST COM,95886,CPT,,,,,both,, ,458.87,458.87,Blue Cross and Blue Shield,Traditional,,177.58,38.7,percent of total billed charges,458.87,0.82,234.02,percent of total billed charges,38.7
EMG W-NRV TST NON,95887,CPT,,,,,both,, ,242.57,242.57,Blue Cross and Blue Shield,Traditional,,93.87,38.7,percent of total billed charges,242.57,0.82,123.71,percent of total billed charges,38.7
MTR-SENS 1-2 NRV TST,95907,CPT,,,,,both,, ,821.43,821.43,Blue Cross and Blue Shield,Traditional,,317.89,38.7,percent of total billed charges,821.43,0.82,418.93,percent of total billed charges,38.7
MTR-SENS 3-4 NRV TST,95908,CPT,,,,,both,, ,821.43,821.43,Blue Cross and Blue Shield,Traditional,,317.89,38.7,percent of total billed charges,821.43,0.82,418.93,percent of total billed charges,38.7
MTR-SENS 5-6 NRV TST,95909,CPT,,,,,both,, ,821.43,821.43,Blue Cross and Blue Shield,Traditional,,317.89,38.7,percent of total billed charges,821.43,0.82,418.93,percent of total billed charges,38.7
MTR-SENS 7-8 NRV TST,95910,CPT,,,,,both,, ,821.43,821.43,Blue Cross and Blue Shield,Traditional,,317.89,38.7,percent of total billed charges,821.43,0.82,418.93,percent of total billed charges,38.7
MTR-SES 9-10 NRV TST,95911,CPT,,,,,both,, ,821.43,821.43,Blue Cross and Blue Shield,Traditional,,317.89,38.7,percent of total billed charges,821.43,0.82,418.93,percent of total billed charges,38.7
MTR-SES 11-12 NRV TS,95912,CPT,,,,,both,, ,1518.74,1518.74,Blue Cross and Blue Shield,Traditional,,587.75,38.7,percent of total billed charges,1518.74,0.82,774.56,percent of total billed charges,38.7
MTR-SNS 13 OR MORE,95913,CPT,,,,,both,, ,1518.74,1518.74,Blue Cross and Blue Shield,Traditional,,587.75,38.7,percent of total billed charges,1518.74,0.82,774.56,percent of total billed charges,38.7
PARASYMP-SYMP HRT RT,95924,CPT,,,,,both,, ,461.44,461.44,Blue Cross and Blue Shield,Traditional,,178.58,38.7,percent of total billed charges,461.44,0.82,235.33,percent of total billed charges,38.7
VISUAL EVOK POTENT,95930,CPT,,,,,both,, ,3397.20,3397.20,Blue Cross and Blue Shield,Traditional,,1314.72,38.7,percent of total billed charges,3397.20,0.82,1732.57,percent of total billed charges,38.7
"REPETIT STIM, EA NE",95937,CPT,,,,,both,, ,3199.95,3199.95,Blue Cross and Blue Shield,Traditional,,1238.38,38.7,percent of total billed charges,3199.95,0.82,1631.97,percent of total billed charges,38.7
CANALITH PER DAY,95992,CPT,,,,,both,, ,158.07,158.07,Blue Cross and Blue Shield,Traditional,,61.17,38.7,percent of total billed charges,158.07,0.82,80.62,percent of total billed charges,38.7
CANALITH PER DAY PT,95992,CPT,,,,,both,, ,101.97,101.97,Blue Cross and Blue Shield,Traditional,,39.46,38.7,percent of total billed charges,101.97,0.82,52,percent of total billed charges,38.7
CANALITH PER DAY PT,95992,CPT,,,,,both,, ,101.97,101.97,Blue Cross and Blue Shield,Traditional,,39.46,38.7,percent of total billed charges,101.97,0.82,52,percent of total billed charges,38.7
CANALITH PER DAY PT,95992,CPT,,,,,both,, ,169.44,169.44,Blue Cross and Blue Shield,Traditional,,65.57,38.7,percent of total billed charges,169.44,0.82,86.41,percent of total billed charges,38.7
CANALITH PER DAY PT,95992,CPT,,,,,both,, ,169.44,169.44,Blue Cross and Blue Shield,Traditional,,65.57,38.7,percent of total billed charges,169.44,0.82,86.41,percent of total billed charges,38.7
APHASIA ASSESS 1HOUR,96105,CPT,,,,,both,, ,813.70,813.70,Blue Cross and Blue Shield,Traditional,,314.90,38.7,percent of total billed charges,813.70,0.82,414.99,percent of total billed charges,38.7
DEV TEST 1ST HR,96112,CPT,,,,,both,, ,813.70,813.70,Blue Cross and Blue Shield,Traditional,,314.90,38.7,percent of total billed charges,813.70,0.82,414.99,percent of total billed charges,38.7
DEV TEST ADD 30M,96113,CPT,,,,,both,, ,763.23,763.23,Blue Cross and Blue Shield,Traditional,,295.37,38.7,percent of total billed charges,763.23,0.82,389.25,percent of total billed charges,38.7
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,253.90,253.90,Blue Cross and Blue Shield,Traditional,,98.26,38.7,percent of total billed charges,253.90,0.82,129.49,percent of total billed charges,38.7
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,253.90,253.90,Blue Cross and Blue Shield,Traditional,,98.26,38.7,percent of total billed charges,253.90,0.82,129.49,percent of total billed charges,38.7
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,487.00,487.00,Blue Cross and Blue Shield,Traditional,,188.47,38.7,percent of total billed charges,487.00,0.82,248.37,percent of total billed charges,38.7
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,487.00,487.00,Blue Cross and Blue Shield,Traditional,,188.47,38.7,percent of total billed charges,487.00,0.82,248.37,percent of total billed charges,38.7
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,501.61,501.61,Blue Cross and Blue Shield,Traditional,,194.12,38.7,percent of total billed charges,501.61,0.82,255.82,percent of total billed charges,38.7
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,501.61,501.61,Blue Cross and Blue Shield,Traditional,,194.12,38.7,percent of total billed charges,501.61,0.82,255.82,percent of total billed charges,38.7
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,1841.23,1841.23,Blue Cross and Blue Shield,Traditional,,712.56,38.7,percent of total billed charges,1841.23,0.82,939.03,percent of total billed charges,38.7
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,70.81,70.81,Blue Cross and Blue Shield,Traditional,,27.40,38.7,percent of total billed charges,70.81,0.82,36.11,percent of total billed charges,38.7
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,70.81,70.81,Blue Cross and Blue Shield,Traditional,,27.40,38.7,percent of total billed charges,70.81,0.82,36.11,percent of total billed charges,38.7
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,135.75,135.75,Blue Cross and Blue Shield,Traditional,,52.54,38.7,percent of total billed charges,135.75,0.82,69.23,percent of total billed charges,38.7
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,135.75,135.75,Blue Cross and Blue Shield,Traditional,,52.54,38.7,percent of total billed charges,135.75,0.82,69.23,percent of total billed charges,38.7
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,139.82,139.82,Blue Cross and Blue Shield,Traditional,,54.11,38.7,percent of total billed charges,139.82,0.82,71.31,percent of total billed charges,38.7
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,139.82,139.82,Blue Cross and Blue Shield,Traditional,,54.11,38.7,percent of total billed charges,139.82,0.82,71.31,percent of total billed charges,38.7
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,1841.23,1841.23,Blue Cross and Blue Shield,Traditional,,712.56,38.7,percent of total billed charges,1841.23,0.82,939.03,percent of total billed charges,38.7
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,412.77,412.77,Blue Cross and Blue Shield,Traditional,,159.74,38.7,percent of total billed charges,412.77,0.82,210.51,percent of total billed charges,38.7
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,412.77,412.77,Blue Cross and Blue Shield,Traditional,,159.74,38.7,percent of total billed charges,412.77,0.82,210.51,percent of total billed charges,38.7
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,928.18,928.18,Blue Cross and Blue Shield,Traditional,,359.21,38.7,percent of total billed charges,928.18,0.82,473.37,percent of total billed charges,38.7
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1301.75,1301.75,Blue Cross and Blue Shield,Traditional,,503.78,38.7,percent of total billed charges,1301.75,0.82,663.89,percent of total billed charges,38.7
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1301.75,1301.75,Blue Cross and Blue Shield,Traditional,,503.78,38.7,percent of total billed charges,1301.75,0.82,663.89,percent of total billed charges,38.7
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1340.80,1340.80,Blue Cross and Blue Shield,Traditional,,518.89,38.7,percent of total billed charges,1340.80,0.82,683.81,percent of total billed charges,38.7
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1340.80,1340.80,Blue Cross and Blue Shield,Traditional,,518.89,38.7,percent of total billed charges,1340.80,0.82,683.81,percent of total billed charges,38.7
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,70.81,70.81,Blue Cross and Blue Shield,Traditional,,27.40,38.7,percent of total billed charges,70.81,0.82,36.11,percent of total billed charges,38.7
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,70.81,70.81,Blue Cross and Blue Shield,Traditional,,27.40,38.7,percent of total billed charges,70.81,0.82,36.11,percent of total billed charges,38.7
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,928.18,928.18,Blue Cross and Blue Shield,Traditional,,359.21,38.7,percent of total billed charges,928.18,0.82,473.37,percent of total billed charges,38.7
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1301.75,1301.75,Blue Cross and Blue Shield,Traditional,,503.78,38.7,percent of total billed charges,1301.75,0.82,663.89,percent of total billed charges,38.7
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1301.75,1301.75,Blue Cross and Blue Shield,Traditional,,503.78,38.7,percent of total billed charges,1301.75,0.82,663.89,percent of total billed charges,38.7
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1340.80,1340.80,Blue Cross and Blue Shield,Traditional,,518.89,38.7,percent of total billed charges,1340.80,0.82,683.81,percent of total billed charges,38.7
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1340.80,1340.80,Blue Cross and Blue Shield,Traditional,,518.89,38.7,percent of total billed charges,1340.80,0.82,683.81,percent of total billed charges,38.7
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,0.82,53.58,percent of total billed charges,38.7
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,0.82,53.58,percent of total billed charges,38.7
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,201.25,201.25,Blue Cross and Blue Shield,Traditional,,77.88,38.7,percent of total billed charges,201.25,0.82,102.64,percent of total billed charges,38.7
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,201.25,201.25,Blue Cross and Blue Shield,Traditional,,77.88,38.7,percent of total billed charges,201.25,0.82,102.64,percent of total billed charges,38.7
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,207.29,207.29,Blue Cross and Blue Shield,Traditional,,80.22,38.7,percent of total billed charges,207.29,0.82,105.72,percent of total billed charges,38.7
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,207.29,207.29,Blue Cross and Blue Shield,Traditional,,80.22,38.7,percent of total billed charges,207.29,0.82,105.72,percent of total billed charges,38.7
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,928.18,928.18,Blue Cross and Blue Shield,Traditional,,359.21,38.7,percent of total billed charges,928.18,0.82,473.37,percent of total billed charges,38.7
CONCURRENT IV THER,96368,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,0.82,53.58,percent of total billed charges,38.7
CONCURRENT IV THER,96368,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,0.82,53.58,percent of total billed charges,38.7
CONCURRENT IV THER,96368,CPT,,,,,both,, ,791.25,791.25,Blue Cross and Blue Shield,Traditional,,306.21,38.7,percent of total billed charges,791.25,0.82,403.54,percent of total billed charges,38.7
CONCURRENT IV THER,96368,CPT,,,,,both,, ,791.25,791.25,Blue Cross and Blue Shield,Traditional,,306.21,38.7,percent of total billed charges,791.25,0.82,403.54,percent of total billed charges,38.7
CONCURRENT IV THER,96368,CPT,,,,,both,, ,814.99,814.99,Blue Cross and Blue Shield,Traditional,,315.40,38.7,percent of total billed charges,814.99,0.82,415.64,percent of total billed charges,38.7
CONCURRENT IV THER,96368,CPT,,,,,both,, ,814.99,814.99,Blue Cross and Blue Shield,Traditional,,315.40,38.7,percent of total billed charges,814.99,0.82,415.64,percent of total billed charges,38.7
CONCURRENT IV THER,96368,CPT,,,,,both,, ,928.18,928.18,Blue Cross and Blue Shield,Traditional,,359.21,38.7,percent of total billed charges,928.18,0.82,473.37,percent of total billed charges,38.7
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,0.82,53.58,percent of total billed charges,38.7
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,0.82,53.58,percent of total billed charges,38.7
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,201.25,201.25,Blue Cross and Blue Shield,Traditional,,77.88,38.7,percent of total billed charges,201.25,0.82,102.64,percent of total billed charges,38.7
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,201.25,201.25,Blue Cross and Blue Shield,Traditional,,77.88,38.7,percent of total billed charges,201.25,0.82,102.64,percent of total billed charges,38.7
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,207.29,207.29,Blue Cross and Blue Shield,Traditional,,80.22,38.7,percent of total billed charges,207.29,0.82,105.72,percent of total billed charges,38.7
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,207.29,207.29,Blue Cross and Blue Shield,Traditional,,80.22,38.7,percent of total billed charges,207.29,0.82,105.72,percent of total billed charges,38.7
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,301.16,301.16,Blue Cross and Blue Shield,Traditional,,116.55,38.7,percent of total billed charges,301.16,0.82,153.59,percent of total billed charges,38.7
S-INJ NON CHEMO IA,96373,CPT,,,,,both,, ,1355.48,1355.48,Blue Cross and Blue Shield,Traditional,,524.57,38.7,percent of total billed charges,1355.48,0.82,691.29,percent of total billed charges,38.7
INJECTION IV PUSH,96374,CPT,,,,,both,, ,1477.47,1477.47,Blue Cross and Blue Shield,Traditional,,571.78,38.7,percent of total billed charges,1477.47,0.82,753.51,percent of total billed charges,38.7
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,201.25,201.25,Blue Cross and Blue Shield,Traditional,,77.88,38.7,percent of total billed charges,201.25,0.82,102.64,percent of total billed charges,38.7
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,201.25,201.25,Blue Cross and Blue Shield,Traditional,,77.88,38.7,percent of total billed charges,201.25,0.82,102.64,percent of total billed charges,38.7
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,207.29,207.29,Blue Cross and Blue Shield,Traditional,,80.22,38.7,percent of total billed charges,207.29,0.82,105.72,percent of total billed charges,38.7
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,253.90,253.90,Blue Cross and Blue Shield,Traditional,,98.26,38.7,percent of total billed charges,253.90,0.82,129.49,percent of total billed charges,38.7
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,253.90,253.90,Blue Cross and Blue Shield,Traditional,,98.26,38.7,percent of total billed charges,253.90,0.82,129.49,percent of total billed charges,38.7
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,501.61,501.61,Blue Cross and Blue Shield,Traditional,,194.12,38.7,percent of total billed charges,501.61,0.82,255.82,percent of total billed charges,38.7
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,1355.48,1355.48,Blue Cross and Blue Shield,Traditional,,524.57,38.7,percent of total billed charges,1355.48,0.82,691.29,percent of total billed charges,38.7
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,0.82,53.58,percent of total billed charges,38.7
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,0.82,53.58,percent of total billed charges,38.7
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,201.25,201.25,Blue Cross and Blue Shield,Traditional,,77.88,38.7,percent of total billed charges,201.25,0.82,102.64,percent of total billed charges,38.7
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,201.25,201.25,Blue Cross and Blue Shield,Traditional,,77.88,38.7,percent of total billed charges,201.25,0.82,102.64,percent of total billed charges,38.7
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,207.29,207.29,Blue Cross and Blue Shield,Traditional,,80.22,38.7,percent of total billed charges,207.29,0.82,105.72,percent of total billed charges,38.7
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,207.29,207.29,Blue Cross and Blue Shield,Traditional,,80.22,38.7,percent of total billed charges,207.29,0.82,105.72,percent of total billed charges,38.7
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,668.99,668.99,Blue Cross and Blue Shield,Traditional,,258.90,38.7,percent of total billed charges,668.99,0.82,341.18,percent of total billed charges,38.7
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,729.19,729.19,Blue Cross and Blue Shield,Traditional,,282.20,38.7,percent of total billed charges,729.19,0.82,371.89,percent of total billed charges,38.7
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,98.50,98.50,Blue Cross and Blue Shield,Traditional,,38.12,38.7,percent of total billed charges,98.50,0.82,50.24,percent of total billed charges,38.7
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,98.50,98.50,Blue Cross and Blue Shield,Traditional,,38.12,38.7,percent of total billed charges,98.50,0.82,50.24,percent of total billed charges,38.7
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,101.46,101.46,Blue Cross and Blue Shield,Traditional,,39.27,38.7,percent of total billed charges,101.46,0.82,51.74,percent of total billed charges,38.7
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,101.46,101.46,Blue Cross and Blue Shield,Traditional,,39.27,38.7,percent of total billed charges,101.46,0.82,51.74,percent of total billed charges,38.7
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,0.82,53.58,percent of total billed charges,38.7
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,0.82,53.58,percent of total billed charges,38.7
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,729.19,729.19,Blue Cross and Blue Shield,Traditional,,282.20,38.7,percent of total billed charges,729.19,0.82,371.89,percent of total billed charges,38.7
CHEMO NON HORM IM SC,96401,CPT,,,,,both,, ,476.63,476.63,Blue Cross and Blue Shield,Traditional,,184.46,38.7,percent of total billed charges,476.63,0.82,243.08,percent of total billed charges,38.7
CHEMO HORMONAL IM SC,96402,CPT,,,,,both,, ,235.36,235.36,Blue Cross and Blue Shield,Traditional,,91.08,38.7,percent of total billed charges,235.36,0.82,120.03,percent of total billed charges,38.7
CHEMO IV PUSH,96409,CPT,,,,,both,, ,382.65,382.65,Blue Cross and Blue Shield,Traditional,,148.09,38.7,percent of total billed charges,382.65,0.82,195.15,percent of total billed charges,38.7
CHEMO EA AD IV PUSH,96411,CPT,,,,,both,, ,117.16,117.16,Blue Cross and Blue Shield,Traditional,,45.34,38.7,percent of total billed charges,117.16,0.82,59.75,percent of total billed charges,38.7
CHEMO IV INFU 1ST HR,96413,CPT,,,,,both,, ,1377.11,1377.11,Blue Cross and Blue Shield,Traditional,,532.94,38.7,percent of total billed charges,1377.11,0.82,702.33,percent of total billed charges,38.7
CHEMO IV IN EA AD HR,96415,CPT,,,,,both,, ,234.58,234.58,Blue Cross and Blue Shield,Traditional,,90.78,38.7,percent of total billed charges,234.58,0.82,119.64,percent of total billed charges,38.7
CHEMO IV EA SEQ INF,96417,CPT,,,,,both,, ,126.18,126.18,Blue Cross and Blue Shield,Traditional,,48.83,38.7,percent of total billed charges,126.18,0.82,64.35,percent of total billed charges,38.7
IR-IRR PORT DRUG DEL,96523,CPT,,,,,both,, ,383.16,383.16,Blue Cross and Blue Shield,Traditional,,148.28,38.7,percent of total billed charges,383.16,0.82,195.41,percent of total billed charges,38.7
HOT-COLD PACKS,97010,CPT,,,,,both,, ,239.27,239.27,Blue Cross and Blue Shield,Traditional,,92.60,38.7,percent of total billed charges,239.27,0.82,122.03,percent of total billed charges,38.7
HOT-COLD PACKS,97010,CPT,,,,,both,, ,259.41,259.41,Blue Cross and Blue Shield,Traditional,,100.39,38.7,percent of total billed charges,259.41,0.82,132.3,percent of total billed charges,38.7
HOT-COLD PACKS OT,97010,CPT,,,,,both,, ,41.20,41.20,Blue Cross and Blue Shield,Traditional,,15.94,38.7,percent of total billed charges,41.20,0.82,21.01,percent of total billed charges,38.7
HOT-COLD PACKS OT,97010,CPT,,,,,both,, ,41.20,41.20,Blue Cross and Blue Shield,Traditional,,15.94,38.7,percent of total billed charges,41.20,0.82,21.01,percent of total billed charges,38.7
HOT-COLD PACKS OT,97010,CPT,,,,,both,, ,41.20,41.20,Blue Cross and Blue Shield,Traditional,,15.94,38.7,percent of total billed charges,41.20,0.82,21.01,percent of total billed charges,38.7
HOT-COLD PACKS OT,97010,CPT,,,,,both,, ,41.20,41.20,Blue Cross and Blue Shield,Traditional,,15.94,38.7,percent of total billed charges,41.20,0.82,21.01,percent of total billed charges,38.7
HOT-COLD PACKS OT,97010,CPT,,,,,both,, ,277.84,277.84,Blue Cross and Blue Shield,Traditional,,107.52,38.7,percent of total billed charges,277.84,0.82,141.7,percent of total billed charges,38.7
HOT-COLD PACKS OT,97010,CPT,,,,,both,, ,277.84,277.84,Blue Cross and Blue Shield,Traditional,,107.52,38.7,percent of total billed charges,277.84,0.82,141.7,percent of total billed charges,38.7
HOT-COLD PACKS PT,97010,CPT,,,,,both,, ,256.21,256.21,Blue Cross and Blue Shield,Traditional,,99.15,38.7,percent of total billed charges,256.21,0.82,130.67,percent of total billed charges,38.7
HOT-COLD PACKS PT,97010,CPT,,,,,both,, ,256.21,256.21,Blue Cross and Blue Shield,Traditional,,99.15,38.7,percent of total billed charges,256.21,0.82,130.67,percent of total billed charges,38.7
MECH TRACTION-VISIT,97012,CPT,,,,,both,, ,485.24,485.24,Blue Cross and Blue Shield,Traditional,,187.79,38.7,percent of total billed charges,485.24,0.82,247.47,percent of total billed charges,38.7
MECH TRACTN-VST PT,97012,CPT,,,,,both,, ,39.40,39.40,Blue Cross and Blue Shield,Traditional,,15.25,38.7,percent of total billed charges,39.40,0.82,20.09,percent of total billed charges,38.7
MECH TRACTN-VST PT,97012,CPT,,,,,both,, ,39.40,39.40,Blue Cross and Blue Shield,Traditional,,15.25,38.7,percent of total billed charges,39.40,0.82,20.09,percent of total billed charges,38.7
MECH TRACTN-VST PT,97012,CPT,,,,,both,, ,519.89,519.89,Blue Cross and Blue Shield,Traditional,,201.20,38.7,percent of total billed charges,519.89,0.82,265.14,percent of total billed charges,38.7
MECH TRACTN-VST PT,97012,CPT,,,,,both,, ,519.89,519.89,Blue Cross and Blue Shield,Traditional,,201.20,38.7,percent of total billed charges,519.89,0.82,265.14,percent of total billed charges,38.7
PARAF BATH-VISIT OT,97018,CPT,,,,,both,, ,41.20,41.20,Blue Cross and Blue Shield,Traditional,,15.94,38.7,percent of total billed charges,41.20,0.82,21.01,percent of total billed charges,38.7
PARAF BATH-VISIT OT,97018,CPT,,,,,both,, ,41.20,41.20,Blue Cross and Blue Shield,Traditional,,15.94,38.7,percent of total billed charges,41.20,0.82,21.01,percent of total billed charges,38.7
PARAF BATH-VISIT OT,97018,CPT,,,,,both,, ,347.88,347.88,Blue Cross and Blue Shield,Traditional,,134.63,38.7,percent of total billed charges,347.88,0.82,177.42,percent of total billed charges,38.7
PARAF BATH-VISIT OT,97018,CPT,,,,,both,, ,347.88,347.88,Blue Cross and Blue Shield,Traditional,,134.63,38.7,percent of total billed charges,347.88,0.82,177.42,percent of total billed charges,38.7
PARAF BATH-VISIT PT,97018,CPT,,,,,both,, ,18.54,18.54,Blue Cross and Blue Shield,Traditional,,7.17,38.7,percent of total billed charges,18.54,0.82,9.46,percent of total billed charges,38.7
PARAF BATH-VISIT PT,97018,CPT,,,,,both,, ,18.54,18.54,Blue Cross and Blue Shield,Traditional,,7.17,38.7,percent of total billed charges,18.54,0.82,9.46,percent of total billed charges,38.7
PARAF BATH-VISIT PT,97018,CPT,,,,,both,, ,320.85,320.85,Blue Cross and Blue Shield,Traditional,,124.17,38.7,percent of total billed charges,320.85,0.82,163.63,percent of total billed charges,38.7
PARAF BATH-VISIT PT,97018,CPT,,,,,both,, ,320.85,320.85,Blue Cross and Blue Shield,Traditional,,124.17,38.7,percent of total billed charges,320.85,0.82,163.63,percent of total billed charges,38.7
PARAFFIN BATH-VISIT,97018,CPT,,,,,both,, ,299.53,299.53,Blue Cross and Blue Shield,Traditional,,115.92,38.7,percent of total billed charges,299.53,0.82,152.76,percent of total billed charges,38.7
PARAFFIN BATH-VISIT,97018,CPT,,,,,both,, ,324.73,324.73,Blue Cross and Blue Shield,Traditional,,125.67,38.7,percent of total billed charges,324.73,0.82,165.61,percent of total billed charges,38.7
WHIRLPOOL THRPY-VIST,97022,CPT,,,,,both,, ,652.70,652.70,Blue Cross and Blue Shield,Traditional,,252.59,38.7,percent of total billed charges,652.70,0.82,332.88,percent of total billed charges,38.7
WHIRLPOOL THRPY-VIST,97022,CPT,,,,,both,, ,707.58,707.58,Blue Cross and Blue Shield,Traditional,,273.83,38.7,percent of total billed charges,707.58,0.82,360.87,percent of total billed charges,38.7
WHRLPL THRPY-VST OT,97022,CPT,,,,,both,, ,46.87,46.87,Blue Cross and Blue Shield,Traditional,,18.14,38.7,percent of total billed charges,46.87,0.82,23.9,percent of total billed charges,38.7
WHRLPL THRPY-VST OT,97022,CPT,,,,,both,, ,46.87,46.87,Blue Cross and Blue Shield,Traditional,,18.14,38.7,percent of total billed charges,46.87,0.82,23.9,percent of total billed charges,38.7
WHRLPL THRPY-VST OT,97022,CPT,,,,,both,, ,46.87,46.87,Blue Cross and Blue Shield,Traditional,,18.14,38.7,percent of total billed charges,46.87,0.82,23.9,percent of total billed charges,38.7
WHRLPL THRPY-VST OT,97022,CPT,,,,,both,, ,46.87,46.87,Blue Cross and Blue Shield,Traditional,,18.14,38.7,percent of total billed charges,46.87,0.82,23.9,percent of total billed charges,38.7
WHRLPL THRPY-VST OT,97022,CPT,,,,,both,, ,758.08,758.08,Blue Cross and Blue Shield,Traditional,,293.38,38.7,percent of total billed charges,758.08,0.82,386.62,percent of total billed charges,38.7
WHRLPL THRPY-VST OT,97022,CPT,,,,,both,, ,758.08,758.08,Blue Cross and Blue Shield,Traditional,,293.38,38.7,percent of total billed charges,758.08,0.82,386.62,percent of total billed charges,38.7
WHRLPL THRPY-VST PT,97022,CPT,,,,,both,, ,699.11,699.11,Blue Cross and Blue Shield,Traditional,,270.56,38.7,percent of total billed charges,699.11,0.82,356.55,percent of total billed charges,38.7
WHRLPL THRPY-VST PT,97022,CPT,,,,,both,, ,699.11,699.11,Blue Cross and Blue Shield,Traditional,,270.56,38.7,percent of total billed charges,699.11,0.82,356.55,percent of total billed charges,38.7
ELEC STIM-MAN-15 MIN,97032,CPT,,,,,both,, ,466.32,466.32,Blue Cross and Blue Shield,Traditional,,180.47,38.7,percent of total billed charges,466.32,0.82,237.82,percent of total billed charges,38.7
ELEC STIM-MAN-15 MIN,97032,CPT,,,,,both,, ,505.50,505.50,Blue Cross and Blue Shield,Traditional,,195.63,38.7,percent of total billed charges,505.50,0.82,257.81,percent of total billed charges,38.7
ELEC STM-MN-15MN OT,97032,CPT,,,,,both,, ,39.40,39.40,Blue Cross and Blue Shield,Traditional,,15.25,38.7,percent of total billed charges,39.40,0.82,20.09,percent of total billed charges,38.7
ELEC STM-MN-15MN OT,97032,CPT,,,,,both,, ,39.40,39.40,Blue Cross and Blue Shield,Traditional,,15.25,38.7,percent of total billed charges,39.40,0.82,20.09,percent of total billed charges,38.7
ELEC STM-MN-15MN OT,97032,CPT,,,,,both,, ,39.40,39.40,Blue Cross and Blue Shield,Traditional,,15.25,38.7,percent of total billed charges,39.40,0.82,20.09,percent of total billed charges,38.7
ELEC STM-MN-15MN OT,97032,CPT,,,,,both,, ,39.40,39.40,Blue Cross and Blue Shield,Traditional,,15.25,38.7,percent of total billed charges,39.40,0.82,20.09,percent of total billed charges,38.7
ELEC STM-MN-15MN OT,97032,CPT,,,,,both,, ,541.52,541.52,Blue Cross and Blue Shield,Traditional,,209.57,38.7,percent of total billed charges,541.52,0.82,276.18,percent of total billed charges,38.7
ELEC STM-MN-15MN OT,97032,CPT,,,,,both,, ,541.52,541.52,Blue Cross and Blue Shield,Traditional,,209.57,38.7,percent of total billed charges,541.52,0.82,276.18,percent of total billed charges,38.7
ELEC STM-MN-15MN PT,97032,CPT,,,,,both,, ,499.55,499.55,Blue Cross and Blue Shield,Traditional,,193.33,38.7,percent of total billed charges,499.55,0.82,254.77,percent of total billed charges,38.7
ELEC STM-MN-15MN PT,97032,CPT,,,,,both,, ,499.55,499.55,Blue Cross and Blue Shield,Traditional,,193.33,38.7,percent of total billed charges,499.55,0.82,254.77,percent of total billed charges,38.7
IONTOPHOR-15 MIN OT,97033,CPT,,,,,both,, ,54.59,54.59,Blue Cross and Blue Shield,Traditional,,21.13,38.7,percent of total billed charges,54.59,0.82,27.84,percent of total billed charges,38.7
IONTOPHOR-15 MIN OT,97033,CPT,,,,,both,, ,54.59,54.59,Blue Cross and Blue Shield,Traditional,,21.13,38.7,percent of total billed charges,54.59,0.82,27.84,percent of total billed charges,38.7
IONTOPHOR-15 MIN OT,97033,CPT,,,,,both,, ,54.59,54.59,Blue Cross and Blue Shield,Traditional,,21.13,38.7,percent of total billed charges,54.59,0.82,27.84,percent of total billed charges,38.7
IONTOPHOR-15 MIN OT,97033,CPT,,,,,both,, ,54.59,54.59,Blue Cross and Blue Shield,Traditional,,21.13,38.7,percent of total billed charges,54.59,0.82,27.84,percent of total billed charges,38.7
IONTOPHOR-15 MIN OT,97033,CPT,,,,,both,, ,764.52,764.52,Blue Cross and Blue Shield,Traditional,,295.87,38.7,percent of total billed charges,764.52,0.82,389.91,percent of total billed charges,38.7
IONTOPHOR-15 MIN OT,97033,CPT,,,,,both,, ,764.52,764.52,Blue Cross and Blue Shield,Traditional,,295.87,38.7,percent of total billed charges,764.52,0.82,389.91,percent of total billed charges,38.7
IONTOPHOR-15 MIN PT,97033,CPT,,,,,both,, ,705.04,705.04,Blue Cross and Blue Shield,Traditional,,272.85,38.7,percent of total billed charges,705.04,0.82,359.57,percent of total billed charges,38.7
IONTOPHOR-15 MIN PT,97033,CPT,,,,,both,, ,705.04,705.04,Blue Cross and Blue Shield,Traditional,,272.85,38.7,percent of total billed charges,705.04,0.82,359.57,percent of total billed charges,38.7
IONTOPHORESIS-15 MIN,97033,CPT,,,,,both,, ,658.28,658.28,Blue Cross and Blue Shield,Traditional,,254.75,38.7,percent of total billed charges,658.28,0.82,335.72,percent of total billed charges,38.7
IONTOPHORESIS-15 MIN,97033,CPT,,,,,both,, ,713.65,713.65,Blue Cross and Blue Shield,Traditional,,276.18,38.7,percent of total billed charges,713.65,0.82,363.96,percent of total billed charges,38.7
CNTRST BTH-15MIN OT,97034,CPT,,,,,both,, ,40.17,40.17,Blue Cross and Blue Shield,Traditional,,15.55,38.7,percent of total billed charges,40.17,0.82,20.49,percent of total billed charges,38.7
CNTRST BTH-15MIN OT,97034,CPT,,,,,both,, ,40.17,40.17,Blue Cross and Blue Shield,Traditional,,15.55,38.7,percent of total billed charges,40.17,0.82,20.49,percent of total billed charges,38.7
CNTRST BTH-15MIN OT,97034,CPT,,,,,both,, ,40.17,40.17,Blue Cross and Blue Shield,Traditional,,15.55,38.7,percent of total billed charges,40.17,0.82,20.49,percent of total billed charges,38.7
CNTRST BTH-15MIN OT,97034,CPT,,,,,both,, ,40.17,40.17,Blue Cross and Blue Shield,Traditional,,15.55,38.7,percent of total billed charges,40.17,0.82,20.49,percent of total billed charges,38.7
CNTRST BTH-15MIN OT,97034,CPT,,,,,both,, ,514.74,514.74,Blue Cross and Blue Shield,Traditional,,199.20,38.7,percent of total billed charges,514.74,0.82,262.52,percent of total billed charges,38.7
CNTRST BTH-15MIN OT,97034,CPT,,,,,both,, ,514.74,514.74,Blue Cross and Blue Shield,Traditional,,199.20,38.7,percent of total billed charges,514.74,0.82,262.52,percent of total billed charges,38.7
CNTRST BTH-15MIN PT,97034,CPT,,,,,both,, ,474.83,474.83,Blue Cross and Blue Shield,Traditional,,183.76,38.7,percent of total billed charges,474.83,0.82,242.16,percent of total billed charges,38.7
CNTRST BTH-15MIN PT,97034,CPT,,,,,both,, ,474.83,474.83,Blue Cross and Blue Shield,Traditional,,183.76,38.7,percent of total billed charges,474.83,0.82,242.16,percent of total billed charges,38.7
CONTRAST BATH-15 MIN,97034,CPT,,,,,both,, ,443.25,443.25,Blue Cross and Blue Shield,Traditional,,171.54,38.7,percent of total billed charges,443.25,0.82,226.06,percent of total billed charges,38.7
CONTRAST BATH-15 MIN,97034,CPT,,,,,both,, ,480.51,480.51,Blue Cross and Blue Shield,Traditional,,185.96,38.7,percent of total billed charges,480.51,0.82,245.06,percent of total billed charges,38.7
ULTRASND-15 MIN OT,97035,CPT,,,,,both,, ,36.57,36.57,Blue Cross and Blue Shield,Traditional,,14.15,38.7,percent of total billed charges,36.57,0.82,18.65,percent of total billed charges,38.7
ULTRASND-15 MIN OT,97035,CPT,,,,,both,, ,36.57,36.57,Blue Cross and Blue Shield,Traditional,,14.15,38.7,percent of total billed charges,36.57,0.82,18.65,percent of total billed charges,38.7
ULTRASND-15 MIN OT,97035,CPT,,,,,both,, ,36.57,36.57,Blue Cross and Blue Shield,Traditional,,14.15,38.7,percent of total billed charges,36.57,0.82,18.65,percent of total billed charges,38.7
ULTRASND-15 MIN OT,97035,CPT,,,,,both,, ,36.57,36.57,Blue Cross and Blue Shield,Traditional,,14.15,38.7,percent of total billed charges,36.57,0.82,18.65,percent of total billed charges,38.7
ULTRASND-15 MIN OT,97035,CPT,,,,,both,, ,611.56,611.56,Blue Cross and Blue Shield,Traditional,,236.67,38.7,percent of total billed charges,611.56,0.82,311.9,percent of total billed charges,38.7
ULTRASND-15 MIN OT,97035,CPT,,,,,both,, ,611.56,611.56,Blue Cross and Blue Shield,Traditional,,236.67,38.7,percent of total billed charges,611.56,0.82,311.9,percent of total billed charges,38.7
ULTRASND-15 MIN PT,97035,CPT,,,,,both,, ,564.18,564.18,Blue Cross and Blue Shield,Traditional,,218.34,38.7,percent of total billed charges,564.18,0.82,287.73,percent of total billed charges,38.7
ULTRASND-15 MIN PT,97035,CPT,,,,,both,, ,564.18,564.18,Blue Cross and Blue Shield,Traditional,,218.34,38.7,percent of total billed charges,564.18,0.82,287.73,percent of total billed charges,38.7
ULTRASOUND-15 MIN,97035,CPT,,,,,both,, ,526.62,526.62,Blue Cross and Blue Shield,Traditional,,203.80,38.7,percent of total billed charges,526.62,0.82,268.58,percent of total billed charges,38.7
ULTRASOUND-15 MIN,97035,CPT,,,,,both,, ,570.95,570.95,Blue Cross and Blue Shield,Traditional,,220.96,38.7,percent of total billed charges,570.95,0.82,291.18,percent of total billed charges,38.7
"Physical therapy, therapeutic exercise .",97110,CPT,,,,,both,,,342.72,342.72,Blue Cross and Blue Shield,Traditional,,132.63,38.7,percent of total billed charges,342.72,0.82,174.79,percent of total billed charges,38.7
THER EXRCS-15MIN OT,97110,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,percent of total billed charges,81.37,0.82,41.5,percent of total billed charges,38.7
THER EXRCS-15MIN OT,97110,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,percent of total billed charges,81.37,0.82,41.5,percent of total billed charges,38.7
THER EXRCS-15MIN OT,97110,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,percent of total billed charges,81.37,0.82,41.5,percent of total billed charges,38.7
THER EXRCS-15MIN OT,97110,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,percent of total billed charges,81.37,0.82,41.5,percent of total billed charges,38.7
THER EXRCS-15MIN OT,97110,CPT,,,,,both,, ,398.10,398.10,Blue Cross and Blue Shield,Traditional,,154.06,38.7,percent of total billed charges,398.10,0.82,203.03,percent of total billed charges,38.7
THER EXRCS-15MIN OT,97110,CPT,,,,,both,, ,398.10,398.10,Blue Cross and Blue Shield,Traditional,,154.06,38.7,percent of total billed charges,398.10,0.82,203.03,percent of total billed charges,38.7
THER EXRCS-15MIN PT,97110,CPT,,,,,both,, ,367.20,367.20,Blue Cross and Blue Shield,Traditional,,142.11,38.7,percent of total billed charges,367.20,0.82,187.27,percent of total billed charges,38.7
THER EXRCS-15MIN PT,97110,CPT,,,,,both,, ,367.20,367.20,Blue Cross and Blue Shield,Traditional,,142.11,38.7,percent of total billed charges,367.20,0.82,187.27,percent of total billed charges,38.7
THERAP EXERCS-15 MIN,97110,CPT,,,,,both,, ,342.72,342.72,Blue Cross and Blue Shield,Traditional,,132.63,38.7,percent of total billed charges,342.72,0.82,174.79,percent of total billed charges,38.7
THERAP EXERCS-15 MIN,97110,CPT,,,,,both,, ,371.55,371.55,Blue Cross and Blue Shield,Traditional,,143.79,38.7,percent of total billed charges,371.55,0.82,189.49,percent of total billed charges,38.7
NEUR RE-ED-15MIN OT,97112,CPT,,,,,both,, ,92.19,92.19,Blue Cross and Blue Shield,Traditional,,35.68,38.7,percent of total billed charges,92.19,0.82,47.02,percent of total billed charges,38.7
NEUR RE-ED-15MIN OT,97112,CPT,,,,,both,, ,92.19,92.19,Blue Cross and Blue Shield,Traditional,,35.68,38.7,percent of total billed charges,92.19,0.82,47.02,percent of total billed charges,38.7
NEUR RE-ED-15MIN OT,97112,CPT,,,,,both,, ,92.19,92.19,Blue Cross and Blue Shield,Traditional,,35.68,38.7,percent of total billed charges,92.19,0.82,47.02,percent of total billed charges,38.7
NEUR RE-ED-15MIN OT,97112,CPT,,,,,both,, ,92.19,92.19,Blue Cross and Blue Shield,Traditional,,35.68,38.7,percent of total billed charges,92.19,0.82,47.02,percent of total billed charges,38.7
NEUR RE-ED-15MIN OT,97112,CPT,,,,,both,, ,486.42,486.42,Blue Cross and Blue Shield,Traditional,,188.24,38.7,percent of total billed charges,486.42,0.82,248.07,percent of total billed charges,38.7
NEUR RE-ED-15MIN OT,97112,CPT,,,,,both,, ,486.42,486.42,Blue Cross and Blue Shield,Traditional,,188.24,38.7,percent of total billed charges,486.42,0.82,248.07,percent of total billed charges,38.7
NEUR RE-ED-15MIN PT,97112,CPT,,,,,both,, ,367.20,367.20,Blue Cross and Blue Shield,Traditional,,142.11,38.7,percent of total billed charges,367.20,0.82,187.27,percent of total billed charges,38.7
NEUR RE-ED-15MIN PT,97112,CPT,,,,,both,, ,367.20,367.20,Blue Cross and Blue Shield,Traditional,,142.11,38.7,percent of total billed charges,367.20,0.82,187.27,percent of total billed charges,38.7
NEURO RE-ED-15 MIN,97112,CPT,,,,,both,, ,342.72,342.72,Blue Cross and Blue Shield,Traditional,,132.63,38.7,percent of total billed charges,342.72,0.82,174.79,percent of total billed charges,38.7
NEURO RE-ED-15 MIN,97112,CPT,,,,,both,, ,454.13,454.13,Blue Cross and Blue Shield,Traditional,,175.75,38.7,percent of total billed charges,454.13,0.82,231.61,percent of total billed charges,38.7
GAIT TRAINING-15 MIN,97116,CPT,,,,,both,, ,342.72,342.72,Blue Cross and Blue Shield,Traditional,,132.63,38.7,percent of total billed charges,342.72,0.82,174.79,percent of total billed charges,38.7
GAIT TRAINING-15 MIN,97116,CPT,,,,,both,, ,454.13,454.13,Blue Cross and Blue Shield,Traditional,,175.75,38.7,percent of total billed charges,454.13,0.82,231.61,percent of total billed charges,38.7
GAIT TRNNG-15MIN OT,97116,CPT,,,,,both,, ,80.34,80.34,Blue Cross and Blue Shield,Traditional,,31.09,38.7,percent of total billed charges,80.34,0.82,40.97,percent of total billed charges,38.7
GAIT TRNNG-15MIN OT,97116,CPT,,,,,both,, ,80.34,80.34,Blue Cross and Blue Shield,Traditional,,31.09,38.7,percent of total billed charges,80.34,0.82,40.97,percent of total billed charges,38.7
GAIT TRNNG-15MIN OT,97116,CPT,,,,,both,, ,80.34,80.34,Blue Cross and Blue Shield,Traditional,,31.09,38.7,percent of total billed charges,80.34,0.82,40.97,percent of total billed charges,38.7
GAIT TRNNG-15MIN OT,97116,CPT,,,,,both,, ,80.34,80.34,Blue Cross and Blue Shield,Traditional,,31.09,38.7,percent of total billed charges,80.34,0.82,40.97,percent of total billed charges,38.7
GAIT TRNNG-15MIN OT,97116,CPT,,,,,both,, ,486.42,486.42,Blue Cross and Blue Shield,Traditional,,188.24,38.7,percent of total billed charges,486.42,0.82,248.07,percent of total billed charges,38.7
GAIT TRNNG-15MIN OT,97116,CPT,,,,,both,, ,486.42,486.42,Blue Cross and Blue Shield,Traditional,,188.24,38.7,percent of total billed charges,486.42,0.82,248.07,percent of total billed charges,38.7
GAIT TRNNG-15MIN PT,97116,CPT,,,,,both,, ,367.20,367.20,Blue Cross and Blue Shield,Traditional,,142.11,38.7,percent of total billed charges,367.20,0.82,187.27,percent of total billed charges,38.7
GAIT TRNNG-15MIN PT,97116,CPT,,,,,both,, ,367.20,367.20,Blue Cross and Blue Shield,Traditional,,142.11,38.7,percent of total billed charges,367.20,0.82,187.27,percent of total billed charges,38.7
MASSAGE THRPY-15 MIN,97124,CPT,,,,,both,, ,294.09,294.09,Blue Cross and Blue Shield,Traditional,,113.81,38.7,percent of total billed charges,294.09,0.82,149.99,percent of total billed charges,38.7
MASSAGE THRPY-15 MIN,97124,CPT,,,,,both,, ,318.84,318.84,Blue Cross and Blue Shield,Traditional,,123.39,38.7,percent of total billed charges,318.84,0.82,162.61,percent of total billed charges,38.7
MASSG THRPY-15MN OT,97124,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29.00,38.7,percent of total billed charges,74.93,0.82,38.21,percent of total billed charges,38.7
MASSG THRPY-15MN OT,97124,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29.00,38.7,percent of total billed charges,74.93,0.82,38.21,percent of total billed charges,38.7
MASSG THRPY-15MN OT,97124,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29.00,38.7,percent of total billed charges,74.93,0.82,38.21,percent of total billed charges,38.7
MASSG THRPY-15MN OT,97124,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29.00,38.7,percent of total billed charges,74.93,0.82,38.21,percent of total billed charges,38.7
MASSG THRPY-15MN OT,97124,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,0.82,174.14,percent of total billed charges,38.7
MASSG THRPY-15MN OT,97124,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,percent of total billed charges,341.45,0.82,174.14,percent of total billed charges,38.7
MASSG THRPY-15MN PT,97124,CPT,,,,,both,, ,314.92,314.92,Blue Cross and Blue Shield,Traditional,,121.87,38.7,percent of total billed charges,314.92,0.82,160.61,percent of total billed charges,38.7
MASSG THRPY-15MN PT,97124,CPT,,,,,both,, ,314.92,314.92,Blue Cross and Blue Shield,Traditional,,121.87,38.7,percent of total billed charges,314.92,0.82,160.61,percent of total billed charges,38.7
COG SKL DV IN15 COTA,97129,CPT,,,,,both,, ,398.10,398.10,Blue Cross and Blue Shield,Traditional,,154.06,38.7,percent of total billed charges,398.10,0.82,203.03,percent of total billed charges,38.7
COG SKL DV INI15 OT,97129,CPT,,,,,both,, ,84.46,84.46,Blue Cross and Blue Shield,Traditional,,32.69,38.7,percent of total billed charges,84.46,0.82,43.07,percent of total billed charges,38.7
COG SKL DV INI15 OT,97129,CPT,,,,,both,, ,84.46,84.46,Blue Cross and Blue Shield,Traditional,,32.69,38.7,percent of total billed charges,84.46,0.82,43.07,percent of total billed charges,38.7
COG SKL DV INI15 OT,97129,CPT,,,,,both,, ,84.46,84.46,Blue Cross and Blue Shield,Traditional,,32.69,38.7,percent of total billed charges,84.46,0.82,43.07,percent of total billed charges,38.7
COG SKL DV INI15 OT,97129,CPT,,,,,both,, ,84.46,84.46,Blue Cross and Blue Shield,Traditional,,32.69,38.7,percent of total billed charges,84.46,0.82,43.07,percent of total billed charges,38.7
COG SKL DV INI15 OT,97129,CPT,,,,,both,, ,398.10,398.10,Blue Cross and Blue Shield,Traditional,,154.06,38.7,percent of total billed charges,398.10,0.82,203.03,percent of total billed charges,38.7
COG SKL DV INI15 PT,97129,CPT,,,,,both,, ,448.57,448.57,Blue Cross and Blue Shield,Traditional,,173.60,38.7,percent of total billed charges,448.57,0.82,228.77,percent of total billed charges,38.7
COG SKL DV INI15 PT,97129,CPT,,,,,both,, ,448.57,448.57,Blue Cross and Blue Shield,Traditional,,173.60,38.7,percent of total billed charges,448.57,0.82,228.77,percent of total billed charges,38.7
COG SKL DV INI15 SP,97129,CPT,,,,,both,, ,398.10,398.10,Blue Cross and Blue Shield,Traditional,,154.06,38.7,percent of total billed charges,398.10,0.82,203.03,percent of total billed charges,38.7
COG SKL DV AD15 COTA,97130,CPT,,,,,both,, ,398.10,398.10,Blue Cross and Blue Shield,Traditional,,154.06,38.7,percent of total billed charges,398.10,0.82,203.03,percent of total billed charges,38.7
COG SKL DV ADD15 OT,97130,CPT,,,,,both,, ,84.46,84.46,Blue Cross and Blue Shield,Traditional,,32.69,38.7,percent of total billed charges,84.46,0.82,43.07,percent of total billed charges,38.7
COG SKL DV ADD15 OT,97130,CPT,,,,,both,, ,84.46,84.46,Blue Cross and Blue Shield,Traditional,,32.69,38.7,percent of total billed charges,84.46,0.82,43.07,percent of total billed charges,38.7
COG SKL DV ADD15 OT,97130,CPT,,,,,both,, ,84.46,84.46,Blue Cross and Blue Shield,Traditional,,32.69,38.7,percent of total billed charges,84.46,0.82,43.07,percent of total billed charges,38.7
COG SKL DV ADD15 OT,97130,CPT,,,,,both,, ,84.46,84.46,Blue Cross and Blue Shield,Traditional,,32.69,38.7,percent of total billed charges,84.46,0.82,43.07,percent of total billed charges,38.7
COG SKL DV ADD15 OT,97130,CPT,,,,,both,, ,398.10,398.10,Blue Cross and Blue Shield,Traditional,,154.06,38.7,percent of total billed charges,398.10,0.82,203.03,percent of total billed charges,38.7
COG SKL DV ADD15 PT,97130,CPT,,,,,both,, ,448.57,448.57,Blue Cross and Blue Shield,Traditional,,173.60,38.7,percent of total billed charges,448.57,0.82,228.77,percent of total billed charges,38.7
COG SKL DV ADD15 PT,97130,CPT,,,,,both,, ,448.57,448.57,Blue Cross and Blue Shield,Traditional,,173.60,38.7,percent of total billed charges,448.57,0.82,228.77,percent of total billed charges,38.7
COG SKL DV ADD15 SP,97130,CPT,,,,,both,, ,398.10,398.10,Blue Cross and Blue Shield,Traditional,,154.06,38.7,percent of total billed charges,398.10,0.82,203.03,percent of total billed charges,38.7
MANUAL THRPY-15 MIN,97140,CPT,,,,,both,, ,342.72,342.72,Blue Cross and Blue Shield,Traditional,,132.63,38.7,percent of total billed charges,342.72,0.82,174.79,percent of total billed charges,38.7
MANUAL THRPY-15 MIN,97140,CPT,,,,,both,, ,454.13,454.13,Blue Cross and Blue Shield,Traditional,,175.75,38.7,percent of total billed charges,454.13,0.82,231.61,percent of total billed charges,38.7
MNL THRPY-15 MIN OT,97140,CPT,,,,,both,, ,73.65,73.65,Blue Cross and Blue Shield,Traditional,,28.50,38.7,percent of total billed charges,73.65,0.82,37.56,percent of total billed charges,38.7
MNL THRPY-15 MIN OT,97140,CPT,,,,,both,, ,73.65,73.65,Blue Cross and Blue Shield,Traditional,,28.50,38.7,percent of total billed charges,73.65,0.82,37.56,percent of total billed charges,38.7
MNL THRPY-15 MIN OT,97140,CPT,,,,,both,, ,73.65,73.65,Blue Cross and Blue Shield,Traditional,,28.50,38.7,percent of total billed charges,73.65,0.82,37.56,percent of total billed charges,38.7
MNL THRPY-15 MIN OT,97140,CPT,,,,,both,, ,73.65,73.65,Blue Cross and Blue Shield,Traditional,,28.50,38.7,percent of total billed charges,73.65,0.82,37.56,percent of total billed charges,38.7
MNL THRPY-15 MIN OT,97140,CPT,,,,,both,, ,486.42,486.42,Blue Cross and Blue Shield,Traditional,,188.24,38.7,percent of total billed charges,486.42,0.82,248.07,percent of total billed charges,38.7
MNL THRPY-15 MIN OT,97140,CPT,,,,,both,, ,486.42,486.42,Blue Cross and Blue Shield,Traditional,,188.24,38.7,percent of total billed charges,486.42,0.82,248.07,percent of total billed charges,38.7
MNL THRPY-15 MIN PT,97140,CPT,,,,,both,, ,367.20,367.20,Blue Cross and Blue Shield,Traditional,,142.11,38.7,percent of total billed charges,367.20,0.82,187.27,percent of total billed charges,38.7
MNL THRPY-15 MIN PT,97140,CPT,,,,,both,, ,367.20,367.20,Blue Cross and Blue Shield,Traditional,,142.11,38.7,percent of total billed charges,367.20,0.82,187.27,percent of total billed charges,38.7
GROUP THRP PROC-VIST,97150,CPT,,,,,both,, ,341.23,341.23,Blue Cross and Blue Shield,Traditional,,132.06,38.7,percent of total billed charges,341.23,0.82,174.03,percent of total billed charges,38.7
GROUP THRP PROC-VIST,97150,CPT,,,,,both,, ,369.92,369.92,Blue Cross and Blue Shield,Traditional,,143.16,38.7,percent of total billed charges,369.92,0.82,188.66,percent of total billed charges,38.7
GRP THRP PRC-VST OT,97150,CPT,,,,,both,, ,48.67,48.67,Blue Cross and Blue Shield,Traditional,,18.84,38.7,percent of total billed charges,48.67,0.82,24.82,percent of total billed charges,38.7
GRP THRP PRC-VST OT,97150,CPT,,,,,both,, ,48.67,48.67,Blue Cross and Blue Shield,Traditional,,18.84,38.7,percent of total billed charges,48.67,0.82,24.82,percent of total billed charges,38.7
GRP THRP PRC-VST OT,97150,CPT,,,,,both,, ,48.67,48.67,Blue Cross and Blue Shield,Traditional,,18.84,38.7,percent of total billed charges,48.67,0.82,24.82,percent of total billed charges,38.7
GRP THRP PRC-VST OT,97150,CPT,,,,,both,, ,48.67,48.67,Blue Cross and Blue Shield,Traditional,,18.84,38.7,percent of total billed charges,48.67,0.82,24.82,percent of total billed charges,38.7
GRP THRP PRC-VST OT,97150,CPT,,,,,both,, ,396.29,396.29,Blue Cross and Blue Shield,Traditional,,153.36,38.7,percent of total billed charges,396.29,0.82,202.11,percent of total billed charges,38.7
GRP THRP PRC-VST OT,97150,CPT,,,,,both,, ,396.29,396.29,Blue Cross and Blue Shield,Traditional,,153.36,38.7,percent of total billed charges,396.29,0.82,202.11,percent of total billed charges,38.7
GRP THRP PRC-VST PT,97150,CPT,,,,,both,, ,365.65,365.65,Blue Cross and Blue Shield,Traditional,,141.51,38.7,percent of total billed charges,365.65,0.82,186.48,percent of total billed charges,38.7
GRP THRP PRC-VST PT,97150,CPT,,,,,both,, ,365.65,365.65,Blue Cross and Blue Shield,Traditional,,141.51,38.7,percent of total billed charges,365.65,0.82,186.48,percent of total billed charges,38.7
PT EVAL- LOW CMP PT,97161,CPT,,,,,both,, ,223.77,223.77,Blue Cross and Blue Shield,Traditional,,86.60,38.7,percent of total billed charges,223.77,0.82,114.12,percent of total billed charges,38.7
PT EVAL- LOW CMP PT,97161,CPT,,,,,both,, ,223.77,223.77,Blue Cross and Blue Shield,Traditional,,86.60,38.7,percent of total billed charges,223.77,0.82,114.12,percent of total billed charges,38.7
PT EVAL- LOW CMP PT,97161,CPT,,,,,both,, ,721.00,721.00,Blue Cross and Blue Shield,Traditional,,279.03,38.7,percent of total billed charges,721.00,0.82,367.71,percent of total billed charges,38.7
PT EVAL- LOW CMP PT,97161,CPT,,,,,both,, ,721.00,721.00,Blue Cross and Blue Shield,Traditional,,279.03,38.7,percent of total billed charges,721.00,0.82,367.71,percent of total billed charges,38.7
PT EVAL- LOW COMP,97161,CPT,,,,,both,, ,673.18,673.18,Blue Cross and Blue Shield,Traditional,,260.52,38.7,percent of total billed charges,673.18,0.82,343.32,percent of total billed charges,38.7
PT-EVAL LOW 15M MCD,97161,CPT,,,,,both,, ,700.00,700.00,Blue Cross and Blue Shield,Traditional,,270.90,38.7,percent of total billed charges,700.00,0.82,357,percent of total billed charges,38.7
PT EVAL- MOD CMP PT,97162,CPT,,,,,both,, ,223.77,223.77,Blue Cross and Blue Shield,Traditional,,86.60,38.7,percent of total billed charges,223.77,0.82,114.12,percent of total billed charges,38.7
PT EVAL- MOD CMP PT,97162,CPT,,,,,both,, ,223.77,223.77,Blue Cross and Blue Shield,Traditional,,86.60,38.7,percent of total billed charges,223.77,0.82,114.12,percent of total billed charges,38.7
PT EVAL- MOD CMP PT,97162,CPT,,,,,both,, ,360.50,360.50,Blue Cross and Blue Shield,Traditional,,139.51,38.7,percent of total billed charges,360.50,0.82,183.86,percent of total billed charges,38.7
PT EVAL- MOD CMP PT,97162,CPT,,,,,both,, ,360.50,360.50,Blue Cross and Blue Shield,Traditional,,139.51,38.7,percent of total billed charges,360.50,0.82,183.86,percent of total billed charges,38.7
PT EVAL- MOD COMP,97162,CPT,,,,,both,, ,673.18,673.18,Blue Cross and Blue Shield,Traditional,,260.52,38.7,percent of total billed charges,673.18,0.82,343.32,percent of total billed charges,38.7
PT-EVAL MOD 15M MCD,97162,CPT,,,,,both,, ,350.00,350.00,Blue Cross and Blue Shield,Traditional,,135.45,38.7,percent of total billed charges,350.00,0.82,178.5,percent of total billed charges,38.7
PT EVAL- HGH CMP PT,97163,CPT,,,,,both,, ,224.03,224.03,Blue Cross and Blue Shield,Traditional,,86.70,38.7,percent of total billed charges,224.03,0.82,114.26,percent of total billed charges,38.7
PT EVAL- HGH CMP PT,97163,CPT,,,,,both,, ,224.03,224.03,Blue Cross and Blue Shield,Traditional,,86.70,38.7,percent of total billed charges,224.03,0.82,114.26,percent of total billed charges,38.7
PT EVAL- HGH CMP PT,97163,CPT,,,,,both,, ,721.00,721.00,Blue Cross and Blue Shield,Traditional,,279.03,38.7,percent of total billed charges,721.00,0.82,367.71,percent of total billed charges,38.7
PT EVAL- HGH CMP PT,97163,CPT,,,,,both,, ,721.00,721.00,Blue Cross and Blue Shield,Traditional,,279.03,38.7,percent of total billed charges,721.00,0.82,367.71,percent of total billed charges,38.7
PT EVAL- HGH COMP,97163,CPT,,,,,both,, ,673.18,673.18,Blue Cross and Blue Shield,Traditional,,260.52,38.7,percent of total billed charges,673.18,0.82,343.32,percent of total billed charges,38.7
PT-EVAL HGH 15M MCD,97163,CPT,,,,,both,, ,233.25,233.25,Blue Cross and Blue Shield,Traditional,,90.27,38.7,percent of total billed charges,233.25,0.82,118.96,percent of total billed charges,38.7
PT RE-EVAL-VISIT,97164,CPT,,,,,both,, ,437.36,437.36,Blue Cross and Blue Shield,Traditional,,169.26,38.7,percent of total billed charges,437.36,0.82,223.05,percent of total billed charges,38.7
PT RE-EVAL-VISIT PT,97164,CPT,,,,,both,, ,151.41,151.41,Blue Cross and Blue Shield,Traditional,,58.60,38.7,percent of total billed charges,151.41,0.82,77.22,percent of total billed charges,38.7
PT RE-EVAL-VISIT PT,97164,CPT,,,,,both,, ,151.41,151.41,Blue Cross and Blue Shield,Traditional,,58.60,38.7,percent of total billed charges,151.41,0.82,77.22,percent of total billed charges,38.7
PT RE-EVAL-VISIT PT,97164,CPT,,,,,both,, ,468.39,468.39,Blue Cross and Blue Shield,Traditional,,181.27,38.7,percent of total billed charges,468.39,0.82,238.88,percent of total billed charges,38.7
PT RE-EVAL-VISIT PT,97164,CPT,,,,,both,, ,468.39,468.39,Blue Cross and Blue Shield,Traditional,,181.27,38.7,percent of total billed charges,468.39,0.82,238.88,percent of total billed charges,38.7
OT EVAL- LOW CMP OT,97165,CPT,,,,,both,, ,223.77,223.77,Blue Cross and Blue Shield,Traditional,,86.60,38.7,percent of total billed charges,223.77,0.82,114.12,percent of total billed charges,38.7
OT EVAL- LOW CMP OT,97165,CPT,,,,,both,, ,781.77,781.77,Blue Cross and Blue Shield,Traditional,,302.54,38.7,percent of total billed charges,781.77,0.82,398.7,percent of total billed charges,38.7
OT EVAL- LOW CMP OT,97165,CPT,,,,,both,, ,781.77,781.77,Blue Cross and Blue Shield,Traditional,,302.54,38.7,percent of total billed charges,781.77,0.82,398.7,percent of total billed charges,38.7
OT EVAL- LOW COMP,97165,CPT,,,,,both,, ,729.80,729.80,Blue Cross and Blue Shield,Traditional,,282.43,38.7,percent of total billed charges,729.80,0.82,372.2,percent of total billed charges,38.7
OT-EVAL LOW 15M MCD,97165,CPT,,,,,both,, ,100.00,100.00,Blue Cross and Blue Shield,Traditional,,38.70,38.7,percent of total billed charges,100.00,0.82,51,percent of total billed charges,38.7
OT-EVAL LOW 15M MCD,97165,CPT,,,,,both,, ,759.00,759.00,Blue Cross and Blue Shield,Traditional,,293.73,38.7,percent of total billed charges,759.00,0.82,387.09,percent of total billed charges,38.7
OT EVAL- MOD CMP OT,97166,CPT,,,,,both,, ,223.77,223.77,Blue Cross and Blue Shield,Traditional,,86.60,38.7,percent of total billed charges,223.77,0.82,114.12,percent of total billed charges,38.7
OT EVAL- MOD CMP OT,97166,CPT,,,,,both,, ,390.89,390.89,Blue Cross and Blue Shield,Traditional,,151.27,38.7,percent of total billed charges,390.89,0.82,199.35,percent of total billed charges,38.7
OT EVAL- MOD CMP OT,97166,CPT,,,,,both,, ,390.89,390.89,Blue Cross and Blue Shield,Traditional,,151.27,38.7,percent of total billed charges,390.89,0.82,199.35,percent of total billed charges,38.7
OT EVAL- MOD COMP,97166,CPT,,,,,both,, ,729.80,729.80,Blue Cross and Blue Shield,Traditional,,282.43,38.7,percent of total billed charges,729.80,0.82,372.2,percent of total billed charges,38.7
OT-EVAL MOD 15M MCD,97166,CPT,,,,,both,, ,100.00,100.00,Blue Cross and Blue Shield,Traditional,,38.70,38.7,percent of total billed charges,100.00,0.82,51,percent of total billed charges,38.7
OT-EVAL MOD 15M MCD,97166,CPT,,,,,both,, ,379.50,379.50,Blue Cross and Blue Shield,Traditional,,146.87,38.7,percent of total billed charges,379.50,0.82,193.55,percent of total billed charges,38.7
OT EVAL- HGH CMP OT,97167,CPT,,,,,both,, ,223.77,223.77,Blue Cross and Blue Shield,Traditional,,86.60,38.7,percent of total billed charges,223.77,0.82,114.12,percent of total billed charges,38.7
OT EVAL- HGH CMP OT,97167,CPT,,,,,both,, ,781.77,781.77,Blue Cross and Blue Shield,Traditional,,302.54,38.7,percent of total billed charges,781.77,0.82,398.7,percent of total billed charges,38.7
OT EVAL- HGH CMP OT,97167,CPT,,,,,both,, ,781.77,781.77,Blue Cross and Blue Shield,Traditional,,302.54,38.7,percent of total billed charges,781.77,0.82,398.7,percent of total billed charges,38.7
OT EVAL- HGH COMP,97167,CPT,,,,,both,, ,729.80,729.80,Blue Cross and Blue Shield,Traditional,,282.43,38.7,percent of total billed charges,729.80,0.82,372.2,percent of total billed charges,38.7
OT-EVAL HGH 15M MCD,97167,CPT,,,,,both,, ,100.00,100.00,Blue Cross and Blue Shield,Traditional,,38.70,38.7,percent of total billed charges,100.00,0.82,51,percent of total billed charges,38.7
OT-EVAL HGH 15M MCD,97167,CPT,,,,,both,, ,253.00,253.00,Blue Cross and Blue Shield,Traditional,,97.91,38.7,percent of total billed charges,253.00,0.82,129.03,percent of total billed charges,38.7
OT RE-EVAL VISIT OT,97168,CPT,,,,,both,, ,151.41,151.41,Blue Cross and Blue Shield,Traditional,,58.60,38.7,percent of total billed charges,151.41,0.82,77.22,percent of total billed charges,38.7
OT RE-EVAL VISIT OT,97168,CPT,,,,,both,, ,151.41,151.41,Blue Cross and Blue Shield,Traditional,,58.60,38.7,percent of total billed charges,151.41,0.82,77.22,percent of total billed charges,38.7
OT RE-EVAL VISIT OT,97168,CPT,,,,,both,, ,507.79,507.79,Blue Cross and Blue Shield,Traditional,,196.51,38.7,percent of total billed charges,507.79,0.82,258.97,percent of total billed charges,38.7
OT RE-EVAL VISIT OT,97168,CPT,,,,,both,, ,507.79,507.79,Blue Cross and Blue Shield,Traditional,,196.51,38.7,percent of total billed charges,507.79,0.82,258.97,percent of total billed charges,38.7
OT RE-EVAL-VISIT,97168,CPT,,,,,both,, ,474.13,474.13,Blue Cross and Blue Shield,Traditional,,183.49,38.7,percent of total billed charges,474.13,0.82,241.81,percent of total billed charges,38.7
THER ACTVT-15MIN OT,97530,CPT,,,,,both,, ,104.29,104.29,Blue Cross and Blue Shield,Traditional,,40.36,38.7,percent of total billed charges,104.29,0.82,53.19,percent of total billed charges,38.7
THER ACTVT-15MIN OT,97530,CPT,,,,,both,, ,104.29,104.29,Blue Cross and Blue Shield,Traditional,,40.36,38.7,percent of total billed charges,104.29,0.82,53.19,percent of total billed charges,38.7
THER ACTVT-15MIN OT,97530,CPT,,,,,both,, ,104.29,104.29,Blue Cross and Blue Shield,Traditional,,40.36,38.7,percent of total billed charges,104.29,0.82,53.19,percent of total billed charges,38.7
THER ACTVT-15MIN OT,97530,CPT,,,,,both,, ,104.29,104.29,Blue Cross and Blue Shield,Traditional,,40.36,38.7,percent of total billed charges,104.29,0.82,53.19,percent of total billed charges,38.7
THER ACTVT-15MIN OT,97530,CPT,,,,,both,, ,398.10,398.10,Blue Cross and Blue Shield,Traditional,,154.06,38.7,percent of total billed charges,398.10,0.82,203.03,percent of total billed charges,38.7
THER ACTVT-15MIN OT,97530,CPT,,,,,both,, ,398.10,398.10,Blue Cross and Blue Shield,Traditional,,154.06,38.7,percent of total billed charges,398.10,0.82,203.03,percent of total billed charges,38.7
THER ACTVT-15MIN PT,97530,CPT,,,,,both,, ,367.20,367.20,Blue Cross and Blue Shield,Traditional,,142.11,38.7,percent of total billed charges,367.20,0.82,187.27,percent of total billed charges,38.7
THER ACTVT-15MIN PT,97530,CPT,,,,,both,, ,367.20,367.20,Blue Cross and Blue Shield,Traditional,,142.11,38.7,percent of total billed charges,367.20,0.82,187.27,percent of total billed charges,38.7
THERAP ACTVTS-15 MIN,97530,CPT,,,,,both,, ,342.72,342.72,Blue Cross and Blue Shield,Traditional,,132.63,38.7,percent of total billed charges,342.72,0.82,174.79,percent of total billed charges,38.7
THERAP ACTVTS-15 MIN,97530,CPT,,,,,both,, ,371.55,371.55,Blue Cross and Blue Shield,Traditional,,143.79,38.7,percent of total billed charges,371.55,0.82,189.49,percent of total billed charges,38.7
SENS INTG-15 MIN,97533,CPT,,,,,both,, ,167.89,167.89,Blue Cross and Blue Shield,Traditional,,64.97,38.7,percent of total billed charges,167.89,0.82,85.62,percent of total billed charges,38.7
SENS INTG-15 MIN OT,97533,CPT,,,,,both,, ,90.13,90.13,Blue Cross and Blue Shield,Traditional,,34.88,38.7,percent of total billed charges,90.13,0.82,45.97,percent of total billed charges,38.7
SENS INTG-15 MIN OT,97533,CPT,,,,,both,, ,90.13,90.13,Blue Cross and Blue Shield,Traditional,,34.88,38.7,percent of total billed charges,90.13,0.82,45.97,percent of total billed charges,38.7
SENS INTG-15 MIN OT,97533,CPT,,,,,both,, ,687.27,687.27,Blue Cross and Blue Shield,Traditional,,265.97,38.7,percent of total billed charges,687.27,0.82,350.51,percent of total billed charges,38.7
SENS INTG-15 MIN OT,97533,CPT,,,,,both,, ,687.27,687.27,Blue Cross and Blue Shield,Traditional,,265.97,38.7,percent of total billed charges,687.27,0.82,350.51,percent of total billed charges,38.7
SENSORY INTEG-15 MIN,97533,CPT,,,,,both,, ,641.59,641.59,Blue Cross and Blue Shield,Traditional,,248.30,38.7,percent of total billed charges,641.59,0.82,327.21,percent of total billed charges,38.7
SELF CARE MGT-15 MIN,97535,CPT,,,,,both,, ,342.72,342.72,Blue Cross and Blue Shield,Traditional,,132.63,38.7,percent of total billed charges,342.72,0.82,174.79,percent of total billed charges,38.7
SELF CARE MGT-15 MIN,97535,CPT,,,,,both,, ,371.55,371.55,Blue Cross and Blue Shield,Traditional,,143.79,38.7,percent of total billed charges,371.55,0.82,189.49,percent of total billed charges,38.7
SLF CRE MGT-15MN OT,97535,CPT,,,,,both,, ,90.13,90.13,Blue Cross and Blue Shield,Traditional,,34.88,38.7,percent of total billed charges,90.13,0.82,45.97,percent of total billed charges,38.7
SLF CRE MGT-15MN OT,97535,CPT,,,,,both,, ,90.13,90.13,Blue Cross and Blue Shield,Traditional,,34.88,38.7,percent of total billed charges,90.13,0.82,45.97,percent of total billed charges,38.7
SLF CRE MGT-15MN OT,97535,CPT,,,,,both,, ,90.13,90.13,Blue Cross and Blue Shield,Traditional,,34.88,38.7,percent of total billed charges,90.13,0.82,45.97,percent of total billed charges,38.7
SLF CRE MGT-15MN OT,97535,CPT,,,,,both,, ,90.13,90.13,Blue Cross and Blue Shield,Traditional,,34.88,38.7,percent of total billed charges,90.13,0.82,45.97,percent of total billed charges,38.7
SLF CRE MGT-15MN OT,97535,CPT,,,,,both,, ,398.10,398.10,Blue Cross and Blue Shield,Traditional,,154.06,38.7,percent of total billed charges,398.10,0.82,203.03,percent of total billed charges,38.7
SLF CRE MGT-15MN OT,97535,CPT,,,,,both,, ,398.10,398.10,Blue Cross and Blue Shield,Traditional,,154.06,38.7,percent of total billed charges,398.10,0.82,203.03,percent of total billed charges,38.7
SLF CRE MGT-15MN PT,97535,CPT,,,,,both,, ,367.20,367.20,Blue Cross and Blue Shield,Traditional,,142.11,38.7,percent of total billed charges,367.20,0.82,187.27,percent of total billed charges,38.7
SLF CRE MGT-15MN PT,97535,CPT,,,,,both,, ,367.20,367.20,Blue Cross and Blue Shield,Traditional,,142.11,38.7,percent of total billed charges,367.20,0.82,187.27,percent of total billed charges,38.7
COM-WK REIN-15MN OT,97537,CPT,,,,,both,, ,86.78,86.78,Blue Cross and Blue Shield,Traditional,,33.58,38.7,percent of total billed charges,86.78,0.82,44.26,percent of total billed charges,38.7
COM-WK REIN-15MN OT,97537,CPT,,,,,both,, ,86.78,86.78,Blue Cross and Blue Shield,Traditional,,33.58,38.7,percent of total billed charges,86.78,0.82,44.26,percent of total billed charges,38.7
COM-WK REIN-15MN OT,97537,CPT,,,,,both,, ,86.78,86.78,Blue Cross and Blue Shield,Traditional,,33.58,38.7,percent of total billed charges,86.78,0.82,44.26,percent of total billed charges,38.7
COM-WK REIN-15MN OT,97537,CPT,,,,,both,, ,86.78,86.78,Blue Cross and Blue Shield,Traditional,,33.58,38.7,percent of total billed charges,86.78,0.82,44.26,percent of total billed charges,38.7
COM-WK REIN-15MN OT,97537,CPT,,,,,both,, ,486.42,486.42,Blue Cross and Blue Shield,Traditional,,188.24,38.7,percent of total billed charges,486.42,0.82,248.07,percent of total billed charges,38.7
COM-WK REIN-15MN OT,97537,CPT,,,,,both,, ,486.42,486.42,Blue Cross and Blue Shield,Traditional,,188.24,38.7,percent of total billed charges,486.42,0.82,248.07,percent of total billed charges,38.7
COM-WK REIN-15MN PT,97537,CPT,,,,,both,, ,448.57,448.57,Blue Cross and Blue Shield,Traditional,,173.60,38.7,percent of total billed charges,448.57,0.82,228.77,percent of total billed charges,38.7
COM-WK REIN-15MN PT,97537,CPT,,,,,both,, ,448.57,448.57,Blue Cross and Blue Shield,Traditional,,173.60,38.7,percent of total billed charges,448.57,0.82,228.77,percent of total billed charges,38.7
COM-WRK REINT-15 MIN,97537,CPT,,,,,both,, ,418.86,418.86,Blue Cross and Blue Shield,Traditional,,162.10,38.7,percent of total billed charges,418.86,0.82,213.62,percent of total billed charges,38.7
COM-WRK REINT-15 MIN,97537,CPT,,,,,both,, ,454.13,454.13,Blue Cross and Blue Shield,Traditional,,175.75,38.7,percent of total billed charges,454.13,0.82,231.61,percent of total billed charges,38.7
WHEELCHR MGT-15 MIN,97542,CPT,,,,,both,, ,418.86,418.86,Blue Cross and Blue Shield,Traditional,,162.10,38.7,percent of total billed charges,418.86,0.82,213.62,percent of total billed charges,38.7
WHEELCHR MGT-15 MIN,97542,CPT,,,,,both,, ,454.13,454.13,Blue Cross and Blue Shield,Traditional,,175.75,38.7,percent of total billed charges,454.13,0.82,231.61,percent of total billed charges,38.7
WHLCHR MGT-15 MIN OT,97542,CPT,,,,,both,, ,87.55,87.55,Blue Cross and Blue Shield,Traditional,,33.88,38.7,percent of total billed charges,87.55,0.82,44.65,percent of total billed charges,38.7
WHLCHR MGT-15 MIN OT,97542,CPT,,,,,both,, ,87.55,87.55,Blue Cross and Blue Shield,Traditional,,33.88,38.7,percent of total billed charges,87.55,0.82,44.65,percent of total billed charges,38.7
WHLCHR MGT-15 MIN OT,97542,CPT,,,,,both,, ,87.55,87.55,Blue Cross and Blue Shield,Traditional,,33.88,38.7,percent of total billed charges,87.55,0.82,44.65,percent of total billed charges,38.7
WHLCHR MGT-15 MIN OT,97542,CPT,,,,,both,, ,87.55,87.55,Blue Cross and Blue Shield,Traditional,,33.88,38.7,percent of total billed charges,87.55,0.82,44.65,percent of total billed charges,38.7
WHLCHR MGT-15 MIN OT,97542,CPT,,,,,both,, ,486.42,486.42,Blue Cross and Blue Shield,Traditional,,188.24,38.7,percent of total billed charges,486.42,0.82,248.07,percent of total billed charges,38.7
WHLCHR MGT-15 MIN OT,97542,CPT,,,,,both,, ,486.42,486.42,Blue Cross and Blue Shield,Traditional,,188.24,38.7,percent of total billed charges,486.42,0.82,248.07,percent of total billed charges,38.7
WHLCHR MGT-15 MIN PT,97542,CPT,,,,,both,, ,448.57,448.57,Blue Cross and Blue Shield,Traditional,,173.60,38.7,percent of total billed charges,448.57,0.82,228.77,percent of total billed charges,38.7
WHLCHR MGT-15 MIN PT,97542,CPT,,,,,both,, ,448.57,448.57,Blue Cross and Blue Shield,Traditional,,173.60,38.7,percent of total billed charges,448.57,0.82,228.77,percent of total billed charges,38.7
WK HR-CD 1ST 2HR OT,97545,CPT,,,,,both,, ,1121.67,1121.67,Blue Cross and Blue Shield,Traditional,,434.09,38.7,percent of total billed charges,1121.67,0.82,572.05,percent of total billed charges,38.7
WK HR-CD 1ST 2HR OT,97545,CPT,,,,,both,, ,1121.67,1121.67,Blue Cross and Blue Shield,Traditional,,434.09,38.7,percent of total billed charges,1121.67,0.82,572.05,percent of total billed charges,38.7
WK HR-CD 1ST 2HR OT,97545,CPT,,,,,both,, ,1121.67,1121.67,Blue Cross and Blue Shield,Traditional,,434.09,38.7,percent of total billed charges,1121.67,0.82,572.05,percent of total billed charges,38.7
WK HR-CD 1ST 2HR OT,97545,CPT,,,,,both,, ,1121.67,1121.67,Blue Cross and Blue Shield,Traditional,,434.09,38.7,percent of total billed charges,1121.67,0.82,572.05,percent of total billed charges,38.7
WK HR-CD 1ST 2HR OT,97545,CPT,,,,,both,, ,1215.92,1215.92,Blue Cross and Blue Shield,Traditional,,470.56,38.7,percent of total billed charges,1215.92,0.82,620.12,percent of total billed charges,38.7
WK HR-CD 1ST 2HR OT,97545,CPT,,,,,both,, ,1215.92,1215.92,Blue Cross and Blue Shield,Traditional,,470.56,38.7,percent of total billed charges,1215.92,0.82,620.12,percent of total billed charges,38.7
WK HR-CD 1ST 2HR PT,97545,CPT,,,,,both,, ,206.00,206.00,Blue Cross and Blue Shield,Traditional,,79.72,38.7,percent of total billed charges,206.00,0.82,105.06,percent of total billed charges,38.7
WK HR-CD 1ST 2HR PT,97545,CPT,,,,,both,, ,206.00,206.00,Blue Cross and Blue Shield,Traditional,,79.72,38.7,percent of total billed charges,206.00,0.82,105.06,percent of total billed charges,38.7
WRK HAR-CND 1ST 2HRS,97545,CPT,,,,,both,, ,1047.07,1047.07,Blue Cross and Blue Shield,Traditional,,405.22,38.7,percent of total billed charges,1047.07,0.82,534.01,percent of total billed charges,38.7
WRK HAR-CND 1ST 2HRS,97545,CPT,,,,,both,, ,1135.14,1135.14,Blue Cross and Blue Shield,Traditional,,439.30,38.7,percent of total billed charges,1135.14,0.82,578.92,percent of total billed charges,38.7
WRK HAR-CND-ADD HR,97546,CPT,,,,,both,, ,460.55,460.55,Blue Cross and Blue Shield,Traditional,,178.23,38.7,percent of total billed charges,460.55,0.82,234.88,percent of total billed charges,38.7
WRK HAR-CND-ADD HR,97546,CPT,,,,,both,, ,567.57,567.57,Blue Cross and Blue Shield,Traditional,,219.65,38.7,percent of total billed charges,567.57,0.82,289.46,percent of total billed charges,38.7
WRK HAR-CND-ADHR OT,97546,CPT,,,,,both,, ,103.00,103.00,Blue Cross and Blue Shield,Traditional,,39.86,38.7,percent of total billed charges,103.00,0.82,52.53,percent of total billed charges,38.7
WRK HAR-CND-ADHR OT,97546,CPT,,,,,both,, ,103.00,103.00,Blue Cross and Blue Shield,Traditional,,39.86,38.7,percent of total billed charges,103.00,0.82,52.53,percent of total billed charges,38.7
WRK HAR-CND-ADHR OT,97546,CPT,,,,,both,, ,103.00,103.00,Blue Cross and Blue Shield,Traditional,,39.86,38.7,percent of total billed charges,103.00,0.82,52.53,percent of total billed charges,38.7
WRK HAR-CND-ADHR OT,97546,CPT,,,,,both,, ,103.00,103.00,Blue Cross and Blue Shield,Traditional,,39.86,38.7,percent of total billed charges,103.00,0.82,52.53,percent of total billed charges,38.7
WRK HAR-CND-ADHR OT,97546,CPT,,,,,both,, ,607.96,607.96,Blue Cross and Blue Shield,Traditional,,235.28,38.7,percent of total billed charges,607.96,0.82,310.06,percent of total billed charges,38.7
WRK HAR-CND-ADHR OT,97546,CPT,,,,,both,, ,607.96,607.96,Blue Cross and Blue Shield,Traditional,,235.28,38.7,percent of total billed charges,607.96,0.82,310.06,percent of total billed charges,38.7
WRK HAR-CND-ADHR PT,97546,CPT,,,,,both,, ,493.37,493.37,Blue Cross and Blue Shield,Traditional,,190.93,38.7,percent of total billed charges,493.37,0.82,251.62,percent of total billed charges,38.7
WRK HAR-CND-ADHR PT,97546,CPT,,,,,both,, ,493.37,493.37,Blue Cross and Blue Shield,Traditional,,190.93,38.7,percent of total billed charges,493.37,0.82,251.62,percent of total billed charges,38.7
DEBRDE LE 20SQCM OT,97597,CPT,,,,,both,, ,447.54,447.54,Blue Cross and Blue Shield,Traditional,,173.20,38.7,percent of total billed charges,447.54,0.82,228.25,percent of total billed charges,38.7
DEBRDE LE 20SQCM OT,97597,CPT,,,,,both,, ,447.54,447.54,Blue Cross and Blue Shield,Traditional,,173.20,38.7,percent of total billed charges,447.54,0.82,228.25,percent of total billed charges,38.7
DEBRDE LE 20SQCM OT,97597,CPT,,,,,both,, ,447.54,447.54,Blue Cross and Blue Shield,Traditional,,173.20,38.7,percent of total billed charges,447.54,0.82,228.25,percent of total billed charges,38.7
DEBRDE LE 20SQCM OT,97597,CPT,,,,,both,, ,447.54,447.54,Blue Cross and Blue Shield,Traditional,,173.20,38.7,percent of total billed charges,447.54,0.82,228.25,percent of total billed charges,38.7
DEBRDE LE 20SQCM OT,97597,CPT,,,,,both,, ,731.82,731.82,Blue Cross and Blue Shield,Traditional,,283.21,38.7,percent of total billed charges,731.82,0.82,373.23,percent of total billed charges,38.7
DEBRDE LE 20SQCM OT,97597,CPT,,,,,both,, ,731.82,731.82,Blue Cross and Blue Shield,Traditional,,283.21,38.7,percent of total billed charges,731.82,0.82,373.23,percent of total billed charges,38.7
DEBRDE LE 20SQCM PT,97597,CPT,,,,,both,, ,675.17,675.17,Blue Cross and Blue Shield,Traditional,,261.29,38.7,percent of total billed charges,675.17,0.82,344.34,percent of total billed charges,38.7
DEBRDE LE 20SQCM PT,97597,CPT,,,,,both,, ,675.17,675.17,Blue Cross and Blue Shield,Traditional,,261.29,38.7,percent of total billed charges,675.17,0.82,344.34,percent of total billed charges,38.7
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,252.25,252.25,Blue Cross and Blue Shield,Traditional,,97.62,38.7,percent of total billed charges,252.25,0.82,128.65,percent of total billed charges,38.7
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,252.25,252.25,Blue Cross and Blue Shield,Traditional,,97.62,38.7,percent of total billed charges,252.25,0.82,128.65,percent of total billed charges,38.7
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,259.82,259.82,Blue Cross and Blue Shield,Traditional,,100.55,38.7,percent of total billed charges,259.82,0.82,132.51,percent of total billed charges,38.7
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,259.82,259.82,Blue Cross and Blue Shield,Traditional,,100.55,38.7,percent of total billed charges,259.82,0.82,132.51,percent of total billed charges,38.7
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,630.26,630.26,Blue Cross and Blue Shield,Traditional,,243.91,38.7,percent of total billed charges,630.26,0.82,321.43,percent of total billed charges,38.7
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,683.29,683.29,Blue Cross and Blue Shield,Traditional,,264.43,38.7,percent of total billed charges,683.29,0.82,348.48,percent of total billed charges,38.7
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,861.67,861.67,Blue Cross and Blue Shield,Traditional,,333.47,38.7,percent of total billed charges,861.67,0.82,439.45,percent of total billed charges,38.7
SLCTV WND DEB =<20CM,97597,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,0.82,389.13,percent of total billed charges,38.7
DEBRDE EA AD20CM OT,97598,CPT,,,,,both,, ,450.63,450.63,Blue Cross and Blue Shield,Traditional,,174.39,38.7,percent of total billed charges,450.63,0.82,229.82,percent of total billed charges,38.7
DEBRDE EA AD20CM OT,97598,CPT,,,,,both,, ,450.63,450.63,Blue Cross and Blue Shield,Traditional,,174.39,38.7,percent of total billed charges,450.63,0.82,229.82,percent of total billed charges,38.7
DEBRDE EA AD20CM OT,97598,CPT,,,,,both,, ,488.48,488.48,Blue Cross and Blue Shield,Traditional,,189.04,38.7,percent of total billed charges,488.48,0.82,249.12,percent of total billed charges,38.7
DEBRDE EA AD20CM OT,97598,CPT,,,,,both,, ,488.48,488.48,Blue Cross and Blue Shield,Traditional,,189.04,38.7,percent of total billed charges,488.48,0.82,249.12,percent of total billed charges,38.7
DEBRDE EA AD20CM PT,97598,CPT,,,,,both,, ,450.63,450.63,Blue Cross and Blue Shield,Traditional,,174.39,38.7,percent of total billed charges,450.63,0.82,229.82,percent of total billed charges,38.7
DEBRDE EA AD20CM PT,97598,CPT,,,,,both,, ,450.63,450.63,Blue Cross and Blue Shield,Traditional,,174.39,38.7,percent of total billed charges,450.63,0.82,229.82,percent of total billed charges,38.7
DEBRDE EA AD20CM PT,97598,CPT,,,,,both,, ,450.63,450.63,Blue Cross and Blue Shield,Traditional,,174.39,38.7,percent of total billed charges,450.63,0.82,229.82,percent of total billed charges,38.7
DEBRDE EA AD20CM PT,97598,CPT,,,,,both,, ,450.63,450.63,Blue Cross and Blue Shield,Traditional,,174.39,38.7,percent of total billed charges,450.63,0.82,229.82,percent of total billed charges,38.7
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,252.25,252.25,Blue Cross and Blue Shield,Traditional,,97.62,38.7,percent of total billed charges,252.25,0.82,128.65,percent of total billed charges,38.7
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,252.25,252.25,Blue Cross and Blue Shield,Traditional,,97.62,38.7,percent of total billed charges,252.25,0.82,128.65,percent of total billed charges,38.7
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,259.82,259.82,Blue Cross and Blue Shield,Traditional,,100.55,38.7,percent of total billed charges,259.82,0.82,132.51,percent of total billed charges,38.7
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,259.82,259.82,Blue Cross and Blue Shield,Traditional,,100.55,38.7,percent of total billed charges,259.82,0.82,132.51,percent of total billed charges,38.7
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,420.57,420.57,Blue Cross and Blue Shield,Traditional,,162.76,38.7,percent of total billed charges,420.57,0.82,214.49,percent of total billed charges,38.7
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,455.94,455.94,Blue Cross and Blue Shield,Traditional,,176.45,38.7,percent of total billed charges,455.94,0.82,232.53,percent of total billed charges,38.7
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,575.10,575.10,Blue Cross and Blue Shield,Traditional,,222.56,38.7,percent of total billed charges,575.10,0.82,293.3,percent of total billed charges,38.7
SLCTV WND DEB >20 CM,97598,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,0.82,389.13,percent of total billed charges,38.7
DBRD NON-SEL-VIS OT,97602,CPT,,,,,both,, ,447.54,447.54,Blue Cross and Blue Shield,Traditional,,173.20,38.7,percent of total billed charges,447.54,0.82,228.25,percent of total billed charges,38.7
DBRD NON-SEL-VIS OT,97602,CPT,,,,,both,, ,447.54,447.54,Blue Cross and Blue Shield,Traditional,,173.20,38.7,percent of total billed charges,447.54,0.82,228.25,percent of total billed charges,38.7
DBRD NON-SEL-VIS OT,97602,CPT,,,,,both,, ,447.54,447.54,Blue Cross and Blue Shield,Traditional,,173.20,38.7,percent of total billed charges,447.54,0.82,228.25,percent of total billed charges,38.7
DBRD NON-SEL-VIS OT,97602,CPT,,,,,both,, ,447.54,447.54,Blue Cross and Blue Shield,Traditional,,173.20,38.7,percent of total billed charges,447.54,0.82,228.25,percent of total billed charges,38.7
DBRD NON-SEL-VIS OT,97602,CPT,,,,,both,, ,521.70,521.70,Blue Cross and Blue Shield,Traditional,,201.90,38.7,percent of total billed charges,521.70,0.82,266.07,percent of total billed charges,38.7
DBRD NON-SEL-VIS OT,97602,CPT,,,,,both,, ,521.70,521.70,Blue Cross and Blue Shield,Traditional,,201.90,38.7,percent of total billed charges,521.70,0.82,266.07,percent of total billed charges,38.7
DBRD NON-SEL-VIS PT,97602,CPT,,,,,both,, ,481.27,481.27,Blue Cross and Blue Shield,Traditional,,186.25,38.7,percent of total billed charges,481.27,0.82,245.45,percent of total billed charges,38.7
DBRD NON-SEL-VIS PT,97602,CPT,,,,,both,, ,481.27,481.27,Blue Cross and Blue Shield,Traditional,,186.25,38.7,percent of total billed charges,481.27,0.82,245.45,percent of total billed charges,38.7
DEBRIDE NON-SELC-VIS,97602,CPT,,,,,both,, ,449.32,449.32,Blue Cross and Blue Shield,Traditional,,173.89,38.7,percent of total billed charges,449.32,0.82,229.15,percent of total billed charges,38.7
DEBRIDE NON-SELC-VIS,97602,CPT,,,,,both,, ,487.13,487.13,Blue Cross and Blue Shield,Traditional,,188.52,38.7,percent of total billed charges,487.13,0.82,248.44,percent of total billed charges,38.7
NON SELECTIVE DEBRID,97602,CPT,,,,,both,, ,158.11,158.11,Blue Cross and Blue Shield,Traditional,,61.19,38.7,percent of total billed charges,158.11,0.82,80.64,percent of total billed charges,38.7
NON SELECTIVE DEBRID,97602,CPT,,,,,both,, ,158.11,158.11,Blue Cross and Blue Shield,Traditional,,61.19,38.7,percent of total billed charges,158.11,0.82,80.64,percent of total billed charges,38.7
NSW DEB WO A/SESSION,97602,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,0.82,389.13,percent of total billed charges,38.7
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,146.78,146.78,Blue Cross and Blue Shield,Traditional,,56.80,38.7,percent of total billed charges,146.78,0.82,74.86,percent of total billed charges,38.7
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,158.11,158.11,Blue Cross and Blue Shield,Traditional,,61.19,38.7,percent of total billed charges,158.11,0.82,80.64,percent of total billed charges,38.7
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,158.11,158.11,Blue Cross and Blue Shield,Traditional,,61.19,38.7,percent of total billed charges,158.11,0.82,80.64,percent of total billed charges,38.7
NEG PRESS WND TX <50,97605,CPT,,,,,both,, ,763.00,763.00,Blue Cross and Blue Shield,Traditional,,295.28,38.7,percent of total billed charges,763.00,0.82,389.13,percent of total billed charges,38.7
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,241.28,241.28,Blue Cross and Blue Shield,Traditional,,93.38,38.7,percent of total billed charges,241.28,0.82,123.05,percent of total billed charges,38.7
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,259.82,259.82,Blue Cross and Blue Shield,Traditional,,100.55,38.7,percent of total billed charges,259.82,0.82,132.51,percent of total billed charges,38.7
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,259.82,259.82,Blue Cross and Blue Shield,Traditional,,100.55,38.7,percent of total billed charges,259.82,0.82,132.51,percent of total billed charges,38.7
NEG PRESS WND TX >50,97606,CPT,,,,,both,, ,1520.00,1520.00,Blue Cross and Blue Shield,Traditional,,588.24,38.7,percent of total billed charges,1520.00,0.82,775.2,percent of total billed charges,38.7
NEG PR WN MD LT 50CM,97607,CPT,,,,,both,, ,463.24,463.24,Blue Cross and Blue Shield,Traditional,,179.27,38.7,percent of total billed charges,463.24,0.82,236.25,percent of total billed charges,38.7
NEG PR WN MD LT 50CM,97607,CPT,,,,,both,, ,463.24,463.24,Blue Cross and Blue Shield,Traditional,,179.27,38.7,percent of total billed charges,463.24,0.82,236.25,percent of total billed charges,38.7
NEG PRES WND TX <=50,97607,CPT,,,,,both,, ,1520.00,1520.00,Blue Cross and Blue Shield,Traditional,,588.24,38.7,percent of total billed charges,1520.00,0.82,775.2,percent of total billed charges,38.7
NEG PR WN MD GT 50CM,97608,CPT,,,,,both,, ,919.79,919.79,Blue Cross and Blue Shield,Traditional,,355.96,38.7,percent of total billed charges,919.79,0.82,469.09,percent of total billed charges,38.7
PHYS PERF-15 MIN OT,97750,CPT,,,,,both,, ,91.93,91.93,Blue Cross and Blue Shield,Traditional,,35.58,38.7,percent of total billed charges,91.93,0.82,46.88,percent of total billed charges,38.7
PHYS PERF-15 MIN OT,97750,CPT,,,,,both,, ,91.93,91.93,Blue Cross and Blue Shield,Traditional,,35.58,38.7,percent of total billed charges,91.93,0.82,46.88,percent of total billed charges,38.7
PHYS PERF-15 MIN OT,97750,CPT,,,,,both,, ,91.93,91.93,Blue Cross and Blue Shield,Traditional,,35.58,38.7,percent of total billed charges,91.93,0.82,46.88,percent of total billed charges,38.7
PHYS PERF-15 MIN OT,97750,CPT,,,,,both,, ,91.93,91.93,Blue Cross and Blue Shield,Traditional,,35.58,38.7,percent of total billed charges,91.93,0.82,46.88,percent of total billed charges,38.7
PHYS PERF-15 MIN OT,97750,CPT,,,,,both,, ,1014.55,1014.55,Blue Cross and Blue Shield,Traditional,,392.63,38.7,percent of total billed charges,1014.55,0.82,517.42,percent of total billed charges,38.7
PHYS PERF-15 MIN OT,97750,CPT,,,,,both,, ,1014.55,1014.55,Blue Cross and Blue Shield,Traditional,,392.63,38.7,percent of total billed charges,1014.55,0.82,517.42,percent of total billed charges,38.7
PHYS PERF-15 MIN PT,97750,CPT,,,,,both,, ,936.01,936.01,Blue Cross and Blue Shield,Traditional,,362.24,38.7,percent of total billed charges,936.01,0.82,477.37,percent of total billed charges,38.7
PHYS PERF-15 MIN PT,97750,CPT,,,,,both,, ,936.01,936.01,Blue Cross and Blue Shield,Traditional,,362.24,38.7,percent of total billed charges,936.01,0.82,477.37,percent of total billed charges,38.7
PHYSICAL PERF-15 MIN,97750,CPT,,,,,both,, ,873.68,873.68,Blue Cross and Blue Shield,Traditional,,338.11,38.7,percent of total billed charges,873.68,0.82,445.58,percent of total billed charges,38.7
PHYSICAL PERF-15 MIN,97750,CPT,,,,,both,, ,947.11,947.11,Blue Cross and Blue Shield,Traditional,,366.53,38.7,percent of total billed charges,947.11,0.82,483.03,percent of total billed charges,38.7
ORTH TRAIN INI-15 MI,97760,CPT,,,,,both,, ,342.72,342.72,Blue Cross and Blue Shield,Traditional,,132.63,38.7,percent of total billed charges,342.72,0.82,174.79,percent of total billed charges,38.7
ORTH TRAIN INI-15 MI,97760,CPT,,,,,both,, ,371.55,371.55,Blue Cross and Blue Shield,Traditional,,143.79,38.7,percent of total billed charges,371.55,0.82,189.49,percent of total billed charges,38.7
ORTH TRN INI15MI OT,97760,CPT,,,,,both,, ,124.12,124.12,Blue Cross and Blue Shield,Traditional,,48.03,38.7,percent of total billed charges,124.12,0.82,63.3,percent of total billed charges,38.7
ORTH TRN INI15MI OT,97760,CPT,,,,,both,, ,124.12,124.12,Blue Cross and Blue Shield,Traditional,,48.03,38.7,percent of total billed charges,124.12,0.82,63.3,percent of total billed charges,38.7
ORTH TRN INI15MI OT,97760,CPT,,,,,both,, ,124.12,124.12,Blue Cross and Blue Shield,Traditional,,48.03,38.7,percent of total billed charges,124.12,0.82,63.3,percent of total billed charges,38.7
ORTH TRN INI15MI OT,97760,CPT,,,,,both,, ,124.12,124.12,Blue Cross and Blue Shield,Traditional,,48.03,38.7,percent of total billed charges,124.12,0.82,63.3,percent of total billed charges,38.7
ORTH TRN INI15MI OT,97760,CPT,,,,,both,, ,398.10,398.10,Blue Cross and Blue Shield,Traditional,,154.06,38.7,percent of total billed charges,398.10,0.82,203.03,percent of total billed charges,38.7
ORTH TRN INI15MI OT,97760,CPT,,,,,both,, ,398.10,398.10,Blue Cross and Blue Shield,Traditional,,154.06,38.7,percent of total billed charges,398.10,0.82,203.03,percent of total billed charges,38.7
ORTH TRN INI15MI PT,97760,CPT,,,,,both,, ,367.20,367.20,Blue Cross and Blue Shield,Traditional,,142.11,38.7,percent of total billed charges,367.20,0.82,187.27,percent of total billed charges,38.7
ORTH TRN INI15MI PT,97760,CPT,,,,,both,, ,367.20,367.20,Blue Cross and Blue Shield,Traditional,,142.11,38.7,percent of total billed charges,367.20,0.82,187.27,percent of total billed charges,38.7
PROS TRAIN INI-15 MI,97761,CPT,,,,,both,, ,342.72,342.72,Blue Cross and Blue Shield,Traditional,,132.63,38.7,percent of total billed charges,342.72,0.82,174.79,percent of total billed charges,38.7
PROS TRAIN INI-15 MI,97761,CPT,,,,,both,, ,371.55,371.55,Blue Cross and Blue Shield,Traditional,,143.79,38.7,percent of total billed charges,371.55,0.82,189.49,percent of total billed charges,38.7
PROS TRN INI15MI OT,97761,CPT,,,,,both,, ,107.38,107.38,Blue Cross and Blue Shield,Traditional,,41.56,38.7,percent of total billed charges,107.38,0.82,54.76,percent of total billed charges,38.7
PROS TRN INI15MI OT,97761,CPT,,,,,both,, ,107.38,107.38,Blue Cross and Blue Shield,Traditional,,41.56,38.7,percent of total billed charges,107.38,0.82,54.76,percent of total billed charges,38.7
PROS TRN INI15MI OT,97761,CPT,,,,,both,, ,107.38,107.38,Blue Cross and Blue Shield,Traditional,,41.56,38.7,percent of total billed charges,107.38,0.82,54.76,percent of total billed charges,38.7
PROS TRN INI15MI OT,97761,CPT,,,,,both,, ,107.38,107.38,Blue Cross and Blue Shield,Traditional,,41.56,38.7,percent of total billed charges,107.38,0.82,54.76,percent of total billed charges,38.7
PROS TRN INI15MI OT,97761,CPT,,,,,both,, ,398.10,398.10,Blue Cross and Blue Shield,Traditional,,154.06,38.7,percent of total billed charges,398.10,0.82,203.03,percent of total billed charges,38.7
PROS TRN INI15MI OT,97761,CPT,,,,,both,, ,398.10,398.10,Blue Cross and Blue Shield,Traditional,,154.06,38.7,percent of total billed charges,398.10,0.82,203.03,percent of total billed charges,38.7
PROS TRN INI15MI PT,97761,CPT,,,,,both,, ,367.20,367.20,Blue Cross and Blue Shield,Traditional,,142.11,38.7,percent of total billed charges,367.20,0.82,187.27,percent of total billed charges,38.7
PROS TRN INI15MI PT,97761,CPT,,,,,both,, ,367.20,367.20,Blue Cross and Blue Shield,Traditional,,142.11,38.7,percent of total billed charges,367.20,0.82,187.27,percent of total billed charges,38.7
PROS-ORTH SUB-15 MIN,97763,CPT,,,,,both,, ,318.29,318.29,Blue Cross and Blue Shield,Traditional,,123.18,38.7,percent of total billed charges,318.29,0.82,162.33,percent of total billed charges,38.7
PROS-ORTH SUB-15 MIN,97763,CPT,,,,,both,, ,358.85,358.85,Blue Cross and Blue Shield,Traditional,,138.87,38.7,percent of total billed charges,358.85,0.82,183.01,percent of total billed charges,38.7
PRS-ORT SUB-15MN OT,97763,CPT,,,,,both,, ,131.07,131.07,Blue Cross and Blue Shield,Traditional,,50.72,38.7,percent of total billed charges,131.07,0.82,66.85,percent of total billed charges,38.7
PRS-ORT SUB-15MN OT,97763,CPT,,,,,both,, ,131.07,131.07,Blue Cross and Blue Shield,Traditional,,50.72,38.7,percent of total billed charges,131.07,0.82,66.85,percent of total billed charges,38.7
PRS-ORT SUB-15MN OT,97763,CPT,,,,,both,, ,131.07,131.07,Blue Cross and Blue Shield,Traditional,,50.72,38.7,percent of total billed charges,131.07,0.82,66.85,percent of total billed charges,38.7
PRS-ORT SUB-15MN OT,97763,CPT,,,,,both,, ,131.07,131.07,Blue Cross and Blue Shield,Traditional,,50.72,38.7,percent of total billed charges,131.07,0.82,66.85,percent of total billed charges,38.7
PRS-ORT SUB-15MN OT,97763,CPT,,,,,both,, ,340.93,340.93,Blue Cross and Blue Shield,Traditional,,131.94,38.7,percent of total billed charges,340.93,0.82,173.87,percent of total billed charges,38.7
PRS-ORT SUB-15MN OT,97763,CPT,,,,,both,, ,340.93,340.93,Blue Cross and Blue Shield,Traditional,,131.94,38.7,percent of total billed charges,340.93,0.82,173.87,percent of total billed charges,38.7
PRS-ORT SUB-15MN PT,97763,CPT,,,,,both,, ,384.45,384.45,Blue Cross and Blue Shield,Traditional,,148.78,38.7,percent of total billed charges,384.45,0.82,196.07,percent of total billed charges,38.7
PRS-ORT SUB-15MN PT,97763,CPT,,,,,both,, ,384.45,384.45,Blue Cross and Blue Shield,Traditional,,148.78,38.7,percent of total billed charges,384.45,0.82,196.07,percent of total billed charges,38.7
MNT INITIAL EA 15 MN,97802,CPT,,,,,both,, ,194.41,194.41,Blue Cross and Blue Shield,Traditional,,75.24,38.7,percent of total billed charges,194.41,0.82,99.15,percent of total billed charges,38.7
MNT REASSES EA 15 MN,97803,CPT,,,,,both,, ,101.46,101.46,Blue Cross and Blue Shield,Traditional,,39.27,38.7,percent of total billed charges,101.46,0.82,51.74,percent of total billed charges,38.7
MNT GROUP EA 30 MIN,97804,CPT,,,,,both,, ,223.25,223.25,Blue Cross and Blue Shield,Traditional,,86.40,38.7,percent of total billed charges,223.25,0.82,113.86,percent of total billed charges,38.7
LAB COLLECTION,99000,CPT,,,,,both,, ,70.00,70.00,Blue Cross and Blue Shield,Traditional,,27.09,38.7,percent of total billed charges,70.00,0.82,35.7,percent of total billed charges,38.7
SPEC CHAIN CUSTODY,99001,CPT,,,,,both,, ,21.33,21.33,Blue Cross and Blue Shield,Traditional,,8.25,38.7,percent of total billed charges,21.33,0.82,10.88,percent of total billed charges,38.7
MSED SAMEGT5 1ST15,99152,CPT,,,,,both,, ,313.38,313.38,Blue Cross and Blue Shield,Traditional,,121.28,38.7,percent of total billed charges,313.38,0.82,159.82,percent of total billed charges,38.7
MODSED SAME ADD15MIN,99153,CPT,,,,,both,, ,417.92,417.92,Blue Cross and Blue Shield,Traditional,,161.74,38.7,percent of total billed charges,417.92,0.82,213.14,percent of total billed charges,38.7
HBO COMM PER SESSION,99183,CPT,,,,,both,, ,990.13,990.13,Blue Cross and Blue Shield,Traditional,,383.18,38.7,percent of total billed charges,990.13,0.82,504.97,percent of total billed charges,38.7
PHLEBOTOMY THERAPEUT,99195,CPT,,,,,both,, ,266.77,266.77,Blue Cross and Blue Shield,Traditional,,103.24,38.7,percent of total billed charges,266.77,0.82,136.05,percent of total billed charges,38.7
CRITICAL CARE LT 74M,99291,CPT,,,,,both,, ,12285.42,593.00,Blue Cross and Blue Shield,Traditional,,4754.46,38.7,percent of total billed charges,12285.42,0.82,6265.56,percent of total billed charges,38.7
CRIT CARE EA 30 MIN,99292,CPT,,,,,both,, ,4418.38,539.98,Blue Cross and Blue Shield,Traditional,,1709.91,38.7,percent of total billed charges,4418.38,0.82,2253.37,percent of total billed charges,38.7
BEHAV CHG SMOKE U 10,99406,CPT,,,,,both,, ,127.46,11.33,Blue Cross and Blue Shield,Traditional,,49.33,38.7,percent of total billed charges,127.46,0.82,65,percent of total billed charges,38.7
BEHAV CHG SMOKE GR10,99407,CPT,,,,,both,, ,127.46,6.70,Blue Cross and Blue Shield,Traditional,,49.33,38.7,percent of total billed charges,127.46,0.82,65,percent of total billed charges,38.7
NEWBORN RESUCITATION,99465,CPT,,,,,both,, ,2447.28,6.70,Blue Cross and Blue Shield,Traditional,,947.10,38.7,percent of total billed charges,2447.28,0.82,1248.11,percent of total billed charges,38.7
RESPIRATORY PANEL PCR,0202U,HCPCS,,,,,both,, ,500.00,0.32,Blue Cross and Blue Shield,Traditional,,193.50,38.7,percent of total billed charges,500.00,0.01,255,percent of total billed charges,38.7
COV19 FLUAB CEPHEID,0240U,CPT,,,,,both,, ,568.00,0.48,Blue Cross and Blue Shield,Traditional,,219.82,38.7,percent of total billed charges,568.00,0.02,289.68,percent of total billed charges,38.7
COV19 FLUAB RSV CEPH,0241U,CPT,,,,,both,, ,570.52,8.76,Blue Cross and Blue Shield,Traditional,,220.79,38.7,percent of total billed charges,570.52,0.34,290.97,percent of total billed charges,38.7
MVP MULTIPLEX VAGINAL DNA PROBE,0352U,HCPCS,,,,,both,, ,570.52,6.84,Blue Cross and Blue Shield,Traditional,,220.79,38.7,percent of total billed charges,570.52,0.27,290.97,percent of total billed charges,38.7
INTRATUBAL OCCLU DEV,A4264,HCPCS,,,,,both,, ,8176.40,6.56,Blue Cross and Blue Shield,Traditional,,3164.27,38.7,percent of total billed charges,8176.40,0.26,4169.96,percent of total billed charges,38.7
TISSUE MARKR IMPLT 2,A4648,HCPCS,,,,,both,, ,1195.32,0.16,Blue Cross and Blue Shield,Traditional,,462.59,38.7,percent of total billed charges,1195.32,0.01,609.61,percent of total billed charges,38.7
TISSUE MARKR IMPLT 3,A4648,HCPCS,,,,,both,, ,2390.63,6.88,Blue Cross and Blue Shield,Traditional,,925.17,38.7,percent of total billed charges,2390.63,0.27,1219.22,percent of total billed charges,38.7
COLLAGEN WITH SILVER (PUROCOL),A6022,HCPCS,,,,,both,, ,28.28,6.28,Blue Cross and Blue Shield,Traditional,,10.94,38.7,percent of total billed charges,28.28,0.24,14.42,percent of total billed charges,38.7
ENDOFORM ANTIMICROBIAL,A6022,HCPCS,,,,,both,, ,41.56,6.40,Blue Cross and Blue Shield,Traditional,,16.08,38.7,percent of total billed charges,41.56,0.25,21.2,percent of total billed charges,38.7
COLLAGEN (PUROCOL),A6023,HCPCS,,,,,both,, ,19.80,1.64,Blue Cross and Blue Shield,Traditional,,7.66,38.7,percent of total billed charges,19.80,0.06,10.1,percent of total billed charges,38.7
CONVAMAX PAD 4X4,A6196,HCPCS,,,,,both,, ,7.68,2.40,Blue Cross and Blue Shield,Traditional,,2.97,38.7,percent of total billed charges,7.68,0.09,3.92,percent of total billed charges,38.7
CONVAMAX PAD 4X8,A6197,HCPCS,,,,,both,, ,8.88,8.44,Blue Cross and Blue Shield,Traditional,,3.44,38.7,percent of total billed charges,8.88,0.33,4.53,percent of total billed charges,38.7
CONVAMAX PAD 6X8,A6197,HCPCS,,,,,both,, ,11.76,3547.64,Blue Cross and Blue Shield,Traditional,,4.55,38.7,percent of total billed charges,11.76,138.36,6,percent of total billed charges,38.7
DRSG GRMCDL 45X2CM AQCL AG MIC,A6197,HCPCS,,,,,both,, ,36.48,551.05,Blue Cross and Blue Shield,Traditional,,14.12,38.7,percent of total billed charges,36.48,21.49,18.6,percent of total billed charges,38.7
DRSG GRMCDL 4X5IN AQCL AG,A6197,HCPCS,,,,,both,, ,31.04,347.11,Blue Cross and Blue Shield,Traditional,,12.01,38.7,percent of total billed charges,31.04,13.54,15.83,percent of total billed charges,38.7
DRSG WND 5X4IN SQ AQCL X HDRFB,A6198,HCPCS,,,,,both,, ,11.16,69.78,Blue Cross and Blue Shield,Traditional,,4.32,38.7,percent of total billed charges,11.16,2.72,5.69,percent of total billed charges,38.7
DRSG ALG 18X.75IN AQCL HDRFB,A6199,HCPCS,,,,,both,, ,14.12,95.53,Blue Cross and Blue Shield,Traditional,,5.46,38.7,percent of total billed charges,14.12,3.73,7.2,percent of total billed charges,38.7
HYDROFERA BLUE TRANSFER 5X4,A6210,HCPCS,,,,,both,, ,24.12,81.89,Blue Cross and Blue Shield,Traditional,,9.33,38.7,percent of total billed charges,24.12,3.19,12.3,percent of total billed charges,38.7
4X4 AQUACEL FOAM NO ADHESIVE,A6211,HCPCS,,,,,both,, ,7.48,312.35,Blue Cross and Blue Shield,Traditional,,2.89,38.7,percent of total billed charges,7.48,12.18,3.81,percent of total billed charges,38.7
"DRESSING,ALLEVYN,SACRUM,SMALL",A6212,HCPCS,,,,,both,, ,21.96,2305.66,Blue Cross and Blue Shield,Traditional,,8.50,38.7,percent of total billed charges,21.96,89.92,11.2,percent of total billed charges,38.7
DRSG LG QUADRILOBE 6 1/16INX6,A6212,HCPCS,,,,,both,, ,11.48,17205.64,Blue Cross and Blue Shield,Traditional,,4.44,38.7,percent of total billed charges,11.48,671.02,5.85,percent of total billed charges,38.7
"HEEL,LIFE,ALLEVYN",A6212,HCPCS,,,,,both,, ,29.16,170.47,Blue Cross and Blue Shield,Traditional,,11.28,38.7,percent of total billed charges,29.16,6.65,14.87,percent of total billed charges,38.7
DRSG MED QUADRILOBE 5 1/16INX5,A6213,HCPCS,,,,,both,, ,9.80,235.61,Blue Cross and Blue Shield,Traditional,,3.79,38.7,percent of total billed charges,9.80,9.19,5,percent of total billed charges,38.7
SACRAL AQUACEL FOAM WITH ADHESIVE,A6213,HCPCS,,,,,both,, ,17.32,69.78,Blue Cross and Blue Shield,Traditional,,6.70,38.7,percent of total billed charges,17.32,2.72,8.83,percent of total billed charges,38.7
4X4 AQUACEL FOAM WITH ADHESIVE,A6214,HCPCS,,,,,both,, ,8.12,62.83,Blue Cross and Blue Shield,Traditional,,3.14,38.7,percent of total billed charges,8.12,2.45,4.14,percent of total billed charges,38.7
DUODERM THIN 4X2,A6237,HCPCS,,,,,both,, ,4.80,83.17,Blue Cross and Blue Shield,Traditional,,1.86,38.7,percent of total billed charges,4.80,3.24,2.45,percent of total billed charges,38.7
DUODERM THIN 4X4,A6238,HCPCS,,,,,both,, ,4.12,529.68,Blue Cross and Blue Shield,Traditional,,1.59,38.7,percent of total billed charges,4.12,20.66,2.1,percent of total billed charges,38.7
TRIAD CREAM 2.5 OUNCES,A6240,HCPCS,,,,,both,, ,3.64,12525.06,Blue Cross and Blue Shield,Traditional,,1.41,38.7,percent of total billed charges,3.64,488.48,1.86,percent of total billed charges,38.7
HYDROGEL,A6248,HCPCS,,,,,both,, ,16.76,102.23,Blue Cross and Blue Shield,Traditional,,6.49,38.7,percent of total billed charges,16.76,3.99,8.55,percent of total billed charges,38.7
NO-RINSE FOAM CLEANSER,A6250,HCPCS,,,,,both,, ,7.96,264.20,Blue Cross and Blue Shield,Traditional,,3.08,38.7,percent of total billed charges,7.96,10.30,4.06,percent of total billed charges,38.7
ABD PADS 5X9,A6252,HCPCS,,,,,both,, ,0.32,69.78,Blue Cross and Blue Shield,Traditional,,0.12,38.7,percent of total billed charges,0.32,2.72,0.16,percent of total billed charges,38.7
ABD PADS 8X10,A6253,HCPCS,,,,,both,, ,0.48,148.84,Blue Cross and Blue Shield,Traditional,,0.19,38.7,percent of total billed charges,0.48,5.80,0.24,percent of total billed charges,38.7
IODOFORM PACKING 1 INCH,A6266,HCPCS,,,,,both,, ,8.76,938.33,Blue Cross and Blue Shield,Traditional,,3.39,38.7,percent of total billed charges,8.76,36.59,4.47,percent of total billed charges,38.7
IODOFORM PACKING 1/2 INCH,A6266,HCPCS,,,,,both,, ,6.84,69.78,Blue Cross and Blue Shield,Traditional,,2.65,38.7,percent of total billed charges,6.84,2.72,3.49,percent of total billed charges,38.7
IODOFORM PACKING 1/4 INCH,A6266,HCPCS,,,,,both,, ,6.56,14752.18,Blue Cross and Blue Shield,Traditional,,2.54,38.7,percent of total billed charges,6.56,575.34,3.35,percent of total billed charges,38.7
STERILE 2X2 GAUZE,A6402,HCPCS,,,,,both,, ,0.08,13.75,Blue Cross and Blue Shield,Traditional,,0.03,38.7,percent of total billed charges,0.08,0.54,0.04,percent of total billed charges,38.7
STERILE 4X4 GAUZE,A6402,HCPCS,,,,,both,, ,0.16,13.75,Blue Cross and Blue Shield,Traditional,,0.06,38.7,percent of total billed charges,0.16,0.54,0.08,percent of total billed charges,38.7
PLAIN PACKING 1 INCH,A6407,HCPCS,,,,,both,, ,6.88,14.16,Blue Cross and Blue Shield,Traditional,,2.66,38.7,percent of total billed charges,6.88,0.55,3.51,percent of total billed charges,38.7
PLAIN PACKING 1/2 INCH,A6407,HCPCS,,,,,both,, ,6.28,13.75,Blue Cross and Blue Shield,Traditional,,2.43,38.7,percent of total billed charges,6.28,0.54,3.2,percent of total billed charges,38.7
PLAIN PACKING 1/4 INCH,A6407,HCPCS,,,,,both,, ,6.40,37.60,Blue Cross and Blue Shield,Traditional,,2.48,38.7,percent of total billed charges,6.40,1.47,3.26,percent of total billed charges,38.7
ACE WRAP 4 INCH,A6449,HCPCS,,,,,both,, ,1.64,47.90,Blue Cross and Blue Shield,Traditional,,0.63,38.7,percent of total billed charges,1.64,1.87,0.84,percent of total billed charges,38.7
ACE WRAP 6 INCH,A6450,HCPCS,,,,,both,, ,2.40,40.94,Blue Cross and Blue Shield,Traditional,,0.93,38.7,percent of total billed charges,2.40,1.60,1.22,percent of total billed charges,38.7
ZINC PASTE TUBES,A6456,HCPCS,,,,,both,, ,8.44,129.01,Blue Cross and Blue Shield,Traditional,,3.27,38.7,percent of total billed charges,8.44,5.03,4.3,percent of total billed charges,38.7
PICO DRESSING KIT,A9272,HCPCS,,,,,both,, ,3547.64,2873.70,Blue Cross and Blue Shield,Traditional,,1372.94,38.7,percent of total billed charges,3547.64,112.07,1809.3,percent of total billed charges,38.7
TC-99M SESTA / DOSE,A9500,HCPCS,,,,,both,, ,551.05,4069.02,Blue Cross and Blue Shield,Traditional,,213.26,38.7,percent of total billed charges,551.05,158.69,281.04,percent of total billed charges,38.7
TC-99M TETRO/UNITDOS,A9502,HCPCS,,,,,both,, ,347.11,4786.15,Blue Cross and Blue Shield,Traditional,,134.33,38.7,percent of total billed charges,347.11,186.66,177.03,percent of total billed charges,38.7
TC99M MEDRO TO 30MCI,A9503,HCPCS,,,,,both,, ,69.78,6684.19,Blue Cross and Blue Shield,Traditional,,27.00,38.7,percent of total billed charges,69.78,260.68,35.59,percent of total billed charges,38.7
"TL-201, PER MCI",A9505,HCPCS,,,,,both,, ,95.53,9567.67,Blue Cross and Blue Shield,Traditional,,36.97,38.7,percent of total billed charges,95.53,373.14,48.72,percent of total billed charges,38.7
TC99M PERTECHNET/MCI,A9512,HCPCS,,,,,both,, ,81.89,14349.19,Blue Cross and Blue Shield,Traditional,,31.69,38.7,percent of total billed charges,81.89,559.62,41.76,percent of total billed charges,38.7
"I123 CAP,DX /100UCI",A9516,HCPCS,,,,,both,, ,312.35,19130.71,Blue Cross and Blue Shield,Traditional,,120.88,38.7,percent of total billed charges,312.35,746.10,159.3,percent of total billed charges,38.7
TC99 TILMAN DX .5MCI,A9520,HCPCS,,,,,both,, ,2305.66,23912.22,Blue Cross and Blue Shield,Traditional,,892.29,38.7,percent of total billed charges,2305.66,932.58,1175.89,percent of total billed charges,38.7
TC99M EXAME / DOSE,A9521,HCPCS,,,,,both,, ,17205.64,31084.37,Blue Cross and Blue Shield,Traditional,,6658.58,38.7,percent of total billed charges,17205.64,1212.29,8774.88,percent of total billed charges,38.7
TC99M MEBROF /15MCI,A9537,HCPCS,,,,,both,, ,170.47,38256.78,Blue Cross and Blue Shield,Traditional,,65.97,38.7,percent of total billed charges,170.47,1492.01,86.94,percent of total billed charges,38.7
TC99M PYROPHOS/25MCI,A9538,HCPCS,,,,,both,, ,235.61,172.01,Blue Cross and Blue Shield,Traditional,,91.18,38.7,percent of total billed charges,235.61,6.71,120.16,percent of total billed charges,38.7
TC99M PENTETAT/25MCI,A9539,HCPCS,,,,,both,, ,69.78,47814.92,Blue Cross and Blue Shield,Traditional,,27.00,38.7,percent of total billed charges,69.78,1864.78,35.59,percent of total billed charges,38.7
TC99M MAA/10MCI,A9540,HCPCS,,,,,both,, ,62.83,57377.95,Blue Cross and Blue Shield,Traditional,,24.32,38.7,percent of total billed charges,62.83,2237.74,32.04,percent of total billed charges,38.7
TC99M SULF COL/20MCI,A9541,HCPCS,,,,,both,, ,83.17,243.85,Blue Cross and Blue Shield,Traditional,,32.19,38.7,percent of total billed charges,83.17,9.51,42.42,percent of total billed charges,38.7
TC99M SULFCOL2/20MCI,A9541,HCPCS,,,,,both,, ,529.68,411.23,Blue Cross and Blue Shield,Traditional,,204.99,38.7,percent of total billed charges,529.68,16.04,270.14,percent of total billed charges,38.7
IN111 PENTETAT/.5MCI,A9548,HCPCS,,,,,both,, ,12525.06,602.55,Blue Cross and Blue Shield,Traditional,,4847.20,38.7,percent of total billed charges,12525.06,23.50,6387.78,percent of total billed charges,38.7
GA67 GALLIUM/MCI,A9556,HCPCS,,,,,both,, ,102.23,841.51,Blue Cross and Blue Shield,Traditional,,39.56,38.7,percent of total billed charges,102.23,32.82,52.14,percent of total billed charges,38.7
XE133 XENON 10MCI,A9558,HCPCS,,,,,both,, ,264.20,1200.21,Blue Cross and Blue Shield,Traditional,,102.25,38.7,percent of total billed charges,264.20,46.81,134.74,percent of total billed charges,38.7
TC99M LABL RBC/30MCI,A9560,HCPCS,,,,,both,, ,69.78,1678.39,Blue Cross and Blue Shield,Traditional,,27.00,38.7,percent of total billed charges,69.78,65.46,35.59,percent of total billed charges,38.7
TC99M OXIDRONA/30MCI,A9561,HCPCS,,,,,both,, ,148.84,2156.56,Blue Cross and Blue Shield,Traditional,,57.60,38.7,percent of total billed charges,148.84,84.11,75.91,percent of total billed charges,38.7
TC99M MERTIATI/15MCI,A9562,HCPCS,,,,,both,, ,938.33,884.51,Blue Cross and Blue Shield,Traditional,,363.13,38.7,percent of total billed charges,938.33,34.50,478.55,percent of total billed charges,38.7
TC99M AEROSOL 75 MCI,A9567,HCPCS,,,,,both,, ,69.78,2467.37,Blue Cross and Blue Shield,Traditional,,27.00,38.7,percent of total billed charges,69.78,96.23,35.59,percent of total billed charges,38.7
IN-111 PENTETRE/6MCI,A9572,HCPCS,,,,,both,, ,14752.18,5379.18,Blue Cross and Blue Shield,Traditional,,5709.09,38.7,percent of total billed charges,14752.18,209.79,7523.61,percent of total billed charges,38.7
INJ GADO DIMEG ML 15,A9577,HCPCS,,,,,both,15,ML,13.75,8391.41,Blue Cross and Blue Shield,Traditional,,5.32,38.7,percent of total billed charges,13.75,327.26,7.01,percent of total billed charges,38.7
INJ GADO DIMEG ML 20,A9577,HCPCS,,,,,both,20,ML,13.75,93836.86,Blue Cross and Blue Shield,Traditional,,5.32,38.7,percent of total billed charges,13.75,3659.64,7.01,percent of total billed charges,38.7
INJ MULTIHANCE /ML,A9577,HCPCS,,,,,both,, ,14.16,99999.00,Blue Cross and Blue Shield,Traditional,,5.48,38.7,percent of total billed charges,14.16,3899.96,7.22,percent of total billed charges,38.7
INJ MULTIHANCE/ ML,A9577,HCPCS,,,,,both,, ,13.75,5379.18,Blue Cross and Blue Shield,Traditional,,5.32,38.7,percent of total billed charges,13.75,209.79,7.01,percent of total billed charges,38.7
INJ GAD-MR1 CONTR ML,A9579,HCPCS,,,,,both,, ,37.60,16735.18,Blue Cross and Blue Shield,Traditional,,14.55,38.7,percent of total billed charges,37.60,652.67,19.18,percent of total billed charges,38.7
INJ GAD-MR2 CONTR ML,A9579,HCPCS,,,,,both,, ,47.90,855.42,Blue Cross and Blue Shield,Traditional,,18.54,38.7,percent of total billed charges,47.90,33.36,24.43,percent of total billed charges,38.7
INJ GAD-MR3 CONTR ML,A9579,HCPCS,,,,,both,, ,40.94,1728.86,Blue Cross and Blue Shield,Traditional,,15.84,38.7,percent of total billed charges,40.94,67.43,20.88,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 1,C1713,HCPCS,,,,,both,, ,129.01,2726.15,Blue Cross and Blue Shield,Traditional,,49.93,38.7,percent of total billed charges,129.01,106.32,65.8,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 10,C1713,HCPCS,,,,,both,, ,2873.70,4234.59,Blue Cross and Blue Shield,Traditional,,1112.12,38.7,percent of total billed charges,2873.70,165.15,1465.59,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 11,C1713,HCPCS,,,,,both,, ,4069.02,6331.93,Blue Cross and Blue Shield,Traditional,,1574.71,38.7,percent of total billed charges,4069.02,246.95,2075.2,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 12,C1713,HCPCS,,,,,both,, ,4786.15,1434.53,Blue Cross and Blue Shield,Traditional,,1852.24,38.7,percent of total billed charges,4786.15,55.95,2440.94,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 13,C1713,HCPCS,,,,,both,, ,6684.19,2390.63,Blue Cross and Blue Shield,Traditional,,2586.78,38.7,percent of total billed charges,6684.19,93.23,3408.94,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 14,C1713,HCPCS,,,,,both,, ,9567.67,717.14,Blue Cross and Blue Shield,Traditional,,3702.69,38.7,percent of total billed charges,9567.67,27.97,4879.51,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 15,C1713,HCPCS,,,,,both,, ,14349.19,956.36,Blue Cross and Blue Shield,Traditional,,5553.14,38.7,percent of total billed charges,14349.19,37.30,7318.09,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 16,C1713,HCPCS,,,,,both,, ,19130.71,11958.56,Blue Cross and Blue Shield,Traditional,,7403.58,38.7,percent of total billed charges,19130.71,466.38,9756.66,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 17,C1713,HCPCS,,,,,both,, ,23912.22,84.20,Blue Cross and Blue Shield,Traditional,,9254.03,38.7,percent of total billed charges,23912.22,3.28,12195.23,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 18,C1713,HCPCS,,,,,both,, ,31084.37,247.72,Blue Cross and Blue Shield,Traditional,,12029.65,38.7,percent of total billed charges,31084.37,9.66,15853.03,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 19,C1713,HCPCS,,,,,both,, ,38256.78,727.18,Blue Cross and Blue Shield,Traditional,,14805.37,38.7,percent of total billed charges,38256.78,28.36,19510.96,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 2,C1713,HCPCS,,,,,both,, ,172.01,1200.21,Blue Cross and Blue Shield,Traditional,,66.57,38.7,percent of total billed charges,172.01,46.81,87.73,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 20,C1713,HCPCS,,,,,both,, ,47814.92,1917.35,Blue Cross and Blue Shield,Traditional,,18504.37,38.7,percent of total billed charges,47814.92,74.78,24385.61,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 21,C1713,HCPCS,,,,,both,, ,57377.95,2634.48,Blue Cross and Blue Shield,Traditional,,22205.27,38.7,percent of total billed charges,57377.95,102.74,29262.75,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 3,C1713,HCPCS,,,,,both,, ,243.85,3351.88,Blue Cross and Blue Shield,Traditional,,94.37,38.7,percent of total billed charges,243.85,130.72,124.36,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 4,C1713,HCPCS,,,,,both,, ,411.23,4786.15,Blue Cross and Blue Shield,Traditional,,159.15,38.7,percent of total billed charges,411.23,186.66,209.73,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 5,C1713,HCPCS,,,,,both,, ,602.55,7177.04,Blue Cross and Blue Shield,Traditional,,233.19,38.7,percent of total billed charges,602.55,279.90,307.3,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 6,C1713,HCPCS,,,,,both,, ,841.51,9567.67,Blue Cross and Blue Shield,Traditional,,325.66,38.7,percent of total billed charges,841.51,373.14,429.17,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 7,C1713,HCPCS,,,,,both,, ,1200.21,14344.55,Blue Cross and Blue Shield,Traditional,,464.48,38.7,percent of total billed charges,1200.21,559.44,612.11,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 8,C1713,HCPCS,,,,,both,, ,1678.39,554.66,Blue Cross and Blue Shield,Traditional,,649.54,38.7,percent of total billed charges,1678.39,21.63,855.98,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 9,C1713,HCPCS,,,,,both,, ,2156.56,1807.39,Blue Cross and Blue Shield,Traditional,,834.59,38.7,percent of total billed charges,2156.56,70.49,1099.85,percent of total billed charges,38.7
BONE CEMENT 1,C1713,HCPCS,,,,,both,, ,884.51,6185.15,Blue Cross and Blue Shield,Traditional,,342.31,38.7,percent of total billed charges,884.51,241.22,451.1,percent of total billed charges,38.7
BONE CEMENT 2,C1713,HCPCS,,,,,both,, ,2467.37,7172.15,Blue Cross and Blue Shield,Traditional,,954.87,38.7,percent of total billed charges,2467.37,279.71,1258.36,percent of total billed charges,38.7
CATH TRNS ARTHR DIR1,C1714,HCPCS,,,,,both,, ,5379.18,15395.93,Blue Cross and Blue Shield,Traditional,,2081.74,38.7,percent of total billed charges,5379.18,600.44,2743.38,percent of total billed charges,38.7
CATH TRNS ARTHR DIR2,C1714,HCPCS,,,,,both,, ,8391.41,1434.53,Blue Cross and Blue Shield,Traditional,,3247.48,38.7,percent of total billed charges,8391.41,55.95,4279.62,percent of total billed charges,38.7
AICD DUAL CHAMBER L1,C1721,HCPCS,,,,,both,, ,93836.86,1912.71,Blue Cross and Blue Shield,Traditional,,36314.86,38.7,percent of total billed charges,93836.86,74.60,47856.8,percent of total billed charges,38.7
AICD SINGLE CHAMBER1,C1722,HCPCS,,,,,both,, ,99999.00,89.61,Blue Cross and Blue Shield,Traditional,,38699.61,38.7,percent of total billed charges,99999.00,3.49,50999.49,percent of total billed charges,38.7
CATH TRNS ARTHR ROT1,C1724,HCPCS,,,,,both,, ,5379.18,2395.52,Blue Cross and Blue Shield,Traditional,,2081.74,38.7,percent of total billed charges,5379.18,93.43,2743.38,percent of total billed charges,38.7
CATH TRNS ARTHR ROT2,C1724,HCPCS,,,,,both,, ,16735.18,3351.88,Blue Cross and Blue Shield,Traditional,,6476.51,38.7,percent of total billed charges,16735.18,130.72,8534.94,percent of total billed charges,38.7
CATH-ANGIO LEVEL 1,C1725,HCPCS,,,,,both,, ,855.42,4781.52,Blue Cross and Blue Shield,Traditional,,331.05,38.7,percent of total billed charges,855.42,186.48,436.26,percent of total billed charges,38.7
CATH-ANGIO LEVEL 2,C1725,HCPCS,,,,,both,, ,1728.86,124.37,Blue Cross and Blue Shield,Traditional,,669.07,38.7,percent of total billed charges,1728.86,4.85,881.72,percent of total billed charges,38.7
CATH-ANGIO LEVEL 3,C1725,HCPCS,,,,,both,, ,2726.15,243.85,Blue Cross and Blue Shield,Traditional,,1055.02,38.7,percent of total billed charges,2726.15,9.51,1390.34,percent of total billed charges,38.7
CATH-ANGIO LEVEL 4,C1725,HCPCS,,,,,both,, ,4234.59,722.03,Blue Cross and Blue Shield,Traditional,,1638.79,38.7,percent of total billed charges,4234.59,28.16,2159.64,percent of total billed charges,38.7
CATH-ANGIO LEVEL 5,C1725,HCPCS,,,,,both,, ,6331.93,960.99,Blue Cross and Blue Shield,Traditional,,2450.46,38.7,percent of total billed charges,6331.93,37.48,3229.28,percent of total billed charges,38.7
CATH BAL DIL NONVAS1,C1726,HCPCS,,,,,both,, ,1434.53,960.99,Blue Cross and Blue Shield,Traditional,,555.16,38.7,percent of total billed charges,1434.53,37.48,731.61,percent of total billed charges,38.7
CATH BAL DIL NONVAS2,C1726,HCPCS,,,,,both,, ,2390.63,1200.21,Blue Cross and Blue Shield,Traditional,,925.17,38.7,percent of total billed charges,2390.63,46.81,1219.22,percent of total billed charges,38.7
CATH BRACHY SEED AD1,C1728,HCPCS,,,,,both,, ,717.14,1439.17,Blue Cross and Blue Shield,Traditional,,277.53,38.7,percent of total billed charges,717.14,56.13,365.74,percent of total billed charges,38.7
CATH BRACHY SEED AD2,C1728,HCPCS,,,,,both,, ,956.36,1673.49,Blue Cross and Blue Shield,Traditional,,370.11,38.7,percent of total billed charges,956.36,65.27,487.74,percent of total billed charges,38.7
CATH DRAINAG LEVEL11,C1729,HCPCS,,,,,both,, ,11958.56,358.70,Blue Cross and Blue Shield,Traditional,,4627.96,38.7,percent of total billed charges,11958.56,13.99,6098.87,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 1,C1729,HCPCS,,,,,both,, ,84.20,478.18,Blue Cross and Blue Shield,Traditional,,32.59,38.7,percent of total billed charges,84.20,18.65,42.94,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 2,C1729,HCPCS,,,,,both,, ,247.72,3586.20,Blue Cross and Blue Shield,Traditional,,95.87,38.7,percent of total billed charges,247.72,139.86,126.34,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 3,C1729,HCPCS,,,,,both,, ,727.18,14344.55,Blue Cross and Blue Shield,Traditional,,281.42,38.7,percent of total billed charges,727.18,559.44,370.86,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 4,C1729,HCPCS,,,,,both,, ,1200.21,5259.70,Blue Cross and Blue Shield,Traditional,,464.48,38.7,percent of total billed charges,1200.21,205.13,612.11,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 5,C1729,HCPCS,,,,,both,, ,1917.35,238.96,Blue Cross and Blue Shield,Traditional,,742.01,38.7,percent of total billed charges,1917.35,9.32,977.85,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 6,C1729,HCPCS,,,,,both,, ,2634.48,1792.97,Blue Cross and Blue Shield,Traditional,,1019.54,38.7,percent of total billed charges,2634.48,69.93,1343.58,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 7,C1729,HCPCS,,,,,both,, ,3351.88,2395.52,Blue Cross and Blue Shield,Traditional,,1297.18,38.7,percent of total billed charges,3351.88,93.43,1709.46,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 8,C1729,HCPCS,,,,,both,, ,4786.15,4781.52,Blue Cross and Blue Shield,Traditional,,1852.24,38.7,percent of total billed charges,4786.15,186.48,2440.94,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 9,C1729,HCPCS,,,,,both,, ,7177.04,478.18,Blue Cross and Blue Shield,Traditional,,2777.51,38.7,percent of total billed charges,7177.04,18.65,3660.29,percent of total billed charges,38.7
CATH-DRAINAG LEVEL10,C1729,HCPCS,,,,,both,, ,9567.67,717.14,Blue Cross and Blue Shield,Traditional,,3702.69,38.7,percent of total billed charges,9567.67,27.97,4879.51,percent of total billed charges,38.7
CATH-DRAINAG LEVEL12,C1729,HCPCS,,,,,both,, ,14344.55,956.36,Blue Cross and Blue Shield,Traditional,,5551.34,38.7,percent of total billed charges,14344.55,37.30,7315.72,percent of total billed charges,38.7
CATH EP 19 OR FEW 1,C1730,HCPCS,,,,,both,, ,554.66,7172.15,Blue Cross and Blue Shield,Traditional,,214.65,38.7,percent of total billed charges,554.66,279.71,282.88,percent of total billed charges,38.7
CATH EP 19 OR FEW 2,C1730,HCPCS,,,,,both,, ,1807.39,9563.04,Blue Cross and Blue Shield,Traditional,,699.46,38.7,percent of total billed charges,1807.39,372.96,921.77,percent of total billed charges,38.7
CATH EP 20 OR MORE 1,C1731,HCPCS,,,,,both,, ,6185.15,1634.61,Blue Cross and Blue Shield,Traditional,,2393.65,38.7,percent of total billed charges,6185.15,63.75,3154.43,percent of total billed charges,38.7
CATH EP DIG/ABL 3D 1,C1732,HCPCS,,,,,both,, ,7172.15,2504.70,Blue Cross and Blue Shield,Traditional,,2775.62,38.7,percent of total billed charges,7172.15,97.68,3657.8,percent of total billed charges,38.7
CATH EP DIG/ABL 3D 2,C1732,HCPCS,,,,,both,, ,15395.93,1438.14,Blue Cross and Blue Shield,Traditional,,5958.22,38.7,percent of total billed charges,15395.93,56.09,7851.92,percent of total billed charges,38.7
CATH HEMODIAL LT 1,C1750,HCPCS,,,,,both,, ,1434.53,57377.95,Blue Cross and Blue Shield,Traditional,,555.16,38.7,percent of total billed charges,1434.53,2237.74,731.61,percent of total billed charges,38.7
CATH HEMODIAL LT 2,C1750,HCPCS,,,,,both,, ,1912.71,1917.35,Blue Cross and Blue Shield,Traditional,,740.22,38.7,percent of total billed charges,1912.71,74.78,975.48,percent of total billed charges,38.7
CATH-INFUS PERIF 1,C1751,HCPCS,,,,,both,, ,89.61,5742.51,Blue Cross and Blue Shield,Traditional,,34.68,38.7,percent of total billed charges,89.61,223.96,45.7,percent of total billed charges,38.7
CATH-INFUS PERIF 10,C1751,HCPCS,,,,,both,, ,2395.52,9567.67,Blue Cross and Blue Shield,Traditional,,927.07,38.7,percent of total billed charges,2395.52,373.14,1221.72,percent of total billed charges,38.7
CATH-INFUS PERIF 11,C1751,HCPCS,,,,,both,, ,3351.88,13393.09,Blue Cross and Blue Shield,Traditional,,1297.18,38.7,percent of total billed charges,3351.88,522.33,1709.46,percent of total billed charges,38.7
CATH-INFUS PERIF 12,C1751,HCPCS,,,,,both,, ,4781.52,17218.25,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,percent of total billed charges,4781.52,671.51,2438.58,percent of total billed charges,38.7
CATH-INFUS PERIF 2,C1751,HCPCS,,,,,both,, ,124.37,23907.59,Blue Cross and Blue Shield,Traditional,,48.13,38.7,percent of total billed charges,124.37,932.40,63.43,percent of total billed charges,38.7
CATH-INFUS PERIF 3,C1751,HCPCS,,,,,both,, ,243.85,33475.26,Blue Cross and Blue Shield,Traditional,,94.37,38.7,percent of total billed charges,243.85,1305.54,124.36,percent of total billed charges,38.7
CATH-INFUS PERIF 4,C1751,HCPCS,,,,,both,, ,722.03,43033.40,Blue Cross and Blue Shield,Traditional,,279.43,38.7,percent of total billed charges,722.03,1678.30,368.24,percent of total billed charges,38.7
CATH-INFUS PERIF 5,C1751,HCPCS,,,,,both,, ,960.99,1796.58,Blue Cross and Blue Shield,Traditional,,371.90,38.7,percent of total billed charges,960.99,70.07,490.1,percent of total billed charges,38.7
CATH-INFUS PERIF 5,C1751,HCPCS,,,,,both,, ,960.99,43033.40,Blue Cross and Blue Shield,Traditional,,371.90,38.7,percent of total billed charges,960.99,1678.30,490.1,percent of total billed charges,38.7
CATH-INFUS PERIF 7,C1751,HCPCS,,,,,both,, ,1200.21,57377.95,Blue Cross and Blue Shield,Traditional,,464.48,38.7,percent of total billed charges,1200.21,2237.74,612.11,percent of total billed charges,38.7
CATH-INFUS PERIF 8,C1751,HCPCS,,,,,both,, ,1439.17,2395.52,Blue Cross and Blue Shield,Traditional,,556.96,38.7,percent of total billed charges,1439.17,93.43,733.98,percent of total billed charges,38.7
CATH-INFUS PERIF 9,C1751,HCPCS,,,,,both,, ,1673.49,4786.15,Blue Cross and Blue Shield,Traditional,,647.64,38.7,percent of total billed charges,1673.49,186.66,853.48,percent of total billed charges,38.7
CATH HEMODIAL ST 1,C1752,HCPCS,,,,,both,, ,358.70,8611.57,Blue Cross and Blue Shield,Traditional,,138.82,38.7,percent of total billed charges,358.70,335.85,182.94,percent of total billed charges,38.7
CATH HEMODIAL ST 2,C1752,HCPCS,,,,,both,, ,478.18,12436.74,Blue Cross and Blue Shield,Traditional,,185.06,38.7,percent of total billed charges,478.18,485.03,243.87,percent of total billed charges,38.7
CATH INTRAVAS ULTRA1,C1753,HCPCS,,,,,both,, ,3586.20,15305.54,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,percent of total billed charges,3586.20,596.92,1828.96,percent of total billed charges,38.7
CATH INTRAVAS ULTRA2,C1753,HCPCS,,,,,both,, ,14344.55,19130.71,Blue Cross and Blue Shield,Traditional,,5551.34,38.7,percent of total billed charges,14344.55,746.10,7315.72,percent of total billed charges,38.7
CATHETER INTRASPINAL,C1755,HCPCS,,,,,both,, ,5259.70,23912.22,Blue Cross and Blue Shield,Traditional,,2035.50,38.7,percent of total billed charges,5259.70,932.58,2682.45,percent of total billed charges,38.7
CATH THRMB/EMBOL 1,C1757,HCPCS,,,,,both,, ,238.96,33475.26,Blue Cross and Blue Shield,Traditional,,92.48,38.7,percent of total billed charges,238.96,1305.54,121.87,percent of total billed charges,38.7
CATH THRMB/EMBOL 2,C1757,HCPCS,,,,,both,, ,1792.97,21590.35,Blue Cross and Blue Shield,Traditional,,693.88,38.7,percent of total billed charges,1792.97,842.02,914.41,percent of total billed charges,38.7
CATH THRMB/EMBOL 3,C1757,HCPCS,,,,,both,, ,2395.52,717.14,Blue Cross and Blue Shield,Traditional,,927.07,38.7,percent of total billed charges,2395.52,27.97,1221.72,percent of total billed charges,38.7
CATH THRMB/EMBOL 4,C1757,HCPCS,,,,,both,, ,4781.52,956.36,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,percent of total billed charges,4781.52,37.30,2438.58,percent of total billed charges,38.7
CATH URETERAL 1,C1758,HCPCS,,,,,both,, ,478.18,8466.86,Blue Cross and Blue Shield,Traditional,,185.06,38.7,percent of total billed charges,478.18,330.21,243.87,percent of total billed charges,38.7
CATH URETERAL 2,C1758,HCPCS,,,,,both,, ,717.14,4456.30,Blue Cross and Blue Shield,Traditional,,277.53,38.7,percent of total billed charges,717.14,173.80,365.74,percent of total billed charges,38.7
CATH URETERAL 3,C1758,HCPCS,,,,,both,, ,956.36,35861.25,Blue Cross and Blue Shield,Traditional,,370.11,38.7,percent of total billed charges,956.36,1398.59,487.74,percent of total billed charges,38.7
CATH INTRA ECHOCARD1,C1759,HCPCS,,,,,both,, ,7172.15,71722.51,Blue Cross and Blue Shield,Traditional,,2775.62,38.7,percent of total billed charges,7172.15,2797.18,3657.8,percent of total billed charges,38.7
CATH INTRA ECHOCARD2,C1759,HCPCS,,,,,both,, ,9563.04,1796.58,Blue Cross and Blue Shield,Traditional,,3700.90,38.7,percent of total billed charges,9563.04,70.07,4877.15,percent of total billed charges,38.7
CLOSURE DEVIC VASC 1,C1760,HCPCS,,,,,both,, ,1634.61,2395.52,Blue Cross and Blue Shield,Traditional,,632.59,38.7,percent of total billed charges,1634.61,93.43,833.65,percent of total billed charges,38.7
CLOSURE DEVIC VASC 2,C1760,HCPCS,,,,,both,, ,2504.70,4786.15,Blue Cross and Blue Shield,Traditional,,969.32,38.7,percent of total billed charges,2504.70,186.66,1277.4,percent of total billed charges,38.7
CONN TISSUE HUMAN 1,C1762,HCPCS,,,,,both,, ,1438.14,9567.67,Blue Cross and Blue Shield,Traditional,,556.56,38.7,percent of total billed charges,1438.14,373.14,733.45,percent of total billed charges,38.7
CONN TISSUE HUMAN 10,C1762,HCPCS,,,,,both,, ,57377.95,14349.19,Blue Cross and Blue Shield,Traditional,,22205.27,38.7,percent of total billed charges,57377.95,559.62,29262.75,percent of total billed charges,38.7
CONN TISSUE HUMAN 2,C1762,HCPCS,,,,,both,, ,1917.35,19130.71,Blue Cross and Blue Shield,Traditional,,742.01,38.7,percent of total billed charges,1917.35,746.10,977.85,percent of total billed charges,38.7
CONN TISSUE HUMAN 3,C1762,HCPCS,,,,,both,, ,5742.51,23912.22,Blue Cross and Blue Shield,Traditional,,2222.35,38.7,percent of total billed charges,5742.51,932.58,2928.68,percent of total billed charges,38.7
CONN TISSUE HUMAN 4,C1762,HCPCS,,,,,both,, ,9567.67,28688.85,Blue Cross and Blue Shield,Traditional,,3702.69,38.7,percent of total billed charges,9567.67,1118.87,4879.51,percent of total billed charges,38.7
CONN TISSUE HUMAN 5,C1762,HCPCS,,,,,both,, ,13393.09,182.83,Blue Cross and Blue Shield,Traditional,,5183.13,38.7,percent of total billed charges,13393.09,7.13,6830.48,percent of total billed charges,38.7
CONN TISSUE HUMAN 6,C1762,HCPCS,,,,,both,, ,17218.25,3830.06,Blue Cross and Blue Shield,Traditional,,6663.46,38.7,percent of total billed charges,17218.25,149.37,8781.31,percent of total billed charges,38.7
CONN TISSUE HUMAN 7,C1762,HCPCS,,,,,both,, ,23907.59,4308.23,Blue Cross and Blue Shield,Traditional,,9252.24,38.7,percent of total billed charges,23907.59,168.02,12192.87,percent of total billed charges,38.7
CONN TISSUE HUMAN 8,C1762,HCPCS,,,,,both,, ,33475.26,4786.15,Blue Cross and Blue Shield,Traditional,,12954.93,38.7,percent of total billed charges,33475.26,186.66,17072.38,percent of total billed charges,38.7
CONN TISSUE HUMAN 9,C1762,HCPCS,,,,,both,, ,43033.40,7177.04,Blue Cross and Blue Shield,Traditional,,16653.93,38.7,percent of total billed charges,43033.40,279.90,21947.03,percent of total billed charges,38.7
TISSUE NON-HUMAN 1,C1763,HCPCS,,,,,both,, ,1796.58,9567.67,Blue Cross and Blue Shield,Traditional,,695.28,38.7,percent of total billed charges,1796.58,373.14,916.26,percent of total billed charges,38.7
TISSUE NON-HUMAN 10,C1763,HCPCS,,,,,both,, ,43033.40,14349.19,Blue Cross and Blue Shield,Traditional,,16653.93,38.7,percent of total billed charges,43033.40,559.62,21947.03,percent of total billed charges,38.7
TISSUE NON-HUMAN 11,C1763,HCPCS,,,,,both,, ,57377.95,19130.71,Blue Cross and Blue Shield,Traditional,,22205.27,38.7,percent of total billed charges,57377.95,746.10,29262.75,percent of total billed charges,38.7
TISSUE NON-HUMAN 2,C1763,HCPCS,,,,,both,, ,2395.52,23912.22,Blue Cross and Blue Shield,Traditional,,927.07,38.7,percent of total billed charges,2395.52,932.58,1221.72,percent of total billed charges,38.7
TISSUE NON-HUMAN 3,C1763,HCPCS,,,,,both,, ,4786.15,31084.37,Blue Cross and Blue Shield,Traditional,,1852.24,38.7,percent of total billed charges,4786.15,1212.29,2440.94,percent of total billed charges,38.7
TISSUE NON-HUMAN 4,C1763,HCPCS,,,,,both,, ,8611.57,38256.78,Blue Cross and Blue Shield,Traditional,,3332.68,38.7,percent of total billed charges,8611.57,1492.01,4391.9,percent of total billed charges,38.7
TISSUE NON-HUMAN 5,C1763,HCPCS,,,,,both,, ,12436.74,243.85,Blue Cross and Blue Shield,Traditional,,4813.02,38.7,percent of total billed charges,12436.74,9.51,6342.74,percent of total billed charges,38.7
TISSUE NON-HUMAN 6,C1763,HCPCS,,,,,both,, ,15305.54,47814.92,Blue Cross and Blue Shield,Traditional,,5923.24,38.7,percent of total billed charges,15305.54,1864.78,7805.83,percent of total billed charges,38.7
TISSUE NON-HUMAN 7,C1763,HCPCS,,,,,both,, ,19130.71,482.81,Blue Cross and Blue Shield,Traditional,,7403.58,38.7,percent of total billed charges,19130.71,18.83,9756.66,percent of total billed charges,38.7
TISSUE NON-HUMAN 8,C1763,HCPCS,,,,,both,, ,23912.22,960.99,Blue Cross and Blue Shield,Traditional,,9254.03,38.7,percent of total billed charges,23912.22,37.48,12195.23,percent of total billed charges,38.7
TISSUE NON-HUMAN 9,C1763,HCPCS,,,,,both,, ,33475.26,1439.17,Blue Cross and Blue Shield,Traditional,,12954.93,38.7,percent of total billed charges,33475.26,56.13,17072.38,percent of total billed charges,38.7
EVENT RECRDR CARDIAC,C1764,HCPCS,,,,,both,, ,21590.35,1917.35,Blue Cross and Blue Shield,Traditional,,8355.47,38.7,percent of total billed charges,21590.35,74.78,11011.08,percent of total billed charges,38.7
ADHESION BARRIER1,C1765,HCPCS,,,,,both,, ,717.14,2395.52,Blue Cross and Blue Shield,Traditional,,277.53,38.7,percent of total billed charges,717.14,93.43,365.74,percent of total billed charges,38.7
ADHESION BARRIER2,C1765,HCPCS,,,,,both,, ,956.36,3351.88,Blue Cross and Blue Shield,Traditional,,370.11,38.7,percent of total billed charges,956.36,130.72,487.74,percent of total billed charges,38.7
ADHESION BARRIER3,C1765,HCPCS,,,,,both,, ,8466.86,3351.88,Blue Cross and Blue Shield,Traditional,,3276.67,38.7,percent of total billed charges,8466.86,130.72,4318.1,percent of total billed charges,38.7
ADHESION BARRIER4,C1765,HCPCS,,,,,both,, ,4456.30,2868.81,Blue Cross and Blue Shield,Traditional,,1724.59,38.7,percent of total billed charges,4456.30,111.88,2272.71,percent of total billed charges,38.7
GENRATR NEUROSTM 1,C1767,HCPCS,,,,,both,, ,35861.25,3825.16,Blue Cross and Blue Shield,Traditional,,13878.30,38.7,percent of total billed charges,35861.25,149.18,18289.24,percent of total billed charges,38.7
GENRATR NEUROSTM 2,C1767,HCPCS,,,,,both,, ,71722.51,14344.55,Blue Cross and Blue Shield,Traditional,,27756.61,38.7,percent of total billed charges,71722.51,559.44,36578.48,percent of total billed charges,38.7
GRAFT VASCULAR 1,C1768,HCPCS,,,,,both,, ,1796.58,2774.56,Blue Cross and Blue Shield,Traditional,,695.28,38.7,percent of total billed charges,1796.58,108.21,916.26,percent of total billed charges,38.7
GRAFT VASCULAR 2,C1768,HCPCS,,,,,both,, ,2395.52,53552.79,Blue Cross and Blue Shield,Traditional,,927.07,38.7,percent of total billed charges,2395.52,2088.56,1221.72,percent of total billed charges,38.7
GRAFT VASCULAR 3,C1768,HCPCS,,,,,both,, ,4786.15,1338.74,Blue Cross and Blue Shield,Traditional,,1852.24,38.7,percent of total billed charges,4786.15,52.21,2440.94,percent of total billed charges,38.7
GRAFT VASCULAR 4,C1768,HCPCS,,,,,both,, ,9567.67,4781.52,Blue Cross and Blue Shield,Traditional,,3702.69,38.7,percent of total billed charges,9567.67,186.48,4879.51,percent of total billed charges,38.7
GRAFT VASCULAR 5,C1768,HCPCS,,,,,both,, ,14349.19,3586.20,Blue Cross and Blue Shield,Traditional,,5553.14,38.7,percent of total billed charges,14349.19,139.86,7318.09,percent of total billed charges,38.7
GRAFT VASCULAR 6,C1768,HCPCS,,,,,both,, ,19130.71,4781.52,Blue Cross and Blue Shield,Traditional,,7403.58,38.7,percent of total billed charges,19130.71,186.48,9756.66,percent of total billed charges,38.7
GRAFT VASCULAR 7,C1768,HCPCS,,,,,both,, ,23912.22,9567.67,Blue Cross and Blue Shield,Traditional,,9254.03,38.7,percent of total billed charges,23912.22,373.14,12195.23,percent of total billed charges,38.7
GRAFT VASCULAR 8,C1768,HCPCS,,,,,both,, ,28688.85,11958.56,Blue Cross and Blue Shield,Traditional,,11102.58,38.7,percent of total billed charges,28688.85,466.38,14631.31,percent of total billed charges,38.7
GUIDEWIRE LEVEL 1,C1769,HCPCS,,,,,both,, ,182.83,19130.71,Blue Cross and Blue Shield,Traditional,,70.76,38.7,percent of total billed charges,182.83,746.10,93.24,percent of total billed charges,38.7
GUIDEWIRE LEVEL 10,C1769,HCPCS,,,,,both,, ,3830.06,23912.22,Blue Cross and Blue Shield,Traditional,,1482.23,38.7,percent of total billed charges,3830.06,932.58,1953.33,percent of total billed charges,38.7
GUIDEWIRE LEVEL 11,C1769,HCPCS,,,,,both,, ,4308.23,31084.37,Blue Cross and Blue Shield,Traditional,,1667.29,38.7,percent of total billed charges,4308.23,1212.29,2197.2,percent of total billed charges,38.7
GUIDEWIRE LEVEL 12,C1769,HCPCS,,,,,both,, ,4786.15,38256.78,Blue Cross and Blue Shield,Traditional,,1852.24,38.7,percent of total billed charges,4786.15,1492.01,2440.94,percent of total billed charges,38.7
GUIDEWIRE LEVEL 13,C1769,HCPCS,,,,,both,, ,7177.04,47819.81,Blue Cross and Blue Shield,Traditional,,2777.51,38.7,percent of total billed charges,7177.04,1864.97,3660.29,percent of total billed charges,38.7
GUIDEWIRE LEVEL 14,C1769,HCPCS,,,,,both,, ,9567.67,71727.14,Blue Cross and Blue Shield,Traditional,,3702.69,38.7,percent of total billed charges,9567.67,2797.36,4879.51,percent of total billed charges,38.7
GUIDEWIRE LEVEL 15,C1769,HCPCS,,,,,both,, ,14349.19,95629.84,Blue Cross and Blue Shield,Traditional,,5553.14,38.7,percent of total billed charges,14349.19,3729.56,7318.09,percent of total billed charges,38.7
GUIDEWIRE LEVEL 16,C1769,HCPCS,,,,,both,, ,19130.71,99999.00,Blue Cross and Blue Shield,Traditional,,7403.58,38.7,percent of total billed charges,19130.71,3899.96,9756.66,percent of total billed charges,38.7
GUIDEWIRE LEVEL 17,C1769,HCPCS,,,,,both,, ,23912.22,23599.62,Blue Cross and Blue Shield,Traditional,,9254.03,38.7,percent of total billed charges,23912.22,920.39,12195.23,percent of total billed charges,38.7
GUIDEWIRE LEVEL 18,C1769,HCPCS,,,,,both,, ,31084.37,9563.04,Blue Cross and Blue Shield,Traditional,,12029.65,38.7,percent of total billed charges,31084.37,372.96,15853.03,percent of total billed charges,38.7
GUIDEWIRE LEVEL 19,C1769,HCPCS,,,,,both,, ,38256.78,3586.20,Blue Cross and Blue Shield,Traditional,,14805.37,38.7,percent of total billed charges,38256.78,139.86,19510.96,percent of total billed charges,38.7
GUIDEWIRE LEVEL 2,C1769,HCPCS,,,,,both,, ,243.85,14344.55,Blue Cross and Blue Shield,Traditional,,94.37,38.7,percent of total billed charges,243.85,559.44,124.36,percent of total billed charges,38.7
GUIDEWIRE LEVEL 20,C1769,HCPCS,,,,,both,, ,47814.92,23907.59,Blue Cross and Blue Shield,Traditional,,18504.37,38.7,percent of total billed charges,47814.92,932.40,24385.61,percent of total billed charges,38.7
GUIDEWIRE LEVEL 3,C1769,HCPCS,,,,,both,, ,482.81,9194.30,Blue Cross and Blue Shield,Traditional,,186.85,38.7,percent of total billed charges,482.81,358.58,246.23,percent of total billed charges,38.7
GUIDEWIRE LEVEL 4,C1769,HCPCS,,,,,both,, ,960.99,717.14,Blue Cross and Blue Shield,Traditional,,371.90,38.7,percent of total billed charges,960.99,27.97,490.1,percent of total billed charges,38.7
GUIDEWIRE LEVEL 5,C1769,HCPCS,,,,,both,, ,1439.17,11958.56,Blue Cross and Blue Shield,Traditional,,556.96,38.7,percent of total billed charges,1439.17,466.38,733.98,percent of total billed charges,38.7
GUIDEWIRE LEVEL 6,C1769,HCPCS,,,,,both,, ,1917.35,14349.19,Blue Cross and Blue Shield,Traditional,,742.01,38.7,percent of total billed charges,1917.35,559.62,977.85,percent of total billed charges,38.7
GUIDEWIRE LEVEL 7,C1769,HCPCS,,,,,both,, ,2395.52,19130.71,Blue Cross and Blue Shield,Traditional,,927.07,38.7,percent of total billed charges,2395.52,746.10,1221.72,percent of total billed charges,38.7
GUIDEWIRE LEVEL 8,C1769,HCPCS,,,,,both,, ,3351.88,28693.74,Blue Cross and Blue Shield,Traditional,,1297.18,38.7,percent of total billed charges,3351.88,1119.06,1709.46,percent of total billed charges,38.7
GUIDEWIRE LEVEL 8,C1769,HCPCS,,,,,both,, ,3351.88,43038.29,Blue Cross and Blue Shield,Traditional,,1297.18,38.7,percent of total billed charges,3351.88,1678.49,1709.46,percent of total billed charges,38.7
REP DEV URINRY W/SL1,C1771,HCPCS,,,,,both,, ,2868.81,960.99,Blue Cross and Blue Shield,Traditional,,1110.23,38.7,percent of total billed charges,2868.81,37.48,1463.09,percent of total billed charges,38.7
REP DEV URINRY W/SL2,C1771,HCPCS,,,,,both,, ,3825.16,1917.35,Blue Cross and Blue Shield,Traditional,,1480.34,38.7,percent of total billed charges,3825.16,74.78,1950.83,percent of total billed charges,38.7
REP DEV URINRY W/SL3,C1771,HCPCS,,,,,both,, ,14344.55,2873.70,Blue Cross and Blue Shield,Traditional,,5551.34,38.7,percent of total billed charges,14344.55,112.07,7315.72,percent of total billed charges,38.7
INF PUMP PROGRAM LV1,C1772,HCPCS,,,,,both,, ,2774.56,3830.06,Blue Cross and Blue Shield,Traditional,,1073.75,38.7,percent of total billed charges,2774.56,149.37,1415.03,percent of total billed charges,38.7
INF PUMP PROGRAM LV3,C1772,HCPCS,,,,,both,, ,53552.79,3830.06,Blue Cross and Blue Shield,Traditional,,20724.93,38.7,percent of total billed charges,53552.79,149.37,27311.92,percent of total billed charges,38.7
CATH-RETRIEVAL 1,C1773,HCPCS,,,,,both,, ,1338.74,6220.69,Blue Cross and Blue Shield,Traditional,,518.09,38.7,percent of total billed charges,1338.74,242.61,682.76,percent of total billed charges,38.7
CATH-RETRIEVAL 2,C1773,HCPCS,,,,,both,, ,4781.52,7655.22,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,percent of total billed charges,4781.52,298.55,2438.58,percent of total billed charges,38.7
JOINT DEVICE IMPLT 1,C1776,HCPCS,,,,,both,, ,3586.20,9567.67,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,percent of total billed charges,3586.20,373.14,1828.96,percent of total billed charges,38.7
JOINT DEVICE IMPLT 2,C1776,HCPCS,,,,,both,, ,4781.52,1792.97,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,percent of total billed charges,4781.52,69.93,2438.58,percent of total billed charges,38.7
JOINT DEVICE IMPLT 3,C1776,HCPCS,,,,,both,, ,9567.67,4781.52,Blue Cross and Blue Shield,Traditional,,3702.69,38.7,percent of total billed charges,9567.67,186.48,4879.51,percent of total billed charges,38.7
JOINT DEVICE IMPLT 4,C1776,HCPCS,,,,,both,, ,11958.56,9563.04,Blue Cross and Blue Shield,Traditional,,4627.96,38.7,percent of total billed charges,11958.56,372.96,6098.87,percent of total billed charges,38.7
JOINT DEVICE IMPLT 5,C1776,HCPCS,,,,,both,, ,19130.71,15780.63,Blue Cross and Blue Shield,Traditional,,7403.58,38.7,percent of total billed charges,19130.71,615.44,9756.66,percent of total billed charges,38.7
JOINT DEVICE IMPLT 6,C1776,HCPCS,,,,,both,, ,23912.22,84273.06,Blue Cross and Blue Shield,Traditional,,9254.03,38.7,percent of total billed charges,23912.22,3286.65,12195.23,percent of total billed charges,38.7
JOINT DEVICE IMPLT 7,C1776,HCPCS,,,,,both,, ,31084.37,28809.36,Blue Cross and Blue Shield,Traditional,,12029.65,38.7,percent of total billed charges,31084.37,1123.57,15853.03,percent of total billed charges,38.7
JOINT DEVICE IMPLT 8,C1776,HCPCS,,,,,both,, ,38256.78,62664.69,Blue Cross and Blue Shield,Traditional,,14805.37,38.7,percent of total billed charges,38256.78,2443.92,19510.96,percent of total billed charges,38.7
JOINT DEVICE IMPLT 9,C1776,HCPCS,,,,,both,, ,47819.81,5302.96,Blue Cross and Blue Shield,Traditional,,18506.27,38.7,percent of total billed charges,47819.81,206.82,24388.1,percent of total billed charges,38.7
JOINT DEVICE IMPLT10,C1776,HCPCS,,,,,both,, ,71727.14,720.74,Blue Cross and Blue Shield,Traditional,,27758.40,38.7,percent of total billed charges,71727.14,28.11,36580.84,percent of total billed charges,38.7
JOINT DEVICE IMPLT11,C1776,HCPCS,,,,,both,, ,95629.84,960.99,Blue Cross and Blue Shield,Traditional,,37008.75,38.7,percent of total billed charges,95629.84,37.48,48771.22,percent of total billed charges,38.7
JOINT DEVICE IMPLT12,C1776,HCPCS,,,,,both,, ,99999.00,1912.71,Blue Cross and Blue Shield,Traditional,,38699.61,38.7,percent of total billed charges,99999.00,74.60,50999.49,percent of total billed charges,38.7
LEAD AICD ENDO SN L1,C1777,HCPCS,,,,,both,, ,23599.62,7833.15,Blue Cross and Blue Shield,Traditional,,9133.05,38.7,percent of total billed charges,23599.62,305.49,12035.81,percent of total billed charges,38.7
LEAD NEUROSTIMULAT 1,C1778,HCPCS,,,,,both,, ,9563.04,3586.20,Blue Cross and Blue Shield,Traditional,,3700.90,38.7,percent of total billed charges,9563.04,139.86,4877.15,percent of total billed charges,38.7
LEAD NEUROSTIMULAT 2,C1778,HCPCS,,,,,both,, ,3586.20,4781.52,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,percent of total billed charges,3586.20,186.48,1828.96,percent of total billed charges,38.7
LEAD NEUROSTIMULAT 3,C1778,HCPCS,,,,,both,, ,14344.55,14344.55,Blue Cross and Blue Shield,Traditional,,5551.34,38.7,percent of total billed charges,14344.55,559.44,7315.72,percent of total billed charges,38.7
LEAD NEUROSTIMULAT 4,C1778,HCPCS,,,,,both,, ,23907.59,23907.59,Blue Cross and Blue Shield,Traditional,,9252.24,38.7,percent of total billed charges,23907.59,932.40,12192.87,percent of total billed charges,38.7
LEAD PMKR TRNSV VDD1,C1779,HCPCS,,,,,both,, ,9194.30,1000.00,Blue Cross and Blue Shield,Traditional,,3558.19,38.7,percent of total billed charges,9194.30,39.00,4689.09,percent of total billed charges,38.7
MESH IMPLANTABLE 1,C1781,HCPCS,,,,,both,, ,717.14,38545.95,Blue Cross and Blue Shield,Traditional,,277.53,38.7,percent of total billed charges,717.14,1503.29,365.74,percent of total billed charges,38.7
MESH IMPLANTABLE 10,C1781,HCPCS,,,,,both,, ,11958.56,31193.29,Blue Cross and Blue Shield,Traditional,,4627.96,38.7,percent of total billed charges,11958.56,1216.54,6098.87,percent of total billed charges,38.7
MESH IMPLANTABLE 11,C1781,HCPCS,,,,,both,, ,14349.19,44561.92,Blue Cross and Blue Shield,Traditional,,5553.14,38.7,percent of total billed charges,14349.19,1737.91,7318.09,percent of total billed charges,38.7
MESH IMPLANTABLE 12,C1781,HCPCS,,,,,both,, ,19130.71,3586.20,Blue Cross and Blue Shield,Traditional,,7403.58,38.7,percent of total billed charges,19130.71,139.86,9756.66,percent of total billed charges,38.7
MESH IMPLANTABLE 13,C1781,HCPCS,,,,,both,, ,28693.74,7172.15,Blue Cross and Blue Shield,Traditional,,11104.48,38.7,percent of total billed charges,28693.74,279.71,14633.81,percent of total billed charges,38.7
MESH IMPLANTABLE 14,C1781,HCPCS,,,,,both,, ,43038.29,14344.55,Blue Cross and Blue Shield,Traditional,,16655.82,38.7,percent of total billed charges,43038.29,559.44,21949.53,percent of total billed charges,38.7
MESH IMPLANTABLE 2,C1781,HCPCS,,,,,both,, ,960.99,23907.59,Blue Cross and Blue Shield,Traditional,,371.90,38.7,percent of total billed charges,960.99,932.40,490.1,percent of total billed charges,38.7
MESH IMPLANTABLE 3,C1781,HCPCS,,,,,both,, ,1917.35,3589.81,Blue Cross and Blue Shield,Traditional,,742.01,38.7,percent of total billed charges,1917.35,140.00,977.85,percent of total billed charges,38.7
MESH IMPLANTABLE 4,C1781,HCPCS,,,,,both,, ,2873.70,4786.15,Blue Cross and Blue Shield,Traditional,,1112.12,38.7,percent of total billed charges,2873.70,186.66,1465.59,percent of total billed charges,38.7
MESH IMPLANTABLE 5,C1781,HCPCS,,,,,both,, ,3830.06,9567.67,Blue Cross and Blue Shield,Traditional,,1482.23,38.7,percent of total billed charges,3830.06,373.14,1953.33,percent of total billed charges,38.7
MESH IMPLANTABLE 5,C1781,HCPCS,,,,,both,, ,3830.06,14344.55,Blue Cross and Blue Shield,Traditional,,1482.23,38.7,percent of total billed charges,3830.06,559.44,1953.33,percent of total billed charges,38.7
MESH IMPLANTABLE 7,C1781,HCPCS,,,,,both,, ,6220.69,3586.20,Blue Cross and Blue Shield,Traditional,,2407.41,38.7,percent of total billed charges,6220.69,139.86,3172.55,percent of total billed charges,38.7
MESH IMPLANTABLE 8,C1781,HCPCS,,,,,both,, ,7655.22,4781.52,Blue Cross and Blue Shield,Traditional,,2962.57,38.7,percent of total billed charges,7655.22,186.48,3904.16,percent of total billed charges,38.7
MESH IMPLANTABLE 9,C1781,HCPCS,,,,,both,, ,9567.67,3586.20,Blue Cross and Blue Shield,Traditional,,3702.69,38.7,percent of total billed charges,9567.67,139.86,4879.51,percent of total billed charges,38.7
MORCELLATOR 1,C1782,HCPCS,,,,,both,, ,1792.97,7172.15,Blue Cross and Blue Shield,Traditional,,693.88,38.7,percent of total billed charges,1792.97,279.71,914.41,percent of total billed charges,38.7
MORCELLATOR 2,C1782,HCPCS,,,,,both,, ,4781.52,99999.00,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,percent of total billed charges,4781.52,3899.96,2438.58,percent of total billed charges,38.7
MORCELLATOR 3,C1782,HCPCS,,,,,both,, ,9563.04,6144.21,Blue Cross and Blue Shield,Traditional,,3700.90,38.7,percent of total billed charges,9563.04,239.62,4877.15,percent of total billed charges,38.7
OCLR DEV INTROP DTR1,C1784,HCPCS,,,,,both,, ,15780.63,7172.15,Blue Cross and Blue Shield,Traditional,,6107.10,38.7,percent of total billed charges,15780.63,279.71,8048.12,percent of total billed charges,38.7
PMKR DUAL RATE-RS L1,C1785,HCPCS,,,,,both,, ,84273.06,7172.15,Blue Cross and Blue Shield,Traditional,,32613.67,38.7,percent of total billed charges,84273.06,279.71,42979.26,percent of total billed charges,38.7
PMKR DUAL RATE-RS L2,C1785,HCPCS,,,,,both,, ,28809.36,9563.04,Blue Cross and Blue Shield,Traditional,,11149.22,38.7,percent of total billed charges,28809.36,372.96,14692.77,percent of total billed charges,38.7
PMKR SINGL RATE-RSL1,C1786,HCPCS,,,,,both,, ,62664.69,358.70,Blue Cross and Blue Shield,Traditional,,24251.24,38.7,percent of total billed charges,62664.69,13.99,31958.99,percent of total billed charges,38.7
PATIENT PROGR NEURO1,C1787,HCPCS,,,,,both,, ,5302.96,1195.32,Blue Cross and Blue Shield,Traditional,,2052.25,38.7,percent of total billed charges,5302.96,46.62,2704.51,percent of total billed charges,38.7
PORT 1,C1788,HCPCS,,,,,both,, ,720.74,1912.71,Blue Cross and Blue Shield,Traditional,,278.93,38.7,percent of total billed charges,720.74,74.60,367.58,percent of total billed charges,38.7
PORT 2,C1788,HCPCS,,,,,both,, ,960.99,896.62,Blue Cross and Blue Shield,Traditional,,371.90,38.7,percent of total billed charges,960.99,34.97,490.1,percent of total billed charges,38.7
PORT 3,C1788,HCPCS,,,,,both,, ,1912.71,1195.32,Blue Cross and Blue Shield,Traditional,,740.22,38.7,percent of total billed charges,1912.71,46.62,975.48,percent of total billed charges,38.7
BREAST IMPLANT 1,C1789,HCPCS,,,,,both,, ,7833.15,113.04,Blue Cross and Blue Shield,Traditional,,3031.43,38.7,percent of total billed charges,7833.15,4.41,3994.91,percent of total billed charges,38.7
PRSTHS PENILE INFL 1,C1813,HCPCS,,,,,both,, ,3586.20,570.11,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,percent of total billed charges,3586.20,22.23,1828.96,percent of total billed charges,38.7
PRSTHS PENILE INFL 2,C1813,HCPCS,,,,,both,, ,4781.52,10237.17,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,percent of total billed charges,4781.52,399.25,2438.58,percent of total billed charges,38.7
PRSTHS PENILE INFL 3,C1813,HCPCS,,,,,both,, ,14344.55,179.22,Blue Cross and Blue Shield,Traditional,,5551.34,38.7,percent of total billed charges,14344.55,6.99,7315.72,percent of total billed charges,38.7
PRSTHS PENILE INFL 4,C1813,HCPCS,,,,,both,, ,23907.59,478.18,Blue Cross and Blue Shield,Traditional,,9252.24,38.7,percent of total billed charges,23907.59,18.65,12192.87,percent of total billed charges,38.7
TISSUE LOCALZ EXCISI,C1819,HCPCS,,,,,both,, ,1000.00,1434.53,Blue Cross and Blue Shield,Traditional,,387.00,38.7,percent of total billed charges,1000.00,55.95,510,percent of total billed charges,38.7
GENRATE NEURO RECHR,C1820,HCPCS,,,,,both,, ,38545.95,611.31,Blue Cross and Blue Shield,Traditional,,14917.28,38.7,percent of total billed charges,38545.95,23.84,19658.43,percent of total billed charges,38.7
INTERSPINOUS IMPL L1,C1821,HCPCS,,,,,both,, ,31193.29,3048.29,Blue Cross and Blue Shield,Traditional,,12071.80,38.7,percent of total billed charges,31193.29,118.88,15908.58,percent of total billed charges,38.7
INTERSPINOUS IMPL L2,C1821,HCPCS,,,,,both,, ,44561.92,717.14,Blue Cross and Blue Shield,Traditional,,17245.46,38.7,percent of total billed charges,44561.92,27.97,22726.58,percent of total billed charges,38.7
STNT COAT/COV W/DEL1,C1874,HCPCS,,,,,both,, ,3586.20,1434.53,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,percent of total billed charges,3586.20,55.95,1828.96,percent of total billed charges,38.7
STNT COAT/COV W/DEL2,C1874,HCPCS,,,,,both,, ,7172.15,2390.63,Blue Cross and Blue Shield,Traditional,,2775.62,38.7,percent of total billed charges,7172.15,93.23,3657.8,percent of total billed charges,38.7
STNT COAT/COV W/DEL3,C1874,HCPCS,,,,,both,, ,14344.55,4781.52,Blue Cross and Blue Shield,Traditional,,5551.34,38.7,percent of total billed charges,14344.55,186.48,7315.72,percent of total billed charges,38.7
STNT COAT/COV W/DEL4,C1874,HCPCS,,,,,both,, ,23907.59,7172.15,Blue Cross and Blue Shield,Traditional,,9252.24,38.7,percent of total billed charges,23907.59,279.71,12192.87,percent of total billed charges,38.7
STNT NO COCV W/DEL 1,C1876,HCPCS,,,,,both,, ,3589.81,9563.04,Blue Cross and Blue Shield,Traditional,,1389.26,38.7,percent of total billed charges,3589.81,372.96,1830.8,percent of total billed charges,38.7
STNT NO COCV W/DEL 2,C1876,HCPCS,,,,,both,, ,4786.15,14344.55,Blue Cross and Blue Shield,Traditional,,1852.24,38.7,percent of total billed charges,4786.15,559.44,2440.94,percent of total billed charges,38.7
STNT NO COCV W/DEL 3,C1876,HCPCS,,,,,both,, ,9567.67,19126.07,Blue Cross and Blue Shield,Traditional,,3702.69,38.7,percent of total billed charges,9567.67,745.92,4879.51,percent of total billed charges,38.7
STNT NO COCV W/DEL 4,C1876,HCPCS,,,,,both,, ,14344.55,76277.94,Blue Cross and Blue Shield,Traditional,,5551.34,38.7,percent of total billed charges,14344.55,2974.84,7315.72,percent of total billed charges,38.7
STNT NO-COA/COV W/O1,C1877,HCPCS,,,,,both,, ,3586.20,16735.18,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,percent of total billed charges,3586.20,652.67,1828.96,percent of total billed charges,38.7
STNT NO-COA/COV W/O2,C1877,HCPCS,,,,,both,, ,4781.52,16206.54,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,percent of total billed charges,4781.52,632.06,2438.58,percent of total billed charges,38.7
VENA CAVA FILTER 1,C1880,HCPCS,,,,,both,, ,3586.20,3586.20,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,percent of total billed charges,3586.20,139.86,1828.96,percent of total billed charges,38.7
VENA CAVA FILTER 2,C1880,HCPCS,,,,,both,, ,7172.15,6646.33,Blue Cross and Blue Shield,Traditional,,2775.62,38.7,percent of total billed charges,7172.15,259.21,3657.8,percent of total billed charges,38.7
AICD OHR THN SGL/DU1,C1882,HCPCS,,,,,both,, ,99999.00,4781.52,Blue Cross and Blue Shield,Traditional,,38699.61,38.7,percent of total billed charges,99999.00,186.48,50999.49,percent of total billed charges,38.7
EMBOLIZ PROTECT SYS1,C1884,HCPCS,,,,,both,, ,6144.21,41218.03,Blue Cross and Blue Shield,Traditional,,2377.81,38.7,percent of total billed charges,6144.21,1607.50,3133.55,percent of total billed charges,38.7
EMBOLIZ PROTECT SYS2,C1884,HCPCS,,,,,both,, ,7172.15,20278.38,Blue Cross and Blue Shield,Traditional,,2775.62,38.7,percent of total billed charges,7172.15,790.86,3657.8,percent of total billed charges,38.7
CATH TRNSLUM ANG LA1,C1885,HCPCS,,,,,both,, ,7172.15,5932.54,Blue Cross and Blue Shield,Traditional,,2775.62,38.7,percent of total billed charges,7172.15,231.37,3657.8,percent of total billed charges,38.7
CATH TRNSLUM ANG LA2,C1885,HCPCS,,,,,both,, ,9563.04,2963.83,Blue Cross and Blue Shield,Traditional,,3700.90,38.7,percent of total billed charges,9563.04,115.59,4877.15,percent of total billed charges,38.7
CATHETER GUIDING 1,C1887,HCPCS,,,,,both,, ,358.70,3586.20,Blue Cross and Blue Shield,Traditional,,138.82,38.7,percent of total billed charges,358.70,139.86,182.94,percent of total billed charges,38.7
CATHETER GUIDING 2,C1887,HCPCS,,,,,both,, ,1195.32,4781.52,Blue Cross and Blue Shield,Traditional,,462.59,38.7,percent of total billed charges,1195.32,186.48,609.61,percent of total billed charges,38.7
CATHETER GUIDING 3,C1887,HCPCS,,,,,both,, ,1912.71,9563.04,Blue Cross and Blue Shield,Traditional,,740.22,38.7,percent of total billed charges,1912.71,372.96,975.48,percent of total billed charges,38.7
CATH ABLTN NOCRD ED1,C1888,HCPCS,,,,,both,, ,896.62,16735.18,Blue Cross and Blue Shield,Traditional,,346.99,38.7,percent of total billed charges,896.62,652.67,457.28,percent of total billed charges,38.7
CATH ABLTN NOCRD ED2,C1888,HCPCS,,,,,both,, ,1195.32,73166.31,Blue Cross and Blue Shield,Traditional,,462.59,38.7,percent of total billed charges,1195.32,2853.49,609.61,percent of total billed charges,38.7
EAR TUBES DRAINAGE 1,C1889,HCPCS,,,,,both,, ,113.04,45918.17,Blue Cross and Blue Shield,Traditional,,43.75,38.7,percent of total billed charges,113.04,1790.81,57.65,percent of total billed charges,38.7
TISSUE EXP NONBREAST,C1889,HCPCS,,,,,both,, ,570.11,99999.00,Blue Cross and Blue Shield,Traditional,,220.63,38.7,percent of total billed charges,570.11,3899.96,290.76,percent of total billed charges,38.7
INF PMP NON-PROG LV1,C1891,HCPCS,,,,,both,, ,10237.17,38894.09,Blue Cross and Blue Shield,Traditional,,3961.78,38.7,percent of total billed charges,10237.17,1516.87,5220.96,percent of total billed charges,38.7
PEEL-AWAY SHEATH 1,C1892,HCPCS,,,,,both,, ,179.22,99999.00,Blue Cross and Blue Shield,Traditional,,69.36,38.7,percent of total billed charges,179.22,3899.96,91.4,percent of total billed charges,38.7
PEEL-AWAY SHEATH 2,C1892,HCPCS,,,,,both,, ,478.18,541.52,Blue Cross and Blue Shield,Traditional,,185.06,38.7,percent of total billed charges,478.18,21.12,243.87,percent of total billed charges,38.7
PEEL-AWAY SHEATH 3,C1892,HCPCS,,,,,both,, ,1434.53,722.03,Blue Cross and Blue Shield,Traditional,,555.16,38.7,percent of total billed charges,1434.53,28.16,731.61,percent of total billed charges,38.7
INT SHTH FIX NO-PL 1,C1893,HCPCS,,,,,both,, ,611.31,3787.83,Blue Cross and Blue Shield,Traditional,,236.58,38.7,percent of total billed charges,611.31,147.73,311.77,percent of total billed charges,38.7
INT SHTH FIX NO-PL 2,C1893,HCPCS,,,,,both,, ,3048.29,545.13,Blue Cross and Blue Shield,Traditional,,1179.69,38.7,percent of total billed charges,3048.29,21.26,1554.63,percent of total billed charges,38.7
SHEATH NON-LASR 1,C1894,HCPCS,,,,,both,, ,717.14,172.01,Blue Cross and Blue Shield,Traditional,,277.53,38.7,percent of total billed charges,717.14,6.71,365.74,percent of total billed charges,38.7
SHEATH NON-LASR 2,C1894,HCPCS,,,,,both,, ,1434.53,1075.84,Blue Cross and Blue Shield,Traditional,,555.16,38.7,percent of total billed charges,1434.53,41.96,731.61,percent of total billed charges,38.7
SHEATH NON-LASR 3,C1894,HCPCS,,,,,both,, ,2390.63,717.14,Blue Cross and Blue Shield,Traditional,,925.17,38.7,percent of total billed charges,2390.63,27.97,1219.22,percent of total billed charges,38.7
SHEATH NON-LASR 4,C1894,HCPCS,,,,,both,, ,4781.52,1434.53,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,percent of total billed charges,4781.52,55.95,2438.58,percent of total billed charges,38.7
SHEATH NON-LASR 5,C1894,HCPCS,,,,,both,, ,7172.15,2390.63,Blue Cross and Blue Shield,Traditional,,2775.62,38.7,percent of total billed charges,7172.15,93.23,3657.8,percent of total billed charges,38.7
SHEATH NON-LASR 6,C1894,HCPCS,,,,,both,, ,9563.04,5379.18,Blue Cross and Blue Shield,Traditional,,3700.90,38.7,percent of total billed charges,9563.04,209.79,4877.15,percent of total billed charges,38.7
SHEATH NON-LASR 7,C1894,HCPCS,,,,,both,, ,14344.55,7172.15,Blue Cross and Blue Shield,Traditional,,5551.34,38.7,percent of total billed charges,14344.55,279.71,7315.72,percent of total billed charges,38.7
SHEATH NON-LASR 8,C1894,HCPCS,,,,,both,, ,19126.07,8266.27,Blue Cross and Blue Shield,Traditional,,7401.79,38.7,percent of total billed charges,19126.07,322.38,9754.3,percent of total billed charges,38.7
LEAD AICD END DUL L1,C1895,HCPCS,,,,,both,, ,76277.94,2393.60,Blue Cross and Blue Shield,Traditional,,29519.56,38.7,percent of total billed charges,76277.94,93.35,38901.75,percent of total billed charges,38.7
LEAD AICD END DUL L2,C1895,HCPCS,,,,,both,, ,16735.18,2393.60,Blue Cross and Blue Shield,Traditional,,6476.51,38.7,percent of total billed charges,16735.18,93.35,8534.94,percent of total billed charges,38.7
LEAD AICD NO-SING L1,C1896,HCPCS,,,,,both,, ,16206.54,6950.12,Blue Cross and Blue Shield,Traditional,,6271.93,38.7,percent of total billed charges,16206.54,271.05,8265.34,percent of total billed charges,38.7
LEAD NEUROSTM TST K1,C1897,HCPCS,,,,,both,, ,3586.20,6950.12,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,percent of total billed charges,3586.20,271.05,1828.96,percent of total billed charges,38.7
LEAD NEUROSTM TST K2,C1897,HCPCS,,,,,both,, ,6646.33,2393.60,Blue Cross and Blue Shield,Traditional,,2572.13,38.7,percent of total billed charges,6646.33,93.35,3389.63,percent of total billed charges,38.7
LEAD PMKR NON-TRN L1,C1898,HCPCS,,,,,both,, ,4781.52,2393.60,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,percent of total billed charges,4781.52,93.35,2438.58,percent of total billed charges,38.7
LEAD PMKR/AICD CMBL1,C1899,HCPCS,,,,,both,, ,41218.03,2393.60,Blue Cross and Blue Shield,Traditional,,15951.38,38.7,percent of total billed charges,41218.03,93.35,21021.2,percent of total billed charges,38.7
LEAD LT VENT COR LV1,C1900,HCPCS,,,,,both,, ,20278.38,2393.60,Blue Cross and Blue Shield,Traditional,,7847.73,38.7,percent of total billed charges,20278.38,93.35,10341.97,percent of total billed charges,38.7
SEALANT PULMNRY LIQD,C2615,HCPCS,,,,,both,, ,5932.54,1035.69,Blue Cross and Blue Shield,Traditional,,2295.89,38.7,percent of total billed charges,5932.54,40.39,3025.6,percent of total billed charges,38.7
STNT NONCOR TM W/O 1,C2617,HCPCS,,,,,both,, ,2963.83,1114.55,Blue Cross and Blue Shield,Traditional,,1147.00,38.7,percent of total billed charges,2963.83,43.47,1511.55,percent of total billed charges,38.7
PROBE CRYOABLATION 1,C2618,HCPCS,,,,,both,, ,3586.20,715.99,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,percent of total billed charges,3586.20,27.92,1828.96,percent of total billed charges,38.7
PROBE CRYOABLATION 2,C2618,HCPCS,,,,,both,, ,4781.52,770.45,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,percent of total billed charges,4781.52,30.05,2438.58,percent of total billed charges,38.7
PROBE CRYOABLATION 3,C2618,HCPCS,,,,,both,, ,9563.04,1197.08,Blue Cross and Blue Shield,Traditional,,3700.90,38.7,percent of total billed charges,9563.04,46.69,4877.15,percent of total billed charges,38.7
PROBE CRYOABLATION 4,C2618,HCPCS,,,,,both,, ,16735.18,1288.29,Blue Cross and Blue Shield,Traditional,,6476.51,38.7,percent of total billed charges,16735.18,50.24,8534.94,percent of total billed charges,38.7
PMKR DUL NON RAT LV1,C2619,HCPCS,,,,,both,, ,73166.31,2669.78,Blue Cross and Blue Shield,Traditional,,28315.36,38.7,percent of total billed charges,73166.31,104.12,37314.82,percent of total billed charges,38.7
PMKR SNGL NON RTE-RE,C2620,HCPCS,,,,,both,, ,45918.17,3114.65,Blue Cross and Blue Shield,Traditional,,17770.33,38.7,percent of total billed charges,45918.17,121.47,23418.27,percent of total billed charges,38.7
PMKR OTHR TH SNGL L1,C2621,HCPCS,,,,,both,, ,99999.00,3115.20,Blue Cross and Blue Shield,Traditional,,38699.61,38.7,percent of total billed charges,99999.00,121.49,50999.49,percent of total billed charges,38.7
PRSTHS PENILE NNINF1,C2622,HCPCS,,,,,both,, ,38894.09,1197.08,Blue Cross and Blue Shield,Traditional,,15052.01,38.7,percent of total billed charges,38894.09,46.69,19835.99,percent of total billed charges,38.7
WIRELESS PRESS SENS,C2624,HCPCS,,,,,both,, ,99999.00,1288.29,Blue Cross and Blue Shield,Traditional,,38699.61,38.7,percent of total billed charges,99999.00,50.24,50999.49,percent of total billed charges,38.7
STNT NON-COR TM DL 1,C2625,HCPCS,,,,,both,, ,541.52,2394.15,Blue Cross and Blue Shield,Traditional,,209.57,38.7,percent of total billed charges,541.52,93.37,276.18,percent of total billed charges,38.7
STNT NON-COR TM DL 2,C2625,HCPCS,,,,,both,, ,722.03,2576.60,Blue Cross and Blue Shield,Traditional,,279.43,38.7,percent of total billed charges,722.03,100.49,368.24,percent of total billed charges,38.7
STNT NON-COR TM DL 3,C2625,HCPCS,,,,,both,, ,3787.83,50.52,Blue Cross and Blue Shield,Traditional,,1465.89,38.7,percent of total billed charges,3787.83,1.97,1931.79,percent of total billed charges,38.7
INF PMP NON-PROG LV1,C2626,HCPCS,,,,,both,, ,545.13,8.00,Blue Cross and Blue Shield,Traditional,,210.97,38.7,percent of total billed charges,545.13,0.31,278.02,percent of total billed charges,38.7
CATH SUPRPUBC-CYSTO1,C2627,HCPCS,,,,,both,, ,172.01,10077.78,Blue Cross and Blue Shield,Traditional,,66.57,38.7,percent of total billed charges,172.01,393.03,87.73,percent of total billed charges,38.7
CATH SUPRPUBC-CYSTO2,C2627,HCPCS,,,,,both,, ,1075.84,2878.85,Blue Cross and Blue Shield,Traditional,,416.35,38.7,percent of total billed charges,1075.84,112.28,548.68,percent of total billed charges,38.7
CATH OCCLUSION 1,C2628,HCPCS,,,,,both,, ,717.14,42411.02,Blue Cross and Blue Shield,Traditional,,277.53,38.7,percent of total billed charges,717.14,1654.03,365.74,percent of total billed charges,38.7
CATH OCCLUSION 2,C2628,HCPCS,,,,,both,, ,1434.53,29428.39,Blue Cross and Blue Shield,Traditional,,555.16,38.7,percent of total billed charges,1434.53,1147.71,731.61,percent of total billed charges,38.7
CATH OCCLUSION 3,C2628,HCPCS,,,,,both,, ,2390.63,106.25,Blue Cross and Blue Shield,Traditional,,925.17,38.7,percent of total billed charges,2390.63,4.14,1219.22,percent of total billed charges,38.7
INTRO/SHEATH LASER 1,C2629,HCPCS,,,,,both,, ,5379.18,106.25,Blue Cross and Blue Shield,Traditional,,2081.74,38.7,percent of total billed charges,5379.18,4.14,2743.38,percent of total billed charges,38.7
INTRO/SHEATH LASER 2,C2629,HCPCS,,,,,both,, ,7172.15,70.81,Blue Cross and Blue Shield,Traditional,,2775.62,38.7,percent of total billed charges,7172.15,2.76,3657.8,percent of total billed charges,38.7
REP DEV URNRY WO SL1,C2631,HCPCS,,,,,both,, ,8266.27,70.81,Blue Cross and Blue Shield,Traditional,,3199.05,38.7,percent of total billed charges,8266.27,2.76,4215.8,percent of total billed charges,38.7
LC S SUB T/A/L 25S,C5271,HCPCS,,,,,both,, ,2393.60,109.18,Blue Cross and Blue Shield,Traditional,,926.32,38.7,percent of total billed charges,2393.60,4.26,1220.74,percent of total billed charges,38.7
LC S SUB T/A/L ADL,C5272,HCPCS,,,,,both,, ,2393.60,143.69,Blue Cross and Blue Shield,Traditional,,926.32,38.7,percent of total billed charges,2393.60,5.60,1220.74,percent of total billed charges,38.7
LC S SUB T/A/L 100SQ,C5273,HCPCS,,,,,both,, ,6950.12,184.63,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,7.20,3544.56,percent of total billed charges,38.7
LC S SUB T/A/L ADL,C5274,HCPCS,,,,,both,, ,6950.12,106.25,Blue Cross and Blue Shield,Traditional,,2689.70,38.7,percent of total billed charges,6950.12,4.14,3544.56,percent of total billed charges,38.7
LC S SUB F/NK/HF/G,C5275,HCPCS,,,,,both,, ,2393.60,106.25,Blue Cross and Blue Shield,Traditional,,926.32,38.7,percent of total billed charges,2393.60,4.14,1220.74,percent of total billed charges,38.7
LC S SUB F/NK/HF/G EA,C5276,HCPCS,,,,,both,, ,2393.60,105.06,Blue Cross and Blue Shield,Traditional,,926.32,38.7,percent of total billed charges,2393.60,4.10,1220.74,percent of total billed charges,38.7
LC S SUB F/NK/HF/G 100SQ,C5277,HCPCS,,,,,both,, ,2393.60,105.06,Blue Cross and Blue Shield,Traditional,,926.32,38.7,percent of total billed charges,2393.60,4.10,1220.74,percent of total billed charges,38.7
LC S SUB F/NK/HF/G EA,C5278,HCPCS,,,,,both,, ,2393.60,109.18,Blue Cross and Blue Shield,Traditional,,926.32,38.7,percent of total billed charges,2393.60,4.26,1220.74,percent of total billed charges,38.7
MRA-ABDOMEN W,C8900,HCPCS,,,,,both,, ,1035.69,143.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,percent of total billed charges,1035.69,5.60,528.2,percent of total billed charges,38.7
MRA-ABDOMEN W,C8900,HCPCS,,,,,both,, ,1114.55,184.63,Blue Cross and Blue Shield,Traditional,,431.33,38.7,percent of total billed charges,1114.55,7.20,568.42,percent of total billed charges,38.7
MRA-ABDOMEN WO,C8901,HCPCS,,,,,both,, ,715.99,106.25,Blue Cross and Blue Shield,Traditional,,277.09,38.7,percent of total billed charges,715.99,4.14,365.15,percent of total billed charges,38.7
MRA-ABDOMEN WO,C8901,HCPCS,,,,,both,, ,770.45,106.25,Blue Cross and Blue Shield,Traditional,,298.16,38.7,percent of total billed charges,770.45,4.14,392.93,percent of total billed charges,38.7
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,1197.08,105.06,Blue Cross and Blue Shield,Traditional,,463.27,38.7,percent of total billed charges,1197.08,4.10,610.51,percent of total billed charges,38.7
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,1288.29,105.06,Blue Cross and Blue Shield,Traditional,,498.57,38.7,percent of total billed charges,1288.29,4.10,657.03,percent of total billed charges,38.7
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,2669.78,109.44,Blue Cross and Blue Shield,Traditional,,1033.20,38.7,percent of total billed charges,2669.78,4.27,1361.59,percent of total billed charges,38.7
MR-BREAST UNI WWO,C8905,HCPCS,,,,,both,, ,3114.65,135.85,Blue Cross and Blue Shield,Traditional,,1205.37,38.7,percent of total billed charges,3114.65,5.30,1588.47,percent of total billed charges,38.7
MR-BREAST BI WWO,C8908,HCPCS,,,,,both,, ,3115.20,1036.25,Blue Cross and Blue Shield,Traditional,,1205.58,38.7,percent of total billed charges,3115.20,40.41,1588.75,percent of total billed charges,38.7
MRA-LW EXTR WWO,C8914,HCPCS,,,,,both,, ,1197.08,1036.25,Blue Cross and Blue Shield,Traditional,,463.27,38.7,percent of total billed charges,1197.08,40.41,610.51,percent of total billed charges,38.7
MRA-LW EXTR WWO,C8914,HCPCS,,,,,both,, ,1288.29,1036.25,Blue Cross and Blue Shield,Traditional,,498.57,38.7,percent of total billed charges,1288.29,40.41,657.03,percent of total billed charges,38.7
MRA-LW EXTR WWO BI,C8914,HCPCS,,,,,both,, ,2394.15,261.62,Blue Cross and Blue Shield,Traditional,,926.54,38.7,percent of total billed charges,2394.15,10.20,1221.02,percent of total billed charges,38.7
MRA-LW EXTR WWO BI,C8914,CPT,,,,,both,, ,2576.60,195.06,Blue Cross and Blue Shield,Traditional,,997.14,38.7,percent of total billed charges,2576.60,7.61,1314.07,percent of total billed charges,38.7
BR-CAD MRI LESION,C8937,HCPCS,,,,,both,, ,50.52,177.16,Blue Cross and Blue Shield,Traditional,,19.55,38.7,percent of total billed charges,50.52,6.91,25.77,percent of total billed charges,38.7
COCAINE HCL NASL 1MG,C9046,HCPCS,,,,,both,4,ML,8.00,177.16,Blue Cross and Blue Shield,Traditional,,3.10,38.7,percent of total billed charges,8.00,6.91,4.08,percent of total billed charges,38.7
IDARUCIZU 2.5GM/50ML,C9399,HCPCS,,,,,both,50,ML,10077.78,177.16,Blue Cross and Blue Shield,Traditional,,3900.10,38.7,percent of total billed charges,10077.78,6.91,5139.67,percent of total billed charges,38.7
REMDESIV 5MG/ML 20ML,C9399,HCPCS,,,,,both,, ,2878.85,9908.34,Blue Cross and Blue Shield,Traditional,,1114.11,38.7,percent of total billed charges,2878.85,386.43,1468.21,percent of total billed charges,38.7
IC-PRQ DE COR STNT,C9600,CPT,,,,,both,, ,42411.02,2101.41,Blue Cross and Blue Shield,Traditional,,16413.06,38.7,percent of total billed charges,42411.02,81.95,21629.62,percent of total billed charges,38.7
IC-PRQ DE CR REV CAB,C9604,CPT,,,,,both,, ,29428.39,22097.11,Blue Cross and Blue Shield,Traditional,,11388.79,38.7,percent of total billed charges,29428.39,861.79,15008.48,percent of total billed charges,38.7
ADMIN FLU VACCINE,G0008,HCPCS,,,,,both,, ,106.25,265.23,Blue Cross and Blue Shield,Traditional,,41.12,38.7,percent of total billed charges,106.25,10.34,54.19,percent of total billed charges,38.7
ADMIN FLU VACCINE,G0008,HCPCS,,,,,both,, ,106.25,160.68,Blue Cross and Blue Shield,Traditional,,41.12,38.7,percent of total billed charges,106.25,6.27,54.19,percent of total billed charges,38.7
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,70.81,160.68,Blue Cross and Blue Shield,Traditional,,27.40,38.7,percent of total billed charges,70.81,6.27,36.11,percent of total billed charges,38.7
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,70.81,133.90,Blue Cross and Blue Shield,Traditional,,27.40,38.7,percent of total billed charges,70.81,5.22,36.11,percent of total billed charges,38.7
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,109.18,133.90,Blue Cross and Blue Shield,Traditional,,42.25,38.7,percent of total billed charges,109.18,5.22,55.68,percent of total billed charges,38.7
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,143.69,443.37,Blue Cross and Blue Shield,Traditional,,55.61,38.7,percent of total billed charges,143.69,17.29,73.28,percent of total billed charges,38.7
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,184.63,480.68,Blue Cross and Blue Shield,Traditional,,71.45,38.7,percent of total billed charges,184.63,18.75,94.16,percent of total billed charges,38.7
ADMIN PNEU VACCINE,G0009,HCPCS,,,,,both,, ,106.25,37.08,Blue Cross and Blue Shield,Traditional,,41.12,38.7,percent of total billed charges,106.25,1.45,54.19,percent of total billed charges,38.7
ADMIN PNEU VACCINE,G0009,HCPCS,,,,,both,, ,106.25,37.08,Blue Cross and Blue Shield,Traditional,,41.12,38.7,percent of total billed charges,106.25,1.45,54.19,percent of total billed charges,38.7
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,105.06,37.08,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,1.45,53.58,percent of total billed charges,38.7
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,105.06,37.08,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,1.45,53.58,percent of total billed charges,38.7
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,109.18,515.00,Blue Cross and Blue Shield,Traditional,,42.25,38.7,percent of total billed charges,109.18,20.09,55.68,percent of total billed charges,38.7
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,143.69,515.00,Blue Cross and Blue Shield,Traditional,,55.61,38.7,percent of total billed charges,143.69,20.09,73.28,percent of total billed charges,38.7
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,184.63,474.83,Blue Cross and Blue Shield,Traditional,,71.45,38.7,percent of total billed charges,184.63,18.52,94.16,percent of total billed charges,38.7
HEP B VACCINE ADMIN,G0010,HCPCS,,,,,both,, ,106.25,474.83,Blue Cross and Blue Shield,Traditional,,41.12,38.7,percent of total billed charges,106.25,18.52,54.19,percent of total billed charges,38.7
HEP B VACCINE ADMIN,G0010,HCPCS,,,,,both,, ,106.25,159.42,Blue Cross and Blue Shield,Traditional,,41.12,38.7,percent of total billed charges,106.25,6.22,54.19,percent of total billed charges,38.7
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,105.06,1189.39,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,46.39,53.58,percent of total billed charges,38.7
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,105.06,1189.39,Blue Cross and Blue Shield,Traditional,,40.66,38.7,percent of total billed charges,105.06,46.39,53.58,percent of total billed charges,38.7
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,109.44,141.21,Blue Cross and Blue Shield,Traditional,,42.35,38.7,percent of total billed charges,109.44,5.51,55.81,percent of total billed charges,38.7
"PSA, SCREENING",G0103,HCPCS,,,,,both,, ,135.85,151.15,Blue Cross and Blue Shield,Traditional,,52.57,38.7,percent of total billed charges,135.85,5.89,69.28,percent of total billed charges,38.7
"PSA, SCREENING",G0103,HCPCS,,,,,both,,,1036.25,151.15,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,5.89,528.49,percent of total billed charges,38.7
"PSA, SCREENING",G0103,CPT,,,,,both,, ,1036.25,610.15,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,23.80,528.49,percent of total billed charges,38.7
"PSA, SCREENING",G0103,CPT,,,,,both,, ,1036.25,653.54,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,25.49,528.49,percent of total billed charges,38.7
DSMT INDIVIDUAL 30M,G0108,HCPCS,,,,,both,, ,261.62,653.54,Blue Cross and Blue Shield,Traditional,,101.25,38.7,percent of total billed charges,261.62,25.49,133.43,percent of total billed charges,38.7
PAP THINLAY LIQ SCRN,G0123,HCPCS,,,,,both,, ,195.06,428.48,Blue Cross and Blue Shield,Traditional,,75.49,38.7,percent of total billed charges,195.06,16.71,99.48,percent of total billed charges,38.7
STRNGTH TRN SLG 15MI,G0237,HCPCS,,,,,both,, ,177.16,428.48,Blue Cross and Blue Shield,Traditional,,68.56,38.7,percent of total billed charges,177.16,16.71,90.35,percent of total billed charges,38.7
RESP FX TRN SGL 15MN,G0238,HCPCS,,,,,both,, ,177.16,1059.54,Blue Cross and Blue Shield,Traditional,,68.56,38.7,percent of total billed charges,177.16,41.32,90.35,percent of total billed charges,38.7
RESP FX TRAIN GROUP,G0239,HCPCS,,,,,both,, ,177.16,113.39,Blue Cross and Blue Shield,Traditional,,68.56,38.7,percent of total billed charges,177.16,4.42,90.35,percent of total billed charges,38.7
DIALYSIS  EMERGENT,G0257,HCPCS,,,,,both,, ,9908.34,165.59,Blue Cross and Blue Shield,Traditional,,3834.53,38.7,percent of total billed charges,9908.34,6.46,5053.25,percent of total billed charges,38.7
IR-ARTHROGRAM SI JTS,G0260,HCPCS,,,,,both,, ,2101.41,42.66,Blue Cross and Blue Shield,Traditional,,813.25,38.7,percent of total billed charges,2101.41,1.66,1071.72,percent of total billed charges,38.7
CC-PLACE CLOS DEV,G0269,HCPCS,,,,,both,, ,22097.11,1036.25,Blue Cross and Blue Shield,Traditional,,8551.58,38.7,percent of total billed charges,22097.11,40.41,11269.53,percent of total billed charges,38.7
HBO FB 30MN,G0277,HCPCS,,,,,both,, ,265.23,215.75,Blue Cross and Blue Shield,Traditional,,102.64,38.7,percent of total billed charges,265.23,8.41,135.27,percent of total billed charges,38.7
BR-TOMO MAMMO BI,G0279,HCPCS,,,,,both,,,160.68,261.00,Blue Cross and Blue Shield,Traditional,,62.18,38.7,percent of total billed charges,160.68,10.18,81.95,percent of total billed charges,38.7
BR-TOMO MAMMO BI,G0279,HCPCS,,,,,both,, ,160.68,520.00,Blue Cross and Blue Shield,Traditional,,62.18,38.7,percent of total billed charges,160.68,20.28,81.95,percent of total billed charges,38.7
BR-TOMO MAMMO UNI,G0279,HCPCS,,,,,both,,,133.90,132.61,Blue Cross and Blue Shield,Traditional,,51.82,38.7,percent of total billed charges,133.90,5.17,68.29,percent of total billed charges,38.7
BR-TOMO MAMMO UNI,G0279,HCPCS,,,,,both,, ,133.90,132.61,Blue Cross and Blue Shield,Traditional,,51.82,38.7,percent of total billed charges,133.90,5.17,68.29,percent of total billed charges,38.7
ELEC STIM-UNATTND-VI,G0283,HCPCS,,,,,both,, ,443.37,249.52,Blue Cross and Blue Shield,Traditional,,171.58,38.7,percent of total billed charges,443.37,9.73,226.12,percent of total billed charges,38.7
ELEC STIM-UNATTND-VI,G0283,HCPCS,,,,,both,, ,480.68,188.75,Blue Cross and Blue Shield,Traditional,,186.02,38.7,percent of total billed charges,480.68,7.36,245.15,percent of total billed charges,38.7
ELEC STM-UNAT-VI OT,G0283,HCPCS,,,,,both,, ,37.08,188.75,Blue Cross and Blue Shield,Traditional,,14.35,38.7,percent of total billed charges,37.08,7.36,18.91,percent of total billed charges,38.7
ELEC STM-UNAT-VI OT,G0283,HCPCS,,,,,both,, ,37.08,251.84,Blue Cross and Blue Shield,Traditional,,14.35,38.7,percent of total billed charges,37.08,9.82,18.91,percent of total billed charges,38.7
ELEC STM-UNAT-VI OT,G0283,HCPCS,,,,,both,, ,37.08,251.84,Blue Cross and Blue Shield,Traditional,,14.35,38.7,percent of total billed charges,37.08,9.82,18.91,percent of total billed charges,38.7
ELEC STM-UNAT-VI OT,G0283,HCPCS,,,,,both,, ,37.08,251.84,Blue Cross and Blue Shield,Traditional,,14.35,38.7,percent of total billed charges,37.08,9.82,18.91,percent of total billed charges,38.7
ELEC STM-UNAT-VI OT,G0283,HCPCS,,,,,both,, ,515.00,251.84,Blue Cross and Blue Shield,Traditional,,199.31,38.7,percent of total billed charges,515.00,9.82,262.65,percent of total billed charges,38.7
ELEC STM-UNAT-VI OT,G0283,HCPCS,,,,,both,, ,515.00,188.75,Blue Cross and Blue Shield,Traditional,,199.31,38.7,percent of total billed charges,515.00,7.36,262.65,percent of total billed charges,38.7
ELEC STM-UNAT-VI PT,G0283,HCPCS,,,,,both,, ,474.83,324.19,Blue Cross and Blue Shield,Traditional,,183.76,38.7,percent of total billed charges,474.83,12.64,242.16,percent of total billed charges,38.7
ELEC STM-UNAT-VI PT,G0283,HCPCS,,,,,both,, ,474.83,324.19,Blue Cross and Blue Shield,Traditional,,183.76,38.7,percent of total billed charges,474.83,12.64,242.16,percent of total billed charges,38.7
SCR FECAL OC BLD 1-3,G0328,HCPCS,,,,,both,, ,159.42,425.91,Blue Cross and Blue Shield,Traditional,,61.70,38.7,percent of total billed charges,159.42,16.61,81.3,percent of total billed charges,38.7
OBSERVATION 1ST HOUR,G0378,HCPCS,,,,,both,, ,1189.39,700.40,Blue Cross and Blue Shield,Traditional,,460.29,38.7,percent of total billed charges,1189.39,27.32,606.59,percent of total billed charges,38.7
OBSERVATION 1ST HOUR,G0378,HCPCS,,,,,both,, ,1189.39,325.25,Blue Cross and Blue Shield,Traditional,,460.29,38.7,percent of total billed charges,1189.39,12.68,606.59,percent of total billed charges,38.7
OBSRVATION ADDL HOUR,G0378,HCPCS,,,,,both,, ,141.21,379.50,Blue Cross and Blue Shield,Traditional,,54.65,38.7,percent of total billed charges,141.21,14.80,72.02,percent of total billed charges,38.7
OBSRVATION ADDL HOUR,G0378,HCPCS,,,,,both,, ,151.15,433.50,Blue Cross and Blue Shield,Traditional,,58.50,38.7,percent of total billed charges,151.15,16.91,77.09,percent of total billed charges,38.7
OBSRVATION ADDL HOUR,G0378,HCPCS,,,,,both,, ,151.15,487.50,Blue Cross and Blue Shield,Traditional,,58.50,38.7,percent of total billed charges,151.15,19.01,77.09,percent of total billed charges,38.7
DIRECT ADMIT TO OBS,G0379,HCPCS,,,,,both,, ,610.15,55.62,Blue Cross and Blue Shield,Traditional,,236.13,38.7,percent of total billed charges,610.15,2.17,311.18,percent of total billed charges,38.7
DIRECT ADMIT TO OBS,G0379,HCPCS,,,,,both,, ,653.54,55.62,Blue Cross and Blue Shield,Traditional,,252.92,38.7,percent of total billed charges,653.54,2.17,333.31,percent of total billed charges,38.7
DIRECT ADMIT TO OBS,G0379,HCPCS,,,,,both,, ,653.54,66.95,Blue Cross and Blue Shield,Traditional,,252.92,38.7,percent of total billed charges,653.54,2.61,333.31,percent of total billed charges,38.7
HOME SLEEP TYPE 3,G0399,HCPCS,,,,,both,, ,428.48,66.95,Blue Cross and Blue Shield,Traditional,,165.82,38.7,percent of total billed charges,428.48,2.61,218.52,percent of total billed charges,38.7
HOME SLEEP TYPE 3,G0399,HCPCS,,,,,both,, ,428.48,294.25,Blue Cross and Blue Shield,Traditional,,165.82,38.7,percent of total billed charges,428.48,11.48,218.52,percent of total billed charges,38.7
PROSTATE NDL BX ANY,G0416,HCPCS,,,,,both,, ,1059.54,60.50,Blue Cross and Blue Shield,Traditional,,410.04,38.7,percent of total billed charges,1059.54,2.36,540.37,percent of total billed charges,38.7
HIV-1 AB EIA,G0432,HCPCS,,,,,both,, ,113.39,123.25,Blue Cross and Blue Shield,Traditional,,43.88,38.7,percent of total billed charges,113.39,4.81,57.83,percent of total billed charges,38.7
HIV1 AG HIV1 HIV2 AB,G0433,CPT,,,,,both,, ,165.59,123.25,Blue Cross and Blue Shield,Traditional,,64.08,38.7,percent of total billed charges,165.59,4.81,84.45,percent of total billed charges,38.7
HIV1-HIV2 AB SNG RES,G0435,CPT,,,,,both,, ,42.66,213.00,Blue Cross and Blue Shield,Traditional,,16.51,38.7,percent of total billed charges,42.66,8.31,21.76,percent of total billed charges,38.7
HIV1-HIV2 AB SNG RES,G0435,CPT,,,,,both,, ,1036.25,209.75,Blue Cross and Blue Shield,Traditional,,401.03,38.7,percent of total billed charges,1036.25,8.18,528.49,percent of total billed charges,38.7
EVAL & MGMT LEVEL 3,G0463,HCPCS,,,,,both,, ,215.75,312.50,Blue Cross and Blue Shield,Traditional,,83.50,38.7,percent of total billed charges,215.75,12.19,110.03,percent of total billed charges,38.7
EVAL & MGMT LEVEL 5,G0463,HCPCS,,,,,both,, ,261.00,309.25,Blue Cross and Blue Shield,Traditional,,101.01,38.7,percent of total billed charges,261.00,12.06,133.11,percent of total billed charges,38.7
HOSPITAL OUTPT VISIT,G0463,HCPCS,,,,,both,, ,520.00,483.50,Blue Cross and Blue Shield,Traditional,,201.24,38.7,percent of total billed charges,520.00,18.86,265.2,percent of total billed charges,38.7
LEVEL 1 EP,G0463,HCPCS,,,,,both,, ,132.61,414.25,Blue Cross and Blue Shield,Traditional,,51.32,38.7,percent of total billed charges,132.61,16.16,67.63,percent of total billed charges,38.7
LEVEL 1 EP,G0463,HCPCS,,,,,both,, ,132.61,602.50,Blue Cross and Blue Shield,Traditional,,51.32,38.7,percent of total billed charges,132.61,23.50,67.63,percent of total billed charges,38.7
LEVEL 1 EP,G0463,HCPCS,,,,,both,, ,249.52,239.73,Blue Cross and Blue Shield,Traditional,,96.56,38.7,percent of total billed charges,249.52,9.35,127.26,percent of total billed charges,38.7
LEVEL 2 EP,G0463,HCPCS,,,,,both,, ,188.75,239.73,Blue Cross and Blue Shield,Traditional,,73.05,38.7,percent of total billed charges,188.75,9.35,96.26,percent of total billed charges,38.7
LEVEL 2 NP,G0463,HCPCS,,,,,both,, ,188.75,239.73,Blue Cross and Blue Shield,Traditional,,73.05,38.7,percent of total billed charges,188.75,9.35,96.26,percent of total billed charges,38.7
LEVEL 3 EP,G0463,HCPCS,,,,,both,, ,251.84,239.73,Blue Cross and Blue Shield,Traditional,,97.46,38.7,percent of total billed charges,251.84,9.35,128.44,percent of total billed charges,38.7
LEVEL 3 EP,G0463,HCPCS,,,,,both,, ,251.84,234.07,Blue Cross and Blue Shield,Traditional,,97.46,38.7,percent of total billed charges,251.84,9.13,128.44,percent of total billed charges,38.7
LEVEL 3 EP,G0463,HCPCS,,,,,both,, ,251.84,234.07,Blue Cross and Blue Shield,Traditional,,97.46,38.7,percent of total billed charges,251.84,9.13,128.44,percent of total billed charges,38.7
LEVEL 3 EP,G0463,HCPCS,,,,,both,, ,251.84,281.71,Blue Cross and Blue Shield,Traditional,,97.46,38.7,percent of total billed charges,251.84,10.99,128.44,percent of total billed charges,38.7
LEVEL 3 NP,G0463,HCPCS,,,,,both,, ,188.75,281.71,Blue Cross and Blue Shield,Traditional,,73.05,38.7,percent of total billed charges,188.75,10.99,96.26,percent of total billed charges,38.7
LEVEL 4 EP,G0463,HCPCS,,,,,both,, ,324.19,261.88,Blue Cross and Blue Shield,Traditional,,125.46,38.7,percent of total billed charges,324.19,10.21,165.34,percent of total billed charges,38.7
LEVEL 4 EP,G0463,HCPCS,,,,,both,, ,324.19,261.88,Blue Cross and Blue Shield,Traditional,,125.46,38.7,percent of total billed charges,324.19,10.21,165.34,percent of total billed charges,38.7
LEVEL 5 EP,G0463,HCPCS,,,,,both,, ,425.91,311.83,Blue Cross and Blue Shield,Traditional,,164.83,38.7,percent of total billed charges,425.91,12.16,217.21,percent of total billed charges,38.7
OB TRIAGE LVL 1 EP,G0463,HCPCS,,,,,both,, ,700.40,311.83,Blue Cross and Blue Shield,Traditional,,271.05,38.7,percent of total billed charges,700.40,12.16,357.2,percent of total billed charges,38.7
PAT EVAL/MGM LEVEL 2,G0463,HCPCS,,,,,both,, ,325.25,289.69,Blue Cross and Blue Shield,Traditional,,125.87,38.7,percent of total billed charges,325.25,11.30,165.88,percent of total billed charges,38.7
PAT EVAL/MGM LEVEL 3,G0463,HCPCS,,,,,both,, ,379.50,289.69,Blue Cross and Blue Shield,Traditional,,146.87,38.7,percent of total billed charges,379.50,11.30,193.55,percent of total billed charges,38.7
PAT EVAL/MGM LEVEL 4,G0463,HCPCS,,,,,both,, ,433.50,317.50,Blue Cross and Blue Shield,Traditional,,167.76,38.7,percent of total billed charges,433.50,12.38,221.09,percent of total billed charges,38.7
PAT EVAL/MGM LEVEL 5,G0463,HCPCS,,,,,both,, ,487.50,317.50,Blue Cross and Blue Shield,Traditional,,188.66,38.7,percent of total billed charges,487.50,12.38,248.63,percent of total billed charges,38.7
PHYSICAL-EMPLOYMENT,G0463,HCPCS,,,,,both,, ,55.62,317.50,Blue Cross and Blue Shield,Traditional,,21.52,38.7,percent of total billed charges,55.62,12.38,28.37,percent of total billed charges,38.7
PHYSICAL-EMPLOYMENT,G0463,HCPCS,,,,,both,, ,55.62,317.50,Blue Cross and Blue Shield,Traditional,,21.52,38.7,percent of total billed charges,55.62,12.38,28.37,percent of total billed charges,38.7
PHYSICAL-SCHOOL,G0463,HCPCS,,,,,both,, ,66.95,166.16,Blue Cross and Blue Shield,Traditional,,25.91,38.7,percent of total billed charges,66.95,6.48,34.14,percent of total billed charges,38.7
PHYSICAL-SCHOOL,G0463,HCPCS,,,,,both,, ,66.95,570.04,Blue Cross and Blue Shield,Traditional,,25.91,38.7,percent of total billed charges,66.95,22.23,34.14,percent of total billed charges,38.7
PSYCH CLINIC TYPE A,G0463,HCPCS,,,,,both,, ,294.25,4719.72,Blue Cross and Blue Shield,Traditional,,113.87,38.7,percent of total billed charges,294.25,184.07,150.07,percent of total billed charges,38.7
URG CARE L1 EP PROF,G0463,HCPCS,,,,,both,, ,60.50,3.00,Blue Cross and Blue Shield,Traditional,,23.41,38.7,percent of total billed charges,60.50,0.12,30.86,percent of total billed charges,38.7
URG CARE L1 NP PROF,G0463,HCPCS,,,,,both,, ,123.25,17.77,Blue Cross and Blue Shield,Traditional,,47.70,38.7,percent of total billed charges,123.25,0.69,62.86,percent of total billed charges,38.7
URG CARE L1 NP PROF,G0463,HCPCS,,,,,both,, ,123.25,0.31,Blue Cross and Blue Shield,Traditional,,47.70,38.7,percent of total billed charges,123.25,0.01,62.86,percent of total billed charges,38.7
URG CARE L2 NP PROF,G0463,HCPCS,,,,,both,, ,213.00,1.03,Blue Cross and Blue Shield,Traditional,,82.43,38.7,percent of total billed charges,213.00,0.04,108.63,percent of total billed charges,38.7
URG CARE L3 EP PROF,G0463,HCPCS,,,,,both,, ,209.75,15.45,Blue Cross and Blue Shield,Traditional,,81.17,38.7,percent of total billed charges,209.75,0.60,106.97,percent of total billed charges,38.7
URG CARE L3 NP PROF,G0463,HCPCS,,,,,both,, ,312.50,15.45,Blue Cross and Blue Shield,Traditional,,120.94,38.7,percent of total billed charges,312.50,0.60,159.38,percent of total billed charges,38.7
URG CARE L4 EP PROF,G0463,HCPCS,,,,,both,, ,309.25,2.68,Blue Cross and Blue Shield,Traditional,,119.68,38.7,percent of total billed charges,309.25,0.10,157.72,percent of total billed charges,38.7
URG CARE L4 NP PROF,G0463,HCPCS,,,,,both,, ,483.50,8.65,Blue Cross and Blue Shield,Traditional,,187.11,38.7,percent of total billed charges,483.50,0.34,246.59,percent of total billed charges,38.7
URG CARE L5 EP PROF,G0463,HCPCS,,,,,both,, ,414.25,4.00,Blue Cross and Blue Shield,Traditional,,160.31,38.7,percent of total billed charges,414.25,0.16,211.27,percent of total billed charges,38.7
URG CARE L5 NP PROF,G0463,HCPCS,,,,,both,, ,602.50,28.00,Blue Cross and Blue Shield,Traditional,,233.17,38.7,percent of total billed charges,602.50,1.09,307.28,percent of total billed charges,38.7
URGENT CARE LVL 1 EP,G0463,HCPCS,,,,,both,, ,239.73,5.56,Blue Cross and Blue Shield,Traditional,,92.78,38.7,percent of total billed charges,239.73,0.22,122.26,percent of total billed charges,38.7
URGENT CARE LVL 1 EP,G0463,HCPCS,,,,,both,, ,239.73,58.97,Blue Cross and Blue Shield,Traditional,,92.78,38.7,percent of total billed charges,239.73,2.30,122.26,percent of total billed charges,38.7
URGENT CARE LVL 1 EP,G0463,HCPCS,,,,,both,, ,239.73,96.31,Blue Cross and Blue Shield,Traditional,,92.78,38.7,percent of total billed charges,239.73,3.76,122.26,percent of total billed charges,38.7
URGENT CARE LVL 1 EP,G0463,HCPCS,,,,,both,, ,239.73,5.15,Blue Cross and Blue Shield,Traditional,,92.78,38.7,percent of total billed charges,239.73,0.20,122.26,percent of total billed charges,38.7
URGENT CARE LVL 2 NP,G0463,HCPCS,,,,,both,, ,234.07,6.39,Blue Cross and Blue Shield,Traditional,,90.59,38.7,percent of total billed charges,234.07,0.25,119.38,percent of total billed charges,38.7
URGENT CARE LVL 2 NP,G0463,HCPCS,,,,,both,, ,234.07,321.36,Blue Cross and Blue Shield,Traditional,,90.59,38.7,percent of total billed charges,234.07,12.53,119.38,percent of total billed charges,38.7
URGENT CARE LVL 3 EP,G0463,HCPCS,,,,,both,, ,281.71,211.15,Blue Cross and Blue Shield,Traditional,,109.02,38.7,percent of total billed charges,281.71,8.23,143.67,percent of total billed charges,38.7
URGENT CARE LVL 3 EP,G0463,HCPCS,,,,,both,, ,281.71,17.00,Blue Cross and Blue Shield,Traditional,,109.02,38.7,percent of total billed charges,281.71,0.66,143.67,percent of total billed charges,38.7
URGENT CARE LVL 3 NP,G0463,HCPCS,,,,,both,, ,261.88,26.78,Blue Cross and Blue Shield,Traditional,,101.35,38.7,percent of total billed charges,261.88,1.04,133.56,percent of total billed charges,38.7
URGENT CARE LVL 3 NP,G0463,HCPCS,,,,,both,, ,261.88,26.78,Blue Cross and Blue Shield,Traditional,,101.35,38.7,percent of total billed charges,261.88,1.04,133.56,percent of total billed charges,38.7
URGENT CARE LVL 4 EP,G0463,HCPCS,,,,,both,, ,311.83,57.94,Blue Cross and Blue Shield,Traditional,,120.68,38.7,percent of total billed charges,311.83,2.26,159.03,percent of total billed charges,38.7
URGENT CARE LVL 4 EP,G0463,HCPCS,,,,,both,, ,311.83,23.69,Blue Cross and Blue Shield,Traditional,,120.68,38.7,percent of total billed charges,311.83,0.92,159.03,percent of total billed charges,38.7
URGENT CARE LVL 4 NP,G0463,HCPCS,,,,,both,, ,289.69,63.09,Blue Cross and Blue Shield,Traditional,,112.11,38.7,percent of total billed charges,289.69,2.46,147.74,percent of total billed charges,38.7
URGENT CARE LVL 4 NP,G0463,HCPCS,,,,,both,, ,289.69,13.00,Blue Cross and Blue Shield,Traditional,,112.11,38.7,percent of total billed charges,289.69,0.51,147.74,percent of total billed charges,38.7
URGENT CARE LVL 5 EP,G0463,HCPCS,,,,,both,, ,317.50,20.34,Blue Cross and Blue Shield,Traditional,,122.87,38.7,percent of total billed charges,317.50,0.79,161.93,percent of total billed charges,38.7
URGENT CARE LVL 5 EP,G0463,HCPCS,,,,,both,, ,317.50,101.71,Blue Cross and Blue Shield,Traditional,,122.87,38.7,percent of total billed charges,317.50,3.97,161.93,percent of total billed charges,38.7
URGENT CARE LVL 5 EP,G0463,HCPCS,,,,,both,, ,317.50,40.69,Blue Cross and Blue Shield,Traditional,,122.87,38.7,percent of total billed charges,317.50,1.59,161.93,percent of total billed charges,38.7
URGENT CARE LVL 5 EP,G0463,HCPCS,,,,,both,, ,317.50,2.00,Blue Cross and Blue Shield,Traditional,,122.87,38.7,percent of total billed charges,317.50,0.08,161.93,percent of total billed charges,38.7
HIV1 AG W HIV 1 2 AB,G0475,HCPCS,,,,,both,, ,166.16,307.46,Blue Cross and Blue Shield,Traditional,,64.30,38.7,percent of total billed charges,166.16,11.99,84.74,percent of total billed charges,38.7
HEPB SCR HI RSK NPRG,G0499,HCPCS,,,,,both,, ,570.04,263.42,Blue Cross and Blue Shield,Traditional,,220.61,38.7,percent of total billed charges,570.04,10.27,290.72,percent of total billed charges,38.7
ABCIXIMAB 10MG,J0130,HCPCS,,,,,both,, ,4719.72,34.25,Blue Cross and Blue Shield,Traditional,,1826.53,38.7,percent of total billed charges,4719.72,1.34,2407.06,percent of total billed charges,38.7
ACETAMINO 10MG INJ,J0131,HCPCS,,,,,both,100,ML,3.00,35.54,Blue Cross and Blue Shield,Traditional,,1.16,38.7,percent of total billed charges,3.00,1.39,1.53,percent of total billed charges,38.7
ACTYLCYSTN INJ 100MG,J0132,HCPCS,,,,,both,30,ML,17.77,43.00,Blue Cross and Blue Shield,Traditional,,6.88,38.7,percent of total billed charges,17.77,1.68,9.06,percent of total billed charges,38.7
ACYCLOVIR 5MG INJ,J0133,HCPCS,,,,,both,, ,0.31,18.28,Blue Cross and Blue Shield,Traditional,,0.12,38.7,percent of total billed charges,0.31,0.71,0.16,percent of total billed charges,38.7
ACYCLOVIR 5MG INJ,J0133,HCPCS,,,,,both,10,ML,1.03,33.48,Blue Cross and Blue Shield,Traditional,,0.40,38.7,percent of total billed charges,1.03,1.31,0.53,percent of total billed charges,38.7
ADENOSINE 1MG INJ,J0153,HCPCS,,,,,both,2,ML,15.45,17.77,Blue Cross and Blue Shield,Traditional,,5.98,38.7,percent of total billed charges,15.45,0.69,7.88,percent of total billed charges,38.7
ADENOSINE 1MG INJ,J0153,HCPCS,,,,,both,2,ML,15.45,6.18,Blue Cross and Blue Shield,Traditional,,5.98,38.7,percent of total billed charges,15.45,0.24,7.88,percent of total billed charges,38.7
ADRENL/EPINEP 0.1MG,J0171,HCPCS,,,,,both,1,ML,2.68,4.33,Blue Cross and Blue Shield,Traditional,,1.04,38.7,percent of total billed charges,2.68,0.17,1.37,percent of total billed charges,38.7
ADRENL/EPINEP 0.1MG,J0171,HCPCS,,,,,both,10,ML,8.65,84.46,Blue Cross and Blue Shield,Traditional,,3.35,38.7,percent of total billed charges,8.65,3.29,4.41,percent of total billed charges,38.7
EPINEPHRINE INJ 30MG/30ML (1 MG/ML),J0171,HCPCS,,,,,both,30,ML,4.00,19.31,Blue Cross and Blue Shield,Traditional,,1.55,38.7,percent of total billed charges,4.00,0.75,2.04,percent of total billed charges,38.7
REMDESIVIR 1MG INJ,J0248,HCPCS,,,,,both,1,EA,28.00,21.89,Blue Cross and Blue Shield,Traditional,,10.84,38.7,percent of total billed charges,28.00,0.85,14.28,percent of total billed charges,38.7
AMKCN SULF INJ 100MG,J0278,HCPCS,,,,,both,2,ML,5.56,12.88,Blue Cross and Blue Shield,Traditional,,2.15,38.7,percent of total billed charges,5.56,0.50,2.84,percent of total billed charges,38.7
AMINOPHYLL 250MG INJ,J0280,HCPCS,,,,,both,20,ML,58.97,12.88,Blue Cross and Blue Shield,Traditional,,22.82,38.7,percent of total billed charges,58.97,0.50,30.07,percent of total billed charges,38.7
AMINOPHYLL 250MG INJ,J0280,HCPCS,,,,,both,10,ML,96.31,14.94,Blue Cross and Blue Shield,Traditional,,37.27,38.7,percent of total billed charges,96.31,0.58,49.12,percent of total billed charges,38.7
AMIODARONE 30MG INJ,J0282,HCPCS,,,,,both,18,ML,5.15,14.94,Blue Cross and Blue Shield,Traditional,,1.99,38.7,percent of total billed charges,5.15,0.58,2.63,percent of total billed charges,38.7
AMIODARONE 30MG INJ,J0282,HCPCS,,,,,both,3,ML,6.39,22.40,Blue Cross and Blue Shield,Traditional,,2.47,38.7,percent of total billed charges,6.39,0.87,3.26,percent of total billed charges,38.7
AMPHOTER B 50MG INJ,J0285,HCPCS,,,,,both,, ,321.36,9.00,Blue Cross and Blue Shield,Traditional,,124.37,38.7,percent of total billed charges,321.36,0.35,163.89,percent of total billed charges,38.7
AMPHOTER B LIPO 10MG,J0289,HCPCS,,,,,both,1,EA,211.15,19.06,Blue Cross and Blue Shield,Traditional,,81.72,38.7,percent of total billed charges,211.15,0.74,107.69,percent of total billed charges,38.7
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,17.00,24.72,Blue Cross and Blue Shield,Traditional,,6.58,38.7,percent of total billed charges,17.00,0.96,8.67,percent of total billed charges,38.7
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,, ,26.78,53.82,Blue Cross and Blue Shield,Traditional,,10.36,38.7,percent of total billed charges,26.78,2.10,13.66,percent of total billed charges,38.7
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,, ,26.78,28.84,Blue Cross and Blue Shield,Traditional,,10.36,38.7,percent of total billed charges,26.78,1.12,13.66,percent of total billed charges,38.7
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,57.94,8.03,Blue Cross and Blue Shield,Traditional,,22.42,38.7,percent of total billed charges,57.94,0.31,29.55,percent of total billed charges,38.7
AMPICILLIN/SUB 1.5GM,J0295,HCPCS,,,,,both,1,EA,23.69,11.59,Blue Cross and Blue Shield,Traditional,,9.17,38.7,percent of total billed charges,23.69,0.45,12.08,percent of total billed charges,38.7
AMPICILLIN/SUB 1.5GM,J0295,HCPCS,,,,,both,, ,63.09,12.88,Blue Cross and Blue Shield,Traditional,,24.42,38.7,percent of total billed charges,63.09,0.50,32.18,percent of total billed charges,38.7
SUCCINYLCHN 20MG INJ,J0330,HCPCS,,,,,both,10,ML,13.00,24.72,Blue Cross and Blue Shield,Traditional,,5.03,38.7,percent of total billed charges,13.00,0.96,6.63,percent of total billed charges,38.7
SUCCINYLCHN 20MG INJ,J0330,HCPCS,,,,,both,, ,20.34,23.69,Blue Cross and Blue Shield,Traditional,,7.87,38.7,percent of total billed charges,20.34,0.92,10.37,percent of total billed charges,38.7
HYDRALAZINE 20MG INJ,J0360,HCPCS,,,,,both,1,ML,101.71,45.06,Blue Cross and Blue Shield,Traditional,,39.36,38.7,percent of total billed charges,101.71,1.76,51.87,percent of total billed charges,38.7
AZITHROMYC 500MG INJ,J0456,HCPCS,,,,,both,1,EA,40.69,56.14,Blue Cross and Blue Shield,Traditional,,15.75,38.7,percent of total billed charges,40.69,2.19,20.75,percent of total billed charges,38.7
ATROPINE 0.01 MG INJ,J0461,HCPCS,,,,,both,1,ML,2.00,16.48,Blue Cross and Blue Shield,Traditional,,0.77,38.7,percent of total billed charges,2.00,0.64,1.02,percent of total billed charges,38.7
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,, ,0.03,24.72,Blue Cross and Blue Shield,Traditional,,0.01,38.7,percent of total billed charges,0.03,0.96,0.02,percent of total billed charges,38.7
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,, ,0.62,236.64,Blue Cross and Blue Shield,Traditional,,0.24,38.7,percent of total billed charges,0.62,9.23,0.32,percent of total billed charges,38.7
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,10,ML,1.03,39.66,Blue Cross and Blue Shield,Traditional,,0.40,38.7,percent of total billed charges,1.03,1.55,0.53,percent of total billed charges,38.7
DIMERCAPRO 100MG INJ,J0470,HCPCS,,,,,both,, ,198.28,687.78,Blue Cross and Blue Shield,Traditional,,76.73,38.7,percent of total billed charges,198.28,26.82,101.12,percent of total billed charges,38.7
DICYCLOMINE 20MG INJ,J0500,HCPCS,,,,,both,2,ML,307.46,85.75,Blue Cross and Blue Shield,Traditional,,118.99,38.7,percent of total billed charges,307.46,3.34,156.8,percent of total billed charges,38.7
BENZTROPN MES 1MGINJ,J0515,HCPCS,,,,,both,2,ML,263.42,3.50,Blue Cross and Blue Shield,Traditional,,101.94,38.7,percent of total billed charges,263.42,0.14,134.34,percent of total billed charges,38.7
PCN G BENZ/PROC 100K,J0558,HCPCS,,,,,both,, ,34.25,38.88,Blue Cross and Blue Shield,Traditional,,13.25,38.7,percent of total billed charges,34.25,1.52,17.47,percent of total billed charges,38.7
PCN G BENZ/PROC 100K,J0558,HCPCS,,,,,both,, ,35.54,38.88,Blue Cross and Blue Shield,Traditional,,13.75,38.7,percent of total billed charges,35.54,1.52,18.13,percent of total billed charges,38.7
PEN G BENZ INJ 100K,J0561,HCPCS,,,,,both,2,ML,43.00,42.75,Blue Cross and Blue Shield,Traditional,,16.64,38.7,percent of total billed charges,43.00,1.67,21.93,percent of total billed charges,38.7
BIVALIRUDIN 1MG INJ,J0583,HCPCS,,,,,both,1,EA,18.28,42.75,Blue Cross and Blue Shield,Traditional,,7.07,38.7,percent of total billed charges,18.28,1.67,9.32,percent of total billed charges,38.7
BOTULINUM TOXI A 1U,J0585,HCPCS,,,,,both,1,EA,33.48,42.75,Blue Cross and Blue Shield,Traditional,,12.96,38.7,percent of total billed charges,33.48,1.67,17.07,percent of total billed charges,38.7
BUTORPHANOL 1MG INJ,J0595,HCPCS,,,,,both,1,ML,17.77,18.80,Blue Cross and Blue Shield,Traditional,,6.88,38.7,percent of total billed charges,17.77,0.73,9.06,percent of total billed charges,38.7
CINACALC 1MG PO ESRD,J0604,HCPCS,,,,,both,, ,6.18,111.50,Blue Cross and Blue Shield,Traditional,,2.39,38.7,percent of total billed charges,6.18,4.35,3.15,percent of total billed charges,38.7
CALCITRIOL .1MCG INJ,J0636,HCPCS,,,,,both,, ,4.33,111.50,Blue Cross and Blue Shield,Traditional,,1.68,38.7,percent of total billed charges,4.33,4.35,2.21,percent of total billed charges,38.7
LEUCOVORIN 50MG INJ,J0640,HCPCS,,,,,both,1,EA,84.46,124.37,Blue Cross and Blue Shield,Traditional,,32.69,38.7,percent of total billed charges,84.46,4.85,43.07,percent of total billed charges,38.7
MEPIVACAINE 10ML INJ,J0670,HCPCS,,,,,both,30,ML,19.31,162.74,Blue Cross and Blue Shield,Traditional,,7.47,38.7,percent of total billed charges,19.31,6.35,9.85,percent of total billed charges,38.7
MEPIVACAINE 10ML INJ,J0670,HCPCS,,,,,both,20,ML,21.89,162.74,Blue Cross and Blue Shield,Traditional,,8.47,38.7,percent of total billed charges,21.89,6.35,11.16,percent of total billed charges,38.7
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,12.88,162.74,Blue Cross and Blue Shield,Traditional,,4.98,38.7,percent of total billed charges,12.88,6.35,6.57,percent of total billed charges,38.7
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,12.88,66.44,Blue Cross and Blue Shield,Traditional,,4.98,38.7,percent of total billed charges,12.88,2.59,6.57,percent of total billed charges,38.7
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,, ,14.94,132.87,Blue Cross and Blue Shield,Traditional,,5.78,38.7,percent of total billed charges,14.94,5.18,7.62,percent of total billed charges,38.7
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,, ,14.94,96.31,Blue Cross and Blue Shield,Traditional,,5.78,38.7,percent of total billed charges,14.94,3.76,7.62,percent of total billed charges,38.7
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,22.40,4.43,Blue Cross and Blue Shield,Traditional,,8.67,38.7,percent of total billed charges,22.40,0.17,11.42,percent of total billed charges,38.7
CEFEPIME 500 MG INJ,J0692,CPT,,,,,both,1,EA,9.00,0.93,Blue Cross and Blue Shield,Traditional,,3.48,38.7,percent of total billed charges,9.00,0.04,4.59,percent of total billed charges,38.7
CEFEPIME 500MG INJ,J0692,HCPCS,,,,,both,, ,19.06,593.28,Blue Cross and Blue Shield,Traditional,,7.38,38.7,percent of total billed charges,19.06,23.14,9.72,percent of total billed charges,38.7
CEFEPIME 500MG INJ,J0692,HCPCS,,,,,both,1,EA,24.72,6.39,Blue Cross and Blue Shield,Traditional,,9.57,38.7,percent of total billed charges,24.72,0.25,12.61,percent of total billed charges,38.7
CEFOXITIN 1GM INJ,J0694,HCPCS,,,,,both,1,EA,53.82,308.49,Blue Cross and Blue Shield,Traditional,,20.83,38.7,percent of total billed charges,53.82,12.03,27.45,percent of total billed charges,38.7
CEFTO50-TAZO25MG INJ,J0695,HCPCS,,,,,both,1,EA,28.84,47.12,Blue Cross and Blue Shield,Traditional,,11.16,38.7,percent of total billed charges,28.84,1.84,14.71,percent of total billed charges,38.7
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,8.03,6881.43,Blue Cross and Blue Shield,Traditional,,3.11,38.7,percent of total billed charges,8.03,268.38,4.1,percent of total billed charges,38.7
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,11.59,5.36,Blue Cross and Blue Shield,Traditional,,4.49,38.7,percent of total billed charges,11.59,0.21,5.91,percent of total billed charges,38.7
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,12.88,12.88,Blue Cross and Blue Shield,Traditional,,4.98,38.7,percent of total billed charges,12.88,0.50,6.57,percent of total billed charges,38.7
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,24.72,1352.91,Blue Cross and Blue Shield,Traditional,,9.57,38.7,percent of total billed charges,24.72,52.76,12.61,percent of total billed charges,38.7
CEFUROXIME 750MG INJ,J0697,HCPCS,,,,,both,, ,23.69,13.91,Blue Cross and Blue Shield,Traditional,,9.17,38.7,percent of total billed charges,23.69,0.54,12.08,percent of total billed charges,38.7
CEFUROXIME 750MG INJ,J0697,HCPCS,,,,,both,, ,45.06,26.78,Blue Cross and Blue Shield,Traditional,,17.44,38.7,percent of total billed charges,45.06,1.04,22.98,percent of total billed charges,38.7
BETAM ACE/SOD PHO3MG,J0702,HCPCS,,,,,both,5,ML,56.14,28.84,Blue Cross and Blue Shield,Traditional,,21.73,38.7,percent of total billed charges,56.14,1.12,28.63,percent of total billed charges,38.7
CEFTAROLIN 10MG INJ,J0712,HCPCS,,,,,both,, ,16.48,78.28,Blue Cross and Blue Shield,Traditional,,6.38,38.7,percent of total billed charges,16.48,3.05,8.4,percent of total billed charges,38.7
CEFTAROLIN 10MG INJ,J0712,HCPCS,,,,,both,, ,24.72,8.55,Blue Cross and Blue Shield,Traditional,,9.57,38.7,percent of total billed charges,24.72,0.33,12.61,percent of total billed charges,38.7
COLISTIME UP TO 150M,J0770,CPT,,,,,both,1,EA,236.64,164.80,Blue Cross and Blue Shield,Traditional,,91.58,38.7,percent of total billed charges,236.64,6.43,120.69,percent of total billed charges,38.7
PROCHLORPE UPTO 10MG,J0780,HCPCS,,,,,both,, ,39.66,298.96,Blue Cross and Blue Shield,Traditional,,15.35,38.7,percent of total billed charges,39.66,11.66,20.23,percent of total billed charges,38.7
COSYNTROPN .25MG INJ,J0834,HCPCS,,,,,both,1,EA,687.78,196.99,Blue Cross and Blue Shield,Traditional,,266.17,38.7,percent of total billed charges,687.78,7.68,350.77,percent of total billed charges,38.7
DALBAVANCIN 5MG INJ,J0875,HCPCS,,,,,both,, ,85.75,1016.61,Blue Cross and Blue Shield,Traditional,,33.19,38.7,percent of total billed charges,85.75,39.65,43.73,percent of total billed charges,38.7
DAPTOMYCIN 1 MG INJ,J0878,HCPCS,,,,,both,1,EA,3.50,7.00,Blue Cross and Blue Shield,Traditional,,1.35,38.7,percent of total billed charges,3.50,0.27,1.79,percent of total billed charges,38.7
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,38.88,4.53,Blue Cross and Blue Shield,Traditional,,15.05,38.7,percent of total billed charges,38.88,0.18,19.83,percent of total billed charges,38.7
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,38.88,4.53,Blue Cross and Blue Shield,Traditional,,15.05,38.7,percent of total billed charges,38.88,0.18,19.83,percent of total billed charges,38.7
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,32.19,Blue Cross and Blue Shield,Traditional,,16.54,38.7,percent of total billed charges,42.75,1.26,21.8,percent of total billed charges,38.7
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,84.72,Blue Cross and Blue Shield,Traditional,,16.54,38.7,percent of total billed charges,42.75,3.30,21.8,percent of total billed charges,38.7
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,144.72,Blue Cross and Blue Shield,Traditional,,16.54,38.7,percent of total billed charges,42.75,5.64,21.8,percent of total billed charges,38.7
ARGATROBAN 1MG NESRD,J0883,HCPCS,,,,,both,2.5,ML,18.80,43.52,Blue Cross and Blue Shield,Traditional,,7.28,38.7,percent of total billed charges,18.80,1.70,9.59,percent of total billed charges,38.7
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,111.50,10.82,Blue Cross and Blue Shield,Traditional,,43.15,38.7,percent of total billed charges,111.50,0.42,56.87,percent of total billed charges,38.7
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,111.50,390.89,Blue Cross and Blue Shield,Traditional,,43.15,38.7,percent of total billed charges,111.50,15.24,56.87,percent of total billed charges,38.7
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,124.37,390.89,Blue Cross and Blue Shield,Traditional,,48.13,38.7,percent of total billed charges,124.37,15.24,63.43,percent of total billed charges,38.7
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,270.89,Blue Cross and Blue Shield,Traditional,,62.98,38.7,percent of total billed charges,162.74,10.56,83,percent of total billed charges,38.7
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,270.89,Blue Cross and Blue Shield,Traditional,,62.98,38.7,percent of total billed charges,162.74,10.56,83,percent of total billed charges,38.7
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,319.82,Blue Cross and Blue Shield,Traditional,,62.98,38.7,percent of total billed charges,162.74,12.47,83,percent of total billed charges,38.7
DEFEROXAMIN 500MGINJ,J0895,HCPCS,,,,,both,1,EA,66.44,319.82,Blue Cross and Blue Shield,Traditional,,25.71,38.7,percent of total billed charges,66.44,12.47,33.88,percent of total billed charges,38.7
DEFEROXAMIN 500MGINJ,J0895,HCPCS,,,,,both,, ,132.87,615.94,Blue Cross and Blue Shield,Traditional,,51.42,38.7,percent of total billed charges,132.87,24.02,67.76,percent of total billed charges,38.7
DENOSUMAB 1MG INJ,J0897,HCPCS,,,,,both,1,ML,96.31,256.99,Blue Cross and Blue Shield,Traditional,,37.27,38.7,percent of total billed charges,96.31,10.02,49.12,percent of total billed charges,38.7
MEDROXYPROG 1MG INJ,J1050,HCPCS,,,,,both,1,ML,4.43,256.99,Blue Cross and Blue Shield,Traditional,,1.71,38.7,percent of total billed charges,4.43,10.02,2.26,percent of total billed charges,38.7
TESTOSTER CYPION 1MG,J1071,HCPCS,,,,,both,, ,0.93,24.72,Blue Cross and Blue Shield,Traditional,,0.36,38.7,percent of total billed charges,0.93,0.96,0.47,percent of total billed charges,38.7
TESTOSTER CYPION 1MG,J1071,HCPCS,,,,,both,, ,593.28,27.81,Blue Cross and Blue Shield,Traditional,,229.60,38.7,percent of total billed charges,593.28,1.08,302.57,percent of total billed charges,38.7
DEXAMETH NA 1MG INJ,J1100,HCPCS,,,,,both,1,ML,6.39,28.84,Blue Cross and Blue Shield,Traditional,,2.47,38.7,percent of total billed charges,6.39,1.12,3.26,percent of total billed charges,38.7
ACETAZOLAMI 500MGINJ,J1120,HCPCS,,,,,both,1,EA,308.49,710.19,Blue Cross and Blue Shield,Traditional,,119.39,38.7,percent of total billed charges,308.49,27.70,157.33,percent of total billed charges,38.7
DIGOXIN 0.5MG INJ,J1160,HCPCS,,,,,both,2,ML,47.12,1505.00,Blue Cross and Blue Shield,Traditional,,18.24,38.7,percent of total billed charges,47.12,58.70,24.03,percent of total billed charges,38.7
DIGOXIN IMMUNE FAB,J1162,HCPCS,,,,,both,1,EA,6881.43,68.50,Blue Cross and Blue Shield,Traditional,,2663.11,38.7,percent of total billed charges,6881.43,2.67,3509.53,percent of total billed charges,38.7
PHENYTOIN NA 50MGINJ,J1165,HCPCS,,,,,both,5,ML,5.36,183.08,Blue Cross and Blue Shield,Traditional,,2.07,38.7,percent of total billed charges,5.36,7.14,2.73,percent of total billed charges,38.7
PHENYTOIN NA 50MGINJ,J1165,HCPCS,,,,,both,2,ML,12.88,217.33,Blue Cross and Blue Shield,Traditional,,4.98,38.7,percent of total billed charges,12.88,8.48,6.57,percent of total billed charges,38.7
DEXRAZOXANE 25OMG IJ,J1190,HCPCS,,,,,both,, ,1352.91,0.52,Blue Cross and Blue Shield,Traditional,,523.58,38.7,percent of total billed charges,1352.91,0.02,689.98,percent of total billed charges,38.7
DIPHENHYDRAM 50MGINJ,J1200,HCPCS,,,,,both,1,ML,13.91,0.93,Blue Cross and Blue Shield,Traditional,,5.38,38.7,percent of total billed charges,13.91,0.04,7.09,percent of total billed charges,38.7
DIPYRIDAMOLE 10MGINJ,J1245,HCPCS,,,,,both,, ,26.78,2.16,Blue Cross and Blue Shield,Traditional,,10.36,38.7,percent of total billed charges,26.78,0.08,13.66,percent of total billed charges,38.7
DOBUTAMINE 250MG INJ,J1250,HCPCS,,,,,both,20,ML,28.84,5.67,Blue Cross and Blue Shield,Traditional,,11.16,38.7,percent of total billed charges,28.84,0.22,14.71,percent of total billed charges,38.7
DOBUTAMINE 250MG INJ,J1250,HCPCS,,,,,both,250,ML,78.28,6.39,Blue Cross and Blue Shield,Traditional,,30.29,38.7,percent of total billed charges,78.28,0.25,39.92,percent of total billed charges,38.7
DOPAMIN HCL 40MG INJ,J1265,HCPCS,,,,,both,250,ML,8.55,19.57,Blue Cross and Blue Shield,Traditional,,3.31,38.7,percent of total billed charges,8.55,0.76,4.36,percent of total billed charges,38.7
EPTIFABITIDE 5MG IJ,J1327,HCPCS,,,,,both,, ,164.80,27.81,Blue Cross and Blue Shield,Traditional,,63.78,38.7,percent of total billed charges,164.80,1.08,84.05,percent of total billed charges,38.7
ERTAPENEM SOD/500MG,J1335,HCPCS,,,,,both,1,EA,298.96,28.84,Blue Cross and Blue Shield,Traditional,,115.70,38.7,percent of total billed charges,298.96,1.12,152.47,percent of total billed charges,38.7
ERYTHROMYC 500MG INJ,J1364,HCPCS,,,,,both,1,EA,196.99,41.72,Blue Cross and Blue Shield,Traditional,,76.24,38.7,percent of total billed charges,196.99,1.63,100.46,percent of total billed charges,38.7
ESTROGEN CNJ 25MGINJ,J1410,HCPCS,,,,,both,, ,1016.61,76.00,Blue Cross and Blue Shield,Traditional,,393.43,38.7,percent of total billed charges,1016.61,2.96,518.47,percent of total billed charges,38.7
FER CARBOXYM 1MG INJ,J1439,HCPCS,,,,,both,15,ML,7.00,57.17,Blue Cross and Blue Shield,Traditional,,2.71,38.7,percent of total billed charges,7.00,2.23,3.57,percent of total billed charges,38.7
TBO-FILGRASTIM 1MCG,J1447,HCPCS,,,,,both,0.5,ML,4.53,57.17,Blue Cross and Blue Shield,Traditional,,1.75,38.7,percent of total billed charges,4.53,2.23,2.31,percent of total billed charges,38.7
TBO-FILGRASTIM 1MCG,J1447,HCPCS,,,,,both,0.5,ML,4.53,57.17,Blue Cross and Blue Shield,Traditional,,1.75,38.7,percent of total billed charges,4.53,2.23,2.31,percent of total billed charges,38.7
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,200,ML,32.19,57.17,Blue Cross and Blue Shield,Traditional,,12.46,38.7,percent of total billed charges,32.19,2.23,16.42,percent of total billed charges,38.7
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,50,ML,84.72,57.17,Blue Cross and Blue Shield,Traditional,,32.79,38.7,percent of total billed charges,84.72,2.23,43.21,percent of total billed charges,38.7
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,100,ML,144.72,38.37,Blue Cross and Blue Shield,Traditional,,56.01,38.7,percent of total billed charges,144.72,1.50,73.81,percent of total billed charges,38.7
"FOMEPIZOLE, 15 MG",J1451,HCPCS,,,,,both,1.5,ML,43.52,51.24,Blue Cross and Blue Shield,Traditional,,16.84,38.7,percent of total billed charges,43.52,2.00,22.2,percent of total billed charges,38.7
FOSAPREPITANT 1MG IJ,J1453,HCPCS,,,,,both,1,EA,10.82,76.74,Blue Cross and Blue Shield,Traditional,,4.19,38.7,percent of total billed charges,10.82,2.99,5.52,percent of total billed charges,38.7
IVIG (PRIVIGEN)500MG,J1459,HCPCS,,,,,both,50,ML,390.89,85.49,Blue Cross and Blue Shield,Traditional,,151.27,38.7,percent of total billed charges,390.89,3.33,199.35,percent of total billed charges,38.7
IVIG (PRIVIGEN)500MG,J1459,HCPCS,,,,,both,50,ML,390.89,1976.31,Blue Cross and Blue Shield,Traditional,,151.27,38.7,percent of total billed charges,390.89,77.08,199.35,percent of total billed charges,38.7
IMMU GLOB LYO 500MG,J1566,HCPCS,,,,,both,, ,270.89,48.15,Blue Cross and Blue Shield,Traditional,,104.83,38.7,percent of total billed charges,270.89,1.88,138.15,percent of total billed charges,38.7
IMMU GLOB LYO 500MG,J1566,HCPCS,,,,,both,, ,270.89,566.00,Blue Cross and Blue Shield,Traditional,,104.83,38.7,percent of total billed charges,270.89,22.07,138.15,percent of total billed charges,38.7
IVIG (OCTAGAM) 500MG,J1568,HCPCS,,,,,both,200,ML,319.82,1612.21,Blue Cross and Blue Shield,Traditional,,123.77,38.7,percent of total billed charges,319.82,62.88,163.11,percent of total billed charges,38.7
IVIG (OCTAGAM) 500MG,J1568,HCPCS,,,,,both,200,ML,319.82,560.84,Blue Cross and Blue Shield,Traditional,,123.77,38.7,percent of total billed charges,319.82,21.87,163.11,percent of total billed charges,38.7
GANCICLOVI SOD 500MG,J1570,HCPCS,,,,,both,1,EA,615.94,132.87,Blue Cross and Blue Shield,Traditional,,238.37,38.7,percent of total billed charges,615.94,5.18,314.13,percent of total billed charges,38.7
IVIG (FLEBOGAM)500MG,J1572,HCPCS,,,,,both,100,ML,256.99,4.22,Blue Cross and Blue Shield,Traditional,,99.46,38.7,percent of total billed charges,256.99,0.16,131.06,percent of total billed charges,38.7
IVIG (FLEBOGAM)500MG,J1572,HCPCS,,,,,both,100,ML,256.99,27.81,Blue Cross and Blue Shield,Traditional,,99.46,38.7,percent of total billed charges,256.99,1.08,131.06,percent of total billed charges,38.7
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,2,ML,24.72,1.00,Blue Cross and Blue Shield,Traditional,,9.57,38.7,percent of total billed charges,24.72,0.04,12.61,percent of total billed charges,38.7
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,, ,27.81,6.39,Blue Cross and Blue Shield,Traditional,,10.76,38.7,percent of total billed charges,27.81,0.25,14.18,percent of total billed charges,38.7
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,2,ML,28.84,12.88,Blue Cross and Blue Shield,Traditional,,11.16,38.7,percent of total billed charges,28.84,0.50,14.71,percent of total billed charges,38.7
GLUCAGON 1MG INJ,J1610,HCPCS,,,,,both,, ,710.19,25.75,Blue Cross and Blue Shield,Traditional,,274.84,38.7,percent of total billed charges,710.19,1.00,362.2,percent of total billed charges,38.7
GLUCAGON 1MG INJ,J1610,HCPCS,,,,,both,1,EA,1505.00,5.67,Blue Cross and Blue Shield,Traditional,,582.44,38.7,percent of total billed charges,1505.00,0.22,767.55,percent of total billed charges,38.7
HALOPERIDOL 5MG INJ,J1630,HCPCS,,,,,both,1,ML,68.50,12.88,Blue Cross and Blue Shield,Traditional,,26.51,38.7,percent of total billed charges,68.50,0.50,34.94,percent of total billed charges,38.7
HALOPER DEC 50MGINJ,J1631,HCPCS,,,,,both,1,ML,183.08,25.75,Blue Cross and Blue Shield,Traditional,,70.85,38.7,percent of total billed charges,183.08,1.00,93.37,percent of total billed charges,38.7
HALOPER DEC 50MGINJ,J1631,HCPCS,,,,,both,1,ML,217.33,6029.88,Blue Cross and Blue Shield,Traditional,,84.11,38.7,percent of total billed charges,217.33,235.17,110.84,percent of total billed charges,38.7
HEPARIN NA 10U FLUSH,J1642,HCPCS,,,,,both,5,ML,0.52,1.18,Blue Cross and Blue Shield,Traditional,,0.20,38.7,percent of total billed charges,0.52,0.05,0.27,percent of total billed charges,38.7
HEPARIN NA 10U FLUSH,J1642,HCPCS,,,,,both,3,ML,0.93,58.45,Blue Cross and Blue Shield,Traditional,,0.36,38.7,percent of total billed charges,0.93,2.28,0.47,percent of total billed charges,38.7
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,2.16,68.24,Blue Cross and Blue Shield,Traditional,,0.84,38.7,percent of total billed charges,2.16,2.66,1.1,percent of total billed charges,38.7
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,5.67,78.28,Blue Cross and Blue Shield,Traditional,,2.19,38.7,percent of total billed charges,5.67,3.05,2.89,percent of total billed charges,38.7
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,6.39,225.31,Blue Cross and Blue Shield,Traditional,,2.47,38.7,percent of total billed charges,6.39,8.79,3.26,percent of total billed charges,38.7
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,19.57,258.79,Blue Cross and Blue Shield,Traditional,,7.57,38.7,percent of total billed charges,19.57,10.09,9.98,percent of total billed charges,38.7
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,500,ML,27.81,19.57,Blue Cross and Blue Shield,Traditional,,10.76,38.7,percent of total billed charges,27.81,0.76,14.18,percent of total billed charges,38.7
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,28.84,15.14,Blue Cross and Blue Shield,Traditional,,11.16,38.7,percent of total billed charges,28.84,0.59,14.71,percent of total billed charges,38.7
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,41.72,24.72,Blue Cross and Blue Shield,Traditional,,16.15,38.7,percent of total billed charges,41.72,0.96,21.28,percent of total billed charges,38.7
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,250,ML,76.00,16.48,Blue Cross and Blue Shield,Traditional,,29.41,38.7,percent of total billed charges,76.00,0.64,38.76,percent of total billed charges,38.7
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.6,ML,57.17,18.28,Blue Cross and Blue Shield,Traditional,,22.12,38.7,percent of total billed charges,57.17,0.71,29.16,percent of total billed charges,38.7
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.4,ML,57.17,8.96,Blue Cross and Blue Shield,Traditional,,22.12,38.7,percent of total billed charges,57.17,0.35,29.16,percent of total billed charges,38.7
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.3,ML,57.17,8.96,Blue Cross and Blue Shield,Traditional,,22.12,38.7,percent of total billed charges,57.17,0.35,29.16,percent of total billed charges,38.7
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,1,ML,57.17,47.12,Blue Cross and Blue Shield,Traditional,,22.12,38.7,percent of total billed charges,57.17,1.84,29.16,percent of total billed charges,38.7
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.8,ML,57.17,4.33,Blue Cross and Blue Shield,Traditional,,22.12,38.7,percent of total billed charges,57.17,0.17,29.16,percent of total billed charges,38.7
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,38.37,11.59,Blue Cross and Blue Shield,Traditional,,14.85,38.7,percent of total billed charges,38.37,0.45,19.57,percent of total billed charges,38.7
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,51.24,1.03,Blue Cross and Blue Shield,Traditional,,19.83,38.7,percent of total billed charges,51.24,0.04,26.13,percent of total billed charges,38.7
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,76.74,3.09,Blue Cross and Blue Shield,Traditional,,29.70,38.7,percent of total billed charges,76.74,0.12,39.14,percent of total billed charges,38.7
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,85.49,7.00,Blue Cross and Blue Shield,Traditional,,33.08,38.7,percent of total billed charges,85.49,0.27,43.6,percent of total billed charges,38.7
TETANUS IG HUM 250U,J1670,HCPCS,,,,,both,1,ML,1976.31,8.34,Blue Cross and Blue Shield,Traditional,,764.83,38.7,percent of total billed charges,1976.31,0.33,1007.92,percent of total billed charges,38.7
HYDROCORTIS 100MGINJ,J1720,HCPCS,,,,,both,1,EA,48.15,3.25,Blue Cross and Blue Shield,Traditional,,18.63,38.7,percent of total billed charges,48.15,0.13,24.56,percent of total billed charges,38.7
MELOXICAM 1MG INJ,J1738,HCPCS,,,,,both,1,ML,566.00,32.19,Blue Cross and Blue Shield,Traditional,,219.04,38.7,percent of total billed charges,566.00,1.26,288.66,percent of total billed charges,38.7
IBUTILIDE 1MG INJ,J1742,HCPCS,,,,,both,, ,1612.21,1.03,Blue Cross and Blue Shield,Traditional,,623.93,38.7,percent of total billed charges,1612.21,0.04,822.23,percent of total billed charges,38.7
INFLIXIMAB 10 MG INJ,J1745,HCPCS,,,,,both,1,EA,560.84,5.15,Blue Cross and Blue Shield,Traditional,,217.05,38.7,percent of total billed charges,560.84,0.20,286.03,percent of total billed charges,38.7
IRON DEX165 INJ 50MG,J1750,HCPCS,,,,,both,, ,132.87,14.94,Blue Cross and Blue Shield,Traditional,,51.42,38.7,percent of total billed charges,132.87,0.58,67.76,percent of total billed charges,38.7
IRON SUCROSE 1MG INJ,J1756,HCPCS,,,,,both,, ,4.22,14.94,Blue Cross and Blue Shield,Traditional,,1.63,38.7,percent of total billed charges,4.22,0.58,2.15,percent of total billed charges,38.7
DROPERIDOL UP TO 5MG,J1790,HCPCS,,,,,both,2,ML,27.81,14.94,Blue Cross and Blue Shield,Traditional,,10.76,38.7,percent of total billed charges,27.81,0.58,14.18,percent of total billed charges,38.7
INSULIN 1 UNT INJ,J1815,CPT,,,,,both,10,ML,1.00,14.75,Blue Cross and Blue Shield,Traditional,,0.39,38.7,percent of total billed charges,1.00,0.58,0.51,percent of total billed charges,38.7
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,, ,6.39,14.94,Blue Cross and Blue Shield,Traditional,,2.47,38.7,percent of total billed charges,6.39,0.58,3.26,percent of total billed charges,38.7
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,1,ML,12.88,16.00,Blue Cross and Blue Shield,Traditional,,4.98,38.7,percent of total billed charges,12.88,0.62,6.57,percent of total billed charges,38.7
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,1,ML,25.75,86.78,Blue Cross and Blue Shield,Traditional,,9.97,38.7,percent of total billed charges,25.75,3.38,13.13,percent of total billed charges,38.7
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,10,ML,5.67,25.75,Blue Cross and Blue Shield,Traditional,,2.19,38.7,percent of total billed charges,5.67,1.00,2.89,percent of total billed charges,38.7
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,4,ML,12.88,133.90,Blue Cross and Blue Shield,Traditional,,4.98,38.7,percent of total billed charges,12.88,5.22,6.57,percent of total billed charges,38.7
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,2,ML,25.75,139.31,Blue Cross and Blue Shield,Traditional,,9.97,38.7,percent of total billed charges,25.75,5.43,13.13,percent of total billed charges,38.7
LUPR 3.75FEMALE/PEDS,J1950,HCPCS,,,,,both,1,EA,6029.88,133.90,Blue Cross and Blue Shield,Traditional,,2333.56,38.7,percent of total billed charges,6029.88,5.22,3075.24,percent of total billed charges,38.7
LEVETIRACET 10MG INJ,J1953,HCPCS,,,,,both,5,ML,1.18,21.37,Blue Cross and Blue Shield,Traditional,,0.46,38.7,percent of total billed charges,1.18,0.83,0.6,percent of total billed charges,38.7
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,100,ML,58.45,42.23,Blue Cross and Blue Shield,Traditional,,22.62,38.7,percent of total billed charges,58.45,1.65,29.81,percent of total billed charges,38.7
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,150,ML,68.24,280.16,Blue Cross and Blue Shield,Traditional,,26.41,38.7,percent of total billed charges,68.24,10.93,34.8,percent of total billed charges,38.7
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,50,ML,78.28,156.30,Blue Cross and Blue Shield,Traditional,,30.29,38.7,percent of total billed charges,78.28,6.10,39.92,percent of total billed charges,38.7
LINEZOLID 200 MG,J2020,HCPCS,,,,,both,300,ML,225.31,0.30,Blue Cross and Blue Shield,Traditional,,87.19,38.7,percent of total billed charges,225.31,0.01,114.91,percent of total billed charges,38.7
LINEZOLID 200 MG,J2020,HCPCS,,,,,both,, ,258.79,42.23,Blue Cross and Blue Shield,Traditional,,100.15,38.7,percent of total billed charges,258.79,1.65,131.98,percent of total billed charges,38.7
LORAZEPAM 2MG INJ,J2060,HCPCS,,,,,both,1,ML,19.57,42.23,Blue Cross and Blue Shield,Traditional,,7.57,38.7,percent of total billed charges,19.57,1.65,9.98,percent of total billed charges,38.7
LORAZEPAM INJ 2MG/ML 10 ML MDV,J2060,HCPCS,,,,,both,, ,15.14,58.97,Blue Cross and Blue Shield,Traditional,,5.86,38.7,percent of total billed charges,15.14,2.30,7.72,percent of total billed charges,38.7
MANNITOL 25% 50MLINJ,J2150,HCPCS,,,,,both,50,ML,24.72,58.97,Blue Cross and Blue Shield,Traditional,,9.57,38.7,percent of total billed charges,24.72,2.30,12.61,percent of total billed charges,38.7
MEPERID HCL 100MGINJ,J2175,HCPCS,,,,,both,1,ML,16.48,58.97,Blue Cross and Blue Shield,Traditional,,6.38,38.7,percent of total billed charges,16.48,2.30,8.4,percent of total billed charges,38.7
MEROPENEMBR 100MGINJ,J2184,HCPCS,,,,,both,, ,18.28,61.03,Blue Cross and Blue Shield,Traditional,,7.07,38.7,percent of total billed charges,18.28,2.38,9.32,percent of total billed charges,38.7
MEROPENEM 100MG INJ,J2185,HCPCS,,,,,both,1,EA,8.96,193.64,Blue Cross and Blue Shield,Traditional,,3.47,38.7,percent of total billed charges,8.96,7.55,4.57,percent of total billed charges,38.7
MEROPENEM 100MG INJ,J2185,HCPCS,,,,,both,1,EA,8.96,1208.71,Blue Cross and Blue Shield,Traditional,,3.47,38.7,percent of total billed charges,8.96,47.14,4.57,percent of total billed charges,38.7
METHYLERGONV .2MGINJ,J2210,HCPCS,,,,,both,1,ML,47.12,302.05,Blue Cross and Blue Shield,Traditional,,18.24,38.7,percent of total billed charges,47.12,11.78,24.03,percent of total billed charges,38.7
METHYLNALTR .1MG INJ,J2212,HCPCS,,,,,both,, ,4.33,250.55,Blue Cross and Blue Shield,Traditional,,1.68,38.7,percent of total billed charges,4.33,9.77,2.21,percent of total billed charges,38.7
MICAFUNGIN 1MG INJ,J2248,HCPCS,,,,,both,1,EA,11.59,41.72,Blue Cross and Blue Shield,Traditional,,4.49,38.7,percent of total billed charges,11.59,1.63,5.91,percent of total billed charges,38.7
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,10,ML,1.03,25.75,Blue Cross and Blue Shield,Traditional,,0.40,38.7,percent of total billed charges,1.03,1.00,0.53,percent of total billed charges,38.7
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,5,ML,3.09,11.33,Blue Cross and Blue Shield,Traditional,,1.20,38.7,percent of total billed charges,3.09,0.44,1.58,percent of total billed charges,38.7
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,2,ML,7.00,11.59,Blue Cross and Blue Shield,Traditional,,2.71,38.7,percent of total billed charges,7.00,0.45,3.57,percent of total billed charges,38.7
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,, ,8.34,41.97,Blue Cross and Blue Shield,Traditional,,3.23,38.7,percent of total billed charges,8.34,1.64,4.25,percent of total billed charges,38.7
MIDAZOL HCL WG 1MG,J2251,HCPCS,,,,,both,50,ML,3.25,44.55,Blue Cross and Blue Shield,Traditional,,1.26,38.7,percent of total billed charges,3.25,1.74,1.66,percent of total billed charges,38.7
MILRINONE 5MG INJ,J2260,HCPCS,,,,,both,100,ML,32.19,48.15,Blue Cross and Blue Shield,Traditional,,12.46,38.7,percent of total billed charges,32.19,1.88,16.42,percent of total billed charges,38.7
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,1.03,24.72,Blue Cross and Blue Shield,Traditional,,0.40,38.7,percent of total billed charges,1.03,0.96,0.53,percent of total billed charges,38.7
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,5.15,167.89,Blue Cross and Blue Shield,Traditional,,1.99,38.7,percent of total billed charges,5.15,6.55,2.63,percent of total billed charges,38.7
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,232.78,Blue Cross and Blue Shield,Traditional,,5.78,38.7,percent of total billed charges,14.94,9.08,7.62,percent of total billed charges,38.7
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,27.81,Blue Cross and Blue Shield,Traditional,,5.78,38.7,percent of total billed charges,14.94,1.08,7.62,percent of total billed charges,38.7
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,13.91,Blue Cross and Blue Shield,Traditional,,5.78,38.7,percent of total billed charges,14.94,0.54,7.62,percent of total billed charges,38.7
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,14.75,139.05,Blue Cross and Blue Shield,Traditional,,5.71,38.7,percent of total billed charges,14.75,5.42,7.52,percent of total billed charges,38.7
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,14.94,95.79,Blue Cross and Blue Shield,Traditional,,5.78,38.7,percent of total billed charges,14.94,3.74,7.62,percent of total billed charges,38.7
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,16.00,1.44,Blue Cross and Blue Shield,Traditional,,6.19,38.7,percent of total billed charges,16.00,0.06,8.16,percent of total billed charges,38.7
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,, ,86.78,2.68,Blue Cross and Blue Shield,Traditional,,33.58,38.7,percent of total billed charges,86.78,0.10,44.26,percent of total billed charges,38.7
NALBUPHINE 10MG INJ,J2300,HCPCS,,,,,both,1,ML,25.75,2.68,Blue Cross and Blue Shield,Traditional,,9.97,38.7,percent of total billed charges,25.75,0.10,13.13,percent of total billed charges,38.7
NALOXONE HCL 1MG INJ,J2310,HCPCS,,,,,both,1,ML,133.90,13.91,Blue Cross and Blue Shield,Traditional,,51.82,38.7,percent of total billed charges,133.90,0.54,68.29,percent of total billed charges,38.7
NALOXONE HCL 1MG INJ,J2310,HCPCS,,,,,both,2,ML,139.31,19.57,Blue Cross and Blue Shield,Traditional,,53.91,38.7,percent of total billed charges,139.31,0.76,71.05,percent of total billed charges,38.7
OCRELIZUMAB 1MG INJ,J2350,HCPCS,,,,,both,10,ML,133.90,12.88,Blue Cross and Blue Shield,Traditional,,51.82,38.7,percent of total billed charges,133.90,0.50,68.29,percent of total billed charges,38.7
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,1,ML,21.37,968.46,Blue Cross and Blue Shield,Traditional,,8.27,38.7,percent of total billed charges,21.37,37.77,10.9,percent of total billed charges,38.7
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,1,ML,42.23,24.72,Blue Cross and Blue Shield,Traditional,,16.34,38.7,percent of total billed charges,42.23,0.96,21.54,percent of total billed charges,38.7
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,, ,280.16,335.01,Blue Cross and Blue Shield,Traditional,,108.42,38.7,percent of total billed charges,280.16,13.07,142.88,percent of total billed charges,38.7
ORPHENADR UP TO 60MG,J2360,HCPCS,,,,,both,2,ML,156.30,62.83,Blue Cross and Blue Shield,Traditional,,60.49,38.7,percent of total billed charges,156.30,2.45,79.71,percent of total billed charges,38.7
CHLOROPR HCL INJ 1MG,J2401,HCPCS,,,,,both,20,ML,0.30,28.33,Blue Cross and Blue Shield,Traditional,,0.12,38.7,percent of total billed charges,0.30,1.10,0.15,percent of total billed charges,38.7
ONDANSETRON 1MG INJ,J2405,HCPCS,,,,,both,2,ML,42.23,34.25,Blue Cross and Blue Shield,Traditional,,16.34,38.7,percent of total billed charges,42.23,1.34,21.54,percent of total billed charges,38.7
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.75,ML,42.23,37.08,Blue Cross and Blue Shield,Traditional,,16.34,38.7,percent of total billed charges,42.23,1.45,21.54,percent of total billed charges,38.7
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,1.5,ML,58.97,1.03,Blue Cross and Blue Shield,Traditional,,22.82,38.7,percent of total billed charges,58.97,0.04,30.07,percent of total billed charges,38.7
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.25,ML,58.97,1.03,Blue Cross and Blue Shield,Traditional,,22.82,38.7,percent of total billed charges,58.97,0.04,30.07,percent of total billed charges,38.7
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,1,ML,58.97,1.03,Blue Cross and Blue Shield,Traditional,,22.82,38.7,percent of total billed charges,58.97,0.04,30.07,percent of total billed charges,38.7
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.5,ML,61.03,1.65,Blue Cross and Blue Shield,Traditional,,23.62,38.7,percent of total billed charges,61.03,0.06,31.13,percent of total billed charges,38.7
PAMIDRONATE 30MG IJ,J2430,HCPCS,,,,,both,10,ML,193.64,1.96,Blue Cross and Blue Shield,Traditional,,74.94,38.7,percent of total billed charges,193.64,0.08,98.76,percent of total billed charges,38.7
PAMIDRONATE 30MG IJ,J2430,HCPCS,,,,,both,, ,1208.71,2.16,Blue Cross and Blue Shield,Traditional,,467.77,38.7,percent of total billed charges,1208.71,0.08,616.44,percent of total billed charges,38.7
PAPAVERINE UPTO 60MG,J2440,HCPCS,,,,,both,, ,302.05,670.53,Blue Cross and Blue Shield,Traditional,,116.89,38.7,percent of total billed charges,302.05,26.15,154.05,percent of total billed charges,38.7
PALONOSETRON 25MCG,J2469,HCPCS,,,,,both,, ,250.55,53.56,Blue Cross and Blue Shield,Traditional,,96.96,38.7,percent of total billed charges,250.55,2.09,127.78,percent of total billed charges,38.7
PANTOPRAZOLE SOD VL,J2470,HCPCS,,,,,both,1,EA,41.72,7366.00,Blue Cross and Blue Shield,Traditional,,16.15,38.7,percent of total billed charges,41.72,287.27,21.28,percent of total billed charges,38.7
PARICALCITOL 1MCGINJ,J2501,HCPCS,,,,,both,1,ML,25.75,347.11,Blue Cross and Blue Shield,Traditional,,9.97,38.7,percent of total billed charges,25.75,13.54,13.13,percent of total billed charges,38.7
PENICI G POT .6MUINJ,J2540,HCPCS,,,,,both,, ,11.33,353.55,Blue Cross and Blue Shield,Traditional,,4.38,38.7,percent of total billed charges,11.33,13.79,5.78,percent of total billed charges,38.7
PENICI G POT .6MUINJ,J2540,HCPCS,,,,,both,1,EA,11.59,6.59,Blue Cross and Blue Shield,Traditional,,4.49,38.7,percent of total billed charges,11.59,0.26,5.91,percent of total billed charges,38.7
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,41.97,14.42,Blue Cross and Blue Shield,Traditional,,16.24,38.7,percent of total billed charges,41.97,0.56,21.4,percent of total billed charges,38.7
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,44.55,17.25,Blue Cross and Blue Shield,Traditional,,17.24,38.7,percent of total billed charges,44.55,0.67,22.72,percent of total billed charges,38.7
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,48.15,20.25,Blue Cross and Blue Shield,Traditional,,18.63,38.7,percent of total billed charges,48.15,0.79,24.56,percent of total billed charges,38.7
PROMETHAZI UPTO 50MG,J2550,HCPCS,,,,,both,1,ML,24.72,49.44,Blue Cross and Blue Shield,Traditional,,9.57,38.7,percent of total billed charges,24.72,1.93,12.61,percent of total billed charges,38.7
PHENOBARB 120MG INJ,J2560,HCPCS,,,,,both,1,ML,167.89,631.91,Blue Cross and Blue Shield,Traditional,,64.97,38.7,percent of total billed charges,167.89,24.64,85.62,percent of total billed charges,38.7
PHENOBARB 120MG INJ,J2560,HCPCS,,,,,both,, ,232.78,402.47,Blue Cross and Blue Shield,Traditional,,90.09,38.7,percent of total billed charges,232.78,15.70,118.72,percent of total billed charges,38.7
OXYTOCIN UP TO 10UN,J2590,HCPCS,,,,,both,1,ML,27.81,28.84,Blue Cross and Blue Shield,Traditional,,10.76,38.7,percent of total billed charges,27.81,1.12,14.18,percent of total billed charges,38.7
DESMOPRESSIN 1MCGINJ,J2597,HCPCS,,,,,both,1,ML,13.91,161.71,Blue Cross and Blue Shield,Traditional,,5.38,38.7,percent of total billed charges,13.91,6.31,7.09,percent of total billed charges,38.7
FLUPHENZI UP TO 25MG,J2680,HCPCS,,,,,both,5,ML,139.05,185.40,Blue Cross and Blue Shield,Traditional,,53.81,38.7,percent of total billed charges,139.05,7.23,70.92,percent of total billed charges,38.7
PROCAINAMID UPTO 1GM,J2690,HCPCS,,,,,both,2,ML,95.79,11.33,Blue Cross and Blue Shield,Traditional,,37.07,38.7,percent of total billed charges,95.79,0.44,48.85,percent of total billed charges,38.7
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,20,ML,1.44,60.00,Blue Cross and Blue Shield,Traditional,,0.56,38.7,percent of total billed charges,1.44,2.34,0.73,percent of total billed charges,38.7
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,50,ML,2.68,75.71,Blue Cross and Blue Shield,Traditional,,1.04,38.7,percent of total billed charges,2.68,2.95,1.37,percent of total billed charges,38.7
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,50,ML,2.68,91.16,Blue Cross and Blue Shield,Traditional,,1.04,38.7,percent of total billed charges,2.68,3.56,1.37,percent of total billed charges,38.7
NEOSTIGMINE .5MG INJ,J2710,HCPCS,,,,,both,10,ML,13.91,26.78,Blue Cross and Blue Shield,Traditional,,5.38,38.7,percent of total billed charges,13.91,1.04,7.09,percent of total billed charges,38.7
NEOSTIGMINE .5MG INJ,J2710,HCPCS,,,,,both,5,ML,19.57,71.84,Blue Cross and Blue Shield,Traditional,,7.57,38.7,percent of total billed charges,19.57,2.80,9.98,percent of total billed charges,38.7
PROTAMINE 10MG INJ,J2720,HCPCS,,,,,both,5,ML,12.88,28.58,Blue Cross and Blue Shield,Traditional,,4.98,38.7,percent of total billed charges,12.88,1.11,6.57,percent of total billed charges,38.7
PHENTOLAMINE 5MG INJ,J2760,HCPCS,,,,,both,1,EA,968.46,28.58,Blue Cross and Blue Shield,Traditional,,374.79,38.7,percent of total billed charges,968.46,1.11,493.91,percent of total billed charges,38.7
METOCLOPRAM 10MG INJ,J2765,HCPCS,,,,,both,2,ML,24.72,28.58,Blue Cross and Blue Shield,Traditional,,9.57,38.7,percent of total billed charges,24.72,1.11,12.61,percent of total billed charges,38.7
REGADENOSON 0.1MG IJ,J2785,HCPCS,,,,,both,5,ML,335.01,18.28,Blue Cross and Blue Shield,Traditional,,129.65,38.7,percent of total billed charges,335.01,0.71,170.86,percent of total billed charges,38.7
RHOPHYLAC 100UNT,J2791,HCPCS,,,,,both,2,ML,62.83,18.28,Blue Cross and Blue Shield,Traditional,,24.32,38.7,percent of total billed charges,62.83,0.71,32.04,percent of total billed charges,38.7
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,28.33,18.54,Blue Cross and Blue Shield,Traditional,,10.96,38.7,percent of total billed charges,28.33,0.72,14.45,percent of total billed charges,38.7
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,34.25,100.94,Blue Cross and Blue Shield,Traditional,,13.25,38.7,percent of total billed charges,34.25,3.94,17.47,percent of total billed charges,38.7
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,37.08,58.97,Blue Cross and Blue Shield,Traditional,,14.35,38.7,percent of total billed charges,37.08,2.30,18.91,percent of total billed charges,38.7
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,30,ML,1.03,58.97,Blue Cross and Blue Shield,Traditional,,0.40,38.7,percent of total billed charges,1.03,2.30,0.53,percent of total billed charges,38.7
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,20,ML,1.03,62.32,Blue Cross and Blue Shield,Traditional,,0.40,38.7,percent of total billed charges,1.03,2.43,0.53,percent of total billed charges,38.7
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,20,ML,1.03,60.00,Blue Cross and Blue Shield,Traditional,,0.40,38.7,percent of total billed charges,1.03,2.34,0.53,percent of total billed charges,38.7
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,, ,1.65,68.00,Blue Cross and Blue Shield,Traditional,,0.64,38.7,percent of total billed charges,1.65,2.65,0.84,percent of total billed charges,38.7
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,100,ML,1.96,75.00,Blue Cross and Blue Shield,Traditional,,0.76,38.7,percent of total billed charges,1.96,2.93,1,percent of total billed charges,38.7
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,10,ML,2.16,95.00,Blue Cross and Blue Shield,Traditional,,0.84,38.7,percent of total billed charges,2.16,3.71,1.1,percent of total billed charges,38.7
SINCALIDE INJ 5MCG,J2805,HCPCS,,,,,both,1,EA,670.53,96.31,Blue Cross and Blue Shield,Traditional,,259.50,38.7,percent of total billed charges,670.53,3.76,341.97,percent of total billed charges,38.7
SOD FERRIC 12.5MGINJ,J2916,HCPCS,,,,,both,5,ML,53.56,13.91,Blue Cross and Blue Shield,Traditional,,20.73,38.7,percent of total billed charges,53.56,0.54,27.32,percent of total billed charges,38.7
RETEPLASE 18.1MG IJ,J2993,HCPCS,,,,,both,, ,7366.00,44.03,Blue Cross and Blue Shield,Traditional,,2850.64,38.7,percent of total billed charges,7366.00,1.72,3756.66,percent of total billed charges,38.7
ALTEPLASE RECOM 1MG,J2997,HCPCS,,,,,both,1,EA,347.11,79.31,Blue Cross and Blue Shield,Traditional,,134.33,38.7,percent of total billed charges,347.11,3.09,177.03,percent of total billed charges,38.7
ALTEPLASE RECOM 1MG,J2997,HCPCS,,,,,both,1,EA,353.55,84.72,Blue Cross and Blue Shield,Traditional,,136.82,38.7,percent of total billed charges,353.55,3.30,180.31,percent of total billed charges,38.7
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,5,ML,6.59,27.81,Blue Cross and Blue Shield,Traditional,,2.55,38.7,percent of total billed charges,6.59,1.08,3.36,percent of total billed charges,38.7
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,2,ML,14.42,31.93,Blue Cross and Blue Shield,Traditional,,5.58,38.7,percent of total billed charges,14.42,1.25,7.35,percent of total billed charges,38.7
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,1,ML,17.25,3.19,Blue Cross and Blue Shield,Traditional,,6.68,38.7,percent of total billed charges,17.25,0.12,8.8,percent of total billed charges,38.7
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,100,ML,20.25,1.13,Blue Cross and Blue Shield,Traditional,,7.84,38.7,percent of total billed charges,20.25,0.04,10.33,percent of total billed charges,38.7
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,20,ML,49.44,2.99,Blue Cross and Blue Shield,Traditional,,19.13,38.7,percent of total billed charges,49.44,0.12,25.21,percent of total billed charges,38.7
SUMATRIPTAN 6MG INJ,J3030,HCPCS,,,,,both,0.5,ML,631.91,12.88,Blue Cross and Blue Shield,Traditional,,244.55,38.7,percent of total billed charges,631.91,0.50,322.27,percent of total billed charges,38.7
TENECTEPLASE 1MG INJ,J3101,HCPCS,,,,,both,1,EA,402.47,13.91,Blue Cross and Blue Shield,Traditional,,155.76,38.7,percent of total billed charges,402.47,0.54,205.26,percent of total billed charges,38.7
TERBUTALINE 1MG INJ,J3105,HCPCS,,,,,both,1,ML,28.84,14.94,Blue Cross and Blue Shield,Traditional,,11.16,38.7,percent of total billed charges,28.84,0.58,14.71,percent of total billed charges,38.7
CHLORPROM UP TO 50MG,J3230,HCPCS,,,,,both,, ,161.71,1.03,Blue Cross and Blue Shield,Traditional,,62.58,38.7,percent of total billed charges,161.71,0.04,82.47,percent of total billed charges,38.7
CHLORPROM UP TO 50MG,J3230,HCPCS,,,,,both,2,ML,185.40,1.03,Blue Cross and Blue Shield,Traditional,,71.75,38.7,percent of total billed charges,185.40,0.04,94.55,percent of total billed charges,38.7
TIGECYCLINE 1 MG INJ,J3243,HCPCS,,,,,both,, ,11.33,2.68,Blue Cross and Blue Shield,Traditional,,4.38,38.7,percent of total billed charges,11.33,0.10,5.78,percent of total billed charges,38.7
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,250,ML,60.00,12.36,Blue Cross and Blue Shield,Traditional,,23.22,38.7,percent of total billed charges,60.00,0.48,30.6,percent of total billed charges,38.7
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,100,ML,75.71,77.77,Blue Cross and Blue Shield,Traditional,,29.30,38.7,percent of total billed charges,75.71,3.03,38.61,percent of total billed charges,38.7
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,15,ML,91.16,332.69,Blue Cross and Blue Shield,Traditional,,35.28,38.7,percent of total billed charges,91.16,12.97,46.49,percent of total billed charges,38.7
TRIMETHOBEN 200MGINJ,J3250,HCPCS,,,,,both,, ,26.78,1005.80,Blue Cross and Blue Shield,Traditional,,10.36,38.7,percent of total billed charges,26.78,39.23,13.66,percent of total billed charges,38.7
TOBRAMYCIN UPTO 80MG,J3260,HCPCS,,,,,both,1,EA,71.84,172.75,Blue Cross and Blue Shield,Traditional,,27.80,38.7,percent of total billed charges,71.84,6.74,36.64,percent of total billed charges,38.7
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,10,ML,28.58,25.75,Blue Cross and Blue Shield,Traditional,,11.06,38.7,percent of total billed charges,28.58,1.00,14.58,percent of total billed charges,38.7
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,4,ML,28.58,25.75,Blue Cross and Blue Shield,Traditional,,11.06,38.7,percent of total billed charges,28.58,1.00,14.58,percent of total billed charges,38.7
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,20,ML,28.58,12.88,Blue Cross and Blue Shield,Traditional,,11.06,38.7,percent of total billed charges,28.58,0.50,14.58,percent of total billed charges,38.7
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,1,ML,18.28,26.78,Blue Cross and Blue Shield,Traditional,,7.07,38.7,percent of total billed charges,18.28,1.04,9.32,percent of total billed charges,38.7
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,1,ML,18.28,25.75,Blue Cross and Blue Shield,Traditional,,7.07,38.7,percent of total billed charges,18.28,1.00,9.32,percent of total billed charges,38.7
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,, ,18.54,68.50,Blue Cross and Blue Shield,Traditional,,7.17,38.7,percent of total billed charges,18.54,2.67,9.46,percent of total billed charges,38.7
DIAZEPAM 5MG INJ,J3360,HCPCS,,,,,both,2,ML,100.94,25.75,Blue Cross and Blue Shield,Traditional,,39.06,38.7,percent of total billed charges,100.94,1.00,51.48,percent of total billed charges,38.7
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,1,EA,58.97,25.75,Blue Cross and Blue Shield,Traditional,,22.82,38.7,percent of total billed charges,58.97,1.00,30.07,percent of total billed charges,38.7
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,1,EA,58.97,41.72,Blue Cross and Blue Shield,Traditional,,22.82,38.7,percent of total billed charges,58.97,1.63,30.07,percent of total billed charges,38.7
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,, ,62.32,24.72,Blue Cross and Blue Shield,Traditional,,24.12,38.7,percent of total billed charges,62.32,0.96,31.78,percent of total billed charges,38.7
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,300,ML,60.00,25.75,Blue Cross and Blue Shield,Traditional,,23.22,38.7,percent of total billed charges,60.00,1.00,30.6,percent of total billed charges,38.7
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,350,ML,68.00,25.75,Blue Cross and Blue Shield,Traditional,,26.32,38.7,percent of total billed charges,68.00,1.00,34.68,percent of total billed charges,38.7
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,250,ML,75.00,24.72,Blue Cross and Blue Shield,Traditional,,29.03,38.7,percent of total billed charges,75.00,0.96,38.25,percent of total billed charges,38.7
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,150,ML,95.00,25.75,Blue Cross and Blue Shield,Traditional,,36.77,38.7,percent of total billed charges,95.00,1.00,48.45,percent of total billed charges,38.7
VEDOLIZUMAB 1MG INJ,J3380,HCPCS,,,,,both,1,EA,96.31,28.84,Blue Cross and Blue Shield,Traditional,,37.27,38.7,percent of total billed charges,96.31,1.12,49.12,percent of total billed charges,38.7
HYDROXYZI UP TO 25MG,J3410,HCPCS,,,,,both,, ,13.91,25.75,Blue Cross and Blue Shield,Traditional,,5.38,38.7,percent of total billed charges,13.91,1.00,7.09,percent of total billed charges,38.7
THIAMINE 100MG INJ,J3411,HCPCS,,,,,both,2,ML,44.03,12.25,Blue Cross and Blue Shield,Traditional,,17.04,38.7,percent of total billed charges,44.03,0.48,22.46,percent of total billed charges,38.7
PYRIDOXINE 100MG INJ,J3415,HCPCS,,,,,both,1,ML,79.31,12.62,Blue Cross and Blue Shield,Traditional,,30.69,38.7,percent of total billed charges,79.31,0.49,40.45,percent of total billed charges,38.7
VIT B12 CYAN 1000MCG,J3420,HCPCS,,,,,both,1,ML,84.72,54.59,Blue Cross and Blue Shield,Traditional,,32.79,38.7,percent of total billed charges,84.72,2.13,43.21,percent of total billed charges,38.7
PHYTONADIONE 1MG INJ,J3430,HCPCS,,,,,both,0.5,ML,27.81,20.34,Blue Cross and Blue Shield,Traditional,,10.76,38.7,percent of total billed charges,27.81,0.79,14.18,percent of total billed charges,38.7
PHYTONADIONE 1MG INJ,J3430,HCPCS,,,,,both,1,ML,31.93,41.20,Blue Cross and Blue Shield,Traditional,,12.36,38.7,percent of total billed charges,31.93,1.61,16.28,percent of total billed charges,38.7
HYALURONID RECOM 1UN,J3473,HCPCS,,,,,both,1,ML,3.19,27.30,Blue Cross and Blue Shield,Traditional,,1.23,38.7,percent of total billed charges,3.19,1.06,1.63,percent of total billed charges,38.7
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,500,ML,1.13,8.55,Blue Cross and Blue Shield,Traditional,,0.44,38.7,percent of total billed charges,1.13,0.33,0.58,percent of total billed charges,38.7
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,2,ML,12.88,0.31,Blue Cross and Blue Shield,Traditional,,4.98,38.7,percent of total billed charges,12.88,0.01,6.57,percent of total billed charges,38.7
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,, ,13.91,0.72,Blue Cross and Blue Shield,Traditional,,5.38,38.7,percent of total billed charges,13.91,0.03,7.09,percent of total billed charges,38.7
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,50,ML,14.94,1.34,Blue Cross and Blue Shield,Traditional,,5.78,38.7,percent of total billed charges,14.94,0.05,7.62,percent of total billed charges,38.7
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,20,ML,1.03,7.00,Blue Cross and Blue Shield,Traditional,,0.40,38.7,percent of total billed charges,1.03,0.27,0.53,percent of total billed charges,38.7
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,20,ML,1.03,107.38,Blue Cross and Blue Shield,Traditional,,0.40,38.7,percent of total billed charges,1.03,4.19,0.53,percent of total billed charges,38.7
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,, ,2.68,19.31,Blue Cross and Blue Shield,Traditional,,1.04,38.7,percent of total billed charges,2.68,0.75,1.37,percent of total billed charges,38.7
ZIDOVUDINE 10MG INJ,J3485,HCPCS,,,,,both,, ,12.36,191.84,Blue Cross and Blue Shield,Traditional,,4.78,38.7,percent of total billed charges,12.36,7.48,6.3,percent of total billed charges,38.7
ZIPRSIDNE MESYL 10MG,J3486,HCPCS,,,,,both,1,EA,77.77,41.46,Blue Cross and Blue Shield,Traditional,,30.10,38.7,percent of total billed charges,77.77,1.62,39.66,percent of total billed charges,38.7
ZOLEDRONIC ACID 1MG,J3489,HCPCS,,,,,both,100,ML,332.69,4.84,Blue Cross and Blue Shield,Traditional,,128.75,38.7,percent of total billed charges,332.69,0.19,169.67,percent of total billed charges,38.7
ZOLEDRONIC ACID 1MG,J3489,HCPCS,,,,,both,5,ML,1005.80,13.39,Blue Cross and Blue Shield,Traditional,,389.24,38.7,percent of total billed charges,1005.80,0.52,512.96,percent of total billed charges,38.7
BRIVARACETAM 50MG TB,J3490,HCPCS,,,,,both,60,EA,172.75,49.18,Blue Cross and Blue Shield,Traditional,,66.85,38.7,percent of total billed charges,172.75,1.92,88.1,percent of total billed charges,38.7
NORM SALIN 1000ML IV,J7030,HCPCS,,,,,both,1000,ML,25.75,53.56,Blue Cross and Blue Shield,Traditional,,9.97,38.7,percent of total billed charges,25.75,2.09,13.13,percent of total billed charges,38.7
NORM SAL STER500MLIV,J7040,HCPCS,,,,,both,500,ML,25.75,0.52,Blue Cross and Blue Shield,Traditional,,9.97,38.7,percent of total billed charges,25.75,0.02,13.13,percent of total billed charges,38.7
D5W/SOD CHL.9% 500ML,J7042,HCPCS,,,,,both,1000,ML,12.88,1.34,Blue Cross and Blue Shield,Traditional,,4.98,38.7,percent of total billed charges,12.88,0.05,6.57,percent of total billed charges,38.7
NORM SALINE 250ML IV,J7050,HCPCS,,,,,both,250,ML,26.78,3.50,Blue Cross and Blue Shield,Traditional,,10.36,38.7,percent of total billed charges,26.78,0.14,13.66,percent of total billed charges,38.7
SOD CHLOR .9% 100ML,J7050,HCPCS,,,,,both,100,ML,25.75,20.34,Blue Cross and Blue Shield,Traditional,,9.97,38.7,percent of total billed charges,25.75,0.79,13.13,percent of total billed charges,38.7
SOD CHLOR .9% 100ML,J7050,HCPCS,,,,,both,100,ML,68.50,78.54,Blue Cross and Blue Shield,Traditional,,26.51,38.7,percent of total billed charges,68.50,3.06,34.94,percent of total billed charges,38.7
SOD CHLOR .9% 150ML,J7050,HCPCS,,,,,both,150,ML,25.75,147.81,Blue Cross and Blue Shield,Traditional,,9.97,38.7,percent of total billed charges,25.75,5.76,13.13,percent of total billed charges,38.7
SOD CHLOR .9% 50ML,J7050,HCPCS,,,,,both,50,ML,25.75,147.81,Blue Cross and Blue Shield,Traditional,,9.97,38.7,percent of total billed charges,25.75,5.76,13.13,percent of total billed charges,38.7
SOD CHLOR .9% 50ML,J7050,HCPCS,,,,,both,50,ML,41.72,265.74,Blue Cross and Blue Shield,Traditional,,16.15,38.7,percent of total billed charges,41.72,10.36,21.28,percent of total billed charges,38.7
DEX 5%/WATER 500ML,J7060,HCPCS,,,,,both,, ,24.72,61.03,Blue Cross and Blue Shield,Traditional,,9.57,38.7,percent of total billed charges,24.72,2.38,12.61,percent of total billed charges,38.7
DEX 5%/WATER 500ML,J7060,HCPCS,,,,,both,500,ML,25.75,5.36,Blue Cross and Blue Shield,Traditional,,9.97,38.7,percent of total billed charges,25.75,0.21,13.13,percent of total billed charges,38.7
DEX 5%/WATER 1000ML,J7070,HCPCS,,,,,both,1000,ML,25.75,87.81,Blue Cross and Blue Shield,Traditional,,9.97,38.7,percent of total billed charges,25.75,3.42,13.13,percent of total billed charges,38.7
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,1000,ML,24.72,25.75,Blue Cross and Blue Shield,Traditional,,9.57,38.7,percent of total billed charges,24.72,1.00,12.61,percent of total billed charges,38.7
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,500,ML,25.75,616.97,Blue Cross and Blue Shield,Traditional,,9.97,38.7,percent of total billed charges,25.75,24.06,13.13,percent of total billed charges,38.7
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,, ,28.84,690.87,Blue Cross and Blue Shield,Traditional,,11.16,38.7,percent of total billed charges,28.84,26.94,14.71,percent of total billed charges,38.7
D5LR UP TO 1000ML,J7121,HCPCS,,,,,both,1000,ML,25.75,777.65,Blue Cross and Blue Shield,Traditional,,9.97,38.7,percent of total billed charges,25.75,30.33,13.13,percent of total billed charges,38.7
PROTHROMB COM 1UN IX,J7168,HCPCS,,,,,both,1,EA,12.25,6.39,Blue Cross and Blue Shield,Traditional,,4.74,38.7,percent of total billed charges,12.25,0.25,6.25,percent of total billed charges,38.7
PROTHROMB COM 1UN IX,J7168,CPT,,,,,both,1,EA,12.62,3.71,Blue Cross and Blue Shield,Traditional,,4.88,38.7,percent of total billed charges,12.62,0.14,6.44,percent of total billed charges,38.7
MOMETA SIN IMP 10MCG,J7402,HCPCS,,,,,both,, ,54.59,61.03,Blue Cross and Blue Shield,Traditional,,21.13,38.7,percent of total billed charges,54.59,2.38,27.84,percent of total billed charges,38.7
AZATHIOPRINE 50MG TB,J7500,HCPCS,,,,,both,100,EA,20.34,531.22,Blue Cross and Blue Shield,Traditional,,7.87,38.7,percent of total billed charges,20.34,20.72,10.37,percent of total billed charges,38.7
CYCLOSPORNE 100MG PO,J7502,HCPCS,,,,,both,, ,41.20,12.00,Blue Cross and Blue Shield,Traditional,,15.94,38.7,percent of total billed charges,41.20,0.47,21.01,percent of total billed charges,38.7
TACROLIMUS 1MG PO,J7507,HCPCS,,,,,both,100,EA,27.30,851.55,Blue Cross and Blue Shield,Traditional,,10.57,38.7,percent of total billed charges,27.30,33.21,13.92,percent of total billed charges,38.7
METHYLPREDNIS 4MG PO,J7509,HCPCS,,,,,both,, ,8.55,1340.29,Blue Cross and Blue Shield,Traditional,,3.31,38.7,percent of total billed charges,8.55,52.27,4.36,percent of total billed charges,38.7
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.10,1301.25,Blue Cross and Blue Shield,Traditional,,0.04,38.7,percent of total billed charges,0.10,50.75,0.05,percent of total billed charges,38.7
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.31,1301.25,Blue Cross and Blue Shield,Traditional,,0.12,38.7,percent of total billed charges,0.31,50.75,0.16,percent of total billed charges,38.7
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.72,101.60,Blue Cross and Blue Shield,Traditional,,0.28,38.7,percent of total billed charges,0.72,3.96,0.37,percent of total billed charges,38.7
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,1.34,283.48,Blue Cross and Blue Shield,Traditional,,0.52,38.7,percent of total billed charges,1.34,11.06,0.68,percent of total billed charges,38.7
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,, ,7.00,884.69,Blue Cross and Blue Shield,Traditional,,2.71,38.7,percent of total billed charges,7.00,34.50,3.57,percent of total billed charges,38.7
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,, ,107.38,638.53,Blue Cross and Blue Shield,Traditional,,41.56,38.7,percent of total billed charges,107.38,24.90,54.76,percent of total billed charges,38.7
CYCLOSPORINE 25MG PO,J7515,HCPCS,,,,,both,, ,19.31,737.05,Blue Cross and Blue Shield,Traditional,,7.47,38.7,percent of total billed charges,19.31,28.74,9.85,percent of total billed charges,38.7
CYCLOSPOR PAREN250MG,J7516,HCPCS,,,,,both,, ,191.84,2646.20,Blue Cross and Blue Shield,Traditional,,74.24,38.7,percent of total billed charges,191.84,103.20,97.84,percent of total billed charges,38.7
MYCOPHE MOF 250MG PO,J7517,HCPCS,,,,,both,100,EA,41.46,2796.36,Blue Cross and Blue Shield,Traditional,,16.05,38.7,percent of total billed charges,41.46,109.06,21.14,percent of total billed charges,38.7
METHACHOL 1MGINH NEB,J7674,HCPCS,,,,,both,1,EA,4.84,1013.80,Blue Cross and Blue Shield,Traditional,,1.87,38.7,percent of total billed charges,4.84,39.54,2.47,percent of total billed charges,38.7
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,, ,13.39,1025.03,Blue Cross and Blue Shield,Traditional,,5.18,38.7,percent of total billed charges,13.39,39.98,6.83,percent of total billed charges,38.7
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,, ,49.18,614.12,Blue Cross and Blue Shield,Traditional,,19.03,38.7,percent of total billed charges,49.18,23.95,25.08,percent of total billed charges,38.7
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,100,EA,53.56,528.13,Blue Cross and Blue Shield,Traditional,,20.73,38.7,percent of total billed charges,53.56,20.60,27.32,percent of total billed charges,38.7
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,, ,0.52,408.14,Blue Cross and Blue Shield,Traditional,,0.20,38.7,percent of total billed charges,0.52,15.92,0.27,percent of total billed charges,38.7
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,100,EA,1.34,623.92,Blue Cross and Blue Shield,Traditional,,0.52,38.7,percent of total billed charges,1.34,24.33,0.68,percent of total billed charges,38.7
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,, ,3.50,1025.03,Blue Cross and Blue Shield,Traditional,,1.35,38.7,percent of total billed charges,3.50,39.98,1.79,percent of total billed charges,38.7
METHOTREXATE 2.5MGPO,J8610,HCPCS,,,,,both,100,EA,20.34,634.60,Blue Cross and Blue Shield,Traditional,,7.87,38.7,percent of total billed charges,20.34,24.75,10.37,percent of total billed charges,38.7
LEUCOVOR CAL 25MG TB,J8999,HCPCS,,,,,both,20,EA,78.54,9.68,Blue Cross and Blue Shield,Traditional,,30.39,38.7,percent of total billed charges,78.54,0.38,40.06,percent of total billed charges,38.7
BENDAMUSTINE 1MG INJ,J9033,HCPCS,,,,,both,, ,147.81,4.12,Blue Cross and Blue Shield,Traditional,,57.20,38.7,percent of total billed charges,147.81,0.16,75.38,percent of total billed charges,38.7
BENDAMUSTINE 1MG INJ,J9033,HCPCS,,,,,both,, ,147.81,7.52,Blue Cross and Blue Shield,Traditional,,57.20,38.7,percent of total billed charges,147.81,0.29,75.38,percent of total billed charges,38.7
BORTEZOMIB .1MG INJ,J9041,HCPCS,,,,,both,, ,265.74,33.73,Blue Cross and Blue Shield,Traditional,,102.84,38.7,percent of total billed charges,265.74,1.32,135.53,percent of total billed charges,38.7
CARBOPLATIN 50MG INJ,J9045,HCPCS,,,,,both,45,ML,61.03,34.25,Blue Cross and Blue Shield,Traditional,,23.62,38.7,percent of total billed charges,61.03,1.34,31.13,percent of total billed charges,38.7
CISPLAT POW/SOL 10MG,J9060,HCPCS,,,,,both,50,ML,5.36,83.25,Blue Cross and Blue Shield,Traditional,,2.07,38.7,percent of total billed charges,5.36,3.25,2.73,percent of total billed charges,38.7
DOCETAXEL 1MG INJ,J9171,HCPCS,,,,,both,, ,87.81,456.00,Blue Cross and Blue Shield,Traditional,,33.98,38.7,percent of total billed charges,87.81,17.78,44.78,percent of total billed charges,38.7
FLUOROURACIL 500MG,J9190,HCPCS,,,,,both,, ,25.75,469.68,Blue Cross and Blue Shield,Traditional,,9.97,38.7,percent of total billed charges,25.75,18.32,13.13,percent of total billed charges,38.7
GEMCITABIN 200MG INJ,J9201,HCPCS,,,,,both,1,EA,616.97,307.80,Blue Cross and Blue Shield,Traditional,,238.77,38.7,percent of total billed charges,616.97,12.00,314.65,percent of total billed charges,38.7
GEMCITABIN 200MG INJ,J9201,HCPCS,,,,,both,, ,690.87,323.00,Blue Cross and Blue Shield,Traditional,,267.37,38.7,percent of total billed charges,690.87,12.60,352.34,percent of total billed charges,38.7
IPILIMUMAB 1MG INJ,J9228,HCPCS,,,,,both,40,ML,777.65,10.82,Blue Cross and Blue Shield,Traditional,,300.95,38.7,percent of total billed charges,777.65,0.42,396.6,percent of total billed charges,38.7
OXALIPLATIN .5MG INJ,J9263,HCPCS,,,,,both,10,ML,6.39,599.72,Blue Cross and Blue Shield,Traditional,,2.47,38.7,percent of total billed charges,6.39,23.39,3.26,percent of total billed charges,38.7
PACLITAXEL 1MG INJ,J9267,HCPCS,,,,,both,, ,3.71,4404.00,Blue Cross and Blue Shield,Traditional,,1.44,38.7,percent of total billed charges,3.71,171.76,1.89,percent of total billed charges,38.7
PERTUZUMAB 1MG INJ,J9306,HCPCS,,,,,both,14,ML,61.03,166.86,Blue Cross and Blue Shield,Traditional,,23.62,38.7,percent of total billed charges,61.03,6.51,31.13,percent of total billed charges,38.7
TRASTUZUMAB 10MG INJ,J9355,HCPCS,,,,,both,, ,531.22,31.93,Blue Cross and Blue Shield,Traditional,,205.58,38.7,percent of total billed charges,531.22,1.25,270.92,percent of total billed charges,38.7
POST OP SHOES,L3260,HCPCS,,,,,both,, ,12.00,133.90,Blue Cross and Blue Shield,Traditional,,4.64,38.7,percent of total billed charges,12.00,5.22,6.12,percent of total billed charges,38.7
ADM IV INF CASI IMDV,M0243,HCPCS,,,,,both,, ,851.55,2544.00,Blue Cross and Blue Shield,Traditional,,329.55,38.7,percent of total billed charges,851.55,99.22,434.29,percent of total billed charges,38.7
ADM IV INF CASI IMDV,M0243,HCPCS,,,,,both,, ,1340.29,3469.00,Blue Cross and Blue Shield,Traditional,,518.69,38.7,percent of total billed charges,1340.29,135.29,683.55,percent of total billed charges,38.7
ADM IV INF BAM ETES,M0245,HCPCS,,,,,both,, ,1301.25,3745.00,Blue Cross and Blue Shield,Traditional,,503.58,38.7,percent of total billed charges,1301.25,146.06,663.64,percent of total billed charges,38.7
ADM IV INF SOTROVIM,M0247,HCPCS,,,,,both,, ,1301.25,3928.00,Blue Cross and Blue Shield,Traditional,,503.58,38.7,percent of total billed charges,1301.25,153.19,663.64,percent of total billed charges,38.7
"PAP SMEAR, SCREEN",P3000,HCPCS,,,,,both,, ,101.60,347.63,Blue Cross and Blue Shield,Traditional,,39.32,38.7,percent of total billed charges,101.60,13.56,51.82,percent of total billed charges,38.7
S-H CRYO EACH UNIT,P9012,HCPCS,,,,,both,, ,283.48,506.25,Blue Cross and Blue Shield,Traditional,,109.71,38.7,percent of total billed charges,283.48,19.74,144.57,percent of total billed charges,38.7
S-H RBC LEUKO REDU,P9016,HCPCS,,,,,both,, ,884.69,6211.00,Blue Cross and Blue Shield,Traditional,,342.38,38.7,percent of total billed charges,884.69,242.23,451.19,percent of total billed charges,38.7
S-H 1 DONOR FFP,P9017,HCPCS,,,,,both,, ,638.53,570.11,Blue Cross and Blue Shield,Traditional,,247.11,38.7,percent of total billed charges,638.53,22.23,325.65,percent of total billed charges,38.7
S-H RED BLD-UNIT,P9021,HCPCS,,,,,both,, ,737.05,5236.00,Blue Cross and Blue Shield,Traditional,,285.24,38.7,percent of total billed charges,737.05,204.20,375.9,percent of total billed charges,38.7
S-H PLAT PHERE L-R,P9035,HCPCS,,,,,both,, ,2646.20,3534.00,Blue Cross and Blue Shield,Traditional,,1024.08,38.7,percent of total billed charges,2646.20,137.83,1349.56,percent of total billed charges,38.7
S-H PLAT A-P L-R IRR,P9037,HCPCS,,,,,both,, ,2796.36,9540.00,Blue Cross and Blue Shield,Traditional,,1082.19,38.7,percent of total billed charges,2796.36,372.06,1426.14,percent of total billed charges,38.7
S-H RBC IRRAD,P9038,HCPCS,,,,,both,, ,1013.80,545.13,Blue Cross and Blue Shield,Traditional,,392.34,38.7,percent of total billed charges,1013.80,21.26,517.04,percent of total billed charges,38.7
S-H RBC L-R IRRAD,P9040,HCPCS,,,,,both,, ,1025.03,70.81,Blue Cross and Blue Shield,Traditional,,396.69,38.7,percent of total billed charges,1025.03,2.76,522.77,percent of total billed charges,38.7
S-H CRYOPRE REDU PLS,P9044,HCPCS,,,,,both,, ,614.12,93.22,Blue Cross and Blue Shield,Traditional,,237.66,38.7,percent of total billed charges,614.12,3.64,313.2,percent of total billed charges,38.7
ALBUMIN 5% 250ML IV,P9045,HCPCS,,,,,both,250,ML,528.13,93.22,Blue Cross and Blue Shield,Traditional,,204.39,38.7,percent of total billed charges,528.13,3.64,269.35,percent of total billed charges,38.7
ALBUMIN 25% 50ML IV,P9047,HCPCS,,,,,both,100,ML,408.14,93.22,Blue Cross and Blue Shield,Traditional,,157.95,38.7,percent of total billed charges,408.14,3.64,208.15,percent of total billed charges,38.7
ALBUMIN 25% 50ML IV,P9047,HCPCS,,,,,both,50,ML,623.92,1184.50,Blue Cross and Blue Shield,Traditional,,241.46,38.7,percent of total billed charges,623.92,46.20,318.2,percent of total billed charges,38.7
S-H BLD L-R CMV- EA,P9051,HCPCS,,,,,both,, ,1025.03,1.65,Blue Cross and Blue Shield,Traditional,,396.69,38.7,percent of total billed charges,1025.03,0.06,522.77,percent of total billed charges,38.7
S-H FFP BTWN8-24HREA,P9059,HCPCS,,,,,both,, ,634.60,49.50,Blue Cross and Blue Shield,Traditional,,245.59,38.7,percent of total billed charges,634.60,1.93,323.65,percent of total billed charges,38.7
FERUMOXYTOL1MG NESRD,Q0138,HCPCS,,,,,both,17,ML,9.68,1.65,Blue Cross and Blue Shield,Traditional,,3.75,38.7,percent of total billed charges,9.68,0.06,4.94,percent of total billed charges,38.7
CHLORPROMAZIN 5MG PO,Q0161,HCPCS,,,,,both,1,EA,4.12,27.81,Blue Cross and Blue Shield,Traditional,,1.59,38.7,percent of total billed charges,4.12,1.08,2.1,percent of total billed charges,38.7
CHLORPROMAZIN 5MG PO,Q0161,HCPCS,,,,,both,, ,7.52,36.82,Blue Cross and Blue Shield,Traditional,,2.91,38.7,percent of total billed charges,7.52,1.44,3.84,percent of total billed charges,38.7
ONDANSETRON 1MG PO,Q0162,HCPCS,,,,,both,, ,33.73,36.82,Blue Cross and Blue Shield,Traditional,,13.05,38.7,percent of total billed charges,33.73,1.44,17.2,percent of total billed charges,38.7
ONDANSETRON 1MG PO,Q0162,HCPCS,,,,,both,50,ML,34.25,6.00,Blue Cross and Blue Shield,Traditional,,13.25,38.7,percent of total billed charges,34.25,0.23,17.47,percent of total billed charges,38.7
TELEHEALTH IP NEURO,Q3014,HCPCS,,,,,both,, ,83.25,6.00,Blue Cross and Blue Shield,Traditional,,32.22,38.7,percent of total billed charges,83.25,0.23,42.46,percent of total billed charges,38.7
TOTAL CONTACT CAST 3 INCH,Q4038,HCPCS,,,,,both,, ,456.00,6.00,Blue Cross and Blue Shield,Traditional,,176.47,38.7,percent of total billed charges,456.00,0.23,232.56,percent of total billed charges,38.7
TOTAL CONTACT CAST 4 INCH,Q4038,HCPCS,,,,,both,, ,469.68,4.00,Blue Cross and Blue Shield,Traditional,,181.77,38.7,percent of total billed charges,469.68,0.16,239.54,percent of total billed charges,38.7
TOTAL CONTACT CAST BOOT LARGE,Q4038,HCPCS,,,,,both,, ,307.80,1337.97,Blue Cross and Blue Shield,Traditional,,119.12,38.7,percent of total billed charges,307.80,52.18,156.98,percent of total billed charges,38.7
TOTAL CONTACT CAST BOOT X-LARGE,Q4038,HCPCS,,,,,both,, ,323.00,12.62,Blue Cross and Blue Shield,Traditional,,125.00,38.7,percent of total billed charges,323.00,0.49,164.73,percent of total billed charges,38.7
OASIS WOUND MAT SQCM,Q4102,HCPCS,,,,,both,, ,10.82,1178.84,Blue Cross and Blue Shield,Traditional,,4.19,38.7,percent of total billed charges,10.82,45.97,5.52,percent of total billed charges,38.7
INTEGRA BMWD SQ CM,Q4104,HCPCS,,,,,both,, ,599.72,0.60,Blue Cross and Blue Shield,Traditional,,232.09,38.7,percent of total billed charges,599.72,0.02,305.86,percent of total billed charges,38.7
INTEGRA SKIN SUB 5X5CM,Q4108,HCPCS,,,,,both,, ,4404.00,0.60,Blue Cross and Blue Shield,Traditional,,1704.35,38.7,percent of total billed charges,4404.00,0.02,2246.04,percent of total billed charges,38.7
DERMACELL SQ CM,Q4122,HCPCS,,,,,both,, ,166.86,7.40,Blue Cross and Blue Shield,Traditional,,64.57,38.7,percent of total billed charges,166.86,0.29,85.1,percent of total billed charges,38.7
OASIS ULTRA TRI SQCM,Q4124,HCPCS,,,,,both,, ,31.93,7.40,Blue Cross and Blue Shield,Traditional,,12.36,38.7,percent of total billed charges,31.93,0.29,16.28,percent of total billed charges,38.7
ACELL DERM MAT 1SQCM,Q4126,HCPCS,,,,,both,, ,133.90,7.40,Blue Cross and Blue Shield,Traditional,,51.82,38.7,percent of total billed charges,133.90,0.29,68.29,percent of total billed charges,38.7
1AMNIOEXCEL SKIN 1.5X1.5CM,Q4137,HCPCS,,,,,both,, ,2544.00,7.40,Blue Cross and Blue Shield,Traditional,,984.53,38.7,percent of total billed charges,2544.00,0.29,1297.44,percent of total billed charges,38.7
AMNIOEXCEL SKIN 2X3CM,Q4137,HCPCS,,,,,both,, ,3469.00,0.70,Blue Cross and Blue Shield,Traditional,,1342.50,38.7,percent of total billed charges,3469.00,0.03,1769.19,percent of total billed charges,38.7
AMNIOEXCEL SKIN 3.5X3.5CM,Q4137,HCPCS,,,,,both,, ,3745.00,0.70,Blue Cross and Blue Shield,Traditional,,1449.32,38.7,percent of total billed charges,3745.00,0.03,1909.95,percent of total billed charges,38.7
AMNIOEXCEL SKIN 4X4CM,Q4137,HCPCS,,,,,both,, ,3928.00,11.07,Blue Cross and Blue Shield,Traditional,,1520.14,38.7,percent of total billed charges,3928.00,0.43,2003.28,percent of total billed charges,38.7
ALLOWRAP DS/DRY SQCM,Q4150,HCPCS,,,,,both,, ,347.63,11.07,Blue Cross and Blue Shield,Traditional,,134.53,38.7,percent of total billed charges,347.63,0.43,177.29,percent of total billed charges,38.7
ALLOWRAP DS/DRY SQCM,Q4150,HCPCS,,,,,both,, ,506.25,11.07,Blue Cross and Blue Shield,Traditional,,195.92,38.7,percent of total billed charges,506.25,0.43,258.19,percent of total billed charges,38.7
HELICOLL (PER SQ CM),Q4164,HCPCS,,,,,both,, ,6211.00,11.07,Blue Cross and Blue Shield,Traditional,,2403.66,38.7,percent of total billed charges,6211.00,0.43,3167.61,percent of total billed charges,38.7
EPIFIX SQ CM,Q4186,HCPCS,,,,,both,, ,570.11,4.00,Blue Cross and Blue Shield,Traditional,,220.63,38.7,percent of total billed charges,570.11,0.16,290.76,percent of total billed charges,38.7
MEMBRANE GRAFT/WRAP (PER SQ CM),Q4205,HCPCS,,,,,both,, ,5236.00,60.50,Blue Cross and Blue Shield,Traditional,,2026.33,38.7,percent of total billed charges,5236.00,2.36,2670.36,percent of total billed charges,38.7
DERM-MAXX (PER SQ CM),Q4238,HCPCS,,,,,both,, ,3534.00,60.50,Blue Cross and Blue Shield,Traditional,,1367.66,38.7,percent of total billed charges,3534.00,2.36,1802.34,percent of total billed charges,38.7
AMNIO-MAX (PER SQ CM),Q4239,HCPCS,,,,,both,, ,9540.00,115.88,Blue Cross and Blue Shield,Traditional,,3691.98,38.7,percent of total billed charges,9540.00,4.52,4865.4,percent of total billed charges,38.7
INFLIXIMAB-DYYB 10MG,Q5103,HCPCS,,,,,both,1,EA,545.13,2.58,Blue Cross and Blue Shield,Traditional,,210.97,38.7,percent of total billed charges,545.13,0.10,278.02,percent of total billed charges,38.7
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,1,ML,70.81,2.58,Blue Cross and Blue Shield,Traditional,,27.40,38.7,percent of total billed charges,70.81,0.10,36.11,percent of total billed charges,38.7
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,, ,93.22,872.41,Blue Cross and Blue Shield,Traditional,,36.08,38.7,percent of total billed charges,93.22,34.02,47.54,percent of total billed charges,38.7
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,1,ML,93.22,120.97,Blue Cross and Blue Shield,Traditional,,36.08,38.7,percent of total billed charges,93.22,4.72,47.54,percent of total billed charges,38.7
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,, ,93.22,172.81,Blue Cross and Blue Shield,Traditional,,36.08,38.7,percent of total billed charges,93.22,6.74,47.54,percent of total billed charges,38.7
INJ PERFLUTRN LIP ML,Q9957,HCPCS,,,,,both,, ,1184.50,710.70,Blue Cross and Blue Shield,Traditional,,458.40,38.7,percent of total billed charges,1184.50,604.10,604.1,percent of total billed charges,38.7
HOCM2 250-299MGML ML,Q9961,HCPCS,,,,,both,, ,1.65,0.99,Blue Cross and Blue Shield,Traditional,,0.64,38.7,percent of total billed charges,1.65,0.84,0.84,percent of total billed charges,38.7
HOCM 350 MG ML 30ML,Q9963,HCPCS,,,,,both,30,ML,49.50,29.70,Blue Cross and Blue Shield,Traditional,,19.16,38.7,percent of total billed charges,49.50,25.25,25.25,percent of total billed charges,38.7
HOCM 350-399MGML IOD,Q9963,HCPCS,,,,,both,, ,1.65,0.99,Blue Cross and Blue Shield,Traditional,,0.64,38.7,percent of total billed charges,1.65,0.84,0.84,percent of total billed charges,38.7
LOC2 200-299MG/ML ML,Q9966,HCPCS,,,,,both,, ,27.81,16.68,Blue Cross and Blue Shield,Traditional,,10.76,38.7,percent of total billed charges,27.81,14.18,14.18,percent of total billed charges,38.7
LOCM 200-299MG/ML ML,Q9966,HCPCS,,,,,both,, ,36.82,22.09,Blue Cross and Blue Shield,Traditional,,14.25,38.7,percent of total billed charges,36.82,18.78,18.78,percent of total billed charges,38.7
LOCM 200-299MG/ML ML,Q9966,HCPCS,,,,,both,, ,36.82,22.09,Blue Cross and Blue Shield,Traditional,,14.25,38.7,percent of total billed charges,36.82,18.78,18.78,percent of total billed charges,38.7
LOCM 240MG 100ML,Q9966,HCPCS,,,,,both,100,ML,6.00,3.60,Blue Cross and Blue Shield,Traditional,,2.32,38.7,percent of total billed charges,6.00,3.06,3.06,percent of total billed charges,38.7
LOCM 240MG 50ML,Q9966,HCPCS,,,,,both,50,ML,6.00,3.60,Blue Cross and Blue Shield,Traditional,,2.32,38.7,percent of total billed charges,6.00,3.06,3.06,percent of total billed charges,38.7
LOCM 270MG 150ML,Q9966,HCPCS,,,,,both,150,ML,6.00,3.60,Blue Cross and Blue Shield,Traditional,,2.32,38.7,percent of total billed charges,6.00,3.06,3.06,percent of total billed charges,38.7
LOCM200MG/ML 41% 200,Q9966,HCPCS,,,,,both,200,ML,4.00,2.40,Blue Cross and Blue Shield,Traditional,,1.55,38.7,percent of total billed charges,4.00,2.04,2.04,percent of total billed charges,38.7
LOC2 300-399MG/ML ML,Q9967,HCPCS,,,,,both,150,ML,1337.97,802.78,Blue Cross and Blue Shield,Traditional,,517.79,38.7,percent of total billed charges,1337.97,682.36,682.36,percent of total billed charges,38.7
LOCM 300-399MG/ML ML,Q9967,HCPCS,,,,,both,50,ML,12.62,7.57,Blue Cross and Blue Shield,Traditional,,4.88,38.7,percent of total billed charges,12.62,6.44,6.44,percent of total billed charges,38.7
LOCM 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,1178.84,707.30,Blue Cross and Blue Shield,Traditional,,456.21,38.7,percent of total billed charges,1178.84,601.21,601.21,percent of total billed charges,38.7
LOCM300MG/ML 61% 100,Q9967,HCPCS,,,,,both,, ,0.60,0.36,Blue Cross and Blue Shield,Traditional,,0.23,38.7,percent of total billed charges,0.60,0.31,0.31,percent of total billed charges,38.7
LOCM300MG/ML 61% 100,Q9967,HCPCS,,,,,both,, ,0.60,0.36,Blue Cross and Blue Shield,Traditional,,0.23,38.7,percent of total billed charges,0.60,0.31,0.31,percent of total billed charges,38.7
LOCM300MG/ML 61% 100,Q9967,HCPCS,,,,,both,100,ML,7.40,4.44,Blue Cross and Blue Shield,Traditional,,2.86,38.7,percent of total billed charges,7.40,3.77,3.77,percent of total billed charges,38.7
LOCM300MG/ML 61% 100,Q9967,HCPCS,,,,,both,100,ML,7.40,4.44,Blue Cross and Blue Shield,Traditional,,2.86,38.7,percent of total billed charges,7.40,3.77,3.77,percent of total billed charges,38.7
LOCM300MG/ML 61% 100,Q9967,HCPCS,,,,,both,100,ML,7.40,4.44,Blue Cross and Blue Shield,Traditional,,2.86,38.7,percent of total billed charges,7.40,3.77,3.77,percent of total billed charges,38.7
LOCM300MG/ML 61% 100,Q9967,HCPCS,,,,,both,100,ML,7.40,4.44,Blue Cross and Blue Shield,Traditional,,2.86,38.7,percent of total billed charges,7.40,3.77,3.77,percent of total billed charges,38.7
LOCM300MG/ML 76% 100,Q9967,HCPCS,,,,,both,, ,0.70,0.42,Blue Cross and Blue Shield,Traditional,,0.27,38.7,percent of total billed charges,0.70,0.36,0.36,percent of total billed charges,38.7
LOCM300MG/ML 76% 100,Q9967,HCPCS,,,,,both,, ,0.70,0.42,Blue Cross and Blue Shield,Traditional,,0.27,38.7,percent of total billed charges,0.70,0.36,0.36,percent of total billed charges,38.7
LOCM300MG/ML 76% 100,Q9967,HCPCS,,,,,both,100,ML,11.07,6.64,Blue Cross and Blue Shield,Traditional,,4.28,38.7,percent of total billed charges,11.07,5.65,5.65,percent of total billed charges,38.7
LOCM300MG/ML 76% 100,Q9967,HCPCS,,,,,both,100,ML,11.07,6.64,Blue Cross and Blue Shield,Traditional,,4.28,38.7,percent of total billed charges,11.07,5.65,5.65,percent of total billed charges,38.7
LOCM300MG/ML 76% 100,Q9967,HCPCS,,,,,both,100,ML,11.07,6.64,Blue Cross and Blue Shield,Traditional,,4.28,38.7,percent of total billed charges,11.07,5.65,5.65,percent of total billed charges,38.7
LOCM300MG/ML 76% 100,Q9967,HCPCS,,,,,both,100,ML,11.07,6.64,Blue Cross and Blue Shield,Traditional,,4.28,38.7,percent of total billed charges,11.07,5.65,5.65,percent of total billed charges,38.7
LOCM300MG/ML 76% 125,Q9967,HCPCS,,,,,both,125,ML,4.00,2.40,Blue Cross and Blue Shield,Traditional,,1.55,38.7,percent of total billed charges,4.00,2.04,2.04,percent of total billed charges,38.7
LOCM300MG/ML M61% 15,Q9967,HCPCS,,,,,both,15,ML,60.50,36.30,Blue Cross and Blue Shield,Traditional,,23.41,38.7,percent of total billed charges,60.50,30.86,30.86,percent of total billed charges,38.7
LOCM300MG/ML M61% 15,Q9967,HCPCS,,,,,both,15,ML,60.50,36.30,Blue Cross and Blue Shield,Traditional,,23.41,38.7,percent of total billed charges,60.50,30.86,30.86,percent of total billed charges,38.7
LACTATION CONSULT,S9443,HCPCS,,,,,both,, ,115.88,69.52,Blue Cross and Blue Shield,Traditional,,44.85,38.7,percent of total billed charges,115.88,59.10,59.1,percent of total billed charges,38.7
NI-CARD REHAB PH 3,S9472,HCPCS,,,,,both,, ,2.58,1.54,Blue Cross and Blue Shield,Traditional,,1.00,38.7,percent of total billed charges,2.58,1.32,1.32,percent of total billed charges,38.7
NI-PULM REHAB PH 3,S9473,HCPCS,,,,,both,, ,2.58,1.54,Blue Cross and Blue Shield,Traditional,,1.00,38.7,percent of total billed charges,2.58,1.32,1.32,percent of total billed charges,38.7
IOP PSYCH PER DIEM,S9480,HCPCS,,,,,both,, ,872.41,523.44,Blue Cross and Blue Shield,Traditional,,337.62,38.7,percent of total billed charges,872.41,444.93,444.93,percent of total billed charges,38.7
CDC COVID19,U0001,HCPCS,,,,,both,, ,120.97,72.58,Blue Cross and Blue Shield,Traditional,,46.82,38.7,percent of total billed charges,120.97,61.69,61.69,percent of total billed charges,38.7
STATE COVID19,U0002,HCPCS,,,,,both,, ,172.81,103.68,Blue Cross and Blue Shield,Traditional,,66.88,38.7,percent of total billed charges,172.81,88.13,88.13,percent of total billed charges,38.7
Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC),470,MS-DRG,,,,,Inpatient,,,13886.51,13886.51,Medicaid,Illinois Medicaid,,13886.51, ,,13886.51,1527.52,7220.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CATH FLUID DRAIN,10030,CPT,,,,,both,, ,1071.33,642.79,Medicaid,Illinois Medicaid,,642.79,,,1071.33,117.85,557.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UNLISTD PROCEDURE,17999,CPT,,,,,both,, ,763.00,457.80,Medicaid,Illinois Medicaid,,262.80,,,763.00,83.93,396.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-BRST DUCTOGRM INJ,19030,CPT,,,,,both,, ,289.43,173.65,Medicaid,Illinois Medicaid,,262.80,,,289.43,31.84,150.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BX OF BREAST OPEN,19101,CPT,,,,,both,, ,14527.16,8716.29,Medicaid,Illinois Medicaid,,226.30,,,14527.16,1597.99,7554.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EXPL P WND EXTREM,20103,CPT,,,,,both,, ,6179.00,3707.40,Medicaid,Illinois Medicaid,,245.31,,,6179.00,679.69,3213.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NJ TENDON SHEATH/LIG,20550,CPT,,,,,both,, ,1128.80,677.28,Medicaid,Illinois Medicaid,,48.82,,,1128.80,124.17,586.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-JOINT ASP-INJ SM,20600,CPT,,,,,both,, ,487.45,292.47,Medicaid,Illinois Medicaid,,48.82,,,487.45,53.62,253.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-DRN INJ SMAL JT W,20604,CPT,,,,,both,, ,726.15,435.69,Medicaid,Illinois Medicaid,,48.82,,,726.15,79.88,377.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-JOINT ASP-INJ IM,20605,CPT,,,,,both,, ,700.66,420.39,Medicaid,Illinois Medicaid,,48.82,,,700.66,77.07,364.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-DRN INJ INTM JT W,20606,CPT,,,,,both,, ,1594.18,956.50,Medicaid,Illinois Medicaid,,242.41,,,1594.18,175.36,828.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-DRN INJ MAJR JT W,20611,CPT,,,,,both,, ,726.15,435.69,Medicaid,Illinois Medicaid,,242.41,,,726.15,79.88,377.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-INJ TMJ ARTHROGRAM,21116,CPT,,,,,both,, ,289.43,173.65,Medicaid,Illinois Medicaid,,262.80,,,289.43,31.84,150.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-INJ SHOULDER ARTH,23350,CPT,,,,,both,, ,289.43,173.65,Medicaid,Illinois Medicaid,,262.80,,,289.43,31.84,150.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-INJ ELBOW ARTHRO,24220,CPT,,,,,both,, ,289.43,173.65,Medicaid,Illinois Medicaid,,226.30,,,289.43,31.84,150.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-INJ WRIST ARTHRO,25246,CPT,,,,,both,, ,289.43,173.65,Medicaid,Illinois Medicaid,,245.31,,,289.43,31.84,150.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-INJ HIP ARTHRO,27093,CPT,,,,,both,, ,289.43,173.65,Medicaid,Illinois Medicaid,,262.80,,,289.43,31.84,150.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-INJ KNEE ARTHRO,27369,CPT,,,,,both,, ,289.43,173.65,Medicaid,Illinois Medicaid,,262.80,,,289.43,31.84,150.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-INJ ANKLE ARTHRO,27648,CPT,,,,,both,, ,289.43,173.65,Medicaid,Illinois Medicaid,,48.82,,,289.43,31.84,150.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EXPLORE FOOT JOINT,28022,CPT,,,,,both,, ,12336.12,7401.67,Medicaid,Illinois Medicaid,,48.82,,,12336.12,1356.97,6414.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMPUT TOE & METATRSL,28810,CPT,,,,,both,, ,12336.12,7401.67,Medicaid,Illinois Medicaid,,48.82,,,12336.12,1356.97,6414.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMPUTATE TOE,28820,CPT,,,,,both,, ,12336.12,7401.67,Medicaid,Illinois Medicaid,,48.82,,,12336.12,1356.97,6414.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT LNG ARM SH PTA,29105,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,242.41,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT LNG ARM SH PTA,29105,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,242.41,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT LNG ARM SH PTA,29105,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,614.11,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT LNG ARM SH PTA,29105,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,204.87,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT LNG ARM SH PTA,29105,CPT,,,,,both,, ,1281.32,768.79,Medicaid,Illinois Medicaid,,204.87,,,1281.32,140.95,666.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT LNG ARM SH PTA,29105,CPT,,,,,both,, ,1281.32,768.79,Medicaid,Illinois Medicaid,,891.77,,,1281.32,140.95,666.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT LNGARM SH COTA,29105,CPT,,,,,both,, ,1388.96,833.37,Medicaid,Illinois Medicaid,,891.77,,,1388.96,152.79,722.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT LNGARM SH COTA,29105,CPT,,,,,both,, ,1388.96,833.37,Medicaid,Illinois Medicaid,,832.45,,,1388.96,152.79,722.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT LONG ARM S-H,29105,CPT,,,,,both,, ,1196.17,717.70,Medicaid,Illinois Medicaid,,360.31,,,1196.17,131.58,622.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT LONG ARM S-H,29105,CPT,,,,,both,, ,1296.73,778.03,Medicaid,Illinois Medicaid,,204.87,,,1296.73,142.64,674.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT SHRT ARM STATC,29125,CPT,,,,,both,, ,909.80,545.88,Medicaid,Illinois Medicaid,,204.87,,,909.80,100.08,473.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT SHRT ARM STATC,29125,CPT,,,,,both,, ,986.30,591.78,Medicaid,Illinois Medicaid,,584.78,,,986.30,108.49,512.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLT SHRT ARM ST PTA,29125,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,584.78,,,270.12,29.71,140.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLT SHRT ARM ST PTA,29125,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,545.88,,,270.12,29.71,140.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLT SHRT ARM ST PTA,29125,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,360.31,,,270.12,29.71,140.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLT SHRT ARM ST PTA,29125,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,226.30,,,270.12,29.71,140.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLT SHRT ARM ST PTA,29125,CPT,,,,,both,, ,974.64,584.78,Medicaid,Illinois Medicaid,,85.12,,,974.64,107.21,506.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLT SHRT ARM ST PTA,29125,CPT,,,,,both,, ,974.64,584.78,Medicaid,Illinois Medicaid,,85.12,,,974.64,107.21,506.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLT SHRTARM ST COTA,29125,CPT,,,,,both,, ,1056.52,633.91,Medicaid,Illinois Medicaid,,242.41,,,1056.52,116.22,549.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLT SHRTARM ST COTA,29125,CPT,,,,,both,, ,1056.52,633.91,Medicaid,Illinois Medicaid,,242.41,,,1056.52,116.22,549.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLN SHRT ARM DY PTA,29126,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,226.30,,,270.12,29.71,140.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLN SHRT ARM DY PTA,29126,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,162.07,,,270.12,29.71,140.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLN SHRT ARM DY PTA,29126,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,162.07,,,270.12,29.71,140.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLN SHRT ARM DY PTA,29126,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,242.41,,,270.12,29.71,140.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLN SHRT ARM DY PTA,29126,CPT,,,,,both,, ,1486.29,891.77,Medicaid,Illinois Medicaid,,242.41,,,1486.29,163.49,772.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLN SHRT ARM DY PTA,29126,CPT,,,,,both,, ,1486.29,891.77,Medicaid,Illinois Medicaid,,226.30,,,1486.29,163.49,772.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT SHRT ARM DYNAM,29126,CPT,,,,,both,, ,1387.43,832.45,Medicaid,Illinois Medicaid,,204.87,,,1387.43,152.62,721.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT SHRT ARM DYNAM,29126,CPT,,,,,both,, ,1504.12,902.47,Medicaid,Illinois Medicaid,,204.87,,,1504.12,165.45,782.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLT SHRTARM DY COTA,29126,CPT,,,,,both,, ,1611.18,966.70,Medicaid,Illinois Medicaid,,242.41,,,1611.18,177.23,837.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLT SHRTARM DY COTA,29126,CPT,,,,,both,, ,1611.18,966.70,Medicaid,Illinois Medicaid,,242.41,,,1611.18,177.23,837.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FINGER STATIC,29130,CPT,,,,,both,, ,299.22,179.53,Medicaid,Illinois Medicaid,,226.30,,,299.22,32.91,155.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FINGER STATIC,29130,CPT,,,,,both,, ,324.42,194.65,Medicaid,Illinois Medicaid,,204.87,,,324.42,35.69,168.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FNGR STAT COTA,29130,CPT,,,,,both,, ,347.63,208.57,Medicaid,Illinois Medicaid,,204.87,,,347.63,38.24,180.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FNGR STAT COTA,29130,CPT,,,,,both,, ,347.63,208.57,Medicaid,Illinois Medicaid,,242.41,,,347.63,38.24,180.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FNGR STATC PTA,29130,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,242.41,,,141.88,15.61,73.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FNGR STATC PTA,29130,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,360.31,,,141.88,15.61,73.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FNGR STATC PTA,29130,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,11.52,,,141.88,15.61,73.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FNGR STATC PTA,29130,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,360.31,,,141.88,15.61,73.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FNGR STATC PTA,29130,CPT,,,,,both,, ,320.59,192.35,Medicaid,Illinois Medicaid,,162.07,,,320.59,35.26,166.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FNGR STATC PTA,29130,CPT,,,,,both,, ,320.59,192.35,Medicaid,Illinois Medicaid,,162.07,,,320.59,35.26,166.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FINGER DYNAM,29131,CPT,,,,,both,, ,453.68,272.20,Medicaid,Illinois Medicaid,,168.25,,,453.68,49.90,235.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FINGER DYNAM,29131,CPT,,,,,both,, ,491.82,295.09,Medicaid,Illinois Medicaid,,5948.40,,,491.82,54.10,255.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FINGR DYNA PTA,29131,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,5948.40,,,141.88,15.61,73.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FINGR DYNA PTA,29131,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,5948.40,,,141.88,15.61,73.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FINGR DYNA PTA,29131,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,3110.77,,,141.88,15.61,73.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FINGR DYNA PTA,29131,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,2065.81,,,141.88,15.61,73.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FINGR DYNA PTA,29131,CPT,,,,,both,, ,485.90,291.54,Medicaid,Illinois Medicaid,,16429.99,,,485.90,53.45,252.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FINGR DYNA PTA,29131,CPT,,,,,both,, ,485.90,291.54,Medicaid,Illinois Medicaid,,3026.80,,,485.90,53.45,252.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FNGR DYNA COTA,29131,CPT,,,,,both,, ,526.85,316.11,Medicaid,Illinois Medicaid,,6799.69,,,526.85,57.95,273.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLNT FNGR DYNA COTA,29131,CPT,,,,,both,, ,526.85,316.11,Medicaid,Illinois Medicaid,,101.25,,,526.85,57.95,273.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING THORAX,29200,CPT,,,,,both,, ,377.17,226.30,Medicaid,Illinois Medicaid,,104.28,,,377.17,41.49,196.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING THORAX PTA,29200,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,524.07,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING THORAX PTA,29200,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,503.52,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING THORAX PTA,29200,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,607.93,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING THORAX PTA,29200,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,239.80,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING THORAX PTA,29200,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,1103.55,,,404.02,44.44,210.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING THORAX PTA,29200,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,7555.65,,,404.02,44.44,210.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING SHOULD PTA,29240,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,19128.61,,,270.12,29.71,140.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING SHOULD PTA,29240,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,27598.88,,,270.12,29.71,140.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING SHOULD PTA,29240,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,19048.12,,,404.02,44.44,210.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING SHOULD PTA,29240,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,31137.40,,,404.02,44.44,210.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING SHOULDER,29240,CPT,,,,,both,, ,377.17,226.30,Medicaid,Illinois Medicaid,,19241.10,,,377.17,41.49,196.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING SHOULDER,29240,CPT,,,,,both,, ,408.86,245.31,Medicaid,Illinois Medicaid,,14844.06,,,408.86,44.97,212.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPNG SHOULD COTA,29240,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,7421.60,,,81.37,8.95,42.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPNG SHOULD COTA,29240,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,5646.95,,,81.37,8.95,42.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPNG SHOULD COTA,29240,CPT,,,,,both,, ,438.01,262.80,Medicaid,Illinois Medicaid,,8470.43,,,438.01,48.18,227.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPNG SHOULD COTA,29240,CPT,,,,,both,, ,438.01,262.80,Medicaid,Illinois Medicaid,,4836.30,,,438.01,48.18,227.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING ELBO-WRIST,29260,CPT,,,,,both,, ,377.17,226.30,Medicaid,Illinois Medicaid,,7254.46,,,377.17,41.49,196.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING ELBO-WRIST,29260,CPT,,,,,both,, ,408.86,245.31,Medicaid,Illinois Medicaid,,1187.41,,,408.86,44.97,212.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPNG ELBO-WRST PTA,29260,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,5723.45,,,81.37,8.95,42.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPNG ELBO-WRST PTA,29260,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,9829.79,,,81.37,8.95,42.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPNG ELBO-WRST PTA,29260,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,42.00,,,81.37,8.95,42.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPNG ELBO-WRST PTA,29260,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,4.91,,,81.37,8.95,42.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPNG ELBO-WRST PTA,29260,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,90.37,,,404.02,44.44,210.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPNG ELBO-WRST PTA,29260,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,54.22,,,404.02,44.44,210.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPNG ELB-WRST COTA,29260,CPT,,,,,both,, ,438.01,262.80,Medicaid,Illinois Medicaid,,13.63,,,438.01,48.18,227.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPNG ELB-WRST COTA,29260,CPT,,,,,both,, ,438.01,262.80,Medicaid,Illinois Medicaid,,27.78,,,438.01,48.18,227.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING HAND-FING,29280,CPT,,,,,both,, ,377.17,226.30,Medicaid,Illinois Medicaid,,29.97,,,377.17,41.49,196.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING HAND-FING,29280,CPT,,,,,both,, ,408.86,245.31,Medicaid,Illinois Medicaid,,1356.33,,,408.86,44.97,212.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPNG HND-FING COTA,29280,CPT,,,,,both,, ,438.01,262.80,Medicaid,Illinois Medicaid,,1356.33,,,438.01,48.18,227.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPNG HND-FING COTA,29280,CPT,,,,,both,, ,438.01,262.80,Medicaid,Illinois Medicaid,,1356.33,,,438.01,48.18,227.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPPNG HND-FING PTA,29280,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,1356.33,,,81.37,8.95,42.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPPNG HND-FING PTA,29280,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,1356.33,,,81.37,8.95,42.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPPNG HND-FING PTA,29280,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,1970.18,,,81.37,8.95,42.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPPNG HND-FING PTA,29280,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,2147.50,,,81.37,8.95,42.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPPNG HND-FING PTA,29280,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,2147.50,,,404.02,44.44,210.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPPNG HND-FING PTA,29280,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,3336.27,,,404.02,44.44,210.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
APPLY RIGID LEG CAST,29445,CPT,,,,,both,, ,1023.52,614.11,Medicaid,Illinois Medicaid,,3336.27,,,1023.52,112.59,532.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AP LNG LEG SPLNT PTA,29505,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,2410.51,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AP LNG LEG SPLNT PTA,29505,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,1422.33,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AP LNG LEG SPLNT PTA,29505,CPT,,,,,both,, ,1486.29,891.77,Medicaid,Illinois Medicaid,,267.09,,,1486.29,163.49,772.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AP LNG LEG SPLNT PTA,29505,CPT,,,,,both,, ,1486.29,891.77,Medicaid,Illinois Medicaid,,233.07,,,1486.29,163.49,772.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
APP LNG LEG SPLINT,29505,CPT,,,,,both,, ,1387.43,832.45,Medicaid,Illinois Medicaid,,280.26,,,1387.43,152.62,721.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
APPLY LNG LEG SPLNT,29505,CPT,,,,,both,, ,600.52,360.31,Medicaid,Illinois Medicaid,,196.35,,,600.52,66.06,312.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AP SHT LEG SPLNT PTA,29515,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,17664.16,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AP SHT LEG SPLNT PTA,29515,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,12188.31,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AP SHT LEG SPLNT PTA,29515,CPT,,,,,both,, ,974.64,584.78,Medicaid,Illinois Medicaid,,12188.31,,,974.64,107.21,506.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AP SHT LEG SPLNT PTA,29515,CPT,,,,,both,, ,974.64,584.78,Medicaid,Illinois Medicaid,,516.18,,,974.64,107.21,506.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
APP SHORT LEG SPLINT,29515,CPT,,,,,both,, ,909.80,545.88,Medicaid,Illinois Medicaid,,949.63,,,909.80,100.08,473.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
APPLY SHRT LEG SPLNT,29515,CPT,,,,,both,, ,600.52,360.31,Medicaid,Illinois Medicaid,,661.72,,,600.52,66.06,312.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING HIP,29520,CPT,,,,,both,, ,377.17,226.30,Medicaid,Illinois Medicaid,,6177.37,,,377.17,41.49,196.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING HIP PTA,29520,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,2260.66,,,141.88,15.61,73.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING HIP PTA,29520,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,2260.66,,,141.88,15.61,73.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING HIP PTA,29520,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,32624.83,,,404.02,44.44,210.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING HIP PTA,29520,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,194.36,,,404.02,44.44,210.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING KNEE,29530,CPT,,,,,both,, ,377.17,226.30,Medicaid,Illinois Medicaid,,194.36,,,377.17,41.49,196.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING KNEE PTA,29530,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,255.23,,,270.12,29.71,140.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING KNEE PTA,29530,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,201.91,,,270.12,29.71,140.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING KNEE PTA,29530,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,1253.46,,,404.02,44.44,210.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING KNEE PTA,29530,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,701.74,,,404.02,44.44,210.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING ANKLE-FOOT,29540,CPT,,,,,both,, ,377.17,226.30,Medicaid,Illinois Medicaid,,3028.66,,,377.17,41.49,196.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPPNG ANKLE-FT PTA,29540,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,378.21,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPPNG ANKLE-FT PTA,29540,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,850.52,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPPNG ANKLE-FT PTA,29540,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,820.86,,,404.02,44.44,210.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPPNG ANKLE-FT PTA,29540,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,377.44,,,404.02,44.44,210.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRAPPING UNA BOOT,29580,CPT,,,,,both,, ,377.17,226.30,Medicaid,Illinois Medicaid,,1247.20,,,377.17,41.49,196.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPPNG UNA BOOT PTA,29580,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,1160.64,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPPNG UNA BOOT PTA,29580,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,1178.66,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPPNG UNA BOOT PTA,29580,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,2407.85,,,404.02,44.44,210.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPPNG UNA BOOT PTA,29580,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,2450.37,,,404.02,44.44,210.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UNNA BOOT STRAPPING,29580,CPT,,,,,both,, ,600.52,360.31,Medicaid,Illinois Medicaid,,1470.22,,,600.52,66.06,312.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UNNA WRAP,29580,CPT,,,,,both,, ,19.20,11.52,Medicaid,Illinois Medicaid,,1624.26,,,19.20,2.11,9.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AP MULTLY COMP LR LEG,29581,CPT,,,,,both,, ,600.52,360.31,Medicaid,Illinois Medicaid,,850.52,,,600.52,66.06,312.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPPNG LOW BCK COTA,29799,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,1273.30,,,270.12,29.71,140.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRPPNG LOW BCK COTA,29799,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,83.52,,,270.12,29.71,140.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SUCTION PROC-NASOTRA,31720,CPT,,,,,both,, ,280.42,168.25,Medicaid,Illinois Medicaid,,89.92,,,280.42,30.85,145.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914.00,5948.40,Medicaid,Illinois Medicaid,,89.92,,,9914.00,1090.54,5155.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914.00,5948.40,Medicaid,Illinois Medicaid,,89.92,,,9914.00,1090.54,5155.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914.00,5948.40,Medicaid,Illinois Medicaid,,743.67,,,9914.00,1090.54,5155.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,5184.63,3110.77,Medicaid,Illinois Medicaid,,179.85,,,5184.63,570.31,2696.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-PERICARDIO W/IMG,33016,CPT,,,,,both,, ,3443.03,2065.81,Medicaid,Illinois Medicaid,,179.85,,,3443.03,378.73,1790.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
P-IMPLNT LOOP REC,33285,CPT,,,,,both,, ,27383.32,16429.99,Medicaid,Illinois Medicaid,,1487.68,,,27383.32,3012.17,14239.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
P-REMOV LOOP REC,33286,CPT,,,,,both,, ,5044.68,3026.80,Medicaid,Illinois Medicaid,,83.52,,,5044.68,554.91,2623.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-IMP PRESS SEN ANG,33289,CPT,,,,,both,, ,11332.83,6799.69,Medicaid,Illinois Medicaid,,89.92,,,11332.83,1246.61,5893.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-INTRO NDL CATH,36000,CPT,,,,,both,, ,168.75,101.25,Medicaid,Illinois Medicaid,,89.92,,,168.75,18.56,87.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-INTRO NDL CATH VEI,36000,CPT,,,,,both,, ,173.81,104.28,Medicaid,Illinois Medicaid,,89.92,,,173.81,19.12,90.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-INJ VENOGRAPHY,36005,CPT,,,,,both,, ,873.46,524.07,Medicaid,Illinois Medicaid,,883.84,,,873.46,96.08,454.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-INTROCATH SEGPULM,36015,CPT,,,,,both,, ,839.21,503.52,Medicaid,Illinois Medicaid,,530.30,,,839.21,92.31,436.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-CATH CAROTD VERT,36100,CPT,,,,,both,, ,1013.23,607.93,Medicaid,Illinois Medicaid,,132.36,,,1013.23,111.46,526.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-CATH EXTREM ART,36140,CPT,,,,,both,, ,399.68,239.80,Medicaid,Illinois Medicaid,,142.47,,,399.68,43.96,207.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-THORACIC 1ST ORDER,36215,CPT,,,,,both,, ,1839.26,1103.55,Medicaid,Illinois Medicaid,,142.47,,,1839.26,202.32,956.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ANG EXT CRT NS,36221,CPT,,,,,both,, ,12592.76,7555.65,Medicaid,Illinois Medicaid,,142.47,,,12592.76,1385.20,6548.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ANG CRT EXT CC BI,36222,CPT,,,,,both,, ,31881.02,19128.61,Medicaid,Illinois Medicaid,,940.82,,,31881.02,3506.91,16578.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ANG CARTD IPS BI,36223,CPT,,,,,both,, ,45998.14,27598.88,Medicaid,Illinois Medicaid,,564.49,,,45998.14,5059.80,23919.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ANG CARTD IPS UNI,36223,CPT,,,,,both,, ,31746.87,19048.12,Medicaid,Illinois Medicaid,,89.92,,,31746.87,3492.16,16508.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ANG INT CAR IP BI,36224,CPT,,,,,both,, ,51895.68,31137.40,Medicaid,Illinois Medicaid,,89.92,,,51895.68,5708.52,26985.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ANG INT CAR IP UN,36224,CPT,,,,,both,, ,32068.51,19241.10,Medicaid,Illinois Medicaid,,456.37,,,32068.51,3527.54,16675.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ANG SUBCL IPS BI,36225,CPT,,,,,both,, ,24740.10,14844.06,Medicaid,Illinois Medicaid,,273.82,,,24740.10,2721.41,12864.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ANG SUBCL IPS UNI,36225,CPT,,,,,both,, ,12369.34,7421.60,Medicaid,Illinois Medicaid,,83.52,,,12369.34,1360.63,6432.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTH PLC EXT CD W-ANG,36227,CPT,,,,,both,, ,9411.59,5646.95,Medicaid,Illinois Medicaid,,89.92,,,9411.59,1035.27,4894.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTH PLC EXT CD W-ANG,36227,CPT,,,,,both,, ,14117.39,8470.43,Medicaid,Illinois Medicaid,,782.23,,,14117.39,1552.91,7341.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-ANG EXT CD IPS BI,36227,CPT,,,,,both,, ,8060.51,4836.30,Medicaid,Illinois Medicaid,,469.33,,,8060.51,886.66,4191.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-ANG EXT CD IPS BI,36227,CPT,,,,,both,, ,12090.77,7254.46,Medicaid,Illinois Medicaid,,132.36,,,12090.77,1329.98,6287.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-ABDOMEN 1ST ORDER,36245,CPT,,,,,both,, ,1979.03,1187.41,Medicaid,Illinois Medicaid,,142.47,,,1979.03,217.69,1029.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-ABDOMEN 2ND ORDER,36246,CPT,,,,,both,, ,9539.09,5723.45,Medicaid,Illinois Medicaid,,142.47,,,9539.09,1049.30,4960.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-ABDOMEN 3RD ORDER,36247,CPT,,,,,both,, ,16382.99,9829.79,Medicaid,Illinois Medicaid,,142.47,,,16382.99,1802.13,8519.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DNA SPECIMEN COLLECTION VENI,36415,CPT,,,,,both,, ,70.00,42.00,Medicaid,Illinois Medicaid,,1128.31,,,70.00,7.70,36.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,, ,8.19,4.91,Medicaid,Illinois Medicaid,,676.98,,,8.19,0.90,4.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,,,90.37,90.37,Medicaid,Illinois Medicaid,,83.52,,,90.37,9.94,46.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,, ,90.37,54.22,Medicaid,Illinois Medicaid,,89.92,,,90.37,9.94,46.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,22.73,13.63,Medicaid,Illinois Medicaid,,89.92,,,22.73,2.50,11.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,46.31,27.78,Medicaid,Illinois Medicaid,,89.92,,,46.31,5.09,24.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,49.96,29.97,Medicaid,Illinois Medicaid,,782.23,,,49.96,5.50,25.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLOOD TRANSF 0 2 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicaid,Illinois Medicaid,,469.33,,,2260.55,248.66,1175.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLOOD TRANSF 2 4 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicaid,Illinois Medicaid,,83.52,,,2260.55,248.66,1175.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLOOD TRANSF 4 6 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicaid,Illinois Medicaid,,89.92,,,2260.55,248.66,1175.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLOOD TRANSF 6 8 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicaid,Illinois Medicaid,,89.92,,,2260.55,248.66,1175.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLOOD TRANSF 8 10 HR,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicaid,Illinois Medicaid,,89.92,,,2260.55,248.66,1175.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLOOD TRANSFUSION,36430,CPT,,,,,both,, ,3283.64,1970.18,Medicaid,Illinois Medicaid,,918.37,,,3283.64,361.20,1707.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLOOD TRANSFUSION,36430,CPT,,,,,both,, ,3579.17,2147.50,Medicaid,Illinois Medicaid,,551.02,,,3579.17,393.71,1861.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLOOD PUSH TRAN U2YR,36440,CPT,,,,,both,, ,3579.17,2147.50,Medicaid,Illinois Medicaid,,89.92,,,3579.17,393.71,1861.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER APHERESIS WBC,36511,CPT,,,,,both,, ,5560.46,3336.27,Medicaid,Illinois Medicaid,,89.92,,,5560.46,611.65,2891.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER APHERESI PLASMA,36514,CPT,,,,,both,, ,5560.46,3336.27,Medicaid,Illinois Medicaid,,83.52,,,5560.46,611.65,2891.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-INS NT CVC GT 5YR,36556,CPT,,,,,both,, ,4017.52,2410.51,Medicaid,Illinois Medicaid,,89.92,,,4017.52,441.93,2089.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-RMV TUN CVC WO SQ,36589,CPT,,,,,both,, ,2370.55,1422.33,Medicaid,Illinois Medicaid,,89.92,,,2370.55,260.76,1232.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLD COLLECT VAD,36591,CPT,,,,,both,, ,445.15,267.09,Medicaid,Illinois Medicaid,,89.92,,,445.15,48.97,231.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLD DRAW CENTRAL LN,36592,CPT,,,,,both,, ,388.45,233.07,Medicaid,Illinois Medicaid,,936.33,,,388.45,42.73,201.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-INJ W FLUR CV DEV,36598,CPT,,,,,both,, ,467.11,280.26,Medicaid,Illinois Medicaid,,561.79,,,467.11,51.38,242.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ARTERIAL PUNCTURE,36600,CPT,,,,,both,, ,327.26,196.35,Medicaid,Illinois Medicaid,,83.52,,,327.26,36.00,170.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-INS ENDO VENA CAVA,37191,CPT,,,,,both,, ,29440.27,17664.16,Medicaid,Illinois Medicaid,,89.92,,,29440.27,3238.43,15308.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-REDO ENDO VENA CAV,37192,CPT,,,,,both,, ,20313.85,12188.31,Medicaid,Illinois Medicaid,,1151.89,,,20313.85,2234.52,10563.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-REM ENDO VENA CAVA,37193,CPT,,,,,both,, ,20313.85,12188.31,Medicaid,Illinois Medicaid,,691.13,,,20313.85,2234.52,10563.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-THROMBOLYSIS CEREB,37195,CPT,,,,,both,, ,860.31,516.18,Medicaid,Illinois Medicaid,,132.36,,,860.31,94.63,447.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-ID SENTINEL NODE,38792,CPT,,,,,both,, ,1582.72,949.63,Medicaid,Illinois Medicaid,,142.47,,,1582.72,174.10,823.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-BX NDL LIVER,47000,CPT,,,,,both,, ,1102.87,661.72,Medicaid,Illinois Medicaid,,142.47,,,1102.87,121.32,573.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-PERC CHOLECYSTOST,47490,CPT,,,,,both,, ,10295.62,6177.37,Medicaid,Illinois Medicaid,,142.47,,,10295.62,1132.52,5353.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ABD PARACEN W IMG,49083,CPT,,,,,both,, ,3767.78,2260.66,Medicaid,Illinois Medicaid,,1381.48,,,3767.78,414.46,1959.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-PERITONEAL LAVAGE,49084,CPT,,,,,both,, ,3767.78,2260.66,Medicaid,Illinois Medicaid,,828.88,,,3767.78,414.46,1959.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LITHOTRIPSY,50590,CPT,,,,,both,, ,54374.73,32624.83,Medicaid,Illinois Medicaid,,83.52,,,54374.73,5981.22,28274.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-URETEROGRM INJ,50684,CPT,,,,,both,, ,323.94,194.36,Medicaid,Illinois Medicaid,,89.92,,,323.94,35.63,168.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-INJ ILEAL CONDUIT,50690,CPT,,,,,both,, ,323.94,194.36,Medicaid,Illinois Medicaid,,538.05,,,323.94,35.63,168.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-CORPCAVERNOSGR INJ,54230,CPT,,,,,both,, ,425.39,255.23,Medicaid,Illinois Medicaid,,322.83,,,425.39,46.79,221.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-INJ CATH HYSTERSO,58340,CPT,,,,,both,, ,336.52,201.91,Medicaid,Illinois Medicaid,,83.52,,,336.52,37.02,174.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FETAL CONTRACTION ST,59020,CPT,,,,,both,, ,2089.10,1253.46,Medicaid,Illinois Medicaid,,89.92,,,2089.10,229.80,1086.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FETAL NON STRESS TES,59025,CPT,,,,,both,, ,1169.57,701.74,Medicaid,Illinois Medicaid,,89.92,,,1169.57,128.65,608.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EXTERNAL CEPHALIC VE,59412,CPT,,,,,both,, ,5047.77,3028.66,Medicaid,Illinois Medicaid,,89.92,,,5047.77,555.25,2624.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-THYROID CORE BX,60100,CPT,,,,,both,, ,630.36,378.21,Medicaid,Illinois Medicaid,,342.70,,,630.36,69.34,327.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-SPINAL TAP DIAGNST,62270,CPT,,,,,both,, ,1417.54,850.52,Medicaid,Illinois Medicaid,,205.62,,,1417.54,155.93,737.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-INJ EPI BLD PATCH,62273,CPT,,,,,both,, ,1368.10,820.86,Medicaid,Illinois Medicaid,,1411.90,,,1368.10,150.49,711.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-MYELOGRAM INJ,62284,CPT,,,,,both,, ,629.07,377.44,Medicaid,Illinois Medicaid,,705.95,,,629.07,69.20,327.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-MYELO CERVICAL,62302,CPT,,,,,both,, ,2078.67,1247.20,Medicaid,Illinois Medicaid,,415.28,,,2078.67,228.65,1080.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-MYELO THORACIC,62303,CPT,,,,,both,, ,1934.41,1160.64,Medicaid,Illinois Medicaid,,83.52,,,1934.41,212.79,1005.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-MYELO LUMBAR,62304,CPT,,,,,both,, ,1964.44,1178.66,Medicaid,Illinois Medicaid,,89.92,,,1964.44,216.09,1021.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-MYELO COMPLETE,62305,CPT,,,,,both,, ,4013.09,2407.85,Medicaid,Illinois Medicaid,,89.92,,,4013.09,441.44,2086.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Injection of substance into spinal canal of lower back or sacrum using imaging guidance,62323,CPT,,,,,both,,,2450.37,2450.37,Medicaid,Illinois Medicaid,,89.92,,,2450.37,269.54,1274.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-DI L-S INJ W IM,62323,CPT,,,,,both,, ,2450.37,1470.22,Medicaid,Illinois Medicaid,,757.53,,,2450.37,269.54,1274.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-DI L-S INJ-IN WIM,62327,CPT,,,,,both,, ,2707.10,1624.26,Medicaid,Illinois Medicaid,,454.51,,,2707.10,297.78,1407.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPINAL TAP DIAG W-IM,62328,CPT,,,,,both,, ,1417.54,850.52,Medicaid,Illinois Medicaid,,484.83,,,1417.54,155.93,737.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-POSTERIOR FOSSA,70010,CPT,,,,,both,, ,2122.18,1273.30,Medicaid,Illinois Medicaid,,1080.31,,,2122.18,233.44,1103.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,1576.55,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,184.23,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,198.37,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,945.93,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,1239.46,743.67,Medicaid,Illinois Medicaid,,1765.72,,,1239.46,136.34,644.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,1059.43,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,408.54,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,2479.48,1487.68,Medicaid,Illinois Medicaid,,439.69,,,2479.48,272.74,1289.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,3726.80,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2236.08,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,184.23,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,198.37,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,,,883.84,883.84,Medicaid,Illinois Medicaid,,1708.30,,,883.84,97.22,459.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,883.84,530.30,Medicaid,Illinois Medicaid,,333.60,,,883.84,97.22,459.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,985.84,,,220.61,24.27,114.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,408.54,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,439.69,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,2400.78,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,,,940.82,940.82,Medicaid,Illinois Medicaid,,184.23,,,940.82,103.49,489.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,940.82,564.49,Medicaid,Illinois Medicaid,,198.37,,,940.82,103.49,489.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2847.17,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1708.30,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,,,456.37,456.37,Medicaid,Illinois Medicaid,,362.91,,,456.37,50.20,237.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,456.37,273.82,Medicaid,Illinois Medicaid,,390.52,,,456.37,50.20,237.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,3178.64,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1907.18,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,,,782.23,782.23,Medicaid,Illinois Medicaid,,408.54,,,782.23,86.05,406.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,782.23,469.33,Medicaid,Illinois Medicaid,,439.69,,,782.23,86.05,406.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,3726.80,,,220.61,24.27,114.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,2236.08,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,184.23,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,198.37,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,,,1128.31,1128.31,Medicaid,Illinois Medicaid,,2737.98,,,1128.31,124.11,586.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,1128.31,676.98,Medicaid,Illinois Medicaid,,1642.78,,,1128.31,124.11,586.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,362.91,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,390.52,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2743.59,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1646.15,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-NASAL BONES CR,70160,CPT,,,,,both,,,782.23,782.23,Medicaid,Illinois Medicaid,,408.54,,,782.23,86.05,406.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,782.23,469.33,Medicaid,Illinois Medicaid,,439.69,,,782.23,86.05,406.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,4317.62,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2590.57,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,535.86,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2355.42,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-ORBITS 4V CR,70200,CPT,,,,,both,,,918.37,918.37,Medicaid,Illinois Medicaid,,1413.25,,,918.37,101.02,477.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,918.37,551.02,Medicaid,Illinois Medicaid,,535.86,,,918.37,101.02,477.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SINUSES LTD CR,70210,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2355.42,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SINUSES LTD CR,70210,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1413.25,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,429.59,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,462.27,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2425.70,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,621.41,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,,,936.33,936.33,Medicaid,Illinois Medicaid,,668.73,,,936.33,103.00,486.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,936.33,561.79,Medicaid,Illinois Medicaid,,2576.08,,,936.33,103.00,486.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,718.24,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,772.97,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SKULL LIMITED CR,70250,CPT,,,,,both,,,1151.89,1151.89,Medicaid,Illinois Medicaid,,3118.68,,,1151.89,126.71,598.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,1151.89,691.13,Medicaid,Illinois Medicaid,,429.59,,,1151.89,126.71,598.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,462.27,,,220.61,24.27,114.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,978.93,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,621.41,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,668.73,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,,,1381.48,1381.48,Medicaid,Illinois Medicaid,,1163.00,,,1381.48,151.96,718.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,1381.48,828.88,Medicaid,Illinois Medicaid,,718.24,,,1381.48,151.96,718.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,772.97,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1601.86,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,,,538.05,538.05,Medicaid,Illinois Medicaid,,429.59,,,538.05,59.19,279.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,538.05,322.83,Medicaid,Illinois Medicaid,,462.27,,,538.05,59.19,279.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,800.93,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,621.41,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,668.73,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1163.00,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,,,342.70,342.70,Medicaid,Illinois Medicaid,,718.24,,,342.70,37.70,178.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,342.70,205.62,Medicaid,Illinois Medicaid,,772.97,,,342.70,37.70,178.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ARTHGRM TMJ BI CR,70332,CPT,,,,,both,, ,2353.18,1411.90,Medicaid,Illinois Medicaid,,1957.87,,,2353.18,258.85,1223.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ARTHROGRAM TMJ CR,70332,CPT,,,,,both,, ,1176.59,705.95,Medicaid,Illinois Medicaid,,429.59,,,1176.59,129.42,611.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HE-ORTHOPANTOGRAM CR,70355,CPT,,,,,both,, ,692.14,415.28,Medicaid,Illinois Medicaid,,462.27,,,692.14,76.14,359.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,4941.28,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2964.76,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,621.41,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,668.73,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,,,757.53,757.53,Medicaid,Illinois Medicaid,,2352.06,,,757.53,83.33,393.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,757.53,454.51,Medicaid,Illinois Medicaid,,1411.23,,,757.53,83.33,393.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-PHX SP EV W CINE,70371,CPT,,,,,both,, ,808.06,484.83,Medicaid,Illinois Medicaid,,718.24,,,808.06,88.89,420.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-SIALOGRAM,70390,CPT,,,,,both,, ,1800.52,1080.31,Medicaid,Illinois Medicaid,,772.97,,,1800.52,198.06,936.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"CT scan, head or brain, without contrast",70450,CPT,,,,,both,,,1576.55,1576.55,Medicaid,Illinois Medicaid,,3811.67,,,1576.55,173.42,819.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-HEAD WO,70450,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,6352.79,,,307.05,33.78,159.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-HEAD WO,70450,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,83.52,,,330.63,36.37,171.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-HEAD WO,70450,CPT,,,,,both,, ,1576.55,945.93,Medicaid,Illinois Medicaid,,89.92,,,1576.55,173.42,819.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-HEAD W,70460,CPT,,,,,both,,,1765.72,1765.72,Medicaid,Illinois Medicaid,,89.92,,,1765.72,194.23,918.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-HEAD W,70460,CPT,,,,,both,, ,1765.72,1059.43,Medicaid,Illinois Medicaid,,89.92,,,1765.72,194.23,918.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-HEAD WWO,70470,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,495.95,,,680.91,74.90,354.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-HEAD WWO,70470,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,297.57,,,732.83,80.61,381.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-HEAD WWO,70470,CPT,,,,,both,,,3726.80,3726.80,Medicaid,Illinois Medicaid,,83.52,,,3726.80,409.95,1937.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-HEAD WWO,70470,CPT,,,,,both,, ,3726.80,2236.08,Medicaid,Illinois Medicaid,,89.92,,,3726.80,409.95,1937.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,89.92,,,307.05,33.78,159.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,89.92,,,330.63,36.37,171.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,2847.17,1708.30,Medicaid,Illinois Medicaid,,750.52,,,2847.17,313.19,1480.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ORBIT EAR W,70481,CPT,,,,,both,, ,556.01,333.60,Medicaid,Illinois Medicaid,,450.31,,,556.01,61.16,289.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ORBIT EAR W,70481,CPT,,,,,both,, ,1643.07,985.84,Medicaid,Illinois Medicaid,,80.32,,,1643.07,180.74,854.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,86.38,,,680.91,74.90,354.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,86.38,,,732.83,80.61,381.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,4001.30,2400.78,Medicaid,Illinois Medicaid,,86.38,,,4001.30,440.14,2080.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,1091.82,,,307.05,33.78,159.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,655.09,,,330.63,36.37,171.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,,,2847.17,2847.17,Medicaid,Illinois Medicaid,,80.32,,,2847.17,313.19,1480.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,2847.17,1708.30,Medicaid,Illinois Medicaid,,86.38,,,2847.17,313.19,1480.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,1652.05,,,604.85,66.53,314.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,991.23,,,650.88,71.60,338.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,,,3178.64,3178.64,Medicaid,Illinois Medicaid,,83.52,,,3178.64,349.65,1652.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,3178.64,1907.18,Medicaid,Illinois Medicaid,,89.92,,,3178.64,349.65,1652.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,89.92,,,680.91,74.90,354.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,89.92,,,732.83,80.61,381.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,,,3726.80,3726.80,Medicaid,Illinois Medicaid,,876.83,,,3726.80,409.95,1937.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,3726.80,2236.08,Medicaid,Illinois Medicaid,,526.09,,,3726.80,409.95,1937.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,132.36,,,307.05,33.78,159.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,142.47,,,330.63,36.37,171.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,,,2737.98,2737.98,Medicaid,Illinois Medicaid,,156.44,,,2737.98,301.18,1423.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,2737.98,1642.78,Medicaid,Illinois Medicaid,,156.44,,,2737.98,301.18,1423.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,1152.17,,,604.85,66.53,314.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,691.30,,,650.88,71.60,338.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-NECK SOFT TIS W,70491,CPT,,,,,both,,,2743.59,2743.59,Medicaid,Illinois Medicaid,,132.36,,,2743.59,301.79,1426.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,2743.59,1646.15,Medicaid,Illinois Medicaid,,142.47,,,2743.59,301.79,1426.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,142.47,,,680.91,74.90,354.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,142.47,,,732.83,80.61,381.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,,,4317.62,4317.62,Medicaid,Illinois Medicaid,,1381.48,,,4317.62,474.94,2245.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,4317.62,2590.57,Medicaid,Illinois Medicaid,,828.88,,,4317.62,474.94,2245.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-HEAD,70496,CPT,,,,,both,, ,893.10,535.86,Medicaid,Illinois Medicaid,,132.36,,,893.10,98.24,464.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-HEAD,70496,CPT,,,,,both,,,2355.42,2355.42,Medicaid,Illinois Medicaid,,142.47,,,2355.42,259.10,1224.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-HEAD,70496,CPT,,,,,both,, ,2355.42,1413.25,Medicaid,Illinois Medicaid,,156.44,,,2355.42,259.10,1224.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-NECK,70498,CPT,,,,,both,, ,893.10,535.86,Medicaid,Illinois Medicaid,,156.44,,,893.10,98.24,464.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-NECK,70498,CPT,,,,,both,,,2355.42,2355.42,Medicaid,Illinois Medicaid,,1877.99,,,2355.42,259.10,1224.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-NECK,70498,CPT,,,,,both,, ,2355.42,1413.25,Medicaid,Illinois Medicaid,,1126.79,,,2355.42,259.10,1224.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,83.52,,,715.99,78.76,372.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,89.92,,,770.45,84.75,400.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,4042.84,2425.70,Medicaid,Illinois Medicaid,,89.92,,,4042.84,444.71,2102.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,89.92,,,1035.69,113.93,538.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,947.27,,,1114.55,122.60,579.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,4293.48,2576.08,Medicaid,Illinois Medicaid,,568.36,,,4293.48,472.28,2232.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,83.52,,,1197.08,131.68,622.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,89.92,,,1288.29,141.71,669.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,5197.81,3118.68,Medicaid,Illinois Medicaid,,89.92,,,5197.81,571.76,2702.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-HEAD WO,70544,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,89.92,,,715.99,78.76,372.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-HEAD WO,70544,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,989.38,,,770.45,84.75,400.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-HEAD WO,70544,CPT,,,,,both,, ,1631.56,978.93,Medicaid,Illinois Medicaid,,593.62,,,1631.56,179.47,848.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-HEAD W,70545,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,184.23,,,1035.69,113.93,538.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-HEAD W,70545,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,198.37,,,1114.55,122.60,579.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-HEAD W,70545,CPT,,,,,both,, ,1938.34,1163.00,Medicaid,Illinois Medicaid,,3833.18,,,1938.34,213.22,1007.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-HEAD WWO,70546,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,2299.90,,,1197.08,131.68,622.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-HEAD WWO,70546,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,362.91,,,1288.29,141.71,669.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-HEAD WWO,70546,CPT,,,,,both,, ,2669.78,1601.86,Medicaid,Illinois Medicaid,,390.52,,,2669.78,293.68,1388.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-NECK WO,70547,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,4107.96,,,715.99,78.76,372.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-NECK WO,70547,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,2464.77,,,770.45,84.75,400.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-NECK WO,70547,CPT,,,,,both,, ,1334.89,800.93,Medicaid,Illinois Medicaid,,408.54,,,1334.89,146.84,694.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-NECK W,70548,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,439.69,,,1035.69,113.93,538.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-NECK W,70548,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,3833.18,,,1114.55,122.60,579.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-NECK W,70548,CPT,,,,,both,, ,1938.34,1163.00,Medicaid,Illinois Medicaid,,2299.90,,,1938.34,213.22,1007.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-NECK WWO,70549,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,163.85,,,1197.08,131.68,622.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-NECK WWO,70549,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,163.85,,,1288.29,141.71,669.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-NECK WWO,70549,CPT,,,,,both,, ,3263.12,1957.87,Medicaid,Illinois Medicaid,,568.92,,,3263.12,358.94,1696.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-BRAIN WO,70551,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,341.35,,,715.99,78.76,372.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-BRAIN WO,70551,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,425.38,,,770.45,84.75,400.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-BRAIN WO,70551,CPT,,,,,both,,,4941.28,4941.28,Medicaid,Illinois Medicaid,,457.89,,,4941.28,543.54,2569.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-BRAIN WO,70551,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,2355.14,,,4941.28,543.54,2569.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-BRAIN W,70552,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,1413.08,,,1035.69,113.93,538.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-BRAIN W,70552,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,429.59,,,1114.55,122.60,579.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-BRAIN W,70552,CPT,,,,,both,,,2352.06,2352.06,Medicaid,Illinois Medicaid,,462.27,,,2352.06,258.73,1223.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-BRAIN W,70552,CPT,,,,,both,, ,2352.06,1411.23,Medicaid,Illinois Medicaid,,4042.84,,,2352.06,258.73,1223.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-BRAIN WWO,70553,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,2425.70,,,1197.08,131.68,622.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-BRAIN WWO,70553,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,4293.48,,,1288.29,141.71,669.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-BRAIN WWO,70553,CPT,,,,,both,, ,6352.79,3811.67,Medicaid,Illinois Medicaid,,2576.08,,,6352.79,698.81,3303.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRI scan of brain before and after contrast,70553,CPT,,,,,both,,,6352.79,6352.79,Medicaid,Illinois Medicaid,,718.24,,,6352.79,698.81,3303.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,772.97,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,5197.81,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,3118.68,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,83.52,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 1V CR,71045,CPT,,,,,both,,,495.95,495.95,Medicaid,Illinois Medicaid,,89.92,,,495.95,54.55,257.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,495.95,297.57,Medicaid,Illinois Medicaid,,89.92,,,495.95,54.55,257.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,89.92,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,261.02,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,156.61,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,83.52,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 2V CR,71046,CPT,,,,,both,,,750.52,750.52,Medicaid,Illinois Medicaid,,89.92,,,750.52,82.56,390.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,750.52,450.31,Medicaid,Illinois Medicaid,,89.92,,,750.52,82.56,390.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,89.92,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Medicaid,Illinois Medicaid,,1085.36,,,143.98,15.84,74.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Medicaid,Illinois Medicaid,,651.21,,,143.98,15.84,74.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Medicaid,Illinois Medicaid,,132.36,,,143.98,15.84,74.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 3V CR,71047,CPT,,,,,both,,,1091.82,1091.82,Medicaid,Illinois Medicaid,,142.47,,,1091.82,120.10,567.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,1091.82,655.09,Medicaid,Illinois Medicaid,,142.47,,,1091.82,120.10,567.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,142.47,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,143.98,86.38,Medicaid,Illinois Medicaid,,667.72,,,143.98,15.84,74.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 4V CR,71048,CPT,,,,,both,,,1652.05,1652.05,Medicaid,Illinois Medicaid,,132.36,,,1652.05,181.73,859.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,1652.05,991.23,Medicaid,Illinois Medicaid,,142.47,,,1652.05,181.73,859.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,142.47,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,142.47,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,882.77,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,83.52,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS UNILAT CR,71100,CPT,,,,,both,,,876.83,876.83,Medicaid,Illinois Medicaid,,89.92,,,876.83,96.45,455.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,876.83,526.09,Medicaid,Illinois Medicaid,,89.92,,,876.83,96.45,455.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,89.92,,,220.61,24.27,114.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,1181.64,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,260.74,156.44,Medicaid,Illinois Medicaid,,708.98,,,260.74,28.68,135.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,260.74,156.44,Medicaid,Illinois Medicaid,,132.36,,,260.74,28.68,135.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,,,1152.17,1152.17,Medicaid,Illinois Medicaid,,142.47,,,1152.17,126.74,599.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,1152.17,691.30,Medicaid,Illinois Medicaid,,142.47,,,1152.17,126.74,599.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,142.47,,,220.61,24.27,114.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,1444.63,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,866.77,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,83.52,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,,,1381.48,1381.48,Medicaid,Illinois Medicaid,,89.92,,,1381.48,151.96,718.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,1381.48,828.88,Medicaid,Illinois Medicaid,,1444.63,,,1381.48,151.96,718.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,866.77,,,220.61,24.27,114.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,83.86,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,260.74,156.44,Medicaid,Illinois Medicaid,,89.59,,,260.74,28.68,135.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,260.74,156.44,Medicaid,Illinois Medicaid,,709.14,,,260.74,28.68,135.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,,,1877.99,1877.99,Medicaid,Illinois Medicaid,,83.86,,,1877.99,206.58,976.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,1877.99,1126.79,Medicaid,Illinois Medicaid,,89.59,,,1877.99,206.58,976.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-STERNUM CR,71120,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,138.42,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,709.14,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,138.42,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,167.55,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-STERNUM CR,71120,CPT,,,,,both,,,947.27,947.27,Medicaid,Illinois Medicaid,,179.18,,,947.27,104.20,492.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-STERNUM CR,71120,CPT,,,,,both,, ,947.27,568.36,Medicaid,Illinois Medicaid,,1418.30,,,947.27,104.20,492.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,167.55,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,179.18,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1418.30,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,83.52,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,,,989.38,989.38,Medicaid,Illinois Medicaid,,83.52,,,989.38,108.83,514.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,989.38,593.62,Medicaid,Illinois Medicaid,,83.52,,,989.38,108.83,514.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,89.92,,,307.05,33.78,159.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,1504.42,,,330.63,36.37,171.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CHEST DIAG WO,71250,CPT,,,,,both,,,3833.18,3833.18,Medicaid,Illinois Medicaid,,902.65,,,3833.18,421.65,1993.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,3833.18,2299.90,Medicaid,Illinois Medicaid,,132.36,,,3833.18,421.65,1993.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,142.47,,,604.85,66.53,314.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,142.47,,,650.88,71.60,338.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CHEST DIAG W,71260,CPT,,,,,both,,,4107.96,4107.96,Medicaid,Illinois Medicaid,,142.47,,,4107.96,451.88,2136.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,4107.96,2464.77,Medicaid,Illinois Medicaid,,1181.19,,,4107.96,451.88,2136.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,1968.65,,,680.91,74.90,354.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,132.36,,,732.83,80.61,381.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CHEST DIAG WWO,71270,CPT,,,,,both,,,3833.18,3833.18,Medicaid,Illinois Medicaid,,142.47,,,3833.18,421.65,1993.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,3833.18,2299.90,Medicaid,Illinois Medicaid,,142.47,,,3833.18,421.65,1993.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,, ,273.09,163.85,Medicaid,Illinois Medicaid,,2229.96,,,273.09,30.04,142.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,, ,273.09,163.85,Medicaid,Illinois Medicaid,,1337.97,,,273.09,30.04,142.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,,,568.92,568.92,Medicaid,Illinois Medicaid,,132.36,,,568.92,62.58,295.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,, ,568.92,341.35,Medicaid,Illinois Medicaid,,142.47,,,568.92,62.58,295.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-CHEST,71275,CPT,,,,,both,, ,708.98,425.38,Medicaid,Illinois Medicaid,,1765.44,,,708.98,77.99,368.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-CHEST,71275,CPT,,,,,both,, ,763.15,457.89,Medicaid,Illinois Medicaid,,1059.26,,,763.15,83.95,396.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-CHEST,71275,CPT,,,,,both,,,2355.14,2355.14,Medicaid,Illinois Medicaid,,184.23,,,2355.14,259.07,1224.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-CHEST,71275,CPT,,,,,both,, ,2355.14,1413.08,Medicaid,Illinois Medicaid,,198.37,,,2355.14,259.07,1224.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CHEST WO,71550,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,3833.18,,,715.99,78.76,372.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CHEST WO,71550,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,2299.90,,,770.45,84.75,400.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CHEST WO,71550,CPT,,,,,both,,,4042.84,4042.84,Medicaid,Illinois Medicaid,,362.91,,,4042.84,444.71,2102.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CHEST WO,71550,CPT,,,,,both,, ,4042.84,2425.70,Medicaid,Illinois Medicaid,,390.52,,,4042.84,444.71,2102.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CHEST W,71551,CPT,,,,,both,,,4293.48,4293.48,Medicaid,Illinois Medicaid,,6031.42,,,4293.48,472.28,2232.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CHEST W,71551,CPT,,,,,both,, ,4293.48,2576.08,Medicaid,Illinois Medicaid,,3618.85,,,4293.48,472.28,2232.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CHEST WWO,71552,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,408.54,,,1197.08,131.68,622.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CHEST WWO,71552,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,439.69,,,1288.29,141.71,669.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CHEST WWO,71552,CPT,,,,,both,,,5197.81,5197.81,Medicaid,Illinois Medicaid,,6031.42,,,5197.81,571.76,2702.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CHEST WWO,71552,CPT,,,,,both,, ,5197.81,3118.68,Medicaid,Illinois Medicaid,,3618.85,,,5197.81,571.76,2702.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,184.23,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,198.37,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,3833.18,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2299.90,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,,,261.02,261.02,Medicaid,Illinois Medicaid,,320.97,,,261.02,28.71,135.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,261.02,156.61,Medicaid,Illinois Medicaid,,1786.22,,,261.02,28.71,135.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,1071.73,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2407.63,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1444.57,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,184.23,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,,,1085.36,1085.36,Medicaid,Illinois Medicaid,,198.37,,,1085.36,119.39,564.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,1085.36,651.21,Medicaid,Illinois Medicaid,,534.68,,,1085.36,119.39,564.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,320.80,,,220.61,24.27,114.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,362.91,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,390.52,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,1653.45,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,1112.87,667.72,Medicaid,Illinois Medicaid,,992.07,,,1112.87,122.42,578.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,267.76,,,220.61,24.27,114.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,1126.62,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,675.97,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,429.59,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,1471.29,882.77,Medicaid,Illinois Medicaid,,462.27,,,1471.29,161.84,765.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,4941.28,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2964.76,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,621.41,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,668.73,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,,,1181.64,1181.64,Medicaid,Illinois Medicaid,,2352.06,,,1181.64,129.98,614.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,1181.64,708.98,Medicaid,Illinois Medicaid,,1411.23,,,1181.64,129.98,614.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,429.59,,,220.61,24.27,114.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,462.27,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,4941.28,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,2964.76,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,,,1444.63,1444.63,Medicaid,Illinois Medicaid,,984.74,,,1444.63,158.91,751.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,1444.63,866.77,Medicaid,Illinois Medicaid,,2351.49,,,1444.63,158.91,751.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,1410.89,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,4941.28,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,,,1444.63,1444.63,Medicaid,Illinois Medicaid,,429.59,,,1444.63,158.91,751.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,1444.63,866.77,Medicaid,Illinois Medicaid,,462.27,,,1444.63,158.91,751.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,139.77,83.86,Medicaid,Illinois Medicaid,,2964.76,,,139.77,15.37,72.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,149.32,89.59,Medicaid,Illinois Medicaid,,621.41,,,149.32,16.43,77.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,1181.91,709.14,Medicaid,Illinois Medicaid,,668.73,,,1181.91,130.01,614.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,139.77,83.86,Medicaid,Illinois Medicaid,,2352.06,,,139.77,15.37,72.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,149.32,89.59,Medicaid,Illinois Medicaid,,1411.23,,,149.32,16.43,77.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,230.71,138.42,Medicaid,Illinois Medicaid,,718.24,,,230.71,25.38,119.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,1181.91,709.14,Medicaid,Illinois Medicaid,,772.97,,,1181.91,130.01,614.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,230.71,138.42,Medicaid,Illinois Medicaid,,6352.79,,,230.71,25.38,119.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,279.26,167.55,Medicaid,Illinois Medicaid,,3811.67,,,279.26,30.72,145.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,298.64,179.18,Medicaid,Illinois Medicaid,,718.24,,,298.64,32.85,155.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,2363.84,1418.30,Medicaid,Illinois Medicaid,,772.97,,,2363.84,260.02,1229.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,279.26,167.55,Medicaid,Illinois Medicaid,,6352.79,,,279.26,30.72,145.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,298.64,179.18,Medicaid,Illinois Medicaid,,3811.67,,,298.64,32.85,155.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,2363.84,1418.30,Medicaid,Illinois Medicaid,,718.24,,,2363.84,260.02,1229.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,772.97,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,6352.79,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,3811.67,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,83.52,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,,,1504.42,1504.42,Medicaid,Illinois Medicaid,,89.92,,,1504.42,165.49,782.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,1504.42,902.65,Medicaid,Illinois Medicaid,,89.92,,,1504.42,165.49,782.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,89.92,,,220.61,24.27,114.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,936.33,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,561.79,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,83.52,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,1968.65,1181.19,Medicaid,Illinois Medicaid,,89.92,,,1968.65,216.55,1023.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"X-Ray, lower back, minimum four views",72110,CPT,,,,,both,,,1968.65,1968.65,Medicaid,Illinois Medicaid, ,1774.99,,,1968.65,216.55,1023.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,1064.99,,,220.61,24.27,114.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,184.23,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,198.37,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPINE W BND CR,72114,CPT,,,,,both,,,2229.96,2229.96,Medicaid,Illinois Medicaid,,3285.58,,,2229.96,245.30,1159.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,2229.96,1337.97,Medicaid,Illinois Medicaid,,1971.34,,,2229.96,245.30,1159.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,3726.80,,,220.61,24.27,114.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,362.91,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPINE BND CR,72120,CPT,,,,,both,,,1765.44,1765.44,Medicaid,Illinois Medicaid,,390.52,,,1765.44,194.20,918.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,1765.44,1059.26,Medicaid,Illinois Medicaid,,2236.08,,,1765.44,194.20,918.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,408.54,,,307.05,33.78,159.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,439.69,,,330.63,36.37,171.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CERV SPINE WO,72125,CPT,,,,,both,,,3833.18,3833.18,Medicaid,Illinois Medicaid,,4047.33,,,3833.18,421.65,1993.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,3833.18,2299.90,Medicaid,Illinois Medicaid,,2428.39,,,3833.18,421.65,1993.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CERV SPINE W,72126,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,429.59,,,604.85,66.53,314.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CERV SPINE W,72126,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,462.27,,,650.88,71.60,338.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CERV SPINE W,72126,CPT,,,,,both,,,6031.42,6031.42,Medicaid,Illinois Medicaid,,4042.84,,,6031.42,663.46,3136.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CERV SPINE W,72126,CPT,,,,,both,, ,6031.42,3618.85,Medicaid,Illinois Medicaid,,2425.70,,,6031.42,663.46,3136.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,621.41,,,680.91,74.90,354.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,668.73,,,732.83,80.61,381.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CERV SPINE WWO,72127,CPT,,,,,both,,,6031.42,6031.42,Medicaid,Illinois Medicaid,,2940.06,,,6031.42,663.46,3136.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,6031.42,3618.85,Medicaid,Illinois Medicaid,,1764.03,,,6031.42,663.46,3136.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,718.24,,,307.05,33.78,159.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,772.97,,,330.63,36.37,171.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-THOR SPINE WO,72128,CPT,,,,,both,,,3833.18,3833.18,Medicaid,Illinois Medicaid,,5197.81,,,3833.18,421.65,1993.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,3833.18,2299.90,Medicaid,Illinois Medicaid,,3118.68,,,3833.18,421.65,1993.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-THOR SPINE W,72129,CPT,,,,,both,, ,534.96,320.97,Medicaid,Illinois Medicaid,,89.92,,,534.96,58.85,278.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-THOR SPINE W,72129,CPT,,,,,both,,,1786.22,1786.22,Medicaid,Illinois Medicaid,,89.92,,,1786.22,196.48,928.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-THOR SPINE W,72129,CPT,,,,,both,, ,1786.22,1071.73,Medicaid,Illinois Medicaid,,83.52,,,1786.22,196.48,928.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-THOR SPINE WWO,72130,CPT,,,,,both,,,2407.63,2407.63,Medicaid,Illinois Medicaid,,89.92,,,2407.63,264.84,1251.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-THOR SPINE WWO,72130,CPT,,,,,both,, ,2407.63,1444.57,Medicaid,Illinois Medicaid,,89.92,,,2407.63,264.84,1251.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,89.92,,,307.05,33.78,159.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,757.53,,,330.63,36.37,171.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LUMB SPINE WO,72131,CPT,,,,,both,,,534.68,534.68,Medicaid,Illinois Medicaid,,454.51,,,534.68,58.81,278.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,534.68,320.80,Medicaid,Illinois Medicaid,,83.52,,,534.68,58.81,278.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,89.92,,,604.85,66.53,314.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,89.92,,,650.88,71.60,338.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LUMB SPINE W,72132,CPT,,,,,both,,,1653.45,1653.45,Medicaid,Illinois Medicaid,,89.92,,,1653.45,181.88,859.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,1653.45,992.07,Medicaid,Illinois Medicaid,,989.38,,,1653.45,181.88,859.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LUMB SPINE WWO,72133,CPT,,,,,both,, ,446.27,267.76,Medicaid,Illinois Medicaid,,593.62,,,446.27,49.09,232.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LUMB SPINE WWO,72133,CPT,,,,,both,,,1126.62,1126.62,Medicaid,Illinois Medicaid,,167.05,,,1126.62,123.93,585.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LUMB SPINE WWO,72133,CPT,,,,,both,, ,1126.62,675.97,Medicaid,Illinois Medicaid,,167.05,,,1126.62,123.93,585.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,179.85,,,715.99,78.76,372.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,179.85,,,770.45,84.75,400.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CERV SPINE WO,72141,CPT,,,,,both,,,4941.28,4941.28,Medicaid,Illinois Medicaid,,179.85,,,4941.28,543.54,2569.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,721.61,,,4941.28,543.54,2569.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CERV SPINE W,72142,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,432.96,,,1035.69,113.93,538.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CERV SPINE W,72142,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,89.92,,,1114.55,122.60,579.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CERV SPINE W,72142,CPT,,,,,both,,,2352.06,2352.06,Medicaid,Illinois Medicaid,,89.92,,,2352.06,258.73,1223.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CERV SPINE W,72142,CPT,,,,,both,, ,2352.06,1411.23,Medicaid,Illinois Medicaid,,89.92,,,2352.06,258.73,1223.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,353.93,,,715.99,78.76,372.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,212.35,,,770.45,84.75,400.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-THOR SPINE WO,72146,CPT,,,,,both,,,4941.28,4941.28,Medicaid,Illinois Medicaid,,164.02,,,4941.28,543.54,2569.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,164.02,,,4941.28,543.54,2569.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-THOR SPINE W,72147,CPT,,,,,both,, ,1641.24,984.74,Medicaid,Illinois Medicaid,,167.05,,,1641.24,180.54,853.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-THOR SPINE W,72147,CPT,,,,,both,,,2351.49,2351.49,Medicaid,Illinois Medicaid,,167.05,,,2351.49,258.66,1222.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-THOR SPINE W,72147,CPT,,,,,both,, ,2351.49,1410.89,Medicaid,Illinois Medicaid,,179.85,,,2351.49,258.66,1222.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRI scan of lower spinal canal,72148,CPT,,,,,both,,,4941.28,4941.28,Medicaid,Illinois Medicaid,,804.69,,,4941.28,543.54,2569.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,482.81,,,715.99,78.76,372.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,82.00,,,770.45,84.75,400.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,82.00,,,4941.28,543.54,2569.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,89.92,,,1035.69,113.93,538.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,402.20,,,1114.55,122.60,579.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LUMB SPINE W,72149,CPT,,,,,both,,,2352.06,2352.06,Medicaid,Illinois Medicaid,,241.32,,,2352.06,258.73,1223.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,2352.06,1411.23,Medicaid,Illinois Medicaid,,167.05,,,2352.06,258.73,1223.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,179.85,,,1197.08,131.68,622.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,179.85,,,1288.29,141.71,669.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CERV SPINE WWO,72156,CPT,,,,,both,,,6352.79,6352.79,Medicaid,Illinois Medicaid,,179.85,,,6352.79,698.81,3303.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,6352.79,3811.67,Medicaid,Illinois Medicaid,,978.43,,,6352.79,698.81,3303.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,587.05,,,1197.08,131.68,622.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,83.52,,,1288.29,141.71,669.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-THOR SPINE WWO,72157,CPT,,,,,both,,,6352.79,6352.79,Medicaid,Illinois Medicaid,,89.92,,,6352.79,698.81,3303.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,6352.79,3811.67,Medicaid,Illinois Medicaid,,89.92,,,6352.79,698.81,3303.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,89.92,,,1197.08,131.68,622.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,489.50,,,1288.29,141.71,669.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LUMB SPINE WWO,72158,CPT,,,,,both,,,6352.79,6352.79,Medicaid,Illinois Medicaid,,293.70,,,6352.79,698.81,3303.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,6352.79,3811.67,Medicaid,Illinois Medicaid,,89.92,,,6352.79,698.81,3303.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-PELVIS CR,72170,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,89.92,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,89.92,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,863.36,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,518.01,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-PELVIS CR,72170,CPT,,,,,both,,,936.33,936.33,Medicaid,Illinois Medicaid,,167.05,,,936.33,103.00,486.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-PELVIS CR,72170,CPT,,,,,both,, ,936.33,561.79,Medicaid,Illinois Medicaid,,167.05,,,936.33,103.00,486.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,179.85,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,179.85,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,,,1774.99,1774.99,Medicaid,Illinois Medicaid,,179.85,,,1774.99,195.25,922.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,1774.99,1064.99,Medicaid,Illinois Medicaid,,1726.71,,,1774.99,195.25,922.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-PELVIS WO,72192,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,1036.02,,,307.05,33.78,159.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-PELVIS WO,72192,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,2249.22,,,330.63,36.37,171.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-PELVIS WO,72192,CPT,,,,,both,,,3285.58,3285.58,Medicaid,Illinois Medicaid,,4498.43,,,3285.58,361.41,1708.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-PELVIS WO,72192,CPT,,,,,both,, ,3285.58,1971.34,Medicaid,Illinois Medicaid,,83.52,,,3285.58,361.41,1708.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"CT scan, pelvis, with contrast",72193,CPT,,,,,both,,,3726.80,3726.80,Medicaid,Illinois Medicaid,,89.92,,,3726.80,409.95,1937.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-PELVIS W,72193,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,89.92,,,604.85,66.53,314.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-PELVIS W,72193,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,89.92,,,650.88,71.60,338.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-PELVIS W,72193,CPT,,,,,both,, ,3726.80,2236.08,Medicaid,Illinois Medicaid,,918.37,,,3726.80,409.95,1937.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-PELVIS WWO,72194,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,551.02,,,680.91,74.90,354.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-PELVIS WWO,72194,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,167.05,,,732.83,80.61,381.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-PELVIS WWO,72194,CPT,,,,,both,,,4047.33,4047.33,Medicaid,Illinois Medicaid,,167.05,,,4047.33,445.21,2104.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-PELVIS WWO,72194,CPT,,,,,both,, ,4047.33,2428.39,Medicaid,Illinois Medicaid,,179.85,,,4047.33,445.21,2104.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-PELVIS WO,72195,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,179.85,,,715.99,78.76,372.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-PELVIS WO,72195,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,179.85,,,770.45,84.75,400.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-PELVIS WO,72195,CPT,,,,,both,,,4042.84,4042.84,Medicaid,Illinois Medicaid,,721.61,,,4042.84,444.71,2102.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-PELVIS WO,72195,CPT,,,,,both,, ,4042.84,2425.70,Medicaid,Illinois Medicaid,,432.96,,,4042.84,444.71,2102.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-PELVIS W,72196,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,89.92,,,1035.69,113.93,538.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-PELVIS W,72196,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,89.92,,,1114.55,122.60,579.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-PELVIS W,72196,CPT,,,,,both,,,2940.06,2940.06,Medicaid,Illinois Medicaid,,89.92,,,2940.06,323.41,1528.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-PELVIS W,72196,CPT,,,,,both,, ,2940.06,1764.03,Medicaid,Illinois Medicaid,,1442.95,,,2940.06,323.41,1528.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-PELVIS WWO,72197,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,865.77,,,1197.08,131.68,622.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-PELVIS WWO,72197,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,89.92,,,1288.29,141.71,669.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-PELVIS WWO,72197,CPT,,,,,both,,,5197.81,5197.81,Medicaid,Illinois Medicaid,,89.92,,,5197.81,571.76,2702.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-PELVIS WWO,72197,CPT,,,,,both,, ,5197.81,3118.68,Medicaid,Illinois Medicaid,,89.92,,,5197.81,571.76,2702.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SI JOINTS 2V CR,72200,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,167.05,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SI JOINTS 2V CR,72200,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,662.39,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,397.43,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,179.85,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,179.85,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,179.85,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,,,757.53,757.53,Medicaid,Illinois Medicaid,,1325.06,,,757.53,83.33,393.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,757.53,454.51,Medicaid,Illinois Medicaid,,795.03,,,757.53,83.33,393.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,83.52,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,89.92,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,89.92,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,89.92,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,,,989.38,989.38,Medicaid,Illinois Medicaid,,804.69,,,989.38,108.83,514.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,989.38,593.62,Medicaid,Illinois Medicaid,,482.81,,,989.38,108.83,514.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,179.85,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,179.85,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,1609.11,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,965.46,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,2249.22,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,,,721.61,721.61,Medicaid,Illinois Medicaid,,2249.22,,,721.61,79.38,375.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,721.61,432.96,Medicaid,Illinois Medicaid,,89.92,,,721.61,79.38,375.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,89.92,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,89.92,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,662.39,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-CLAVICLE CR,73000,CPT,,,,,both,,,353.93,353.93,Medicaid,Illinois Medicaid,,397.43,,,353.93,38.93,184.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,353.93,212.35,Medicaid,Illinois Medicaid,,167.05,,,353.93,38.93,184.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,273.37,164.02,Medicaid,Illinois Medicaid,,167.05,,,273.37,30.07,142.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,273.37,164.02,Medicaid,Illinois Medicaid,,179.85,,,273.37,30.07,142.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,179.85,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,179.85,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,1325.06,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,,,804.69,804.69,Medicaid,Illinois Medicaid,,795.03,,,804.69,88.52,418.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,132.36,,,804.69,88.52,418.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SCAPULA CR,73010,CPT,,,,,both,, ,136.68,82.00,Medicaid,Illinois Medicaid,,142.47,,,136.68,15.03,71.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SCAPULA CR,73010,CPT,,,,,both,, ,136.68,82.00,Medicaid,Illinois Medicaid,,142.47,,,136.68,15.03,71.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SCAPULA CR,73010,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,142.47,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SCAPULA CR,73010,CPT,,,,,both,,,402.20,402.20,Medicaid,Illinois Medicaid,,721.61,,,402.20,44.24,209.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SCAPULA CR,73010,CPT,,,,,both,, ,402.20,241.32,Medicaid,Illinois Medicaid,,432.96,,,402.20,44.24,209.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,264.90,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,285.10,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,1444.91,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,866.94,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,,,978.43,978.43,Medicaid,Illinois Medicaid,,89.92,,,978.43,107.63,508.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,978.43,587.05,Medicaid,Illinois Medicaid,,89.92,,,978.43,107.63,508.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,89.92,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,607.94,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,364.76,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,167.05,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 1V CR,73020,CPT,,,,,both,,,489.50,489.50,Medicaid,Illinois Medicaid,,167.05,,,489.50,53.85,254.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,489.50,293.70,Medicaid,Illinois Medicaid,,179.85,,,489.50,53.85,254.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,179.85,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,179.85,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1216.16,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,,,863.36,863.36,Medicaid,Illinois Medicaid,,729.69,,,863.36,94.97,448.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,863.36,518.01,Medicaid,Illinois Medicaid,,89.92,,,863.36,94.97,448.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,89.92,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,89.92,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,662.39,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,397.43,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,167.05,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,,,1726.71,1726.71,Medicaid,Illinois Medicaid,,167.05,,,1726.71,189.94,897.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,1726.71,1036.02,Medicaid,Illinois Medicaid,,179.85,,,1726.71,189.94,897.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ARTHROGM SHLDR CR,73040,CPT,,,,,both,, ,3748.70,2249.22,Medicaid,Illinois Medicaid,,179.85,,,3748.70,412.36,1949.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ATHGRM SHLD BI CR,73040,CPT,,,,,both,, ,7497.39,4498.43,Medicaid,Illinois Medicaid,,179.85,,,7497.39,824.71,3898.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,1325.06,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,795.03,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2249.22,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2249.22,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-AC JTS BILAT CR,73050,CPT,,,,,both,,,918.37,918.37,Medicaid,Illinois Medicaid,,89.92,,,918.37,101.02,477.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,918.37,551.02,Medicaid,Illinois Medicaid,,89.92,,,918.37,101.02,477.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,89.92,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,662.39,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,397.43,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,167.05,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,167.05,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,,,721.61,721.61,Medicaid,Illinois Medicaid,,179.85,,,721.61,79.38,375.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,721.61,432.96,Medicaid,Illinois Medicaid,,179.85,,,721.61,79.38,375.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,179.85,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1325.06,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,795.03,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HUMERUS CR,73060,CPT,,,,,both,,,1442.95,1442.95,Medicaid,Illinois Medicaid,,89.92,,,1442.95,158.72,750.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HUMERUS CR,73060,CPT,,,,,both,, ,1442.95,865.77,Medicaid,Illinois Medicaid,,89.92,,,1442.95,158.72,750.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,89.92,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,804.69,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,482.81,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,167.05,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 2V CR,73070,CPT,,,,,both,,,662.39,662.39,Medicaid,Illinois Medicaid,,167.05,,,662.39,72.86,344.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,662.39,397.43,Medicaid,Illinois Medicaid,,179.85,,,662.39,72.86,344.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,179.85,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,179.85,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,1609.11,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,,,1325.06,1325.06,Medicaid,Illinois Medicaid,,965.46,,,1325.06,145.76,689.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,1325.06,795.03,Medicaid,Illinois Medicaid,,167.05,,,1325.06,145.76,689.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,167.05,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,179.85,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1137.30,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,682.38,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 3V CR,73080,CPT,,,,,both,,,804.69,804.69,Medicaid,Illinois Medicaid,,89.92,,,804.69,88.52,418.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,89.92,,,804.69,88.52,418.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,89.92,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,568.64,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,,,1609.11,1609.11,Medicaid,Illinois Medicaid,,341.18,,,1609.11,177.00,836.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,1609.11,965.46,Medicaid,Illinois Medicaid,,184.23,,,1609.11,177.00,836.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ARTHRGRM ELBOW BI,73085,CPT,,,,,both,, ,3748.70,2249.22,Medicaid,Illinois Medicaid,,198.37,,,3748.70,412.36,1949.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ARTHRGRM ELBOW BI,73085,CPT,,,,,both,, ,3748.70,2249.22,Medicaid,Illinois Medicaid,,3015.85,,,3748.70,412.36,1949.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1809.51,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,368.64,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,396.58,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FOREARM 2V CR,73090,CPT,,,,,both,,,662.39,662.39,Medicaid,Illinois Medicaid,,3618.85,,,662.39,72.86,344.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,662.39,397.43,Medicaid,Illinois Medicaid,,333.60,,,662.39,72.86,344.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,3350.14,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,2010.08,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,1947.60,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,1168.56,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,2337.12,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,,,1325.06,1325.06,Medicaid,Illinois Medicaid,,859.03,,,1325.06,145.76,689.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,1325.06,795.03,Medicaid,Illinois Medicaid,,924.54,,,1325.06,145.76,689.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,2425.70,,,220.61,24.27,114.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,429.59,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,462.27,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,2470.50,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-UP EXT INFANT CR,73092,CPT,,,,,both,,,721.61,721.61,Medicaid,Illinois Medicaid,,1482.30,,,721.61,79.38,375.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,721.61,432.96,Medicaid,Illinois Medicaid,,1436.49,,,721.61,79.38,375.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,441.50,264.90,Medicaid,Illinois Medicaid,,1545.96,,,441.50,48.57,229.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,475.18,285.10,Medicaid,Illinois Medicaid,,3118.68,,,475.18,52.27,247.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,,,1444.91,1444.91,Medicaid,Illinois Medicaid,,718.24,,,1444.91,158.94,751.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,1444.91,866.94,Medicaid,Illinois Medicaid,,772.97,,,1444.91,158.94,751.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2598.76,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1559.25,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,429.59,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 2V CR,73100,CPT,,,,,both,,,607.94,607.94,Medicaid,Illinois Medicaid,,462.27,,,607.94,66.87,316.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,607.94,364.76,Medicaid,Illinois Medicaid,,2523.26,,,607.94,66.87,316.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,1513.95,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,621.41,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,668.73,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,4293.48,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,2576.08,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,,,1216.16,1216.16,Medicaid,Illinois Medicaid,,718.24,,,1216.16,133.78,632.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,1216.16,729.69,Medicaid,Illinois Medicaid,,772.97,,,1216.16,133.78,632.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,4941.28,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2964.76,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,83.52,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,,,662.39,662.39,Medicaid,Illinois Medicaid,,89.92,,,662.39,72.86,344.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,662.39,397.43,Medicaid,Illinois Medicaid,,89.92,,,662.39,72.86,344.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,89.92,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,333.44,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,200.06,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,83.86,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,89.59,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,,,1325.06,1325.06,Medicaid,Illinois Medicaid,,89.59,,,1325.06,145.76,689.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,1325.06,795.03,Medicaid,Illinois Medicaid,,89.59,,,1325.06,145.76,689.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ARTHRGRM WRIST BI,73115,CPT,,,,,both,, ,3748.70,2249.22,Medicaid,Illinois Medicaid,,532.49,,,3748.70,412.36,1949.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ARTHRGRM WRIST BI,73115,CPT,,,,,both,, ,3748.70,2249.22,Medicaid,Illinois Medicaid,,125.96,,,3748.70,412.36,1949.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,134.72,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,134.72,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,134.72,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 2V CR,73120,CPT,,,,,both,,,662.39,662.39,Medicaid,Illinois Medicaid,,798.57,,,662.39,72.86,344.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 2V CR,73120,CPT,,,,,both,, ,662.39,397.43,Medicaid,Illinois Medicaid,,132.52,,,662.39,72.86,344.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,142.80,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,142.80,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,142.80,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,1774.70,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,1064.82,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,,,1325.06,1325.06,Medicaid,Illinois Medicaid,,132.52,,,1325.06,145.76,689.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,1325.06,795.03,Medicaid,Illinois Medicaid,,142.80,,,1325.06,145.76,689.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,142.80,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,142.80,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1774.70,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 3V CR,73130,CPT,,,,,both,,,804.69,804.69,Medicaid,Illinois Medicaid,,1064.82,,,804.69,88.52,418.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 3V CR,73130,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,265.23,,,804.69,88.52,418.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,285.61,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,285.61,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,285.61,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,3549.69,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,2129.81,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,,,1609.11,1609.11,Medicaid,Illinois Medicaid,,2256.12,,,1609.11,177.00,836.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,1609.11,965.46,Medicaid,Illinois Medicaid,,2256.12,,,1609.11,177.00,836.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,88.92,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,88.92,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,88.92,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,,,1137.30,1137.30,Medicaid,Illinois Medicaid,,88.92,,,1137.30,125.10,591.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,1137.30,682.38,Medicaid,Illinois Medicaid,,307.05,,,1137.30,125.10,591.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,184.23,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,89.92,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,89.92,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,,,568.64,568.64,Medicaid,Illinois Medicaid,,89.92,,,568.64,62.55,295.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,568.64,341.18,Medicaid,Illinois Medicaid,,782.23,,,568.64,62.55,295.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,469.33,,,307.05,33.78,159.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,167.05,,,330.63,36.37,171.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-UPPER EXT WO,73200,CPT,,,,,both,,,3015.85,3015.85,Medicaid,Illinois Medicaid,,167.05,,,3015.85,331.74,1568.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,3015.85,1809.51,Medicaid,Illinois Medicaid,,179.85,,,3015.85,331.74,1568.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,614.40,368.64,Medicaid,Illinois Medicaid,,179.85,,,614.40,67.58,319.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,660.98,396.58,Medicaid,Illinois Medicaid,,179.85,,,660.98,72.71,343.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,6031.42,3618.85,Medicaid,Illinois Medicaid,,1564.76,,,6031.42,663.46,3136.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-UPPER EXT W,73201,CPT,,,,,both,, ,556.01,333.60,Medicaid,Illinois Medicaid,,938.85,,,556.01,61.16,289.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-UPPER EXT W,73201,CPT,,,,,both,,,3350.14,3350.14,Medicaid,Illinois Medicaid,,89.92,,,3350.14,368.52,1742.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-UPPER EXT W,73201,CPT,,,,,both,, ,3350.14,2010.08,Medicaid,Illinois Medicaid,,89.92,,,3350.14,368.52,1742.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-UPPER EXT,73206,CPT,,,,,both,,,1947.60,1947.60,Medicaid,Illinois Medicaid,,89.92,,,1947.60,214.24,1012.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-UPPER EXT,73206,CPT,,,,,both,, ,1947.60,1168.56,Medicaid,Illinois Medicaid,,721.61,,,1947.60,214.24,1012.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-UPPER EXT BI,73206,CPT,,,,,both,, ,3895.20,2337.12,Medicaid,Illinois Medicaid,,432.96,,,3895.20,428.47,2025.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,1431.72,859.03,Medicaid,Illinois Medicaid,,167.05,,,1431.72,157.49,744.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,1540.90,924.54,Medicaid,Illinois Medicaid,,167.05,,,1540.90,169.50,801.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,4042.84,2425.70,Medicaid,Illinois Medicaid,,179.85,,,4042.84,444.71,2102.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,179.85,,,715.99,78.76,372.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,179.85,,,770.45,84.75,400.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER EXT WO,73218,CPT,,,,,both,,,2470.50,2470.50,Medicaid,Illinois Medicaid,,1442.95,,,2470.50,271.76,1284.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,2470.50,1482.30,Medicaid,Illinois Medicaid,,865.77,,,2470.50,271.76,1284.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,2394.15,1436.49,Medicaid,Illinois Medicaid,,89.92,,,2394.15,263.36,1244.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,2576.60,1545.96,Medicaid,Illinois Medicaid,,89.92,,,2576.60,283.43,1339.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,5197.81,3118.68,Medicaid,Illinois Medicaid,,89.92,,,5197.81,571.76,2702.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,981.24,,,1197.08,131.68,622.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,588.74,,,1288.29,141.71,669.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER EXT WWO,73220,CPT,,,,,both,,,2598.76,2598.76,Medicaid,Illinois Medicaid,,167.05,,,2598.76,285.86,1351.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,2598.76,1559.25,Medicaid,Illinois Medicaid,,167.05,,,2598.76,285.86,1351.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,179.85,,,715.99,78.76,372.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,179.85,,,770.45,84.75,400.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER JOINT WO,73221,CPT,,,,,both,,,2523.26,2523.26,Medicaid,Illinois Medicaid,,179.85,,,2523.26,277.56,1312.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,2523.26,1513.95,Medicaid,Illinois Medicaid,,1962.48,,,2523.26,277.56,1312.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,1177.48,,,1035.69,113.93,538.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,89.92,,,1114.55,122.60,579.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER JOINT W,73222,CPT,,,,,both,,,4293.48,4293.48,Medicaid,Illinois Medicaid,,89.92,,,4293.48,472.28,2232.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,4293.48,2576.08,Medicaid,Illinois Medicaid,,89.92,,,4293.48,472.28,2232.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,1070.49,,,1197.08,131.68,622.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,642.29,,,1288.29,141.71,669.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER JOINT WWO,73223,CPT,,,,,both,,,4941.28,4941.28,Medicaid,Illinois Medicaid,,167.05,,,4941.28,543.54,2569.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,167.05,,,4941.28,543.54,2569.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,179.85,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,179.85,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,179.85,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2141.27,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,,,333.44,333.44,Medicaid,Illinois Medicaid,,1284.76,,,333.44,36.68,173.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,333.44,200.06,Medicaid,Illinois Medicaid,,83.52,,,333.44,36.68,173.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,139.77,83.86,Medicaid,Illinois Medicaid,,89.92,,,139.77,15.37,72.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Medicaid,Illinois Medicaid,,89.92,,,149.32,16.43,77.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Medicaid,Illinois Medicaid,,89.92,,,149.32,16.43,77.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Medicaid,Illinois Medicaid,,721.61,,,149.32,16.43,77.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,887.49,532.49,Medicaid,Illinois Medicaid,,432.96,,,887.49,97.62,461.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,209.94,125.96,Medicaid,Illinois Medicaid,,4512.40,,,209.94,23.09,109.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Medicaid,Illinois Medicaid,,2256.12,,,224.54,24.70,116.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Medicaid,Illinois Medicaid,,167.05,,,224.54,24.70,116.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Medicaid,Illinois Medicaid,,167.05,,,224.54,24.70,116.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,1330.96,798.57,Medicaid,Illinois Medicaid,,179.85,,,1330.96,146.41,692.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,179.85,,,220.88,24.30,114.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.80,Medicaid,Illinois Medicaid,,179.85,,,238.01,26.18,123.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.80,Medicaid,Illinois Medicaid,,1442.95,,,238.01,26.18,123.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.80,Medicaid,Illinois Medicaid,,865.77,,,238.01,26.18,123.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,,,1774.70,1774.70,Medicaid,Illinois Medicaid,,89.92,,,1774.70,195.22,922.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,1774.70,1064.82,Medicaid,Illinois Medicaid,,89.92,,,1774.70,195.22,922.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,89.92,,,220.88,24.30,114.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.80,Medicaid,Illinois Medicaid,,721.61,,,238.01,26.18,123.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.80,Medicaid,Illinois Medicaid,,432.96,,,238.01,26.18,123.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.80,Medicaid,Illinois Medicaid,,167.05,,,238.01,26.18,123.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,,,1774.70,1774.70,Medicaid,Illinois Medicaid,,179.85,,,1774.70,195.22,922.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,1774.70,1064.82,Medicaid,Illinois Medicaid,,179.85,,,1774.70,195.22,922.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,442.06,265.23,Medicaid,Illinois Medicaid,,179.85,,,442.06,48.63,229.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Medicaid,Illinois Medicaid,,1442.95,,,476.02,52.36,247.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Medicaid,Illinois Medicaid,,865.77,,,476.02,52.36,247.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Medicaid,Illinois Medicaid,,83.52,,,476.02,52.36,247.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,,,3549.69,3549.69,Medicaid,Illinois Medicaid,,89.92,,,3549.69,390.47,1845.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,3549.69,2129.81,Medicaid,Illinois Medicaid,,89.92,,,3549.69,390.47,1845.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ARTHGRM BI HIP CR,73525,CPT,,,,,both,, ,3760.20,2256.12,Medicaid,Illinois Medicaid,,89.92,,,3760.20,413.62,1955.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ARTHGRM BI HIP CR,73525,CPT,,,,,both,, ,3760.20,2256.12,Medicaid,Illinois Medicaid,,721.61,,,3760.20,413.62,1955.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.20,88.92,Medicaid,Illinois Medicaid,,432.96,,,148.20,16.30,77.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.20,88.92,Medicaid,Illinois Medicaid,,89.92,,,148.20,16.30,77.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.20,88.92,Medicaid,Illinois Medicaid,,89.92,,,148.20,16.30,77.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.20,88.92,Medicaid,Illinois Medicaid,,89.92,,,148.20,16.30,77.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 1V CR,73551,CPT,,,,,both,,,307.05,307.05,Medicaid,Illinois Medicaid,,720.49,,,307.05,33.78,159.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,432.29,,,307.05,33.78,159.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,167.05,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,167.05,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,179.85,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 2V CR,73552,CPT,,,,,both,,,782.23,782.23,Medicaid,Illinois Medicaid,,179.85,,,782.23,86.05,406.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,782.23,469.33,Medicaid,Illinois Medicaid,,179.85,,,782.23,86.05,406.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,1107.82,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,664.69,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,89.92,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,89.92,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,89.92,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,,,1564.76,1564.76,Medicaid,Illinois Medicaid,,804.69,,,1564.76,172.12,813.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,1564.76,938.85,Medicaid,Illinois Medicaid,,482.81,,,1564.76,172.12,813.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,167.05,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,167.05,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,179.85,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,,,721.61,721.61,Medicaid,Illinois Medicaid,,179.85,,,721.61,79.38,375.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,721.61,432.96,Medicaid,Illinois Medicaid,,179.85,,,721.61,79.38,375.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,1609.11,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,965.46,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,2256.12,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,2256.12,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,89.92,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,,,1442.95,1442.95,Medicaid,Illinois Medicaid,,89.92,,,1442.95,158.72,750.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,1442.95,865.77,Medicaid,Illinois Medicaid,,89.92,,,1442.95,158.72,750.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,553.77,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,332.26,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,167.05,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 3V CR,73562,CPT,,,,,both,,,981.24,981.24,Medicaid,Illinois Medicaid,,167.05,,,981.24,107.94,510.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,981.24,588.74,Medicaid,Illinois Medicaid,,179.85,,,981.24,107.94,510.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,179.85,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,179.85,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,1107.82,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,664.69,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,89.92,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,,,1962.48,1962.48,Medicaid,Illinois Medicaid,,89.92,,,1962.48,215.87,1020.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,1962.48,1177.48,Medicaid,Illinois Medicaid,,89.92,,,1962.48,215.87,1020.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,662.39,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,397.43,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,167.05,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,,,1070.49,1070.49,Medicaid,Illinois Medicaid,,167.05,,,1070.49,117.75,556.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,1070.49,642.29,Medicaid,Illinois Medicaid,,179.85,,,1070.49,117.75,556.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,179.85,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,179.85,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,1250.97,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,750.58,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,89.92,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,,,2141.27,2141.27,Medicaid,Illinois Medicaid,,89.92,,,2141.27,235.54,1113.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,2141.27,1284.76,Medicaid,Illinois Medicaid,,89.92,,,2141.27,235.54,1113.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,353.93,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,212.35,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,167.05,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,167.05,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,,,721.61,721.61,Medicaid,Illinois Medicaid,,179.85,,,721.61,79.38,375.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,721.61,432.96,Medicaid,Illinois Medicaid,,179.85,,,721.61,79.38,375.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ARTHRGRM KNEE BI,73580,CPT,,,,,both,, ,7520.68,4512.40,Medicaid,Illinois Medicaid,,179.85,,,7520.68,827.27,3910.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ARTHROGRAM KNEE,73580,CPT,,,,,both,, ,3760.20,2256.12,Medicaid,Illinois Medicaid,,662.39,,,3760.20,413.62,1955.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,397.43,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,89.92,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,89.92,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,89.92,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,568.64,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,,,1442.95,1442.95,Medicaid,Illinois Medicaid,,341.18,,,1442.95,158.72,750.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,1442.95,865.77,Medicaid,Illinois Medicaid,,167.05,,,1442.95,158.72,750.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,167.05,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,179.85,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1137.30,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TIB FIB 2V CR,73590,CPT,,,,,both,,,721.61,721.61,Medicaid,Illinois Medicaid,,682.38,,,721.61,79.38,375.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,721.61,432.96,Medicaid,Illinois Medicaid,,184.23,,,721.61,79.38,375.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,198.37,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,3013.04,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,1807.82,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,368.64,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,,,1442.95,1442.95,Medicaid,Illinois Medicaid,,396.58,,,1442.95,158.72,750.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,1442.95,865.77,Medicaid,Illinois Medicaid,,2964.76,,,1442.95,158.72,750.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,362.91,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,362.91,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,390.52,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,3013.04,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,,,721.61,721.61,Medicaid,Illinois Medicaid,,1807.82,,,721.61,79.38,375.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,721.61,432.96,Medicaid,Illinois Medicaid,,408.54,,,721.61,79.38,375.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,439.69,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,3013.04,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1807.82,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 2V CR,73600,CPT,,,,,both,,,720.49,720.49,Medicaid,Illinois Medicaid,,817.10,,,720.49,79.25,374.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,720.49,432.29,Medicaid,Illinois Medicaid,,879.40,,,720.49,79.25,374.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,2964.76,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,924.54,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,2964.76,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,429.59,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,429.59,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,,,1107.82,1107.82,Medicaid,Illinois Medicaid,,462.27,,,1107.82,121.86,576.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,1107.82,664.69,Medicaid,Illinois Medicaid,,2470.50,,,1107.82,121.86,576.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1482.30,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,832.76,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,499.65,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,,,804.69,804.69,Medicaid,Illinois Medicaid,,621.41,,,804.69,88.52,418.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,668.73,,,804.69,88.52,418.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,1436.49,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,1545.96,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,718.24,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,772.97,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,3084.06,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,,,1609.11,1609.11,Medicaid,Illinois Medicaid,,1850.43,,,1609.11,177.00,836.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,1609.11,965.46,Medicaid,Illinois Medicaid,,4941.28,,,1609.11,177.00,836.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ARTHRGRM ANKLE BI,73615,CPT,,,,,both,, ,3760.20,2256.12,Medicaid,Illinois Medicaid,,429.59,,,3760.20,413.62,1955.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ARTHRGRM ANKLE BI,73615,CPT,,,,,both,, ,3760.20,2256.12,Medicaid,Illinois Medicaid,,462.27,,,3760.20,413.62,1955.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2964.76,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,859.03,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,924.54,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 2V CR,73620,CPT,,,,,both,,,553.77,553.77,Medicaid,Illinois Medicaid,,5928.86,,,553.77,60.91,287.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,553.77,332.26,Medicaid,Illinois Medicaid,,621.41,,,553.77,60.91,287.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,668.73,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,4293.48,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,2576.08,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,4584.66,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,718.24,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,,,1107.82,1107.82,Medicaid,Illinois Medicaid,,772.97,,,1107.82,121.86,576.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,1107.82,664.69,Medicaid,Illinois Medicaid,,5197.81,,,1107.82,121.86,576.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,3118.68,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,6237.38,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,83.52,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,,,662.39,662.39,Medicaid,Illinois Medicaid,,89.92,,,662.39,72.86,344.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,662.39,397.43,Medicaid,Illinois Medicaid,,89.92,,,662.39,72.86,344.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,89.92,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,694.38,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,416.62,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,83.52,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,89.92,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,,,1250.97,1250.97,Medicaid,Illinois Medicaid,,1144.03,,,1250.97,137.61,650.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,1250.97,750.58,Medicaid,Illinois Medicaid,,686.41,,,1250.97,137.61,650.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,83.52,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,89.92,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,89.92,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,,,353.93,353.93,Medicaid,Illinois Medicaid,,89.92,,,353.93,38.93,184.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,353.93,212.35,Medicaid,Illinois Medicaid,,868.40,,,353.93,38.93,184.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,521.04,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,970.85,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,582.51,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,184.23,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,198.37,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,,,662.39,662.39,Medicaid,Illinois Medicaid,,3285.58,,,662.39,72.86,344.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,662.39,397.43,Medicaid,Illinois Medicaid,,1971.34,,,662.39,72.86,344.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,362.91,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,390.52,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,3726.80,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,,,568.64,568.64,Medicaid,Illinois Medicaid,,2236.08,,,568.64,62.55,295.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,568.64,341.18,Medicaid,Illinois Medicaid,,408.54,,,568.64,62.55,295.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,439.69,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,4317.62,,,278.43,30.63,144.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,2590.57,,,299.76,32.97,155.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,,,1137.30,1137.30,Medicaid,Illinois Medicaid,,535.86,,,1137.30,125.10,591.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,1137.30,682.38,Medicaid,Illinois Medicaid,,535.86,,,1137.30,125.10,591.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,1894.27,,,307.05,33.78,159.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,1136.56,,,330.63,36.37,171.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT WO,73700,CPT,,,,,both,,,3013.04,3013.04,Medicaid,Illinois Medicaid,,535.86,,,3013.04,331.43,1566.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,3013.04,1807.82,Medicaid,Illinois Medicaid,,1894.27,,,3013.04,331.43,1566.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,614.40,368.64,Medicaid,Illinois Medicaid,,1136.56,,,614.40,67.58,319.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,660.98,396.58,Medicaid,Illinois Medicaid,,352.30,,,660.98,72.71,343.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,379.24,,,4941.28,543.54,2569.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT W,73701,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,6571.44,,,604.85,66.53,314.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT W,73701,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,3942.86,,,604.85,66.53,314.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT W,73701,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,7453.61,,,650.88,71.60,338.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT W,73701,CPT,,,,,both,,,3013.04,3013.04,Medicaid,Illinois Medicaid,,568.53,,,3013.04,331.43,1566.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT W,73701,CPT,,,,,both,, ,3013.04,1807.82,Medicaid,Illinois Medicaid,,611.81,,,3013.04,331.43,1566.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,4472.16,,,680.91,74.90,354.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,568.53,,,732.83,80.61,381.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT WWO,73702,CPT,,,,,both,,,3013.04,3013.04,Medicaid,Illinois Medicaid,,611.81,,,3013.04,331.43,1566.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,3013.04,1807.82,Medicaid,Illinois Medicaid,,8364.95,,,3013.04,331.43,1566.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,1361.84,817.10,Medicaid,Illinois Medicaid,,5018.97,,,1361.84,149.80,708.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,1465.68,879.40,Medicaid,Illinois Medicaid,,429.59,,,1465.68,161.22,762.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,462.27,,,4941.28,543.54,2569.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,1540.90,924.54,Medicaid,Illinois Medicaid,,4042.84,,,1540.90,169.50,801.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,2425.70,,,4941.28,543.54,2569.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,621.41,,,715.99,78.76,372.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,668.73,,,715.99,78.76,372.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,4293.48,,,770.45,84.75,400.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR WO,73718,CPT,,,,,both,,,2470.50,2470.50,Medicaid,Illinois Medicaid,,2576.08,,,2470.50,271.76,1284.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,2470.50,1482.30,Medicaid,Illinois Medicaid,,718.24,,,2470.50,271.76,1284.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR W,73719,CPT,,,,,both,,,832.76,832.76,Medicaid,Illinois Medicaid,,772.97,,,832.76,91.60,433.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,832.76,499.65,Medicaid,Illinois Medicaid,,5197.81,,,832.76,91.60,433.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,3118.68,,,1035.69,113.93,538.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,736.26,,,1114.55,122.60,579.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR BI WWO,73720,CPT,,,,,both,, ,2394.15,1436.49,Medicaid,Illinois Medicaid,,234.75,,,2394.15,263.36,1244.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR BI WWO,73720,CPT,,,,,both,, ,2576.60,1545.96,Medicaid,Illinois Medicaid,,934.54,,,2576.60,283.43,1339.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,1091.26,,,1197.08,131.68,622.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,900.55,,,1288.29,141.71,669.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR WWO,73720,CPT,,,,,both,,,3084.06,3084.06,Medicaid,Illinois Medicaid,,1051.51,,,3084.06,339.25,1603.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,3084.06,1850.43,Medicaid,Illinois Medicaid,,2006.20,,,3084.06,339.25,1603.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRI scan of leg joint,73721,CPT,,,,,both,,,4941.28,4941.28,Medicaid,Illinois Medicaid,,1274.14,,,4941.28,543.54,2569.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LW JOINT WO,73721,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,1274.14,,,715.99,78.76,372.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LW JOINT WO,73721,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,1134.54,,,770.45,84.75,400.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LW JOINT WO,73721,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,1399.95,,,4941.28,543.54,2569.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,1431.72,859.03,Medicaid,Illinois Medicaid,,1181.19,,,1431.72,157.49,744.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,1540.90,924.54,Medicaid,Illinois Medicaid,,2233.54,,,1540.90,169.50,801.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,9881.44,5928.86,Medicaid,Illinois Medicaid,,620.40,,,9881.44,1086.96,5138.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LW JOINT W,73722,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,782.57,,,1035.69,113.93,538.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LW JOINT W,73722,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,815.41,,,1114.55,122.60,579.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LW JOINT W,73722,CPT,,,,,both,,,4293.48,4293.48,Medicaid,Illinois Medicaid,,559.44,,,4293.48,472.28,2232.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LW JOINT W,73722,CPT,,,,,both,, ,4293.48,2576.08,Medicaid,Illinois Medicaid,,1101.70,,,4293.48,472.28,2232.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LW JOINT W BI,73722,CPT,,,,,both,, ,7641.10,4584.66,Medicaid,Illinois Medicaid,,1263.20,,,7641.10,840.52,3973.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,1299.07,,,1197.08,131.68,622.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,844.72,,,1288.29,141.71,669.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LW JOINT WWO,73723,CPT,,,,,both,,,5197.81,5197.81,Medicaid,Illinois Medicaid,,418.99,,,5197.81,571.76,2702.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,5197.81,3118.68,Medicaid,Illinois Medicaid,,814.57,,,5197.81,571.76,2702.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-LW JOINT WWO BI,73723,CPT,,,,,both,, ,10395.64,6237.38,Medicaid,Illinois Medicaid,,814.57,,,10395.64,1143.52,5405.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,697.66,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,586.05,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1704.21,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,1022.52,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,,,694.38,694.38,Medicaid,Illinois Medicaid,,1989.98,,,694.38,76.38,361.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,694.38,416.62,Medicaid,Illinois Medicaid,,1193.98,,,694.38,76.38,361.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,1195.00,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,348.09,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,,,1144.03,1144.03,Medicaid,Illinois Medicaid,,1017.84,,,1144.03,125.84,594.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,1144.03,686.41,Medicaid,Illinois Medicaid,,348.09,,,1144.03,125.84,594.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,1017.84,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,5089.80,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,5714.31,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,6719.85,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,,,868.40,868.40,Medicaid,Illinois Medicaid,,7544.37,,,868.40,95.52,451.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,868.40,521.04,Medicaid,Illinois Medicaid,,390.52,,,868.40,95.52,451.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABD SER PA CXR CR,74022,CPT,,,,,both,,,970.85,970.85,Medicaid,Illinois Medicaid,,1413.25,,,970.85,106.79,504.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-ABD SER PA CXR CR,74022,CPT,,,,,both,, ,970.85,582.51,Medicaid,Illinois Medicaid,,4512.45,,,970.85,106.79,504.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,5066.12,,,307.05,33.78,159.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,4512.45,,,330.63,36.37,171.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABDOMEN WO,74150,CPT,,,,,both,,,3285.58,3285.58,Medicaid,Illinois Medicaid,,5053.99,,,3285.58,361.41,1708.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,3285.58,1971.34,Medicaid,Illinois Medicaid,,8018.77,,,3285.58,361.41,1708.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABDOMEN W,74160,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,2542.41,,,604.85,66.53,314.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABDOMEN W,74160,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,7414.70,,,650.88,71.60,338.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABDOMEN W,74160,CPT,,,,,both,,,3726.80,3726.80,Medicaid,Illinois Medicaid,,231.72,,,3726.80,409.95,1937.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABDOMEN W,74160,CPT,,,,,both,, ,3726.80,2236.08,Medicaid,Illinois Medicaid,,4585.05,,,3726.80,409.95,1937.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,5147.63,,,680.91,74.90,354.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,5147.63,,,732.83,80.61,381.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABDOMEN WWO,74170,CPT,,,,,both,,,4317.62,4317.62,Medicaid,Illinois Medicaid,,2106.00,,,4317.62,474.94,2245.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,4317.62,2590.57,Medicaid,Illinois Medicaid,,2364.40,,,4317.62,474.94,2245.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,893.10,535.86,Medicaid,Illinois Medicaid,,5353.93,,,893.10,98.24,464.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,893.10,535.86,Medicaid,Illinois Medicaid,,2349.24,,,893.10,98.24,464.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,,,1894.27,1894.27,Medicaid,Illinois Medicaid,,308.01,,,1894.27,208.37,985.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,1894.27,1136.56,Medicaid,Illinois Medicaid,,1258.99,,,1894.27,208.37,985.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-ABDOMEN,74175,CPT,,,,,both,, ,893.10,535.86,Medicaid,Illinois Medicaid,,1589.40,,,893.10,98.24,464.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-ABDOMEN,74175,CPT,,,,,both,,,1894.27,1894.27,Medicaid,Illinois Medicaid,,672.27,,,1894.27,208.37,985.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-ABDOMEN,74175,CPT,,,,,both,, ,1894.27,1136.56,Medicaid,Illinois Medicaid,,332.26,,,1894.27,208.37,985.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,587.17,352.30,Medicaid,Illinois Medicaid,,284.58,,,587.17,64.59,305.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,632.08,379.24,Medicaid,Illinois Medicaid,,83.52,,,632.08,69.53,328.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABD PELVIS WO,74176,CPT,,,,,both,,,6571.44,6571.44,Medicaid,Illinois Medicaid,,89.92,,,6571.44,722.86,3417.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,6571.44,3942.86,Medicaid,Illinois Medicaid,,89.92,,,6571.44,722.86,3417.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT scan of abdomen and pelvis with contrast,74177,CPT,,,,,both,,,7453.61,7453.61,Medicaid,Illinois Medicaid,,89.92,,,7453.61,819.90,3875.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,947.56,568.53,Medicaid,Illinois Medicaid,,453.84,,,947.56,104.23,492.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,1019.69,611.81,Medicaid,Illinois Medicaid,,455.19,,,1019.69,112.17,530.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,7453.61,4472.16,Medicaid,Illinois Medicaid,,714.20,,,7453.61,819.90,3875.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,947.56,568.53,Medicaid,Illinois Medicaid,,1218.07,,,947.56,104.23,492.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,1019.69,611.81,Medicaid,Illinois Medicaid,,317.10,,,1019.69,112.17,530.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABD PELVIS WWO,74178,CPT,,,,,both,,,8364.95,8364.95,Medicaid,Illinois Medicaid,,322.15,,,8364.95,920.14,4349.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,8364.95,5018.97,Medicaid,Illinois Medicaid,,294.70,,,8364.95,920.14,4349.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,115.86,,,715.99,78.76,372.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,124.78,,,770.45,84.75,400.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ABDOMEN WO,74181,CPT,,,,,both,,,4042.84,4042.84,Medicaid,Illinois Medicaid,,434.48,,,4042.84,444.71,2102.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,4042.84,2425.70,Medicaid,Illinois Medicaid,,196.02,,,4042.84,444.71,2102.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ABDOMEN W,74182,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,211.00,,,1035.69,113.93,538.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ABDOMEN W,74182,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,2030.68,,,1114.55,122.60,579.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ABDOMEN W,74182,CPT,,,,,both,,,4293.48,4293.48,Medicaid,Illinois Medicaid,,1218.40,,,4293.48,472.28,2232.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ABDOMEN W,74182,CPT,,,,,both,, ,4293.48,2576.08,Medicaid,Illinois Medicaid,,196.02,,,4293.48,472.28,2232.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,211.00,,,1197.08,131.68,622.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,961.75,,,1288.29,141.71,669.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ABDOMEN WWO,74183,CPT,,,,,both,,,5197.81,5197.81,Medicaid,Illinois Medicaid,,131.18,,,5197.81,571.76,2702.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,5197.81,3118.68,Medicaid,Illinois Medicaid,,131.18,,,5197.81,571.76,2702.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-ESOPHAGUS,74220,CPT,,,,,both,, ,1227.11,736.26,Medicaid,Illinois Medicaid,,1008.07,,,1227.11,134.98,638.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-MOD BA SWALLOW,74230,CPT,,,,,both,, ,391.26,234.75,Medicaid,Illinois Medicaid,,131.18,,,391.26,43.04,203.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-GI SERIES,74240,CPT,,,,,both,, ,1557.58,934.54,Medicaid,Illinois Medicaid,,131.18,,,1557.58,171.33,809.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-UPPER GI SINGLE,74240,CPT,,,,,both,, ,1818.77,1091.26,Medicaid,Illinois Medicaid,,1680.12,,,1818.77,200.06,945.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-GI SERIES AIR,74246,CPT,,,,,both,, ,1500.93,900.55,Medicaid,Illinois Medicaid,,1008.07,,,1500.93,165.10,780.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-UPPER GI DOUBLE,74246,CPT,,,,,both,, ,1752.53,1051.51,Medicaid,Illinois Medicaid,,262.37,,,1752.53,192.78,911.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-LOWER GI FOLLOW,74248,CPT,,,,,both,, ,3343.68,2006.20,Medicaid,Illinois Medicaid,,262.37,,,3343.68,367.80,1738.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-SMALL BOWEL CR,74250,CPT,,,,,both,, ,2123.58,1274.14,Medicaid,Illinois Medicaid,,2015.97,,,2123.58,233.59,1104.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-SM BWL ENT TBE CR,74251,CPT,,,,,both,, ,2123.58,1274.14,Medicaid,Illinois Medicaid,,2330.73,,,2123.58,233.59,1104.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-BARIUM ENEMA,74270,CPT,,,,,both,, ,1890.90,1134.54,Medicaid,Illinois Medicaid,,196.02,,,1890.90,208.00,983.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-BARIUM ENEMA AIR,74280,CPT,,,,,both,, ,2333.25,1399.95,Medicaid,Illinois Medicaid,,211.00,,,2333.25,256.66,1213.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SU-CHOLE W GRAMS DR,74300,CPT,,,,,both,, ,1968.65,1181.19,Medicaid,Illinois Medicaid,,1398.43,,,1968.65,216.55,1023.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-ENDO BILIARY,74328,CPT,,,,,both,, ,3722.58,2233.54,Medicaid,Illinois Medicaid,,196.02,,,3722.58,409.48,1935.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-ENDO PANCREATIC,74329,CPT,,,,,both,, ,1034.01,620.40,Medicaid,Illinois Medicaid,,211.00,,,1034.01,113.74,537.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-ENDO BIL PANC,74330,CPT,,,,,both,, ,1304.29,782.57,Medicaid,Illinois Medicaid,,1908.87,,,1304.29,143.47,678.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-LONG GI TUBE PLC,74340,CPT,,,,,both,, ,1359.02,815.41,Medicaid,Illinois Medicaid,,1145.32,,,1359.02,149.49,706.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-ENTEROCLYSIS PLAC,74355,CPT,,,,,both,, ,932.40,559.44,Medicaid,Illinois Medicaid,,196.02,,,932.40,102.56,484.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-IVP CR,74400,CPT,,,,,both,, ,1836.17,1101.70,Medicaid,Illinois Medicaid,,211.00,,,1836.17,201.98,954.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-UROGRAPH RETRO CR,74420,CPT,,,,,both,, ,2105.34,1263.20,Medicaid,Illinois Medicaid,,2030.68,,,2105.34,231.59,1094.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-UROGRAPHY ANTE CR,74425,CPT,,,,,both,, ,2165.12,1299.07,Medicaid,Illinois Medicaid,,1218.40,,,2165.12,238.16,1125.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-CYSTOGRM 3VPLS CR,74430,CPT,,,,,both,, ,1407.87,844.72,Medicaid,Illinois Medicaid,,196.02,,,1407.87,154.87,732.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-CAVERNOSOGRAPH CR,74445,CPT,,,,,both,, ,698.32,418.99,Medicaid,Illinois Medicaid,,211.00,,,698.32,76.82,363.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-UCG RETRO CR,74450,CPT,,,,,both,, ,1357.62,814.57,Medicaid,Illinois Medicaid,,1965.00,,,1357.62,149.34,705.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-UCG VOIDING,74455,CPT,,,,,both,, ,1357.62,814.57,Medicaid,Illinois Medicaid,,1179.00,,,1357.62,149.34,705.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-UCG VOIDING CR,74455,CPT,,,,,both,, ,1162.77,697.66,Medicaid,Illinois Medicaid,,196.02,,,1162.77,127.90,604.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-DILATION GU,74485,CPT,,,,,both,, ,976.75,586.05,Medicaid,Illinois Medicaid,,211.00,,,976.75,107.44,507.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-HYSTERSALPINGO CR,74740,CPT,,,,,both,,,1704.21,1704.21,Medicaid,Illinois Medicaid,,813.67,,,1704.21,187.46,886.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-HYSTERSALPINGO CR,74740,CPT,,,,,both,, ,1704.21,1022.52,Medicaid,Illinois Medicaid,,488.20,,,1704.21,187.46,886.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-HYSTERSALPINGOGRM,74740,CPT,,,,,both,,,1989.98,1989.98,Medicaid,Illinois Medicaid,,197.70,,,1989.98,218.90,1034.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-HYSTERSALPINGOGRM,74740,CPT,,,,,both,, ,1989.98,1193.98,Medicaid,Illinois Medicaid,,1931.60,,,1989.98,218.90,1034.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-PERINEOGRAM CR,74775,CPT,,,,,both,, ,1991.67,1195.00,Medicaid,Illinois Medicaid,,196.02,,,1991.67,219.08,1035.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-HT ACC LV RV W,75573,CPT,,,,,both,, ,580.15,348.09,Medicaid,Illinois Medicaid,,211.00,,,580.15,63.82,301.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-HT ACC LV RV W,75573,CPT,,,,,both,, ,1696.40,1017.84,Medicaid,Illinois Medicaid,,1158.96,,,1696.40,186.60,882.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-HT CARD FUNC W,75574,CPT,,,,,both,, ,580.15,348.09,Medicaid,Illinois Medicaid,,197.70,,,580.15,63.82,301.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-HT CARD FUNC W,75574,CPT,,,,,both,, ,1696.40,1017.84,Medicaid,Illinois Medicaid,,196.02,,,1696.40,186.60,882.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-ABD AORTA SERIAL,75625,CPT,,,,,both,, ,8483.00,5089.80,Medicaid,Illinois Medicaid,,211.00,,,8483.00,933.13,4411.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ABD AORTA SERIAL,75625,CPT,,,,,both,, ,9523.86,5714.31,Medicaid,Illinois Medicaid,,346.20,,,9523.86,1047.62,4952.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-AABF SERIAL     ,75630,CPT,,,,,both,, ,11199.75,6719.85,Medicaid,Illinois Medicaid,,388.68,,,11199.75,1231.97,5823.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-AABF SERIAL,75630,CPT,,,,,both,, ,12573.95,7544.37,Medicaid,Illinois Medicaid,,131.18,,,12573.95,1383.13,6538.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-ABD ART W RUNOFF,75635,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,141.28,,,650.88,71.60,338.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CTA-ABD ART W RUNOFF,75635,CPT,,,,,both,, ,2355.42,1413.25,Medicaid,Illinois Medicaid,,388.68,,,2355.42,259.10,1224.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-ANGIO EXTREM UNI,75710,CPT,,,,,both,, ,7520.75,4512.45,Medicaid,Illinois Medicaid,,196.02,,,7520.75,827.28,3910.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ANGIO EXTREM UNI,75710,CPT,,,,,both,, ,8443.54,5066.12,Medicaid,Illinois Medicaid,,211.00,,,8443.54,928.79,4390.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-ANGIO EXTREM BI ,75716,CPT,,,,,both,, ,7520.75,4512.45,Medicaid,Illinois Medicaid,,655.09,,,7520.75,827.28,3910.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ANGIO EXTREM BI,75716,CPT,,,,,both,, ,8423.33,5053.99,Medicaid,Illinois Medicaid,,393.05,,,8423.33,926.57,4380.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ANGIO VISCERAL SE,75726,CPT,,,,,both,, ,13364.62,8018.77,Medicaid,Illinois Medicaid,,211.00,,,13364.62,1470.11,6949.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ANG PULMONARY UNI,75741,CPT,,,,,both,, ,4237.35,2542.41,Medicaid,Illinois Medicaid,,718.92,,,4237.35,466.11,2203.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ANG PULMONARY BI,75743,CPT,,,,,both,, ,12357.84,7414.70,Medicaid,Illinois Medicaid,,196.02,,,12357.84,1359.36,6426.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-SHUNTOGRAM,75809,CPT,,,,,both,, ,386.21,231.72,Medicaid,Illinois Medicaid,,211.00,,,386.21,42.48,200.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,7641.75,4585.05,Medicaid,Illinois Medicaid,,475.90,,,7641.75,840.59,3973.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,8579.39,5147.63,Medicaid,Illinois Medicaid,,131.18,,,8579.39,943.73,4461.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,8579.39,5147.63,Medicaid,Illinois Medicaid,,141.28,,,8579.39,943.73,4461.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-VENOGRAM EXT BI ,75822,CPT,,,,,both,, ,3510.00,2106.00,Medicaid,Illinois Medicaid,,468.33,,,3510.00,386.10,1825.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-VENOGRAM EXT BI,75822,CPT,,,,,both,, ,3940.68,2364.40,Medicaid,Illinois Medicaid,,689.62,,,3940.68,433.47,2049.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-VENACAVAGRAM INF,75825,CPT,,,,,both,, ,8923.22,5353.93,Medicaid,Illinois Medicaid,,196.02,,,8923.22,981.55,4640.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-VENOUS SAMPL CATH,75893,CPT,,,,,both,, ,3915.41,2349.24,Medicaid,Illinois Medicaid,,211.00,,,3915.41,430.70,2036.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ANGIO EXIST CATH,75898,CPT,,,,,both,, ,513.35,308.01,Medicaid,Illinois Medicaid,,413.77,,,513.35,56.47,266.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-DRAIN TUBE CHANGE,75984,CPT,,,,,both,, ,2098.33,1258.99,Medicaid,Illinois Medicaid,,196.02,,,2098.33,230.82,1091.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-ABSC DRN CATH PLA,75989,CPT,,,,,both,, ,2649.01,1589.40,Medicaid,Illinois Medicaid,,211.00,,,2649.01,291.39,1377.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABSC DRN CATH PLA,75989,CPT,,,,,both,, ,1120.45,672.27,Medicaid,Illinois Medicaid,,1931.60,,,1120.45,123.25,582.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-FLUORO 1 HOUR,76000,CPT,,,,,both,, ,553.77,332.26,Medicaid,Illinois Medicaid,,1158.96,,,553.77,60.91,287.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-FLUORO 1 HOUR CR,76000,CPT,,,,,both,, ,474.31,284.58,Medicaid,Illinois Medicaid,,125.96,,,474.31,52.17,246.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,125.96,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,262.37,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,196.02,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,211.00,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,756.41,453.84,Medicaid,Illinois Medicaid,,2005.70,,,756.41,83.21,393.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-FISTULOGRAM CR,76080,CPT,,,,,both,, ,758.66,455.19,Medicaid,Illinois Medicaid,,1203.42,,,758.66,83.45,394.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EXAM SURG SPECMN CR,76098,CPT,,,,,both,, ,1190.34,714.20,Medicaid,Illinois Medicaid,,196.02,,,1190.34,130.94,618.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TOMOGRAM ONE PLNE CR,76100,CPT,,,,,both,, ,2030.12,1218.07,Medicaid,Illinois Medicaid,,211.00,,,2030.12,223.31,1055.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-3D W POSTPROCESS,76377,CPT,,,,,both,, ,528.50,317.10,Medicaid,Illinois Medicaid,,780.05,,,528.50,58.14,274.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-3D W POSTPROCESS,76377,CPT,,,,,both,, ,536.93,322.15,Medicaid,Illinois Medicaid,,196.02,,,536.93,59.06,279.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-3D W POSTPROCESS,76377,CPT,,,,,both,, ,491.18,294.70,Medicaid,Illinois Medicaid,,211.00,,,491.18,54.03,255.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,193.10,115.86,Medicaid,Illinois Medicaid,,227.01,,,193.10,21.24,100.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,207.98,124.78,Medicaid,Illinois Medicaid,,113.50,,,207.98,22.88,108.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,724.14,434.48,Medicaid,Illinois Medicaid,,131.18,,,724.14,79.66,376.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,141.28,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,478.60,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,,,2030.68,2030.68,Medicaid,Illinois Medicaid,,426.30,,,2030.68,223.37,1055.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,2030.68,1218.40,Medicaid,Illinois Medicaid,,1332.75,,,2030.68,223.37,1055.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,1332.75,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,362.74,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,1602.93,961.75,Medicaid,Illinois Medicaid,,1181.19,,,1602.93,176.32,833.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,218.64,131.18,Medicaid,Illinois Medicaid,,312.72,,,218.64,24.05,113.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,218.64,131.18,Medicaid,Illinois Medicaid,,332.26,,,218.64,24.05,113.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,1680.12,1008.07,Medicaid,Illinois Medicaid,,1589.40,,,1680.12,184.81,873.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-BREAST LIMITED,76642,CPT,,,,,both,, ,218.64,131.18,Medicaid,Illinois Medicaid,,1894.38,,,218.64,24.05,113.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-BREAST LIMITED,76642,CPT,,,,,both,, ,218.64,131.18,Medicaid,Illinois Medicaid,,404.83,,,218.64,24.05,113.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-BREAST LIMITED,76642,CPT,,,,,both,,,1680.12,1680.12,Medicaid,Illinois Medicaid,,404.83,,,1680.12,184.81,873.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-BREAST LIMITED,76642,CPT,,,,,both,, ,1680.12,1008.07,Medicaid,Illinois Medicaid,,463.27,,,1680.12,184.81,873.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,437.29,262.37,Medicaid,Illinois Medicaid,,498.48,,,437.29,48.10,227.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,437.29,262.37,Medicaid,Illinois Medicaid,,881.43,,,437.29,48.10,227.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,3359.95,2015.97,Medicaid,Illinois Medicaid,,463.27,,,3359.95,369.59,1747.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Ultrasound of abdomen,76700,CPT,,,,,both,,,2330.73,2330.73,Medicaid,Illinois Medicaid,,498.48,,,2330.73,256.38,1211.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,1133.86,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,107.12,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,2330.73,1398.43,Medicaid,Illinois Medicaid,,64.27,,,2330.73,256.38,1211.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,48.20,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,60.00,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABDOMEN LTD WO,76705,CPT,,,,,both,,,1908.87,1908.87,Medicaid,Illinois Medicaid,,246.89,,,1908.87,209.98,992.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,1908.87,1145.32,Medicaid,Illinois Medicaid,,246.89,,,1908.87,209.98,992.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,263.73,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,269.29,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABDOMEN RETROPER,76770,CPT,,,,,both,,,2030.68,2030.68,Medicaid,Illinois Medicaid,,448.82,,,2030.68,223.37,1055.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,2030.68,1218.40,Medicaid,Illinois Medicaid,,246.89,,,2030.68,223.37,1055.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,246.89,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,263.73,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,,,1965.00,1965.00,Medicaid,Illinois Medicaid,,334.18,,,1965.00,216.15,1021.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,1965.00,1179.00,Medicaid,Illinois Medicaid,,556.97,,,1965.00,216.15,1021.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,207.18,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,207.18,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELV PREG 14 WKS,76801,CPT,,,,,both,,,813.67,813.67,Medicaid,Illinois Medicaid,,220.93,,,813.67,89.50,423.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,813.67,488.20,Medicaid,Illinois Medicaid,,293.39,,,813.67,89.50,423.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PLV PRG 14 WKS AD,76802,CPT,,,,,both,, ,329.51,197.70,Medicaid,Illinois Medicaid,,220.00,,,329.51,36.25,171.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,76805,CPT,,,,,both,,,1931.60,1931.60,Medicaid,Illinois Medicaid,,488.99,,,1931.60,212.48,1004.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELVIS PREG,76805,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,83.52,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELVIS PREG,76805,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,83.52,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELVIS PREG,76805,CPT,,,,,both,, ,1931.60,1158.96,Medicaid,Illinois Medicaid,,89.92,,,1931.60,212.48,1004.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELVS PREG GESADD,76810,CPT,,,,,both,, ,329.51,197.70,Medicaid,Illinois Medicaid,,721.61,,,329.51,36.25,171.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,432.96,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,83.52,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,577.00,346.20,Medicaid,Illinois Medicaid,,89.92,,,577.00,63.47,300.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,647.80,388.68,Medicaid,Illinois Medicaid,,1904.10,,,647.80,71.26,336.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,218.64,131.18,Medicaid,Illinois Medicaid,,1142.46,,,218.64,24.05,113.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,235.48,141.28,Medicaid,Illinois Medicaid,,523.46,,,235.48,25.90,122.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,647.80,388.68,Medicaid,Illinois Medicaid,,314.07,,,647.80,71.26,336.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,132.36,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,142.47,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PLV PRG TRNSV,76817,CPT,,,,,both,,,655.09,655.09,Medicaid,Illinois Medicaid,,418.20,,,655.09,72.06,340.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,655.09,393.05,Medicaid,Illinois Medicaid,,250.92,,,655.09,72.06,340.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-FETAL BIO W NST,76818,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,132.36,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-FETAL BIO W NST,76818,CPT,,,,,both,, ,1198.20,718.92,Medicaid,Illinois Medicaid,,142.47,,,1198.20,131.80,623.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,142.47,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,142.47,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,793.18,475.90,Medicaid,Illinois Medicaid,,833.32,,,793.18,87.25,412.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,218.64,131.18,Medicaid,Illinois Medicaid,,499.99,,,218.64,24.05,113.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,235.48,141.28,Medicaid,Illinois Medicaid,,83.52,,,235.48,25.90,122.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,780.55,468.33,Medicaid,Illinois Medicaid,,89.92,,,780.55,85.86,405.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Ultrasound pelvis through vagina,76830,CPT,,,,,both,,,689.62,689.62,Medicaid,Illinois Medicaid,,1387.37,,,689.62,75.86,358.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,832.42,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,131.35,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,689.62,413.77,Medicaid,Illinois Medicaid,,141.46,,,689.62,75.86,358.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELVIS NON OB,76856,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,368.13,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELVIS NON OB,76856,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,131.35,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELVIS NON OB,76856,CPT,,,,,both,,,1931.60,1931.60,Medicaid,Illinois Medicaid,,141.46,,,1931.60,212.48,1004.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELVIS NON OB,76856,CPT,,,,,both,, ,1931.60,1158.96,Medicaid,Illinois Medicaid,,430.83,,,1931.60,212.48,1004.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,209.94,125.96,Medicaid,Illinois Medicaid,,258.49,,,209.94,23.09,109.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,209.94,125.96,Medicaid,Illinois Medicaid,,83.52,,,209.94,23.09,109.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,437.29,262.37,Medicaid,Illinois Medicaid,,89.92,,,437.29,48.10,227.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-SCROTUM,76870,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,160.14,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-SCROTUM,76870,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,615.22,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-SCROTUM,76870,CPT,,,,,both,,,2005.70,2005.70,Medicaid,Illinois Medicaid,,819.16,,,2005.70,220.63,1042.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-SCROTUM,76870,CPT,,,,,both,, ,2005.70,1203.42,Medicaid,Illinois Medicaid,,1031.75,,,2005.70,220.63,1042.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-TRANSRECTAL,76872,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,819.16,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-TRANSRECTAL,76872,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,1130.78,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-TRANSRECTAL,76872,CPT,,,,,both,, ,1300.09,780.05,Medicaid,Illinois Medicaid,,1130.78,,,1300.09,143.01,676.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,3197.84,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,845.58,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,378.35,227.01,Medicaid,Illinois Medicaid,,845.58,,,378.35,41.62,196.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,189.17,113.50,Medicaid,Illinois Medicaid,,845.58,,,189.17,20.81,98.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,218.64,131.18,Medicaid,Illinois Medicaid,,2950.64,,,218.64,24.05,113.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,235.48,141.28,Medicaid,Illinois Medicaid,,2298.03,,,235.48,25.90,122.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-VAS ACCSS SITES,76937,CPT,,,,,both,, ,797.67,478.60,Medicaid,Illinois Medicaid,,2298.03,,,797.67,87.74,414.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-VAS ACCSS SITES ,76937,CPT,,,,,both,, ,710.50,426.30,Medicaid,Illinois Medicaid,,2453.15,,,710.50,78.16,369.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-GUIDE NEEDLE PLAC,76942,CPT,,,,,both,, ,2221.26,1332.75,Medicaid,Illinois Medicaid,,4088.59,,,2221.26,244.34,1155.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-GUIDE AMNIOCENT,76946,CPT,,,,,both,, ,2221.26,1332.75,Medicaid,Illinois Medicaid,,2453.15,,,2221.26,244.34,1155.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-GUIDE INTRAOPERAT,76998,CPT,,,,,both,, ,604.57,362.74,Medicaid,Illinois Medicaid,,2049.44,,,604.57,66.50,314.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-FLUORO CVAD ANY,77001,CPT,,,,,both,, ,1968.65,1181.19,Medicaid,Illinois Medicaid,,3415.74,,,1968.65,216.55,1023.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-NEDL GUIDE FLUORO,77002,CPT,,,,,both,, ,521.21,312.72,Medicaid,Illinois Medicaid,,2049.44,,,521.21,57.33,271.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FL-FLUORO GUIDE SPIN,77003,CPT,,,,,both,, ,553.77,332.26,Medicaid,Illinois Medicaid,,926.22,,,553.77,60.91,287.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-GUIDE NEEDLE BX,77012,CPT,,,,,both,, ,2649.01,1589.40,Medicaid,Illinois Medicaid,,1228.12,,,2649.01,291.39,1377.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-GUIDE TISSUE ABLA,77013,CPT,,,,,both,, ,3157.31,1894.38,Medicaid,Illinois Medicaid,,2049.44,,,3157.31,347.30,1641.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-BREAST UNI WO,77046,CPT,,,,,both,, ,674.73,404.83,Medicaid,Illinois Medicaid,,2146.00,,,674.73,74.22,350.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-BREAST BIL WO,77047,CPT,,,,,both,, ,674.73,404.83,Medicaid,Illinois Medicaid,,1515.95,,,674.73,74.22,350.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,772.13,463.27,Medicaid,Illinois Medicaid,,1515.95,,,772.13,84.93,401.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,830.80,498.48,Medicaid,Illinois Medicaid,,3512.04,,,830.80,91.39,432.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,1469.05,881.43,Medicaid,Illinois Medicaid,,2107.22,,,1469.05,161.60,763.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,772.13,463.27,Medicaid,Illinois Medicaid,,2911.81,,,772.13,84.93,401.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,830.80,498.48,Medicaid,Illinois Medicaid,,1747.08,,,830.80,91.39,432.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,1889.78,1133.86,Medicaid,Illinois Medicaid,,1031.90,,,1889.78,207.88,982.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-TOMO MAMM SCR BI,77063,CPT,,,,,both,,,107.12,107.12,Medicaid,Illinois Medicaid,,2245.03,,,107.12,11.78,55.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-TOMO MAMM SCR BI,77063,CPT,,,,,both,, ,107.12,64.27,Medicaid,Illinois Medicaid,,7071.47,,,107.12,11.78,55.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-TOMO MAMM SCR UNI,77063,CPT,,,,,both,, ,80.34,48.20,Medicaid,Illinois Medicaid,,4242.88,,,80.34,8.84,41.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-TOMOSYN SCR AD BI,77063,CPT,,,,,both,, ,100.00,60.00,Medicaid,Illinois Medicaid,,2881.89,,,100.00,11.00,52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,411.49,246.89,Medicaid,Illinois Medicaid,,2049.44,,,411.49,45.26,213.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,411.49,246.89,Medicaid,Illinois Medicaid,,1910.70,,,411.49,45.26,213.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,439.55,263.73,Medicaid,Illinois Medicaid,,2049.44,,,439.55,48.35,228.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,448.82,269.29,Medicaid,Illinois Medicaid,,4088.59,,,448.82,49.37,233.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Mammography of one breast,77065,CPT,,,,,both,,,448.82,448.82,Medicaid,Illinois Medicaid,,2453.15,,,448.82,49.37,233.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,411.49,246.89,Medicaid,Illinois Medicaid,,2154.19,,,411.49,45.26,213.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,411.49,246.89,Medicaid,Illinois Medicaid,,6243.60,,,411.49,45.26,213.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,439.55,263.73,Medicaid,Illinois Medicaid,,3746.16,,,439.55,48.35,228.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,556.97,334.18,Medicaid,Illinois Medicaid,,5338.59,,,556.97,61.27,289.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Mammography of both breasts,77066,CPT,,,,,both,,,556.97,556.97,Medicaid,Illinois Medicaid,,969.64,,,556.97,61.27,289.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,345.31,207.18,Medicaid,Illinois Medicaid,,2154.19,,,345.31,37.98,179.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,345.31,207.18,Medicaid,Illinois Medicaid,,2881.57,,,345.31,37.98,179.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,368.23,220.93,Medicaid,Illinois Medicaid,,2881.57,,,368.23,40.51,191.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,488.99,293.39,Medicaid,Illinois Medicaid,,2881.57,,,488.99,53.79,254.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-DIG MAMMO SCRN UN,77067,CPT,,,,,both,, ,366.68,220.00,Medicaid,Illinois Medicaid,,370.64,,,366.68,40.33,190.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Mammography, screening, bilateral",77067,CPT,,,,,both,,,488.99,488.99,Medicaid,Illinois Medicaid,,2154.19,,,488.99,53.79,254.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,2754.49,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,2950.64,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2950.64,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE AGE STUDY CR,77072,CPT,,,,,both,,,721.61,721.61,Medicaid,Illinois Medicaid,,3677.87,,,721.61,79.38,375.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,721.61,432.96,Medicaid,Illinois Medicaid,,2754.49,,,721.61,79.38,375.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,3025.72,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,3150.87,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE LENGTH STUDY CR,77073,CPT,,,,,both,,,1904.10,1904.10,Medicaid,Illinois Medicaid,,356.12,,,1904.10,209.45,990.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,1904.10,1142.46,Medicaid,Illinois Medicaid,,1029.90,,,1904.10,209.45,990.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BNE SRVY LTD METS CR,77074,CPT,,,,,both,,,523.46,523.46,Medicaid,Illinois Medicaid,,17.51,,,523.46,57.58,272.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BNE SRVY LTD METS CR,77074,CPT,,,,,both,, ,523.46,314.07,Medicaid,Illinois Medicaid,,98.17,,,523.46,57.58,272.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,53.71,,,220.61,24.27,114.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,306.49,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BNE SRVY CMP METS CR,77075,CPT,,,,,both,,,418.20,418.20,Medicaid,Illinois Medicaid,,510.83,,,418.20,46.00,217.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,418.20,250.92,Medicaid,Illinois Medicaid,,1796.88,,,418.20,46.00,217.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,1078.12,,,220.61,24.27,114.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,44.46,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,234.24,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,630.96,,,237.45,26.12,123.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE SRVY INFANT CR,77076,CPT,,,,,both,,,833.32,833.32,Medicaid,Illinois Medicaid,,67.02,,,833.32,91.67,433.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,833.32,499.99,Medicaid,Illinois Medicaid,,378.57,,,833.32,91.67,433.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,1727.55,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,210.50,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
JOINT SURVEY 1V CR,77077,CPT,,,,,both,,,1387.37,1387.37,Medicaid,Illinois Medicaid,,1036.53,,,1387.37,152.61,721.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,1387.37,832.42,Medicaid,Illinois Medicaid,,565.84,,,1387.37,152.61,721.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,218.93,131.35,Medicaid,Illinois Medicaid,,52.03,,,218.93,24.08,113.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,235.77,141.46,Medicaid,Illinois Medicaid,,339.50,,,235.77,25.93,122.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,613.55,368.13,Medicaid,Illinois Medicaid,,339.50,,,613.55,67.49,319.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEXA AXIAL,77080,CPT,,,,,both,, ,218.93,131.35,Medicaid,Illinois Medicaid,,570.89,,,218.93,24.08,113.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEXA AXIAL,77080,CPT,,,,,both,, ,235.77,141.46,Medicaid,Illinois Medicaid,,55.06,,,235.77,25.93,122.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEXA AXIAL,77080,CPT,,,,,both,,,430.83,430.83,Medicaid,Illinois Medicaid,,342.53,,,430.83,47.39,224.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEXA AXIAL,77080,CPT,,,,,both,, ,430.83,258.49,Medicaid,Illinois Medicaid,,169.24,,,430.83,47.39,224.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,3484.29,,,139.21,15.31,72.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,2090.57,,,149.88,16.49,77.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,266.91,160.14,Medicaid,Illinois Medicaid,,51.87,,,266.91,29.36,138.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-THYR UPT S-M-SUPP,78012,CPT,,,,,both,, ,1025.37,615.22,Medicaid,Illinois Medicaid,,270.28,,,1025.37,112.79,533.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-THYROID IMG W-BF,78013,CPT,,,,,both,, ,1365.27,819.16,Medicaid,Illinois Medicaid,,450.48,,,1365.27,150.18,709.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-THY UPT IMG W-BF,78014,CPT,,,,,both,, ,1719.59,1031.75,Medicaid,Illinois Medicaid,,1130.16,,,1719.59,189.15,894.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-PAR PLAN THY IMG,78070,CPT,,,,,both,, ,1365.27,819.16,Medicaid,Illinois Medicaid,,111.63,,,1365.27,150.18,709.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-PARA PLN IMG SPEC,78071,CPT,,,,,both,, ,1884.64,1130.78,Medicaid,Illinois Medicaid,,104.41,,,1884.64,207.31,980.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-PAR PL IMG SPE CT,78072,CPT,,,,,both,, ,1884.64,1130.78,Medicaid,Illinois Medicaid,,414.77,,,1884.64,207.31,980.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-ADRENAL IMAGING,78075,CPT,,,,,both,, ,5329.74,3197.84,Medicaid,Illinois Medicaid,,327.71,,,5329.74,586.27,2771.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-BONE MARROW LMTD,78102,CPT,,,,,both,, ,1409.30,845.58,Medicaid,Illinois Medicaid,,621.75,,,1409.30,155.02,732.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-BONE MARROW MULT,78103,CPT,,,,,both,, ,1409.30,845.58,Medicaid,Illinois Medicaid,,53.04,,,1409.30,155.02,732.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-BONE MARROW BODY,78104,CPT,,,,,both,, ,1409.30,845.58,Medicaid,Illinois Medicaid,,54.89,,,1409.30,155.02,732.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-LYMPHATICS NODES,78195,CPT,,,,,both,, ,4917.74,2950.64,Medicaid,Illinois Medicaid,,933.30,,,4917.74,540.95,2557.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-LIVER,78201,CPT,,,,,both,, ,3830.06,2298.03,Medicaid,Illinois Medicaid,,933.30,,,3830.06,421.31,1991.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-LIVER AND SPLEEN,78215,CPT,,,,,both,, ,3830.06,2298.03,Medicaid,Illinois Medicaid,,933.30,,,3830.06,421.31,1991.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-HEPATOBILIARY SYS,78226,CPT,,,,,both,, ,4088.59,2453.15,Medicaid,Illinois Medicaid,,57.25,,,4088.59,449.74,2126.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-HEPATOBIL W PHARM,78227,CPT,,,,,both,,,4088.59,4088.59,Medicaid,Illinois Medicaid,,57.25,,,4088.59,449.74,2126.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-HEPATOBIL W PHARM,78227,CPT,,,,,both,, ,4088.59,2453.15,Medicaid,Illinois Medicaid,,78.13,,,4088.59,449.74,2126.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-GI REFLUX,78262,CPT,,,,,both,, ,3415.74,2049.44,Medicaid,Illinois Medicaid,,472.54,,,3415.74,375.73,1776.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-GASTRIC EMPTYING,78264,CPT,,,,,both,,,3415.74,3415.74,Medicaid,Illinois Medicaid,,78.13,,,3415.74,375.73,1776.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-GASTRIC EMPTYING,78264,CPT,,,,,both,, ,3415.74,2049.44,Medicaid,Illinois Medicaid,,414.63,,,3415.74,375.73,1776.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-GAST EMPT SM BWL,78265,CPT,,,,,both,, ,1543.71,926.22,Medicaid,Illinois Medicaid,,79.65,,,1543.71,169.81,802.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-GE SM BWL CLN MUL,78266,CPT,,,,,both,, ,2046.87,1228.12,Medicaid,Illinois Medicaid,,711.79,,,2046.87,225.16,1064.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-GI BLOOD LOSS,78278,CPT,,,,,both,, ,3415.74,2049.44,Medicaid,Illinois Medicaid,,427.07,,,3415.74,375.73,1776.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-MECKELS SCAN,78290,CPT,,,,,both,, ,3576.68,2146.00,Medicaid,Illinois Medicaid,,414.63,,,3576.68,393.43,1859.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-BONE SCAN LMTD,78300,CPT,,,,,both,, ,2526.59,1515.95,Medicaid,Illinois Medicaid,,79.65,,,2526.59,277.92,1313.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-BONE SCAN MULTI,78305,CPT,,,,,both,, ,2526.59,1515.95,Medicaid,Illinois Medicaid,,427.07,,,2526.59,277.92,1313.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-BONE SCAN BODY,78306,CPT,,,,,both,,,3512.04,3512.04,Medicaid,Illinois Medicaid,,115.19,,,3512.04,386.32,1826.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-BONE SCAN BODY,78306,CPT,,,,,both,, ,3512.04,2107.22,Medicaid,Illinois Medicaid,,518.51,,,3512.04,386.32,1826.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-BONE SCAN 3 PHASE,78315,CPT,,,,,both,,,2911.81,2911.81,Medicaid,Illinois Medicaid,,64.15,,,2911.81,320.30,1514.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-BONE SCAN 3 PHASE,78315,CPT,,,,,both,, ,2911.81,1747.08,Medicaid,Illinois Medicaid,,540.57,,,2911.81,320.30,1514.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-VASCULAR FLOW,78445,CPT,,,,,both,, ,1719.84,1031.90,Medicaid,Illinois Medicaid,,63.31,,,1719.84,189.18,894.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-MYOCRD SPECT SNGL,78451,CPT,,,,,both,, ,3741.73,2245.03,Medicaid,Illinois Medicaid,,61.47,,,3741.73,411.59,1945.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-MYOCRD SPECT MULT,78452,CPT,,,,,both,,,7071.47,7071.47,Medicaid,Illinois Medicaid,,522.73,,,7071.47,777.86,3677.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-MYOCRD SPECT MULT,78452,CPT,,,,,both,, ,7071.47,4242.88,Medicaid,Illinois Medicaid,,63.31,,,7071.47,777.86,3677.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-MYOCARD SINGLE,78453,CPT,,,,,both,, ,4803.15,2881.89,Medicaid,Illinois Medicaid,,63.31,,,4803.15,528.35,2497.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-MYOCARD INFARCT,78466,CPT,,,,,both,, ,3415.74,2049.44,Medicaid,Illinois Medicaid,,522.73,,,3415.74,375.73,1776.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-MYOCARD INF SPECT,78469,CPT,,,,,both,, ,3184.50,1910.70,Medicaid,Illinois Medicaid,,522.73,,,3184.50,350.30,1655.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-GATED BLD POOL SN,78472,CPT,,,,,both,, ,3415.74,2049.44,Medicaid,Illinois Medicaid,,63.31,,,3415.74,375.73,1776.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-LUNG VENT IMAGING,78579,CPT,,,,,both,,,4088.59,4088.59,Medicaid,Illinois Medicaid,,420.72,,,4088.59,449.74,2126.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-LUNG VENT IMAGING,78579,CPT,,,,,both,, ,4088.59,2453.15,Medicaid,Illinois Medicaid,,252.43,,,4088.59,449.74,2126.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-LUNG PERF PARTICU,78580,CPT,,,,,both,, ,3590.32,2154.19,Medicaid,Illinois Medicaid,,115.19,,,3590.32,394.94,1866.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-LUNG VENT PERFUS,78582,CPT,,,,,both,,,6243.60,6243.60,Medicaid,Illinois Medicaid,,86.22,,,6243.60,686.80,3246.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-LUNG VENT PERFUS,78582,CPT,,,,,both,, ,6243.60,3746.16,Medicaid,Illinois Medicaid,,73.42,,,6243.60,686.80,3246.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-LUNG PERFVENT DIF,78598,CPT,,,,,both,, ,8897.66,5338.59,Medicaid,Illinois Medicaid,,73.42,,,8897.66,978.74,4626.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-BRAIN CSF CISTERN,78630,CPT,,,,,both,, ,1616.07,969.64,Medicaid,Illinois Medicaid,,72.57,,,1616.07,177.77,840.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-KIDNEY STATIC,78700,CPT,,,,,both,, ,3590.32,2154.19,Medicaid,Illinois Medicaid,,522.73,,,3590.32,394.94,1866.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-KIDNEY STATIC FLO,78701,CPT,,,,,both,, ,4802.63,2881.57,Medicaid,Illinois Medicaid,,522.73,,,4802.63,528.29,2497.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-KIDNEY VF NO PHRM,78707,CPT,,,,,both,, ,4802.63,2881.57,Medicaid,Illinois Medicaid,,508.58,,,4802.63,528.29,2497.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-KID VF PHRM SNGL,78708,CPT,,,,,both,, ,4802.63,2881.57,Medicaid,Illinois Medicaid,,508.58,,,4802.63,528.29,2497.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-KIDNEY FUNCTION,78725,CPT,,,,,both,, ,617.74,370.64,Medicaid,Illinois Medicaid,,84.03,,,617.74,67.95,321.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-URIN BLDDR REFLUX,78740,CPT,,,,,both,, ,3590.32,2154.19,Medicaid,Illinois Medicaid,,55.06,,,3590.32,394.94,1866.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-TUMOR LOC LMTD,78800,CPT,,,,,both,, ,4590.83,2754.49,Medicaid,Illinois Medicaid,,55.06,,,4590.83,504.99,2387.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-TUMOR LOC LMTD 1D,78800,CPT,,,,,both,, ,4917.74,2950.64,Medicaid,Illinois Medicaid,,1054.54,,,4917.74,540.95,2557.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-TUMOR LOC MULTI,78801,CPT,,,,,both,, ,4917.74,2950.64,Medicaid,Illinois Medicaid,,527.27,,,4917.74,540.95,2557.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-TUMOR LOC BDY 1D,78802,CPT,,,,,both,, ,6129.79,3677.87,Medicaid,Illinois Medicaid,,540.57,,,6129.79,674.28,3187.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-TUMOR LOC BODY,78802,CPT,,,,,both,, ,4590.83,2754.49,Medicaid,Illinois Medicaid,,459.57,,,4590.83,504.99,2387.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-TUMR LOC SPECT 1D,78803,CPT,,,,,both,, ,5042.88,3025.72,Medicaid,Illinois Medicaid,,154.26,,,5042.88,554.72,2622.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-TUMR LOC BDY >1D,78804,CPT,,,,,both,, ,5251.46,3150.87,Medicaid,Illinois Medicaid,,154.26,,,5251.46,577.66,2730.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NM-UNLISTED MISC,78999,CPT,,,,,both,, ,593.54,356.12,Medicaid,Illinois Medicaid,,493.42,,,593.54,65.29,308.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NUCLEAR RX IV ADMIN,79101,CPT,,,,,both,, ,1716.50,1029.90,Medicaid,Illinois Medicaid,,493.42,,,1716.50,188.82,892.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BASIC META W-ION CA,80047,CPT,,,,,both,, ,29.19,17.51,Medicaid,Illinois Medicaid,,468.66,,,29.19,3.21,15.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BASIC META W-ION CA,80047,CPT,,,,,both,, ,163.63,98.17,Medicaid,Illinois Medicaid,,89.76,,,163.63,18.00,85.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BASIC METABO CA TOTA,80048,CPT,,,,,both,, ,89.53,53.71,Medicaid,Illinois Medicaid,,89.76,,,89.53,9.85,46.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BASIC METABO CA TOTA,80048,CPT,,,,,both,, ,510.83,306.49,Medicaid,Illinois Medicaid,,86.22,,,510.83,56.19,265.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Basic metabolic panel,80048,CPT,,,,,both,,,510.83,510.83,Medicaid,Illinois Medicaid,,45.30, ,,510.83,56.19,265.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GENERAL HEALTH PANEL,80050,CPT,,,,,both,,,1796.88,1796.88,Medicaid,Illinois Medicaid,,267.42,,,1796.88,197.66,934.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GENERAL HEALTH PANEL,80050,CPT,,,,,both,, ,1796.88,1078.12,Medicaid,Illinois Medicaid,,459.57,,,1796.88,197.66,934.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELECTROLYTE PANEL,80051,CPT,,,,,both,, ,74.10,44.46,Medicaid,Illinois Medicaid,,63.31,,,74.10,8.15,38.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELECTROLYTE PANEL,80051,CPT,,,,,both,, ,390.41,234.24,Medicaid,Illinois Medicaid,,63.31,,,390.41,42.95,203.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Blood test, comprehensive group of blood chemicals",80053,CPT,,,,,both,,,630.96,630.96,Medicaid,Illinois Medicaid,,300.66,,,630.96,69.41,328.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COMP METAB PANEL,80053,CPT,,,,,both,, ,111.70,67.02,Medicaid,Illinois Medicaid,,95.79,,,111.70,12.29,58.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COMP METAB PANEL,80053,CPT,,,,,both,, ,630.96,378.57,Medicaid,Illinois Medicaid,,119.27,,,630.96,69.41,328.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Obstetric blood test panel,80055,CPT,,,,,both,,,1727.55,1727.55,Medicaid,Illinois Medicaid,,524.07,,,1727.55,190.03,898.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OBSTETRIC PANEL,80055,CPT,,,,,both,, ,350.84,210.50,Medicaid,Illinois Medicaid,,89.04,,,350.84,38.59,182.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OBSTETRIC PANEL,80055,CPT,,,,,both,, ,1727.55,1036.53,Medicaid,Illinois Medicaid,,327.71,,,1727.55,190.03,898.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Blood test, lipids (cholesterol and triglycerides)",80061,CPT,,,,,both,,,565.84,565.84,Medicaid,Illinois Medicaid,,327.71,,,565.84,62.24,294.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LIPID PANEL,80061,CPT,,,,,both,, ,86.73,52.03,Medicaid,Illinois Medicaid,,205.20,,,86.73,9.54,45.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q92145 LIPID PANEL,80061,CPT,,,,,both,, ,565.84,339.50,Medicaid,Illinois Medicaid,,486.85,,,565.84,62.24,294.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q92145 LIPID PANEL,80061,CPT,,,,,both,, ,565.84,339.50,Medicaid,Illinois Medicaid,,82.68,,,565.84,62.24,294.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Kidney function panel test,80069,CPT,,,,,both,,,570.89,570.89,Medicaid,Illinois Medicaid,,82.68,,,570.89,62.80,296.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RENAL FUNCTION PANEL,80069,CPT,,,,,both,, ,91.77,55.06,Medicaid,Illinois Medicaid,,216.00,,,91.77,10.09,47.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RENAL FUNCTION PANEL,80069,CPT,,,,,both,, ,570.89,342.53,Medicaid,Illinois Medicaid,,69.60,,,570.89,62.80,296.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,, ,282.08,169.24,Medicaid,Illinois Medicaid,,36.00,,,282.08,31.03,146.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,,,3484.29,3484.29,Medicaid,Illinois Medicaid,,36.00,,,3484.29,383.27,1811.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,, ,3484.29,2090.57,Medicaid,Illinois Medicaid,,120.00,,,3484.29,383.27,1811.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPATIC FUNCTION PAN,80076,CPT,,,,,both,, ,86.45,51.87,Medicaid,Illinois Medicaid,,80.32,,,86.45,9.51,44.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPATIC FUNCTION PAN,80076,CPT,,,,,both,, ,450.48,270.28,Medicaid,Illinois Medicaid,,80.32,,,450.48,49.55,234.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Liver function blood test panel,80076,CPT,,,,,both,,,450.48,450.48,Medicaid,Illinois Medicaid,,1174.34,,,450.48,49.55,234.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OBSTETRIC PNL W HIV,80081,CPT,,,,,both,, ,1883.60,1130.16,Medicaid,Illinois Medicaid,,704.60,,,1883.60,207.20,979.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ACETAMINOPHEN QT,80143,CPT,,,,,both,, ,186.06,111.63,Medicaid,Illinois Medicaid,,704.60,,,186.06,20.47,96.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36298 ADM LEV IBD,80145,CPT,,,,,both,, ,174.02,104.41,Medicaid,Illinois Medicaid,,436.84,,,174.02,19.14,90.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMIKACIN,80150,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,428.08,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36721 AMIOD HPLC/LC,80151,CPT,,,,,both,, ,546.19,327.71,Medicaid,Illinois Medicaid,,428.08,,,546.19,60.08,284.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CARBAMAZEPINE TOTAL,80156,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,428.08,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q18948 CBZ FREE LCMS,80157,CPT,,,,,both,, ,88.40,53.04,Medicaid,Illinois Medicaid,,110.80,,,88.40,9.72,45.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYCLOSPORINE,80158,CPT,,,,,both,, ,91.49,54.89,Medicaid,Illinois Medicaid,,110.80,,,91.49,10.06,47.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYCLOSPORINE,80158,CPT,,,,,both,, ,1555.50,933.30,Medicaid,Illinois Medicaid,,80.32,,,1555.50,171.11,808.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15220CYC A BL LCMSM,80158,CPT,,,,,both,, ,1555.50,933.30,Medicaid,Illinois Medicaid,,161.49,,,1555.50,171.11,808.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8812 CYA TRGH BL IA,80158,CPT,,,,,both,, ,1555.50,933.30,Medicaid,Illinois Medicaid,,80.32,,,1555.50,171.11,808.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q1769 CLOZAP LCMSMS,80159,CPT,,,,,both,, ,95.43,57.25,Medicaid,Illinois Medicaid,,462.60,,,95.43,10.50,49.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q1769 CLOZAP LCMSMS,80159,CPT,,,,,both,, ,95.43,57.25,Medicaid,Illinois Medicaid,,80.32,,,95.43,10.50,49.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DIGOXIN TOTAL,80162,CPT,,,,,both,, ,130.23,78.13,Medicaid,Illinois Medicaid,,495.95,,,130.23,14.33,67.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DIGOXIN TOTAL,80162,CPT,,,,,both,, ,787.57,472.54,Medicaid,Illinois Medicaid,,495.95,,,787.57,86.63,409.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DIGOXIN FREE,80163,CPT,,,,,both,, ,130.23,78.13,Medicaid,Illinois Medicaid,,495.95,,,130.23,14.33,67.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q6651 VALP ACID TOT,80164,CPT,,,,,both,, ,691.06,414.63,Medicaid,Illinois Medicaid,,495.95,,,691.06,76.02,359.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VALPROIC ACID TOTAL,80164,CPT,,,,,both,, ,132.76,79.65,Medicaid,Illinois Medicaid,,495.95,,,132.76,14.60,69.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VALPROIC ACID TOTAL,80164,CPT,,,,,both,,,711.79,711.79,Medicaid,Illinois Medicaid,,495.95,,,711.79,78.30,370.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VALPROIC ACID TOTAL,80164,CPT,,,,,both,, ,711.79,427.07,Medicaid,Illinois Medicaid,,342.87,,,711.79,78.30,370.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q6651 VALP ACID FREE,80165,CPT,,,,,both,, ,691.06,414.63,Medicaid,Illinois Medicaid,,80.32,,,691.06,76.02,359.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VALPROIC ACID FREE,80165,CPT,,,,,both,, ,132.76,79.65,Medicaid,Illinois Medicaid,,556.90,,,132.76,14.60,69.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VALPROIC ACID FREE,80165,CPT,,,,,both,, ,711.79,427.07,Medicaid,Illinois Medicaid,,80.32,,,711.79,78.30,370.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q3081 FELBAMATE MS,80167,CPT,,,,,both,, ,191.99,115.19,Medicaid,Illinois Medicaid,,80.32,,,191.99,21.12,99.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ETHOSUXIMIDE,80168,CPT,,,,,both,, ,864.19,518.51,Medicaid,Illinois Medicaid,,486.85,,,864.19,95.06,449.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q18883 EVEROLI LM/MS,80169,CPT,,,,,both,, ,106.93,64.15,Medicaid,Illinois Medicaid,,80.32,,,106.93,11.76,55.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GENTAMICIN,80170,CPT,,,,,both,, ,900.96,540.57,Medicaid,Illinois Medicaid,,360.00,,,900.96,99.11,468.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GABAPENTIN QT,80171,CPT,,,,,both,, ,105.53,63.31,Medicaid,Illinois Medicaid,,488.54,,,105.53,11.61,54.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L716811 GABAP LCMSMS,80171,CPT,,,,,both,, ,102.46,61.47,Medicaid,Illinois Medicaid,,488.54,,,102.46,11.27,53.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HALOPERIDOL,80173,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,80.32,,,871.22,95.83,453.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q22060 LAMOTR LCMSMS,80175,CPT,,,,,both,, ,105.53,63.31,Medicaid,Illinois Medicaid,,80.32,,,105.53,11.61,54.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q22060 LAMOTR LCMSMS,80175,CPT,,,,,both,, ,105.53,63.31,Medicaid,Illinois Medicaid,,80.32,,,105.53,11.61,54.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q605 LIDOCAINE IA,80176,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,71.55,,,871.22,95.83,453.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q605 LIDOCAINE IA,80176,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,88.74,,,871.22,95.83,453.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15142 LEVE LC/MS/MS,80177,CPT,,,,,both,, ,105.53,63.31,Medicaid,Illinois Medicaid,,180.00,,,105.53,11.61,54.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Lithium,80178,CPT,,,,,both,,,420.72,420.72,Medicaid,Illinois Medicaid,,80.32,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LITHIUM,80178,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,320.64,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SALICYLATE QT,80179,CPT,,,,,both,, ,191.99,115.19,Medicaid,Illinois Medicaid,,80.32,,,191.99,21.12,99.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10662 MPA LC/MS/MS,80180,CPT,,,,,both,, ,143.71,86.22,Medicaid,Illinois Medicaid,,320.64,,,143.71,15.81,74.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36637 OCBZ LC/MS/MS,80183,CPT,,,,,both,, ,122.37,73.42,Medicaid,Illinois Medicaid,,80.32,,,122.37,13.46,63.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36637 OCBZ LC/MS/MS,80183,CPT,,,,,both,, ,122.37,73.42,Medicaid,Illinois Medicaid,,136.74,,,122.37,13.46,63.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHENOBARBITAL,80184,CPT,,,,,both,, ,120.96,72.57,Medicaid,Illinois Medicaid,,80.32,,,120.96,13.31,62.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q751 PHENOBARBITAL,80184,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,80.32,,,871.22,95.83,453.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q751 PHENOBARBITAL,80184,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,196.52,,,871.22,95.83,453.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L70706 PHENYTOIN TOT,80185,CPT,,,,,both,, ,847.64,508.58,Medicaid,Illinois Medicaid,,80.02,,,847.64,93.24,440.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L70706 PHENYTOIN TOT,80185,CPT,,,,,both,, ,847.64,508.58,Medicaid,Illinois Medicaid,,242.50,,,847.64,93.24,440.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHENYTOIN TOTAL,80185,CPT,,,,,both,, ,140.05,84.03,Medicaid,Illinois Medicaid,,242.50,,,140.05,15.41,72.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L70706PHENYTOIN FREE,80186,CPT,,,,,both,, ,91.77,55.06,Medicaid,Illinois Medicaid,,80.32,,,91.77,10.09,47.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L70706PHENYTOIN FREE,80186,CPT,,,,,both,, ,91.77,55.06,Medicaid,Illinois Medicaid,,80.32,,,91.77,10.09,47.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRIMIDONE,80188,CPT,,,,,both,, ,1757.58,1054.54,Medicaid,Illinois Medicaid,,80.32,,,1757.58,193.33,913.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q751 PRIMIDONE,80188,CPT,,,,,both,, ,878.79,527.27,Medicaid,Illinois Medicaid,,80.32,,,878.79,96.67,456.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROCAINAMIDE+NAPA,80192,CPT,,,,,both,, ,900.96,540.57,Medicaid,Illinois Medicaid,,80.32,,,900.96,99.11,468.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
QUINIDINE,80194,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,80.32,,,765.96,84.26,398.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SIROLIMUS,80195,CPT,,,,,both,, ,257.10,154.26,Medicaid,Illinois Medicaid,,257.14,,,257.10,28.28,133.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SIROLIMUS,80195,CPT,,,,,both,, ,257.10,154.26,Medicaid,Illinois Medicaid,,257.14,,,257.10,28.28,133.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q70007 TAC HS LCMSMS,80197,CPT,,,,,both,, ,822.37,493.42,Medicaid,Illinois Medicaid,,80.32,,,822.37,90.46,427.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q70007 TAC HS LCMSMS,80197,CPT,,,,,both,, ,822.37,493.42,Medicaid,Illinois Medicaid,,486.85,,,822.37,90.46,427.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THEOPHYLLINE,80198,CPT,,,,,both,, ,781.11,468.66,Medicaid,Illinois Medicaid,,80.32,,,781.11,85.92,406.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"THEOPHYLLINE, SERUM",80198,CPT,,,,,both,, ,149.60,89.76,Medicaid,Illinois Medicaid,,80.32,,,149.60,16.46,77.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"THEOPHYLLINE, SERUM",80198,CPT,,,,,both,, ,149.60,89.76,Medicaid,Illinois Medicaid,,80.32,,,149.60,16.46,77.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TIAGABINE QT,80199,CPT,,,,,both,, ,143.71,86.22,Medicaid,Illinois Medicaid,,80.32,,,143.71,15.81,74.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TOBRAMYCIN,80200,CPT,,,,,both,, ,75.50,45.30,Medicaid,Illinois Medicaid,,80.32,,,75.50,8.31,39.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TOPIRAMATE,80201,CPT,,,,,both,, ,445.71,267.42,Medicaid,Illinois Medicaid,,247.20,,,445.71,49.03,231.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VANCOMYCIN,80202,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,80.32,,,765.96,84.26,398.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ZONISAMIDE,80203,CPT,,,,,both,, ,105.53,63.31,Medicaid,Illinois Medicaid,,327.71,,,105.53,11.61,54.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ZONISAMIDE,80203,CPT,,,,,both,, ,105.53,63.31,Medicaid,Illinois Medicaid,,342.87,,,105.53,11.61,54.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q648 METHOTREXATE IA,80204,CPT,,,,,both,, ,501.10,300.66,Medicaid,Illinois Medicaid,,80.32,,,501.10,55.12,260.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L503870 INFLIXIMAB,80230,CPT,,,,,both,, ,159.65,95.79,Medicaid,Illinois Medicaid,,240.26,,,159.65,17.56,83.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L504567 VEDOLIZUMAB,80280,CPT,,,,,both,, ,198.79,119.27,Medicaid,Illinois Medicaid,,20.03,,,198.79,21.87,103.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DRUG UNSPEC QUANT,80299,CPT,,,,,both,, ,873.46,524.07,Medicaid,Illinois Medicaid,,144.15,,,873.46,96.08,454.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L7609 DOXEPIN LCMSMS,80299,CPT,,,,,both,, ,148.40,89.04,Medicaid,Illinois Medicaid,,210.50,,,148.40,16.32,77.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q2548 DRUG UNSPEC QT,80299,CPT,,,,,both,, ,546.19,327.71,Medicaid,Illinois Medicaid,,14.31,,,546.19,60.08,284.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q2548 DRUG UNSPEC QT,80299,CPT,,,,,both,, ,546.19,327.71,Medicaid,Illinois Medicaid,,126.30,,,546.19,60.08,284.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q29391DEXAMET LCMSMS,80299,CPT,,,,,both,, ,342.00,205.20,Medicaid,Illinois Medicaid,,108.11,,,342.00,37.62,177.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8389 FLUOXET LCMSMS,80299,CPT,,,,,both,, ,811.42,486.85,Medicaid,Illinois Medicaid,,6.33,,,811.42,89.26,421.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRS DRG IA VIS,80305,CPT,,,,,both,, ,137.80,82.68,Medicaid,Illinois Medicaid,,108.11,,,137.80,15.16,71.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRS DRG IA MET,80306,CPT,,,,,both,, ,137.80,82.68,Medicaid,Illinois Medicaid,,14.14,,,137.80,15.16,71.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
733726 URINE DRUG PROFILE 14/MEDWATCH,80307,CPT,,,,,both,, ,360.00,216.00,Medicaid,Illinois Medicaid,,420.72,,,360.00,39.60,187.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DRUGPROF ORAL FLD,80307,CPT,,,,,both,, ,116.00,69.60,Medicaid,Illinois Medicaid,,252.43,,,116.00,12.76,60.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L074401 AMPH UR SCRN,80307,CPT,,,,,both,, ,60.00,36.00,Medicaid,Illinois Medicaid,,18.38,,,60.00,6.60,31.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L074401 AMPH UR SCRN,80307,CPT,,,,,both,, ,60.00,36.00,Medicaid,Illinois Medicaid,,3156.75,,,60.00,6.60,31.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L733740 ULTRM SCR UR,80307,CPT,,,,,both,, ,200.00,120.00,Medicaid,Illinois Medicaid,,1075.20,,,200.00,22.00,104,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 DAB SCN PRES,80307,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,331.33,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 DAB SCN PRES,80307,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,292.69,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRS DRG IA ANAZ,80307,CPT,,,,,both,,,1174.34,1174.34,Medicaid,Illinois Medicaid,,236.30,,,1174.34,129.18,610.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19027 CONF DRUG 1 U,80307,CPT,,,,,both,, ,1174.34,704.60,Medicaid,Illinois Medicaid,,405.00,,,1174.34,129.18,610.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19027 CONF DRUG 1 U,80307,CPT,,,,,both,, ,1174.34,704.60,Medicaid,Illinois Medicaid,,660.00,,,1174.34,129.18,610.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q643 METHYL ALC BL C,80320,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,558.00,,,728.07,80.09,378.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALKALOIDS NOS MS,80323,CPT,,,,,both,, ,713.47,428.08,Medicaid,Illinois Medicaid,,360.00,,,713.47,78.48,371,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q90642NIC&COT S LCMS,80323,CPT,,,,,both,, ,713.47,428.08,Medicaid,Illinois Medicaid,,366.00,,,713.47,78.48,371,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q90646NIC&COT U LCMS,80323,CPT,,,,,both,, ,713.47,428.08,Medicaid,Illinois Medicaid,,578.13,,,713.47,78.48,371,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q241Z AMPHET U GC/MS,80324,CPT,,,,,both,, ,184.68,110.80,Medicaid,Illinois Medicaid,,1310.19,,,184.68,20.31,96.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q241Z AMPHET U GC/MS,80324,CPT,,,,,both,, ,184.68,110.80,Medicaid,Illinois Medicaid,,655.09,,,184.68,20.31,96.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 AMPH MS 5P,80326,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,1310.19,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANABOLC STRD MS 1-2,80327,CPT,,,,,both,, ,269.16,161.49,Medicaid,Illinois Medicaid,,1310.19,,,269.16,29.61,139.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 ANLGNO MS 6P,80331,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,1117.87,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANTIDPRS SERO MS 3-5,80333,CPT,,,,,both,, ,771.01,462.60,Medicaid,Illinois Medicaid,,2038.03,,,771.01,84.81,400.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 AD MS 6PL,80334,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,2038.03,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q272 NORTRI LC/MS/MS,80335,CPT,,,,,both,, ,826.59,495.95,Medicaid,Illinois Medicaid,,286.62,,,826.59,90.92,429.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q272 NORTRI LC/MS/MS,80335,CPT,,,,,both,, ,826.59,495.95,Medicaid,Illinois Medicaid,,783.93,,,826.59,90.92,429.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q412 DESIPRAM LCMSMS,80335,CPT,,,,,both,, ,826.59,495.95,Medicaid,Illinois Medicaid,,854.48,,,826.59,90.92,429.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q412 DESIPRAM LCMSMS,80335,CPT,,,,,both,, ,826.59,495.95,Medicaid,Illinois Medicaid,,854.48,,,826.59,90.92,429.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q887 IMIPRAM LCMSMS,80335,CPT,,,,,both,, ,826.59,495.95,Medicaid,Illinois Medicaid,,1356.00,,,826.59,90.92,429.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q887 IMIPRAM LCMSMS,80335,CPT,,,,,both,, ,826.59,495.95,Medicaid,Illinois Medicaid,,519.02,,,826.59,90.92,429.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANTIDPRS TRIC MS 3-5,80336,CPT,,,,,both,, ,571.45,342.87,Medicaid,Illinois Medicaid,,211.34,,,571.45,62.86,297.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 ADEP TRI 6PL,80337,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,2335.44,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANTIDPRS NOS MS,80338,CPT,,,,,both,, ,928.18,556.90,Medicaid,Illinois Medicaid,,2335.44,,,928.18,102.10,482.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 AD NOS MS,80338,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,576.11,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 AED MS 7P,80341,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,381.94,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANTIPSYCH NOS MS 1-3,80342,CPT,,,,,both,, ,811.42,486.85,Medicaid,Illinois Medicaid,,411.00,,,811.42,89.26,421.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 APD MS 7P,80344,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,1815.30,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L809630 FLTZP MS,80346,CPT,,,,,both,, ,600.00,360.00,Medicaid,Illinois Medicaid,,2038.03,,,600.00,66.00,312,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q340 CLONAZEP LCMSMS,80346,CPT,,,,,both,, ,814.24,488.54,Medicaid,Illinois Medicaid,,405.00,,,814.24,89.57,423.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q340 CLONAZEP LCMSMS,80346,CPT,,,,,both,, ,814.24,488.54,Medicaid,Illinois Medicaid,,421.18,,,814.24,89.57,423.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 BZD MS 13P,80347,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,491.74,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 BUP MS,80348,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,150.21,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 BUP MS,80348,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,366.45,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q93031 BUPRENOPHINE & METABOLITIES LC/MS,80348,CPT,,,,,both,, ,119.25,71.55,Medicaid,Illinois Medicaid,,141.06,,,119.25,13.12,62.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CANNABINDS NATUR MS,80349,CPT,,,,,both,, ,147.91,88.74,Medicaid,Illinois Medicaid,,434.65,,,147.91,16.27,76.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790697 SYNCBD WB MS,80352,CPT,,,,,both,, ,300.00,180.00,Medicaid,Illinois Medicaid,,370.82,,,300.00,33.00,156,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 COCAINE MS,80353,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,200.85,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FENTANYL MS,80354,CPT,,,,,both,, ,534.41,320.64,Medicaid,Illinois Medicaid,,637.24,,,534.41,58.79,277.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 FENT MET MS,80354,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,637.24,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GABAPENTIN NONBLD MS,80355,CPT,,,,,both,, ,534.41,320.64,Medicaid,Illinois Medicaid,,519.02,,,534.41,58.79,277.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 GPT NBLD MS,80355,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,519.02,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEROIN METABOLITE MS,80356,CPT,,,,,both,, ,227.91,136.74,Medicaid,Illinois Medicaid,,2592.00,,,227.91,25.07,118.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 KET NKET MS,80357,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,1200.00,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 MTD MS,80358,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,370.80,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
METHADONE MS,80358,CPT,,,,,both,, ,327.54,196.52,Medicaid,Illinois Medicaid,,65.67,,,327.54,36.03,170.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L791194 MDMA MS,80359,CPT,,,,,both,, ,133.38,80.02,Medicaid,Illinois Medicaid,,687.25,,,133.38,14.67,69.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q84578 MDMA MS,80359,CPT,,,,,both,, ,404.17,242.50,Medicaid,Illinois Medicaid,,360.00,,,404.17,44.46,210.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q84578 MDMA MS,80359,CPT,,,,,both,, ,404.17,242.50,Medicaid,Illinois Medicaid,,279.88,,,404.17,44.46,210.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 MPH MS,80360,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,249.30,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 OPI MS 1P,80361,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,475.06,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OPIATES MS 1 PL,80361,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,685.80,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q20907 OPI MS,80361,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,202.25,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 OPD OPI MS5P,80364,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,207.47,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 OXY MS,80365,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,48.33,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q20907 OXY MS,80365,CPT,,,,,both,, ,428.58,257.14,Medicaid,Illinois Medicaid,,204.78,,,428.58,47.14,222.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q20907 OXY MS,80365,CPT,,,,,both,, ,428.58,257.14,Medicaid,Illinois Medicaid,,49.67,,,428.58,47.14,222.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 PGB MS,80366,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,1405.84,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PREGABALIN MS,80366,CPT,,,,,both,, ,811.42,486.85,Medicaid,Illinois Medicaid,,200.40,,,811.42,89.26,421.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 PPX MS,80367,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,21.04,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 SED HYP MS,80368,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,207.47,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 SM RLX MS3PL,80370,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,207.47,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 STIM SYN MS,80371,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,207.47,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 TAPENTADL MS,80372,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,207.47,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L761019TRAMADOL CONF,80373,CPT,,,,,both,, ,412.00,247.20,Medicaid,Illinois Medicaid,,207.47,,,412.00,45.32,214.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 TRA MS,80373,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,46.64,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEF DRUG NOS MS 1-3,80375,CPT,,,,,both,, ,546.19,327.71,Medicaid,Illinois Medicaid,,660.98,,,546.19,60.08,284.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEF DRUG NOS MS 7PL,80377,CPT,,,,,both,, ,571.45,342.87,Medicaid,Illinois Medicaid,,396.58,,,571.45,62.86,297.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 DRGNOS MS 7P,80377,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,106.72,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Manual urinalysis test with examination using microscope,81001,CPT,,,,,both,,,240.26,240.26,Medicaid,Illinois Medicaid,,389.01,,,240.26,26.43,124.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"UA, AUTO W-SCOPE",81001,CPT,,,,,both,, ,33.39,20.03,Medicaid,Illinois Medicaid,,389.01,,,33.39,3.67,17.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"UA, AUTO W-SCOPE",81001,CPT,,,,,both,, ,240.26,144.15,Medicaid,Illinois Medicaid,,1419.81,,,240.26,26.43,124.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Automated urinalysis test,81003,CPT,,,,,both,,,210.50,210.50,Medicaid,Illinois Medicaid,,352.47,,,210.50,23.16,109.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"UA, AUTO, W-O SCOPE",81003,CPT,,,,,both,, ,23.85,14.31,Medicaid,Illinois Medicaid,,352.47,,,23.85,2.62,12.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"UA, AUTO, W-O SCOPE",81003,CPT,,,,,both,, ,210.50,126.30,Medicaid,Illinois Medicaid,,352.47,,,210.50,23.16,109.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URINALYSIS,81005,CPT,,,,,both,, ,180.19,108.11,Medicaid,Illinois Medicaid,,581.50,,,180.19,19.82,93.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MICROSCOPIC EX OF UR,81015,CPT,,,,,both,, ,10.55,6.33,Medicaid,Illinois Medicaid,,581.50,,,10.55,1.16,5.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MICROSCOPIC EX OF UR,81015,CPT,,,,,both,, ,180.19,108.11,Medicaid,Illinois Medicaid,,631.00,,,180.19,19.82,93.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URINE PREG TEST QL,81025,CPT,,,,,both,, ,23.58,14.14,Medicaid,Illinois Medicaid,,631.00,,,23.58,2.59,12.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URINE PREG TEST QL,81025,CPT,,,,,both,,,420.72,420.72,Medicaid,Illinois Medicaid,,685.23,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URINE PREG TEST QL,81025,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,685.23,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"L910235 URINE VOLUME, TIMED",81050,CPT,,,,,both,, ,30.64,18.38,Medicaid,Illinois Medicaid,,685.23,,,30.64,3.37,15.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91863 BRCADVAN COMP,81162,CPT,,,,,both,, ,5261.25,3156.75,Medicaid,Illinois Medicaid,,423.53,,,5261.25,578.74,2735.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L480510 BCRABL1 KDMA,81170,CPT,,,,,both,, ,1792.00,1075.20,Medicaid,Illinois Medicaid,,318.28,,,1792.00,197.12,931.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91065 P210 BCRABL1,81206,CPT,,,,,both,, ,552.22,331.33,Medicaid,Illinois Medicaid,,318.28,,,552.22,60.74,287.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91065 P190 BCRABL1,81207,CPT,,,,,both,, ,487.83,292.69,Medicaid,Illinois Medicaid,,159.30,,,487.83,53.66,253.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BRAF GENE ANALY V600,81210,CPT,,,,,both,, ,393.84,236.30,Medicaid,Illinois Medicaid,,49.67,,,393.84,43.32,204.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L489450 CALR MA,81219,CPT,,,,,both,, ,675.00,405.00,Medicaid,Illinois Medicaid,,105.58,,,675.00,74.25,351,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10458 CFSCN OLA-PCR,81220,CPT,,,,,both,, ,1100.00,660.00,Medicaid,Illinois Medicaid,,524.24,,,1100.00,121.00,572,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L252900 CF CFTR DD,81222,CPT,,,,,both,, ,930.00,558.00,Medicaid,Illinois Medicaid,,92.45,,,930.00,102.30,483.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L511230 CYT P450 2D6,81226,CPT,,,,,both,, ,600.00,360.00,Medicaid,Illinois Medicaid,,414.77,,,600.00,66.00,312,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q161608 CYP2C9 GN AN,81227,CPT,,,,,both,, ,610.00,366.00,Medicaid,Illinois Medicaid,,414.77,,,610.00,67.10,317.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EGFR GENE COM VAR,81235,CPT,,,,,both,, ,963.55,578.13,Medicaid,Illinois Medicaid,,414.77,,,963.55,105.99,501.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
F2 GEN ANALY 20210GA,81240,CPT,,,,,both,, ,2183.65,1310.19,Medicaid,Illinois Medicaid,,41.08,,,2183.65,240.20,1135.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q17909 PGM HYBEACONS,81240,CPT,,,,,both,, ,1091.82,655.09,Medicaid,Illinois Medicaid,,311.21,,,1091.82,120.10,567.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q17900 FVLM HYBEACON,81241,CPT,,,,,both,, ,2183.65,1310.19,Medicaid,Illinois Medicaid,,311.21,,,2183.65,240.20,1135.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q17900 FVLM HYBEACON,81241,CPT,,,,,both,, ,2183.65,1310.19,Medicaid,Illinois Medicaid,,461.59,,,2183.65,240.20,1135.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FMR1 GENE ANALY AB,81243,CPT,,,,,both,, ,1863.12,1117.87,Medicaid,Illinois Medicaid,,461.59,,,1863.12,204.94,968.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q35079 HHC FRFLP-PCR,81256,CPT,,,,,both,, ,3396.72,2038.03,Medicaid,Illinois Medicaid,,86.22,,,3396.72,373.64,1766.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q35079 HHC FRFLP-PCR,81256,CPT,,,,,both,, ,3396.72,2038.03,Medicaid,Illinois Medicaid,,649.03,,,3396.72,373.64,1766.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11175AGLOB MUT PCR,81257,CPT,,,,,both,, ,477.70,286.62,Medicaid,Illinois Medicaid,,649.03,,,477.70,52.55,248.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L489421 JAK2V617F QL,81270,CPT,,,,,both,, ,1306.56,783.93,Medicaid,Illinois Medicaid,,649.03,,,1306.56,143.72,679.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16539 JAK2 V617F QL,81270,CPT,,,,,both,, ,1424.14,854.48,Medicaid,Illinois Medicaid,,69.60,,,1424.14,156.66,740.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16539 JAK2 V617F QL,81270,CPT,,,,,both,, ,1424.14,854.48,Medicaid,Illinois Medicaid,,280.22,,,1424.14,156.66,740.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L511040 CHRO ANA CMA,81277,CPT,,,,,both,, ,2260.00,1356.00,Medicaid,Illinois Medicaid,,280.22,,,2260.00,248.60,1175.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L115101 JAK2 EX12-15,81279,CPT,,,,,both,, ,865.04,519.02,Medicaid,Illinois Medicaid,,450.81,,,865.04,95.15,449.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q90251 IL28B RT-PCR,81283,CPT,,,,,both,, ,352.24,211.34,Medicaid,Illinois Medicaid,,450.81,,,352.24,38.75,183.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q17911 MTHFR DNA HYB,81291,CPT,,,,,both,, ,3892.40,2335.44,Medicaid,Illinois Medicaid,,450.81,,,3892.40,428.16,2024.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q17911 MTHFR DNA HYB,81291,CPT,,,,,both,, ,3892.40,2335.44,Medicaid,Illinois Medicaid,,450.81,,,3892.40,428.16,2024.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MICROSAT INSTAB VAR,81301,CPT,,,,,both,, ,960.19,576.11,Medicaid,Illinois Medicaid,,450.81,,,960.19,105.62,499.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PCA3 KLK3 RATIO,81313,CPT,,,,,both,, ,636.57,381.94,Medicaid,Illinois Medicaid,,40.75,,,636.57,70.02,331.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q18041 SMA CAR SCN,81329,CPT,,,,,both,, ,685.00,411.00,Medicaid,Illinois Medicaid,,562.13,,,685.00,75.35,356.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15340 ALPHA-1 ANTITRYPSIN (AAT) MUTATIO,81332,CPT,,,,,both,, ,3025.50,1815.30,Medicaid,Illinois Medicaid,,562.13,,,3025.50,332.81,1573.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SERPINA1 GENE ANA CV,81332,CPT,,,,,both,, ,3396.72,2038.03,Medicaid,Illinois Medicaid,,164.86,,,3396.72,373.64,1766.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L489150 MPL MUT AN,81338,CPT,,,,,both,, ,675.00,405.00,Medicaid,Illinois Medicaid,,31.83,,,675.00,74.25,351,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q92476 MPL MA QL,81339,CPT,,,,,both,, ,701.97,421.18,Medicaid,Illinois Medicaid,,169.75,,,701.97,77.22,365.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CSI153 UGTIA1 GEN AN,81350,CPT,,,,,both,, ,819.57,491.74,Medicaid,Illinois Medicaid,,31.83,,,819.57,90.15,426.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15584 HLA-B27 DETER,81374,CPT,,,,,both,, ,250.36,150.21,Medicaid,Illinois Medicaid,,169.75,,,250.36,27.54,130.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q17135 HLA2 TYP LR 1,81376,CPT,,,,,both,, ,610.75,366.45,Medicaid,Illinois Medicaid,,60.45,,,610.75,67.18,317.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L167082 HLA2 LR1 AG,81377,CPT,,,,,both,, ,235.10,141.06,Medicaid,Illinois Medicaid,,19.19,,,235.10,25.86,122.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HLA1 TYP HR 1 AL EA,81381,CPT,,,,,both,, ,724.42,434.65,Medicaid,Illinois Medicaid,,126.30,,,724.42,79.69,376.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q17135 HLA2 TYP HR 1,81382,CPT,,,,,both,, ,618.04,370.82,Medicaid,Illinois Medicaid,,166.55,,,618.04,67.98,321.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L167082 HLA2 HR1 AL,81383,CPT,,,,,both,, ,334.75,200.85,Medicaid,Illinois Medicaid,,126.30,,,334.75,36.82,174.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q90808 MP L2,81401,CPT,,,,,both,, ,1062.07,637.24,Medicaid,Illinois Medicaid,,99.52,,,1062.07,116.83,552.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q90808 MP L2,81401,CPT,,,,,both,, ,1062.07,637.24,Medicaid,Illinois Medicaid,,321.64,,,1062.07,116.83,552.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51115 RHD GENOTYPE,81403,CPT,,,,,both,, ,865.04,519.02,Medicaid,Illinois Medicaid,,321.64,,,865.04,95.15,449.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51115 RHD GENOTYPE,81403,CPT,,,,,both,, ,865.04,519.02,Medicaid,Illinois Medicaid,,75.00,,,865.04,95.15,449.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L630540 THRB,81405,CPT,,,,,both,, ,4320.00,2592.00,Medicaid,Illinois Medicaid,,391.03,,,4320.00,475.20,2246.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
B5306-6 ACGH MOL KAR,81406,CPT,,,,,both,, ,2000.00,1200.00,Medicaid,Illinois Medicaid,,167.55,,,2000.00,220.00,1040,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BB893-9 UNL MOL PTH,81479,CPT,,,,,both,, ,618.00,370.80,Medicaid,Illinois Medicaid,,710.38,,,618.00,67.98,321.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NBS SCID,81479,CPT,,,,,both,, ,109.46,65.67,Medicaid,Illinois Medicaid,,426.22,,,109.46,12.04,56.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UNLIST MOLEC PATH,81479,CPT,,,,,both,, ,1145.43,687.25,Medicaid,Illinois Medicaid,,178.67,,,1145.43,126.00,595.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L140045 OVARIAN MALIGNANCY RISK - ROMA,81500,CPT,,,,,both,, ,600.00,360.00,Medicaid,Illinois Medicaid,,477.76,,,600.00,66.00,312,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FTL CGEN ABN 4 ANAL,81511,CPT,,,,,both,, ,466.48,279.88,Medicaid,Illinois Medicaid,,32.67,,,466.48,51.31,242.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q30294 QUAD SCREEN,81511,CPT,,,,,both,, ,415.50,249.30,Medicaid,Illinois Medicaid,,189.28,,,415.50,45.71,216.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FTL CGEN ABN 5 ANAL,81512,CPT,,,,,both,, ,791.78,475.06,Medicaid,Illinois Medicaid,,189.28,,,791.78,87.10,411.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L550659 LIVR BIOMRKR,81517,CPT,,,,,both,, ,1143.00,685.80,Medicaid,Illinois Medicaid,,21.21,,,1143.00,125.73,594.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q92688 LIVER FIBROS,81596,CPT,,,,,both,, ,337.09,202.25,Medicaid,Illinois Medicaid,,796.27,,,337.09,37.08,175.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ACETON-KETON SERM QL,82009,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,477.76,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ACETON-KETON SERM QT,82010,CPT,,,,,both,, ,80.55,48.33,Medicaid,Illinois Medicaid,,477.76,,,80.55,8.86,41.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ACETON-KETON SERM QT,82010,CPT,,,,,both,, ,341.30,204.78,Medicaid,Illinois Medicaid,,412.87,,,341.30,37.54,177.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NBS ACYLCARNITINE QL,82016,CPT,,,,,both,, ,82.79,49.67,Medicaid,Illinois Medicaid,,247.72,,,82.79,9.11,43.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADRENOCORT ACTH,82024,CPT,,,,,both,, ,2343.07,1405.84,Medicaid,Illinois Medicaid,,247.72,,,2343.07,257.74,1218.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q211 ACTH PL IA,82024,CPT,,,,,both,, ,334.00,200.40,Medicaid,Illinois Medicaid,,247.72,,,334.00,36.74,173.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALBUMIN SERUM,82040,CPT,,,,,both,, ,35.08,21.04,Medicaid,Illinois Medicaid,,712.69,,,35.08,3.86,18.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,712.69,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14966 ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,28.79,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q70858 ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,207.47,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q70858 ALBUMIN FLUID,82042,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,122.09,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q70858 ALBUMIN FLUID,82042,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,122.09,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MICROALB QNT,82043,CPT,,,,,both,, ,77.74,46.64,Medicaid,Illinois Medicaid,,72.91,,,77.74,8.55,40.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MICROALB QNT,82043,CPT,,,,,both,,,660.98,660.98,Medicaid,Illinois Medicaid,,315.75,,,660.98,72.71,343.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MICROALB QNT,82043,CPT,,,,,both,, ,660.98,396.58,Medicaid,Illinois Medicaid,,315.75,,,660.98,72.71,343.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ETHANOL IA,82077,CPT,,,,,both,, ,177.88,106.72,Medicaid,Illinois Medicaid,,703.08,,,177.88,19.57,92.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q227 ALDOLASE ENZEMA,82085,CPT,,,,,both,, ,648.35,389.01,Medicaid,Illinois Medicaid,,45.12,,,648.35,71.32,337.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q227 ALDOLASE ENZEMA,82085,CPT,,,,,both,, ,648.35,389.01,Medicaid,Illinois Medicaid,,157.96,,,648.35,71.32,337.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALDOSTERONE,82088,CPT,,,,,both,, ,2366.36,1419.81,Medicaid,Illinois Medicaid,,157.96,,,2366.36,260.30,1230.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16845 ALDOSTERONE,82088,CPT,,,,,both,, ,587.45,352.47,Medicaid,Illinois Medicaid,,157.96,,,587.45,64.62,305.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q17181 ALDOST LCMSMS,82088,CPT,,,,,both,, ,587.45,352.47,Medicaid,Illinois Medicaid,,157.96,,,587.45,64.62,305.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q229 ALDOSTERONE U24,82088,CPT,,,,,both,, ,587.45,352.47,Medicaid,Illinois Medicaid,,515.82,,,587.45,64.62,305.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q235 A1A QT NEPH,82103,CPT,,,,,both,, ,969.17,581.50,Medicaid,Illinois Medicaid,,515.82,,,969.17,106.61,503.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q235 A1A QT NEPH,82103,CPT,,,,,both,, ,969.17,581.50,Medicaid,Illinois Medicaid,,266.75,,,969.17,106.61,503.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q853 A1AT PHENO IEF,82104,CPT,,,,,both,, ,1051.68,631.00,Medicaid,Illinois Medicaid,,266.75,,,1051.68,115.68,546.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q853 A1AT PHENO IEF,82104,CPT,,,,,both,, ,1051.68,631.00,Medicaid,Illinois Medicaid,,244.72,,,1051.68,115.68,546.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AFP SERUM,82105,CPT,,,,,both,, ,1142.06,685.23,Medicaid,Illinois Medicaid,,266.75,,,1142.06,125.63,593.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q237 AFP TUMR MRK IA,82105,CPT,,,,,both,, ,1142.06,685.23,Medicaid,Illinois Medicaid,,237.60,,,1142.06,125.63,593.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q5059 MAT SER AFP IA,82105,CPT,,,,,both,, ,1142.06,685.23,Medicaid,Illinois Medicaid,,237.60,,,1142.06,125.63,593.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AFP AMNIOTIC FLD,82106,CPT,,,,,both,, ,705.89,423.53,Medicaid,Illinois Medicaid,,23.23,,,705.89,77.65,367.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19529 AFP/L3 LIBASY,82107,CPT,,,,,both,, ,530.47,318.28,Medicaid,Illinois Medicaid,,207.47,,,530.47,58.35,275.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19529 AFP/L3 LIBASY,82107,CPT,,,,,both,, ,530.47,318.28,Medicaid,Illinois Medicaid,,207.47,,,530.47,58.35,275.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALUMINUM,82108,CPT,,,,,both,, ,265.51,159.30,Medicaid,Illinois Medicaid,,207.47,,,265.51,29.21,138.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NBS AMINO ACD MUL QL,82128,CPT,,,,,both,, ,82.79,49.67,Medicaid,Illinois Medicaid,,207.47,,,82.79,9.11,43.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10947CYSTN U24 LCMS,82131,CPT,,,,,both,, ,175.98,105.58,Medicaid,Illinois Medicaid,,29.80,,,175.98,19.36,91.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMINO ACID QUAN 6+,82139,CPT,,,,,both,, ,873.74,524.24,Medicaid,Illinois Medicaid,,189.28,,,873.74,96.11,454.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMMONIA,82140,CPT,,,,,both,, ,154.09,92.45,Medicaid,Illinois Medicaid,,338.16,,,154.09,16.95,80.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,338.16,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L910235 AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,338.16,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q442 AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,405.68,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMYLASE,82150,CPT,,,,,both,, ,68.48,41.08,Medicaid,Illinois Medicaid,,405.68,,,68.48,7.53,35.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q845 AMYLASE,82150,CPT,,,,,both,, ,518.69,311.21,Medicaid,Illinois Medicaid,,145.50,,,518.69,57.06,269.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q845 AMYLASE,82150,CPT,,,,,both,, ,518.69,311.21,Medicaid,Illinois Medicaid,,121.68,,,518.69,57.06,269.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"ANDROSTENEDIONE, LCMS",82157,CPT,,,,,both,, ,769.33,461.59,Medicaid,Illinois Medicaid,,145.50,,,769.33,84.63,400.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"ANDROSTENEDIONE, LCMS",82157,CPT,,,,,both,, ,769.33,461.59,Medicaid,Illinois Medicaid,,145.50,,,769.33,84.63,400.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANGIOTENSIN CONV ENZ,82164,CPT,,,,,both,, ,143.71,86.22,Medicaid,Illinois Medicaid,,145.50,,,143.71,15.81,74.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANGIOTENSIN CONV ENZ,82164,CPT,,,,,both,, ,1081.72,649.03,Medicaid,Illinois Medicaid,,168.06,,,1081.72,118.99,562.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34692 ACE CSF KINET,82164,CPT,,,,,both,, ,1081.72,649.03,Medicaid,Illinois Medicaid,,317.52,,,1081.72,118.99,562.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q683 ACE SP,82164,CPT,,,,,both,, ,1081.72,649.03,Medicaid,Illinois Medicaid,,112.08,,,1081.72,118.99,562.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANTI-MULLERIAN HORM,82166,CPT,,,,,both,, ,116.00,69.60,Medicaid,Illinois Medicaid,,621.75,,,116.00,12.76,60.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q92145 APOLIPOPROTEI,82172,CPT,,,,,both,, ,467.04,280.22,Medicaid,Illinois Medicaid,,621.75,,,467.04,51.37,242.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q92145 APOLIPOPROTEI,82172,CPT,,,,,both,, ,467.04,280.22,Medicaid,Illinois Medicaid,,621.75,,,467.04,51.37,242.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,621.75,,,751.36,82.65,390.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q269 AS BL ICP/MS,82175,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,563.31,,,751.36,82.65,390.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36438 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,563.31,,,751.36,82.65,390.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7507 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,563.47,,,751.36,82.65,390.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7655 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,79.31,,,751.36,82.65,390.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q929 VIT C LC/MS/MS,82180,CPT,,,,,both,, ,67.92,40.75,Medicaid,Illinois Medicaid,,1343.58,,,67.92,7.47,35.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q852 B2M SERUM NEPH,82232,CPT,,,,,both,, ,936.89,562.13,Medicaid,Illinois Medicaid,,806.14,,,936.89,103.06,487.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q852 B2M SERUM NEPH,82232,CPT,,,,,both,, ,936.89,562.13,Medicaid,Illinois Medicaid,,201.46,,,936.89,103.06,487.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14801 BILE AC ENZ,82239,CPT,,,,,both,, ,274.77,164.86,Medicaid,Illinois Medicaid,,97.80,,,274.77,30.22,142.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BILIRUBIN TOTAL,82247,CPT,,,,,both,, ,53.05,31.83,Medicaid,Illinois Medicaid,,23.23,,,53.05,5.84,27.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BILIRUBIN TOTAL,82247,CPT,,,,,both,, ,282.92,169.75,Medicaid,Illinois Medicaid,,258.00,,,282.92,31.12,147.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BILIRUBIN DIRECT,82248,CPT,,,,,both,, ,53.05,31.83,Medicaid,Illinois Medicaid,,360.00,,,53.05,5.84,27.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BILIRUBIN DIRECT,82248,CPT,,,,,both,, ,282.92,169.75,Medicaid,Illinois Medicaid,,192.31,,,282.92,31.12,147.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NBS BIOTINIDASE,82261,CPT,,,,,both,, ,100.75,60.45,Medicaid,Illinois Medicaid,,192.31,,,100.75,11.08,52.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLD OCCULT FECES 1-3,82270,CPT,,,,,both,, ,31.99,19.19,Medicaid,Illinois Medicaid,,192.31,,,31.99,3.52,16.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLD OCCULT FECES 1-3,82270,CPT,,,,,both,, ,210.50,126.30,Medicaid,Illinois Medicaid,,192.31,,,210.50,23.16,109.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLD OCCULT OTHER SRC,82271,CPT,,,,,both,, ,277.59,166.55,Medicaid,Illinois Medicaid,,38.56,,,277.59,30.53,144.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLD OCC NON CA SCREE,82272,CPT,,,,,both,, ,210.50,126.30,Medicaid,Illinois Medicaid,,282.92,,,210.50,23.16,109.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLD OCCULT FECES EIA,82274,CPT,,,,,both,, ,165.87,99.52,Medicaid,Illinois Medicaid,,169.75,,,165.87,18.25,86.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q299CADMIUM BL ICPMS,82300,CPT,,,,,both,, ,536.08,321.64,Medicaid,Illinois Medicaid,,169.75,,,536.08,58.97,278.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q299CADMIUM BL ICPMS,82300,CPT,,,,,both,, ,536.08,321.64,Medicaid,Illinois Medicaid,,375.70,,,536.08,58.97,278.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q672 CADMIUM,82300,CPT,,,,,both,, ,125.00,75.00,Medicaid,Illinois Medicaid,,375.70,,,125.00,13.75,65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L504115VITD 25-OH LC,82306,CPT,,,,,both,, ,651.73,391.03,Medicaid,Illinois Medicaid,,68.20,,,651.73,71.69,338.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VITAMIN D 25OH,82306,CPT,,,,,both,, ,279.26,167.55,Medicaid,Illinois Medicaid,,372.33,,,279.26,30.72,145.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VITAMIN D 25OH,82306,CPT,,,,,both,,,710.38,710.38,Medicaid,Illinois Medicaid,,11.45,,,710.38,78.14,369.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VITAMIN D 25OH,82306,CPT,,,,,both,, ,710.38,426.22,Medicaid,Illinois Medicaid,,285.17,,,710.38,78.14,369.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CALCITONIN,82308,CPT,,,,,both,, ,297.79,178.67,Medicaid,Illinois Medicaid,,171.10,,,297.79,32.76,154.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q30742 CALCITONIN IA,82308,CPT,,,,,both,, ,796.27,477.76,Medicaid,Illinois Medicaid,,19.70,,,796.27,87.59,414.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CALCIUM TOTAL,82310,CPT,,,,,both,, ,54.45,32.67,Medicaid,Illinois Medicaid,,285.17,,,54.45,5.99,28.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L54601 CALCIUM TOTAL,82310,CPT,,,,,both,, ,315.48,189.28,Medicaid,Illinois Medicaid,,171.10,,,315.48,34.70,164.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L54601 CALCIUM TOTAL,82310,CPT,,,,,both,, ,315.48,189.28,Medicaid,Illinois Medicaid,,171.10,,,315.48,34.70,164.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CALCIUM IONIZED,82330,CPT,,,,,both,, ,35.36,21.21,Medicaid,Illinois Medicaid,,171.10,,,35.36,3.89,18.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CALCIUM IONIZED,82330,CPT,,,,,both,,,796.27,796.27,Medicaid,Illinois Medicaid,,171.10,,,796.27,87.59,414.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q306 ICA ISE,82330,CPT,,,,,both,, ,796.27,477.76,Medicaid,Illinois Medicaid,,157.12,,,796.27,87.59,414.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q306 ICA ISE,82330,CPT,,,,,both,, ,796.27,477.76,Medicaid,Illinois Medicaid,,157.12,,,796.27,87.59,414.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CALCIUM URI QN TIMED,82340,CPT,,,,,both,,,412.87,412.87,Medicaid,Illinois Medicaid,,171.10,,,412.87,45.42,214.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CALCIUM URI QN TIMED,82340,CPT,,,,,both,, ,412.87,247.72,Medicaid,Illinois Medicaid,,171.10,,,412.87,45.42,214.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"L910235 CALCIUM, URINE",82340,CPT,,,,,both,, ,412.87,247.72,Medicaid,Illinois Medicaid,,171.10,,,412.87,45.42,214.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q442 CALCIUM URI QN,82340,CPT,,,,,both,, ,412.87,247.72,Medicaid,Illinois Medicaid,,555.45,,,412.87,45.42,214.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q30260 STN ANAL NID,82365,CPT,,,,,both,, ,1187.82,712.69,Medicaid,Illinois Medicaid,,333.27,,,1187.82,130.66,617.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q30260 STN ANAL NID,82365,CPT,,,,,both,, ,1187.82,712.69,Medicaid,Illinois Medicaid,,581.16,,,1187.82,130.66,617.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CARBON DIOXIDE CO2,82374,CPT,,,,,both,, ,47.99,28.79,Medicaid,Illinois Medicaid,,581.16,,,47.99,5.28,24.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CARBON DIOXIDE CO2,82374,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,66.85,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CARBON MONOXIDE QUAN,82375,CPT,,,,,both,, ,203.49,122.09,Medicaid,Illinois Medicaid,,641.06,,,203.49,22.38,105.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CARBON MONOXIDE QUAN,82375,CPT,,,,,both,, ,203.49,122.09,Medicaid,Illinois Medicaid,,384.63,,,203.49,22.38,105.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CARCINOEMBRYONIC AG,82378,CPT,,,,,both,, ,121.53,72.91,Medicaid,Illinois Medicaid,,110.13,,,121.53,13.37,63.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L480095 CEA SM,82378,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,72.75,,,526.26,57.89,273.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L480095 CEA SM,82378,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,171.10,,,526.26,57.89,273.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CAROTENE,82380,CPT,,,,,both,, ,1171.81,703.08,Medicaid,Illinois Medicaid,,30.00,,,1171.81,128.90,609.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L1529 CAROTENE HPLC,82380,CPT,,,,,both,, ,75.20,45.12,Medicaid,Illinois Medicaid,,158.13,,,75.20,8.27,39.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q318CATEC FR U24 HPL,82384,CPT,,,,,both,, ,263.27,157.96,Medicaid,Illinois Medicaid,,158.13,,,263.27,28.96,136.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q318CATEC FR U24 HPL,82384,CPT,,,,,both,, ,263.27,157.96,Medicaid,Illinois Medicaid,,398.61,,,263.27,28.96,136.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q318CATEC FR U24 HPL,82384,CPT,,,,,both,, ,263.27,157.96,Medicaid,Illinois Medicaid,,398.61,,,263.27,28.96,136.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q318CATEC FR U24 HPL,82384,CPT,,,,,both,, ,263.27,157.96,Medicaid,Illinois Medicaid,,106.43,,,263.27,28.96,136.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q326 CERULOP NEPHELO,82390,CPT,,,,,both,, ,859.70,515.82,Medicaid,Illinois Medicaid,,162.16,,,859.70,94.57,447.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q326 CERULOP NEPHELO,82390,CPT,,,,,both,, ,859.70,515.82,Medicaid,Illinois Medicaid,,162.16,,,859.70,94.57,447.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHEMILUM ASSAY NOS,82397,CPT,,,,,both,, ,444.59,266.75,Medicaid,Illinois Medicaid,,91.10,,,444.59,48.90,231.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L503870 CHEM ASY NOS,82397,CPT,,,,,both,, ,444.59,266.75,Medicaid,Illinois Medicaid,,227.50,,,444.59,48.90,231.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L504567 CHEM ASY NOS,82397,CPT,,,,,both,, ,407.88,244.72,Medicaid,Illinois Medicaid,,784.42,,,407.88,44.87,212.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34445 INHIBIN B CL,82397,CPT,,,,,both,, ,444.59,266.75,Medicaid,Illinois Medicaid,,332.93,,,444.59,48.90,231.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37227 ANTI-MULLERIAN HORMONE(AMH)FEMALE,82397,CPT,,,,,both,, ,396.00,237.60,Medicaid,Illinois Medicaid,,248.89,,,396.00,43.56,205.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37227 ANTI-MULLERIAN HORMONE(AMH)FEMALE,82397,CPT,,,,,both,, ,396.00,237.60,Medicaid,Illinois Medicaid,,248.89,,,396.00,43.56,205.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHLORIDE BLOOD,82435,CPT,,,,,both,, ,38.73,23.23,Medicaid,Illinois Medicaid,,137.38,,,38.73,4.26,20.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHLORIDE BLOOD,82435,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,160.48,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"L910235 CHLORIDE, URINE",82436,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,160.48,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"L910235 CHLORIDE, URINE",82436,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,869.64,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHLORIDES OTHER FLD,82438,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,869.64,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHOLESTEROL TOTAL,82465,CPT,,,,,both,, ,49.68,29.80,Medicaid,Illinois Medicaid,,585.87,,,49.68,5.46,25.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHOLESTEROL TOTAL,82465,CPT,,,,,both,, ,315.48,189.28,Medicaid,Illinois Medicaid,,585.87,,,315.48,34.70,164.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHOLINESTERASE SERUM,82480,CPT,,,,,both,, ,563.60,338.16,Medicaid,Illinois Medicaid,,585.87,,,563.60,62.00,293.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q338 CHOLINEST SER,82480,CPT,,,,,both,, ,563.60,338.16,Medicaid,Illinois Medicaid,,537.50,,,563.60,62.00,293.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7961 CHOLINEST SER,82480,CPT,,,,,both,, ,563.60,338.16,Medicaid,Illinois Medicaid,,585.87,,,563.60,62.00,293.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q338 CHOLINEST RBC,82482,CPT,,,,,both,, ,676.14,405.68,Medicaid,Illinois Medicaid,,585.87,,,676.14,74.38,351.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q338 CHOLINEST RBC,82482,CPT,,,,,both,, ,676.14,405.68,Medicaid,Illinois Medicaid,,102.21,,,676.14,74.38,351.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHROMIUM,82495,CPT,,,,,both,, ,242.50,145.50,Medicaid,Illinois Medicaid,,1036.53,,,242.50,26.68,126.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHROMIUM U,82495,CPT,,,,,both,, ,202.80,121.68,Medicaid,Illinois Medicaid,,182.71,,,202.80,22.31,105.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"L910235 CITRATE, URINE",82507,CPT,,,,,both,, ,242.50,145.50,Medicaid,Illinois Medicaid,,190.46,,,242.50,26.68,126.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11315 CIT AC U24 SP,82507,CPT,,,,,both,, ,242.50,145.50,Medicaid,Illinois Medicaid,,190.46,,,242.50,26.68,126.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q442 CITRATE,82507,CPT,,,,,both,, ,242.50,145.50,Medicaid,Illinois Medicaid,,69.88,,,242.50,26.68,126.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COLLAGEN CROSSLINKS,82523,CPT,,,,,both,, ,280.11,168.06,Medicaid,Illinois Medicaid,,69.88,,,280.11,30.81,145.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L500089 C-TELO ELISA,82523,CPT,,,,,both,, ,529.20,317.52,Medicaid,Illinois Medicaid,,151.10,,,529.20,58.21,275.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"N-TELOPEP (NTX), UR",82523,CPT,,,,,both,, ,186.80,112.08,Medicaid,Illinois Medicaid,,1577.11,,,186.80,20.55,97.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q363 CU ICP/MS AS,82525,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,946.26,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q363 CU ICP/MS AS,82525,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,561.12,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q363 CU ICP/MS AS,82525,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,360.55,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q363 CU ICP/MS AS,82525,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,360.55,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q198978CORTIS LCMSMS,82530,CPT,,,,,both,, ,938.86,563.31,Medicaid,Illinois Medicaid,,73.32,,,938.86,103.27,488.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q198978CORTIS LCMSMS,82530,CPT,,,,,both,, ,938.86,563.31,Medicaid,Illinois Medicaid,,460.92,,,938.86,103.27,488.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36423 CORT FR LCMSM,82530,CPT,,,,,both,, ,939.13,563.47,Medicaid,Illinois Medicaid,,460.92,,,939.13,103.30,488.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CORTISOL TOTAL,82533,CPT,,,,,both,, ,132.19,79.31,Medicaid,Illinois Medicaid,,53.21,,,132.19,14.54,68.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CORTISOL TOTAL,82533,CPT,,,,,both,,,1343.58,1343.58,Medicaid,Illinois Medicaid,,60.45,,,1343.58,147.79,698.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CORTISOL TOTAL,82533,CPT,,,,,both,, ,1343.58,806.14,Medicaid,Illinois Medicaid,,864.19,,,1343.58,147.79,698.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L500179SALIV CORT MS,82533,CPT,,,,,both,, ,335.78,201.46,Medicaid,Illinois Medicaid,,518.51,,,335.78,36.94,174.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L500440 CORTISOL TOT,82533,CPT,,,,,both,, ,163.00,97.80,Medicaid,Illinois Medicaid,,421.01,,,163.00,17.93,84.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CREATINE,82540,CPT,,,,,both,, ,38.73,23.23,Medicaid,Illinois Medicaid,,65.16,,,38.73,4.26,20.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L823430 OMEGACHECK (EPA+DPA+DHA),82542,CPT,,,,,both,, ,430.00,258.00,Medicaid,Illinois Medicaid,,735.65,,,430.00,47.30,223.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
N-METHLHIST 24H UR,82542,CPT,,,,,both,, ,600.00,360.00,Medicaid,Illinois Medicaid,,441.39,,,600.00,66.00,312,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16602 IODINE U24,82542,CPT,,,,,both,, ,320.53,192.31,Medicaid,Illinois Medicaid,,376.38,,,320.53,35.26,166.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16602 IODINE U24,82542,CPT,,,,,both,, ,320.53,192.31,Medicaid,Illinois Medicaid,,376.38,,,320.53,35.26,166.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16602 IODINE U24,82542,CPT,,,,,both,, ,320.53,192.31,Medicaid,Illinois Medicaid,,40.08,,,320.53,35.26,166.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16602 IODINE U24,82542,CPT,,,,,both,, ,320.53,192.31,Medicaid,Illinois Medicaid,,29.97,,,320.53,35.26,166.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CPK TOTAL,82550,CPT,,,,,both,, ,64.27,38.56,Medicaid,Illinois Medicaid,,132.52,,,64.27,7.07,33.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CPK TOTAL,82550,CPT,,,,,both,,,282.92,282.92,Medicaid,Illinois Medicaid,,132.52,,,282.92,31.12,147.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q6422 CPK TOTAL,82550,CPT,,,,,both,, ,282.92,169.75,Medicaid,Illinois Medicaid,,132.52,,,282.92,31.12,147.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q6422 CPK TOTAL,82550,CPT,,,,,both,, ,282.92,169.75,Medicaid,Illinois Medicaid,,132.52,,,282.92,31.12,147.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q6422 CPK ISOENZYMES,82552,CPT,,,,,both,, ,626.18,375.70,Medicaid,Illinois Medicaid,,132.52,,,626.18,68.88,325.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q6422 CPK ISOENZYMES,82552,CPT,,,,,both,, ,626.18,375.70,Medicaid,Illinois Medicaid,,132.52,,,626.18,68.88,325.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CPK MB FRACTION,82553,CPT,,,,,both,, ,113.67,68.20,Medicaid,Illinois Medicaid,,132.52,,,113.67,12.50,59.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CPK MB FRACTION,82553,CPT,,,,,both,, ,620.56,372.33,Medicaid,Illinois Medicaid,,132.52,,,620.56,68.26,322.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CREATININE BLOOD,82565,CPT,,,,,both,, ,19.09,11.45,Medicaid,Illinois Medicaid,,118.05,,,19.09,2.10,9.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CREATININE BLOOD,82565,CPT,,,,,both,,,285.17,285.17,Medicaid,Illinois Medicaid,,132.52,,,285.17,31.37,148.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CREATININE BLOOD,82565,CPT,,,,,both,, ,285.17,171.10,Medicaid,Illinois Medicaid,,132.52,,,285.17,31.37,148.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CREATININE UR-OTHER,82570,CPT,,,,,both,, ,32.84,19.70,Medicaid,Illinois Medicaid,,132.52,,,32.84,3.61,17.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CREATININE UR-OTHER,82570,CPT,,,,,both,,,285.17,285.17,Medicaid,Illinois Medicaid,,132.52,,,285.17,31.37,148.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CREATININE UR-OTHER,82570,CPT,,,,,both,, ,285.17,171.10,Medicaid,Illinois Medicaid,,76.28,,,285.17,31.37,148.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q1648 CREATININE UR-,82570,CPT,,,,,both,, ,285.17,171.10,Medicaid,Illinois Medicaid,,543.78,,,285.17,31.37,148.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q17422 CREATIN PTF C,82570,CPT,,,,,both,, ,285.17,171.10,Medicaid,Illinois Medicaid,,89.25,,,285.17,31.37,148.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q442 CREATININE UR-O,82570,CPT,,,,,both,, ,285.17,171.10,Medicaid,Illinois Medicaid,,89.25,,,285.17,31.37,148.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q5244 CREAT UR,82570,CPT,,,,,both,, ,261.87,157.12,Medicaid,Illinois Medicaid,,89.25,,,261.87,28.81,136.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q5244 CREAT UR,82570,CPT,,,,,both,, ,261.87,157.12,Medicaid,Illinois Medicaid,,89.25,,,261.87,28.81,136.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q682 CREATININE UR-O,82570,CPT,,,,,both,, ,285.17,171.10,Medicaid,Illinois Medicaid,,233.40,,,285.17,31.37,148.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7507 CREATIN UR-OTH,82570,CPT,,,,,both,, ,285.17,171.10,Medicaid,Illinois Medicaid,,233.40,,,285.17,31.37,148.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8525 CREATININE UR-,82570,CPT,,,,,both,, ,285.17,171.10,Medicaid,Illinois Medicaid,,233.40,,,285.17,31.37,148.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CREATININE CLEARANCE,82575,CPT,,,,,both,,,555.45,555.45,Medicaid,Illinois Medicaid,,370.82,,,555.45,61.10,288.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CREATININE CLEARANCE,82575,CPT,,,,,both,, ,555.45,333.27,Medicaid,Illinois Medicaid,,1056.23,,,555.45,61.10,288.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36562 C-GLOB SER VI,82595,CPT,,,,,both,, ,968.60,581.16,Medicaid,Illinois Medicaid,,60.37,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36562 C-GLOB SER VI,82595,CPT,,,,,both,, ,968.60,581.16,Medicaid,Illinois Medicaid,,60.37,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VITAMIN B-12,82607,CPT,,,,,both,, ,111.43,66.85,Medicaid,Illinois Medicaid,,518.34,,,111.43,12.26,57.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VITAMIN B-12,82607,CPT,,,,,both,,,641.06,641.06,Medicaid,Illinois Medicaid,,518.34,,,641.06,70.52,333.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VITAMIN B-12,82607,CPT,,,,,both,, ,641.06,384.63,Medicaid,Illinois Medicaid,,49.50,,,641.06,70.52,333.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VITAMIN B-12 BINDING,82608,CPT,,,,,both,, ,183.56,110.13,Medicaid,Illinois Medicaid,,247.72,,,183.56,20.19,95.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10570 CYSTAT C NEPH,82610,CPT,,,,,both,, ,121.25,72.75,Medicaid,Illinois Medicaid,,13.13,,,121.25,13.34,63.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"L910235 CREATININE, URINE",82615,CPT,,,,,both,, ,285.17,171.10,Medicaid,Illinois Medicaid,,240.26,,,285.17,31.37,148.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L910235 CYSTINE/HOMOCYSTINE UR,82615,CPT,,,,,both,, ,50.00,30.00,Medicaid,Illinois Medicaid,,144.15,,,50.00,5.50,26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19894DHEA UN LCMSMS,82626,CPT,,,,,both,, ,263.55,158.13,Medicaid,Illinois Medicaid,,450.48,,,263.55,28.99,137.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19894DHEA UN LCMSMS,82626,CPT,,,,,both,, ,263.55,158.13,Medicaid,Illinois Medicaid,,270.28,,,263.55,28.99,137.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q402 DHEA SULFATE IA,82627,CPT,,,,,both,, ,664.35,398.61,Medicaid,Illinois Medicaid,,455.37,,,664.35,73.08,345.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q402 DHEA SULFATE IA,82627,CPT,,,,,both,, ,664.35,398.61,Medicaid,Illinois Medicaid,,112.83,,,664.35,73.08,345.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEOXYCORTISOL,82634,CPT,,,,,both,, ,177.39,106.43,Medicaid,Illinois Medicaid,,615.85,,,177.39,19.51,92.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7961 DIBUCAINE NUMB,82638,CPT,,,,,both,, ,270.28,162.16,Medicaid,Illinois Medicaid,,36.00,,,270.28,29.73,140.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7961 DIBUCAINE NUMB,82638,CPT,,,,,both,, ,270.28,162.16,Medicaid,Illinois Medicaid,,5.25,,,270.28,29.73,140.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DIHYDROTESTOST (DHT),82642,CPT,,,,,both,, ,151.84,91.10,Medicaid,Illinois Medicaid,,59.61,,,151.84,16.70,78.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DIHYDROXY VITAMIN D,82652,CPT,,,,,both,, ,379.18,227.50,Medicaid,Illinois Medicaid,,42.60,,,379.18,41.71,197.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DIHYDROXY VITAMIN D,82652,CPT,,,,,both,, ,1307.38,784.42,Medicaid,Illinois Medicaid,,247.72,,,1307.38,143.81,679.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16558 VITD LCMSMS,82652,CPT,,,,,both,, ,554.89,332.93,Medicaid,Illinois Medicaid,,36.60,,,554.89,61.04,288.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L123234 PE FEC ELISA,82653,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,158.29,,,414.83,45.63,215.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L123234 PE FEC ELISA,82653,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,179.35,,,414.83,45.63,215.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14693 PE-1 IA,82656,CPT,,,,,both,, ,228.97,137.38,Medicaid,Illinois Medicaid,,82.35,,,228.97,25.19,119.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q146938 PE-1 FEC,82656,CPT,,,,,both,, ,267.48,160.48,Medicaid,Illinois Medicaid,,487.53,,,267.48,29.42,139.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q146938 PE-1 FEC,82656,CPT,,,,,both,, ,267.48,160.48,Medicaid,Illinois Medicaid,,487.53,,,267.48,29.42,139.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q427 ERYTHROPOIET IA,82668,CPT,,,,,both,, ,1449.41,869.64,Medicaid,Illinois Medicaid,,487.53,,,1449.41,159.44,753.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q427 ERYTHROPOIET IA,82668,CPT,,,,,both,, ,1449.41,869.64,Medicaid,Illinois Medicaid,,487.53,,,1449.41,159.44,753.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Medicaid,Illinois Medicaid,,82.18,,,976.46,107.41,507.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L500649 ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Medicaid,Illinois Medicaid,,721.11,,,976.46,107.41,507.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q30289 ESTRADIOL US,82670,CPT,,,,,both,, ,976.46,585.87,Medicaid,Illinois Medicaid,,44.91,,,976.46,107.41,507.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36169 ESTRA FR DIR,82670,CPT,,,,,both,, ,895.84,537.50,Medicaid,Illinois Medicaid,,113.40,,,895.84,98.54,465.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36169 ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Medicaid,Illinois Medicaid,,665.53,,,976.46,107.41,507.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4021 ESTRADIOL IA,82670,CPT,,,,,both,, ,976.46,585.87,Medicaid,Illinois Medicaid,,665.53,,,976.46,107.41,507.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36742 EST FR LCMSMS,82671,CPT,,,,,both,, ,170.36,102.21,Medicaid,Illinois Medicaid,,374.02,,,170.36,18.74,88.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ESTROGEN TOTAL,82672,CPT,,,,,both,, ,1727.55,1036.53,Medicaid,Illinois Medicaid,,105.08,,,1727.55,190.03,898.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q439 ESTROG TOT RIA,82672,CPT,,,,,both,, ,304.53,182.71,Medicaid,Illinois Medicaid,,64.89,,,304.53,33.50,158.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34883 ESTRIO LCMSMS,82677,CPT,,,,,both,, ,317.44,190.46,Medicaid,Illinois Medicaid,,46.14,,,317.44,34.92,165.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34883 ESTRIO LCMSMS,82677,CPT,,,,,both,, ,317.44,190.46,Medicaid,Illinois Medicaid,,108.36,,,317.44,34.92,165.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q23244 ESTRON LCMSMS,82679,CPT,,,,,both,, ,116.47,69.88,Medicaid,Illinois Medicaid,,108.36,,,116.47,12.81,60.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q23244 ESTRON LCMSMS,82679,CPT,,,,,both,, ,116.47,69.88,Medicaid,Illinois Medicaid,,212.86,,,116.47,12.81,60.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L500649 ESTRA FR DIR,82681,CPT,,,,,both,, ,251.84,151.10,Medicaid,Illinois Medicaid,,57.42,,,251.84,27.70,130.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ETHYLENE GLYCOL,82693,CPT,,,,,both,,,1577.11,1577.11,Medicaid,Illinois Medicaid,,454.97,,,1577.11,173.48,820.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ETHYLENE GLYCOL,82693,CPT,,,,,both,, ,1577.11,946.26,Medicaid,Illinois Medicaid,,272.98,,,1577.11,173.48,820.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q801 ETHYL GLY CHRMT,82693,CPT,,,,,both,, ,935.21,561.12,Medicaid,Illinois Medicaid,,272.98,,,935.21,102.87,486.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q3967 FEC FT QL MIC,82705,CPT,,,,,both,, ,600.92,360.55,Medicaid,Illinois Medicaid,,73.25,,,600.92,66.10,312.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q3967 FEC FT QL MIC,82705,CPT,,,,,both,, ,600.92,360.55,Medicaid,Illinois Medicaid,,414.77,,,600.92,66.10,312.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FECAL FAT QUANT 72HR,82710,CPT,,,,,both,, ,122.20,73.32,Medicaid,Illinois Medicaid,,224.14,,,122.20,13.44,63.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q455 FEC FT QT NMR,82710,CPT,,,,,both,, ,768.20,460.92,Medicaid,Illinois Medicaid,,231.05,,,768.20,84.50,399.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q455 FEC FT QT NMR,82710,CPT,,,,,both,, ,768.20,460.92,Medicaid,Illinois Medicaid,,231.05,,,768.20,84.50,399.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q90559 VLCFA,82726,CPT,,,,,both,, ,88.69,53.21,Medicaid,Illinois Medicaid,,231.05,,,88.69,9.76,46.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FERRITIN,82728,CPT,,,,,both,, ,100.75,60.45,Medicaid,Illinois Medicaid,,136.74,,,100.75,11.08,52.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FERRITIN,82728,CPT,,,,,both,,,864.19,864.19,Medicaid,Illinois Medicaid,,136.74,,,864.19,95.06,449.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FERRITIN,82728,CPT,,,,,both,, ,864.19,518.51,Medicaid,Illinois Medicaid,,730.36,,,864.19,95.06,449.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FETAL FIBRONECTIN,82731,CPT,,,,,both,, ,701.69,421.01,Medicaid,Illinois Medicaid,,585.87,,,701.69,77.19,364.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FOLIC ACID SERUM,82746,CPT,,,,,both,, ,108.61,65.16,Medicaid,Illinois Medicaid,,585.87,,,108.61,11.95,56.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FOLIC ACID SERUM,82746,CPT,,,,,both,,,735.65,735.65,Medicaid,Illinois Medicaid,,585.87,,,735.65,80.92,382.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FOLIC ACID SERUM,82746,CPT,,,,,both,, ,735.65,441.39,Medicaid,Illinois Medicaid,,360.55,,,735.65,80.92,382.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q467 FOLATE RBC IA,82747,CPT,,,,,both,, ,627.30,376.38,Medicaid,Illinois Medicaid,,97.33,,,627.30,69.00,326.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q467 FOLATE RBC IA,82747,CPT,,,,,both,, ,627.30,376.38,Medicaid,Illinois Medicaid,,360.72,,,627.30,69.00,326.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NBS GALACTOSE,82760,CPT,,,,,both,, ,66.80,40.08,Medicaid,Illinois Medicaid,,765.96,,,66.80,7.35,34.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NBS GALACTOSE TRANS,82776,CPT,,,,,both,, ,49.96,29.97,Medicaid,Illinois Medicaid,,459.57,,,49.96,5.50,25.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19955GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,421.63,,,220.88,24.30,114.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19955GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,459.57,,,220.88,24.30,114.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19955GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,421.63,,,220.88,24.30,114.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19955GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,459.57,,,220.88,24.30,114.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36336 GAMMGLB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,378.00,,,220.88,24.30,114.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36336 GAMMGLB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,421.63,,,220.88,24.30,114.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36336 GAMMGLB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,180.00,,,220.88,24.30,114.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36336 GAMMGLB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,312.00,,,220.88,24.30,114.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q38940 GAMMAGLOB M G A D,82784,CPT,,,,,both,, ,196.75,118.05,Medicaid,Illinois Medicaid,,48.90,,,196.75,21.64,102.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q539 IGA IMMUNOTURB,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,459.57,,,220.88,24.30,114.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q539 IGA IMMUNOTURB,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,409.35,,,220.88,24.30,114.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q539 IGA IMMUNOTURB,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,459.57,,,220.88,24.30,114.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q539 IGA IMMUNOTURB,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,459.57,,,220.88,24.30,114.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GAMMAGLOBULIN IGE,82785,CPT,,,,,both,, ,127.14,76.28,Medicaid,Illinois Medicaid,,459.57,,,127.14,13.99,66.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GAMMAGLOBULIN IGE,82785,CPT,,,,,both,, ,906.30,543.78,Medicaid,Illinois Medicaid,,459.57,,,906.30,99.69,471.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10659 GAMMAGLOB IGE,82785,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,459.57,,,148.75,16.36,77.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10659 GAMMAGLOB IGE,82785,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,110.40,,,148.75,16.36,77.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10659 GAMMAGLOB IGE,82785,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,720.00,,,148.75,16.36,77.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10659 GAMMAGLOB IGE,82785,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,436.84,,,148.75,16.36,77.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"IGG SUB 1,2,3 OR 4",82787,CPT,,,,,both,, ,389.01,233.40,Medicaid,Illinois Medicaid,,436.84,,,389.01,42.79,202.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q143422 IGG SUB4 NEP,82787,CPT,,,,,both,, ,389.01,233.40,Medicaid,Illinois Medicaid,,436.84,,,389.01,42.79,202.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q7903IGG SUB 1,2,3,4",82787,CPT,,,,,both,, ,389.01,233.40,Medicaid,Illinois Medicaid,,436.84,,,389.01,42.79,202.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLOOD PH,82800,CPT,,,,,both,, ,618.04,370.82,Medicaid,Illinois Medicaid,,436.84,,,618.04,67.98,321.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLD GAS W-O2 SAT DIR,82805,CPT,,,,,both,, ,1760.39,1056.23,Medicaid,Illinois Medicaid,,436.84,,,1760.39,193.64,915.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLD GAS POC/O2 SAT,82810,CPT,,,,,both,, ,100.63,60.37,Medicaid,Illinois Medicaid,,436.84,,,100.63,11.07,52.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLD GAS POC/O2 SAT,82810,CPT,,,,,both,, ,100.63,60.37,Medicaid,Illinois Medicaid,,436.84,,,100.63,11.07,52.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q478 GASTRIN IA,82941,CPT,,,,,both,, ,863.91,518.34,Medicaid,Illinois Medicaid,,105.00,,,863.91,95.03,449.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q478 GASTRIN IA,82941,CPT,,,,,both,, ,863.91,518.34,Medicaid,Illinois Medicaid,,248.89,,,863.91,95.03,449.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q519 GLUCAG EXT-RIA,82943,CPT,,,,,both,, ,82.51,49.50,Medicaid,Illinois Medicaid,,248.89,,,82.51,9.08,42.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GLUCOSE BODY FLUID,82945,CPT,,,,,both,, ,412.87,247.72,Medicaid,Illinois Medicaid,,228.35,,,412.87,45.42,214.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"GLUCOSE, QUANT",82947,CPT,,,,,both,, ,21.89,13.13,Medicaid,Illinois Medicaid,,103.62,,,21.89,2.41,11.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"GLUCOSE, QUANT",82947,CPT,,,,,both,,,240.26,240.26,Medicaid,Illinois Medicaid,,102.00,,,240.26,26.43,124.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"GLUCOSE, QUANT",82947,CPT,,,,,both,, ,240.26,144.15,Medicaid,Illinois Medicaid,,46.48,,,240.26,26.43,124.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"GLUCOSE, POST DOSE",82950,CPT,,,,,both,,,450.48,450.48,Medicaid,Illinois Medicaid,,221.70,,,450.48,49.55,234.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"GLUCOSE, POST DOSE",82950,CPT,,,,,both,, ,450.48,270.28,Medicaid,Illinois Medicaid,,221.70,,,450.48,49.55,234.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GTT 3 SPEC,82951,CPT,,,,,both,, ,758.95,455.37,Medicaid,Illinois Medicaid,,221.70,,,758.95,83.48,394.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GTT ADD SP,82952,CPT,,,,,both,, ,188.05,112.83,Medicaid,Illinois Medicaid,,221.70,,,188.05,20.69,97.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"G6PD, QUANT",82955,CPT,,,,,both,, ,1026.43,615.85,Medicaid,Illinois Medicaid,,248.89,,,1026.43,112.91,533.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"L121003 G6PD, QUANT",82955,CPT,,,,,both,, ,60.00,36.00,Medicaid,Illinois Medicaid,,248.89,,,60.00,6.60,31.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"GLU,HOME USE DIAGNOS",82962,CPT,,,,,both,, ,8.76,5.25,Medicaid,Illinois Medicaid,,248.89,,,8.76,0.96,4.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"GLU,HOME USE DIAGNOS",82962,CPT,,,,,both,, ,99.35,59.61,Medicaid,Illinois Medicaid,,248.89,,,99.35,10.93,51.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GGT,82977,CPT,,,,,both,, ,71.01,42.60,Medicaid,Illinois Medicaid,,266.75,,,71.01,7.81,36.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GGT,82977,CPT,,,,,both,, ,412.87,247.72,Medicaid,Illinois Medicaid,,266.75,,,412.87,45.42,214.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L7700 GSH TOT,82978,CPT,,,,,both,, ,61.00,36.60,Medicaid,Illinois Medicaid,,248.89,,,61.00,6.71,31.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GLYCATED PROTEIN,82985,CPT,,,,,both,, ,263.83,158.29,Medicaid,Illinois Medicaid,,248.89,,,263.83,29.02,137.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8340 FRUCTOSAMINE C,82985,CPT,,,,,both,, ,298.92,179.35,Medicaid,Illinois Medicaid,,248.89,,,298.92,32.88,155.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FOLLICLE STIM HORM,83001,CPT,,,,,both,, ,137.25,82.35,Medicaid,Illinois Medicaid,,248.89,,,137.25,15.10,71.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L4309 FSH ECLIA,83001,CPT,,,,,both,, ,812.55,487.53,Medicaid,Illinois Medicaid,,62.17,,,812.55,89.38,422.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L4309 FSH ECLIA,83001,CPT,,,,,both,, ,812.55,487.53,Medicaid,Illinois Medicaid,,62.17,,,812.55,89.38,422.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L4283 LH ECLIA,83002,CPT,,,,,both,, ,812.55,487.53,Medicaid,Illinois Medicaid,,252.43,,,812.55,89.38,422.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L4283 LH ECLIA,83002,CPT,,,,,both,, ,812.55,487.53,Medicaid,Illinois Medicaid,,252.43,,,812.55,89.38,422.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEUTEINIZING HORMONE,83002,CPT,,,,,both,, ,136.97,82.18,Medicaid,Illinois Medicaid,,32.33,,,136.97,15.07,71.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GROWTH HORMONE,83003,CPT,,,,,both,, ,1201.85,721.11,Medicaid,Illinois Medicaid,,360.55,,,1201.85,132.20,624.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q521 GH IA,83003,CPT,,,,,both,, ,74.86,44.91,Medicaid,Illinois Medicaid,,379.41,,,74.86,8.23,38.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91823 GRTH STM GN 2,83006,CPT,,,,,both,, ,189.00,113.40,Medicaid,Illinois Medicaid,,116.36,,,189.00,20.79,98.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L1628 HAPTOGLOB IMM,83010,CPT,,,,,both,, ,1109.23,665.53,Medicaid,Illinois Medicaid,,116.36,,,1109.23,122.02,576.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L1628 HAPTOGLOB IMM,83010,CPT,,,,,both,, ,1109.23,665.53,Medicaid,Illinois Medicaid,,116.36,,,1109.23,122.02,576.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14839H.PYLO UREA IR,83013,CPT,,,,,both,, ,623.38,374.02,Medicaid,Illinois Medicaid,,38.39,,,623.38,68.57,324.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HEAVY METALS, QUANT",83018,CPT,,,,,both,, ,175.14,105.08,Medicaid,Illinois Medicaid,,345.79,,,175.14,19.27,91.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L121690 - HEMOGLOBIN ELECTRO,83020,CPT,,,,,both,, ,108.15,64.89,Medicaid,Illinois Medicaid,,207.47,,,108.15,11.90,56.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NBS HGB ELECTRO,83020,CPT,,,,,both,, ,76.90,46.14,Medicaid,Illinois Medicaid,,51.69,,,76.90,8.46,39.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q35489 HEMOGLO CHROM,83021,CPT,,,,,both,, ,180.60,108.36,Medicaid,Illinois Medicaid,,526.26,,,180.60,19.87,93.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q35489 HEMOGLO CHROM,83021,CPT,,,,,both,, ,180.60,108.36,Medicaid,Illinois Medicaid,,315.75,,,180.60,19.87,93.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HEMOGLOB,FETGAL,QUAL",83033,CPT,,,,,both,, ,354.77,212.86,Medicaid,Illinois Medicaid,,98.51,,,354.77,39.02,184.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEMOGLOBIN A1C,83036,CPT,,,,,both,, ,95.71,57.42,Medicaid,Illinois Medicaid,,63.15,,,95.71,10.53,49.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEMOGLOBIN A1C,83036,CPT,,,,,both,,,454.97,454.97,Medicaid,Illinois Medicaid,,691.29,,,454.97,50.05,236.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q496 HEMOGLO A1C ITA,83036,CPT,,,,,both,, ,454.97,272.98,Medicaid,Illinois Medicaid,,414.77,,,454.97,50.05,236.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q496 HEMOGLO A1C ITA,83036,CPT,,,,,both,, ,454.97,272.98,Medicaid,Illinois Medicaid,,360.55,,,454.97,50.05,236.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"METHEMOGLOBIN,QUAN",83050,CPT,,,,,both,, ,122.09,73.25,Medicaid,Illinois Medicaid,,360.55,,,122.09,13.43,63.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HEMOGLOBIN, PLASMA",83051,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,35.70,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HEMOSIDERIN, QUAL",83070,CPT,,,,,both,, ,373.57,224.14,Medicaid,Illinois Medicaid,,414.77,,,373.57,41.09,194.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HISTAMINE,83088,CPT,,,,,both,, ,385.09,231.05,Medicaid,Illinois Medicaid,,160.48,,,385.09,42.36,200.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36586 HISTAM PL RIA,83088,CPT,,,,,both,, ,385.09,231.05,Medicaid,Illinois Medicaid,,34.18,,,385.09,42.36,200.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4946 HISTAM U24 IA,83088,CPT,,,,,both,, ,385.09,231.05,Medicaid,Illinois Medicaid,,414.77,,,385.09,42.36,200.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q31789 HCYSTEINE ENZ,83090,CPT,,,,,both,, ,227.91,136.74,Medicaid,Illinois Medicaid,,369.45,,,227.91,25.07,118.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q31789 HCYSTEINE ENZ,83090,CPT,,,,,both,, ,227.91,136.74,Medicaid,Illinois Medicaid,,369.45,,,227.91,25.07,118.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CORTICOSTEROIDS,83491,CPT,,,,,both,, ,1217.28,730.36,Medicaid,Illinois Medicaid,,414.77,,,1217.28,133.90,632.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
5-HIAA,83497,CPT,,,,,both,, ,976.46,585.87,Medicaid,Illinois Medicaid,,414.77,,,976.46,107.41,507.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q1648 5-HIAA,83497,CPT,,,,,both,, ,976.46,585.87,Medicaid,Illinois Medicaid,,414.77,,,976.46,107.41,507.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q523 5-HIAA U24 HPLC,83497,CPT,,,,,both,, ,976.46,585.87,Medicaid,Illinois Medicaid,,414.77,,,976.46,107.41,507.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HYDROXYPROGES 17-D,83498,CPT,,,,,both,, ,600.92,360.55,Medicaid,Illinois Medicaid,,414.77,,,600.92,66.10,312.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NBS HYDROXYPROG 17-D,83498,CPT,,,,,both,, ,162.23,97.33,Medicaid,Illinois Medicaid,,414.77,,,162.23,17.85,84.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q17180 17-OHP LCMSMS,83498,CPT,,,,,both,, ,601.20,360.72,Medicaid,Illinois Medicaid,,105.08,,,601.20,66.13,312.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"IMMUNOASSAY, OTHER",83516,CPT,,,,,both,,,765.96,765.96,Medicaid,Illinois Medicaid,,518.34,,,765.96,84.26,398.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"IMMUNOASSAY, OTHER",83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,40.75,,,765.96,84.26,398.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L162045 IA OTH,83516,CPT,,,,,both,, ,702.72,421.63,Medicaid,Illinois Medicaid,,420.72,,,702.72,77.30,365.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L163061 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,252.43,,,765.96,84.26,398.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L165126 IA OTH,83516,CPT,,,,,both,, ,702.72,421.63,Medicaid,Illinois Medicaid,,280.22,,,702.72,77.30,365.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L341142 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,67.36,,,765.96,84.26,398.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L520057 ANTI-HMGCR,83516,CPT,,,,,both,, ,630.00,378.00,Medicaid,Illinois Medicaid,,67.36,,,630.00,69.30,327.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L520085 IA OTHER,83516,CPT,,,,,both,, ,702.72,421.63,Medicaid,Illinois Medicaid,,129.83,,,702.72,77.30,365.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L520139 ANTI-GP210AB,83516,CPT,,,,,both,, ,300.00,180.00,Medicaid,Illinois Medicaid,,224.81,,,300.00,33.00,156,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L520311 CARP AB,83516,CPT,,,,,both,, ,520.00,312.00,Medicaid,Illinois Medicaid,,224.81,,,520.00,57.20,270.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L6486PARIET AB ELISA,83516,CPT,,,,,both,, ,81.50,48.90,Medicaid,Illinois Medicaid,,36.37,,,81.50,8.97,42.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15114PARCL AB ELISA,83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,288.47,,,765.96,84.26,398.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q18855 KU AUTOANTIBODIES,83516,CPT,,,,,both,, ,682.25,409.35,Medicaid,Illinois Medicaid,,342.53,,,682.25,75.05,354.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19899RNA P-III ELIS,83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,40.20,,,765.96,84.26,398.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34283 RIBO P AB IA,83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,40.20,,,765.96,84.26,398.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36336 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,29.80,,,765.96,84.26,398.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37056 HISTON AB EIA,83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,344.10,,,765.96,84.26,398.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q39226  21OH AB,83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,206.46,,,765.96,84.26,398.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L10421 MSH,83519,CPT,,,,,both,, ,184.00,110.40,Medicaid,Illinois Medicaid,,206.46,,,184.00,20.24,95.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L504600 MUSCLE SPECIFIC KINASE,83519,CPT,,,,,both,, ,1200.00,720.00,Medicaid,Illinois Medicaid,,79.80,,,1200.00,132.00,624,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q206 ACHR AB RIA,83519,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,189.00,,,728.07,80.09,378.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q206 ACHR AB RIA,83519,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,234.29,,,728.07,80.09,378.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q206 ACHR AB RIA,83519,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,241.32,,,728.07,80.09,378.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q206 ACHR AB RIA,83519,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,241.32,,,728.07,80.09,378.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36590 IGFBP-1 RIA,83519,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,450.81,,,728.07,80.09,378.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36590 IGFBP-1 RIA,83519,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,450.81,,,728.07,80.09,378.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36590 IGFBP-1 RIA,83519,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,450.81,,,728.07,80.09,378.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36590 IGFBP-1 RIA,83519,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,450.81,,,728.07,80.09,378.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L117021 VEGF SER,83520,CPT,,,,,both,, ,175.00,105.00,Medicaid,Illinois Medicaid,,450.81,,,175.00,19.25,91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L146712 LEPTIN S EIA,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,1559.43,,,414.83,45.63,215.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L146712 LEPTIN S EIA,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,293.19,,,414.83,45.63,215.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L146795INHIBIN B EIA,83520,CPT,,,,,both,, ,380.59,228.35,Medicaid,Illinois Medicaid,,293.19,,,380.59,41.86,197.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L500016PROTHR FR 1+2,83520,CPT,,,,,both,, ,172.70,103.62,Medicaid,Illinois Medicaid,,293.19,,,172.70,19.00,89.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L500124 MMP9,83520,CPT,,,,,both,, ,170.00,102.00,Medicaid,Illinois Medicaid,,305.48,,,170.00,18.70,88.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NBS IMMUNOASSAY NOS,83520,CPT,,,,,both,, ,77.47,46.48,Medicaid,Illinois Medicaid,,305.48,,,77.47,8.52,40.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16034 BULLOUS PEMPHIGOID (BP180) ANTIBO,83520,CPT,,,,,both,, ,369.50,221.70,Medicaid,Illinois Medicaid,,376.38,,,369.50,40.65,192.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16034 BULLOUS PEMPHIGOID (BP180) ANTIBO,83520,CPT,,,,,both,, ,369.50,221.70,Medicaid,Illinois Medicaid,,376.38,,,369.50,40.65,192.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16034 BULLOUS PEMPHIGOID (BP180) ANTIBO,83520,CPT,,,,,both,, ,369.50,221.70,Medicaid,Illinois Medicaid,,270.00,,,369.50,40.65,192.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16034 BULLOUS PEMPHIGOID (BP180) ANTIBO,83520,CPT,,,,,both,, ,369.50,221.70,Medicaid,Illinois Medicaid,,167.73,,,369.50,40.65,192.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16039 MBL ELISA,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,1229.07,,,414.83,45.63,215.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16039 MBL ELISA,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,737.44,,,414.83,45.63,215.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q257 GBM AB IGG IA,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,252.43,,,414.83,45.63,215.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q257 GBM AB IGG IA,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,252.43,,,414.83,45.63,215.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8658 ALPH SUB ECLIA,83520,CPT,,,,,both,, ,444.59,266.75,Medicaid,Illinois Medicaid,,224.85,,,444.59,48.90,231.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8658 ALPH SUB ECLIA,83520,CPT,,,,,both,, ,444.59,266.75,Medicaid,Illinois Medicaid,,560.45,,,444.59,48.90,231.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q90123 IA NOS,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,522.73,,,414.83,45.63,215.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q90123 IA NOS,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,522.73,,,414.83,45.63,215.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91455 14-3-3 ETA PR,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,318.45,,,414.83,45.63,215.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91455 14-3-3 ETA PR,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,318.45,,,414.83,45.63,215.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L121137 LTCHN KAPLAM,83521,CPT,,,,,both,, ,103.62,62.17,Medicaid,Illinois Medicaid,,237.61,,,103.62,11.40,53.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L121137 LTCHN KAPLAM,83521,CPT,,,,,both,, ,103.62,62.17,Medicaid,Illinois Medicaid,,237.61,,,103.62,11.40,53.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11233 LTCHN KAP LAM,83521,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,24.53,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11233 LTCHN KAP LAM,83521,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,252.43,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"INSULIN, TOTAL",83525,CPT,,,,,both,, ,53.89,32.33,Medicaid,Illinois Medicaid,,30.54,,,53.89,5.93,28.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"INSULIN, TOTAL",83525,CPT,,,,,both,, ,600.92,360.55,Medicaid,Illinois Medicaid,,40.24,,,600.92,66.10,312.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q561 INSULIN IA,83525,CPT,,,,,both,, ,632.36,379.41,Medicaid,Illinois Medicaid,,252.43,,,632.36,69.56,328.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"INSULIN, FREE",83527,CPT,,,,,both,, ,193.94,116.36,Medicaid,Illinois Medicaid,,122.16,,,193.94,21.33,100.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L501561 INSULIN FREE,83527,CPT,,,,,both,, ,193.94,116.36,Medicaid,Illinois Medicaid,,268.43,,,193.94,21.33,100.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36700 INSULIN FR IA,83527,CPT,,,,,both,, ,193.94,116.36,Medicaid,Illinois Medicaid,,396.58,,,193.94,21.33,100.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IRON,83540,CPT,,,,,both,, ,63.99,38.39,Medicaid,Illinois Medicaid,,396.58,,,63.99,7.04,33.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IRON,83540,CPT,,,,,both,,,345.79,345.79,Medicaid,Illinois Medicaid,,396.58,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IRON,83540,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,396.58,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IRON BINDING CAPACIT,83550,CPT,,,,,both,, ,86.16,51.69,Medicaid,Illinois Medicaid,,252.29,,,86.16,9.48,44.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IRON BINDING CAPACIT,83550,CPT,,,,,both,,,526.26,526.26,Medicaid,Illinois Medicaid,,96.33,,,526.26,57.89,273.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IRON BINDING CAPACIT,83550,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,852.29,,,526.26,57.89,273.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"17-KETOSTEROIDS, TOT",83586,CPT,,,,,both,, ,164.19,98.51,Medicaid,Illinois Medicaid,,144.15,,,164.19,18.06,85.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LACTIC ACID,83605,CPT,,,,,both,, ,105.25,63.15,Medicaid,Illinois Medicaid,,144.15,,,105.25,11.58,54.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LACTIC ACID,83605,CPT,,,,,both,,,691.29,691.29,Medicaid,Illinois Medicaid,,144.15,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LACTIC ACID,83605,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,80.32,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LACTATE DEHYDROGENASE LDH FLUID,83615,CPT,,,,,both,, ,600.92,360.55,Medicaid,Illinois Medicaid,,237.45,,,600.92,66.10,312.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LACTATE DEHYDROGENASE LDH FLUID,83615,CPT,,,,,both,, ,600.92,360.55,Medicaid,Illinois Medicaid,,237.45,,,600.92,66.10,312.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LACTATE DEHYDROLDH,83615,CPT,,,,,both,, ,59.50,35.70,Medicaid,Illinois Medicaid,,19.70,,,59.50,6.55,30.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LDH ISOENZYMES,83625,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,19.70,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10156 LACTOFER IA,83630,CPT,,,,,both,, ,267.48,160.48,Medicaid,Illinois Medicaid,,324.51,,,267.48,29.42,139.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEAD,83655,CPT,,,,,both,, ,56.97,34.18,Medicaid,Illinois Medicaid,,30.64,,,56.97,6.27,29.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,252.43,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q3058 LEAD, BLOOD (OSHA)",83655,CPT,,,,,both,, ,615.75,369.45,Medicaid,Illinois Medicaid,,252.43,,,615.75,67.73,320.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q3058 LEAD, BLOOD (OSHA)",83655,CPT,,,,,both,, ,615.75,369.45,Medicaid,Illinois Medicaid,,382.44,,,615.75,67.73,320.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36438 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,382.44,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36440LEAD U24 ICPMS,83655,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,233.40,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q599 PB BL ICP/MS,83655,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,28.12,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q601 PB U ICP/MS,83655,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,207.47,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7507 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,207.47,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7655 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,207.47,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"FETAL LUNG,L-S RATIO",83661,CPT,,,,,both,, ,175.14,105.08,Medicaid,Illinois Medicaid,,207.47,,,175.14,19.27,91.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"FETAL LUNG, FPIA",83663,CPT,,,,,both,, ,863.91,518.34,Medicaid,Illinois Medicaid,,378.57,,,863.91,95.03,449.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LIPASE,83690,CPT,,,,,both,, ,67.92,40.75,Medicaid,Illinois Medicaid,,292.85,,,67.92,7.47,35.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LIPASE,83690,CPT,,,,,both,,,420.72,420.72,Medicaid,Illinois Medicaid,,486.85,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LIPASE,83690,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,486.85,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34604 LIPOPRT A ITA,83695,CPT,,,,,both,, ,467.04,280.22,Medicaid,Illinois Medicaid,,28.29,,,467.04,51.37,242.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q92145 LIPOPROTEIN,83695,CPT,,,,,both,, ,112.27,67.36,Medicaid,Illinois Medicaid,,240.26,,,112.27,12.35,58.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q92145 LIPOPROTEIN,83695,CPT,,,,,both,, ,112.27,67.36,Medicaid,Illinois Medicaid,,144.15,,,112.27,12.35,58.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q94220 LP-PLA2,83698,CPT,,,,,both,, ,216.39,129.83,Medicaid,Illinois Medicaid,,207.47,,,216.39,23.80,112.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q92145 LIPOPROT BLD,83704,CPT,,,,,both,, ,374.69,224.81,Medicaid,Illinois Medicaid,,345.79,,,374.69,41.22,194.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q92145 LIPOPROT BLD,83704,CPT,,,,,both,, ,374.69,224.81,Medicaid,Illinois Medicaid,,207.47,,,374.69,41.22,194.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"LIPOPROTEIN, HDL",83718,CPT,,,,,both,, ,60.63,36.37,Medicaid,Illinois Medicaid,,207.47,,,60.63,6.67,31.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"LIPOPROTEIN, HDL",83718,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,63.15,,,480.79,52.89,250.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"LIPOPROTEIN, LDL",83721,CPT,,,,,both,, ,570.89,342.53,Medicaid,Illinois Medicaid,,621.75,,,570.89,62.80,296.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L80283 MG RBC AAS-IC,83735,CPT,,,,,both,, ,67.00,40.20,Medicaid,Illinois Medicaid,,98.85,,,67.00,7.37,34.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L80283 MG RBC AAS-IC,83735,CPT,,,,,both,, ,67.00,40.20,Medicaid,Illinois Medicaid,,98.85,,,67.00,7.37,34.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MAGNESIUM,83735,CPT,,,,,both,, ,49.68,29.80,Medicaid,Illinois Medicaid,,232.73,,,49.68,5.46,25.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MAGNESIUM,83735,CPT,,,,,both,,,344.10,344.10,Medicaid,Illinois Medicaid,,730.36,,,344.10,37.85,178.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q442 MAGNESIUM,83735,CPT,,,,,both,, ,344.10,206.46,Medicaid,Illinois Medicaid,,730.36,,,344.10,37.85,178.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q442 MAGNESIUM,83735,CPT,,,,,both,, ,344.10,206.46,Medicaid,Illinois Medicaid,,37.54,,,344.10,37.85,178.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MANGANESE WHOLE BLOOD,83785,CPT,,,,,both,, ,133.00,79.80,Medicaid,Illinois Medicaid,,139.26,,,133.00,14.63,69.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L70034 I S/P ICP/MS,83789,CPT,,,,,both,, ,315.00,189.00,Medicaid,Illinois Medicaid,,139.26,,,315.00,34.65,163.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L70222 I U ICP/MS,83789,CPT,,,,,both,, ,390.49,234.29,Medicaid,Illinois Medicaid,,376.98,,,390.49,42.95,203.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91745THIOPUR LCMSMS,83789,CPT,,,,,both,, ,402.20,241.32,Medicaid,Illinois Medicaid,,85.88,,,402.20,44.24,209.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91745THIOPUR LCMSMS,83789,CPT,,,,,both,, ,402.20,241.32,Medicaid,Illinois Medicaid,,646.50,,,402.20,44.24,209.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,575.85,,,751.36,82.65,390.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36438 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,575.85,,,751.36,82.65,390.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q636 HG BL ICP/MS,83825,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,234.07,,,751.36,82.65,390.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7507 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,1036.25,,,751.36,82.65,390.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7655 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,81.51,,,751.36,82.65,390.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
METANEPHRINES,83835,CPT,,,,,both,, ,2599.05,1559.43,Medicaid,Illinois Medicaid,,621.75,,,2599.05,285.90,1351.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14961 METANEPHRINES,83835,CPT,,,,,both,, ,488.65,293.19,Medicaid,Illinois Medicaid,,621.75,,,488.65,53.75,254.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14962MNFR U24 LCMSM,83835,CPT,,,,,both,, ,488.65,293.19,Medicaid,Illinois Medicaid,,1036.25,,,488.65,53.75,254.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19548 MN FRC LCMSMS,83835,CPT,,,,,both,, ,488.65,293.19,Medicaid,Illinois Medicaid,,81.51,,,488.65,53.75,254.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q70858 MYELIN BASIC,83873,CPT,,,,,both,, ,509.14,305.48,Medicaid,Illinois Medicaid,,621.75,,,509.14,56.01,264.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q70858 MYELIN BASIC,83873,CPT,,,,,both,, ,509.14,305.48,Medicaid,Illinois Medicaid,,621.75,,,509.14,56.01,264.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L3079MYOGL QT U ICMA,83874,CPT,,,,,both,, ,627.30,376.38,Medicaid,Illinois Medicaid,,21.55,,,627.30,69.00,326.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L3079MYOGL QT U ICMA,83874,CPT,,,,,both,, ,627.30,376.38,Medicaid,Illinois Medicaid,,224.85,,,627.30,69.00,326.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L143000 NT-PROBNP,83880,CPT,,,,,both,, ,450.00,270.00,Medicaid,Illinois Medicaid,,252.43,,,450.00,49.50,234,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,, ,279.55,167.73,Medicaid,Illinois Medicaid,,252.43,,,279.55,30.75,145.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,,,1229.07,1229.07,Medicaid,Illinois Medicaid,,252.43,,,1229.07,135.20,639.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,, ,1229.07,737.44,Medicaid,Illinois Medicaid,,252.43,,,1229.07,135.20,639.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37863 NEPHELOM NOS,83883,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,420.72,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37863 NEPHELOM NOS,83883,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,252.43,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q38940 NEPHELOMETRY NOS,83883,CPT,,,,,both,, ,374.75,224.85,Medicaid,Illinois Medicaid,,252.43,,,374.75,41.22,194.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NICKEL,83885,CPT,,,,,both,, ,934.09,560.45,Medicaid,Illinois Medicaid,,21.55,,,934.09,102.75,485.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14624 5'NUCLEO C-KN,83915,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,252.43,,,871.22,95.83,453.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14624 5'NUCLEO C-KN,83915,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,63.48,,,871.22,95.83,453.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q70858 OLIGOCLONAL B,83916,CPT,,,,,both,, ,530.75,318.45,Medicaid,Illinois Medicaid,,325.65,,,530.75,58.38,275.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q70858 OLIGOCLONAL B,83916,CPT,,,,,both,, ,530.75,318.45,Medicaid,Illinois Medicaid,,365.60,,,530.75,58.38,275.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34879 MMA MS/MS,83921,CPT,,,,,both,, ,396.02,237.61,Medicaid,Illinois Medicaid,,365.60,,,396.02,43.56,205.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34879 MMA MS/MS,83921,CPT,,,,,both,, ,396.02,237.61,Medicaid,Illinois Medicaid,,365.60,,,396.02,43.56,205.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L2071 OSMALALITY FPD,83930,CPT,,,,,both,, ,40.89,24.53,Medicaid,Illinois Medicaid,,365.60,,,40.89,4.50,21.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"OSMOLALITY, BLOOD",83930,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,257.82,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L3442 OSMOLALI U FPD,83935,CPT,,,,,both,, ,50.90,30.54,Medicaid,Illinois Medicaid,,257.82,,,50.90,5.60,26.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"OSMOLALITY,URINE",83935,CPT,,,,,both,, ,67.07,40.24,Medicaid,Illinois Medicaid,,257.82,,,67.07,7.38,34.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"OSMOLALITY,URINE",83935,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,81.84,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L10249 OSTREOC ELISA,83937,CPT,,,,,both,, ,203.60,122.16,Medicaid,Illinois Medicaid,,81.84,,,203.60,22.40,105.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OSTEOCALCIN,83937,CPT,,,,,both,, ,447.39,268.43,Medicaid,Illinois Medicaid,,106.50,,,447.39,49.21,232.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q682 OXALATE,83945,CPT,,,,,both,, ,660.98,396.58,Medicaid,Illinois Medicaid,,119.56,,,660.98,72.71,343.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q682 OXALATE,83945,CPT,,,,,both,, ,660.98,396.58,Medicaid,Illinois Medicaid,,119.56,,,660.98,72.71,343.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q682 OXALATE,83945,CPT,,,,,both,, ,660.98,396.58,Medicaid,Illinois Medicaid,,160.14,,,660.98,72.71,343.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q682 OXALATE,83945,CPT,,,,,both,, ,660.98,396.58,Medicaid,Illinois Medicaid,,202.25,,,660.98,72.71,343.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L15610 PTH INT ECLIA,83970,CPT,,,,,both,, ,420.49,252.29,Medicaid,Illinois Medicaid,,442.90,,,420.49,46.25,218.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PARATHORMONE PTH,83970,CPT,,,,,both,, ,160.55,96.33,Medicaid,Illinois Medicaid,,442.90,,,160.55,17.66,83.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PARATHORMONE PTH,83970,CPT,,,,,both,, ,1420.49,852.29,Medicaid,Illinois Medicaid,,640.10,,,1420.49,156.25,738.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"L910235 PH FLUID, NOS",83986,CPT,,,,,both,, ,240.26,144.15,Medicaid,Illinois Medicaid,,196.02,,,240.26,26.43,124.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PH FLUID,NOS",83986,CPT,,,,,both,, ,240.26,144.15,Medicaid,Illinois Medicaid,,196.02,,,240.26,26.43,124.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q442 PH FLUID,NOS",83986,CPT,,,,,both,, ,240.26,144.15,Medicaid,Illinois Medicaid,,285.27,,,240.26,26.43,124.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L790600 PCP MS,83992,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,285.27,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16796 CALPRO STL IA,83993,CPT,,,,,both,, ,395.75,237.45,Medicaid,Illinois Medicaid,,892.20,,,395.75,43.53,205.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16796 CALPRO STL IA,83993,CPT,,,,,both,, ,395.75,237.45,Medicaid,Illinois Medicaid,,108.45,,,395.75,43.53,205.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37356 PNENYLAL HPLC,84030,CPT,,,,,both,, ,32.84,19.70,Medicaid,Illinois Medicaid,,245.70,,,32.84,3.61,17.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37356 PNENYLAL HPLC,84030,CPT,,,,,both,, ,32.84,19.70,Medicaid,Illinois Medicaid,,245.70,,,32.84,3.61,17.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PHOSPHATASE, PROSTAT",84066,CPT,,,,,both,, ,540.85,324.51,Medicaid,Illinois Medicaid,,56.74,,,540.85,59.49,281.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PHOSPHATASE,ALKALINE",84075,CPT,,,,,both,, ,51.08,30.64,Medicaid,Illinois Medicaid,,172.95,,,51.08,5.62,26.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q6432 PHOSPHATAS ALK,84075,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,172.95,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q6432 PHOSPHATAS ALK,84075,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,172.95,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q6432 PHOSPH ALK ISO,84080,CPT,,,,,both,, ,637.41,382.44,Medicaid,Illinois Medicaid,,28.45,,,637.41,70.12,331.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q6432 PHOSPH ALK ISO,84080,CPT,,,,,both,, ,637.41,382.44,Medicaid,Illinois Medicaid,,345.79,,,637.41,70.12,331.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHOSPHATIDYLGLYCEROL,84081,CPT,,,,,both,, ,389.01,233.40,Medicaid,Illinois Medicaid,,207.47,,,389.01,42.79,202.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PHOSPHORUS, BLOOD",84100,CPT,,,,,both,, ,46.87,28.12,Medicaid,Illinois Medicaid,,207.47,,,46.87,5.16,24.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PHOSPHORUS, BLOOD",84100,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,207.47,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"L910235 PHOSPHORUS, URINE",84105,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,28.79,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PHOSPHORUS, URINE",84105,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,345.79,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q442 PHOSPHORUS, URI",84105,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,207.47,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PORPHOBILINOGEN,QUAN",84110,CPT,,,,,both,, ,630.96,378.57,Medicaid,Illinois Medicaid,,49.50,,,630.96,69.41,328.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PAMG-1 QUALITATIVE,84112,CPT,,,,,both,, ,488.09,292.85,Medicaid,Illinois Medicaid,,522.22,,,488.09,53.69,253.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L3194 PORPH QT U24,84120,CPT,,,,,both,, ,811.43,486.85,Medicaid,Illinois Medicaid,,522.22,,,811.43,89.26,421.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PORPHYRINS,UR,QUAN",84120,CPT,,,,,both,, ,811.42,486.85,Medicaid,Illinois Medicaid,,56.24,,,811.42,89.26,421.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
POTASSIUM SER PL WB,84132,CPT,,,,,both,, ,47.15,28.29,Medicaid,Illinois Medicaid,,56.24,,,47.15,5.19,24.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
POTASSIUM SER PL WB,84132,CPT,,,,,both,,,240.26,240.26,Medicaid,Illinois Medicaid,,56.24,,,240.26,26.43,124.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
POTASSIUM SER PL WB,84132,CPT,,,,,both,, ,240.26,144.15,Medicaid,Illinois Medicaid,,126.30,,,240.26,26.43,124.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"L910235 POTASSIUM, URINE",84133,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,56.24,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"POTASSIUM, URINE",84133,CPT,,,,,both,,,345.79,345.79,Medicaid,Illinois Medicaid,,134.40,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"POTASSIUM, URINE",84133,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,19.02,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q442 POTASSIUM, URIN",84133,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,19.02,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PREALBUMIN,84134,CPT,,,,,both,, ,105.25,63.15,Medicaid,Illinois Medicaid,,610.30,,,105.25,11.58,54.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PREALBUMIN,84134,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,1017.17,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PREGNENOLONE MS,84140,CPT,,,,,both,, ,164.75,98.85,Medicaid,Illinois Medicaid,,610.30,,,164.75,18.12,85.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PREGNENOLONE MS,84140,CPT,,,,,both,, ,164.75,98.85,Medicaid,Illinois Medicaid,,610.30,,,164.75,18.12,85.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PREGNENOLONE,17-OH",84143,CPT,,,,,both,, ,387.89,232.73,Medicaid,Illinois Medicaid,,581.16,,,387.89,42.67,201.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L4317 PROGESTE ECLIA,84144,CPT,,,,,both,, ,1217.28,730.36,Medicaid,Illinois Medicaid,,968.60,,,1217.28,133.90,632.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L4317 PROGESTE ECLIA,84144,CPT,,,,,both,, ,1217.28,730.36,Medicaid,Illinois Medicaid,,581.16,,,1217.28,133.90,632.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROGESTERONE,84144,CPT,,,,,both,, ,62.58,37.54,Medicaid,Illinois Medicaid,,114.51,,,62.58,6.88,32.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16265 PROCALCIT IFA,84145,CPT,,,,,both,, ,232.11,139.26,Medicaid,Illinois Medicaid,,581.16,,,232.11,25.53,120.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16265 PROCALCIT IFA,84145,CPT,,,,,both,, ,232.11,139.26,Medicaid,Illinois Medicaid,,126.69,,,232.11,25.53,120.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L4465 PROLACTI ECLIA,84146,CPT,,,,,both,, ,628.30,376.98,Medicaid,Illinois Medicaid,,791.19,,,628.30,69.11,326.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROLACTIN,84146,CPT,,,,,both,, ,143.14,85.88,Medicaid,Illinois Medicaid,,161.49,,,143.14,15.75,74.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROLACTIN,84146,CPT,,,,,both,, ,1077.50,646.50,Medicaid,Illinois Medicaid,,182.21,,,1077.50,118.53,560.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16122 PROLACTIN,84146,CPT,,,,,both,, ,959.75,575.85,Medicaid,Illinois Medicaid,,94.13,,,959.75,105.57,499.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16122 PROLACTIN,84146,CPT,,,,,both,, ,959.75,575.85,Medicaid,Illinois Medicaid,,862.39,,,959.75,105.57,499.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q93958 23BPG UR,84150,CPT,,,,,both,, ,390.13,234.07,Medicaid,Illinois Medicaid,,104.74,,,390.13,42.91,202.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PSA (prostate specific antigen),84153,CPT,,,,,both,,,1036.25,1036.25,Medicaid,Illinois Medicaid,,153.07,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PSA, TOTAL",84153,CPT,,,,,both,, ,135.85,81.51,Medicaid,Illinois Medicaid,,153.07,,,135.85,14.94,70.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q31348 PSA, TOTAL",84153,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,23.23,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q31348 PSA, TOTAL",84153,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,243.34,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PSA (prostate specific antigen),84154,CPT,,,,,both,,,1036.25,1036.25,Medicaid,Illinois Medicaid,,372.33,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PSA, FREE",84154,CPT,,,,,both,, ,135.85,81.51,Medicaid,Illinois Medicaid,,372.33,,,135.85,14.94,70.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q31348 PSA, FREE",84154,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,39.91,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q31348 PSA, FREE",84154,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,620.56,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,35.93,21.55,Medicaid,Illinois Medicaid,,117.42,,,35.93,3.95,18.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q38940 PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,374.75,224.85,Medicaid,Illinois Medicaid,,127.98,,,374.75,41.22,194.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q747 PROTEIN TOT SER,84155,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,737.61,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q747 PROTEIN TOT SER,84155,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,442.56,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q747 PROTEIN TOT SER,84155,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,442.56,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q747 PROTEIN TOT SER,84155,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,74.43,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROT TOTL RANDOM URI,84156,CPT,,,,,both,,,420.72,420.72,Medicaid,Illinois Medicaid,,439.87,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8525 PROT TOTL RAND,84156,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,706.96,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8525 PROT TOTL RAND,84156,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,136.57,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROTEIN TOT OTHR SRC,84157,CPT,,,,,both,, ,35.93,21.55,Medicaid,Illinois Medicaid,,136.57,,,35.93,3.95,18.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q749 PROT TOT OTH SR,84157,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,108.00,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROTEINELECTR FR-QNT,84165,CPT,,,,,both,, ,105.81,63.48,Medicaid,Illinois Medicaid,,22.90,,,105.81,11.64,55.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q38940 PROTEINELECTR FR QNT,84165,CPT,,,,,both,, ,542.75,325.65,Medicaid,Illinois Medicaid,,207.47,,,542.75,59.70,282.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q747 PROTEINELECTR F,84165,CPT,,,,,both,, ,609.34,365.60,Medicaid,Illinois Medicaid,,23.57,,,609.34,67.03,316.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q747 PROTEINELECTR F,84165,CPT,,,,,both,, ,609.34,365.60,Medicaid,Illinois Medicaid,,207.47,,,609.34,67.03,316.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q747 PROTEINELECTR F,84165,CPT,,,,,both,, ,609.34,365.60,Medicaid,Illinois Medicaid,,477.93,,,609.34,67.03,316.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q747 PROTEINELECTR F,84165,CPT,,,,,both,, ,609.34,365.60,Medicaid,Illinois Medicaid,,477.93,,,609.34,67.03,316.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROT E-PHOR-URIN-CSF,84166,CPT,,,,,both,, ,429.71,257.82,Medicaid,Illinois Medicaid,,56.58,,,429.71,47.27,223.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q749 PROT E-PHOR-URI,84166,CPT,,,,,both,, ,429.71,257.82,Medicaid,Illinois Medicaid,,23.57,,,429.71,47.27,223.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8525 PROT E-PHOR-UR,84166,CPT,,,,,both,, ,429.71,257.82,Medicaid,Illinois Medicaid,,207.47,,,429.71,47.27,223.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q94777 WEST BLOT PRB,84182,CPT,,,,,both,, ,136.40,81.84,Medicaid,Illinois Medicaid,,315.75,,,136.40,15.00,70.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q94777 WEST BLOT PRB,84182,CPT,,,,,both,, ,136.40,81.84,Medicaid,Illinois Medicaid,,623.59,,,136.40,15.00,70.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q22996 PROTOPORPH RBC QUAN,84202,CPT,,,,,both,, ,177.50,106.50,Medicaid,Illinois Medicaid,,514.98,,,177.50,19.53,92.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q948 ZPP HEMATOFLUOR,84202,CPT,,,,,both,, ,199.27,119.56,Medicaid,Illinois Medicaid,,514.98,,,199.27,21.92,103.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q948 ZPP HEMATOFLUOR,84202,CPT,,,,,both,, ,199.27,119.56,Medicaid,Illinois Medicaid,,131.52,,,199.27,21.92,103.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROINSULIN,84206,CPT,,,,,both,, ,266.91,160.14,Medicaid,Illinois Medicaid,,80.32,,,266.91,29.36,138.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q760 PROINSULIN IA,84206,CPT,,,,,both,, ,337.09,202.25,Medicaid,Illinois Medicaid,,713.19,,,337.09,37.08,175.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q926 B6 PL LC/MS/MS,84207,CPT,,,,,both,, ,738.17,442.90,Medicaid,Illinois Medicaid,,427.91,,,738.17,81.20,383.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q926 B6 PL LC/MS/MS,84207,CPT,,,,,both,, ,738.17,442.90,Medicaid,Illinois Medicaid,,17.51,,,738.17,81.20,383.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PYRUVATE,84210,CPT,,,,,both,, ,1066.84,640.10,Medicaid,Illinois Medicaid,,277.59,,,1066.84,117.35,554.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91031 STFR NEPHELOM,84238,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,166.55,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91031 STFR NEPHELOM,84238,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,207.47,,,326.71,35.94,169.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16845 RENIN,84244,CPT,,,,,both,, ,475.46,285.27,Medicaid,Illinois Medicaid,,207.47,,,475.46,52.30,247.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16845 RENIN,84244,CPT,,,,,both,, ,475.46,285.27,Medicaid,Illinois Medicaid,,345.79,,,475.46,52.30,247.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RENIN,84244,CPT,,,,,both,, ,1487.01,892.20,Medicaid,Illinois Medicaid,,26.60,,,1487.01,163.57,773.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VITAMIN B-2,84252,CPT,,,,,both,, ,180.75,108.45,Medicaid,Illinois Medicaid,,285.17,,,180.75,19.88,93.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q5507 SELENIUM AS,84255,CPT,,,,,both,, ,409.50,245.70,Medicaid,Illinois Medicaid,,171.10,,,409.50,45.05,212.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q5507 SELENIUM AS,84255,CPT,,,,,both,, ,409.50,245.70,Medicaid,Illinois Medicaid,,207.47,,,409.50,45.05,212.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SEROTONIN,84260,CPT,,,,,both,, ,94.58,56.74,Medicaid,Illinois Medicaid,,207.47,,,94.58,10.40,49.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14966 SEX HORM BIND,84270,CPT,,,,,both,, ,288.25,172.95,Medicaid,Illinois Medicaid,,207.47,,,288.25,31.71,149.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q30740 SHBG IA,84270,CPT,,,,,both,, ,288.25,172.95,Medicaid,Illinois Medicaid,,213.03,,,288.25,31.71,149.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SEX HORM BIND GLOB,84270,CPT,,,,,both,, ,288.25,172.95,Medicaid,Illinois Medicaid,,213.03,,,288.25,31.71,149.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,, ,47.43,28.45,Medicaid,Illinois Medicaid,,70.02,,,47.43,5.22,24.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,,,345.79,345.79,Medicaid,Illinois Medicaid,,203.01,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,221.28,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"L910235 SODIUM, URINE",84300,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,177.49,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q442 SODIUM, URINE R",84300,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,177.49,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,, ,47.99,28.79,Medicaid,Illinois Medicaid,,111.64,,,47.99,5.28,24.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,,,345.79,345.79,Medicaid,Illinois Medicaid,,111.64,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,118.21,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SODIUM OTHER SOURCE,84302,CPT,,,,,both,, ,82.51,49.50,Medicaid,Illinois Medicaid,,113.33,,,82.51,9.08,42.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16293 IGF-I LC/MS,84305,CPT,,,,,both,, ,870.37,522.22,Medicaid,Illinois Medicaid,,113.33,,,870.37,95.74,452.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16293 IGF-I LC/MS,84305,CPT,,,,,both,, ,870.37,522.22,Medicaid,Illinois Medicaid,,436.84,,,870.37,95.74,452.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADENO DEAMNASE BFLD,84311,CPT,,,,,both,, ,93.74,56.24,Medicaid,Illinois Medicaid,,666.88,,,93.74,10.31,48.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q175858 CHOLEST PF C,84311,CPT,,,,,both,, ,93.74,56.24,Medicaid,Illinois Medicaid,,649.03,,,93.74,10.31,48.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SPECTROPHOTO, NOS",84311,CPT,,,,,both,, ,93.74,56.24,Medicaid,Illinois Medicaid,,649.03,,,93.74,10.31,48.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPECIFIC GRAVITY,84315,CPT,,,,,both,, ,210.50,126.30,Medicaid,Illinois Medicaid,,48.00,,,210.50,23.16,109.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SUGARS, SING, QUAL",84376,CPT,,,,,both,, ,93.74,56.24,Medicaid,Illinois Medicaid,,539.06,,,93.74,10.31,48.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GLYCOMARK,84378,CPT,,,,,both,, ,224.00,134.40,Medicaid,Illinois Medicaid,,539.06,,,224.00,24.64,116.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q442 SULFATE, URINE",84392,CPT,,,,,both,, ,31.71,19.02,Medicaid,Illinois Medicaid,,89.08,,,31.71,3.49,16.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q442 SULFATE, URINE",84392,CPT,,,,,both,, ,31.71,19.02,Medicaid,Illinois Medicaid,,455.19,,,31.71,3.49,16.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q18944 TST FREE,84402,CPT,,,,,both,, ,1017.17,610.30,Medicaid,Illinois Medicaid,,455.19,,,1017.17,111.89,528.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36170 TESTOST FREE,84402,CPT,,,,,both,,,1017.17,1017.17,Medicaid,Illinois Medicaid,,44.46,,,1017.17,111.89,528.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36170 TESTOST FREE,84402,CPT,,,,,both,, ,1017.17,610.30,Medicaid,Illinois Medicaid,,420.72,,,1017.17,111.89,528.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"TESTOSTERONE, FREE",84402,CPT,,,,,both,, ,1017.17,610.30,Medicaid,Illinois Medicaid,,252.43,,,1017.17,111.89,528.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14966 TESTOST TOTAL,84403,CPT,,,,,both,, ,968.60,581.16,Medicaid,Illinois Medicaid,,164.70,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36170 TESTOST TOTAL,84403,CPT,,,,,both,,,968.60,968.60,Medicaid,Illinois Medicaid,,135.00,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36170 TESTOST TOTAL,84403,CPT,,,,,both,, ,968.60,581.16,Medicaid,Illinois Medicaid,,135.00,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"TESTOSTERONE, TOTAL",84403,CPT,,,,,both,, ,190.86,114.51,Medicaid,Illinois Medicaid,,207.47,,,190.86,20.99,99.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"TESTOSTERONE, TOTAL",84403,CPT,,,,,both,, ,968.60,581.16,Medicaid,Illinois Medicaid,,28.79,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L70282 TEST FR WB T,84410,CPT,,,,,both,, ,211.15,126.69,Medicaid,Illinois Medicaid,,61.80,,,211.15,23.23,109.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L121186VITB1 BL HPLC,84425,CPT,,,,,both,, ,1318.66,791.19,Medicaid,Illinois Medicaid,,20.37,,,1318.66,145.05,685.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q5042 B1 BL LC/MS/MS,84425,CPT,,,,,both,, ,269.16,161.49,Medicaid,Illinois Medicaid,,112.99,,,269.16,29.61,139.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q90353 VIT B1 LCMSMS,84425,CPT,,,,,both,, ,303.69,182.21,Medicaid,Illinois Medicaid,,67.53,,,303.69,33.41,157.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VITAMIN B-1,84425,CPT,,,,,both,, ,156.89,94.13,Medicaid,Illinois Medicaid,,19.70,,,156.89,17.26,81.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VITAMIN B-1,84425,CPT,,,,,both,, ,1437.33,862.39,Medicaid,Illinois Medicaid,,7.90,,,1437.33,158.11,747.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THIOCYANATE,84430,CPT,,,,,both,, ,174.57,104.74,Medicaid,Illinois Medicaid,,262.99,,,174.57,19.20,90.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q30278 THYROGLOBULIN,84432,CPT,,,,,both,, ,255.13,153.07,Medicaid,Illinois Medicaid,,157.79,,,255.13,28.06,132.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q30278 THYROGLOBULIN,84432,CPT,,,,,both,, ,255.13,153.07,Medicaid,Illinois Medicaid,,7.90,,,255.13,28.06,132.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"THYROXINE T4,TOTAL",84436,CPT,,,,,both,, ,38.73,23.23,Medicaid,Illinois Medicaid,,262.99,,,38.73,4.26,20.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"THYROXINE T4,TOTAL",84436,CPT,,,,,both,, ,405.57,243.34,Medicaid,Illinois Medicaid,,157.79,,,405.57,44.61,210.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q35167 T4FREE DED-IA,84439,CPT,,,,,both,, ,620.56,372.33,Medicaid,Illinois Medicaid,,157.79,,,620.56,68.26,322.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q35167 T4FREE DED-IA,84439,CPT,,,,,both,, ,620.56,372.33,Medicaid,Illinois Medicaid,,6.00,,,620.56,68.26,322.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"THYROXINE T4, FREE",84439,CPT,,,,,both,, ,66.52,39.91,Medicaid,Illinois Medicaid,,17.34,,,66.52,7.32,34.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"THYROXINE T4, FREE",84439,CPT,,,,,both,,,620.56,620.56,Medicaid,Illinois Medicaid,,256.98,,,620.56,68.26,322.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L1735 TBG SER ICMA,84442,CPT,,,,,both,, ,195.70,117.42,Medicaid,Illinois Medicaid,,428.30,,,195.70,21.53,101.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THYROXINE BIND GLOB,84442,CPT,,,,,both,, ,213.31,127.98,Medicaid,Illinois Medicaid,,14.47,,,213.31,23.46,110.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Blood test, thyroid stimulating hormone (TSH)",84443,CPT,,,,,both,,,737.61,737.61,Medicaid,Illinois Medicaid,,247.72,,,737.61,81.14,383.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q90123 TSH,84443,CPT,,,,,both,, ,737.61,442.56,Medicaid,Illinois Medicaid,,412.87,,,737.61,81.14,383.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q90123 TSH,84443,CPT,,,,,both,, ,737.61,442.56,Medicaid,Illinois Medicaid,,279.88,,,737.61,81.14,383.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THYROID STIM TSH,84443,CPT,,,,,both,, ,124.05,74.43,Medicaid,Illinois Medicaid,,3.63,,,124.05,13.65,64.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q30551 TSI IA,84445,CPT,,,,,both,, ,733.12,439.87,Medicaid,Illinois Medicaid,,293.86,,,733.12,80.64,381.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THYROID STIM IMMUNO,84445,CPT,,,,,both,, ,1178.27,706.96,Medicaid,Illinois Medicaid,,23.57,,,1178.27,129.61,612.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q931 VIT E HPLC,84446,CPT,,,,,both,, ,227.62,136.57,Medicaid,Illinois Medicaid,,252.43,,,227.62,25.04,118.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q931 VIT E HPLC,84446,CPT,,,,,both,, ,227.62,136.57,Medicaid,Illinois Medicaid,,9.93,,,227.62,25.04,118.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L500440 TRANSCORTIN,84449,CPT,,,,,both,, ,180.00,108.00,Medicaid,Illinois Medicaid,,171.10,,,180.00,19.80,93.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TRANSFERASE AST,84450,CPT,,,,,both,, ,38.17,22.90,Medicaid,Illinois Medicaid,,9.93,,,38.17,4.20,19.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TRANSFERASE AST,84450,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,171.10,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TRANSFERASE ALT,84460,CPT,,,,,both,, ,39.29,23.57,Medicaid,Illinois Medicaid,,142.30,,,39.29,4.32,20.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TRANSFERASE ALT,84460,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,150.00,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q891 TRANSFERRI NEPH,84466,CPT,,,,,both,, ,796.55,477.93,Medicaid,Illinois Medicaid,,44.95,,,796.55,87.62,414.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q891 TRANSFERRI NEPH,84466,CPT,,,,,both,, ,796.55,477.93,Medicaid,Illinois Medicaid,,72.91,,,796.55,87.62,414.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TRANSFERRIN,84466,CPT,,,,,both,, ,94.31,56.58,Medicaid,Illinois Medicaid,,72.91,,,94.31,10.37,49.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TRIGLYCERIDES,84478,CPT,,,,,both,, ,39.29,23.57,Medicaid,Illinois Medicaid,,72.91,,,39.29,4.32,20.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TRIGLYCERIDES,84478,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,201.41,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
T3-T4 UPTAKE,84479,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,201.41,,,526.26,57.89,273.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"T3,TOTAL",84480,CPT,,,,,both,, ,1039.33,623.59,Medicaid,Illinois Medicaid,,436.84,,,1039.33,114.33,540.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"T3,FREE",84481,CPT,,,,,both,, ,858.30,514.98,Medicaid,Illinois Medicaid,,424.11,,,858.30,94.41,446.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q90963 T3 REV LCMSMS,84482,CPT,,,,,both,, ,858.30,514.98,Medicaid,Illinois Medicaid,,811.20,,,858.30,94.41,446.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"T3,REVERSE",84482,CPT,,,,,both,, ,219.20,131.52,Medicaid,Illinois Medicaid,,247.20,,,219.20,24.11,113.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"TROPONIN,QNT",84484,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,698.71,,,133.88,14.73,69.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"TROPONIN,QNT",84484,CPT,,,,,both,,,713.19,713.19,Medicaid,Illinois Medicaid,,698.71,,,713.19,78.45,370.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"TROPONIN,QNT",84484,CPT,,,,,both,, ,713.19,427.91,Medicaid,Illinois Medicaid,,108.95,,,713.19,78.45,370.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,, ,29.19,17.51,Medicaid,Illinois Medicaid,,90.93,,,29.19,3.21,15.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,,,277.59,277.59,Medicaid,Illinois Medicaid,,85.54,,,277.59,30.53,144.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,, ,277.59,166.55,Medicaid,Illinois Medicaid,,85.54,,,277.59,30.53,144.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"L910235 UREA NITROGEN, URINE",84540,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,1158.45,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"L910235 UREA NITROGEN, URINE",84540,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,579.13,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"UREA NITROGEN,URINE",84540,CPT,,,,,both,,,345.79,345.79,Medicaid,Illinois Medicaid,,43.27,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"URIC ACID, BLOOD",84550,CPT,,,,,both,, ,44.34,26.60,Medicaid,Illinois Medicaid,,1144.48,,,44.34,4.88,23.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"URIC ACID, BLOOD",84550,CPT,,,,,both,,,285.17,285.17,Medicaid,Illinois Medicaid,,1165.53,,,285.17,31.37,148.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"URIC ACID, BLOOD",84550,CPT,,,,,both,, ,285.17,171.10,Medicaid,Illinois Medicaid,,756.81,,,285.17,31.37,148.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"L910235 URIC ACID, URINE",84560,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,756.81,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q442 URIC ACID,URINE",84560,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,252.43,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"URIC ACID,URINE RAND",84560,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,69.66,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L4143 VMA U24 LCMSMS,84585,CPT,,,,,both,, ,355.05,213.03,Medicaid,Illinois Medicaid,,756.81,,,355.05,39.06,184.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L4143 VMA U24 LCMSMS,84585,CPT,,,,,both,, ,355.05,213.03,Medicaid,Illinois Medicaid,,756.81,,,355.05,39.06,184.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VANILLYLMANDELIC ACID (VMA) SERUM,84585,CPT,,,,,both,, ,116.70,70.02,Medicaid,Illinois Medicaid,,91.92,,,116.70,12.84,60.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L10397 VIP PL RIA,84586,CPT,,,,,both,, ,338.36,203.01,Medicaid,Illinois Medicaid,,90.60,,,338.36,37.22,175.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VASOINTESTINAL PEP,84586,CPT,,,,,both,, ,368.80,221.28,Medicaid,Illinois Medicaid,,563.98,,,368.80,40.57,191.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q252 AVP ADH EXT-RIA,84588,CPT,,,,,both,, ,295.83,177.49,Medicaid,Illinois Medicaid,,563.98,,,295.83,32.54,153.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q252 AVP ADH EXT-RIA,84588,CPT,,,,,both,, ,295.83,177.49,Medicaid,Illinois Medicaid,,252.43,,,295.83,32.54,153.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q921 VIT A HPLC,84590,CPT,,,,,both,, ,186.08,111.64,Medicaid,Illinois Medicaid,,563.98,,,186.08,20.47,96.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q921 VIT A HPLC,84590,CPT,,,,,both,, ,186.08,111.64,Medicaid,Illinois Medicaid,,143.81,,,186.08,20.47,96.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"VITAMIN ASSAY, NOS",84591,CPT,,,,,both,, ,197.03,118.21,Medicaid,Illinois Medicaid,,357.85,,,197.03,21.67,102.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36585 VITAM K HPLC,84597,CPT,,,,,both,, ,188.89,113.33,Medicaid,Illinois Medicaid,,340.20,,,188.89,20.78,98.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36585 VITAM K HPLC,84597,CPT,,,,,both,, ,188.89,113.33,Medicaid,Illinois Medicaid,,100.70,,,188.89,20.78,98.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VOLATILES,84600,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,414.94,,,728.07,80.09,378.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
XYLOSE ABSORPTION,84620,CPT,,,,,both,, ,1111.47,666.88,Medicaid,Illinois Medicaid,,60.28,,,1111.47,122.26,577.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q945 ZN ICP/MS AS,84630,CPT,,,,,both,, ,1081.72,649.03,Medicaid,Illinois Medicaid,,886.09,,,1081.72,118.99,562.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q945 ZN ICP/MS AS,84630,CPT,,,,,both,, ,1081.72,649.03,Medicaid,Illinois Medicaid,,531.65,,,1081.72,118.99,562.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ZINC WHOLE BLOOD,84630,CPT,,,,,both,, ,80.00,48.00,Medicaid,Illinois Medicaid,,50.18,,,80.00,8.80,41.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q372 C-PEPTIDE IA,84681,CPT,,,,,both,, ,898.44,539.06,Medicaid,Illinois Medicaid,,621.75,,,898.44,98.83,467.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q372 C-PEPTIDE IA,84681,CPT,,,,,both,, ,898.44,539.06,Medicaid,Illinois Medicaid,,112.83,,,898.44,98.83,467.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HCG QUANT,84702,CPT,,,,,both,, ,148.47,89.08,Medicaid,Illinois Medicaid,,133.20,,,148.47,16.33,77.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L140450 HCG TUMOR MK,84702,CPT,,,,,both,, ,758.66,455.19,Medicaid,Illinois Medicaid,,315.75,,,758.66,83.45,394.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L140450 HCG TUMOR MK,84702,CPT,,,,,both,, ,758.66,455.19,Medicaid,Illinois Medicaid,,315.75,,,758.66,83.45,394.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HCG, QUAL",84703,CPT,,,,,both,, ,74.10,44.46,Medicaid,Illinois Medicaid,,209.83,,,74.10,8.15,38.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HCG, QUAL",84703,CPT,,,,,both,,,420.72,420.72,Medicaid,Illinois Medicaid,,764.55,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HCG, QUAL",84703,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,83.43,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CLIN CHEM TEST NOS,84999,CPT,,,,,both,, ,274.50,164.70,Medicaid,Illinois Medicaid,,156.61,,,274.50,30.20,142.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L820610Z K FEC,84999,CPT,,,,,both,, ,225.00,135.00,Medicaid,Illinois Medicaid,,270.28,,,225.00,24.75,117,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L820610Z K FEC,84999,CPT,,,,,both,, ,225.00,135.00,Medicaid,Illinois Medicaid,,206.80,,,225.00,24.75,117,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLEEDING TIME,85002,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,96.33,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AUTO DIFF WBC COUNT,85004,CPT,,,,,both,, ,47.99,28.79,Medicaid,Illinois Medicaid,,96.33,,,47.99,5.28,24.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AUTO DIFF WBC COUNT,85004,CPT,,,,,both,, ,103.00,61.80,Medicaid,Illinois Medicaid,,107.88,,,103.00,11.33,53.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"WBC DIFF, MAN",85007,CPT,,,,,both,, ,33.96,20.37,Medicaid,Illinois Medicaid,,92.11,,,33.96,3.74,17.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"WBC DIFF, MAN",85007,CPT,,,,,both,, ,188.33,112.99,Medicaid,Illinois Medicaid,,92.11,,,188.33,20.72,97.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLOOD SMEAR SCAN,85008,CPT,,,,,both,, ,112.55,67.53,Medicaid,Illinois Medicaid,,430.27,,,112.55,12.38,58.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HEMATOCRIT, SPUN",85013,CPT,,,,,both,, ,32.84,19.70,Medicaid,Illinois Medicaid,,8.76,,,32.84,3.61,17.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,, ,13.18,7.90,Medicaid,Illinois Medicaid,,258.16,,,13.18,1.45,6.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,,,262.99,262.99,Medicaid,Illinois Medicaid,,436.84,,,262.99,28.93,136.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,, ,262.99,157.79,Medicaid,Illinois Medicaid,,218.92,,,262.99,28.93,136.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEMOGLOBIN,85018,CPT,,,,,both,, ,13.18,7.90,Medicaid,Illinois Medicaid,,218.92,,,13.18,1.45,6.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEMOGLOBIN,85018,CPT,,,,,both,,,262.99,262.99,Medicaid,Illinois Medicaid,,15.99,,,262.99,28.93,136.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEMOGLOBIN,85018,CPT,,,,,both,, ,262.99,157.79,Medicaid,Illinois Medicaid,,345.79,,,262.99,28.93,136.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEMOGLOBIN,85018,CPT,,,,,both,, ,262.99,157.79,Medicaid,Illinois Medicaid,,207.47,,,262.99,28.93,136.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L121003 HEMOGLOBIN,85018,CPT,,,,,both,, ,10.00,6.00,Medicaid,Illinois Medicaid,,231.59,,,10.00,1.10,5.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CBC W-PLT AUTO COMPD,85025,CPT,,,,,both,, ,28.90,17.34,Medicaid,Illinois Medicaid,,224.85,,,28.90,3.18,15.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CBC W-PLT AUTO COMPD,85025,CPT,,,,,both,, ,428.30,256.98,Medicaid,Illinois Medicaid,,252.43,,,428.30,47.11,222.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Complete blood cell count, with differential white blood cells, automated",85025,CPT,,,,,both,,,428.30,428.30,Medicaid,Illinois Medicaid,,252.43,,,428.30,47.11,222.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CBC W-PLT,85027,CPT,,,,,both,, ,24.13,14.47,Medicaid,Illinois Medicaid,,315.75,,,24.13,2.65,12.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CBC W-PLT,85027,CPT,,,,,both,, ,412.87,247.72,Medicaid,Illinois Medicaid,,315.75,,,412.87,45.42,214.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Complete blood count, automated",85027,CPT,,,,,both,,,412.87,412.87,Medicaid,Illinois Medicaid,,480.79,,,412.87,45.42,214.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MAN CELL CT ELP,85032,CPT,,,,,both,, ,466.48,279.88,Medicaid,Illinois Medicaid,,288.47,,,466.48,51.31,242.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L1917 RBC COUNT,85041,CPT,,,,,both,, ,6.06,3.63,Medicaid,Illinois Medicaid,,288.47,,,6.06,0.67,3.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"RETIC COUNT, MANUAL",85044,CPT,,,,,both,, ,489.78,293.86,Medicaid,Illinois Medicaid,,35.36,,,489.78,53.88,254.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"RETIC COUNT, FLOW",85045,CPT,,,,,both,, ,39.29,23.57,Medicaid,Illinois Medicaid,,288.47,,,39.29,4.32,20.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"RETIC COUNT, FLOW",85045,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,288.47,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WBC COUNT,85048,CPT,,,,,both,, ,16.55,9.93,Medicaid,Illinois Medicaid,,48.16,,,16.55,1.82,8.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WBC COUNT,85048,CPT,,,,,both,, ,285.17,171.10,Medicaid,Illinois Medicaid,,39.74,,,285.17,31.37,148.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CBC-PLT AUTORP CDM,85049,CPT,,,,,both,, ,16.55,9.93,Medicaid,Illinois Medicaid,,39.74,,,16.55,1.82,8.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CBC-PLT AUTORP CDM,85049,CPT,,,,,both,, ,285.17,171.10,Medicaid,Illinois Medicaid,,30.81,,,285.17,31.37,148.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE MARROW INTERPRE,85097,CPT,,,,,both,, ,237.17,142.30,Medicaid,Illinois Medicaid,,89.25,,,237.17,26.09,123.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
APIXABAN ANTI-XA,85130,CPT,,,,,both,, ,250.00,150.00,Medicaid,Illinois Medicaid,,89.25,,,250.00,27.50,130,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q331 FACT II ACT PCD,85210,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,89.25,,,74.93,8.24,38.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FACTOR V ASSAY,85220,CPT,,,,,both,, ,121.53,72.91,Medicaid,Illinois Medicaid,,89.25,,,121.53,13.37,63.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L86249 FACT V ACT CD,85220,CPT,,,,,both,, ,121.53,72.91,Medicaid,Illinois Medicaid,,89.25,,,121.53,13.37,63.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q344 FACT V CLOT PCD,85220,CPT,,,,,both,, ,121.53,72.91,Medicaid,Illinois Medicaid,,61.97,,,121.53,13.37,63.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L800599FACTVII ACT C,85230,CPT,,,,,both,, ,335.69,201.41,Medicaid,Illinois Medicaid,,61.97,,,335.69,36.93,174.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L800599FACTVII ACT C,85230,CPT,,,,,both,, ,335.69,201.41,Medicaid,Illinois Medicaid,,421.63,,,335.69,36.93,174.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"FACTOR VIII, AHG",85240,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,308.68,,,728.07,80.09,378.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L503333 FAC8 AHG,85240,CPT,,,,,both,, ,706.86,424.11,Medicaid,Illinois Medicaid,,300.43,,,706.86,77.75,367.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FACTOR VIII RISTOCET,85245,CPT,,,,,both,, ,1352.01,811.20,Medicaid,Illinois Medicaid,,300.43,,,1352.01,148.72,703.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L164509 VWF ACTIV PA,85245,CPT,,,,,both,, ,412.00,247.20,Medicaid,Illinois Medicaid,,300.43,,,412.00,45.32,214.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4919 VWF AG ITA,85246,CPT,,,,,both,, ,1164.52,698.71,Medicaid,Illinois Medicaid,,300.43,,,1164.52,128.10,605.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4919 VWF AG ITA,85246,CPT,,,,,both,, ,1164.52,698.71,Medicaid,Illinois Medicaid,,522.73,,,1164.52,128.10,605.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"FACT VIII,VW,MULTIME",85247,CPT,,,,,both,, ,181.59,108.95,Medicaid,Illinois Medicaid,,280.72,,,181.59,19.97,94.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FACTOR IX,85250,CPT,,,,,both,, ,151.56,90.93,Medicaid,Illinois Medicaid,,280.72,,,151.56,16.67,78.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FACTOR X,85260,CPT,,,,,both,, ,142.58,85.54,Medicaid,Illinois Medicaid,,280.72,,,142.58,15.68,74.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FACTOR XI,85270,CPT,,,,,both,, ,142.58,85.54,Medicaid,Illinois Medicaid,,49.84,,,142.58,15.68,74.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANTITHROMBIN IIIACTI,85300,CPT,,,,,both,, ,1930.76,1158.45,Medicaid,Illinois Medicaid,,291.69,,,1930.76,212.38,1004,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L015040 ANTITHROMBIN ACTIVITY,85300,CPT,,,,,both,, ,965.23,579.13,Medicaid,Illinois Medicaid,,300.43,,,965.23,106.18,501.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q5158 ATIII AG FRNEP,85301,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,72.30,,,72.13,7.93,37.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PROTEIN C, AG",85302,CPT,,,,,both,, ,1907.47,1144.48,Medicaid,Illinois Medicaid,,55.06,,,1907.47,209.82,991.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4948 PROT C AG IA,85302,CPT,,,,,both,, ,1942.55,1165.53,Medicaid,Illinois Medicaid,,539.06,,,1942.55,213.68,1010.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q1777 PROT C ACT,85303,CPT,,,,,both,, ,1261.35,756.81,Medicaid,Illinois Medicaid,,494.55,,,1261.35,138.75,655.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q1777 PROT C ACT,85303,CPT,,,,,both,, ,1261.35,756.81,Medicaid,Illinois Medicaid,,898.44,,,1261.35,138.75,655.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q7942 PROTEIN C, ACT",85303,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,539.06,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L117754 PROT S TOT,85305,CPT,,,,,both,, ,116.10,69.66,Medicaid,Illinois Medicaid,,539.06,,,116.10,12.77,60.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q5165 PROT S AG ITA,85305,CPT,,,,,both,, ,1261.35,756.81,Medicaid,Illinois Medicaid,,56.07,,,1261.35,138.75,655.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q5165 PROT S AG ITA,85305,CPT,,,,,both,, ,1261.35,756.81,Medicaid,Illinois Medicaid,,328.38,,,1261.35,138.75,655.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L117754 PROT S FREE,85306,CPT,,,,,both,, ,153.20,91.92,Medicaid,Illinois Medicaid,,328.38,,,153.20,16.85,79.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PROTEIN S, FREE",85306,CPT,,,,,both,, ,151.00,90.60,Medicaid,Illinois Medicaid,,33.12,,,151.00,16.61,78.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PROTEIN S, FREE",85306,CPT,,,,,both,, ,939.98,563.98,Medicaid,Illinois Medicaid,,33.12,,,939.98,103.40,488.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10170 PROT S AG ITA,85306,CPT,,,,,both,, ,939.98,563.98,Medicaid,Illinois Medicaid,,33.12,,,939.98,103.40,488.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q1779 PROT S ACT,85306,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,317.94,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q7942 PROTEIN S, FRE",85306,CPT,,,,,both,, ,939.98,563.98,Medicaid,Illinois Medicaid,,43.11,,,939.98,103.40,488.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROTEIN C ACTIVATED,85307,CPT,,,,,both,, ,239.69,143.81,Medicaid,Illinois Medicaid,,323.67,,,239.69,26.37,124.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q22 APCR RVVT-BSE AS,85307,CPT,,,,,both,, ,596.43,357.85,Medicaid,Illinois Medicaid,,113.50,,,596.43,65.61,310.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SOLUB LIV AG AB(RDL),85316,CPT,,,,,both,, ,567.00,340.20,Medicaid,Illinois Medicaid,,99.35,,,567.00,62.37,294.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COAG TIME ACTIVATED,85347,CPT,,,,,both,, ,167.84,100.70,Medicaid,Illinois Medicaid,,30.64,,,167.84,18.46,87.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FDP-FSP AGG SLIDE,85362,CPT,,,,,both,, ,691.58,414.94,Medicaid,Illinois Medicaid,,311.21,,,691.58,76.07,359.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"D-DIMER, QUANT",85379,CPT,,,,,both,, ,100.48,60.28,Medicaid,Illinois Medicaid,,599.85,,,100.48,11.05,52.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"D-DIMER, QUANT",85379,CPT,,,,,both,,,886.09,886.09,Medicaid,Illinois Medicaid,,151.22,,,886.09,97.47,460.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"D-DIMER, QUANT",85379,CPT,,,,,both,, ,886.09,531.65,Medicaid,Illinois Medicaid,,151.22,,,886.09,97.47,460.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FIBRINOGEN ACTIVITY,85384,CPT,,,,,both,, ,83.64,50.18,Medicaid,Illinois Medicaid,,151.22,,,83.64,9.20,43.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FIBRINOGEN ACTIVITY,85384,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,151.22,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14532 ADAMTS13 IA,85397,CPT,,,,,both,, ,188.05,112.83,Medicaid,Illinois Medicaid,,151.22,,,188.05,20.69,97.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36555 PAI-1 IA,85415,CPT,,,,,both,, ,222.01,133.20,Medicaid,Illinois Medicaid,,151.22,,,222.01,24.42,115.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LSKBFHS FET HGB ST,85460,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,257.65,,,526.26,57.89,273.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LSKBFHS FET HGB ST,85460,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,257.65,,,526.26,57.89,273.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"FETAL HGB, ROSETTE",85461,CPT,,,,,both,, ,349.72,209.83,Medicaid,Illinois Medicaid,,257.65,,,349.72,38.47,181.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPARIN ASSAY,85520,CPT,,,,,both,, ,1274.26,764.55,Medicaid,Illinois Medicaid,,257.65,,,1274.26,140.17,662.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L117101 HEPARIN A-XA,85520,CPT,,,,,both,, ,139.05,83.43,Medicaid,Illinois Medicaid,,257.65,,,139.05,15.30,72.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MURAMIDASE,85549,CPT,,,,,both,, ,261.02,156.61,Medicaid,Illinois Medicaid,,257.65,,,261.02,28.71,135.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RBC OSMOTIC FRAGW-IN,85557,CPT,,,,,both,, ,450.48,270.28,Medicaid,Illinois Medicaid,,84.87,,,450.48,49.55,234.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PLATELET AGGREGATION,85576,CPT,,,,,both,, ,344.67,206.80,Medicaid,Illinois Medicaid,,84.87,,,344.67,37.91,179.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
QRX143590 DRVVT CONF,85597,CPT,,,,,both,, ,160.55,96.33,Medicaid,Illinois Medicaid,,84.87,,,160.55,17.66,83.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
QRX143590 DRVVT CONF,85597,CPT,,,,,both,, ,160.55,96.33,Medicaid,Illinois Medicaid,,43.27,,,160.55,17.66,83.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L117079 HEX PHOS,85598,CPT,,,,,both,, ,179.80,107.88,Medicaid,Illinois Medicaid,,148.69,,,179.80,19.78,93.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q143583HEXA PHSE CD,85598,CPT,,,,,both,, ,153.52,92.11,Medicaid,Illinois Medicaid,,24.42,,,153.52,16.89,79.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q143583HEXA PHSE CD,85598,CPT,,,,,both,, ,153.52,92.11,Medicaid,Illinois Medicaid,,414.77,,,153.52,16.89,79.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Blood test, clotting time",85610,CPT,,,,,both,,,430.27,430.27,Medicaid,Illinois Medicaid,,414.77,,,430.27,47.33,223.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROTHROMBIN TIME,85610,CPT,,,,,both,, ,14.60,8.76,Medicaid,Illinois Medicaid,,414.77,,,14.60,1.61,7.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROTHROMBIN TIME,85610,CPT,,,,,both,, ,430.27,258.16,Medicaid,Illinois Medicaid,,414.77,,,430.27,47.33,223.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PROTHROMBIN, SUBSTIT",85611,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,414.77,,,728.07,80.09,378.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7079 RUSSELL VIPER,85613,CPT,,,,,both,, ,364.88,218.92,Medicaid,Illinois Medicaid,,414.77,,,364.88,40.14,189.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7079 RUSSELL VIPER,85613,CPT,,,,,both,, ,364.88,218.92,Medicaid,Illinois Medicaid,,414.77,,,364.88,40.14,189.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SED RATE, AUTOMATED",85652,CPT,,,,,both,, ,26.66,15.99,Medicaid,Illinois Medicaid,,414.77,,,26.66,2.93,13.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SED RATE, AUTOMATED",85652,CPT,,,,,both,,,345.79,345.79,Medicaid,Illinois Medicaid,,414.77,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SED RATE, AUTOMATED",85652,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,47.99,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51226 SICKLE C  SCR,85660,CPT,,,,,both,, ,385.99,231.59,Medicaid,Illinois Medicaid,,590.59,,,385.99,42.46,200.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37679 SICKLE CELL SCRN WITH REFLEX HEMO,85660,CPT,,,,,both,, ,374.75,224.85,Medicaid,Illinois Medicaid,,590.59,,,374.75,41.22,194.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q825 SICKL CL HS SOL,85660,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,145.50,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q825 SICKL CL HS SOL,85660,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,119.23,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q883 THROMB CLT BCS,85670,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,119.23,,,526.26,57.89,273.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q883 THROMB CLT BCS,85670,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,646.50,,,526.26,57.89,273.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Coagulation assessment blood test,85730,CPT,,,,,both,,,480.79,480.79,Medicaid,Illinois Medicaid,,291.69,,,480.79,52.89,250.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7079 THROMBOPLAST T,85730,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,131.46,,,480.79,52.89,250.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7079 THROMBOPLAST T,85730,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,646.50,,,480.79,52.89,250.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THROMBOPLAST TIMEPTT,85730,CPT,,,,,both,, ,58.94,35.36,Medicaid,Illinois Medicaid,,646.50,,,58.94,6.48,30.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PTT-LA MIX,85732,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,553.80,,,480.79,52.89,250.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PTT-LA MIX,85732,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,621.75,,,480.79,52.89,250.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VISCOSITY EXAM,85810,CPT,,,,,both,, ,80.27,48.16,Medicaid,Illinois Medicaid,,621.75,,,80.27,8.83,41.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q94609 ALG IGG QT,86001,CPT,,,,,both,, ,66.24,39.74,Medicaid,Illinois Medicaid,,36.03,,,66.24,7.29,34.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q94609 ALG IGG QT,86001,CPT,,,,,both,, ,66.24,39.74,Medicaid,Illinois Medicaid,,317.94,,,66.24,7.29,34.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,51.36,30.81,Medicaid,Illinois Medicaid,,446.19,,,51.36,5.65,26.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,104.91,,,148.75,16.36,77.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L602635 - ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,164.53,,,148.75,16.36,77.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10643 ALG IGE QT,86003,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,150.94,,,148.75,16.36,77.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10659 ALLERGEN IGE,86003,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,329.22,,,148.75,16.36,77.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10715 ALLERGEN IGE,86003,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,329.22,,,148.75,16.36,77.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91681 ALLERGEN IGE,86008,CPT,,,,,both,, ,103.29,61.97,Medicaid,Illinois Medicaid,,164.53,,,103.29,11.36,53.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91681 ALLERGEN IGE,86008,CPT,,,,,both,, ,103.29,61.97,Medicaid,Illinois Medicaid,,164.53,,,103.29,11.36,53.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L6643 ASMA ELISA,86015,CPT,,,,,both,, ,702.72,421.63,Medicaid,Illinois Medicaid,,164.53,,,702.72,77.30,365.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15043 ACTIN AB EA,86015,CPT,,,,,both,, ,514.48,308.68,Medicaid,Illinois Medicaid,,164.53,,,514.48,56.59,267.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34151 PR-3 AB IA,86021,CPT,,,,,both,, ,500.72,300.43,Medicaid,Illinois Medicaid,,164.53,,,500.72,55.08,260.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34151 PR-3 AB IA,86021,CPT,,,,,both,, ,500.72,300.43,Medicaid,Illinois Medicaid,,164.53,,,500.72,55.08,260.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34151 PR-3 AB IA,86021,CPT,,,,,both,, ,500.72,300.43,Medicaid,Illinois Medicaid,,164.53,,,500.72,55.08,260.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34151 PR-3 AB IA,86021,CPT,,,,,both,, ,500.72,300.43,Medicaid,Illinois Medicaid,,164.53,,,500.72,55.08,260.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PLATELET AB,86022,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,164.53,,,871.22,95.83,453.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14627SRA UNF RB-14C,86022,CPT,,,,,both,, ,467.88,280.72,Medicaid,Illinois Medicaid,,164.53,,,467.88,51.47,243.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14874 PLATELET AB,86022,CPT,,,,,both,, ,467.88,280.72,Medicaid,Illinois Medicaid,,164.53,,,467.88,51.47,243.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q414 HEP-IND PLAT AB,86022,CPT,,,,,both,, ,467.88,280.72,Medicaid,Illinois Medicaid,,164.53,,,467.88,51.47,243.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91740PLATELT IGG FC,86023,CPT,,,,,both,, ,83.08,49.84,Medicaid,Illinois Medicaid,,164.53,,,83.08,9.14,43.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L162045 FLUORS AB SC,86036,CPT,,,,,both,, ,486.16,291.69,Medicaid,Illinois Medicaid,,164.53,,,486.16,53.48,252.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q70171 ANCA SCN IA,86036,CPT,,,,,both,, ,500.72,300.43,Medicaid,Illinois Medicaid,,53.94,,,500.72,55.08,260.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L163061 ANCA TITER,86037,CPT,,,,,both,, ,120.50,72.30,Medicaid,Illinois Medicaid,,156.38,,,120.50,13.26,62.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANA,86038,CPT,,,,,both,, ,91.77,55.06,Medicaid,Illinois Medicaid,,317.94,,,91.77,10.09,47.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANA,86038,CPT,,,,,both,, ,898.44,539.06,Medicaid,Illinois Medicaid,,317.94,,,898.44,98.83,467.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L164947 ANA IFA,86038,CPT,,,,,both,, ,824.26,494.55,Medicaid,Illinois Medicaid,,317.94,,,824.26,90.67,428.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16814 ANA IFA REFIA,86038,CPT,,,,,both,,,898.44,898.44,Medicaid,Illinois Medicaid,,317.94,,,898.44,98.83,467.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16814 ANA IFA REFIA,86038,CPT,,,,,both,, ,898.44,539.06,Medicaid,Illinois Medicaid,,317.94,,,898.44,98.83,467.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q249 ANA SCRN IFA,86038,CPT,,,,,both,, ,898.44,539.06,Medicaid,Illinois Medicaid,,317.94,,,898.44,98.83,467.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"ANA,TITER",86039,CPT,,,,,both,, ,93.46,56.07,Medicaid,Illinois Medicaid,,317.94,,,93.46,10.28,48.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
QRX ANA TITER PATTRN,86039,CPT,,,,,both,, ,547.31,328.38,Medicaid,Illinois Medicaid,,317.94,,,547.31,60.20,284.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
QRX ANA TITER PATTRN,86039,CPT,,,,,both,, ,547.31,328.38,Medicaid,Illinois Medicaid,,283.20,,,547.31,60.20,284.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ACETYLCH RCPT BND AB,86041,CPT,,,,,both,, ,55.20,33.12,Medicaid,Illinois Medicaid,,730.36,,,55.20,6.07,28.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ACETYLC RCPT BLCK AB,86042,CPT,,,,,both,, ,55.20,33.12,Medicaid,Illinois Medicaid,,317.94,,,55.20,6.07,28.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ACTYLC RCPT MODL AB,86043,CPT,,,,,both,, ,55.20,33.12,Medicaid,Illinois Medicaid,,317.94,,,55.20,6.07,28.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q38321 AQP4 NMOIGG,86052,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,34.59,,,529.91,58.29,275.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"ASO,TITER",86060,CPT,,,,,both,, ,71.85,43.11,Medicaid,Illinois Medicaid,,459.57,,,71.85,7.90,37.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"ASO,TITER",86060,CPT,,,,,both,, ,539.45,323.67,Medicaid,Illinois Medicaid,,459.57,,,539.45,59.34,280.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q265 ASO AB ITA,86060,CPT,,,,,both,, ,189.17,113.50,Medicaid,Illinois Medicaid,,265.27,,,189.17,20.81,98.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYS BB SERV TRAN RE,86078,CPT,,,,,both,, ,165.59,99.35,Medicaid,Illinois Medicaid,,289.15,,,165.59,18.21,86.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
C-REACTIVE PROTEIN,86140,CPT,,,,,both,, ,51.08,30.64,Medicaid,Illinois Medicaid,,65.67,,,51.08,5.62,26.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
C-REACTIVE PROTEIN,86140,CPT,,,,,both,, ,518.69,311.21,Medicaid,Illinois Medicaid,,430.05,,,518.69,57.06,269.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10124 HS-CRP NEPHEL,86141,CPT,,,,,both,, ,999.76,599.85,Medicaid,Illinois Medicaid,,482.81,,,999.76,109.97,519.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q30340 BETA-2 GLYCOP,86146,CPT,,,,,both,, ,252.04,151.22,Medicaid,Illinois Medicaid,,482.81,,,252.04,27.72,131.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q30340 BETA-2 GLYCOP,86146,CPT,,,,,both,, ,252.04,151.22,Medicaid,Illinois Medicaid,,482.81,,,252.04,27.72,131.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36552 B2-GPIAB IGA,86146,CPT,,,,,both,, ,252.04,151.22,Medicaid,Illinois Medicaid,,482.81,,,252.04,27.72,131.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36552 B2-GPIAB IGA,86146,CPT,,,,,both,, ,252.04,151.22,Medicaid,Illinois Medicaid,,482.81,,,252.04,27.72,131.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36554B-2-GP1 IGG IA,86146,CPT,,,,,both,, ,252.04,151.22,Medicaid,Illinois Medicaid,,83.19,,,252.04,27.72,131.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36554B-2-GP1 IGG IA,86146,CPT,,,,,both,, ,252.04,151.22,Medicaid,Illinois Medicaid,,11.45,,,252.04,27.72,131.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L161950CARDIOLIPIN A,86147,CPT,,,,,both,, ,429.43,257.65,Medicaid,Illinois Medicaid,,288.47,,,429.43,47.24,223.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L161950CARDIOLIPIN A,86147,CPT,,,,,both,, ,429.43,257.65,Medicaid,Illinois Medicaid,,289.15,,,429.43,47.24,223.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4661 C-LIPIN AB IGA,86147,CPT,,,,,both,, ,429.43,257.65,Medicaid,Illinois Medicaid,,289.15,,,429.43,47.24,223.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4661 C-LIPIN AB IGA,86147,CPT,,,,,both,, ,429.43,257.65,Medicaid,Illinois Medicaid,,257.55,,,429.43,47.24,223.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4663 C-LIPIN AB IGM,86147,CPT,,,,,both,, ,429.43,257.65,Medicaid,Illinois Medicaid,,130.51,,,429.43,47.24,223.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4663 C-LIPIN AB IGM,86147,CPT,,,,,both,, ,429.43,257.65,Medicaid,Illinois Medicaid,,130.51,,,429.43,47.24,223.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHOSPHATIDYLSERIN AB,86148,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,42.00,,,141.46,15.56,73.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHOSPHOLIPID AB,86148,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,48.66,,,141.46,15.56,73.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14890 PHOSPHOLIPID,86148,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,41.42,,,141.46,15.56,73.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CELL ENUM IS AND ID,86152,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,545.85,,,72.13,7.93,37.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"COLD AGG, TITER",86157,CPT,,,,,both,, ,247.83,148.69,Medicaid,Illinois Medicaid,,612.82,,,247.83,27.26,128.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L6353COLD HEMAGGL QT,86157,CPT,,,,,both,, ,40.70,24.42,Medicaid,Illinois Medicaid,,612.82,,,40.70,4.48,21.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"COMPLEMENT AG, EA",86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,408.04,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19882 COMP AG,86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,408.04,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34888 COMPLE C7 RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,408.04,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34889 COMPLE C8 RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,87.39,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q351 C3 COMPL ITA,86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,124.44,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q353 C4C COMP ITA,86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,124.44,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q354 COMPLEM C5 RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,414.77,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q433 COMPL CP C2 RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,30.00,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q981 COMPL C C1Q RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,178.00,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q297 C1 INH FUNC IA,86161,CPT,,,,,both,, ,79.99,47.99,Medicaid,Illinois Medicaid,,436.84,,,79.99,8.80,41.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q618 COMPL CH50 LIPO,86162,CPT,,,,,both,, ,984.32,590.59,Medicaid,Illinois Medicaid,,178.00,,,984.32,108.28,511.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q618 COMPL CH50 LIPO,86162,CPT,,,,,both,, ,984.32,590.59,Medicaid,Illinois Medicaid,,178.00,,,984.32,108.28,511.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11173 CCP AB IGG IA,86200,CPT,,,,,both,, ,242.50,145.50,Medicaid,Illinois Medicaid,,158.55,,,242.50,26.68,126.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L96286 ADNASE-B NEPH,86215,CPT,,,,,both,, ,198.72,119.23,Medicaid,Illinois Medicaid,,33.57,,,198.72,21.86,103.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L96286 ADNASE-B NEPH,86215,CPT,,,,,both,, ,198.72,119.23,Medicaid,Illinois Medicaid,,253.38,,,198.72,21.86,103.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"DNA AB,NATIVE-DOUBL",86225,CPT,,,,,both,, ,1077.50,646.50,Medicaid,Illinois Medicaid,,130.51,,,1077.50,118.53,560.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L165092 DNA DS AB,86225,CPT,,,,,both,, ,486.16,291.69,Medicaid,Illinois Medicaid,,185.24,,,486.16,53.48,252.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L96346 DSDNA AB IA,86225,CPT,,,,,both,, ,219.10,131.46,Medicaid,Illinois Medicaid,,185.24,,,219.10,24.10,113.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19882 DNA DS AB,86225,CPT,,,,,both,, ,1077.50,646.50,Medicaid,Illinois Medicaid,,130.51,,,1077.50,118.53,560.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q255 DNA DS AB IA,86225,CPT,,,,,both,, ,1077.50,646.50,Medicaid,Illinois Medicaid,,130.51,,,1077.50,118.53,560.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14857 SSDNA ANTIBODY (IGG),86226,CPT,,,,,both,, ,923.00,553.80,Medicaid,Illinois Medicaid,,909.39,,,923.00,101.53,479.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q45972 SSDNA IGG EIA,86226,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,909.39,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q45972 SSDNA IGG EIA,86226,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,493.76,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L165126 ENDMYS AB IG,86231,CPT,,,,,both,, ,60.05,36.03,Medicaid,Illinois Medicaid,,527.27,,,60.05,6.61,31.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15064 ENDOMYS AB IG,86231,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,317.94,,,529.91,58.29,275.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19955 ENDOMYS AB IG,86231,CPT,,,,,both,, ,743.65,446.19,Medicaid,Illinois Medicaid,,34.59,,,743.65,81.80,386.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANTI-ENA,86235,CPT,,,,,both,, ,174.85,104.91,Medicaid,Illinois Medicaid,,459.57,,,174.85,19.23,90.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,459.57,,,274.22,30.16,142.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L165092 ANTI-ENA,86235,CPT,,,,,both,, ,251.58,150.94,Medicaid,Illinois Medicaid,,108.24,,,251.58,27.67,130.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L520085 ANTI-ENS,86235,CPT,,,,,both,, ,548.71,329.22,Medicaid,Illinois Medicaid,,409.72,,,548.71,60.36,285.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L520085 ANTI-ENS,86235,CPT,,,,,both,, ,548.71,329.22,Medicaid,Illinois Medicaid,,409.72,,,548.71,60.36,285.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16088 CENTR B AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,409.72,,,274.22,30.16,142.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q171728MI-2 AAB RIPA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,409.72,,,274.22,30.16,142.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19882 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,317.94,,,274.22,30.16,142.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19887 RNP AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,248.89,,,274.22,30.16,142.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34088 CHROMAT AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,134.72,,,274.22,30.16,142.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37923 SM AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,134.72,,,274.22,30.16,142.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q38568 SS-A IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,328.38,,,274.22,30.16,142.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q38569 SS-B IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,103.74,,,274.22,30.16,142.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4942 SCLEROD AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,103.74,,,274.22,30.16,142.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q5810 JO-1 AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,88.74,,,274.22,30.16,142.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7448 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,240.71,,,274.22,30.16,142.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q94025 PM-SCL AB EIA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,33.51,,,274.22,30.16,142.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q94685 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,262.37,,,274.22,30.16,142.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q94777 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,221.86,,,274.22,30.16,142.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L165620 STRIATIONAL ANTIBODIES,86255,CPT,,,,,both,, ,89.90,53.94,Medicaid,Illinois Medicaid,,403.05,,,89.90,9.89,46.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LC505225 ACETYLCHOLINE RECEPT-MODULAT AB,86255,CPT,,,,,both,, ,260.64,156.38,Medicaid,Illinois Medicaid,,241.83,,,260.64,28.67,135.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q261 FLUORES AB SCN,86255,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,241.83,,,529.91,58.29,275.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q261 FLUORES AB SCN,86255,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,29.34,,,529.91,58.29,275.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q261 FLUORES AB SCN,86255,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,252.43,,,529.91,58.29,275.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q261 FLUORES AB SCN,86255,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,252.43,,,529.91,58.29,275.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q263 SMTH MUS AB WRE,86255,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,25.26,,,529.91,58.29,275.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q263 SMTH MUS AB WRE,86255,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,247.72,,,529.91,58.29,275.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q263 SMTH MUS AB WRE,86255,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,26.10,,,529.91,58.29,275.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q263 SMTH MUS AB WRE,86255,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,247.72,,,529.91,58.29,275.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91985 ENDOMYSIAL(IGG)ANTIBODY SCRN TITR,86255,CPT,,,,,both,, ,472.00,283.20,Medicaid,Illinois Medicaid,,72.30,,,472.00,51.92,245.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"FLUORESCENT AB,TITER",86256,CPT,,,,,both,, ,1217.28,730.36,Medicaid,Illinois Medicaid,,87.57,,,1217.28,133.90,632.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L831723 FLUOR AB TIT,86256,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,87.57,,,529.91,58.29,275.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L831723 FLUOR AB TIT,86256,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,462.27,,,529.91,58.29,275.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L165126 GLIA AB IGA,86258,CPT,,,,,both,, ,57.65,34.59,Medicaid,Illinois Medicaid,,92.45,,,57.65,6.34,29.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8889 GLIA AB IGG IA,86258,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,92.45,,,765.96,84.26,398.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8889 GLIA AB IGG IA,86258,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,208.99,,,765.96,84.26,398.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L143404 CA15-3 ECLIA,86300,CPT,,,,,both,, ,442.13,265.27,Medicaid,Illinois Medicaid,,158.46,,,442.13,48.63,229.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q29493 CA 27.29 IA,86300,CPT,,,,,both,, ,481.92,289.15,Medicaid,Illinois Medicaid,,360.55,,,481.92,53.01,250.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TUMR AG CA15-3 27-29,86300,CPT,,,,,both,, ,109.46,65.67,Medicaid,Illinois Medicaid,,360.55,,,109.46,12.04,56.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q17638 CA 19-9 PERITONEAL FLUID,86301,CPT,,,,,both,, ,716.75,430.05,Medicaid,Illinois Medicaid,,80.66,,,716.75,78.84,372.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4698 CA 19-9 IA,86301,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,80.66,,,804.69,88.52,418.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4698 CA 19-9 IA,86301,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,139.26,,,804.69,88.52,418.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q29256 CA 125 IA,86304,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,139.26,,,804.69,88.52,418.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91155 TUMR AG CA125,86304,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,100.70,,,804.69,88.52,418.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TUMOR AG CA 125,86304,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,343.87,,,804.69,88.52,418.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91155 HE4,86305,CPT,,,,,both,, ,138.65,83.19,Medicaid,Illinois Medicaid,,343.87,,,138.65,15.25,72.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HETEROPHILE AB SCREE,86308,CPT,,,,,both,, ,19.09,11.45,Medicaid,Illinois Medicaid,,243.17,,,19.09,2.10,9.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HETEROPHILE AB SCREE,86308,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,243.17,,,480.79,52.89,250.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16379 CGA ECLIA,86316,CPT,,,,,both,, ,481.92,289.15,Medicaid,Illinois Medicaid,,243.17,,,481.92,53.01,250.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16379 CGA ECLIA,86316,CPT,,,,,both,, ,481.92,289.15,Medicaid,Illinois Medicaid,,94.30,,,481.92,53.01,250.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q17410 ALPHA-FETOPROTEIN PERITONEAL FLUI,86316,CPT,,,,,both,, ,429.25,257.55,Medicaid,Illinois Medicaid,,165.37,,,429.25,47.22,223.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16963 INF AGENT IMM,86317,CPT,,,,,both,, ,217.52,130.51,Medicaid,Illinois Medicaid,,446.10,,,217.52,23.93,113.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16963 INF AGENT IMM,86317,CPT,,,,,both,, ,217.52,130.51,Medicaid,Illinois Medicaid,,171.94,,,217.52,23.93,113.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TETANUS/DIPTHERIA AB,86317,CPT,,,,,both,, ,70.00,42.00,Medicaid,Illinois Medicaid,,171.94,,,70.00,7.70,36.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15914 C4 BND PL RID,86329,CPT,,,,,both,, ,81.11,48.66,Medicaid,Illinois Medicaid,,414.77,,,81.11,8.92,42.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14978 IMMUNODI OUCN,86331,CPT,,,,,both,, ,69.04,41.42,Medicaid,Illinois Medicaid,,414.77,,,69.04,7.59,35.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q38940 IMMUNOFIXATION ELECT,86334,CPT,,,,,both,, ,909.75,545.85,Medicaid,Illinois Medicaid,,72.00,,,909.75,100.07,473.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q549 IFE SERUM,86334,CPT,,,,,both,, ,1021.37,612.82,Medicaid,Illinois Medicaid,,41.93,,,1021.37,112.35,531.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q549 IFE SERUM,86334,CPT,,,,,both,, ,1021.37,612.82,Medicaid,Illinois Medicaid,,44.79,,,1021.37,112.35,531.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM E-PHORS-URIN-CSF,86335,CPT,,,,,both,, ,680.07,408.04,Medicaid,Illinois Medicaid,,612.90,,,680.07,74.81,353.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10640 B2TF EL-IF,86335,CPT,,,,,both,, ,680.07,408.04,Medicaid,Illinois Medicaid,,668.05,,,680.07,74.81,353.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q213 IFE U,86335,CPT,,,,,both,, ,680.07,408.04,Medicaid,Illinois Medicaid,,668.05,,,680.07,74.81,353.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INHIBIN A,86336,CPT,,,,,both,, ,145.66,87.39,Medicaid,Illinois Medicaid,,766.24,,,145.66,16.02,75.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36178 INSUL AAB RBA,86337,CPT,,,,,both,, ,207.41,124.44,Medicaid,Illinois Medicaid,,291.50,,,207.41,22.82,107.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36178 INSUL AAB RBA,86337,CPT,,,,,both,, ,207.41,124.44,Medicaid,Illinois Medicaid,,60.79,,,207.41,22.82,107.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INTRINSIC FACTOR AB,86340,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,225.49,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L10413 IFB AB ICMA,86340,CPT,,,,,both,, ,50.00,30.00,Medicaid,Illinois Medicaid,,127.20,,,50.00,5.50,26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ISLET CELL AB,86341,CPT,,,,,both,, ,296.67,178.00,Medicaid,Illinois Medicaid,,126.30,,,296.67,32.63,154.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34878 GAD-65 AB RBA,86341,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,126.30,,,728.07,80.09,378.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36177 IA2 AB,86341,CPT,,,,,both,, ,296.67,178.00,Medicaid,Illinois Medicaid,,217.74,,,296.67,32.63,154.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36741 ISL CL AB IFA,86341,CPT,,,,,both,, ,296.67,178.00,Medicaid,Illinois Medicaid,,217.74,,,296.67,32.63,154.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q93022 ZINC TRANSPORTER 8 (ZNT8)ANTIBODY,86341,CPT,,,,,both,, ,264.25,158.55,Medicaid,Illinois Medicaid,,217.74,,,264.25,29.07,137.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q90123 LEUK HIST REL,86343,CPT,,,,,both,, ,55.95,33.57,Medicaid,Illinois Medicaid,,217.74,,,55.95,6.15,29.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L820022 CHRN URTICAR,86352,CPT,,,,,both,, ,422.30,253.38,Medicaid,Illinois Medicaid,,126.30,,,422.30,46.45,219.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q39588 B CELLS, TOTA",86355,CPT,,,,,both,, ,217.52,130.51,Medicaid,Illinois Medicaid,,126.30,,,217.52,23.93,113.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10981 RITXN SN CD20,86356,CPT,,,,,both,, ,308.74,185.24,Medicaid,Illinois Medicaid,,307.17,,,308.74,33.96,160.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10981 RITXN SN CD20,86356,CPT,,,,,both,, ,308.74,185.24,Medicaid,Illinois Medicaid,,153.58,,,308.74,33.96,160.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37088 NK CELLS CF,86357,CPT,,,,,both,, ,217.52,130.51,Medicaid,Illinois Medicaid,,153.58,,,217.52,23.93,113.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q39588 T CELLS, TOTA",86359,CPT,,,,,both,, ,217.52,130.51,Medicaid,Illinois Medicaid,,621.75,,,217.52,23.93,113.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7924 LYMPH SUBP4 FC,86360,CPT,,,,,both,, ,1515.65,909.39,Medicaid,Illinois Medicaid,,170.59,,,1515.65,166.72,788.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7924 LYMPH SUBP4 FC,86360,CPT,,,,,both,, ,1515.65,909.39,Medicaid,Illinois Medicaid,,156.51,,,1515.65,166.72,788.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8360 LYMP SUB P5 FC,86361,CPT,,,,,both,, ,822.94,493.76,Medicaid,Illinois Medicaid,,341.18,,,822.94,90.52,427.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"T CELL, ABSO CD4",86361,CPT,,,,,both,, ,878.79,527.27,Medicaid,Illinois Medicaid,,341.18,,,878.79,96.67,456.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36952 MOG AB,86362,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,34.01,,,529.91,58.29,275.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L165126TTG AB IGG IA,86364,CPT,,,,,both,, ,57.65,34.59,Medicaid,Illinois Medicaid,,44.95,,,57.65,6.34,29.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11070 TTG AB IGG IA,86364,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,44.95,,,765.96,84.26,398.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11070 TTG AB IGG IA,86364,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,44.95,,,765.96,84.26,398.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L504600 MSCLSPECKINAB,86366,CPT,,,,,both,, ,180.40,108.24,Medicaid,Illinois Medicaid,,44.95,,,180.40,19.84,93.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15038LKM1 AB IGG IA,86376,CPT,,,,,both,, ,682.88,409.72,Medicaid,Illinois Medicaid,,829.05,,,682.88,75.12,355.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15038LKM1 AB IGG IA,86376,CPT,,,,,both,, ,682.88,409.72,Medicaid,Illinois Medicaid,,435.49,,,682.88,75.12,355.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15038LKM1 AB IGG IA,86376,CPT,,,,,both,, ,682.88,409.72,Medicaid,Illinois Medicaid,,202.92,,,682.88,75.12,355.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15038LKM1 AB IGG IA,86376,CPT,,,,,both,, ,682.88,409.72,Medicaid,Illinois Medicaid,,30.42,,,682.88,75.12,355.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q259 MITO AB IA,86381,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,77.96,,,529.91,58.29,275.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q30321 MM2AB IGG EIA,86381,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,211.00,,,414.83,45.63,215.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q94106 NEUT TST VIR,86382,CPT,,,,,both,, ,224.54,134.72,Medicaid,Illinois Medicaid,,211.00,,,224.54,24.70,116.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q94106 NEUT TST VIR,86382,CPT,,,,,both,, ,224.54,134.72,Medicaid,Illinois Medicaid,,211.00,,,224.54,24.70,116.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PART AGGLUT.SCREEN,86403,CPT,,,,,both,, ,547.31,328.38,Medicaid,Illinois Medicaid,,211.00,,,547.31,60.20,284.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16786 S.PN AG U LA,86403,CPT,,,,,both,, ,172.90,103.74,Medicaid,Illinois Medicaid,,114.51,,,172.90,19.02,89.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16786 S.PN AG U LA,86403,CPT,,,,,both,, ,172.90,103.74,Medicaid,Illinois Medicaid,,180.00,,,172.90,19.02,89.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PART AGGLUT. TITER,86406,CPT,,,,,both,, ,147.91,88.74,Medicaid,Illinois Medicaid,,138.15,,,147.91,16.27,76.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37521 RA FACT QT,86431,CPT,,,,,both,, ,401.19,240.71,Medicaid,Illinois Medicaid,,155.10,,,401.19,44.13,208.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RHEUMATOID FACT QUAN,86431,CPT,,,,,both,, ,55.85,33.51,Medicaid,Illinois Medicaid,,155.10,,,55.85,6.14,29.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RHEUMATOID FACT QUAN,86431,CPT,,,,,both,, ,437.29,262.37,Medicaid,Illinois Medicaid,,155.10,,,437.29,48.10,227.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LRX182877 QTFERON TU,86480,CPT,,,,,both,, ,369.77,221.86,Medicaid,Illinois Medicaid,,155.10,,,369.77,40.67,192.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19453 TB GOLD BIO A,86480,CPT,,,,,both,,,403.05,403.05,Medicaid,Illinois Medicaid,,270.28,,,403.05,44.34,209.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19453 TB GOLD BIO A,86480,CPT,,,,,both,, ,403.05,241.83,Medicaid,Illinois Medicaid,,270.28,,,403.05,44.34,209.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19453 TB GOLD BIO A,86480,CPT,,,,,both,, ,403.05,241.83,Medicaid,Illinois Medicaid,,539.06,,,403.05,44.34,209.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L006099 RFLX RPR,86592,CPT,,,,,both,, ,48.90,29.34,Medicaid,Illinois Medicaid,,539.06,,,48.90,5.38,25.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L12005 RPR CHAR FLOC,86592,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,1047.19,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L12005 RPR CHAR FLOC,86592,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,628.31,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SYPHILIS TEST, QUAL",86592,CPT,,,,,both,, ,42.10,25.26,Medicaid,Illinois Medicaid,,42.19,,,42.10,4.63,21.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L6460 RPR QT CHAR FL,86593,CPT,,,,,both,, ,412.88,247.72,Medicaid,Illinois Medicaid,,599.85,,,412.88,45.42,214.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SYPHILIS TEST, QUANT",86593,CPT,,,,,both,, ,43.50,26.10,Medicaid,Illinois Medicaid,,599.85,,,43.50,4.79,22.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SYPHILIS TEST, QUANT",86593,CPT,,,,,both,, ,412.87,247.72,Medicaid,Illinois Medicaid,,328.72,,,412.87,45.42,214.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VOLT-GTD CA CHNL AB,86596,CPT,,,,,both,, ,120.50,72.30,Medicaid,Illinois Medicaid,,328.72,,,120.50,13.26,62.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q94609 ASP AB,86606,CPT,,,,,both,, ,145.95,87.57,Medicaid,Illinois Medicaid,,328.72,,,145.95,16.05,75.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q94609 ASP AB,86606,CPT,,,,,both,, ,145.95,87.57,Medicaid,Illinois Medicaid,,725.82,,,145.95,16.05,75.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34329 LISTERI AB CF,86609,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,435.49,,,770.45,84.75,400.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q94609 BACTERUIM AB,86609,CPT,,,,,both,, ,154.09,92.45,Medicaid,Illinois Medicaid,,42.00,,,154.09,16.95,80.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q94609 BACTERUIM AB,86609,CPT,,,,,both,, ,154.09,92.45,Medicaid,Illinois Medicaid,,42.00,,,154.09,16.95,80.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BARTONELLA AB,86611,CPT,,,,,both,, ,348.32,208.99,Medicaid,Illinois Medicaid,,177.49,,,348.32,38.32,181.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34251 BARTONELLA AB,86611,CPT,,,,,both,, ,264.11,158.46,Medicaid,Illinois Medicaid,,177.49,,,264.11,29.05,137.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q932 BLASTOM AB ID S,86612,CPT,,,,,both,, ,600.92,360.55,Medicaid,Illinois Medicaid,,93.63,,,600.92,66.10,312.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q932 BLASTOM AB ID S,86612,CPT,,,,,both,, ,600.92,360.55,Medicaid,Illinois Medicaid,,468.67,,,600.92,66.10,312.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37294 B PERTUS AB,86615,CPT,,,,,both,, ,134.44,80.66,Medicaid,Illinois Medicaid,,468.66,,,134.44,14.79,69.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37294 B PERTUS AB,86615,CPT,,,,,both,, ,134.44,80.66,Medicaid,Illinois Medicaid,,468.66,,,134.44,14.79,69.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8593 BORRELIA BURG.,86617,CPT,,,,,both,, ,232.11,139.26,Medicaid,Illinois Medicaid,,197.70,,,232.11,25.53,120.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8593 BORRELIA BURG.,86617,CPT,,,,,both,, ,232.11,139.26,Medicaid,Illinois Medicaid,,324.14,,,232.11,25.53,120.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LYME DISEASE AB,86618,CPT,,,,,both,, ,167.84,100.70,Medicaid,Illinois Medicaid,,57.93,,,167.84,18.46,87.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q6646 LYM AB IGG/IGM,86618,CPT,,,,,both,, ,573.13,343.87,Medicaid,Illinois Medicaid,,353.31,,,573.13,63.04,298.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q6646 LYM AB IGG/IGM,86618,CPT,,,,,both,, ,573.13,343.87,Medicaid,Illinois Medicaid,,353.31,,,573.13,63.04,298.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Medicaid,Illinois Medicaid,,353.31,,,405.29,44.58,210.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91068 BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Medicaid,Illinois Medicaid,,339.67,,,405.29,44.58,210.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91121 BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Medicaid,Illinois Medicaid,,339.67,,,405.29,44.58,210.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CANDIDA AB,86628,CPT,,,,,both,, ,157.18,94.30,Medicaid,Illinois Medicaid,,339.67,,,157.18,17.29,81.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHLAMYDIA AB,86631,CPT,,,,,both,, ,275.62,165.37,Medicaid,Illinois Medicaid,,339.67,,,275.62,30.32,143.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q38481 C.PNEU AB IGM,86632,CPT,,,,,both,, ,743.51,446.10,Medicaid,Illinois Medicaid,,145.50,,,743.51,81.79,386.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q5157 C.TRACH AB IGM,86632,CPT,,,,,both,, ,286.57,171.94,Medicaid,Illinois Medicaid,,145.50,,,286.57,31.52,149.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q5157 C.TRACH AB IGM,86632,CPT,,,,,both,, ,286.57,171.94,Medicaid,Illinois Medicaid,,145.50,,,286.57,31.52,149.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q906 COCCIDIO AB CF,86635,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,145.50,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q906 COCCIDIO AB CF,86635,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,38.56,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L806606 Q FEV,86638,CPT,,,,,both,, ,120.00,72.00,Medicaid,Illinois Medicaid,,38.56,,,120.00,13.20,62.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37071 COXIELLA BRUN,86638,CPT,,,,,both,, ,69.89,41.93,Medicaid,Illinois Medicaid,,38.56,,,69.89,7.69,36.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q30430 CRYPTO AB IFA,86641,CPT,,,,,both,, ,74.65,44.79,Medicaid,Illinois Medicaid,,57.00,,,74.65,8.21,38.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L6494 CMV IGG CLIA,86644,CPT,,,,,both,, ,1021.50,612.90,Medicaid,Illinois Medicaid,,145.50,,,1021.50,112.37,531.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q403 CMV AB IGG IA,86644,CPT,,,,,both,, ,1113.43,668.05,Medicaid,Illinois Medicaid,,145.50,,,1113.43,122.48,578.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q403 CMV AB IGG IA,86644,CPT,,,,,both,, ,1113.43,668.05,Medicaid,Illinois Medicaid,,145.50,,,1113.43,122.48,578.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"CMV AB, IGM",86645,CPT,,,,,both,, ,1277.07,766.24,Medicaid,Illinois Medicaid,,145.50,,,1277.07,140.48,664.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8503 CMV AB IGM IA,86645,CPT,,,,,both,, ,485.84,291.50,Medicaid,Illinois Medicaid,,53.21,,,485.84,53.44,252.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37512 DIPTHTHER AB,86648,CPT,,,,,both,, ,101.32,60.79,Medicaid,Illinois Medicaid,,543.78,,,101.32,11.15,52.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ENTEROVIRUS AB,86658,CPT,,,,,both,, ,375.82,225.49,Medicaid,Illinois Medicaid,,522.73,,,375.82,41.34,195.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L830764 ENTEROVIR AB,86658,CPT,,,,,both,, ,212.00,127.20,Medicaid,Illinois Medicaid,,522.73,,,212.00,23.32,110.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EBV IGG TO EAD,86663,CPT,,,,,both,, ,210.50,126.30,Medicaid,Illinois Medicaid,,66.69,,,210.50,23.16,109.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EBV IGG TO EAD,86663,CPT,,,,,both,, ,210.50,126.30,Medicaid,Illinois Medicaid,,522.73,,,210.50,23.16,109.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q6421EPST-BARR, EBNA",86664,CPT,,,,,both,, ,362.91,217.74,Medicaid,Illinois Medicaid,,76.62,,,362.91,39.92,188.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q6421EPST-BARR, EBNA",86664,CPT,,,,,both,, ,362.91,217.74,Medicaid,Illinois Medicaid,,76.62,,,362.91,39.92,188.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q6421EPSTE-BARR, VCA",86665,CPT,,,,,both,, ,362.91,217.74,Medicaid,Illinois Medicaid,,123.60,,,362.91,39.92,188.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q6421EPSTE-BARR, VCA",86665,CPT,,,,,both,, ,362.91,217.74,Medicaid,Illinois Medicaid,,134.72,,,362.91,39.92,188.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8474 EBV VCA IGG IA,86665,CPT,,,,,both,, ,210.50,126.30,Medicaid,Illinois Medicaid,,134.72,,,210.50,23.16,109.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8474 EBV VCA IGG IA,86665,CPT,,,,,both,, ,210.50,126.30,Medicaid,Illinois Medicaid,,59.10,,,210.50,23.16,109.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34271 EHRLICHIA AB,86666,CPT,,,,,both,, ,511.95,307.17,Medicaid,Illinois Medicaid,,148.69,,,511.95,56.31,266.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34464 EHRLICHIA AB,86666,CPT,,,,,both,, ,255.98,153.58,Medicaid,Illinois Medicaid,,148.69,,,255.98,28.16,133.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34464 EHRLICHIA AB,86666,CPT,,,,,both,, ,255.98,153.58,Medicaid,Illinois Medicaid,,148.69,,,255.98,28.16,133.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FRANCISELLA TULARENS,86668,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,148.69,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"FUNGUS AB, NOS",86671,CPT,,,,,both,, ,284.32,170.59,Medicaid,Illinois Medicaid,,148.69,,,284.32,31.28,147.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L162045 FUNG AB NOS,86671,CPT,,,,,both,, ,260.85,156.51,Medicaid,Illinois Medicaid,,79.44,,,260.85,28.69,135.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10295 SCAB IGA IA,86671,CPT,,,,,both,, ,568.64,341.18,Medicaid,Illinois Medicaid,,103.74,,,568.64,62.55,295.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10295 SCAB IGA IA,86671,CPT,,,,,both,, ,568.64,341.18,Medicaid,Illinois Medicaid,,103.74,,,568.64,62.55,295.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37695 H PYLORI AB Q,86677,CPT,,,,,both,, ,56.69,34.01,Medicaid,Illinois Medicaid,,29.34,,,56.69,6.24,29.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34309STRONGY AB IGG,86682,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,498.88,,,74.93,8.24,38.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34309STRONGY AB IGG,86682,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,543.78,,,74.93,8.24,38.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34309STRONGY AB IGG,86682,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,543.78,,,74.93,8.24,38.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34309STRONGY AB IGG,86682,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,66.69,,,74.93,8.24,38.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HEPATITIS, DELTA AGE",86692,CPT,,,,,both,, ,1381.76,829.05,Medicaid,Illinois Medicaid,,543.78,,,1381.76,151.99,718.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4990 HEP D AB TOTAL,86692,CPT,,,,,both,, ,725.82,435.49,Medicaid,Illinois Medicaid,,151.56,,,725.82,79.84,377.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HERPES SIMP NON-SPEC,86694,CPT,,,,,both,, ,338.21,202.92,Medicaid,Illinois Medicaid,,151.56,,,338.21,37.20,175.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L164806 HSV1/2 IGM,86694,CPT,,,,,both,, ,50.70,30.42,Medicaid,Illinois Medicaid,,151.56,,,50.70,5.58,26.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HERPES SIMP TYPE 1,86695,CPT,,,,,both,, ,129.94,77.96,Medicaid,Illinois Medicaid,,131.52,,,129.94,14.29,67.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q3636 HSV1 IGG IA,86695,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,129.50,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q3636 HSV1 IGG IA,86695,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,369.00,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q3636 HSV1 IGG IA,86695,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,74.94,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q3636 HSV1 IGG IA,86695,CPT,,,,,both,, ,351.68,211.00,Medicaid,Illinois Medicaid,,74.94,,,351.68,38.68,182.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HERPES SIMP TYPE 2,86696,CPT,,,,,both,, ,190.86,114.51,Medicaid,Illinois Medicaid,,58.26,,,190.86,20.99,99.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L163006 HSV2 AB IG,86696,CPT,,,,,both,, ,300.00,180.00,Medicaid,Illinois Medicaid,,450.81,,,300.00,33.00,156,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q17170 HERPES SIMPLEX VIRUS 2 (IGG),86696,CPT,,,,,both,, ,230.25,138.15,Medicaid,Illinois Medicaid,,450.81,,,230.25,25.33,119.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q3640 HSV 2 SPEC AB,86696,CPT,,,,,both,, ,258.50,155.10,Medicaid,Illinois Medicaid,,450.81,,,258.50,28.44,134.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q3640 HSV 2 SPEC AB,86696,CPT,,,,,both,, ,258.50,155.10,Medicaid,Illinois Medicaid,,450.81,,,258.50,28.44,134.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q3640 HSV 2 SPEC AB,86696,CPT,,,,,both,, ,258.50,155.10,Medicaid,Illinois Medicaid,,401.55,,,258.50,28.44,134.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q3640 HSV 2 SPEC AB,86696,CPT,,,,,both,, ,258.50,155.10,Medicaid,Illinois Medicaid,,418.99,,,258.50,28.44,134.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q938 HISTOPLASMA,86698,CPT,,,,,both,, ,450.48,270.28,Medicaid,Illinois Medicaid,,215.05,,,450.48,49.55,234.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q938 HISTOPLASMA,86698,CPT,,,,,both,, ,450.48,270.28,Medicaid,Illinois Medicaid,,52.20,,,450.48,49.55,234.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q501 HBC AB TOT IA,86704,CPT,,,,,both,, ,898.44,539.06,Medicaid,Illinois Medicaid,,869.64,,,898.44,98.83,467.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q501 HBC AB TOT IA,86704,CPT,,,,,both,, ,898.44,539.06,Medicaid,Illinois Medicaid,,869.64,,,898.44,98.83,467.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HEP B CORE AB, IGM",86705,CPT,,,,,both,,,1047.19,1047.19,Medicaid,Illinois Medicaid,,42.00,,,1047.19,115.19,544.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HEP B CORE AB, IGM",86705,CPT,,,,,both,, ,1047.19,628.31,Medicaid,Illinois Medicaid,,213.60,,,1047.19,115.19,544.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L16881 HBC IGM ICMA,86705,CPT,,,,,both,, ,70.33,42.19,Medicaid,Illinois Medicaid,,94.20,,,70.33,7.74,36.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q556 HBEAB IA,86707,CPT,,,,,both,, ,999.76,599.85,Medicaid,Illinois Medicaid,,37.05,,,999.76,109.97,519.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q556 HBEAB IA,86707,CPT,,,,,both,, ,999.76,599.85,Medicaid,Illinois Medicaid,,318.00,,,999.76,109.97,519.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HEP A AB, TOTAL",86708,CPT,,,,,both,, ,547.88,328.72,Medicaid,Illinois Medicaid,,190.80,,,547.88,60.27,284.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L6726HEPA AB TOT ICM,86708,CPT,,,,,both,, ,547.88,328.72,Medicaid,Illinois Medicaid,,175.05,,,547.88,60.27,284.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36504 HEPA AB IGM I,86708,CPT,,,,,both,, ,547.88,328.72,Medicaid,Illinois Medicaid,,104.58,,,547.88,60.27,284.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HEP A AB, IGM",86709,CPT,,,,,both,,,725.82,725.82,Medicaid,Illinois Medicaid,,104.58,,,725.82,79.84,377.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HEP A AB, IGM",86709,CPT,,,,,both,, ,725.82,435.49,Medicaid,Illinois Medicaid,,293.19,,,725.82,79.84,377.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L28928 HEP A AB IGM,86709,CPT,,,,,both,, ,70.00,42.00,Medicaid,Illinois Medicaid,,285.10,,,70.00,7.70,36.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L28928 HEP A AB IGM,86709,CPT,,,,,both,, ,70.00,42.00,Medicaid,Illinois Medicaid,,150.38,,,70.00,7.70,36.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7250 INFLUENZA VIRU,86710,CPT,,,,,both,, ,295.83,177.49,Medicaid,Illinois Medicaid,,150.38,,,295.83,32.54,153.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q7250 INFLUENZA VIRU,86710,CPT,,,,,both,, ,295.83,177.49,Medicaid,Illinois Medicaid,,23.74,,,295.83,32.54,153.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91665 STRAT JCV AB,86711,CPT,,,,,both,, ,156.06,93.63,Medicaid,Illinois Medicaid,,195.68,,,156.06,17.17,81.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L164616 LEGIONELL AB,86713,CPT,,,,,both,, ,781.12,468.67,Medicaid,Illinois Medicaid,,453.84,,,781.12,85.92,406.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L819877 LEGIONELL AB,86713,CPT,,,,,both,, ,781.11,468.66,Medicaid,Illinois Medicaid,,2364.73,,,781.11,85.92,406.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L819877 LEGIONELL AB,86713,CPT,,,,,both,, ,781.11,468.66,Medicaid,Illinois Medicaid,,23.23,,,781.11,85.92,406.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEPTOSPIRA AB,86720,CPT,,,,,both,, ,329.51,197.70,Medicaid,Illinois Medicaid,,97.39,,,329.51,36.25,171.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L96552MUMPS IGG CLIA,86735,CPT,,,,,both,, ,540.24,324.14,Medicaid,Illinois Medicaid,,58.43,,,540.24,59.43,280.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MUMPS AB,86735,CPT,,,,,both,, ,96.55,57.93,Medicaid,Illinois Medicaid,,58.43,,,96.55,10.62,50.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MUMPS AB,86735,CPT,,,,,both,, ,588.85,353.31,Medicaid,Illinois Medicaid,,23.23,,,588.85,64.77,306.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36565 MUMPS IGM IFA,86735,CPT,,,,,both,, ,588.85,353.31,Medicaid,Illinois Medicaid,,97.39,,,588.85,64.77,306.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8624 MUMPSAB IGG IA,86735,CPT,,,,,both,, ,588.85,353.31,Medicaid,Illinois Medicaid,,58.43,,,588.85,64.77,306.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q659 MP AB IGG EIA,86738,CPT,,,,,both,, ,566.12,339.67,Medicaid,Illinois Medicaid,,58.43,,,566.12,62.27,294.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q659 MP AB IGG EIA,86738,CPT,,,,,both,, ,566.12,339.67,Medicaid,Illinois Medicaid,,166.71,,,566.12,62.27,294.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q659 MP AB IGG EIA,86738,CPT,,,,,both,, ,566.12,339.67,Medicaid,Illinois Medicaid,,217.52,,,566.12,62.27,294.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q659 MP AB IGG EIA,86738,CPT,,,,,both,, ,566.12,339.67,Medicaid,Illinois Medicaid,,130.51,,,566.12,62.27,294.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8945 PARVO IGG EIA,86747,CPT,,,,,both,, ,242.50,145.50,Medicaid,Illinois Medicaid,,130.51,,,242.50,26.68,126.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8945 PARVO IGG EIA,86747,CPT,,,,,both,, ,242.50,145.50,Medicaid,Illinois Medicaid,,134.40,,,242.50,26.68,126.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8945 PARVO IGG EIA,86747,CPT,,,,,both,, ,242.50,145.50,Medicaid,Illinois Medicaid,,275.62,,,242.50,26.68,126.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8945 PARVO IGG EIA,86747,CPT,,,,,both,, ,242.50,145.50,Medicaid,Illinois Medicaid,,165.37,,,242.50,26.68,126.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34278 ENTAB IGG ELI,86753,CPT,,,,,both,, ,64.27,38.56,Medicaid,Illinois Medicaid,,103.00,,,64.27,7.07,33.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34300 PROTOZ AB NOS,86753,CPT,,,,,both,, ,64.27,38.56,Medicaid,Illinois Medicaid,,61.80,,,64.27,7.07,33.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q90827 T CRUZI AB IA,86753,CPT,,,,,both,, ,64.27,38.56,Medicaid,Illinois Medicaid,,250.07,,,64.27,7.07,33.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L96131 RSV AB QT,86756,CPT,,,,,both,, ,95.00,57.00,Medicaid,Illinois Medicaid,,150.04,,,95.00,10.45,49.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPOTTED FEVER IGG,86757,CPT,,,,,both,, ,242.50,145.50,Medicaid,Illinois Medicaid,,140.28,,,242.50,26.68,126.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPOTTED FEVER IGG,86757,CPT,,,,,both,, ,242.50,145.50,Medicaid,Illinois Medicaid,,84.87,,,242.50,26.68,126.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPOTTED FEVER IGG,86757,CPT,,,,,both,, ,242.50,145.50,Medicaid,Illinois Medicaid,,127.46,,,242.50,26.68,126.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPOTTED FEVER IGG,86757,CPT,,,,,both,, ,242.50,145.50,Medicaid,Illinois Medicaid,,138.93,,,242.50,26.68,126.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RUBELLA AB,86762,CPT,,,,,both,, ,88.69,53.21,Medicaid,Illinois Medicaid,,84.87,,,88.69,9.76,46.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RUBELLA AB,86762,CPT,,,,,both,, ,906.30,543.78,Medicaid,Illinois Medicaid,,84.87,,,906.30,99.69,471.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34256 MEASAB IGMIA,86765,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,148.19,,,871.22,95.83,453.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q964 MEAS AB IGG IA,86765,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,84.87,,,871.22,95.83,453.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RUBEOLA AB,86765,CPT,,,,,both,, ,111.15,66.69,Medicaid,Illinois Medicaid,,37.08,,,111.15,12.23,57.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RUBEOLA AB,86765,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,131.18,,,871.22,95.83,453.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91121 SALMONELLA AB,86768,CPT,,,,,both,, ,127.70,76.62,Medicaid,Illinois Medicaid,,89.61,,,127.70,14.05,66.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91121 SALMONELLA AB,86768,CPT,,,,,both,, ,127.70,76.62,Medicaid,Illinois Medicaid,,97.67,,,127.70,14.05,66.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L164055 COVID19ABIGG,86769,CPT,,,,,both,, ,206.00,123.60,Medicaid,Illinois Medicaid,,328.05,,,206.00,22.66,107.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q39504 COVID19 ABIGG,86769,CPT,,,,,both,, ,224.54,134.72,Medicaid,Illinois Medicaid,,106.43,,,224.54,24.70,116.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q39504 COVID19 ABIGG,86769,CPT,,,,,both,, ,224.54,134.72,Medicaid,Illinois Medicaid,,106.43,,,224.54,24.70,116.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4862 TET ATOX ELISA,86774,CPT,,,,,both,, ,98.51,59.10,Medicaid,Illinois Medicaid,,106.43,,,98.51,10.84,51.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q3679 TOXOPLAS AB IA,86777,CPT,,,,,both,, ,247.83,148.69,Medicaid,Illinois Medicaid,,106.43,,,247.83,27.26,128.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8636 TOXOPLASMA AB,86777,CPT,,,,,both,, ,247.83,148.69,Medicaid,Illinois Medicaid,,106.43,,,247.83,27.26,128.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TOXOPLASMA AB,86777,CPT,,,,,both,, ,247.83,148.69,Medicaid,Illinois Medicaid,,691.29,,,247.83,27.26,128.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8636 TOXOPL AB IGM,86778,CPT,,,,,both,, ,247.83,148.69,Medicaid,Illinois Medicaid,,414.77,,,247.83,27.26,128.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8636 TOXOPL AB IGM,86778,CPT,,,,,both,, ,247.83,148.69,Medicaid,Illinois Medicaid,,55.74,,,247.83,27.26,128.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L082370 TREP AB IA,86780,CPT,,,,,both,, ,132.40,79.44,Medicaid,Illinois Medicaid,,301.72,,,132.40,14.56,68.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4112 FTA-ABS IFA,86780,CPT,,,,,both,, ,172.90,103.74,Medicaid,Illinois Medicaid,,181.03,,,172.90,19.02,89.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4112 FTA-ABS IFA,86780,CPT,,,,,both,, ,172.90,103.74,Medicaid,Illinois Medicaid,,55.74,,,172.90,19.02,89.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TREPONEMAL AB,86780,CPT,,,,,both,, ,48.90,29.34,Medicaid,Illinois Medicaid,,56.74,,,48.90,5.38,25.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L96206 VZV IGG CLIA,86787,CPT,,,,,both,, ,831.47,498.88,Medicaid,Illinois Medicaid,,50.85,,,831.47,91.46,432.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4439 VZV AB IGG IA,86787,CPT,,,,,both,, ,906.30,543.78,Medicaid,Illinois Medicaid,,998.91,,,906.30,99.69,471.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8683 VZV AB IGM IA,86787,CPT,,,,,both,, ,906.30,543.78,Medicaid,Illinois Medicaid,,599.34,,,906.30,99.69,471.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VARICELLA-ZOSTER AB,86787,CPT,,,,,both,, ,111.15,66.69,Medicaid,Illinois Medicaid,,51.72,,,111.15,12.23,57.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VARICELLA-ZOSTER AB,86787,CPT,,,,,both,, ,906.30,543.78,Medicaid,Illinois Medicaid,,414.77,,,906.30,99.69,471.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q16012 WNVAB IGM EIA,86788,CPT,,,,,both,, ,252.61,151.56,Medicaid,Illinois Medicaid,,623.38,,,252.61,27.79,131.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36596 WEST NILE VIR,86788,CPT,,,,,both,, ,252.61,151.56,Medicaid,Illinois Medicaid,,374.02,,,252.61,27.79,131.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WEST NILE VIR AB IGM,86788,CPT,,,,,both,, ,252.61,151.56,Medicaid,Illinois Medicaid,,374.02,,,252.61,27.79,131.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q36596 WEST NILE VIR,86789,CPT,,,,,both,, ,219.20,131.52,Medicaid,Illinois Medicaid,,247.72,,,219.20,24.11,113.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WEST NILE VIR AB,86789,CPT,,,,,both,, ,215.84,129.50,Medicaid,Illinois Medicaid,,146.66,,,215.84,23.74,112.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L878033 HHV-7 IGM IF,86790,CPT,,,,,both,, ,615.00,369.00,Medicaid,Illinois Medicaid,,233.40,,,615.00,67.65,319.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q15085 VIRUS AB, NOS",86790,CPT,,,,,both,, ,124.90,74.94,Medicaid,Illinois Medicaid,,233.40,,,124.90,13.74,64.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q15085 VIRUS AB, NOS",86790,CPT,,,,,both,, ,124.90,74.94,Medicaid,Illinois Medicaid,,39.23,,,124.90,13.74,64.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q94264 ZIKA AB IGM,86794,CPT,,,,,both,, ,97.11,58.26,Medicaid,Illinois Medicaid,,420.72,,,97.11,10.68,50.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q267 TG AB IA,86800,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,252.43,,,751.36,82.65,390.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q267 TG AB IA,86800,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,35.86,,,751.36,82.65,390.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q267 TG AB IA,86800,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,495.95,,,751.36,82.65,390.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q267 TG AB IA,86800,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,297.57,,,751.36,82.65,390.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q90814 THYROID CANCER (THYROGLOBULIN)MON,86800,CPT,,,,,both,, ,669.25,401.55,Medicaid,Illinois Medicaid,,25.42,,,669.25,73.62,348.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPATITIS C AB TEST,86803,CPT,,,,,both,, ,698.32,418.99,Medicaid,Illinois Medicaid,,209.99,,,698.32,76.82,363.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HEP C AB TEST,CONFIR",86804,CPT,,,,,both,, ,358.42,215.05,Medicaid,Illinois Medicaid,,209.99,,,358.42,39.43,186.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOTOXIC REACTIVE AB SCREEN/STANDARD,86807,CPT,,,,,both,, ,87.00,52.20,Medicaid,Illinois Medicaid,,207.47,,,87.00,9.57,45.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q528 HLA-B27 AG FC,86812,CPT,,,,,both,, ,1449.41,869.64,Medicaid,Illinois Medicaid,,315.42,,,1449.41,159.44,753.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q528 HLA-B27 AG FC,86812,CPT,,,,,both,, ,1449.41,869.64,Medicaid,Illinois Medicaid,,311.21,,,1449.41,159.44,753.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HLA SOLID PHASE/CALSS I&II AB QUAL,86828,CPT,,,,,both,, ,70.00,42.00,Medicaid,Illinois Medicaid,,287.37,,,70.00,7.70,36.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HLA SOLID PHASE/CLASS 1 AB QUAL HIGHDEF,86832,CPT,,,,,both,, ,356.00,213.60,Medicaid,Illinois Medicaid,,73.92,,,356.00,39.16,185.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L117065 PROTH AB IGG,86849,CPT,,,,,both,, ,157.00,94.20,Medicaid,Illinois Medicaid,,73.92,,,157.00,17.27,81.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,, ,61.75,37.05,Medicaid,Illinois Medicaid,,73.92,,,61.75,6.79,32.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,,,318.00,318.00,Medicaid,Illinois Medicaid,,73.92,,,318.00,34.98,165.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,, ,318.00,190.80,Medicaid,Illinois Medicaid,,842.70,,,318.00,34.98,165.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51200 AB SCRN,86850,CPT,,,,,both,, ,291.75,175.05,Medicaid,Illinois Medicaid,,92.34,,,291.75,32.09,151.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51128 AB ELUTION,86860,CPT,,,,,both,, ,174.30,104.58,Medicaid,Illinois Medicaid,,662.67,,,174.30,19.17,90.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51128 AB ELUTION,86860,CPT,,,,,both,, ,174.30,104.58,Medicaid,Illinois Medicaid,,662.67,,,174.30,19.17,90.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"ANTIBODY ID,EA PANEL",86870,CPT,,,,,both,, ,488.65,293.19,Medicaid,Illinois Medicaid,,827.43,,,488.65,53.75,254.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51108 AB ID EA PNL,86870,CPT,,,,,both,, ,475.18,285.10,Medicaid,Illinois Medicaid,,496.45,,,475.18,52.27,247.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51612 DAT,86880,CPT,,,,,both,, ,250.64,150.38,Medicaid,Illinois Medicaid,,496.45,,,250.64,27.57,130.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51612 DAT,86880,CPT,,,,,both,, ,250.64,150.38,Medicaid,Illinois Medicaid,,496.45,,,250.64,27.57,130.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IDAT QUAL EA RGT RBC,86885,CPT,,,,,both,, ,39.57,23.74,Medicaid,Illinois Medicaid,,194.00,,,39.57,4.35,20.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IDAT EACH AB TITER,86886,CPT,,,,,both,, ,326.14,195.68,Medicaid,Illinois Medicaid,,194.00,,,326.14,35.88,169.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"AUTO COMPONENT,PROCS",86890,CPT,,,,,both,, ,756.41,453.84,Medicaid,Illinois Medicaid,,328.38,,,756.41,83.21,393.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AUTOL BID OP SALV,86891,CPT,,,,,both,, ,3941.23,2364.73,Medicaid,Illinois Medicaid,,143.98,,,3941.23,433.54,2049.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLOOD TYPING ABO,86900,CPT,,,,,both,, ,38.73,23.23,Medicaid,Illinois Medicaid,,143.99,,,38.73,4.26,20.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLOOD TYPING ABO,86900,CPT,,,,,both,,,97.39,97.39,Medicaid,Illinois Medicaid,,203.59,,,97.39,10.71,50.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
REF  BLD TYPING ABO,86900,CPT,,,,,both,, ,97.39,58.43,Medicaid,Illinois Medicaid,,143.99,,,97.39,10.71,50.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
REF  BLD TYPING ABO,86900,CPT,,,,,both,, ,97.39,58.43,Medicaid,Illinois Medicaid,,233.07,,,97.39,10.71,50.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLOOD TYPING RH D,86901,CPT,,,,,both,, ,38.73,23.23,Medicaid,Illinois Medicaid,,288.47,,,38.73,4.26,20.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLOOD TYPING RH D,86901,CPT,,,,,both,,,97.39,97.39,Medicaid,Illinois Medicaid,,124.62,,,97.39,10.71,50.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
REF  BLD TYPING RH D,86901,CPT,,,,,both,, ,97.39,58.43,Medicaid,Illinois Medicaid,,288.47,,,97.39,10.71,50.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
REF  BLD TYPING RH D,86901,CPT,,,,,both,, ,97.39,58.43,Medicaid,Illinois Medicaid,,180.36,,,97.39,10.71,50.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLD TYPE DONOR EA AG,86902,CPT,,,,,both,, ,277.86,166.71,Medicaid,Illinois Medicaid,,64.32,,,277.86,30.56,144.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BLD TYPING OTHER AG,86905,CPT,,,,,both,,,217.52,217.52,Medicaid,Illinois Medicaid,,192.15,,,217.52,23.93,113.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51232 RBC AG TYP,86905,CPT,,,,,both,, ,217.52,130.51,Medicaid,Illinois Medicaid,,192.15,,,217.52,23.93,113.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51232 RBC AG TYP,86905,CPT,,,,,both,, ,217.52,130.51,Medicaid,Illinois Medicaid,,84.87,,,217.52,23.93,113.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51920 RH PHENO,86906,CPT,,,,,both,, ,224.00,134.40,Medicaid,Illinois Medicaid,,84.87,,,224.00,24.64,116.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COMPATIB TEST IS,86920,CPT,,,,,both,,,275.62,275.62,Medicaid,Illinois Medicaid,,84.87,,,275.62,30.32,143.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COMPATIB TEST IS,86920,CPT,,,,,both,, ,275.62,165.37,Medicaid,Illinois Medicaid,,108.11,,,275.62,30.32,143.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COMPATIB TEST INCUB,86921,CPT,,,,,both,,,103.00,103.00,Medicaid,Illinois Medicaid,,351.63,,,103.00,11.33,53.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COMPATIB TEST INCUB,86921,CPT,,,,,both,, ,103.00,61.80,Medicaid,Illinois Medicaid,,351.63,,,103.00,11.33,53.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COMPATIB TEST AHG,86922,CPT,,,,,both,,,250.07,250.07,Medicaid,Illinois Medicaid,,25.26,,,250.07,27.51,130.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COMPATIB TEST AHG,86922,CPT,,,,,both,, ,250.07,150.04,Medicaid,Illinois Medicaid,,207.47,,,250.07,27.51,130.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FFP THAWING,86927,CPT,,,,,both,, ,233.80,140.28,Medicaid,Illinois Medicaid,,304.64,,,233.80,25.72,121.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PLATELETS POOLING,86965,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,304.64,,,141.46,15.56,73.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51010 CHEM TREATMNT,86970,CPT,,,,,both,, ,212.44,127.46,Medicaid,Illinois Medicaid,,304.64,,,212.44,23.37,110.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RBC PRETREAT CHEM,86970,CPT,,,,,both,, ,231.55,138.93,Medicaid,Illinois Medicaid,,304.64,,,231.55,25.47,120.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51701 ENZYME TREAT,86971,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,333.27,,,141.46,15.56,73.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51701 ENZYME TREAT,86971,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,114.51,,,141.46,15.56,73.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51122 RBC CELL SEP,86972,CPT,,,,,both,, ,246.99,148.19,Medicaid,Illinois Medicaid,,114.51,,,246.99,27.17,128.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"RBC PRETREAT,SER,INC",86975,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,252.43,,,141.46,15.56,73.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"RBC PRETREAT,SER DIL",86976,CPT,,,,,both,, ,61.80,37.08,Medicaid,Illinois Medicaid,,288.47,,,61.80,6.80,32.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RBC PRETREAT W-INHIB,86977,CPT,,,,,both,, ,218.64,131.18,Medicaid,Illinois Medicaid,,288.47,,,218.64,24.05,113.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
O51234 ADSORPTION,86978,CPT,,,,,both,, ,149.35,89.61,Medicaid,Illinois Medicaid,,557.92,,,149.35,16.43,77.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RBC PRETREAT DIFF EA,86978,CPT,,,,,both,, ,162.79,97.67,Medicaid,Illinois Medicaid,,557.92,,,162.79,17.91,84.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPLIT BLOOD OR PROD,86985,CPT,,,,,both,, ,546.75,328.05,Medicaid,Illinois Medicaid,,249.40,,,546.75,60.14,284.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34286 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Medicaid,Illinois Medicaid,,249.40,,,177.39,19.51,92.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37213 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Medicaid,Illinois Medicaid,,249.40,,,177.39,19.51,92.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q39480 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Medicaid,Illinois Medicaid,,282.41,,,177.39,19.51,92.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4554 SPECIMEN CONCE,87015,CPT,,,,,both,, ,177.39,106.43,Medicaid,Illinois Medicaid,,282.41,,,177.39,19.51,92.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPECIMEN CONCENTRATI,87015,CPT,,,,,both,, ,177.39,106.43,Medicaid,Illinois Medicaid,,282.41,,,177.39,19.51,92.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULTURE BLOOD BACTER,87040,CPT,,,,,both,,,691.29,691.29,Medicaid,Illinois Medicaid,,318.79,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULTURE BLOOD BACTER,87040,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,318.79,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT STL BACT W-ISOL,87045,CPT,,,,,both,, ,92.90,55.74,Medicaid,Illinois Medicaid,,315.42,,,92.90,10.22,48.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT STL BACT W-ISOL,87045,CPT,,,,,both,,,301.72,301.72,Medicaid,Illinois Medicaid,,315.42,,,301.72,33.19,156.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT STL BACT W-ISOL,87045,CPT,,,,,both,, ,301.72,181.03,Medicaid,Illinois Medicaid,,315.42,,,301.72,33.19,156.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT STL BACT EA ADD,87046,CPT,,,,,both,, ,92.90,55.74,Medicaid,Illinois Medicaid,,93.60,,,92.90,10.22,48.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT STL BACT EA ADD,87046,CPT,,,,,both,, ,94.58,56.74,Medicaid,Illinois Medicaid,,166.71,,,94.58,10.40,49.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULTURE BACTERIA OTH,87070,CPT,,,,,both,, ,84.76,50.85,Medicaid,Illinois Medicaid,,166.71,,,84.76,9.32,44.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULTURE BACTERIA OTH,87070,CPT,,,,,both,,,998.91,998.91,Medicaid,Illinois Medicaid,,223.13,,,998.91,109.88,519.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULTURE BACTERIA OTH,87070,CPT,,,,,both,, ,998.91,599.34,Medicaid,Illinois Medicaid,,223.13,,,998.91,109.88,519.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L188227 CULTURE BACT,87070,CPT,,,,,both,, ,86.20,51.72,Medicaid,Illinois Medicaid,,311.21,,,86.20,9.48,44.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT BAC AEROB OT QT,87071,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,95.48,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT BACT ANA ANY SO,87075,CPT,,,,,both,,,623.38,623.38,Medicaid,Illinois Medicaid,,73.25,,,623.38,68.57,324.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L8904 ANAEROBIC CULT,87075,CPT,,,,,both,, ,623.38,374.02,Medicaid,Illinois Medicaid,,74.16,,,623.38,68.57,324.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L8904 ANAEROBIC CULT,87075,CPT,,,,,both,, ,623.38,374.02,Medicaid,Illinois Medicaid,,67.02,,,623.38,68.57,324.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT ANAERO IDENT EA,87076,CPT,,,,,both,, ,412.87,247.72,Medicaid,Illinois Medicaid,,70.89,,,412.87,45.42,214.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L182345 ORG ID ANAER,87076,CPT,,,,,both,, ,244.44,146.66,Medicaid,Illinois Medicaid,,414.77,,,244.44,26.89,127.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT AEROBIC ID REF,87077,CPT,,,,,both,, ,389.01,233.40,Medicaid,Illinois Medicaid,,792.85,,,389.01,42.79,202.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT AEROBIC ID REF,87077,CPT,,,,,both,, ,389.01,233.40,Medicaid,Illinois Medicaid,,38.73,,,389.01,42.79,202.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULTURE SCREEN ONLY,87081,CPT,,,,,both,, ,65.39,39.23,Medicaid,Illinois Medicaid,,120.07,,,65.39,7.19,34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULTURE SCREEN ONLY,87081,CPT,,,,,both,,,420.72,420.72,Medicaid,Illinois Medicaid,,120.07,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULTURE SCREEN ONLY,87081,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,115.49,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT URINE-COLONY CT,87086,CPT,,,,,both,, ,59.78,35.86,Medicaid,Illinois Medicaid,,110.13,,,59.78,6.58,31.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT URINE-COLONY CT,87086,CPT,,,,,both,,,495.95,495.95,Medicaid,Illinois Medicaid,,110.13,,,495.95,54.55,257.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT URINE-COLONY CT,87086,CPT,,,,,both,, ,495.95,297.57,Medicaid,Illinois Medicaid,,570.04,,,495.95,54.55,257.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT URINE W-P ID,87088,CPT,,,,,both,, ,42.37,25.42,Medicaid,Illinois Medicaid,,342.02,,,42.37,4.66,22.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L188243CUL SKIN FUNG,87101,CPT,,,,,both,, ,349.99,209.99,Medicaid,Illinois Medicaid,,602.38,,,349.99,38.50,181.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L188243CUL SKIN FUNG,87101,CPT,,,,,both,, ,349.99,209.99,Medicaid,Illinois Medicaid,,602.38,,,349.99,38.50,181.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT FUNGUS ISOLATIO,87102,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,193.49,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4553 CULT FUNGUS IS,87102,CPT,,,,,both,, ,525.70,315.42,Medicaid,Illinois Medicaid,,193.49,,,525.70,57.83,273.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULTURE FUNGUS BLOOD,87103,CPT,,,,,both,, ,518.69,311.21,Medicaid,Illinois Medicaid,,70.89,,,518.69,57.06,269.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4606 FUNGUS CULT BL,87103,CPT,,,,,both,, ,478.95,287.37,Medicaid,Illinois Medicaid,,575.60,,,478.95,52.68,249.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q575 FUNGAL ID EXAM,87106,CPT,,,,,both,, ,123.21,73.92,Medicaid,Illinois Medicaid,,74.16,,,123.21,13.55,64.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q575 FUNGAL ID EXAM,87106,CPT,,,,,both,, ,123.21,73.92,Medicaid,Illinois Medicaid,,414.77,,,123.21,13.55,64.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L8474 MOLD IDENTIF,87107,CPT,,,,,both,, ,123.21,73.92,Medicaid,Illinois Medicaid,,50.52,,,123.21,13.55,64.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L8474 MOLD IDENTIF,87107,CPT,,,,,both,, ,123.21,73.92,Medicaid,Illinois Medicaid,,53.01,,,123.21,13.55,64.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT MYCOPLASMA,87109,CPT,,,,,both,, ,1404.50,842.70,Medicaid,Illinois Medicaid,,67.86,,,1404.50,154.50,730.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UREA-MYCOPLS HOM CULT,87109,CPT,,,,,both,, ,153.90,92.34,Medicaid,Illinois Medicaid,,93.79,,,153.90,16.93,80.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q690 CULTURE CHLAMYD,87110,CPT,,,,,both,, ,1104.45,662.67,Medicaid,Illinois Medicaid,,95.40,,,1104.45,121.49,574.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q690 CULTURE CHLAMYD,87110,CPT,,,,,both,, ,1104.45,662.67,Medicaid,Illinois Medicaid,,531.65,,,1104.45,121.49,574.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT MYCOBACTERIA,87116,CPT,,,,,both,,,827.43,827.43,Medicaid,Illinois Medicaid,,73.18,,,827.43,91.02,430.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CULT MYCOBACTERIA,87116,CPT,,,,,both,, ,827.43,496.45,Medicaid,Illinois Medicaid,,73.18,,,827.43,91.02,430.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10526MBAC BL CMBCS,87116,CPT,,,,,both,, ,827.43,496.45,Medicaid,Illinois Medicaid,,531.65,,,827.43,91.02,430.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4554 CULT MYCOBACTE,87116,CPT,,,,,both,, ,827.43,496.45,Medicaid,Illinois Medicaid,,531.65,,,827.43,91.02,430.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q690 CULT TYPE IMMUN,87140,CPT,,,,,both,, ,323.34,194.00,Medicaid,Illinois Medicaid,,169.08,,,323.34,35.57,168.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q690 CULT TYPE IMMUN,87140,CPT,,,,,both,, ,323.34,194.00,Medicaid,Illinois Medicaid,,990.00,,,323.34,35.57,168.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"CULT TYPE,IMMUNOLOGI",87147,CPT,,,,,both,, ,547.31,328.38,Medicaid,Illinois Medicaid,,105.00,,,547.31,60.20,284.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"CULT TYPE,NUCLEIC AC",87149,CPT,,,,,both,, ,239.97,143.98,Medicaid,Illinois Medicaid,,63.16,,,239.97,26.40,124.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LRX183755 AFB ID PB,87149,CPT,,,,,both,, ,239.99,143.99,Medicaid,Illinois Medicaid,,968.60,,,239.99,26.40,124.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DNA-RNA AMPLI PROBE,87150,CPT,,,,,both,, ,339.33,203.59,Medicaid,Illinois Medicaid,,533.17,,,339.33,37.33,176.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LRX183327 MOLD ID,87153,CPT,,,,,both,, ,239.99,143.99,Medicaid,Illinois Medicaid,,581.16,,,239.99,26.40,124.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
QRX9000010 AFB ID,87153,CPT,,,,,both,, ,388.45,233.07,Medicaid,Illinois Medicaid,,581.16,,,388.45,42.73,201.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MACRO EXAM ARTHROPOD,87168,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,581.16,,,480.79,52.89,250.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MACRO EXAM PARASITE,87169,CPT,,,,,both,, ,207.70,124.62,Medicaid,Illinois Medicaid,,581.16,,,207.70,22.85,108,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PINWORM EXAM,87172,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,188.10,,,480.79,52.89,250.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE HOMOGENIZ CUL,87176,CPT,,,,,both,, ,300.60,180.36,Medicaid,Illinois Medicaid,,631.00,,,300.60,33.07,156.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OVA-PARASITES SMEARS,87177,CPT,,,,,both,, ,107.21,64.32,Medicaid,Illinois Medicaid,,533.83,,,107.21,11.79,55.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q681 OVA-PARASITES S,87177,CPT,,,,,both,, ,320.25,192.15,Medicaid,Illinois Medicaid,,262.71,,,320.25,35.23,166.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q681 OVA-PARASITES S,87177,CPT,,,,,both,, ,320.25,192.15,Medicaid,Illinois Medicaid,,129.06,,,320.25,35.23,166.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MICROB SUSCEP DIFFUS,87181,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,887.49,,,141.46,15.56,73.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q18869 MOD HODGE DD,87184,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,532.49,,,141.46,15.56,73.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q18869 MOD HODGE DD,87184,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,654.12,,,141.46,15.56,73.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MICROB SUSCEP ENZYME,87185,CPT,,,,,both,, ,180.19,108.11,Medicaid,Illinois Medicaid,,201.07,,,180.19,19.82,93.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MICROBE SUSCEPT REF,87186,CPT,,,,,both,, ,586.05,351.63,Medicaid,Illinois Medicaid,,606.75,,,586.05,64.47,304.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MICROBE SUSCEPT REF,87186,CPT,,,,,both,, ,586.05,351.63,Medicaid,Illinois Medicaid,,606.75,,,586.05,64.47,304.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SMEAR,GRAM STAIN",87205,CPT,,,,,both,, ,42.10,25.26,Medicaid,Illinois Medicaid,,437.34,,,42.10,4.63,21.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SMEAR,GRAM STAIN",87205,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,437.34,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4503AC-FST BACI STN,87206,CPT,,,,,both,, ,507.74,304.64,Medicaid,Illinois Medicaid,,640.10,,,507.74,55.85,264.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4503AC-FST BACI STN,87206,CPT,,,,,both,, ,507.74,304.64,Medicaid,Illinois Medicaid,,1280.21,,,507.74,55.85,264.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4503AC-FST BACI STN,87206,CPT,,,,,both,, ,507.74,304.64,Medicaid,Illinois Medicaid,,1280.21,,,507.74,55.85,264.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q4503AC-FST BACI STN,87206,CPT,,,,,both,, ,507.74,304.64,Medicaid,Illinois Medicaid,,2073.06,,,507.74,55.85,264.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SMEAR,SPECIAL STAIN",87207,CPT,,,,,both,, ,555.45,333.27,Medicaid,Illinois Medicaid,,581.16,,,555.45,61.10,288.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q681 SMEAR COMPLEX S,87209,CPT,,,,,both,, ,190.86,114.51,Medicaid,Illinois Medicaid,,581.16,,,190.86,20.99,99.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q681 SMEAR COMPLEX S,87209,CPT,,,,,both,, ,190.86,114.51,Medicaid,Illinois Medicaid,,307.33,,,190.86,20.99,99.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SMEARWET MOUNT SAL-I,87210,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,307.33,,,420.72,46.28,218.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8628 SCABIES MIC EX,87220,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,1031.31,,,480.79,52.89,250.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8628 SCABIES MIC EX,87220,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,1082.67,,,480.79,52.89,250.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q689 VIR CULT IFA-TC,87252,CPT,,,,,both,, ,929.87,557.92,Medicaid,Illinois Medicaid,,1082.67,,,929.87,102.29,483.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q689 VIR CULT IFA-TC,87252,CPT,,,,,both,, ,929.87,557.92,Medicaid,Illinois Medicaid,,118.18,,,929.87,102.29,483.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L186015 VIR INOC SHL,87254,CPT,,,,,both,, ,415.68,249.40,Medicaid,Illinois Medicaid,,489.54,,,415.68,45.72,216.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q17495VIRUS INOCU SH,87254,CPT,,,,,both,, ,415.68,249.40,Medicaid,Illinois Medicaid,,489.54,,,415.68,45.72,216.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VIRUS INOCU SHELL VI,87254,CPT,,,,,both,, ,415.68,249.40,Medicaid,Illinois Medicaid,,223.47,,,415.68,45.72,216.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q2649 HSV CULT WREF,87255,CPT,,,,,both,, ,470.69,282.41,Medicaid,Illinois Medicaid,,223.47,,,470.69,51.78,244.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q841 HSV CULT HS,87255,CPT,,,,,both,, ,470.69,282.41,Medicaid,Illinois Medicaid,,108.00,,,470.69,51.78,244.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VIRUS ISOLATION GEN,87255,CPT,,,,,both,, ,470.69,282.41,Medicaid,Illinois Medicaid,,118.21,,,470.69,51.78,244.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q34966 PERTUSSIS AG,",87265,CPT,,,,,both,, ,531.32,318.79,Medicaid,Illinois Medicaid,,118.21,,,531.32,58.45,276.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q34966 PERTUSSIS AG,",87265,CPT,,,,,both,, ,531.32,318.79,Medicaid,Illinois Medicaid,,105.30,,,531.32,58.45,276.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INFAGT DT QLSQT CRYP,87272,CPT,,,,,both,, ,525.70,315.42,Medicaid,Illinois Medicaid,,533.17,,,525.70,57.83,273.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37213 INFAGT DT QLS,87272,CPT,,,,,both,, ,525.70,315.42,Medicaid,Illinois Medicaid,,581.16,,,525.70,57.83,273.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q39480 INFAGT DT QLS,87272,CPT,,,,,both,, ,525.70,315.42,Medicaid,Illinois Medicaid,,581.16,,,525.70,57.83,273.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L188227 LEGION PNEUM,87278,CPT,,,,,both,, ,156.00,93.60,Medicaid,Illinois Medicaid,,581.16,,,156.00,17.16,81.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34475 LEGPNE AG DFA,87278,CPT,,,,,both,, ,277.86,166.71,Medicaid,Illinois Medicaid,,581.16,,,277.86,30.56,144.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34475 LEGPNE AG DFA,87278,CPT,,,,,both,, ,277.86,166.71,Medicaid,Illinois Medicaid,,184.80,,,277.86,30.56,144.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34286 PNEUMOCYSTIS,87281,CPT,,,,,both,, ,371.89,223.13,Medicaid,Illinois Medicaid,,144.82,,,371.89,40.91,193.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34286 PNEUMOCYSTIS,87281,CPT,,,,,both,, ,371.89,223.13,Medicaid,Illinois Medicaid,,132.87,,,371.89,40.91,193.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VARICELLA ZOSTER AGI,87290,CPT,,,,,both,, ,518.69,311.21,Medicaid,Illinois Medicaid,,129.00,,,518.69,57.06,269.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"ANTIB DETECT NOS, IF",87299,CPT,,,,,both,, ,159.14,95.48,Medicaid,Illinois Medicaid,,98.88,,,159.14,17.51,82.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AG DETECT POLYVAL IF,87300,CPT,,,,,both,, ,122.09,73.25,Medicaid,Illinois Medicaid,,342.31,,,122.09,13.43,63.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L185041 ADV 40/41 IA,87301,CPT,,,,,both,, ,123.60,74.16,Medicaid,Illinois Medicaid,,105.00,,,123.60,13.60,64.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14950ASPE AG EIA IA,87305,CPT,,,,,both,, ,111.70,67.02,Medicaid,Illinois Medicaid,,105.00,,,111.70,12.29,58.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CLOSTRIDIUM DIF TOXN,87324,CPT,,,,,both,, ,118.16,70.89,Medicaid,Illinois Medicaid,,750.20,,,118.16,13.00,61.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CLOSTRIDIUM DIF TOXN,87324,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,94.57,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CRYPTOCOCCUS NEOF AG,87327,CPT,,,,,both,, ,1321.42,792.85,Medicaid,Illinois Medicaid,,141.86,,,1321.42,145.36,687.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"CRYPTOSPOR AG,EIA",87328,CPT,,,,,both,, ,64.55,38.73,Medicaid,Illinois Medicaid,,67.98,,,64.55,7.10,33.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q39480 INFAGT DT QLS,87329,CPT,,,,,both,, ,200.12,120.07,Medicaid,Illinois Medicaid,,202.08,,,200.12,22.01,104.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q39480 INFAGT DT QLS,87329,CPT,,,,,both,, ,200.12,120.07,Medicaid,Illinois Medicaid,,70.89,,,200.12,22.01,104.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8625 GIARDAG EIA IA,87329,CPT,,,,,both,, ,192.49,115.49,Medicaid,Illinois Medicaid,,70.89,,,192.49,21.17,100.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34838 HPYLAG EIA IA,87338,CPT,,,,,both,, ,183.56,110.13,Medicaid,Illinois Medicaid,,47.26,,,183.56,20.19,95.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34838 HPYLAG EIA IA,87338,CPT,,,,,both,, ,183.56,110.13,Medicaid,Illinois Medicaid,,70.90,,,183.56,20.19,95.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HBSAG,87340,CPT,,,,,both,,,570.04,570.04,Medicaid,Illinois Medicaid,,167.73,,,570.04,62.70,296.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HBSAG,87340,CPT,,,,,both,, ,570.04,342.02,Medicaid,Illinois Medicaid,,167.73,,,570.04,62.70,296.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q555 HBEAG IA,87350,CPT,,,,,both,, ,1003.97,602.38,Medicaid,Illinois Medicaid,,167.73,,,1003.97,110.44,522.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q555 HBEAG IA,87350,CPT,,,,,both,, ,1003.97,602.38,Medicaid,Illinois Medicaid,,167.73,,,1003.97,110.44,522.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91212H.GALA AG U IA,87385,CPT,,,,,both,, ,322.49,193.49,Medicaid,Illinois Medicaid,,279.55,,,322.49,35.47,167.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91212H.GALA AG U IA,87385,CPT,,,,,both,, ,322.49,193.49,Medicaid,Illinois Medicaid,,177.49,,,322.49,35.47,167.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"INFLUENZA A AG,EIA",87400,CPT,,,,,both,, ,118.16,70.89,Medicaid,Illinois Medicaid,,105.00,,,118.16,13.00,61.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"INFLUENZA A AG,EIA",87400,CPT,,,,,both,, ,959.34,575.60,Medicaid,Illinois Medicaid,,108.00,,,959.34,105.53,498.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L6866 ROTAVIRUS DDIA,87425,CPT,,,,,both,, ,123.60,74.16,Medicaid,Illinois Medicaid,,417.76,,,123.60,13.60,64.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"ROTAVIRUS AG,EIA",87425,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,417.76,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COVID19 AG EIA,87426,CPT,,,,,both,, ,84.20,50.52,Medicaid,Illinois Medicaid,,1487.17,,,84.20,9.26,43.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COVID19 AG EIA,87426,CPT,,,,,both,, ,88.35,53.01,Medicaid,Illinois Medicaid,,1487.17,,,88.35,9.72,45.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SHIGA-LIKE TOX AG,EI",87427,CPT,,,,,both,, ,113.10,67.86,Medicaid,Illinois Medicaid,,607.09,,,113.10,12.44,58.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"SHIGA-LIKE TOX AG,EI",87427,CPT,,,,,both,, ,156.33,93.79,Medicaid,Illinois Medicaid,,607.09,,,156.33,17.20,81.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COVID19AG FLUAB SOF2,87428,CPT,,,,,both,, ,159.00,95.40,Medicaid,Illinois Medicaid,,455.37,,,159.00,17.49,82.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"AG DETEC NOS,EIA MUL",87449,CPT,,,,,both,, ,886.09,531.65,Medicaid,Illinois Medicaid,,607.09,,,886.09,97.47,460.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FUNGITELL SERUM,87449,CPT,,,,,both,, ,121.98,73.18,Medicaid,Illinois Medicaid,,607.09,,,121.98,13.42,63.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FUNGITELL SERUM,87449,CPT,,,,,both,, ,121.98,73.18,Medicaid,Illinois Medicaid,,607.09,,,121.98,13.42,63.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15544 NOROV EIA IA,87449,CPT,,,,,both,, ,886.09,531.65,Medicaid,Illinois Medicaid,,607.09,,,886.09,97.47,460.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8856 LEGIO AG U IA,87449,CPT,,,,,both,, ,886.09,531.65,Medicaid,Illinois Medicaid,,540.75,,,886.09,97.47,460.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CANDIDA DNA AMP PROB,87481,CPT,,,,,both,, ,281.80,169.08,Medicaid,Illinois Medicaid,,272.64,,,281.80,31.00,146.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L183410 M ENCEPH CSF,87483,CPT,,,,,both,, ,1650.00,990.00,Medicaid,Illinois Medicaid,,272.64,,,1650.00,181.50,858,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L139650 CPNEU DNA,87486,CPT,,,,,both,, ,175.00,105.00,Medicaid,Illinois Medicaid,,272.64,,,175.00,19.25,91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37444 C PNEUMO PCR,87486,CPT,,,,,both,, ,105.27,63.16,Medicaid,Illinois Medicaid,,429.09,,,105.27,11.58,54.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHLMYD TRACH DNA AMP,87491,CPT,,,,,both,,,968.60,968.60,Medicaid,Illinois Medicaid,,393.66,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L180021 CTRACH AMPPR,87491,CPT,,,,,both,, ,888.63,533.17,Medicaid,Illinois Medicaid,,429.09,,,888.63,97.75,462.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11361 C.TRA RNA TMA,87491,CPT,,,,,both,, ,968.60,581.16,Medicaid,Illinois Medicaid,,429.09,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11361 C.TRA RNA TMA,87491,CPT,,,,,both,, ,968.60,581.16,Medicaid,Illinois Medicaid,,18.52,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11361 C.TRA RNA TMA,87491,CPT,,,,,both,, ,968.60,581.16,Medicaid,Illinois Medicaid,,62.47,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11361 C.TRA RNA TMA,87491,CPT,,,,,both,, ,968.60,581.16,Medicaid,Illinois Medicaid,,26.77,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
C DIFF AMPLI PROBE,87493,CPT,,,,,both,, ,313.51,188.10,Medicaid,Illinois Medicaid,,166.71,,,313.51,34.49,163.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10601 CMV QL RT-PCR,87496,CPT,,,,,both,, ,1051.68,631.00,Medicaid,Illinois Medicaid,,24.75,,,1051.68,115.68,546.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10600 CMV QT RT-PCR,87497,CPT,,,,,both,, ,889.73,533.83,Medicaid,Illinois Medicaid,,171.10,,,889.73,97.87,462.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15082EVRNA QL RTPCR,87498,CPT,,,,,both,, ,437.85,262.71,Medicaid,Illinois Medicaid,,103.74,,,437.85,48.16,227.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INFLU DNA AMP PROBE,87502,CPT,,,,,both,, ,215.11,129.06,Medicaid,Illinois Medicaid,,95.17,,,215.11,23.66,111.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INFLU DNA AMP PROBE,87502,CPT,,,,,both,,,887.49,887.49,Medicaid,Illinois Medicaid,,95.17,,,887.49,97.62,461.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INFLU DNA AMP PROBE,87502,CPT,,,,,both,, ,887.49,532.49,Medicaid,Illinois Medicaid,,464.12,,,887.49,97.62,461.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L183480 GI PRO STOOL,87507,CPT,,,,,both,, ,1090.20,654.12,Medicaid,Illinois Medicaid,,1091.94,,,1090.20,119.92,566.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GARDNER VAG DNA QUAN,87512,CPT,,,,,both,, ,335.12,201.07,Medicaid,Illinois Medicaid,,1091.94,,,335.12,36.86,174.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8369 HBV QT RT-PCR,87517,CPT,,,,,both,, ,1011.26,606.75,Medicaid,Illinois Medicaid,,967.14,,,1011.26,111.24,525.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q8369 HBV QT RT-PCR,87517,CPT,,,,,both,, ,1011.26,606.75,Medicaid,Illinois Medicaid,,967.14,,,1011.26,111.24,525.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37273 HCVRNA QL TMA,87521,CPT,,,,,both,, ,728.91,437.34,Medicaid,Illinois Medicaid,,967.14,,,728.91,80.18,379.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37273 HCVRNA QL TMA,87521,CPT,,,,,both,, ,728.91,437.34,Medicaid,Illinois Medicaid,,879.00,,,728.91,80.18,379.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11348 HCV QT RT-PCR,87522,CPT,,,,,both,, ,1066.84,640.10,Medicaid,Illinois Medicaid,,62.40,,,1066.84,117.35,554.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q35645 HCV RNAQT RT-,87522,CPT,,,,,both,, ,2133.69,1280.21,Medicaid,Illinois Medicaid,,513.97,,,2133.69,234.71,1109.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q35645 HCV RNAQT RT-,87522,CPT,,,,,both,, ,2133.69,1280.21,Medicaid,Illinois Medicaid,,1986.33,,,2133.69,234.71,1109.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HSV, DNA, AMP PROBE",87529,CPT,,,,,both,, ,3455.10,2073.06,Medicaid,Illinois Medicaid,,65.84,,,3455.10,380.06,1796.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q34257 HSV, DNA, AMP",87529,CPT,,,,,both,, ,968.60,581.16,Medicaid,Illinois Medicaid,,65.84,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q34257 HSV, DNA, AMP",87529,CPT,,,,,both,, ,968.60,581.16,Medicaid,Illinois Medicaid,,65.84,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q19502 HSV, DNA, QUA",87530,CPT,,,,,both,, ,512.23,307.33,Medicaid,Illinois Medicaid,,142.30,,,512.23,56.35,266.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q19502 HSV, DNA, QUA",87530,CPT,,,,,both,, ,512.23,307.33,Medicaid,Illinois Medicaid,,221.28,,,512.23,56.35,266.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HIV-1, DNA,AMP PROBE",87535,CPT,,,,,both,, ,1718.85,1031.31,Medicaid,Illinois Medicaid,,221.28,,,1718.85,189.07,893.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q40085 HIV1RNA RTPCR,87536,CPT,,,,,both,, ,1804.46,1082.67,Medicaid,Illinois Medicaid,,65.84,,,1804.46,198.49,938.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q40085 HIV1RNA RTPCR,87536,CPT,,,,,both,, ,1804.46,1082.67,Medicaid,Illinois Medicaid,,86.89,,,1804.46,198.49,938.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q15062 LEGION PNEU,D",87541,CPT,,,,,both,, ,196.98,118.18,Medicaid,Illinois Medicaid,,46.14,,,196.98,21.67,102.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q30298MTB COMP RTPCR,87556,CPT,,,,,both,, ,815.91,489.54,Medicaid,Illinois Medicaid,,140.44,,,815.91,89.75,424.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q30298MTB COMP RTPCR,87556,CPT,,,,,both,, ,815.91,489.54,Medicaid,Illinois Medicaid,,113.84,,,815.91,89.75,424.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q16064 M.AVIUM-INTR,",87561,CPT,,,,,both,, ,372.45,223.47,Medicaid,Illinois Medicaid,,113.84,,,372.45,40.97,193.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Q16064 M.AVIUM-INTR,",87561,CPT,,,,,both,, ,372.45,223.47,Medicaid,Illinois Medicaid,,60.96,,,372.45,40.97,193.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L180076 M GENT NAA,87563,CPT,,,,,both,, ,180.00,108.00,Medicaid,Illinois Medicaid,,60.96,,,180.00,19.80,93.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L139650 MPNEU DNA,87581,CPT,,,,,both,, ,197.03,118.21,Medicaid,Illinois Medicaid,,60.96,,,197.03,21.67,102.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L139650 MPNEU DNA,87581,CPT,,,,,both,, ,197.03,118.21,Medicaid,Illinois Medicaid,,60.96,,,197.03,21.67,102.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37444 MP QL RT-PCR,87581,CPT,,,,,both,, ,175.50,105.30,Medicaid,Illinois Medicaid,,60.96,,,175.50,19.31,91.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L180021 NG AMP PRB,87591,CPT,,,,,both,, ,888.63,533.17,Medicaid,Illinois Medicaid,,34.68,,,888.63,97.75,462.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11362 N.GON RNA TMA,87591,CPT,,,,,both,, ,968.60,581.16,Medicaid,Illinois Medicaid,,65.84,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11362 N.GON RNA TMA,87591,CPT,,,,,both,, ,968.60,581.16,Medicaid,Illinois Medicaid,,65.84,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11362 N.GON RNA TMA,87591,CPT,,,,,both,, ,968.60,581.16,Medicaid,Illinois Medicaid,,142.30,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11362 N.GON RNA TMA,87591,CPT,,,,,both,, ,968.60,581.16,Medicaid,Illinois Medicaid,,60.96,,,968.60,106.55,503.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L140230 ORTHOPOX VRS,87593,CPT,,,,,both,, ,308.00,184.80,Medicaid,Illinois Medicaid,,60.96,,,308.00,33.88,160.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HPV HIGH RISK TYPES,87624,CPT,,,,,both,, ,241.38,144.82,Medicaid,Illinois Medicaid,,60.96,,,241.38,26.55,125.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L199305 HPV HR,87624,CPT,,,,,both,, ,221.45,132.87,Medicaid,Illinois Medicaid,,60.96,,,221.45,24.36,115.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q92090 HPV HIGH RISK,87624,CPT,,,,,both,, ,215.00,129.00,Medicaid,Illinois Medicaid,,65.84,,,215.00,23.65,111.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L507460 HPV GEN16 18,87625,CPT,,,,,both,, ,164.80,98.88,Medicaid,Illinois Medicaid,,142.30,,,164.80,18.13,85.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RESP VIRUS 3-5 TARG,87631,CPT,,,,,both,, ,570.52,342.31,Medicaid,Illinois Medicaid,,123.27,,,570.52,62.76,296.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L139650 RES V 12-25,87633,CPT,,,,,both,, ,175.00,105.00,Medicaid,Illinois Medicaid,,140.44,,,175.00,19.25,91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L139650 RES V 12-25,87633,CPT,,,,,both,, ,175.00,105.00,Medicaid,Illinois Medicaid,,153.07,,,175.00,19.25,91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37444 RESP VIR PCR,87633,CPT,,,,,both,, ,1250.34,750.20,Medicaid,Illinois Medicaid,,136.35,,,1250.34,137.54,650.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RSV DNA/ MA AMP PROB,87634,CPT,,,,,both,, ,157.62,94.57,Medicaid,Illinois Medicaid,,43.27,,,157.62,17.34,81.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RSV DNA/ MA AMP PROB,87634,CPT,,,,,both,, ,236.44,141.86,Medicaid,Illinois Medicaid,,41.93,,,236.44,26.01,122.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COVID19 PRB,87635,CPT,,,,,both,, ,113.30,67.98,Medicaid,Illinois Medicaid,,121.92,,,113.30,12.46,58.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COVID19 PRB,87635,CPT,,,,,both,, ,336.81,202.08,Medicaid,Illinois Medicaid,,121.92,,,336.81,37.05,175.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"STAPH A,DNA,PROBE",87640,CPT,,,,,both,, ,118.16,70.89,Medicaid,Illinois Medicaid,,117.21,,,118.16,13.00,61.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"MR-STAPH,DNA,PROBE",87641,CPT,,,,,both,, ,118.16,70.89,Medicaid,Illinois Medicaid,,36.00,,,118.16,13.00,61.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"STREP A,DNA,AMP PROB",87651,CPT,,,,,both,, ,78.78,47.26,Medicaid,Illinois Medicaid,,216.00,,,78.78,8.67,40.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"STREP A,DNA,AMP PROB",87651,CPT,,,,,both,, ,118.18,70.90,Medicaid,Illinois Medicaid,,43.27,,,118.18,13.00,61.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19550T.VAGIN QL TMA,87661,CPT,,,,,both,, ,279.55,167.73,Medicaid,Illinois Medicaid,,2081.98,,,279.55,30.75,145.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19550T.VAGIN QL TMA,87661,CPT,,,,,both,, ,279.55,167.73,Medicaid,Illinois Medicaid,,2081.98,,,279.55,30.75,145.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19550T.VAGIN QL TMA,87661,CPT,,,,,both,, ,279.55,167.73,Medicaid,Illinois Medicaid,,812.38,,,279.55,30.75,145.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q19550T.VAGIN QL TMA,87661,CPT,,,,,both,, ,279.55,167.73,Medicaid,Illinois Medicaid,,849.93,,,279.55,30.75,145.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
T VAGINALIS AMP,87661,CPT,,,,,both,,,279.55,279.55,Medicaid,Illinois Medicaid,,509.42,,,279.55,30.75,145.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q93870 ZIKA RNA QL,87662,CPT,,,,,both,, ,295.83,177.49,Medicaid,Illinois Medicaid,,509.42,,,295.83,32.54,153.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L139650 DET AGNT DNA,87798,CPT,,,,,both,, ,175.00,105.00,Medicaid,Illinois Medicaid,,851.45,,,175.00,19.25,91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L180040 DET AGT NOS,87798,CPT,,,,,both,, ,180.00,108.00,Medicaid,Illinois Medicaid,,58.26,,,180.00,19.80,93.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L180060 DET AGT NOS,87798,CPT,,,,,both,, ,696.28,417.76,Medicaid,Illinois Medicaid,,58.26,,,696.28,76.59,362.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L180060 DET AGT NOS,87798,CPT,,,,,both,, ,696.28,417.76,Medicaid,Illinois Medicaid,,838.48,,,696.28,76.59,362.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11068DET AGNT DNAAM,87798,CPT,,,,,both,, ,2478.63,1487.17,Medicaid,Illinois Medicaid,,999.65,,,2478.63,272.65,1288.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11068DET AGNT DNAAM,87798,CPT,,,,,both,, ,2478.63,1487.17,Medicaid,Illinois Medicaid,,999.65,,,2478.63,272.65,1288.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11190 WNVR CSF RT-P,87798,CPT,,,,,both,, ,1011.83,607.09,Medicaid,Illinois Medicaid,,1020.19,,,1011.83,111.30,526.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11190 WNVR CSF RT-P,87798,CPT,,,,,both,, ,1011.83,607.09,Medicaid,Illinois Medicaid,,2575.58,,,1011.83,111.30,526.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11365DET AGNT DNAAM,87798,CPT,,,,,both,, ,758.95,455.37,Medicaid,Illinois Medicaid,,606.00,,,758.95,83.48,394.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15062DET AGNT DNAAM,87798,CPT,,,,,both,, ,1011.83,607.09,Medicaid,Illinois Medicaid,,867.45,,,1011.83,111.30,526.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15062DET AGNT DNAAM,87798,CPT,,,,,both,, ,1011.83,607.09,Medicaid,Illinois Medicaid,,1264.55,,,1011.83,111.30,526.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q18835 P.JIRO QL PCR,87798,CPT,,,,,both,, ,1011.83,607.09,Medicaid,Illinois Medicaid,,1264.55,,,1011.83,111.30,526.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q18835 P.JIRO QL PCR,87798,CPT,,,,,both,, ,1011.83,607.09,Medicaid,Illinois Medicaid,,1037.70,,,1011.83,111.30,526.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q91475 SURESWAB MYCOPLASMA GENITALIUMPCR,87798,CPT,,,,,both,, ,901.25,540.75,Medicaid,Illinois Medicaid,,960.07,,,901.25,99.14,468.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"DETECT AGNT NOS,DNAQ",87799,CPT,,,,,both,, ,454.41,272.64,Medicaid,Illinois Medicaid,,315.42,,,454.41,49.99,236.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q10186 EBV QT RT-PCR,87799,CPT,,,,,both,, ,454.41,272.64,Medicaid,Illinois Medicaid,,315.42,,,454.41,49.99,236.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q11274 BKV QT RT-PCR,87799,CPT,,,,,both,, ,454.41,272.64,Medicaid,Illinois Medicaid,,146.17,,,454.41,49.99,236.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"DETECT AGT MULT,DNAA",87801,CPT,,,,,both,, ,715.16,429.09,Medicaid,Illinois Medicaid,,201.91,,,715.16,78.67,371.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L180021 DET AGT MULT,87801,CPT,,,,,both,, ,656.11,393.66,Medicaid,Illinois Medicaid,,647.17,,,656.11,72.17,341.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15564LYME RT-PCR SF,87801,CPT,,,,,both,, ,715.16,429.09,Medicaid,Illinois Medicaid,,647.17,,,715.16,78.67,371.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q15777LYM QL BL RTPC,87801,CPT,,,,,both,, ,715.16,429.09,Medicaid,Illinois Medicaid,,577.62,,,715.16,78.67,371.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INFLUENZA ASSAY W-OP,87804,CPT,,,,,both,, ,30.87,18.52,Medicaid,Illinois Medicaid,,225.15,,,30.87,3.40,16.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INFLUENZA ASSAY W-OP,87804,CPT,,,,,both,, ,104.12,62.47,Medicaid,Illinois Medicaid,,109.62,,,104.12,11.45,54.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RSV ASSAY W-OPTIC,87807,CPT,,,,,both,, ,44.62,26.77,Medicaid,Illinois Medicaid,,170.42,,,44.62,4.91,23.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RSV ASSAY W-OPTIC,87807,CPT,,,,,both,, ,277.86,166.71,Medicaid,Illinois Medicaid,,43.27,,,277.86,30.56,144.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STREP A ASSAY W-OPTI,87880,CPT,,,,,both,, ,41.25,24.75,Medicaid,Illinois Medicaid,,43.27,,,41.25,4.54,21.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STREP A ASSAY W-OPTI,87880,CPT,,,,,both,, ,285.17,171.10,Medicaid,Illinois Medicaid,,65.84,,,285.17,31.37,148.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AGENT NOS ASSAY W-OP,87899,CPT,,,,,both,, ,172.90,103.74,Medicaid,Illinois Medicaid,,142.30,,,172.90,19.02,89.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L183009 SPNEU AG U C,87899,CPT,,,,,both,, ,158.62,95.17,Medicaid,Illinois Medicaid,,238.96,,,158.62,17.45,82.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L183009 SPNEU AG U C,87899,CPT,,,,,both,, ,158.62,95.17,Medicaid,Illinois Medicaid,,221.28,,,158.62,17.45,82.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34949 PHENO INF DRG,87900,CPT,,,,,both,, ,773.54,464.12,Medicaid,Illinois Medicaid,,221.28,,,773.54,85.09,402.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34949 GENO DNA HIV,87901,CPT,,,,,both,, ,1819.90,1091.94,Medicaid,Illinois Medicaid,,43.27,,,1819.90,200.19,946.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q34949 GENO DNA HIV,87901,CPT,,,,,both,, ,1819.90,1091.94,Medicaid,Illinois Medicaid,,65.84,,,1819.90,200.19,946.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"GENOTYPE,DNA,HEPAT C",87902,CPT,,,,,both,, ,1611.91,967.14,Medicaid,Illinois Medicaid,,20.20,,,1611.91,177.31,838.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q37811 HCVRNA GN MPR,87902,CPT,,,,,both,, ,1611.91,967.14,Medicaid,Illinois Medicaid,,145.16,,,1611.91,177.31,838.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q92447 HCVG1 NS5A DR,87902,CPT,,,,,both,, ,1611.91,967.14,Medicaid,Illinois Medicaid,,65.84,,,1611.91,177.31,838.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L551690PHENO DNA HIV,87903,CPT,,,,,both,, ,1465.00,879.00,Medicaid,Illinois Medicaid,,65.84,,,1465.00,161.15,761.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L551690PHENO DNA HIV,87904,CPT,,,,,both,, ,104.00,62.40,Medicaid,Illinois Medicaid,,65.84,,,104.00,11.44,54.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HIV GEN DNA REV OTH,87906,CPT,,,,,both,, ,856.62,513.97,Medicaid,Illinois Medicaid,,142.30,,,856.62,94.23,445.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AUTOPSY COMPL WO-CNS,88020,CPT,,,,,both,, ,3310.55,1986.33,Medicaid,Illinois Medicaid,,221.28,,,3310.55,364.16,1721.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOPATH FLD NOT V-C,88104,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,65.84,,,109.74,12.07,57.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOPATH FLD FTRW-IN,88106,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,142.30,,,109.74,12.07,57.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOPATH CONCENT TEC,88108,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,43.27,,,109.74,12.07,57.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOCELL ENH X CR-VG,88112,CPT,,,,,both,, ,237.17,142.30,Medicaid,Illinois Medicaid,,65.84,,,237.17,26.09,123.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTO UR 3-5PROB EA S,88120,CPT,,,,,both,, ,368.80,221.28,Medicaid,Illinois Medicaid,,65.84,,,368.80,40.57,191.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTO UR 3-5 PROB CMP,88121,CPT,,,,,both,, ,368.80,221.28,Medicaid,Illinois Medicaid,,142.80,,,368.80,40.57,191.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FORENSIC CYTOPATHOLO,88125,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,142.80,,,109.74,12.07,57.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SEX CHROMATIN ID BAR,88130,CPT,,,,,both,, ,144.83,86.89,Medicaid,Illinois Medicaid,,132.70,,,144.83,15.93,75.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SEX CHROM ID POLYMOR,88140,CPT,,,,,both,, ,76.90,46.14,Medicaid,Illinois Medicaid,,162.34,,,76.90,8.46,39.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L192555 PAP LB,88142,CPT,,,,,both,, ,234.07,140.44,Medicaid,Illinois Medicaid,,1216.89,,,234.07,25.75,121.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PAP THINLAY LIQ DIAG,88142,CPT,,,,,both,, ,189.74,113.84,Medicaid,Illinois Medicaid,,162.34,,,189.74,20.87,98.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOPATH C-V THNLYRE,88143,CPT,,,,,both,, ,189.74,113.84,Medicaid,Illinois Medicaid,,142.30,,,189.74,20.87,98.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOP C-V AUTOMATED,88147,CPT,,,,,both,, ,101.60,60.96,Medicaid,Illinois Medicaid,,221.28,,,101.60,11.18,52.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOP C-V AUTO RESCR,88148,CPT,,,,,both,, ,101.60,60.96,Medicaid,Illinois Medicaid,,142.30,,,101.60,11.18,52.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOPATH C-V MANUAL,88150,CPT,,,,,both,, ,101.60,60.96,Medicaid,Illinois Medicaid,,881.26,,,101.60,11.18,52.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOP C-V AUTO REDO,88152,CPT,,,,,both,, ,101.60,60.96,Medicaid,Illinois Medicaid,,881.26,,,101.60,11.18,52.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOPATH C-V REDO,88153,CPT,,,,,both,, ,101.60,60.96,Medicaid,Illinois Medicaid,,221.28,,,101.60,11.18,52.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOP C-V INDX ADDON,88155,CPT,,,,,both,, ,57.81,34.68,Medicaid,Illinois Medicaid,,43.27,,,57.81,6.36,30.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOP SMR OTHR SOURC,88160,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,138.42,,,109.74,12.07,57.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOP SMR OTH PRE-SC,88161,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,182.88,,,109.74,12.07,57.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOP SMR OTH S5SLID,88162,CPT,,,,,both,, ,237.17,142.30,Medicaid,Illinois Medicaid,,132.03,,,237.17,26.09,123.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"CYTOP TBS,C-V,MANUAL",88164,CPT,,,,,both,, ,101.60,60.96,Medicaid,Illinois Medicaid,,205.62,,,101.60,11.18,52.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"CYTOP TBS,C-V,REDO",88165,CPT,,,,,both,, ,101.60,60.96,Medicaid,Illinois Medicaid,,205.62,,,101.60,11.18,52.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"CYTOP TBS,C-V AUTORE",88166,CPT,,,,,both,, ,101.60,60.96,Medicaid,Illinois Medicaid,,125.62,,,101.60,11.18,52.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"CYTOP TBS,C-C,SELECT",88167,CPT,,,,,both,, ,101.60,60.96,Medicaid,Illinois Medicaid,,131.35,,,101.60,11.18,52.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOPATH EVAL OF FNA,88172,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,132.03,,,109.74,12.07,57.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"CYTOP EVAL,FNA,REPOR",88173,CPT,,,,,both,, ,237.17,142.30,Medicaid,Illinois Medicaid,,132.03,,,237.17,26.09,123.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTO-CERVICALRP CDM,88174,CPT,,,,,both,, ,205.45,123.27,Medicaid,Illinois Medicaid,,205.62,,,205.45,22.60,106.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L199305 PAP AU MN RS,88175,CPT,,,,,both,, ,234.07,140.44,Medicaid,Illinois Medicaid,,254.62,,,234.07,25.75,121.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PAP DIAG AUTO MAN RS,88175,CPT,,,,,both,, ,255.13,153.07,Medicaid,Illinois Medicaid,,43.27,,,255.13,28.06,132.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q92090 PAP DIAG AUTO,88175,CPT,,,,,both,, ,227.25,136.35,Medicaid,Illinois Medicaid,,45.13,,,227.25,25.00,118.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTO EVAL FNA ADD,88177,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,32.50,,,72.13,7.93,37.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CELL MRK STDY CY-DNA,88182,CPT,,,,,both,, ,69.89,41.93,Medicaid,Illinois Medicaid,,414.77,,,69.89,7.69,36.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q35080FLOWCY-TC 1MRK,88184,CPT,,,,,both,, ,203.21,121.92,Medicaid,Illinois Medicaid,,65.67,,,203.21,22.35,105.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q35080FLOWCY-TC 1MRK,88184,CPT,,,,,both,, ,203.21,121.92,Medicaid,Illinois Medicaid,,207.47,,,203.21,22.35,105.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"FLOWCYTOMETRY-TC,ADD",88185,CPT,,,,,both,, ,195.35,117.21,Medicaid,Illinois Medicaid,,207.47,,,195.35,21.49,101.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q35080 FLOWCY-TC ADD,88185,CPT,,,,,both,, ,60.00,36.00,Medicaid,Illinois Medicaid,,311.21,,,60.00,6.60,31.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
A3001780 FLWCY 16MRK,88189,CPT,,,,,both,, ,360.00,216.00,Medicaid,Illinois Medicaid,,43.27,,,360.00,39.60,187.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOPATHOLOGY PROCED,88199,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,315.75,,,72.13,7.93,37.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14596 TISSUE CULT L,88230,CPT,,,,,both,, ,3469.98,2081.98,Medicaid,Illinois Medicaid,,407.41,,,3469.98,381.70,1804.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14596 TISSUE CULT L,88230,CPT,,,,,both,, ,3469.98,2081.98,Medicaid,Illinois Medicaid,,571.80,,,3469.98,381.70,1804.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE CULT SKIN/BIO,88233,CPT,,,,,both,, ,1353.98,812.38,Medicaid,Illinois Medicaid,,248.59,,,1353.98,148.94,704.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"TISSUE CULT, PLACENT",88235,CPT,,,,,both,, ,1416.56,849.93,Medicaid,Illinois Medicaid,,831.05,,,1416.56,155.82,736.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14600 TIS CUL BM,88237,CPT,,,,,both,, ,849.04,509.42,Medicaid,Illinois Medicaid,,857.01,,,849.04,93.39,441.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14600 TIS CUL BM,88237,CPT,,,,,both,, ,849.04,509.42,Medicaid,Illinois Medicaid,,1120.27,,,849.04,93.39,441.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE CULTURE TUMOR,88239,CPT,,,,,both,, ,1419.09,851.45,Medicaid,Illinois Medicaid,,1226.88,,,1419.09,156.10,737.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CELL CRYOPRESERV-STO,88240,CPT,,,,,both,, ,97.11,58.26,Medicaid,Illinois Medicaid,,63.03,,,97.11,10.68,50.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FROZEN CELL PREPARAT,88241,CPT,,,,,both,, ,97.11,58.26,Medicaid,Illinois Medicaid,,63.03,,,97.11,10.68,50.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHROMOSOME ANAL20-25,88245,CPT,,,,,both,, ,1397.47,838.48,Medicaid,Illinois Medicaid,,86.21,,,1397.47,153.72,726.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHROMOSOM ANAL50-100,88248,CPT,,,,,both,, ,1666.09,999.65,Medicaid,Illinois Medicaid,,138.43,,,1666.09,183.27,866.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHROMOSOME ANALYS100,88249,CPT,,,,,both,, ,1666.09,999.65,Medicaid,Illinois Medicaid,,97.35,,,1666.09,183.27,866.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHROMOSOME ANALYS  5,88261,CPT,,,,,both,, ,1700.32,1020.19,Medicaid,Illinois Medicaid,,97.35,,,1700.32,187.04,884.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHROMOSOME ANAL15-20,88262,CPT,,,,,both,, ,4292.64,2575.58,Medicaid,Illinois Medicaid,,63.03,,,4292.64,472.19,2232.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14596 CHR AN 15-20,88262,CPT,,,,,both,, ,1010.00,606.00,Medicaid,Illinois Medicaid,,63.03,,,1010.00,111.10,525.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHROMOSOME ANALYS 45,88263,CPT,,,,,both,, ,1445.75,867.45,Medicaid,Illinois Medicaid,,71.53,,,1445.75,159.03,751.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14600 CHRM AN 20-25,88264,CPT,,,,,both,, ,2107.59,1264.55,Medicaid,Illinois Medicaid,,71.53,,,2107.59,231.83,1095.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q14600 CHRM AN 20-25,88264,CPT,,,,,both,, ,2107.59,1264.55,Medicaid,Illinois Medicaid,,29.25,,,2107.59,231.83,1095.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHROMOSOME ANAL-PLAC,88267,CPT,,,,,both,, ,1729.51,1037.70,Medicaid,Illinois Medicaid,,29.25,,,1729.51,190.25,899.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHROMOSOM ANAL AMNIO,88269,CPT,,,,,both,, ,1600.13,960.07,Medicaid,Illinois Medicaid,,79.10,,,1600.13,176.01,832.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q12070 CYTOGEN PRO,88271,CPT,,,,,both,, ,525.70,315.42,Medicaid,Illinois Medicaid,,260.79,,,525.70,57.83,273.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q12070 CYTOGEN PRO,88271,CPT,,,,,both,, ,525.70,315.42,Medicaid,Illinois Medicaid,,523.14,,,525.70,57.83,273.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOGENETICS 3-5,88272,CPT,,,,,both,, ,243.63,146.17,Medicaid,Illinois Medicaid,,124.83,,,243.63,26.80,126.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOGENETICS 25-99,88274,CPT,,,,,both,, ,336.52,201.91,Medicaid,Illinois Medicaid,,1113.79,,,336.52,37.02,174.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q12070CYTOGN 100-300,88275,CPT,,,,,both,, ,1078.63,647.17,Medicaid,Illinois Medicaid,,1164.62,,,1078.63,118.65,560.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Q12070CYTOGN 100-300,88275,CPT,,,,,both,, ,1078.63,647.17,Medicaid,Illinois Medicaid,,230.25,,,1078.63,118.65,560.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHROMOSOME KARYOT ST,88280,CPT,,,,,both,, ,962.71,577.62,Medicaid,Illinois Medicaid,,87.13,,,962.71,105.90,500.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHROMOSOM BANDINGSTU,88283,CPT,,,,,both,, ,375.26,225.15,Medicaid,Illinois Medicaid,,81.27,,,375.26,41.28,195.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHROMOSOME CT ADDITI,88285,CPT,,,,,both,, ,182.71,109.62,Medicaid,Illinois Medicaid,,282.73,,,182.71,20.10,95.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHROMOS STDY ADD HIG,88289,CPT,,,,,both,, ,284.04,170.42,Medicaid,Illinois Medicaid,,126.07,,,284.04,31.24,147.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYTOGENETIC STUDY,88299,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,210.12,,,72.13,7.93,37.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SURG PATH GROSS LVL1,88300,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,222.32,,,72.13,7.93,37.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SURG PATH GROSS LVL2,88302,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,366.93,,,109.74,12.07,57.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SURG PATH GROSS LVL3,88304,CPT,,,,,both,, ,237.17,142.30,Medicaid,Illinois Medicaid,,326.46,,,237.17,26.09,123.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SURG PATH GROSS LVL4,88305,CPT,,,,,both,, ,398.27,238.96,Medicaid,Illinois Medicaid,,116.95,,,398.27,43.81,207.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SURG PATH GROSS LVL5,88307,CPT,,,,,both,, ,368.80,221.28,Medicaid,Illinois Medicaid,,122.98,,,368.80,40.57,191.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SURG PATH GROSS LVL6,88309,CPT,,,,,both,, ,368.80,221.28,Medicaid,Illinois Medicaid,,186.48,,,368.80,40.57,191.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DECALCIFY TISSUE,88311,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,149.86,,,72.13,7.93,37.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPECIAL STAINS GRP 1,88312,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,454.69,,,109.74,12.07,57.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPECIAL STAINS GRP 2,88313,CPT,,,,,both,, ,33.68,20.20,Medicaid,Illinois Medicaid,,143.37,,,33.68,3.70,17.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPECIAL STAINS GRP 2,88313,CPT,,,,,both,, ,241.94,145.16,Medicaid,Illinois Medicaid,,238.96,,,241.94,26.61,125.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HISTOCHEMICAL STAIN,88314,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,181.05,,,109.74,12.07,57.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ENZYME HISTOCHEMISTR,88319,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,179.83,,,109.74,12.07,57.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MICROSLIDE-CONSULN-P,88321,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,299.73,,,109.74,12.07,57.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MICROSLID CONSUL-W-P,88323,CPT,,,,,both,, ,237.17,142.30,Medicaid,Illinois Medicaid,,187.35,,,237.17,26.09,123.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COMPRE REVIEW OFDATA,88325,CPT,,,,,both,, ,368.80,221.28,Medicaid,Illinois Medicaid,,215.83,,,368.80,40.57,191.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PATH CONSULT INTROP,88329,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,359.73,,,109.74,12.07,57.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PATH CONSULT INT-1BL,88331,CPT,,,,,both,, ,237.17,142.30,Medicaid,Illinois Medicaid,,194.25,,,237.17,26.09,123.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PATH CONSULT-INTRADD,88332,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,505.21,,,72.13,7.93,37.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INOP CYTOPAT CNSLT 1,88333,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,842.03,,,109.74,12.07,57.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INOP CYTOPAT CNSLT 2,88334,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,237.62,,,109.74,12.07,57.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ICC ADD AB PER SLIDE,88341,CPT,,,,,both,, ,238.01,142.80,Medicaid,Illinois Medicaid,,220.94,,,238.01,26.18,123.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
1ST SEP ID AB,88342,CPT,,,,,both,, ,238.01,142.80,Medicaid,Illinois Medicaid,,132.56,,,238.01,26.18,123.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ICC MLTPX AB ST,88344,CPT,,,,,both,, ,221.17,132.70,Medicaid,Illinois Medicaid,,413.59,,,221.17,24.33,115.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMF SPEC 1ST AB ST,88346,CPT,,,,,both,, ,270.57,162.34,Medicaid,Illinois Medicaid,,176.55,,,270.57,29.76,140.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELECTRON MICROSCOPY,88348,CPT,,,,,both,, ,2028.15,1216.89,Medicaid,Illinois Medicaid,,573.50,,,2028.15,223.10,1054.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMF/SPEC ADD AB ST,88350,CPT,,,,,both,, ,270.57,162.34,Medicaid,Illinois Medicaid,,309.02,,,270.57,29.76,140.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANALYSIS SKELET MUSC,88355,CPT,,,,,both,, ,237.17,142.30,Medicaid,Illinois Medicaid,,309.02,,,237.17,26.09,123.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANALYSIS NERVE,88356,CPT,,,,,both,, ,368.80,221.28,Medicaid,Illinois Medicaid,,5944.85,,,368.80,40.57,191.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANALYSIS TUMOR,88358,CPT,,,,,both,, ,237.17,142.30,Medicaid,Illinois Medicaid,,2974.12,,,237.17,26.09,123.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TUMOR IHC QT MAN,88360,CPT,,,,,both,, ,1468.77,881.26,Medicaid,Illinois Medicaid,,109.35,,,1468.77,161.56,763.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TUMOR IHC QT UTO,88361,CPT,,,,,both,, ,1468.77,881.26,Medicaid,Illinois Medicaid,,423.17,,,1468.77,161.56,763.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NERVE TEASING PREPAR,88362,CPT,,,,,both,, ,368.80,221.28,Medicaid,Illinois Medicaid,,194.51,,,368.80,40.57,191.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
XM ARCHIVE TIS MOLEC,88363,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,81.30,,,72.13,7.93,37.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TIS HYBRD AD SNG PRB,88364,CPT,,,,,both,, ,230.71,138.42,Medicaid,Illinois Medicaid,,488.53,,,230.71,25.38,119.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TIS HYBRD SPEC INIT,88365,CPT,,,,,both,, ,304.81,182.88,Medicaid,Illinois Medicaid,,109.35,,,304.81,33.53,158.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INS HYBR AUT SP INIT,88367,CPT,,,,,both,, ,220.05,132.03,Medicaid,Illinois Medicaid,,488.53,,,220.05,24.21,114.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INS HYBRD MAN SP INI,88368,CPT,,,,,both,, ,342.70,205.62,Medicaid,Illinois Medicaid,,488.53,,,342.70,37.70,178.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INS HYBRD MAN SNG PR,88369,CPT,,,,,both,, ,342.70,205.62,Medicaid,Illinois Medicaid,,109.35,,,342.70,37.70,178.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROTEIN-WEST BLOTTIS,88371,CPT,,,,,both,, ,209.38,125.62,Medicaid,Illinois Medicaid,,109.35,,,209.38,23.03,108.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROTEIN ANALYSW/PROB,88372,CPT,,,,,both,, ,218.93,131.35,Medicaid,Illinois Medicaid,,488.53,,,218.93,24.08,113.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INS HYBR AUT SNG PR,88373,CPT,,,,,both,, ,220.05,132.03,Medicaid,Illinois Medicaid,,423.17,,,220.05,24.21,114.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INS HYBR AUT MUL PR,88374,CPT,,,,,both,, ,220.05,132.03,Medicaid,Illinois Medicaid,,234.06,,,220.05,24.21,114.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INS HYBR MAN MUL PR,88377,CPT,,,,,both,, ,342.70,205.62,Medicaid,Illinois Medicaid,,512.94,,,342.70,37.70,178.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MICRODISSECTION MANU,88381,CPT,,,,,both,, ,424.38,254.62,Medicaid,Illinois Medicaid,,488.22,,,424.38,46.68,220.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SURGICAL PATH PROCED,88399,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,488.22,,,72.13,7.93,37.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BILIRUBIN TOT TRANS,88720,CPT,,,,,both,, ,75.22,45.13,Medicaid,Illinois Medicaid,,457.93,,,75.22,8.27,39.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CELL CTW-DIF BODYFLU,89051,CPT,,,,,both,, ,54.17,32.50,Medicaid,Illinois Medicaid,,423.17,,,54.17,5.96,28.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CELL CTW-DIF BODYFLU,89051,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,454.84,,,691.29,76.04,359.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEUKOCY ASSES FEC QL,89055,CPT,,,,,both,, ,109.46,65.67,Medicaid,Illinois Medicaid,,517.57,,,109.46,12.04,56.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CRYSTALS SYNOVIAL FLD,89060,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,340.67,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CRYSTALS SYNOVIAL FLD,89060,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,39054.66,,,345.79,38.04,179.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NASAL SMEAR-EOSINOPH,89190,CPT,,,,,both,, ,518.69,311.21,Medicaid,Illinois Medicaid,,39054.66,,,518.69,57.06,269.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
UNL MISC PATH TEST,89240,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,53231.43,,,72.13,7.93,37.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SEMEN ANYL PRES-M-S,89321,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,53231.43,,,526.26,57.89,273.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPATITIS B GLOB IM,90371,CPT,,,,,both,, ,679.03,407.41,Medicaid,Illinois Medicaid,,53231.43,,,679.03,74.69,353.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPATITIS B GLOB IM,90371,CPT,,,,,both,1,ML,953.00,571.80,Medicaid,Illinois Medicaid,,53231.43,,,953.00,104.83,495.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RABIES IG IM/SC 150U,90375,CPT,,,,,both,3,ML,414.33,248.59,Medicaid,Illinois Medicaid,,53231.43,,,414.33,45.58,215.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RABIES IG IM/SC 150U,90375,CPT,,,,,both,, ,1385.09,831.05,Medicaid,Illinois Medicaid,,53231.43,,,1385.09,152.36,720.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RABIES IG IM/SC 150U,90375,CPT,,,,,both,, ,1428.35,857.01,Medicaid,Illinois Medicaid,,53231.43,,,1428.35,157.12,742.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RABIES IG IM/SC 150U,90375,HCPCS,,,,,both,5,ML,1867.13,1120.27,Medicaid,Illinois Medicaid,,53231.43,,,1867.13,205.38,970.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RABIES IG IM/SC 150U,90375,HCPCS,,,,,both,1,ML,2044.81,1226.88,Medicaid,Illinois Medicaid,,53231.43,,,2044.81,224.93,1063.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,229.74,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,229.74,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,143.69,86.21,Medicaid,Illinois Medicaid,,3618.85,,,143.69,15.81,74.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,230.72,138.43,Medicaid,Illinois Medicaid,,3320.05,,,230.72,25.38,119.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM INJ SINGLE,90471,CPT,,,,,both,, ,162.25,97.35,Medicaid,Illinois Medicaid,,2677.48,,,162.25,17.85,84.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM INJ SINGLE,90471,CPT,,,,,both,, ,162.25,97.35,Medicaid,Illinois Medicaid,,2918.45,,,162.25,17.85,84.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,2762.15,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,3010.74,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,119.22,71.53,Medicaid,Illinois Medicaid,,1426.80,,,119.22,13.11,61.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,119.22,71.53,Medicaid,Illinois Medicaid,,17451.85,,,119.22,13.11,61.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM INJ EA ADD,90472,CPT,,,,,both,, ,48.75,29.25,Medicaid,Illinois Medicaid,,11244.97,,,48.75,5.36,25.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM INJ EA ADD,90472,CPT,,,,,both,, ,48.75,29.25,Medicaid,Illinois Medicaid,,11244.97,,,48.75,5.36,25.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HAEMOPH B TETAN INJ,90648,CPT,,,,,both,, ,131.84,79.10,Medicaid,Illinois Medicaid,,2419.81,,,131.84,14.50,68.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FLU VAC NOPRSV ANTIG,90662,CPT,,,,,both,0.7,ML,434.66,260.79,Medicaid,Illinois Medicaid,,322.75,,,434.66,47.81,226.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PNEUMOCOC 13-VAL IM,90670,CPT,,,,,both,0.5,ML,871.90,523.14,Medicaid,Illinois Medicaid,,260.33,,,871.90,95.91,453.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FLU VAC CCIIV4 PF&AB,90674,CPT,,,,,both,0.5,ML,208.06,124.83,Medicaid,Illinois Medicaid,,918.50,,,208.06,22.89,108.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RABIES VAC IM,90675,CPT,,,,,both,1,EA,1856.32,1113.79,Medicaid,Illinois Medicaid,,39.09,,,1856.32,204.20,965.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RABIES VAC IM,90675,CPT,,,,,both,, ,1941.04,1164.62,Medicaid,Illinois Medicaid,,39.09,,,1941.04,213.51,1009.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FLU VAC QUAD DNA HA,90682,CPT,,,,,both,, ,383.75,230.25,Medicaid,Illinois Medicaid,,428.89,,,383.75,42.21,199.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FLU VACIIV4 PF .5ML,90686,CPT,,,,,both,, ,145.23,87.13,Medicaid,Illinois Medicaid,,3113.64,,,145.23,15.98,75.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FLU VAC IIV4 .25ML,90687,CPT,,,,,both,, ,135.45,81.27,Medicaid,Illinois Medicaid,,677.17,,,135.45,14.90,70.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
M-M-R II INJ,90707,CPT,,,,,both,1,EA,471.23,282.73,Medicaid,Illinois Medicaid,,1199.69,,,471.23,51.84,245.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TD IM NO PRSRV GE 7Y,90714,CPT,,,,,both,0.5,ML,210.12,126.07,Medicaid,Illinois Medicaid,,5820.63,,,210.12,23.11,109.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DIPH/TET/ACPERT .5ML,90715,CPT,,,,,both,0.5,ML,350.20,210.12,Medicaid,Illinois Medicaid,,957.74,,,350.20,38.52,182.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DIPH/TET/ACPERT .5ML,90715,CPT,,,,,both,0.5,ML,370.54,222.32,Medicaid,Illinois Medicaid,,7281.58,,,370.54,40.76,192.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VARICELLA VIR VAC SC,90716,CPT,,,,,both,1,EA,611.56,366.93,Medicaid,Illinois Medicaid,,5346.16,,,611.56,67.27,318.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PNEUMO-VAC 2YR-ADULT,90732,CPT,,,,,both,0.5,ML,544.10,326.46,Medicaid,Illinois Medicaid,,2713.63,,,544.10,59.85,282.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEP B VAC PED,90744,CPT,,,,,both,, ,194.93,116.95,Medicaid,Illinois Medicaid,,5406.72,,,194.93,21.44,101.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEP B VAC PED,90744,CPT,,,,,both,0.5,ML,204.97,122.98,Medicaid,Illinois Medicaid,,981.54,,,204.97,22.55,106.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INTERACTIVE ADD-ON,90785,CPT,,,,,both,, ,310.80,186.48,Medicaid,Illinois Medicaid,,325.06,,,310.80,34.19,161.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PSYCH DIAG EVAL,90791,CPT,,,,,both,, ,249.78,149.86,Medicaid,Illinois Medicaid,,369.87,,,249.78,27.48,129.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PSYCH DIAG EVAL,90791,CPT,,,,,both,, ,757.82,454.69,Medicaid,Illinois Medicaid,,3810.12,,,757.82,83.36,394.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PSYCHOTHERAPY 30 MIN,90832,CPT,,,,,both,, ,238.96,143.37,Medicaid,Illinois Medicaid,,23758.39,,,238.96,26.29,124.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Psychotherapy, 30 min",90832,CPT,,,,,both,,,238.96,238.96,Medicaid,Illinois Medicaid,,26007.45,,,238.96,26.29,124.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PSYCHOTHER 30M W/E&M,90833,CPT,,,,,both,, ,301.75,181.05,Medicaid,Illinois Medicaid,,43345.75,,,301.75,33.19,156.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PSYCHOTHERAPY 45 MIN,90834,CPT,,,,,both,, ,299.73,179.83,Medicaid,Illinois Medicaid,,26007.45,,,299.73,32.97,155.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Psychotherapy, 45 min",90834,CPT,,,,,both,,,299.73,299.73,Medicaid,Illinois Medicaid,,20800.33,,,299.73,32.97,155.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PSYCHOTHER 45M W/E&M,90836,CPT,,,,,both,, ,312.25,187.35,Medicaid,Illinois Medicaid,,21684.22,,,312.25,34.35,162.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PSYCHOTHERAPY 60 MIN,90837,CPT,,,,,both,, ,359.73,215.83,Medicaid,Illinois Medicaid,,44558.57,,,359.73,39.57,187.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Psychotherapy, 60 min",90837,CPT,,,,,both,,,359.73,359.73,Medicaid,Illinois Medicaid,,45442.62,,,359.73,39.57,187.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PSYCHOTHER 60M W/E&M,90838,CPT,,,,,both,, ,323.75,194.25,Medicaid,Illinois Medicaid,,29557.70,,,323.75,35.61,168.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FAM THERAPY W/PATIEN,90847,CPT,,,,,both,, ,842.03,505.21,Medicaid,Illinois Medicaid,,30441.60,,,842.03,92.62,437.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Family psychotherapy, including patient, 50 min",90847,CPT,,,,,both,,,842.03,842.03,Medicaid,Illinois Medicaid,,29557.70,,,842.03,92.62,437.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MULTI-FAM GRP PSYCH,90849,CPT,,,,,both,, ,396.04,237.62,Medicaid,Illinois Medicaid,,30441.60,,,396.04,43.56,205.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Group psychotherapy,90853,CPT,,,,,both,,,220.94,220.94,Medicaid,Illinois Medicaid,,271.14,,,220.94,24.30,114.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PSYCH GROUP THERAPY,90853,CPT,,,,,both,, ,220.94,132.56,Medicaid,Illinois Medicaid,,7898.19,,,220.94,24.30,114.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PSYCH GROUP THERAPY,90853,CPT,,,,,both,, ,689.33,413.59,Medicaid,Illinois Medicaid,,2249.05,,,689.33,75.83,358.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MEDICATION MGMT,90863,CPT,,,,,both,, ,294.25,176.55,Medicaid,Illinois Medicaid,,1951.48,,,294.25,32.37,153.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TMS INITIAL & 1ST TX,90867,CPT,,,,,both,, ,955.84,573.50,Medicaid,Illinois Medicaid,,3071.77,,,955.84,105.14,497.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TMS SUBSEQUENT TX,90868,CPT,,,,,both,, ,515.04,309.02,Medicaid,Illinois Medicaid,,3071.77,,,515.04,56.65,267.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TMS REMAPPING & TX,90869,CPT,,,,,both,, ,515.04,309.02,Medicaid,Illinois Medicaid,,425.80,,,515.04,56.65,267.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEMODIALY SING EVAL,90935,CPT,,,,,both,, ,9908.09,5944.85,Medicaid,Illinois Medicaid,,425.80,,,9908.09,1089.89,5152.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OTH DIALY SING EVAL,90945,CPT,,,,,both,, ,4956.88,2974.12,Medicaid,Illinois Medicaid,,41100.70,,,4956.88,545.26,2577.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP AR MCD TRMT 15MIN,92507,CPT,,,,,both,, ,182.25,109.35,Medicaid,Illinois Medicaid,,2802.32,,,182.25,20.05,94.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-HEAR-TX-INDI VIST,92507,CPT,,,,,both,, ,705.29,423.17,Medicaid,Illinois Medicaid,,2802.32,,,705.29,77.58,366.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-HEAR-GROUP-VISIT,92508,CPT,,,,,both,, ,324.19,194.51,Medicaid,Illinois Medicaid,,2802.32,,,324.19,35.66,168.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EV SP FLUENCY 15,92521,CPT,,,,,both,, ,135.50,81.30,Medicaid,Illinois Medicaid,,2802.32,,,135.50,14.91,70.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EVAL SPEECH FLUENCY,92521,CPT,,,,,both,, ,814.22,488.53,Medicaid,Illinois Medicaid,,2802.32,,,814.22,89.56,423.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EV SP PROD 15,92522,CPT,,,,,both,, ,182.25,109.35,Medicaid,Illinois Medicaid,,2802.32,,,182.25,20.05,94.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EVAL SPEECH SND PROD,92522,CPT,,,,,both,, ,814.22,488.53,Medicaid,Illinois Medicaid,,2802.32,,,814.22,89.56,423.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EVAL SP SND PROD CMP,92523,CPT,,,,,both,, ,814.22,488.53,Medicaid,Illinois Medicaid,,2802.32,,,814.22,89.56,423.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP SOUND LANG CMP 15,92523,CPT,,,,,both,, ,182.25,109.35,Medicaid,Illinois Medicaid,,2802.32,,,182.25,20.05,94.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BEH QL ANAL VOICE 15,92524,CPT,,,,,both,, ,182.25,109.35,Medicaid,Illinois Medicaid,,2802.32,,,182.25,20.05,94.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BEHAV QL ANAL VOICE,92524,CPT,,,,,both,, ,814.22,488.53,Medicaid,Illinois Medicaid,,13575.30,,,814.22,89.56,423.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ORAL FUNC TX-VIS,92526,CPT,,,,,both,, ,705.29,423.17,Medicaid,Illinois Medicaid,,13575.30,,,705.29,77.58,366.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EVAL VOICE PROS DEV,92597,CPT,,,,,both,, ,390.11,234.06,Medicaid,Illinois Medicaid,,13575.30,,,390.11,42.91,202.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COCHLE IMP INTIL LT7,92601,CPT,,,,,both,, ,854.90,512.94,Medicaid,Illinois Medicaid,,13575.30,,,854.90,94.04,444.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-EVAL NSG DEV 1STH,92605,CPT,,,,,both,, ,813.70,488.22,Medicaid,Illinois Medicaid,,13575.30,,,813.70,89.51,423.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-EVAL SP DEV 1STHR,92607,CPT,,,,,both,, ,813.70,488.22,Medicaid,Illinois Medicaid,,13575.30,,,813.70,89.51,423.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-EVAL SP DEV AD30M,92608,CPT,,,,,both,, ,763.23,457.93,Medicaid,Illinois Medicaid,,2802.32,,,763.23,83.96,396.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-THER SVC SPCH DEV,92609,CPT,,,,,both,, ,705.29,423.17,Medicaid,Illinois Medicaid,,2802.32,,,705.29,77.58,366.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-EVAL SWL WO RADOP,92610,CPT,,,,,both,, ,758.08,454.84,Medicaid,Illinois Medicaid,,2802.32,,,758.08,83.39,394.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SP-EVAL SWL W-RADOPQ,92611,CPT,,,,,both,, ,862.63,517.57,Medicaid,Illinois Medicaid,,2802.32,,,862.63,94.89,448.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AUD EVOKE HR BRD STM,92651,CPT,,,,,both,, ,567.79,340.67,Medicaid,Illinois Medicaid,,13575.30,,,567.79,62.46,295.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"IC-PTCA, SINGLE",92920,CPT,,,,,both,, ,65091.11,39054.66,Medicaid,Illinois Medicaid,,27732.59,,,65091.11,7160.02,33847.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"IC-PTCA, ADDL",92921,CPT,,,,,both,, ,65091.11,39054.66,Medicaid,Illinois Medicaid,,27732.59,,,65091.11,7160.02,33847.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IC-PRQ CRD STN W-ANG,92928,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,27732.59,,,88719.05,9759.10,46133.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IC-PRQ STNT W-ANG EA,92929,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,2802.32,,,88719.05,9759.10,46133.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IC-PRQ CRD ST-AT-ANG,92933,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,101.50,,,88719.05,9759.10,46133.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IC-PRQ ST-AT-ANG EA,92934,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,116.18,,,88719.05,9759.10,46133.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IC-PRQ RV BYP GRF IN,92937,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,177.82,,,88719.05,9759.10,46133.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IC-PRQ RV BYP GRF AD,92938,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,255.07,,,88719.05,9759.10,46133.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IC-PRQ CARD REV 1 VS,92941,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,274.54,,,88719.05,9759.10,46133.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IC-PRQ REVSC CHR 1VS,92943,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,7628.59,,,88719.05,9759.10,46133.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IC-PRQ REVSC CHR ADD,92944,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,255.07,,,88719.05,9759.10,46133.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CPR,92950,CPT,,,,,both,, ,382.90,229.74,Medicaid,Illinois Medicaid,,274.54,,,382.90,42.12,199.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CPR,92950,CPT,,,,,both,, ,382.90,229.74,Medicaid,Illinois Medicaid,,1473.77,,,382.90,42.12,199.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CPR,92950,CPT,,,,,both,, ,6031.42,3618.85,Medicaid,Illinois Medicaid,,100.42,,,6031.42,663.46,3136.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CPR ASSIST (NON ER),92950,CPT,,,,,both,, ,5533.42,3320.05,Medicaid,Illinois Medicaid,,2291.54,,,5533.42,608.68,2877.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-TEMP EXT PACE,92953,CPT,,,,,both,, ,4462.48,2677.48,Medicaid,Illinois Medicaid,,160.99,,,4462.48,490.87,2320.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-TEMP EXT PACE,92953,CPT,,,,,both,, ,4864.09,2918.45,Medicaid,Illinois Medicaid,,3416.30,,,4864.09,535.05,2529.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-CARDIOVERSION,92960,CPT,,,,,both,, ,4603.59,2762.15,Medicaid,Illinois Medicaid,,3051.84,,,4603.59,506.39,2393.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-CARDIOVERSION,92960,CPT,,,,,both,, ,5017.90,3010.74,Medicaid,Illinois Medicaid,,1524.91,,,5017.90,551.97,2609.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"EP-CARDIOVER,INTERN",92961,CPT,,,,,both,, ,2378.01,1426.80,Medicaid,Illinois Medicaid,,936.11,,,2378.01,261.58,1236.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IC-COR THROMBECTOMY,92973,CPT,,,,,both,, ,29086.43,17451.85,Medicaid,Illinois Medicaid,,3049.83,,,29086.43,3199.51,15124.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IC-INTRCOR THROMBOL,92975,CPT,,,,,both,, ,18741.62,11244.97,Medicaid,Illinois Medicaid,,1524.91,,,18741.62,2061.58,9745.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IC-INTRCOR THROMBOL,92975,CPT,,,,,both,, ,18741.62,11244.97,Medicaid,Illinois Medicaid,,1215.60,,,18741.62,2061.58,9745.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"THROMBOLY,CORONRY,IV",92977,CPT,,,,,both,, ,4033.02,2419.81,Medicaid,Illinois Medicaid,,3051.84,,,4033.02,443.63,2097.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"IC-IVUS, INIT",92978,CPT,,,,,both,, ,537.92,322.75,Medicaid,Illinois Medicaid,,255.07,,,537.92,59.17,279.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"IC-IVUS, ADDL",92979,CPT,,,,,both,, ,433.89,260.33,Medicaid,Illinois Medicaid,,274.54,,,433.89,47.73,225.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EKG 12 LEAD ED STAFF,93005,CPT,,,,,both,, ,1530.84,918.50,Medicaid,Illinois Medicaid,,179.83,,,1530.84,168.39,796.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EKG 12 LEAD UC STAFF,93005,CPT,,,,,both,, ,65.15,39.09,Medicaid,Illinois Medicaid,,193.59,,,65.15,7.17,33.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EKG 12 LEAD UC STAFF,93005,CPT,,,,,both,, ,65.15,39.09,Medicaid,Illinois Medicaid,,1524.91,,,65.15,7.17,33.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"NI-EKG, 12 LEADS",93005,CPT,,,,,both,, ,714.82,428.89,Medicaid,Illinois Medicaid,,255.07,,,714.82,78.63,371.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-STRESS TEST,93017,CPT,,,,,both,, ,5189.40,3113.64,Medicaid,Illinois Medicaid,,274.54,,,5189.40,570.83,2698.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-MICROVOLT T,93025,CPT,,,,,both,, ,1128.62,677.17,Medicaid,Illinois Medicaid,,493.93,,,1128.62,124.15,586.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"NI-EKG, 1-3 LEADS",93041,CPT,,,,,both,, ,1999.49,1199.69,Medicaid,Illinois Medicaid,,255.07,,,1999.49,219.94,1039.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-HOLT RECRD TO48HR,93225,CPT,,,,,both,, ,9701.06,5820.63,Medicaid,Illinois Medicaid,,274.54,,,9701.06,1067.12,5044.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-HOLT WSCAN TO48HR,93226,CPT,,,,,both,, ,1596.24,957.74,Medicaid,Illinois Medicaid,,497.33,,,1596.24,175.59,830.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-TTE 2D W DOPP,93306,CPT,,,,,both,, ,12135.98,7281.58,Medicaid,Illinois Medicaid,,999.30,,,12135.98,1334.96,6310.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-TTE 2D MM COMP WO,93307,CPT,,,,,both,, ,8910.27,5346.16,Medicaid,Illinois Medicaid,,775.28,,,8910.27,980.13,4633.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-TTE 2D MM LTD WO,93308,CPT,,,,,both,, ,4522.73,2713.63,Medicaid,Illinois Medicaid,,255.07,,,4522.73,497.50,2351.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-TEE COMP 2D MM WO,93312,CPT,,,,,both,, ,9011.21,5406.72,Medicaid,Illinois Medicaid,,274.54,,,9011.21,991.23,4685.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ECHO DOPP COMP AD,93320,CPT,,,,,both,, ,1635.90,981.54,Medicaid,Illinois Medicaid,,504.90,,,1635.90,179.95,850.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-ECHO DOP LTD,93321,CPT,,,,,both,, ,541.78,325.06,Medicaid,Illinois Medicaid,,586.54,,,541.78,59.60,281.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ECHO DOP CO FL AD,93325,CPT,,,,,both,, ,616.46,369.87,Medicaid,Illinois Medicaid,,586.54,,,616.46,67.81,320.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-TTE STRESS WO,93350,CPT,,,,,both,, ,6350.21,3810.12,Medicaid,Illinois Medicaid,,2774.35,,,6350.21,698.52,3302.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-RHC,93451,CPT,,,,,both,, ,39597.32,23758.39,Medicaid,Illinois Medicaid,,2982.78,,,39597.32,4355.71,20590.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-LHC VENT PUNC,93452,CPT,,,,,both,, ,43345.75,26007.45,Medicaid,Illinois Medicaid,,2982.78,,,43345.75,4768.03,22539.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Insertion of catheter into left heart for diagnosis,93452,CPT,,,,,both,,,43345.75,43345.75,Medicaid,Illinois Medicaid,,318.27,,,43345.75,4768.03,22539.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-R-L CATH LV PUNC,93453,CPT,,,,,both,, ,43345.75,26007.45,Medicaid,Illinois Medicaid,,1416.76,,,43345.75,4768.03,22539.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-ANGIO CORON ONLY,93454,CPT,,,,,both,, ,34667.23,20800.33,Medicaid,Illinois Medicaid,,576.90,,,34667.23,3813.40,18026.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-S-I VNT ATR ANGIO,93455,CPT,,,,,both,, ,36140.38,21684.22,Medicaid,Illinois Medicaid,,184.16,,,36140.38,3975.44,18793,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-R HRT CORONRY ART,93456,CPT,,,,,both,, ,74264.29,44558.57,Medicaid,Illinois Medicaid,,653.84,,,74264.29,8169.07,38617.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-R HRT ART-GRF ANG,93457,CPT,,,,,both,, ,75737.70,45442.62,Medicaid,Illinois Medicaid,,275.47,,,75737.70,8331.15,39383.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-L HRT ARTERY-VENT,93458,CPT,,,,,both,, ,49262.84,29557.70,Medicaid,Illinois Medicaid,,136.44,,,49262.84,5418.91,25616.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-L HRT ART-GRF ANG,93459,CPT,,,,,both,, ,50736.00,30441.60,Medicaid,Illinois Medicaid,,136.44,,,50736.00,5580.96,26382.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-R-L HRT ART-VENT,93460,CPT,,,,,both,, ,49262.84,29557.70,Medicaid,Illinois Medicaid,,341.70,,,49262.84,5418.91,25616.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-R-L HRT ART-ANGIO,93461,CPT,,,,,both,, ,50736.00,30441.60,Medicaid,Illinois Medicaid,,351.95,,,50736.00,5580.96,26382.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-DRUM ADM-HEMODYNC,93463,CPT,,,,,both,, ,451.91,271.14,Medicaid,Illinois Medicaid,,415.05,,,451.91,49.71,234.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INSERTION FLOW CATH,93503,CPT,,,,,both,, ,13163.66,7898.19,Medicaid,Illinois Medicaid,,427.50,,,13163.66,1448.00,6845.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-INJ L VENT-ATRIAL,93565,CPT,,,,,both,, ,3748.43,2249.05,Medicaid,Illinois Medicaid,,637.00,,,3748.43,412.33,1949.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-INJ R VENT-ATRIAL,93566,CPT,,,,,both,, ,3252.48,1951.48,Medicaid,Illinois Medicaid,,431.82,,,3252.48,357.77,1691.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-INJ SUPRV AORTOGR,93567,CPT,,,,,both,, ,5119.62,3071.77,Medicaid,Illinois Medicaid,,419.25,,,5119.62,563.16,2662.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-INJ PULM ART HRTC,93568,CPT,,,,,both,, ,5119.62,3071.77,Medicaid,Illinois Medicaid,,431.82,,,5119.62,563.16,2662.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEART FLOW MEASURE,93571,CPT,,,,,both,, ,709.67,425.80,Medicaid,Illinois Medicaid,,419.25,,,709.67,78.06,369.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEART FLOW MEAS ADD,93572,CPT,,,,,both,, ,709.67,425.80,Medicaid,Illinois Medicaid,,1662.88,,,709.67,78.06,369.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-PDA CLOSE PERC,93582,CPT,,,,,both,, ,68501.18,41100.70,Medicaid,Illinois Medicaid,,205.63,,,68501.18,7535.13,35620.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-HIS BUNDLE REC,93600,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,714.87,,,4670.54,513.76,2428.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-INTRAATRIAL REC,93602,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,585.09,,,4670.54,513.76,2428.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-RV RECORD,93603,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,126.53,,,4670.54,513.76,2428.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-MAP TACHY,93609,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,329.23,,,4670.54,513.76,2428.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-INTRAATRIAL PAC,93610,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,329.23,,,4670.54,513.76,2428.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-INTRAVENT PAC,93612,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,329.23,,,4670.54,513.76,2428.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-MAP ADD,93613,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,1680.18,,,4670.54,513.76,2428.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-ATRI RECORD ESO,93615,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,185.40,,,4670.54,513.76,2428.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-ATRI REC-PAC ESO,93616,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,185.40,,,4670.54,513.76,2428.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-INDUC ARRY PAC,93618,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,185.40,,,4670.54,513.76,2428.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-COMP EP W-O ARRY,93619,CPT,,,,,both,, ,22625.50,13575.30,Medicaid,Illinois Medicaid,,478.48,,,22625.50,2488.81,11765.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-COMP EP W- ARRY,93620,CPT,,,,,both,, ,22625.50,13575.30,Medicaid,Illinois Medicaid,,478.48,,,22625.50,2488.81,11765.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"EP-LA PACING, ADD",93621,CPT,,,,,both,, ,22625.50,13575.30,Medicaid,Illinois Medicaid,,232.80,,,22625.50,2488.81,11765.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"EP-LV PACING, ADD",93622,CPT,,,,,both,, ,22625.50,13575.30,Medicaid,Illinois Medicaid,,281.34,,,22625.50,2488.81,11765.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-PROG STIM IV DRUG,93623,CPT,,,,,both,, ,22625.50,13575.30,Medicaid,Illinois Medicaid,,281.34,,,22625.50,2488.81,11765.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-F-U EPW-ARRY IND,93624,CPT,,,,,both,, ,22625.50,13575.30,Medicaid,Illinois Medicaid,,70.91,,,22625.50,2488.81,11765.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-INTRA OP MAPPNG,93631,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,35.38,,,4670.54,513.76,2428.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"EP-EVAL LEAD,INDUC",93640,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,42.33,,,4670.54,513.76,2428.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"EP-EVAL GEN, INDUC",93641,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,42.48,,,4670.54,513.76,2428.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-EVAL PREV DEVICE,93642,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,42.33,,,4670.54,513.76,2428.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-ABLATE AV NODE,93650,CPT,,,,,both,, ,22625.50,13575.30,Medicaid,Illinois Medicaid,,42.48,,,22625.50,2488.81,11765.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-ABLATE SPRVNT ART,93653,CPT,,,,,both,, ,46220.99,27732.59,Medicaid,Illinois Medicaid,,1542.52,,,46220.99,5084.31,24034.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-ABLATE VENT TACY,93654,CPT,,,,,both,, ,46220.99,27732.59,Medicaid,Illinois Medicaid,,1542.52,,,46220.99,5084.31,24034.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-ATR FIB PULM VN I,93656,CPT,,,,,both,, ,46220.99,27732.59,Medicaid,Illinois Medicaid,,1542.52,,,46220.99,5084.31,24034.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EP-INTCRD ECHO INTER,93662,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,1542.52,,,4670.54,513.76,2428.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PAD REHB PER SESSION,93668,CPT,,,,,both,, ,169.18,101.50,Medicaid,Illinois Medicaid,,257.08,,,169.18,18.61,87.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-CARD REHAB W-O MO,93797,CPT,,,,,both,, ,193.64,116.18,Medicaid,Illinois Medicaid,,375.00,,,193.64,21.30,100.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-CARDI REHAB W- MO,93798,CPT,,,,,both,, ,296.38,177.82,Medicaid,Illinois Medicaid,,1542.52,,,296.38,32.60,154.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-CAROTID DPLX SCAN,93880,CPT,,,,,both,, ,425.13,255.07,Medicaid,Illinois Medicaid,,1542.52,,,425.13,46.76,221.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-CAROTID DPLX SCAN,93880,CPT,,,,,both,, ,457.58,274.54,Medicaid,Illinois Medicaid,,257.08,,,457.58,50.33,237.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-CRAN DPLX SCN BIL,93880,CPT,,,,,both,, ,12714.32,7628.59,Medicaid,Illinois Medicaid,,375.00,,,12714.32,1398.58,6611.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-CAROTID DUP DOPLR,93882,CPT,,,,,both,, ,425.13,255.07,Medicaid,Illinois Medicaid,,1542.52,,,425.13,46.76,221.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-CAROTID DUP DOPLR,93882,CPT,,,,,both,, ,457.58,274.54,Medicaid,Illinois Medicaid,,1542.52,,,457.58,50.33,237.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-EXT ARTERIAL LTD,93922,CPT,,,,,both,, ,2456.29,1473.77,Medicaid,Illinois Medicaid,,2570.88,,,2456.29,270.19,1277.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-EXT ARTERIAL LTD,93922,CPT,,,,,both,, ,167.38,100.42,Medicaid,Illinois Medicaid,,1542.52,,,167.38,18.41,87.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-EXT ARTERIAL COMP,93923,CPT,,,,,both,, ,3819.24,2291.54,Medicaid,Illinois Medicaid,,1542.52,,,3819.24,420.12,1986,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-NON INV ARTER EXT,93923,CPT,,,,,both,, ,268.32,160.99,Medicaid,Illinois Medicaid,,645.34,,,268.32,29.52,139.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-STD LE STRS REST,93924,CPT,,,,,both,, ,5693.84,3416.30,Medicaid,Illinois Medicaid,,626.55,,,5693.84,626.32,2960.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-LW EXT DPX ART BI,93925,CPT,,,,,both,, ,5086.40,3051.84,Medicaid,Illinois Medicaid,,645.34,,,5086.40,559.50,2644.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-LW EXT DPX ART UN,93926,CPT,,,,,both,, ,2541.53,1524.91,Medicaid,Illinois Medicaid,,2017.50,,,2541.53,279.57,1321.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-LW EXT DPX ART UN,93926,CPT,,,,,both,, ,1560.19,936.11,Medicaid,Illinois Medicaid,,2674.24,,,1560.19,171.62,811.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-UP EXT DPX ART BI,93930,CPT,,,,,both,, ,5083.05,3049.83,Medicaid,Illinois Medicaid,,291.85,,,5083.05,559.14,2643.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-UP EXT DPX ART UN,93931,CPT,,,,,both,, ,2541.53,1524.91,Medicaid,Illinois Medicaid,,291.85,,,2541.53,279.57,1321.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-UP EXT DPX ART UN,93931,CPT,,,,,both,, ,2026.01,1215.60,Medicaid,Illinois Medicaid,,12.67,,,2026.01,222.86,1053.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,5086.40,3051.84,Medicaid,Illinois Medicaid,,12.67,,,5086.40,559.50,2644.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,425.13,255.07,Medicaid,Illinois Medicaid,,12.67,,,425.13,46.76,221.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,457.58,274.54,Medicaid,Illinois Medicaid,,12.67,,,457.58,50.33,237.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,299.73,179.83,Medicaid,Illinois Medicaid,,269.14,,,299.73,32.97,155.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,322.65,193.59,Medicaid,Illinois Medicaid,,269.14,,,322.65,35.49,167.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,2541.53,1524.91,Medicaid,Illinois Medicaid,,251.31,,,2541.53,279.57,1321.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,425.13,255.07,Medicaid,Illinois Medicaid,,272.47,,,425.13,46.76,221.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,457.58,274.54,Medicaid,Illinois Medicaid,,251.31,,,457.58,50.33,237.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,823.23,493.93,Medicaid,Illinois Medicaid,,272.47,,,823.23,90.56,428.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,425.13,255.07,Medicaid,Illinois Medicaid,,291.85,,,425.13,46.76,221.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,457.58,274.54,Medicaid,Illinois Medicaid,,291.85,,,457.58,50.33,237.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,828.89,497.33,Medicaid,Illinois Medicaid,,9.73,,,828.89,91.18,431.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-DPLXSCN GRFT ARTA,93978,CPT,,,,,both,, ,1665.51,999.30,Medicaid,Illinois Medicaid,,9.73,,,1665.51,183.21,866.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,1292.14,775.28,Medicaid,Illinois Medicaid,,9.73,,,1292.14,142.14,671.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,425.13,255.07,Medicaid,Illinois Medicaid,,9.73,,,425.13,46.76,221.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,457.58,274.54,Medicaid,Illinois Medicaid,,269.14,,,457.58,50.33,237.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,841.51,504.90,Medicaid,Illinois Medicaid,,269.14,,,841.51,92.57,437.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VESS MAP HEMO ACC BI,93985,CPT,,,,,both,, ,977.58,586.54,Medicaid,Illinois Medicaid,,1963.23,,,977.58,107.53,508.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VESS MAP HEMO ACC UN,93986,CPT,,,,,both,, ,977.58,586.54,Medicaid,Illinois Medicaid,,3351.87,,,977.58,107.53,508.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-DUPSCN HEMODIAL,93990,CPT,,,,,both,, ,4623.93,2774.35,Medicaid,Illinois Medicaid,,4297.57,,,4623.93,508.63,2404.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MECH VENT INITIAL,94002,CPT,,,,,both,, ,4971.30,2982.78,Medicaid,Illinois Medicaid,,5258.56,,,4971.30,546.84,2585.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MECH VENT DAILY SUBS,94003,CPT,,,,,both,, ,4971.30,2982.78,Medicaid,Illinois Medicaid,,275.32,,,4971.30,546.84,2585.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPIROMETRY,94010,CPT,,,,,both,, ,530.45,318.27,Medicaid,Illinois Medicaid,,275.32,,,530.45,58.35,275.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BRONCHO EVAL PRE/PST,94060,CPT,,,,,both,, ,2361.28,1416.76,Medicaid,Illinois Medicaid,,145.54,,,2361.28,259.74,1227.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
METHACHOLINE CHALLEN,94070,CPT,,,,,both,, ,961.51,576.90,Medicaid,Illinois Medicaid,,492.85,,,961.51,105.77,499.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MAXIMUM VOLUNTARY VE,94200,CPT,,,,,both,, ,306.94,184.16,Medicaid,Illinois Medicaid,,492.85,,,306.94,33.76,159.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HAST WITH 02 TITRATE,94453,CPT,,,,,both,, ,1089.74,653.84,Medicaid,Illinois Medicaid,,492.85,,,1089.74,119.87,566.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PULM STRESS SIMPLE,94618,CPT,,,,,both,, ,459.12,275.47,Medicaid,Illinois Medicaid,,492.85,,,459.12,50.50,238.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PULM REHAB WO OXIMET,94625,CPT,,,,,both,, ,227.40,136.44,Medicaid,Illinois Medicaid,,492.85,,,227.40,25.01,118.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PULM REHAB W OXIMET,94626,CPT,,,,,both,, ,227.40,136.44,Medicaid,Illinois Medicaid,,911.24,,,227.40,25.01,118.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INHALATION TRTMT INI,94640,CPT,,,,,both,, ,569.50,341.70,Medicaid,Illinois Medicaid,,911.24,,,569.50,62.65,296.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INHALATION TRTMT INI,94640,CPT,,,,,both,, ,586.59,351.95,Medicaid,Illinois Medicaid,,276.86,,,586.59,64.52,305.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INHALATION TRTMT SUB,94640,CPT,,,,,both,, ,691.75,415.05,Medicaid,Illinois Medicaid,,2038.32,,,691.75,76.09,359.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INHALATION TRTMT SUB,94640,CPT,,,,,both,, ,712.50,427.50,Medicaid,Illinois Medicaid,,1919.97,,,712.50,78.38,370.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PENTAMIDINE ARSL INH,94642,CPT,,,,,both,, ,1061.67,637.00,Medicaid,Illinois Medicaid,,94.84,,,1061.67,116.78,552.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AEROSOL OBSTRUCT 1HR,94644,CPT,,,,,both,, ,719.71,431.82,Medicaid,Illinois Medicaid,,61.18,,,719.71,79.17,374.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONT INH TX ED 1HR,94644,CPT,,,,,both,, ,698.75,419.25,Medicaid,Illinois Medicaid,,61.18,,,698.75,76.86,363.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AEROSOL OBSTR ADD HR,94645,CPT,,,,,both,, ,719.71,431.82,Medicaid,Illinois Medicaid,,101.66,,,719.71,79.17,374.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONT INH TX ED AD HR,94645,CPT,,,,,both,, ,698.75,419.25,Medicaid,Illinois Medicaid,,101.66,,,698.75,76.86,363.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BIPAP/CPAP,94660,CPT,,,,,both,, ,2771.47,1662.88,Medicaid,Illinois Medicaid,,488.22,,,2771.47,304.86,1441.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EVAL-DEMO INHL DEVCE,94664,CPT,,,,,both,, ,342.73,205.63,Medicaid,Illinois Medicaid,,488.22,,,342.73,37.70,178.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MANIP CHST WALL INIT,94667,CPT,,,,,both,, ,1191.45,714.87,Medicaid,Illinois Medicaid,,457.93,,,1191.45,131.06,619.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MANIP CHST WALL SBSQ,94668,CPT,,,,,both,, ,975.15,585.09,Medicaid,Illinois Medicaid,,152.34,,,975.15,107.27,507.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MECHAN CHST WALL OSC,94669,CPT,,,,,both,, ,210.89,126.53,Medicaid,Illinois Medicaid,,152.34,,,210.89,23.20,109.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PF TST PLETHYSMOGRA,94726,CPT,,,,,both,, ,548.73,329.23,Medicaid,Illinois Medicaid,,292.20,,,548.73,60.36,285.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PF TEST BY GAS,94727,CPT,,,,,both,, ,548.73,329.23,Medicaid,Illinois Medicaid,,292.20,,,548.73,60.36,285.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PF TEST OSCILLOMETRY,94728,CPT,,,,,both,, ,548.73,329.23,Medicaid,Illinois Medicaid,,300.96,,,548.73,60.36,285.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CO2-MEMBANE DIFF CAP,94729,CPT,,,,,both,, ,2800.31,1680.18,Medicaid,Illinois Medicaid,,300.96,,,2800.31,308.03,1456.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309.00,185.40,Medicaid,Illinois Medicaid,,1104.73,,,309.00,33.99,160.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309.00,185.40,Medicaid,Illinois Medicaid,,42.48,,,309.00,33.99,160.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309.00,185.40,Medicaid,Illinois Medicaid,,42.48,,,309.00,33.99,160.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PULSE OX NWBRN MULTI,94761,CPT,,,,,both,, ,797.48,478.48,Medicaid,Illinois Medicaid,,81.45,,,797.48,87.72,414.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PULSE OX NWBRN MULTI,94761,CPT,,,,,both,, ,797.48,478.48,Medicaid,Illinois Medicaid,,81.45,,,797.48,87.72,414.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PULSE OX CONTINUOS,94762,CPT,,,,,both,, ,388.00,232.80,Medicaid,Illinois Medicaid,,83.89,,,388.00,42.68,201.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PULSE OX CONTINUOS,94762,CPT,,,,,both,, ,468.91,281.34,Medicaid,Illinois Medicaid,,83.89,,,468.91,51.58,243.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PULSE OX CONTINUOS,94762,CPT,,,,,both,, ,468.91,281.34,Medicaid,Illinois Medicaid,,1104.73,,,468.91,51.58,243.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CAR SEAT BED TST 60M,94780,CPT,,,,,both,, ,118.19,70.91,Medicaid,Illinois Medicaid,,247.66,,,118.19,13.00,61.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CAR SE-BED TST AD 30,94781,CPT,,,,,both,, ,58.97,35.38,Medicaid,Illinois Medicaid,,247.66,,,58.97,6.49,30.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALLERGY INJ SIM,95115,CPT,,,,,both,, ,70.56,42.33,Medicaid,Illinois Medicaid,,556.90,,,70.56,7.76,36.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALLERGY INJ SIM,95115,CPT,,,,,both,, ,70.81,42.48,Medicaid,Illinois Medicaid,,781.05,,,70.81,7.79,36.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALLERGY INJ MUL,95117,CPT,,,,,both,, ,70.56,42.33,Medicaid,Illinois Medicaid,,781.05,,,70.56,7.76,36.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALLERGY INJ MUL,95117,CPT,,,,,both,, ,70.81,42.48,Medicaid,Illinois Medicaid,,804.48,,,70.81,7.79,36.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
POLYSOMNO GT4 LT6YO,95782,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,804.48,,,2570.88,282.80,1336.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
POLYSOMNO GT4 LT6YO,95782,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,42.48,,,2570.88,282.80,1336.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
POLYS-CPAP GT4 LT6YO,95783,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,42.48,,,2570.88,282.80,1336.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
POLYS-CPAP GT4 LT6YO,95783,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,556.90,,,2570.88,282.80,1336.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SLPSTDY UNATT AN-ST,95800,CPT,,,,,both,, ,428.48,257.08,Medicaid,Illinois Medicaid,,781.05,,,428.48,47.13,222.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SLPSTDY UNATT AN-ST,95800,CPT,,,,,both,, ,625.00,375.00,Medicaid,Illinois Medicaid,,781.05,,,625.00,68.75,325,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MULTI SLEEP LAT,95805,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,804.48,,,2570.88,282.80,1336.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MULTI SLEEP LAT,95805,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,804.48,,,2570.88,282.80,1336.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SLPSTDY UNATT RS EFF,95806,CPT,,,,,both,, ,428.48,257.08,Medicaid,Illinois Medicaid,,63.03,,,428.48,47.13,222.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SLPSTDY UNATT RS EFF,95806,CPT,,,,,both,, ,625.00,375.00,Medicaid,Illinois Medicaid,,63.03,,,625.00,68.75,325,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
POLYSOMNO GT4 GE6YO,95810,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,120.75,,,2570.88,282.80,1336.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
POLYSOMNO GT4 GE6YO,95810,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,120.75,,,2570.88,282.80,1336.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
Sleep study,95810,CPT,,,,,both,,,2570.88,2570.88,Medicaid,Illinois Medicaid,,124.37,,,2570.88,282.80,1336.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
POLYS-CPAP GT4 GE6YO,95811,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,124.37,,,2570.88,282.80,1336.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
POLYS-CPAP GT4 GE6YO,95811,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,556.90,,,2570.88,282.80,1336.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EEG 41-60 MIN,95812,CPT,,,,,both,, ,1075.58,645.34,Medicaid,Illinois Medicaid,,63.03,,,1075.58,118.31,559.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EEG GT 1 HOUR,95813,CPT,,,,,both,, ,1044.25,626.55,Medicaid,Illinois Medicaid,,63.03,,,1044.25,114.87,543.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EEG AWAKE DROWSY,95816,CPT,,,,,both,, ,1075.58,645.34,Medicaid,Illinois Medicaid,,474.75,,,1075.58,118.31,559.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EEG AWAKE ASLEEP,95819,CPT,,,,,both,, ,3362.50,2017.50,Medicaid,Illinois Medicaid,,474.75,,,3362.50,369.88,1748.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EEG ASLEEP,95822,CPT,,,,,both,, ,4457.07,2674.24,Medicaid,Illinois Medicaid,,488.99,,,4457.07,490.28,2317.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM WR EA EXTRK COTA,95851,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,488.99,,,486.42,53.51,252.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM WR EA EXTRK COTA,95851,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,556.90,,,486.42,53.51,252.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM WR EA EXTRNK PTA,95851,CPT,,,,,both,, ,21.12,12.67,Medicaid,Illinois Medicaid,,63.03,,,21.12,2.32,10.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM WR EA EXTRNK PTA,95851,CPT,,,,,both,, ,21.12,12.67,Medicaid,Illinois Medicaid,,63.03,,,21.12,2.32,10.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM WR EA EXTRNK PTA,95851,CPT,,,,,both,, ,21.12,12.67,Medicaid,Illinois Medicaid,,120.75,,,21.12,2.32,10.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM WR EA EXTRNK PTA,95851,CPT,,,,,both,, ,21.12,12.67,Medicaid,Illinois Medicaid,,120.75,,,21.12,2.32,10.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM WR EA EXTRNK PTA,95851,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,124.37,,,448.57,49.34,233.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM WR EA EXTRNK PTA,95851,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,124.37,,,448.57,49.34,233.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM W-R EA EXT-TRNK,95851,CPT,,,,,both,, ,418.86,251.31,Medicaid,Illinois Medicaid,,180.69,,,418.86,46.07,217.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM W-R EA EXT-TRNK,95851,CPT,,,,,both,, ,454.13,272.47,Medicaid,Illinois Medicaid,,813.28,,,454.13,49.95,236.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM W-R HND W-WO COM,95852,CPT,,,,,both,, ,418.86,251.31,Medicaid,Illinois Medicaid,,886.48,,,418.86,46.07,217.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM W-R HND W-WO COM,95852,CPT,,,,,both,, ,454.13,272.47,Medicaid,Illinois Medicaid,,120.75,,,454.13,49.95,236.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM WR HND W-WO COTA,95852,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,120.75,,,486.42,53.51,252.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM WR HND W-WO COTA,95852,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,124.37,,,486.42,53.51,252.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM W-R HND W-WO PTA,95852,CPT,,,,,both,, ,16.22,9.73,Medicaid,Illinois Medicaid,,152.34,,,16.22,1.78,8.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM W-R HND W-WO PTA,95852,CPT,,,,,both,, ,16.22,9.73,Medicaid,Illinois Medicaid,,152.34,,,16.22,1.78,8.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM W-R HND W-WO PTA,95852,CPT,,,,,both,, ,16.22,9.73,Medicaid,Illinois Medicaid,,300.96,,,16.22,1.78,8.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM W-R HND W-WO PTA,95852,CPT,,,,,both,, ,16.22,9.73,Medicaid,Illinois Medicaid,,813.28,,,16.22,1.78,8.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM W-R HND W-WO PTA,95852,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,63.03,,,448.57,49.34,233.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROM W-R HND W-WO PTA,95852,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,63.03,,,448.57,49.34,233.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"EMG, 1 EXTREM",95860,CPT,,,,,both,, ,3272.05,1963.23,Medicaid,Illinois Medicaid,,120.75,,,3272.05,359.93,1701.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"EMG, 2 EXTREM",95861,CPT,,,,,both,, ,5586.46,3351.87,Medicaid,Illinois Medicaid,,120.75,,,5586.46,614.51,2904.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"EMG, 3 EXTREM",95863,CPT,,,,,both,, ,7162.62,4297.57,Medicaid,Illinois Medicaid,,124.37,,,7162.62,787.89,3724.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"EMG, 4 EXTREM",95864,CPT,,,,,both,, ,8764.27,5258.56,Medicaid,Illinois Medicaid,,124.37,,,8764.27,964.07,4557.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"EMG, W-NERVE TEST",95885,CPT,,,,,both,, ,458.87,275.32,Medicaid,Illinois Medicaid,,401.39,,,458.87,50.48,238.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EMG W-NRV TST COM,95886,CPT,,,,,both,, ,458.87,275.32,Medicaid,Illinois Medicaid,,437.51,,,458.87,50.48,238.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EMG W-NRV TST NON,95887,CPT,,,,,both,, ,242.57,145.54,Medicaid,Illinois Medicaid,,59.10,,,242.57,26.68,126.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MTR-SENS 1-2 NRV TST,95907,CPT,,,,,both,, ,821.43,492.85,Medicaid,Illinois Medicaid,,59.10,,,821.43,90.36,427.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MTR-SENS 3-4 NRV TST,95908,CPT,,,,,both,, ,821.43,492.85,Medicaid,Illinois Medicaid,,60.87,,,821.43,90.36,427.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MTR-SENS 5-6 NRV TST,95909,CPT,,,,,both,, ,821.43,492.85,Medicaid,Illinois Medicaid,,60.87,,,821.43,90.36,427.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MTR-SENS 7-8 NRV TST,95910,CPT,,,,,both,, ,821.43,492.85,Medicaid,Illinois Medicaid,,63.03,,,821.43,90.36,427.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MTR-SES 9-10 NRV TST,95911,CPT,,,,,both,, ,821.43,492.85,Medicaid,Illinois Medicaid,,63.03,,,821.43,90.36,427.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MTR-SES 11-12 NRV TS,95912,CPT,,,,,both,, ,1518.74,911.24,Medicaid,Illinois Medicaid,,437.51,,,1518.74,167.06,789.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MTR-SNS 13 OR MORE,95913,CPT,,,,,both,, ,1518.74,911.24,Medicaid,Illinois Medicaid,,285.97,,,1518.74,167.06,789.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PARASYMP-SYMP HRT RT,95924,CPT,,,,,both,, ,461.44,276.86,Medicaid,Illinois Medicaid,,141.21,,,461.44,50.76,239.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VISUAL EVOK POTENT,95930,CPT,,,,,both,, ,3397.20,2038.32,Medicaid,Illinois Medicaid,,229.59,,,3397.20,373.69,1766.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"REPETIT STIM, EA NE",95937,CPT,,,,,both,, ,3199.95,1919.97,Medicaid,Illinois Medicaid,,70.29,,,3199.95,351.99,1663.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CANALITH PER DAY,95992,CPT,,,,,both,, ,158.07,94.84,Medicaid,Illinois Medicaid,,826.26,,,158.07,17.39,82.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CANALITH PER DAY PTA,95992,CPT,,,,,both,, ,101.97,61.18,Medicaid,Illinois Medicaid,,140.74,,,101.97,11.22,53.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CANALITH PER DAY PTA,95992,CPT,,,,,both,, ,101.97,61.18,Medicaid,Illinois Medicaid,,75.70,,,101.97,11.22,53.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CANALITH PER DAY PTA,95992,CPT,,,,,both,, ,169.44,101.66,Medicaid,Illinois Medicaid,,229.89,,,169.44,18.64,88.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CANALITH PER DAY PTA,95992,CPT,,,,,both,, ,169.44,101.66,Medicaid,Illinois Medicaid,,143.56,,,169.44,18.64,88.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
APHASIA ASSESS 1HOUR,96105,CPT,,,,,both,, ,813.70,488.22,Medicaid,Illinois Medicaid,,155.64,,,813.70,89.51,423.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEV TEST 1ST HR,96112,CPT,,,,,both,, ,813.70,488.22,Medicaid,Illinois Medicaid,,166.70,,,813.70,89.51,423.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEV TEST ADD 30M,96113,CPT,,,,,both,, ,763.23,457.93,Medicaid,Illinois Medicaid,,166.70,,,763.23,83.96,396.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,253.90,152.34,Medicaid,Illinois Medicaid,,24.72,,,253.90,27.93,132.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,253.90,152.34,Medicaid,Illinois Medicaid,,24.72,,,253.90,27.93,132.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,487.00,292.20,Medicaid,Illinois Medicaid,,24.72,,,487.00,53.57,253.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,487.00,292.20,Medicaid,Illinois Medicaid,,24.72,,,487.00,53.57,253.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,501.61,300.96,Medicaid,Illinois Medicaid,,153.72,,,501.61,55.18,260.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,501.61,300.96,Medicaid,Illinois Medicaid,,153.72,,,501.61,55.18,260.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,1841.23,1104.73,Medicaid,Illinois Medicaid,,291.14,,,1841.23,202.54,957.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,70.81,42.48,Medicaid,Illinois Medicaid,,23.64,,,70.81,7.79,36.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,70.81,42.48,Medicaid,Illinois Medicaid,,23.64,,,70.81,7.79,36.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,135.75,81.45,Medicaid,Illinois Medicaid,,311.93,,,135.75,14.93,70.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,135.75,81.45,Medicaid,Illinois Medicaid,,311.93,,,135.75,14.93,70.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,139.82,83.89,Medicaid,Illinois Medicaid,,11.12,,,139.82,15.38,72.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,139.82,83.89,Medicaid,Illinois Medicaid,,11.12,,,139.82,15.38,72.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,1841.23,1104.73,Medicaid,Illinois Medicaid,,192.51,,,1841.23,202.54,957.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,412.77,247.66,Medicaid,Illinois Medicaid,,192.51,,,412.77,45.40,214.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,412.77,247.66,Medicaid,Illinois Medicaid,,24.72,,,412.77,45.40,214.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,928.18,556.90,Medicaid,Illinois Medicaid,,24.72,,,928.18,102.10,482.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1301.75,781.05,Medicaid,Illinois Medicaid,,208.72,,,1301.75,143.19,676.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1301.75,781.05,Medicaid,Illinois Medicaid,,208.72,,,1301.75,143.19,676.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1340.80,804.48,Medicaid,Illinois Medicaid,,179.71,,,1340.80,147.49,697.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1340.80,804.48,Medicaid,Illinois Medicaid,,194.83,,,1340.80,147.49,697.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,70.81,42.48,Medicaid,Illinois Medicaid,,391.62,,,70.81,7.79,36.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,70.81,42.48,Medicaid,Illinois Medicaid,,424.54,,,70.81,7.79,36.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,928.18,556.90,Medicaid,Illinois Medicaid,,454.84,,,928.18,102.10,482.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1301.75,781.05,Medicaid,Illinois Medicaid,,454.84,,,1301.75,143.19,676.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1301.75,781.05,Medicaid,Illinois Medicaid,,28.12,,,1301.75,143.19,676.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1340.80,804.48,Medicaid,Illinois Medicaid,,28.12,,,1340.80,147.49,697.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1340.80,804.48,Medicaid,Illinois Medicaid,,28.12,,,1340.80,147.49,697.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,28.12,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,419.46,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,201.25,120.75,Medicaid,Illinois Medicaid,,419.46,,,201.25,22.14,104.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,201.25,120.75,Medicaid,Illinois Medicaid,,324.91,,,201.25,22.14,104.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,207.29,124.37,Medicaid,Illinois Medicaid,,324.91,,,207.29,22.80,107.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,207.29,124.37,Medicaid,Illinois Medicaid,,279.79,,,207.29,22.80,107.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,928.18,556.90,Medicaid,Illinois Medicaid,,303.30,,,928.18,102.10,482.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONCURRENT IV THER,96368,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,23.64,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONCURRENT IV THER,96368,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,23.64,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONCURRENT IV THER,96368,CPT,,,,,both,, ,791.25,474.75,Medicaid,Illinois Medicaid,,23.64,,,791.25,87.04,411.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONCURRENT IV THER,96368,CPT,,,,,both,, ,791.25,474.75,Medicaid,Illinois Medicaid,,23.64,,,791.25,87.04,411.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONCURRENT IV THER,96368,CPT,,,,,both,, ,814.99,488.99,Medicaid,Illinois Medicaid,,299.73,,,814.99,89.65,423.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONCURRENT IV THER,96368,CPT,,,,,both,, ,814.99,488.99,Medicaid,Illinois Medicaid,,299.73,,,814.99,89.65,423.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONCURRENT IV THER,96368,CPT,,,,,both,, ,928.18,556.90,Medicaid,Illinois Medicaid,,458.71,,,928.18,102.10,482.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,458.71,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,32.75,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,201.25,120.75,Medicaid,Illinois Medicaid,,32.75,,,201.25,22.14,104.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,201.25,120.75,Medicaid,Illinois Medicaid,,32.75,,,201.25,22.14,104.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,207.29,124.37,Medicaid,Illinois Medicaid,,32.75,,,207.29,22.80,107.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,207.29,124.37,Medicaid,Illinois Medicaid,,423.02,,,207.29,22.80,107.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,301.16,180.69,Medicaid,Illinois Medicaid,,423.02,,,301.16,33.13,156.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-INJ NON CHEMO IA,96373,CPT,,,,,both,, ,1355.48,813.28,Medicaid,Illinois Medicaid,,394.96,,,1355.48,149.10,704.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INJECTION IV PUSH,96374,CPT,,,,,both,, ,1477.47,886.48,Medicaid,Illinois Medicaid,,428.19,,,1477.47,162.52,768.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,201.25,120.75,Medicaid,Illinois Medicaid,,24.10,,,201.25,22.14,104.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,201.25,120.75,Medicaid,Illinois Medicaid,,24.10,,,201.25,22.14,104.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,207.29,124.37,Medicaid,Illinois Medicaid,,24.10,,,207.29,22.80,107.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,253.90,152.34,Medicaid,Illinois Medicaid,,24.10,,,253.90,27.93,132.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,253.90,152.34,Medicaid,Illinois Medicaid,,284.89,,,253.90,27.93,132.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,501.61,300.96,Medicaid,Illinois Medicaid,,284.89,,,501.61,55.18,260.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,1355.48,813.28,Medicaid,Illinois Medicaid,,308.84,,,1355.48,149.10,704.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,308.84,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,265.95,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,201.25,120.75,Medicaid,Illinois Medicaid,,288.30,,,201.25,22.14,104.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,201.25,120.75,Medicaid,Illinois Medicaid,,366.93,,,201.25,22.14,104.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,207.29,124.37,Medicaid,Illinois Medicaid,,366.93,,,207.29,22.80,107.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,207.29,124.37,Medicaid,Illinois Medicaid,,21.94,,,207.29,22.80,107.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,668.99,401.39,Medicaid,Illinois Medicaid,,21.94,,,668.99,73.59,347.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,729.19,437.51,Medicaid,Illinois Medicaid,,21.94,,,729.19,80.21,379.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,98.50,59.10,Medicaid,Illinois Medicaid,,21.94,,,98.50,10.84,51.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,98.50,59.10,Medicaid,Illinois Medicaid,,338.50,,,98.50,10.84,51.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,101.46,60.87,Medicaid,Illinois Medicaid,,338.50,,,101.46,11.16,52.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,101.46,60.87,Medicaid,Illinois Medicaid,,315.97,,,101.46,11.16,52.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,342.57,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,342.72,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,729.19,437.51,Medicaid,Illinois Medicaid,,48.82,,,729.19,80.21,379.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHEMO NON HORM IM SC,96401,CPT,,,,,both,, ,476.63,285.97,Medicaid,Illinois Medicaid,,48.82,,,476.63,52.43,247.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHEMO HORMONAL IM SC,96402,CPT,,,,,both,, ,235.36,141.21,Medicaid,Illinois Medicaid,,48.82,,,235.36,25.89,122.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHEMO IV PUSH,96409,CPT,,,,,both,, ,382.65,229.59,Medicaid,Illinois Medicaid,,48.82,,,382.65,42.09,198.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHEMO EA AD IV PUSH,96411,CPT,,,,,both,, ,117.16,70.29,Medicaid,Illinois Medicaid,,220.32,,,117.16,12.89,60.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHEMO IV INFU 1ST HR,96413,CPT,,,,,both,, ,1377.11,826.26,Medicaid,Illinois Medicaid,,220.32,,,1377.11,151.48,716.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHEMO IV IN EA AD HR,96415,CPT,,,,,both,, ,234.58,140.74,Medicaid,Illinois Medicaid,,238.86,,,234.58,25.80,121.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHEMO IV EA SEQ INF,96417,CPT,,,,,both,, ,126.18,75.70,Medicaid,Illinois Medicaid,,238.86,,,126.18,13.88,65.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-IRR PORT DRUG DEL,96523,CPT,,,,,both,, ,383.16,229.89,Medicaid,Illinois Medicaid,,205.63,,,383.16,42.15,199.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HOT-COLD PACKS,97010,CPT,,,,,both,, ,239.27,143.56,Medicaid,Illinois Medicaid,,222.93,,,239.27,26.32,124.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HOT-COLD PACKS,97010,CPT,,,,,both,, ,259.41,155.64,Medicaid,Illinois Medicaid,,55.31,,,259.41,28.54,134.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HOT-COLD PACKS COTA,97010,CPT,,,,,both,, ,277.84,166.70,Medicaid,Illinois Medicaid,,55.31,,,277.84,30.56,144.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HOT-COLD PACKS COTA,97010,CPT,,,,,both,, ,277.84,166.70,Medicaid,Illinois Medicaid,,55.31,,,277.84,30.56,144.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HOT-COLD PACKS PTA,97010,CPT,,,,,both,, ,41.20,24.72,Medicaid,Illinois Medicaid,,55.31,,,41.20,4.53,21.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HOT-COLD PACKS PTA,97010,CPT,,,,,both,, ,41.20,24.72,Medicaid,Illinois Medicaid,,220.32,,,41.20,4.53,21.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HOT-COLD PACKS PTA,97010,CPT,,,,,both,, ,41.20,24.72,Medicaid,Illinois Medicaid,,220.32,,,41.20,4.53,21.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HOT-COLD PACKS PTA,97010,CPT,,,,,both,, ,41.20,24.72,Medicaid,Illinois Medicaid,,291.85,,,41.20,4.53,21.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HOT-COLD PACKS PTA,97010,CPT,,,,,both,, ,256.21,153.72,Medicaid,Illinois Medicaid,,291.85,,,256.21,28.18,133.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HOT-COLD PACKS PTA,97010,CPT,,,,,both,, ,256.21,153.72,Medicaid,Illinois Medicaid,,205.63,,,256.21,28.18,133.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MECH TRACTION-VISIT,97012,CPT,,,,,both,, ,485.24,291.14,Medicaid,Illinois Medicaid,,272.47,,,485.24,53.38,252.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MECH TRACTN-VST PTA,97012,CPT,,,,,both,, ,39.40,23.64,Medicaid,Illinois Medicaid,,205.63,,,39.40,4.33,20.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MECH TRACTN-VST PTA,97012,CPT,,,,,both,, ,39.40,23.64,Medicaid,Illinois Medicaid,,272.47,,,39.40,4.33,20.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MECH TRACTN-VST PTA,97012,CPT,,,,,both,, ,519.89,311.93,Medicaid,Illinois Medicaid,,291.85,,,519.89,57.19,270.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MECH TRACTN-VST PTA,97012,CPT,,,,,both,, ,519.89,311.93,Medicaid,Illinois Medicaid,,291.85,,,519.89,57.19,270.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PARAF BATH-VISIT PTA,97018,CPT,,,,,both,, ,18.54,11.12,Medicaid,Illinois Medicaid,,48.20,,,18.54,2.04,9.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PARAF BATH-VISIT PTA,97018,CPT,,,,,both,, ,18.54,11.12,Medicaid,Illinois Medicaid,,48.20,,,18.54,2.04,9.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PARAF BATH-VISIT PTA,97018,CPT,,,,,both,, ,320.85,192.51,Medicaid,Illinois Medicaid,,48.20,,,320.85,35.29,166.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PARAF BATH-VISIT PTA,97018,CPT,,,,,both,, ,320.85,192.51,Medicaid,Illinois Medicaid,,48.20,,,320.85,35.29,166.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PARAF BTH-VISIT COTA,97018,CPT,,,,,both,, ,41.20,24.72,Medicaid,Illinois Medicaid,,220.32,,,41.20,4.53,21.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PARAF BTH-VISIT COTA,97018,CPT,,,,,both,, ,41.20,24.72,Medicaid,Illinois Medicaid,,220.32,,,41.20,4.53,21.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PARAF BTH-VISIT COTA,97018,CPT,,,,,both,, ,347.88,208.72,Medicaid,Illinois Medicaid,,176.45,,,347.88,38.27,180.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PARAF BTH-VISIT COTA,97018,CPT,,,,,both,, ,347.88,208.72,Medicaid,Illinois Medicaid,,191.30,,,347.88,38.27,180.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PARAFFIN BATH-VISIT,97018,CPT,,,,,both,, ,299.53,179.71,Medicaid,Illinois Medicaid,,204.87,,,299.53,32.95,155.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PARAFFIN BATH-VISIT,97018,CPT,,,,,both,, ,324.73,194.83,Medicaid,Illinois Medicaid,,204.87,,,324.73,35.72,168.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHIRLPOOL THRPY-VIST,97022,CPT,,,,,both,, ,652.70,391.62,Medicaid,Illinois Medicaid,,44.95,,,652.70,71.80,339.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHIRLPOOL THRPY-VIST,97022,CPT,,,,,both,, ,707.58,424.54,Medicaid,Illinois Medicaid,,44.95,,,707.58,77.83,367.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHRLPL THPY-VST COTA,97022,CPT,,,,,both,, ,758.08,454.84,Medicaid,Illinois Medicaid,,44.95,,,758.08,83.39,394.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHRLPL THPY-VST COTA,97022,CPT,,,,,both,, ,758.08,454.84,Medicaid,Illinois Medicaid,,44.95,,,758.08,83.39,394.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHRLPL THRPY-VST PTA,97022,CPT,,,,,both,, ,46.87,28.12,Medicaid,Illinois Medicaid,,188.95,,,46.87,5.16,24.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHRLPL THRPY-VST PTA,97022,CPT,,,,,both,, ,46.87,28.12,Medicaid,Illinois Medicaid,,188.95,,,46.87,5.16,24.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHRLPL THRPY-VST PTA,97022,CPT,,,,,both,, ,46.87,28.12,Medicaid,Illinois Medicaid,,238.86,,,46.87,5.16,24.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHRLPL THRPY-VST PTA,97022,CPT,,,,,both,, ,46.87,28.12,Medicaid,Illinois Medicaid,,238.86,,,46.87,5.16,24.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHRLPL THRPY-VST PTA,97022,CPT,,,,,both,, ,699.11,419.46,Medicaid,Illinois Medicaid,,50.67,,,699.11,76.90,363.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHRLPL THRPY-VST PTA,97022,CPT,,,,,both,, ,699.11,419.46,Medicaid,Illinois Medicaid,,50.67,,,699.11,76.90,363.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELE STM-MN-15MN COTA,97032,CPT,,,,,both,, ,541.52,324.91,Medicaid,Illinois Medicaid,,50.67,,,541.52,59.57,281.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELE STM-MN-15MN COTA,97032,CPT,,,,,both,, ,541.52,324.91,Medicaid,Illinois Medicaid,,50.67,,,541.52,59.57,281.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STIM-MAN-15 MIN,97032,CPT,,,,,both,, ,466.32,279.79,Medicaid,Illinois Medicaid,,269.14,,,466.32,51.30,242.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STIM-MAN-15 MIN,97032,CPT,,,,,both,, ,505.50,303.30,Medicaid,Illinois Medicaid,,269.14,,,505.50,55.61,262.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STM-MN-15MN PTA,97032,CPT,,,,,both,, ,39.40,23.64,Medicaid,Illinois Medicaid,,238.86,,,39.40,4.33,20.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STM-MN-15MN PTA,97032,CPT,,,,,both,, ,39.40,23.64,Medicaid,Illinois Medicaid,,238.86,,,39.40,4.33,20.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STM-MN-15MN PTA,97032,CPT,,,,,both,, ,39.40,23.64,Medicaid,Illinois Medicaid,,238.86,,,39.40,4.33,20.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STM-MN-15MN PTA,97032,CPT,,,,,both,, ,39.40,23.64,Medicaid,Illinois Medicaid,,50.67,,,39.40,4.33,20.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STM-MN-15MN PTA,97032,CPT,,,,,both,, ,499.55,299.73,Medicaid,Illinois Medicaid,,50.67,,,499.55,54.95,259.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STM-MN-15MN PTA,97032,CPT,,,,,both,, ,499.55,299.73,Medicaid,Illinois Medicaid,,50.67,,,499.55,54.95,259.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IONTOPHO-15 MIN COTA,97033,CPT,,,,,both,, ,764.52,458.71,Medicaid,Illinois Medicaid,,50.67,,,764.52,84.10,397.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IONTOPHO-15 MIN COTA,97033,CPT,,,,,both,, ,764.52,458.71,Medicaid,Illinois Medicaid,,269.14,,,764.52,84.10,397.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IONTOPHOR-15 MIN PTA,97033,CPT,,,,,both,, ,54.59,32.75,Medicaid,Illinois Medicaid,,269.14,,,54.59,6.00,28.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IONTOPHOR-15 MIN PTA,97033,CPT,,,,,both,, ,54.59,32.75,Medicaid,Illinois Medicaid,,238.86,,,54.59,6.00,28.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IONTOPHOR-15 MIN PTA,97033,CPT,,,,,both,, ,54.59,32.75,Medicaid,Illinois Medicaid,,205.63,,,54.59,6.00,28.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IONTOPHOR-15 MIN PTA,97033,CPT,,,,,both,, ,54.59,32.75,Medicaid,Illinois Medicaid,,272.47,,,54.59,6.00,28.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IONTOPHOR-15 MIN PTA,97033,CPT,,,,,both,, ,705.04,423.02,Medicaid,Illinois Medicaid,,44.19,,,705.04,77.55,366.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IONTOPHOR-15 MIN PTA,97033,CPT,,,,,both,, ,705.04,423.02,Medicaid,Illinois Medicaid,,44.19,,,705.04,77.55,366.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IONTOPHORESIS-15 MIN,97033,CPT,,,,,both,, ,658.28,394.96,Medicaid,Illinois Medicaid,,44.19,,,658.28,72.41,342.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IONTOPHORESIS-15 MIN,97033,CPT,,,,,both,, ,713.65,428.19,Medicaid,Illinois Medicaid,,44.19,,,713.65,78.50,371.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CNTRST BTH-15MIN PTA,97034,CPT,,,,,both,, ,40.17,24.10,Medicaid,Illinois Medicaid,,220.32,,,40.17,4.42,20.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CNTRST BTH-15MIN PTA,97034,CPT,,,,,both,, ,40.17,24.10,Medicaid,Illinois Medicaid,,220.32,,,40.17,4.42,20.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CNTRST BTH-15MIN PTA,97034,CPT,,,,,both,, ,40.17,24.10,Medicaid,Illinois Medicaid,,291.85,,,40.17,4.42,20.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CNTRST BTH-15MIN PTA,97034,CPT,,,,,both,, ,40.17,24.10,Medicaid,Illinois Medicaid,,291.85,,,40.17,4.42,20.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CNTRST BTH-15MIN PTA,97034,CPT,,,,,both,, ,474.83,284.89,Medicaid,Illinois Medicaid,,204.73,,,474.83,52.23,246.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CNTRST BTH-15MIN PTA,97034,CPT,,,,,both,, ,474.83,284.89,Medicaid,Illinois Medicaid,,221.95,,,474.83,52.23,246.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CNTRST BTH-15MN COTA,97034,CPT,,,,,both,, ,514.74,308.84,Medicaid,Illinois Medicaid,,237.77,,,514.74,56.62,267.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CNTRST BTH-15MN COTA,97034,CPT,,,,,both,, ,514.74,308.84,Medicaid,Illinois Medicaid,,237.77,,,514.74,56.62,267.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONTRAST BATH-15 MIN,97034,CPT,,,,,both,, ,443.25,265.95,Medicaid,Illinois Medicaid,,29.20,,,443.25,48.76,230.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONTRAST BATH-15 MIN,97034,CPT,,,,,both,, ,480.51,288.30,Medicaid,Illinois Medicaid,,29.20,,,480.51,52.86,249.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ULTRASND-15 MIN COTA,97035,CPT,,,,,both,, ,611.56,366.93,Medicaid,Illinois Medicaid,,29.20,,,611.56,67.27,318.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ULTRASND-15 MIN COTA,97035,CPT,,,,,both,, ,611.56,366.93,Medicaid,Illinois Medicaid,,29.20,,,611.56,67.27,318.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ULTRASND-15 MIN PTA,97035,CPT,,,,,both,, ,36.57,21.94,Medicaid,Illinois Medicaid,,219.39,,,36.57,4.02,19.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ULTRASND-15 MIN PTA,97035,CPT,,,,,both,, ,36.57,21.94,Medicaid,Illinois Medicaid,,219.39,,,36.57,4.02,19.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ULTRASND-15 MIN PTA,97035,CPT,,,,,both,, ,36.57,21.94,Medicaid,Illinois Medicaid,,134.26,,,36.57,4.02,19.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ULTRASND-15 MIN PTA,97035,CPT,,,,,both,, ,36.57,21.94,Medicaid,Illinois Medicaid,,134.26,,,36.57,4.02,19.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ULTRASND-15 MIN PTA,97035,CPT,,,,,both,, ,564.18,338.50,Medicaid,Illinois Medicaid,,432.60,,,564.18,62.06,293.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ULTRASND-15 MIN PTA,97035,CPT,,,,,both,, ,564.18,338.50,Medicaid,Illinois Medicaid,,432.60,,,564.18,62.06,293.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ULTRASOUND-15 MIN,97035,CPT,,,,,both,, ,526.62,315.97,Medicaid,Illinois Medicaid,,403.90,,,526.62,57.93,273.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ULTRASOUND-15 MIN,97035,CPT,,,,,both,, ,570.95,342.57,Medicaid,Illinois Medicaid,,420.00,,,570.95,62.80,296.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"Physical therapy, therapeutic exercise .",97110,CPT,,,,,both,,,342.72,342.72,Medicaid,Illinois Medicaid,,134.26,,,342.72,37.70,178.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER EXRCS-15MIN PTA,97110,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,134.26,,,81.37,8.95,42.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER EXRCS-15MIN PTA,97110,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,216.30,,,81.37,8.95,42.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER EXRCS-15MIN PTA,97110,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,216.30,,,81.37,8.95,42.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER EXRCS-15MIN PTA,97110,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,403.90,,,81.37,8.95,42.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER EXRCS-15MIN PTA,97110,CPT,,,,,both,, ,367.20,220.32,Medicaid,Illinois Medicaid,,210.00,,,367.20,40.39,190.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER EXRCS-15MIN PTA,97110,CPT,,,,,both,, ,367.20,220.32,Medicaid,Illinois Medicaid,,134.41,,,367.20,40.39,190.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER EXRCS-15MN COTA,97110,CPT,,,,,both,, ,398.10,238.86,Medicaid,Illinois Medicaid,,134.41,,,398.10,43.79,207.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER EXRCS-15MN COTA,97110,CPT,,,,,both,, ,398.10,238.86,Medicaid,Illinois Medicaid,,432.60,,,398.10,43.79,207.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAP EXERCS-15 MIN,97110,CPT,,,,,both,, ,342.72,205.63,Medicaid,Illinois Medicaid,,432.60,,,342.72,37.70,178.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAP EXERCS-15 MIN,97110,CPT,,,,,both,, ,371.55,222.93,Medicaid,Illinois Medicaid,,403.90,,,371.55,40.87,193.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEUR RE-ED-15MIN PTA,97112,CPT,,,,,both,, ,92.19,55.31,Medicaid,Illinois Medicaid,,139.95,,,92.19,10.14,47.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEUR RE-ED-15MIN PTA,97112,CPT,,,,,both,, ,92.19,55.31,Medicaid,Illinois Medicaid,,262.41,,,92.19,10.14,47.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEUR RE-ED-15MIN PTA,97112,CPT,,,,,both,, ,92.19,55.31,Medicaid,Illinois Medicaid,,90.84,,,92.19,10.14,47.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEUR RE-ED-15MIN PTA,97112,CPT,,,,,both,, ,92.19,55.31,Medicaid,Illinois Medicaid,,90.84,,,92.19,10.14,47.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEUR RE-ED-15MIN PTA,97112,CPT,,,,,both,, ,367.20,220.32,Medicaid,Illinois Medicaid,,281.03,,,367.20,40.39,190.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEUR RE-ED-15MIN PTA,97112,CPT,,,,,both,, ,367.20,220.32,Medicaid,Illinois Medicaid,,281.03,,,367.20,40.39,190.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEUR RE-ED-15MN COTA,97112,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,134.26,,,486.42,53.51,252.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEUR RE-ED-15MN COTA,97112,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,437.88,,,486.42,53.51,252.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEURO RE-ED-15 MIN,97112,CPT,,,,,both,, ,342.72,205.63,Medicaid,Illinois Medicaid,,469.06,,,342.72,37.70,178.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEURO RE-ED-15 MIN,97112,CPT,,,,,both,, ,454.13,272.47,Medicaid,Illinois Medicaid,,469.06,,,454.13,49.95,236.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GAIT TRAINING-15 MIN,97116,CPT,,,,,both,, ,342.72,205.63,Medicaid,Illinois Medicaid,,60.00,,,342.72,37.70,178.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GAIT TRAINING-15 MIN,97116,CPT,,,,,both,, ,454.13,272.47,Medicaid,Illinois Medicaid,,455.40,,,454.13,49.95,236.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GAIT TRNG-15MIN COTA,97116,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,134.26,,,486.42,53.51,252.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GAIT TRNG-15MIN COTA,97116,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,437.88,,,486.42,53.51,252.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GAIT TRNNG-15MIN PTA,97116,CPT,,,,,both,, ,80.34,48.20,Medicaid,Illinois Medicaid,,234.53,,,80.34,8.84,41.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GAIT TRNNG-15MIN PTA,97116,CPT,,,,,both,, ,80.34,48.20,Medicaid,Illinois Medicaid,,234.53,,,80.34,8.84,41.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GAIT TRNNG-15MIN PTA,97116,CPT,,,,,both,, ,80.34,48.20,Medicaid,Illinois Medicaid,,60.00,,,80.34,8.84,41.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GAIT TRNNG-15MIN PTA,97116,CPT,,,,,both,, ,80.34,48.20,Medicaid,Illinois Medicaid,,227.70,,,80.34,8.84,41.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GAIT TRNNG-15MIN PTA,97116,CPT,,,,,both,, ,367.20,220.32,Medicaid,Illinois Medicaid,,134.26,,,367.20,40.39,190.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GAIT TRNNG-15MIN PTA,97116,CPT,,,,,both,, ,367.20,220.32,Medicaid,Illinois Medicaid,,437.88,,,367.20,40.39,190.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MASSAGE THRPY-15 MIN,97124,CPT,,,,,both,, ,294.09,176.45,Medicaid,Illinois Medicaid,,469.06,,,294.09,32.35,152.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MASSAGE THRPY-15 MIN,97124,CPT,,,,,both,, ,318.84,191.30,Medicaid,Illinois Medicaid,,469.06,,,318.84,35.07,165.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MASSG THRP-15MN COTA,97124,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,60.00,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MASSG THRP-15MN COTA,97124,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,151.80,,,341.45,37.56,177.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MASSG THRPY-15MN PTA,97124,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,90.84,,,74.93,8.24,38.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MASSG THRPY-15MN PTA,97124,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,90.84,,,74.93,8.24,38.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MASSG THRPY-15MN PTA,97124,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,304.67,,,74.93,8.24,38.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MASSG THRPY-15MN PTA,97124,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,304.67,,,74.93,8.24,38.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MASSG THRPY-15MN PTA,97124,CPT,,,,,both,, ,314.92,188.95,Medicaid,Illinois Medicaid,,284.47,,,314.92,34.64,163.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MASSG THRPY-15MN PTA,97124,CPT,,,,,both,, ,314.92,188.95,Medicaid,Illinois Medicaid,,238.86,,,314.92,34.64,163.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV IN15 COTA,97129,CPT,,,,,both,, ,398.10,238.86,Medicaid,Illinois Medicaid,,238.86,,,398.10,43.79,207.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV INI15 OT,97129,CPT,,,,,both,, ,398.10,238.86,Medicaid,Illinois Medicaid,,62.57,,,398.10,43.79,207.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV INI15 PTA,97129,CPT,,,,,both,, ,84.46,50.67,Medicaid,Illinois Medicaid,,62.57,,,84.46,9.29,43.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV INI15 PTA,97129,CPT,,,,,both,, ,84.46,50.67,Medicaid,Illinois Medicaid,,62.57,,,84.46,9.29,43.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV INI15 PTA,97129,CPT,,,,,both,, ,84.46,50.67,Medicaid,Illinois Medicaid,,62.57,,,84.46,9.29,43.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV INI15 PTA,97129,CPT,,,,,both,, ,84.46,50.67,Medicaid,Illinois Medicaid,,220.32,,,84.46,9.29,43.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV INI15 PTA,97129,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,220.32,,,448.57,49.34,233.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV INI15 PTA,97129,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,205.63,,,448.57,49.34,233.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV INI15 SP,97129,CPT,,,,,both,, ,398.10,238.86,Medicaid,Illinois Medicaid,,222.93,,,398.10,43.79,207.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV AD15 COTA,97130,CPT,,,,,both,, ,398.10,238.86,Medicaid,Illinois Medicaid,,100.73,,,398.10,43.79,207.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV ADD15 OT,97130,CPT,,,,,both,, ,398.10,238.86,Medicaid,Illinois Medicaid,,54.07,,,398.10,43.79,207.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV ADD15 PTA,97130,CPT,,,,,both,, ,84.46,50.67,Medicaid,Illinois Medicaid,,54.07,,,84.46,9.29,43.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV ADD15 PTA,97130,CPT,,,,,both,, ,84.46,50.67,Medicaid,Illinois Medicaid,,412.36,,,84.46,9.29,43.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV ADD15 PTA,97130,CPT,,,,,both,, ,84.46,50.67,Medicaid,Illinois Medicaid,,412.36,,,84.46,9.29,43.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV ADD15 PTA,97130,CPT,,,,,both,, ,84.46,50.67,Medicaid,Illinois Medicaid,,384.95,,,84.46,9.29,43.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV ADD15 PTA,97130,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,205.63,,,448.57,49.34,233.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV ADD15 PTA,97130,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,222.93,,,448.57,49.34,233.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COG SKL DV ADD15 SP,97130,CPT,,,,,both,, ,398.10,238.86,Medicaid,Illinois Medicaid,,238.86,,,398.10,43.79,207.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MANUAL THRPY-15 MIN,97140,CPT,,,,,both,, ,342.72,205.63,Medicaid,Illinois Medicaid,,238.86,,,342.72,37.70,178.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MANUAL THRPY-15 MIN,97140,CPT,,,,,both,, ,454.13,272.47,Medicaid,Illinois Medicaid,,54.07,,,454.13,49.95,236.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MNL THRPY-15 MIN PTA,97140,CPT,,,,,both,, ,73.65,44.19,Medicaid,Illinois Medicaid,,54.07,,,73.65,8.10,38.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MNL THRPY-15 MIN PTA,97140,CPT,,,,,both,, ,73.65,44.19,Medicaid,Illinois Medicaid,,54.07,,,73.65,8.10,38.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MNL THRPY-15 MIN PTA,97140,CPT,,,,,both,, ,73.65,44.19,Medicaid,Illinois Medicaid,,54.07,,,73.65,8.10,38.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MNL THRPY-15 MIN PTA,97140,CPT,,,,,both,, ,73.65,44.19,Medicaid,Illinois Medicaid,,220.32,,,73.65,8.10,38.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MNL THRPY-15 MIN PTA,97140,CPT,,,,,both,, ,367.20,220.32,Medicaid,Illinois Medicaid,,220.32,,,367.20,40.39,190.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MNL THRPY-15 MIN PTA,97140,CPT,,,,,both,, ,367.20,220.32,Medicaid,Illinois Medicaid,,291.85,,,367.20,40.39,190.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MNL THRPY-15MIN COTA,97140,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,291.85,,,486.42,53.51,252.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MNL THRPY-15MIN COTA,97140,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,52.06,,,486.42,53.51,252.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GROUP THRP PROC-VIST,97150,CPT,,,,,both,, ,341.23,204.73,Medicaid,Illinois Medicaid,,52.06,,,341.23,37.54,177.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GROUP THRP PROC-VIST,97150,CPT,,,,,both,, ,369.92,221.95,Medicaid,Illinois Medicaid,,52.06,,,369.92,40.69,192.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GRP THR PRC-VST COTA,97150,CPT,,,,,both,, ,396.29,237.77,Medicaid,Illinois Medicaid,,52.06,,,396.29,43.59,206.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GRP THR PRC-VST COTA,97150,CPT,,,,,both,, ,396.29,237.77,Medicaid,Illinois Medicaid,,269.14,,,396.29,43.59,206.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GRP THRP PRC-VST PTA,97150,CPT,,,,,both,, ,48.67,29.20,Medicaid,Illinois Medicaid,,269.14,,,48.67,5.35,25.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GRP THRP PRC-VST PTA,97150,CPT,,,,,both,, ,48.67,29.20,Medicaid,Illinois Medicaid,,251.31,,,48.67,5.35,25.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GRP THRP PRC-VST PTA,97150,CPT,,,,,both,, ,48.67,29.20,Medicaid,Illinois Medicaid,,272.47,,,48.67,5.35,25.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GRP THRP PRC-VST PTA,97150,CPT,,,,,both,, ,48.67,29.20,Medicaid,Illinois Medicaid,,251.31,,,48.67,5.35,25.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GRP THRP PRC-VST PTA,97150,CPT,,,,,both,, ,365.65,219.39,Medicaid,Illinois Medicaid,,272.47,,,365.65,40.22,190.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GRP THRP PRC-VST PTA,97150,CPT,,,,,both,, ,365.65,219.39,Medicaid,Illinois Medicaid,,52.53,,,365.65,40.22,190.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT EVAL- LOW CMP PTA,97161,CPT,,,,,both,, ,223.77,134.26,Medicaid,Illinois Medicaid,,52.53,,,223.77,24.61,116.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT EVAL- LOW CMP PTA,97161,CPT,,,,,both,, ,223.77,134.26,Medicaid,Illinois Medicaid,,52.53,,,223.77,24.61,116.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT EVAL- LOW CMP PTA,97161,CPT,,,,,both,, ,721.00,432.60,Medicaid,Illinois Medicaid,,52.53,,,721.00,79.31,374.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT EVAL- LOW CMP PTA,97161,CPT,,,,,both,, ,721.00,432.60,Medicaid,Illinois Medicaid,,269.14,,,721.00,79.31,374.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT EVAL- LOW COMP,97161,CPT,,,,,both,, ,673.18,403.90,Medicaid,Illinois Medicaid,,269.14,,,673.18,74.05,350.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT-EVAL LOW 15M MCD,97161,CPT,,,,,both,, ,700.00,420.00,Medicaid,Illinois Medicaid,,291.85,,,700.00,77.00,364,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT EVAL- MOD CMP PTA,97162,CPT,,,,,both,, ,223.77,134.26,Medicaid,Illinois Medicaid,,291.85,,,223.77,24.61,116.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT EVAL- MOD CMP PTA,97162,CPT,,,,,both,, ,223.77,134.26,Medicaid,Illinois Medicaid,,123.60,,,223.77,24.61,116.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT EVAL- MOD CMP PTA,97162,CPT,,,,,both,, ,360.50,216.30,Medicaid,Illinois Medicaid,,123.60,,,360.50,39.66,187.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT EVAL- MOD CMP PTA,97162,CPT,,,,,both,, ,360.50,216.30,Medicaid,Illinois Medicaid,,673.00,,,360.50,39.66,187.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT EVAL- MOD COMP,97162,CPT,,,,,both,, ,673.18,403.90,Medicaid,Illinois Medicaid,,673.00,,,673.18,74.05,350.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT-EVAL MOD 15M MCD,97162,CPT,,,,,both,, ,350.00,210.00,Medicaid,Illinois Medicaid,,673.00,,,350.00,38.50,182,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT EVAL- HGH CMP PTA,97163,CPT,,,,,both,, ,224.03,134.41,Medicaid,Illinois Medicaid,,673.00,,,224.03,24.64,116.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT EVAL- HGH CMP PTA,97163,CPT,,,,,both,, ,224.03,134.41,Medicaid,Illinois Medicaid,,729.55,,,224.03,24.64,116.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT EVAL- HGH CMP PTA,97163,CPT,,,,,both,, ,721.00,432.60,Medicaid,Illinois Medicaid,,729.55,,,721.00,79.31,374.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT EVAL- HGH CMP PTA,97163,CPT,,,,,both,, ,721.00,432.60,Medicaid,Illinois Medicaid,,628.24,,,721.00,79.31,374.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT EVAL- HGH COMP,97163,CPT,,,,,both,, ,673.18,403.90,Medicaid,Illinois Medicaid,,681.08,,,673.18,74.05,350.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT-EVAL HGH 15M MCD,97163,CPT,,,,,both,, ,233.25,139.95,Medicaid,Illinois Medicaid,,364.77,,,233.25,25.66,121.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT RE-EVAL-VISIT,97164,CPT,,,,,both,, ,437.36,262.41,Medicaid,Illinois Medicaid,,364.77,,,437.36,48.11,227.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT RE-EVAL-VISIT PTA,97164,CPT,,,,,both,, ,151.41,90.84,Medicaid,Illinois Medicaid,,276.33,,,151.41,16.66,78.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT RE-EVAL-VISIT PTA,97164,CPT,,,,,both,, ,151.41,90.84,Medicaid,Illinois Medicaid,,340.54,,,151.41,16.66,78.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT RE-EVAL-VISIT PTA,97164,CPT,,,,,both,, ,468.39,281.03,Medicaid,Illinois Medicaid,,61.80,,,468.39,51.52,243.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PT RE-EVAL-VISIT PTA,97164,CPT,,,,,both,, ,468.39,281.03,Medicaid,Illinois Medicaid,,61.80,,,468.39,51.52,243.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT EVAL- LOW CMP OT,97165,CPT,,,,,both,, ,223.77,134.26,Medicaid,Illinois Medicaid,,61.80,,,223.77,24.61,116.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT EVAL- LOW COMP,97165,CPT,,,,,both,, ,729.80,437.88,Medicaid,Illinois Medicaid,,61.80,,,729.80,80.28,379.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT EVAL-LOW CMP COTA,97165,CPT,,,,,both,, ,781.77,469.06,Medicaid,Illinois Medicaid,,296.02,,,781.77,85.99,406.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT EVAL-LOW CMP COTA,97165,CPT,,,,,both,, ,781.77,469.06,Medicaid,Illinois Medicaid,,296.02,,,781.77,85.99,406.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT-EVAL LOW 15M MCD,97165,CPT,,,,,both,, ,100.00,60.00,Medicaid,Illinois Medicaid,,439.09,,,100.00,11.00,52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT-EVAL LOW 15M MCD,97165,CPT,,,,,both,, ,759.00,455.40,Medicaid,Illinois Medicaid,,439.09,,,759.00,83.49,394.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT EVAL- MOD CMP OT,97166,CPT,,,,,both,, ,223.77,134.26,Medicaid,Illinois Medicaid,,268.52,,,223.77,24.61,116.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT EVAL- MOD COMP,97166,CPT,,,,,both,, ,729.80,437.88,Medicaid,Illinois Medicaid,,268.52,,,729.80,80.28,379.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT EVAL-MOD CMP COTA,97166,CPT,,,,,both,, ,390.89,234.53,Medicaid,Illinois Medicaid,,268.52,,,390.89,43.00,203.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT EVAL-MOD CMP COTA,97166,CPT,,,,,both,, ,390.89,234.53,Medicaid,Illinois Medicaid,,268.52,,,390.89,43.00,203.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT-EVAL MOD 15M MCD,97166,CPT,,,,,both,, ,100.00,60.00,Medicaid,Illinois Medicaid,,405.10,,,100.00,11.00,52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT-EVAL MOD 15M MCD,97166,CPT,,,,,both,, ,379.50,227.70,Medicaid,Illinois Medicaid,,405.10,,,379.50,41.75,197.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT EVAL- HGH CMP OT,97167,CPT,,,,,both,, ,223.77,134.26,Medicaid,Illinois Medicaid,,151.35,,,223.77,24.61,116.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT EVAL- HGH COMP,97167,CPT,,,,,both,, ,729.80,437.88,Medicaid,Illinois Medicaid,,151.35,,,729.80,80.28,379.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT EVAL-HGH CMP COTA,97167,CPT,,,,,both,, ,781.77,469.06,Medicaid,Illinois Medicaid,,155.89,,,781.77,85.99,406.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT EVAL-HGH CMP COTA,97167,CPT,,,,,both,, ,781.77,469.06,Medicaid,Illinois Medicaid,,155.89,,,781.77,85.99,406.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT-EVAL HGH 15M MCD,97167,CPT,,,,,both,, ,100.00,60.00,Medicaid,Illinois Medicaid,,378.15,,,100.00,11.00,52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT-EVAL HGH 15M MCD,97167,CPT,,,,,both,, ,253.00,151.80,Medicaid,Illinois Medicaid,,409.97,,,253.00,27.83,131.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT RE-EVAL VIST COTA,97168,CPT,,,,,both,, ,151.41,90.84,Medicaid,Illinois Medicaid,,517.00,,,151.41,16.66,78.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT RE-EVAL VIST COTA,97168,CPT,,,,,both,, ,151.41,90.84,Medicaid,Illinois Medicaid,,457.80,,,151.41,16.66,78.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT RE-EVAL VIST COTA,97168,CPT,,,,,both,, ,507.79,304.67,Medicaid,Illinois Medicaid,,270.37,,,507.79,55.86,264.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT RE-EVAL VIST COTA,97168,CPT,,,,,both,, ,507.79,304.67,Medicaid,Illinois Medicaid,,270.37,,,507.79,55.86,264.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OT RE-EVAL-VISIT,97168,CPT,,,,,both,, ,474.13,284.47,Medicaid,Illinois Medicaid,,293.08,,,474.13,52.15,246.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER ACTV-15MIN COTA,97530,CPT,,,,,both,, ,398.10,238.86,Medicaid,Illinois Medicaid,,293.08,,,398.10,43.79,207.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER ACTV-15MIN COTA,97530,CPT,,,,,both,, ,398.10,238.86,Medicaid,Illinois Medicaid,,270.37,,,398.10,43.79,207.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER ACTVT-15MIN PTA,97530,CPT,,,,,both,, ,104.29,62.57,Medicaid,Illinois Medicaid,,270.37,,,104.29,11.47,54.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER ACTVT-15MIN PTA,97530,CPT,,,,,both,, ,104.29,62.57,Medicaid,Illinois Medicaid,,270.37,,,104.29,11.47,54.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER ACTVT-15MIN PTA,97530,CPT,,,,,both,, ,104.29,62.57,Medicaid,Illinois Medicaid,,270.37,,,104.29,11.47,54.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER ACTVT-15MIN PTA,97530,CPT,,,,,both,, ,104.29,62.57,Medicaid,Illinois Medicaid,,151.35,,,104.29,11.47,54.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER ACTVT-15MIN PTA,97530,CPT,,,,,both,, ,367.20,220.32,Medicaid,Illinois Medicaid,,151.35,,,367.20,40.39,190.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THER ACTVT-15MIN PTA,97530,CPT,,,,,both,, ,367.20,220.32,Medicaid,Illinois Medicaid,,155.89,,,367.20,40.39,190.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAP ACTVTS-15 MIN,97530,CPT,,,,,both,, ,342.72,205.63,Medicaid,Illinois Medicaid,,155.89,,,342.72,37.70,178.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THERAP ACTVTS-15 MIN,97530,CPT,,,,,both,, ,371.55,222.93,Medicaid,Illinois Medicaid,,252.34,,,371.55,40.87,193.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SENS INTG-15 MIN,97533,CPT,,,,,both,, ,167.89,100.73,Medicaid,Illinois Medicaid,,273.56,,,167.89,18.47,87.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SENS INTG-15MIN COTA,97533,CPT,,,,,both,, ,90.13,54.07,Medicaid,Illinois Medicaid,,345.06,,,90.13,9.91,46.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SENS INTG-15MIN COTA,97533,CPT,,,,,both,, ,90.13,54.07,Medicaid,Illinois Medicaid,,457.80,,,90.13,9.91,46.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SENS INTG-15MIN COTA,97533,CPT,,,,,both,, ,687.27,412.36,Medicaid,Illinois Medicaid,,313.02,,,687.27,75.60,357.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SENS INTG-15MIN COTA,97533,CPT,,,,,both,, ,687.27,412.36,Medicaid,Illinois Medicaid,,313.02,,,687.27,75.60,357.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SENSORY INTEG-15 MIN,97533,CPT,,,,,both,, ,641.59,384.95,Medicaid,Illinois Medicaid,,268.52,,,641.59,70.57,333.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SELF CARE MGT-15 MIN,97535,CPT,,,,,both,, ,342.72,205.63,Medicaid,Illinois Medicaid,,268.52,,,342.72,37.70,178.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SELF CARE MGT-15 MIN,97535,CPT,,,,,both,, ,371.55,222.93,Medicaid,Illinois Medicaid,,268.52,,,371.55,40.87,193.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SLF CR MGT-15MN COTA,97535,CPT,,,,,both,, ,398.10,238.86,Medicaid,Illinois Medicaid,,268.52,,,398.10,43.79,207.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SLF CR MGT-15MN COTA,97535,CPT,,,,,both,, ,398.10,238.86,Medicaid,Illinois Medicaid,,288.76,,,398.10,43.79,207.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SLF CRE MGT-15MN PTA,97535,CPT,,,,,both,, ,90.13,54.07,Medicaid,Illinois Medicaid,,288.76,,,90.13,9.91,46.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SLF CRE MGT-15MN PTA,97535,CPT,,,,,both,, ,90.13,54.07,Medicaid,Illinois Medicaid,,269.59,,,90.13,9.91,46.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SLF CRE MGT-15MN PTA,97535,CPT,,,,,both,, ,90.13,54.07,Medicaid,Illinois Medicaid,,292.27,,,90.13,9.91,46.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SLF CRE MGT-15MN PTA,97535,CPT,,,,,both,, ,90.13,54.07,Medicaid,Illinois Medicaid,,94.86,,,90.13,9.91,46.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SLF CRE MGT-15MN PTA,97535,CPT,,,,,both,, ,367.20,220.32,Medicaid,Illinois Medicaid,,94.86,,,367.20,40.39,190.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SLF CRE MGT-15MN PTA,97535,CPT,,,,,both,, ,367.20,220.32,Medicaid,Illinois Medicaid,,457.80,,,367.20,40.39,190.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CM-WK REIN-15MN COTA,97537,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,88.06,,,486.42,53.51,252.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CM-WK REIN-15MN COTA,97537,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,94.86,,,486.42,53.51,252.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COM-WK REIN-15MN PTA,97537,CPT,,,,,both,, ,86.78,52.06,Medicaid,Illinois Medicaid,,94.86,,,86.78,9.55,45.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COM-WK REIN-15MN PTA,97537,CPT,,,,,both,, ,86.78,52.06,Medicaid,Illinois Medicaid,,457.80,,,86.78,9.55,45.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COM-WK REIN-15MN PTA,97537,CPT,,,,,both,, ,86.78,52.06,Medicaid,Illinois Medicaid,,144.76,,,86.78,9.55,45.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COM-WK REIN-15MN PTA,97537,CPT,,,,,both,, ,86.78,52.06,Medicaid,Illinois Medicaid,,155.89,,,86.78,9.55,45.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COM-WK REIN-15MN PTA,97537,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,155.89,,,448.57,49.34,233.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COM-WK REIN-15MN PTA,97537,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,912.00,,,448.57,49.34,233.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COM-WRK REINT-15 MIN,97537,CPT,,,,,both,, ,418.86,251.31,Medicaid,Illinois Medicaid,,277.94,,,418.86,46.07,217.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COM-WRK REINT-15 MIN,97537,CPT,,,,,both,, ,454.13,272.47,Medicaid,Illinois Medicaid,,277.94,,,454.13,49.95,236.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHEELCHR MGT-15 MIN,97542,CPT,,,,,both,, ,418.86,251.31,Medicaid,Illinois Medicaid,,912.00,,,418.86,46.07,217.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHEELCHR MGT-15 MIN,97542,CPT,,,,,both,, ,454.13,272.47,Medicaid,Illinois Medicaid,,551.87,,,454.13,49.95,236.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHLCHR MGT-15MIN PTA,97542,CPT,,,,,both,, ,87.55,52.53,Medicaid,Illinois Medicaid,,55.15,,,87.55,9.63,45.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHLCHR MGT-15MIN PTA,97542,CPT,,,,,both,, ,87.55,52.53,Medicaid,Illinois Medicaid,,55.15,,,87.55,9.63,45.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHLCHR MGT-15MIN PTA,97542,CPT,,,,,both,, ,87.55,52.53,Medicaid,Illinois Medicaid,,55.15,,,87.55,9.63,45.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHLCHR MGT-15MIN PTA,97542,CPT,,,,,both,, ,87.55,52.53,Medicaid,Illinois Medicaid,,55.15,,,87.55,9.63,45.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHLCHR MGT-15MIN PTA,97542,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,561.60,,,448.57,49.34,233.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHLCHR MGT-15MIN PTA,97542,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,561.60,,,448.57,49.34,233.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHLCHR MGT-15MN COTA,97542,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,608.73,,,486.42,53.51,252.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WHLCHR MGT-15MN COTA,97542,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,608.73,,,486.42,53.51,252.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WK HR-CD 1ST 2HR PTA,97545,CPT,,,,,both,, ,206.00,123.60,Medicaid,Illinois Medicaid,,524.20,,,206.00,22.66,107.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WK HR-CD 1ST 2HR PTA,97545,CPT,,,,,both,, ,206.00,123.60,Medicaid,Illinois Medicaid,,568.26,,,206.00,22.66,107.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WK HR-CD 1ST 2HR PTA,97545,CPT,,,,,both,, ,1121.67,673.00,Medicaid,Illinois Medicaid,,205.63,,,1121.67,123.38,583.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WK HR-CD 1ST 2HR PTA,97545,CPT,,,,,both,, ,1121.67,673.00,Medicaid,Illinois Medicaid,,222.93,,,1121.67,123.38,583.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WK HR-CD 1ST 2HR PTA,97545,CPT,,,,,both,, ,1121.67,673.00,Medicaid,Illinois Medicaid,,238.86,,,1121.67,123.38,583.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WK HR-CD 1ST 2HR PTA,97545,CPT,,,,,both,, ,1121.67,673.00,Medicaid,Illinois Medicaid,,238.86,,,1121.67,123.38,583.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WK HR-CD IN 2HR COTA,97545,CPT,,,,,both,, ,1215.92,729.55,Medicaid,Illinois Medicaid,,74.47,,,1215.92,133.75,632.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WK HR-CD IN 2HR COTA,97545,CPT,,,,,both,, ,1215.92,729.55,Medicaid,Illinois Medicaid,,74.47,,,1215.92,133.75,632.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WRK HAR-CND 1ST 2HRS,97545,CPT,,,,,both,, ,1047.07,628.24,Medicaid,Illinois Medicaid,,74.47,,,1047.07,115.18,544.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WRK HAR-CND 1ST 2HRS,97545,CPT,,,,,both,, ,1135.14,681.08,Medicaid,Illinois Medicaid,,74.47,,,1135.14,124.87,590.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WK HAR-CND-ADHR COTA,97546,CPT,,,,,both,, ,607.96,364.77,Medicaid,Illinois Medicaid,,220.32,,,607.96,66.88,316.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WK HAR-CND-ADHR COTA,97546,CPT,,,,,both,, ,607.96,364.77,Medicaid,Illinois Medicaid,,220.32,,,607.96,66.88,316.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WRK HAR-CND-ADD HR,97546,CPT,,,,,both,, ,460.55,276.33,Medicaid,Illinois Medicaid,,205.63,,,460.55,50.66,239.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WRK HAR-CND-ADD HR,97546,CPT,,,,,both,, ,567.57,340.54,Medicaid,Illinois Medicaid,,222.93,,,567.57,62.43,295.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WRK HAR-CND-ADHR PTA,97546,CPT,,,,,both,, ,103.00,61.80,Medicaid,Illinois Medicaid,,238.86,,,103.00,11.33,53.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WRK HAR-CND-ADHR PTA,97546,CPT,,,,,both,, ,103.00,61.80,Medicaid,Illinois Medicaid,,238.86,,,103.00,11.33,53.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WRK HAR-CND-ADHR PTA,97546,CPT,,,,,both,, ,103.00,61.80,Medicaid,Illinois Medicaid,,64.42,,,103.00,11.33,53.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WRK HAR-CND-ADHR PTA,97546,CPT,,,,,both,, ,103.00,61.80,Medicaid,Illinois Medicaid,,64.42,,,103.00,11.33,53.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WRK HAR-CND-ADHR PTA,97546,CPT,,,,,both,, ,493.37,296.02,Medicaid,Illinois Medicaid,,64.42,,,493.37,54.27,256.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WRK HAR-CND-ADHR PTA,97546,CPT,,,,,both,, ,493.37,296.02,Medicaid,Illinois Medicaid,,64.42,,,493.37,54.27,256.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRD LE 20SQCM COTA,97597,CPT,,,,,both,, ,731.82,439.09,Medicaid,Illinois Medicaid,,220.32,,,731.82,80.50,380.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRD LE 20SQCM COTA,97597,CPT,,,,,both,, ,731.82,439.09,Medicaid,Illinois Medicaid,,220.32,,,731.82,80.50,380.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRDE LE 20SQCM PTA,97597,CPT,,,,,both,, ,447.54,268.52,Medicaid,Illinois Medicaid,,190.97,,,447.54,49.23,232.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRDE LE 20SQCM PTA,97597,CPT,,,,,both,, ,447.54,268.52,Medicaid,Illinois Medicaid,,215.31,,,447.54,49.23,232.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRDE LE 20SQCM PTA,97597,CPT,,,,,both,, ,447.54,268.52,Medicaid,Illinois Medicaid,,204.55,,,447.54,49.23,232.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRDE LE 20SQCM PTA,97597,CPT,,,,,both,, ,447.54,268.52,Medicaid,Illinois Medicaid,,204.55,,,447.54,49.23,232.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRDE LE 20SQCM PTA,97597,CPT,,,,,both,, ,675.17,405.10,Medicaid,Illinois Medicaid,,78.64,,,675.17,74.27,351.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRDE LE 20SQCM PTA,97597,CPT,,,,,both,, ,675.17,405.10,Medicaid,Illinois Medicaid,,78.64,,,675.17,74.27,351.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,252.25,151.35,Medicaid,Illinois Medicaid,,78.64,,,252.25,27.75,131.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,252.25,151.35,Medicaid,Illinois Medicaid,,78.64,,,252.25,27.75,131.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,259.82,155.89,Medicaid,Illinois Medicaid,,230.67,,,259.82,28.58,135.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,259.82,155.89,Medicaid,Illinois Medicaid,,230.67,,,259.82,28.58,135.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,630.26,378.15,Medicaid,Illinois Medicaid,,116.64,,,630.26,69.33,327.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,683.29,409.97,Medicaid,Illinois Medicaid,,60.87,,,683.29,75.16,355.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,861.67,517.00,Medicaid,Illinois Medicaid,,133.95,,,861.67,94.78,448.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SLCTV WND DEB =<20CM,97597,CPT,,,,,both,, ,763.00,457.80,Medicaid,Illinois Medicaid,,42.00,,,763.00,83.93,396.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRD EA AD20CM COTA,97598,CPT,,,,,both,, ,450.63,270.37,Medicaid,Illinois Medicaid,,12.79,,,450.63,49.57,234.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRD EA AD20CM COTA,97598,CPT,,,,,both,, ,450.63,270.37,Medicaid,Illinois Medicaid,,188.02,,,450.63,49.57,234.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRD EA AD20CM COTA,97598,CPT,,,,,both,, ,488.48,293.08,Medicaid,Illinois Medicaid,,250.75,,,488.48,53.73,254.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRD EA AD20CM COTA,97598,CPT,,,,,both,, ,488.48,293.08,Medicaid,Illinois Medicaid,,594.07,,,488.48,53.73,254.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRDE EA AD20CM PTA,97598,CPT,,,,,both,, ,450.63,270.37,Medicaid,Illinois Medicaid,,160.06,,,450.63,49.57,234.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRDE EA AD20CM PTA,97598,CPT,,,,,both,, ,450.63,270.37,Medicaid,Illinois Medicaid,,658.96,,,450.63,49.57,234.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRDE EA AD20CM PTA,97598,CPT,,,,,both,, ,450.63,270.37,Medicaid,Illinois Medicaid,,658.96,,,450.63,49.57,234.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRDE EA AD20CM PTA,97598,CPT,,,,,both,, ,450.63,270.37,Medicaid,Illinois Medicaid,,1155.08,,,450.63,49.57,234.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,252.25,151.35,Medicaid,Illinois Medicaid,,2096.47,,,252.25,27.75,131.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,252.25,151.35,Medicaid,Illinois Medicaid,,3905.47,,,252.25,27.75,131.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,259.82,155.89,Medicaid,Illinois Medicaid,,5155.54,,,259.82,28.58,135.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,259.82,155.89,Medicaid,Illinois Medicaid,,7371.25,,,259.82,28.58,135.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,420.57,252.34,Medicaid,Illinois Medicaid,,2651.02,,,420.57,46.26,218.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,455.94,273.56,Medicaid,Illinois Medicaid,,76.47,,,455.94,50.15,237.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,575.10,345.06,Medicaid,Illinois Medicaid,,76.47,,,575.10,63.26,299.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SLCTV WND DEB >20 CM,97598,CPT,,,,,both,, ,763.00,457.80,Medicaid,Illinois Medicaid,,1468.36,,,763.00,83.93,396.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DBRD NONSEL-VIS COTA,97602,CPT,,,,,both,, ,521.70,313.02,Medicaid,Illinois Medicaid,,278.25,,,521.70,57.39,271.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DBRD NONSEL-VIS COTA,97602,CPT,,,,,both,, ,521.70,313.02,Medicaid,Illinois Medicaid,,355.80,,,521.70,57.39,271.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DBRD NON-SEL-VIS PTA,97602,CPT,,,,,both,, ,447.54,268.52,Medicaid,Illinois Medicaid,,323.98,,,447.54,49.23,232.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DBRD NON-SEL-VIS PTA,97602,CPT,,,,,both,, ,447.54,268.52,Medicaid,Illinois Medicaid,,8.49,,,447.54,49.23,232.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DBRD NON-SEL-VIS PTA,97602,CPT,,,,,both,, ,447.54,268.52,Medicaid,Illinois Medicaid,,8.49,,,447.54,49.23,232.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DBRD NON-SEL-VIS PTA,97602,CPT,,,,,both,, ,447.54,268.52,Medicaid,Illinois Medicaid,,8.49,,,447.54,49.23,232.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DBRD NON-SEL-VIS PTA,97602,CPT,,,,,both,, ,481.27,288.76,Medicaid,Illinois Medicaid,,8.49,,,481.27,52.94,250.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DBRD NON-SEL-VIS PTA,97602,CPT,,,,,both,, ,481.27,288.76,Medicaid,Illinois Medicaid,,6.79,,,481.27,52.94,250.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRIDE NON-SELC-VIS,97602,CPT,,,,,both,, ,449.32,269.59,Medicaid,Illinois Medicaid,,5.00,,,449.32,49.43,233.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEBRIDE NON-SELC-VIS,97602,CPT,,,,,both,, ,487.13,292.27,Medicaid,Illinois Medicaid,,5.00,,,487.13,53.58,253.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NON SELECTIVE DEBRID,97602,CPT,,,,,both,, ,158.11,94.86,Medicaid,Illinois Medicaid,,5.00,,,158.11,17.39,82.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NON SELECTIVE DEBRID,97602,CPT,,,,,both,, ,158.11,94.86,Medicaid,Illinois Medicaid,,5.00,,,158.11,17.39,82.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NSW DEB WO A/SESSION,97602,CPT,,,,,both,, ,763.00,457.80,Medicaid,Illinois Medicaid,,4.02,,,763.00,83.93,396.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,146.78,88.06,Medicaid,Illinois Medicaid,,4.02,,,146.78,16.15,76.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,158.11,94.86,Medicaid,Illinois Medicaid,,5.62,,,158.11,17.39,82.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,158.11,94.86,Medicaid,Illinois Medicaid,,6.49,,,158.11,17.39,82.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEG PRESS WND TX <50,97605,CPT,,,,,both,, ,763.00,457.80,Medicaid,Illinois Medicaid,,6.49,,,763.00,83.93,396.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,241.28,144.76,Medicaid,Illinois Medicaid,,4.20,,,241.28,26.54,125.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,259.82,155.89,Medicaid,Illinois Medicaid,,4.20,,,259.82,28.58,135.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,259.82,155.89,Medicaid,Illinois Medicaid,,4.20,,,259.82,28.58,135.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEG PRESS WND TX >50,97606,CPT,,,,,both,, ,1520.00,912.00,Medicaid,Illinois Medicaid,,4.20,,,1520.00,167.20,790.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEG PR WN MD LT 50CM,97607,CPT,,,,,both,, ,463.24,277.94,Medicaid,Illinois Medicaid,,4.02,,,463.24,50.96,240.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEG PR WN MD LT 50CM,97607,CPT,,,,,both,, ,463.24,277.94,Medicaid,Illinois Medicaid,,57.31,,,463.24,50.96,240.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEG PRES WND TX <=50,97607,CPT,,,,,both,, ,1520.00,912.00,Medicaid,Illinois Medicaid,,81.27,,,1520.00,167.20,790.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEG PR WN MD GT 50CM,97608,CPT,,,,,both,, ,919.79,551.87,Medicaid,Illinois Medicaid,,81.27,,,919.79,101.18,478.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYS PERF-15 MIN PTA,97750,CPT,,,,,both,, ,91.93,55.15,Medicaid,Illinois Medicaid,,8.19,,,91.93,10.11,47.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYS PERF-15 MIN PTA,97750,CPT,,,,,both,, ,91.93,55.15,Medicaid,Illinois Medicaid,,453.15,,,91.93,10.11,47.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYS PERF-15 MIN PTA,97750,CPT,,,,,both,, ,91.93,55.15,Medicaid,Illinois Medicaid,,12.51,,,91.93,10.11,47.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYS PERF-15 MIN PTA,97750,CPT,,,,,both,, ,91.93,55.15,Medicaid,Illinois Medicaid,,1470.68,,,91.93,10.11,47.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYS PERF-15 MIN PTA,97750,CPT,,,,,both,, ,936.01,561.60,Medicaid,Illinois Medicaid,,1823.41,,,936.01,102.96,486.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYS PERF-15 MIN PTA,97750,CPT,,,,,both,, ,936.01,561.60,Medicaid,Illinois Medicaid,,1911.78,,,936.01,102.96,486.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYS PERF-15MIN COTA,97750,CPT,,,,,both,, ,1014.55,608.73,Medicaid,Illinois Medicaid,,2588.34,,,1014.55,111.60,527.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYS PERF-15MIN COTA,97750,CPT,,,,,both,, ,1014.55,608.73,Medicaid,Illinois Medicaid,,2764.62,,,1014.55,111.60,527.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYSICAL PERF-15 MIN,97750,CPT,,,,,both,, ,873.68,524.20,Medicaid,Illinois Medicaid,,4882.04,,,873.68,96.10,454.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYSICAL PERF-15 MIN,97750,CPT,,,,,both,, ,947.11,568.26,Medicaid,Illinois Medicaid,,5294.86,,,947.11,104.18,492.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ORTH TRAIN INI-15 MI,97760,CPT,,,,,both,, ,342.72,205.63,Medicaid,Illinois Medicaid,,5588.73,,,342.72,37.70,178.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ORTH TRAIN INI-15 MI,97760,CPT,,,,,both,, ,371.55,222.93,Medicaid,Illinois Medicaid,,6471.39,,,371.55,40.87,193.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ORTH TRN IN15MI COTA,97760,CPT,,,,,both,, ,398.10,238.86,Medicaid,Illinois Medicaid,,9787.42,,,398.10,43.79,207.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ORTH TRN IN15MI COTA,97760,CPT,,,,,both,, ,398.10,238.86,Medicaid,Illinois Medicaid,,20.94,,,398.10,43.79,207.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ORTH TRN INI15MI PTA,97760,CPT,,,,,both,, ,124.12,74.47,Medicaid,Illinois Medicaid,,20.94,,,124.12,13.65,64.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ORTH TRN INI15MI PTA,97760,CPT,,,,,both,, ,124.12,74.47,Medicaid,Illinois Medicaid,,35.08,,,124.12,13.65,64.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ORTH TRN INI15MI PTA,97760,CPT,,,,,both,, ,124.12,74.47,Medicaid,Illinois Medicaid,,35.08,,,124.12,13.65,64.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ORTH TRN INI15MI PTA,97760,CPT,,,,,both,, ,124.12,74.47,Medicaid,Illinois Medicaid,,20.55,,,124.12,13.65,64.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ORTH TRN INI15MI PTA,97760,CPT,,,,,both,, ,367.20,220.32,Medicaid,Illinois Medicaid,,20.55,,,367.20,40.39,190.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ORTH TRN INI15MI PTA,97760,CPT,,,,,both,, ,367.20,220.32,Medicaid,Illinois Medicaid,,20.55,,,367.20,40.39,190.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROS TRAIN INI-15 MI,97761,CPT,,,,,both,, ,342.72,205.63,Medicaid,Illinois Medicaid,,20.55,,,342.72,37.70,178.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROS TRAIN INI-15 MI,97761,CPT,,,,,both,, ,371.55,222.93,Medicaid,Illinois Medicaid,,6.79,,,371.55,40.87,193.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROS TRN IN15MI COTA,97761,CPT,,,,,both,, ,398.10,238.86,Medicaid,Illinois Medicaid,,60.40,,,398.10,43.79,207.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROS TRN IN15MI COTA,97761,CPT,,,,,both,, ,398.10,238.86,Medicaid,Illinois Medicaid,,193.74,,,398.10,43.79,207.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROS TRN INI15MI PTA,97761,CPT,,,,,both,, ,107.38,64.42,Medicaid,Illinois Medicaid,,0.67,,,107.38,11.81,55.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROS TRN INI15MI PTA,97761,CPT,,,,,both,, ,107.38,64.42,Medicaid,Illinois Medicaid,,7.57,,,107.38,11.81,55.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROS TRN INI15MI PTA,97761,CPT,,,,,both,, ,107.38,64.42,Medicaid,Illinois Medicaid,,7.57,,,107.38,11.81,55.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROS TRN INI15MI PTA,97761,CPT,,,,,both,, ,107.38,64.42,Medicaid,Illinois Medicaid,,4.20,,,107.38,11.81,55.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROS TRN INI15MI PTA,97761,CPT,,,,,both,, ,367.20,220.32,Medicaid,Illinois Medicaid,,4.20,,,367.20,40.39,190.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROS TRN INI15MI PTA,97761,CPT,,,,,both,, ,367.20,220.32,Medicaid,Illinois Medicaid,,4.20,,,367.20,40.39,190.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROS-ORTH SUB-15 MIN,97763,CPT,,,,,both,, ,318.29,190.97,Medicaid,Illinois Medicaid,,4.20,,,318.29,35.01,165.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROS-ORTH SUB-15 MIN,97763,CPT,,,,,both,, ,358.85,215.31,Medicaid,Illinois Medicaid,,5.13,,,358.85,39.47,186.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRS-ORT SUB15MN COTA,97763,CPT,,,,,both,, ,340.93,204.55,Medicaid,Illinois Medicaid,,5.13,,,340.93,37.50,177.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRS-ORT SUB15MN COTA,97763,CPT,,,,,both,, ,340.93,204.55,Medicaid,Illinois Medicaid,,5.13,,,340.93,37.50,177.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRS-ORT SUB-15MN PTA,97763,CPT,,,,,both,, ,131.07,78.64,Medicaid,Illinois Medicaid,,5.13,,,131.07,14.42,68.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRS-ORT SUB-15MN PTA,97763,CPT,,,,,both,, ,131.07,78.64,Medicaid,Illinois Medicaid,,4.02,,,131.07,14.42,68.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRS-ORT SUB-15MN PTA,97763,CPT,,,,,both,, ,131.07,78.64,Medicaid,Illinois Medicaid,,4.81,,,131.07,14.42,68.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRS-ORT SUB-15MN PTA,97763,CPT,,,,,both,, ,131.07,78.64,Medicaid,Illinois Medicaid,,5.80,,,131.07,14.42,68.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRS-ORT SUB-15MN PTA,97763,CPT,,,,,both,, ,384.45,230.67,Medicaid,Illinois Medicaid,,10.81,,,384.45,42.29,199.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRS-ORT SUB-15MN PTA,97763,CPT,,,,,both,, ,384.45,230.67,Medicaid,Illinois Medicaid,,65.50,,,384.45,42.29,199.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MNT INITIAL EA 15 MN,97802,CPT,,,,,both,, ,194.41,116.64,Medicaid,Illinois Medicaid,,65.50,,,194.41,21.39,101.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MNT REASSES EA 15 MN,97803,CPT,,,,,both,, ,101.46,60.87,Medicaid,Illinois Medicaid,,328.20,,,101.46,11.16,52.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MNT GROUP EA 30 MIN,97804,CPT,,,,,both,, ,223.25,133.95,Medicaid,Illinois Medicaid,,15.45,,,223.25,24.56,116.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LAB COLLECTION,99000,CPT,,,,,both,, ,70.00,42.00,Medicaid,Illinois Medicaid,,5.43,,,70.00,7.70,36.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SPEC CHAIN CUSTODY,99001,CPT,,,,,both,, ,21.33,12.79,Medicaid,Illinois Medicaid,,5.43,,,21.33,2.35,11.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MSED SAMEGT5 1ST15,99152,CPT,,,,,both,, ,313.38,188.02,Medicaid,Illinois Medicaid,,5.43,,,313.38,34.47,162.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MODSED SAME ADD15MIN,99153,CPT,,,,,both,, ,417.92,250.75,Medicaid,Illinois Medicaid,,5.43,,,417.92,45.97,217.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HBO COMM PER SESSION,99183,CPT,,,,,both,, ,990.13,594.07,Medicaid,Illinois Medicaid,,4.02,,,990.13,108.91,514.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHLEBOTOMY THERAPEUT,99195,CPT,,,,,both,, ,266.77,160.06,Medicaid,Illinois Medicaid,,3.03,,,266.77,29.34,138.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SUTURE REMOVAL/RECHE,99281,CPT,,,,,Outpatient,, ,1098.28,658.96,Medicaid,Illinois Medicaid,,20.08,,,1098.28,120.81,571.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SUTURE REMOVAL/RECHE,99281,CPT,,,,,Outpatient,, ,1098.28,658.96,Medicaid,Illinois Medicaid,,14.67,,,1098.28,120.81,571.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LIMITED ED VISIT,99282,CPT,,,,,Outpatient,, ,1925.14,1155.08,Medicaid,Illinois Medicaid,,14.67,,,1925.14,211.77,1001.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INTERMEDIATE ED VIST,99283,CPT,,,,,Outpatient,, ,3494.12,2096.47,Medicaid,Illinois Medicaid,,41.40,,,3494.12,384.35,1816.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EXTENDED ED VISIT,99284,CPT,,,,,Outpatient,, ,6509.13,3905.47,Medicaid,Illinois Medicaid,,2.59,,,6509.13,716.00,3384.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COMPREHENSIVE ED VST,99285,CPT,,,,,Outpatient,, ,8592.58,5155.54,Medicaid,Illinois Medicaid,,2.59,,,8592.58,945.18,4468.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CRITICAL CARE LT 74M,99291,CPT,,,,,both,, ,12285.42,7371.25,Medicaid,Illinois Medicaid,,21.01,,,12285.42,1351.40,6388.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CRIT CARE EA 30 MIN,99292,CPT,,,,,both,, ,4418.38,2651.02,Medicaid,Illinois Medicaid,,14.98,,,4418.38,486.02,2297.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BEHAV CHG SMOKE U 10,99406,CPT,,,,,both,, ,127.46,76.47,Medicaid,Illinois Medicaid,,14.55,,,127.46,14.02,66.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BEHAV CHG SMOKE GR10,99407,CPT,,,,,both,, ,127.46,76.47,Medicaid,Illinois Medicaid,,11.10,,,127.46,14.02,66.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEWBORN RESUCITATION,99465,CPT,,,,,both,, ,2447.28,1468.36,Medicaid,Illinois Medicaid,,11.89,,,2447.28,269.20,1272.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RESPIRATORY PANEL PCR,0202U,HCPCS,,,,,both,, ,500.00,300.00,Medicaid,Illinois Medicaid,,14.67,,,500.00,55.00,260,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COV19 FLUAB CEPHEID,0240U,CPT,,,,,both,, ,568.00,340.80,Medicaid,Illinois Medicaid,,300.00,,,568.00,62.48,295.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COV19 FLUAB RSV CEPH,0241U,CPT,,,,,both,, ,570.52,342.31,Medicaid,Illinois Medicaid,,340.80,,,570.52,62.76,296.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MVP MULTIPLEX VAGINAL DNA PROBE,0352U,HCPCS,,,,,both,, ,570.52,342.31,Medicaid,Illinois Medicaid,,342.31,,,570.52,62.76,296.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INTRATUBAL OCCLU DEV,A4264,HCPCS,,,,,both,, ,8176.40,4905.84,Medicaid,Illinois Medicaid,,342.31,,,8176.40,899.40,4251.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE MARKR IMPLT 1,A4648,HCPCS,,,,,both,, ,179.22,107.53,Medicaid,Illinois Medicaid,,4905.84,,,179.22,19.71,93.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE MARKR IMPLT 2,A4648,HCPCS,,,,,both,, ,1195.32,717.19,Medicaid,Illinois Medicaid,,107.53,,,1195.32,131.49,621.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE MARKR IMPLT 3,A4648,HCPCS,,,,,both,, ,2390.63,1434.37,Medicaid,Illinois Medicaid,,717.19,,,2390.63,262.97,1243.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COLLAGEN WITH SILVER (PUROCOL),A6022,HCPCS,,,,,both,, ,28.28,16.96,Medicaid,Illinois Medicaid,,1434.37,,,28.28,3.11,14.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ENDOFORM ANTIMICROBIAL,A6022,HCPCS,,,,,both,, ,41.56,24.93,Medicaid,Illinois Medicaid,,16.96,,,41.56,4.57,21.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COLLAGEN (PUROCOL),A6023,HCPCS,,,,,both,, ,19.80,11.88,Medicaid,Illinois Medicaid,,24.93,,,19.80,2.18,10.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONVAMAX PAD 4X4,A6196,HCPCS,,,,,both,, ,7.68,4.60,Medicaid,Illinois Medicaid,,11.88,,,7.68,0.84,3.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONVAMAX PAD 4X8,A6197,HCPCS,,,,,both,, ,8.88,5.32,Medicaid,Illinois Medicaid,,4.60,,,8.88,0.98,4.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONVAMAX PAD 6X8,A6197,HCPCS,,,,,both,, ,11.76,7.05,Medicaid,Illinois Medicaid,,5.32,,,11.76,1.29,6.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DRSG GRMCDL 45X2CM AQCL AG MIC,A6197,HCPCS,,,,,both,, ,36.48,21.88,Medicaid,Illinois Medicaid,,7.05,,,36.48,4.01,18.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DRSG GRMCDL 4X5IN AQCL AG,A6197,HCPCS,,,,,both,, ,31.04,18.62,Medicaid,Illinois Medicaid,,21.88,,,31.04,3.41,16.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DRSG WND 5X4IN SQ AQCL X HDRFB,A6198,HCPCS,,,,,both,, ,11.16,6.69,Medicaid,Illinois Medicaid,,18.62,,,11.16,1.23,5.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DRSG ALG 18X.75IN AQCL HDRFB,A6199,HCPCS,,,,,both,, ,14.12,8.47,Medicaid,Illinois Medicaid,,6.69,,,14.12,1.55,7.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HYDROFERA BLUE TRANSFER 5X4,A6210,HCPCS,,,,,both,, ,24.12,14.47,Medicaid,Illinois Medicaid,,8.47,,,24.12,2.65,12.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
4X4 AQUACEL FOAM NO ADHESIVE,A6211,HCPCS,,,,,both,, ,7.48,4.48,Medicaid,Illinois Medicaid,,14.47,,,7.48,0.82,3.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"DRESSING,ALLEVYN,SACRUM,SMALL",A6212,HCPCS,,,,,both,, ,21.96,13.17,Medicaid,Illinois Medicaid,,4.48,,,21.96,2.42,11.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DRSG LG QUADRILOBE 6 1/16INX6,A6212,HCPCS,,,,,both,, ,11.48,6.88,Medicaid,Illinois Medicaid,,13.17,,,11.48,1.26,5.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"HEEL,LIFE,ALLEVYN",A6212,HCPCS,,,,,both,, ,29.16,17.49,Medicaid,Illinois Medicaid,,6.88,,,29.16,3.21,15.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DRSG MED QUADRILOBE 5 1/16INX5,A6213,HCPCS,,,,,both,, ,9.80,5.88,Medicaid,Illinois Medicaid,,17.49,,,9.80,1.08,5.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SACRAL AQUACEL FOAM WITH ADHESIVE,A6213,HCPCS,,,,,both,, ,17.32,10.39,Medicaid,Illinois Medicaid,,5.88,,,17.32,1.91,9.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
4X4 AQUACEL FOAM WITH ADHESIVE,A6214,HCPCS,,,,,both,, ,8.12,4.87,Medicaid,Illinois Medicaid,,10.39,,,8.12,0.89,4.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DUODERM THIN 4X2,A6237,HCPCS,,,,,both,, ,4.80,2.88,Medicaid,Illinois Medicaid,,4.87,,,4.80,0.53,2.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DUODERM THIN 4X4,A6238,HCPCS,,,,,both,, ,4.12,2.47,Medicaid,Illinois Medicaid,,2.88,,,4.12,0.45,2.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TRIAD CREAM 2.5 OUNCES,A6240,HCPCS,,,,,both,, ,3.64,2.18,Medicaid,Illinois Medicaid,,2.47,,,3.64,0.40,1.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HYDROGEL,A6248,HCPCS,,,,,both,, ,16.76,10.05,Medicaid,Illinois Medicaid,,2.18,,,16.76,1.84,8.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NO-RINSE FOAM CLEANSER,A6250,HCPCS,,,,,both,, ,7.96,4.77,Medicaid,Illinois Medicaid,,10.05,,,7.96,0.88,4.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ABD PADS 5X9,A6252,HCPCS,,,,,both,, ,0.32,0.19,Medicaid,Illinois Medicaid,,4.77,,,0.32,0.04,0.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ABD PADS 8X10,A6253,HCPCS,,,,,both,, ,0.48,0.28,Medicaid,Illinois Medicaid,,0.19,,,0.48,0.05,0.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IODOFORM PACKING 1 INCH,A6266,HCPCS,,,,,both,, ,8.76,5.25,Medicaid,Illinois Medicaid,,0.28,,,8.76,0.96,4.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IODOFORM PACKING 1/2 INCH,A6266,HCPCS,,,,,both,, ,6.84,4.10,Medicaid,Illinois Medicaid,,5.25,,,6.84,0.75,3.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IODOFORM PACKING 1/4 INCH,A6266,HCPCS,,,,,both,, ,6.56,3.93,Medicaid,Illinois Medicaid,,4.10,,,6.56,0.72,3.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STERILE 2X2 GAUZE,A6402,HCPCS,,,,,both,, ,0.08,0.04,Medicaid,Illinois Medicaid,,3.93,,,0.08,0.01,0.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STERILE 4X4 GAUZE,A6402,HCPCS,,,,,both,, ,0.16,0.09,Medicaid,Illinois Medicaid,,0.04,,,0.16,0.02,0.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PLAIN PACKING 1 INCH,A6407,HCPCS,,,,,both,, ,6.88,4.12,Medicaid,Illinois Medicaid,,0.09,,,6.88,0.76,3.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PLAIN PACKING 1/2 INCH,A6407,HCPCS,,,,,both,, ,6.28,3.76,Medicaid,Illinois Medicaid,,4.12,,,6.28,0.69,3.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PLAIN PACKING 1/4 INCH,A6407,HCPCS,,,,,both,, ,6.40,3.84,Medicaid,Illinois Medicaid,,3.76,,,6.40,0.70,3.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ACE WRAP 4 INCH,A6449,HCPCS,,,,,both,, ,1.64,0.98,Medicaid,Illinois Medicaid,,3.84,,,1.64,0.18,0.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ACE WRAP 6 INCH,A6450,HCPCS,,,,,both,, ,2.40,1.44,Medicaid,Illinois Medicaid,,0.98,,,2.40,0.26,1.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ZINC PASTE TUBES,A6456,HCPCS,,,,,both,, ,8.44,5.06,Medicaid,Illinois Medicaid,,1.44,,,8.44,0.93,4.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PICO DRESSING KIT,A9272,HCPCS,,,,,both,, ,3547.64,2128.58,Medicaid,Illinois Medicaid,,5.06,,,3547.64,390.24,1844.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TC-99M SESTA / DOSE,A9500,HCPCS,,,,,both,, ,551.05,330.63,Medicaid,Illinois Medicaid,,2128.58,,,551.05,60.62,286.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TC-99M TETRO/UNITDOS,A9502,HCPCS,,,,,both,, ,347.11,208.26,Medicaid,Illinois Medicaid,,330.63,,,347.11,38.18,180.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TC99M MEDRO TO 30MCI,A9503,HCPCS,,,,,both,, ,69.78,41.86,Medicaid,Illinois Medicaid,,208.26,,,69.78,7.68,36.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"TL-201, PER MCI",A9505,HCPCS,,,,,both,, ,95.53,57.31,Medicaid,Illinois Medicaid,,41.86,,,95.53,10.51,49.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TC99M PERTECHNET/MCI,A9512,HCPCS,,,,,both,, ,81.89,49.13,Medicaid,Illinois Medicaid,,57.31,,,81.89,9.01,42.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"I123 CAP,DX /100UCI",A9516,HCPCS,,,,,both,, ,312.35,187.41,Medicaid,Illinois Medicaid,,49.13,,,312.35,34.36,162.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TC99 TILMAN DX .5MCI,A9520,HCPCS,,,,,both,, ,2305.66,1383.39,Medicaid,Illinois Medicaid,,187.41,,,2305.66,253.62,1198.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TC99M EXAME / DOSE,A9521,HCPCS,,,,,both,, ,17205.64,10323.38,Medicaid,Illinois Medicaid,,1383.39,,,17205.64,1892.62,8946.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TC99M MEBROF /15MCI,A9537,HCPCS,,,,,both,, ,170.47,102.28,Medicaid,Illinois Medicaid,,10323.38,,,170.47,18.75,88.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TC99M PYROPHOS/25MCI,A9538,HCPCS,,,,,both,, ,235.61,141.36,Medicaid,Illinois Medicaid,,102.28,,,235.61,25.92,122.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TC99M PENTETAT/25MCI,A9539,HCPCS,,,,,both,, ,69.78,41.86,Medicaid,Illinois Medicaid,,141.36,,,69.78,7.68,36.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TC99M MAA/10MCI,A9540,HCPCS,,,,,both,, ,62.83,37.69,Medicaid,Illinois Medicaid,,41.86,,,62.83,6.91,32.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TC99M SULF COL/20MCI,A9541,HCPCS,,,,,both,, ,83.17,49.90,Medicaid,Illinois Medicaid,,37.69,,,83.17,9.15,43.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TC99M SULFCOL2/20MCI,A9541,HCPCS,,,,,both,, ,529.68,317.80,Medicaid,Illinois Medicaid,,49.90,,,529.68,58.26,275.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IN111 PENTETAT/.5MCI,A9548,HCPCS,,,,,both,, ,12525.06,7515.03,Medicaid,Illinois Medicaid,,317.80,,,12525.06,1377.76,6513.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GA67 GALLIUM/MCI,A9556,HCPCS,,,,,both,, ,102.23,61.33,Medicaid,Illinois Medicaid,,7515.03,,,102.23,11.25,53.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
XE133 XENON 10MCI,A9558,HCPCS,,,,,both,, ,264.20,158.52,Medicaid,Illinois Medicaid,,61.33,,,264.20,29.06,137.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TC99M LABL RBC/30MCI,A9560,HCPCS,,,,,both,, ,69.78,41.86,Medicaid,Illinois Medicaid,,158.52,,,69.78,7.68,36.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TC99M OXIDRONA/30MCI,A9561,HCPCS,,,,,both,, ,148.84,89.30,Medicaid,Illinois Medicaid,,41.86,,,148.84,16.37,77.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TC99M MERTIATI/15MCI,A9562,HCPCS,,,,,both,, ,938.33,562.99,Medicaid,Illinois Medicaid,,89.30,,,938.33,103.22,487.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TC99M AEROSOL 75 MCI,A9567,HCPCS,,,,,both,, ,69.78,41.86,Medicaid,Illinois Medicaid,,562.99,,,69.78,7.68,36.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IN-111 PENTETRE/6MCI,A9572,HCPCS,,,,,both,, ,14752.18,8851.30,Medicaid,Illinois Medicaid,,41.86,,,14752.18,1622.74,7671.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INJ GADO DIMEG ML 15,A9577,HCPCS,,,,,both,15,ML,13.75,8.25,Medicaid,Illinois Medicaid,,8851.30,,,13.75,1.51,7.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INJ GADO DIMEG ML 20,A9577,HCPCS,,,,,both,20,ML,13.75,8.25,Medicaid,Illinois Medicaid,,8.25,,,13.75,1.51,7.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INJ MULTIHANCE /ML,A9577,HCPCS,,,,,both,, ,14.16,8.49,Medicaid,Illinois Medicaid,,8.25,,,14.16,1.56,7.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INJ MULTIHANCE/ ML,A9577,HCPCS,,,,,both,, ,13.75,8.25,Medicaid,Illinois Medicaid,,8.49,,,13.75,1.51,7.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INJ GAD-MR1 CONTR ML,A9579,HCPCS,,,,,both,, ,37.60,22.56,Medicaid,Illinois Medicaid,,8.25,,,37.60,4.14,19.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INJ GAD-MR2 CONTR ML,A9579,HCPCS,,,,,both,, ,47.90,28.74,Medicaid,Illinois Medicaid,,22.56,,,47.90,5.27,24.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INJ GAD-MR3 CONTR ML,A9579,HCPCS,,,,,both,, ,40.94,24.56,Medicaid,Illinois Medicaid,,28.74,,,40.94,4.50,21.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 1,C1713,HCPCS,,,,,both,, ,129.01,77.40,Medicaid,Illinois Medicaid,,24.56,,,129.01,14.19,67.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 10,C1713,HCPCS,,,,,both,, ,2873.70,1724.22,Medicaid,Illinois Medicaid,,77.40,,,2873.70,316.11,1494.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 11,C1713,HCPCS,,,,,both,, ,4069.02,2441.41,Medicaid,Illinois Medicaid,,1724.22,,,4069.02,447.59,2115.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 12,C1713,HCPCS,,,,,both,, ,4786.15,2871.69,Medicaid,Illinois Medicaid,,2441.41,,,4786.15,526.48,2488.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 13,C1713,HCPCS,,,,,both,, ,6684.19,4010.51,Medicaid,Illinois Medicaid,,2871.69,,,6684.19,735.26,3475.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 14,C1713,HCPCS,,,,,both,, ,9567.67,5740.60,Medicaid,Illinois Medicaid,,4010.51,,,9567.67,1052.44,4975.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 15,C1713,HCPCS,,,,,both,, ,14349.19,8609.51,Medicaid,Illinois Medicaid,,5740.60,,,14349.19,1578.41,7461.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 16,C1713,HCPCS,,,,,both,, ,19130.71,11478.42,Medicaid,Illinois Medicaid,,8609.51,,,19130.71,2104.38,9947.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 17,C1713,HCPCS,,,,,both,, ,23912.22,14347.33,Medicaid,Illinois Medicaid,,11478.42,,,23912.22,2630.34,12434.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 18,C1713,HCPCS,,,,,both,, ,31084.37,18650.62,Medicaid,Illinois Medicaid,,14347.33,,,31084.37,3419.28,16163.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 19,C1713,HCPCS,,,,,both,, ,38256.78,22954.06,Medicaid,Illinois Medicaid,,18650.62,,,38256.78,4208.25,19893.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 2,C1713,HCPCS,,,,,both,, ,172.01,103.20,Medicaid,Illinois Medicaid,,22954.06,,,172.01,18.92,89.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 20,C1713,HCPCS,,,,,both,, ,47814.92,28688.95,Medicaid,Illinois Medicaid,,103.20,,,47814.92,5259.64,24863.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 21,C1713,HCPCS,,,,,both,, ,57377.95,34426.77,Medicaid,Illinois Medicaid,,28688.95,,,57377.95,6311.57,29836.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 3,C1713,HCPCS,,,,,both,, ,243.85,146.31,Medicaid,Illinois Medicaid,,34426.77,,,243.85,26.82,126.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 4,C1713,HCPCS,,,,,both,, ,411.23,246.73,Medicaid,Illinois Medicaid,,146.31,,,411.23,45.24,213.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 5,C1713,HCPCS,,,,,both,, ,602.55,361.53,Medicaid,Illinois Medicaid,,246.73,,,602.55,66.28,313.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 6,C1713,HCPCS,,,,,both,, ,841.51,504.90,Medicaid,Illinois Medicaid,,361.53,,,841.51,92.57,437.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 7,C1713,HCPCS,,,,,both,, ,1200.21,720.12,Medicaid,Illinois Medicaid,,504.90,,,1200.21,132.02,624.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 8,C1713,HCPCS,,,,,both,, ,1678.39,1007.03,Medicaid,Illinois Medicaid,,720.12,,,1678.39,184.62,872.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ANCHOR/SCRW LEVEL 9,C1713,HCPCS,,,,,both,, ,2156.56,1293.93,Medicaid,Illinois Medicaid,,1007.03,,,2156.56,237.22,1121.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE CEMENT 1,C1713,HCPCS,,,,,both,, ,884.51,530.70,Medicaid,Illinois Medicaid,,1293.93,,,884.51,97.30,459.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BONE CEMENT 2,C1713,HCPCS,,,,,both,, ,2467.37,1480.42,Medicaid,Illinois Medicaid,,530.70,,,2467.37,271.41,1283.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH TRNS ARTHR DIR1,C1714,HCPCS,,,,,both,, ,5379.18,3227.50,Medicaid,Illinois Medicaid,,1480.42,,,5379.18,591.71,2797.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH TRNS ARTHR DIR2,C1714,HCPCS,,,,,both,, ,8391.41,5034.84,Medicaid,Illinois Medicaid,,3227.50,,,8391.41,923.06,4363.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AICD DUAL CHAMBER L1,C1721,HCPCS,,,,,both,, ,93836.86,56302.11,Medicaid,Illinois Medicaid,,5034.84,,,93836.86,10322.05,48795.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AICD SINGLE CHAMBER1,C1722,HCPCS,,,,,both,, ,99999.00,59999.40,Medicaid,Illinois Medicaid,,56302.11,,,99999.00,10999.89,51999.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH TRNS ARTHR ROT1,C1724,HCPCS,,,,,both,, ,5379.18,3227.50,Medicaid,Illinois Medicaid,,59999.40,,,5379.18,591.71,2797.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH TRNS ARTHR ROT2,C1724,HCPCS,,,,,both,, ,16735.18,10041.10,Medicaid,Illinois Medicaid,,3227.50,,,16735.18,1840.87,8702.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-ANGIO LEVEL 1,C1725,HCPCS,,,,,both,, ,855.42,513.25,Medicaid,Illinois Medicaid,,10041.10,,,855.42,94.10,444.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-ANGIO LEVEL 2,C1725,HCPCS,,,,,both,, ,1728.86,1037.31,Medicaid,Illinois Medicaid,,513.25,,,1728.86,190.17,899.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-ANGIO LEVEL 3,C1725,HCPCS,,,,,both,, ,2726.15,1635.69,Medicaid,Illinois Medicaid,,1037.31,,,2726.15,299.88,1417.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-ANGIO LEVEL 4,C1725,HCPCS,,,,,both,, ,4234.59,2540.75,Medicaid,Illinois Medicaid,,1635.69,,,4234.59,465.80,2201.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-ANGIO LEVEL 5,C1725,HCPCS,,,,,both,, ,6331.93,3799.15,Medicaid,Illinois Medicaid,,2540.75,,,6331.93,696.51,3292.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH BAL DIL NONVAS1,C1726,HCPCS,,,,,both,, ,1434.53,860.71,Medicaid,Illinois Medicaid,,3799.15,,,1434.53,157.80,745.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH BAL DIL NONVAS2,C1726,HCPCS,,,,,both,, ,2390.63,1434.37,Medicaid,Illinois Medicaid,,860.71,,,2390.63,262.97,1243.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH BRACHY SEED AD1,C1728,HCPCS,,,,,both,, ,717.14,430.28,Medicaid,Illinois Medicaid,,1434.37,,,717.14,78.89,372.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH BRACHY SEED AD2,C1728,HCPCS,,,,,both,, ,956.36,573.81,Medicaid,Illinois Medicaid,,430.28,,,956.36,105.20,497.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH DRAINAG LEVEL11,C1729,HCPCS,,,,,both,, ,11958.56,7175.13,Medicaid,Illinois Medicaid,,573.81,,,11958.56,1315.44,6218.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-DRAINAG LEVEL 1,C1729,HCPCS,,,,,both,, ,84.20,50.52,Medicaid,Illinois Medicaid,,7175.13,,,84.20,9.26,43.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-DRAINAG LEVEL 2,C1729,HCPCS,,,,,both,, ,247.72,148.63,Medicaid,Illinois Medicaid,,50.52,,,247.72,27.25,128.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-DRAINAG LEVEL 3,C1729,HCPCS,,,,,both,, ,727.18,436.30,Medicaid,Illinois Medicaid,,148.63,,,727.18,79.99,378.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-DRAINAG LEVEL 4,C1729,HCPCS,,,,,both,, ,1200.21,720.12,Medicaid,Illinois Medicaid,,436.30,,,1200.21,132.02,624.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-DRAINAG LEVEL 5,C1729,HCPCS,,,,,both,, ,1917.35,1150.41,Medicaid,Illinois Medicaid,,720.12,,,1917.35,210.91,997.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-DRAINAG LEVEL 6,C1729,HCPCS,,,,,both,, ,2634.48,1580.68,Medicaid,Illinois Medicaid,,1150.41,,,2634.48,289.79,1369.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-DRAINAG LEVEL 7,C1729,HCPCS,,,,,both,, ,3351.88,2011.12,Medicaid,Illinois Medicaid,,1580.68,,,3351.88,368.71,1742.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-DRAINAG LEVEL 8,C1729,HCPCS,,,,,both,, ,4786.15,2871.69,Medicaid,Illinois Medicaid,,2011.12,,,4786.15,526.48,2488.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-DRAINAG LEVEL 9,C1729,HCPCS,,,,,both,, ,7177.04,4306.22,Medicaid,Illinois Medicaid,,2871.69,,,7177.04,789.47,3732.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-DRAINAG LEVEL10,C1729,HCPCS,,,,,both,, ,9567.67,5740.60,Medicaid,Illinois Medicaid,,4306.22,,,9567.67,1052.44,4975.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-DRAINAG LEVEL12,C1729,HCPCS,,,,,both,, ,14344.55,8606.73,Medicaid,Illinois Medicaid,,5740.60,,,14344.55,1577.90,7459.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH EP 19 OR FEW 1,C1730,HCPCS,,,,,both,, ,554.66,332.79,Medicaid,Illinois Medicaid,,8606.73,,,554.66,61.01,288.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH EP 19 OR FEW 2,C1730,HCPCS,,,,,both,, ,1807.39,1084.43,Medicaid,Illinois Medicaid,,332.79,,,1807.39,198.81,939.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH EP 20 OR MORE 1,C1731,HCPCS,,,,,both,, ,6185.15,3711.09,Medicaid,Illinois Medicaid,,1084.43,,,6185.15,680.37,3216.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH EP DIG/ABL 3D 1,C1732,HCPCS,,,,,both,, ,7172.15,4303.29,Medicaid,Illinois Medicaid,,3711.09,,,7172.15,788.94,3729.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH EP DIG/ABL 3D 2,C1732,HCPCS,,,,,both,, ,15395.93,9237.55,Medicaid,Illinois Medicaid,,4303.29,,,15395.93,1693.55,8005.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH HEMODIAL LT 1,C1750,HCPCS,,,,,both,, ,1434.53,860.71,Medicaid,Illinois Medicaid,,9237.55,,,1434.53,157.80,745.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH HEMODIAL LT 2,C1750,HCPCS,,,,,both,, ,1912.71,1147.62,Medicaid,Illinois Medicaid,,860.71,,,1912.71,210.40,994.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-INFUS PERIF 1,C1751,HCPCS,,,,,both,, ,89.61,53.76,Medicaid,Illinois Medicaid,,1147.62,,,89.61,9.86,46.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-INFUS PERIF 10,C1751,HCPCS,,,,,both,, ,2395.52,1437.31,Medicaid,Illinois Medicaid,,53.76,,,2395.52,263.51,1245.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-INFUS PERIF 11,C1751,HCPCS,,,,,both,, ,3351.88,2011.12,Medicaid,Illinois Medicaid,,1437.31,,,3351.88,368.71,1742.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-INFUS PERIF 12,C1751,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,2011.12,,,4781.52,525.97,2486.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-INFUS PERIF 2,C1751,HCPCS,,,,,both,, ,124.37,74.62,Medicaid,Illinois Medicaid,,2868.91,,,124.37,13.68,64.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-INFUS PERIF 3,C1751,HCPCS,,,,,both,, ,243.85,146.31,Medicaid,Illinois Medicaid,,74.62,,,243.85,26.82,126.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-INFUS PERIF 4,C1751,HCPCS,,,,,both,, ,722.03,433.21,Medicaid,Illinois Medicaid,,146.31,,,722.03,79.42,375.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-INFUS PERIF 6,C1751,HCPCS,,,,,both,, ,960.99,576.59,Medicaid,Illinois Medicaid,,433.21,,,960.99,105.71,499.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-INFUS PERIF 6,C1751,HCPCS,,,,,both,, ,960.99,576.59,Medicaid,Illinois Medicaid,,576.59,,,960.99,105.71,499.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-INFUS PERIF 7,C1751,HCPCS,,,,,both,, ,1200.21,720.12,Medicaid,Illinois Medicaid,,576.59,,,1200.21,132.02,624.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-INFUS PERIF 8,C1751,HCPCS,,,,,both,, ,1439.17,863.50,Medicaid,Illinois Medicaid,,720.12,,,1439.17,158.31,748.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-INFUS PERIF 9,C1751,HCPCS,,,,,both,, ,1673.49,1004.09,Medicaid,Illinois Medicaid,,863.50,,,1673.49,184.08,870.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH HEMODIAL ST 1,C1752,HCPCS,,,,,both,, ,358.70,215.22,Medicaid,Illinois Medicaid,,1004.09,,,358.70,39.46,186.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH HEMODIAL ST 2,C1752,HCPCS,,,,,both,, ,478.18,286.90,Medicaid,Illinois Medicaid,,215.22,,,478.18,52.60,248.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH INTRAVAS ULTRA1,C1753,HCPCS,,,,,both,, ,3586.20,2151.72,Medicaid,Illinois Medicaid,,286.90,,,3586.20,394.48,1864.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH INTRAVAS ULTRA2,C1753,HCPCS,,,,,both,, ,14344.55,8606.73,Medicaid,Illinois Medicaid,,2151.72,,,14344.55,1577.90,7459.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATHETER INTRASPINAL,C1755,HCPCS,,,,,both,, ,5259.70,3155.82,Medicaid,Illinois Medicaid,,8606.73,,,5259.70,578.57,2735.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH THRMB/EMBOL 1,C1757,HCPCS,,,,,both,, ,238.96,143.37,Medicaid,Illinois Medicaid,,3155.82,,,238.96,26.29,124.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH THRMB/EMBOL 2,C1757,HCPCS,,,,,both,, ,1792.97,1075.78,Medicaid,Illinois Medicaid,,143.37,,,1792.97,197.23,932.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH THRMB/EMBOL 3,C1757,HCPCS,,,,,both,, ,2395.52,1437.31,Medicaid,Illinois Medicaid,,1075.78,,,2395.52,263.51,1245.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH THRMB/EMBOL 4,C1757,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,1437.31,,,4781.52,525.97,2486.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH URETERAL 1,C1758,HCPCS,,,,,both,, ,478.18,286.90,Medicaid,Illinois Medicaid,,2868.91,,,478.18,52.60,248.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH URETERAL 2,C1758,HCPCS,,,,,both,, ,717.14,430.28,Medicaid,Illinois Medicaid,,286.90,,,717.14,78.89,372.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH URETERAL 3,C1758,HCPCS,,,,,both,, ,956.36,573.81,Medicaid,Illinois Medicaid,,430.28,,,956.36,105.20,497.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH INTRA ECHOCARD1,C1759,HCPCS,,,,,both,, ,7172.15,4303.29,Medicaid,Illinois Medicaid,,573.81,,,7172.15,788.94,3729.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH INTRA ECHOCARD2,C1759,HCPCS,,,,,both,, ,9563.04,5737.82,Medicaid,Illinois Medicaid,,4303.29,,,9563.04,1051.93,4972.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CLOSURE DEVIC VASC 1,C1760,HCPCS,,,,,both,, ,1634.61,980.76,Medicaid,Illinois Medicaid,,5737.82,,,1634.61,179.81,850,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CLOSURE DEVIC VASC 2,C1760,HCPCS,,,,,both,, ,2504.70,1502.82,Medicaid,Illinois Medicaid,,980.76,,,2504.70,275.52,1302.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONN TISSUE HUMAN 1,C1762,HCPCS,,,,,both,, ,1438.14,862.88,Medicaid,Illinois Medicaid,,1502.82,,,1438.14,158.20,747.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONN TISSUE HUMAN 10,C1762,HCPCS,,,,,both,, ,57377.95,34426.77,Medicaid,Illinois Medicaid,,862.88,,,57377.95,6311.57,29836.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONN TISSUE HUMAN 2,C1762,HCPCS,,,,,both,, ,1917.35,1150.41,Medicaid,Illinois Medicaid,,34426.77,,,1917.35,210.91,997.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONN TISSUE HUMAN 3,C1762,HCPCS,,,,,both,, ,5742.51,3445.50,Medicaid,Illinois Medicaid,,1150.41,,,5742.51,631.68,2986.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONN TISSUE HUMAN 4,C1762,HCPCS,,,,,both,, ,9567.67,5740.60,Medicaid,Illinois Medicaid,,3445.50,,,9567.67,1052.44,4975.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONN TISSUE HUMAN 5,C1762,HCPCS,,,,,both,, ,13393.09,8035.85,Medicaid,Illinois Medicaid,,5740.60,,,13393.09,1473.24,6964.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONN TISSUE HUMAN 6,C1762,HCPCS,,,,,both,, ,17218.25,10330.95,Medicaid,Illinois Medicaid,,8035.85,,,17218.25,1894.01,8953.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONN TISSUE HUMAN 7,C1762,HCPCS,,,,,both,, ,23907.59,14344.55,Medicaid,Illinois Medicaid,,10330.95,,,23907.59,2629.83,12431.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONN TISSUE HUMAN 8,C1762,HCPCS,,,,,both,, ,33475.26,20085.15,Medicaid,Illinois Medicaid,,14344.55,,,33475.26,3682.28,17407.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CONN TISSUE HUMAN 9,C1762,HCPCS,,,,,both,, ,43033.40,25820.04,Medicaid,Illinois Medicaid,,20085.15,,,43033.40,4733.67,22377.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE NON-HUMAN 1,C1763,HCPCS,,,,,both,, ,1796.58,1077.94,Medicaid,Illinois Medicaid,,25820.04,,,1796.58,197.62,934.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE NON-HUMAN 10,C1763,HCPCS,,,,,both,, ,43033.40,25820.04,Medicaid,Illinois Medicaid,,1077.94,,,43033.40,4733.67,22377.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE NON-HUMAN 11,C1763,HCPCS,,,,,both,, ,57377.95,34426.77,Medicaid,Illinois Medicaid,,25820.04,,,57377.95,6311.57,29836.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE NON-HUMAN 2,C1763,HCPCS,,,,,both,, ,2395.52,1437.31,Medicaid,Illinois Medicaid,,34426.77,,,2395.52,263.51,1245.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE NON-HUMAN 3,C1763,HCPCS,,,,,both,, ,4786.15,2871.69,Medicaid,Illinois Medicaid,,1437.31,,,4786.15,526.48,2488.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE NON-HUMAN 4,C1763,HCPCS,,,,,both,, ,8611.57,5166.94,Medicaid,Illinois Medicaid,,2871.69,,,8611.57,947.27,4478.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE NON-HUMAN 5,C1763,HCPCS,,,,,both,, ,12436.74,7462.04,Medicaid,Illinois Medicaid,,5166.94,,,12436.74,1368.04,6467.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE NON-HUMAN 6,C1763,HCPCS,,,,,both,, ,15305.54,9183.32,Medicaid,Illinois Medicaid,,7462.04,,,15305.54,1683.61,7958.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE NON-HUMAN 7,C1763,HCPCS,,,,,both,, ,19130.71,11478.42,Medicaid,Illinois Medicaid,,9183.32,,,19130.71,2104.38,9947.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE NON-HUMAN 8,C1763,HCPCS,,,,,both,, ,23912.22,14347.33,Medicaid,Illinois Medicaid,,11478.42,,,23912.22,2630.34,12434.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE NON-HUMAN 9,C1763,HCPCS,,,,,both,, ,33475.26,20085.15,Medicaid,Illinois Medicaid,,14347.33,,,33475.26,3682.28,17407.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EVENT RECRDR CARDIAC,C1764,HCPCS,,,,,both,, ,21590.35,12954.21,Medicaid,Illinois Medicaid,,20085.15,,,21590.35,2374.94,11226.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADHESION BARRIER1,C1765,HCPCS,,,,,both,, ,717.14,430.28,Medicaid,Illinois Medicaid,,12954.21,,,717.14,78.89,372.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADHESION BARRIER2,C1765,HCPCS,,,,,both,, ,956.36,573.81,Medicaid,Illinois Medicaid,,430.28,,,956.36,105.20,497.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADHESION BARRIER3,C1765,HCPCS,,,,,both,, ,8466.86,5080.11,Medicaid,Illinois Medicaid,,573.81,,,8466.86,931.35,4402.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADHESION BARRIER4,C1765,HCPCS,,,,,both,, ,4456.30,2673.78,Medicaid,Illinois Medicaid,,5080.11,,,4456.30,490.19,2317.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GENRATR NEUROSTM 1,C1767,HCPCS,,,,,both,, ,35861.25,21516.75,Medicaid,Illinois Medicaid,,2673.78,,,35861.25,3944.74,18647.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GENRATR NEUROSTM 2,C1767,HCPCS,,,,,both,, ,71722.51,43033.50,Medicaid,Illinois Medicaid,,21516.75,,,71722.51,7889.48,37295.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GRAFT VASCULAR 1,C1768,HCPCS,,,,,both,, ,1796.58,1077.94,Medicaid,Illinois Medicaid,,43033.50,,,1796.58,197.62,934.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GRAFT VASCULAR 2,C1768,HCPCS,,,,,both,, ,2395.52,1437.31,Medicaid,Illinois Medicaid,,1077.94,,,2395.52,263.51,1245.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GRAFT VASCULAR 3,C1768,HCPCS,,,,,both,, ,4786.15,2871.69,Medicaid,Illinois Medicaid,,1437.31,,,4786.15,526.48,2488.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GRAFT VASCULAR 4,C1768,HCPCS,,,,,both,, ,9567.67,5740.60,Medicaid,Illinois Medicaid,,2871.69,,,9567.67,1052.44,4975.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GRAFT VASCULAR 5,C1768,HCPCS,,,,,both,, ,14349.19,8609.51,Medicaid,Illinois Medicaid,,5740.60,,,14349.19,1578.41,7461.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GRAFT VASCULAR 6,C1768,HCPCS,,,,,both,, ,19130.71,11478.42,Medicaid,Illinois Medicaid,,8609.51,,,19130.71,2104.38,9947.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GRAFT VASCULAR 7,C1768,HCPCS,,,,,both,, ,23912.22,14347.33,Medicaid,Illinois Medicaid,,11478.42,,,23912.22,2630.34,12434.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GRAFT VASCULAR 8,C1768,HCPCS,,,,,both,, ,28688.85,17213.31,Medicaid,Illinois Medicaid,,14347.33,,,28688.85,3155.77,14918.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 1,C1769,HCPCS,,,,,both,, ,182.83,109.69,Medicaid,Illinois Medicaid,,17213.31,,,182.83,20.11,95.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 10,C1769,HCPCS,,,,,both,, ,3830.06,2298.03,Medicaid,Illinois Medicaid,,109.69,,,3830.06,421.31,1991.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 11,C1769,HCPCS,,,,,both,, ,4308.23,2584.93,Medicaid,Illinois Medicaid,,2298.03,,,4308.23,473.91,2240.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 12,C1769,HCPCS,,,,,both,, ,4786.15,2871.69,Medicaid,Illinois Medicaid,,2584.93,,,4786.15,526.48,2488.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 13,C1769,HCPCS,,,,,both,, ,7177.04,4306.22,Medicaid,Illinois Medicaid,,2871.69,,,7177.04,789.47,3732.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 14,C1769,HCPCS,,,,,both,, ,9567.67,5740.60,Medicaid,Illinois Medicaid,,4306.22,,,9567.67,1052.44,4975.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 15,C1769,HCPCS,,,,,both,, ,14349.19,8609.51,Medicaid,Illinois Medicaid,,5740.60,,,14349.19,1578.41,7461.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 16,C1769,HCPCS,,,,,both,, ,19130.71,11478.42,Medicaid,Illinois Medicaid,,8609.51,,,19130.71,2104.38,9947.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 17,C1769,HCPCS,,,,,both,, ,23912.22,14347.33,Medicaid,Illinois Medicaid,,11478.42,,,23912.22,2630.34,12434.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 18,C1769,HCPCS,,,,,both,, ,31084.37,18650.62,Medicaid,Illinois Medicaid,,14347.33,,,31084.37,3419.28,16163.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 19,C1769,HCPCS,,,,,both,, ,38256.78,22954.06,Medicaid,Illinois Medicaid,,18650.62,,,38256.78,4208.25,19893.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 2,C1769,HCPCS,,,,,both,, ,243.85,146.31,Medicaid,Illinois Medicaid,,22954.06,,,243.85,26.82,126.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 20,C1769,HCPCS,,,,,both,, ,47814.92,28688.95,Medicaid,Illinois Medicaid,,146.31,,,47814.92,5259.64,24863.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 3,C1769,HCPCS,,,,,both,, ,482.81,289.68,Medicaid,Illinois Medicaid,,28688.95,,,482.81,53.11,251.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 4,C1769,HCPCS,,,,,both,, ,960.99,576.59,Medicaid,Illinois Medicaid,,289.68,,,960.99,105.71,499.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 5,C1769,HCPCS,,,,,both,, ,1439.17,863.50,Medicaid,Illinois Medicaid,,576.59,,,1439.17,158.31,748.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 6,C1769,HCPCS,,,,,both,, ,1917.35,1150.41,Medicaid,Illinois Medicaid,,863.50,,,1917.35,210.91,997.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 7,C1769,HCPCS,,,,,both,, ,2395.52,1437.31,Medicaid,Illinois Medicaid,,1150.41,,,2395.52,263.51,1245.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 9,C1769,HCPCS,,,,,both,, ,3351.88,2011.12,Medicaid,Illinois Medicaid,,1437.31,,,3351.88,368.71,1742.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GUIDEWIRE LEVEL 9,C1769,HCPCS,,,,,both,, ,3351.88,2011.12,Medicaid,Illinois Medicaid,,2011.12,,,3351.88,368.71,1742.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
REP DEV URINRY W/SL1,C1771,HCPCS,,,,,both,, ,2868.81,1721.28,Medicaid,Illinois Medicaid,,2011.12,,,2868.81,315.57,1491.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
REP DEV URINRY W/SL2,C1771,HCPCS,,,,,both,, ,3825.16,2295.09,Medicaid,Illinois Medicaid,,1721.28,,,3825.16,420.77,1989.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
REP DEV URINRY W/SL3,C1771,HCPCS,,,,,both,, ,14344.55,8606.73,Medicaid,Illinois Medicaid,,2295.09,,,14344.55,1577.90,7459.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INF PUMP PROGRAM LV1,C1772,HCPCS,,,,,both,, ,2774.56,1664.73,Medicaid,Illinois Medicaid,,8606.73,,,2774.56,305.20,1442.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INF PUMP PROGRAM LV3,C1772,HCPCS,,,,,both,, ,53552.79,32131.67,Medicaid,Illinois Medicaid,,1664.73,,,53552.79,5890.81,27847.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-RETRIEVAL 1,C1773,HCPCS,,,,,both,, ,1338.74,803.24,Medicaid,Illinois Medicaid,,32131.67,,,1338.74,147.26,696.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH-RETRIEVAL 2,C1773,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,803.24,,,4781.52,525.97,2486.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
JOINT DEVICE IMPLT 1,C1776,HCPCS,,,,,both,, ,3586.20,2151.72,Medicaid,Illinois Medicaid,,2151.72,,,3586.20,394.48,1864.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
JOINT DEVICE IMPLT 2,C1776,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,2868.91,,,4781.52,525.97,2486.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
JOINT DEVICE IMPLT 3,C1776,HCPCS,,,,,both,, ,9567.67,5740.60,Medicaid,Illinois Medicaid,,5740.60,,,9567.67,1052.44,4975.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
JOINT DEVICE IMPLT 4,C1776,HCPCS,,,,,both,, ,11958.56,7175.13,Medicaid,Illinois Medicaid,,7175.13,,,11958.56,1315.44,6218.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
JOINT DEVICE IMPLT 5,C1776,HCPCS,,,,,both,, ,19130.71,11478.42,Medicaid,Illinois Medicaid,,11478.42,,,19130.71,2104.38,9947.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
JOINT DEVICE IMPLT 6,C1776,HCPCS,,,,,both,, ,23912.22,14347.33,Medicaid,Illinois Medicaid,,14347.33,,,23912.22,2630.34,12434.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
JOINT DEVICE IMPLT 7,C1776,HCPCS,,,,,both,, ,31084.37,18650.62,Medicaid,Illinois Medicaid,,18650.62,,,31084.37,3419.28,16163.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
JOINT DEVICE IMPLT 8,C1776,HCPCS,,,,,both,, ,38256.78,22954.06,Medicaid,Illinois Medicaid,,22954.06,,,38256.78,4208.25,19893.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
JOINT DEVICE IMPLT 9,C1776,HCPCS,,,,,both,, ,47819.81,28691.88,Medicaid,Illinois Medicaid,,28691.88,,,47819.81,5260.18,24866.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
JOINT DEVICE IMPLT10,C1776,HCPCS,,,,,both,, ,71727.14,43036.28,Medicaid,Illinois Medicaid,,43036.28,,,71727.14,7889.99,37298.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
JOINT DEVICE IMPLT11,C1776,HCPCS,,,,,both,, ,95629.84,57377.90,Medicaid,Illinois Medicaid,,57377.90,,,95629.84,10519.28,49727.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
JOINT DEVICE IMPLT12,C1776,HCPCS,,,,,both,, ,99999.00,59999.40,Medicaid,Illinois Medicaid,,59999.40,,,99999.00,10999.89,51999.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEAD AICD ENDO SN L1,C1777,HCPCS,,,,,both,, ,23599.62,14159.77,Medicaid,Illinois Medicaid,,14159.77,,,23599.62,2595.96,12271.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEAD NEUROSTIMULAT 1,C1778,HCPCS,,,,,both,, ,9563.04,5737.82,Medicaid,Illinois Medicaid,,5737.82,,,9563.04,1051.93,4972.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEAD NEUROSTIMULAT 2,C1778,HCPCS,,,,,both,, ,3586.20,2151.72,Medicaid,Illinois Medicaid,,2151.72,,,3586.20,394.48,1864.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEAD NEUROSTIMULAT 3,C1778,HCPCS,,,,,both,, ,14344.55,8606.73,Medicaid,Illinois Medicaid,,8606.73,,,14344.55,1577.90,7459.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEAD NEUROSTIMULAT 4,C1778,HCPCS,,,,,both,, ,23907.59,14344.55,Medicaid,Illinois Medicaid,,14344.55,,,23907.59,2629.83,12431.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEAD PMKR TRNSV VDD1,C1779,HCPCS,,,,,both,, ,9194.30,5516.58,Medicaid,Illinois Medicaid,,5516.58,,,9194.30,1011.37,4781.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MESH IMPLANTABLE 1,C1781,HCPCS,,,,,both,, ,717.14,430.28,Medicaid,Illinois Medicaid,,430.28,,,717.14,78.89,372.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MESH IMPLANTABLE 10,C1781,HCPCS,,,,,both,, ,11958.56,7175.13,Medicaid,Illinois Medicaid,,7175.13,,,11958.56,1315.44,6218.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MESH IMPLANTABLE 11,C1781,HCPCS,,,,,both,, ,14349.19,8609.51,Medicaid,Illinois Medicaid,,8609.51,,,14349.19,1578.41,7461.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MESH IMPLANTABLE 12,C1781,HCPCS,,,,,both,, ,19130.71,11478.42,Medicaid,Illinois Medicaid,,11478.42,,,19130.71,2104.38,9947.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MESH IMPLANTABLE 13,C1781,HCPCS,,,,,both,, ,28693.74,17216.24,Medicaid,Illinois Medicaid,,17216.24,,,28693.74,3156.31,14920.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MESH IMPLANTABLE 14,C1781,HCPCS,,,,,both,, ,43038.29,25822.97,Medicaid,Illinois Medicaid,,25822.97,,,43038.29,4734.21,22379.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MESH IMPLANTABLE 2,C1781,HCPCS,,,,,both,, ,960.99,576.59,Medicaid,Illinois Medicaid,,576.59,,,960.99,105.71,499.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MESH IMPLANTABLE 3,C1781,HCPCS,,,,,both,, ,1917.35,1150.41,Medicaid,Illinois Medicaid,,1150.41,,,1917.35,210.91,997.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MESH IMPLANTABLE 4,C1781,HCPCS,,,,,both,, ,2873.70,1724.22,Medicaid,Illinois Medicaid,,1724.22,,,2873.70,316.11,1494.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MESH IMPLANTABLE 6,C1781,HCPCS,,,,,both,, ,3830.06,2298.03,Medicaid,Illinois Medicaid,,2298.03,,,3830.06,421.31,1991.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MESH IMPLANTABLE 6,C1781,HCPCS,,,,,both,, ,3830.06,2298.03,Medicaid,Illinois Medicaid,,2298.03,,,3830.06,421.31,1991.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MESH IMPLANTABLE 7,C1781,HCPCS,,,,,both,, ,6220.69,3732.41,Medicaid,Illinois Medicaid,,3732.41,,,6220.69,684.28,3234.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MESH IMPLANTABLE 8,C1781,HCPCS,,,,,both,, ,7655.22,4593.13,Medicaid,Illinois Medicaid,,4593.13,,,7655.22,842.07,3980.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MESH IMPLANTABLE 9,C1781,HCPCS,,,,,both,, ,9567.67,5740.60,Medicaid,Illinois Medicaid,,5740.60,,,9567.67,1052.44,4975.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MORCELLATOR 1,C1782,HCPCS,,,,,both,, ,1792.97,1075.78,Medicaid,Illinois Medicaid,,1075.78,,,1792.97,197.23,932.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MORCELLATOR 2,C1782,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,2868.91,,,4781.52,525.97,2486.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MORCELLATOR 3,C1782,HCPCS,,,,,both,, ,9563.04,5737.82,Medicaid,Illinois Medicaid,,5737.82,,,9563.04,1051.93,4972.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OCLR DEV INTROP DTR1,C1784,HCPCS,,,,,both,, ,15780.63,9468.37,Medicaid,Illinois Medicaid,,9468.37,,,15780.63,1735.87,8205.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PMKR DUAL RATE-RS L1,C1785,HCPCS,,,,,both,, ,84273.06,50563.83,Medicaid,Illinois Medicaid,,50563.83,,,84273.06,9270.04,43821.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PMKR DUAL RATE-RS L2,C1785,HCPCS,,,,,both,, ,28809.36,17285.61,Medicaid,Illinois Medicaid,,17285.61,,,28809.36,3169.03,14980.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PMKR SINGL RATE-RSL1,C1786,HCPCS,,,,,both,, ,62664.69,37598.81,Medicaid,Illinois Medicaid,,37598.81,,,62664.69,6893.12,32585.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PATIENT PROGR NEURO1,C1787,HCPCS,,,,,both,, ,5302.96,3181.77,Medicaid,Illinois Medicaid,,3181.77,,,5302.96,583.33,2757.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PORT 1,C1788,HCPCS,,,,,both,, ,720.74,432.44,Medicaid,Illinois Medicaid,,432.44,,,720.74,79.28,374.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PORT 2,C1788,HCPCS,,,,,both,, ,960.99,576.59,Medicaid,Illinois Medicaid,,576.59,,,960.99,105.71,499.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PORT 3,C1788,HCPCS,,,,,both,, ,1912.71,1147.62,Medicaid,Illinois Medicaid,,1147.62,,,1912.71,210.40,994.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BREAST IMPLANT 1,C1789,HCPCS,,,,,both,, ,7833.15,4699.89,Medicaid,Illinois Medicaid,,4699.89,,,7833.15,861.65,4073.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRSTHS PENILE INFL 1,C1813,HCPCS,,,,,both,, ,3586.20,2151.72,Medicaid,Illinois Medicaid,,2151.72,,,3586.20,394.48,1864.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRSTHS PENILE INFL 2,C1813,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,2868.91,,,4781.52,525.97,2486.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRSTHS PENILE INFL 3,C1813,HCPCS,,,,,both,, ,14344.55,8606.73,Medicaid,Illinois Medicaid,,8606.73,,,14344.55,1577.90,7459.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRSTHS PENILE INFL 4,C1813,HCPCS,,,,,both,, ,23907.59,14344.55,Medicaid,Illinois Medicaid,,14344.55,,,23907.59,2629.83,12431.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE LOCALZ EXCISI,C1819,HCPCS,,,,,both,, ,1000.00,600.00,Medicaid,Illinois Medicaid,,600.00,,,1000.00,110.00,520,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GENRATE NEURO RECHR,C1820,HCPCS,,,,,both,, ,38545.95,23127.57,Medicaid,Illinois Medicaid,,23127.57,,,38545.95,4240.05,20043.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INTERSPINOUS IMPL L1,C1821,HCPCS,,,,,both,, ,31193.29,18715.97,Medicaid,Illinois Medicaid,,18715.97,,,31193.29,3431.26,16220.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INTERSPINOUS IMPL L2,C1821,HCPCS,,,,,both,, ,44561.92,26737.15,Medicaid,Illinois Medicaid,,26737.15,,,44561.92,4901.81,23172.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STNT COAT/COV W/DEL1,C1874,HCPCS,,,,,both,, ,3586.20,2151.72,Medicaid,Illinois Medicaid,,2151.72,,,3586.20,394.48,1864.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STNT COAT/COV W/DEL2,C1874,HCPCS,,,,,both,, ,7172.15,4303.29,Medicaid,Illinois Medicaid,,4303.29,,,7172.15,788.94,3729.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STNT COAT/COV W/DEL3,C1874,HCPCS,,,,,both,, ,14344.55,8606.73,Medicaid,Illinois Medicaid,,8606.73,,,14344.55,1577.90,7459.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STNT COAT/COV W/DEL4,C1874,HCPCS,,,,,both,, ,23907.59,14344.55,Medicaid,Illinois Medicaid,,14344.55,,,23907.59,2629.83,12431.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STNT NO COCV W/DEL 1,C1876,HCPCS,,,,,both,, ,3589.81,2153.88,Medicaid,Illinois Medicaid,,2153.88,,,3589.81,394.88,1866.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STNT NO COCV W/DEL 2,C1876,HCPCS,,,,,both,, ,4786.15,2871.69,Medicaid,Illinois Medicaid,,2871.69,,,4786.15,526.48,2488.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STNT NO COCV W/DEL 3,C1876,HCPCS,,,,,both,, ,9567.67,5740.60,Medicaid,Illinois Medicaid,,5740.60,,,9567.67,1052.44,4975.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STNT NO COCV W/DEL 4,C1876,HCPCS,,,,,both,, ,14344.55,8606.73,Medicaid,Illinois Medicaid,,8606.73,,,14344.55,1577.90,7459.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STNT NO-COA/COV W/O1,C1877,HCPCS,,,,,both,, ,3586.20,2151.72,Medicaid,Illinois Medicaid,,2151.72,,,3586.20,394.48,1864.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STNT NO-COA/COV W/O2,C1877,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,2868.91,,,4781.52,525.97,2486.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VENA CAVA FILTER 1,C1880,HCPCS,,,,,both,, ,3586.20,2151.72,Medicaid,Illinois Medicaid,,2151.72,,,3586.20,394.48,1864.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VENA CAVA FILTER 2,C1880,HCPCS,,,,,both,, ,7172.15,4303.29,Medicaid,Illinois Medicaid,,4303.29,,,7172.15,788.94,3729.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AICD OHR THN SGL/DU1,C1882,HCPCS,,,,,both,, ,99999.00,59999.40,Medicaid,Illinois Medicaid,,59999.40,,,99999.00,10999.89,51999.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EMBOLIZ PROTECT SYS1,C1884,HCPCS,,,,,both,, ,6144.21,3686.52,Medicaid,Illinois Medicaid,,3686.52,,,6144.21,675.86,3194.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EMBOLIZ PROTECT SYS2,C1884,HCPCS,,,,,both,, ,7172.15,4303.29,Medicaid,Illinois Medicaid,,4303.29,,,7172.15,788.94,3729.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH TRNSLUM ANG LA1,C1885,HCPCS,,,,,both,, ,7172.15,4303.29,Medicaid,Illinois Medicaid,,4303.29,,,7172.15,788.94,3729.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH TRNSLUM ANG LA2,C1885,HCPCS,,,,,both,, ,9563.04,5737.82,Medicaid,Illinois Medicaid,,5737.82,,,9563.04,1051.93,4972.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATHETER GUIDING 1,C1887,HCPCS,,,,,both,, ,358.70,215.22,Medicaid,Illinois Medicaid,,215.22,,,358.70,39.46,186.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATHETER GUIDING 2,C1887,HCPCS,,,,,both,, ,1195.32,717.19,Medicaid,Illinois Medicaid,,717.19,,,1195.32,131.49,621.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATHETER GUIDING 3,C1887,HCPCS,,,,,both,, ,1912.71,1147.62,Medicaid,Illinois Medicaid,,1147.62,,,1912.71,210.40,994.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH ABLTN NOCRD ED1,C1888,HCPCS,,,,,both,, ,896.62,537.97,Medicaid,Illinois Medicaid,,537.97,,,896.62,98.63,466.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH ABLTN NOCRD ED2,C1888,HCPCS,,,,,both,, ,1195.32,717.19,Medicaid,Illinois Medicaid,,717.19,,,1195.32,131.49,621.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EAR TUBES DRAINAGE 1,C1889,HCPCS,,,,,both,, ,113.04,67.82,Medicaid,Illinois Medicaid,,67.82,,,113.04,12.43,58.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TISSUE EXP NONBREAST,C1889,HCPCS,,,,,both,, ,570.11,342.06,Medicaid,Illinois Medicaid,,342.06,,,570.11,62.71,296.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INF PMP NON-PROG LV1,C1891,HCPCS,,,,,both,, ,10237.17,6142.30,Medicaid,Illinois Medicaid,,6142.30,,,10237.17,1126.09,5323.33,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PEEL-AWAY SHEATH 1,C1892,HCPCS,,,,,both,, ,179.22,107.53,Medicaid,Illinois Medicaid,,107.53,,,179.22,19.71,93.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PEEL-AWAY SHEATH 2,C1892,HCPCS,,,,,both,, ,478.18,286.90,Medicaid,Illinois Medicaid,,286.90,,,478.18,52.60,248.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PEEL-AWAY SHEATH 3,C1892,HCPCS,,,,,both,, ,1434.53,860.71,Medicaid,Illinois Medicaid,,860.71,,,1434.53,157.80,745.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INT SHTH FIX NO-PL 1,C1893,HCPCS,,,,,both,, ,611.31,366.78,Medicaid,Illinois Medicaid,,366.78,,,611.31,67.24,317.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INT SHTH FIX NO-PL 2,C1893,HCPCS,,,,,both,, ,3048.29,1828.97,Medicaid,Illinois Medicaid,,1828.97,,,3048.29,335.31,1585.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SHEATH NON-LASR 1,C1894,HCPCS,,,,,both,, ,717.14,430.28,Medicaid,Illinois Medicaid,,430.28,,,717.14,78.89,372.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SHEATH NON-LASR 2,C1894,HCPCS,,,,,both,, ,1434.53,860.71,Medicaid,Illinois Medicaid,,860.71,,,1434.53,157.80,745.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SHEATH NON-LASR 3,C1894,HCPCS,,,,,both,, ,2390.63,1434.37,Medicaid,Illinois Medicaid,,1434.37,,,2390.63,262.97,1243.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SHEATH NON-LASR 4,C1894,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,2868.91,,,4781.52,525.97,2486.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SHEATH NON-LASR 5,C1894,HCPCS,,,,,both,, ,7172.15,4303.29,Medicaid,Illinois Medicaid,,4303.29,,,7172.15,788.94,3729.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SHEATH NON-LASR 6,C1894,HCPCS,,,,,both,, ,9563.04,5737.82,Medicaid,Illinois Medicaid,,5737.82,,,9563.04,1051.93,4972.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SHEATH NON-LASR 7,C1894,HCPCS,,,,,both,, ,14344.55,8606.73,Medicaid,Illinois Medicaid,,8606.73,,,14344.55,1577.90,7459.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SHEATH NON-LASR 8,C1894,HCPCS,,,,,both,, ,19126.07,11475.64,Medicaid,Illinois Medicaid,,11475.64,,,19126.07,2103.87,9945.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEAD AICD END DUL L1,C1895,HCPCS,,,,,both,, ,76277.94,45766.76,Medicaid,Illinois Medicaid,,45766.76,,,76277.94,8390.57,39664.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEAD AICD END DUL L2,C1895,HCPCS,,,,,both,, ,16735.18,10041.10,Medicaid,Illinois Medicaid,,10041.10,,,16735.18,1840.87,8702.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEAD AICD NO-SING L1,C1896,HCPCS,,,,,both,, ,16206.54,9723.92,Medicaid,Illinois Medicaid,,9723.92,,,16206.54,1782.72,8427.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEAD NEUROSTM TST K1,C1897,HCPCS,,,,,both,, ,3586.20,2151.72,Medicaid,Illinois Medicaid,,2151.72,,,3586.20,394.48,1864.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEAD NEUROSTM TST K2,C1897,HCPCS,,,,,both,, ,6646.33,3987.79,Medicaid,Illinois Medicaid,,3987.79,,,6646.33,731.10,3456.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEAD PMKR NON-TRN L1,C1898,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,2868.91,,,4781.52,525.97,2486.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEAD PMKR/AICD CMBL1,C1899,HCPCS,,,,,both,, ,41218.03,24730.81,Medicaid,Illinois Medicaid,,24730.81,,,41218.03,4533.98,21433.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEAD LT VENT COR LV1,C1900,HCPCS,,,,,both,, ,20278.38,12167.02,Medicaid,Illinois Medicaid,,12167.02,,,20278.38,2230.62,10544.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SEALANT PULMNRY LIQD,C2615,HCPCS,,,,,both,, ,5932.54,3559.52,Medicaid,Illinois Medicaid,,3559.52,,,5932.54,652.58,3084.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STNT NONCOR TM W/O 1,C2617,HCPCS,,,,,both,, ,2963.83,1778.29,Medicaid,Illinois Medicaid,,1778.29,,,2963.83,326.02,1541.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROBE CRYOABLATION 1,C2618,HCPCS,,,,,both,, ,3586.20,2151.72,Medicaid,Illinois Medicaid,,2151.72,,,3586.20,394.48,1864.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROBE CRYOABLATION 2,C2618,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,2868.91,,,4781.52,525.97,2486.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROBE CRYOABLATION 3,C2618,HCPCS,,,,,both,, ,9563.04,5737.82,Medicaid,Illinois Medicaid,,5737.82,,,9563.04,1051.93,4972.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROBE CRYOABLATION 4,C2618,HCPCS,,,,,both,, ,16735.18,10041.10,Medicaid,Illinois Medicaid,,10041.10,,,16735.18,1840.87,8702.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PMKR DUL NON RAT LV1,C2619,HCPCS,,,,,both,, ,73166.31,43899.78,Medicaid,Illinois Medicaid,,43899.78,,,73166.31,8048.29,38046.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PMKR SNGL NON RTE-RE,C2620,HCPCS,,,,,both,, ,45918.17,27550.90,Medicaid,Illinois Medicaid,,27550.90,,,45918.17,5051.00,23877.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PMKR OTHR TH SNGL L1,C2621,HCPCS,,,,,both,, ,99999.00,59999.40,Medicaid,Illinois Medicaid,,59999.40,,,99999.00,10999.89,51999.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PRSTHS PENILE NNINF1,C2622,HCPCS,,,,,both,, ,38894.09,23336.45,Medicaid,Illinois Medicaid,,23336.45,,,38894.09,4278.35,20224.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
WIRELESS PRESS SENS,C2624,HCPCS,,,,,both,, ,99999.00,59999.40,Medicaid,Illinois Medicaid,,59999.40,,,99999.00,10999.89,51999.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STNT NON-COR TM DL 1,C2625,HCPCS,,,,,both,, ,541.52,324.91,Medicaid,Illinois Medicaid,,324.91,,,541.52,59.57,281.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STNT NON-COR TM DL 2,C2625,HCPCS,,,,,both,, ,722.03,433.21,Medicaid,Illinois Medicaid,,433.21,,,722.03,79.42,375.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STNT NON-COR TM DL 3,C2625,HCPCS,,,,,both,, ,3787.83,2272.69,Medicaid,Illinois Medicaid,,2272.69,,,3787.83,416.66,1969.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INF PMP NON-PROG LV1,C2626,HCPCS,,,,,both,, ,545.13,327.07,Medicaid,Illinois Medicaid,,327.07,,,545.13,59.96,283.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH SUPRPUBC-CYSTO1,C2627,HCPCS,,,,,both,, ,172.01,103.20,Medicaid,Illinois Medicaid,,103.20,,,172.01,18.92,89.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH SUPRPUBC-CYSTO2,C2627,HCPCS,,,,,both,, ,1075.84,645.50,Medicaid,Illinois Medicaid,,645.50,,,1075.84,118.34,559.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH OCCLUSION 1,C2628,HCPCS,,,,,both,, ,717.14,430.28,Medicaid,Illinois Medicaid,,430.28,,,717.14,78.89,372.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH OCCLUSION 2,C2628,HCPCS,,,,,both,, ,1434.53,860.71,Medicaid,Illinois Medicaid,,860.71,,,1434.53,157.80,745.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CATH OCCLUSION 3,C2628,HCPCS,,,,,both,, ,2390.63,1434.37,Medicaid,Illinois Medicaid,,1434.37,,,2390.63,262.97,1243.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INTRO/SHEATH LASER 1,C2629,HCPCS,,,,,both,, ,5379.18,3227.50,Medicaid,Illinois Medicaid,,3227.50,,,5379.18,591.71,2797.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INTRO/SHEATH LASER 2,C2629,HCPCS,,,,,both,, ,7172.15,4303.29,Medicaid,Illinois Medicaid,,4303.29,,,7172.15,788.94,3729.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
REP DEV URNRY WO SL1,C2631,HCPCS,,,,,both,, ,8266.27,4959.76,Medicaid,Illinois Medicaid,,4959.76,,,8266.27,909.29,4298.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LC S SUB T/A/L 25S,C5271,HCPCS,,,,,both,, ,2393.60,1436.16,Medicaid,Illinois Medicaid,,1436.16,,,2393.60,263.30,1244.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LC S SUB T/A/L ADL,C5272,HCPCS,,,,,both,, ,2393.60,1436.16,Medicaid,Illinois Medicaid,,1436.16,,,2393.60,263.30,1244.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LC S SUB T/A/L 100SQ,C5273,HCPCS,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,4170.07,,,6950.12,764.51,3614.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LC S SUB T/A/L ADL,C5274,HCPCS,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,4170.07,,,6950.12,764.51,3614.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LC S SUB F/NK/HF/G,C5275,HCPCS,,,,,both,, ,2393.60,1436.16,Medicaid,Illinois Medicaid,,1436.16,,,2393.60,263.30,1244.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LC S SUB F/NK/HF/G EA,C5276,HCPCS,,,,,both,, ,2393.60,1436.16,Medicaid,Illinois Medicaid,,1436.16,,,2393.60,263.30,1244.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LC S SUB F/NK/HF/G 100SQ,C5277,HCPCS,,,,,both,, ,2393.60,1436.16,Medicaid,Illinois Medicaid,,1436.16,,,2393.60,263.30,1244.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LC S SUB F/NK/HF/G EA,C5278,HCPCS,,,,,both,, ,2393.60,1436.16,Medicaid,Illinois Medicaid,,1436.16,,,2393.60,263.30,1244.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-ABDOMEN W,C8900,HCPCS,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,621.41,,,1035.69,113.93,538.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-ABDOMEN W,C8900,HCPCS,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,668.73,,,1114.55,122.60,579.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-ABDOMEN WO,C8901,HCPCS,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,429.59,,,715.99,78.76,372.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-ABDOMEN WO,C8901,HCPCS,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,462.27,,,770.45,84.75,400.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,718.24,,,1197.08,131.68,622.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,772.97,,,1288.29,141.71,669.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,2669.78,1601.86,Medicaid,Illinois Medicaid,,1601.86,,,2669.78,293.68,1388.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-BREAST UNI WWO,C8905,HCPCS,,,,,both,, ,3114.65,1868.79,Medicaid,Illinois Medicaid,,1868.79,,,3114.65,342.61,1619.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MR-BREAST BI WWO,C8908,HCPCS,,,,,both,, ,3115.20,1869.12,Medicaid,Illinois Medicaid,,1869.12,,,3115.20,342.67,1619.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-LW EXTR WWO,C8914,HCPCS,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,718.24,,,1197.08,131.68,622.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-LW EXTR WWO,C8914,HCPCS,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,772.97,,,1288.29,141.71,669.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-LW EXTR WWO BI,C8914,HCPCS,,,,,both,, ,2394.15,1436.49,Medicaid,Illinois Medicaid,,1436.49,,,2394.15,263.36,1244.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MRA-LW EXTR WWO BI,C8914,CPT,,,,,both,, ,2576.60,1545.96,Medicaid,Illinois Medicaid,,1545.96,,,2576.60,283.43,1339.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-CAD MRI LESION,C8937,HCPCS,,,,,both,, ,50.52,30.31,Medicaid,Illinois Medicaid,,30.31,,,50.52,5.56,26.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COCAINE HCL NASL 1MG,C9046,HCPCS,,,,,both,4,ML,8.00,4.80,Medicaid,Illinois Medicaid,,4.80,,,8.00,0.88,4.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IDARUCIZU 2.5GM/50ML,C9399,HCPCS,,,,,both,50,ML,10077.78,6046.66,Medicaid,Illinois Medicaid,,6046.66,,,10077.78,1108.56,5240.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
REMDESIV 5MG/ML 20ML,C9399,HCPCS,,,,,both,, ,2878.85,1727.31,Medicaid,Illinois Medicaid,,1727.31,,,2878.85,316.67,1497,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IC-PRQ DE COR STNT,C9600,CPT,,,,,both,, ,42411.02,25446.61,Medicaid,Illinois Medicaid,,25446.61,,,42411.02,4665.21,22053.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IC-PRQ DE CR REV CAB,C9604,CPT,,,,,both,, ,29428.39,17657.03,Medicaid,Illinois Medicaid,,17657.03,,,29428.39,3237.12,15302.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADMIN FLU VACCINE,G0008,HCPCS,,,,,both,, ,106.25,63.75,Medicaid,Illinois Medicaid,,63.75,,,106.25,11.69,55.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADMIN FLU VACCINE,G0008,HCPCS,,,,,both,, ,106.25,63.75,Medicaid,Illinois Medicaid,,63.75,,,106.25,11.69,55.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,70.81,42.48,Medicaid,Illinois Medicaid,,42.48,,,70.81,7.79,36.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,70.81,42.48,Medicaid,Illinois Medicaid,,42.48,,,70.81,7.79,36.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,109.18,65.50,Medicaid,Illinois Medicaid,,65.50,,,109.18,12.01,56.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,143.69,86.21,Medicaid,Illinois Medicaid,,86.21,,,143.69,15.81,74.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,184.63,110.77,Medicaid,Illinois Medicaid,,110.77,,,184.63,20.31,96.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADMIN PNEU VACCINE,G0009,HCPCS,,,,,both,, ,106.25,63.75,Medicaid,Illinois Medicaid,,63.75,,,106.25,11.69,55.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADMIN PNEU VACCINE,G0009,HCPCS,,,,,both,, ,106.25,63.75,Medicaid,Illinois Medicaid,,63.75,,,106.25,11.69,55.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,63.03,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,63.03,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,109.18,65.50,Medicaid,Illinois Medicaid,,65.50,,,109.18,12.01,56.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,143.69,86.21,Medicaid,Illinois Medicaid,,86.21,,,143.69,15.81,74.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,184.63,110.77,Medicaid,Illinois Medicaid,,110.77,,,184.63,20.31,96.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEP B VACCINE ADMIN,G0010,HCPCS,,,,,both,, ,106.25,63.75,Medicaid,Illinois Medicaid,,63.75,,,106.25,11.69,55.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEP B VACCINE ADMIN,G0010,HCPCS,,,,,both,, ,106.25,63.75,Medicaid,Illinois Medicaid,,63.75,,,106.25,11.69,55.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,63.03,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,63.03,,,105.06,11.56,54.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,109.44,65.66,Medicaid,Illinois Medicaid,,65.66,,,109.44,12.04,56.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PSA SCRN TO LABCORP,G0103,HCPCS,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,621.75,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PSA SCRN TO LABCORP,G0103,HCPCS,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,621.75,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PSA, SCREENING",G0103,HCPCS,,,,,both,, ,135.85,81.51,Medicaid,Illinois Medicaid,,81.51,,,135.85,14.94,70.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PSA, SCREENING",G0103,HCPCS,,,,,both,,,1036.25,1036.25,Medicaid,Illinois Medicaid,,1036.25,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DSMT INDIVIDUAL 30M,G0108,HCPCS,,,,,both,, ,261.62,156.97,Medicaid,Illinois Medicaid,,156.97,,,261.62,28.78,136.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PAP THINLAY LIQ SCRN,G0123,HCPCS,,,,,both,, ,195.06,117.03,Medicaid,Illinois Medicaid,,117.03,,,195.06,21.46,101.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STRNGTH TRN SLG 15MI,G0237,HCPCS,,,,,both,, ,177.16,106.29,Medicaid,Illinois Medicaid,,106.29,,,177.16,19.49,92.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RESP FX TRN SGL 15MN,G0238,HCPCS,,,,,both,, ,177.16,106.29,Medicaid,Illinois Medicaid,,106.29,,,177.16,19.49,92.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RESP FX TRAIN GROUP,G0239,HCPCS,,,,,both,, ,177.16,106.29,Medicaid,Illinois Medicaid,,106.29,,,177.16,19.49,92.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DIALYSIS  EMERGENT,G0257,HCPCS,,,,,both,, ,9908.34,5945.00,Medicaid,Illinois Medicaid,,5945.00,,,9908.34,1089.92,5152.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IR-ARTHROGRAM SI JTS,G0260,HCPCS,,,,,both,, ,2101.41,1260.84,Medicaid,Illinois Medicaid,,1260.84,,,2101.41,231.16,1092.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CC-PLACE CLOS DEV,G0269,HCPCS,,,,,both,, ,22097.11,13258.26,Medicaid,Illinois Medicaid,,13258.26,,,22097.11,2430.68,11490.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HBO FB 30MN,G0277,HCPCS,,,,,both,, ,265.23,159.13,Medicaid,Illinois Medicaid,,159.13,,,265.23,29.18,137.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-TOMO MAMMO BI,G0279,HCPCS,,,,,both,,,160.68,160.68,Medicaid,Illinois Medicaid,50,160.68,,,160.68,17.67,83.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-TOMO MAMMO BI,G0279,HCPCS,,,,,both,, ,160.68,96.40,Medicaid,Illinois Medicaid,,96.40,,,160.68,17.67,83.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-TOMO MAMMO UNI,G0279,HCPCS,,,,,both,,,133.90,133.90,Medicaid,Illinois Medicaid,,133.90,,,133.90,14.73,69.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BR-TOMO MAMMO UNI,G0279,HCPCS,,,,,both,, ,133.90,80.34,Medicaid,Illinois Medicaid,,80.34,,,133.90,14.73,69.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STIM-UNATTND-VI,G0283,HCPCS,,,,,both,, ,443.37,266.02,Medicaid,Illinois Medicaid,,266.02,,,443.37,48.77,230.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STIM-UNATTND-VI,G0283,HCPCS,,,,,both,, ,480.68,288.40,Medicaid,Illinois Medicaid,,288.40,,,480.68,52.87,249.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STM-UNATVI COTA,G0283,HCPCS,,,,,both,, ,515.00,309.00,Medicaid,Illinois Medicaid,,309.00,,,515.00,56.65,267.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STM-UNATVI COTA,G0283,HCPCS,,,,,both,, ,515.00,309.00,Medicaid,Illinois Medicaid,,309.00,,,515.00,56.65,267.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STM-UNAT-VI PTA,G0283,HCPCS,,,,,both,, ,37.08,22.24,Medicaid,Illinois Medicaid,,22.24,,,37.08,4.08,19.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STM-UNAT-VI PTA,G0283,HCPCS,,,,,both,, ,37.08,22.24,Medicaid,Illinois Medicaid,,22.24,,,37.08,4.08,19.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STM-UNAT-VI PTA,G0283,HCPCS,,,,,both,, ,37.08,22.24,Medicaid,Illinois Medicaid,,22.24,,,37.08,4.08,19.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STM-UNAT-VI PTA,G0283,HCPCS,,,,,both,, ,37.08,22.24,Medicaid,Illinois Medicaid,,22.24,,,37.08,4.08,19.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STM-UNAT-VI PTA,G0283,HCPCS,,,,,both,, ,474.83,284.89,Medicaid,Illinois Medicaid,,284.89,,,474.83,52.23,246.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ELEC STM-UNAT-VI PTA,G0283,HCPCS,,,,,both,, ,474.83,284.89,Medicaid,Illinois Medicaid,,284.89,,,474.83,52.23,246.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SCR FECAL OC BLD 1-3,G0328,HCPCS,,,,,both,, ,159.42,95.65,Medicaid,Illinois Medicaid,,95.65,,,159.42,17.54,82.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L&D OBSERV 1ST HOUR,G0378,CPT,,,,,both,, ,1189.39,713.63,Medicaid,Illinois Medicaid,,713.63,,,1189.39,130.83,618.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L&D OBSERV 1ST HOUR,G0378,CPT,,,,,both,, ,1189.39,713.63,Medicaid,Illinois Medicaid,,713.63,,,1189.39,130.83,618.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L&D OBSERV ADDL HOUR,G0378,CPT,,,,,both,, ,151.15,90.69,Medicaid,Illinois Medicaid,,90.69,,,151.15,16.63,78.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L&D OBSERV ADDL HOUR,G0378,CPT,,,,,both,, ,151.15,90.69,Medicaid,Illinois Medicaid,,90.69,,,151.15,16.63,78.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OBSRVATION ADDL HOUR,G0378,HCPCS,,,,,both,, ,141.21,84.72,Medicaid,Illinois Medicaid,,84.72,,,141.21,15.53,73.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DIRECT ADMIT TO OBS,G0379,HCPCS,,,,,both,, ,610.15,366.09,Medicaid,Illinois Medicaid,,366.09,,,610.15,67.12,317.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L&D DIRECT ADMIT OBS,G0379,HCPCS,,,,,both,, ,653.54,392.12,Medicaid,Illinois Medicaid,,392.12,,,653.54,71.89,339.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
L&D DIRECT ADMIT OBS,G0379,HCPCS,,,,,both,, ,653.54,392.12,Medicaid,Illinois Medicaid,,392.12,,,653.54,71.89,339.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HOME SLEEP TYPE 3,G0399,HCPCS,,,,,both,, ,428.48,257.08,Medicaid,Illinois Medicaid,,257.08,,,428.48,47.13,222.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HOME SLEEP TYPE 3,G0399,HCPCS,,,,,both,, ,428.48,257.08,Medicaid,Illinois Medicaid,,257.08,,,428.48,47.13,222.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROSTATE NDL BX ANY,G0416,HCPCS,,,,,both,, ,1059.54,635.72,Medicaid,Illinois Medicaid,,635.72,,,1059.54,116.55,550.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HIV-1 AB EIA,G0432,HCPCS,,,,,both,, ,113.39,68.03,Medicaid,Illinois Medicaid,,68.03,,,113.39,12.47,58.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HIV1 AG HIV1 HIV2 AB,G0433,CPT,,,,,both,, ,165.59,99.35,Medicaid,Illinois Medicaid,,99.35,,,165.59,18.21,86.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HIV1-HIV2 AB SNG RES,G0435,CPT,,,,,both,, ,42.66,25.59,Medicaid,Illinois Medicaid,,25.59,,,42.66,4.69,22.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HIV1-HIV2 AB SNG RES,G0435,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,621.75,,,1036.25,113.99,538.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EVAL & MGMT LEVEL 3,G0463,HCPCS,,,,,both,, ,215.75,129.45,Medicaid,Illinois Medicaid,,129.45,,,215.75,23.73,112.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EVAL & MGMT LEVEL 5,G0463,HCPCS,,,,,both,, ,261.00,156.60,Medicaid,Illinois Medicaid,,156.60,,,261.00,28.71,135.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HOSPITAL OUTPT VISIT,G0463,HCPCS,,,,,both,, ,520.00,312.00,Medicaid,Illinois Medicaid,,312.00,,,520.00,57.20,270.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEVEL 1 EP,G0463,HCPCS,,,,,both,, ,249.52,149.71,Medicaid,Illinois Medicaid,,149.71,,,249.52,27.45,129.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEVEL 2 EP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Medicaid,Illinois Medicaid,,113.25,,,188.75,20.76,98.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEVEL 2 NP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Medicaid,Illinois Medicaid,,113.25,,,188.75,20.76,98.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEVEL 3 NP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Medicaid,Illinois Medicaid,,113.25,,,188.75,20.76,98.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEVEL 5 EP,G0463,HCPCS,,,,,both,, ,425.91,255.54,Medicaid,Illinois Medicaid,,255.54,,,425.91,46.85,221.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEVEL 5 NP,G0463,HCPCS,,,,,both,, ,324.19,194.51,Medicaid,Illinois Medicaid,,194.51,,,324.19,35.66,168.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEVEL 5 NP,G0463,HCPCS,,,,,both,, ,324.19,194.51,Medicaid,Illinois Medicaid,,194.51,,,324.19,35.66,168.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OB TRIAGE LVL 1 EP,G0463,HCPCS,,,,,both,, ,700.40,420.24,Medicaid,Illinois Medicaid,,420.24,,,700.40,77.04,364.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PAT EVAL/MGM LEVEL 2,G0463,HCPCS,,,,,both,, ,325.25,195.15,Medicaid,Illinois Medicaid,,195.15,,,325.25,35.78,169.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PAT EVAL/MGM LEVEL 3,G0463,HCPCS,,,,,both,, ,379.50,227.70,Medicaid,Illinois Medicaid,,227.70,,,379.50,41.75,197.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PAT EVAL/MGM LEVEL 4,G0463,HCPCS,,,,,both,, ,433.50,260.10,Medicaid,Illinois Medicaid,,260.10,,,433.50,47.69,225.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PAT EVAL/MGM LEVEL 5,G0463,HCPCS,,,,,both,, ,487.50,292.50,Medicaid,Illinois Medicaid,,292.50,,,487.50,53.63,253.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYSICAL-EMPLOYMENT,G0463,HCPCS,,,,,both,, ,55.62,33.37,Medicaid,Illinois Medicaid,,33.37,,,55.62,6.12,28.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYSICAL-EMPLOYMENT,G0463,HCPCS,,,,,both,, ,55.62,33.37,Medicaid,Illinois Medicaid,,33.37,,,55.62,6.12,28.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYSICAL-SCHOOL,G0463,HCPCS,,,,,both,, ,66.95,40.17,Medicaid,Illinois Medicaid,,40.17,,,66.95,7.36,34.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYSICAL-SCHOOL,G0463,HCPCS,,,,,both,, ,66.95,40.17,Medicaid,Illinois Medicaid,,40.17,,,66.95,7.36,34.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PSYCH CLINIC TYPE A,G0463,HCPCS,,,,,both,, ,294.25,176.55,Medicaid,Illinois Medicaid,,176.55,,,294.25,32.37,153.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SUTURE REMOVAL,G0463,HCPCS,,,,,both,, ,132.61,79.56,Medicaid,Illinois Medicaid,,79.56,,,132.61,14.59,68.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SUTURE REMOVAL,G0463,HCPCS,,,,,both,, ,132.61,79.56,Medicaid,Illinois Medicaid,,79.56,,,132.61,14.59,68.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URG CARE L1 EP PROF,G0463,HCPCS,,,,,both,, ,60.50,36.30,Medicaid,Illinois Medicaid,,36.30,,,60.50,6.66,31.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URG CARE L2 EP PROF,G0463,HCPCS,,,,,both,, ,123.25,73.95,Medicaid,Illinois Medicaid,,73.95,,,123.25,13.56,64.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URG CARE L2 EP PROF,G0463,HCPCS,,,,,both,, ,123.25,73.95,Medicaid,Illinois Medicaid,,73.95,,,123.25,13.56,64.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URG CARE L2 NP PROF,G0463,HCPCS,,,,,both,, ,213.00,127.80,Medicaid,Illinois Medicaid,,127.80,,,213.00,23.43,110.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URG CARE L3 EP PROF,G0463,HCPCS,,,,,both,, ,209.75,125.85,Medicaid,Illinois Medicaid,,125.85,,,209.75,23.07,109.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URG CARE L3 NP PROF,G0463,HCPCS,,,,,both,, ,312.50,187.50,Medicaid,Illinois Medicaid,,187.50,,,312.50,34.38,162.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URG CARE L4 EP PROF,G0463,HCPCS,,,,,both,, ,309.25,185.55,Medicaid,Illinois Medicaid,,185.55,,,309.25,34.02,160.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URG CARE L4 NP PROF,G0463,HCPCS,,,,,both,, ,483.50,290.10,Medicaid,Illinois Medicaid,,290.10,,,483.50,53.19,251.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URG CARE L5 EP PROF,G0463,HCPCS,,,,,both,, ,414.25,248.55,Medicaid,Illinois Medicaid,,248.55,,,414.25,45.57,215.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URG CARE L5 NP PROF,G0463,HCPCS,,,,,both,, ,602.50,361.50,Medicaid,Illinois Medicaid,,361.50,,,602.50,66.28,313.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 2 EP,G0463,HCPCS,,,,,both,, ,251.84,151.10,Medicaid,Illinois Medicaid,,151.10,,,251.84,27.70,130.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 2 EP,G0463,HCPCS,,,,,both,, ,251.84,151.10,Medicaid,Illinois Medicaid,,151.10,,,251.84,27.70,130.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 2 EP,G0463,HCPCS,,,,,both,, ,251.84,151.10,Medicaid,Illinois Medicaid,,151.10,,,251.84,27.70,130.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 2 EP,G0463,HCPCS,,,,,both,, ,251.84,151.10,Medicaid,Illinois Medicaid,,151.10,,,251.84,27.70,130.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 2 NP,G0463,HCPCS,,,,,both,, ,234.07,140.44,Medicaid,Illinois Medicaid,,140.44,,,234.07,25.75,121.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 2 NP,G0463,HCPCS,,,,,both,, ,234.07,140.44,Medicaid,Illinois Medicaid,,140.44,,,234.07,25.75,121.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 3 EP,G0463,HCPCS,,,,,both,, ,281.71,169.02,Medicaid,Illinois Medicaid,,169.02,,,281.71,30.99,146.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 3 EP,G0463,HCPCS,,,,,both,, ,281.71,169.02,Medicaid,Illinois Medicaid,,169.02,,,281.71,30.99,146.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 3 NP,G0463,HCPCS,,,,,both,, ,261.88,157.12,Medicaid,Illinois Medicaid,,157.12,,,261.88,28.81,136.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 3 NP,G0463,HCPCS,,,,,both,, ,261.88,157.12,Medicaid,Illinois Medicaid,,157.12,,,261.88,28.81,136.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 4 EP,G0463,HCPCS,,,,,both,, ,311.83,187.09,Medicaid,Illinois Medicaid,,187.09,,,311.83,34.30,162.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 4 EP,G0463,HCPCS,,,,,both,, ,311.83,187.09,Medicaid,Illinois Medicaid,,187.09,,,311.83,34.30,162.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 4 NP,G0463,HCPCS,,,,,both,, ,289.69,173.81,Medicaid,Illinois Medicaid,,173.81,,,289.69,31.87,150.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 4 NP,G0463,HCPCS,,,,,both,, ,289.69,173.81,Medicaid,Illinois Medicaid,,173.81,,,289.69,31.87,150.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 5 NP,G0463,HCPCS,,,,,both,, ,317.50,190.50,Medicaid,Illinois Medicaid,,190.50,,,317.50,34.93,165.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 5 NP,G0463,HCPCS,,,,,both,, ,317.50,190.50,Medicaid,Illinois Medicaid,,190.50,,,317.50,34.93,165.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 5 NP,G0463,HCPCS,,,,,both,, ,317.50,190.50,Medicaid,Illinois Medicaid,,190.50,,,317.50,34.93,165.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE LVL 5 NP,G0463,HCPCS,,,,,both,, ,317.50,190.50,Medicaid,Illinois Medicaid,,190.50,,,317.50,34.93,165.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE- SUT REM,G0463,HCPCS,,,,,both,, ,239.73,143.83,Medicaid,Illinois Medicaid,,143.83,,,239.73,26.37,124.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE- SUT REM,G0463,HCPCS,,,,,both,, ,239.73,143.83,Medicaid,Illinois Medicaid,,143.83,,,239.73,26.37,124.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE- SUT REM,G0463,HCPCS,,,,,both,, ,239.73,143.83,Medicaid,Illinois Medicaid,,143.83,,,239.73,26.37,124.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
URGENT CARE- SUT REM,G0463,HCPCS,,,,,both,, ,239.73,143.83,Medicaid,Illinois Medicaid,,143.83,,,239.73,26.37,124.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EVAL & MGMT LEVEL 4,G0463,HCPCS,,,,,Outpatient,, ,237.25,142.35,Medicaid,Illinois Medicaid,,142.35,,,237.25,26.10,123.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"New patient office of other outpatient visit, typically 60 min",G0463,HCPCS,,,,,Outpatient,,,317.50,317.50,Medicaid,Illinois Medicaid,,317.50,,,317.50,34.93,165.1,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"New patient office of other outpatient visit, typically 45 min",G0463,HCPCS,,,,,Outpatient,,,289.69,289.69,Medicaid,Illinois Medicaid,,289.69,,,289.69,31.87,150.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"New patient office or other outpatient visit, typically 30 min",G0463,HCPCS,,,,,Outpatient,,,261.88,261.88,Medicaid,Illinois Medicaid,,261.88,,,261.88,28.81,136.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HIV1 AG W HIV 1 2 AB,G0475,HCPCS,,,,,both,, ,166.16,99.69,Medicaid,Illinois Medicaid,,99.69,,,166.16,18.28,86.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPB SCR HI RSK NPRG,G0499,HCPCS,,,,,both,, ,570.04,342.02,Medicaid,Illinois Medicaid,,342.02,,,570.04,62.70,296.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ABCIXIMAB 10MG,J0130,HCPCS,,,,,both,, ,4719.72,2831.83,Medicaid,Illinois Medicaid,,2831.83,,,4719.72,519.17,2454.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ACETAMINO 10MG INJ,J0131,HCPCS,,,,,both,100,ML,3.00,1.80,Medicaid,Illinois Medicaid,,1.80,,,3.00,0.33,1.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ACTYLCYSTN INJ 100MG,J0132,HCPCS,,,,,both,30,ML,17.77,10.66,Medicaid,Illinois Medicaid,,10.66,,,17.77,1.95,9.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ACYCLOVIR 5MG INJ,J0133,HCPCS,,,,,both,, ,0.31,0.18,Medicaid,Illinois Medicaid,,0.18,,,0.31,0.03,0.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ACYCLOVIR 5MG INJ,J0133,HCPCS,,,,,both,10,ML,1.03,0.61,Medicaid,Illinois Medicaid,,0.61,,,1.03,0.11,0.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADENOSINE 1MG INJ,J0153,HCPCS,,,,,both,4,ML,15.45,9.27,Medicaid,Illinois Medicaid,,9.27,,,15.45,1.70,8.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADENOSINE 1MG INJ,J0153,HCPCS,,,,,both,4,ML,15.45,9.27,Medicaid,Illinois Medicaid,,9.27,,,15.45,1.70,8.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADRENL/EPINEP 0.1MG,J0171,HCPCS,,,,,both,1,ML,2.68,1.60,Medicaid,Illinois Medicaid,,1.60,,,2.68,0.29,1.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADRENL/EPINEP 0.1MG,J0171,HCPCS,,,,,both,10,ML,8.65,5.19,Medicaid,Illinois Medicaid,,5.19,,,8.65,0.95,4.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EPINEPHRINE INJ 30MG/30ML (1 MG/ML),J0171,HCPCS,,,,,both,30,ML,4.00,2.40,Medicaid,Illinois Medicaid,,2.40,,,4.00,0.44,2.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
REMDESIVIR 1MG INJ,J0248,HCPCS,,,,,both,1,EA,28.00,16.80,Medicaid,Illinois Medicaid,,16.80,,,28.00,3.08,14.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMKCN SULF INJ 100MG,J0278,HCPCS,,,,,both,2,ML,5.56,3.33,Medicaid,Illinois Medicaid,,3.33,,,5.56,0.61,2.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMINOPHYLL 250MG INJ,J0280,HCPCS,,,,,both,20,ML,58.97,35.38,Medicaid,Illinois Medicaid,,35.38,,,58.97,6.49,30.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMINOPHYLL 250MG INJ,J0280,HCPCS,,,,,both,10,ML,96.31,57.78,Medicaid,Illinois Medicaid,,57.78,,,96.31,10.59,50.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMIODARONE 30MG INJ,J0282,HCPCS,,,,,both,18,ML,5.15,3.09,Medicaid,Illinois Medicaid,,3.09,,,5.15,0.57,2.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMIODARONE 30MG INJ,J0282,HCPCS,,,,,both,3,ML,6.39,3.83,Medicaid,Illinois Medicaid,,3.83,,,6.39,0.70,3.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMPHOTER B 50MG INJ,J0285,HCPCS,,,,,both,, ,321.36,192.81,Medicaid,Illinois Medicaid,,192.81,,,321.36,35.35,167.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMPHOTER B LIPO 10MG,J0289,HCPCS,,,,,both,1,EA,211.15,126.69,Medicaid,Illinois Medicaid,,126.69,,,211.15,23.23,109.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,17.00,10.20,Medicaid,Illinois Medicaid,,10.20,,,17.00,1.87,8.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,26.78,16.06,Medicaid,Illinois Medicaid,,16.06,,,26.78,2.95,13.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,26.78,16.06,Medicaid,Illinois Medicaid,,16.06,,,26.78,2.95,13.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,57.94,34.76,Medicaid,Illinois Medicaid,,34.76,,,57.94,6.37,30.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMPICILLIN/SUB 1.5GM,J0295,HCPCS,,,,,both,1,EA,23.69,14.21,Medicaid,Illinois Medicaid,,14.21,,,23.69,2.61,12.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMPICILLIN/SUB 1.5GM,J0295,HCPCS,,,,,both,, ,63.09,37.85,Medicaid,Illinois Medicaid,,37.85,,,63.09,6.94,32.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SUCCINYLCHN 20MG INJ,J0330,HCPCS,,,,,both,10,ML,13.00,7.80,Medicaid,Illinois Medicaid,,7.80,,,13.00,1.43,6.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SUCCINYLCHN 20MG INJ,J0330,HCPCS,,,,,both,, ,20.34,12.20,Medicaid,Illinois Medicaid,,12.20,,,20.34,2.24,10.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HYDRALAZINE 20MG INJ,J0360,HCPCS,,,,,both,1,ML,101.71,61.02,Medicaid,Illinois Medicaid,,61.02,,,101.71,11.19,52.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AZITHROMYC 500MG INJ,J0456,HCPCS,,,,,both,1,EA,40.69,24.41,Medicaid,Illinois Medicaid,,24.41,,,40.69,4.48,21.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ATROPINE 0.01 MG INJ,J0461,HCPCS,,,,,both,1,ML,2.00,1.20,Medicaid,Illinois Medicaid,,1.20,,,2.00,0.22,1.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,, ,0.62,0.37,Medicaid,Illinois Medicaid,,0.37,,,0.62,0.07,0.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,10,ML,1.03,0.61,Medicaid,Illinois Medicaid,,0.61,,,1.03,0.11,0.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DIMERCAPRO 100MG INJ,J0470,HCPCS,,,,,both,, ,198.28,118.96,Medicaid,Illinois Medicaid,,118.96,,,198.28,21.81,103.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DICYCLOMINE 20MG INJ,J0500,HCPCS,,,,,both,2,ML,307.46,184.47,Medicaid,Illinois Medicaid,,184.47,,,307.46,33.82,159.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BENZTROPN MES 1MGINJ,J0515,HCPCS,,,,,both,2,ML,263.42,158.05,Medicaid,Illinois Medicaid,,158.05,,,263.42,28.98,136.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PCN G BENZ/PROC 100K,J0558,HCPCS,,,,,both,, ,34.25,20.55,Medicaid,Illinois Medicaid,,20.55,,,34.25,3.77,17.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PCN G BENZ/PROC 100K,J0558,HCPCS,,,,,both,, ,35.54,21.32,Medicaid,Illinois Medicaid,,21.32,,,35.54,3.91,18.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PEN G BENZ INJ 100K,J0561,HCPCS,,,,,both,2,ML,43.00,25.80,Medicaid,Illinois Medicaid,,25.80,,,43.00,4.73,22.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BIVALIRUDIN 1MG INJ,J0583,HCPCS,,,,,both,1,EA,18.28,10.96,Medicaid,Illinois Medicaid,,10.96,,,18.28,2.01,9.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BOTULINUM TOXI A 1U,J0585,HCPCS,,,,,both,1,EA,33.48,20.08,Medicaid,Illinois Medicaid,,20.08,,,33.48,3.68,17.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BUTORPHANOL 1MG INJ,J0595,HCPCS,,,,,both,1,ML,17.77,10.66,Medicaid,Illinois Medicaid,,10.66,,,17.77,1.95,9.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CINACALC 1MG PO ESRD,J0604,HCPCS,,,,,both,, ,6.18,3.70,Medicaid,Illinois Medicaid,,3.70,,,6.18,0.68,3.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CALCITRIOL .1MCG INJ,J0636,HCPCS,,,,,both,, ,4.33,2.59,Medicaid,Illinois Medicaid,,2.59,,,4.33,0.48,2.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEUCOVORIN 50MG INJ,J0640,HCPCS,,,,,both,1,EA,84.46,50.67,Medicaid,Illinois Medicaid,,50.67,,,84.46,9.29,43.92,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MEPIVACAINE 10ML INJ,J0670,HCPCS,,,,,both,30,ML,19.31,11.58,Medicaid,Illinois Medicaid,,11.58,,,19.31,2.12,10.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MEPIVACAINE 10ML INJ,J0670,HCPCS,,,,,both,20,ML,21.89,13.13,Medicaid,Illinois Medicaid,,13.13,,,21.89,2.41,11.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,12.88,7.72,Medicaid,Illinois Medicaid,,7.72,,,12.88,1.42,6.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,12.88,7.72,Medicaid,Illinois Medicaid,,7.72,,,12.88,1.42,6.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,, ,14.94,8.96,Medicaid,Illinois Medicaid,,8.96,,,14.94,1.64,7.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,, ,14.94,8.96,Medicaid,Illinois Medicaid,,8.96,,,14.94,1.64,7.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,22.40,13.44,Medicaid,Illinois Medicaid,,13.44,,,22.40,2.46,11.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFEPIME 500 MG INJ,J0692,CPT,,,,,both,1,EA,9.00,5.40,Medicaid,Illinois Medicaid,,5.40,,,9.00,0.99,4.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFEPIME 500MG INJ,J0692,HCPCS,,,,,both,, ,19.06,11.43,Medicaid,Illinois Medicaid,,11.43,,,19.06,2.10,9.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFEPIME 500MG INJ,J0692,HCPCS,,,,,both,1,EA,24.72,14.83,Medicaid,Illinois Medicaid,,14.83,,,24.72,2.72,12.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFOXITIN 1GM INJ,J0694,HCPCS,,,,,both,1,EA,53.82,32.29,Medicaid,Illinois Medicaid,,32.29,,,53.82,5.92,27.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFTO50-TAZO25MG INJ,J0695,HCPCS,,,,,both,1,EA,28.84,17.30,Medicaid,Illinois Medicaid,,17.30,,,28.84,3.17,15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,8.03,4.81,Medicaid,Illinois Medicaid,,4.81,,,8.03,0.88,4.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,11.59,6.95,Medicaid,Illinois Medicaid,,6.95,,,11.59,1.27,6.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,12.88,7.72,Medicaid,Illinois Medicaid,,7.72,,,12.88,1.42,6.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,24.72,14.83,Medicaid,Illinois Medicaid,,14.83,,,24.72,2.72,12.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFUROXIME 750MG INJ,J0697,HCPCS,,,,,both,, ,23.69,14.21,Medicaid,Illinois Medicaid,,14.21,,,23.69,2.61,12.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFUROXIME 750MG INJ,J0697,HCPCS,,,,,both,, ,45.06,27.03,Medicaid,Illinois Medicaid,,27.03,,,45.06,4.96,23.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BETAM ACE/SOD PHO3MG,J0702,HCPCS,,,,,both,5,ML,56.14,33.68,Medicaid,Illinois Medicaid,,33.68,,,56.14,6.18,29.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFTAROLIN 10MG INJ,J0712,HCPCS,,,,,both,, ,16.48,9.88,Medicaid,Illinois Medicaid,,9.88,,,16.48,1.81,8.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CEFTAROLIN 10MG INJ,J0712,HCPCS,,,,,both,, ,24.72,14.83,Medicaid,Illinois Medicaid,,14.83,,,24.72,2.72,12.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COLISTIME UP TO 150M,J0770,CPT,,,,,both,1,EA,236.64,141.98,Medicaid,Illinois Medicaid,,141.98,,,236.64,26.03,123.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROCHLORPE UPTO 10MG,J0780,HCPCS,,,,,both,, ,39.66,23.79,Medicaid,Illinois Medicaid,,23.79,,,39.66,4.36,20.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
COSYNTROPN .25MG INJ,J0834,HCPCS,,,,,both,1,EA,687.78,412.66,Medicaid,Illinois Medicaid,,412.66,,,687.78,75.66,357.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DALBAVANCIN 5MG INJ,J0875,HCPCS,,,,,both,, ,85.75,51.45,Medicaid,Illinois Medicaid,,51.45,,,85.75,9.43,44.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DAPTOMYCIN 1 MG INJ,J0878,HCPCS,,,,,both,1,EA,3.50,2.10,Medicaid,Illinois Medicaid,,2.10,,,3.50,0.39,1.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,38.88,23.32,Medicaid,Illinois Medicaid,,23.32,,,38.88,4.28,20.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,38.88,23.32,Medicaid,Illinois Medicaid,,23.32,,,38.88,4.28,20.22,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Medicaid,Illinois Medicaid,,25.65,,,42.75,4.70,22.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Medicaid,Illinois Medicaid,,25.65,,,42.75,4.70,22.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Medicaid,Illinois Medicaid,,25.65,,,42.75,4.70,22.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ARGATROBAN 1MG NESRD,J0883,HCPCS,,,,,both,2.5,ML,18.80,11.28,Medicaid,Illinois Medicaid,,11.28,,,18.80,2.07,9.78,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,111.50,66.90,Medicaid,Illinois Medicaid,,66.90,,,111.50,12.27,57.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,111.50,66.90,Medicaid,Illinois Medicaid,,66.90,,,111.50,12.27,57.98,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,124.37,74.62,Medicaid,Illinois Medicaid,,74.62,,,124.37,13.68,64.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Medicaid,Illinois Medicaid,,97.64,,,162.74,17.90,84.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Medicaid,Illinois Medicaid,,97.64,,,162.74,17.90,84.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Medicaid,Illinois Medicaid,,97.64,,,162.74,17.90,84.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEFEROXAMIN 500MGINJ,J0895,HCPCS,,,,,both,1,EA,66.44,39.86,Medicaid,Illinois Medicaid,,39.86,,,66.44,7.31,34.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEFEROXAMIN 500MGINJ,J0895,HCPCS,,,,,both,, ,132.87,79.72,Medicaid,Illinois Medicaid,,79.72,,,132.87,14.62,69.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DENOSUMAB 1MG INJ,J0897,HCPCS,,,,,both,1,ML,96.31,57.78,Medicaid,Illinois Medicaid,,57.78,,,96.31,10.59,50.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MEDROXYPROG 1MG INJ,J1050,HCPCS,,,,,both,1,ML,4.43,2.65,Medicaid,Illinois Medicaid,,2.65,,,4.43,0.49,2.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TESTOSTER CYPION 1MG,J1071,HCPCS,,,,,both,, ,0.93,0.55,Medicaid,Illinois Medicaid,,0.55,,,0.93,0.10,0.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TESTOSTER CYPION 1MG,J1071,HCPCS,,,,,both,, ,593.28,355.96,Medicaid,Illinois Medicaid,,355.96,,,593.28,65.26,308.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEXAMETH NA 1MG INJ,J1100,HCPCS,,,,,both,1,ML,6.39,3.83,Medicaid,Illinois Medicaid,,3.83,,,6.39,0.70,3.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ACETAZOLAMI 500MGINJ,J1120,HCPCS,,,,,both,1,EA,308.49,185.09,Medicaid,Illinois Medicaid,,185.09,,,308.49,33.93,160.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DIGOXIN 0.5MG INJ,J1160,HCPCS,,,,,both,2,ML,47.12,28.27,Medicaid,Illinois Medicaid,,28.27,,,47.12,5.18,24.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DIGOXIN IMMUNE FAB,J1162,HCPCS,,,,,both,1,EA,6881.43,4128.85,Medicaid,Illinois Medicaid,,4128.85,,,6881.43,756.96,3578.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHENYTOIN NA 50MGINJ,J1165,HCPCS,,,,,both,5,ML,5.36,3.21,Medicaid,Illinois Medicaid,,3.21,,,5.36,0.59,2.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHENYTOIN NA 50MGINJ,J1165,HCPCS,,,,,both,2,ML,12.88,7.72,Medicaid,Illinois Medicaid,,7.72,,,12.88,1.42,6.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEXRAZOXANE 25OMG IJ,J1190,HCPCS,,,,,both,, ,1352.91,811.74,Medicaid,Illinois Medicaid,,811.74,,,1352.91,148.82,703.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DIPHENHYDRAM 50MGINJ,J1200,HCPCS,,,,,both,1,ML,13.91,8.34,Medicaid,Illinois Medicaid,,8.34,,,13.91,1.53,7.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DIPYRIDAMOLE 10MGINJ,J1245,HCPCS,,,,,both,, ,26.78,16.06,Medicaid,Illinois Medicaid,,16.06,,,26.78,2.95,13.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DOBUTAMINE 250MG INJ,J1250,HCPCS,,,,,both,20,ML,28.84,17.30,Medicaid,Illinois Medicaid,,17.30,,,28.84,3.17,15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DOBUTAMINE 250MG INJ,J1250,HCPCS,,,,,both,250,ML,78.28,46.96,Medicaid,Illinois Medicaid,,46.96,,,78.28,8.61,40.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DOPAMIN HCL 40MG INJ,J1265,HCPCS,,,,,both,250,ML,8.55,5.13,Medicaid,Illinois Medicaid,,5.13,,,8.55,0.94,4.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EPTIFABITIDE 5MG IJ,J1327,HCPCS,,,,,both,, ,164.80,98.88,Medicaid,Illinois Medicaid,,98.88,,,164.80,18.13,85.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ERTAPENEM SOD/500MG,J1335,HCPCS,,,,,both,1,EA,298.96,179.37,Medicaid,Illinois Medicaid,,179.37,,,298.96,32.89,155.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ERYTHROMYC 500MG INJ,J1364,HCPCS,,,,,both,1,EA,196.99,118.19,Medicaid,Illinois Medicaid,,118.19,,,196.99,21.67,102.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ESTROGEN CNJ 25MGINJ,J1410,HCPCS,,,,,both,, ,1016.61,609.96,Medicaid,Illinois Medicaid,,609.96,,,1016.61,111.83,528.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FER CARBOXYM 1MG INJ,J1439,HCPCS,,,,,both,15,ML,7.00,4.20,Medicaid,Illinois Medicaid,,4.20,,,7.00,0.77,3.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TBO-FILGRASTIM 1MCG,J1447,HCPCS,,,,,both,0.8,ML,4.53,2.71,Medicaid,Illinois Medicaid,,2.71,,,4.53,0.50,2.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TBO-FILGRASTIM 1MCG,J1447,HCPCS,,,,,both,0.8,ML,4.53,2.71,Medicaid,Illinois Medicaid,,2.71,,,4.53,0.50,2.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,200,ML,32.19,19.31,Medicaid,Illinois Medicaid,,19.31,,,32.19,3.54,16.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,50,ML,84.72,50.83,Medicaid,Illinois Medicaid,,50.83,,,84.72,9.32,44.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,100,ML,144.72,86.83,Medicaid,Illinois Medicaid,,86.83,,,144.72,15.92,75.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"FOMEPIZOLE, 15 MG",J1451,HCPCS,,,,,both,1.5,ML,43.52,26.11,Medicaid,Illinois Medicaid,,26.11,,,43.52,4.79,22.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FOSAPREPITANT 1MG IJ,J1453,HCPCS,,,,,both,1,EA,10.82,6.49,Medicaid,Illinois Medicaid,,6.49,,,10.82,1.19,5.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IVIG (PRIVIGEN)500MG,J1459,HCPCS,,,,,both,200,ML,390.89,234.53,Medicaid,Illinois Medicaid,,234.53,,,390.89,43.00,203.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IVIG (PRIVIGEN)500MG,J1459,HCPCS,,,,,both,200,ML,390.89,234.53,Medicaid,Illinois Medicaid,,234.53,,,390.89,43.00,203.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMMU GLOB LYO 500MG,J1566,HCPCS,,,,,both,, ,270.89,162.53,Medicaid,Illinois Medicaid,,162.53,,,270.89,29.80,140.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IMMU GLOB LYO 500MG,J1566,HCPCS,,,,,both,, ,270.89,162.53,Medicaid,Illinois Medicaid,,162.53,,,270.89,29.80,140.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IVIG (OCTAGAM) 500MG,J1568,HCPCS,,,,,both,100,ML,319.82,191.89,Medicaid,Illinois Medicaid,,191.89,,,319.82,35.18,166.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IVIG (OCTAGAM) 500MG,J1568,HCPCS,,,,,both,100,ML,319.82,191.89,Medicaid,Illinois Medicaid,,191.89,,,319.82,35.18,166.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GANCICLOVI SOD 500MG,J1570,HCPCS,,,,,both,1,EA,615.94,369.56,Medicaid,Illinois Medicaid,,369.56,,,615.94,67.75,320.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IVIG (FLEBOGAM)500MG,J1572,HCPCS,,,,,both,200,ML,256.99,154.19,Medicaid,Illinois Medicaid,,154.19,,,256.99,28.27,133.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IVIG (FLEBOGAM)500MG,J1572,HCPCS,,,,,both,200,ML,256.99,154.19,Medicaid,Illinois Medicaid,,154.19,,,256.99,28.27,133.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,2,ML,24.72,14.83,Medicaid,Illinois Medicaid,,14.83,,,24.72,2.72,12.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,, ,27.81,16.68,Medicaid,Illinois Medicaid,,16.68,,,27.81,3.06,14.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,2,ML,28.84,17.30,Medicaid,Illinois Medicaid,,17.30,,,28.84,3.17,15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GLUCAGON 1MG INJ,J1610,HCPCS,,,,,both,, ,710.19,426.11,Medicaid,Illinois Medicaid,,426.11,,,710.19,78.12,369.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GLUCAGON 1MG INJ,J1610,HCPCS,,,,,both,1,EA,1505.00,903.00,Medicaid,Illinois Medicaid,,903.00,,,1505.00,165.55,782.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HALOPERIDOL 5MG INJ,J1630,HCPCS,,,,,both,1,ML,68.50,41.10,Medicaid,Illinois Medicaid,,41.10,,,68.50,7.54,35.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HALOPER DEC 50MGINJ,J1631,HCPCS,,,,,both,1,ML,183.08,109.84,Medicaid,Illinois Medicaid,,109.84,,,183.08,20.14,95.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HALOPER DEC 50MGINJ,J1631,HCPCS,,,,,both,1,ML,217.33,130.39,Medicaid,Illinois Medicaid,,130.39,,,217.33,23.91,113.01,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPARIN NA 10U FLUSH,J1642,HCPCS,,,,,both,5,ML,0.52,0.31,Medicaid,Illinois Medicaid,,0.31,,,0.52,0.06,0.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPARIN NA 10U FLUSH,J1642,HCPCS,,,,,both,3,ML,0.93,0.55,Medicaid,Illinois Medicaid,,0.55,,,0.93,0.10,0.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,2.16,1.29,Medicaid,Illinois Medicaid,,1.29,,,2.16,0.24,1.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,5.67,3.40,Medicaid,Illinois Medicaid,,3.40,,,5.67,0.62,2.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,6.39,3.83,Medicaid,Illinois Medicaid,,3.83,,,6.39,0.70,3.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,19.57,11.74,Medicaid,Illinois Medicaid,,11.74,,,19.57,2.15,10.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,500,ML,27.81,16.68,Medicaid,Illinois Medicaid,,16.68,,,27.81,3.06,14.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,28.84,17.30,Medicaid,Illinois Medicaid,,17.30,,,28.84,3.17,15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,41.72,25.03,Medicaid,Illinois Medicaid,,25.03,,,41.72,4.59,21.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,250,ML,76.00,45.60,Medicaid,Illinois Medicaid,,45.60,,,76.00,8.36,39.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.4,ML,57.17,34.30,Medicaid,Illinois Medicaid,,34.30,,,57.17,6.29,29.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.3,ML,57.17,34.30,Medicaid,Illinois Medicaid,,34.30,,,57.17,6.29,29.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,1,ML,57.17,34.30,Medicaid,Illinois Medicaid,,34.30,,,57.17,6.29,29.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.8,ML,57.17,34.30,Medicaid,Illinois Medicaid,,34.30,,,57.17,6.29,29.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.6,ML,57.17,34.30,Medicaid,Illinois Medicaid,,34.30,,,57.17,6.29,29.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,38.37,23.02,Medicaid,Illinois Medicaid,,23.02,,,38.37,4.22,19.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,51.24,30.74,Medicaid,Illinois Medicaid,,30.74,,,51.24,5.64,26.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,76.74,46.04,Medicaid,Illinois Medicaid,,46.04,,,76.74,8.44,39.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,85.49,51.29,Medicaid,Illinois Medicaid,,51.29,,,85.49,9.40,44.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TETANUS IG HUM 250U,J1670,HCPCS,,,,,both,1,ML,1976.31,1185.78,Medicaid,Illinois Medicaid,,1185.78,,,1976.31,217.39,1027.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HYDROCORTIS 100MGINJ,J1720,HCPCS,,,,,both,1,EA,48.15,28.89,Medicaid,Illinois Medicaid,,28.89,,,48.15,5.30,25.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MELOXICAM 1MG INJ,J1738,HCPCS,,,,,both,1,ML,566.00,339.60,Medicaid,Illinois Medicaid,,339.60,,,566.00,62.26,294.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IBUTILIDE 1MG INJ,J1742,HCPCS,,,,,both,, ,1612.21,967.32,Medicaid,Illinois Medicaid,,967.32,,,1612.21,177.34,838.35,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INFLIXIMAB 10 MG INJ,J1745,HCPCS,,,,,both,1,EA,560.84,336.50,Medicaid,Illinois Medicaid,,336.50,,,560.84,61.69,291.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IRON DEX165 INJ 50MG,J1750,HCPCS,,,,,both,, ,132.87,79.72,Medicaid,Illinois Medicaid,,79.72,,,132.87,14.62,69.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IRON SUCROSE 1MG INJ,J1756,HCPCS,,,,,both,, ,4.22,2.53,Medicaid,Illinois Medicaid,,2.53,,,4.22,0.46,2.19,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DROPERIDOL UP TO 5MG,J1790,HCPCS,,,,,both,2,ML,27.81,16.68,Medicaid,Illinois Medicaid,,16.68,,,27.81,3.06,14.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INSULIN 1 UNT INJ,J1815,CPT,,,,,both,10,ML,1.00,0.60,Medicaid,Illinois Medicaid,,0.60,,,1.00,0.11,0.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,, ,6.39,3.83,Medicaid,Illinois Medicaid,,3.83,,,6.39,0.70,3.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,1,ML,12.88,7.72,Medicaid,Illinois Medicaid,,7.72,,,12.88,1.42,6.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,1,ML,25.75,15.45,Medicaid,Illinois Medicaid,,15.45,,,25.75,2.83,13.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,10,ML,5.67,3.40,Medicaid,Illinois Medicaid,,3.40,,,5.67,0.62,2.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,4,ML,12.88,7.72,Medicaid,Illinois Medicaid,,7.72,,,12.88,1.42,6.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,2,ML,25.75,15.45,Medicaid,Illinois Medicaid,,15.45,,,25.75,2.83,13.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LUPR 3.75FEMALE/PEDS,J1950,HCPCS,,,,,both,1,EA,6029.88,3617.92,Medicaid,Illinois Medicaid,,3617.92,,,6029.88,663.29,3135.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEVETIRACET 10MG INJ,J1953,HCPCS,,,,,both,5,ML,1.18,0.70,Medicaid,Illinois Medicaid,,0.70,,,1.18,0.13,0.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,100,ML,58.45,35.07,Medicaid,Illinois Medicaid,,35.07,,,58.45,6.43,30.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,150,ML,68.24,40.94,Medicaid,Illinois Medicaid,,40.94,,,68.24,7.51,35.48,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,50,ML,78.28,46.96,Medicaid,Illinois Medicaid,,46.96,,,78.28,8.61,40.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LINEZOLID 200 MG,J2020,HCPCS,,,,,both,300,ML,225.31,135.18,Medicaid,Illinois Medicaid,,135.18,,,225.31,24.78,117.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LINEZOLID 200 MG,J2020,HCPCS,,,,,both,, ,258.79,155.27,Medicaid,Illinois Medicaid,,155.27,,,258.79,28.47,134.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LORAZEPAM 2MG INJ,J2060,HCPCS,,,,,both,1,ML,19.57,11.74,Medicaid,Illinois Medicaid,,11.74,,,19.57,2.15,10.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LORAZEPAM INJ 2MG/ML 10 ML MDV,J2060,HCPCS,,,,,both,, ,15.14,9.08,Medicaid,Illinois Medicaid,,9.08,,,15.14,1.67,7.87,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MANNITOL 25% 50MLINJ,J2150,HCPCS,,,,,both,50,ML,24.72,14.83,Medicaid,Illinois Medicaid,,14.83,,,24.72,2.72,12.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MEPERID HCL 100MGINJ,J2175,HCPCS,,,,,both,1,ML,16.48,9.88,Medicaid,Illinois Medicaid,,9.88,,,16.48,1.81,8.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MEROPENEMBR 100MGINJ,J2184,HCPCS,,,,,both,, ,18.28,10.96,Medicaid,Illinois Medicaid,,10.96,,,18.28,2.01,9.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MEROPENEM 100MG INJ,J2185,HCPCS,,,,,both,1,EA,8.96,5.37,Medicaid,Illinois Medicaid,,5.37,,,8.96,0.99,4.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MEROPENEM 100MG INJ,J2185,HCPCS,,,,,both,1,EA,8.96,5.37,Medicaid,Illinois Medicaid,,5.37,,,8.96,0.99,4.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
METHYLERGONV .2MGINJ,J2210,HCPCS,,,,,both,1,ML,47.12,28.27,Medicaid,Illinois Medicaid,,28.27,,,47.12,5.18,24.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
METHYLNALTR .1MG INJ,J2212,HCPCS,,,,,both,, ,4.33,2.59,Medicaid,Illinois Medicaid,,2.59,,,4.33,0.48,2.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MICAFUNGIN 1MG INJ,J2248,HCPCS,,,,,both,1,EA,11.59,6.95,Medicaid,Illinois Medicaid,,6.95,,,11.59,1.27,6.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,10,ML,1.03,0.61,Medicaid,Illinois Medicaid,,0.61,,,1.03,0.11,0.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,5,ML,3.09,1.85,Medicaid,Illinois Medicaid,,1.85,,,3.09,0.34,1.61,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,2,ML,7.00,4.20,Medicaid,Illinois Medicaid,,4.20,,,7.00,0.77,3.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,, ,8.34,5.00,Medicaid,Illinois Medicaid,,5.00,,,8.34,0.92,4.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MIDAZOL HCL WG 1MG,J2251,HCPCS,,,,,both,50,ML,3.25,1.95,Medicaid,Illinois Medicaid,,1.95,,,3.25,0.36,1.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MILRINONE 5MG INJ,J2260,HCPCS,,,,,both,100,ML,32.19,19.31,Medicaid,Illinois Medicaid,,19.31,,,32.19,3.54,16.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,1.03,0.61,Medicaid,Illinois Medicaid,,0.61,,,1.03,0.11,0.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,5.15,3.09,Medicaid,Illinois Medicaid,,3.09,,,5.15,0.57,2.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Medicaid,Illinois Medicaid,,8.96,,,14.94,1.64,7.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Medicaid,Illinois Medicaid,,8.96,,,14.94,1.64,7.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Medicaid,Illinois Medicaid,,8.96,,,14.94,1.64,7.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,14.75,8.85,Medicaid,Illinois Medicaid,,8.85,,,14.75,1.62,7.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,14.94,8.96,Medicaid,Illinois Medicaid,,8.96,,,14.94,1.64,7.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,16.00,9.60,Medicaid,Illinois Medicaid,,9.60,,,16.00,1.76,8.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,, ,86.78,52.06,Medicaid,Illinois Medicaid,,52.06,,,86.78,9.55,45.13,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NALBUPHINE 10MG INJ,J2300,HCPCS,,,,,both,1,ML,25.75,15.45,Medicaid,Illinois Medicaid,,15.45,,,25.75,2.83,13.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NALOXONE HCL 1MG INJ,J2310,HCPCS,,,,,both,1,ML,133.90,80.34,Medicaid,Illinois Medicaid,,80.34,,,133.90,14.73,69.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NALOXONE HCL 1MG INJ,J2310,HCPCS,,,,,both,2,ML,139.31,83.58,Medicaid,Illinois Medicaid,,83.58,,,139.31,15.32,72.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OCRELIZUMAB 1MG INJ,J2350,HCPCS,,,,,both,10,ML,133.90,80.34,Medicaid,Illinois Medicaid,,80.34,,,133.90,14.73,69.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,1,ML,21.37,12.82,Medicaid,Illinois Medicaid,,12.82,,,21.37,2.35,11.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,1,ML,42.23,25.33,Medicaid,Illinois Medicaid,,25.33,,,42.23,4.65,21.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,, ,280.16,168.09,Medicaid,Illinois Medicaid,,168.09,,,280.16,30.82,145.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ORPHENADR UP TO 60MG,J2360,HCPCS,,,,,both,2,ML,156.30,93.78,Medicaid,Illinois Medicaid,,93.78,,,156.30,17.19,81.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHLOROPR HCL INJ 1MG,J2401,HCPCS,,,,,both,20,ML,0.30,0.18,Medicaid,Illinois Medicaid,,0.18,,,0.30,0.03,0.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ONDANSETRON 1MG INJ,J2405,HCPCS,,,,,both,2,ML,42.23,25.33,Medicaid,Illinois Medicaid,,25.33,,,42.23,4.65,21.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.75,ML,42.23,25.33,Medicaid,Illinois Medicaid,,25.33,,,42.23,4.65,21.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,1,ML,58.97,35.38,Medicaid,Illinois Medicaid,,35.38,,,58.97,6.49,30.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,1.5,ML,58.97,35.38,Medicaid,Illinois Medicaid,,35.38,,,58.97,6.49,30.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.25,ML,58.97,35.38,Medicaid,Illinois Medicaid,,35.38,,,58.97,6.49,30.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.5,ML,61.03,36.61,Medicaid,Illinois Medicaid,,36.61,,,61.03,6.71,31.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PAMIDRONATE 30MG IJ,J2430,HCPCS,,,,,both,10,ML,193.64,116.18,Medicaid,Illinois Medicaid,,116.18,,,193.64,21.30,100.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PAMIDRONATE 30MG IJ,J2430,HCPCS,,,,,both,, ,1208.71,725.22,Medicaid,Illinois Medicaid,,725.22,,,1208.71,132.96,628.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PAPAVERINE UPTO 60MG,J2440,HCPCS,,,,,both,, ,302.05,181.23,Medicaid,Illinois Medicaid,,181.23,,,302.05,33.23,157.07,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PALONOSETRON 25MCG,J2469,HCPCS,,,,,both,, ,250.55,150.33,Medicaid,Illinois Medicaid,,150.33,,,250.55,27.56,130.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PANTOPRAZOLE SOD VL,J2470,HCPCS,,,,,both,1,EA,41.72,25.03,Medicaid,Illinois Medicaid,,25.03,,,41.72,4.59,21.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PARICALCITOL 1MCGINJ,J2501,HCPCS,,,,,both,1,ML,25.75,15.45,Medicaid,Illinois Medicaid,,15.45,,,25.75,2.83,13.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PENICI G POT .6MUINJ,J2540,HCPCS,,,,,both,, ,11.33,6.79,Medicaid,Illinois Medicaid,,6.79,,,11.33,1.25,5.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PENICI G POT .6MUINJ,J2540,HCPCS,,,,,both,1,EA,11.59,6.95,Medicaid,Illinois Medicaid,,6.95,,,11.59,1.27,6.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,41.97,25.18,Medicaid,Illinois Medicaid,,25.18,,,41.97,4.62,21.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,44.55,26.73,Medicaid,Illinois Medicaid,,26.73,,,44.55,4.90,23.17,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,48.15,28.89,Medicaid,Illinois Medicaid,,28.89,,,48.15,5.30,25.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROMETHAZI UPTO 50MG,J2550,HCPCS,,,,,both,1,ML,24.72,14.83,Medicaid,Illinois Medicaid,,14.83,,,24.72,2.72,12.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHENOBARB 120MG INJ,J2560,HCPCS,,,,,both,1,ML,167.89,100.73,Medicaid,Illinois Medicaid,,100.73,,,167.89,18.47,87.3,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHENOBARB 120MG INJ,J2560,HCPCS,,,,,both,, ,232.78,139.66,Medicaid,Illinois Medicaid,,139.66,,,232.78,25.61,121.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OXYTOCIN UP TO 10UN,J2590,HCPCS,,,,,both,1,ML,27.81,16.68,Medicaid,Illinois Medicaid,,16.68,,,27.81,3.06,14.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DESMOPRESSIN 1MCGINJ,J2597,HCPCS,,,,,both,1,ML,13.91,8.34,Medicaid,Illinois Medicaid,,8.34,,,13.91,1.53,7.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FLUPHENZI UP TO 25MG,J2680,HCPCS,,,,,both,5,ML,139.05,83.43,Medicaid,Illinois Medicaid,,83.43,,,139.05,15.30,72.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROCAINAMID UPTO 1GM,J2690,HCPCS,,,,,both,2,ML,95.79,57.47,Medicaid,Illinois Medicaid,,57.47,,,95.79,10.54,49.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,20,ML,1.44,0.86,Medicaid,Illinois Medicaid,,0.86,,,1.44,0.16,0.75,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,100,ML,2.68,1.60,Medicaid,Illinois Medicaid,,1.60,,,2.68,0.29,1.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,100,ML,2.68,1.60,Medicaid,Illinois Medicaid,,1.60,,,2.68,0.29,1.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEOSTIGMINE .5MG INJ,J2710,HCPCS,,,,,both,10,ML,13.91,8.34,Medicaid,Illinois Medicaid,,8.34,,,13.91,1.53,7.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NEOSTIGMINE .5MG INJ,J2710,HCPCS,,,,,both,5,ML,19.57,11.74,Medicaid,Illinois Medicaid,,11.74,,,19.57,2.15,10.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROTAMINE 10MG INJ,J2720,HCPCS,,,,,both,5,ML,12.88,7.72,Medicaid,Illinois Medicaid,,7.72,,,12.88,1.42,6.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHENTOLAMINE 5MG INJ,J2760,HCPCS,,,,,both,1,EA,968.46,581.07,Medicaid,Illinois Medicaid,,581.07,,,968.46,106.53,503.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
METOCLOPRAM 10MG INJ,J2765,HCPCS,,,,,both,2,ML,24.72,14.83,Medicaid,Illinois Medicaid,,14.83,,,24.72,2.72,12.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
REGADENOSON 0.1MG IJ,J2785,HCPCS,,,,,both,5,ML,335.01,201.00,Medicaid,Illinois Medicaid,,201.00,,,335.01,36.85,174.21,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RHOPHYLAC 100UNT,J2791,HCPCS,,,,,both,2,ML,62.83,37.69,Medicaid,Illinois Medicaid,,37.69,,,62.83,6.91,32.67,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,28.33,16.99,Medicaid,Illinois Medicaid,,16.99,,,28.33,3.12,14.73,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,34.25,20.55,Medicaid,Illinois Medicaid,,20.55,,,34.25,3.77,17.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,37.08,22.24,Medicaid,Illinois Medicaid,,22.24,,,37.08,4.08,19.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,20,ML,1.03,0.61,Medicaid,Illinois Medicaid,,0.61,,,1.03,0.11,0.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,30,ML,1.03,0.61,Medicaid,Illinois Medicaid,,0.61,,,1.03,0.11,0.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,20,ML,1.03,0.61,Medicaid,Illinois Medicaid,,0.61,,,1.03,0.11,0.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,, ,1.65,0.99,Medicaid,Illinois Medicaid,,0.99,,,1.65,0.18,0.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,100,ML,1.96,1.17,Medicaid,Illinois Medicaid,,1.17,,,1.96,0.22,1.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,10,ML,2.16,1.29,Medicaid,Illinois Medicaid,,1.29,,,2.16,0.24,1.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SINCALIDE INJ 5MCG,J2805,HCPCS,,,,,both,1,EA,670.53,402.31,Medicaid,Illinois Medicaid,,402.31,,,670.53,73.76,348.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SOD FERRIC 12.5MGINJ,J2916,HCPCS,,,,,both,5,ML,53.56,32.13,Medicaid,Illinois Medicaid,,32.13,,,53.56,5.89,27.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RETEPLASE 18.1MG IJ,J2993,HCPCS,,,,,both,, ,7366.00,4419.60,Medicaid,Illinois Medicaid,,4419.60,,,7366.00,810.26,3830.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALTEPLASE RECOM 1MG,J2997,HCPCS,,,,,both,1,EA,347.11,208.26,Medicaid,Illinois Medicaid,,208.26,,,347.11,38.18,180.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALTEPLASE RECOM 1MG,J2997,HCPCS,,,,,both,1,EA,353.55,212.13,Medicaid,Illinois Medicaid,,212.13,,,353.55,38.89,183.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,5,ML,6.59,3.95,Medicaid,Illinois Medicaid,,3.95,,,6.59,0.72,3.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,2,ML,14.42,8.65,Medicaid,Illinois Medicaid,,8.65,,,14.42,1.59,7.5,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,1,ML,17.25,10.35,Medicaid,Illinois Medicaid,,10.35,,,17.25,1.90,8.97,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,100,ML,20.25,12.15,Medicaid,Illinois Medicaid,,12.15,,,20.25,2.23,10.53,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,20,ML,49.44,29.66,Medicaid,Illinois Medicaid,,29.66,,,49.44,5.44,25.71,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SUMATRIPTAN 6MG INJ,J3030,HCPCS,,,,,both,0.5,ML,631.91,379.14,Medicaid,Illinois Medicaid,,379.14,,,631.91,69.51,328.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TENECTEPLASE 1MG INJ,J3101,HCPCS,,,,,both,1,EA,402.47,241.48,Medicaid,Illinois Medicaid,,241.48,,,402.47,44.27,209.28,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TERBUTALINE 1MG INJ,J3105,HCPCS,,,,,both,1,ML,28.84,17.30,Medicaid,Illinois Medicaid,,17.30,,,28.84,3.17,15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHLORPROM UP TO 50MG,J3230,HCPCS,,,,,both,, ,161.71,97.02,Medicaid,Illinois Medicaid,,97.02,,,161.71,17.79,84.09,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHLORPROM UP TO 50MG,J3230,HCPCS,,,,,both,2,ML,185.40,111.24,Medicaid,Illinois Medicaid,,111.24,,,185.40,20.39,96.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TIGECYCLINE 1 MG INJ,J3243,HCPCS,,,,,both,, ,11.33,6.79,Medicaid,Illinois Medicaid,,6.79,,,11.33,1.25,5.89,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,250,ML,60.00,36.00,Medicaid,Illinois Medicaid,,36.00,,,60.00,6.60,31.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,100,ML,75.71,45.42,Medicaid,Illinois Medicaid,,45.42,,,75.71,8.33,39.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,15,ML,91.16,54.69,Medicaid,Illinois Medicaid,,54.69,,,91.16,10.03,47.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TRIMETHOBEN 200MGINJ,J3250,HCPCS,,,,,both,, ,26.78,16.06,Medicaid,Illinois Medicaid,,16.06,,,26.78,2.95,13.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TOBRAMYCIN UPTO 80MG,J3260,HCPCS,,,,,both,1,EA,71.84,43.10,Medicaid,Illinois Medicaid,,43.10,,,71.84,7.90,37.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,20,ML,28.58,17.14,Medicaid,Illinois Medicaid,,17.14,,,28.58,3.14,14.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,10,ML,28.58,17.14,Medicaid,Illinois Medicaid,,17.14,,,28.58,3.14,14.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,4,ML,28.58,17.14,Medicaid,Illinois Medicaid,,17.14,,,28.58,3.14,14.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,, ,18.28,10.96,Medicaid,Illinois Medicaid,,10.96,,,18.28,2.01,9.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,, ,18.28,10.96,Medicaid,Illinois Medicaid,,10.96,,,18.28,2.01,9.51,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,, ,18.54,11.12,Medicaid,Illinois Medicaid,,11.12,,,18.54,2.04,9.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DIAZEPAM 5MG INJ,J3360,HCPCS,,,,,both,2,ML,100.94,60.56,Medicaid,Illinois Medicaid,,60.56,,,100.94,11.10,52.49,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,1,EA,58.97,35.38,Medicaid,Illinois Medicaid,,35.38,,,58.97,6.49,30.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,1,EA,58.97,35.38,Medicaid,Illinois Medicaid,,35.38,,,58.97,6.49,30.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,, ,62.32,37.39,Medicaid,Illinois Medicaid,,37.39,,,62.32,6.86,32.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,300,ML,60.00,36.00,Medicaid,Illinois Medicaid,,36.00,,,60.00,6.60,31.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,350,ML,68.00,40.80,Medicaid,Illinois Medicaid,,40.80,,,68.00,7.48,35.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,250,ML,75.00,45.00,Medicaid,Illinois Medicaid,,45.00,,,75.00,8.25,39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,150,ML,95.00,57.00,Medicaid,Illinois Medicaid,,57.00,,,95.00,10.45,49.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VEDOLIZUMAB 1MG INJ,J3380,HCPCS,,,,,both,1,EA,96.31,57.78,Medicaid,Illinois Medicaid,,57.78,,,96.31,10.59,50.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HYDROXYZI UP TO 25MG,J3410,HCPCS,,,,,both,, ,13.91,8.34,Medicaid,Illinois Medicaid,,8.34,,,13.91,1.53,7.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
THIAMINE 100MG INJ,J3411,HCPCS,,,,,both,2,ML,44.03,26.41,Medicaid,Illinois Medicaid,,26.41,,,44.03,4.84,22.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PYRIDOXINE 100MG INJ,J3415,HCPCS,,,,,both,1,ML,79.31,47.58,Medicaid,Illinois Medicaid,,47.58,,,79.31,8.72,41.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
VIT B12 CYAN 1000MCG,J3420,HCPCS,,,,,both,1,ML,84.72,50.83,Medicaid,Illinois Medicaid,,50.83,,,84.72,9.32,44.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYTONADIONE 1MG INJ,J3430,HCPCS,,,,,both,0.5,ML,27.81,16.68,Medicaid,Illinois Medicaid,,16.68,,,27.81,3.06,14.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PHYTONADIONE 1MG INJ,J3430,HCPCS,,,,,both,1,ML,31.93,19.15,Medicaid,Illinois Medicaid,,19.15,,,31.93,3.51,16.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HYALURONID RECOM 1UN,J3473,HCPCS,,,,,both,1,ML,3.19,1.91,Medicaid,Illinois Medicaid,,1.91,,,3.19,0.35,1.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,500,ML,1.13,0.67,Medicaid,Illinois Medicaid,,0.67,,,1.13,0.12,0.59,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,20,ML,2.99,1.79,Medicaid,Illinois Medicaid,,1.79,,,2.99,0.33,1.55,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,2,ML,12.88,7.72,Medicaid,Illinois Medicaid,,7.72,,,12.88,1.42,6.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,, ,13.91,8.34,Medicaid,Illinois Medicaid,,8.34,,,13.91,1.53,7.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,50,ML,14.94,8.96,Medicaid,Illinois Medicaid,,8.96,,,14.94,1.64,7.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,100,ML,1.03,0.61,Medicaid,Illinois Medicaid,,0.61,,,1.03,0.11,0.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,100,ML,1.03,0.61,Medicaid,Illinois Medicaid,,0.61,,,1.03,0.11,0.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,, ,2.68,1.60,Medicaid,Illinois Medicaid,,1.60,,,2.68,0.29,1.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ZIDOVUDINE 10MG INJ,J3485,HCPCS,,,,,both,, ,12.36,7.41,Medicaid,Illinois Medicaid,,7.41,,,12.36,1.36,6.43,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ZIPRSIDNE MESYL 10MG,J3486,HCPCS,,,,,both,1,EA,77.77,46.66,Medicaid,Illinois Medicaid,,46.66,,,77.77,8.55,40.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ZOLEDRONIC ACID 1MG,J3489,HCPCS,,,,,both,100,ML,332.69,199.61,Medicaid,Illinois Medicaid,,199.61,,,332.69,36.60,173,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ZOLEDRONIC ACID 1MG,J3489,HCPCS,,,,,both,5,ML,1005.80,603.48,Medicaid,Illinois Medicaid,,603.48,,,1005.80,110.64,523.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BRIVARACETAM 50MG TB,J3490,HCPCS,,,,,both,60,EA,172.75,103.65,Medicaid,Illinois Medicaid,,103.65,,,172.75,19.00,89.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NORM SALIN 1000ML IV,J7030,HCPCS,,,,,both,1000,ML,25.75,15.45,Medicaid,Illinois Medicaid,,15.45,,,25.75,2.83,13.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NORM SAL STER500MLIV,J7040,HCPCS,,,,,both,500,ML,25.75,15.45,Medicaid,Illinois Medicaid,,15.45,,,25.75,2.83,13.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
D5W/SOD CHL.9% 500ML,J7042,HCPCS,,,,,both,1000,ML,12.88,7.72,Medicaid,Illinois Medicaid,,7.72,,,12.88,1.42,6.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NORM SALINE 250ML IV,J7050,HCPCS,,,,,both,250,ML,26.78,16.06,Medicaid,Illinois Medicaid,,16.06,,,26.78,2.95,13.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SOD CHLOR .9% 100ML,J7050,HCPCS,,,,,both,100,ML,25.75,15.45,Medicaid,Illinois Medicaid,,15.45,,,25.75,2.83,13.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SOD CHLOR .9% 100ML,J7050,HCPCS,,,,,both,100,ML,68.50,41.10,Medicaid,Illinois Medicaid,,41.10,,,68.50,7.54,35.62,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SOD CHLOR .9% 150ML,J7050,HCPCS,,,,,both,150,ML,25.75,15.45,Medicaid,Illinois Medicaid,,15.45,,,25.75,2.83,13.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SOD CHLOR .9% 50ML,J7050,HCPCS,,,,,both,50,ML,25.75,15.45,Medicaid,Illinois Medicaid,,15.45,,,25.75,2.83,13.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
SOD CHLOR .9% 50ML,J7050,HCPCS,,,,,both,50,ML,41.72,25.03,Medicaid,Illinois Medicaid,,25.03,,,41.72,4.59,21.69,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEX 5%/WATER 500ML,J7060,HCPCS,,,,,both,, ,24.72,14.83,Medicaid,Illinois Medicaid,,14.83,,,24.72,2.72,12.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEX 5%/WATER 500ML,J7060,HCPCS,,,,,both,500,ML,25.75,15.45,Medicaid,Illinois Medicaid,,15.45,,,25.75,2.83,13.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEX 5%/WATER 1000ML,J7070,HCPCS,,,,,both,1000,ML,25.75,15.45,Medicaid,Illinois Medicaid,,15.45,,,25.75,2.83,13.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,1000,ML,24.72,14.83,Medicaid,Illinois Medicaid,,14.83,,,24.72,2.72,12.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,500,ML,25.75,15.45,Medicaid,Illinois Medicaid,,15.45,,,25.75,2.83,13.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,, ,28.84,17.30,Medicaid,Illinois Medicaid,,17.30,,,28.84,3.17,15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
D5LR UP TO 1000ML,J7121,HCPCS,,,,,both,1000,ML,25.75,15.45,Medicaid,Illinois Medicaid,,15.45,,,25.75,2.83,13.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROTHROMB COM 1UN IX,J7168,HCPCS,,,,,both,1,EA,12.25,7.35,Medicaid,Illinois Medicaid,,7.35,,,12.25,1.35,6.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PROTHROMB COM 1UN IX,J7168,CPT,,,,,both,1,EA,12.62,7.57,Medicaid,Illinois Medicaid,,7.57,,,12.62,1.39,6.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MOMETA SIN IMP 10MCG,J7402,HCPCS,,,,,both,, ,54.59,32.75,Medicaid,Illinois Medicaid,,32.75,,,54.59,6.00,28.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AZATHIOPRINE 50MG TB,J7500,HCPCS,,,,,both,100,EA,20.34,12.20,Medicaid,Illinois Medicaid,,12.20,,,20.34,2.24,10.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYCLOSPORNE 100MG PO,J7502,HCPCS,,,,,both,, ,41.20,24.72,Medicaid,Illinois Medicaid,,24.72,,,41.20,4.53,21.42,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TACROLIMUS 1MG PO,J7507,HCPCS,,,,,both,100,EA,27.30,16.38,Medicaid,Illinois Medicaid,,16.38,,,27.30,3.00,14.2,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
METHYLPREDNIS 4MG PO,J7509,HCPCS,,,,,both,, ,8.55,5.13,Medicaid,Illinois Medicaid,,5.13,,,8.55,0.94,4.45,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.10,0.06,Medicaid,Illinois Medicaid,,0.06,,,0.10,0.01,0.05,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.31,0.18,Medicaid,Illinois Medicaid,,0.18,,,0.31,0.03,0.16,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.72,0.43,Medicaid,Illinois Medicaid,,0.43,,,0.72,0.08,0.37,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,1.34,0.80,Medicaid,Illinois Medicaid,,0.80,,,1.34,0.15,0.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,, ,7.00,4.20,Medicaid,Illinois Medicaid,,4.20,,,7.00,0.77,3.64,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,, ,107.38,64.42,Medicaid,Illinois Medicaid,,64.42,,,107.38,11.81,55.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYCLOSPORINE 25MG PO,J7515,HCPCS,,,,,both,, ,19.31,11.58,Medicaid,Illinois Medicaid,,11.58,,,19.31,2.12,10.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYCLOSPOR PAREN250MG,J7516,HCPCS,,,,,both,, ,191.84,115.10,Medicaid,Illinois Medicaid,,115.10,,,191.84,21.10,99.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MYCOPHE MOF 250MG PO,J7517,HCPCS,,,,,both,100,EA,41.46,24.87,Medicaid,Illinois Medicaid,,24.87,,,41.46,4.56,21.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
METHACHOL 1MGINH NEB,J7674,HCPCS,,,,,both,1,EA,4.84,2.90,Medicaid,Illinois Medicaid,,2.90,,,4.84,0.53,2.52,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,, ,13.39,8.03,Medicaid,Illinois Medicaid,,8.03,,,13.39,1.47,6.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,, ,49.18,29.50,Medicaid,Illinois Medicaid,,29.50,,,49.18,5.41,25.57,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,100,EA,53.56,32.13,Medicaid,Illinois Medicaid,,32.13,,,53.56,5.89,27.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,, ,0.52,0.31,Medicaid,Illinois Medicaid,,0.31,,,0.52,0.06,0.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,100,EA,1.34,0.80,Medicaid,Illinois Medicaid,,0.80,,,1.34,0.15,0.7,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,, ,3.50,2.10,Medicaid,Illinois Medicaid,,2.10,,,3.50,0.39,1.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
METHOTREXATE 2.5MGPO,J8610,HCPCS,,,,,both,100,EA,20.34,12.20,Medicaid,Illinois Medicaid,,12.20,,,20.34,2.24,10.58,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LEUCOVOR CAL 25MG TB,J8999,HCPCS,,,,,both,20,EA,78.54,47.12,Medicaid,Illinois Medicaid,,47.12,,,78.54,8.64,40.84,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BENDAMUSTINE 1MG INJ,J9033,HCPCS,,,,,both,, ,147.81,88.68,Medicaid,Illinois Medicaid,,88.68,,,147.81,16.26,76.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BENDAMUSTINE 1MG INJ,J9033,HCPCS,,,,,both,, ,147.81,88.68,Medicaid,Illinois Medicaid,,88.68,,,147.81,16.26,76.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
BORTEZOMIB .1MG INJ,J9041,HCPCS,,,,,both,, ,265.74,159.44,Medicaid,Illinois Medicaid,,159.44,,,265.74,29.23,138.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CARBOPLATIN 50MG INJ,J9045,HCPCS,,,,,both,45,ML,61.03,36.61,Medicaid,Illinois Medicaid,,36.61,,,61.03,6.71,31.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CISPLAT POW/SOL 10MG,J9060,HCPCS,,,,,both,50,ML,5.36,3.21,Medicaid,Illinois Medicaid,,3.21,,,5.36,0.59,2.79,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DOCETAXEL 1MG INJ,J9171,HCPCS,,,,,both,, ,87.81,52.68,Medicaid,Illinois Medicaid,,52.68,,,87.81,9.66,45.66,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FLUOROURACIL 500MG,J9190,HCPCS,,,,,both,, ,25.75,15.45,Medicaid,Illinois Medicaid,,15.45,,,25.75,2.83,13.39,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GEMCITABIN 200MG INJ,J9201,HCPCS,,,,,both,1,EA,616.97,370.18,Medicaid,Illinois Medicaid,,370.18,,,616.97,67.87,320.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
GEMCITABIN 200MG INJ,J9201,HCPCS,,,,,both,, ,690.87,414.52,Medicaid,Illinois Medicaid,,414.52,,,690.87,76.00,359.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IPILIMUMAB 1MG INJ,J9228,HCPCS,,,,,both,40,ML,777.65,466.59,Medicaid,Illinois Medicaid,,466.59,,,777.65,85.54,404.38,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OXALIPLATIN .5MG INJ,J9263,HCPCS,,,,,both,10,ML,6.39,3.83,Medicaid,Illinois Medicaid,,3.83,,,6.39,0.70,3.32,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PACLITAXEL 1MG INJ,J9267,HCPCS,,,,,both,, ,3.71,2.22,Medicaid,Illinois Medicaid,,2.22,,,3.71,0.41,1.93,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
PERTUZUMAB 1MG INJ,J9306,HCPCS,,,,,both,14,ML,61.03,36.61,Medicaid,Illinois Medicaid,,36.61,,,61.03,6.71,31.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TRASTUZUMAB 10MG INJ,J9355,HCPCS,,,,,both,, ,531.22,318.73,Medicaid,Illinois Medicaid,,318.73,,,531.22,58.43,276.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
POST OP SHOES,L3260,HCPCS,,,,,both,, ,12.00,7.20,Medicaid,Illinois Medicaid,,7.20,,,12.00,1.32,6.24,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADM IV INF CASI IMDV,M0243,HCPCS,,,,,both,, ,851.55,510.93,Medicaid,Illinois Medicaid,,510.93,,,851.55,93.67,442.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADM IV INF CASI IMDV,M0243,HCPCS,,,,,both,, ,1340.29,804.17,Medicaid,Illinois Medicaid,,804.17,,,1340.29,147.43,696.95,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADM IV INF BAM ETES,M0245,HCPCS,,,,,both,, ,1301.25,780.75,Medicaid,Illinois Medicaid,,780.75,,,1301.25,143.14,676.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ADM IV INF SOTROVIM,M0247,HCPCS,,,,,both,, ,1301.25,780.75,Medicaid,Illinois Medicaid,,780.75,,,1301.25,143.14,676.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
"PAP SMEAR, SCREEN",P3000,HCPCS,,,,,both,, ,101.60,60.96,Medicaid,Illinois Medicaid,,60.96,,,101.60,11.18,52.83,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-H CRYO EACH UNIT,P9012,HCPCS,,,,,both,, ,283.48,170.08,Medicaid,Illinois Medicaid,,170.08,,,283.48,31.18,147.41,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-H RBC LEUKO REDU,P9016,HCPCS,,,,,both,, ,884.69,530.81,Medicaid,Illinois Medicaid,,530.81,,,884.69,97.32,460.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-H 1 DONOR FFP,P9017,HCPCS,,,,,both,, ,638.53,383.11,Medicaid,Illinois Medicaid,,383.11,,,638.53,70.24,332.04,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-H RED BLD-UNIT,P9021,HCPCS,,,,,both,, ,737.05,442.23,Medicaid,Illinois Medicaid,,442.23,,,737.05,81.08,383.27,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-H PLAT PHERE L-R,P9035,HCPCS,,,,,both,, ,2646.20,1587.72,Medicaid,Illinois Medicaid,,1587.72,,,2646.20,291.08,1376.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-H PLAT A-P L-R IRR,P9037,HCPCS,,,,,both,, ,2796.36,1677.81,Medicaid,Illinois Medicaid,,1677.81,,,2796.36,307.60,1454.11,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-H RBC IRRAD,P9038,HCPCS,,,,,both,, ,1013.80,608.28,Medicaid,Illinois Medicaid,,608.28,,,1013.80,111.52,527.18,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-H RBC L-R IRRAD,P9040,HCPCS,,,,,both,, ,1025.03,615.01,Medicaid,Illinois Medicaid,,615.01,,,1025.03,112.75,533.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-H CRYOPRE REDU PLS,P9044,HCPCS,,,,,both,, ,614.12,368.47,Medicaid,Illinois Medicaid,,368.47,,,614.12,67.55,319.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALBUMIN 5% 250ML IV,P9045,HCPCS,,,,,both,250,ML,528.13,316.87,Medicaid,Illinois Medicaid,,316.87,,,528.13,58.09,274.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALBUMIN 25% 50ML IV,P9047,HCPCS,,,,,both,100,ML,408.14,244.88,Medicaid,Illinois Medicaid,,244.88,,,408.14,44.90,212.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALBUMIN 25% 50ML IV,P9047,HCPCS,,,,,both,50,ML,623.92,374.35,Medicaid,Illinois Medicaid,,374.35,,,623.92,68.63,324.44,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-H BLD L-R CMV- EA,P9051,HCPCS,,,,,both,, ,1025.03,615.01,Medicaid,Illinois Medicaid,,615.01,,,1025.03,112.75,533.02,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
S-H FFP BTWN8-24HREA,P9059,HCPCS,,,,,both,, ,634.60,380.76,Medicaid,Illinois Medicaid,,380.76,,,634.60,69.81,329.99,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
FERUMOXYTOL1MG NESRD,Q0138,HCPCS,,,,,both,17,ML,9.68,5.80,Medicaid,Illinois Medicaid,,5.80,,,9.68,1.06,5.03,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHLORPROMAZIN 5MG PO,Q0161,HCPCS,,,,,both,1,EA,4.12,2.47,Medicaid,Illinois Medicaid,,2.47,,,4.12,0.45,2.14,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CHLORPROMAZIN 5MG PO,Q0161,HCPCS,,,,,both,, ,7.52,4.51,Medicaid,Illinois Medicaid,,4.51,,,7.52,0.83,3.91,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ONDANSETRON 1MG PO,Q0162,HCPCS,,,,,both,, ,33.73,20.23,Medicaid,Illinois Medicaid,,20.23,,,33.73,3.71,17.54,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ONDANSETRON 1MG PO,Q0162,HCPCS,,,,,both,50,ML,34.25,20.55,Medicaid,Illinois Medicaid,,20.55,,,34.25,3.77,17.81,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TELEHEALTH IP NEURO,Q3014,HCPCS,,,,,both,, ,83.25,49.95,Medicaid,Illinois Medicaid,,49.95,,,83.25,9.16,43.29,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TOTAL CONTACT CAST 3 INCH,Q4038,HCPCS,,,,,both,, ,456.00,273.60,Medicaid,Illinois Medicaid,,273.60,,,456.00,50.16,237.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TOTAL CONTACT CAST 4 INCH,Q4038,HCPCS,,,,,both,, ,469.68,281.80,Medicaid,Illinois Medicaid,,281.80,,,469.68,51.66,244.23,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TOTAL CONTACT CAST BOOT LARGE,Q4038,HCPCS,,,,,both,, ,307.80,184.68,Medicaid,Illinois Medicaid,,184.68,,,307.80,33.86,160.06,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
TOTAL CONTACT CAST BOOT X-LARGE,Q4038,HCPCS,,,,,both,, ,323.00,193.80,Medicaid,Illinois Medicaid,,193.80,,,323.00,35.53,167.96,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OASIS WOUND MAT SQCM,Q4102,HCPCS,,,,,both,, ,10.82,6.49,Medicaid,Illinois Medicaid,,6.49,,,10.82,1.19,5.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INTEGRA BMWD SQ CM,Q4104,HCPCS,,,,,both,, ,599.72,359.83,Medicaid,Illinois Medicaid,,359.83,,,599.72,65.97,311.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INTEGRA SKIN SUB 5X5CM,Q4108,HCPCS,,,,,both,, ,4404.00,2642.40,Medicaid,Illinois Medicaid,,2642.40,,,4404.00,484.44,2290.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DERMACELL SQ CM,Q4122,HCPCS,,,,,both,, ,166.86,100.11,Medicaid,Illinois Medicaid,,100.11,,,166.86,18.35,86.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
OASIS ULTRA TRI SQCM,Q4124,HCPCS,,,,,both,, ,31.93,19.15,Medicaid,Illinois Medicaid,,19.15,,,31.93,3.51,16.6,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ACELL DERM MAT 1SQCM,Q4126,HCPCS,,,,,both,, ,133.90,80.34,Medicaid,Illinois Medicaid,,80.34,,,133.90,14.73,69.63,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
1AMNIOEXCEL SKIN 1.5X1.5CM,Q4137,HCPCS,,,,,both,, ,2544.00,1526.40,Medicaid,Illinois Medicaid,,1526.40,,,2544.00,279.84,1322.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMNIOEXCEL SKIN 2X3CM,Q4137,HCPCS,,,,,both,, ,3469.00,2081.40,Medicaid,Illinois Medicaid,,2081.40,,,3469.00,381.59,1803.88,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMNIOEXCEL SKIN 3.5X3.5CM,Q4137,HCPCS,,,,,both,, ,3745.00,2247.00,Medicaid,Illinois Medicaid,,2247.00,,,3745.00,411.95,1947.4,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMNIOEXCEL SKIN 4X4CM,Q4137,HCPCS,,,,,both,, ,3928.00,2356.80,Medicaid,Illinois Medicaid,,2356.80,,,3928.00,432.08,2042.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALLOWRAP DS/DRY SQCM,Q4150,HCPCS,,,,,both,, ,347.63,208.57,Medicaid,Illinois Medicaid,,208.57,,,347.63,38.24,180.77,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
ALLOWRAP DS/DRY SQCM,Q4150,HCPCS,,,,,both,, ,506.25,303.75,Medicaid,Illinois Medicaid,,303.75,,,506.25,55.69,263.25,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HELICOLL (PER SQ CM),Q4164,HCPCS,,,,,both,, ,6211.00,3726.60,Medicaid,Illinois Medicaid,,3726.60,,,6211.00,683.21,3229.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EPIFIX SQ CM,Q4186,HCPCS,,,,,both,, ,570.11,342.06,Medicaid,Illinois Medicaid,,342.06,,,570.11,62.71,296.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
MEMBRANE GRAFT/WRAP (PER SQ CM),Q4205,HCPCS,,,,,both,, ,5236.00,3141.60,Medicaid,Illinois Medicaid,,3141.60,,,5236.00,575.96,2722.72,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
DERM-MAXX (PER SQ CM),Q4238,HCPCS,,,,,both,, ,3534.00,2120.40,Medicaid,Illinois Medicaid,,2120.40,,,3534.00,388.74,1837.68,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
AMNIO-MAX (PER SQ CM),Q4239,HCPCS,,,,,both,, ,9540.00,5724.00,Medicaid,Illinois Medicaid,,5724.00,,,9540.00,1049.40,4960.8,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INFLIXIMAB-DYYB 10MG,Q5103,HCPCS,,,,,both,1,EA,545.13,327.07,Medicaid,Illinois Medicaid,,327.07,,,545.13,59.96,283.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,1,ML,70.81,42.48,Medicaid,Illinois Medicaid,,42.48,,,70.81,7.79,36.82,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,, ,93.22,55.93,Medicaid,Illinois Medicaid,,55.93,,,93.22,10.25,48.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,, ,93.22,55.93,Medicaid,Illinois Medicaid,,55.93,,,93.22,10.25,48.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,1,ML,93.22,55.93,Medicaid,Illinois Medicaid,,55.93,,,93.22,10.25,48.47,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
INJ PERFLUTRN LIP ML,Q9957,HCPCS,,,,,both,, ,1184.50,710.70,Medicaid,Illinois Medicaid,,710.70,,,1184.50,130.30,615.94,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HOCM2 250-299MGML ML,Q9961,HCPCS,,,,,both,, ,1.65,0.99,Medicaid,Illinois Medicaid,,0.99,,,1.65,0.18,0.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HOCM 350 MG ML 30ML,Q9963,HCPCS,,,,,both,30,ML,49.50,29.70,Medicaid,Illinois Medicaid,,29.70,,,49.50,5.45,25.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
HOCM 350-399MGML IOD,Q9963,HCPCS,,,,,both,, ,1.65,0.99,Medicaid,Illinois Medicaid,,0.99,,,1.65,0.18,0.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOC2 200-299MG/ML ML,Q9966,HCPCS,,,,,both,, ,27.81,16.68,Medicaid,Illinois Medicaid,,16.68,,,27.81,3.06,14.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM 240MG 100ML,Q9966,HCPCS,,,,,both,100,ML,6.00,3.60,Medicaid,Illinois Medicaid,,3.60,,,6.00,0.66,3.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM 240MG 50ML,Q9966,HCPCS,,,,,both,50,ML,6.00,3.60,Medicaid,Illinois Medicaid,,3.60,,,6.00,0.66,3.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM 270MG 150ML,Q9966,HCPCS,,,,,both,150,ML,6.00,3.60,Medicaid,Illinois Medicaid,,3.60,,,6.00,0.66,3.12,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM200MG/ML 41% 200,Q9966,HCPCS,,,,,both,200,ML,4.00,2.40,Medicaid,Illinois Medicaid,,2.40,,,4.00,0.44,2.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM200MG/ML M41% 10,Q9966,HCPCS,,,,,both,20,ML,36.82,22.09,Medicaid,Illinois Medicaid,,22.09,,,36.82,4.05,19.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM200MG/ML M41% 10,Q9966,HCPCS,,,,,both,20,ML,36.82,22.09,Medicaid,Illinois Medicaid,,22.09,,,36.82,4.05,19.15,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOC2 300-399MG/ML ML,Q9967,HCPCS,,,,,both,150,ML,1337.97,802.78,Medicaid,Illinois Medicaid,,802.78,,,1337.97,147.18,695.74,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOC3 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,60.50,36.30,Medicaid,Illinois Medicaid,,36.30,,,60.50,6.66,31.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOC3 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,60.50,36.30,Medicaid,Illinois Medicaid,,36.30,,,60.50,6.66,31.46,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOC5 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,0.70,0.42,Medicaid,Illinois Medicaid,,0.42,,,0.70,0.08,0.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOC5 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,0.70,0.42,Medicaid,Illinois Medicaid,,0.42,,,0.70,0.08,0.36,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOC6 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,0.60,0.36,Medicaid,Illinois Medicaid,,0.36,,,0.60,0.07,0.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOC6 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,0.60,0.36,Medicaid,Illinois Medicaid,,0.36,,,0.60,0.07,0.31,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM 300-399MG/ML ML,Q9967,HCPCS,,,,,both,50,ML,12.62,7.57,Medicaid,Illinois Medicaid,,7.57,,,12.62,1.39,6.56,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,1178.84,707.30,Medicaid,Illinois Medicaid,,707.30,,,1178.84,129.67,613,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM300MG/ML 61% 50,Q9967,HCPCS,,,,,both,50,ML,7.40,4.44,Medicaid,Illinois Medicaid,,4.44,,,7.40,0.81,3.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM300MG/ML 61% 50,Q9967,HCPCS,,,,,both,50,ML,7.40,4.44,Medicaid,Illinois Medicaid,,4.44,,,7.40,0.81,3.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM300MG/ML 61% 50,Q9967,HCPCS,,,,,both,50,ML,7.40,4.44,Medicaid,Illinois Medicaid,,4.44,,,7.40,0.81,3.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM300MG/ML 61% 50,Q9967,HCPCS,,,,,both,50,ML,7.40,4.44,Medicaid,Illinois Medicaid,,4.44,,,7.40,0.81,3.85,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM300MG/ML 76% 125,Q9967,HCPCS,,,,,both,125,ML,4.00,2.40,Medicaid,Illinois Medicaid,,2.40,,,4.00,0.44,2.08,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM300MG/ML 76% 50,Q9967,HCPCS,,,,,both,50,ML,11.07,6.64,Medicaid,Illinois Medicaid,,6.64,,,11.07,1.22,5.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM300MG/ML 76% 50,Q9967,HCPCS,,,,,both,50,ML,11.07,6.64,Medicaid,Illinois Medicaid,,6.64,,,11.07,1.22,5.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM300MG/ML 76% 50,Q9967,HCPCS,,,,,both,50,ML,11.07,6.64,Medicaid,Illinois Medicaid,,6.64,,,11.07,1.22,5.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LOCM300MG/ML 76% 50,Q9967,HCPCS,,,,,both,50,ML,11.07,6.64,Medicaid,Illinois Medicaid,,6.64,,,11.07,1.22,5.76,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
LACTATION CONSULT,S9443,HCPCS,,,,,both,, ,115.88,69.52,Medicaid,Illinois Medicaid,,69.52,,,115.88,12.75,60.26,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-CARD REHAB PH 3,S9472,HCPCS,,,,,both,, ,2.58,1.54,Medicaid,Illinois Medicaid,,1.54,,,2.58,0.28,1.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
NI-PULM REHAB PH 3,S9473,HCPCS,,,,,both,, ,2.58,1.54,Medicaid,Illinois Medicaid,,1.54,,,2.58,0.28,1.34,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
IOP PSYCH PER DIEM,S9480,HCPCS,,,,,both,, ,872.41,523.44,Medicaid,Illinois Medicaid,,523.44,,,872.41,95.97,453.65,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CDC COVID19,U0001,HCPCS,,,,,both,, ,120.97,72.58,Medicaid,Illinois Medicaid,,72.58,,,120.97,13.31,62.9,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
STATE COVID19,U0002,HCPCS,,,,,both,, ,172.81,103.68,Medicaid,Illinois Medicaid,,103.68,,,172.81,19.01,89.86,Fee Schedule ,Medicaid EAPG on intensity of service Avg is 6% Gross Charge
CT-CATH FLUID DRAIN,10030,CPT,,,,,both,, ,1071.33,642.79,Medicare,Medicare,,642.79,,,1071.33,149.99,546.38,Fee Schedule,Medicare APC Fee Schedule
I&D ABSCS SMPL/SGL,10060,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
I&D ABSCS COMP/MULTI,10061,CPT,,,,,both,, ,1519.68,911.80,Medicare,Medicare,,911.80,,,1519.68,212.76,775.04,Fee Schedule,Medicare APC Fee Schedule
INC & REM FB SQ SMPL,10120,CPT,,,,,both,, ,1519.68,911.80,Medicare,Medicare,,911.80,,,1519.68,212.76,775.04,Fee Schedule,Medicare APC Fee Schedule
INC & REM FB SQ COMP,10121,CPT,,,,,both,, ,6179.00,3707.40,Medicare,Medicare,,3707.40,,,6179.00,865.06,3151.29,Fee Schedule,Medicare APC Fee Schedule
I&D HEMATOMA/FLUID,10140,CPT,,,,,both,, ,6179.00,3707.40,Medicare,Medicare,,3707.40,,,6179.00,865.06,3151.29,Fee Schedule,Medicare APC Fee Schedule
PNXR ASP ABS HEM CYT,10160,CPT,,,,,both,, ,1519.68,911.80,Medicare,Medicare,,911.80,,,1519.68,212.76,775.04,Fee Schedule,Medicare APC Fee Schedule
I&D CPLX PO WND INF,10180,CPT,,,,,both,, ,10829.40,6497.64,Medicare,Medicare,,6497.64,,,10829.40,1516.12,5522.99,Fee Schedule,Medicare APC Fee Schedule
DEBR EXZ/INF SKN <10%,11000,CPT,,,,,both,, ,2393.60,1436.16,Medicare,Medicare,,1436.16,,,2393.60,335.10,1220.74,Fee Schedule,Medicare APC Fee Schedule
DEBR EXZ/INF SKN E A,11001,CPT,,,,,both,, ,2393.60,1436.16,Medicare,Medicare,,1436.16,,,2393.60,335.10,1220.74,Fee Schedule,Medicare APC Fee Schedule
DEB SKN BONE FX SITE,11012,CPT,,,,,both,, ,10829.40,6497.64,Medicare,Medicare,,6497.64,,,10829.40,1516.12,5522.99,Fee Schedule,Medicare APC Fee Schedule
DEB SUB TIS 20 SQ CM<,11042,CPT,,,,,both,, ,1519.68,911.80,Medicare,Medicare,,911.80,,,1519.68,212.76,775.04,Fee Schedule,Medicare APC Fee Schedule
DEB MUSC/FSCA <20 SQ,11043,CPT,,,,,both,, ,2393.60,1436.16,Medicare,Medicare,,1436.16,,,2393.60,335.10,1220.74,Fee Schedule,Medicare APC Fee Schedule
DEB BONE 20 SQ CM/<,11044,CPT,,,,,both,, ,6179.00,3707.40,Medicare,Medicare,,3707.40,,,6179.00,865.06,3151.29,Fee Schedule,Medicare APC Fee Schedule
DEB SUB TISS EA ADDL,11045,CPT,,,,,both,, ,6179.00,3707.40,Medicare,Medicare,,3707.40,,,6179.00,865.06,3151.29,Fee Schedule,Medicare APC Fee Schedule
DEB MUSC/FSCA EA ADL,11046,CPT,,,,,both,, ,6179.00,3707.40,Medicare,Medicare,,3707.40,,,6179.00,865.06,3151.29,Fee Schedule,Medicare APC Fee Schedule
DEB BONE EA ADDL,11047,CPT,,,,,both,, ,6179.00,3707.40,Medicare,Medicare,,3707.40,,,6179.00,865.06,3151.29,Fee Schedule,Medicare APC Fee Schedule
PARG/CUTG B9 SGL LES,11055,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
TRIM SKIN LESION 2-4,11056,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
TRIM SKIN LESIONS >4,11057,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
TNGNTL BX SKN SGL LES,11102,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
TNGNTL BX SKN EA ADD,11103,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
PUNCH BX SKN SGL LES,11104,CPT,,,,,both,, ,1519.68,911.80,Medicare,Medicare,,911.80,,,1519.68,212.76,775.04,Fee Schedule,Medicare APC Fee Schedule
PUNCH BX SKN EA ADDL,11105,CPT,,,,,both,, ,1519.68,911.80,Medicare,Medicare,,911.80,,,1519.68,212.76,775.04,Fee Schedule,Medicare APC Fee Schedule
INCIS BX SKN SGL LES,11106,CPT,,,,,both,, ,2393.60,1436.16,Medicare,Medicare,,1436.16,,,2393.60,335.10,1220.74,Fee Schedule,Medicare APC Fee Schedule
INCAL BX SKN EA ADDL,11107,CPT,,,,,both,, ,2393.60,1436.16,Medicare,Medicare,,1436.16,,,2393.60,335.10,1220.74,Fee Schedule,Medicare APC Fee Schedule
RMV SKN TAGS<=15 LES,11200,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
RMV SKN TAGS EA ADDL,11201,CPT,,,,,both,, ,233.12,139.87,Medicare,Medicare,,139.87,,,233.12,32.64,118.89,Fee Schedule,Medicare APC Fee Schedule
DEBRIDEMENT NAIL 1-5,11720,CPT,,,,,both,, ,233.12,139.87,Medicare,Medicare,,139.87,,,233.12,32.64,118.89,Fee Schedule,Medicare APC Fee Schedule
DEBRIDEMENT NAIL >6,11721,CPT,,,,,both,, ,233.12,139.87,Medicare,Medicare,,139.87,,,233.12,32.64,118.89,Fee Schedule,Medicare APC Fee Schedule
RMV NAIL PLATE SGL,11730,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
RMV NAIL PLATE E ADD,11732,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
EVAC SU HEMATOMA,11740,CPT,,,,,both,, ,486.84,292.10,Medicare,Medicare,,292.10,,,486.84,68.16,248.29,Fee Schedule,Medicare APC Fee Schedule
TT F/C/M/N/A/G/H/F,14040,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
TT F/C/M/N/A/G/H/F AD,14041,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
WND PR T/A/L 100SQCM,15002,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
WND PR ADL 100 SQCM,15003,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
WND PREP F/N/HF/G,15004,CPT,,,,,both,, ,2393.60,1436.16,Medicare,Medicare,,1436.16,,,2393.60,335.10,1220.74,Fee Schedule,Medicare APC Fee Schedule
WND PREP F/N/HF/G ADL,15005,CPT,,,,,both,, ,2393.60,1436.16,Medicare,Medicare,,1436.16,,,2393.60,335.10,1220.74,Fee Schedule,Medicare APC Fee Schedule
PINCH GRFT UP TO 2CM,15050,CPT,,,,,both,, ,2393.60,1436.16,Medicare,Medicare,,1436.16,,,2393.60,335.10,1220.74,Fee Schedule,Medicare APC Fee Schedule
SKIN SPLT GRFT T/A/L,15100,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
SKN SPLT GRF T/A/L EA,15101,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
EPIDRM AUTOGRFT T/A/L,15110,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
EPIDR AUTGF T/A/L EA,15111,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
EPIDR AGRFT F/N/H/G,15115,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
EPI AGRFT F/N/HF/G ADL,15116,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
SKN SPLT AGRFT F/N/H/G,15120,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,8203.82,,,13673.04,1914.23,6973.25,Fee Schedule,Medicare APC Fee Schedule
SKN SPLT AGRF F/N/H/G ADD,15121,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,8203.82,,,13673.04,1914.23,6973.25,Fee Schedule,Medicare APC Fee Schedule
DERM AUTOGRAF T/A/L,15130,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
DERM AGRAF T/A/L ADL,15131,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
DERM AGRF F/N/H/G,15135,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,8203.82,,,13673.04,1914.23,6973.25,Fee Schedule,Medicare APC Fee Schedule
DERM AGRF F/N/H/G ADD,15136,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,8203.82,,,13673.04,1914.23,6973.25,Fee Schedule,Medicare APC Fee Schedule
CULT SKN GRF T/A/L,15150,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
CUL SKN GRF T/A/L A,15151,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
CUL SKN GRF T/A/L +%,15152,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
CUL SKN GRF F/N/H/G,15155,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,8203.82,,,13673.04,1914.23,6973.25,Fee Schedule,Medicare APC Fee Schedule
CUL SKN GRF F/N/H/G ADD,15156,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,8203.82,,,13673.04,1914.23,6973.25,Fee Schedule,Medicare APC Fee Schedule
CUL EPIDR GRF F/N/HFG +%,15157,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,8203.82,,,13673.04,1914.23,6973.25,Fee Schedule,Medicare APC Fee Schedule
FTH GRF TRNK 20SQ/<,15200,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
FTH GRF FR TRNK EA AD,15201,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
FTH GF S/A/L 20 SQ/<,15220,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
FTH GF S/A/L 20 SQ E A,15221,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
FTH GR F/C/C/M/N/AX/G/H/F,15240,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
FTH GR F/C/C/M/N/AX/G/H/F EA,15241,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
FTH GR FR N/E/E/L 20SQ/<,15260,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
FTH GR FR N/E/E/L E A,15261,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
SKN SUB GRAFT T/A/L,15271,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
SKN SUB GRFT ADDL,15272,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
SKN S GRFT >100SQ,15273,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,8203.82,,,13673.04,1914.23,6973.25,Fee Schedule,Medicare APC Fee Schedule
SKN S GR ADD 100SQ,15274,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,8203.82,,,13673.04,1914.23,6973.25,Fee Schedule,Medicare APC Fee Schedule
SKN S GR F/NK/HF/G 25SQCM,15275,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
SKN S GR F/N/HF/G ADL,15276,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
SKN S GR F/N/HF/G CH,15277,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
SKN S GR F/N/HF/G CH ADD,15278,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
INIT TX 1ST DEG BURN,16000,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
DRS DEB PTHICK BRN S,16020,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
DRS DEB PTHICK BRN M,16025,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
DRS DEB PTHICK BRN L,16030,CPT,,,,,both,, ,1519.68,911.80,Medicare,Medicare,,911.80,,,1519.68,212.76,775.04,Fee Schedule,Medicare APC Fee Schedule
DESTRCT PREMAL LES,17000,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
DESTRCT PREMAL 2-14,17003,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
DESTRCT PREMAL 15+,17004,CPT,,,,,both,, ,1519.68,911.80,Medicare,Medicare,,911.80,,,1519.68,212.76,775.04,Fee Schedule,Medicare APC Fee Schedule
DESTR CV LES <=10 SQ,17106,CPT,,,,,both,, ,1519.68,911.80,Medicare,Medicare,,911.80,,,1519.68,212.76,775.04,Fee Schedule,Medicare APC Fee Schedule
DESTR CV LES 10-50 SQ,17107,CPT,,,,,both,, ,2393.60,1436.16,Medicare,Medicare,,1436.16,,,2393.60,335.10,1220.74,Fee Schedule,Medicare APC Fee Schedule
DESTR CV LES > 50 SQ,17108,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
DESTRUCT B9 LES 1-14,17110,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
CHEM CAUT GRANL TISS,17250,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
UNLISTD PROCEDURE,17999,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
S-BRST DUCTOGRM INJ,19030,CPT,,,,,both,, ,289.43,173.65,Medicare,Medicare,,173.65,,,289.43,40.52,147.61,Fee Schedule,Medicare APC Fee Schedule
BX OF BREAST OPEN,19101,CPT,,,,,both,, ,14527.16,8716.29,Medicare,Medicare,,8716.29,,,14527.16,2033.80,7408.85,Fee Schedule,Medicare APC Fee Schedule
EXPL P WND EXTREM,20103,CPT,,,,,both,, ,6179.00,3707.40,Medicare,Medicare,,3707.40,,,6179.00,865.06,3151.29,Fee Schedule,Medicare APC Fee Schedule
NJ TENDON SHEATH/LIG,20550,CPT,,,,,both,, ,1128.80,677.28,Medicare,Medicare,,677.28,,,1128.80,158.03,575.69,Fee Schedule,Medicare APC Fee Schedule
S-JOINT ASP-INJ SM,20600,CPT,,,,,both,, ,487.45,292.47,Medicare,Medicare,,292.47,,,487.45,68.24,248.6,Fee Schedule,Medicare APC Fee Schedule
US-DRN INJ SMAL JT W,20604,CPT,,,,,both,, ,726.15,435.69,Medicare,Medicare,,435.69,,,726.15,101.66,370.34,Fee Schedule,Medicare APC Fee Schedule
S-JOINT ASP-INJ IM,20605,CPT,,,,,both,, ,700.66,420.39,Medicare,Medicare,,420.39,,,700.66,98.09,357.34,Fee Schedule,Medicare APC Fee Schedule
US-DRN INJ INTM JT W,20606,CPT,,,,,both,, ,1594.18,956.50,Medicare,Medicare,,956.50,,,1594.18,223.19,813.03,Fee Schedule,Medicare APC Fee Schedule
US-DRN INJ MAJR JT W,20611,CPT,,,,,both,, ,726.15,435.69,Medicare,Medicare,,435.69,,,726.15,101.66,370.34,Fee Schedule,Medicare APC Fee Schedule
S-INJ TMJ ARTHROGRAM,21116,CPT,,,,,both,, ,289.43,173.65,Medicare,Medicare,,173.65,,,289.43,40.52,147.61,Fee Schedule,Medicare APC Fee Schedule
S-INJ SHOULDER ARTH,23350,CPT,,,,,both,, ,289.43,173.65,Medicare,Medicare,,173.65,,,289.43,40.52,147.61,Fee Schedule,Medicare APC Fee Schedule
S-INJ ELBOW ARTHRO,24220,CPT,,,,,both,, ,289.43,173.65,Medicare,Medicare,,173.65,,,289.43,40.52,147.61,Fee Schedule,Medicare APC Fee Schedule
S-INJ WRIST ARTHRO,25246,CPT,,,,,both,, ,289.43,173.65,Medicare,Medicare,,173.65,,,289.43,40.52,147.61,Fee Schedule,Medicare APC Fee Schedule
S-INJ HIP ARTHRO,27093,CPT,,,,,both,, ,289.43,173.65,Medicare,Medicare,,173.65,,,289.43,40.52,147.61,Fee Schedule,Medicare APC Fee Schedule
S-INJ KNEE ARTHRO,27369,CPT,,,,,both,, ,289.43,173.65,Medicare,Medicare,,173.65,,,289.43,40.52,147.61,Fee Schedule,Medicare APC Fee Schedule
S-INJ ANKLE ARTHRO,27648,CPT,,,,,both,, ,289.43,173.65,Medicare,Medicare,,173.65,,,289.43,40.52,147.61,Fee Schedule,Medicare APC Fee Schedule
EXPLORE FOOT JOINT,28022,CPT,,,,,both,, ,12336.12,7401.67,Medicare,Medicare,,7401.67,,,12336.12,1727.06,6291.42,Fee Schedule,Medicare APC Fee Schedule
AMPUT TOE & METATRSL,28810,CPT,,,,,both,, ,12336.12,7401.67,Medicare,Medicare,,7401.67,,,12336.12,1727.06,6291.42,Fee Schedule,Medicare APC Fee Schedule
AMPUTATE TOE,28820,CPT,,,,,both,, ,12336.12,7401.67,Medicare,Medicare,,7401.67,,,12336.12,1727.06,6291.42,Fee Schedule,Medicare APC Fee Schedule
SPLNT LNG ARM S-H OT,29105,CPT,,,,,both,, ,1388.96,833.37,Medicare,Medicare,,833.37,,,1388.96,194.45,708.37,Fee Schedule,Medicare APC Fee Schedule
SPLNT LNG ARM S-H OT,29105,CPT,,,,,both,, ,1388.96,833.37,Medicare,Medicare,,833.37,,,1388.96,194.45,708.37,Fee Schedule,Medicare APC Fee Schedule
SPLNT LNG ARM S-H PT,29105,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
SPLNT LNG ARM S-H PT,29105,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
SPLNT LNG ARM S-H PT,29105,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
SPLNT LNG ARM S-H PT,29105,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
SPLNT LNG ARM S-H PT,29105,CPT,,,,,both,, ,1281.32,768.79,Medicare,Medicare,,768.79,,,1281.32,179.38,653.47,Fee Schedule,Medicare APC Fee Schedule
SPLNT LNG ARM S-H PT,29105,CPT,,,,,both,, ,1281.32,768.79,Medicare,Medicare,,768.79,,,1281.32,179.38,653.47,Fee Schedule,Medicare APC Fee Schedule
SPLNT LONG ARM S-H,29105,CPT,,,,,both,, ,1196.17,717.70,Medicare,Medicare,,717.70,,,1196.17,167.46,610.05,Fee Schedule,Medicare APC Fee Schedule
SPLNT LONG ARM S-H,29105,CPT,,,,,both,, ,1296.73,778.03,Medicare,Medicare,,778.03,,,1296.73,181.54,661.33,Fee Schedule,Medicare APC Fee Schedule
SPLNT SHRT ARM STATC,29125,CPT,,,,,both,, ,909.80,545.88,Medicare,Medicare,,545.88,,,909.80,127.37,464,Fee Schedule,Medicare APC Fee Schedule
SPLNT SHRT ARM STATC,29125,CPT,,,,,both,, ,986.30,591.78,Medicare,Medicare,,591.78,,,986.30,138.08,503.01,Fee Schedule,Medicare APC Fee Schedule
SPLT SHRT ARM ST OT,29125,CPT,,,,,both,, ,1056.52,633.91,Medicare,Medicare,,633.91,,,1056.52,147.91,538.83,Fee Schedule,Medicare APC Fee Schedule
SPLT SHRT ARM ST OT,29125,CPT,,,,,both,, ,1056.52,633.91,Medicare,Medicare,,633.91,,,1056.52,147.91,538.83,Fee Schedule,Medicare APC Fee Schedule
SPLT SHRT ARM ST PT,29125,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,162.07,,,270.12,37.82,137.76,Fee Schedule,Medicare APC Fee Schedule
SPLT SHRT ARM ST PT,29125,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,162.07,,,270.12,37.82,137.76,Fee Schedule,Medicare APC Fee Schedule
SPLT SHRT ARM ST PT,29125,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,162.07,,,270.12,37.82,137.76,Fee Schedule,Medicare APC Fee Schedule
SPLT SHRT ARM ST PT,29125,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,162.07,,,270.12,37.82,137.76,Fee Schedule,Medicare APC Fee Schedule
SPLT SHRT ARM ST PT,29125,CPT,,,,,both,, ,974.64,584.78,Medicare,Medicare,,584.78,,,974.64,136.45,497.07,Fee Schedule,Medicare APC Fee Schedule
SPLT SHRT ARM ST PT,29125,CPT,,,,,both,, ,974.64,584.78,Medicare,Medicare,,584.78,,,974.64,136.45,497.07,Fee Schedule,Medicare APC Fee Schedule
SPLN SHRT ARM DY OT,29126,CPT,,,,,both,, ,1611.18,966.70,Medicare,Medicare,,966.70,,,1611.18,225.57,821.7,Fee Schedule,Medicare APC Fee Schedule
SPLN SHRT ARM DY OT,29126,CPT,,,,,both,, ,1611.18,966.70,Medicare,Medicare,,966.70,,,1611.18,225.57,821.7,Fee Schedule,Medicare APC Fee Schedule
SPLN SHRT ARM DY PT,29126,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,162.07,,,270.12,37.82,137.76,Fee Schedule,Medicare APC Fee Schedule
SPLN SHRT ARM DY PT,29126,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,162.07,,,270.12,37.82,137.76,Fee Schedule,Medicare APC Fee Schedule
SPLN SHRT ARM DY PT,29126,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,162.07,,,270.12,37.82,137.76,Fee Schedule,Medicare APC Fee Schedule
SPLN SHRT ARM DY PT,29126,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,162.07,,,270.12,37.82,137.76,Fee Schedule,Medicare APC Fee Schedule
SPLN SHRT ARM DY PT,29126,CPT,,,,,both,, ,1486.29,891.77,Medicare,Medicare,,891.77,,,1486.29,208.08,758.01,Fee Schedule,Medicare APC Fee Schedule
SPLN SHRT ARM DY PT,29126,CPT,,,,,both,, ,1486.29,891.77,Medicare,Medicare,,891.77,,,1486.29,208.08,758.01,Fee Schedule,Medicare APC Fee Schedule
SPLNT SHRT ARM DYNAM,29126,CPT,,,,,both,, ,1387.43,832.45,Medicare,Medicare,,832.45,,,1387.43,194.24,707.59,Fee Schedule,Medicare APC Fee Schedule
SPLNT SHRT ARM DYNAM,29126,CPT,,,,,both,, ,1504.12,902.47,Medicare,Medicare,,902.47,,,1504.12,210.58,767.1,Fee Schedule,Medicare APC Fee Schedule
SPLNT FINGER STATIC,29130,CPT,,,,,both,, ,299.22,179.53,Medicare,Medicare,,179.53,,,299.22,41.89,152.6,Fee Schedule,Medicare APC Fee Schedule
SPLNT FINGER STATIC,29130,CPT,,,,,both,, ,324.42,194.65,Medicare,Medicare,,194.65,,,324.42,45.42,165.45,Fee Schedule,Medicare APC Fee Schedule
SPLNT FNGR STATC OT,29130,CPT,,,,,both,, ,347.63,208.57,Medicare,Medicare,,208.57,,,347.63,48.67,177.29,Fee Schedule,Medicare APC Fee Schedule
SPLNT FNGR STATC OT,29130,CPT,,,,,both,, ,347.63,208.57,Medicare,Medicare,,208.57,,,347.63,48.67,177.29,Fee Schedule,Medicare APC Fee Schedule
SPLNT FNGR STATC PT,29130,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,85.12,,,141.88,19.86,72.36,Fee Schedule,Medicare APC Fee Schedule
SPLNT FNGR STATC PT,29130,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,85.12,,,141.88,19.86,72.36,Fee Schedule,Medicare APC Fee Schedule
SPLNT FNGR STATC PT,29130,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,85.12,,,141.88,19.86,72.36,Fee Schedule,Medicare APC Fee Schedule
SPLNT FNGR STATC PT,29130,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,85.12,,,141.88,19.86,72.36,Fee Schedule,Medicare APC Fee Schedule
SPLNT FNGR STATC PT,29130,CPT,,,,,both,, ,320.59,192.35,Medicare,Medicare,,192.35,,,320.59,44.88,163.5,Fee Schedule,Medicare APC Fee Schedule
SPLNT FNGR STATC PT,29130,CPT,,,,,both,, ,320.59,192.35,Medicare,Medicare,,192.35,,,320.59,44.88,163.5,Fee Schedule,Medicare APC Fee Schedule
SPLNT FINGER DYNAM,29131,CPT,,,,,both,, ,453.68,272.20,Medicare,Medicare,,272.20,,,453.68,63.52,231.38,Fee Schedule,Medicare APC Fee Schedule
SPLNT FINGER DYNAM,29131,CPT,,,,,both,, ,491.82,295.09,Medicare,Medicare,,295.09,,,491.82,68.85,250.83,Fee Schedule,Medicare APC Fee Schedule
SPLNT FINGR DYNA OT,29131,CPT,,,,,both,, ,526.85,316.11,Medicare,Medicare,,316.11,,,526.85,73.76,268.69,Fee Schedule,Medicare APC Fee Schedule
SPLNT FINGR DYNA OT,29131,CPT,,,,,both,, ,526.85,316.11,Medicare,Medicare,,316.11,,,526.85,73.76,268.69,Fee Schedule,Medicare APC Fee Schedule
SPLNT FINGR DYNA PT,29131,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,85.12,,,141.88,19.86,72.36,Fee Schedule,Medicare APC Fee Schedule
SPLNT FINGR DYNA PT,29131,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,85.12,,,141.88,19.86,72.36,Fee Schedule,Medicare APC Fee Schedule
SPLNT FINGR DYNA PT,29131,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,85.12,,,141.88,19.86,72.36,Fee Schedule,Medicare APC Fee Schedule
SPLNT FINGR DYNA PT,29131,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,85.12,,,141.88,19.86,72.36,Fee Schedule,Medicare APC Fee Schedule
SPLNT FINGR DYNA PT,29131,CPT,,,,,both,, ,485.90,291.54,Medicare,Medicare,,291.54,,,485.90,68.03,247.81,Fee Schedule,Medicare APC Fee Schedule
SPLNT FINGR DYNA PT,29131,CPT,,,,,both,, ,485.90,291.54,Medicare,Medicare,,291.54,,,485.90,68.03,247.81,Fee Schedule,Medicare APC Fee Schedule
STRAPPING THORAX,29200,CPT,,,,,both,, ,377.17,226.30,Medicare,Medicare,,226.30,,,377.17,52.80,192.36,Fee Schedule,Medicare APC Fee Schedule
STRAPPING THORAX PT,29200,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
STRAPPING THORAX PT,29200,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
STRAPPING THORAX PT,29200,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
STRAPPING THORAX PT,29200,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
STRAPPING THORAX PT,29200,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,242.41,,,404.02,56.56,206.05,Fee Schedule,Medicare APC Fee Schedule
STRAPPING THORAX PT,29200,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,242.41,,,404.02,56.56,206.05,Fee Schedule,Medicare APC Fee Schedule
STRAPPING SHOULD OT,29240,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,48.82,,,81.37,11.39,41.5,Fee Schedule,Medicare APC Fee Schedule
STRAPPING SHOULD OT,29240,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,48.82,,,81.37,11.39,41.5,Fee Schedule,Medicare APC Fee Schedule
STRAPPING SHOULD OT,29240,CPT,,,,,both,, ,438.01,262.80,Medicare,Medicare,,262.80,,,438.01,61.32,223.39,Fee Schedule,Medicare APC Fee Schedule
STRAPPING SHOULD OT,29240,CPT,,,,,both,, ,438.01,262.80,Medicare,Medicare,,262.80,,,438.01,61.32,223.39,Fee Schedule,Medicare APC Fee Schedule
STRAPPING SHOULD PT,29240,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,162.07,,,270.12,37.82,137.76,Fee Schedule,Medicare APC Fee Schedule
STRAPPING SHOULD PT,29240,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,162.07,,,270.12,37.82,137.76,Fee Schedule,Medicare APC Fee Schedule
STRAPPING SHOULD PT,29240,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,242.41,,,404.02,56.56,206.05,Fee Schedule,Medicare APC Fee Schedule
STRAPPING SHOULD PT,29240,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,242.41,,,404.02,56.56,206.05,Fee Schedule,Medicare APC Fee Schedule
STRAPPING SHOULDER,29240,CPT,,,,,both,, ,377.17,226.30,Medicare,Medicare,,226.30,,,377.17,52.80,192.36,Fee Schedule,Medicare APC Fee Schedule
STRAPPING SHOULDER,29240,CPT,,,,,both,, ,408.86,245.31,Medicare,Medicare,,245.31,,,408.86,57.24,208.52,Fee Schedule,Medicare APC Fee Schedule
STRAPPING ELBO-WRIST,29260,CPT,,,,,both,, ,377.17,226.30,Medicare,Medicare,,226.30,,,377.17,52.80,192.36,Fee Schedule,Medicare APC Fee Schedule
STRAPPING ELBO-WRIST,29260,CPT,,,,,both,, ,408.86,245.31,Medicare,Medicare,,245.31,,,408.86,57.24,208.52,Fee Schedule,Medicare APC Fee Schedule
STRPNG ELBO-WRST OT,29260,CPT,,,,,both,, ,438.01,262.80,Medicare,Medicare,,262.80,,,438.01,61.32,223.39,Fee Schedule,Medicare APC Fee Schedule
STRPNG ELBO-WRST OT,29260,CPT,,,,,both,, ,438.01,262.80,Medicare,Medicare,,262.80,,,438.01,61.32,223.39,Fee Schedule,Medicare APC Fee Schedule
STRPNG ELBO-WRST PT,29260,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,48.82,,,81.37,11.39,41.5,Fee Schedule,Medicare APC Fee Schedule
STRPNG ELBO-WRST PT,29260,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,48.82,,,81.37,11.39,41.5,Fee Schedule,Medicare APC Fee Schedule
STRPNG ELBO-WRST PT,29260,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,48.82,,,81.37,11.39,41.5,Fee Schedule,Medicare APC Fee Schedule
STRPNG ELBO-WRST PT,29260,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,48.82,,,81.37,11.39,41.5,Fee Schedule,Medicare APC Fee Schedule
STRPNG ELBO-WRST PT,29260,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,242.41,,,404.02,56.56,206.05,Fee Schedule,Medicare APC Fee Schedule
STRPNG ELBO-WRST PT,29260,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,242.41,,,404.02,56.56,206.05,Fee Schedule,Medicare APC Fee Schedule
STRAPPING HAND-FING,29280,CPT,,,,,both,, ,377.17,226.30,Medicare,Medicare,,226.30,,,377.17,52.80,192.36,Fee Schedule,Medicare APC Fee Schedule
STRAPPING HAND-FING,29280,CPT,,,,,both,, ,408.86,245.31,Medicare,Medicare,,245.31,,,408.86,57.24,208.52,Fee Schedule,Medicare APC Fee Schedule
STRPPNG HND-FING OT,29280,CPT,,,,,both,, ,438.01,262.80,Medicare,Medicare,,262.80,,,438.01,61.32,223.39,Fee Schedule,Medicare APC Fee Schedule
STRPPNG HND-FING OT,29280,CPT,,,,,both,, ,438.01,262.80,Medicare,Medicare,,262.80,,,438.01,61.32,223.39,Fee Schedule,Medicare APC Fee Schedule
STRPPNG HND-FING PT,29280,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,48.82,,,81.37,11.39,41.5,Fee Schedule,Medicare APC Fee Schedule
STRPPNG HND-FING PT,29280,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,48.82,,,81.37,11.39,41.5,Fee Schedule,Medicare APC Fee Schedule
STRPPNG HND-FING PT,29280,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,48.82,,,81.37,11.39,41.5,Fee Schedule,Medicare APC Fee Schedule
STRPPNG HND-FING PT,29280,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,48.82,,,81.37,11.39,41.5,Fee Schedule,Medicare APC Fee Schedule
STRPPNG HND-FING PT,29280,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,242.41,,,404.02,56.56,206.05,Fee Schedule,Medicare APC Fee Schedule
STRPPNG HND-FING PT,29280,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,242.41,,,404.02,56.56,206.05,Fee Schedule,Medicare APC Fee Schedule
APPLY RIGID LEG CAST,29445,CPT,,,,,both,, ,1023.52,614.11,Medicare,Medicare,,614.11,,,1023.52,143.29,522,Fee Schedule,Medicare APC Fee Schedule
AP LNG LEG SPLNT PT,29505,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
AP LNG LEG SPLNT PT,29505,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
AP LNG LEG SPLNT PT,29505,CPT,,,,,both,, ,1486.29,891.77,Medicare,Medicare,,891.77,,,1486.29,208.08,758.01,Fee Schedule,Medicare APC Fee Schedule
AP LNG LEG SPLNT PT,29505,CPT,,,,,both,, ,1486.29,891.77,Medicare,Medicare,,891.77,,,1486.29,208.08,758.01,Fee Schedule,Medicare APC Fee Schedule
APP LNG LEG SPLINT,29505,CPT,,,,,both,, ,1387.43,832.45,Medicare,Medicare,,832.45,,,1387.43,194.24,707.59,Fee Schedule,Medicare APC Fee Schedule
APPLY LNG LEG SPLNT,29505,CPT,,,,,both,, ,600.52,360.31,Medicare,Medicare,,360.31,,,600.52,84.07,306.27,Fee Schedule,Medicare APC Fee Schedule
AP SHT LEG SPLNT PT,29515,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
AP SHT LEG SPLNT PT,29515,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
AP SHT LEG SPLNT PT,29515,CPT,,,,,both,, ,974.64,584.78,Medicare,Medicare,,584.78,,,974.64,136.45,497.07,Fee Schedule,Medicare APC Fee Schedule
AP SHT LEG SPLNT PT,29515,CPT,,,,,both,, ,974.64,584.78,Medicare,Medicare,,584.78,,,974.64,136.45,497.07,Fee Schedule,Medicare APC Fee Schedule
APP SHORT LEG SPLINT,29515,CPT,,,,,both,, ,909.80,545.88,Medicare,Medicare,,545.88,,,909.80,127.37,464,Fee Schedule,Medicare APC Fee Schedule
APPLY SHRT LEG SPLNT,29515,CPT,,,,,both,, ,600.52,360.31,Medicare,Medicare,,360.31,,,600.52,84.07,306.27,Fee Schedule,Medicare APC Fee Schedule
STRAPPING HIP,29520,CPT,,,,,both,, ,377.17,226.30,Medicare,Medicare,,226.30,,,377.17,52.80,192.36,Fee Schedule,Medicare APC Fee Schedule
STRAPPING HIP PT,29520,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,85.12,,,141.88,19.86,72.36,Fee Schedule,Medicare APC Fee Schedule
STRAPPING HIP PT,29520,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,85.12,,,141.88,19.86,72.36,Fee Schedule,Medicare APC Fee Schedule
STRAPPING HIP PT,29520,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,242.41,,,404.02,56.56,206.05,Fee Schedule,Medicare APC Fee Schedule
STRAPPING HIP PT,29520,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,242.41,,,404.02,56.56,206.05,Fee Schedule,Medicare APC Fee Schedule
STRAPPING KNEE,29530,CPT,,,,,both,, ,377.17,226.30,Medicare,Medicare,,226.30,,,377.17,52.80,192.36,Fee Schedule,Medicare APC Fee Schedule
STRAPPING KNEE PT,29530,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,162.07,,,270.12,37.82,137.76,Fee Schedule,Medicare APC Fee Schedule
STRAPPING KNEE PT,29530,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,162.07,,,270.12,37.82,137.76,Fee Schedule,Medicare APC Fee Schedule
STRAPPING KNEE PT,29530,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,242.41,,,404.02,56.56,206.05,Fee Schedule,Medicare APC Fee Schedule
STRAPPING KNEE PT,29530,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,242.41,,,404.02,56.56,206.05,Fee Schedule,Medicare APC Fee Schedule
STRAPPING ANKLE-FOOT,29540,CPT,,,,,both,, ,377.17,226.30,Medicare,Medicare,,226.30,,,377.17,52.80,192.36,Fee Schedule,Medicare APC Fee Schedule
STRPPNG ANKLE-FT PT,29540,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
STRPPNG ANKLE-FT PT,29540,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
STRPPNG ANKLE-FT PT,29540,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,242.41,,,404.02,56.56,206.05,Fee Schedule,Medicare APC Fee Schedule
STRPPNG ANKLE-FT PT,29540,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,242.41,,,404.02,56.56,206.05,Fee Schedule,Medicare APC Fee Schedule
STRAPPING UNA BOOT,29580,CPT,,,,,both,, ,377.17,226.30,Medicare,Medicare,,226.30,,,377.17,52.80,192.36,Fee Schedule,Medicare APC Fee Schedule
STRPPNG UNA BOOT PT,29580,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
STRPPNG UNA BOOT PT,29580,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
STRPPNG UNA BOOT PT,29580,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,242.41,,,404.02,56.56,206.05,Fee Schedule,Medicare APC Fee Schedule
STRPPNG UNA BOOT PT,29580,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,242.41,,,404.02,56.56,206.05,Fee Schedule,Medicare APC Fee Schedule
UNNA BOOT STRAPPING,29580,CPT,,,,,both,, ,600.52,360.31,Medicare,Medicare,,360.31,,,600.52,84.07,306.27,Fee Schedule,Medicare APC Fee Schedule
UNNA WRAP,29580,CPT,,,,,both,, ,19.20,11.52,Medicare,Medicare,,11.52,,,19.20,2.69,9.79,Fee Schedule,Medicare APC Fee Schedule
AP MULTLY COMP LR LEG,29581,CPT,,,,,both,, ,600.52,360.31,Medicare,Medicare,,360.31,,,600.52,84.07,306.27,Fee Schedule,Medicare APC Fee Schedule
STRPPNG LOW BACK OT,29799,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,162.07,,,270.12,37.82,137.76,Fee Schedule,Medicare APC Fee Schedule
STRPPNG LOW BACK OT,29799,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,162.07,,,270.12,37.82,137.76,Fee Schedule,Medicare APC Fee Schedule
SUCTION PROC-NASOTRA,31720,CPT,,,,,both,, ,280.42,168.25,Medicare,Medicare,,168.25,,,280.42,39.26,143.01,Fee Schedule,Medicare APC Fee Schedule
CT-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914.00,5948.40,Medicare,Medicare,,5948.40,,,9914.00,1387.96,5056.14,Fee Schedule,Medicare APC Fee Schedule
IR-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914.00,5948.40,Medicare,Medicare,,5948.40,,,9914.00,1387.96,5056.14,Fee Schedule,Medicare APC Fee Schedule
IR-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914.00,5948.40,Medicare,Medicare,,5948.40,,,9914.00,1387.96,5056.14,Fee Schedule,Medicare APC Fee Schedule
US-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,5184.63,3110.77,Medicare,Medicare,,3110.77,,,5184.63,725.85,2644.16,Fee Schedule,Medicare APC Fee Schedule
CC-PERICARDIO W/IMG,33016,CPT,,,,,both,, ,3443.03,2065.81,Medicare,Medicare,,2065.81,,,3443.03,482.02,1755.95,Fee Schedule,Medicare APC Fee Schedule
P-IMPLNT LOOP REC,33285,CPT,,,,,both,, ,27383.32,16429.99,Medicare,Medicare,,16429.99,,,27383.32,3833.66,13965.49,Fee Schedule,Medicare APC Fee Schedule
P-REMOV LOOP REC,33286,CPT,,,,,both,, ,5044.68,3026.80,Medicare,Medicare,,3026.80,,,5044.68,706.26,2572.79,Fee Schedule,Medicare APC Fee Schedule
CC-IMP PRESS SEN ANG,33289,CPT,,,,,both,, ,11332.83,6799.69,Medicare,Medicare,,6799.69,,,11332.83,1586.60,5779.74,Fee Schedule,Medicare APC Fee Schedule
S-INTRO NDL CATH,36000,CPT,,,,,both,, ,168.75,101.25,Medicare,Medicare,,101.25,,,168.75,23.63,86.06,Fee Schedule,Medicare APC Fee Schedule
S-INTRO NDL CATH VEI,36000,CPT,,,,,both,, ,173.81,104.28,Medicare,Medicare,,104.28,,,173.81,24.33,88.64,Fee Schedule,Medicare APC Fee Schedule
S-INJ VENOGRAPHY,36005,CPT,,,,,both,, ,873.46,524.07,Medicare,Medicare,,524.07,,,873.46,122.28,445.46,Fee Schedule,Medicare APC Fee Schedule
S-INTROCATH SEGPULM,36015,CPT,,,,,both,, ,839.21,503.52,Medicare,Medicare,,503.52,,,839.21,117.49,428,Fee Schedule,Medicare APC Fee Schedule
S-CATH CAROTD VERT,36100,CPT,,,,,both,, ,1013.23,607.93,Medicare,Medicare,,607.93,,,1013.23,141.85,516.75,Fee Schedule,Medicare APC Fee Schedule
S-CATH EXTREM ART,36140,CPT,,,,,both,, ,399.68,239.80,Medicare,Medicare,,239.80,,,399.68,55.96,203.84,Fee Schedule,Medicare APC Fee Schedule
S-THORACIC 1ST ORDER,36215,CPT,,,,,both,, ,1839.26,1103.55,Medicare,Medicare,,1103.55,,,1839.26,257.50,938.02,Fee Schedule,Medicare APC Fee Schedule
IR-ANG EXT CRT NS,36221,CPT,,,,,both,, ,12592.76,7555.65,Medicare,Medicare,,7555.65,,,12592.76,1762.99,6422.31,Fee Schedule,Medicare APC Fee Schedule
IR-ANG CRT EXT CC BI,36222,CPT,,,,,both,, ,31881.02,19128.61,Medicare,Medicare,,19128.61,,,31881.02,4463.34,16259.32,Fee Schedule,Medicare APC Fee Schedule
IR-ANG CARTD IPS BI,36223,CPT,,,,,both,, ,45998.14,27598.88,Medicare,Medicare,,27598.88,,,45998.14,6439.74,23459.05,Fee Schedule,Medicare APC Fee Schedule
IR-ANG CARTD IPS UNI,36223,CPT,,,,,both,, ,31746.87,19048.12,Medicare,Medicare,,19048.12,,,31746.87,4444.56,16190.9,Fee Schedule,Medicare APC Fee Schedule
IR-ANG INT CAR IP BI,36224,CPT,,,,,both,, ,51895.68,31137.40,Medicare,Medicare,,31137.40,,,51895.68,7265.40,26466.8,Fee Schedule,Medicare APC Fee Schedule
IR-ANG INT CAR IP UN,36224,CPT,,,,,both,, ,32068.51,19241.10,Medicare,Medicare,,19241.10,,,32068.51,4489.59,16354.94,Fee Schedule,Medicare APC Fee Schedule
IR-ANG SUBCL IPS BI,36225,CPT,,,,,both,, ,24740.10,14844.06,Medicare,Medicare,,14844.06,,,24740.10,3463.61,12617.45,Fee Schedule,Medicare APC Fee Schedule
IR-ANG SUBCL IPS UNI,36225,CPT,,,,,both,, ,12369.34,7421.60,Medicare,Medicare,,7421.60,,,12369.34,1731.71,6308.36,Fee Schedule,Medicare APC Fee Schedule
CTH PLC EXT CD W-ANG,36227,CPT,,,,,both,, ,9411.59,5646.95,Medicare,Medicare,,5646.95,,,9411.59,1317.62,4799.91,Fee Schedule,Medicare APC Fee Schedule
CTH PLC EXT CD W-ANG,36227,CPT,,,,,both,, ,14117.39,8470.43,Medicare,Medicare,,8470.43,,,14117.39,1976.43,7199.87,Fee Schedule,Medicare APC Fee Schedule
S-ANG EXT CD IPS BI,36227,CPT,,,,,both,, ,8060.51,4836.30,Medicare,Medicare,,4836.30,,,8060.51,1128.47,4110.86,Fee Schedule,Medicare APC Fee Schedule
S-ANG EXT CD IPS BI,36227,CPT,,,,,both,, ,12090.77,7254.46,Medicare,Medicare,,7254.46,,,12090.77,1692.71,6166.29,Fee Schedule,Medicare APC Fee Schedule
S-ABDOMEN 1ST ORDER,36245,CPT,,,,,both,, ,1979.03,1187.41,Medicare,Medicare,,1187.41,,,1979.03,277.06,1009.31,Fee Schedule,Medicare APC Fee Schedule
S-ABDOMEN 2ND ORDER,36246,CPT,,,,,both,, ,9539.09,5723.45,Medicare,Medicare,,5723.45,,,9539.09,1335.47,4864.94,Fee Schedule,Medicare APC Fee Schedule
S-ABDOMEN 3RD ORDER,36247,CPT,,,,,both,, ,16382.99,9829.79,Medicare,Medicare,,9829.79,,,16382.99,2293.62,8355.32,Fee Schedule,Medicare APC Fee Schedule
DNA SPECIMEN COLLECTION VENI,36415,CPT,,,,,both,, ,70.00,42.00,Medicare,Medicare,,42.00,,,70.00,9.80,35.7,Fee Schedule,Medicare APC Fee Schedule
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,, ,8.19,4.91,Medicare,Medicare,,4.91,,,8.19,1.15,4.18,Fee Schedule,Medicare APC Fee Schedule
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,,,90.37,90.37,Medicare,Medicare,,90.37,,,90.37,12.65,46.09,Fee Schedule,Medicare APC Fee Schedule
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,, ,90.37,54.22,Medicare,Medicare,,54.22,,,90.37,12.65,46.09,Fee Schedule,Medicare APC Fee Schedule
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,22.73,13.63,Medicare,Medicare,,13.63,,,22.73,3.18,11.59,Fee Schedule,Medicare APC Fee Schedule
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,46.31,27.78,Medicare,Medicare,,27.78,,,46.31,6.48,23.62,Fee Schedule,Medicare APC Fee Schedule
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,49.96,29.97,Medicare,Medicare,,29.97,,,49.96,6.99,25.48,Fee Schedule,Medicare APC Fee Schedule
BLOOD TRANSF 0 2 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicare,Medicare,,1356.33,,,2260.55,316.48,1152.88,Fee Schedule,Medicare APC Fee Schedule
BLOOD TRANSF 2 4 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicare,Medicare,,1356.33,,,2260.55,316.48,1152.88,Fee Schedule,Medicare APC Fee Schedule
BLOOD TRANSF 4 6 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicare,Medicare,,1356.33,,,2260.55,316.48,1152.88,Fee Schedule,Medicare APC Fee Schedule
BLOOD TRANSF 6 8 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicare,Medicare,,1356.33,,,2260.55,316.48,1152.88,Fee Schedule,Medicare APC Fee Schedule
BLOOD TRANSF 8 10 HR,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicare,Medicare,,1356.33,,,2260.55,316.48,1152.88,Fee Schedule,Medicare APC Fee Schedule
BLOOD TRANSFUSION,36430,CPT,,,,,both,, ,3283.64,1970.18,Medicare,Medicare,,1970.18,,,3283.64,459.71,1674.66,Fee Schedule,Medicare APC Fee Schedule
BLOOD TRANSFUSION,36430,CPT,,,,,both,, ,3579.17,2147.50,Medicare,Medicare,,2147.50,,,3579.17,501.08,1825.38,Fee Schedule,Medicare APC Fee Schedule
BLOOD PUSH TRAN U2YR,36440,CPT,,,,,both,, ,3579.17,2147.50,Medicare,Medicare,,2147.50,,,3579.17,501.08,1825.38,Fee Schedule,Medicare APC Fee Schedule
THER APHERESIS WBC,36511,CPT,,,,,both,, ,5560.46,3336.27,Medicare,Medicare,,3336.27,,,5560.46,778.46,2835.83,Fee Schedule,Medicare APC Fee Schedule
THER APHERESI PLASMA,36514,CPT,,,,,both,, ,5560.46,3336.27,Medicare,Medicare,,3336.27,,,5560.46,778.46,2835.83,Fee Schedule,Medicare APC Fee Schedule
CC-INS NT CVC GT 5YR,36556,CPT,,,,,both,, ,4017.52,2410.51,Medicare,Medicare,,2410.51,,,4017.52,562.45,2048.94,Fee Schedule,Medicare APC Fee Schedule
IR-RMV TUN CVC WO SQ,36589,CPT,,,,,both,, ,2370.55,1422.33,Medicare,Medicare,,1422.33,,,2370.55,331.88,1208.98,Fee Schedule,Medicare APC Fee Schedule
BLD COLLECT VAD,36591,CPT,,,,,both,, ,445.15,267.09,Medicare,Medicare,,267.09,,,445.15,62.32,227.03,Fee Schedule,Medicare APC Fee Schedule
BLD DRAW CENTRAL LN,36592,CPT,,,,,both,, ,388.45,233.07,Medicare,Medicare,,233.07,,,388.45,54.38,198.11,Fee Schedule,Medicare APC Fee Schedule
IR-INJ W FLUR CV DEV,36598,CPT,,,,,both,, ,467.11,280.26,Medicare,Medicare,,280.26,,,467.11,65.40,238.23,Fee Schedule,Medicare APC Fee Schedule
ARTERIAL PUNCTURE,36600,CPT,,,,,both,, ,327.26,196.35,Medicare,Medicare,,196.35,,,327.26,45.82,166.9,Fee Schedule,Medicare APC Fee Schedule
S-INS ENDO VENA CAVA,37191,CPT,,,,,both,, ,29440.27,17664.16,Medicare,Medicare,,17664.16,,,29440.27,4121.64,15014.54,Fee Schedule,Medicare APC Fee Schedule
S-REDO ENDO VENA CAV,37192,CPT,,,,,both,, ,20313.85,12188.31,Medicare,Medicare,,12188.31,,,20313.85,2843.94,10360.06,Fee Schedule,Medicare APC Fee Schedule
S-REM ENDO VENA CAVA,37193,CPT,,,,,both,, ,20313.85,12188.31,Medicare,Medicare,,12188.31,,,20313.85,2843.94,10360.06,Fee Schedule,Medicare APC Fee Schedule
S-THROMBOLYSIS CEREB,37195,CPT,,,,,both,, ,860.31,516.18,Medicare,Medicare,,516.18,,,860.31,120.44,438.76,Fee Schedule,Medicare APC Fee Schedule
S-ID SENTINEL NODE,38792,CPT,,,,,both,, ,1582.72,949.63,Medicare,Medicare,,949.63,,,1582.72,221.58,807.19,Fee Schedule,Medicare APC Fee Schedule
S-BX NDL LIVER,47000,CPT,,,,,both,, ,1102.87,661.72,Medicare,Medicare,,661.72,,,1102.87,154.40,562.46,Fee Schedule,Medicare APC Fee Schedule
CT-PERC CHOLECYSTOST,47490,CPT,,,,,both,, ,10295.62,6177.37,Medicare,Medicare,,6177.37,,,10295.62,1441.39,5250.77,Fee Schedule,Medicare APC Fee Schedule
IR-ABD PARACEN W IMG,49083,CPT,,,,,both,, ,3767.78,2260.66,Medicare,Medicare,,2260.66,,,3767.78,527.49,1921.57,Fee Schedule,Medicare APC Fee Schedule
IR-PERITONEAL LAVAGE,49084,CPT,,,,,both,, ,3767.78,2260.66,Medicare,Medicare,,2260.66,,,3767.78,527.49,1921.57,Fee Schedule,Medicare APC Fee Schedule
LITHOTRIPSY,50590,CPT,,,,,both,, ,54374.73,32624.83,Medicare,Medicare,,32624.83,,,54374.73,7612.46,27731.11,Fee Schedule,Medicare APC Fee Schedule
S-URETEROGRM INJ,50684,CPT,,,,,both,, ,323.94,194.36,Medicare,Medicare,,194.36,,,323.94,45.35,165.21,Fee Schedule,Medicare APC Fee Schedule
S-INJ ILEAL CONDUIT,50690,CPT,,,,,both,, ,323.94,194.36,Medicare,Medicare,,194.36,,,323.94,45.35,165.21,Fee Schedule,Medicare APC Fee Schedule
S-CORPCAVERNOSGR INJ,54230,CPT,,,,,both,, ,425.39,255.23,Medicare,Medicare,,255.23,,,425.39,59.55,216.95,Fee Schedule,Medicare APC Fee Schedule
S-INJ CATH HYSTERSO,58340,CPT,,,,,both,, ,336.52,201.91,Medicare,Medicare,,201.91,,,336.52,47.11,171.63,Fee Schedule,Medicare APC Fee Schedule
FETAL CONTRACTION ST,59020,CPT,,,,,both,, ,2089.10,1253.46,Medicare,Medicare,,1253.46,,,2089.10,292.47,1065.44,Fee Schedule,Medicare APC Fee Schedule
FETAL NON STRESS TES,59025,CPT,,,,,both,, ,1169.57,701.74,Medicare,Medicare,,701.74,,,1169.57,163.74,596.48,Fee Schedule,Medicare APC Fee Schedule
EXTERNAL CEPHALIC VE,59412,CPT,,,,,both,, ,5047.77,3028.66,Medicare,Medicare,,3028.66,,,5047.77,706.69,2574.36,Fee Schedule,Medicare APC Fee Schedule
S-THYROID CORE BX,60100,CPT,,,,,both,, ,630.36,378.21,Medicare,Medicare,,378.21,,,630.36,88.25,321.48,Fee Schedule,Medicare APC Fee Schedule
S-SPINAL TAP DIAGNST,62270,CPT,,,,,both,, ,1417.54,850.52,Medicare,Medicare,,850.52,,,1417.54,198.46,722.95,Fee Schedule,Medicare APC Fee Schedule
S-INJ EPI BLD PATCH,62273,CPT,,,,,both,, ,1368.10,820.86,Medicare,Medicare,,820.86,,,1368.10,191.53,697.73,Fee Schedule,Medicare APC Fee Schedule
S-MYELOGRAM INJ,62284,CPT,,,,,both,, ,629.07,377.44,Medicare,Medicare,,377.44,,,629.07,88.07,320.83,Fee Schedule,Medicare APC Fee Schedule
IR-MYELO CERVICAL,62302,CPT,,,,,both,, ,2078.67,1247.20,Medicare,Medicare,,1247.20,,,2078.67,291.01,1060.12,Fee Schedule,Medicare APC Fee Schedule
IR-MYELO THORACIC,62303,CPT,,,,,both,, ,1934.41,1160.64,Medicare,Medicare,,1160.64,,,1934.41,270.82,986.55,Fee Schedule,Medicare APC Fee Schedule
IR-MYELO LUMBAR,62304,CPT,,,,,both,, ,1964.44,1178.66,Medicare,Medicare,,1178.66,,,1964.44,275.02,1001.86,Fee Schedule,Medicare APC Fee Schedule
IR-MYELO COMPLETE,62305,CPT,,,,,both,, ,4013.09,2407.85,Medicare,Medicare,,2407.85,,,4013.09,561.83,2046.68,Fee Schedule,Medicare APC Fee Schedule
Injection of substance into spinal canal of lower back or sacrum using imaging guidance,62323,CPT,,,,,both,,,2450.37,2450.37,Medicare,Medicare,,2450.37,,,2450.37,343.05,1249.69,Fee Schedule,Medicare APC Fee Schedule
IR-DI L-S INJ W IM,62323,CPT,,,,,both,, ,2450.37,1470.22,Medicare,Medicare,,1470.22,,,2450.37,343.05,1249.69,Fee Schedule,Medicare APC Fee Schedule
IR-DI L-S INJ-IN WIM,62327,CPT,,,,,both,, ,2707.10,1624.26,Medicare,Medicare,,1624.26,,,2707.10,378.99,1380.62,Fee Schedule,Medicare APC Fee Schedule
SPINAL TAP DIAG W-IM,62328,CPT,,,,,both,, ,1417.54,850.52,Medicare,Medicare,,850.52,,,1417.54,198.46,722.95,Fee Schedule,Medicare APC Fee Schedule
IR-POSTERIOR FOSSA,70010,CPT,,,,,both,, ,2122.18,1273.30,Medicare,Medicare,,1273.30,,,2122.18,297.11,1082.31,Fee Schedule,Medicare APC Fee Schedule
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,1239.46,743.67,Medicare,Medicare,,743.67,,,1239.46,173.52,632.12,Fee Schedule,Medicare APC Fee Schedule
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,2479.48,1487.68,Medicare,Medicare,,1487.68,,,2479.48,347.13,1264.53,Fee Schedule,Medicare APC Fee Schedule
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,,,883.84,883.84,Medicare,Medicare,,883.84,,,883.84,123.74,450.76,Fee Schedule,Medicare APC Fee Schedule
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,883.84,530.30,Medicare,Medicare,,530.30,,,883.84,123.74,450.76,Fee Schedule,Medicare APC Fee Schedule
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,132.36,,,220.61,30.89,112.51,Fee Schedule,Medicare APC Fee Schedule
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,,,940.82,940.82,Medicare,Medicare,,940.82,,,940.82,131.71,479.82,Fee Schedule,Medicare APC Fee Schedule
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,940.82,564.49,Medicare,Medicare,,564.49,,,940.82,131.71,479.82,Fee Schedule,Medicare APC Fee Schedule
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,,,456.37,456.37,Medicare,Medicare,,456.37,,,456.37,63.89,232.75,Fee Schedule,Medicare APC Fee Schedule
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,456.37,273.82,Medicare,Medicare,,273.82,,,456.37,63.89,232.75,Fee Schedule,Medicare APC Fee Schedule
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,,,782.23,782.23,Medicare,Medicare,,782.23,,,782.23,109.51,398.94,Fee Schedule,Medicare APC Fee Schedule
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,782.23,469.33,Medicare,Medicare,,469.33,,,782.23,109.51,398.94,Fee Schedule,Medicare APC Fee Schedule
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,132.36,,,220.61,30.89,112.51,Fee Schedule,Medicare APC Fee Schedule
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,,,1128.31,1128.31,Medicare,Medicare,,1128.31,,,1128.31,157.96,575.44,Fee Schedule,Medicare APC Fee Schedule
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,1128.31,676.98,Medicare,Medicare,,676.98,,,1128.31,157.96,575.44,Fee Schedule,Medicare APC Fee Schedule
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-NASAL BONES CR,70160,CPT,,,,,both,,,782.23,782.23,Medicare,Medicare,,782.23,,,782.23,109.51,398.94,Fee Schedule,Medicare APC Fee Schedule
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,782.23,469.33,Medicare,Medicare,,469.33,,,782.23,109.51,398.94,Fee Schedule,Medicare APC Fee Schedule
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-ORBITS 4V CR,70200,CPT,,,,,both,,,918.37,918.37,Medicare,Medicare,,918.37,,,918.37,128.57,468.37,Fee Schedule,Medicare APC Fee Schedule
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,918.37,551.02,Medicare,Medicare,,551.02,,,918.37,128.57,468.37,Fee Schedule,Medicare APC Fee Schedule
HE-SINUSES LTD CR,70210,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-SINUSES LTD CR,70210,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,,,936.33,936.33,Medicare,Medicare,,936.33,,,936.33,131.09,477.53,Fee Schedule,Medicare APC Fee Schedule
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,936.33,561.79,Medicare,Medicare,,561.79,,,936.33,131.09,477.53,Fee Schedule,Medicare APC Fee Schedule
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-SKULL LIMITED CR,70250,CPT,,,,,both,,,1151.89,1151.89,Medicare,Medicare,,1151.89,,,1151.89,161.26,587.46,Fee Schedule,Medicare APC Fee Schedule
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,1151.89,691.13,Medicare,Medicare,,691.13,,,1151.89,161.26,587.46,Fee Schedule,Medicare APC Fee Schedule
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,132.36,,,220.61,30.89,112.51,Fee Schedule,Medicare APC Fee Schedule
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,,,1381.48,1381.48,Medicare,Medicare,,1381.48,,,1381.48,193.41,704.55,Fee Schedule,Medicare APC Fee Schedule
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,1381.48,828.88,Medicare,Medicare,,828.88,,,1381.48,193.41,704.55,Fee Schedule,Medicare APC Fee Schedule
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,,,538.05,538.05,Medicare,Medicare,,538.05,,,538.05,75.33,274.41,Fee Schedule,Medicare APC Fee Schedule
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,538.05,322.83,Medicare,Medicare,,322.83,,,538.05,75.33,274.41,Fee Schedule,Medicare APC Fee Schedule
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,,,342.70,342.70,Medicare,Medicare,,342.70,,,342.70,47.98,174.78,Fee Schedule,Medicare APC Fee Schedule
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,342.70,205.62,Medicare,Medicare,,205.62,,,342.70,47.98,174.78,Fee Schedule,Medicare APC Fee Schedule
IR-ARTHGRM TMJ BI CR,70332,CPT,,,,,both,, ,2353.18,1411.90,Medicare,Medicare,,1411.90,,,2353.18,329.45,1200.12,Fee Schedule,Medicare APC Fee Schedule
IR-ARTHROGRAM TMJ CR,70332,CPT,,,,,both,, ,1176.59,705.95,Medicare,Medicare,,705.95,,,1176.59,164.72,600.06,Fee Schedule,Medicare APC Fee Schedule
HE-ORTHOPANTOGRAM CR,70355,CPT,,,,,both,, ,692.14,415.28,Medicare,Medicare,,415.28,,,692.14,96.90,352.99,Fee Schedule,Medicare APC Fee Schedule
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,,,757.53,757.53,Medicare,Medicare,,757.53,,,757.53,106.05,386.34,Fee Schedule,Medicare APC Fee Schedule
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,757.53,454.51,Medicare,Medicare,,454.51,,,757.53,106.05,386.34,Fee Schedule,Medicare APC Fee Schedule
FL-PHX SP EV W CINE,70371,CPT,,,,,both,, ,808.06,484.83,Medicare,Medicare,,484.83,,,808.06,113.13,412.11,Fee Schedule,Medicare APC Fee Schedule
IR-SIALOGRAM,70390,CPT,,,,,both,, ,1800.52,1080.31,Medicare,Medicare,,1080.31,,,1800.52,252.07,918.27,Fee Schedule,Medicare APC Fee Schedule
"CT scan, head or brain, without contrast",70450,CPT,,,,,both,,,1576.55,1576.55,Medicare,Medicare,,1576.55,,,1576.55,220.72,804.04,Fee Schedule,Medicare APC Fee Schedule
CT-HEAD WO,70450,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,184.23,,,307.05,42.99,156.6,Fee Schedule,Medicare APC Fee Schedule
CT-HEAD WO,70450,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,198.37,,,330.63,46.29,168.62,Fee Schedule,Medicare APC Fee Schedule
CT-HEAD WO,70450,CPT,,,,,both,, ,1576.55,945.93,Medicare,Medicare,,945.93,,,1576.55,220.72,804.04,Fee Schedule,Medicare APC Fee Schedule
CT-HEAD W,70460,CPT,,,,,both,,,1765.72,1765.72,Medicare,Medicare,,1765.72,,,1765.72,247.20,900.52,Fee Schedule,Medicare APC Fee Schedule
CT-HEAD W,70460,CPT,,,,,both,, ,1765.72,1059.43,Medicare,Medicare,,1059.43,,,1765.72,247.20,900.52,Fee Schedule,Medicare APC Fee Schedule
CT-HEAD WWO,70470,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,408.54,,,680.91,95.33,347.26,Fee Schedule,Medicare APC Fee Schedule
CT-HEAD WWO,70470,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,439.69,,,732.83,102.60,373.74,Fee Schedule,Medicare APC Fee Schedule
CT-HEAD WWO,70470,CPT,,,,,both,,,3726.80,3726.80,Medicare,Medicare,,3726.80,,,3726.80,521.75,1900.67,Fee Schedule,Medicare APC Fee Schedule
CT-HEAD WWO,70470,CPT,,,,,both,, ,3726.80,2236.08,Medicare,Medicare,,2236.08,,,3726.80,521.75,1900.67,Fee Schedule,Medicare APC Fee Schedule
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,184.23,,,307.05,42.99,156.6,Fee Schedule,Medicare APC Fee Schedule
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,198.37,,,330.63,46.29,168.62,Fee Schedule,Medicare APC Fee Schedule
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,2847.17,1708.30,Medicare,Medicare,,1708.30,,,2847.17,398.60,1452.06,Fee Schedule,Medicare APC Fee Schedule
CT-ORBIT EAR W,70481,CPT,,,,,both,, ,556.01,333.60,Medicare,Medicare,,333.60,,,556.01,77.84,283.57,Fee Schedule,Medicare APC Fee Schedule
CT-ORBIT EAR W,70481,CPT,,,,,both,, ,1643.07,985.84,Medicare,Medicare,,985.84,,,1643.07,230.03,837.97,Fee Schedule,Medicare APC Fee Schedule
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,408.54,,,680.91,95.33,347.26,Fee Schedule,Medicare APC Fee Schedule
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,439.69,,,732.83,102.60,373.74,Fee Schedule,Medicare APC Fee Schedule
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,4001.30,2400.78,Medicare,Medicare,,2400.78,,,4001.30,560.18,2040.66,Fee Schedule,Medicare APC Fee Schedule
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,184.23,,,307.05,42.99,156.6,Fee Schedule,Medicare APC Fee Schedule
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,198.37,,,330.63,46.29,168.62,Fee Schedule,Medicare APC Fee Schedule
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,,,2847.17,2847.17,Medicare,Medicare,,2847.17,,,2847.17,398.60,1452.06,Fee Schedule,Medicare APC Fee Schedule
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,2847.17,1708.30,Medicare,Medicare,,1708.30,,,2847.17,398.60,1452.06,Fee Schedule,Medicare APC Fee Schedule
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,362.91,,,604.85,84.68,308.47,Fee Schedule,Medicare APC Fee Schedule
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,390.52,,,650.88,91.12,331.95,Fee Schedule,Medicare APC Fee Schedule
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,,,3178.64,3178.64,Medicare,Medicare,,3178.64,,,3178.64,445.01,1621.11,Fee Schedule,Medicare APC Fee Schedule
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,3178.64,1907.18,Medicare,Medicare,,1907.18,,,3178.64,445.01,1621.11,Fee Schedule,Medicare APC Fee Schedule
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,408.54,,,680.91,95.33,347.26,Fee Schedule,Medicare APC Fee Schedule
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,439.69,,,732.83,102.60,373.74,Fee Schedule,Medicare APC Fee Schedule
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,,,3726.80,3726.80,Medicare,Medicare,,3726.80,,,3726.80,521.75,1900.67,Fee Schedule,Medicare APC Fee Schedule
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,3726.80,2236.08,Medicare,Medicare,,2236.08,,,3726.80,521.75,1900.67,Fee Schedule,Medicare APC Fee Schedule
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,184.23,,,307.05,42.99,156.6,Fee Schedule,Medicare APC Fee Schedule
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,198.37,,,330.63,46.29,168.62,Fee Schedule,Medicare APC Fee Schedule
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,,,2737.98,2737.98,Medicare,Medicare,,2737.98,,,2737.98,383.32,1396.37,Fee Schedule,Medicare APC Fee Schedule
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,2737.98,1642.78,Medicare,Medicare,,1642.78,,,2737.98,383.32,1396.37,Fee Schedule,Medicare APC Fee Schedule
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,362.91,,,604.85,84.68,308.47,Fee Schedule,Medicare APC Fee Schedule
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,390.52,,,650.88,91.12,331.95,Fee Schedule,Medicare APC Fee Schedule
CT-NECK SOFT TIS W,70491,CPT,,,,,both,,,2743.59,2743.59,Medicare,Medicare,,2743.59,,,2743.59,384.10,1399.23,Fee Schedule,Medicare APC Fee Schedule
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,2743.59,1646.15,Medicare,Medicare,,1646.15,,,2743.59,384.10,1399.23,Fee Schedule,Medicare APC Fee Schedule
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,408.54,,,680.91,95.33,347.26,Fee Schedule,Medicare APC Fee Schedule
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,439.69,,,732.83,102.60,373.74,Fee Schedule,Medicare APC Fee Schedule
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,,,4317.62,4317.62,Medicare,Medicare,,4317.62,,,4317.62,604.47,2201.99,Fee Schedule,Medicare APC Fee Schedule
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,4317.62,2590.57,Medicare,Medicare,,2590.57,,,4317.62,604.47,2201.99,Fee Schedule,Medicare APC Fee Schedule
CTA-HEAD,70496,CPT,,,,,both,, ,893.10,535.86,Medicare,Medicare,,535.86,,,893.10,125.03,455.48,Fee Schedule,Medicare APC Fee Schedule
CTA-HEAD,70496,CPT,,,,,both,,,2355.42,2355.42,Medicare,Medicare,,2355.42,,,2355.42,329.76,1201.26,Fee Schedule,Medicare APC Fee Schedule
CTA-HEAD,70496,CPT,,,,,both,, ,2355.42,1413.25,Medicare,Medicare,,1413.25,,,2355.42,329.76,1201.26,Fee Schedule,Medicare APC Fee Schedule
CTA-NECK,70498,CPT,,,,,both,, ,893.10,535.86,Medicare,Medicare,,535.86,,,893.10,125.03,455.48,Fee Schedule,Medicare APC Fee Schedule
CTA-NECK,70498,CPT,,,,,both,,,2355.42,2355.42,Medicare,Medicare,,2355.42,,,2355.42,329.76,1201.26,Fee Schedule,Medicare APC Fee Schedule
CTA-NECK,70498,CPT,,,,,both,, ,2355.42,1413.25,Medicare,Medicare,,1413.25,,,2355.42,329.76,1201.26,Fee Schedule,Medicare APC Fee Schedule
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,429.59,,,715.99,100.24,365.15,Fee Schedule,Medicare APC Fee Schedule
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,462.27,,,770.45,107.86,392.93,Fee Schedule,Medicare APC Fee Schedule
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,4042.84,2425.70,Medicare,Medicare,,2425.70,,,4042.84,566.00,2061.85,Fee Schedule,Medicare APC Fee Schedule
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,621.41,,,1035.69,145.00,528.2,Fee Schedule,Medicare APC Fee Schedule
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,668.73,,,1114.55,156.04,568.42,Fee Schedule,Medicare APC Fee Schedule
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,4293.48,2576.08,Medicare,Medicare,,2576.08,,,4293.48,601.09,2189.67,Fee Schedule,Medicare APC Fee Schedule
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,718.24,,,1197.08,167.59,610.51,Fee Schedule,Medicare APC Fee Schedule
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,772.97,,,1288.29,180.36,657.03,Fee Schedule,Medicare APC Fee Schedule
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,5197.81,3118.68,Medicare,Medicare,,3118.68,,,5197.81,727.69,2650.88,Fee Schedule,Medicare APC Fee Schedule
MRA-HEAD WO,70544,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,429.59,,,715.99,100.24,365.15,Fee Schedule,Medicare APC Fee Schedule
MRA-HEAD WO,70544,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,462.27,,,770.45,107.86,392.93,Fee Schedule,Medicare APC Fee Schedule
MRA-HEAD WO,70544,CPT,,,,,both,, ,1631.56,978.93,Medicare,Medicare,,978.93,,,1631.56,228.42,832.1,Fee Schedule,Medicare APC Fee Schedule
MRA-HEAD W,70545,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,621.41,,,1035.69,145.00,528.2,Fee Schedule,Medicare APC Fee Schedule
MRA-HEAD W,70545,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,668.73,,,1114.55,156.04,568.42,Fee Schedule,Medicare APC Fee Schedule
MRA-HEAD W,70545,CPT,,,,,both,, ,1938.34,1163.00,Medicare,Medicare,,1163.00,,,1938.34,271.37,988.55,Fee Schedule,Medicare APC Fee Schedule
MRA-HEAD WWO,70546,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,718.24,,,1197.08,167.59,610.51,Fee Schedule,Medicare APC Fee Schedule
MRA-HEAD WWO,70546,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,772.97,,,1288.29,180.36,657.03,Fee Schedule,Medicare APC Fee Schedule
MRA-HEAD WWO,70546,CPT,,,,,both,, ,2669.78,1601.86,Medicare,Medicare,,1601.86,,,2669.78,373.77,1361.59,Fee Schedule,Medicare APC Fee Schedule
MRA-NECK WO,70547,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,429.59,,,715.99,100.24,365.15,Fee Schedule,Medicare APC Fee Schedule
MRA-NECK WO,70547,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,462.27,,,770.45,107.86,392.93,Fee Schedule,Medicare APC Fee Schedule
MRA-NECK WO,70547,CPT,,,,,both,, ,1334.89,800.93,Medicare,Medicare,,800.93,,,1334.89,186.88,680.79,Fee Schedule,Medicare APC Fee Schedule
MRA-NECK W,70548,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,621.41,,,1035.69,145.00,528.2,Fee Schedule,Medicare APC Fee Schedule
MRA-NECK W,70548,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,668.73,,,1114.55,156.04,568.42,Fee Schedule,Medicare APC Fee Schedule
MRA-NECK W,70548,CPT,,,,,both,, ,1938.34,1163.00,Medicare,Medicare,,1163.00,,,1938.34,271.37,988.55,Fee Schedule,Medicare APC Fee Schedule
MRA-NECK WWO,70549,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,718.24,,,1197.08,167.59,610.51,Fee Schedule,Medicare APC Fee Schedule
MRA-NECK WWO,70549,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,772.97,,,1288.29,180.36,657.03,Fee Schedule,Medicare APC Fee Schedule
MRA-NECK WWO,70549,CPT,,,,,both,, ,3263.12,1957.87,Medicare,Medicare,,1957.87,,,3263.12,456.84,1664.19,Fee Schedule,Medicare APC Fee Schedule
MR-BRAIN WO,70551,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,429.59,,,715.99,100.24,365.15,Fee Schedule,Medicare APC Fee Schedule
MR-BRAIN WO,70551,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,462.27,,,770.45,107.86,392.93,Fee Schedule,Medicare APC Fee Schedule
MR-BRAIN WO,70551,CPT,,,,,both,,,4941.28,4941.28,Medicare,Medicare,,4941.28,,,4941.28,691.78,2520.05,Fee Schedule,Medicare APC Fee Schedule
MR-BRAIN WO,70551,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,2964.76,,,4941.28,691.78,2520.05,Fee Schedule,Medicare APC Fee Schedule
MR-BRAIN W,70552,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,621.41,,,1035.69,145.00,528.2,Fee Schedule,Medicare APC Fee Schedule
MR-BRAIN W,70552,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,668.73,,,1114.55,156.04,568.42,Fee Schedule,Medicare APC Fee Schedule
MR-BRAIN W,70552,CPT,,,,,both,,,2352.06,2352.06,Medicare,Medicare,,2352.06,,,2352.06,329.29,1199.55,Fee Schedule,Medicare APC Fee Schedule
MR-BRAIN W,70552,CPT,,,,,both,, ,2352.06,1411.23,Medicare,Medicare,,1411.23,,,2352.06,329.29,1199.55,Fee Schedule,Medicare APC Fee Schedule
MR-BRAIN WWO,70553,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,718.24,,,1197.08,167.59,610.51,Fee Schedule,Medicare APC Fee Schedule
MR-BRAIN WWO,70553,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,772.97,,,1288.29,180.36,657.03,Fee Schedule,Medicare APC Fee Schedule
MR-BRAIN WWO,70553,CPT,,,,,both,, ,6352.79,3811.67,Medicare,Medicare,,3811.67,,,6352.79,889.39,3239.92,Fee Schedule,Medicare APC Fee Schedule
MRI scan of brain before and after contrast,70553,CPT,,,,,both,,,6352.79,6352.79,Medicare,Medicare,,6352.79,,,6352.79,889.39,3239.92,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 1V CR,71045,CPT,,,,,both,,,495.95,495.95,Medicare,Medicare,,495.95,,,495.95,69.43,252.93,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,495.95,297.57,Medicare,Medicare,,297.57,,,495.95,69.43,252.93,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 2V CR,71046,CPT,,,,,both,,,750.52,750.52,Medicare,Medicare,,750.52,,,750.52,105.07,382.77,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,750.52,450.31,Medicare,Medicare,,450.31,,,750.52,105.07,382.77,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Medicare,Medicare,,86.38,,,143.98,20.16,73.43,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Medicare,Medicare,,86.38,,,143.98,20.16,73.43,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Medicare,Medicare,,86.38,,,143.98,20.16,73.43,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 3V CR,71047,CPT,,,,,both,,,1091.82,1091.82,Medicare,Medicare,,1091.82,,,1091.82,152.85,556.83,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,1091.82,655.09,Medicare,Medicare,,655.09,,,1091.82,152.85,556.83,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,143.98,86.38,Medicare,Medicare,,86.38,,,143.98,20.16,73.43,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 4V CR,71048,CPT,,,,,both,,,1652.05,1652.05,Medicare,Medicare,,1652.05,,,1652.05,231.29,842.55,Fee Schedule,Medicare APC Fee Schedule
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,1652.05,991.23,Medicare,Medicare,,991.23,,,1652.05,231.29,842.55,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS UNILAT CR,71100,CPT,,,,,both,,,876.83,876.83,Medicare,Medicare,,876.83,,,876.83,122.76,447.18,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,876.83,526.09,Medicare,Medicare,,526.09,,,876.83,122.76,447.18,Fee Schedule,Medicare APC Fee Schedule
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,132.36,,,220.61,30.89,112.51,Fee Schedule,Medicare APC Fee Schedule
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,260.74,156.44,Medicare,Medicare,,156.44,,,260.74,36.50,132.98,Fee Schedule,Medicare APC Fee Schedule
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,260.74,156.44,Medicare,Medicare,,156.44,,,260.74,36.50,132.98,Fee Schedule,Medicare APC Fee Schedule
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,,,1152.17,1152.17,Medicare,Medicare,,1152.17,,,1152.17,161.30,587.61,Fee Schedule,Medicare APC Fee Schedule
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,1152.17,691.30,Medicare,Medicare,,691.30,,,1152.17,161.30,587.61,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,132.36,,,220.61,30.89,112.51,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,,,1381.48,1381.48,Medicare,Medicare,,1381.48,,,1381.48,193.41,704.55,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,1381.48,828.88,Medicare,Medicare,,828.88,,,1381.48,193.41,704.55,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,132.36,,,220.61,30.89,112.51,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,260.74,156.44,Medicare,Medicare,,156.44,,,260.74,36.50,132.98,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,260.74,156.44,Medicare,Medicare,,156.44,,,260.74,36.50,132.98,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,,,1877.99,1877.99,Medicare,Medicare,,1877.99,,,1877.99,262.92,957.77,Fee Schedule,Medicare APC Fee Schedule
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,1877.99,1126.79,Medicare,Medicare,,1126.79,,,1877.99,262.92,957.77,Fee Schedule,Medicare APC Fee Schedule
CH-STERNUM CR,71120,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-STERNUM CR,71120,CPT,,,,,both,,,947.27,947.27,Medicare,Medicare,,947.27,,,947.27,132.62,483.11,Fee Schedule,Medicare APC Fee Schedule
CH-STERNUM CR,71120,CPT,,,,,both,, ,947.27,568.36,Medicare,Medicare,,568.36,,,947.27,132.62,483.11,Fee Schedule,Medicare APC Fee Schedule
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,,,989.38,989.38,Medicare,Medicare,,989.38,,,989.38,138.51,504.58,Fee Schedule,Medicare APC Fee Schedule
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,989.38,593.62,Medicare,Medicare,,593.62,,,989.38,138.51,504.58,Fee Schedule,Medicare APC Fee Schedule
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,184.23,,,307.05,42.99,156.6,Fee Schedule,Medicare APC Fee Schedule
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,198.37,,,330.63,46.29,168.62,Fee Schedule,Medicare APC Fee Schedule
CT-CHEST DIAG WO,71250,CPT,,,,,both,,,3833.18,3833.18,Medicare,Medicare,,3833.18,,,3833.18,536.65,1954.92,Fee Schedule,Medicare APC Fee Schedule
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,3833.18,2299.90,Medicare,Medicare,,2299.90,,,3833.18,536.65,1954.92,Fee Schedule,Medicare APC Fee Schedule
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,362.91,,,604.85,84.68,308.47,Fee Schedule,Medicare APC Fee Schedule
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,390.52,,,650.88,91.12,331.95,Fee Schedule,Medicare APC Fee Schedule
CT-CHEST DIAG W,71260,CPT,,,,,both,,,4107.96,4107.96,Medicare,Medicare,,4107.96,,,4107.96,575.11,2095.06,Fee Schedule,Medicare APC Fee Schedule
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,4107.96,2464.77,Medicare,Medicare,,2464.77,,,4107.96,575.11,2095.06,Fee Schedule,Medicare APC Fee Schedule
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,408.54,,,680.91,95.33,347.26,Fee Schedule,Medicare APC Fee Schedule
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,439.69,,,732.83,102.60,373.74,Fee Schedule,Medicare APC Fee Schedule
CT-CHEST DIAG WWO,71270,CPT,,,,,both,,,3833.18,3833.18,Medicare,Medicare,,3833.18,,,3833.18,536.65,1954.92,Fee Schedule,Medicare APC Fee Schedule
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,3833.18,2299.90,Medicare,Medicare,,2299.90,,,3833.18,536.65,1954.92,Fee Schedule,Medicare APC Fee Schedule
CT-LOW DOSE CNCR SCR,71271,CPT,,,,,both,, ,273.09,163.85,Medicare,Medicare,,163.85,,,273.09,38.23,139.28,Fee Schedule,Medicare APC Fee Schedule
CT-LOW DOSE CNCR SCR,71271,CPT,,,,,both,, ,273.09,163.85,Medicare,Medicare,,163.85,,,273.09,38.23,139.28,Fee Schedule,Medicare APC Fee Schedule
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,,,568.92,568.92,Medicare,Medicare,,568.92,,,568.92,79.65,290.15,Fee Schedule,Medicare APC Fee Schedule
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,, ,568.92,341.35,Medicare,Medicare,,341.35,,,568.92,79.65,290.15,Fee Schedule,Medicare APC Fee Schedule
CTA-CHEST,71275,CPT,,,,,both,, ,708.98,425.38,Medicare,Medicare,,425.38,,,708.98,99.26,361.58,Fee Schedule,Medicare APC Fee Schedule
CTA-CHEST,71275,CPT,,,,,both,, ,763.15,457.89,Medicare,Medicare,,457.89,,,763.15,106.84,389.21,Fee Schedule,Medicare APC Fee Schedule
CTA-CHEST,71275,CPT,,,,,both,,,2355.14,2355.14,Medicare,Medicare,,2355.14,,,2355.14,329.72,1201.12,Fee Schedule,Medicare APC Fee Schedule
CTA-CHEST,71275,CPT,,,,,both,, ,2355.14,1413.08,Medicare,Medicare,,1413.08,,,2355.14,329.72,1201.12,Fee Schedule,Medicare APC Fee Schedule
MR-CHEST WO,71550,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,429.59,,,715.99,100.24,365.15,Fee Schedule,Medicare APC Fee Schedule
MR-CHEST WO,71550,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,462.27,,,770.45,107.86,392.93,Fee Schedule,Medicare APC Fee Schedule
MR-CHEST WO,71550,CPT,,,,,both,,,4042.84,4042.84,Medicare,Medicare,,4042.84,,,4042.84,566.00,2061.85,Fee Schedule,Medicare APC Fee Schedule
MR-CHEST WO,71550,CPT,,,,,both,, ,4042.84,2425.70,Medicare,Medicare,,2425.70,,,4042.84,566.00,2061.85,Fee Schedule,Medicare APC Fee Schedule
MR-CHEST W,71551,CPT,,,,,both,,,4293.48,4293.48,Medicare,Medicare,,4293.48,,,4293.48,601.09,2189.67,Fee Schedule,Medicare APC Fee Schedule
MR-CHEST W,71551,CPT,,,,,both,, ,4293.48,2576.08,Medicare,Medicare,,2576.08,,,4293.48,601.09,2189.67,Fee Schedule,Medicare APC Fee Schedule
MR-CHEST WWO,71552,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,718.24,,,1197.08,167.59,610.51,Fee Schedule,Medicare APC Fee Schedule
MR-CHEST WWO,71552,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,772.97,,,1288.29,180.36,657.03,Fee Schedule,Medicare APC Fee Schedule
MR-CHEST WWO,71552,CPT,,,,,both,,,5197.81,5197.81,Medicare,Medicare,,5197.81,,,5197.81,727.69,2650.88,Fee Schedule,Medicare APC Fee Schedule
MR-CHEST WWO,71552,CPT,,,,,both,, ,5197.81,3118.68,Medicare,Medicare,,3118.68,,,5197.81,727.69,2650.88,Fee Schedule,Medicare APC Fee Schedule
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,,,261.02,261.02,Medicare,Medicare,,261.02,,,261.02,36.54,133.12,Fee Schedule,Medicare APC Fee Schedule
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,261.02,156.61,Medicare,Medicare,,156.61,,,261.02,36.54,133.12,Fee Schedule,Medicare APC Fee Schedule
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,,,1085.36,1085.36,Medicare,Medicare,,1085.36,,,1085.36,151.95,553.53,Fee Schedule,Medicare APC Fee Schedule
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,1085.36,651.21,Medicare,Medicare,,651.21,,,1085.36,151.95,553.53,Fee Schedule,Medicare APC Fee Schedule
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,132.36,,,220.61,30.89,112.51,Fee Schedule,Medicare APC Fee Schedule
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,1112.87,667.72,Medicare,Medicare,,667.72,,,1112.87,155.80,567.56,Fee Schedule,Medicare APC Fee Schedule
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,132.36,,,220.61,30.89,112.51,Fee Schedule,Medicare APC Fee Schedule
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,1471.29,882.77,Medicare,Medicare,,882.77,,,1471.29,205.98,750.36,Fee Schedule,Medicare APC Fee Schedule
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,,,1181.64,1181.64,Medicare,Medicare,,1181.64,,,1181.64,165.43,602.64,Fee Schedule,Medicare APC Fee Schedule
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,1181.64,708.98,Medicare,Medicare,,708.98,,,1181.64,165.43,602.64,Fee Schedule,Medicare APC Fee Schedule
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,132.36,,,220.61,30.89,112.51,Fee Schedule,Medicare APC Fee Schedule
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,,,1444.63,1444.63,Medicare,Medicare,,1444.63,,,1444.63,202.25,736.76,Fee Schedule,Medicare APC Fee Schedule
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,1444.63,866.77,Medicare,Medicare,,866.77,,,1444.63,202.25,736.76,Fee Schedule,Medicare APC Fee Schedule
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,,,1444.63,1444.63,Medicare,Medicare,,1444.63,,,1444.63,202.25,736.76,Fee Schedule,Medicare APC Fee Schedule
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,1444.63,866.77,Medicare,Medicare,,866.77,,,1444.63,202.25,736.76,Fee Schedule,Medicare APC Fee Schedule
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,139.77,83.86,Medicare,Medicare,,83.86,,,139.77,19.57,71.28,Fee Schedule,Medicare APC Fee Schedule
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,149.32,89.59,Medicare,Medicare,,89.59,,,149.32,20.90,76.15,Fee Schedule,Medicare APC Fee Schedule
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,1181.91,709.14,Medicare,Medicare,,709.14,,,1181.91,165.47,602.77,Fee Schedule,Medicare APC Fee Schedule
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,139.77,83.86,Medicare,Medicare,,83.86,,,139.77,19.57,71.28,Fee Schedule,Medicare APC Fee Schedule
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,149.32,89.59,Medicare,Medicare,,89.59,,,149.32,20.90,76.15,Fee Schedule,Medicare APC Fee Schedule
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,230.71,138.42,Medicare,Medicare,,138.42,,,230.71,32.30,117.66,Fee Schedule,Medicare APC Fee Schedule
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,1181.91,709.14,Medicare,Medicare,,709.14,,,1181.91,165.47,602.77,Fee Schedule,Medicare APC Fee Schedule
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,230.71,138.42,Medicare,Medicare,,138.42,,,230.71,32.30,117.66,Fee Schedule,Medicare APC Fee Schedule
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,279.26,167.55,Medicare,Medicare,,167.55,,,279.26,39.10,142.42,Fee Schedule,Medicare APC Fee Schedule
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,298.64,179.18,Medicare,Medicare,,179.18,,,298.64,41.81,152.31,Fee Schedule,Medicare APC Fee Schedule
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,2363.84,1418.30,Medicare,Medicare,,1418.30,,,2363.84,330.94,1205.56,Fee Schedule,Medicare APC Fee Schedule
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,279.26,167.55,Medicare,Medicare,,167.55,,,279.26,39.10,142.42,Fee Schedule,Medicare APC Fee Schedule
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,298.64,179.18,Medicare,Medicare,,179.18,,,298.64,41.81,152.31,Fee Schedule,Medicare APC Fee Schedule
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,2363.84,1418.30,Medicare,Medicare,,1418.30,,,2363.84,330.94,1205.56,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,,,1504.42,1504.42,Medicare,Medicare,,1504.42,,,1504.42,210.62,767.25,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,1504.42,902.65,Medicare,Medicare,,902.65,,,1504.42,210.62,767.25,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,132.36,,,220.61,30.89,112.51,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,1968.65,1181.19,Medicare,Medicare,,1181.19,,,1968.65,275.61,1004.01,Fee Schedule,Medicare APC Fee Schedule
"X-Ray, lower back, minimum four views",72110,CPT,,,,,both,,,1968.65,1968.65,Medicare,Medicare,,1968.65,,,1968.65,275.61,1004.01,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,132.36,,,220.61,30.89,112.51,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPINE W BND CR,72114,CPT,,,,,both,,,2229.96,2229.96,Medicare,Medicare,,2229.96,,,2229.96,312.19,1137.28,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,2229.96,1337.97,Medicare,Medicare,,1337.97,,,2229.96,312.19,1137.28,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,132.36,,,220.61,30.89,112.51,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPINE BND CR,72120,CPT,,,,,both,,,1765.44,1765.44,Medicare,Medicare,,1765.44,,,1765.44,247.16,900.37,Fee Schedule,Medicare APC Fee Schedule
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,1765.44,1059.26,Medicare,Medicare,,1059.26,,,1765.44,247.16,900.37,Fee Schedule,Medicare APC Fee Schedule
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,184.23,,,307.05,42.99,156.6,Fee Schedule,Medicare APC Fee Schedule
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,198.37,,,330.63,46.29,168.62,Fee Schedule,Medicare APC Fee Schedule
CT-CERV SPINE WO,72125,CPT,,,,,both,,,3833.18,3833.18,Medicare,Medicare,,3833.18,,,3833.18,536.65,1954.92,Fee Schedule,Medicare APC Fee Schedule
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,3833.18,2299.90,Medicare,Medicare,,2299.90,,,3833.18,536.65,1954.92,Fee Schedule,Medicare APC Fee Schedule
CT-CERV SPINE W,72126,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,362.91,,,604.85,84.68,308.47,Fee Schedule,Medicare APC Fee Schedule
CT-CERV SPINE W,72126,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,390.52,,,650.88,91.12,331.95,Fee Schedule,Medicare APC Fee Schedule
CT-CERV SPINE W,72126,CPT,,,,,both,,,6031.42,6031.42,Medicare,Medicare,,6031.42,,,6031.42,844.40,3076.02,Fee Schedule,Medicare APC Fee Schedule
CT-CERV SPINE W,72126,CPT,,,,,both,, ,6031.42,3618.85,Medicare,Medicare,,3618.85,,,6031.42,844.40,3076.02,Fee Schedule,Medicare APC Fee Schedule
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,408.54,,,680.91,95.33,347.26,Fee Schedule,Medicare APC Fee Schedule
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,439.69,,,732.83,102.60,373.74,Fee Schedule,Medicare APC Fee Schedule
CT-CERV SPINE WWO,72127,CPT,,,,,both,,,6031.42,6031.42,Medicare,Medicare,,6031.42,,,6031.42,844.40,3076.02,Fee Schedule,Medicare APC Fee Schedule
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,6031.42,3618.85,Medicare,Medicare,,3618.85,,,6031.42,844.40,3076.02,Fee Schedule,Medicare APC Fee Schedule
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,184.23,,,307.05,42.99,156.6,Fee Schedule,Medicare APC Fee Schedule
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,198.37,,,330.63,46.29,168.62,Fee Schedule,Medicare APC Fee Schedule
CT-THOR SPINE WO,72128,CPT,,,,,both,,,3833.18,3833.18,Medicare,Medicare,,3833.18,,,3833.18,536.65,1954.92,Fee Schedule,Medicare APC Fee Schedule
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,3833.18,2299.90,Medicare,Medicare,,2299.90,,,3833.18,536.65,1954.92,Fee Schedule,Medicare APC Fee Schedule
CT-THOR SPINE W,72129,CPT,,,,,both,, ,534.96,320.97,Medicare,Medicare,,320.97,,,534.96,74.89,272.83,Fee Schedule,Medicare APC Fee Schedule
CT-THOR SPINE W,72129,CPT,,,,,both,,,1786.22,1786.22,Medicare,Medicare,,1786.22,,,1786.22,250.07,910.97,Fee Schedule,Medicare APC Fee Schedule
CT-THOR SPINE W,72129,CPT,,,,,both,, ,1786.22,1071.73,Medicare,Medicare,,1071.73,,,1786.22,250.07,910.97,Fee Schedule,Medicare APC Fee Schedule
CT-THOR SPINE WWO,72130,CPT,,,,,both,,,2407.63,2407.63,Medicare,Medicare,,2407.63,,,2407.63,337.07,1227.89,Fee Schedule,Medicare APC Fee Schedule
CT-THOR SPINE WWO,72130,CPT,,,,,both,, ,2407.63,1444.57,Medicare,Medicare,,1444.57,,,2407.63,337.07,1227.89,Fee Schedule,Medicare APC Fee Schedule
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,184.23,,,307.05,42.99,156.6,Fee Schedule,Medicare APC Fee Schedule
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,198.37,,,330.63,46.29,168.62,Fee Schedule,Medicare APC Fee Schedule
CT-LUMB SPINE WO,72131,CPT,,,,,both,,,534.68,534.68,Medicare,Medicare,,534.68,,,534.68,74.86,272.69,Fee Schedule,Medicare APC Fee Schedule
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,534.68,320.80,Medicare,Medicare,,320.80,,,534.68,74.86,272.69,Fee Schedule,Medicare APC Fee Schedule
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,362.91,,,604.85,84.68,308.47,Fee Schedule,Medicare APC Fee Schedule
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,390.52,,,650.88,91.12,331.95,Fee Schedule,Medicare APC Fee Schedule
CT-LUMB SPINE W,72132,CPT,,,,,both,,,1653.45,1653.45,Medicare,Medicare,,1653.45,,,1653.45,231.48,843.26,Fee Schedule,Medicare APC Fee Schedule
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,1653.45,992.07,Medicare,Medicare,,992.07,,,1653.45,231.48,843.26,Fee Schedule,Medicare APC Fee Schedule
CT-LUMB SPINE WWO,72133,CPT,,,,,both,, ,446.27,267.76,Medicare,Medicare,,267.76,,,446.27,62.48,227.6,Fee Schedule,Medicare APC Fee Schedule
CT-LUMB SPINE WWO,72133,CPT,,,,,both,,,1126.62,1126.62,Medicare,Medicare,,1126.62,,,1126.62,157.73,574.58,Fee Schedule,Medicare APC Fee Schedule
CT-LUMB SPINE WWO,72133,CPT,,,,,both,, ,1126.62,675.97,Medicare,Medicare,,675.97,,,1126.62,157.73,574.58,Fee Schedule,Medicare APC Fee Schedule
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,429.59,,,715.99,100.24,365.15,Fee Schedule,Medicare APC Fee Schedule
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,462.27,,,770.45,107.86,392.93,Fee Schedule,Medicare APC Fee Schedule
MR-CERV SPINE WO,72141,CPT,,,,,both,,,4941.28,4941.28,Medicare,Medicare,,4941.28,,,4941.28,691.78,2520.05,Fee Schedule,Medicare APC Fee Schedule
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,2964.76,,,4941.28,691.78,2520.05,Fee Schedule,Medicare APC Fee Schedule
MR-CERV SPINE W,72142,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,621.41,,,1035.69,145.00,528.2,Fee Schedule,Medicare APC Fee Schedule
MR-CERV SPINE W,72142,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,668.73,,,1114.55,156.04,568.42,Fee Schedule,Medicare APC Fee Schedule
MR-CERV SPINE W,72142,CPT,,,,,both,,,2352.06,2352.06,Medicare,Medicare,,2352.06,,,2352.06,329.29,1199.55,Fee Schedule,Medicare APC Fee Schedule
MR-CERV SPINE W,72142,CPT,,,,,both,, ,2352.06,1411.23,Medicare,Medicare,,1411.23,,,2352.06,329.29,1199.55,Fee Schedule,Medicare APC Fee Schedule
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,429.59,,,715.99,100.24,365.15,Fee Schedule,Medicare APC Fee Schedule
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,462.27,,,770.45,107.86,392.93,Fee Schedule,Medicare APC Fee Schedule
MR-THOR SPINE WO,72146,CPT,,,,,both,,,4941.28,4941.28,Medicare,Medicare,,4941.28,,,4941.28,691.78,2520.05,Fee Schedule,Medicare APC Fee Schedule
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,2964.76,,,4941.28,691.78,2520.05,Fee Schedule,Medicare APC Fee Schedule
MR-THOR SPINE W,72147,CPT,,,,,both,, ,1641.24,984.74,Medicare,Medicare,,984.74,,,1641.24,229.77,837.03,Fee Schedule,Medicare APC Fee Schedule
MR-THOR SPINE W,72147,CPT,,,,,both,,,2351.49,2351.49,Medicare,Medicare,,2351.49,,,2351.49,329.21,1199.26,Fee Schedule,Medicare APC Fee Schedule
MR-THOR SPINE W,72147,CPT,,,,,both,, ,2351.49,1410.89,Medicare,Medicare,,1410.89,,,2351.49,329.21,1199.26,Fee Schedule,Medicare APC Fee Schedule
MRI scan of lower spinal canal,72148,CPT,,,,,both,,,4941.28,4941.28,Medicare,Medicare,,4941.28,,,4941.28,691.78,2520.05,Fee Schedule,Medicare APC Fee Schedule
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,429.59,,,715.99,100.24,365.15,Fee Schedule,Medicare APC Fee Schedule
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,462.27,,,770.45,107.86,392.93,Fee Schedule,Medicare APC Fee Schedule
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,2964.76,,,4941.28,691.78,2520.05,Fee Schedule,Medicare APC Fee Schedule
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,621.41,,,1035.69,145.00,528.2,Fee Schedule,Medicare APC Fee Schedule
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,668.73,,,1114.55,156.04,568.42,Fee Schedule,Medicare APC Fee Schedule
MR-LUMB SPINE W,72149,CPT,,,,,both,,,2352.06,2352.06,Medicare,Medicare,,2352.06,,,2352.06,329.29,1199.55,Fee Schedule,Medicare APC Fee Schedule
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,2352.06,1411.23,Medicare,Medicare,,1411.23,,,2352.06,329.29,1199.55,Fee Schedule,Medicare APC Fee Schedule
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,718.24,,,1197.08,167.59,610.51,Fee Schedule,Medicare APC Fee Schedule
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,772.97,,,1288.29,180.36,657.03,Fee Schedule,Medicare APC Fee Schedule
MR-CERV SPINE WWO,72156,CPT,,,,,both,,,6352.79,6352.79,Medicare,Medicare,,6352.79,,,6352.79,889.39,3239.92,Fee Schedule,Medicare APC Fee Schedule
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,6352.79,3811.67,Medicare,Medicare,,3811.67,,,6352.79,889.39,3239.92,Fee Schedule,Medicare APC Fee Schedule
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,718.24,,,1197.08,167.59,610.51,Fee Schedule,Medicare APC Fee Schedule
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,772.97,,,1288.29,180.36,657.03,Fee Schedule,Medicare APC Fee Schedule
MR-THOR SPINE WWO,72157,CPT,,,,,both,,,6352.79,6352.79,Medicare,Medicare,,6352.79,,,6352.79,889.39,3239.92,Fee Schedule,Medicare APC Fee Schedule
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,6352.79,3811.67,Medicare,Medicare,,3811.67,,,6352.79,889.39,3239.92,Fee Schedule,Medicare APC Fee Schedule
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,718.24,,,1197.08,167.59,610.51,Fee Schedule,Medicare APC Fee Schedule
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,772.97,,,1288.29,180.36,657.03,Fee Schedule,Medicare APC Fee Schedule
MR-LUMB SPINE WWO,72158,CPT,,,,,both,,,6352.79,6352.79,Medicare,Medicare,,6352.79,,,6352.79,889.39,3239.92,Fee Schedule,Medicare APC Fee Schedule
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,6352.79,3811.67,Medicare,Medicare,,3811.67,,,6352.79,889.39,3239.92,Fee Schedule,Medicare APC Fee Schedule
LE-PELVIS CR,72170,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-PELVIS CR,72170,CPT,,,,,both,,,936.33,936.33,Medicare,Medicare,,936.33,,,936.33,131.09,477.53,Fee Schedule,Medicare APC Fee Schedule
LE-PELVIS CR,72170,CPT,,,,,both,, ,936.33,561.79,Medicare,Medicare,,561.79,,,936.33,131.09,477.53,Fee Schedule,Medicare APC Fee Schedule
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,,,1774.99,1774.99,Medicare,Medicare,,1774.99,,,1774.99,248.50,905.24,Fee Schedule,Medicare APC Fee Schedule
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,1774.99,1064.99,Medicare,Medicare,,1064.99,,,1774.99,248.50,905.24,Fee Schedule,Medicare APC Fee Schedule
CT-PELVIS WO,72192,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,184.23,,,307.05,42.99,156.6,Fee Schedule,Medicare APC Fee Schedule
CT-PELVIS WO,72192,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,198.37,,,330.63,46.29,168.62,Fee Schedule,Medicare APC Fee Schedule
CT-PELVIS WO,72192,CPT,,,,,both,,,3285.58,3285.58,Medicare,Medicare,,3285.58,,,3285.58,459.98,1675.65,Fee Schedule,Medicare APC Fee Schedule
CT-PELVIS WO,72192,CPT,,,,,both,, ,3285.58,1971.34,Medicare,Medicare,,1971.34,,,3285.58,459.98,1675.65,Fee Schedule,Medicare APC Fee Schedule
"CT scan, pelvis, with contrast",72193,CPT,,,,,both,,,3726.80,3726.80,Medicare,Medicare,,3726.80,,,3726.80,521.75,1900.67,Fee Schedule,Medicare APC Fee Schedule
CT-PELVIS W,72193,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,362.91,,,604.85,84.68,308.47,Fee Schedule,Medicare APC Fee Schedule
CT-PELVIS W,72193,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,390.52,,,650.88,91.12,331.95,Fee Schedule,Medicare APC Fee Schedule
CT-PELVIS W,72193,CPT,,,,,both,, ,3726.80,2236.08,Medicare,Medicare,,2236.08,,,3726.80,521.75,1900.67,Fee Schedule,Medicare APC Fee Schedule
CT-PELVIS WWO,72194,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,408.54,,,680.91,95.33,347.26,Fee Schedule,Medicare APC Fee Schedule
CT-PELVIS WWO,72194,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,439.69,,,732.83,102.60,373.74,Fee Schedule,Medicare APC Fee Schedule
CT-PELVIS WWO,72194,CPT,,,,,both,,,4047.33,4047.33,Medicare,Medicare,,4047.33,,,4047.33,566.63,2064.14,Fee Schedule,Medicare APC Fee Schedule
CT-PELVIS WWO,72194,CPT,,,,,both,, ,4047.33,2428.39,Medicare,Medicare,,2428.39,,,4047.33,566.63,2064.14,Fee Schedule,Medicare APC Fee Schedule
MR-PELVIS WO,72195,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,429.59,,,715.99,100.24,365.15,Fee Schedule,Medicare APC Fee Schedule
MR-PELVIS WO,72195,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,462.27,,,770.45,107.86,392.93,Fee Schedule,Medicare APC Fee Schedule
MR-PELVIS WO,72195,CPT,,,,,both,,,4042.84,4042.84,Medicare,Medicare,,4042.84,,,4042.84,566.00,2061.85,Fee Schedule,Medicare APC Fee Schedule
MR-PELVIS WO,72195,CPT,,,,,both,, ,4042.84,2425.70,Medicare,Medicare,,2425.70,,,4042.84,566.00,2061.85,Fee Schedule,Medicare APC Fee Schedule
MR-PELVIS W,72196,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,621.41,,,1035.69,145.00,528.2,Fee Schedule,Medicare APC Fee Schedule
MR-PELVIS W,72196,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,668.73,,,1114.55,156.04,568.42,Fee Schedule,Medicare APC Fee Schedule
MR-PELVIS W,72196,CPT,,,,,both,,,2940.06,2940.06,Medicare,Medicare,,2940.06,,,2940.06,411.61,1499.43,Fee Schedule,Medicare APC Fee Schedule
MR-PELVIS W,72196,CPT,,,,,both,, ,2940.06,1764.03,Medicare,Medicare,,1764.03,,,2940.06,411.61,1499.43,Fee Schedule,Medicare APC Fee Schedule
MR-PELVIS WWO,72197,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,718.24,,,1197.08,167.59,610.51,Fee Schedule,Medicare APC Fee Schedule
MR-PELVIS WWO,72197,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,772.97,,,1288.29,180.36,657.03,Fee Schedule,Medicare APC Fee Schedule
MR-PELVIS WWO,72197,CPT,,,,,both,,,5197.81,5197.81,Medicare,Medicare,,5197.81,,,5197.81,727.69,2650.88,Fee Schedule,Medicare APC Fee Schedule
MR-PELVIS WWO,72197,CPT,,,,,both,, ,5197.81,3118.68,Medicare,Medicare,,3118.68,,,5197.81,727.69,2650.88,Fee Schedule,Medicare APC Fee Schedule
SP-SI JOINTS 2V CR,72200,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-SI JOINTS 2V CR,72200,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,,,757.53,757.53,Medicare,Medicare,,757.53,,,757.53,106.05,386.34,Fee Schedule,Medicare APC Fee Schedule
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,757.53,454.51,Medicare,Medicare,,454.51,,,757.53,106.05,386.34,Fee Schedule,Medicare APC Fee Schedule
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,,,989.38,989.38,Medicare,Medicare,,989.38,,,989.38,138.51,504.58,Fee Schedule,Medicare APC Fee Schedule
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,989.38,593.62,Medicare,Medicare,,593.62,,,989.38,138.51,504.58,Fee Schedule,Medicare APC Fee Schedule
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,,,721.61,721.61,Medicare,Medicare,,721.61,,,721.61,101.03,368.02,Fee Schedule,Medicare APC Fee Schedule
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,721.61,432.96,Medicare,Medicare,,432.96,,,721.61,101.03,368.02,Fee Schedule,Medicare APC Fee Schedule
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-CLAVICLE CR,73000,CPT,,,,,both,,,353.93,353.93,Medicare,Medicare,,353.93,,,353.93,49.55,180.5,Fee Schedule,Medicare APC Fee Schedule
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,353.93,212.35,Medicare,Medicare,,212.35,,,353.93,49.55,180.5,Fee Schedule,Medicare APC Fee Schedule
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,273.37,164.02,Medicare,Medicare,,164.02,,,273.37,38.27,139.42,Fee Schedule,Medicare APC Fee Schedule
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,273.37,164.02,Medicare,Medicare,,164.02,,,273.37,38.27,139.42,Fee Schedule,Medicare APC Fee Schedule
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,,,804.69,804.69,Medicare,Medicare,,804.69,,,804.69,112.66,410.39,Fee Schedule,Medicare APC Fee Schedule
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,482.81,,,804.69,112.66,410.39,Fee Schedule,Medicare APC Fee Schedule
UE-SCAPULA CR,73010,CPT,,,,,both,, ,136.68,82.00,Medicare,Medicare,,82.00,,,136.68,19.14,69.71,Fee Schedule,Medicare APC Fee Schedule
UE-SCAPULA CR,73010,CPT,,,,,both,, ,136.68,82.00,Medicare,Medicare,,82.00,,,136.68,19.14,69.71,Fee Schedule,Medicare APC Fee Schedule
UE-SCAPULA CR,73010,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-SCAPULA CR,73010,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-SCAPULA CR,73010,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-SCAPULA CR,73010,CPT,,,,,both,,,402.20,402.20,Medicare,Medicare,,402.20,,,402.20,56.31,205.12,Fee Schedule,Medicare APC Fee Schedule
UE-SCAPULA CR,73010,CPT,,,,,both,, ,402.20,241.32,Medicare,Medicare,,241.32,,,402.20,56.31,205.12,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,,,978.43,978.43,Medicare,Medicare,,978.43,,,978.43,136.98,499,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,978.43,587.05,Medicare,Medicare,,587.05,,,978.43,136.98,499,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 1V CR,73020,CPT,,,,,both,,,489.50,489.50,Medicare,Medicare,,489.50,,,489.50,68.53,249.65,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,489.50,293.70,Medicare,Medicare,,293.70,,,489.50,68.53,249.65,Fee Schedule,Medicare APC Fee Schedule
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,,,863.36,863.36,Medicare,Medicare,,863.36,,,863.36,120.87,440.31,Fee Schedule,Medicare APC Fee Schedule
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,863.36,518.01,Medicare,Medicare,,518.01,,,863.36,120.87,440.31,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,,,1726.71,1726.71,Medicare,Medicare,,1726.71,,,1726.71,241.74,880.62,Fee Schedule,Medicare APC Fee Schedule
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,1726.71,1036.02,Medicare,Medicare,,1036.02,,,1726.71,241.74,880.62,Fee Schedule,Medicare APC Fee Schedule
IR-ARTHROGM SHLDR CR,73040,CPT,,,,,both,, ,3748.70,2249.22,Medicare,Medicare,,2249.22,,,3748.70,524.82,1911.84,Fee Schedule,Medicare APC Fee Schedule
IR-ATHGRM SHLD BI CR,73040,CPT,,,,,both,, ,7497.39,4498.43,Medicare,Medicare,,4498.43,,,7497.39,1049.63,3823.67,Fee Schedule,Medicare APC Fee Schedule
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-AC JTS BILAT CR,73050,CPT,,,,,both,,,918.37,918.37,Medicare,Medicare,,918.37,,,918.37,128.57,468.37,Fee Schedule,Medicare APC Fee Schedule
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,918.37,551.02,Medicare,Medicare,,551.02,,,918.37,128.57,468.37,Fee Schedule,Medicare APC Fee Schedule
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,,,721.61,721.61,Medicare,Medicare,,721.61,,,721.61,101.03,368.02,Fee Schedule,Medicare APC Fee Schedule
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,721.61,432.96,Medicare,Medicare,,432.96,,,721.61,101.03,368.02,Fee Schedule,Medicare APC Fee Schedule
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-HUMERUS CR,73060,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-HUMERUS CR,73060,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-HUMERUS CR,73060,CPT,,,,,both,,,1442.95,1442.95,Medicare,Medicare,,1442.95,,,1442.95,202.01,735.9,Fee Schedule,Medicare APC Fee Schedule
UE-HUMERUS CR,73060,CPT,,,,,both,, ,1442.95,865.77,Medicare,Medicare,,865.77,,,1442.95,202.01,735.9,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 2V CR,73070,CPT,,,,,both,,,662.39,662.39,Medicare,Medicare,,662.39,,,662.39,92.73,337.82,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,662.39,397.43,Medicare,Medicare,,397.43,,,662.39,92.73,337.82,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,,,1325.06,1325.06,Medicare,Medicare,,1325.06,,,1325.06,185.51,675.78,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,1325.06,795.03,Medicare,Medicare,,795.03,,,1325.06,185.51,675.78,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 3V CR,73080,CPT,,,,,both,,,804.69,804.69,Medicare,Medicare,,804.69,,,804.69,112.66,410.39,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,482.81,,,804.69,112.66,410.39,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,,,1609.11,1609.11,Medicare,Medicare,,1609.11,,,1609.11,225.28,820.65,Fee Schedule,Medicare APC Fee Schedule
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,1609.11,965.46,Medicare,Medicare,,965.46,,,1609.11,225.28,820.65,Fee Schedule,Medicare APC Fee Schedule
IR-ARTHROGRAM ELBOW,73085,CPT,,,,,both,, ,3748.70,2249.22,Medicare,Medicare,,2249.22,,,3748.70,524.82,1911.84,Fee Schedule,Medicare APC Fee Schedule
IR-ARTHROGRAM ELBOW,73085,CPT,,,,,both,, ,3748.70,2249.22,Medicare,Medicare,,2249.22,,,3748.70,524.82,1911.84,Fee Schedule,Medicare APC Fee Schedule
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-FOREARM 2V CR,73090,CPT,,,,,both,,,662.39,662.39,Medicare,Medicare,,662.39,,,662.39,92.73,337.82,Fee Schedule,Medicare APC Fee Schedule
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,662.39,397.43,Medicare,Medicare,,397.43,,,662.39,92.73,337.82,Fee Schedule,Medicare APC Fee Schedule
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,,,1325.06,1325.06,Medicare,Medicare,,1325.06,,,1325.06,185.51,675.78,Fee Schedule,Medicare APC Fee Schedule
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,1325.06,795.03,Medicare,Medicare,,795.03,,,1325.06,185.51,675.78,Fee Schedule,Medicare APC Fee Schedule
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,132.36,,,220.61,30.89,112.51,Fee Schedule,Medicare APC Fee Schedule
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
UE-UP EXT INFANT CR,73092,CPT,,,,,both,,,721.61,721.61,Medicare,Medicare,,721.61,,,721.61,101.03,368.02,Fee Schedule,Medicare APC Fee Schedule
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,721.61,432.96,Medicare,Medicare,,432.96,,,721.61,101.03,368.02,Fee Schedule,Medicare APC Fee Schedule
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,441.50,264.90,Medicare,Medicare,,264.90,,,441.50,61.81,225.17,Fee Schedule,Medicare APC Fee Schedule
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,475.18,285.10,Medicare,Medicare,,285.10,,,475.18,66.53,242.34,Fee Schedule,Medicare APC Fee Schedule
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,,,1444.91,1444.91,Medicare,Medicare,,1444.91,,,1444.91,202.29,736.9,Fee Schedule,Medicare APC Fee Schedule
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,1444.91,866.94,Medicare,Medicare,,866.94,,,1444.91,202.29,736.9,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 2V CR,73100,CPT,,,,,both,,,607.94,607.94,Medicare,Medicare,,607.94,,,607.94,85.11,310.05,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,607.94,364.76,Medicare,Medicare,,364.76,,,607.94,85.11,310.05,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,,,1216.16,1216.16,Medicare,Medicare,,1216.16,,,1216.16,170.26,620.24,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,1216.16,729.69,Medicare,Medicare,,729.69,,,1216.16,170.26,620.24,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,,,662.39,662.39,Medicare,Medicare,,662.39,,,662.39,92.73,337.82,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,662.39,397.43,Medicare,Medicare,,397.43,,,662.39,92.73,337.82,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,,,1325.06,1325.06,Medicare,Medicare,,1325.06,,,1325.06,185.51,675.78,Fee Schedule,Medicare APC Fee Schedule
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,1325.06,795.03,Medicare,Medicare,,795.03,,,1325.06,185.51,675.78,Fee Schedule,Medicare APC Fee Schedule
IR-ARTHROGRAM WRIST,73115,CPT,,,,,both,, ,3748.70,2249.22,Medicare,Medicare,,2249.22,,,3748.70,524.82,1911.84,Fee Schedule,Medicare APC Fee Schedule
IR-ARTHROGRAM WRIST,73115,CPT,,,,,both,, ,3748.70,2249.22,Medicare,Medicare,,2249.22,,,3748.70,524.82,1911.84,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 2V CR,73120,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 2V CR,73120,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 2V CR,73120,CPT,,,,,both,,,662.39,662.39,Medicare,Medicare,,662.39,,,662.39,92.73,337.82,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 2V CR,73120,CPT,,,,,both,, ,662.39,397.43,Medicare,Medicare,,397.43,,,662.39,92.73,337.82,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,,,1325.06,1325.06,Medicare,Medicare,,1325.06,,,1325.06,185.51,675.78,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,1325.06,795.03,Medicare,Medicare,,795.03,,,1325.06,185.51,675.78,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 3V CR,73130,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 3V CR,73130,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 3V CR,73130,CPT,,,,,both,,,804.69,804.69,Medicare,Medicare,,804.69,,,804.69,112.66,410.39,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 3V CR,73130,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,482.81,,,804.69,112.66,410.39,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,,,1609.11,1609.11,Medicare,Medicare,,1609.11,,,1609.11,225.28,820.65,Fee Schedule,Medicare APC Fee Schedule
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,1609.11,965.46,Medicare,Medicare,,965.46,,,1609.11,225.28,820.65,Fee Schedule,Medicare APC Fee Schedule
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,,,1137.30,1137.30,Medicare,Medicare,,1137.30,,,1137.30,159.22,580.02,Fee Schedule,Medicare APC Fee Schedule
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,1137.30,682.38,Medicare,Medicare,,682.38,,,1137.30,159.22,580.02,Fee Schedule,Medicare APC Fee Schedule
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,,,568.64,568.64,Medicare,Medicare,,568.64,,,568.64,79.61,290.01,Fee Schedule,Medicare APC Fee Schedule
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,568.64,341.18,Medicare,Medicare,,341.18,,,568.64,79.61,290.01,Fee Schedule,Medicare APC Fee Schedule
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,184.23,,,307.05,42.99,156.6,Fee Schedule,Medicare APC Fee Schedule
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,198.37,,,330.63,46.29,168.62,Fee Schedule,Medicare APC Fee Schedule
CT-UPPER EXT WO,73200,CPT,,,,,both,,,3015.85,3015.85,Medicare,Medicare,,3015.85,,,3015.85,422.22,1538.08,Fee Schedule,Medicare APC Fee Schedule
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,3015.85,1809.51,Medicare,Medicare,,1809.51,,,3015.85,422.22,1538.08,Fee Schedule,Medicare APC Fee Schedule
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,614.40,368.64,Medicare,Medicare,,368.64,,,614.40,86.02,313.34,Fee Schedule,Medicare APC Fee Schedule
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,660.98,396.58,Medicare,Medicare,,396.58,,,660.98,92.54,337.1,Fee Schedule,Medicare APC Fee Schedule
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,6031.42,3618.85,Medicare,Medicare,,3618.85,,,6031.42,844.40,3076.02,Fee Schedule,Medicare APC Fee Schedule
CT-UPPER EXT W,73201,CPT,,,,,both,, ,556.01,333.60,Medicare,Medicare,,333.60,,,556.01,77.84,283.57,Fee Schedule,Medicare APC Fee Schedule
CT-UPPER EXT W,73201,CPT,,,,,both,,,3350.14,3350.14,Medicare,Medicare,,3350.14,,,3350.14,469.02,1708.57,Fee Schedule,Medicare APC Fee Schedule
CT-UPPER EXT W,73201,CPT,,,,,both,, ,3350.14,2010.08,Medicare,Medicare,,2010.08,,,3350.14,469.02,1708.57,Fee Schedule,Medicare APC Fee Schedule
CTA-UPPER EXT,73206,CPT,,,,,both,,,1947.60,1947.60,Medicare,Medicare,,1947.60,,,1947.60,272.66,993.28,Fee Schedule,Medicare APC Fee Schedule
CTA-UPPER EXT,73206,CPT,,,,,both,, ,1947.60,1168.56,Medicare,Medicare,,1168.56,,,1947.60,272.66,993.28,Fee Schedule,Medicare APC Fee Schedule
CTA-UPPER EXT BI,73206,CPT,,,,,both,, ,3895.20,2337.12,Medicare,Medicare,,2337.12,,,3895.20,545.33,1986.55,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,1431.72,859.03,Medicare,Medicare,,859.03,,,1431.72,200.44,730.18,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,1540.90,924.54,Medicare,Medicare,,924.54,,,1540.90,215.73,785.86,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,4042.84,2425.70,Medicare,Medicare,,2425.70,,,4042.84,566.00,2061.85,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,429.59,,,715.99,100.24,365.15,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,462.27,,,770.45,107.86,392.93,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER EXT WO,73218,CPT,,,,,both,,,2470.50,2470.50,Medicare,Medicare,,2470.50,,,2470.50,345.87,1259.96,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,2470.50,1482.30,Medicare,Medicare,,1482.30,,,2470.50,345.87,1259.96,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,2394.15,1436.49,Medicare,Medicare,,1436.49,,,2394.15,335.18,1221.02,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,2576.60,1545.96,Medicare,Medicare,,1545.96,,,2576.60,360.72,1314.07,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,5197.81,3118.68,Medicare,Medicare,,3118.68,,,5197.81,727.69,2650.88,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,718.24,,,1197.08,167.59,610.51,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,772.97,,,1288.29,180.36,657.03,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER EXT WWO,73220,CPT,,,,,both,,,2598.76,2598.76,Medicare,Medicare,,2598.76,,,2598.76,363.83,1325.37,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,2598.76,1559.25,Medicare,Medicare,,1559.25,,,2598.76,363.83,1325.37,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,429.59,,,715.99,100.24,365.15,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,462.27,,,770.45,107.86,392.93,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER JOINT WO,73221,CPT,,,,,both,,,2523.26,2523.26,Medicare,Medicare,,2523.26,,,2523.26,353.26,1286.86,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,2523.26,1513.95,Medicare,Medicare,,1513.95,,,2523.26,353.26,1286.86,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,621.41,,,1035.69,145.00,528.2,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,668.73,,,1114.55,156.04,568.42,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER JOINT W,73222,CPT,,,,,both,,,4293.48,4293.48,Medicare,Medicare,,4293.48,,,4293.48,601.09,2189.67,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,4293.48,2576.08,Medicare,Medicare,,2576.08,,,4293.48,601.09,2189.67,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,718.24,,,1197.08,167.59,610.51,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,772.97,,,1288.29,180.36,657.03,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER JOINT WWO,73223,CPT,,,,,both,,,4941.28,4941.28,Medicare,Medicare,,4941.28,,,4941.28,691.78,2520.05,Fee Schedule,Medicare APC Fee Schedule
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,2964.76,,,4941.28,691.78,2520.05,Fee Schedule,Medicare APC Fee Schedule
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,,,333.44,333.44,Medicare,Medicare,,333.44,,,333.44,46.68,170.05,Fee Schedule,Medicare APC Fee Schedule
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,333.44,200.06,Medicare,Medicare,,200.06,,,333.44,46.68,170.05,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,139.77,83.86,Medicare,Medicare,,83.86,,,139.77,19.57,71.28,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Medicare,Medicare,,89.59,,,149.32,20.90,76.15,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Medicare,Medicare,,89.59,,,149.32,20.90,76.15,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Medicare,Medicare,,89.59,,,149.32,20.90,76.15,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,887.49,532.49,Medicare,Medicare,,532.49,,,887.49,124.25,452.62,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,209.94,125.96,Medicare,Medicare,,125.96,,,209.94,29.39,107.07,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Medicare,Medicare,,134.72,,,224.54,31.44,114.52,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Medicare,Medicare,,134.72,,,224.54,31.44,114.52,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Medicare,Medicare,,134.72,,,224.54,31.44,114.52,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,1330.96,798.57,Medicare,Medicare,,798.57,,,1330.96,186.33,678.79,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,132.52,,,220.88,30.92,112.65,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.80,Medicare,Medicare,,142.80,,,238.01,33.32,121.39,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.80,Medicare,Medicare,,142.80,,,238.01,33.32,121.39,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.80,Medicare,Medicare,,142.80,,,238.01,33.32,121.39,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,,,1774.70,1774.70,Medicare,Medicare,,1774.70,,,1774.70,248.46,905.1,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,1774.70,1064.82,Medicare,Medicare,,1064.82,,,1774.70,248.46,905.1,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,132.52,,,220.88,30.92,112.65,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.80,Medicare,Medicare,,142.80,,,238.01,33.32,121.39,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.80,Medicare,Medicare,,142.80,,,238.01,33.32,121.39,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.80,Medicare,Medicare,,142.80,,,238.01,33.32,121.39,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,,,1774.70,1774.70,Medicare,Medicare,,1774.70,,,1774.70,248.46,905.1,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,1774.70,1064.82,Medicare,Medicare,,1064.82,,,1774.70,248.46,905.1,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,442.06,265.23,Medicare,Medicare,,265.23,,,442.06,61.89,225.45,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Medicare,Medicare,,285.61,,,476.02,66.64,242.77,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Medicare,Medicare,,285.61,,,476.02,66.64,242.77,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Medicare,Medicare,,285.61,,,476.02,66.64,242.77,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,,,3549.69,3549.69,Medicare,Medicare,,3549.69,,,3549.69,496.96,1810.34,Fee Schedule,Medicare APC Fee Schedule
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,3549.69,2129.81,Medicare,Medicare,,2129.81,,,3549.69,496.96,1810.34,Fee Schedule,Medicare APC Fee Schedule
IR-ARTHROGRAM HIP CR,73525,CPT,,,,,both,, ,3760.20,2256.12,Medicare,Medicare,,2256.12,,,3760.20,526.43,1917.7,Fee Schedule,Medicare APC Fee Schedule
IR-ARTHROGRAM HIP CR,73525,CPT,,,,,both,, ,3760.20,2256.12,Medicare,Medicare,,2256.12,,,3760.20,526.43,1917.7,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.20,88.92,Medicare,Medicare,,88.92,,,148.20,20.75,75.58,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.20,88.92,Medicare,Medicare,,88.92,,,148.20,20.75,75.58,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.20,88.92,Medicare,Medicare,,88.92,,,148.20,20.75,75.58,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.20,88.92,Medicare,Medicare,,88.92,,,148.20,20.75,75.58,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 1V CR,73551,CPT,,,,,both,,,307.05,307.05,Medicare,Medicare,,307.05,,,307.05,42.99,156.6,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,184.23,,,307.05,42.99,156.6,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 2V CR,73552,CPT,,,,,both,,,782.23,782.23,Medicare,Medicare,,782.23,,,782.23,109.51,398.94,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,782.23,469.33,Medicare,Medicare,,469.33,,,782.23,109.51,398.94,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,,,1564.76,1564.76,Medicare,Medicare,,1564.76,,,1564.76,219.07,798.03,Fee Schedule,Medicare APC Fee Schedule
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,1564.76,938.85,Medicare,Medicare,,938.85,,,1564.76,219.07,798.03,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,,,721.61,721.61,Medicare,Medicare,,721.61,,,721.61,101.03,368.02,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,721.61,432.96,Medicare,Medicare,,432.96,,,721.61,101.03,368.02,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,,,1442.95,1442.95,Medicare,Medicare,,1442.95,,,1442.95,202.01,735.9,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,1442.95,865.77,Medicare,Medicare,,865.77,,,1442.95,202.01,735.9,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 3V CR,73562,CPT,,,,,both,,,981.24,981.24,Medicare,Medicare,,981.24,,,981.24,137.37,500.43,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,981.24,588.74,Medicare,Medicare,,588.74,,,981.24,137.37,500.43,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,,,1962.48,1962.48,Medicare,Medicare,,1962.48,,,1962.48,274.75,1000.86,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,1962.48,1177.48,Medicare,Medicare,,1177.48,,,1962.48,274.75,1000.86,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,,,1070.49,1070.49,Medicare,Medicare,,1070.49,,,1070.49,149.87,545.95,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,1070.49,642.29,Medicare,Medicare,,642.29,,,1070.49,149.87,545.95,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,,,2141.27,2141.27,Medicare,Medicare,,2141.27,,,2141.27,299.78,1092.05,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,2141.27,1284.76,Medicare,Medicare,,1284.76,,,2141.27,299.78,1092.05,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,,,721.61,721.61,Medicare,Medicare,,721.61,,,721.61,101.03,368.02,Fee Schedule,Medicare APC Fee Schedule
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,721.61,432.96,Medicare,Medicare,,432.96,,,721.61,101.03,368.02,Fee Schedule,Medicare APC Fee Schedule
IR-ARTHRGRM KNEE BI,73580,CPT,,,,,both,, ,7520.68,4512.40,Medicare,Medicare,,4512.40,,,7520.68,1052.90,3835.55,Fee Schedule,Medicare APC Fee Schedule
IR-ARTHROGRAM KNEE,73580,CPT,,,,,both,, ,3760.20,2256.12,Medicare,Medicare,,2256.12,,,3760.20,526.43,1917.7,Fee Schedule,Medicare APC Fee Schedule
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,,,1442.95,1442.95,Medicare,Medicare,,1442.95,,,1442.95,202.01,735.9,Fee Schedule,Medicare APC Fee Schedule
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,1442.95,865.77,Medicare,Medicare,,865.77,,,1442.95,202.01,735.9,Fee Schedule,Medicare APC Fee Schedule
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-TIB FIB 2V CR,73590,CPT,,,,,both,,,721.61,721.61,Medicare,Medicare,,721.61,,,721.61,101.03,368.02,Fee Schedule,Medicare APC Fee Schedule
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,721.61,432.96,Medicare,Medicare,,432.96,,,721.61,101.03,368.02,Fee Schedule,Medicare APC Fee Schedule
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,,,1442.95,1442.95,Medicare,Medicare,,1442.95,,,1442.95,202.01,735.9,Fee Schedule,Medicare APC Fee Schedule
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,1442.95,865.77,Medicare,Medicare,,865.77,,,1442.95,202.01,735.9,Fee Schedule,Medicare APC Fee Schedule
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,,,721.61,721.61,Medicare,Medicare,,721.61,,,721.61,101.03,368.02,Fee Schedule,Medicare APC Fee Schedule
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,721.61,432.96,Medicare,Medicare,,432.96,,,721.61,101.03,368.02,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 2V CR,73600,CPT,,,,,both,,,720.49,720.49,Medicare,Medicare,,720.49,,,720.49,100.87,367.45,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,720.49,432.29,Medicare,Medicare,,432.29,,,720.49,100.87,367.45,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,,,1107.82,1107.82,Medicare,Medicare,,1107.82,,,1107.82,155.09,564.99,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,1107.82,664.69,Medicare,Medicare,,664.69,,,1107.82,155.09,564.99,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,,,804.69,804.69,Medicare,Medicare,,804.69,,,804.69,112.66,410.39,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,482.81,,,804.69,112.66,410.39,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,,,1609.11,1609.11,Medicare,Medicare,,1609.11,,,1609.11,225.28,820.65,Fee Schedule,Medicare APC Fee Schedule
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,1609.11,965.46,Medicare,Medicare,,965.46,,,1609.11,225.28,820.65,Fee Schedule,Medicare APC Fee Schedule
IR-ARTHROGRAM ANKLE,73615,CPT,,,,,both,, ,3760.20,2256.12,Medicare,Medicare,,2256.12,,,3760.20,526.43,1917.7,Fee Schedule,Medicare APC Fee Schedule
IR-ARTHROGRAM ANKLE,73615,CPT,,,,,both,, ,3760.20,2256.12,Medicare,Medicare,,2256.12,,,3760.20,526.43,1917.7,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 2V CR,73620,CPT,,,,,both,,,553.77,553.77,Medicare,Medicare,,553.77,,,553.77,77.53,282.42,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,553.77,332.26,Medicare,Medicare,,332.26,,,553.77,77.53,282.42,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,,,1107.82,1107.82,Medicare,Medicare,,1107.82,,,1107.82,155.09,564.99,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,1107.82,664.69,Medicare,Medicare,,664.69,,,1107.82,155.09,564.99,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,,,662.39,662.39,Medicare,Medicare,,662.39,,,662.39,92.73,337.82,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,662.39,397.43,Medicare,Medicare,,397.43,,,662.39,92.73,337.82,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,,,1250.97,1250.97,Medicare,Medicare,,1250.97,,,1250.97,175.14,637.99,Fee Schedule,Medicare APC Fee Schedule
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,1250.97,750.58,Medicare,Medicare,,750.58,,,1250.97,175.14,637.99,Fee Schedule,Medicare APC Fee Schedule
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,,,353.93,353.93,Medicare,Medicare,,353.93,,,353.93,49.55,180.5,Fee Schedule,Medicare APC Fee Schedule
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,353.93,212.35,Medicare,Medicare,,212.35,,,353.93,49.55,180.5,Fee Schedule,Medicare APC Fee Schedule
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,,,662.39,662.39,Medicare,Medicare,,662.39,,,662.39,92.73,337.82,Fee Schedule,Medicare APC Fee Schedule
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,662.39,397.43,Medicare,Medicare,,397.43,,,662.39,92.73,337.82,Fee Schedule,Medicare APC Fee Schedule
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,167.05,,,278.43,38.98,142,Fee Schedule,Medicare APC Fee Schedule
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,,,568.64,568.64,Medicare,Medicare,,568.64,,,568.64,79.61,290.01,Fee Schedule,Medicare APC Fee Schedule
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,568.64,341.18,Medicare,Medicare,,341.18,,,568.64,79.61,290.01,Fee Schedule,Medicare APC Fee Schedule
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,179.85,,,299.76,41.97,152.88,Fee Schedule,Medicare APC Fee Schedule
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,,,1137.30,1137.30,Medicare,Medicare,,1137.30,,,1137.30,159.22,580.02,Fee Schedule,Medicare APC Fee Schedule
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,1137.30,682.38,Medicare,Medicare,,682.38,,,1137.30,159.22,580.02,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,184.23,,,307.05,42.99,156.6,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,198.37,,,330.63,46.29,168.62,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT WO,73700,CPT,,,,,both,,,3013.04,3013.04,Medicare,Medicare,,3013.04,,,3013.04,421.83,1536.65,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,3013.04,1807.82,Medicare,Medicare,,1807.82,,,3013.04,421.83,1536.65,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,614.40,368.64,Medicare,Medicare,,368.64,,,614.40,86.02,313.34,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,660.98,396.58,Medicare,Medicare,,396.58,,,660.98,92.54,337.1,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,2964.76,,,4941.28,691.78,2520.05,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT W,73701,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,390.52,,,650.88,91.12,331.95,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT W,73701,CPT,,,,,both,,,3013.04,3013.04,Medicare,Medicare,,3013.04,,,3013.04,421.83,1536.65,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT W,73701,CPT,,,,,both,, ,3013.04,1807.82,Medicare,Medicare,,1807.82,,,3013.04,421.83,1536.65,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT W BI,73701,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,362.91,,,604.85,84.68,308.47,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT W BI,73701,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,362.91,,,604.85,84.68,308.47,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,408.54,,,680.91,95.33,347.26,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,439.69,,,732.83,102.60,373.74,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT WWO,73702,CPT,,,,,both,,,3013.04,3013.04,Medicare,Medicare,,3013.04,,,3013.04,421.83,1536.65,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,3013.04,1807.82,Medicare,Medicare,,1807.82,,,3013.04,421.83,1536.65,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,1361.84,817.10,Medicare,Medicare,,817.10,,,1361.84,190.66,694.54,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,1465.68,879.40,Medicare,Medicare,,879.40,,,1465.68,205.20,747.5,Fee Schedule,Medicare APC Fee Schedule
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,2964.76,,,4941.28,691.78,2520.05,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,429.59,,,715.99,100.24,365.15,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,429.59,,,715.99,100.24,365.15,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,1540.90,924.54,Medicare,Medicare,,924.54,,,1540.90,215.73,785.86,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,2964.76,,,4941.28,691.78,2520.05,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,462.27,,,770.45,107.86,392.93,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR WO,73718,CPT,,,,,both,,,2470.50,2470.50,Medicare,Medicare,,2470.50,,,2470.50,345.87,1259.96,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,2470.50,1482.30,Medicare,Medicare,,1482.30,,,2470.50,345.87,1259.96,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR W,73719,CPT,,,,,both,,,832.76,832.76,Medicare,Medicare,,832.76,,,832.76,116.59,424.71,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,832.76,499.65,Medicare,Medicare,,499.65,,,832.76,116.59,424.71,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,621.41,,,1035.69,145.00,528.2,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,668.73,,,1114.55,156.04,568.42,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR BI WWO,73720,CPT,,,,,both,, ,2394.15,1436.49,Medicare,Medicare,,1436.49,,,2394.15,335.18,1221.02,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR BI WWO,73720,CPT,,,,,both,, ,2576.60,1545.96,Medicare,Medicare,,1545.96,,,2576.60,360.72,1314.07,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,718.24,,,1197.08,167.59,610.51,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,772.97,,,1288.29,180.36,657.03,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR WWO,73720,CPT,,,,,both,,,3084.06,3084.06,Medicare,Medicare,,3084.06,,,3084.06,431.77,1572.87,Fee Schedule,Medicare APC Fee Schedule
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,3084.06,1850.43,Medicare,Medicare,,1850.43,,,3084.06,431.77,1572.87,Fee Schedule,Medicare APC Fee Schedule
MRI scan of leg joint,73721,CPT,,,,,both,,,4941.28,4941.28,Medicare,Medicare,,4941.28,,,4941.28,691.78,2520.05,Fee Schedule,Medicare APC Fee Schedule
MR-LW JOINT WO,73721,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,429.59,,,715.99,100.24,365.15,Fee Schedule,Medicare APC Fee Schedule
MR-LW JOINT WO,73721,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,462.27,,,770.45,107.86,392.93,Fee Schedule,Medicare APC Fee Schedule
MR-LW JOINT WO,73721,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,2964.76,,,4941.28,691.78,2520.05,Fee Schedule,Medicare APC Fee Schedule
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,1431.72,859.03,Medicare,Medicare,,859.03,,,1431.72,200.44,730.18,Fee Schedule,Medicare APC Fee Schedule
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,1540.90,924.54,Medicare,Medicare,,924.54,,,1540.90,215.73,785.86,Fee Schedule,Medicare APC Fee Schedule
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,9881.44,5928.86,Medicare,Medicare,,5928.86,,,9881.44,1383.40,5039.53,Fee Schedule,Medicare APC Fee Schedule
MR-LW JOINT W,73722,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,621.41,,,1035.69,145.00,528.2,Fee Schedule,Medicare APC Fee Schedule
MR-LW JOINT W,73722,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,668.73,,,1114.55,156.04,568.42,Fee Schedule,Medicare APC Fee Schedule
MR-LW JOINT W,73722,CPT,,,,,both,,,4293.48,4293.48,Medicare,Medicare,,4293.48,,,4293.48,601.09,2189.67,Fee Schedule,Medicare APC Fee Schedule
MR-LW JOINT W,73722,CPT,,,,,both,, ,4293.48,2576.08,Medicare,Medicare,,2576.08,,,4293.48,601.09,2189.67,Fee Schedule,Medicare APC Fee Schedule
MR-LW JOINT W BI,73722,CPT,,,,,both,, ,7641.10,4584.66,Medicare,Medicare,,4584.66,,,7641.10,1069.75,3896.96,Fee Schedule,Medicare APC Fee Schedule
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,718.24,,,1197.08,167.59,610.51,Fee Schedule,Medicare APC Fee Schedule
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,772.97,,,1288.29,180.36,657.03,Fee Schedule,Medicare APC Fee Schedule
MR-LW JOINT WWO,73723,CPT,,,,,both,,,5197.81,5197.81,Medicare,Medicare,,5197.81,,,5197.81,727.69,2650.88,Fee Schedule,Medicare APC Fee Schedule
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,5197.81,3118.68,Medicare,Medicare,,3118.68,,,5197.81,727.69,2650.88,Fee Schedule,Medicare APC Fee Schedule
MR-LW JOINT WWO BI,73723,CPT,,,,,both,, ,10395.64,6237.38,Medicare,Medicare,,6237.38,,,10395.64,1455.39,5301.78,Fee Schedule,Medicare APC Fee Schedule
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,,,694.38,694.38,Medicare,Medicare,,694.38,,,694.38,97.21,354.13,Fee Schedule,Medicare APC Fee Schedule
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,694.38,416.62,Medicare,Medicare,,416.62,,,694.38,97.21,354.13,Fee Schedule,Medicare APC Fee Schedule
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,,,1144.03,1144.03,Medicare,Medicare,,1144.03,,,1144.03,160.16,583.46,Fee Schedule,Medicare APC Fee Schedule
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,1144.03,686.41,Medicare,Medicare,,686.41,,,1144.03,160.16,583.46,Fee Schedule,Medicare APC Fee Schedule
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,,,868.40,868.40,Medicare,Medicare,,868.40,,,868.40,121.58,442.88,Fee Schedule,Medicare APC Fee Schedule
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,868.40,521.04,Medicare,Medicare,,521.04,,,868.40,121.58,442.88,Fee Schedule,Medicare APC Fee Schedule
CH-ABD SER PA CXR CR,74022,CPT,,,,,both,,,970.85,970.85,Medicare,Medicare,,970.85,,,970.85,135.92,495.13,Fee Schedule,Medicare APC Fee Schedule
CH-ABD SER PA CXR CR,74022,CPT,,,,,both,, ,970.85,582.51,Medicare,Medicare,,582.51,,,970.85,135.92,495.13,Fee Schedule,Medicare APC Fee Schedule
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,184.23,,,307.05,42.99,156.6,Fee Schedule,Medicare APC Fee Schedule
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,198.37,,,330.63,46.29,168.62,Fee Schedule,Medicare APC Fee Schedule
CT-ABDOMEN WO,74150,CPT,,,,,both,,,3285.58,3285.58,Medicare,Medicare,,3285.58,,,3285.58,459.98,1675.65,Fee Schedule,Medicare APC Fee Schedule
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,3285.58,1971.34,Medicare,Medicare,,1971.34,,,3285.58,459.98,1675.65,Fee Schedule,Medicare APC Fee Schedule
CT-ABDOMEN W,74160,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,362.91,,,604.85,84.68,308.47,Fee Schedule,Medicare APC Fee Schedule
CT-ABDOMEN W,74160,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,390.52,,,650.88,91.12,331.95,Fee Schedule,Medicare APC Fee Schedule
CT-ABDOMEN W,74160,CPT,,,,,both,,,3726.80,3726.80,Medicare,Medicare,,3726.80,,,3726.80,521.75,1900.67,Fee Schedule,Medicare APC Fee Schedule
CT-ABDOMEN W,74160,CPT,,,,,both,, ,3726.80,2236.08,Medicare,Medicare,,2236.08,,,3726.80,521.75,1900.67,Fee Schedule,Medicare APC Fee Schedule
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,408.54,,,680.91,95.33,347.26,Fee Schedule,Medicare APC Fee Schedule
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,439.69,,,732.83,102.60,373.74,Fee Schedule,Medicare APC Fee Schedule
CT-ABDOMEN WWO,74170,CPT,,,,,both,,,4317.62,4317.62,Medicare,Medicare,,4317.62,,,4317.62,604.47,2201.99,Fee Schedule,Medicare APC Fee Schedule
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,4317.62,2590.57,Medicare,Medicare,,2590.57,,,4317.62,604.47,2201.99,Fee Schedule,Medicare APC Fee Schedule
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,893.10,535.86,Medicare,Medicare,,535.86,,,893.10,125.03,455.48,Fee Schedule,Medicare APC Fee Schedule
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,893.10,535.86,Medicare,Medicare,,535.86,,,893.10,125.03,455.48,Fee Schedule,Medicare APC Fee Schedule
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,,,1894.27,1894.27,Medicare,Medicare,,1894.27,,,1894.27,265.20,966.08,Fee Schedule,Medicare APC Fee Schedule
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,1894.27,1136.56,Medicare,Medicare,,1136.56,,,1894.27,265.20,966.08,Fee Schedule,Medicare APC Fee Schedule
CTA-ABDOMEN,74175,CPT,,,,,both,, ,893.10,535.86,Medicare,Medicare,,535.86,,,893.10,125.03,455.48,Fee Schedule,Medicare APC Fee Schedule
CTA-ABDOMEN,74175,CPT,,,,,both,,,1894.27,1894.27,Medicare,Medicare,,1894.27,,,1894.27,265.20,966.08,Fee Schedule,Medicare APC Fee Schedule
CTA-ABDOMEN,74175,CPT,,,,,both,, ,1894.27,1136.56,Medicare,Medicare,,1136.56,,,1894.27,265.20,966.08,Fee Schedule,Medicare APC Fee Schedule
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,587.17,352.30,Medicare,Medicare,,352.30,,,587.17,82.20,299.46,Fee Schedule,Medicare APC Fee Schedule
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,632.08,379.24,Medicare,Medicare,,379.24,,,632.08,88.49,322.36,Fee Schedule,Medicare APC Fee Schedule
CT-ABD PELVIS WO,74176,CPT,,,,,both,,,6571.44,6571.44,Medicare,Medicare,,6571.44,,,6571.44,920.00,3351.43,Fee Schedule,Medicare APC Fee Schedule
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,6571.44,3942.86,Medicare,Medicare,,3942.86,,,6571.44,920.00,3351.43,Fee Schedule,Medicare APC Fee Schedule
CT scan of abdomen and pelvis with contrast,74177,CPT,,,,,both,,,7453.61,7453.61,Medicare,Medicare,,7453.61,,,7453.61,1043.51,3801.34,Fee Schedule,Medicare APC Fee Schedule
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,947.56,568.53,Medicare,Medicare,,568.53,,,947.56,132.66,483.26,Fee Schedule,Medicare APC Fee Schedule
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,1019.69,611.81,Medicare,Medicare,,611.81,,,1019.69,142.76,520.04,Fee Schedule,Medicare APC Fee Schedule
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,7453.61,4472.16,Medicare,Medicare,,4472.16,,,7453.61,1043.51,3801.34,Fee Schedule,Medicare APC Fee Schedule
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,947.56,568.53,Medicare,Medicare,,568.53,,,947.56,132.66,483.26,Fee Schedule,Medicare APC Fee Schedule
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,1019.69,611.81,Medicare,Medicare,,611.81,,,1019.69,142.76,520.04,Fee Schedule,Medicare APC Fee Schedule
CT-ABD PELVIS WWO,74178,CPT,,,,,both,,,8364.95,8364.95,Medicare,Medicare,,8364.95,,,8364.95,1171.09,4266.12,Fee Schedule,Medicare APC Fee Schedule
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,8364.95,5018.97,Medicare,Medicare,,5018.97,,,8364.95,1171.09,4266.12,Fee Schedule,Medicare APC Fee Schedule
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,429.59,,,715.99,100.24,365.15,Fee Schedule,Medicare APC Fee Schedule
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,462.27,,,770.45,107.86,392.93,Fee Schedule,Medicare APC Fee Schedule
MR-ABDOMEN WO,74181,CPT,,,,,both,,,4042.84,4042.84,Medicare,Medicare,,4042.84,,,4042.84,566.00,2061.85,Fee Schedule,Medicare APC Fee Schedule
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,4042.84,2425.70,Medicare,Medicare,,2425.70,,,4042.84,566.00,2061.85,Fee Schedule,Medicare APC Fee Schedule
MR-ABDOMEN W,74182,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,621.41,,,1035.69,145.00,528.2,Fee Schedule,Medicare APC Fee Schedule
MR-ABDOMEN W,74182,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,668.73,,,1114.55,156.04,568.42,Fee Schedule,Medicare APC Fee Schedule
MR-ABDOMEN W,74182,CPT,,,,,both,,,4293.48,4293.48,Medicare,Medicare,,4293.48,,,4293.48,601.09,2189.67,Fee Schedule,Medicare APC Fee Schedule
MR-ABDOMEN W,74182,CPT,,,,,both,, ,4293.48,2576.08,Medicare,Medicare,,2576.08,,,4293.48,601.09,2189.67,Fee Schedule,Medicare APC Fee Schedule
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,718.24,,,1197.08,167.59,610.51,Fee Schedule,Medicare APC Fee Schedule
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,772.97,,,1288.29,180.36,657.03,Fee Schedule,Medicare APC Fee Schedule
MR-ABDOMEN WWO,74183,CPT,,,,,both,,,5197.81,5197.81,Medicare,Medicare,,5197.81,,,5197.81,727.69,2650.88,Fee Schedule,Medicare APC Fee Schedule
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,5197.81,3118.68,Medicare,Medicare,,3118.68,,,5197.81,727.69,2650.88,Fee Schedule,Medicare APC Fee Schedule
FL-ESOPHAGUS,74220,CPT,,,,,both,, ,1227.11,736.26,Medicare,Medicare,,736.26,,,1227.11,171.80,625.83,Fee Schedule,Medicare APC Fee Schedule
FL-MOD BA SWALLOW,74230,CPT,,,,,both,, ,391.26,234.75,Medicare,Medicare,,234.75,,,391.26,54.78,199.54,Fee Schedule,Medicare APC Fee Schedule
FL-GI SERIES,74240,CPT,,,,,both,, ,1557.58,934.54,Medicare,Medicare,,934.54,,,1557.58,218.06,794.37,Fee Schedule,Medicare APC Fee Schedule
FL-UPPER GI SINGLE,74240,CPT,,,,,both,, ,1818.77,1091.26,Medicare,Medicare,,1091.26,,,1818.77,254.63,927.57,Fee Schedule,Medicare APC Fee Schedule
FL-GI SERIES AIR,74246,CPT,,,,,both,, ,1500.93,900.55,Medicare,Medicare,,900.55,,,1500.93,210.13,765.47,Fee Schedule,Medicare APC Fee Schedule
FL-UPPER GI DOUBLE,74246,CPT,,,,,both,, ,1752.53,1051.51,Medicare,Medicare,,1051.51,,,1752.53,245.35,893.79,Fee Schedule,Medicare APC Fee Schedule
FL-LOWER GI FOLLOW,74248,CPT,,,,,both,, ,3343.68,2006.20,Medicare,Medicare,,2006.20,,,3343.68,468.12,1705.28,Fee Schedule,Medicare APC Fee Schedule
FL-SMALL BOWEL CR,74250,CPT,,,,,both,, ,2123.58,1274.14,Medicare,Medicare,,1274.14,,,2123.58,297.30,1083.03,Fee Schedule,Medicare APC Fee Schedule
FL-SM BWL ENT TBE CR,74251,CPT,,,,,both,, ,2123.58,1274.14,Medicare,Medicare,,1274.14,,,2123.58,297.30,1083.03,Fee Schedule,Medicare APC Fee Schedule
FL-BARIUM ENEMA,74270,CPT,,,,,both,, ,1890.90,1134.54,Medicare,Medicare,,1134.54,,,1890.90,264.73,964.36,Fee Schedule,Medicare APC Fee Schedule
FL-BARIUM ENEMA AIR,74280,CPT,,,,,both,, ,2333.25,1399.95,Medicare,Medicare,,1399.95,,,2333.25,326.66,1189.96,Fee Schedule,Medicare APC Fee Schedule
SU-CHOLE W GRAMS DR,74300,CPT,,,,,both,, ,1968.65,1181.19,Medicare,Medicare,,1181.19,,,1968.65,275.61,1004.01,Fee Schedule,Medicare APC Fee Schedule
FL-ENDO BILIARY,74328,CPT,,,,,both,, ,3722.58,2233.54,Medicare,Medicare,,2233.54,,,3722.58,521.16,1898.52,Fee Schedule,Medicare APC Fee Schedule
FL-ENDO PANCREATIC,74329,CPT,,,,,both,, ,1034.01,620.40,Medicare,Medicare,,620.40,,,1034.01,144.76,527.35,Fee Schedule,Medicare APC Fee Schedule
FL-ENDO BIL PANC,74330,CPT,,,,,both,, ,1304.29,782.57,Medicare,Medicare,,782.57,,,1304.29,182.60,665.19,Fee Schedule,Medicare APC Fee Schedule
FL-LONG GI TUBE PLC,74340,CPT,,,,,both,, ,1359.02,815.41,Medicare,Medicare,,815.41,,,1359.02,190.26,693.1,Fee Schedule,Medicare APC Fee Schedule
FL-ENTEROCLYSIS PLAC,74355,CPT,,,,,both,, ,932.40,559.44,Medicare,Medicare,,559.44,,,932.40,130.54,475.52,Fee Schedule,Medicare APC Fee Schedule
FL-IVP CR,74400,CPT,,,,,both,, ,1836.17,1101.70,Medicare,Medicare,,1101.70,,,1836.17,257.06,936.45,Fee Schedule,Medicare APC Fee Schedule
FL-UROGRAPH RETRO CR,74420,CPT,,,,,both,, ,2105.34,1263.20,Medicare,Medicare,,1263.20,,,2105.34,294.75,1073.72,Fee Schedule,Medicare APC Fee Schedule
FL-UROGRAPHY ANTE CR,74425,CPT,,,,,both,, ,2165.12,1299.07,Medicare,Medicare,,1299.07,,,2165.12,303.12,1104.21,Fee Schedule,Medicare APC Fee Schedule
FL-CYSTOGRM 3VPLS CR,74430,CPT,,,,,both,, ,1407.87,844.72,Medicare,Medicare,,844.72,,,1407.87,197.10,718.01,Fee Schedule,Medicare APC Fee Schedule
FL-CAVERNOSOGRAPH CR,74445,CPT,,,,,both,, ,698.32,418.99,Medicare,Medicare,,418.99,,,698.32,97.76,356.14,Fee Schedule,Medicare APC Fee Schedule
FL-UCG RETRO CR,74450,CPT,,,,,both,, ,1357.62,814.57,Medicare,Medicare,,814.57,,,1357.62,190.07,692.39,Fee Schedule,Medicare APC Fee Schedule
FL-UCG VOIDING,74455,CPT,,,,,both,, ,1357.62,814.57,Medicare,Medicare,,814.57,,,1357.62,190.07,692.39,Fee Schedule,Medicare APC Fee Schedule
FL-UCG VOIDING CR,74455,CPT,,,,,both,, ,1162.77,697.66,Medicare,Medicare,,697.66,,,1162.77,162.79,593.01,Fee Schedule,Medicare APC Fee Schedule
IR-DILATION GU,74485,CPT,,,,,both,, ,976.75,586.05,Medicare,Medicare,,586.05,,,976.75,136.75,498.14,Fee Schedule,Medicare APC Fee Schedule
IR-HYSTERSALPINGO CR,74740,CPT,,,,,both,,,1704.21,1704.21,Medicare,Medicare,,1704.21,,,1704.21,238.59,869.15,Fee Schedule,Medicare APC Fee Schedule
IR-HYSTERSALPINGO CR,74740,CPT,,,,,both,, ,1704.21,1022.52,Medicare,Medicare,,1022.52,,,1704.21,238.59,869.15,Fee Schedule,Medicare APC Fee Schedule
IR-HYSTERSALPINGOGRM,74740,CPT,,,,,both,,,1989.98,1989.98,Medicare,Medicare,,1989.98,,,1989.98,278.60,1014.89,Fee Schedule,Medicare APC Fee Schedule
IR-HYSTERSALPINGOGRM,74740,CPT,,,,,both,, ,1989.98,1193.98,Medicare,Medicare,,1193.98,,,1989.98,278.60,1014.89,Fee Schedule,Medicare APC Fee Schedule
IR-PERINEOGRAM CR,74775,CPT,,,,,both,, ,1991.67,1195.00,Medicare,Medicare,,1195.00,,,1991.67,278.83,1015.75,Fee Schedule,Medicare APC Fee Schedule
CT-HT ACC LV RV W,75573,CPT,,,,,both,, ,580.15,348.09,Medicare,Medicare,,348.09,,,580.15,81.22,295.88,Fee Schedule,Medicare APC Fee Schedule
CT-HT ACC LV RV W,75573,CPT,,,,,both,, ,1696.40,1017.84,Medicare,Medicare,,1017.84,,,1696.40,237.50,865.16,Fee Schedule,Medicare APC Fee Schedule
CT-HT CARD FUNC W,75574,CPT,,,,,both,, ,580.15,348.09,Medicare,Medicare,,348.09,,,580.15,81.22,295.88,Fee Schedule,Medicare APC Fee Schedule
CT-HT CARD FUNC W,75574,CPT,,,,,both,, ,1696.40,1017.84,Medicare,Medicare,,1017.84,,,1696.40,237.50,865.16,Fee Schedule,Medicare APC Fee Schedule
CATH-ABD AORTA SERIAL,75625,CPT,,,,,both,, ,8483.00,5089.80,Medicare,Medicare,,5089.80,,,8483.00,1187.62,4326.33,Fee Schedule,Medicare APC Fee Schedule
IR-ABD AORTA SERIAL,75625,CPT,,,,,both,, ,9523.86,5714.31,Medicare,Medicare,,5714.31,,,9523.86,1333.34,4857.17,Fee Schedule,Medicare APC Fee Schedule
CATH-AABF SERIAL     ,75630,CPT,,,,,both,, ,11199.75,6719.85,Medicare,Medicare,,6719.85,,,11199.75,1567.97,5711.87,Fee Schedule,Medicare APC Fee Schedule
IR-AABF SERIAL,75630,CPT,,,,,both,, ,12573.95,7544.37,Medicare,Medicare,,7544.37,,,12573.95,1760.35,6412.71,Fee Schedule,Medicare APC Fee Schedule
CTA-ABD ART W RUNOFF,75635,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,390.52,,,650.88,91.12,331.95,Fee Schedule,Medicare APC Fee Schedule
CTA-ABD ART W RUNOFF,75635,CPT,,,,,both,, ,2355.42,1413.25,Medicare,Medicare,,1413.25,,,2355.42,329.76,1201.26,Fee Schedule,Medicare APC Fee Schedule
CATH-ANGIO EXTREM UNI,75710,CPT,,,,,both,, ,7520.75,4512.45,Medicare,Medicare,,4512.45,,,7520.75,1052.91,3835.58,Fee Schedule,Medicare APC Fee Schedule
IR-ANGIO EXTREM UNI,75710,CPT,,,,,both,, ,8443.54,5066.12,Medicare,Medicare,,5066.12,,,8443.54,1182.10,4306.21,Fee Schedule,Medicare APC Fee Schedule
CATH-ANGIO EXTREM BI ,75716,CPT,,,,,both,, ,7520.75,4512.45,Medicare,Medicare,,4512.45,,,7520.75,1052.91,3835.58,Fee Schedule,Medicare APC Fee Schedule
IR-ANGIO EXTREM BI,75716,CPT,,,,,both,, ,8423.33,5053.99,Medicare,Medicare,,5053.99,,,8423.33,1179.27,4295.9,Fee Schedule,Medicare APC Fee Schedule
IR-ANGIO VISCERAL SE,75726,CPT,,,,,both,, ,13364.62,8018.77,Medicare,Medicare,,8018.77,,,13364.62,1871.05,6815.96,Fee Schedule,Medicare APC Fee Schedule
IR-ANG PULMONARY UNI,75741,CPT,,,,,both,, ,4237.35,2542.41,Medicare,Medicare,,2542.41,,,4237.35,593.23,2161.05,Fee Schedule,Medicare APC Fee Schedule
IR-ANG PULMONARY BI,75743,CPT,,,,,both,, ,12357.84,7414.70,Medicare,Medicare,,7414.70,,,12357.84,1730.10,6302.5,Fee Schedule,Medicare APC Fee Schedule
IR-SHUNTOGRAM,75809,CPT,,,,,both,, ,386.21,231.72,Medicare,Medicare,,231.72,,,386.21,54.07,196.97,Fee Schedule,Medicare APC Fee Schedule
CATH-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,7641.75,4585.05,Medicare,Medicare,,4585.05,,,7641.75,1069.85,3897.29,Fee Schedule,Medicare APC Fee Schedule
IR-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,8579.39,5147.63,Medicare,Medicare,,5147.63,,,8579.39,1201.11,4375.49,Fee Schedule,Medicare APC Fee Schedule
IR-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,8579.39,5147.63,Medicare,Medicare,,5147.63,,,8579.39,1201.11,4375.49,Fee Schedule,Medicare APC Fee Schedule
CATH-VENOGRAM EXT BI ,75822,CPT,,,,,both,, ,3510.00,2106.00,Medicare,Medicare,,2106.00,,,3510.00,491.40,1790.1,Fee Schedule,Medicare APC Fee Schedule
IR-VENOGRAM EXT BI,75822,CPT,,,,,both,, ,3940.68,2364.40,Medicare,Medicare,,2364.40,,,3940.68,551.70,2009.75,Fee Schedule,Medicare APC Fee Schedule
IR-VENACAVAGRAM INF,75825,CPT,,,,,both,, ,8923.22,5353.93,Medicare,Medicare,,5353.93,,,8923.22,1249.25,4550.84,Fee Schedule,Medicare APC Fee Schedule
IR-VENOUS SAMPL CATH,75893,CPT,,,,,both,, ,3915.41,2349.24,Medicare,Medicare,,2349.24,,,3915.41,548.16,1996.86,Fee Schedule,Medicare APC Fee Schedule
IR-ANGIO EXIST CATH,75898,CPT,,,,,both,, ,513.35,308.01,Medicare,Medicare,,308.01,,,513.35,71.87,261.81,Fee Schedule,Medicare APC Fee Schedule
IR-DRAIN TUBE CHANGE,75984,CPT,,,,,both,, ,2098.33,1258.99,Medicare,Medicare,,1258.99,,,2098.33,293.77,1070.15,Fee Schedule,Medicare APC Fee Schedule
CT-ABSC DRN CATH PLA,75989,CPT,,,,,both,, ,2649.01,1589.40,Medicare,Medicare,,1589.40,,,2649.01,370.86,1351,Fee Schedule,Medicare APC Fee Schedule
US-ABSC DRN CATH PLA,75989,CPT,,,,,both,, ,1120.45,672.27,Medicare,Medicare,,672.27,,,1120.45,156.86,571.43,Fee Schedule,Medicare APC Fee Schedule
FL-FLUORO 1 HOUR,76000,CPT,,,,,both,, ,553.77,332.26,Medicare,Medicare,,332.26,,,553.77,77.53,282.42,Fee Schedule,Medicare APC Fee Schedule
FL-FLUORO 1 HOUR CR,76000,CPT,,,,,both,, ,474.31,284.58,Medicare,Medicare,,284.58,,,474.31,66.40,241.9,Fee Schedule,Medicare APC Fee Schedule
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,756.41,453.84,Medicare,Medicare,,453.84,,,756.41,105.90,385.77,Fee Schedule,Medicare APC Fee Schedule
IR-FISTULOGRAM CR,76080,CPT,,,,,both,, ,758.66,455.19,Medicare,Medicare,,455.19,,,758.66,106.21,386.92,Fee Schedule,Medicare APC Fee Schedule
EXAM SURG SPECMN CR,76098,CPT,,,,,both,, ,1190.34,714.20,Medicare,Medicare,,714.20,,,1190.34,166.65,607.07,Fee Schedule,Medicare APC Fee Schedule
TOMOGRAM ONE PLNE CR,76100,CPT,,,,,both,, ,2030.12,1218.07,Medicare,Medicare,,1218.07,,,2030.12,284.22,1035.36,Fee Schedule,Medicare APC Fee Schedule
CT-3D W POSTPROCESS,76377,CPT,,,,,both,, ,528.50,317.10,Medicare,Medicare,,317.10,,,528.50,73.99,269.54,Fee Schedule,Medicare APC Fee Schedule
CT-3D W POSTPROCESS,76377,CPT,,,,,both,, ,536.93,322.15,Medicare,Medicare,,322.15,,,536.93,75.17,273.83,Fee Schedule,Medicare APC Fee Schedule
MR-3D W POSTPROCESS,76377,CPT,,,,,both,, ,491.18,294.70,Medicare,Medicare,,294.70,,,491.18,68.77,250.5,Fee Schedule,Medicare APC Fee Schedule
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,193.10,115.86,Medicare,Medicare,,115.86,,,193.10,27.03,98.48,Fee Schedule,Medicare APC Fee Schedule
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,207.98,124.78,Medicare,Medicare,,124.78,,,207.98,29.12,106.07,Fee Schedule,Medicare APC Fee Schedule
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,724.14,434.48,Medicare,Medicare,,434.48,,,724.14,101.38,369.31,Fee Schedule,Medicare APC Fee Schedule
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,,,2030.68,2030.68,Medicare,Medicare,,2030.68,,,2030.68,284.30,1035.65,Fee Schedule,Medicare APC Fee Schedule
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,2030.68,1218.40,Medicare,Medicare,,1218.40,,,2030.68,284.30,1035.65,Fee Schedule,Medicare APC Fee Schedule
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,1602.93,961.75,Medicare,Medicare,,961.75,,,1602.93,224.41,817.49,Fee Schedule,Medicare APC Fee Schedule
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,218.64,131.18,Medicare,Medicare,,131.18,,,218.64,30.61,111.51,Fee Schedule,Medicare APC Fee Schedule
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,218.64,131.18,Medicare,Medicare,,131.18,,,218.64,30.61,111.51,Fee Schedule,Medicare APC Fee Schedule
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,1680.12,1008.07,Medicare,Medicare,,1008.07,,,1680.12,235.22,856.86,Fee Schedule,Medicare APC Fee Schedule
US-BREAST LIMITED,76642,CPT,,,,,both,, ,218.64,131.18,Medicare,Medicare,,131.18,,,218.64,30.61,111.51,Fee Schedule,Medicare APC Fee Schedule
US-BREAST LIMITED,76642,CPT,,,,,both,, ,218.64,131.18,Medicare,Medicare,,131.18,,,218.64,30.61,111.51,Fee Schedule,Medicare APC Fee Schedule
US-BREAST LIMITED,76642,CPT,,,,,both,,,1680.12,1680.12,Medicare,Medicare,,1680.12,,,1680.12,235.22,856.86,Fee Schedule,Medicare APC Fee Schedule
US-BREAST LIMITED,76642,CPT,,,,,both,, ,1680.12,1008.07,Medicare,Medicare,,1008.07,,,1680.12,235.22,856.86,Fee Schedule,Medicare APC Fee Schedule
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,437.29,262.37,Medicare,Medicare,,262.37,,,437.29,61.22,223.02,Fee Schedule,Medicare APC Fee Schedule
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,437.29,262.37,Medicare,Medicare,,262.37,,,437.29,61.22,223.02,Fee Schedule,Medicare APC Fee Schedule
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,3359.95,2015.97,Medicare,Medicare,,2015.97,,,3359.95,470.39,1713.57,Fee Schedule,Medicare APC Fee Schedule
Ultrasound of abdomen,76700,CPT,,,,,both,,,2330.73,2330.73,Medicare,Medicare,,2330.73,,,2330.73,326.30,1188.67,Fee Schedule,Medicare APC Fee Schedule
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,2330.73,1398.43,Medicare,Medicare,,1398.43,,,2330.73,326.30,1188.67,Fee Schedule,Medicare APC Fee Schedule
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-ABDOMEN LTD WO,76705,CPT,,,,,both,,,1908.87,1908.87,Medicare,Medicare,,1908.87,,,1908.87,267.24,973.52,Fee Schedule,Medicare APC Fee Schedule
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,1908.87,1145.32,Medicare,Medicare,,1145.32,,,1908.87,267.24,973.52,Fee Schedule,Medicare APC Fee Schedule
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-ABDOMEN RETROPER,76770,CPT,,,,,both,,,2030.68,2030.68,Medicare,Medicare,,2030.68,,,2030.68,284.30,1035.65,Fee Schedule,Medicare APC Fee Schedule
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,2030.68,1218.40,Medicare,Medicare,,1218.40,,,2030.68,284.30,1035.65,Fee Schedule,Medicare APC Fee Schedule
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,,,1965.00,1965.00,Medicare,Medicare,,1965.00,,,1965.00,275.10,1002.15,Fee Schedule,Medicare APC Fee Schedule
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,1965.00,1179.00,Medicare,Medicare,,1179.00,,,1965.00,275.10,1002.15,Fee Schedule,Medicare APC Fee Schedule
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-PELV PREG 14 WKS,76801,CPT,,,,,both,,,813.67,813.67,Medicare,Medicare,,813.67,,,813.67,113.91,414.97,Fee Schedule,Medicare APC Fee Schedule
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,813.67,488.20,Medicare,Medicare,,488.20,,,813.67,113.91,414.97,Fee Schedule,Medicare APC Fee Schedule
US-PLV PRG 14 WKS AD,76802,CPT,,,,,both,, ,329.51,197.70,Medicare,Medicare,,197.70,,,329.51,46.13,168.05,Fee Schedule,Medicare APC Fee Schedule
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,76805,CPT,,,,,both,,,1931.60,1931.60,Medicare,Medicare,,1931.60,,,1931.60,270.42,985.12,Fee Schedule,Medicare APC Fee Schedule
US-PELVIS PREG,76805,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
US-PELVIS PREG,76805,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-PELVIS PREG,76805,CPT,,,,,both,, ,1931.60,1158.96,Medicare,Medicare,,1158.96,,,1931.60,270.42,985.12,Fee Schedule,Medicare APC Fee Schedule
US-PELVS PREG GESADD,76810,CPT,,,,,both,, ,329.51,197.70,Medicare,Medicare,,197.70,,,329.51,46.13,168.05,Fee Schedule,Medicare APC Fee Schedule
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,577.00,346.20,Medicare,Medicare,,346.20,,,577.00,80.78,294.27,Fee Schedule,Medicare APC Fee Schedule
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,647.80,388.68,Medicare,Medicare,,388.68,,,647.80,90.69,330.38,Fee Schedule,Medicare APC Fee Schedule
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,218.64,131.18,Medicare,Medicare,,131.18,,,218.64,30.61,111.51,Fee Schedule,Medicare APC Fee Schedule
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,235.48,141.28,Medicare,Medicare,,141.28,,,235.48,32.97,120.09,Fee Schedule,Medicare APC Fee Schedule
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,647.80,388.68,Medicare,Medicare,,388.68,,,647.80,90.69,330.38,Fee Schedule,Medicare APC Fee Schedule
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-PLV PRG TRNSV,76817,CPT,,,,,both,,,655.09,655.09,Medicare,Medicare,,655.09,,,655.09,91.71,334.1,Fee Schedule,Medicare APC Fee Schedule
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,655.09,393.05,Medicare,Medicare,,393.05,,,655.09,91.71,334.1,Fee Schedule,Medicare APC Fee Schedule
US-FETAL BIO W NST,76818,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-FETAL BIO W NST,76818,CPT,,,,,both,, ,1198.20,718.92,Medicare,Medicare,,718.92,,,1198.20,167.75,611.08,Fee Schedule,Medicare APC Fee Schedule
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,793.18,475.90,Medicare,Medicare,,475.90,,,793.18,111.05,404.52,Fee Schedule,Medicare APC Fee Schedule
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,218.64,131.18,Medicare,Medicare,,131.18,,,218.64,30.61,111.51,Fee Schedule,Medicare APC Fee Schedule
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,235.48,141.28,Medicare,Medicare,,141.28,,,235.48,32.97,120.09,Fee Schedule,Medicare APC Fee Schedule
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,780.55,468.33,Medicare,Medicare,,468.33,,,780.55,109.28,398.08,Fee Schedule,Medicare APC Fee Schedule
Ultrasound pelvis through vagina,76830,CPT,,,,,both,,,689.62,689.62,Medicare,Medicare,,689.62,,,689.62,96.55,351.71,Fee Schedule,Medicare APC Fee Schedule
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,689.62,413.77,Medicare,Medicare,,413.77,,,689.62,96.55,351.71,Fee Schedule,Medicare APC Fee Schedule
US-PELVIS NON OB,76856,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
US-PELVIS NON OB,76856,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-PELVIS NON OB,76856,CPT,,,,,both,,,1931.60,1931.60,Medicare,Medicare,,1931.60,,,1931.60,270.42,985.12,Fee Schedule,Medicare APC Fee Schedule
US-PELVIS NON OB,76856,CPT,,,,,both,, ,1931.60,1158.96,Medicare,Medicare,,1158.96,,,1931.60,270.42,985.12,Fee Schedule,Medicare APC Fee Schedule
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,209.94,125.96,Medicare,Medicare,,125.96,,,209.94,29.39,107.07,Fee Schedule,Medicare APC Fee Schedule
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,209.94,125.96,Medicare,Medicare,,125.96,,,209.94,29.39,107.07,Fee Schedule,Medicare APC Fee Schedule
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,437.29,262.37,Medicare,Medicare,,262.37,,,437.29,61.22,223.02,Fee Schedule,Medicare APC Fee Schedule
US-SCROTUM,76870,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
US-SCROTUM,76870,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-SCROTUM,76870,CPT,,,,,both,,,2005.70,2005.70,Medicare,Medicare,,2005.70,,,2005.70,280.80,1022.91,Fee Schedule,Medicare APC Fee Schedule
US-SCROTUM,76870,CPT,,,,,both,, ,2005.70,1203.42,Medicare,Medicare,,1203.42,,,2005.70,280.80,1022.91,Fee Schedule,Medicare APC Fee Schedule
US-TRANSRECTAL,76872,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
US-TRANSRECTAL,76872,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-TRANSRECTAL,76872,CPT,,,,,both,, ,1300.09,780.05,Medicare,Medicare,,780.05,,,1300.09,182.01,663.05,Fee Schedule,Medicare APC Fee Schedule
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,378.35,227.01,Medicare,Medicare,,227.01,,,378.35,52.97,192.96,Fee Schedule,Medicare APC Fee Schedule
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,189.17,113.50,Medicare,Medicare,,113.50,,,189.17,26.48,96.48,Fee Schedule,Medicare APC Fee Schedule
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,218.64,131.18,Medicare,Medicare,,131.18,,,218.64,30.61,111.51,Fee Schedule,Medicare APC Fee Schedule
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,235.48,141.28,Medicare,Medicare,,141.28,,,235.48,32.97,120.09,Fee Schedule,Medicare APC Fee Schedule
NI-VAS ACCSS SITES,76937,CPT,,,,,both,, ,797.67,478.60,Medicare,Medicare,,478.60,,,797.67,111.67,406.81,Fee Schedule,Medicare APC Fee Schedule
NI-VAS ACCSS SITES ,76937,CPT,,,,,both,, ,710.50,426.30,Medicare,Medicare,,426.30,,,710.50,99.47,362.36,Fee Schedule,Medicare APC Fee Schedule
US-GUIDE NEEDLE PLAC,76942,CPT,,,,,both,, ,2221.26,1332.75,Medicare,Medicare,,1332.75,,,2221.26,310.98,1132.84,Fee Schedule,Medicare APC Fee Schedule
US-GUIDE AMNIOCENT,76946,CPT,,,,,both,, ,2221.26,1332.75,Medicare,Medicare,,1332.75,,,2221.26,310.98,1132.84,Fee Schedule,Medicare APC Fee Schedule
US-GUIDE INTRAOPERAT,76998,CPT,,,,,both,, ,604.57,362.74,Medicare,Medicare,,362.74,,,604.57,84.64,308.33,Fee Schedule,Medicare APC Fee Schedule
FL-FLUORO CVAD ANY,77001,CPT,,,,,both,, ,1968.65,1181.19,Medicare,Medicare,,1181.19,,,1968.65,275.61,1004.01,Fee Schedule,Medicare APC Fee Schedule
FL-NEDL GUIDE FLUORO,77002,CPT,,,,,both,, ,521.21,312.72,Medicare,Medicare,,312.72,,,521.21,72.97,265.82,Fee Schedule,Medicare APC Fee Schedule
FL-FLUORO GUIDE SPIN,77003,CPT,,,,,both,, ,553.77,332.26,Medicare,Medicare,,332.26,,,553.77,77.53,282.42,Fee Schedule,Medicare APC Fee Schedule
CT-GUIDE NEEDLE BX,77012,CPT,,,,,both,, ,2649.01,1589.40,Medicare,Medicare,,1589.40,,,2649.01,370.86,1351,Fee Schedule,Medicare APC Fee Schedule
CT-GUIDE TISSUE ABLA,77013,CPT,,,,,both,, ,3157.31,1894.38,Medicare,Medicare,,1894.38,,,3157.31,442.02,1610.23,Fee Schedule,Medicare APC Fee Schedule
MR-BREAST UNI WO,77046,CPT,,,,,both,, ,674.73,404.83,Medicare,Medicare,,404.83,,,674.73,94.46,344.11,Fee Schedule,Medicare APC Fee Schedule
MR-BREAST BIL WO,77047,CPT,,,,,both,, ,674.73,404.83,Medicare,Medicare,,404.83,,,674.73,94.46,344.11,Fee Schedule,Medicare APC Fee Schedule
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,772.13,463.27,Medicare,Medicare,,463.27,,,772.13,108.10,393.79,Fee Schedule,Medicare APC Fee Schedule
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,830.80,498.48,Medicare,Medicare,,498.48,,,830.80,116.31,423.71,Fee Schedule,Medicare APC Fee Schedule
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,1469.05,881.43,Medicare,Medicare,,881.43,,,1469.05,205.67,749.22,Fee Schedule,Medicare APC Fee Schedule
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,772.13,463.27,Medicare,Medicare,,463.27,,,772.13,108.10,393.79,Fee Schedule,Medicare APC Fee Schedule
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,830.80,498.48,Medicare,Medicare,,498.48,,,830.80,116.31,423.71,Fee Schedule,Medicare APC Fee Schedule
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,1889.78,1133.86,Medicare,Medicare,,1133.86,,,1889.78,264.57,963.79,Fee Schedule,Medicare APC Fee Schedule
BR-TOMO MAMM SCR BI,77063,CPT,,,,,both,,,107.12,107.12,Medicare,Medicare,,107.12,,,107.12,15.00,54.63,Fee Schedule,Medicare APC Fee Schedule
BR-TOMO MAMM SCR BI,77063,CPT,,,,,both,, ,107.12,64.27,Medicare,Medicare,,64.27,,,107.12,15.00,54.63,Fee Schedule,Medicare APC Fee Schedule
BR-TOMO MAMM SCR UNI,77063,CPT,,,,,both,, ,80.34,48.20,Medicare,Medicare,,48.20,,,80.34,11.25,40.97,Fee Schedule,Medicare APC Fee Schedule
BR-TOMOSYN SCR AD BI,77063,CPT,,,,,both,, ,100.00,60.00,Medicare,Medicare,,60.00,,,100.00,14.00,51,Fee Schedule,Medicare APC Fee Schedule
BR-DIG MAMMO UNI GG,77065,CPT,,,,,both,, ,411.49,246.89,Medicare,Medicare,,246.89,,,411.49,57.61,209.86,Fee Schedule,Medicare APC Fee Schedule
BR-DIG MAMMO UNI GG,77065,CPT,,,,,both,, ,411.49,246.89,Medicare,Medicare,,246.89,,,411.49,57.61,209.86,Fee Schedule,Medicare APC Fee Schedule
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,439.55,263.73,Medicare,Medicare,,263.73,,,439.55,61.54,224.17,Fee Schedule,Medicare APC Fee Schedule
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,448.82,269.29,Medicare,Medicare,,269.29,,,448.82,62.83,228.9,Fee Schedule,Medicare APC Fee Schedule
Mammography of one breast,77065,CPT,,,,,both,,,448.82,448.82,Medicare,Medicare,,448.82,,,448.82,62.83,228.9,Fee Schedule,Medicare APC Fee Schedule
BR-DIG MAMMO BI GG,77066,CPT,,,,,both,, ,411.49,246.89,Medicare,Medicare,,246.89,,,411.49,57.61,209.86,Fee Schedule,Medicare APC Fee Schedule
BR-DIG MAMMO BI GG,77066,CPT,,,,,both,, ,411.49,246.89,Medicare,Medicare,,246.89,,,411.49,57.61,209.86,Fee Schedule,Medicare APC Fee Schedule
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,439.55,263.73,Medicare,Medicare,,263.73,,,439.55,61.54,224.17,Fee Schedule,Medicare APC Fee Schedule
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,556.97,334.18,Medicare,Medicare,,334.18,,,556.97,77.98,284.05,Fee Schedule,Medicare APC Fee Schedule
Mammography of both breasts,77066,CPT,,,,,both,,,556.97,556.97,Medicare,Medicare,,556.97,,,556.97,77.98,284.05,Fee Schedule,Medicare APC Fee Schedule
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,368.23,220.93,Medicare,Medicare,,220.93,,,368.23,51.55,187.8,Fee Schedule,Medicare APC Fee Schedule
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,488.99,293.39,Medicare,Medicare,,293.39,,,488.99,68.46,249.38,Fee Schedule,Medicare APC Fee Schedule
BR-DIG MAMMO SCRN UN,77067,CPT,,,,,both,, ,345.31,207.18,Medicare,Medicare,,207.18,,,345.31,48.34,176.11,Fee Schedule,Medicare APC Fee Schedule
BR-DIG MAMMO SCRN UN,77067,CPT,,,,,both,, ,345.31,207.18,Medicare,Medicare,,207.18,,,345.31,48.34,176.11,Fee Schedule,Medicare APC Fee Schedule
BR-DIG MAMMO SCRN UN,77067,CPT,,,,,both,, ,366.68,220.00,Medicare,Medicare,,220.00,,,366.68,51.34,187.01,Fee Schedule,Medicare APC Fee Schedule
"Mammography, screening, bilateral",77067,CPT,,,,,both,,,488.99,488.99,Medicare,Medicare,,488.99,,,488.99,68.46,249.38,Fee Schedule,Medicare APC Fee Schedule
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
BONE AGE STUDY CR,77072,CPT,,,,,both,,,721.61,721.61,Medicare,Medicare,,721.61,,,721.61,101.03,368.02,Fee Schedule,Medicare APC Fee Schedule
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,721.61,432.96,Medicare,Medicare,,432.96,,,721.61,101.03,368.02,Fee Schedule,Medicare APC Fee Schedule
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
BONE LENGTH STUDY CR,77073,CPT,,,,,both,,,1904.10,1904.10,Medicare,Medicare,,1904.10,,,1904.10,266.57,971.09,Fee Schedule,Medicare APC Fee Schedule
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,1904.10,1142.46,Medicare,Medicare,,1142.46,,,1904.10,266.57,971.09,Fee Schedule,Medicare APC Fee Schedule
BNE SRVY LTD METS CR,77074,CPT,,,,,both,,,523.46,523.46,Medicare,Medicare,,523.46,,,523.46,73.28,266.96,Fee Schedule,Medicare APC Fee Schedule
BNE SRVY LTD METS CR,77074,CPT,,,,,both,, ,523.46,314.07,Medicare,Medicare,,314.07,,,523.46,73.28,266.96,Fee Schedule,Medicare APC Fee Schedule
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,132.36,,,220.61,30.89,112.51,Fee Schedule,Medicare APC Fee Schedule
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
BNE SRVY CMP METS CR,77075,CPT,,,,,both,,,418.20,418.20,Medicare,Medicare,,418.20,,,418.20,58.55,213.28,Fee Schedule,Medicare APC Fee Schedule
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,418.20,250.92,Medicare,Medicare,,250.92,,,418.20,58.55,213.28,Fee Schedule,Medicare APC Fee Schedule
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,132.36,,,220.61,30.89,112.51,Fee Schedule,Medicare APC Fee Schedule
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,142.47,,,237.45,33.24,121.1,Fee Schedule,Medicare APC Fee Schedule
BONE SRVY INFANT CR,77076,CPT,,,,,both,,,833.32,833.32,Medicare,Medicare,,833.32,,,833.32,116.66,424.99,Fee Schedule,Medicare APC Fee Schedule
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,833.32,499.99,Medicare,Medicare,,499.99,,,833.32,116.66,424.99,Fee Schedule,Medicare APC Fee Schedule
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
JOINT SURVEY 1V CR,77077,CPT,,,,,both,,,1387.37,1387.37,Medicare,Medicare,,1387.37,,,1387.37,194.23,707.56,Fee Schedule,Medicare APC Fee Schedule
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,1387.37,832.42,Medicare,Medicare,,832.42,,,1387.37,194.23,707.56,Fee Schedule,Medicare APC Fee Schedule
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,218.93,131.35,Medicare,Medicare,,131.35,,,218.93,30.65,111.65,Fee Schedule,Medicare APC Fee Schedule
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,235.77,141.46,Medicare,Medicare,,141.46,,,235.77,33.01,120.24,Fee Schedule,Medicare APC Fee Schedule
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,613.55,368.13,Medicare,Medicare,,368.13,,,613.55,85.90,312.91,Fee Schedule,Medicare APC Fee Schedule
DEXA AXIAL,77080,CPT,,,,,both,, ,218.93,131.35,Medicare,Medicare,,131.35,,,218.93,30.65,111.65,Fee Schedule,Medicare APC Fee Schedule
DEXA AXIAL,77080,CPT,,,,,both,, ,235.77,141.46,Medicare,Medicare,,141.46,,,235.77,33.01,120.24,Fee Schedule,Medicare APC Fee Schedule
DEXA AXIAL,77080,CPT,,,,,both,,,430.83,430.83,Medicare,Medicare,,430.83,,,430.83,60.32,219.72,Fee Schedule,Medicare APC Fee Schedule
DEXA AXIAL,77080,CPT,,,,,both,, ,430.83,258.49,Medicare,Medicare,,258.49,,,430.83,60.32,219.72,Fee Schedule,Medicare APC Fee Schedule
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,83.52,,,139.21,19.49,71,Fee Schedule,Medicare APC Fee Schedule
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,89.92,,,149.88,20.98,76.44,Fee Schedule,Medicare APC Fee Schedule
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,266.91,160.14,Medicare,Medicare,,160.14,,,266.91,37.37,136.12,Fee Schedule,Medicare APC Fee Schedule
NM-THYR UPT S-M-SUPP,78012,CPT,,,,,both,, ,1025.37,615.22,Medicare,Medicare,,615.22,,,1025.37,143.55,522.94,Fee Schedule,Medicare APC Fee Schedule
NM-THYROID IMG W-BF,78013,CPT,,,,,both,, ,1365.27,819.16,Medicare,Medicare,,819.16,,,1365.27,191.14,696.29,Fee Schedule,Medicare APC Fee Schedule
NM-THY UPT IMG W-BF,78014,CPT,,,,,both,, ,1719.59,1031.75,Medicare,Medicare,,1031.75,,,1719.59,240.74,876.99,Fee Schedule,Medicare APC Fee Schedule
NM-PAR PLAN THY IMG,78070,CPT,,,,,both,, ,1365.27,819.16,Medicare,Medicare,,819.16,,,1365.27,191.14,696.29,Fee Schedule,Medicare APC Fee Schedule
NM-PARA PLN IMG SPEC,78071,CPT,,,,,both,, ,1884.64,1130.78,Medicare,Medicare,,1130.78,,,1884.64,263.85,961.17,Fee Schedule,Medicare APC Fee Schedule
NM-PAR PL IMG SPE CT,78072,CPT,,,,,both,, ,1884.64,1130.78,Medicare,Medicare,,1130.78,,,1884.64,263.85,961.17,Fee Schedule,Medicare APC Fee Schedule
NM-ADRENAL IMAGING,78075,CPT,,,,,both,, ,5329.74,3197.84,Medicare,Medicare,,3197.84,,,5329.74,746.16,2718.17,Fee Schedule,Medicare APC Fee Schedule
NM-BONE MARROW LMTD,78102,CPT,,,,,both,, ,1409.30,845.58,Medicare,Medicare,,845.58,,,1409.30,197.30,718.74,Fee Schedule,Medicare APC Fee Schedule
NM-BONE MARROW MULT,78103,CPT,,,,,both,, ,1409.30,845.58,Medicare,Medicare,,845.58,,,1409.30,197.30,718.74,Fee Schedule,Medicare APC Fee Schedule
NM-BONE MARROW BODY,78104,CPT,,,,,both,, ,1409.30,845.58,Medicare,Medicare,,845.58,,,1409.30,197.30,718.74,Fee Schedule,Medicare APC Fee Schedule
NM-LYMPHATICS NODES,78195,CPT,,,,,both,, ,4917.74,2950.64,Medicare,Medicare,,2950.64,,,4917.74,688.48,2508.05,Fee Schedule,Medicare APC Fee Schedule
NM-LIVER,78201,CPT,,,,,both,, ,3830.06,2298.03,Medicare,Medicare,,2298.03,,,3830.06,536.21,1953.33,Fee Schedule,Medicare APC Fee Schedule
NM-LIVER AND SPLEEN,78215,CPT,,,,,both,, ,3830.06,2298.03,Medicare,Medicare,,2298.03,,,3830.06,536.21,1953.33,Fee Schedule,Medicare APC Fee Schedule
NM-HEPATOBILIARY SYS,78226,CPT,,,,,both,, ,4088.59,2453.15,Medicare,Medicare,,2453.15,,,4088.59,572.40,2085.18,Fee Schedule,Medicare APC Fee Schedule
NM-HEPATOBIL W PHARM,78227,CPT,,,,,both,,,4088.59,4088.59,Medicare,Medicare,,4088.59,,,4088.59,572.40,2085.18,Fee Schedule,Medicare APC Fee Schedule
NM-HEPATOBIL W PHARM,78227,CPT,,,,,both,, ,4088.59,2453.15,Medicare,Medicare,,2453.15,,,4088.59,572.40,2085.18,Fee Schedule,Medicare APC Fee Schedule
NM-GI REFLUX,78262,CPT,,,,,both,, ,3415.74,2049.44,Medicare,Medicare,,2049.44,,,3415.74,478.20,1742.03,Fee Schedule,Medicare APC Fee Schedule
NM-GASTRIC EMPTYING,78264,CPT,,,,,both,,,3415.74,3415.74,Medicare,Medicare,,3415.74,,,3415.74,478.20,1742.03,Fee Schedule,Medicare APC Fee Schedule
NM-GASTRIC EMPTYING,78264,CPT,,,,,both,, ,3415.74,2049.44,Medicare,Medicare,,2049.44,,,3415.74,478.20,1742.03,Fee Schedule,Medicare APC Fee Schedule
NM-GAST EMPT SM BWL,78265,CPT,,,,,both,, ,1543.71,926.22,Medicare,Medicare,,926.22,,,1543.71,216.12,787.29,Fee Schedule,Medicare APC Fee Schedule
NM-GE SM BWL CLN MUL,78266,CPT,,,,,both,, ,2046.87,1228.12,Medicare,Medicare,,1228.12,,,2046.87,286.56,1043.9,Fee Schedule,Medicare APC Fee Schedule
NM-GI BLOOD LOSS,78278,CPT,,,,,both,, ,3415.74,2049.44,Medicare,Medicare,,2049.44,,,3415.74,478.20,1742.03,Fee Schedule,Medicare APC Fee Schedule
NM-MECKELS SCAN,78290,CPT,,,,,both,, ,3576.68,2146.00,Medicare,Medicare,,2146.00,,,3576.68,500.74,1824.11,Fee Schedule,Medicare APC Fee Schedule
NM-BONE SCAN LMTD,78300,CPT,,,,,both,, ,2526.59,1515.95,Medicare,Medicare,,1515.95,,,2526.59,353.72,1288.56,Fee Schedule,Medicare APC Fee Schedule
NM-BONE SCAN MULTI,78305,CPT,,,,,both,, ,2526.59,1515.95,Medicare,Medicare,,1515.95,,,2526.59,353.72,1288.56,Fee Schedule,Medicare APC Fee Schedule
NM-BONE SCAN BODY,78306,CPT,,,,,both,,,3512.04,3512.04,Medicare,Medicare,,3512.04,,,3512.04,491.69,1791.14,Fee Schedule,Medicare APC Fee Schedule
NM-BONE SCAN BODY,78306,CPT,,,,,both,, ,3512.04,2107.22,Medicare,Medicare,,2107.22,,,3512.04,491.69,1791.14,Fee Schedule,Medicare APC Fee Schedule
NM-BONE SCAN 3 PHASE,78315,CPT,,,,,both,,,2911.81,2911.81,Medicare,Medicare,,2911.81,,,2911.81,407.65,1485.02,Fee Schedule,Medicare APC Fee Schedule
NM-BONE SCAN 3 PHASE,78315,CPT,,,,,both,, ,2911.81,1747.08,Medicare,Medicare,,1747.08,,,2911.81,407.65,1485.02,Fee Schedule,Medicare APC Fee Schedule
NM-VASCULAR FLOW,78445,CPT,,,,,both,, ,1719.84,1031.90,Medicare,Medicare,,1031.90,,,1719.84,240.78,877.12,Fee Schedule,Medicare APC Fee Schedule
NM-MYOCRD SPECT SNGL,78451,CPT,,,,,both,, ,3741.73,2245.03,Medicare,Medicare,,2245.03,,,3741.73,523.84,1908.28,Fee Schedule,Medicare APC Fee Schedule
NM-MYOCRD SPECT MULT,78452,CPT,,,,,both,,,7071.47,7071.47,Medicare,Medicare,,7071.47,,,7071.47,990.01,3606.45,Fee Schedule,Medicare APC Fee Schedule
NM-MYOCRD SPECT MULT,78452,CPT,,,,,both,, ,7071.47,4242.88,Medicare,Medicare,,4242.88,,,7071.47,990.01,3606.45,Fee Schedule,Medicare APC Fee Schedule
NM-MYOCARD SINGLE,78453,CPT,,,,,both,, ,4803.15,2881.89,Medicare,Medicare,,2881.89,,,4803.15,672.44,2449.61,Fee Schedule,Medicare APC Fee Schedule
NM-MYOCARD INFARCT,78466,CPT,,,,,both,, ,3415.74,2049.44,Medicare,Medicare,,2049.44,,,3415.74,478.20,1742.03,Fee Schedule,Medicare APC Fee Schedule
NM-MYOCARD INF SPECT,78469,CPT,,,,,both,, ,3184.50,1910.70,Medicare,Medicare,,1910.70,,,3184.50,445.83,1624.1,Fee Schedule,Medicare APC Fee Schedule
NM-GATED BLD POOL SN,78472,CPT,,,,,both,, ,3415.74,2049.44,Medicare,Medicare,,2049.44,,,3415.74,478.20,1742.03,Fee Schedule,Medicare APC Fee Schedule
NM-LUNG VENT IMAGING,78579,CPT,,,,,both,,,4088.59,4088.59,Medicare,Medicare,,4088.59,,,4088.59,572.40,2085.18,Fee Schedule,Medicare APC Fee Schedule
NM-LUNG VENT IMAGING,78579,CPT,,,,,both,, ,4088.59,2453.15,Medicare,Medicare,,2453.15,,,4088.59,572.40,2085.18,Fee Schedule,Medicare APC Fee Schedule
NM-LUNG PERF PARTICU,78580,CPT,,,,,both,, ,3590.32,2154.19,Medicare,Medicare,,2154.19,,,3590.32,502.64,1831.06,Fee Schedule,Medicare APC Fee Schedule
NM-LUNG VENT PERFUS,78582,CPT,,,,,both,,,6243.60,6243.60,Medicare,Medicare,,6243.60,,,6243.60,874.10,3184.24,Fee Schedule,Medicare APC Fee Schedule
NM-LUNG VENT PERFUS,78582,CPT,,,,,both,, ,6243.60,3746.16,Medicare,Medicare,,3746.16,,,6243.60,874.10,3184.24,Fee Schedule,Medicare APC Fee Schedule
NM-LUNG PERFVENT DIF,78598,CPT,,,,,both,, ,8897.66,5338.59,Medicare,Medicare,,5338.59,,,8897.66,1245.67,4537.81,Fee Schedule,Medicare APC Fee Schedule
NM-BRAIN CSF CISTERN,78630,CPT,,,,,both,, ,1616.07,969.64,Medicare,Medicare,,969.64,,,1616.07,226.25,824.2,Fee Schedule,Medicare APC Fee Schedule
NM-KIDNEY STATIC,78700,CPT,,,,,both,, ,3590.32,2154.19,Medicare,Medicare,,2154.19,,,3590.32,502.64,1831.06,Fee Schedule,Medicare APC Fee Schedule
NM-KIDNEY STATIC FLO,78701,CPT,,,,,both,, ,4802.63,2881.57,Medicare,Medicare,,2881.57,,,4802.63,672.37,2449.34,Fee Schedule,Medicare APC Fee Schedule
NM-KIDNEY VF NO PHRM,78707,CPT,,,,,both,, ,4802.63,2881.57,Medicare,Medicare,,2881.57,,,4802.63,672.37,2449.34,Fee Schedule,Medicare APC Fee Schedule
NM-KID VF PHRM SNGL,78708,CPT,,,,,both,, ,4802.63,2881.57,Medicare,Medicare,,2881.57,,,4802.63,672.37,2449.34,Fee Schedule,Medicare APC Fee Schedule
NM-KIDNEY FUNCTION,78725,CPT,,,,,both,, ,617.74,370.64,Medicare,Medicare,,370.64,,,617.74,86.48,315.05,Fee Schedule,Medicare APC Fee Schedule
NM-URIN BLDDR REFLUX,78740,CPT,,,,,both,, ,3590.32,2154.19,Medicare,Medicare,,2154.19,,,3590.32,502.64,1831.06,Fee Schedule,Medicare APC Fee Schedule
NM-TUMOR LOC LMTD,78800,CPT,,,,,both,, ,4590.83,2754.49,Medicare,Medicare,,2754.49,,,4590.83,642.72,2341.32,Fee Schedule,Medicare APC Fee Schedule
NM-TUMOR LOC LMTD 1D,78800,CPT,,,,,both,, ,4917.74,2950.64,Medicare,Medicare,,2950.64,,,4917.74,688.48,2508.05,Fee Schedule,Medicare APC Fee Schedule
NM-TUMOR LOC MULTI,78801,CPT,,,,,both,, ,4917.74,2950.64,Medicare,Medicare,,2950.64,,,4917.74,688.48,2508.05,Fee Schedule,Medicare APC Fee Schedule
NM-TUMOR LOC BDY 1D,78802,CPT,,,,,both,, ,6129.79,3677.87,Medicare,Medicare,,3677.87,,,6129.79,858.17,3126.19,Fee Schedule,Medicare APC Fee Schedule
NM-TUMOR LOC BODY,78802,CPT,,,,,both,, ,4590.83,2754.49,Medicare,Medicare,,2754.49,,,4590.83,642.72,2341.32,Fee Schedule,Medicare APC Fee Schedule
NM-TUMR LOC SPECT 1D,78803,CPT,,,,,both,, ,5042.88,3025.72,Medicare,Medicare,,3025.72,,,5042.88,706.00,2571.87,Fee Schedule,Medicare APC Fee Schedule
NM-TUMR LOC BDY >1D,78804,CPT,,,,,both,, ,5251.46,3150.87,Medicare,Medicare,,3150.87,,,5251.46,735.20,2678.24,Fee Schedule,Medicare APC Fee Schedule
NM-UNLISTED MISC,78999,CPT,,,,,both,, ,593.54,356.12,Medicare,Medicare,,356.12,,,593.54,83.10,302.71,Fee Schedule,Medicare APC Fee Schedule
NUCLEAR RX IV ADMIN,79101,CPT,,,,,both,, ,1716.50,1029.90,Medicare,Medicare,,1029.90,,,1716.50,240.31,875.42,Fee Schedule,Medicare APC Fee Schedule
BASIC META W-ION CA,80047,CPT,,,,,both,, ,29.19,17.51,Medicare,Medicare,,17.51,,,29.19,4.09,14.89,Fee Schedule,Medicare APC Fee Schedule
BASIC META W-ION CA,80047,CPT,,,,,both,, ,163.63,98.17,Medicare,Medicare,,98.17,,,163.63,22.91,83.45,Fee Schedule,Medicare APC Fee Schedule
BASIC METABO CA TOTA,80048,CPT,,,,,both,, ,89.53,53.71,Medicare,Medicare,,53.71,,,89.53,12.53,45.66,Fee Schedule,Medicare APC Fee Schedule
BASIC METABO CA TOTA,80048,CPT,,,,,both,, ,510.83,306.49,Medicare,Medicare,,306.49,,,510.83,71.52,260.52,Fee Schedule,Medicare APC Fee Schedule
Basic metabolic panel,80048,CPT,,,,,both,,,510.83,510.83,Medicare,Medicare,,510.83,, ,510.83,71.52,260.52,Fee Schedule,Medicare APC Fee Schedule
GENERAL HEALTH PANEL,80050,CPT,,,,,both,,,1796.88,1796.88,Medicare,Medicare,,1796.88,,,1796.88,251.56,916.41,Fee Schedule,Medicare APC Fee Schedule
GENERAL HEALTH PANEL,80050,CPT,,,,,both,, ,1796.88,1078.12,Medicare,Medicare,,1078.12,,,1796.88,251.56,916.41,Fee Schedule,Medicare APC Fee Schedule
ELECTROLYTE PANEL,80051,CPT,,,,,both,, ,74.10,44.46,Medicare,Medicare,,44.46,,,74.10,10.37,37.79,Fee Schedule,Medicare APC Fee Schedule
ELECTROLYTE PANEL,80051,CPT,,,,,both,, ,390.41,234.24,Medicare,Medicare,,234.24,,,390.41,54.66,199.11,Fee Schedule,Medicare APC Fee Schedule
"Blood test, comprehensive group of blood chemicals",80053,CPT,,,,,both,,,630.96,630.96,Medicare,Medicare,,630.96,,,630.96,88.33,321.79,Fee Schedule,Medicare APC Fee Schedule
COMP METAB PANEL,80053,CPT,,,,,both,, ,111.70,67.02,Medicare,Medicare,,67.02,,,111.70,15.64,56.97,Fee Schedule,Medicare APC Fee Schedule
COMP METAB PANEL,80053,CPT,,,,,both,, ,630.96,378.57,Medicare,Medicare,,378.57,,,630.96,88.33,321.79,Fee Schedule,Medicare APC Fee Schedule
Obstetric blood test panel,80055,CPT,,,,,both,,,1727.55,1727.55,Medicare,Medicare,,1727.55,,,1727.55,241.86,881.05,Fee Schedule,Medicare APC Fee Schedule
OBSTETRIC PANEL,80055,CPT,,,,,both,, ,350.84,210.50,Medicare,Medicare,,210.50,,,350.84,49.12,178.93,Fee Schedule,Medicare APC Fee Schedule
OBSTETRIC PANEL,80055,CPT,,,,,both,, ,1727.55,1036.53,Medicare,Medicare,,1036.53,,,1727.55,241.86,881.05,Fee Schedule,Medicare APC Fee Schedule
"Blood test, lipids (cholesterol and triglycerides)",80061,CPT,,,,,both,,,565.84,565.84,Medicare,Medicare,,565.84,,,565.84,79.22,288.58,Fee Schedule,Medicare APC Fee Schedule
LIPID PANEL,80061,CPT,,,,,both,, ,86.73,52.03,Medicare,Medicare,,52.03,,,86.73,12.14,44.23,Fee Schedule,Medicare APC Fee Schedule
LIPID PANEL,80061,CPT,,,,,both,, ,565.84,339.50,Medicare,Medicare,,339.50,,,565.84,79.22,288.58,Fee Schedule,Medicare APC Fee Schedule
LIPID PANEL,80061,CPT,,,,,both,, ,565.84,339.50,Medicare,Medicare,,339.50,,,565.84,79.22,288.58,Fee Schedule,Medicare APC Fee Schedule
Kidney function panel test,80069,CPT,,,,,both,,,570.89,570.89,Medicare,Medicare,,570.89,,,570.89,79.92,291.15,Fee Schedule,Medicare APC Fee Schedule
RENAL FUNCTION PANEL,80069,CPT,,,,,both,, ,91.77,55.06,Medicare,Medicare,,55.06,,,91.77,12.85,46.8,Fee Schedule,Medicare APC Fee Schedule
RENAL FUNCTION PANEL,80069,CPT,,,,,both,, ,570.89,342.53,Medicare,Medicare,,342.53,,,570.89,79.92,291.15,Fee Schedule,Medicare APC Fee Schedule
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,, ,282.08,169.24,Medicare,Medicare,,169.24,,,282.08,39.49,143.86,Fee Schedule,Medicare APC Fee Schedule
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,,,3484.29,3484.29,Medicare,Medicare,,3484.29,,,3484.29,487.80,1776.99,Fee Schedule,Medicare APC Fee Schedule
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,, ,3484.29,2090.57,Medicare,Medicare,,2090.57,,,3484.29,487.80,1776.99,Fee Schedule,Medicare APC Fee Schedule
HEPATIC FUNCTION PAN,80076,CPT,,,,,both,, ,86.45,51.87,Medicare,Medicare,,51.87,,,86.45,12.10,44.09,Fee Schedule,Medicare APC Fee Schedule
HEPATIC FUNCTION PAN,80076,CPT,,,,,both,, ,450.48,270.28,Medicare,Medicare,,270.28,,,450.48,63.07,229.74,Fee Schedule,Medicare APC Fee Schedule
Liver function blood test panel,80076,CPT,,,,,both,,,450.48,450.48,Medicare,Medicare,,450.48,,,450.48,63.07,229.74,Fee Schedule,Medicare APC Fee Schedule
OBSTETRIC PNL W HIV,80081,CPT,,,,,both,, ,1883.60,1130.16,Medicare,Medicare,,1130.16,,,1883.60,263.70,960.64,Fee Schedule,Medicare APC Fee Schedule
ACETAMINOPHEN QT,80143,CPT,,,,,both,, ,186.06,111.63,Medicare,Medicare,,111.63,,,186.06,26.05,94.89,Fee Schedule,Medicare APC Fee Schedule
Q36298 ADM LEV IBD,80145,CPT,,,,,both,, ,174.02,104.41,Medicare,Medicare,,104.41,,,174.02,24.36,88.75,Fee Schedule,Medicare APC Fee Schedule
AMIKACIN,80150,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q36721 AMIOD HPLC/LC,80151,CPT,,,,,both,, ,546.19,327.71,Medicare,Medicare,,327.71,,,546.19,76.47,278.56,Fee Schedule,Medicare APC Fee Schedule
CARBAMAZEPINE TOTAL,80156,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
Q18948 CBZ FREE LCMS,80157,CPT,,,,,both,, ,88.40,53.04,Medicare,Medicare,,53.04,,,88.40,12.38,45.08,Fee Schedule,Medicare APC Fee Schedule
CYCLOSPORINE,80158,CPT,,,,,both,, ,91.49,54.89,Medicare,Medicare,,54.89,,,91.49,12.81,46.66,Fee Schedule,Medicare APC Fee Schedule
CYCLOSPORINE,80158,CPT,,,,,both,, ,1555.50,933.30,Medicare,Medicare,,933.30,,,1555.50,217.77,793.31,Fee Schedule,Medicare APC Fee Schedule
Q15220CYC A BL LCMSM,80158,CPT,,,,,both,, ,1555.50,933.30,Medicare,Medicare,,933.30,,,1555.50,217.77,793.31,Fee Schedule,Medicare APC Fee Schedule
Q8812 CYA TRGH BL IA,80158,CPT,,,,,both,, ,1555.50,933.30,Medicare,Medicare,,933.30,,,1555.50,217.77,793.31,Fee Schedule,Medicare APC Fee Schedule
CLOZAPINE QT,80159,CPT,,,,,both,, ,95.43,57.25,Medicare,Medicare,,57.25,,,95.43,13.36,48.67,Fee Schedule,Medicare APC Fee Schedule
CLOZAPINE QT,80159,CPT,,,,,both,, ,95.43,57.25,Medicare,Medicare,,57.25,,,95.43,13.36,48.67,Fee Schedule,Medicare APC Fee Schedule
DIGOXIN TOTAL,80162,CPT,,,,,both,, ,130.23,78.13,Medicare,Medicare,,78.13,,,130.23,18.23,66.42,Fee Schedule,Medicare APC Fee Schedule
DIGOXIN TOTAL,80162,CPT,,,,,both,, ,787.57,472.54,Medicare,Medicare,,472.54,,,787.57,110.26,401.66,Fee Schedule,Medicare APC Fee Schedule
DIGOXIN FREE,80163,CPT,,,,,both,, ,130.23,78.13,Medicare,Medicare,,78.13,,,130.23,18.23,66.42,Fee Schedule,Medicare APC Fee Schedule
Q6651 VALP ACID TOT,80164,CPT,,,,,both,, ,691.06,414.63,Medicare,Medicare,,414.63,,,691.06,96.75,352.44,Fee Schedule,Medicare APC Fee Schedule
VALPROIC ACID TOTAL,80164,CPT,,,,,both,, ,132.76,79.65,Medicare,Medicare,,79.65,,,132.76,18.59,67.71,Fee Schedule,Medicare APC Fee Schedule
VALPROIC ACID TOTAL,80164,CPT,,,,,both,,,711.79,711.79,Medicare,Medicare,,711.79,,,711.79,99.65,363.01,Fee Schedule,Medicare APC Fee Schedule
VALPROIC ACID TOTAL,80164,CPT,,,,,both,, ,711.79,427.07,Medicare,Medicare,,427.07,,,711.79,99.65,363.01,Fee Schedule,Medicare APC Fee Schedule
Q6651 VALP ACID FREE,80165,CPT,,,,,both,, ,691.06,414.63,Medicare,Medicare,,414.63,,,691.06,96.75,352.44,Fee Schedule,Medicare APC Fee Schedule
VALPROIC ACID FREE,80165,CPT,,,,,both,, ,132.76,79.65,Medicare,Medicare,,79.65,,,132.76,18.59,67.71,Fee Schedule,Medicare APC Fee Schedule
VALPROIC ACID FREE,80165,CPT,,,,,both,, ,711.79,427.07,Medicare,Medicare,,427.07,,,711.79,99.65,363.01,Fee Schedule,Medicare APC Fee Schedule
Q3081 FELBAMATE MS,80167,CPT,,,,,both,, ,191.99,115.19,Medicare,Medicare,,115.19,,,191.99,26.88,97.91,Fee Schedule,Medicare APC Fee Schedule
ETHOSUXIMIDE,80168,CPT,,,,,both,, ,864.19,518.51,Medicare,Medicare,,518.51,,,864.19,120.99,440.74,Fee Schedule,Medicare APC Fee Schedule
Q18883 EVEROLI LM/MS,80169,CPT,,,,,both,, ,106.93,64.15,Medicare,Medicare,,64.15,,,106.93,14.97,54.53,Fee Schedule,Medicare APC Fee Schedule
GENTAMICIN,80170,CPT,,,,,both,, ,900.96,540.57,Medicare,Medicare,,540.57,,,900.96,126.13,459.49,Fee Schedule,Medicare APC Fee Schedule
GABAPENTIN QT,80171,CPT,,,,,both,, ,105.53,63.31,Medicare,Medicare,,63.31,,,105.53,14.77,53.82,Fee Schedule,Medicare APC Fee Schedule
L716811 GABAP LCMSMS,80171,CPT,,,,,both,, ,102.46,61.47,Medicare,Medicare,,61.47,,,102.46,14.34,52.25,Fee Schedule,Medicare APC Fee Schedule
HALOPERIDOL,80173,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,522.73,,,871.22,121.97,444.32,Fee Schedule,Medicare APC Fee Schedule
LAMOTRIGINE QT,80175,CPT,,,,,both,, ,105.53,63.31,Medicare,Medicare,,63.31,,,105.53,14.77,53.82,Fee Schedule,Medicare APC Fee Schedule
LAMOTRIGINE QT,80175,CPT,,,,,both,, ,105.53,63.31,Medicare,Medicare,,63.31,,,105.53,14.77,53.82,Fee Schedule,Medicare APC Fee Schedule
LIDOCAINE,80176,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,522.73,,,871.22,121.97,444.32,Fee Schedule,Medicare APC Fee Schedule
LIDOCAINE,80176,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,522.73,,,871.22,121.97,444.32,Fee Schedule,Medicare APC Fee Schedule
Q15142 LEVE LC/MS/MS,80177,CPT,,,,,both,, ,105.53,63.31,Medicare,Medicare,,63.31,,,105.53,14.77,53.82,Fee Schedule,Medicare APC Fee Schedule
Lithium,80178,CPT,,,,,both,,,420.72,420.72,Medicare,Medicare,,420.72,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
LITHIUM,80178,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
SALICYLATE QT,80179,CPT,,,,,both,, ,191.99,115.19,Medicare,Medicare,,115.19,,,191.99,26.88,97.91,Fee Schedule,Medicare APC Fee Schedule
Q10662 MPA LC/MS/MS,80180,CPT,,,,,both,, ,143.71,86.22,Medicare,Medicare,,86.22,,,143.71,20.12,73.29,Fee Schedule,Medicare APC Fee Schedule
OXCARBAEPINE QT,80183,CPT,,,,,both,, ,122.37,73.42,Medicare,Medicare,,73.42,,,122.37,17.13,62.41,Fee Schedule,Medicare APC Fee Schedule
OXCARBAEPINE QT,80183,CPT,,,,,both,, ,122.37,73.42,Medicare,Medicare,,73.42,,,122.37,17.13,62.41,Fee Schedule,Medicare APC Fee Schedule
PHENOBARBITAL,80184,CPT,,,,,both,, ,120.96,72.57,Medicare,Medicare,,72.57,,,120.96,16.93,61.69,Fee Schedule,Medicare APC Fee Schedule
PHENOBARBITAL,80184,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,522.73,,,871.22,121.97,444.32,Fee Schedule,Medicare APC Fee Schedule
PHENOBARBITAL,80184,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,522.73,,,871.22,121.97,444.32,Fee Schedule,Medicare APC Fee Schedule
PHENYTOIN TOTAL,80185,CPT,,,,,both,, ,140.05,84.03,Medicare,Medicare,,84.03,,,140.05,19.61,71.43,Fee Schedule,Medicare APC Fee Schedule
PHENYTOIN TOTAL,80185,CPT,,,,,both,, ,847.64,508.58,Medicare,Medicare,,508.58,,,847.64,118.67,432.3,Fee Schedule,Medicare APC Fee Schedule
PHENYTOIN TOTAL,80185,CPT,,,,,both,, ,847.64,508.58,Medicare,Medicare,,508.58,,,847.64,118.67,432.3,Fee Schedule,Medicare APC Fee Schedule
Q3189 PHENY FR UF-IA,80186,CPT,,,,,both,, ,91.77,55.06,Medicare,Medicare,,55.06,,,91.77,12.85,46.8,Fee Schedule,Medicare APC Fee Schedule
Q3189 PHENY FR UF-IA,80186,CPT,,,,,both,, ,91.77,55.06,Medicare,Medicare,,55.06,,,91.77,12.85,46.8,Fee Schedule,Medicare APC Fee Schedule
PRIMIDONE,80188,CPT,,,,,both,, ,1757.58,1054.54,Medicare,Medicare,,1054.54,,,1757.58,246.06,896.37,Fee Schedule,Medicare APC Fee Schedule
Q751 PRIMIDONE,80188,CPT,,,,,both,, ,878.79,527.27,Medicare,Medicare,,527.27,,,878.79,123.03,448.18,Fee Schedule,Medicare APC Fee Schedule
PROCAINAMIDE+NAPA,80192,CPT,,,,,both,, ,900.96,540.57,Medicare,Medicare,,540.57,,,900.96,126.13,459.49,Fee Schedule,Medicare APC Fee Schedule
QUINIDINE,80194,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,459.57,,,765.96,107.23,390.64,Fee Schedule,Medicare APC Fee Schedule
SIROLIMUS,80195,CPT,,,,,both,, ,257.10,154.26,Medicare,Medicare,,154.26,,,257.10,35.99,131.12,Fee Schedule,Medicare APC Fee Schedule
SIROLIMUS,80195,CPT,,,,,both,, ,257.10,154.26,Medicare,Medicare,,154.26,,,257.10,35.99,131.12,Fee Schedule,Medicare APC Fee Schedule
TACROLIMUS,80197,CPT,,,,,both,, ,822.37,493.42,Medicare,Medicare,,493.42,,,822.37,115.13,419.41,Fee Schedule,Medicare APC Fee Schedule
TACROLIMUS,80197,CPT,,,,,both,, ,822.37,493.42,Medicare,Medicare,,493.42,,,822.37,115.13,419.41,Fee Schedule,Medicare APC Fee Schedule
THEOPHYLLINE,80198,CPT,,,,,both,, ,149.60,89.76,Medicare,Medicare,,89.76,,,149.60,20.94,76.3,Fee Schedule,Medicare APC Fee Schedule
THEOPHYLLINE,80198,CPT,,,,,both,, ,149.60,89.76,Medicare,Medicare,,89.76,,,149.60,20.94,76.3,Fee Schedule,Medicare APC Fee Schedule
THEOPHYLLINE,80198,CPT,,,,,both,, ,781.11,468.66,Medicare,Medicare,,468.66,,,781.11,109.36,398.37,Fee Schedule,Medicare APC Fee Schedule
TIAGABINE QT,80199,CPT,,,,,both,, ,143.71,86.22,Medicare,Medicare,,86.22,,,143.71,20.12,73.29,Fee Schedule,Medicare APC Fee Schedule
TOBRAMYCIN,80200,CPT,,,,,both,, ,75.50,45.30,Medicare,Medicare,,45.30,,,75.50,10.57,38.51,Fee Schedule,Medicare APC Fee Schedule
TOPIRAMATE,80201,CPT,,,,,both,, ,445.71,267.42,Medicare,Medicare,,267.42,,,445.71,62.40,227.31,Fee Schedule,Medicare APC Fee Schedule
VANCOMYCIN,80202,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,459.57,,,765.96,107.23,390.64,Fee Schedule,Medicare APC Fee Schedule
ZONISAMIDE QT,80203,CPT,,,,,both,, ,105.53,63.31,Medicare,Medicare,,63.31,,,105.53,14.77,53.82,Fee Schedule,Medicare APC Fee Schedule
ZONISAMIDE QT,80203,CPT,,,,,both,, ,105.53,63.31,Medicare,Medicare,,63.31,,,105.53,14.77,53.82,Fee Schedule,Medicare APC Fee Schedule
Q648 METHOTREXATE IA,80204,CPT,,,,,both,, ,501.10,300.66,Medicare,Medicare,,300.66,,,501.10,70.15,255.56,Fee Schedule,Medicare APC Fee Schedule
L503870 INFLIXIMAB,80230,CPT,,,,,both,, ,159.65,95.79,Medicare,Medicare,,95.79,,,159.65,22.35,81.42,Fee Schedule,Medicare APC Fee Schedule
L504567 VEDOLIZUMAB,80280,CPT,,,,,both,, ,198.79,119.27,Medicare,Medicare,,119.27,,,198.79,27.83,101.38,Fee Schedule,Medicare APC Fee Schedule
DRUG UNSPEC QUANT,80299,CPT,,,,,both,, ,873.46,524.07,Medicare,Medicare,,524.07,,,873.46,122.28,445.46,Fee Schedule,Medicare APC Fee Schedule
L7609 DOXEPIN LCMSMS,80299,CPT,,,,,both,, ,148.40,89.04,Medicare,Medicare,,89.04,,,148.40,20.78,75.68,Fee Schedule,Medicare APC Fee Schedule
Q29391DEXAMET LCMSMS,80299,CPT,,,,,both,, ,342.00,205.20,Medicare,Medicare,,205.20,,,342.00,47.88,174.42,Fee Schedule,Medicare APC Fee Schedule
Q78222DEXAMET LCMSMS,80299,CPT,,,,,both,, ,546.19,327.71,Medicare,Medicare,,327.71,,,546.19,76.47,278.56,Fee Schedule,Medicare APC Fee Schedule
Q78222DEXAMET LCMSMS,80299,CPT,,,,,both,, ,546.19,327.71,Medicare,Medicare,,327.71,,,546.19,76.47,278.56,Fee Schedule,Medicare APC Fee Schedule
Q8389 FLUOXET LCMSMS,80299,CPT,,,,,both,, ,811.42,486.85,Medicare,Medicare,,486.85,,,811.42,113.60,413.82,Fee Schedule,Medicare APC Fee Schedule
PRS DRG IA VIS,80305,CPT,,,,,both,, ,137.80,82.68,Medicare,Medicare,,82.68,,,137.80,19.29,70.28,Fee Schedule,Medicare APC Fee Schedule
PRS DRG IA MET,80306,CPT,,,,,both,, ,137.80,82.68,Medicare,Medicare,,82.68,,,137.80,19.29,70.28,Fee Schedule,Medicare APC Fee Schedule
733726 URINE DRUG PROFILE 14/MEDWATCH,80307,CPT,,,,,both,, ,360.00,216.00,Medicare,Medicare,,216.00,,,360.00,50.40,183.6,Fee Schedule,Medicare APC Fee Schedule
DRUGPROF ORAL FLD,80307,CPT,,,,,both,, ,116.00,69.60,Medicare,Medicare,,69.60,,,116.00,16.24,59.16,Fee Schedule,Medicare APC Fee Schedule
ETHANOL UR QUAL,80307,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
ETHANOL UR QUAL,80307,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
L074401 AMPH UR SCRN,80307,CPT,,,,,both,, ,60.00,36.00,Medicare,Medicare,,36.00,,,60.00,8.40,30.6,Fee Schedule,Medicare APC Fee Schedule
L074401 AMPH UR SCRN,80307,CPT,,,,,both,, ,60.00,36.00,Medicare,Medicare,,36.00,,,60.00,8.40,30.6,Fee Schedule,Medicare APC Fee Schedule
L733740 ULTRM SCR UR,80307,CPT,,,,,both,, ,200.00,120.00,Medicare,Medicare,,120.00,,,200.00,28.00,102,Fee Schedule,Medicare APC Fee Schedule
PRS DRG IA ANAZ,80307,CPT,,,,,both,,,1174.34,1174.34,Medicare,Medicare,,1174.34,,,1174.34,164.41,598.91,Fee Schedule,Medicare APC Fee Schedule
PRS DRG IA ANAZ,80307,CPT,,,,,both,, ,1174.34,704.60,Medicare,Medicare,,704.60,,,1174.34,164.41,598.91,Fee Schedule,Medicare APC Fee Schedule
PRS DRG IA ANAZ,80307,CPT,,,,,both,, ,1174.34,704.60,Medicare,Medicare,,704.60,,,1174.34,164.41,598.91,Fee Schedule,Medicare APC Fee Schedule
Q643 METHYL ALC BL C,80320,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,436.84,,,728.07,101.93,371.32,Fee Schedule,Medicare APC Fee Schedule
ALKALOIDS NOS MS,80323,CPT,,,,,both,, ,713.47,428.08,Medicare,Medicare,,428.08,,,713.47,99.89,363.87,Fee Schedule,Medicare APC Fee Schedule
Q90642NIC&COT S LCMS,80323,CPT,,,,,both,, ,713.47,428.08,Medicare,Medicare,,428.08,,,713.47,99.89,363.87,Fee Schedule,Medicare APC Fee Schedule
Q90646NIC&COT U LCMS,80323,CPT,,,,,both,, ,713.47,428.08,Medicare,Medicare,,428.08,,,713.47,99.89,363.87,Fee Schedule,Medicare APC Fee Schedule
AMPHETAMINES MS 1-2,80324,CPT,,,,,both,, ,184.68,110.80,Medicare,Medicare,,110.80,,,184.68,25.86,94.19,Fee Schedule,Medicare APC Fee Schedule
AMPHETAMINES MS 1-2,80324,CPT,,,,,both,, ,184.68,110.80,Medicare,Medicare,,110.80,,,184.68,25.86,94.19,Fee Schedule,Medicare APC Fee Schedule
L790600 AMPH MS 5P,80326,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
ANABOLC STRD MS 1-2,80327,CPT,,,,,both,, ,269.16,161.49,Medicare,Medicare,,161.49,,,269.16,37.68,137.27,Fee Schedule,Medicare APC Fee Schedule
L790600 ANLGNO MS 6P,80331,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
ANTIDPRS SERO MS 3-5,80333,CPT,,,,,both,, ,771.01,462.60,Medicare,Medicare,,462.60,,,771.01,107.94,393.22,Fee Schedule,Medicare APC Fee Schedule
L790600 AD MS 6PL,80334,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
ANTIDPRS TRIC MS 1-2,80335,CPT,,,,,both,, ,826.59,495.95,Medicare,Medicare,,495.95,,,826.59,115.72,421.56,Fee Schedule,Medicare APC Fee Schedule
ANTIDPRS TRIC MS 1-2,80335,CPT,,,,,both,, ,826.59,495.95,Medicare,Medicare,,495.95,,,826.59,115.72,421.56,Fee Schedule,Medicare APC Fee Schedule
Q30013 CLOMIPRA LCMS,80335,CPT,,,,,both,, ,826.59,495.95,Medicare,Medicare,,495.95,,,826.59,115.72,421.56,Fee Schedule,Medicare APC Fee Schedule
Q30013 CLOMIPRA LCMS,80335,CPT,,,,,both,, ,826.59,495.95,Medicare,Medicare,,495.95,,,826.59,115.72,421.56,Fee Schedule,Medicare APC Fee Schedule
Q423AMITRIP HPLC/LCM,80335,CPT,,,,,both,, ,826.59,495.95,Medicare,Medicare,,495.95,,,826.59,115.72,421.56,Fee Schedule,Medicare APC Fee Schedule
Q423AMITRIP HPLC/LCM,80335,CPT,,,,,both,, ,826.59,495.95,Medicare,Medicare,,495.95,,,826.59,115.72,421.56,Fee Schedule,Medicare APC Fee Schedule
ANTIDPRS TRIC MS 3-5,80336,CPT,,,,,both,, ,571.45,342.87,Medicare,Medicare,,342.87,,,571.45,80.00,291.44,Fee Schedule,Medicare APC Fee Schedule
L790600 ADEP TRI 6PL,80337,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
ANTIDPRS NOS MS,80338,CPT,,,,,both,, ,928.18,556.90,Medicare,Medicare,,556.90,,,928.18,129.95,473.37,Fee Schedule,Medicare APC Fee Schedule
L790600 AD NOS MS,80338,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
L790600 AED MS 7P,80341,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
ANTIPSYCH NOS MS 1-3,80342,CPT,,,,,both,, ,811.42,486.85,Medicare,Medicare,,486.85,,,811.42,113.60,413.82,Fee Schedule,Medicare APC Fee Schedule
L790600 APD MS 7P,80344,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
BENZODIAZ MS 1-12,80346,CPT,,,,,both,, ,814.24,488.54,Medicare,Medicare,,488.54,,,814.24,113.99,415.26,Fee Schedule,Medicare APC Fee Schedule
BENZODIAZ MS 1-12,80346,CPT,,,,,both,, ,814.24,488.54,Medicare,Medicare,,488.54,,,814.24,113.99,415.26,Fee Schedule,Medicare APC Fee Schedule
L809630 FLTZP MS,80346,CPT,,,,,both,, ,600.00,360.00,Medicare,Medicare,,360.00,,,600.00,84.00,306,Fee Schedule,Medicare APC Fee Schedule
L790600 BZD MS 13P,80347,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
BUPRENORPHINE MS,80348,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
BUPRENORPHINE MS,80348,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
Q93031 BUPRENOPHINE & METABOLITIES LC/MS,80348,CPT,,,,,both,, ,119.25,71.55,Medicare,Medicare,,71.55,,,119.25,16.70,60.82,Fee Schedule,Medicare APC Fee Schedule
CANNABINDS NATUR MS,80349,CPT,,,,,both,, ,147.91,88.74,Medicare,Medicare,,88.74,,,147.91,20.71,75.43,Fee Schedule,Medicare APC Fee Schedule
L790697 SYNCBD WB MS,80352,CPT,,,,,both,, ,300.00,180.00,Medicare,Medicare,,180.00,,,300.00,42.00,153,Fee Schedule,Medicare APC Fee Schedule
L790600 COCAINE MS,80353,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
FENTANYL MS,80354,CPT,,,,,both,, ,534.41,320.64,Medicare,Medicare,,320.64,,,534.41,74.82,272.55,Fee Schedule,Medicare APC Fee Schedule
L790600 FENT MET MS,80354,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
GABAPENTIN NONBLD MS,80355,CPT,,,,,both,, ,534.41,320.64,Medicare,Medicare,,320.64,,,534.41,74.82,272.55,Fee Schedule,Medicare APC Fee Schedule
L790600 GPT NBLD MS,80355,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
HEROIN METABOLITE MS,80356,CPT,,,,,both,, ,227.91,136.74,Medicare,Medicare,,136.74,,,227.91,31.91,116.23,Fee Schedule,Medicare APC Fee Schedule
L790600 KET NKET MS,80357,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
L790600 MTD MS,80358,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
METHADONE MS,80358,CPT,,,,,both,, ,327.54,196.52,Medicare,Medicare,,196.52,,,327.54,45.86,167.05,Fee Schedule,Medicare APC Fee Schedule
L791194 MDMA MS,80359,CPT,,,,,both,, ,133.38,80.02,Medicare,Medicare,,80.02,,,133.38,18.67,68.02,Fee Schedule,Medicare APC Fee Schedule
MDA MDEA MOMA MS,80359,CPT,,,,,both,, ,404.17,242.50,Medicare,Medicare,,242.50,,,404.17,56.58,206.13,Fee Schedule,Medicare APC Fee Schedule
MDA MDEA MOMA MS,80359,CPT,,,,,both,, ,404.17,242.50,Medicare,Medicare,,242.50,,,404.17,56.58,206.13,Fee Schedule,Medicare APC Fee Schedule
L790600 MPH MS,80360,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
L790600 OPI MS 1P,80361,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
OPIATES MS 1 PL,80361,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
Q20907 OPI MS,80361,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
L790600 OPD OPI MS5P,80364,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
L790600 OXY MS,80365,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
OXYCODONE MS,80365,CPT,,,,,both,, ,428.58,257.14,Medicare,Medicare,,257.14,,,428.58,60.00,218.58,Fee Schedule,Medicare APC Fee Schedule
OXYCODONE MS,80365,CPT,,,,,both,, ,428.58,257.14,Medicare,Medicare,,257.14,,,428.58,60.00,218.58,Fee Schedule,Medicare APC Fee Schedule
L790600 PGB MS,80366,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
PREGABALIN MS,80366,CPT,,,,,both,, ,811.42,486.85,Medicare,Medicare,,486.85,,,811.42,113.60,413.82,Fee Schedule,Medicare APC Fee Schedule
L790600 PPX MS,80367,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
L790600 SED HYP MS,80368,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
L790600 SM RLX MS3PL,80370,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
L790600 STIM SYN MS,80371,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
L790600 TAPENTADL MS,80372,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
L761019TRAMADOL CONF,80373,CPT,,,,,both,, ,412.00,247.20,Medicare,Medicare,,247.20,,,412.00,57.68,210.12,Fee Schedule,Medicare APC Fee Schedule
L790600 TRA MS,80373,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
DEF DRUG NOS MS 1-3,80375,CPT,,,,,both,, ,546.19,327.71,Medicare,Medicare,,327.71,,,546.19,76.47,278.56,Fee Schedule,Medicare APC Fee Schedule
DEF DRUG NOS MS 7PL,80377,CPT,,,,,both,, ,571.45,342.87,Medicare,Medicare,,342.87,,,571.45,80.00,291.44,Fee Schedule,Medicare APC Fee Schedule
L790600 DRGNOS MS 7P,80377,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
Manual urinalysis test with examination using microscope,81001,CPT,,,,,both,,,240.26,240.26,Medicare,Medicare,,240.26,,,240.26,33.64,122.53,Fee Schedule,Medicare APC Fee Schedule
"UA, AUTO W-SCOPE",81001,CPT,,,,,both,, ,33.39,20.03,Medicare,Medicare,,20.03,,,33.39,4.67,17.03,Fee Schedule,Medicare APC Fee Schedule
"UA, AUTO W-SCOPE",81001,CPT,,,,,both,, ,240.26,144.15,Medicare,Medicare,,144.15,,,240.26,33.64,122.53,Fee Schedule,Medicare APC Fee Schedule
Automated urinalysis test,81003,CPT,,,,,both,,,210.50,210.50,Medicare,Medicare,,210.50,,,210.50,29.47,107.36,Fee Schedule,Medicare APC Fee Schedule
"UA, AUTO, W-O SCOPE",81003,CPT,,,,,both,, ,23.85,14.31,Medicare,Medicare,,14.31,,,23.85,3.34,12.16,Fee Schedule,Medicare APC Fee Schedule
"UA, AUTO, W-O SCOPE",81003,CPT,,,,,both,, ,210.50,126.30,Medicare,Medicare,,126.30,,,210.50,29.47,107.36,Fee Schedule,Medicare APC Fee Schedule
URINALYSIS,81005,CPT,,,,,both,, ,180.19,108.11,Medicare,Medicare,,108.11,,,180.19,25.23,91.9,Fee Schedule,Medicare APC Fee Schedule
MICROSCOPIC EX OF UR,81015,CPT,,,,,both,, ,10.55,6.33,Medicare,Medicare,,6.33,,,10.55,1.48,5.38,Fee Schedule,Medicare APC Fee Schedule
MICROSCOPIC EX OF UR,81015,CPT,,,,,both,, ,180.19,108.11,Medicare,Medicare,,108.11,,,180.19,25.23,91.9,Fee Schedule,Medicare APC Fee Schedule
URINE PREG TEST QL,81025,CPT,,,,,both,, ,23.58,14.14,Medicare,Medicare,,14.14,,,23.58,3.30,12.03,Fee Schedule,Medicare APC Fee Schedule
URINE PREG TEST QL,81025,CPT,,,,,both,,,420.72,420.72,Medicare,Medicare,,420.72,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
URINE PREG TEST QL,81025,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
"L910235 URINE VOLUME, TIMED",81050,CPT,,,,,both,, ,30.64,18.38,Medicare,Medicare,,18.38,,,30.64,4.29,15.63,Fee Schedule,Medicare APC Fee Schedule
Q91863 BRCADVAN COMP,81162,CPT,,,,,both,, ,5261.25,3156.75,Medicare,Medicare,,3156.75,,,5261.25,736.58,2683.24,Fee Schedule,Medicare APC Fee Schedule
L480510 BCRABL1 KDMA,81170,CPT,,,,,both,, ,1792.00,1075.20,Medicare,Medicare,,1075.20,,,1792.00,250.88,913.92,Fee Schedule,Medicare APC Fee Schedule
Q91065 P210 BCRABL1,81206,CPT,,,,,both,, ,552.22,331.33,Medicare,Medicare,,331.33,,,552.22,77.31,281.63,Fee Schedule,Medicare APC Fee Schedule
Q91065 P190 BCRABL1,81207,CPT,,,,,both,, ,487.83,292.69,Medicare,Medicare,,292.69,,,487.83,68.30,248.79,Fee Schedule,Medicare APC Fee Schedule
BRAF GENE ANALY V600,81210,CPT,,,,,both,, ,393.84,236.30,Medicare,Medicare,,236.30,,,393.84,55.14,200.86,Fee Schedule,Medicare APC Fee Schedule
L489450 CALR MA,81219,CPT,,,,,both,, ,675.00,405.00,Medicare,Medicare,,405.00,,,675.00,94.50,344.25,Fee Schedule,Medicare APC Fee Schedule
Q10458 CFSCN OLA-PCR,81220,CPT,,,,,both,, ,1100.00,660.00,Medicare,Medicare,,660.00,,,1100.00,154.00,561,Fee Schedule,Medicare APC Fee Schedule
L252900 CF CFTR DD,81222,CPT,,,,,both,, ,930.00,558.00,Medicare,Medicare,,558.00,,,930.00,130.20,474.3,Fee Schedule,Medicare APC Fee Schedule
L511230 CYT P450 2D6,81226,CPT,,,,,both,, ,600.00,360.00,Medicare,Medicare,,360.00,,,600.00,84.00,306,Fee Schedule,Medicare APC Fee Schedule
Q161608 CYP2C9 GN AN,81227,CPT,,,,,both,, ,610.00,366.00,Medicare,Medicare,,366.00,,,610.00,85.40,311.1,Fee Schedule,Medicare APC Fee Schedule
EGFR GENE COM VAR,81235,CPT,,,,,both,, ,963.55,578.13,Medicare,Medicare,,578.13,,,963.55,134.90,491.41,Fee Schedule,Medicare APC Fee Schedule
F2 GEN ANALY 20210GA,81240,CPT,,,,,both,, ,2183.65,1310.19,Medicare,Medicare,,1310.19,,,2183.65,305.71,1113.66,Fee Schedule,Medicare APC Fee Schedule
Q17909 PGM HYBEACONS,81240,CPT,,,,,both,, ,1091.82,655.09,Medicare,Medicare,,655.09,,,1091.82,152.85,556.83,Fee Schedule,Medicare APC Fee Schedule
F5 GENE ANALY LEID V,81241,CPT,,,,,both,, ,2183.65,1310.19,Medicare,Medicare,,1310.19,,,2183.65,305.71,1113.66,Fee Schedule,Medicare APC Fee Schedule
F5 GENE ANALY LEID V,81241,CPT,,,,,both,, ,2183.65,1310.19,Medicare,Medicare,,1310.19,,,2183.65,305.71,1113.66,Fee Schedule,Medicare APC Fee Schedule
FMR1 GENE ANALY AB,81243,CPT,,,,,both,, ,1863.12,1117.87,Medicare,Medicare,,1117.87,,,1863.12,260.84,950.19,Fee Schedule,Medicare APC Fee Schedule
HFE GENE ANALY CV,81256,CPT,,,,,both,, ,3396.72,2038.03,Medicare,Medicare,,2038.03,,,3396.72,475.54,1732.33,Fee Schedule,Medicare APC Fee Schedule
HFE GENE ANALY CV,81256,CPT,,,,,both,, ,3396.72,2038.03,Medicare,Medicare,,2038.03,,,3396.72,475.54,1732.33,Fee Schedule,Medicare APC Fee Schedule
Q11175AGLOB MUT PCR,81257,CPT,,,,,both,, ,477.70,286.62,Medicare,Medicare,,286.62,,,477.70,66.88,243.63,Fee Schedule,Medicare APC Fee Schedule
JAK2 GEN ANALY V617F,81270,CPT,,,,,both,, ,1424.14,854.48,Medicare,Medicare,,854.48,,,1424.14,199.38,726.31,Fee Schedule,Medicare APC Fee Schedule
JAK2 GEN ANALY V617F,81270,CPT,,,,,both,, ,1424.14,854.48,Medicare,Medicare,,854.48,,,1424.14,199.38,726.31,Fee Schedule,Medicare APC Fee Schedule
L489421 JAK2V617F QL,81270,CPT,,,,,both,, ,1306.56,783.93,Medicare,Medicare,,783.93,,,1306.56,182.92,666.35,Fee Schedule,Medicare APC Fee Schedule
L511040 CHRO ANA CMA,81277,CPT,,,,,both,, ,2260.00,1356.00,Medicare,Medicare,,1356.00,,,2260.00,316.40,1152.6,Fee Schedule,Medicare APC Fee Schedule
L115101 JAK2 EX12-15,81279,CPT,,,,,both,, ,865.04,519.02,Medicare,Medicare,,519.02,,,865.04,121.11,441.17,Fee Schedule,Medicare APC Fee Schedule
Q90251 IL28B RT-PCR,81283,CPT,,,,,both,, ,352.24,211.34,Medicare,Medicare,,211.34,,,352.24,49.31,179.64,Fee Schedule,Medicare APC Fee Schedule
MTHFR GENE ANALY CV,81291,CPT,,,,,both,, ,3892.40,2335.44,Medicare,Medicare,,2335.44,,,3892.40,544.94,1985.12,Fee Schedule,Medicare APC Fee Schedule
MTHFR GENE ANALY CV,81291,CPT,,,,,both,, ,3892.40,2335.44,Medicare,Medicare,,2335.44,,,3892.40,544.94,1985.12,Fee Schedule,Medicare APC Fee Schedule
MICROSAT INSTAB VAR,81301,CPT,,,,,both,, ,960.19,576.11,Medicare,Medicare,,576.11,,,960.19,134.43,489.7,Fee Schedule,Medicare APC Fee Schedule
PCA3 KLK3 RATIO,81313,CPT,,,,,both,, ,636.57,381.94,Medicare,Medicare,,381.94,,,636.57,89.12,324.65,Fee Schedule,Medicare APC Fee Schedule
Q18041 SMA CAR SCN,81329,CPT,,,,,both,, ,685.00,411.00,Medicare,Medicare,,411.00,,,685.00,95.90,349.35,Fee Schedule,Medicare APC Fee Schedule
Q15340 ALPHA-1 ANTITRYPSIN (AAT) MUTATIO,81332,CPT,,,,,both,, ,3025.50,1815.30,Medicare,Medicare,,1815.30,,,3025.50,423.57,1543.01,Fee Schedule,Medicare APC Fee Schedule
SERPINA1 GENE ANA CV,81332,CPT,,,,,both,, ,3396.72,2038.03,Medicare,Medicare,,2038.03,,,3396.72,475.54,1732.33,Fee Schedule,Medicare APC Fee Schedule
L489150 MPL MUT AN,81338,CPT,,,,,both,, ,675.00,405.00,Medicare,Medicare,,405.00,,,675.00,94.50,344.25,Fee Schedule,Medicare APC Fee Schedule
Q92476 MPL MA QL,81339,CPT,,,,,both,, ,701.97,421.18,Medicare,Medicare,,421.18,,,701.97,98.28,358,Fee Schedule,Medicare APC Fee Schedule
CSI153 UGTIA1 GEN AN,81350,CPT,,,,,both,, ,819.57,491.74,Medicare,Medicare,,491.74,,,819.57,114.74,417.98,Fee Schedule,Medicare APC Fee Schedule
Q15584 HLA-B27 DETER,81374,CPT,,,,,both,, ,250.36,150.21,Medicare,Medicare,,150.21,,,250.36,35.05,127.68,Fee Schedule,Medicare APC Fee Schedule
Q17135 HLA2 TYP LR 1,81376,CPT,,,,,both,, ,610.75,366.45,Medicare,Medicare,,366.45,,,610.75,85.51,311.48,Fee Schedule,Medicare APC Fee Schedule
L167082 HLA2 LR1 AG,81377,CPT,,,,,both,, ,235.10,141.06,Medicare,Medicare,,141.06,,,235.10,32.91,119.9,Fee Schedule,Medicare APC Fee Schedule
HLA1 TYP HR 1 AL EA,81381,CPT,,,,,both,, ,724.42,434.65,Medicare,Medicare,,434.65,,,724.42,101.42,369.45,Fee Schedule,Medicare APC Fee Schedule
Q17135 HLA2 TYP HR 1,81382,CPT,,,,,both,, ,618.04,370.82,Medicare,Medicare,,370.82,,,618.04,86.53,315.2,Fee Schedule,Medicare APC Fee Schedule
L167082 HLA2 HR1 AL,81383,CPT,,,,,both,, ,334.75,200.85,Medicare,Medicare,,200.85,,,334.75,46.87,170.72,Fee Schedule,Medicare APC Fee Schedule
MOLEC PATH LEV 2,81401,CPT,,,,,both,, ,1062.07,637.24,Medicare,Medicare,,637.24,,,1062.07,148.69,541.66,Fee Schedule,Medicare APC Fee Schedule
MOLEC PATH LEV 2,81401,CPT,,,,,both,, ,1062.07,637.24,Medicare,Medicare,,637.24,,,1062.07,148.69,541.66,Fee Schedule,Medicare APC Fee Schedule
Q16536 JAK2 EX 12&13,81403,CPT,,,,,both,, ,865.04,519.02,Medicare,Medicare,,519.02,,,865.04,121.11,441.17,Fee Schedule,Medicare APC Fee Schedule
Q16536 JAK2 EX 12&13,81403,CPT,,,,,both,, ,865.04,519.02,Medicare,Medicare,,519.02,,,865.04,121.11,441.17,Fee Schedule,Medicare APC Fee Schedule
L630540 THRB,81405,CPT,,,,,both,, ,4320.00,2592.00,Medicare,Medicare,,2592.00,,,4320.00,604.80,2203.2,Fee Schedule,Medicare APC Fee Schedule
B5306-6 ACGH MOL KAR,81406,CPT,,,,,both,, ,2000.00,1200.00,Medicare,Medicare,,1200.00,,,2000.00,280.00,1020,Fee Schedule,Medicare APC Fee Schedule
BB893-9 UNL MOL PTH,81479,CPT,,,,,both,, ,618.00,370.80,Medicare,Medicare,,370.80,,,618.00,86.52,315.18,Fee Schedule,Medicare APC Fee Schedule
NBS SCID,81479,CPT,,,,,both,, ,109.46,65.67,Medicare,Medicare,,65.67,,,109.46,15.32,55.82,Fee Schedule,Medicare APC Fee Schedule
UNLIST MOLEC PATH,81479,CPT,,,,,both,, ,1145.43,687.25,Medicare,Medicare,,687.25,,,1145.43,160.36,584.17,Fee Schedule,Medicare APC Fee Schedule
L140045 OVARIAN MALIGNANCY RISK - ROMA,81500,CPT,,,,,both,, ,600.00,360.00,Medicare,Medicare,,360.00,,,600.00,84.00,306,Fee Schedule,Medicare APC Fee Schedule
FTL CGEN ABN 4 ANAL,81511,CPT,,,,,both,, ,466.48,279.88,Medicare,Medicare,,279.88,,,466.48,65.31,237.9,Fee Schedule,Medicare APC Fee Schedule
Q30294 QUAD SCREEN,81511,CPT,,,,,both,, ,415.50,249.30,Medicare,Medicare,,249.30,,,415.50,58.17,211.91,Fee Schedule,Medicare APC Fee Schedule
FTL CGEN ABN 5 ANAL,81512,CPT,,,,,both,, ,791.78,475.06,Medicare,Medicare,,475.06,,,791.78,110.85,403.81,Fee Schedule,Medicare APC Fee Schedule
L550659 LIVR BIOMRKR,81517,CPT,,,,,both,, ,1143.00,685.80,Medicare,Medicare,,685.80,,,1143.00,160.02,582.93,Fee Schedule,Medicare APC Fee Schedule
Q92688 LIVER FIBROS,81596,CPT,,,,,both,, ,337.09,202.25,Medicare,Medicare,,202.25,,,337.09,47.19,171.92,Fee Schedule,Medicare APC Fee Schedule
ACETON-KETON SERM QL,82009,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
ACETON-KETON SERM QT,82010,CPT,,,,,both,, ,80.55,48.33,Medicare,Medicare,,48.33,,,80.55,11.28,41.08,Fee Schedule,Medicare APC Fee Schedule
ACETON-KETON SERM QT,82010,CPT,,,,,both,, ,341.30,204.78,Medicare,Medicare,,204.78,,,341.30,47.78,174.06,Fee Schedule,Medicare APC Fee Schedule
NBS ACYLCARNITINE QL,82016,CPT,,,,,both,, ,82.79,49.67,Medicare,Medicare,,49.67,,,82.79,11.59,42.22,Fee Schedule,Medicare APC Fee Schedule
ADRENOCORT ACTH,82024,CPT,,,,,both,, ,2343.07,1405.84,Medicare,Medicare,,1405.84,,,2343.07,328.03,1194.97,Fee Schedule,Medicare APC Fee Schedule
Q211 ACTH PL IA,82024,CPT,,,,,both,, ,334.00,200.40,Medicare,Medicare,,200.40,,,334.00,46.76,170.34,Fee Schedule,Medicare APC Fee Schedule
ALBUMIN SERUM,82040,CPT,,,,,both,, ,35.08,21.04,Medicare,Medicare,,21.04,,,35.08,4.91,17.89,Fee Schedule,Medicare APC Fee Schedule
ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
Q14966 ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
Q70858 ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
ALBUMIN FLUID,82042,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
ALBUMIN FLUID,82042,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
MICROALB QNT,82043,CPT,,,,,both,, ,77.74,46.64,Medicare,Medicare,,46.64,,,77.74,10.88,39.65,Fee Schedule,Medicare APC Fee Schedule
MICROALB QNT,82043,CPT,,,,,both,,,660.98,660.98,Medicare,Medicare,,660.98,,,660.98,92.54,337.1,Fee Schedule,Medicare APC Fee Schedule
MICROALB QNT,82043,CPT,,,,,both,, ,660.98,396.58,Medicare,Medicare,,396.58,,,660.98,92.54,337.1,Fee Schedule,Medicare APC Fee Schedule
ETHANOL IA,82077,CPT,,,,,both,, ,177.88,106.72,Medicare,Medicare,,106.72,,,177.88,24.90,90.72,Fee Schedule,Medicare APC Fee Schedule
ALDOLASE,82085,CPT,,,,,both,, ,648.35,389.01,Medicare,Medicare,,389.01,,,648.35,90.77,330.66,Fee Schedule,Medicare APC Fee Schedule
ALDOLASE,82085,CPT,,,,,both,, ,648.35,389.01,Medicare,Medicare,,389.01,,,648.35,90.77,330.66,Fee Schedule,Medicare APC Fee Schedule
ALDOSTERONE,82088,CPT,,,,,both,, ,2366.36,1419.81,Medicare,Medicare,,1419.81,,,2366.36,331.29,1206.84,Fee Schedule,Medicare APC Fee Schedule
Q16845 ALDOSTERONE,82088,CPT,,,,,both,, ,587.45,352.47,Medicare,Medicare,,352.47,,,587.45,82.24,299.6,Fee Schedule,Medicare APC Fee Schedule
Q17181 ALDOST LCMSMS,82088,CPT,,,,,both,, ,587.45,352.47,Medicare,Medicare,,352.47,,,587.45,82.24,299.6,Fee Schedule,Medicare APC Fee Schedule
Q229 ALDOSTERONE U24,82088,CPT,,,,,both,, ,587.45,352.47,Medicare,Medicare,,352.47,,,587.45,82.24,299.6,Fee Schedule,Medicare APC Fee Schedule
ALPHA 1-ANTITRYP TOT,82103,CPT,,,,,both,, ,969.17,581.50,Medicare,Medicare,,581.50,,,969.17,135.68,494.28,Fee Schedule,Medicare APC Fee Schedule
ALPHA 1-ANTITRYP TOT,82103,CPT,,,,,both,, ,969.17,581.50,Medicare,Medicare,,581.50,,,969.17,135.68,494.28,Fee Schedule,Medicare APC Fee Schedule
ALPHA 1-ANTITRYP PHE,82104,CPT,,,,,both,, ,1051.68,631.00,Medicare,Medicare,,631.00,,,1051.68,147.24,536.36,Fee Schedule,Medicare APC Fee Schedule
ALPHA 1-ANTITRYP PHE,82104,CPT,,,,,both,, ,1051.68,631.00,Medicare,Medicare,,631.00,,,1051.68,147.24,536.36,Fee Schedule,Medicare APC Fee Schedule
AFP SERUM,82105,CPT,,,,,both,, ,1142.06,685.23,Medicare,Medicare,,685.23,,,1142.06,159.89,582.45,Fee Schedule,Medicare APC Fee Schedule
Q237 AFP TUMR MRK IA,82105,CPT,,,,,both,, ,1142.06,685.23,Medicare,Medicare,,685.23,,,1142.06,159.89,582.45,Fee Schedule,Medicare APC Fee Schedule
Q5059 MAT SER AFP IA,82105,CPT,,,,,both,, ,1142.06,685.23,Medicare,Medicare,,685.23,,,1142.06,159.89,582.45,Fee Schedule,Medicare APC Fee Schedule
AFP AMNIOTIC FLD,82106,CPT,,,,,both,, ,705.89,423.53,Medicare,Medicare,,423.53,,,705.89,98.82,360,Fee Schedule,Medicare APC Fee Schedule
AFP-L3 AND TOTL AFP,82107,CPT,,,,,both,, ,530.47,318.28,Medicare,Medicare,,318.28,,,530.47,74.27,270.54,Fee Schedule,Medicare APC Fee Schedule
AFP-L3 AND TOTL AFP,82107,CPT,,,,,both,, ,530.47,318.28,Medicare,Medicare,,318.28,,,530.47,74.27,270.54,Fee Schedule,Medicare APC Fee Schedule
ALUMINUM,82108,CPT,,,,,both,, ,265.51,159.30,Medicare,Medicare,,159.30,,,265.51,37.17,135.41,Fee Schedule,Medicare APC Fee Schedule
NBS AMINO ACD MUL QL,82128,CPT,,,,,both,, ,82.79,49.67,Medicare,Medicare,,49.67,,,82.79,11.59,42.22,Fee Schedule,Medicare APC Fee Schedule
Q10947CYSTN U24 LCMS,82131,CPT,,,,,both,, ,175.98,105.58,Medicare,Medicare,,105.58,,,175.98,24.64,89.75,Fee Schedule,Medicare APC Fee Schedule
AMINO ACID QUAN 6+,82139,CPT,,,,,both,, ,873.74,524.24,Medicare,Medicare,,524.24,,,873.74,122.32,445.61,Fee Schedule,Medicare APC Fee Schedule
AMMONIA,82140,CPT,,,,,both,, ,154.09,92.45,Medicare,Medicare,,92.45,,,154.09,21.57,78.59,Fee Schedule,Medicare APC Fee Schedule
AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
L910235 AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q442 AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
AMYLASE,82150,CPT,,,,,both,, ,68.48,41.08,Medicare,Medicare,,41.08,,,68.48,9.59,34.92,Fee Schedule,Medicare APC Fee Schedule
AMYLASE,82150,CPT,,,,,both,, ,518.69,311.21,Medicare,Medicare,,311.21,,,518.69,72.62,264.53,Fee Schedule,Medicare APC Fee Schedule
AMYLASE,82150,CPT,,,,,both,, ,518.69,311.21,Medicare,Medicare,,311.21,,,518.69,72.62,264.53,Fee Schedule,Medicare APC Fee Schedule
ANDROSTENEDIONE,82157,CPT,,,,,both,, ,769.33,461.59,Medicare,Medicare,,461.59,,,769.33,107.71,392.36,Fee Schedule,Medicare APC Fee Schedule
ANDROSTENEDIONE,82157,CPT,,,,,both,, ,769.33,461.59,Medicare,Medicare,,461.59,,,769.33,107.71,392.36,Fee Schedule,Medicare APC Fee Schedule
ANGIOTENSIN CONV ENZ,82164,CPT,,,,,both,, ,143.71,86.22,Medicare,Medicare,,86.22,,,143.71,20.12,73.29,Fee Schedule,Medicare APC Fee Schedule
ANGIOTENSIN CONV ENZ,82164,CPT,,,,,both,, ,1081.72,649.03,Medicare,Medicare,,649.03,,,1081.72,151.44,551.68,Fee Schedule,Medicare APC Fee Schedule
Q34692 ACE CSF KINET,82164,CPT,,,,,both,, ,1081.72,649.03,Medicare,Medicare,,649.03,,,1081.72,151.44,551.68,Fee Schedule,Medicare APC Fee Schedule
Q683 ACE SP,82164,CPT,,,,,both,, ,1081.72,649.03,Medicare,Medicare,,649.03,,,1081.72,151.44,551.68,Fee Schedule,Medicare APC Fee Schedule
ANTI-MULLERIAN HORM,82166,CPT,,,,,both,, ,116.00,69.60,Medicare,Medicare,,69.60,,,116.00,16.24,59.16,Fee Schedule,Medicare APC Fee Schedule
APOLIPOPROTEIN EACH,82172,CPT,,,,,both,, ,467.04,280.22,Medicare,Medicare,,280.22,,,467.04,65.39,238.19,Fee Schedule,Medicare APC Fee Schedule
APOLIPOPROTEIN EACH,82172,CPT,,,,,both,, ,467.04,280.22,Medicare,Medicare,,280.22,,,467.04,65.39,238.19,Fee Schedule,Medicare APC Fee Schedule
ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,450.81,,,751.36,105.19,383.19,Fee Schedule,Medicare APC Fee Schedule
Q269 AS BL ICP/MS,82175,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,450.81,,,751.36,105.19,383.19,Fee Schedule,Medicare APC Fee Schedule
Q36438 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,450.81,,,751.36,105.19,383.19,Fee Schedule,Medicare APC Fee Schedule
Q7507 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,450.81,,,751.36,105.19,383.19,Fee Schedule,Medicare APC Fee Schedule
Q7655 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,450.81,,,751.36,105.19,383.19,Fee Schedule,Medicare APC Fee Schedule
Q929 VIT C LC/MS/MS,82180,CPT,,,,,both,, ,67.92,40.75,Medicare,Medicare,,40.75,,,67.92,9.51,34.64,Fee Schedule,Medicare APC Fee Schedule
BETA-2 MICROGLOBULIN,82232,CPT,,,,,both,, ,936.89,562.13,Medicare,Medicare,,562.13,,,936.89,131.16,477.81,Fee Schedule,Medicare APC Fee Schedule
BETA-2 MICROGLOBULIN,82232,CPT,,,,,both,, ,936.89,562.13,Medicare,Medicare,,562.13,,,936.89,131.16,477.81,Fee Schedule,Medicare APC Fee Schedule
Q14801 BILE AC ENZ,82239,CPT,,,,,both,, ,274.77,164.86,Medicare,Medicare,,164.86,,,274.77,38.47,140.13,Fee Schedule,Medicare APC Fee Schedule
BILIRUBIN TOTAL,82247,CPT,,,,,both,, ,53.05,31.83,Medicare,Medicare,,31.83,,,53.05,7.43,27.06,Fee Schedule,Medicare APC Fee Schedule
BILIRUBIN TOTAL,82247,CPT,,,,,both,, ,282.92,169.75,Medicare,Medicare,,169.75,,,282.92,39.61,144.29,Fee Schedule,Medicare APC Fee Schedule
BILIRUBIN DIRECT,82248,CPT,,,,,both,, ,53.05,31.83,Medicare,Medicare,,31.83,,,53.05,7.43,27.06,Fee Schedule,Medicare APC Fee Schedule
BILIRUBIN DIRECT,82248,CPT,,,,,both,, ,282.92,169.75,Medicare,Medicare,,169.75,,,282.92,39.61,144.29,Fee Schedule,Medicare APC Fee Schedule
NBS BIOTINIDASE,82261,CPT,,,,,both,, ,100.75,60.45,Medicare,Medicare,,60.45,,,100.75,14.11,51.38,Fee Schedule,Medicare APC Fee Schedule
BLD OCCULT FECES 1-3,82270,CPT,,,,,both,, ,31.99,19.19,Medicare,Medicare,,19.19,,,31.99,4.48,16.31,Fee Schedule,Medicare APC Fee Schedule
BLD OCCULT FECES 1-3,82270,CPT,,,,,both,, ,210.50,126.30,Medicare,Medicare,,126.30,,,210.50,29.47,107.36,Fee Schedule,Medicare APC Fee Schedule
BLD OCCULT OTHER SRC,82271,CPT,,,,,both,, ,277.59,166.55,Medicare,Medicare,,166.55,,,277.59,38.86,141.57,Fee Schedule,Medicare APC Fee Schedule
BLD OCC NON CA SCREE,82272,CPT,,,,,both,, ,210.50,126.30,Medicare,Medicare,,126.30,,,210.50,29.47,107.36,Fee Schedule,Medicare APC Fee Schedule
BLD OCCULT FECES EIA,82274,CPT,,,,,both,, ,165.87,99.52,Medicare,Medicare,,99.52,,,165.87,23.22,84.59,Fee Schedule,Medicare APC Fee Schedule
CADMIUM,82300,CPT,,,,,both,, ,536.08,321.64,Medicare,Medicare,,321.64,,,536.08,75.05,273.4,Fee Schedule,Medicare APC Fee Schedule
CADMIUM,82300,CPT,,,,,both,, ,536.08,321.64,Medicare,Medicare,,321.64,,,536.08,75.05,273.4,Fee Schedule,Medicare APC Fee Schedule
Q672 CADMIUM,82300,CPT,,,,,both,, ,125.00,75.00,Medicare,Medicare,,75.00,,,125.00,17.50,63.75,Fee Schedule,Medicare APC Fee Schedule
L504115VITD 25-OH LC,82306,CPT,,,,,both,, ,651.73,391.03,Medicare,Medicare,,391.03,,,651.73,91.24,332.38,Fee Schedule,Medicare APC Fee Schedule
VITAMIN D 25OH,82306,CPT,,,,,both,, ,279.26,167.55,Medicare,Medicare,,167.55,,,279.26,39.10,142.42,Fee Schedule,Medicare APC Fee Schedule
VITAMIN D 25OH,82306,CPT,,,,,both,,,710.38,710.38,Medicare,Medicare,,710.38,,,710.38,99.45,362.29,Fee Schedule,Medicare APC Fee Schedule
VITAMIN D 25OH,82306,CPT,,,,,both,, ,710.38,426.22,Medicare,Medicare,,426.22,,,710.38,99.45,362.29,Fee Schedule,Medicare APC Fee Schedule
CALCITONIN,82308,CPT,,,,,both,, ,297.79,178.67,Medicare,Medicare,,178.67,,,297.79,41.69,151.87,Fee Schedule,Medicare APC Fee Schedule
Q30742 CALCITONIN IA,82308,CPT,,,,,both,, ,796.27,477.76,Medicare,Medicare,,477.76,,,796.27,111.48,406.1,Fee Schedule,Medicare APC Fee Schedule
CALCIUM TOTAL,82310,CPT,,,,,both,, ,54.45,32.67,Medicare,Medicare,,32.67,,,54.45,7.62,27.77,Fee Schedule,Medicare APC Fee Schedule
CALCIUM TOTAL,82310,CPT,,,,,both,, ,315.48,189.28,Medicare,Medicare,,189.28,,,315.48,44.17,160.89,Fee Schedule,Medicare APC Fee Schedule
CALCIUM TOTAL,82310,CPT,,,,,both,, ,315.48,189.28,Medicare,Medicare,,189.28,,,315.48,44.17,160.89,Fee Schedule,Medicare APC Fee Schedule
CALCIUM IONIZED,82330,CPT,,,,,both,, ,35.36,21.21,Medicare,Medicare,,21.21,,,35.36,4.95,18.03,Fee Schedule,Medicare APC Fee Schedule
CALCIUM IONIZED,82330,CPT,,,,,both,,,796.27,796.27,Medicare,Medicare,,796.27,,,796.27,111.48,406.1,Fee Schedule,Medicare APC Fee Schedule
CALCIUM IONIZED,82330,CPT,,,,,both,, ,796.27,477.76,Medicare,Medicare,,477.76,,,796.27,111.48,406.1,Fee Schedule,Medicare APC Fee Schedule
CALCIUM IONIZED,82330,CPT,,,,,both,, ,796.27,477.76,Medicare,Medicare,,477.76,,,796.27,111.48,406.1,Fee Schedule,Medicare APC Fee Schedule
CALCIUM URI QN TIMED,82340,CPT,,,,,both,,,412.87,412.87,Medicare,Medicare,,412.87,,,412.87,57.80,210.56,Fee Schedule,Medicare APC Fee Schedule
CALCIUM URI QN TIMED,82340,CPT,,,,,both,, ,412.87,247.72,Medicare,Medicare,,247.72,,,412.87,57.80,210.56,Fee Schedule,Medicare APC Fee Schedule
"L910235 CALCIUM, URINE",82340,CPT,,,,,both,, ,412.87,247.72,Medicare,Medicare,,247.72,,,412.87,57.80,210.56,Fee Schedule,Medicare APC Fee Schedule
Q442 CALCIUM URI QN,82340,CPT,,,,,both,, ,412.87,247.72,Medicare,Medicare,,247.72,,,412.87,57.80,210.56,Fee Schedule,Medicare APC Fee Schedule
CALCULUS INFRARED,82365,CPT,,,,,both,, ,1187.82,712.69,Medicare,Medicare,,712.69,,,1187.82,166.29,605.79,Fee Schedule,Medicare APC Fee Schedule
CALCULUS INFRARED,82365,CPT,,,,,both,, ,1187.82,712.69,Medicare,Medicare,,712.69,,,1187.82,166.29,605.79,Fee Schedule,Medicare APC Fee Schedule
CARBON DIOXIDE CO2,82374,CPT,,,,,both,, ,47.99,28.79,Medicare,Medicare,,28.79,,,47.99,6.72,24.47,Fee Schedule,Medicare APC Fee Schedule
CARBON DIOXIDE CO2,82374,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
CARBON MONOXIDE QUAN,82375,CPT,,,,,both,, ,203.49,122.09,Medicare,Medicare,,122.09,,,203.49,28.49,103.78,Fee Schedule,Medicare APC Fee Schedule
CARBON MONOXIDE QUAN,82375,CPT,,,,,both,, ,203.49,122.09,Medicare,Medicare,,122.09,,,203.49,28.49,103.78,Fee Schedule,Medicare APC Fee Schedule
CARCINOEMBRYONIC AG,82378,CPT,,,,,both,, ,121.53,72.91,Medicare,Medicare,,72.91,,,121.53,17.01,61.98,Fee Schedule,Medicare APC Fee Schedule
CARCINOEMBRYONIC AG,82378,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,315.75,,,526.26,73.68,268.39,Fee Schedule,Medicare APC Fee Schedule
CARCINOEMBRYONIC AG,82378,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,315.75,,,526.26,73.68,268.39,Fee Schedule,Medicare APC Fee Schedule
CAROTENE,82380,CPT,,,,,both,, ,1171.81,703.08,Medicare,Medicare,,703.08,,,1171.81,164.05,597.62,Fee Schedule,Medicare APC Fee Schedule
L1529 CAROTENE HPLC,82380,CPT,,,,,both,, ,75.20,45.12,Medicare,Medicare,,45.12,,,75.20,10.53,38.35,Fee Schedule,Medicare APC Fee Schedule
CATECHOL FRACTNTD,82384,CPT,,,,,both,, ,263.27,157.96,Medicare,Medicare,,157.96,,,263.27,36.86,134.27,Fee Schedule,Medicare APC Fee Schedule
CATECHOL FRACTNTD,82384,CPT,,,,,both,, ,263.27,157.96,Medicare,Medicare,,157.96,,,263.27,36.86,134.27,Fee Schedule,Medicare APC Fee Schedule
CATECHOL FRACTNTD,82384,CPT,,,,,both,, ,263.27,157.96,Medicare,Medicare,,157.96,,,263.27,36.86,134.27,Fee Schedule,Medicare APC Fee Schedule
CATECHOL FRACTNTD,82384,CPT,,,,,both,, ,263.27,157.96,Medicare,Medicare,,157.96,,,263.27,36.86,134.27,Fee Schedule,Medicare APC Fee Schedule
CERULOPLASMIN,82390,CPT,,,,,both,, ,859.70,515.82,Medicare,Medicare,,515.82,,,859.70,120.36,438.45,Fee Schedule,Medicare APC Fee Schedule
CERULOPLASMIN,82390,CPT,,,,,both,, ,859.70,515.82,Medicare,Medicare,,515.82,,,859.70,120.36,438.45,Fee Schedule,Medicare APC Fee Schedule
CHEMILUM ASSAY NOS,82397,CPT,,,,,both,, ,444.59,266.75,Medicare,Medicare,,266.75,,,444.59,62.24,226.74,Fee Schedule,Medicare APC Fee Schedule
L503870 CHEM ASY NOS,82397,CPT,,,,,both,, ,444.59,266.75,Medicare,Medicare,,266.75,,,444.59,62.24,226.74,Fee Schedule,Medicare APC Fee Schedule
L504567 CHEM ASY NOS,82397,CPT,,,,,both,, ,407.88,244.72,Medicare,Medicare,,244.72,,,407.88,57.10,208.02,Fee Schedule,Medicare APC Fee Schedule
Q34445 INHIBIN B CL,82397,CPT,,,,,both,, ,444.59,266.75,Medicare,Medicare,,266.75,,,444.59,62.24,226.74,Fee Schedule,Medicare APC Fee Schedule
Q37226 ANTI-MULLERIAN HORMONE (AMH) MALE,82397,CPT,,,,,both,, ,396.00,237.60,Medicare,Medicare,,237.60,,,396.00,55.44,201.96,Fee Schedule,Medicare APC Fee Schedule
Q37226 ANTI-MULLERIAN HORMONE (AMH) MALE,82397,CPT,,,,,both,, ,396.00,237.60,Medicare,Medicare,,237.60,,,396.00,55.44,201.96,Fee Schedule,Medicare APC Fee Schedule
CHLORIDE BLOOD,82435,CPT,,,,,both,, ,38.73,23.23,Medicare,Medicare,,23.23,,,38.73,5.42,19.75,Fee Schedule,Medicare APC Fee Schedule
CHLORIDE BLOOD,82435,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
CHLORIDE URINE RAN,82436,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
CHLORIDE URINE RAN,82436,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
CHLORIDES OTHER FLD,82438,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
CHOLESTEROL TOTAL,82465,CPT,,,,,both,, ,49.68,29.80,Medicare,Medicare,,29.80,,,49.68,6.96,25.34,Fee Schedule,Medicare APC Fee Schedule
CHOLESTEROL TOTAL,82465,CPT,,,,,both,, ,315.48,189.28,Medicare,Medicare,,189.28,,,315.48,44.17,160.89,Fee Schedule,Medicare APC Fee Schedule
CHOLINESTERASE SERUM,82480,CPT,,,,,both,, ,563.60,338.16,Medicare,Medicare,,338.16,,,563.60,78.90,287.44,Fee Schedule,Medicare APC Fee Schedule
Q338 CHOLINEST SER,82480,CPT,,,,,both,, ,563.60,338.16,Medicare,Medicare,,338.16,,,563.60,78.90,287.44,Fee Schedule,Medicare APC Fee Schedule
Q7961 CHOLINEST SER,82480,CPT,,,,,both,, ,563.60,338.16,Medicare,Medicare,,338.16,,,563.60,78.90,287.44,Fee Schedule,Medicare APC Fee Schedule
CHOLINESTERASE RBC,82482,CPT,,,,,both,, ,676.14,405.68,Medicare,Medicare,,405.68,,,676.14,94.66,344.83,Fee Schedule,Medicare APC Fee Schedule
CHOLINESTERASE RBC,82482,CPT,,,,,both,, ,676.14,405.68,Medicare,Medicare,,405.68,,,676.14,94.66,344.83,Fee Schedule,Medicare APC Fee Schedule
CHROMIUM,82495,CPT,,,,,both,, ,242.50,145.50,Medicare,Medicare,,145.50,,,242.50,33.95,123.68,Fee Schedule,Medicare APC Fee Schedule
CHROMIUM U,82495,CPT,,,,,both,, ,202.80,121.68,Medicare,Medicare,,121.68,,,202.80,28.39,103.43,Fee Schedule,Medicare APC Fee Schedule
"L910235 CITRATE, URINE",82507,CPT,,,,,both,, ,242.50,145.50,Medicare,Medicare,,145.50,,,242.50,33.95,123.68,Fee Schedule,Medicare APC Fee Schedule
Q11315 CIT AC U24 SP,82507,CPT,,,,,both,, ,242.50,145.50,Medicare,Medicare,,145.50,,,242.50,33.95,123.68,Fee Schedule,Medicare APC Fee Schedule
Q442 CITRATE,82507,CPT,,,,,both,, ,242.50,145.50,Medicare,Medicare,,145.50,,,242.50,33.95,123.68,Fee Schedule,Medicare APC Fee Schedule
COLLAGEN CROSSLINKS,82523,CPT,,,,,both,, ,280.11,168.06,Medicare,Medicare,,168.06,,,280.11,39.22,142.86,Fee Schedule,Medicare APC Fee Schedule
L500089 C-TELO ELISA,82523,CPT,,,,,both,, ,529.20,317.52,Medicare,Medicare,,317.52,,,529.20,74.09,269.89,Fee Schedule,Medicare APC Fee Schedule
"N-TELOPEP (NTX), UR",82523,CPT,,,,,both,, ,186.80,112.08,Medicare,Medicare,,112.08,,,186.80,26.15,95.27,Fee Schedule,Medicare APC Fee Schedule
COPPER SERUM,82525,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
COPPER SERUM,82525,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
COPPER SERUM,82525,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
COPPER SERUM,82525,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
Q11280CORTU24 LCMSMS,82530,CPT,,,,,both,, ,938.86,563.31,Medicare,Medicare,,563.31,,,938.86,131.44,478.82,Fee Schedule,Medicare APC Fee Schedule
Q11280CORTU24 LCMSMS,82530,CPT,,,,,both,, ,938.86,563.31,Medicare,Medicare,,563.31,,,938.86,131.44,478.82,Fee Schedule,Medicare APC Fee Schedule
Q36423 CORT FR LCMSM,82530,CPT,,,,,both,, ,939.13,563.47,Medicare,Medicare,,563.47,,,939.13,131.48,478.96,Fee Schedule,Medicare APC Fee Schedule
CORTISOL TOTAL,82533,CPT,,,,,both,, ,132.19,79.31,Medicare,Medicare,,79.31,,,132.19,18.51,67.42,Fee Schedule,Medicare APC Fee Schedule
CORTISOL TOTAL,82533,CPT,,,,,both,,,1343.58,1343.58,Medicare,Medicare,,1343.58,,,1343.58,188.10,685.23,Fee Schedule,Medicare APC Fee Schedule
CORTISOL TOTAL,82533,CPT,,,,,both,, ,1343.58,806.14,Medicare,Medicare,,806.14,,,1343.58,188.10,685.23,Fee Schedule,Medicare APC Fee Schedule
L500179SALIV CORT MS,82533,CPT,,,,,both,, ,335.78,201.46,Medicare,Medicare,,201.46,,,335.78,47.01,171.25,Fee Schedule,Medicare APC Fee Schedule
L500440 CORTISOL TOT,82533,CPT,,,,,both,, ,163.00,97.80,Medicare,Medicare,,97.80,,,163.00,22.82,83.13,Fee Schedule,Medicare APC Fee Schedule
CREATINE,82540,CPT,,,,,both,, ,38.73,23.23,Medicare,Medicare,,23.23,,,38.73,5.42,19.75,Fee Schedule,Medicare APC Fee Schedule
COL CHRM NODRG EA,82542,CPT,,,,,both,, ,320.53,192.31,Medicare,Medicare,,192.31,,,320.53,44.87,163.47,Fee Schedule,Medicare APC Fee Schedule
COL CHRM NODRG EA,82542,CPT,,,,,both,, ,320.53,192.31,Medicare,Medicare,,192.31,,,320.53,44.87,163.47,Fee Schedule,Medicare APC Fee Schedule
COL CHRM NODRG EA,82542,CPT,,,,,both,, ,320.53,192.31,Medicare,Medicare,,192.31,,,320.53,44.87,163.47,Fee Schedule,Medicare APC Fee Schedule
COL CHRM NODRG EA,82542,CPT,,,,,both,, ,320.53,192.31,Medicare,Medicare,,192.31,,,320.53,44.87,163.47,Fee Schedule,Medicare APC Fee Schedule
L823430 OMEGACHECK (EPA+DPA+DHA),82542,CPT,,,,,both,, ,430.00,258.00,Medicare,Medicare,,258.00,,,430.00,60.20,219.3,Fee Schedule,Medicare APC Fee Schedule
N-METHLHIST 24H UR,82542,CPT,,,,,both,, ,600.00,360.00,Medicare,Medicare,,360.00,,,600.00,84.00,306,Fee Schedule,Medicare APC Fee Schedule
CPK TOTAL,82550,CPT,,,,,both,, ,64.27,38.56,Medicare,Medicare,,38.56,,,64.27,9.00,32.78,Fee Schedule,Medicare APC Fee Schedule
CPK TOTAL,82550,CPT,,,,,both,,,282.92,282.92,Medicare,Medicare,,282.92,,,282.92,39.61,144.29,Fee Schedule,Medicare APC Fee Schedule
CPK TOTAL,82550,CPT,,,,,both,, ,282.92,169.75,Medicare,Medicare,,169.75,,,282.92,39.61,144.29,Fee Schedule,Medicare APC Fee Schedule
CPK TOTAL,82550,CPT,,,,,both,, ,282.92,169.75,Medicare,Medicare,,169.75,,,282.92,39.61,144.29,Fee Schedule,Medicare APC Fee Schedule
CPK ISOENZYMES,82552,CPT,,,,,both,, ,626.18,375.70,Medicare,Medicare,,375.70,,,626.18,87.67,319.35,Fee Schedule,Medicare APC Fee Schedule
CPK ISOENZYMES,82552,CPT,,,,,both,, ,626.18,375.70,Medicare,Medicare,,375.70,,,626.18,87.67,319.35,Fee Schedule,Medicare APC Fee Schedule
CPK MB FRACTION,82553,CPT,,,,,both,, ,113.67,68.20,Medicare,Medicare,,68.20,,,113.67,15.91,57.97,Fee Schedule,Medicare APC Fee Schedule
CPK MB FRACTION,82553,CPT,,,,,both,, ,620.56,372.33,Medicare,Medicare,,372.33,,,620.56,86.88,316.49,Fee Schedule,Medicare APC Fee Schedule
CREATININE BLOOD,82565,CPT,,,,,both,, ,19.09,11.45,Medicare,Medicare,,11.45,,,19.09,2.67,9.74,Fee Schedule,Medicare APC Fee Schedule
CREATININE BLOOD,82565,CPT,,,,,both,,,285.17,285.17,Medicare,Medicare,,285.17,,,285.17,39.92,145.44,Fee Schedule,Medicare APC Fee Schedule
CREATININE BLOOD,82565,CPT,,,,,both,, ,285.17,171.10,Medicare,Medicare,,171.10,,,285.17,39.92,145.44,Fee Schedule,Medicare APC Fee Schedule
CREATININE UR-OTHER,82570,CPT,,,,,both,, ,32.84,19.70,Medicare,Medicare,,19.70,,,32.84,4.60,16.75,Fee Schedule,Medicare APC Fee Schedule
CREATININE UR-OTHER,82570,CPT,,,,,both,,,285.17,285.17,Medicare,Medicare,,285.17,,,285.17,39.92,145.44,Fee Schedule,Medicare APC Fee Schedule
CREATININE UR-OTHER,82570,CPT,,,,,both,, ,285.17,171.10,Medicare,Medicare,,171.10,,,285.17,39.92,145.44,Fee Schedule,Medicare APC Fee Schedule
Q14961 CREATININE UR,82570,CPT,,,,,both,, ,261.87,157.12,Medicare,Medicare,,157.12,,,261.87,36.66,133.55,Fee Schedule,Medicare APC Fee Schedule
Q14961 CREATININE UR,82570,CPT,,,,,both,, ,261.87,157.12,Medicare,Medicare,,157.12,,,261.87,36.66,133.55,Fee Schedule,Medicare APC Fee Schedule
Q1648 CREATININE UR-,82570,CPT,,,,,both,, ,285.17,171.10,Medicare,Medicare,,171.10,,,285.17,39.92,145.44,Fee Schedule,Medicare APC Fee Schedule
Q17422 CREATIN PTF C,82570,CPT,,,,,both,, ,285.17,171.10,Medicare,Medicare,,171.10,,,285.17,39.92,145.44,Fee Schedule,Medicare APC Fee Schedule
Q442 CREATININE UR-O,82570,CPT,,,,,both,, ,285.17,171.10,Medicare,Medicare,,171.10,,,285.17,39.92,145.44,Fee Schedule,Medicare APC Fee Schedule
Q682 CREATININE UR-O,82570,CPT,,,,,both,, ,285.17,171.10,Medicare,Medicare,,171.10,,,285.17,39.92,145.44,Fee Schedule,Medicare APC Fee Schedule
Q7507 CREATIN UR-OTH,82570,CPT,,,,,both,, ,285.17,171.10,Medicare,Medicare,,171.10,,,285.17,39.92,145.44,Fee Schedule,Medicare APC Fee Schedule
Q8525 CREATININE UR-,82570,CPT,,,,,both,, ,285.17,171.10,Medicare,Medicare,,171.10,,,285.17,39.92,145.44,Fee Schedule,Medicare APC Fee Schedule
CREATININE CLEARANCE,82575,CPT,,,,,both,,,555.45,555.45,Medicare,Medicare,,555.45,,,555.45,77.76,283.28,Fee Schedule,Medicare APC Fee Schedule
CREATININE CLEARANCE,82575,CPT,,,,,both,, ,555.45,333.27,Medicare,Medicare,,333.27,,,555.45,77.76,283.28,Fee Schedule,Medicare APC Fee Schedule
CRYOGLOBULIN,82595,CPT,,,,,both,, ,968.60,581.16,Medicare,Medicare,,581.16,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
CRYOGLOBULIN,82595,CPT,,,,,both,, ,968.60,581.16,Medicare,Medicare,,581.16,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
VITAMIN B-12,82607,CPT,,,,,both,, ,111.43,66.85,Medicare,Medicare,,66.85,,,111.43,15.60,56.83,Fee Schedule,Medicare APC Fee Schedule
VITAMIN B-12,82607,CPT,,,,,both,,,641.06,641.06,Medicare,Medicare,,641.06,,,641.06,89.75,326.94,Fee Schedule,Medicare APC Fee Schedule
VITAMIN B-12,82607,CPT,,,,,both,, ,641.06,384.63,Medicare,Medicare,,384.63,,,641.06,89.75,326.94,Fee Schedule,Medicare APC Fee Schedule
VITAMIN B-12 BINDING,82608,CPT,,,,,both,, ,183.56,110.13,Medicare,Medicare,,110.13,,,183.56,25.70,93.62,Fee Schedule,Medicare APC Fee Schedule
Q10570 CYSTAT C NEPH,82610,CPT,,,,,both,, ,121.25,72.75,Medicare,Medicare,,72.75,,,121.25,16.98,61.84,Fee Schedule,Medicare APC Fee Schedule
"L910235 CREATININE, URINE",82615,CPT,,,,,both,, ,285.17,171.10,Medicare,Medicare,,171.10,,,285.17,39.92,145.44,Fee Schedule,Medicare APC Fee Schedule
L910235 CYSTINE/HOMOCYSTINE UR,82615,CPT,,,,,both,, ,50.00,30.00,Medicare,Medicare,,30.00,,,50.00,7.00,25.5,Fee Schedule,Medicare APC Fee Schedule
DHEA,82626,CPT,,,,,both,, ,263.55,158.13,Medicare,Medicare,,158.13,,,263.55,36.90,134.41,Fee Schedule,Medicare APC Fee Schedule
DHEA,82626,CPT,,,,,both,, ,263.55,158.13,Medicare,Medicare,,158.13,,,263.55,36.90,134.41,Fee Schedule,Medicare APC Fee Schedule
DHEA-S,82627,CPT,,,,,both,, ,664.35,398.61,Medicare,Medicare,,398.61,,,664.35,93.01,338.82,Fee Schedule,Medicare APC Fee Schedule
DHEA-S,82627,CPT,,,,,both,, ,664.35,398.61,Medicare,Medicare,,398.61,,,664.35,93.01,338.82,Fee Schedule,Medicare APC Fee Schedule
DEOXYCORTISOL,82634,CPT,,,,,both,, ,177.39,106.43,Medicare,Medicare,,106.43,,,177.39,24.83,90.47,Fee Schedule,Medicare APC Fee Schedule
DIBUCAINE NUMBER,82638,CPT,,,,,both,, ,270.28,162.16,Medicare,Medicare,,162.16,,,270.28,37.84,137.84,Fee Schedule,Medicare APC Fee Schedule
DIBUCAINE NUMBER,82638,CPT,,,,,both,, ,270.28,162.16,Medicare,Medicare,,162.16,,,270.28,37.84,137.84,Fee Schedule,Medicare APC Fee Schedule
DIHYDROTESTOST (DHT),82642,CPT,,,,,both,, ,151.84,91.10,Medicare,Medicare,,91.10,,,151.84,21.26,77.44,Fee Schedule,Medicare APC Fee Schedule
DIHYDROXY VITAMIN D,82652,CPT,,,,,both,, ,379.18,227.50,Medicare,Medicare,,227.50,,,379.18,53.09,193.38,Fee Schedule,Medicare APC Fee Schedule
DIHYDROXY VITAMIN D,82652,CPT,,,,,both,, ,1307.38,784.42,Medicare,Medicare,,784.42,,,1307.38,183.03,666.76,Fee Schedule,Medicare APC Fee Schedule
Q16558 VITD LCMSMS,82652,CPT,,,,,both,, ,554.89,332.93,Medicare,Medicare,,332.93,,,554.89,77.68,282.99,Fee Schedule,Medicare APC Fee Schedule
Q14693 ELAST PANC QT,82653,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,248.89,,,414.83,58.08,211.56,Fee Schedule,Medicare APC Fee Schedule
Q14693 ELAST PANC QT,82653,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,248.89,,,414.83,58.08,211.56,Fee Schedule,Medicare APC Fee Schedule
"PANCREA ELASTAS,FEC",82656,CPT,,,,,both,, ,267.48,160.48,Medicare,Medicare,,160.48,,,267.48,37.45,136.41,Fee Schedule,Medicare APC Fee Schedule
"PANCREA ELASTAS,FEC",82656,CPT,,,,,both,, ,267.48,160.48,Medicare,Medicare,,160.48,,,267.48,37.45,136.41,Fee Schedule,Medicare APC Fee Schedule
Q14693 PE-1 IA,82656,CPT,,,,,both,, ,228.97,137.38,Medicare,Medicare,,137.38,,,228.97,32.06,116.77,Fee Schedule,Medicare APC Fee Schedule
ERYTHROPOIETIN,82668,CPT,,,,,both,, ,1449.41,869.64,Medicare,Medicare,,869.64,,,1449.41,202.92,739.2,Fee Schedule,Medicare APC Fee Schedule
ERYTHROPOIETIN,82668,CPT,,,,,both,, ,1449.41,869.64,Medicare,Medicare,,869.64,,,1449.41,202.92,739.2,Fee Schedule,Medicare APC Fee Schedule
ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Medicare,Medicare,,585.87,,,976.46,136.70,497.99,Fee Schedule,Medicare APC Fee Schedule
L500649 ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Medicare,Medicare,,585.87,,,976.46,136.70,497.99,Fee Schedule,Medicare APC Fee Schedule
Q30289 ESTRADIOL US,82670,CPT,,,,,both,, ,976.46,585.87,Medicare,Medicare,,585.87,,,976.46,136.70,497.99,Fee Schedule,Medicare APC Fee Schedule
Q36169 ESTRA FR DIR,82670,CPT,,,,,both,, ,895.84,537.50,Medicare,Medicare,,537.50,,,895.84,125.42,456.88,Fee Schedule,Medicare APC Fee Schedule
Q36169 ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Medicare,Medicare,,585.87,,,976.46,136.70,497.99,Fee Schedule,Medicare APC Fee Schedule
Q4021 ESTRADIOL IA,82670,CPT,,,,,both,, ,976.46,585.87,Medicare,Medicare,,585.87,,,976.46,136.70,497.99,Fee Schedule,Medicare APC Fee Schedule
Q36742 EST FR LCMSMS,82671,CPT,,,,,both,, ,170.36,102.21,Medicare,Medicare,,102.21,,,170.36,23.85,86.88,Fee Schedule,Medicare APC Fee Schedule
ESTROGEN TOTAL,82672,CPT,,,,,both,, ,1727.55,1036.53,Medicare,Medicare,,1036.53,,,1727.55,241.86,881.05,Fee Schedule,Medicare APC Fee Schedule
Q439 ESTROG TOT RIA,82672,CPT,,,,,both,, ,304.53,182.71,Medicare,Medicare,,182.71,,,304.53,42.63,155.31,Fee Schedule,Medicare APC Fee Schedule
ESTRIOL,82677,CPT,,,,,both,, ,317.44,190.46,Medicare,Medicare,,190.46,,,317.44,44.44,161.89,Fee Schedule,Medicare APC Fee Schedule
ESTRIOL,82677,CPT,,,,,both,, ,317.44,190.46,Medicare,Medicare,,190.46,,,317.44,44.44,161.89,Fee Schedule,Medicare APC Fee Schedule
ESTRONE,82679,CPT,,,,,both,, ,116.47,69.88,Medicare,Medicare,,69.88,,,116.47,16.31,59.4,Fee Schedule,Medicare APC Fee Schedule
ESTRONE,82679,CPT,,,,,both,, ,116.47,69.88,Medicare,Medicare,,69.88,,,116.47,16.31,59.4,Fee Schedule,Medicare APC Fee Schedule
L500649 ESTRA FR DIR,82681,CPT,,,,,both,, ,251.84,151.10,Medicare,Medicare,,151.10,,,251.84,35.26,128.44,Fee Schedule,Medicare APC Fee Schedule
ETHYLENE GLYCOL,82693,CPT,,,,,both,,,1577.11,1577.11,Medicare,Medicare,,1577.11,,,1577.11,220.80,804.33,Fee Schedule,Medicare APC Fee Schedule
ETHYLENE GLYCOL,82693,CPT,,,,,both,, ,1577.11,946.26,Medicare,Medicare,,946.26,,,1577.11,220.80,804.33,Fee Schedule,Medicare APC Fee Schedule
Q801 ETHYL GLY CHRMT,82693,CPT,,,,,both,, ,935.21,561.12,Medicare,Medicare,,561.12,,,935.21,130.93,476.96,Fee Schedule,Medicare APC Fee Schedule
FAT-LIPID FECES QUAL,82705,CPT,,,,,both,, ,600.92,360.55,Medicare,Medicare,,360.55,,,600.92,84.13,306.47,Fee Schedule,Medicare APC Fee Schedule
FAT-LIPID FECES QUAL,82705,CPT,,,,,both,, ,600.92,360.55,Medicare,Medicare,,360.55,,,600.92,84.13,306.47,Fee Schedule,Medicare APC Fee Schedule
FAT-LIPID FECES QUAN,82710,CPT,,,,,both,, ,768.20,460.92,Medicare,Medicare,,460.92,,,768.20,107.55,391.78,Fee Schedule,Medicare APC Fee Schedule
FAT-LIPID FECES QUAN,82710,CPT,,,,,both,, ,768.20,460.92,Medicare,Medicare,,460.92,,,768.20,107.55,391.78,Fee Schedule,Medicare APC Fee Schedule
FECAL FAT QUANT 72HR,82710,CPT,,,,,both,, ,122.20,73.32,Medicare,Medicare,,73.32,,,122.20,17.11,62.32,Fee Schedule,Medicare APC Fee Schedule
Q90559 VLCFA,82726,CPT,,,,,both,, ,88.69,53.21,Medicare,Medicare,,53.21,,,88.69,12.42,45.23,Fee Schedule,Medicare APC Fee Schedule
FERRITIN,82728,CPT,,,,,both,, ,100.75,60.45,Medicare,Medicare,,60.45,,,100.75,14.11,51.38,Fee Schedule,Medicare APC Fee Schedule
FERRITIN,82728,CPT,,,,,both,,,864.19,864.19,Medicare,Medicare,,864.19,,,864.19,120.99,440.74,Fee Schedule,Medicare APC Fee Schedule
FERRITIN,82728,CPT,,,,,both,, ,864.19,518.51,Medicare,Medicare,,518.51,,,864.19,120.99,440.74,Fee Schedule,Medicare APC Fee Schedule
FETAL FIBRONECTIN,82731,CPT,,,,,both,, ,701.69,421.01,Medicare,Medicare,,421.01,,,701.69,98.24,357.86,Fee Schedule,Medicare APC Fee Schedule
FOLIC ACID SERUM,82746,CPT,,,,,both,, ,108.61,65.16,Medicare,Medicare,,65.16,,,108.61,15.21,55.39,Fee Schedule,Medicare APC Fee Schedule
FOLIC ACID SERUM,82746,CPT,,,,,both,,,735.65,735.65,Medicare,Medicare,,735.65,,,735.65,102.99,375.18,Fee Schedule,Medicare APC Fee Schedule
FOLIC ACID SERUM,82746,CPT,,,,,both,, ,735.65,441.39,Medicare,Medicare,,441.39,,,735.65,102.99,375.18,Fee Schedule,Medicare APC Fee Schedule
FOLIC ACID RBC,82747,CPT,,,,,both,, ,627.30,376.38,Medicare,Medicare,,376.38,,,627.30,87.82,319.92,Fee Schedule,Medicare APC Fee Schedule
FOLIC ACID RBC,82747,CPT,,,,,both,, ,627.30,376.38,Medicare,Medicare,,376.38,,,627.30,87.82,319.92,Fee Schedule,Medicare APC Fee Schedule
NBS GALACTOSE,82760,CPT,,,,,both,, ,66.80,40.08,Medicare,Medicare,,40.08,,,66.80,9.35,34.07,Fee Schedule,Medicare APC Fee Schedule
NBS GALACTOSE TRANS,82776,CPT,,,,,both,, ,49.96,29.97,Medicare,Medicare,,29.97,,,49.96,6.99,25.48,Fee Schedule,Medicare APC Fee Schedule
GAMMAGLOB M-G-A-D,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,132.52,,,220.88,30.92,112.65,Fee Schedule,Medicare APC Fee Schedule
GAMMAGLOB M-G-A-D,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,132.52,,,220.88,30.92,112.65,Fee Schedule,Medicare APC Fee Schedule
GAMMAGLOB M-G-A-D,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,132.52,,,220.88,30.92,112.65,Fee Schedule,Medicare APC Fee Schedule
GAMMAGLOB M-G-A-D,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,132.52,,,220.88,30.92,112.65,Fee Schedule,Medicare APC Fee Schedule
Q38940 GAMMAGLOB M G A D,82784,CPT,,,,,both,, ,196.75,118.05,Medicare,Medicare,,118.05,,,196.75,27.55,100.34,Fee Schedule,Medicare APC Fee Schedule
Q541 IGD NEPHELOMET,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,132.52,,,220.88,30.92,112.65,Fee Schedule,Medicare APC Fee Schedule
Q541 IGD NEPHELOMET,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,132.52,,,220.88,30.92,112.65,Fee Schedule,Medicare APC Fee Schedule
Q541 IGD NEPHELOMET,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,132.52,,,220.88,30.92,112.65,Fee Schedule,Medicare APC Fee Schedule
Q541 IGD NEPHELOMET,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,132.52,,,220.88,30.92,112.65,Fee Schedule,Medicare APC Fee Schedule
Q70858GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,132.52,,,220.88,30.92,112.65,Fee Schedule,Medicare APC Fee Schedule
Q70858GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,132.52,,,220.88,30.92,112.65,Fee Schedule,Medicare APC Fee Schedule
Q70858GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,132.52,,,220.88,30.92,112.65,Fee Schedule,Medicare APC Fee Schedule
Q70858GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,132.52,,,220.88,30.92,112.65,Fee Schedule,Medicare APC Fee Schedule
GAMMAGLOBULIN IGE,82785,CPT,,,,,both,, ,127.14,76.28,Medicare,Medicare,,76.28,,,127.14,17.80,64.84,Fee Schedule,Medicare APC Fee Schedule
GAMMAGLOBULIN IGE,82785,CPT,,,,,both,, ,906.30,543.78,Medicare,Medicare,,543.78,,,906.30,126.88,462.21,Fee Schedule,Medicare APC Fee Schedule
Q542 IGE IA,82785,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,89.25,,,148.75,20.83,75.86,Fee Schedule,Medicare APC Fee Schedule
Q542 IGE IA,82785,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,89.25,,,148.75,20.83,75.86,Fee Schedule,Medicare APC Fee Schedule
Q542 IGE IA,82785,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,89.25,,,148.75,20.83,75.86,Fee Schedule,Medicare APC Fee Schedule
Q542 IGE IA,82785,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,89.25,,,148.75,20.83,75.86,Fee Schedule,Medicare APC Fee Schedule
"IGG SUB 1,2,3 OR 4",82787,CPT,,,,,both,, ,389.01,233.40,Medicare,Medicare,,233.40,,,389.01,54.46,198.4,Fee Schedule,Medicare APC Fee Schedule
Q143422 IGG SUB4 NEP,82787,CPT,,,,,both,, ,389.01,233.40,Medicare,Medicare,,233.40,,,389.01,54.46,198.4,Fee Schedule,Medicare APC Fee Schedule
"Q7903IGG SUB 1,2,3,4",82787,CPT,,,,,both,, ,389.01,233.40,Medicare,Medicare,,233.40,,,389.01,54.46,198.4,Fee Schedule,Medicare APC Fee Schedule
BLOOD PH,82800,CPT,,,,,both,, ,618.04,370.82,Medicare,Medicare,,370.82,,,618.04,86.53,315.2,Fee Schedule,Medicare APC Fee Schedule
BLD GAS W-O2 SAT DIR,82805,CPT,,,,,both,, ,1760.39,1056.23,Medicare,Medicare,,1056.23,,,1760.39,246.45,897.8,Fee Schedule,Medicare APC Fee Schedule
"BLD GAS, O2 SAT ONLY",82810,CPT,,,,,both,, ,100.63,60.37,Medicare,Medicare,,60.37,,,100.63,14.09,51.32,Fee Schedule,Medicare APC Fee Schedule
"BLD GAS, O2 SAT ONLY",82810,CPT,,,,,both,, ,100.63,60.37,Medicare,Medicare,,60.37,,,100.63,14.09,51.32,Fee Schedule,Medicare APC Fee Schedule
GASTRIN,82941,CPT,,,,,both,, ,863.91,518.34,Medicare,Medicare,,518.34,,,863.91,120.95,440.59,Fee Schedule,Medicare APC Fee Schedule
GASTRIN,82941,CPT,,,,,both,, ,863.91,518.34,Medicare,Medicare,,518.34,,,863.91,120.95,440.59,Fee Schedule,Medicare APC Fee Schedule
Q519 GLUCAG EXT-RIA,82943,CPT,,,,,both,, ,82.51,49.50,Medicare,Medicare,,49.50,,,82.51,11.55,42.08,Fee Schedule,Medicare APC Fee Schedule
GLUCOSE BODY FLUID,82945,CPT,,,,,both,, ,412.87,247.72,Medicare,Medicare,,247.72,,,412.87,57.80,210.56,Fee Schedule,Medicare APC Fee Schedule
"GLUCOSE, QUANT",82947,CPT,,,,,both,, ,21.89,13.13,Medicare,Medicare,,13.13,,,21.89,3.06,11.16,Fee Schedule,Medicare APC Fee Schedule
"GLUCOSE, QUANT",82947,CPT,,,,,both,,,240.26,240.26,Medicare,Medicare,,240.26,,,240.26,33.64,122.53,Fee Schedule,Medicare APC Fee Schedule
"GLUCOSE, QUANT",82947,CPT,,,,,both,, ,240.26,144.15,Medicare,Medicare,,144.15,,,240.26,33.64,122.53,Fee Schedule,Medicare APC Fee Schedule
"GLUCOSE, POST DOSE",82950,CPT,,,,,both,,,450.48,450.48,Medicare,Medicare,,450.48,,,450.48,63.07,229.74,Fee Schedule,Medicare APC Fee Schedule
"GLUCOSE, POST DOSE",82950,CPT,,,,,both,, ,450.48,270.28,Medicare,Medicare,,270.28,,,450.48,63.07,229.74,Fee Schedule,Medicare APC Fee Schedule
GTT 3 SPEC,82951,CPT,,,,,both,, ,758.95,455.37,Medicare,Medicare,,455.37,,,758.95,106.25,387.06,Fee Schedule,Medicare APC Fee Schedule
GTT ADD SP,82952,CPT,,,,,both,, ,188.05,112.83,Medicare,Medicare,,112.83,,,188.05,26.33,95.91,Fee Schedule,Medicare APC Fee Schedule
"G6PD, QUANT",82955,CPT,,,,,both,, ,1026.43,615.85,Medicare,Medicare,,615.85,,,1026.43,143.70,523.48,Fee Schedule,Medicare APC Fee Schedule
"L121003 G6PD, QUANT",82955,CPT,,,,,both,, ,60.00,36.00,Medicare,Medicare,,36.00,,,60.00,8.40,30.6,Fee Schedule,Medicare APC Fee Schedule
"GLU,HOME USE DIAGNOS",82962,CPT,,,,,both,, ,8.76,5.25,Medicare,Medicare,,5.25,,,8.76,1.23,4.47,Fee Schedule,Medicare APC Fee Schedule
"GLU,HOME USE DIAGNOS",82962,CPT,,,,,both,, ,99.35,59.61,Medicare,Medicare,,59.61,,,99.35,13.91,50.67,Fee Schedule,Medicare APC Fee Schedule
GGT,82977,CPT,,,,,both,, ,71.01,42.60,Medicare,Medicare,,42.60,,,71.01,9.94,36.22,Fee Schedule,Medicare APC Fee Schedule
GGT,82977,CPT,,,,,both,, ,412.87,247.72,Medicare,Medicare,,247.72,,,412.87,57.80,210.56,Fee Schedule,Medicare APC Fee Schedule
L7700 GSH TOT,82978,CPT,,,,,both,, ,61.00,36.60,Medicare,Medicare,,36.60,,,61.00,8.54,31.11,Fee Schedule,Medicare APC Fee Schedule
GLYCATED PROTEIN,82985,CPT,,,,,both,, ,263.83,158.29,Medicare,Medicare,,158.29,,,263.83,36.94,134.55,Fee Schedule,Medicare APC Fee Schedule
Q8340 FRUCTOSAMINE C,82985,CPT,,,,,both,, ,298.92,179.35,Medicare,Medicare,,179.35,,,298.92,41.85,152.45,Fee Schedule,Medicare APC Fee Schedule
FOLLICLE STIM HORM,83001,CPT,,,,,both,, ,137.25,82.35,Medicare,Medicare,,82.35,,,137.25,19.22,70,Fee Schedule,Medicare APC Fee Schedule
FOLLICLE STIM HORM,83001,CPT,,,,,both,, ,812.55,487.53,Medicare,Medicare,,487.53,,,812.55,113.76,414.4,Fee Schedule,Medicare APC Fee Schedule
FOLLICLE STIM HORM,83001,CPT,,,,,both,, ,812.55,487.53,Medicare,Medicare,,487.53,,,812.55,113.76,414.4,Fee Schedule,Medicare APC Fee Schedule
LEUTEINIZING HORMONE,83002,CPT,,,,,both,, ,136.97,82.18,Medicare,Medicare,,82.18,,,136.97,19.18,69.85,Fee Schedule,Medicare APC Fee Schedule
LEUTEINIZING HORMONE,83002,CPT,,,,,both,, ,812.55,487.53,Medicare,Medicare,,487.53,,,812.55,113.76,414.4,Fee Schedule,Medicare APC Fee Schedule
LEUTEINIZING HORMONE,83002,CPT,,,,,both,, ,812.55,487.53,Medicare,Medicare,,487.53,,,812.55,113.76,414.4,Fee Schedule,Medicare APC Fee Schedule
GROWTH HORMONE,83003,CPT,,,,,both,, ,1201.85,721.11,Medicare,Medicare,,721.11,,,1201.85,168.26,612.94,Fee Schedule,Medicare APC Fee Schedule
Q521 GH IA,83003,CPT,,,,,both,, ,74.86,44.91,Medicare,Medicare,,44.91,,,74.86,10.48,38.18,Fee Schedule,Medicare APC Fee Schedule
Q91823 GRTH STM GN 2,83006,CPT,,,,,both,, ,189.00,113.40,Medicare,Medicare,,113.40,,,189.00,26.46,96.39,Fee Schedule,Medicare APC Fee Schedule
"HAPTOGLOBIN, QUANT",83010,CPT,,,,,both,, ,1109.23,665.53,Medicare,Medicare,,665.53,,,1109.23,155.29,565.71,Fee Schedule,Medicare APC Fee Schedule
"HAPTOGLOBIN, QUANT",83010,CPT,,,,,both,, ,1109.23,665.53,Medicare,Medicare,,665.53,,,1109.23,155.29,565.71,Fee Schedule,Medicare APC Fee Schedule
Q14839H.PYLO UREA IR,83013,CPT,,,,,both,, ,623.38,374.02,Medicare,Medicare,,374.02,,,623.38,87.27,317.92,Fee Schedule,Medicare APC Fee Schedule
"HEAVY METALS, QUANT",83018,CPT,,,,,both,, ,175.14,105.08,Medicare,Medicare,,105.08,,,175.14,24.52,89.32,Fee Schedule,Medicare APC Fee Schedule
L121690 - HEMOGLOBIN ELECTRO,83020,CPT,,,,,both,, ,108.15,64.89,Medicare,Medicare,,64.89,,,108.15,15.14,55.16,Fee Schedule,Medicare APC Fee Schedule
NBS HGB ELECTRO,83020,CPT,,,,,both,, ,76.90,46.14,Medicare,Medicare,,46.14,,,76.90,10.77,39.22,Fee Schedule,Medicare APC Fee Schedule
"HEMOGLOBIN, CHROMA",83021,CPT,,,,,both,, ,180.60,108.36,Medicare,Medicare,,108.36,,,180.60,25.28,92.11,Fee Schedule,Medicare APC Fee Schedule
"HEMOGLOBIN, CHROMA",83021,CPT,,,,,both,, ,180.60,108.36,Medicare,Medicare,,108.36,,,180.60,25.28,92.11,Fee Schedule,Medicare APC Fee Schedule
"HEMOGLOB,FETGAL,QUAL",83033,CPT,,,,,both,, ,354.77,212.86,Medicare,Medicare,,212.86,,,354.77,49.67,180.93,Fee Schedule,Medicare APC Fee Schedule
HEMOGLOBIN A1C,83036,CPT,,,,,both,, ,95.71,57.42,Medicare,Medicare,,57.42,,,95.71,13.40,48.81,Fee Schedule,Medicare APC Fee Schedule
HEMOGLOBIN A1C,83036,CPT,,,,,both,,,454.97,454.97,Medicare,Medicare,,454.97,,,454.97,63.70,232.03,Fee Schedule,Medicare APC Fee Schedule
HEMOGLOBIN A1C,83036,CPT,,,,,both,, ,454.97,272.98,Medicare,Medicare,,272.98,,,454.97,63.70,232.03,Fee Schedule,Medicare APC Fee Schedule
HEMOGLOBIN A1C,83036,CPT,,,,,both,, ,454.97,272.98,Medicare,Medicare,,272.98,,,454.97,63.70,232.03,Fee Schedule,Medicare APC Fee Schedule
"METHEMOGLOBIN,QUAN",83050,CPT,,,,,both,, ,122.09,73.25,Medicare,Medicare,,73.25,,,122.09,17.09,62.27,Fee Schedule,Medicare APC Fee Schedule
"HEMOGLOBIN, PLASMA",83051,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
"HEMOSIDERIN, QUAL",83070,CPT,,,,,both,, ,373.57,224.14,Medicare,Medicare,,224.14,,,373.57,52.30,190.52,Fee Schedule,Medicare APC Fee Schedule
HISTAMINE,83088,CPT,,,,,both,, ,385.09,231.05,Medicare,Medicare,,231.05,,,385.09,53.91,196.4,Fee Schedule,Medicare APC Fee Schedule
Q36586 HISTAM PL RIA,83088,CPT,,,,,both,, ,385.09,231.05,Medicare,Medicare,,231.05,,,385.09,53.91,196.4,Fee Schedule,Medicare APC Fee Schedule
Q4946 HISTAM U24 IA,83088,CPT,,,,,both,, ,385.09,231.05,Medicare,Medicare,,231.05,,,385.09,53.91,196.4,Fee Schedule,Medicare APC Fee Schedule
HOMOCYSTEINE,83090,CPT,,,,,both,, ,227.91,136.74,Medicare,Medicare,,136.74,,,227.91,31.91,116.23,Fee Schedule,Medicare APC Fee Schedule
HOMOCYSTEINE,83090,CPT,,,,,both,, ,227.91,136.74,Medicare,Medicare,,136.74,,,227.91,31.91,116.23,Fee Schedule,Medicare APC Fee Schedule
CORTICOSTEROIDS,83491,CPT,,,,,both,, ,1217.28,730.36,Medicare,Medicare,,730.36,,,1217.28,170.42,620.81,Fee Schedule,Medicare APC Fee Schedule
5-HIAA,83497,CPT,,,,,both,, ,976.46,585.87,Medicare,Medicare,,585.87,,,976.46,136.70,497.99,Fee Schedule,Medicare APC Fee Schedule
Q1648 5-HIAA,83497,CPT,,,,,both,, ,976.46,585.87,Medicare,Medicare,,585.87,,,976.46,136.70,497.99,Fee Schedule,Medicare APC Fee Schedule
Q523 5-HIAA U24 HPLC,83497,CPT,,,,,both,, ,976.46,585.87,Medicare,Medicare,,585.87,,,976.46,136.70,497.99,Fee Schedule,Medicare APC Fee Schedule
HYDROXYPROGES 17-D,83498,CPT,,,,,both,, ,600.92,360.55,Medicare,Medicare,,360.55,,,600.92,84.13,306.47,Fee Schedule,Medicare APC Fee Schedule
NBS HYDROXYPROG 17-D,83498,CPT,,,,,both,, ,162.23,97.33,Medicare,Medicare,,97.33,,,162.23,22.71,82.74,Fee Schedule,Medicare APC Fee Schedule
Q17180 17-OHP LCMSMS,83498,CPT,,,,,both,, ,601.20,360.72,Medicare,Medicare,,360.72,,,601.20,84.17,306.61,Fee Schedule,Medicare APC Fee Schedule
"IMMUNOASSAY, OTHER",83516,CPT,,,,,both,,,765.96,765.96,Medicare,Medicare,,765.96,,,765.96,107.23,390.64,Fee Schedule,Medicare APC Fee Schedule
"IMMUNOASSAY, OTHER",83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,459.57,,,765.96,107.23,390.64,Fee Schedule,Medicare APC Fee Schedule
L162045 IA OTH,83516,CPT,,,,,both,, ,702.72,421.63,Medicare,Medicare,,421.63,,,702.72,98.38,358.39,Fee Schedule,Medicare APC Fee Schedule
L163061 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,459.57,,,765.96,107.23,390.64,Fee Schedule,Medicare APC Fee Schedule
L165126 IA OTH,83516,CPT,,,,,both,, ,702.72,421.63,Medicare,Medicare,,421.63,,,702.72,98.38,358.39,Fee Schedule,Medicare APC Fee Schedule
L341142 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,459.57,,,765.96,107.23,390.64,Fee Schedule,Medicare APC Fee Schedule
L520057 ANTI-HMGCR,83516,CPT,,,,,both,, ,630.00,378.00,Medicare,Medicare,,378.00,,,630.00,88.20,321.3,Fee Schedule,Medicare APC Fee Schedule
L520085 IA OTHER,83516,CPT,,,,,both,, ,702.72,421.63,Medicare,Medicare,,421.63,,,702.72,98.38,358.39,Fee Schedule,Medicare APC Fee Schedule
L520139 ANTI-GP210AB,83516,CPT,,,,,both,, ,300.00,180.00,Medicare,Medicare,,180.00,,,300.00,42.00,153,Fee Schedule,Medicare APC Fee Schedule
L520311 CARP AB,83516,CPT,,,,,both,, ,520.00,312.00,Medicare,Medicare,,312.00,,,520.00,72.80,265.2,Fee Schedule,Medicare APC Fee Schedule
L6486PARIET AB ELISA,83516,CPT,,,,,both,, ,81.50,48.90,Medicare,Medicare,,48.90,,,81.50,11.41,41.57,Fee Schedule,Medicare APC Fee Schedule
Q15114PARCL AB ELISA,83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,459.57,,,765.96,107.23,390.64,Fee Schedule,Medicare APC Fee Schedule
Q18855 KU AUTOANTIBODIES,83516,CPT,,,,,both,, ,682.25,409.35,Medicare,Medicare,,409.35,,,682.25,95.52,347.95,Fee Schedule,Medicare APC Fee Schedule
Q19899RNA P-III ELIS,83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,459.57,,,765.96,107.23,390.64,Fee Schedule,Medicare APC Fee Schedule
Q34283 RIBO P AB IA,83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,459.57,,,765.96,107.23,390.64,Fee Schedule,Medicare APC Fee Schedule
Q36336 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,459.57,,,765.96,107.23,390.64,Fee Schedule,Medicare APC Fee Schedule
Q37056 HISTON AB EIA,83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,459.57,,,765.96,107.23,390.64,Fee Schedule,Medicare APC Fee Schedule
Q39226  21OH AB,83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,459.57,,,765.96,107.23,390.64,Fee Schedule,Medicare APC Fee Schedule
"IMMUNOASSAY, RIA",83519,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,436.84,,,728.07,101.93,371.32,Fee Schedule,Medicare APC Fee Schedule
"IMMUNOASSAY, RIA",83519,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,436.84,,,728.07,101.93,371.32,Fee Schedule,Medicare APC Fee Schedule
"IMMUNOASSAY, RIA",83519,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,436.84,,,728.07,101.93,371.32,Fee Schedule,Medicare APC Fee Schedule
"IMMUNOASSAY, RIA",83519,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,436.84,,,728.07,101.93,371.32,Fee Schedule,Medicare APC Fee Schedule
L10421 MSH,83519,CPT,,,,,both,, ,184.00,110.40,Medicare,Medicare,,110.40,,,184.00,25.76,93.84,Fee Schedule,Medicare APC Fee Schedule
L504600 MUSCLE SPECIFIC KINASE,83519,CPT,,,,,both,, ,1200.00,720.00,Medicare,Medicare,,720.00,,,1200.00,168.00,612,Fee Schedule,Medicare APC Fee Schedule
Q34478 PTH-RP IA,83519,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,436.84,,,728.07,101.93,371.32,Fee Schedule,Medicare APC Fee Schedule
Q34478 PTH-RP IA,83519,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,436.84,,,728.07,101.93,371.32,Fee Schedule,Medicare APC Fee Schedule
Q34478 PTH-RP IA,83519,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,436.84,,,728.07,101.93,371.32,Fee Schedule,Medicare APC Fee Schedule
Q34478 PTH-RP IA,83519,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,436.84,,,728.07,101.93,371.32,Fee Schedule,Medicare APC Fee Schedule
"IMMUNOASSAY, NOS",83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,248.89,,,414.83,58.08,211.56,Fee Schedule,Medicare APC Fee Schedule
"IMMUNOASSAY, NOS",83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,248.89,,,414.83,58.08,211.56,Fee Schedule,Medicare APC Fee Schedule
L117021 VEGF SER,83520,CPT,,,,,both,, ,175.00,105.00,Medicare,Medicare,,105.00,,,175.00,24.50,89.25,Fee Schedule,Medicare APC Fee Schedule
L146795INHIBIN B EIA,83520,CPT,,,,,both,, ,380.59,228.35,Medicare,Medicare,,228.35,,,380.59,53.28,194.1,Fee Schedule,Medicare APC Fee Schedule
L500016PROTHR FR 1+2,83520,CPT,,,,,both,, ,172.70,103.62,Medicare,Medicare,,103.62,,,172.70,24.18,88.08,Fee Schedule,Medicare APC Fee Schedule
L500124 MMP9,83520,CPT,,,,,both,, ,170.00,102.00,Medicare,Medicare,,102.00,,,170.00,23.80,86.7,Fee Schedule,Medicare APC Fee Schedule
L520085 IA NOS,83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,248.89,,,414.83,58.08,211.56,Fee Schedule,Medicare APC Fee Schedule
L520085 IA NOS,83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,248.89,,,414.83,58.08,211.56,Fee Schedule,Medicare APC Fee Schedule
NBS IMMUNOASSAY NOS,83520,CPT,,,,,both,, ,77.47,46.48,Medicare,Medicare,,46.48,,,77.47,10.85,39.51,Fee Schedule,Medicare APC Fee Schedule
Q113354 IA NOS,83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,248.89,,,414.83,58.08,211.56,Fee Schedule,Medicare APC Fee Schedule
Q113354 IA NOS,83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,248.89,,,414.83,58.08,211.56,Fee Schedule,Medicare APC Fee Schedule
Q145128 VEGF ELISA,83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,248.89,,,414.83,58.08,211.56,Fee Schedule,Medicare APC Fee Schedule
Q145128 VEGF ELISA,83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,248.89,,,414.83,58.08,211.56,Fee Schedule,Medicare APC Fee Schedule
Q16136 BULLOUS PEMPHOGOID BP230 IGG,83520,CPT,,,,,both,, ,369.50,221.70,Medicare,Medicare,,221.70,,,369.50,51.73,188.45,Fee Schedule,Medicare APC Fee Schedule
Q16136 BULLOUS PEMPHOGOID BP230 IGG,83520,CPT,,,,,both,, ,369.50,221.70,Medicare,Medicare,,221.70,,,369.50,51.73,188.45,Fee Schedule,Medicare APC Fee Schedule
Q16136 BULLOUS PEMPHOGOID BP230 IGG,83520,CPT,,,,,both,, ,369.50,221.70,Medicare,Medicare,,221.70,,,369.50,51.73,188.45,Fee Schedule,Medicare APC Fee Schedule
Q16136 BULLOUS PEMPHOGOID BP230 IGG,83520,CPT,,,,,both,, ,369.50,221.70,Medicare,Medicare,,221.70,,,369.50,51.73,188.45,Fee Schedule,Medicare APC Fee Schedule
Q34458 IGFBP-3 IA,83520,CPT,,,,,both,, ,444.59,266.75,Medicare,Medicare,,266.75,,,444.59,62.24,226.74,Fee Schedule,Medicare APC Fee Schedule
Q34458 IGFBP-3 IA,83520,CPT,,,,,both,, ,444.59,266.75,Medicare,Medicare,,266.75,,,444.59,62.24,226.74,Fee Schedule,Medicare APC Fee Schedule
Q34484 TRYPTASE FIA,83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,248.89,,,414.83,58.08,211.56,Fee Schedule,Medicare APC Fee Schedule
Q34484 TRYPTASE FIA,83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,248.89,,,414.83,58.08,211.56,Fee Schedule,Medicare APC Fee Schedule
L121210 LTCHN KAPLAM,83521,CPT,,,,,both,, ,103.62,62.17,Medicare,Medicare,,62.17,,,103.62,14.51,52.85,Fee Schedule,Medicare APC Fee Schedule
L121210 LTCHN KAPLAM,83521,CPT,,,,,both,, ,103.62,62.17,Medicare,Medicare,,62.17,,,103.62,14.51,52.85,Fee Schedule,Medicare APC Fee Schedule
Q11234 LTCHN KAP LAM,83521,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
Q11234 LTCHN KAP LAM,83521,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
"INSULIN, TOTAL",83525,CPT,,,,,both,, ,53.89,32.33,Medicare,Medicare,,32.33,,,53.89,7.54,27.48,Fee Schedule,Medicare APC Fee Schedule
"INSULIN, TOTAL",83525,CPT,,,,,both,, ,600.92,360.55,Medicare,Medicare,,360.55,,,600.92,84.13,306.47,Fee Schedule,Medicare APC Fee Schedule
Q561 INSULIN IA,83525,CPT,,,,,both,, ,632.36,379.41,Medicare,Medicare,,379.41,,,632.36,88.53,322.5,Fee Schedule,Medicare APC Fee Schedule
"INSULIN, FREE",83527,CPT,,,,,both,, ,193.94,116.36,Medicare,Medicare,,116.36,,,193.94,27.15,98.91,Fee Schedule,Medicare APC Fee Schedule
L501561 INSULIN FREE,83527,CPT,,,,,both,, ,193.94,116.36,Medicare,Medicare,,116.36,,,193.94,27.15,98.91,Fee Schedule,Medicare APC Fee Schedule
Q36700 INSULIN FR IA,83527,CPT,,,,,both,, ,193.94,116.36,Medicare,Medicare,,116.36,,,193.94,27.15,98.91,Fee Schedule,Medicare APC Fee Schedule
IRON,83540,CPT,,,,,both,, ,63.99,38.39,Medicare,Medicare,,38.39,,,63.99,8.96,32.63,Fee Schedule,Medicare APC Fee Schedule
IRON,83540,CPT,,,,,both,,,345.79,345.79,Medicare,Medicare,,345.79,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
IRON,83540,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
IRON BINDING CAPACIT,83550,CPT,,,,,both,, ,86.16,51.69,Medicare,Medicare,,51.69,,,86.16,12.06,43.94,Fee Schedule,Medicare APC Fee Schedule
IRON BINDING CAPACIT,83550,CPT,,,,,both,,,526.26,526.26,Medicare,Medicare,,526.26,,,526.26,73.68,268.39,Fee Schedule,Medicare APC Fee Schedule
IRON BINDING CAPACIT,83550,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,315.75,,,526.26,73.68,268.39,Fee Schedule,Medicare APC Fee Schedule
"17-KETOSTEROIDS, TOT",83586,CPT,,,,,both,, ,164.19,98.51,Medicare,Medicare,,98.51,,,164.19,22.99,83.74,Fee Schedule,Medicare APC Fee Schedule
LACTIC ACID,83605,CPT,,,,,both,, ,105.25,63.15,Medicare,Medicare,,63.15,,,105.25,14.74,53.68,Fee Schedule,Medicare APC Fee Schedule
LACTIC ACID,83605,CPT,,,,,both,,,691.29,691.29,Medicare,Medicare,,691.29,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
LACTIC ACID,83605,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
LACTATE DEHYDROLDH,83615,CPT,,,,,both,, ,59.50,35.70,Medicare,Medicare,,35.70,,,59.50,8.33,30.35,Fee Schedule,Medicare APC Fee Schedule
LACTATE DEHYDROLDH,83615,CPT,,,,,both,, ,600.92,360.55,Medicare,Medicare,,360.55,,,600.92,84.13,306.47,Fee Schedule,Medicare APC Fee Schedule
LACTATE DEHYDROLDH,83615,CPT,,,,,both,, ,600.92,360.55,Medicare,Medicare,,360.55,,,600.92,84.13,306.47,Fee Schedule,Medicare APC Fee Schedule
LDH ISOENZYMES,83625,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q10156 LACTOFER IA,83630,CPT,,,,,both,, ,267.48,160.48,Medicare,Medicare,,160.48,,,267.48,37.45,136.41,Fee Schedule,Medicare APC Fee Schedule
LEAD,83655,CPT,,,,,both,, ,56.97,34.18,Medicare,Medicare,,34.18,,,56.97,7.98,29.05,Fee Schedule,Medicare APC Fee Schedule
LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q22996 LEAD,83655,CPT,,,,,both,, ,615.75,369.45,Medicare,Medicare,,369.45,,,615.75,86.21,314.03,Fee Schedule,Medicare APC Fee Schedule
Q22996 LEAD,83655,CPT,,,,,both,, ,615.75,369.45,Medicare,Medicare,,369.45,,,615.75,86.21,314.03,Fee Schedule,Medicare APC Fee Schedule
Q36438 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q36440LEAD U24 ICPMS,83655,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q599 PB BL ICP/MS,83655,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q601 PB U ICP/MS,83655,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q7507 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q7655 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
"FETAL LUNG,L-S RATIO",83661,CPT,,,,,both,, ,175.14,105.08,Medicare,Medicare,,105.08,,,175.14,24.52,89.32,Fee Schedule,Medicare APC Fee Schedule
"FETAL LUNG, FPIA",83663,CPT,,,,,both,, ,863.91,518.34,Medicare,Medicare,,518.34,,,863.91,120.95,440.59,Fee Schedule,Medicare APC Fee Schedule
LIPASE,83690,CPT,,,,,both,, ,67.92,40.75,Medicare,Medicare,,40.75,,,67.92,9.51,34.64,Fee Schedule,Medicare APC Fee Schedule
LIPASE,83690,CPT,,,,,both,,,420.72,420.72,Medicare,Medicare,,420.72,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
LIPASE,83690,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
LIPOPROTEIN A,83695,CPT,,,,,both,, ,112.27,67.36,Medicare,Medicare,,67.36,,,112.27,15.72,57.26,Fee Schedule,Medicare APC Fee Schedule
LIPOPROTEIN A,83695,CPT,,,,,both,, ,112.27,67.36,Medicare,Medicare,,67.36,,,112.27,15.72,57.26,Fee Schedule,Medicare APC Fee Schedule
Q34604 LIPOPRT A ITA,83695,CPT,,,,,both,, ,467.04,280.22,Medicare,Medicare,,280.22,,,467.04,65.39,238.19,Fee Schedule,Medicare APC Fee Schedule
Q94220 LP-PLA2,83698,CPT,,,,,both,, ,216.39,129.83,Medicare,Medicare,,129.83,,,216.39,30.29,110.36,Fee Schedule,Medicare APC Fee Schedule
LIPOPROT BLD BY NMR,83704,CPT,,,,,both,, ,374.69,224.81,Medicare,Medicare,,224.81,,,374.69,52.46,191.09,Fee Schedule,Medicare APC Fee Schedule
LIPOPROT BLD BY NMR,83704,CPT,,,,,both,, ,374.69,224.81,Medicare,Medicare,,224.81,,,374.69,52.46,191.09,Fee Schedule,Medicare APC Fee Schedule
"LIPOPROTEIN, HDL",83718,CPT,,,,,both,, ,60.63,36.37,Medicare,Medicare,,36.37,,,60.63,8.49,30.92,Fee Schedule,Medicare APC Fee Schedule
"LIPOPROTEIN, HDL",83718,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,288.47,,,480.79,67.31,245.2,Fee Schedule,Medicare APC Fee Schedule
"LIPOPROTEIN, LDL",83721,CPT,,,,,both,, ,570.89,342.53,Medicare,Medicare,,342.53,,,570.89,79.92,291.15,Fee Schedule,Medicare APC Fee Schedule
"L910235 MAGNESIUM, URINE",83735,CPT,,,,,both,, ,67.00,40.20,Medicare,Medicare,,40.20,,,67.00,9.38,34.17,Fee Schedule,Medicare APC Fee Schedule
"L910235 MAGNESIUM, URINE",83735,CPT,,,,,both,, ,67.00,40.20,Medicare,Medicare,,40.20,,,67.00,9.38,34.17,Fee Schedule,Medicare APC Fee Schedule
MAGNESIUM,83735,CPT,,,,,both,, ,49.68,29.80,Medicare,Medicare,,29.80,,,49.68,6.96,25.34,Fee Schedule,Medicare APC Fee Schedule
MAGNESIUM,83735,CPT,,,,,both,,,344.10,344.10,Medicare,Medicare,,344.10,,,344.10,48.17,175.49,Fee Schedule,Medicare APC Fee Schedule
MAGNESIUM,83735,CPT,,,,,both,, ,344.10,206.46,Medicare,Medicare,,206.46,,,344.10,48.17,175.49,Fee Schedule,Medicare APC Fee Schedule
MAGNESIUM,83735,CPT,,,,,both,, ,344.10,206.46,Medicare,Medicare,,206.46,,,344.10,48.17,175.49,Fee Schedule,Medicare APC Fee Schedule
MANGANESE WHOLE BLOOD,83785,CPT,,,,,both,, ,133.00,79.80,Medicare,Medicare,,79.80,,,133.00,18.62,67.83,Fee Schedule,Medicare APC Fee Schedule
L70034 I S/P ICP/MS,83789,CPT,,,,,both,, ,315.00,189.00,Medicare,Medicare,,189.00,,,315.00,44.10,160.65,Fee Schedule,Medicare APC Fee Schedule
L70222 I U ICP/MS,83789,CPT,,,,,both,, ,390.49,234.29,Medicare,Medicare,,234.29,,,390.49,54.67,199.15,Fee Schedule,Medicare APC Fee Schedule
MASS SPECTRO QUANT,83789,CPT,,,,,both,, ,402.20,241.32,Medicare,Medicare,,241.32,,,402.20,56.31,205.12,Fee Schedule,Medicare APC Fee Schedule
MASS SPECTRO QUANT,83789,CPT,,,,,both,, ,402.20,241.32,Medicare,Medicare,,241.32,,,402.20,56.31,205.12,Fee Schedule,Medicare APC Fee Schedule
MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,450.81,,,751.36,105.19,383.19,Fee Schedule,Medicare APC Fee Schedule
Q36438 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,450.81,,,751.36,105.19,383.19,Fee Schedule,Medicare APC Fee Schedule
Q636 HG BL ICP/MS,83825,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,450.81,,,751.36,105.19,383.19,Fee Schedule,Medicare APC Fee Schedule
Q7507 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,450.81,,,751.36,105.19,383.19,Fee Schedule,Medicare APC Fee Schedule
Q7655 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,450.81,,,751.36,105.19,383.19,Fee Schedule,Medicare APC Fee Schedule
METANEPHRINES,83835,CPT,,,,,both,, ,2599.05,1559.43,Medicare,Medicare,,1559.43,,,2599.05,363.87,1325.52,Fee Schedule,Medicare APC Fee Schedule
Q14961 METANEPHRINES,83835,CPT,,,,,both,, ,488.65,293.19,Medicare,Medicare,,293.19,,,488.65,68.41,249.21,Fee Schedule,Medicare APC Fee Schedule
Q14962MNFR U24 LCMSM,83835,CPT,,,,,both,, ,488.65,293.19,Medicare,Medicare,,293.19,,,488.65,68.41,249.21,Fee Schedule,Medicare APC Fee Schedule
Q19548 MN FRC LCMSMS,83835,CPT,,,,,both,, ,488.65,293.19,Medicare,Medicare,,293.19,,,488.65,68.41,249.21,Fee Schedule,Medicare APC Fee Schedule
MYELIN BASIC PROTEIN,83873,CPT,,,,,both,, ,509.14,305.48,Medicare,Medicare,,305.48,,,509.14,71.28,259.66,Fee Schedule,Medicare APC Fee Schedule
MYELIN BASIC PROTEIN,83873,CPT,,,,,both,, ,509.14,305.48,Medicare,Medicare,,305.48,,,509.14,71.28,259.66,Fee Schedule,Medicare APC Fee Schedule
MYOGLOBIN,83874,CPT,,,,,both,, ,627.30,376.38,Medicare,Medicare,,376.38,,,627.30,87.82,319.92,Fee Schedule,Medicare APC Fee Schedule
MYOGLOBIN,83874,CPT,,,,,both,, ,627.30,376.38,Medicare,Medicare,,376.38,,,627.30,87.82,319.92,Fee Schedule,Medicare APC Fee Schedule
L143000 NT-PROBNP,83880,CPT,,,,,both,, ,450.00,270.00,Medicare,Medicare,,270.00,,,450.00,63.00,229.5,Fee Schedule,Medicare APC Fee Schedule
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,, ,279.55,167.73,Medicare,Medicare,,167.73,,,279.55,39.14,142.57,Fee Schedule,Medicare APC Fee Schedule
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,,,1229.07,1229.07,Medicare,Medicare,,1229.07,,,1229.07,172.07,626.83,Fee Schedule,Medicare APC Fee Schedule
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,, ,1229.07,737.44,Medicare,Medicare,,737.44,,,1229.07,172.07,626.83,Fee Schedule,Medicare APC Fee Schedule
"NEPHELOMETRY, NOS",83883,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
"NEPHELOMETRY, NOS",83883,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
Q38940 NEPHELOMETRY NOS,83883,CPT,,,,,both,, ,374.75,224.85,Medicare,Medicare,,224.85,,,374.75,52.47,191.12,Fee Schedule,Medicare APC Fee Schedule
NICKEL,83885,CPT,,,,,both,, ,934.09,560.45,Medicare,Medicare,,560.45,,,934.09,130.77,476.39,Fee Schedule,Medicare APC Fee Schedule
NUCLEOTIDASE 5',83915,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,522.73,,,871.22,121.97,444.32,Fee Schedule,Medicare APC Fee Schedule
NUCLEOTIDASE 5',83915,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,522.73,,,871.22,121.97,444.32,Fee Schedule,Medicare APC Fee Schedule
OLIGOCLONAL BANDS,83916,CPT,,,,,both,, ,530.75,318.45,Medicare,Medicare,,318.45,,,530.75,74.31,270.68,Fee Schedule,Medicare APC Fee Schedule
OLIGOCLONAL BANDS,83916,CPT,,,,,both,, ,530.75,318.45,Medicare,Medicare,,318.45,,,530.75,74.31,270.68,Fee Schedule,Medicare APC Fee Schedule
"ORGAN ACID,SIN,QUAN",83921,CPT,,,,,both,, ,396.02,237.61,Medicare,Medicare,,237.61,,,396.02,55.44,201.97,Fee Schedule,Medicare APC Fee Schedule
"ORGAN ACID,SIN,QUAN",83921,CPT,,,,,both,, ,396.02,237.61,Medicare,Medicare,,237.61,,,396.02,55.44,201.97,Fee Schedule,Medicare APC Fee Schedule
L2071 OSMALALITY FPD,83930,CPT,,,,,both,, ,40.89,24.53,Medicare,Medicare,,24.53,,,40.89,5.72,20.85,Fee Schedule,Medicare APC Fee Schedule
"OSMOLALITY, BLOOD",83930,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
L3442 OSMOLALI U FPD,83935,CPT,,,,,both,, ,50.90,30.54,Medicare,Medicare,,30.54,,,50.90,7.13,25.96,Fee Schedule,Medicare APC Fee Schedule
"OSMOLALITY,URINE",83935,CPT,,,,,both,, ,67.07,40.24,Medicare,Medicare,,40.24,,,67.07,9.39,34.21,Fee Schedule,Medicare APC Fee Schedule
"OSMOLALITY,URINE",83935,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
L10249 OSTREOC ELISA,83937,CPT,,,,,both,, ,203.60,122.16,Medicare,Medicare,,122.16,,,203.60,28.50,103.84,Fee Schedule,Medicare APC Fee Schedule
OSTEOCALCIN,83937,CPT,,,,,both,, ,447.39,268.43,Medicare,Medicare,,268.43,,,447.39,62.63,228.17,Fee Schedule,Medicare APC Fee Schedule
OXALATE,83945,CPT,,,,,both,, ,660.98,396.58,Medicare,Medicare,,396.58,,,660.98,92.54,337.1,Fee Schedule,Medicare APC Fee Schedule
OXALATE,83945,CPT,,,,,both,, ,660.98,396.58,Medicare,Medicare,,396.58,,,660.98,92.54,337.1,Fee Schedule,Medicare APC Fee Schedule
OXALATE,83945,CPT,,,,,both,, ,660.98,396.58,Medicare,Medicare,,396.58,,,660.98,92.54,337.1,Fee Schedule,Medicare APC Fee Schedule
OXALATE,83945,CPT,,,,,both,, ,660.98,396.58,Medicare,Medicare,,396.58,,,660.98,92.54,337.1,Fee Schedule,Medicare APC Fee Schedule
L15610 PTH INT ECLIA,83970,CPT,,,,,both,, ,420.49,252.29,Medicare,Medicare,,252.29,,,420.49,58.87,214.45,Fee Schedule,Medicare APC Fee Schedule
PARATHORMONE PTH,83970,CPT,,,,,both,, ,160.55,96.33,Medicare,Medicare,,96.33,,,160.55,22.48,81.88,Fee Schedule,Medicare APC Fee Schedule
PARATHORMONE PTH,83970,CPT,,,,,both,, ,1420.49,852.29,Medicare,Medicare,,852.29,,,1420.49,198.87,724.45,Fee Schedule,Medicare APC Fee Schedule
"L910235 PH FLUID, NOS",83986,CPT,,,,,both,, ,240.26,144.15,Medicare,Medicare,,144.15,,,240.26,33.64,122.53,Fee Schedule,Medicare APC Fee Schedule
"PH FLUID,NOS",83986,CPT,,,,,both,, ,240.26,144.15,Medicare,Medicare,,144.15,,,240.26,33.64,122.53,Fee Schedule,Medicare APC Fee Schedule
"Q442 PH FLUID,NOS",83986,CPT,,,,,both,, ,240.26,144.15,Medicare,Medicare,,144.15,,,240.26,33.64,122.53,Fee Schedule,Medicare APC Fee Schedule
L790600 PCP MS,83992,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
CALPROTECTIN FECAL,83993,CPT,,,,,both,, ,395.75,237.45,Medicare,Medicare,,237.45,,,395.75,55.41,201.83,Fee Schedule,Medicare APC Fee Schedule
CALPROTECTIN FECAL,83993,CPT,,,,,both,, ,395.75,237.45,Medicare,Medicare,,237.45,,,395.75,55.41,201.83,Fee Schedule,Medicare APC Fee Schedule
NBS PHENYLALANINE BL,84030,CPT,,,,,both,, ,32.84,19.70,Medicare,Medicare,,19.70,,,32.84,4.60,16.75,Fee Schedule,Medicare APC Fee Schedule
NBS PHENYLALANINE BL,84030,CPT,,,,,both,, ,32.84,19.70,Medicare,Medicare,,19.70,,,32.84,4.60,16.75,Fee Schedule,Medicare APC Fee Schedule
"PHOSPHATASE, PROSTAT",84066,CPT,,,,,both,, ,540.85,324.51,Medicare,Medicare,,324.51,,,540.85,75.72,275.83,Fee Schedule,Medicare APC Fee Schedule
"PHOSPHATASE,ALKALINE",84075,CPT,,,,,both,, ,51.08,30.64,Medicare,Medicare,,30.64,,,51.08,7.15,26.05,Fee Schedule,Medicare APC Fee Schedule
"PHOSPHATASE,ALKALINE",84075,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
"PHOSPHATASE,ALKALINE",84075,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
"PHOSPHATASE,ALK ISO",84080,CPT,,,,,both,, ,637.41,382.44,Medicare,Medicare,,382.44,,,637.41,89.24,325.08,Fee Schedule,Medicare APC Fee Schedule
"PHOSPHATASE,ALK ISO",84080,CPT,,,,,both,, ,637.41,382.44,Medicare,Medicare,,382.44,,,637.41,89.24,325.08,Fee Schedule,Medicare APC Fee Schedule
PHOSPHATIDYLGLYCEROL,84081,CPT,,,,,both,, ,389.01,233.40,Medicare,Medicare,,233.40,,,389.01,54.46,198.4,Fee Schedule,Medicare APC Fee Schedule
"PHOSPHORUS, BLOOD",84100,CPT,,,,,both,, ,46.87,28.12,Medicare,Medicare,,28.12,,,46.87,6.56,23.9,Fee Schedule,Medicare APC Fee Schedule
"PHOSPHORUS, BLOOD",84100,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"L910235 PHOSPHORUS, URINE",84105,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"PHOSPHORUS, URINE",84105,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"Q442 PHOSPHORUS, URI",84105,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"PORPHOBILINOGEN,QUAN",84110,CPT,,,,,both,, ,630.96,378.57,Medicare,Medicare,,378.57,,,630.96,88.33,321.79,Fee Schedule,Medicare APC Fee Schedule
PAMG-1 QUALITATIVE,84112,CPT,,,,,both,, ,488.09,292.85,Medicare,Medicare,,292.85,,,488.09,68.33,248.93,Fee Schedule,Medicare APC Fee Schedule
L3194 PORPH QT U24,84120,CPT,,,,,both,, ,811.43,486.85,Medicare,Medicare,,486.85,,,811.43,113.60,413.83,Fee Schedule,Medicare APC Fee Schedule
"PORPHYRINS,UR,QUAN",84120,CPT,,,,,both,, ,811.42,486.85,Medicare,Medicare,,486.85,,,811.42,113.60,413.82,Fee Schedule,Medicare APC Fee Schedule
POTASSIUM SER PL WB,84132,CPT,,,,,both,, ,47.15,28.29,Medicare,Medicare,,28.29,,,47.15,6.60,24.05,Fee Schedule,Medicare APC Fee Schedule
POTASSIUM SER PL WB,84132,CPT,,,,,both,,,240.26,240.26,Medicare,Medicare,,240.26,,,240.26,33.64,122.53,Fee Schedule,Medicare APC Fee Schedule
POTASSIUM SER PL WB,84132,CPT,,,,,both,, ,240.26,144.15,Medicare,Medicare,,144.15,,,240.26,33.64,122.53,Fee Schedule,Medicare APC Fee Schedule
"L910235 POTASSIUM, URINE",84133,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"POTASSIUM, URINE",84133,CPT,,,,,both,,,345.79,345.79,Medicare,Medicare,,345.79,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"POTASSIUM, URINE",84133,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"Q442 POTASSIUM, URIN",84133,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
PREALBUMIN,84134,CPT,,,,,both,, ,105.25,63.15,Medicare,Medicare,,63.15,,,105.25,14.74,53.68,Fee Schedule,Medicare APC Fee Schedule
PREALBUMIN,84134,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
PREGNENOLONE,84140,CPT,,,,,both,, ,164.75,98.85,Medicare,Medicare,,98.85,,,164.75,23.07,84.02,Fee Schedule,Medicare APC Fee Schedule
PREGNENOLONE,84140,CPT,,,,,both,, ,164.75,98.85,Medicare,Medicare,,98.85,,,164.75,23.07,84.02,Fee Schedule,Medicare APC Fee Schedule
"PREGNENOLONE,17-OH",84143,CPT,,,,,both,, ,387.89,232.73,Medicare,Medicare,,232.73,,,387.89,54.30,197.82,Fee Schedule,Medicare APC Fee Schedule
PROGESTERONE,84144,CPT,,,,,both,, ,62.58,37.54,Medicare,Medicare,,37.54,,,62.58,8.76,31.92,Fee Schedule,Medicare APC Fee Schedule
PROGESTERONE,84144,CPT,,,,,both,, ,1217.28,730.36,Medicare,Medicare,,730.36,,,1217.28,170.42,620.81,Fee Schedule,Medicare APC Fee Schedule
PROGESTERONE,84144,CPT,,,,,both,, ,1217.28,730.36,Medicare,Medicare,,730.36,,,1217.28,170.42,620.81,Fee Schedule,Medicare APC Fee Schedule
PROCALCITONIN PCT,84145,CPT,,,,,both,, ,232.11,139.26,Medicare,Medicare,,139.26,,,232.11,32.50,118.38,Fee Schedule,Medicare APC Fee Schedule
PROCALCITONIN PCT,84145,CPT,,,,,both,, ,232.11,139.26,Medicare,Medicare,,139.26,,,232.11,32.50,118.38,Fee Schedule,Medicare APC Fee Schedule
L4465 PROLACTI ECLIA,84146,CPT,,,,,both,, ,628.30,376.98,Medicare,Medicare,,376.98,,,628.30,87.96,320.43,Fee Schedule,Medicare APC Fee Schedule
PROLACTIN,84146,CPT,,,,,both,, ,143.14,85.88,Medicare,Medicare,,85.88,,,143.14,20.04,73,Fee Schedule,Medicare APC Fee Schedule
PROLACTIN,84146,CPT,,,,,both,, ,1077.50,646.50,Medicare,Medicare,,646.50,,,1077.50,150.85,549.53,Fee Schedule,Medicare APC Fee Schedule
Q40049 PROLACTIN,84146,CPT,,,,,both,, ,959.75,575.85,Medicare,Medicare,,575.85,,,959.75,134.37,489.47,Fee Schedule,Medicare APC Fee Schedule
Q40049 PROLACTIN,84146,CPT,,,,,both,, ,959.75,575.85,Medicare,Medicare,,575.85,,,959.75,134.37,489.47,Fee Schedule,Medicare APC Fee Schedule
Q93958 23BPG UR,84150,CPT,,,,,both,, ,390.13,234.07,Medicare,Medicare,,234.07,,,390.13,54.62,198.97,Fee Schedule,Medicare APC Fee Schedule
PSA (prostate specific antigen),84153,CPT,,,,,both,,,1036.25,1036.25,Medicare,Medicare,,1036.25,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
"PSA, TOTAL",84153,CPT,,,,,both,, ,135.85,81.51,Medicare,Medicare,,81.51,,,135.85,19.02,69.28,Fee Schedule,Medicare APC Fee Schedule
"PSA, TOTAL",84153,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
"PSA, TOTAL",84153,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
PSA (prostate specific antigen),84154,CPT,,,,,both,,,1036.25,1036.25,Medicare,Medicare,,1036.25,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
"PSA, FREE",84154,CPT,,,,,both,, ,135.85,81.51,Medicare,Medicare,,81.51,,,135.85,19.02,69.28,Fee Schedule,Medicare APC Fee Schedule
"PSA, FREE",84154,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
"PSA, FREE",84154,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,35.93,21.55,Medicare,Medicare,,21.55,,,35.93,5.03,18.32,Fee Schedule,Medicare APC Fee Schedule
PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
Q38940 PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,374.75,224.85,Medicare,Medicare,,224.85,,,374.75,52.47,191.12,Fee Schedule,Medicare APC Fee Schedule
PROT TOTL RANDOM URI,84156,CPT,,,,,both,,,420.72,420.72,Medicare,Medicare,,420.72,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
PROT TOTL RANDOM URI,84156,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
PROT TOTL RANDOM URI,84156,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
PROTEIN TOT OTHR SRC,84157,CPT,,,,,both,, ,35.93,21.55,Medicare,Medicare,,21.55,,,35.93,5.03,18.32,Fee Schedule,Medicare APC Fee Schedule
Q749 PROT TOT OTH SR,84157,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
PROTEINELECTR FR-QNT,84165,CPT,,,,,both,, ,105.81,63.48,Medicare,Medicare,,63.48,,,105.81,14.81,53.96,Fee Schedule,Medicare APC Fee Schedule
PROTEINELECTR FR-QNT,84165,CPT,,,,,both,, ,609.34,365.60,Medicare,Medicare,,365.60,,,609.34,85.31,310.76,Fee Schedule,Medicare APC Fee Schedule
PROTEINELECTR FR-QNT,84165,CPT,,,,,both,, ,609.34,365.60,Medicare,Medicare,,365.60,,,609.34,85.31,310.76,Fee Schedule,Medicare APC Fee Schedule
PROTEINELECTR FR-QNT,84165,CPT,,,,,both,, ,609.34,365.60,Medicare,Medicare,,365.60,,,609.34,85.31,310.76,Fee Schedule,Medicare APC Fee Schedule
PROTEINELECTR FR-QNT,84165,CPT,,,,,both,, ,609.34,365.60,Medicare,Medicare,,365.60,,,609.34,85.31,310.76,Fee Schedule,Medicare APC Fee Schedule
Q38940 PROTEINELECTR FR QNT,84165,CPT,,,,,both,, ,542.75,325.65,Medicare,Medicare,,325.65,,,542.75,75.99,276.8,Fee Schedule,Medicare APC Fee Schedule
PROT E-PHOR-URIN-CSF,84166,CPT,,,,,both,, ,429.71,257.82,Medicare,Medicare,,257.82,,,429.71,60.16,219.15,Fee Schedule,Medicare APC Fee Schedule
Q749 PROT E-PHOR-URI,84166,CPT,,,,,both,, ,429.71,257.82,Medicare,Medicare,,257.82,,,429.71,60.16,219.15,Fee Schedule,Medicare APC Fee Schedule
Q8525 PROT E-PHOR-UR,84166,CPT,,,,,both,, ,429.71,257.82,Medicare,Medicare,,257.82,,,429.71,60.16,219.15,Fee Schedule,Medicare APC Fee Schedule
Q94685 WEST BLOT PRB,84182,CPT,,,,,both,, ,136.40,81.84,Medicare,Medicare,,81.84,,,136.40,19.10,69.56,Fee Schedule,Medicare APC Fee Schedule
Q94685 WEST BLOT PRB,84182,CPT,,,,,both,, ,136.40,81.84,Medicare,Medicare,,81.84,,,136.40,19.10,69.56,Fee Schedule,Medicare APC Fee Schedule
"PROTOPORPH,RBC,QUAN",84202,CPT,,,,,both,, ,199.27,119.56,Medicare,Medicare,,119.56,,,199.27,27.90,101.63,Fee Schedule,Medicare APC Fee Schedule
"PROTOPORPH,RBC,QUAN",84202,CPT,,,,,both,, ,199.27,119.56,Medicare,Medicare,,119.56,,,199.27,27.90,101.63,Fee Schedule,Medicare APC Fee Schedule
Q22996 PROTOPORPH RBC QUAN,84202,CPT,,,,,both,, ,177.50,106.50,Medicare,Medicare,,106.50,,,177.50,24.85,90.53,Fee Schedule,Medicare APC Fee Schedule
PROINSULIN,84206,CPT,,,,,both,, ,266.91,160.14,Medicare,Medicare,,160.14,,,266.91,37.37,136.12,Fee Schedule,Medicare APC Fee Schedule
Q760 PROINSULIN IA,84206,CPT,,,,,both,, ,337.09,202.25,Medicare,Medicare,,202.25,,,337.09,47.19,171.92,Fee Schedule,Medicare APC Fee Schedule
VITAMIN B-6,84207,CPT,,,,,both,, ,738.17,442.90,Medicare,Medicare,,442.90,,,738.17,103.34,376.47,Fee Schedule,Medicare APC Fee Schedule
VITAMIN B-6,84207,CPT,,,,,both,, ,738.17,442.90,Medicare,Medicare,,442.90,,,738.17,103.34,376.47,Fee Schedule,Medicare APC Fee Schedule
PYRUVATE,84210,CPT,,,,,both,, ,1066.84,640.10,Medicare,Medicare,,640.10,,,1066.84,149.36,544.09,Fee Schedule,Medicare APC Fee Schedule
"RECEPTOR, NON-ENDO",84238,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
"RECEPTOR, NON-ENDO",84238,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,196.02,,,326.71,45.74,166.62,Fee Schedule,Medicare APC Fee Schedule
Q16846 PL REN LCMSMS,84244,CPT,,,,,both,, ,475.46,285.27,Medicare,Medicare,,285.27,,,475.46,66.56,242.48,Fee Schedule,Medicare APC Fee Schedule
Q16846 PL REN LCMSMS,84244,CPT,,,,,both,, ,475.46,285.27,Medicare,Medicare,,285.27,,,475.46,66.56,242.48,Fee Schedule,Medicare APC Fee Schedule
RENIN,84244,CPT,,,,,both,, ,1487.01,892.20,Medicare,Medicare,,892.20,,,1487.01,208.18,758.38,Fee Schedule,Medicare APC Fee Schedule
VITAMIN B-2,84252,CPT,,,,,both,, ,180.75,108.45,Medicare,Medicare,,108.45,,,180.75,25.31,92.18,Fee Schedule,Medicare APC Fee Schedule
SELENIUM,84255,CPT,,,,,both,, ,409.50,245.70,Medicare,Medicare,,245.70,,,409.50,57.33,208.85,Fee Schedule,Medicare APC Fee Schedule
SELENIUM,84255,CPT,,,,,both,, ,409.50,245.70,Medicare,Medicare,,245.70,,,409.50,57.33,208.85,Fee Schedule,Medicare APC Fee Schedule
SEROTONIN,84260,CPT,,,,,both,, ,94.58,56.74,Medicare,Medicare,,56.74,,,94.58,13.24,48.24,Fee Schedule,Medicare APC Fee Schedule
Q14966 SEX HORM BIND,84270,CPT,,,,,both,, ,288.25,172.95,Medicare,Medicare,,172.95,,,288.25,40.36,147.01,Fee Schedule,Medicare APC Fee Schedule
Q30740 SHBG IA,84270,CPT,,,,,both,, ,288.25,172.95,Medicare,Medicare,,172.95,,,288.25,40.36,147.01,Fee Schedule,Medicare APC Fee Schedule
SEX HORM BIND GLOB,84270,CPT,,,,,both,, ,288.25,172.95,Medicare,Medicare,,172.95,,,288.25,40.36,147.01,Fee Schedule,Medicare APC Fee Schedule
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,, ,47.43,28.45,Medicare,Medicare,,28.45,,,47.43,6.64,24.19,Fee Schedule,Medicare APC Fee Schedule
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,,,345.79,345.79,Medicare,Medicare,,345.79,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"L910235 SODIUM, URINE",84300,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"Q442 SODIUM, URINE R",84300,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,, ,47.99,28.79,Medicare,Medicare,,28.79,,,47.99,6.72,24.47,Fee Schedule,Medicare APC Fee Schedule
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,,,345.79,345.79,Medicare,Medicare,,345.79,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
SODIUM OTHER SOURCE,84302,CPT,,,,,both,, ,82.51,49.50,Medicare,Medicare,,49.50,,,82.51,11.55,42.08,Fee Schedule,Medicare APC Fee Schedule
SOMATOMEDIN,84305,CPT,,,,,both,, ,870.37,522.22,Medicare,Medicare,,522.22,,,870.37,121.85,443.89,Fee Schedule,Medicare APC Fee Schedule
SOMATOMEDIN,84305,CPT,,,,,both,, ,870.37,522.22,Medicare,Medicare,,522.22,,,870.37,121.85,443.89,Fee Schedule,Medicare APC Fee Schedule
ADENO DEAMNASE BFLD,84311,CPT,,,,,both,, ,93.74,56.24,Medicare,Medicare,,56.24,,,93.74,13.12,47.81,Fee Schedule,Medicare APC Fee Schedule
Q175858 CHOLEST PF C,84311,CPT,,,,,both,, ,93.74,56.24,Medicare,Medicare,,56.24,,,93.74,13.12,47.81,Fee Schedule,Medicare APC Fee Schedule
"SPECTROPHOTO, NOS",84311,CPT,,,,,both,, ,93.74,56.24,Medicare,Medicare,,56.24,,,93.74,13.12,47.81,Fee Schedule,Medicare APC Fee Schedule
SPECIFIC GRAVITY,84315,CPT,,,,,both,, ,210.50,126.30,Medicare,Medicare,,126.30,,,210.50,29.47,107.36,Fee Schedule,Medicare APC Fee Schedule
"SUGARS, SING, QUAL",84376,CPT,,,,,both,, ,93.74,56.24,Medicare,Medicare,,56.24,,,93.74,13.12,47.81,Fee Schedule,Medicare APC Fee Schedule
GLYCOMARK,84378,CPT,,,,,both,, ,224.00,134.40,Medicare,Medicare,,134.40,,,224.00,31.36,114.24,Fee Schedule,Medicare APC Fee Schedule
"L910235 SULFATE, URINE",84392,CPT,,,,,both,, ,31.71,19.02,Medicare,Medicare,,19.02,,,31.71,4.44,16.17,Fee Schedule,Medicare APC Fee Schedule
"L910235 SULFATE, URINE",84392,CPT,,,,,both,, ,31.71,19.02,Medicare,Medicare,,19.02,,,31.71,4.44,16.17,Fee Schedule,Medicare APC Fee Schedule
Q18944 TST FREE,84402,CPT,,,,,both,, ,1017.17,610.30,Medicare,Medicare,,610.30,,,1017.17,142.40,518.76,Fee Schedule,Medicare APC Fee Schedule
Q36170 TESTOST FREE,84402,CPT,,,,,both,,,1017.17,1017.17,Medicare,Medicare,,1017.17,,,1017.17,142.40,518.76,Fee Schedule,Medicare APC Fee Schedule
Q36170 TESTOST FREE,84402,CPT,,,,,both,, ,1017.17,610.30,Medicare,Medicare,,610.30,,,1017.17,142.40,518.76,Fee Schedule,Medicare APC Fee Schedule
"TESTOSTERONE, FREE",84402,CPT,,,,,both,, ,1017.17,610.30,Medicare,Medicare,,610.30,,,1017.17,142.40,518.76,Fee Schedule,Medicare APC Fee Schedule
Q14966 TESTOST TOTAL,84403,CPT,,,,,both,, ,968.60,581.16,Medicare,Medicare,,581.16,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
Q36170 TESTOST TOTAL,84403,CPT,,,,,both,,,968.60,968.60,Medicare,Medicare,,968.60,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
Q36170 TESTOST TOTAL,84403,CPT,,,,,both,, ,968.60,581.16,Medicare,Medicare,,581.16,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
"TESTOSTERONE, TOTAL",84403,CPT,,,,,both,, ,190.86,114.51,Medicare,Medicare,,114.51,,,190.86,26.72,97.34,Fee Schedule,Medicare APC Fee Schedule
"TESTOSTERONE, TOTAL",84403,CPT,,,,,both,, ,968.60,581.16,Medicare,Medicare,,581.16,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
L70282 TEST FR WB T,84410,CPT,,,,,both,, ,211.15,126.69,Medicare,Medicare,,126.69,,,211.15,29.56,107.69,Fee Schedule,Medicare APC Fee Schedule
L121186VITB1 BL HPLC,84425,CPT,,,,,both,, ,1318.66,791.19,Medicare,Medicare,,791.19,,,1318.66,184.61,672.52,Fee Schedule,Medicare APC Fee Schedule
Q5042 B1 BL LC/MS/MS,84425,CPT,,,,,both,, ,269.16,161.49,Medicare,Medicare,,161.49,,,269.16,37.68,137.27,Fee Schedule,Medicare APC Fee Schedule
Q90353 VIT B1 LCMSMS,84425,CPT,,,,,both,, ,303.69,182.21,Medicare,Medicare,,182.21,,,303.69,42.52,154.88,Fee Schedule,Medicare APC Fee Schedule
VITAMIN B-1,84425,CPT,,,,,both,, ,156.89,94.13,Medicare,Medicare,,94.13,,,156.89,21.96,80.01,Fee Schedule,Medicare APC Fee Schedule
VITAMIN B-1,84425,CPT,,,,,both,, ,1437.33,862.39,Medicare,Medicare,,862.39,,,1437.33,201.23,733.04,Fee Schedule,Medicare APC Fee Schedule
THIOCYANATE,84430,CPT,,,,,both,, ,174.57,104.74,Medicare,Medicare,,104.74,,,174.57,24.44,89.03,Fee Schedule,Medicare APC Fee Schedule
Q15561 QT THYR WO AB,84432,CPT,,,,,both,, ,255.13,153.07,Medicare,Medicare,,153.07,,,255.13,35.72,130.12,Fee Schedule,Medicare APC Fee Schedule
Q15561 QT THYR WO AB,84432,CPT,,,,,both,, ,255.13,153.07,Medicare,Medicare,,153.07,,,255.13,35.72,130.12,Fee Schedule,Medicare APC Fee Schedule
"THYROXINE T4,TOTAL",84436,CPT,,,,,both,, ,38.73,23.23,Medicare,Medicare,,23.23,,,38.73,5.42,19.75,Fee Schedule,Medicare APC Fee Schedule
"THYROXINE T4,TOTAL",84436,CPT,,,,,both,, ,405.57,243.34,Medicare,Medicare,,243.34,,,405.57,56.78,206.84,Fee Schedule,Medicare APC Fee Schedule
"THYROXINE T4, FREE",84439,CPT,,,,,both,, ,66.52,39.91,Medicare,Medicare,,39.91,,,66.52,9.31,33.93,Fee Schedule,Medicare APC Fee Schedule
"THYROXINE T4, FREE",84439,CPT,,,,,both,,,620.56,620.56,Medicare,Medicare,,620.56,,,620.56,86.88,316.49,Fee Schedule,Medicare APC Fee Schedule
"THYROXINE T4, FREE",84439,CPT,,,,,both,, ,620.56,372.33,Medicare,Medicare,,372.33,,,620.56,86.88,316.49,Fee Schedule,Medicare APC Fee Schedule
"THYROXINE T4, FREE",84439,CPT,,,,,both,, ,620.56,372.33,Medicare,Medicare,,372.33,,,620.56,86.88,316.49,Fee Schedule,Medicare APC Fee Schedule
L1735 TBG SER ICMA,84442,CPT,,,,,both,, ,195.70,117.42,Medicare,Medicare,,117.42,,,195.70,27.40,99.81,Fee Schedule,Medicare APC Fee Schedule
THYROXINE BIND GLOB,84442,CPT,,,,,both,, ,213.31,127.98,Medicare,Medicare,,127.98,,,213.31,29.86,108.79,Fee Schedule,Medicare APC Fee Schedule
"Blood test, thyroid stimulating hormone (TSH)",84443,CPT,,,,,both,,,737.61,737.61,Medicare,Medicare,,737.61,,,737.61,103.27,376.18,Fee Schedule,Medicare APC Fee Schedule
THYROID STIM TSH,84443,CPT,,,,,both,, ,124.05,74.43,Medicare,Medicare,,74.43,,,124.05,17.37,63.27,Fee Schedule,Medicare APC Fee Schedule
THYROID STIM TSH,84443,CPT,,,,,both,, ,737.61,442.56,Medicare,Medicare,,442.56,,,737.61,103.27,376.18,Fee Schedule,Medicare APC Fee Schedule
THYROID STIM TSH,84443,CPT,,,,,both,, ,737.61,442.56,Medicare,Medicare,,442.56,,,737.61,103.27,376.18,Fee Schedule,Medicare APC Fee Schedule
Q30551 TSI IA,84445,CPT,,,,,both,, ,733.12,439.87,Medicare,Medicare,,439.87,,,733.12,102.64,373.89,Fee Schedule,Medicare APC Fee Schedule
THYROID STIM IMMUNO,84445,CPT,,,,,both,, ,1178.27,706.96,Medicare,Medicare,,706.96,,,1178.27,164.96,600.92,Fee Schedule,Medicare APC Fee Schedule
VITAMIN E,84446,CPT,,,,,both,, ,227.62,136.57,Medicare,Medicare,,136.57,,,227.62,31.87,116.09,Fee Schedule,Medicare APC Fee Schedule
VITAMIN E,84446,CPT,,,,,both,, ,227.62,136.57,Medicare,Medicare,,136.57,,,227.62,31.87,116.09,Fee Schedule,Medicare APC Fee Schedule
L500440 TRANSCORTIN,84449,CPT,,,,,both,, ,180.00,108.00,Medicare,Medicare,,108.00,,,180.00,25.20,91.8,Fee Schedule,Medicare APC Fee Schedule
TRANSFERASE AST,84450,CPT,,,,,both,, ,38.17,22.90,Medicare,Medicare,,22.90,,,38.17,5.34,19.47,Fee Schedule,Medicare APC Fee Schedule
TRANSFERASE AST,84450,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
TRANSFERASE ALT,84460,CPT,,,,,both,, ,39.29,23.57,Medicare,Medicare,,23.57,,,39.29,5.50,20.04,Fee Schedule,Medicare APC Fee Schedule
TRANSFERASE ALT,84460,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
TRANSFERRIN,84466,CPT,,,,,both,, ,94.31,56.58,Medicare,Medicare,,56.58,,,94.31,13.20,48.1,Fee Schedule,Medicare APC Fee Schedule
TRANSFERRIN,84466,CPT,,,,,both,, ,796.55,477.93,Medicare,Medicare,,477.93,,,796.55,111.52,406.24,Fee Schedule,Medicare APC Fee Schedule
TRANSFERRIN,84466,CPT,,,,,both,, ,796.55,477.93,Medicare,Medicare,,477.93,,,796.55,111.52,406.24,Fee Schedule,Medicare APC Fee Schedule
TRIGLYCERIDES,84478,CPT,,,,,both,, ,39.29,23.57,Medicare,Medicare,,23.57,,,39.29,5.50,20.04,Fee Schedule,Medicare APC Fee Schedule
TRIGLYCERIDES,84478,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
T3-T4 UPTAKE,84479,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,315.75,,,526.26,73.68,268.39,Fee Schedule,Medicare APC Fee Schedule
"T3,TOTAL",84480,CPT,,,,,both,, ,1039.33,623.59,Medicare,Medicare,,623.59,,,1039.33,145.51,530.06,Fee Schedule,Medicare APC Fee Schedule
"T3,FREE",84481,CPT,,,,,both,, ,858.30,514.98,Medicare,Medicare,,514.98,,,858.30,120.16,437.73,Fee Schedule,Medicare APC Fee Schedule
Q90963 T3 REV LCMSMS,84482,CPT,,,,,both,, ,858.30,514.98,Medicare,Medicare,,514.98,,,858.30,120.16,437.73,Fee Schedule,Medicare APC Fee Schedule
"T3,REVERSE",84482,CPT,,,,,both,, ,219.20,131.52,Medicare,Medicare,,131.52,,,219.20,30.69,111.79,Fee Schedule,Medicare APC Fee Schedule
"TROPONIN,QNT",84484,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,80.32,,,133.88,18.74,68.28,Fee Schedule,Medicare APC Fee Schedule
"TROPONIN,QNT",84484,CPT,,,,,both,,,713.19,713.19,Medicare,Medicare,,713.19,,,713.19,99.85,363.73,Fee Schedule,Medicare APC Fee Schedule
"TROPONIN,QNT",84484,CPT,,,,,both,, ,713.19,427.91,Medicare,Medicare,,427.91,,,713.19,99.85,363.73,Fee Schedule,Medicare APC Fee Schedule
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,, ,29.19,17.51,Medicare,Medicare,,17.51,,,29.19,4.09,14.89,Fee Schedule,Medicare APC Fee Schedule
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,,,277.59,277.59,Medicare,Medicare,,277.59,,,277.59,38.86,141.57,Fee Schedule,Medicare APC Fee Schedule
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,, ,277.59,166.55,Medicare,Medicare,,166.55,,,277.59,38.86,141.57,Fee Schedule,Medicare APC Fee Schedule
"UREA NITROGEN,URINE",84540,CPT,,,,,both,,,345.79,345.79,Medicare,Medicare,,345.79,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"UREA NITROGEN,URINE",84540,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"UREA NITROGEN,URINE",84540,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"URIC ACID, BLOOD",84550,CPT,,,,,both,, ,44.34,26.60,Medicare,Medicare,,26.60,,,44.34,6.21,22.61,Fee Schedule,Medicare APC Fee Schedule
"URIC ACID, BLOOD",84550,CPT,,,,,both,,,285.17,285.17,Medicare,Medicare,,285.17,,,285.17,39.92,145.44,Fee Schedule,Medicare APC Fee Schedule
"URIC ACID, BLOOD",84550,CPT,,,,,both,, ,285.17,171.10,Medicare,Medicare,,171.10,,,285.17,39.92,145.44,Fee Schedule,Medicare APC Fee Schedule
"L910235 URIC ACID, URINE",84560,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"Q442 URIC ACID,URINE",84560,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"URIC ACID,URINE RAND",84560,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
VANILLYLMANDELIC ACID (VMA) SERUM,84585,CPT,,,,,both,, ,116.70,70.02,Medicare,Medicare,,70.02,,,116.70,16.34,59.52,Fee Schedule,Medicare APC Fee Schedule
"VMA, URINE",84585,CPT,,,,,both,, ,355.05,213.03,Medicare,Medicare,,213.03,,,355.05,49.71,181.08,Fee Schedule,Medicare APC Fee Schedule
"VMA, URINE",84585,CPT,,,,,both,, ,355.05,213.03,Medicare,Medicare,,213.03,,,355.05,49.71,181.08,Fee Schedule,Medicare APC Fee Schedule
L10397 VIP PL RIA,84586,CPT,,,,,both,, ,338.36,203.01,Medicare,Medicare,,203.01,,,338.36,47.37,172.56,Fee Schedule,Medicare APC Fee Schedule
VASOINTESTINAL PEP,84586,CPT,,,,,both,, ,368.80,221.28,Medicare,Medicare,,221.28,,,368.80,51.63,188.09,Fee Schedule,Medicare APC Fee Schedule
VASOPRESSIN,84588,CPT,,,,,both,, ,295.83,177.49,Medicare,Medicare,,177.49,,,295.83,41.42,150.87,Fee Schedule,Medicare APC Fee Schedule
VASOPRESSIN,84588,CPT,,,,,both,, ,295.83,177.49,Medicare,Medicare,,177.49,,,295.83,41.42,150.87,Fee Schedule,Medicare APC Fee Schedule
VITAMIN A,84590,CPT,,,,,both,, ,186.08,111.64,Medicare,Medicare,,111.64,,,186.08,26.05,94.9,Fee Schedule,Medicare APC Fee Schedule
VITAMIN A,84590,CPT,,,,,both,, ,186.08,111.64,Medicare,Medicare,,111.64,,,186.08,26.05,94.9,Fee Schedule,Medicare APC Fee Schedule
"VITAMIN ASSAY, NOS",84591,CPT,,,,,both,, ,197.03,118.21,Medicare,Medicare,,118.21,,,197.03,27.58,100.49,Fee Schedule,Medicare APC Fee Schedule
VITAMIN K,84597,CPT,,,,,both,, ,188.89,113.33,Medicare,Medicare,,113.33,,,188.89,26.44,96.33,Fee Schedule,Medicare APC Fee Schedule
VITAMIN K,84597,CPT,,,,,both,, ,188.89,113.33,Medicare,Medicare,,113.33,,,188.89,26.44,96.33,Fee Schedule,Medicare APC Fee Schedule
VOLATILES,84600,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,436.84,,,728.07,101.93,371.32,Fee Schedule,Medicare APC Fee Schedule
XYLOSE ABSORPTION,84620,CPT,,,,,both,, ,1111.47,666.88,Medicare,Medicare,,666.88,,,1111.47,155.61,566.85,Fee Schedule,Medicare APC Fee Schedule
ZINC,84630,CPT,,,,,both,, ,1081.72,649.03,Medicare,Medicare,,649.03,,,1081.72,151.44,551.68,Fee Schedule,Medicare APC Fee Schedule
ZINC,84630,CPT,,,,,both,, ,1081.72,649.03,Medicare,Medicare,,649.03,,,1081.72,151.44,551.68,Fee Schedule,Medicare APC Fee Schedule
ZINC WHOLE BLOOD,84630,CPT,,,,,both,, ,80.00,48.00,Medicare,Medicare,,48.00,,,80.00,11.20,40.8,Fee Schedule,Medicare APC Fee Schedule
C-PEPTIDE,84681,CPT,,,,,both,, ,898.44,539.06,Medicare,Medicare,,539.06,,,898.44,125.78,458.2,Fee Schedule,Medicare APC Fee Schedule
C-PEPTIDE,84681,CPT,,,,,both,, ,898.44,539.06,Medicare,Medicare,,539.06,,,898.44,125.78,458.2,Fee Schedule,Medicare APC Fee Schedule
HCG QUANT,84702,CPT,,,,,both,, ,148.47,89.08,Medicare,Medicare,,89.08,,,148.47,20.79,75.72,Fee Schedule,Medicare APC Fee Schedule
HCG QUANT,84702,CPT,,,,,both,, ,758.66,455.19,Medicare,Medicare,,455.19,,,758.66,106.21,386.92,Fee Schedule,Medicare APC Fee Schedule
HCG QUANT,84702,CPT,,,,,both,, ,758.66,455.19,Medicare,Medicare,,455.19,,,758.66,106.21,386.92,Fee Schedule,Medicare APC Fee Schedule
"HCG, QUAL",84703,CPT,,,,,both,, ,74.10,44.46,Medicare,Medicare,,44.46,,,74.10,10.37,37.79,Fee Schedule,Medicare APC Fee Schedule
"HCG, QUAL",84703,CPT,,,,,both,,,420.72,420.72,Medicare,Medicare,,420.72,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
"HCG, QUAL",84703,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
CLIN CHEM TEST NOS,84999,CPT,,,,,both,, ,274.50,164.70,Medicare,Medicare,,164.70,,,274.50,38.43,140,Fee Schedule,Medicare APC Fee Schedule
L123413 TMAO,84999,CPT,,,,,both,, ,225.00,135.00,Medicare,Medicare,,135.00,,,225.00,31.50,114.75,Fee Schedule,Medicare APC Fee Schedule
L123413 TMAO,84999,CPT,,,,,both,, ,225.00,135.00,Medicare,Medicare,,135.00,,,225.00,31.50,114.75,Fee Schedule,Medicare APC Fee Schedule
BLEEDING TIME,85002,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
AUTO DIFF WBC COUNT,85004,CPT,,,,,both,, ,47.99,28.79,Medicare,Medicare,,28.79,,,47.99,6.72,24.47,Fee Schedule,Medicare APC Fee Schedule
AUTO DIFF WBC COUNT,85004,CPT,,,,,both,, ,103.00,61.80,Medicare,Medicare,,61.80,,,103.00,14.42,52.53,Fee Schedule,Medicare APC Fee Schedule
"WBC DIFF, MAN",85007,CPT,,,,,both,, ,33.96,20.37,Medicare,Medicare,,20.37,,,33.96,4.75,17.32,Fee Schedule,Medicare APC Fee Schedule
"WBC DIFF, MAN",85007,CPT,,,,,both,, ,188.33,112.99,Medicare,Medicare,,112.99,,,188.33,26.37,96.05,Fee Schedule,Medicare APC Fee Schedule
BLOOD SMEAR SCAN,85008,CPT,,,,,both,, ,112.55,67.53,Medicare,Medicare,,67.53,,,112.55,15.76,57.4,Fee Schedule,Medicare APC Fee Schedule
"HEMATOCRIT, SPUN",85013,CPT,,,,,both,, ,32.84,19.70,Medicare,Medicare,,19.70,,,32.84,4.60,16.75,Fee Schedule,Medicare APC Fee Schedule
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,, ,13.18,7.90,Medicare,Medicare,,7.90,,,13.18,1.85,6.72,Fee Schedule,Medicare APC Fee Schedule
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,,,262.99,262.99,Medicare,Medicare,,262.99,,,262.99,36.82,134.12,Fee Schedule,Medicare APC Fee Schedule
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,, ,262.99,157.79,Medicare,Medicare,,157.79,,,262.99,36.82,134.12,Fee Schedule,Medicare APC Fee Schedule
HEMOGLOBIN,85018,CPT,,,,,both,, ,13.18,7.90,Medicare,Medicare,,7.90,,,13.18,1.85,6.72,Fee Schedule,Medicare APC Fee Schedule
HEMOGLOBIN,85018,CPT,,,,,both,,,262.99,262.99,Medicare,Medicare,,262.99,,,262.99,36.82,134.12,Fee Schedule,Medicare APC Fee Schedule
HEMOGLOBIN,85018,CPT,,,,,both,, ,262.99,157.79,Medicare,Medicare,,157.79,,,262.99,36.82,134.12,Fee Schedule,Medicare APC Fee Schedule
HEMOGLOBIN,85018,CPT,,,,,both,, ,262.99,157.79,Medicare,Medicare,,157.79,,,262.99,36.82,134.12,Fee Schedule,Medicare APC Fee Schedule
L121003 HEMOGLOBIN,85018,CPT,,,,,both,, ,10.00,6.00,Medicare,Medicare,,6.00,,,10.00,1.40,5.1,Fee Schedule,Medicare APC Fee Schedule
CBC W-PLT AUTO COMPD,85025,CPT,,,,,both,, ,28.90,17.34,Medicare,Medicare,,17.34,,,28.90,4.05,14.74,Fee Schedule,Medicare APC Fee Schedule
CBC W-PLT AUTO COMPD,85025,CPT,,,,,both,, ,428.30,256.98,Medicare,Medicare,,256.98,,,428.30,59.96,218.43,Fee Schedule,Medicare APC Fee Schedule
"Complete blood cell count, with differential white blood cells, automated",85025,CPT,,,,,both,,,428.30,428.30,Medicare,Medicare,,428.30,,,428.30,59.96,218.43,Fee Schedule,Medicare APC Fee Schedule
CBC W-PLT,85027,CPT,,,,,both,, ,24.13,14.47,Medicare,Medicare,,14.47,,,24.13,3.38,12.31,Fee Schedule,Medicare APC Fee Schedule
CBC W-PLT,85027,CPT,,,,,both,, ,412.87,247.72,Medicare,Medicare,,247.72,,,412.87,57.80,210.56,Fee Schedule,Medicare APC Fee Schedule
"Complete blood count, automated",85027,CPT,,,,,both,,,412.87,412.87,Medicare,Medicare,,412.87,,,412.87,57.80,210.56,Fee Schedule,Medicare APC Fee Schedule
MAN CELL CT ELP,85032,CPT,,,,,both,, ,466.48,279.88,Medicare,Medicare,,279.88,,,466.48,65.31,237.9,Fee Schedule,Medicare APC Fee Schedule
L1917 RBC COUNT,85041,CPT,,,,,both,, ,6.06,3.63,Medicare,Medicare,,3.63,,,6.06,0.85,3.09,Fee Schedule,Medicare APC Fee Schedule
"RETIC COUNT, MANUAL",85044,CPT,,,,,both,, ,489.78,293.86,Medicare,Medicare,,293.86,,,489.78,68.57,249.79,Fee Schedule,Medicare APC Fee Schedule
"RETIC COUNT, FLOW",85045,CPT,,,,,both,, ,39.29,23.57,Medicare,Medicare,,23.57,,,39.29,5.50,20.04,Fee Schedule,Medicare APC Fee Schedule
"RETIC COUNT, FLOW",85045,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
WBC COUNT,85048,CPT,,,,,both,, ,16.55,9.93,Medicare,Medicare,,9.93,,,16.55,2.32,8.44,Fee Schedule,Medicare APC Fee Schedule
WBC COUNT,85048,CPT,,,,,both,, ,285.17,171.10,Medicare,Medicare,,171.10,,,285.17,39.92,145.44,Fee Schedule,Medicare APC Fee Schedule
CBC-PLT AUTORP CDM,85049,CPT,,,,,both,, ,16.55,9.93,Medicare,Medicare,,9.93,,,16.55,2.32,8.44,Fee Schedule,Medicare APC Fee Schedule
CBC-PLT AUTORP CDM,85049,CPT,,,,,both,, ,285.17,171.10,Medicare,Medicare,,171.10,,,285.17,39.92,145.44,Fee Schedule,Medicare APC Fee Schedule
BONE MARROW INTERPRE,85097,CPT,,,,,both,, ,237.17,142.30,Medicare,Medicare,,142.30,,,237.17,33.20,120.96,Fee Schedule,Medicare APC Fee Schedule
APIXABAN ANTI-XA,85130,CPT,,,,,both,, ,250.00,150.00,Medicare,Medicare,,150.00,,,250.00,35.00,127.5,Fee Schedule,Medicare APC Fee Schedule
Q331 FACT II ACT PCD,85210,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,44.95,,,74.93,10.49,38.21,Fee Schedule,Medicare APC Fee Schedule
FACTOR V ASSAY,85220,CPT,,,,,both,, ,121.53,72.91,Medicare,Medicare,,72.91,,,121.53,17.01,61.98,Fee Schedule,Medicare APC Fee Schedule
L86249 FACT V ACT CD,85220,CPT,,,,,both,, ,121.53,72.91,Medicare,Medicare,,72.91,,,121.53,17.01,61.98,Fee Schedule,Medicare APC Fee Schedule
Q344 FACT V CLOT PCD,85220,CPT,,,,,both,, ,121.53,72.91,Medicare,Medicare,,72.91,,,121.53,17.01,61.98,Fee Schedule,Medicare APC Fee Schedule
FACTOR VII ASSAY,85230,CPT,,,,,both,, ,335.69,201.41,Medicare,Medicare,,201.41,,,335.69,47.00,171.2,Fee Schedule,Medicare APC Fee Schedule
FACTOR VII ASSAY,85230,CPT,,,,,both,, ,335.69,201.41,Medicare,Medicare,,201.41,,,335.69,47.00,171.2,Fee Schedule,Medicare APC Fee Schedule
"FACTOR VIII, AHG",85240,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,436.84,,,728.07,101.93,371.32,Fee Schedule,Medicare APC Fee Schedule
L503333 FAC8 AHG,85240,CPT,,,,,both,, ,706.86,424.11,Medicare,Medicare,,424.11,,,706.86,98.96,360.5,Fee Schedule,Medicare APC Fee Schedule
FACTOR VIII RISTOCET,85245,CPT,,,,,both,, ,1352.01,811.20,Medicare,Medicare,,811.20,,,1352.01,189.28,689.53,Fee Schedule,Medicare APC Fee Schedule
L164509 VWF ACTIV PA,85245,CPT,,,,,both,, ,412.00,247.20,Medicare,Medicare,,247.20,,,412.00,57.68,210.12,Fee Schedule,Medicare APC Fee Schedule
FACTOR VIII VW AG,85246,CPT,,,,,both,, ,1164.52,698.71,Medicare,Medicare,,698.71,,,1164.52,163.03,593.91,Fee Schedule,Medicare APC Fee Schedule
FACTOR VIII VW AG,85246,CPT,,,,,both,, ,1164.52,698.71,Medicare,Medicare,,698.71,,,1164.52,163.03,593.91,Fee Schedule,Medicare APC Fee Schedule
"FACT VIII,VW,MULTIME",85247,CPT,,,,,both,, ,181.59,108.95,Medicare,Medicare,,108.95,,,181.59,25.42,92.61,Fee Schedule,Medicare APC Fee Schedule
FACTOR IX,85250,CPT,,,,,both,, ,151.56,90.93,Medicare,Medicare,,90.93,,,151.56,21.22,77.3,Fee Schedule,Medicare APC Fee Schedule
FACTOR X,85260,CPT,,,,,both,, ,142.58,85.54,Medicare,Medicare,,85.54,,,142.58,19.96,72.72,Fee Schedule,Medicare APC Fee Schedule
FACTOR XI,85270,CPT,,,,,both,, ,142.58,85.54,Medicare,Medicare,,85.54,,,142.58,19.96,72.72,Fee Schedule,Medicare APC Fee Schedule
ANTITHROMBIN IIIACTI,85300,CPT,,,,,both,, ,1930.76,1158.45,Medicare,Medicare,,1158.45,,,1930.76,270.31,984.69,Fee Schedule,Medicare APC Fee Schedule
L015040 ANTITHROMBIN ACTIVITY,85300,CPT,,,,,both,, ,965.23,579.13,Medicare,Medicare,,579.13,,,965.23,135.13,492.27,Fee Schedule,Medicare APC Fee Schedule
Q5158 ATIII AG FRNEP,85301,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,43.27,,,72.13,10.10,36.79,Fee Schedule,Medicare APC Fee Schedule
"PROTEIN C, AG",85302,CPT,,,,,both,, ,1907.47,1144.48,Medicare,Medicare,,1144.48,,,1907.47,267.05,972.81,Fee Schedule,Medicare APC Fee Schedule
Q4948 PROT C AG IA,85302,CPT,,,,,both,, ,1942.55,1165.53,Medicare,Medicare,,1165.53,,,1942.55,271.96,990.7,Fee Schedule,Medicare APC Fee Schedule
"PROTEIN C, ACTIVITY",85303,CPT,,,,,both,, ,1261.35,756.81,Medicare,Medicare,,756.81,,,1261.35,176.59,643.29,Fee Schedule,Medicare APC Fee Schedule
"PROTEIN C, ACTIVITY",85303,CPT,,,,,both,, ,1261.35,756.81,Medicare,Medicare,,756.81,,,1261.35,176.59,643.29,Fee Schedule,Medicare APC Fee Schedule
"Q7942 PROTEIN C, ACT",85303,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
L117754 PROT S TOT,85305,CPT,,,,,both,, ,116.10,69.66,Medicare,Medicare,,69.66,,,116.10,16.25,59.21,Fee Schedule,Medicare APC Fee Schedule
"PROTEIN S, TOTAL",85305,CPT,,,,,both,, ,1261.35,756.81,Medicare,Medicare,,756.81,,,1261.35,176.59,643.29,Fee Schedule,Medicare APC Fee Schedule
"PROTEIN S, TOTAL",85305,CPT,,,,,both,, ,1261.35,756.81,Medicare,Medicare,,756.81,,,1261.35,176.59,643.29,Fee Schedule,Medicare APC Fee Schedule
L117754 PROT S FREE,85306,CPT,,,,,both,, ,153.20,91.92,Medicare,Medicare,,91.92,,,153.20,21.45,78.13,Fee Schedule,Medicare APC Fee Schedule
"PROTEIN S, FREE",85306,CPT,,,,,both,, ,151.00,90.60,Medicare,Medicare,,90.60,,,151.00,21.14,77.01,Fee Schedule,Medicare APC Fee Schedule
"PROTEIN S, FREE",85306,CPT,,,,,both,, ,939.98,563.98,Medicare,Medicare,,563.98,,,939.98,131.60,479.39,Fee Schedule,Medicare APC Fee Schedule
Q10170 PROT S AG ITA,85306,CPT,,,,,both,, ,939.98,563.98,Medicare,Medicare,,563.98,,,939.98,131.60,479.39,Fee Schedule,Medicare APC Fee Schedule
Q1779 PROT S ACT,85306,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
"Q7942 PROTEIN S, FRE",85306,CPT,,,,,both,, ,939.98,563.98,Medicare,Medicare,,563.98,,,939.98,131.60,479.39,Fee Schedule,Medicare APC Fee Schedule
PROTEIN C ACTIVATED,85307,CPT,,,,,both,, ,239.69,143.81,Medicare,Medicare,,143.81,,,239.69,33.56,122.24,Fee Schedule,Medicare APC Fee Schedule
Q22 APCR RVVT-BSE AS,85307,CPT,,,,,both,, ,596.43,357.85,Medicare,Medicare,,357.85,,,596.43,83.50,304.18,Fee Schedule,Medicare APC Fee Schedule
SOLUB LIV AG AB(RDL),85316,CPT,,,,,both,, ,567.00,340.20,Medicare,Medicare,,340.20,,,567.00,79.38,289.17,Fee Schedule,Medicare APC Fee Schedule
COAG TIME ACTIVATED,85347,CPT,,,,,both,, ,167.84,100.70,Medicare,Medicare,,100.70,,,167.84,23.50,85.6,Fee Schedule,Medicare APC Fee Schedule
FDP-FSP AGG SLIDE,85362,CPT,,,,,both,, ,691.58,414.94,Medicare,Medicare,,414.94,,,691.58,96.82,352.71,Fee Schedule,Medicare APC Fee Schedule
"D-DIMER, QUANT",85379,CPT,,,,,both,, ,100.48,60.28,Medicare,Medicare,,60.28,,,100.48,14.07,51.24,Fee Schedule,Medicare APC Fee Schedule
"D-DIMER, QUANT",85379,CPT,,,,,both,,,886.09,886.09,Medicare,Medicare,,886.09,,,886.09,124.05,451.91,Fee Schedule,Medicare APC Fee Schedule
"D-DIMER, QUANT",85379,CPT,,,,,both,, ,886.09,531.65,Medicare,Medicare,,531.65,,,886.09,124.05,451.91,Fee Schedule,Medicare APC Fee Schedule
FIBRINOGEN ACTIVITY,85384,CPT,,,,,both,, ,83.64,50.18,Medicare,Medicare,,50.18,,,83.64,11.71,42.66,Fee Schedule,Medicare APC Fee Schedule
FIBRINOGEN ACTIVITY,85384,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
Q14532 ADAMTS13 IA,85397,CPT,,,,,both,, ,188.05,112.83,Medicare,Medicare,,112.83,,,188.05,26.33,95.91,Fee Schedule,Medicare APC Fee Schedule
Q36555 PAI-1 IA,85415,CPT,,,,,both,, ,222.01,133.20,Medicare,Medicare,,133.20,,,222.01,31.08,113.23,Fee Schedule,Medicare APC Fee Schedule
FETAL HGB KLEIH-BETK,85460,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,315.75,,,526.26,73.68,268.39,Fee Schedule,Medicare APC Fee Schedule
FETAL HGB KLEIH-BETK,85460,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,315.75,,,526.26,73.68,268.39,Fee Schedule,Medicare APC Fee Schedule
"FETAL HGB, ROSETTE",85461,CPT,,,,,both,, ,349.72,209.83,Medicare,Medicare,,209.83,,,349.72,48.96,178.36,Fee Schedule,Medicare APC Fee Schedule
HEPARIN ASSAY,85520,CPT,,,,,both,, ,1274.26,764.55,Medicare,Medicare,,764.55,,,1274.26,178.40,649.87,Fee Schedule,Medicare APC Fee Schedule
L117101 HEPARIN A-XA,85520,CPT,,,,,both,, ,139.05,83.43,Medicare,Medicare,,83.43,,,139.05,19.47,70.92,Fee Schedule,Medicare APC Fee Schedule
MURAMIDASE,85549,CPT,,,,,both,, ,261.02,156.61,Medicare,Medicare,,156.61,,,261.02,36.54,133.12,Fee Schedule,Medicare APC Fee Schedule
RBC OSMOTIC FRAGW-IN,85557,CPT,,,,,both,, ,450.48,270.28,Medicare,Medicare,,270.28,,,450.48,63.07,229.74,Fee Schedule,Medicare APC Fee Schedule
PLATELET AGGREGATION,85576,CPT,,,,,both,, ,344.67,206.80,Medicare,Medicare,,206.80,,,344.67,48.25,175.78,Fee Schedule,Medicare APC Fee Schedule
PLTT NEUTRALIZATION,85597,CPT,,,,,both,, ,160.55,96.33,Medicare,Medicare,,96.33,,,160.55,22.48,81.88,Fee Schedule,Medicare APC Fee Schedule
PLTT NEUTRALIZATION,85597,CPT,,,,,both,, ,160.55,96.33,Medicare,Medicare,,96.33,,,160.55,22.48,81.88,Fee Schedule,Medicare APC Fee Schedule
HEXAGONAL PHOSPHOLIP,85598,CPT,,,,,both,, ,153.52,92.11,Medicare,Medicare,,92.11,,,153.52,21.49,78.3,Fee Schedule,Medicare APC Fee Schedule
HEXAGONAL PHOSPHOLIP,85598,CPT,,,,,both,, ,153.52,92.11,Medicare,Medicare,,92.11,,,153.52,21.49,78.3,Fee Schedule,Medicare APC Fee Schedule
L117079 HEX PHOS,85598,CPT,,,,,both,, ,179.80,107.88,Medicare,Medicare,,107.88,,,179.80,25.17,91.7,Fee Schedule,Medicare APC Fee Schedule
"Blood test, clotting time",85610,CPT,,,,,both,,,430.27,430.27,Medicare,Medicare,,430.27,,,430.27,60.24,219.44,Fee Schedule,Medicare APC Fee Schedule
PROTHROMBIN TIME,85610,CPT,,,,,both,, ,14.60,8.76,Medicare,Medicare,,8.76,,,14.60,2.04,7.45,Fee Schedule,Medicare APC Fee Schedule
PROTHROMBIN TIME,85610,CPT,,,,,both,, ,430.27,258.16,Medicare,Medicare,,258.16,,,430.27,60.24,219.44,Fee Schedule,Medicare APC Fee Schedule
"PROTHROMBIN, SUBSTIT",85611,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,436.84,,,728.07,101.93,371.32,Fee Schedule,Medicare APC Fee Schedule
RUSSELL VIPER VEN DI,85613,CPT,,,,,both,, ,364.88,218.92,Medicare,Medicare,,218.92,,,364.88,51.08,186.09,Fee Schedule,Medicare APC Fee Schedule
RUSSELL VIPER VEN DI,85613,CPT,,,,,both,, ,364.88,218.92,Medicare,Medicare,,218.92,,,364.88,51.08,186.09,Fee Schedule,Medicare APC Fee Schedule
"SED RATE, AUTOMATED",85652,CPT,,,,,both,, ,26.66,15.99,Medicare,Medicare,,15.99,,,26.66,3.73,13.6,Fee Schedule,Medicare APC Fee Schedule
"SED RATE, AUTOMATED",85652,CPT,,,,,both,,,345.79,345.79,Medicare,Medicare,,345.79,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"SED RATE, AUTOMATED",85652,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
O51226 SICKLE C  SCR,85660,CPT,,,,,both,, ,385.99,231.59,Medicare,Medicare,,231.59,,,385.99,54.04,196.85,Fee Schedule,Medicare APC Fee Schedule
Q37679 SICKLE CELL SCRN WITH REFLEX HEMO,85660,CPT,,,,,both,, ,374.75,224.85,Medicare,Medicare,,224.85,,,374.75,52.47,191.12,Fee Schedule,Medicare APC Fee Schedule
SICKLE CELL TEST RED,85660,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
SICKLE CELL TEST RED,85660,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
THROMBIN TIME,85670,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,315.75,,,526.26,73.68,268.39,Fee Schedule,Medicare APC Fee Schedule
THROMBIN TIME,85670,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,315.75,,,526.26,73.68,268.39,Fee Schedule,Medicare APC Fee Schedule
Coagulation assessment blood test,85730,CPT,,,,,both,,,480.79,480.79,Medicare,Medicare,,480.79,,,480.79,67.31,245.2,Fee Schedule,Medicare APC Fee Schedule
THROMBOPLAST TIMEPTT,85730,CPT,,,,,both,, ,58.94,35.36,Medicare,Medicare,,35.36,,,58.94,8.25,30.06,Fee Schedule,Medicare APC Fee Schedule
THROMBOPLAST TIMEPTT,85730,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,288.47,,,480.79,67.31,245.2,Fee Schedule,Medicare APC Fee Schedule
THROMBOPLAST TIMEPTT,85730,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,288.47,,,480.79,67.31,245.2,Fee Schedule,Medicare APC Fee Schedule
PTT SUBSTITUT,85732,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,288.47,,,480.79,67.31,245.2,Fee Schedule,Medicare APC Fee Schedule
PTT SUBSTITUT,85732,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,288.47,,,480.79,67.31,245.2,Fee Schedule,Medicare APC Fee Schedule
VISCOSITY EXAM,85810,CPT,,,,,both,, ,80.27,48.16,Medicare,Medicare,,48.16,,,80.27,11.24,40.94,Fee Schedule,Medicare APC Fee Schedule
ALLERGEN IGG QT,86001,CPT,,,,,both,, ,66.24,39.74,Medicare,Medicare,,39.74,,,66.24,9.27,33.78,Fee Schedule,Medicare APC Fee Schedule
ALLERGEN IGG QT,86001,CPT,,,,,both,, ,66.24,39.74,Medicare,Medicare,,39.74,,,66.24,9.27,33.78,Fee Schedule,Medicare APC Fee Schedule
ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,51.36,30.81,Medicare,Medicare,,30.81,,,51.36,7.19,26.19,Fee Schedule,Medicare APC Fee Schedule
ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,89.25,,,148.75,20.83,75.86,Fee Schedule,Medicare APC Fee Schedule
L602635 - ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,89.25,,,148.75,20.83,75.86,Fee Schedule,Medicare APC Fee Schedule
Q10643 ALG IGE QT,86003,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,89.25,,,148.75,20.83,75.86,Fee Schedule,Medicare APC Fee Schedule
Q10659 ALLERGEN IGE,86003,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,89.25,,,148.75,20.83,75.86,Fee Schedule,Medicare APC Fee Schedule
Q10715 ALLERGEN IGE,86003,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,89.25,,,148.75,20.83,75.86,Fee Schedule,Medicare APC Fee Schedule
ALLG SPEC IGE REC EA,86008,CPT,,,,,both,, ,103.29,61.97,Medicare,Medicare,,61.97,,,103.29,14.46,52.68,Fee Schedule,Medicare APC Fee Schedule
ALLG SPEC IGE REC EA,86008,CPT,,,,,both,, ,103.29,61.97,Medicare,Medicare,,61.97,,,103.29,14.46,52.68,Fee Schedule,Medicare APC Fee Schedule
L6643 ASMA ELISA,86015,CPT,,,,,both,, ,702.72,421.63,Medicare,Medicare,,421.63,,,702.72,98.38,358.39,Fee Schedule,Medicare APC Fee Schedule
Q15043 ACTIN AB EA,86015,CPT,,,,,both,, ,514.48,308.68,Medicare,Medicare,,308.68,,,514.48,72.03,262.38,Fee Schedule,Medicare APC Fee Schedule
WBC AB IDENT,86021,CPT,,,,,both,, ,500.72,300.43,Medicare,Medicare,,300.43,,,500.72,70.10,255.37,Fee Schedule,Medicare APC Fee Schedule
WBC AB IDENT,86021,CPT,,,,,both,, ,500.72,300.43,Medicare,Medicare,,300.43,,,500.72,70.10,255.37,Fee Schedule,Medicare APC Fee Schedule
WBC AB IDENT,86021,CPT,,,,,both,, ,500.72,300.43,Medicare,Medicare,,300.43,,,500.72,70.10,255.37,Fee Schedule,Medicare APC Fee Schedule
WBC AB IDENT,86021,CPT,,,,,both,, ,500.72,300.43,Medicare,Medicare,,300.43,,,500.72,70.10,255.37,Fee Schedule,Medicare APC Fee Schedule
PLATELET AB,86022,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,522.73,,,871.22,121.97,444.32,Fee Schedule,Medicare APC Fee Schedule
Q14627SRA UNF RB-14C,86022,CPT,,,,,both,, ,467.88,280.72,Medicare,Medicare,,280.72,,,467.88,65.50,238.62,Fee Schedule,Medicare APC Fee Schedule
Q14874 PLATELET AB,86022,CPT,,,,,both,, ,467.88,280.72,Medicare,Medicare,,280.72,,,467.88,65.50,238.62,Fee Schedule,Medicare APC Fee Schedule
Q414 HEP-IND PLAT AB,86022,CPT,,,,,both,, ,467.88,280.72,Medicare,Medicare,,280.72,,,467.88,65.50,238.62,Fee Schedule,Medicare APC Fee Schedule
Q91740PLATELT IGG FC,86023,CPT,,,,,both,, ,83.08,49.84,Medicare,Medicare,,49.84,,,83.08,11.63,42.37,Fee Schedule,Medicare APC Fee Schedule
L162045 FLUORS AB SC,86036,CPT,,,,,both,, ,486.16,291.69,Medicare,Medicare,,291.69,,,486.16,68.06,247.94,Fee Schedule,Medicare APC Fee Schedule
Q70171 ANCA SCN IA,86036,CPT,,,,,both,, ,500.72,300.43,Medicare,Medicare,,300.43,,,500.72,70.10,255.37,Fee Schedule,Medicare APC Fee Schedule
L163061 ANCA TITER,86037,CPT,,,,,both,, ,120.50,72.30,Medicare,Medicare,,72.30,,,120.50,16.87,61.46,Fee Schedule,Medicare APC Fee Schedule
ANA,86038,CPT,,,,,both,, ,91.77,55.06,Medicare,Medicare,,55.06,,,91.77,12.85,46.8,Fee Schedule,Medicare APC Fee Schedule
ANA,86038,CPT,,,,,both,, ,898.44,539.06,Medicare,Medicare,,539.06,,,898.44,125.78,458.2,Fee Schedule,Medicare APC Fee Schedule
L164947 ANA IFA,86038,CPT,,,,,both,, ,824.26,494.55,Medicare,Medicare,,494.55,,,824.26,115.40,420.37,Fee Schedule,Medicare APC Fee Schedule
Q16814 ANA IFA REFIA,86038,CPT,,,,,both,,,898.44,898.44,Medicare,Medicare,,898.44,,,898.44,125.78,458.2,Fee Schedule,Medicare APC Fee Schedule
Q16814 ANA IFA REFIA,86038,CPT,,,,,both,, ,898.44,539.06,Medicare,Medicare,,539.06,,,898.44,125.78,458.2,Fee Schedule,Medicare APC Fee Schedule
Q249 ANA SCRN IFA,86038,CPT,,,,,both,, ,898.44,539.06,Medicare,Medicare,,539.06,,,898.44,125.78,458.2,Fee Schedule,Medicare APC Fee Schedule
"ANA,TITER",86039,CPT,,,,,both,, ,93.46,56.07,Medicare,Medicare,,56.07,,,93.46,13.08,47.66,Fee Schedule,Medicare APC Fee Schedule
"ANA,TITER",86039,CPT,,,,,both,, ,547.31,328.38,Medicare,Medicare,,328.38,,,547.31,76.62,279.13,Fee Schedule,Medicare APC Fee Schedule
"ANA,TITER",86039,CPT,,,,,both,, ,547.31,328.38,Medicare,Medicare,,328.38,,,547.31,76.62,279.13,Fee Schedule,Medicare APC Fee Schedule
ACETYLCH RCPT BND AB,86041,CPT,,,,,both,, ,55.20,33.12,Medicare,Medicare,,33.12,,,55.20,7.73,28.15,Fee Schedule,Medicare APC Fee Schedule
ACETYLC RCPT BLCK AB,86042,CPT,,,,,both,, ,55.20,33.12,Medicare,Medicare,,33.12,,,55.20,7.73,28.15,Fee Schedule,Medicare APC Fee Schedule
ACTYLC RCPT MODL AB,86043,CPT,,,,,both,, ,55.20,33.12,Medicare,Medicare,,33.12,,,55.20,7.73,28.15,Fee Schedule,Medicare APC Fee Schedule
Q38321 AQP4 NMOIGG,86052,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,317.94,,,529.91,74.19,270.25,Fee Schedule,Medicare APC Fee Schedule
"ASO,TITER",86060,CPT,,,,,both,, ,71.85,43.11,Medicare,Medicare,,43.11,,,71.85,10.06,36.64,Fee Schedule,Medicare APC Fee Schedule
"ASO,TITER",86060,CPT,,,,,both,, ,539.45,323.67,Medicare,Medicare,,323.67,,,539.45,75.52,275.12,Fee Schedule,Medicare APC Fee Schedule
Q265 ASO AB ITA,86060,CPT,,,,,both,, ,189.17,113.50,Medicare,Medicare,,113.50,,,189.17,26.48,96.48,Fee Schedule,Medicare APC Fee Schedule
PHYS BB SERV TRAN RE,86078,CPT,,,,,both,, ,165.59,99.35,Medicare,Medicare,,99.35,,,165.59,23.18,84.45,Fee Schedule,Medicare APC Fee Schedule
C-REACTIVE PROTEIN,86140,CPT,,,,,both,, ,51.08,30.64,Medicare,Medicare,,30.64,,,51.08,7.15,26.05,Fee Schedule,Medicare APC Fee Schedule
C-REACTIVE PROTEIN,86140,CPT,,,,,both,, ,518.69,311.21,Medicare,Medicare,,311.21,,,518.69,72.62,264.53,Fee Schedule,Medicare APC Fee Schedule
Q10124 HS-CRP NEPHEL,86141,CPT,,,,,both,, ,999.76,599.85,Medicare,Medicare,,599.85,,,999.76,139.97,509.88,Fee Schedule,Medicare APC Fee Schedule
BETA-2 GLYCOPROT AB,86146,CPT,,,,,both,, ,252.04,151.22,Medicare,Medicare,,151.22,,,252.04,35.29,128.54,Fee Schedule,Medicare APC Fee Schedule
BETA-2 GLYCOPROT AB,86146,CPT,,,,,both,, ,252.04,151.22,Medicare,Medicare,,151.22,,,252.04,35.29,128.54,Fee Schedule,Medicare APC Fee Schedule
Q14890 BETA-2 GLYCOP,86146,CPT,,,,,both,, ,252.04,151.22,Medicare,Medicare,,151.22,,,252.04,35.29,128.54,Fee Schedule,Medicare APC Fee Schedule
Q14890 BETA-2 GLYCOP,86146,CPT,,,,,both,, ,252.04,151.22,Medicare,Medicare,,151.22,,,252.04,35.29,128.54,Fee Schedule,Medicare APC Fee Schedule
Q36553B-2-GP1 IGM IA,86146,CPT,,,,,both,, ,252.04,151.22,Medicare,Medicare,,151.22,,,252.04,35.29,128.54,Fee Schedule,Medicare APC Fee Schedule
Q36553B-2-GP1 IGM IA,86146,CPT,,,,,both,, ,252.04,151.22,Medicare,Medicare,,151.22,,,252.04,35.29,128.54,Fee Schedule,Medicare APC Fee Schedule
"CARDIOLIPIN AB,IGG",86147,CPT,,,,,both,, ,429.43,257.65,Medicare,Medicare,,257.65,,,429.43,60.12,219.01,Fee Schedule,Medicare APC Fee Schedule
"CARDIOLIPIN AB,IGG",86147,CPT,,,,,both,, ,429.43,257.65,Medicare,Medicare,,257.65,,,429.43,60.12,219.01,Fee Schedule,Medicare APC Fee Schedule
Q14890 CARDIOLIPIN A,86147,CPT,,,,,both,, ,429.43,257.65,Medicare,Medicare,,257.65,,,429.43,60.12,219.01,Fee Schedule,Medicare APC Fee Schedule
Q14890 CARDIOLIPIN A,86147,CPT,,,,,both,, ,429.43,257.65,Medicare,Medicare,,257.65,,,429.43,60.12,219.01,Fee Schedule,Medicare APC Fee Schedule
Q4662 C-LIPIN AB IGG,86147,CPT,,,,,both,, ,429.43,257.65,Medicare,Medicare,,257.65,,,429.43,60.12,219.01,Fee Schedule,Medicare APC Fee Schedule
Q4662 C-LIPIN AB IGG,86147,CPT,,,,,both,, ,429.43,257.65,Medicare,Medicare,,257.65,,,429.43,60.12,219.01,Fee Schedule,Medicare APC Fee Schedule
PHOSPHATIDYLSERIN AB,86148,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,84.87,,,141.46,19.80,72.14,Fee Schedule,Medicare APC Fee Schedule
PHOSPHOLIPID AB,86148,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,84.87,,,141.46,19.80,72.14,Fee Schedule,Medicare APC Fee Schedule
Q14890 PHOSPHOLIPID,86148,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,84.87,,,141.46,19.80,72.14,Fee Schedule,Medicare APC Fee Schedule
CELL ENUM IS AND ID,86152,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,43.27,,,72.13,10.10,36.79,Fee Schedule,Medicare APC Fee Schedule
"COLD AGG, TITER",86157,CPT,,,,,both,, ,247.83,148.69,Medicare,Medicare,,148.69,,,247.83,34.70,126.39,Fee Schedule,Medicare APC Fee Schedule
L6353COLD HEMAGGL QT,86157,CPT,,,,,both,, ,40.70,24.42,Medicare,Medicare,,24.42,,,40.70,5.70,20.76,Fee Schedule,Medicare APC Fee Schedule
"COMPLEMENT AG, EA",86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q19882 COMP AG,86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q34888 COMPLE C7 RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q34889 COMPLE C8 RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q351 C3 COMPL ITA,86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q353 C4C COMP ITA,86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q354 COMPLEM C5 RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q433 COMPL CP C2 RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q981 COMPL C C1Q RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
Q297 C1 INH FUNC IA,86161,CPT,,,,,both,, ,79.99,47.99,Medicare,Medicare,,47.99,,,79.99,11.20,40.79,Fee Schedule,Medicare APC Fee Schedule
"COMP, TOTAL CH50",86162,CPT,,,,,both,, ,984.32,590.59,Medicare,Medicare,,590.59,,,984.32,137.80,502,Fee Schedule,Medicare APC Fee Schedule
"COMP, TOTAL CH50",86162,CPT,,,,,both,, ,984.32,590.59,Medicare,Medicare,,590.59,,,984.32,137.80,502,Fee Schedule,Medicare APC Fee Schedule
Q11173 CCP AB IGG IA,86200,CPT,,,,,both,, ,242.50,145.50,Medicare,Medicare,,145.50,,,242.50,33.95,123.68,Fee Schedule,Medicare APC Fee Schedule
DEOXYRIBONUCLEASE AB,86215,CPT,,,,,both,, ,198.72,119.23,Medicare,Medicare,,119.23,,,198.72,27.82,101.35,Fee Schedule,Medicare APC Fee Schedule
DEOXYRIBONUCLEASE AB,86215,CPT,,,,,both,, ,198.72,119.23,Medicare,Medicare,,119.23,,,198.72,27.82,101.35,Fee Schedule,Medicare APC Fee Schedule
"DNA AB,NATIVE-DOUBL",86225,CPT,,,,,both,, ,1077.50,646.50,Medicare,Medicare,,646.50,,,1077.50,150.85,549.53,Fee Schedule,Medicare APC Fee Schedule
L165092 DNA DS AB,86225,CPT,,,,,both,, ,486.16,291.69,Medicare,Medicare,,291.69,,,486.16,68.06,247.94,Fee Schedule,Medicare APC Fee Schedule
L96346 DSDNA AB IA,86225,CPT,,,,,both,, ,219.10,131.46,Medicare,Medicare,,131.46,,,219.10,30.67,111.74,Fee Schedule,Medicare APC Fee Schedule
Q19882 DNA DS AB,86225,CPT,,,,,both,, ,1077.50,646.50,Medicare,Medicare,,646.50,,,1077.50,150.85,549.53,Fee Schedule,Medicare APC Fee Schedule
Q255 DNA DS AB IA,86225,CPT,,,,,both,, ,1077.50,646.50,Medicare,Medicare,,646.50,,,1077.50,150.85,549.53,Fee Schedule,Medicare APC Fee Schedule
DNA AB SINGLE STRAND,86226,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
DNA AB SINGLE STRAND,86226,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
Q14857 SSDNA ANTIBODY (IGG),86226,CPT,,,,,both,, ,923.00,553.80,Medicare,Medicare,,553.80,,,923.00,129.22,470.73,Fee Schedule,Medicare APC Fee Schedule
L165126 ENDMYS AB IG,86231,CPT,,,,,both,, ,60.05,36.03,Medicare,Medicare,,36.03,,,60.05,8.41,30.63,Fee Schedule,Medicare APC Fee Schedule
Q15064 ENDOMYS AB IG,86231,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,317.94,,,529.91,74.19,270.25,Fee Schedule,Medicare APC Fee Schedule
Q19955 ENDOMYS AB IG,86231,CPT,,,,,both,, ,743.65,446.19,Medicare,Medicare,,446.19,,,743.65,104.11,379.26,Fee Schedule,Medicare APC Fee Schedule
ANTI-ENA,86235,CPT,,,,,both,, ,174.85,104.91,Medicare,Medicare,,104.91,,,174.85,24.48,89.17,Fee Schedule,Medicare APC Fee Schedule
ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,164.53,,,274.22,38.39,139.85,Fee Schedule,Medicare APC Fee Schedule
L165092 ANTI-ENA,86235,CPT,,,,,both,, ,251.58,150.94,Medicare,Medicare,,150.94,,,251.58,35.22,128.31,Fee Schedule,Medicare APC Fee Schedule
Q16088 CENTR B AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,164.53,,,274.22,38.39,139.85,Fee Schedule,Medicare APC Fee Schedule
Q171728MI-2 AAB RIPA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,164.53,,,274.22,38.39,139.85,Fee Schedule,Medicare APC Fee Schedule
Q19882 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,164.53,,,274.22,38.39,139.85,Fee Schedule,Medicare APC Fee Schedule
Q19887 RNP AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,164.53,,,274.22,38.39,139.85,Fee Schedule,Medicare APC Fee Schedule
Q34088 CHROMAT AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,164.53,,,274.22,38.39,139.85,Fee Schedule,Medicare APC Fee Schedule
Q37923 SM AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,164.53,,,274.22,38.39,139.85,Fee Schedule,Medicare APC Fee Schedule
Q38568 SS-A IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,164.53,,,274.22,38.39,139.85,Fee Schedule,Medicare APC Fee Schedule
Q38569 SS-B IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,164.53,,,274.22,38.39,139.85,Fee Schedule,Medicare APC Fee Schedule
Q4942 SCLEROD AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,164.53,,,274.22,38.39,139.85,Fee Schedule,Medicare APC Fee Schedule
Q5810 JO-1 AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,164.53,,,274.22,38.39,139.85,Fee Schedule,Medicare APC Fee Schedule
Q7448 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,164.53,,,274.22,38.39,139.85,Fee Schedule,Medicare APC Fee Schedule
Q7832 ANTI-ENA,86235,CPT,,,,,both,, ,548.71,329.22,Medicare,Medicare,,329.22,,,548.71,76.82,279.84,Fee Schedule,Medicare APC Fee Schedule
Q7832 ANTI-ENA,86235,CPT,,,,,both,, ,548.71,329.22,Medicare,Medicare,,329.22,,,548.71,76.82,279.84,Fee Schedule,Medicare APC Fee Schedule
Q94025 PM-SCL AB EIA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,164.53,,,274.22,38.39,139.85,Fee Schedule,Medicare APC Fee Schedule
Q94685 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,164.53,,,274.22,38.39,139.85,Fee Schedule,Medicare APC Fee Schedule
Q94777 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,164.53,,,274.22,38.39,139.85,Fee Schedule,Medicare APC Fee Schedule
"FLUORESCENT AB,SCREE",86255,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,317.94,,,529.91,74.19,270.25,Fee Schedule,Medicare APC Fee Schedule
"FLUORESCENT AB,SCREE",86255,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,317.94,,,529.91,74.19,270.25,Fee Schedule,Medicare APC Fee Schedule
"FLUORESCENT AB,SCREE",86255,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,317.94,,,529.91,74.19,270.25,Fee Schedule,Medicare APC Fee Schedule
"FLUORESCENT AB,SCREE",86255,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,317.94,,,529.91,74.19,270.25,Fee Schedule,Medicare APC Fee Schedule
L165620 STRIATIONAL ANTIBODIES,86255,CPT,,,,,both,, ,89.90,53.94,Medicare,Medicare,,53.94,,,89.90,12.59,45.85,Fee Schedule,Medicare APC Fee Schedule
LC505225 ACETYLCHOLINE RECEPT-MODULAT AB,86255,CPT,,,,,both,, ,260.64,156.38,Medicare,Medicare,,156.38,,,260.64,36.49,132.93,Fee Schedule,Medicare APC Fee Schedule
Q37092 DNA DS CRITH,86255,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,317.94,,,529.91,74.19,270.25,Fee Schedule,Medicare APC Fee Schedule
Q37092 DNA DS CRITH,86255,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,317.94,,,529.91,74.19,270.25,Fee Schedule,Medicare APC Fee Schedule
Q37092 DNA DS CRITH,86255,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,317.94,,,529.91,74.19,270.25,Fee Schedule,Medicare APC Fee Schedule
Q37092 DNA DS CRITH,86255,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,317.94,,,529.91,74.19,270.25,Fee Schedule,Medicare APC Fee Schedule
Q91985 ENDOMYSIAL(IGG)ANTIBODY SCRN TITR,86255,CPT,,,,,both,, ,472.00,283.20,Medicare,Medicare,,283.20,,,472.00,66.08,240.72,Fee Schedule,Medicare APC Fee Schedule
"FLUORESCENT AB,TITER",86256,CPT,,,,,both,, ,1217.28,730.36,Medicare,Medicare,,730.36,,,1217.28,170.42,620.81,Fee Schedule,Medicare APC Fee Schedule
"Q261 FLUORES AB, TIT",86256,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,317.94,,,529.91,74.19,270.25,Fee Schedule,Medicare APC Fee Schedule
"Q261 FLUORES AB, TIT",86256,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,317.94,,,529.91,74.19,270.25,Fee Schedule,Medicare APC Fee Schedule
L165126 GLIA AB IGA,86258,CPT,,,,,both,, ,57.65,34.59,Medicare,Medicare,,34.59,,,57.65,8.07,29.4,Fee Schedule,Medicare APC Fee Schedule
Q11212GLIA AB IGG IA,86258,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,459.57,,,765.96,107.23,390.64,Fee Schedule,Medicare APC Fee Schedule
Q11212GLIA AB IGG IA,86258,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,459.57,,,765.96,107.23,390.64,Fee Schedule,Medicare APC Fee Schedule
L143404 CA15-3 ECLIA,86300,CPT,,,,,both,, ,442.13,265.27,Medicare,Medicare,,265.27,,,442.13,61.90,225.49,Fee Schedule,Medicare APC Fee Schedule
Q29493 CA 27.29 IA,86300,CPT,,,,,both,, ,481.92,289.15,Medicare,Medicare,,289.15,,,481.92,67.47,245.78,Fee Schedule,Medicare APC Fee Schedule
TUMR AG CA15-3 27-29,86300,CPT,,,,,both,, ,109.46,65.67,Medicare,Medicare,,65.67,,,109.46,15.32,55.82,Fee Schedule,Medicare APC Fee Schedule
Q17638 CA 19-9 PERITONEAL FLUID,86301,CPT,,,,,both,, ,716.75,430.05,Medicare,Medicare,,430.05,,,716.75,100.35,365.54,Fee Schedule,Medicare APC Fee Schedule
TUMOR AG CA 19-9,86301,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,482.81,,,804.69,112.66,410.39,Fee Schedule,Medicare APC Fee Schedule
TUMOR AG CA 19-9,86301,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,482.81,,,804.69,112.66,410.39,Fee Schedule,Medicare APC Fee Schedule
Q29256 CA 125 IA,86304,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,482.81,,,804.69,112.66,410.39,Fee Schedule,Medicare APC Fee Schedule
Q91155 TUMR AG CA125,86304,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,482.81,,,804.69,112.66,410.39,Fee Schedule,Medicare APC Fee Schedule
TUMOR AG CA 125,86304,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,482.81,,,804.69,112.66,410.39,Fee Schedule,Medicare APC Fee Schedule
Q91155 HE4,86305,CPT,,,,,both,, ,138.65,83.19,Medicare,Medicare,,83.19,,,138.65,19.41,70.71,Fee Schedule,Medicare APC Fee Schedule
HETEROPHILE AB SCREE,86308,CPT,,,,,both,, ,19.09,11.45,Medicare,Medicare,,11.45,,,19.09,2.67,9.74,Fee Schedule,Medicare APC Fee Schedule
HETEROPHILE AB SCREE,86308,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,288.47,,,480.79,67.31,245.2,Fee Schedule,Medicare APC Fee Schedule
Q17410 ALPHA-FETOPROTEIN PERITONEAL FLUI,86316,CPT,,,,,both,, ,429.25,257.55,Medicare,Medicare,,257.55,,,429.25,60.10,218.92,Fee Schedule,Medicare APC Fee Schedule
"TUMOR AG, OTHER",86316,CPT,,,,,both,, ,481.92,289.15,Medicare,Medicare,,289.15,,,481.92,67.47,245.78,Fee Schedule,Medicare APC Fee Schedule
"TUMOR AG, OTHER",86316,CPT,,,,,both,, ,481.92,289.15,Medicare,Medicare,,289.15,,,481.92,67.47,245.78,Fee Schedule,Medicare APC Fee Schedule
INF AGENT IMMUNO QUA,86317,CPT,,,,,both,, ,217.52,130.51,Medicare,Medicare,,130.51,,,217.52,30.45,110.94,Fee Schedule,Medicare APC Fee Schedule
INF AGENT IMMUNO QUA,86317,CPT,,,,,both,, ,217.52,130.51,Medicare,Medicare,,130.51,,,217.52,30.45,110.94,Fee Schedule,Medicare APC Fee Schedule
TETANUS/DIPTHERIA AB,86317,CPT,,,,,both,, ,70.00,42.00,Medicare,Medicare,,42.00,,,70.00,9.80,35.7,Fee Schedule,Medicare APC Fee Schedule
Q15914 C4 BND PL RID,86329,CPT,,,,,both,, ,81.11,48.66,Medicare,Medicare,,48.66,,,81.11,11.36,41.37,Fee Schedule,Medicare APC Fee Schedule
Q14978 IMMUNODI OUCN,86331,CPT,,,,,both,, ,69.04,41.42,Medicare,Medicare,,41.42,,,69.04,9.67,35.21,Fee Schedule,Medicare APC Fee Schedule
IMMUNOFIXATION ELECT,86334,CPT,,,,,both,, ,1021.37,612.82,Medicare,Medicare,,612.82,,,1021.37,142.99,520.9,Fee Schedule,Medicare APC Fee Schedule
IMMUNOFIXATION ELECT,86334,CPT,,,,,both,, ,1021.37,612.82,Medicare,Medicare,,612.82,,,1021.37,142.99,520.9,Fee Schedule,Medicare APC Fee Schedule
Q38940 IMMUNOFIXATION ELECT,86334,CPT,,,,,both,, ,909.75,545.85,Medicare,Medicare,,545.85,,,909.75,127.37,463.97,Fee Schedule,Medicare APC Fee Schedule
IMM E-PHORS-URIN-CSF,86335,CPT,,,,,both,, ,680.07,408.04,Medicare,Medicare,,408.04,,,680.07,95.21,346.84,Fee Schedule,Medicare APC Fee Schedule
Q10640 B2TF EL-IF,86335,CPT,,,,,both,, ,680.07,408.04,Medicare,Medicare,,408.04,,,680.07,95.21,346.84,Fee Schedule,Medicare APC Fee Schedule
Q213 IFE U,86335,CPT,,,,,both,, ,680.07,408.04,Medicare,Medicare,,408.04,,,680.07,95.21,346.84,Fee Schedule,Medicare APC Fee Schedule
INHIBIN A,86336,CPT,,,,,both,, ,145.66,87.39,Medicare,Medicare,,87.39,,,145.66,20.39,74.29,Fee Schedule,Medicare APC Fee Schedule
INSULIN AB,86337,CPT,,,,,both,, ,207.41,124.44,Medicare,Medicare,,124.44,,,207.41,29.04,105.78,Fee Schedule,Medicare APC Fee Schedule
INSULIN AB,86337,CPT,,,,,both,, ,207.41,124.44,Medicare,Medicare,,124.44,,,207.41,29.04,105.78,Fee Schedule,Medicare APC Fee Schedule
INTRINSIC FACTOR AB,86340,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
L10413 IFB AB ICMA,86340,CPT,,,,,both,, ,50.00,30.00,Medicare,Medicare,,30.00,,,50.00,7.00,25.5,Fee Schedule,Medicare APC Fee Schedule
ISLET CELL AB,86341,CPT,,,,,both,, ,296.67,178.00,Medicare,Medicare,,178.00,,,296.67,41.53,151.3,Fee Schedule,Medicare APC Fee Schedule
Q34878 GAD-65 AB RBA,86341,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,436.84,,,728.07,101.93,371.32,Fee Schedule,Medicare APC Fee Schedule
Q36177 IA2 AB,86341,CPT,,,,,both,, ,296.67,178.00,Medicare,Medicare,,178.00,,,296.67,41.53,151.3,Fee Schedule,Medicare APC Fee Schedule
Q36741 ISL CL AB IFA,86341,CPT,,,,,both,, ,296.67,178.00,Medicare,Medicare,,178.00,,,296.67,41.53,151.3,Fee Schedule,Medicare APC Fee Schedule
Q93022 ZINC TRANSPORTER 8 (ZNT8)ANTIBODY,86341,CPT,,,,,both,, ,264.25,158.55,Medicare,Medicare,,158.55,,,264.25,37.00,134.77,Fee Schedule,Medicare APC Fee Schedule
Q90123 LEUK HIST REL,86343,CPT,,,,,both,, ,55.95,33.57,Medicare,Medicare,,33.57,,,55.95,7.83,28.53,Fee Schedule,Medicare APC Fee Schedule
L820022 CHRN URTICAR,86352,CPT,,,,,both,, ,422.30,253.38,Medicare,Medicare,,253.38,,,422.30,59.12,215.37,Fee Schedule,Medicare APC Fee Schedule
"Q39588 B CELLS, TOTA",86355,CPT,,,,,both,, ,217.52,130.51,Medicare,Medicare,,130.51,,,217.52,30.45,110.94,Fee Schedule,Medicare APC Fee Schedule
MONONUC CELL AG QT,86356,CPT,,,,,both,, ,308.74,185.24,Medicare,Medicare,,185.24,,,308.74,43.22,157.46,Fee Schedule,Medicare APC Fee Schedule
MONONUC CELL AG QT,86356,CPT,,,,,both,, ,308.74,185.24,Medicare,Medicare,,185.24,,,308.74,43.22,157.46,Fee Schedule,Medicare APC Fee Schedule
Q37088 NK CELLS CF,86357,CPT,,,,,both,, ,217.52,130.51,Medicare,Medicare,,130.51,,,217.52,30.45,110.94,Fee Schedule,Medicare APC Fee Schedule
"Q39588 T CELLS, TOTA",86359,CPT,,,,,both,, ,217.52,130.51,Medicare,Medicare,,130.51,,,217.52,30.45,110.94,Fee Schedule,Medicare APC Fee Schedule
"T CELL,ABSO CD4-CD8",86360,CPT,,,,,both,, ,1515.65,909.39,Medicare,Medicare,,909.39,,,1515.65,212.19,772.98,Fee Schedule,Medicare APC Fee Schedule
"T CELL,ABSO CD4-CD8",86360,CPT,,,,,both,, ,1515.65,909.39,Medicare,Medicare,,909.39,,,1515.65,212.19,772.98,Fee Schedule,Medicare APC Fee Schedule
Q8360 LYMP SUB P5 FC,86361,CPT,,,,,both,, ,822.94,493.76,Medicare,Medicare,,493.76,,,822.94,115.21,419.7,Fee Schedule,Medicare APC Fee Schedule
"T CELL, ABSO CD4",86361,CPT,,,,,both,, ,878.79,527.27,Medicare,Medicare,,527.27,,,878.79,123.03,448.18,Fee Schedule,Medicare APC Fee Schedule
Q36952 MOG AB,86362,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,317.94,,,529.91,74.19,270.25,Fee Schedule,Medicare APC Fee Schedule
L165126TTG AB IGG IA,86364,CPT,,,,,both,, ,57.65,34.59,Medicare,Medicare,,34.59,,,57.65,8.07,29.4,Fee Schedule,Medicare APC Fee Schedule
Q8821 TTG AB IGA IA,86364,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,459.57,,,765.96,107.23,390.64,Fee Schedule,Medicare APC Fee Schedule
Q8821 TTG AB IGA IA,86364,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,459.57,,,765.96,107.23,390.64,Fee Schedule,Medicare APC Fee Schedule
L504600 MSCLSPECKINAB,86366,CPT,,,,,both,, ,180.40,108.24,Medicare,Medicare,,108.24,,,180.40,25.26,92,Fee Schedule,Medicare APC Fee Schedule
MICROSOMAL AB,86376,CPT,,,,,both,, ,682.88,409.72,Medicare,Medicare,,409.72,,,682.88,95.60,348.27,Fee Schedule,Medicare APC Fee Schedule
MICROSOMAL AB,86376,CPT,,,,,both,, ,682.88,409.72,Medicare,Medicare,,409.72,,,682.88,95.60,348.27,Fee Schedule,Medicare APC Fee Schedule
MICROSOMAL AB,86376,CPT,,,,,both,, ,682.88,409.72,Medicare,Medicare,,409.72,,,682.88,95.60,348.27,Fee Schedule,Medicare APC Fee Schedule
MICROSOMAL AB,86376,CPT,,,,,both,, ,682.88,409.72,Medicare,Medicare,,409.72,,,682.88,95.60,348.27,Fee Schedule,Medicare APC Fee Schedule
Q259 MITO AB IA,86381,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,317.94,,,529.91,74.19,270.25,Fee Schedule,Medicare APC Fee Schedule
Q30321 MM2AB IGG EIA,86381,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,248.89,,,414.83,58.08,211.56,Fee Schedule,Medicare APC Fee Schedule
"NEUTRALIZ TEST,VIRAL",86382,CPT,,,,,both,, ,224.54,134.72,Medicare,Medicare,,134.72,,,224.54,31.44,114.52,Fee Schedule,Medicare APC Fee Schedule
"NEUTRALIZ TEST,VIRAL",86382,CPT,,,,,both,, ,224.54,134.72,Medicare,Medicare,,134.72,,,224.54,31.44,114.52,Fee Schedule,Medicare APC Fee Schedule
PART AGGLUT.SCREEN,86403,CPT,,,,,both,, ,547.31,328.38,Medicare,Medicare,,328.38,,,547.31,76.62,279.13,Fee Schedule,Medicare APC Fee Schedule
Q11196 CRYPTOC AG LA,86403,CPT,,,,,both,, ,172.90,103.74,Medicare,Medicare,,103.74,,,172.90,24.21,88.18,Fee Schedule,Medicare APC Fee Schedule
Q11196 CRYPTOC AG LA,86403,CPT,,,,,both,, ,172.90,103.74,Medicare,Medicare,,103.74,,,172.90,24.21,88.18,Fee Schedule,Medicare APC Fee Schedule
PART AGGLUT. TITER,86406,CPT,,,,,both,, ,147.91,88.74,Medicare,Medicare,,88.74,,,147.91,20.71,75.43,Fee Schedule,Medicare APC Fee Schedule
Q37521 RA FACT QT,86431,CPT,,,,,both,, ,401.19,240.71,Medicare,Medicare,,240.71,,,401.19,56.17,204.61,Fee Schedule,Medicare APC Fee Schedule
RHEUMATOID FACT QUAN,86431,CPT,,,,,both,, ,55.85,33.51,Medicare,Medicare,,33.51,,,55.85,7.82,28.48,Fee Schedule,Medicare APC Fee Schedule
RHEUMATOID FACT QUAN,86431,CPT,,,,,both,, ,437.29,262.37,Medicare,Medicare,,262.37,,,437.29,61.22,223.02,Fee Schedule,Medicare APC Fee Schedule
LRX182877 QTFERON TU,86480,CPT,,,,,both,, ,369.77,221.86,Medicare,Medicare,,221.86,,,369.77,51.77,188.58,Fee Schedule,Medicare APC Fee Schedule
Q19453 TB GOLD BIO A,86480,CPT,,,,,both,,,403.05,403.05,Medicare,Medicare,,403.05,,,403.05,56.43,205.56,Fee Schedule,Medicare APC Fee Schedule
TB TEST CELL IM MEAS,86480,CPT,,,,,both,, ,403.05,241.83,Medicare,Medicare,,241.83,,,403.05,56.43,205.56,Fee Schedule,Medicare APC Fee Schedule
TB TEST CELL IM MEAS,86480,CPT,,,,,both,, ,403.05,241.83,Medicare,Medicare,,241.83,,,403.05,56.43,205.56,Fee Schedule,Medicare APC Fee Schedule
L006099 RFLX RPR,86592,CPT,,,,,both,, ,48.90,29.34,Medicare,Medicare,,29.34,,,48.90,6.85,24.94,Fee Schedule,Medicare APC Fee Schedule
"SYPHILIS TEST, QUAL",86592,CPT,,,,,both,, ,42.10,25.26,Medicare,Medicare,,25.26,,,42.10,5.89,21.47,Fee Schedule,Medicare APC Fee Schedule
"SYPHILIS TEST, QUAL",86592,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
"SYPHILIS TEST, QUAL",86592,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
L6460 RPR QT CHAR FL,86593,CPT,,,,,both,, ,412.88,247.72,Medicare,Medicare,,247.72,,,412.88,57.80,210.57,Fee Schedule,Medicare APC Fee Schedule
"SYPHILIS TEST, QUANT",86593,CPT,,,,,both,, ,43.50,26.10,Medicare,Medicare,,26.10,,,43.50,6.09,22.19,Fee Schedule,Medicare APC Fee Schedule
"SYPHILIS TEST, QUANT",86593,CPT,,,,,both,, ,412.87,247.72,Medicare,Medicare,,247.72,,,412.87,57.80,210.56,Fee Schedule,Medicare APC Fee Schedule
VOLT-GTD CA CHNL AB,86596,CPT,,,,,both,, ,120.50,72.30,Medicare,Medicare,,72.30,,,120.50,16.87,61.46,Fee Schedule,Medicare APC Fee Schedule
ASPERGILLUS AB,86606,CPT,,,,,both,, ,145.95,87.57,Medicare,Medicare,,87.57,,,145.95,20.43,74.43,Fee Schedule,Medicare APC Fee Schedule
ASPERGILLUS AB,86606,CPT,,,,,both,, ,145.95,87.57,Medicare,Medicare,,87.57,,,145.95,20.43,74.43,Fee Schedule,Medicare APC Fee Schedule
"BACTERUIM AB, NOS",86609,CPT,,,,,both,, ,154.09,92.45,Medicare,Medicare,,92.45,,,154.09,21.57,78.59,Fee Schedule,Medicare APC Fee Schedule
"BACTERUIM AB, NOS",86609,CPT,,,,,both,, ,154.09,92.45,Medicare,Medicare,,92.45,,,154.09,21.57,78.59,Fee Schedule,Medicare APC Fee Schedule
Q34329 LISTERI AB CF,86609,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,462.27,,,770.45,107.86,392.93,Fee Schedule,Medicare APC Fee Schedule
BARTONELLA AB,86611,CPT,,,,,both,, ,348.32,208.99,Medicare,Medicare,,208.99,,,348.32,48.76,177.64,Fee Schedule,Medicare APC Fee Schedule
Q34251 BARTONELLA AB,86611,CPT,,,,,both,, ,264.11,158.46,Medicare,Medicare,,158.46,,,264.11,36.98,134.7,Fee Schedule,Medicare APC Fee Schedule
BLASTOMYCES AB,86612,CPT,,,,,both,, ,600.92,360.55,Medicare,Medicare,,360.55,,,600.92,84.13,306.47,Fee Schedule,Medicare APC Fee Schedule
BLASTOMYCES AB,86612,CPT,,,,,both,, ,600.92,360.55,Medicare,Medicare,,360.55,,,600.92,84.13,306.47,Fee Schedule,Medicare APC Fee Schedule
BORDETELLA AB,86615,CPT,,,,,both,, ,134.44,80.66,Medicare,Medicare,,80.66,,,134.44,18.82,68.56,Fee Schedule,Medicare APC Fee Schedule
BORDETELLA AB,86615,CPT,,,,,both,, ,134.44,80.66,Medicare,Medicare,,80.66,,,134.44,18.82,68.56,Fee Schedule,Medicare APC Fee Schedule
BORRELIA BURG.CONFIR,86617,CPT,,,,,both,, ,232.11,139.26,Medicare,Medicare,,139.26,,,232.11,32.50,118.38,Fee Schedule,Medicare APC Fee Schedule
BORRELIA BURG.CONFIR,86617,CPT,,,,,both,, ,232.11,139.26,Medicare,Medicare,,139.26,,,232.11,32.50,118.38,Fee Schedule,Medicare APC Fee Schedule
LYME DISEASE AB,86618,CPT,,,,,both,, ,167.84,100.70,Medicare,Medicare,,100.70,,,167.84,23.50,85.6,Fee Schedule,Medicare APC Fee Schedule
LYME DISEASE AB,86618,CPT,,,,,both,, ,573.13,343.87,Medicare,Medicare,,343.87,,,573.13,80.24,292.3,Fee Schedule,Medicare APC Fee Schedule
LYME DISEASE AB,86618,CPT,,,,,both,, ,573.13,343.87,Medicare,Medicare,,343.87,,,573.13,80.24,292.3,Fee Schedule,Medicare APC Fee Schedule
BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Medicare,Medicare,,243.17,,,405.29,56.74,206.7,Fee Schedule,Medicare APC Fee Schedule
Q91068 BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Medicare,Medicare,,243.17,,,405.29,56.74,206.7,Fee Schedule,Medicare APC Fee Schedule
Q91121 BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Medicare,Medicare,,243.17,,,405.29,56.74,206.7,Fee Schedule,Medicare APC Fee Schedule
CANDIDA AB,86628,CPT,,,,,both,, ,157.18,94.30,Medicare,Medicare,,94.30,,,157.18,22.01,80.16,Fee Schedule,Medicare APC Fee Schedule
CHLAMYDIA AB,86631,CPT,,,,,both,, ,275.62,165.37,Medicare,Medicare,,165.37,,,275.62,38.59,140.57,Fee Schedule,Medicare APC Fee Schedule
CHLAMYDIA IGM AB,86632,CPT,,,,,both,, ,286.57,171.94,Medicare,Medicare,,171.94,,,286.57,40.12,146.15,Fee Schedule,Medicare APC Fee Schedule
CHLAMYDIA IGM AB,86632,CPT,,,,,both,, ,286.57,171.94,Medicare,Medicare,,171.94,,,286.57,40.12,146.15,Fee Schedule,Medicare APC Fee Schedule
Q38481 C.PNEU AB IGM,86632,CPT,,,,,both,, ,743.51,446.10,Medicare,Medicare,,446.10,,,743.51,104.09,379.19,Fee Schedule,Medicare APC Fee Schedule
COCCIDIOIDES AB,86635,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
COCCIDIOIDES AB,86635,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
L806606 Q FEV,86638,CPT,,,,,both,, ,120.00,72.00,Medicare,Medicare,,72.00,,,120.00,16.80,61.2,Fee Schedule,Medicare APC Fee Schedule
Q37071 COXIELLA BRUN,86638,CPT,,,,,both,, ,69.89,41.93,Medicare,Medicare,,41.93,,,69.89,9.78,35.64,Fee Schedule,Medicare APC Fee Schedule
Q30430 CRYPTO AB IFA,86641,CPT,,,,,both,, ,74.65,44.79,Medicare,Medicare,,44.79,,,74.65,10.45,38.07,Fee Schedule,Medicare APC Fee Schedule
CMV AB,86644,CPT,,,,,both,, ,1113.43,668.05,Medicare,Medicare,,668.05,,,1113.43,155.88,567.85,Fee Schedule,Medicare APC Fee Schedule
CMV AB,86644,CPT,,,,,both,, ,1113.43,668.05,Medicare,Medicare,,668.05,,,1113.43,155.88,567.85,Fee Schedule,Medicare APC Fee Schedule
L6494 CMV IGG CLIA,86644,CPT,,,,,both,, ,1021.50,612.90,Medicare,Medicare,,612.90,,,1021.50,143.01,520.97,Fee Schedule,Medicare APC Fee Schedule
"CMV AB, IGM",86645,CPT,,,,,both,, ,1277.07,766.24,Medicare,Medicare,,766.24,,,1277.07,178.79,651.31,Fee Schedule,Medicare APC Fee Schedule
Q8503 CMV AB IGM IA,86645,CPT,,,,,both,, ,485.84,291.50,Medicare,Medicare,,291.50,,,485.84,68.02,247.78,Fee Schedule,Medicare APC Fee Schedule
Q37512 DIPTHTHER AB,86648,CPT,,,,,both,, ,101.32,60.79,Medicare,Medicare,,60.79,,,101.32,14.18,51.67,Fee Schedule,Medicare APC Fee Schedule
ENTEROVIRUS AB,86658,CPT,,,,,both,, ,375.82,225.49,Medicare,Medicare,,225.49,,,375.82,52.61,191.67,Fee Schedule,Medicare APC Fee Schedule
L830764 ENTEROVIR AB,86658,CPT,,,,,both,, ,212.00,127.20,Medicare,Medicare,,127.20,,,212.00,29.68,108.12,Fee Schedule,Medicare APC Fee Schedule
"EPSTEIN-BARR AB, EA",86663,CPT,,,,,both,, ,210.50,126.30,Medicare,Medicare,,126.30,,,210.50,29.47,107.36,Fee Schedule,Medicare APC Fee Schedule
"EPSTEIN-BARR AB, EA",86663,CPT,,,,,both,, ,210.50,126.30,Medicare,Medicare,,126.30,,,210.50,29.47,107.36,Fee Schedule,Medicare APC Fee Schedule
"EPSTEIN-BARR, EBNA",86664,CPT,,,,,both,, ,362.91,217.74,Medicare,Medicare,,217.74,,,362.91,50.81,185.08,Fee Schedule,Medicare APC Fee Schedule
"EPSTEIN-BARR, EBNA",86664,CPT,,,,,both,, ,362.91,217.74,Medicare,Medicare,,217.74,,,362.91,50.81,185.08,Fee Schedule,Medicare APC Fee Schedule
"EPSTEIN-BARR, VCA",86665,CPT,,,,,both,, ,362.91,217.74,Medicare,Medicare,,217.74,,,362.91,50.81,185.08,Fee Schedule,Medicare APC Fee Schedule
"EPSTEIN-BARR, VCA",86665,CPT,,,,,both,, ,362.91,217.74,Medicare,Medicare,,217.74,,,362.91,50.81,185.08,Fee Schedule,Medicare APC Fee Schedule
Q8426 EBV VCA IGM IA,86665,CPT,,,,,both,, ,210.50,126.30,Medicare,Medicare,,126.30,,,210.50,29.47,107.36,Fee Schedule,Medicare APC Fee Schedule
Q8426 EBV VCA IGM IA,86665,CPT,,,,,both,, ,210.50,126.30,Medicare,Medicare,,126.30,,,210.50,29.47,107.36,Fee Schedule,Medicare APC Fee Schedule
EHRLICHIA AB,86666,CPT,,,,,both,, ,255.98,153.58,Medicare,Medicare,,153.58,,,255.98,35.84,130.55,Fee Schedule,Medicare APC Fee Schedule
EHRLICHIA AB,86666,CPT,,,,,both,, ,255.98,153.58,Medicare,Medicare,,153.58,,,255.98,35.84,130.55,Fee Schedule,Medicare APC Fee Schedule
Q34271 EHRLICHIA AB,86666,CPT,,,,,both,, ,511.95,307.17,Medicare,Medicare,,307.17,,,511.95,71.67,261.09,Fee Schedule,Medicare APC Fee Schedule
FRANCISELLA TULARENS,86668,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
"FUNGUS AB, NOS",86671,CPT,,,,,both,, ,284.32,170.59,Medicare,Medicare,,170.59,,,284.32,39.80,145,Fee Schedule,Medicare APC Fee Schedule
L162045 FUNG AB NOS,86671,CPT,,,,,both,, ,260.85,156.51,Medicare,Medicare,,156.51,,,260.85,36.52,133.03,Fee Schedule,Medicare APC Fee Schedule
Q10294 SCAB IGG IA,86671,CPT,,,,,both,, ,568.64,341.18,Medicare,Medicare,,341.18,,,568.64,79.61,290.01,Fee Schedule,Medicare APC Fee Schedule
Q10294 SCAB IGG IA,86671,CPT,,,,,both,, ,568.64,341.18,Medicare,Medicare,,341.18,,,568.64,79.61,290.01,Fee Schedule,Medicare APC Fee Schedule
Q37695 H PYLORI AB Q,86677,CPT,,,,,both,, ,56.69,34.01,Medicare,Medicare,,34.01,,,56.69,7.94,28.91,Fee Schedule,Medicare APC Fee Schedule
Q91307 ECHIN IGG EIA,86682,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,44.95,,,74.93,10.49,38.21,Fee Schedule,Medicare APC Fee Schedule
Q91307 ECHIN IGG EIA,86682,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,44.95,,,74.93,10.49,38.21,Fee Schedule,Medicare APC Fee Schedule
Q91307 ECHIN IGG EIA,86682,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,44.95,,,74.93,10.49,38.21,Fee Schedule,Medicare APC Fee Schedule
Q91307 ECHIN IGG EIA,86682,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,44.95,,,74.93,10.49,38.21,Fee Schedule,Medicare APC Fee Schedule
"HEPATITIS, DELTA AGE",86692,CPT,,,,,both,, ,1381.76,829.05,Medicare,Medicare,,829.05,,,1381.76,193.45,704.7,Fee Schedule,Medicare APC Fee Schedule
Q4990 HEP D AB TOTAL,86692,CPT,,,,,both,, ,725.82,435.49,Medicare,Medicare,,435.49,,,725.82,101.61,370.17,Fee Schedule,Medicare APC Fee Schedule
HERPES SIMP NON-SPEC,86694,CPT,,,,,both,, ,338.21,202.92,Medicare,Medicare,,202.92,,,338.21,47.35,172.49,Fee Schedule,Medicare APC Fee Schedule
L164806 HSV1/2 IGM,86694,CPT,,,,,both,, ,50.70,30.42,Medicare,Medicare,,30.42,,,50.70,7.10,25.86,Fee Schedule,Medicare APC Fee Schedule
HERPES SIMP TYPE 1,86695,CPT,,,,,both,, ,129.94,77.96,Medicare,Medicare,,77.96,,,129.94,18.19,66.27,Fee Schedule,Medicare APC Fee Schedule
HERPES SIMP TYPE 1,86695,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
HERPES SIMP TYPE 1,86695,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
HERPES SIMP TYPE 1,86695,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
HERPES SIMP TYPE 1,86695,CPT,,,,,both,, ,351.68,211.00,Medicare,Medicare,,211.00,,,351.68,49.24,179.36,Fee Schedule,Medicare APC Fee Schedule
HERPES SIMP TYPE 2,86696,CPT,,,,,both,, ,190.86,114.51,Medicare,Medicare,,114.51,,,190.86,26.72,97.34,Fee Schedule,Medicare APC Fee Schedule
HERPES SIMP TYPE 2,86696,CPT,,,,,both,, ,258.50,155.10,Medicare,Medicare,,155.10,,,258.50,36.19,131.84,Fee Schedule,Medicare APC Fee Schedule
HERPES SIMP TYPE 2,86696,CPT,,,,,both,, ,258.50,155.10,Medicare,Medicare,,155.10,,,258.50,36.19,131.84,Fee Schedule,Medicare APC Fee Schedule
HERPES SIMP TYPE 2,86696,CPT,,,,,both,, ,258.50,155.10,Medicare,Medicare,,155.10,,,258.50,36.19,131.84,Fee Schedule,Medicare APC Fee Schedule
HERPES SIMP TYPE 2,86696,CPT,,,,,both,, ,258.50,155.10,Medicare,Medicare,,155.10,,,258.50,36.19,131.84,Fee Schedule,Medicare APC Fee Schedule
L163006 HSV2 AB IG,86696,CPT,,,,,both,, ,300.00,180.00,Medicare,Medicare,,180.00,,,300.00,42.00,153,Fee Schedule,Medicare APC Fee Schedule
Q17170 HERPES SIMPLEX VIRUS 2 (IGG),86696,CPT,,,,,both,, ,230.25,138.15,Medicare,Medicare,,138.15,,,230.25,32.24,117.43,Fee Schedule,Medicare APC Fee Schedule
HISTOPLASMA,86698,CPT,,,,,both,, ,450.48,270.28,Medicare,Medicare,,270.28,,,450.48,63.07,229.74,Fee Schedule,Medicare APC Fee Schedule
HISTOPLASMA,86698,CPT,,,,,both,, ,450.48,270.28,Medicare,Medicare,,270.28,,,450.48,63.07,229.74,Fee Schedule,Medicare APC Fee Schedule
HEP B CORE TOT,86704,CPT,,,,,both,, ,898.44,539.06,Medicare,Medicare,,539.06,,,898.44,125.78,458.2,Fee Schedule,Medicare APC Fee Schedule
HEP B CORE TOT,86704,CPT,,,,,both,, ,898.44,539.06,Medicare,Medicare,,539.06,,,898.44,125.78,458.2,Fee Schedule,Medicare APC Fee Schedule
"HEP B CORE AB, IGM",86705,CPT,,,,,both,,,1047.19,1047.19,Medicare,Medicare,,1047.19,,,1047.19,146.61,534.07,Fee Schedule,Medicare APC Fee Schedule
"HEP B CORE AB, IGM",86705,CPT,,,,,both,, ,1047.19,628.31,Medicare,Medicare,,628.31,,,1047.19,146.61,534.07,Fee Schedule,Medicare APC Fee Schedule
L16881 HBC IGM ICMA,86705,CPT,,,,,both,, ,70.33,42.19,Medicare,Medicare,,42.19,,,70.33,9.85,35.87,Fee Schedule,Medicare APC Fee Schedule
HEP BE AB,86707,CPT,,,,,both,, ,999.76,599.85,Medicare,Medicare,,599.85,,,999.76,139.97,509.88,Fee Schedule,Medicare APC Fee Schedule
HEP BE AB,86707,CPT,,,,,both,, ,999.76,599.85,Medicare,Medicare,,599.85,,,999.76,139.97,509.88,Fee Schedule,Medicare APC Fee Schedule
"HEP A AB, TOTAL",86708,CPT,,,,,both,, ,547.88,328.72,Medicare,Medicare,,328.72,,,547.88,76.70,279.42,Fee Schedule,Medicare APC Fee Schedule
L6726HEPA AB TOT ICM,86708,CPT,,,,,both,, ,547.88,328.72,Medicare,Medicare,,328.72,,,547.88,76.70,279.42,Fee Schedule,Medicare APC Fee Schedule
Q36504 HEPA AB IGM I,86708,CPT,,,,,both,, ,547.88,328.72,Medicare,Medicare,,328.72,,,547.88,76.70,279.42,Fee Schedule,Medicare APC Fee Schedule
"HEP A AB, IGM",86709,CPT,,,,,both,,,725.82,725.82,Medicare,Medicare,,725.82,,,725.82,101.61,370.17,Fee Schedule,Medicare APC Fee Schedule
"HEP A AB, IGM",86709,CPT,,,,,both,, ,725.82,435.49,Medicare,Medicare,,435.49,,,725.82,101.61,370.17,Fee Schedule,Medicare APC Fee Schedule
L6734 HEP A IGM ICMA,86709,CPT,,,,,both,, ,70.00,42.00,Medicare,Medicare,,42.00,,,70.00,9.80,35.7,Fee Schedule,Medicare APC Fee Schedule
L6734 HEP A IGM ICMA,86709,CPT,,,,,both,, ,70.00,42.00,Medicare,Medicare,,42.00,,,70.00,9.80,35.7,Fee Schedule,Medicare APC Fee Schedule
INFLUENZA VIRUS AB,86710,CPT,,,,,both,, ,295.83,177.49,Medicare,Medicare,,177.49,,,295.83,41.42,150.87,Fee Schedule,Medicare APC Fee Schedule
INFLUENZA VIRUS AB,86710,CPT,,,,,both,, ,295.83,177.49,Medicare,Medicare,,177.49,,,295.83,41.42,150.87,Fee Schedule,Medicare APC Fee Schedule
Q91665 STRAT JCV AB,86711,CPT,,,,,both,, ,156.06,93.63,Medicare,Medicare,,93.63,,,156.06,21.85,79.59,Fee Schedule,Medicare APC Fee Schedule
L164616 LEGIONELL AB,86713,CPT,,,,,both,, ,781.12,468.67,Medicare,Medicare,,468.67,,,781.12,109.36,398.37,Fee Schedule,Medicare APC Fee Schedule
LEGIONELLA AB,86713,CPT,,,,,both,, ,781.11,468.66,Medicare,Medicare,,468.66,,,781.11,109.36,398.37,Fee Schedule,Medicare APC Fee Schedule
LEGIONELLA AB,86713,CPT,,,,,both,, ,781.11,468.66,Medicare,Medicare,,468.66,,,781.11,109.36,398.37,Fee Schedule,Medicare APC Fee Schedule
LEPTOSPIRA AB,86720,CPT,,,,,both,, ,329.51,197.70,Medicare,Medicare,,197.70,,,329.51,46.13,168.05,Fee Schedule,Medicare APC Fee Schedule
L96552MUMPS IGG CLIA,86735,CPT,,,,,both,, ,540.24,324.14,Medicare,Medicare,,324.14,,,540.24,75.63,275.52,Fee Schedule,Medicare APC Fee Schedule
MUMPS AB,86735,CPT,,,,,both,, ,96.55,57.93,Medicare,Medicare,,57.93,,,96.55,13.52,49.24,Fee Schedule,Medicare APC Fee Schedule
MUMPS AB,86735,CPT,,,,,both,, ,588.85,353.31,Medicare,Medicare,,353.31,,,588.85,82.44,300.31,Fee Schedule,Medicare APC Fee Schedule
Q36565 MUMPS IGM IFA,86735,CPT,,,,,both,, ,588.85,353.31,Medicare,Medicare,,353.31,,,588.85,82.44,300.31,Fee Schedule,Medicare APC Fee Schedule
Q8624 MUMPSAB IGG IA,86735,CPT,,,,,both,, ,588.85,353.31,Medicare,Medicare,,353.31,,,588.85,82.44,300.31,Fee Schedule,Medicare APC Fee Schedule
MYCOPLASMA AB,86738,CPT,,,,,both,, ,566.12,339.67,Medicare,Medicare,,339.67,,,566.12,79.26,288.72,Fee Schedule,Medicare APC Fee Schedule
MYCOPLASMA AB,86738,CPT,,,,,both,, ,566.12,339.67,Medicare,Medicare,,339.67,,,566.12,79.26,288.72,Fee Schedule,Medicare APC Fee Schedule
MYCOPLASMA AB,86738,CPT,,,,,both,, ,566.12,339.67,Medicare,Medicare,,339.67,,,566.12,79.26,288.72,Fee Schedule,Medicare APC Fee Schedule
MYCOPLASMA AB,86738,CPT,,,,,both,, ,566.12,339.67,Medicare,Medicare,,339.67,,,566.12,79.26,288.72,Fee Schedule,Medicare APC Fee Schedule
PARVOVIRUS AB,86747,CPT,,,,,both,, ,242.50,145.50,Medicare,Medicare,,145.50,,,242.50,33.95,123.68,Fee Schedule,Medicare APC Fee Schedule
PARVOVIRUS AB,86747,CPT,,,,,both,, ,242.50,145.50,Medicare,Medicare,,145.50,,,242.50,33.95,123.68,Fee Schedule,Medicare APC Fee Schedule
PARVOVIRUS AB,86747,CPT,,,,,both,, ,242.50,145.50,Medicare,Medicare,,145.50,,,242.50,33.95,123.68,Fee Schedule,Medicare APC Fee Schedule
PARVOVIRUS AB,86747,CPT,,,,,both,, ,242.50,145.50,Medicare,Medicare,,145.50,,,242.50,33.95,123.68,Fee Schedule,Medicare APC Fee Schedule
Q34278 ENTAB IGG ELI,86753,CPT,,,,,both,, ,64.27,38.56,Medicare,Medicare,,38.56,,,64.27,9.00,32.78,Fee Schedule,Medicare APC Fee Schedule
Q34300 PROTOZ AB NOS,86753,CPT,,,,,both,, ,64.27,38.56,Medicare,Medicare,,38.56,,,64.27,9.00,32.78,Fee Schedule,Medicare APC Fee Schedule
Q90827 T CRUZI AB IA,86753,CPT,,,,,both,, ,64.27,38.56,Medicare,Medicare,,38.56,,,64.27,9.00,32.78,Fee Schedule,Medicare APC Fee Schedule
L96131 RSV AB QT,86756,CPT,,,,,both,, ,95.00,57.00,Medicare,Medicare,,57.00,,,95.00,13.30,48.45,Fee Schedule,Medicare APC Fee Schedule
RICKETTSIA AB,86757,CPT,,,,,both,, ,242.50,145.50,Medicare,Medicare,,145.50,,,242.50,33.95,123.68,Fee Schedule,Medicare APC Fee Schedule
RICKETTSIA AB,86757,CPT,,,,,both,, ,242.50,145.50,Medicare,Medicare,,145.50,,,242.50,33.95,123.68,Fee Schedule,Medicare APC Fee Schedule
RICKETTSIA AB,86757,CPT,,,,,both,, ,242.50,145.50,Medicare,Medicare,,145.50,,,242.50,33.95,123.68,Fee Schedule,Medicare APC Fee Schedule
RICKETTSIA AB,86757,CPT,,,,,both,, ,242.50,145.50,Medicare,Medicare,,145.50,,,242.50,33.95,123.68,Fee Schedule,Medicare APC Fee Schedule
RUBELLA AB,86762,CPT,,,,,both,, ,88.69,53.21,Medicare,Medicare,,53.21,,,88.69,12.42,45.23,Fee Schedule,Medicare APC Fee Schedule
RUBELLA AB,86762,CPT,,,,,both,, ,906.30,543.78,Medicare,Medicare,,543.78,,,906.30,126.88,462.21,Fee Schedule,Medicare APC Fee Schedule
Q34256 MEASAB IGMIA,86765,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,522.73,,,871.22,121.97,444.32,Fee Schedule,Medicare APC Fee Schedule
Q964 MEAS AB IGG IA,86765,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,522.73,,,871.22,121.97,444.32,Fee Schedule,Medicare APC Fee Schedule
RUBEOLA AB,86765,CPT,,,,,both,, ,111.15,66.69,Medicare,Medicare,,66.69,,,111.15,15.56,56.69,Fee Schedule,Medicare APC Fee Schedule
RUBEOLA AB,86765,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,522.73,,,871.22,121.97,444.32,Fee Schedule,Medicare APC Fee Schedule
SALMONELLA AB,86768,CPT,,,,,both,, ,127.70,76.62,Medicare,Medicare,,76.62,,,127.70,17.88,65.13,Fee Schedule,Medicare APC Fee Schedule
SALMONELLA AB,86768,CPT,,,,,both,, ,127.70,76.62,Medicare,Medicare,,76.62,,,127.70,17.88,65.13,Fee Schedule,Medicare APC Fee Schedule
COVID19 AB,86769,CPT,,,,,both,, ,224.54,134.72,Medicare,Medicare,,134.72,,,224.54,31.44,114.52,Fee Schedule,Medicare APC Fee Schedule
COVID19 AB,86769,CPT,,,,,both,, ,224.54,134.72,Medicare,Medicare,,134.72,,,224.54,31.44,114.52,Fee Schedule,Medicare APC Fee Schedule
L164055 COVID19ABIGG,86769,CPT,,,,,both,, ,206.00,123.60,Medicare,Medicare,,123.60,,,206.00,28.84,105.06,Fee Schedule,Medicare APC Fee Schedule
Q4862 TET ATOX ELISA,86774,CPT,,,,,both,, ,98.51,59.10,Medicare,Medicare,,59.10,,,98.51,13.79,50.24,Fee Schedule,Medicare APC Fee Schedule
Q3679 TOXOPLAS AB IA,86777,CPT,,,,,both,, ,247.83,148.69,Medicare,Medicare,,148.69,,,247.83,34.70,126.39,Fee Schedule,Medicare APC Fee Schedule
Q8636 TOXOPLASMA AB,86777,CPT,,,,,both,, ,247.83,148.69,Medicare,Medicare,,148.69,,,247.83,34.70,126.39,Fee Schedule,Medicare APC Fee Schedule
TOXOPLASMA AB,86777,CPT,,,,,both,, ,247.83,148.69,Medicare,Medicare,,148.69,,,247.83,34.70,126.39,Fee Schedule,Medicare APC Fee Schedule
"TOXOPLASMA AB, IGM",86778,CPT,,,,,both,, ,247.83,148.69,Medicare,Medicare,,148.69,,,247.83,34.70,126.39,Fee Schedule,Medicare APC Fee Schedule
"TOXOPLASMA AB, IGM",86778,CPT,,,,,both,, ,247.83,148.69,Medicare,Medicare,,148.69,,,247.83,34.70,126.39,Fee Schedule,Medicare APC Fee Schedule
L082370 TREP AB IA,86780,CPT,,,,,both,, ,132.40,79.44,Medicare,Medicare,,79.44,,,132.40,18.54,67.52,Fee Schedule,Medicare APC Fee Schedule
"TREP. PALLIDUM,CONFI",86780,CPT,,,,,both,, ,172.90,103.74,Medicare,Medicare,,103.74,,,172.90,24.21,88.18,Fee Schedule,Medicare APC Fee Schedule
"TREP. PALLIDUM,CONFI",86780,CPT,,,,,both,, ,172.90,103.74,Medicare,Medicare,,103.74,,,172.90,24.21,88.18,Fee Schedule,Medicare APC Fee Schedule
TREPONEMAL AB,86780,CPT,,,,,both,, ,48.90,29.34,Medicare,Medicare,,29.34,,,48.90,6.85,24.94,Fee Schedule,Medicare APC Fee Schedule
L96206 VZV IGG CLIA,86787,CPT,,,,,both,, ,831.47,498.88,Medicare,Medicare,,498.88,,,831.47,116.41,424.05,Fee Schedule,Medicare APC Fee Schedule
Q4439 VZV AB IGG IA,86787,CPT,,,,,both,, ,906.30,543.78,Medicare,Medicare,,543.78,,,906.30,126.88,462.21,Fee Schedule,Medicare APC Fee Schedule
Q8683 VZV AB IGM IA,86787,CPT,,,,,both,, ,906.30,543.78,Medicare,Medicare,,543.78,,,906.30,126.88,462.21,Fee Schedule,Medicare APC Fee Schedule
VARICELLA-ZOSTER AB,86787,CPT,,,,,both,, ,111.15,66.69,Medicare,Medicare,,66.69,,,111.15,15.56,56.69,Fee Schedule,Medicare APC Fee Schedule
VARICELLA-ZOSTER AB,86787,CPT,,,,,both,, ,906.30,543.78,Medicare,Medicare,,543.78,,,906.30,126.88,462.21,Fee Schedule,Medicare APC Fee Schedule
Q16012 WNVAB IGM EIA,86788,CPT,,,,,both,, ,252.61,151.56,Medicare,Medicare,,151.56,,,252.61,35.37,128.83,Fee Schedule,Medicare APC Fee Schedule
Q36596 WEST NILE VIR,86788,CPT,,,,,both,, ,252.61,151.56,Medicare,Medicare,,151.56,,,252.61,35.37,128.83,Fee Schedule,Medicare APC Fee Schedule
WEST NILE VIR AB IGM,86788,CPT,,,,,both,, ,252.61,151.56,Medicare,Medicare,,151.56,,,252.61,35.37,128.83,Fee Schedule,Medicare APC Fee Schedule
Q36596 WEST NILE VIR,86789,CPT,,,,,both,, ,219.20,131.52,Medicare,Medicare,,131.52,,,219.20,30.69,111.79,Fee Schedule,Medicare APC Fee Schedule
WEST NILE VIR AB,86789,CPT,,,,,both,, ,215.84,129.50,Medicare,Medicare,,129.50,,,215.84,30.22,110.08,Fee Schedule,Medicare APC Fee Schedule
L878033 HHV-7 IGM IF,86790,CPT,,,,,both,, ,615.00,369.00,Medicare,Medicare,,369.00,,,615.00,86.10,313.65,Fee Schedule,Medicare APC Fee Schedule
Q36175HLTV I/II CL-I,86790,CPT,,,,,both,, ,124.90,74.94,Medicare,Medicare,,74.94,,,124.90,17.49,63.7,Fee Schedule,Medicare APC Fee Schedule
Q36175HLTV I/II CL-I,86790,CPT,,,,,both,, ,124.90,74.94,Medicare,Medicare,,74.94,,,124.90,17.49,63.7,Fee Schedule,Medicare APC Fee Schedule
Q94264 ZIKA AB IGM,86794,CPT,,,,,both,, ,97.11,58.26,Medicare,Medicare,,58.26,,,97.11,13.60,49.53,Fee Schedule,Medicare APC Fee Schedule
Q90814 THYROID CANCER (THYROGLOBULIN)MON,86800,CPT,,,,,both,, ,669.25,401.55,Medicare,Medicare,,401.55,,,669.25,93.70,341.32,Fee Schedule,Medicare APC Fee Schedule
THYROGLOBULIN AB,86800,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,450.81,,,751.36,105.19,383.19,Fee Schedule,Medicare APC Fee Schedule
THYROGLOBULIN AB,86800,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,450.81,,,751.36,105.19,383.19,Fee Schedule,Medicare APC Fee Schedule
THYROGLOBULIN AB,86800,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,450.81,,,751.36,105.19,383.19,Fee Schedule,Medicare APC Fee Schedule
THYROGLOBULIN AB,86800,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,450.81,,,751.36,105.19,383.19,Fee Schedule,Medicare APC Fee Schedule
HEPATITIS C AB TEST,86803,CPT,,,,,both,, ,698.32,418.99,Medicare,Medicare,,418.99,,,698.32,97.76,356.14,Fee Schedule,Medicare APC Fee Schedule
"HEP C AB TEST,CONFIR",86804,CPT,,,,,both,, ,358.42,215.05,Medicare,Medicare,,215.05,,,358.42,50.18,182.79,Fee Schedule,Medicare APC Fee Schedule
CYTOTOXIC REACTIVE AB SCREEN/STANDARD,86807,CPT,,,,,both,, ,87.00,52.20,Medicare,Medicare,,52.20,,,87.00,12.18,44.37,Fee Schedule,Medicare APC Fee Schedule
"HLA  A,B,OR C,SING",86812,CPT,,,,,both,, ,1449.41,869.64,Medicare,Medicare,,869.64,,,1449.41,202.92,739.2,Fee Schedule,Medicare APC Fee Schedule
"HLA  A,B,OR C,SING",86812,CPT,,,,,both,, ,1449.41,869.64,Medicare,Medicare,,869.64,,,1449.41,202.92,739.2,Fee Schedule,Medicare APC Fee Schedule
HLA SOLID PHASE/CALSS I&II AB QUAL,86828,CPT,,,,,both,, ,70.00,42.00,Medicare,Medicare,,42.00,,,70.00,9.80,35.7,Fee Schedule,Medicare APC Fee Schedule
HLA SOLID PHASE/CLASS 1 AB QUAL HIGHDEF,86832,CPT,,,,,both,, ,356.00,213.60,Medicare,Medicare,,213.60,,,356.00,49.84,181.56,Fee Schedule,Medicare APC Fee Schedule
L117065 PROTH AB IGG,86849,CPT,,,,,both,, ,157.00,94.20,Medicare,Medicare,,94.20,,,157.00,21.98,80.07,Fee Schedule,Medicare APC Fee Schedule
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,, ,61.75,37.05,Medicare,Medicare,,37.05,,,61.75,8.65,31.49,Fee Schedule,Medicare APC Fee Schedule
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,,,318.00,318.00,Medicare,Medicare,,318.00,,,318.00,44.52,162.18,Fee Schedule,Medicare APC Fee Schedule
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,, ,318.00,190.80,Medicare,Medicare,,190.80,,,318.00,44.52,162.18,Fee Schedule,Medicare APC Fee Schedule
O51200 AB SCRN,86850,CPT,,,,,both,, ,291.75,175.05,Medicare,Medicare,,175.05,,,291.75,40.85,148.79,Fee Schedule,Medicare APC Fee Schedule
"ANTIBODY ELUTION,RBC",86860,CPT,,,,,both,, ,174.30,104.58,Medicare,Medicare,,104.58,,,174.30,24.40,88.89,Fee Schedule,Medicare APC Fee Schedule
"ANTIBODY ELUTION,RBC",86860,CPT,,,,,both,, ,174.30,104.58,Medicare,Medicare,,104.58,,,174.30,24.40,88.89,Fee Schedule,Medicare APC Fee Schedule
"ANTIBODY ID,EA PANEL",86870,CPT,,,,,both,, ,488.65,293.19,Medicare,Medicare,,293.19,,,488.65,68.41,249.21,Fee Schedule,Medicare APC Fee Schedule
O51108 AB ID EA PNL,86870,CPT,,,,,both,, ,475.18,285.10,Medicare,Medicare,,285.10,,,475.18,66.53,242.34,Fee Schedule,Medicare APC Fee Schedule
DIRECT COOMBS TEST,86880,CPT,,,,,both,, ,250.64,150.38,Medicare,Medicare,,150.38,,,250.64,35.09,127.83,Fee Schedule,Medicare APC Fee Schedule
DIRECT COOMBS TEST,86880,CPT,,,,,both,, ,250.64,150.38,Medicare,Medicare,,150.38,,,250.64,35.09,127.83,Fee Schedule,Medicare APC Fee Schedule
IDAT QUAL EA RGT RBC,86885,CPT,,,,,both,, ,39.57,23.74,Medicare,Medicare,,23.74,,,39.57,5.54,20.18,Fee Schedule,Medicare APC Fee Schedule
IDAT EACH AB TITER,86886,CPT,,,,,both,, ,326.14,195.68,Medicare,Medicare,,195.68,,,326.14,45.66,166.33,Fee Schedule,Medicare APC Fee Schedule
"AUTO COMPONENT,PROCS",86890,CPT,,,,,both,, ,756.41,453.84,Medicare,Medicare,,453.84,,,756.41,105.90,385.77,Fee Schedule,Medicare APC Fee Schedule
AUTOL BID OP SALV,86891,CPT,,,,,both,, ,3941.23,2364.73,Medicare,Medicare,,2364.73,,,3941.23,551.77,2010.03,Fee Schedule,Medicare APC Fee Schedule
BLOOD TYPING ABO,86900,CPT,,,,,both,, ,38.73,23.23,Medicare,Medicare,,23.23,,,38.73,5.42,19.75,Fee Schedule,Medicare APC Fee Schedule
BLOOD TYPING ABO,86900,CPT,,,,,both,,,97.39,97.39,Medicare,Medicare,,97.39,,,97.39,13.63,49.67,Fee Schedule,Medicare APC Fee Schedule
BLOOD TYPING ABO,86900,CPT,,,,,both,, ,97.39,58.43,Medicare,Medicare,,58.43,,,97.39,13.63,49.67,Fee Schedule,Medicare APC Fee Schedule
BLOOD TYPING ABO,86900,CPT,,,,,both,, ,97.39,58.43,Medicare,Medicare,,58.43,,,97.39,13.63,49.67,Fee Schedule,Medicare APC Fee Schedule
BLOOD TYPING RH D,86901,CPT,,,,,both,, ,38.73,23.23,Medicare,Medicare,,23.23,,,38.73,5.42,19.75,Fee Schedule,Medicare APC Fee Schedule
BLOOD TYPING RH D,86901,CPT,,,,,both,,,97.39,97.39,Medicare,Medicare,,97.39,,,97.39,13.63,49.67,Fee Schedule,Medicare APC Fee Schedule
BLOOD TYPING RH D,86901,CPT,,,,,both,, ,97.39,58.43,Medicare,Medicare,,58.43,,,97.39,13.63,49.67,Fee Schedule,Medicare APC Fee Schedule
BLOOD TYPING RH D,86901,CPT,,,,,both,, ,97.39,58.43,Medicare,Medicare,,58.43,,,97.39,13.63,49.67,Fee Schedule,Medicare APC Fee Schedule
BLD TYPE DONOR EA AG,86902,CPT,,,,,both,, ,277.86,166.71,Medicare,Medicare,,166.71,,,277.86,38.90,141.71,Fee Schedule,Medicare APC Fee Schedule
BLD TYPING OTHER AG,86905,CPT,,,,,both,,,217.52,217.52,Medicare,Medicare,,217.52,,,217.52,30.45,110.94,Fee Schedule,Medicare APC Fee Schedule
BLD TYPING OTHER AG,86905,CPT,,,,,both,, ,217.52,130.51,Medicare,Medicare,,130.51,,,217.52,30.45,110.94,Fee Schedule,Medicare APC Fee Schedule
BLD TYPING OTHER AG,86905,CPT,,,,,both,, ,217.52,130.51,Medicare,Medicare,,130.51,,,217.52,30.45,110.94,Fee Schedule,Medicare APC Fee Schedule
O51920 RH PHENO,86906,CPT,,,,,both,, ,224.00,134.40,Medicare,Medicare,,134.40,,,224.00,31.36,114.24,Fee Schedule,Medicare APC Fee Schedule
COMPATIB TEST IS,86920,CPT,,,,,both,,,275.62,275.62,Medicare,Medicare,,275.62,,,275.62,38.59,140.57,Fee Schedule,Medicare APC Fee Schedule
COMPATIB TEST IS,86920,CPT,,,,,both,, ,275.62,165.37,Medicare,Medicare,,165.37,,,275.62,38.59,140.57,Fee Schedule,Medicare APC Fee Schedule
COMPATIB TEST INCUB,86921,CPT,,,,,both,,,103.00,103.00,Medicare,Medicare,,103.00,,,103.00,14.42,52.53,Fee Schedule,Medicare APC Fee Schedule
COMPATIB TEST INCUB,86921,CPT,,,,,both,, ,103.00,61.80,Medicare,Medicare,,61.80,,,103.00,14.42,52.53,Fee Schedule,Medicare APC Fee Schedule
COMPATIB TEST AHG,86922,CPT,,,,,both,,,250.07,250.07,Medicare,Medicare,,250.07,,,250.07,35.01,127.54,Fee Schedule,Medicare APC Fee Schedule
COMPATIB TEST AHG,86922,CPT,,,,,both,, ,250.07,150.04,Medicare,Medicare,,150.04,,,250.07,35.01,127.54,Fee Schedule,Medicare APC Fee Schedule
FFP THAWING,86927,CPT,,,,,both,, ,233.80,140.28,Medicare,Medicare,,140.28,,,233.80,32.73,119.24,Fee Schedule,Medicare APC Fee Schedule
PLATELETS POOLING,86965,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,84.87,,,141.46,19.80,72.14,Fee Schedule,Medicare APC Fee Schedule
O51010 CHEM TREATMNT,86970,CPT,,,,,both,, ,212.44,127.46,Medicare,Medicare,,127.46,,,212.44,29.74,108.34,Fee Schedule,Medicare APC Fee Schedule
RBC PRETREAT CHEM,86970,CPT,,,,,both,, ,231.55,138.93,Medicare,Medicare,,138.93,,,231.55,32.42,118.09,Fee Schedule,Medicare APC Fee Schedule
RBC PRETREAT ENZ,86971,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,84.87,,,141.46,19.80,72.14,Fee Schedule,Medicare APC Fee Schedule
RBC PRETREAT ENZ,86971,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,84.87,,,141.46,19.80,72.14,Fee Schedule,Medicare APC Fee Schedule
O51122 RBC CELL SEP,86972,CPT,,,,,both,, ,246.99,148.19,Medicare,Medicare,,148.19,,,246.99,34.58,125.96,Fee Schedule,Medicare APC Fee Schedule
"RBC PRETREAT,SER,INC",86975,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,84.87,,,141.46,19.80,72.14,Fee Schedule,Medicare APC Fee Schedule
"RBC PRETREAT,SER DIL",86976,CPT,,,,,both,, ,61.80,37.08,Medicare,Medicare,,37.08,,,61.80,8.65,31.52,Fee Schedule,Medicare APC Fee Schedule
RBC PRETREAT W-INHIB,86977,CPT,,,,,both,, ,218.64,131.18,Medicare,Medicare,,131.18,,,218.64,30.61,111.51,Fee Schedule,Medicare APC Fee Schedule
O51234 ADSORPTION,86978,CPT,,,,,both,, ,149.35,89.61,Medicare,Medicare,,89.61,,,149.35,20.91,76.17,Fee Schedule,Medicare APC Fee Schedule
RBC PRETREAT DIFF EA,86978,CPT,,,,,both,, ,162.79,97.67,Medicare,Medicare,,97.67,,,162.79,22.79,83.02,Fee Schedule,Medicare APC Fee Schedule
SPLIT BLOOD OR PROD,86985,CPT,,,,,both,, ,546.75,328.05,Medicare,Medicare,,328.05,,,546.75,76.55,278.84,Fee Schedule,Medicare APC Fee Schedule
Q34286 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Medicare,Medicare,,106.43,,,177.39,24.83,90.47,Fee Schedule,Medicare APC Fee Schedule
Q37213 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Medicare,Medicare,,106.43,,,177.39,24.83,90.47,Fee Schedule,Medicare APC Fee Schedule
Q39480 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Medicare,Medicare,,106.43,,,177.39,24.83,90.47,Fee Schedule,Medicare APC Fee Schedule
Q4554 SPECIMEN CONCE,87015,CPT,,,,,both,, ,177.39,106.43,Medicare,Medicare,,106.43,,,177.39,24.83,90.47,Fee Schedule,Medicare APC Fee Schedule
SPECIMEN CONCENTRATI,87015,CPT,,,,,both,, ,177.39,106.43,Medicare,Medicare,,106.43,,,177.39,24.83,90.47,Fee Schedule,Medicare APC Fee Schedule
CULTURE BLOOD BACTER,87040,CPT,,,,,both,,,691.29,691.29,Medicare,Medicare,,691.29,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
CULTURE BLOOD BACTER,87040,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
CULT STL BACT W-ISOL,87045,CPT,,,,,both,, ,92.90,55.74,Medicare,Medicare,,55.74,,,92.90,13.01,47.38,Fee Schedule,Medicare APC Fee Schedule
CULT STL BACT W-ISOL,87045,CPT,,,,,both,,,301.72,301.72,Medicare,Medicare,,301.72,,,301.72,42.24,153.88,Fee Schedule,Medicare APC Fee Schedule
CULT STL BACT W-ISOL,87045,CPT,,,,,both,, ,301.72,181.03,Medicare,Medicare,,181.03,,,301.72,42.24,153.88,Fee Schedule,Medicare APC Fee Schedule
CULT STL BACT EA ADD,87046,CPT,,,,,both,, ,92.90,55.74,Medicare,Medicare,,55.74,,,92.90,13.01,47.38,Fee Schedule,Medicare APC Fee Schedule
CULT STL BACT EA ADD,87046,CPT,,,,,both,, ,94.58,56.74,Medicare,Medicare,,56.74,,,94.58,13.24,48.24,Fee Schedule,Medicare APC Fee Schedule
CULTURE BACTERIA OTH,87070,CPT,,,,,both,, ,84.76,50.85,Medicare,Medicare,,50.85,,,84.76,11.87,43.23,Fee Schedule,Medicare APC Fee Schedule
CULTURE BACTERIA OTH,87070,CPT,,,,,both,,,998.91,998.91,Medicare,Medicare,,998.91,,,998.91,139.85,509.44,Fee Schedule,Medicare APC Fee Schedule
CULTURE BACTERIA OTH,87070,CPT,,,,,both,, ,998.91,599.34,Medicare,Medicare,,599.34,,,998.91,139.85,509.44,Fee Schedule,Medicare APC Fee Schedule
L188227 CULTURE BACT,87070,CPT,,,,,both,, ,86.20,51.72,Medicare,Medicare,,51.72,,,86.20,12.07,43.96,Fee Schedule,Medicare APC Fee Schedule
CULT BAC AEROB OT QT,87071,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
CULT BACT ANA ANY SO,87075,CPT,,,,,both,,,623.38,623.38,Medicare,Medicare,,623.38,,,623.38,87.27,317.92,Fee Schedule,Medicare APC Fee Schedule
CULT BACT ANA ANY SO,87075,CPT,,,,,both,, ,623.38,374.02,Medicare,Medicare,,374.02,,,623.38,87.27,317.92,Fee Schedule,Medicare APC Fee Schedule
CULT BACT ANA ANY SO,87075,CPT,,,,,both,, ,623.38,374.02,Medicare,Medicare,,374.02,,,623.38,87.27,317.92,Fee Schedule,Medicare APC Fee Schedule
CULT ANAERO IDENT EA,87076,CPT,,,,,both,, ,412.87,247.72,Medicare,Medicare,,247.72,,,412.87,57.80,210.56,Fee Schedule,Medicare APC Fee Schedule
L182345 ORG ID ANAER,87076,CPT,,,,,both,, ,244.44,146.66,Medicare,Medicare,,146.66,,,244.44,34.22,124.66,Fee Schedule,Medicare APC Fee Schedule
CULT AEROBIC IDENTIF,87077,CPT,,,,,both,, ,389.01,233.40,Medicare,Medicare,,233.40,,,389.01,54.46,198.4,Fee Schedule,Medicare APC Fee Schedule
CULT AEROBIC IDENTIF,87077,CPT,,,,,both,, ,389.01,233.40,Medicare,Medicare,,233.40,,,389.01,54.46,198.4,Fee Schedule,Medicare APC Fee Schedule
CULTURE SCREEN ONLY,87081,CPT,,,,,both,, ,65.39,39.23,Medicare,Medicare,,39.23,,,65.39,9.15,33.35,Fee Schedule,Medicare APC Fee Schedule
CULTURE SCREEN ONLY,87081,CPT,,,,,both,,,420.72,420.72,Medicare,Medicare,,420.72,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
CULTURE SCREEN ONLY,87081,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
CULT URINE-COLONY CT,87086,CPT,,,,,both,, ,59.78,35.86,Medicare,Medicare,,35.86,,,59.78,8.37,30.49,Fee Schedule,Medicare APC Fee Schedule
CULT URINE-COLONY CT,87086,CPT,,,,,both,,,495.95,495.95,Medicare,Medicare,,495.95,,,495.95,69.43,252.93,Fee Schedule,Medicare APC Fee Schedule
CULT URINE-COLONY CT,87086,CPT,,,,,both,, ,495.95,297.57,Medicare,Medicare,,297.57,,,495.95,69.43,252.93,Fee Schedule,Medicare APC Fee Schedule
CULT URINE W-P ID,87088,CPT,,,,,both,, ,42.37,25.42,Medicare,Medicare,,25.42,,,42.37,5.93,21.61,Fee Schedule,Medicare APC Fee Schedule
CULT SKIN FUNGI,87101,CPT,,,,,both,, ,349.99,209.99,Medicare,Medicare,,209.99,,,349.99,49.00,178.49,Fee Schedule,Medicare APC Fee Schedule
CULT SKIN FUNGI,87101,CPT,,,,,both,, ,349.99,209.99,Medicare,Medicare,,209.99,,,349.99,49.00,178.49,Fee Schedule,Medicare APC Fee Schedule
CULT FUNGUS ISOLATIO,87102,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
Q4553 CULT FUNGUS IS,87102,CPT,,,,,both,, ,525.70,315.42,Medicare,Medicare,,315.42,,,525.70,73.60,268.11,Fee Schedule,Medicare APC Fee Schedule
CULTURE FUNGUS BLOOD,87103,CPT,,,,,both,, ,518.69,311.21,Medicare,Medicare,,311.21,,,518.69,72.62,264.53,Fee Schedule,Medicare APC Fee Schedule
Q4606 FUNGUS CULT BL,87103,CPT,,,,,both,, ,478.95,287.37,Medicare,Medicare,,287.37,,,478.95,67.05,244.26,Fee Schedule,Medicare APC Fee Schedule
FUNGI IDENTIF YEAST,87106,CPT,,,,,both,, ,123.21,73.92,Medicare,Medicare,,73.92,,,123.21,17.25,62.84,Fee Schedule,Medicare APC Fee Schedule
FUNGI IDENTIF YEAST,87106,CPT,,,,,both,, ,123.21,73.92,Medicare,Medicare,,73.92,,,123.21,17.25,62.84,Fee Schedule,Medicare APC Fee Schedule
"FUNGI IDENTIF, MOLD",87107,CPT,,,,,both,, ,123.21,73.92,Medicare,Medicare,,73.92,,,123.21,17.25,62.84,Fee Schedule,Medicare APC Fee Schedule
"FUNGI IDENTIF, MOLD",87107,CPT,,,,,both,, ,123.21,73.92,Medicare,Medicare,,73.92,,,123.21,17.25,62.84,Fee Schedule,Medicare APC Fee Schedule
CULT MYCOPLASMA,87109,CPT,,,,,both,, ,1404.50,842.70,Medicare,Medicare,,842.70,,,1404.50,196.63,716.3,Fee Schedule,Medicare APC Fee Schedule
UREA-MYCOPLS HOM CULT,87109,CPT,,,,,both,, ,153.90,92.34,Medicare,Medicare,,92.34,,,153.90,21.55,78.49,Fee Schedule,Medicare APC Fee Schedule
CULTURE CHLAMYDIA,87110,CPT,,,,,both,, ,1104.45,662.67,Medicare,Medicare,,662.67,,,1104.45,154.62,563.27,Fee Schedule,Medicare APC Fee Schedule
CULTURE CHLAMYDIA,87110,CPT,,,,,both,, ,1104.45,662.67,Medicare,Medicare,,662.67,,,1104.45,154.62,563.27,Fee Schedule,Medicare APC Fee Schedule
CULT MYCOBACTERIA,87116,CPT,,,,,both,,,827.43,827.43,Medicare,Medicare,,827.43,,,827.43,115.84,421.99,Fee Schedule,Medicare APC Fee Schedule
CULT MYCOBACTERIA,87116,CPT,,,,,both,, ,827.43,496.45,Medicare,Medicare,,496.45,,,827.43,115.84,421.99,Fee Schedule,Medicare APC Fee Schedule
Q10526MBAC BL CMBCS,87116,CPT,,,,,both,, ,827.43,496.45,Medicare,Medicare,,496.45,,,827.43,115.84,421.99,Fee Schedule,Medicare APC Fee Schedule
Q4554 CULT MYCOBACTE,87116,CPT,,,,,both,, ,827.43,496.45,Medicare,Medicare,,496.45,,,827.43,115.84,421.99,Fee Schedule,Medicare APC Fee Schedule
CULT TYPE IMMUNOFLUO,87140,CPT,,,,,both,, ,323.34,194.00,Medicare,Medicare,,194.00,,,323.34,45.27,164.9,Fee Schedule,Medicare APC Fee Schedule
CULT TYPE IMMUNOFLUO,87140,CPT,,,,,both,, ,323.34,194.00,Medicare,Medicare,,194.00,,,323.34,45.27,164.9,Fee Schedule,Medicare APC Fee Schedule
"CULT TYPE,IMMUNOLOGI",87147,CPT,,,,,both,, ,547.31,328.38,Medicare,Medicare,,328.38,,,547.31,76.62,279.13,Fee Schedule,Medicare APC Fee Schedule
"CULT TYPE,NUCLEIC AC",87149,CPT,,,,,both,, ,239.97,143.98,Medicare,Medicare,,143.98,,,239.97,33.60,122.38,Fee Schedule,Medicare APC Fee Schedule
LRX183755 AFB ID PB,87149,CPT,,,,,both,, ,239.99,143.99,Medicare,Medicare,,143.99,,,239.99,33.60,122.39,Fee Schedule,Medicare APC Fee Schedule
DNA-RNA AMPLI PROBE,87150,CPT,,,,,both,, ,339.33,203.59,Medicare,Medicare,,203.59,,,339.33,47.51,173.06,Fee Schedule,Medicare APC Fee Schedule
LRX183327 MOLD ID,87153,CPT,,,,,both,, ,239.99,143.99,Medicare,Medicare,,143.99,,,239.99,33.60,122.39,Fee Schedule,Medicare APC Fee Schedule
QRX9000010 AFB ID,87153,CPT,,,,,both,, ,388.45,233.07,Medicare,Medicare,,233.07,,,388.45,54.38,198.11,Fee Schedule,Medicare APC Fee Schedule
MACRO EXAM ARTHROPOD,87168,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,288.47,,,480.79,67.31,245.2,Fee Schedule,Medicare APC Fee Schedule
MACRO EXAM PARASITE,87169,CPT,,,,,both,, ,207.70,124.62,Medicare,Medicare,,124.62,,,207.70,29.08,105.93,Fee Schedule,Medicare APC Fee Schedule
PINWORM EXAM,87172,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,288.47,,,480.79,67.31,245.2,Fee Schedule,Medicare APC Fee Schedule
TISSUE HOMOGENIZ CUL,87176,CPT,,,,,both,, ,300.60,180.36,Medicare,Medicare,,180.36,,,300.60,42.08,153.31,Fee Schedule,Medicare APC Fee Schedule
OVA-PARASITES SMEARS,87177,CPT,,,,,both,, ,107.21,64.32,Medicare,Medicare,,64.32,,,107.21,15.01,54.68,Fee Schedule,Medicare APC Fee Schedule
OVA-PARASITES SMEARS,87177,CPT,,,,,both,, ,320.25,192.15,Medicare,Medicare,,192.15,,,320.25,44.84,163.33,Fee Schedule,Medicare APC Fee Schedule
OVA-PARASITES SMEARS,87177,CPT,,,,,both,, ,320.25,192.15,Medicare,Medicare,,192.15,,,320.25,44.84,163.33,Fee Schedule,Medicare APC Fee Schedule
MICROB SUSCEP DIFFUS,87181,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,84.87,,,141.46,19.80,72.14,Fee Schedule,Medicare APC Fee Schedule
MICROBE SUSCEP DISK,87184,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,84.87,,,141.46,19.80,72.14,Fee Schedule,Medicare APC Fee Schedule
MICROBE SUSCEP DISK,87184,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,84.87,,,141.46,19.80,72.14,Fee Schedule,Medicare APC Fee Schedule
MICROB SUSCEP ENZYME,87185,CPT,,,,,both,, ,180.19,108.11,Medicare,Medicare,,108.11,,,180.19,25.23,91.9,Fee Schedule,Medicare APC Fee Schedule
MICROBE SUSCEPT MIC,87186,CPT,,,,,both,, ,586.05,351.63,Medicare,Medicare,,351.63,,,586.05,82.05,298.89,Fee Schedule,Medicare APC Fee Schedule
MICROBE SUSCEPT MIC,87186,CPT,,,,,both,, ,586.05,351.63,Medicare,Medicare,,351.63,,,586.05,82.05,298.89,Fee Schedule,Medicare APC Fee Schedule
"SMEAR,GRAM STAIN",87205,CPT,,,,,both,, ,42.10,25.26,Medicare,Medicare,,25.26,,,42.10,5.89,21.47,Fee Schedule,Medicare APC Fee Schedule
"SMEAR,GRAM STAIN",87205,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
SMEAR FLUORES-ACI ST,87206,CPT,,,,,both,, ,507.74,304.64,Medicare,Medicare,,304.64,,,507.74,71.08,258.95,Fee Schedule,Medicare APC Fee Schedule
SMEAR FLUORES-ACI ST,87206,CPT,,,,,both,, ,507.74,304.64,Medicare,Medicare,,304.64,,,507.74,71.08,258.95,Fee Schedule,Medicare APC Fee Schedule
SMEAR FLUORES-ACI ST,87206,CPT,,,,,both,, ,507.74,304.64,Medicare,Medicare,,304.64,,,507.74,71.08,258.95,Fee Schedule,Medicare APC Fee Schedule
SMEAR FLUORES-ACI ST,87206,CPT,,,,,both,, ,507.74,304.64,Medicare,Medicare,,304.64,,,507.74,71.08,258.95,Fee Schedule,Medicare APC Fee Schedule
"SMEAR,SPECIAL STAIN",87207,CPT,,,,,both,, ,555.45,333.27,Medicare,Medicare,,333.27,,,555.45,77.76,283.28,Fee Schedule,Medicare APC Fee Schedule
SMEAR COMPLEX STN,87209,CPT,,,,,both,, ,190.86,114.51,Medicare,Medicare,,114.51,,,190.86,26.72,97.34,Fee Schedule,Medicare APC Fee Schedule
SMEAR COMPLEX STN,87209,CPT,,,,,both,, ,190.86,114.51,Medicare,Medicare,,114.51,,,190.86,26.72,97.34,Fee Schedule,Medicare APC Fee Schedule
SMEARWET MOUNT SAL-I,87210,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,252.43,,,420.72,58.90,214.57,Fee Schedule,Medicare APC Fee Schedule
TISSUE EX FOR FUNGI,87220,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,288.47,,,480.79,67.31,245.2,Fee Schedule,Medicare APC Fee Schedule
TISSUE EX FOR FUNGI,87220,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,288.47,,,480.79,67.31,245.2,Fee Schedule,Medicare APC Fee Schedule
VIRUS INOCULAT TISSU,87252,CPT,,,,,both,, ,929.87,557.92,Medicare,Medicare,,557.92,,,929.87,130.18,474.23,Fee Schedule,Medicare APC Fee Schedule
VIRUS INOCULAT TISSU,87252,CPT,,,,,both,, ,929.87,557.92,Medicare,Medicare,,557.92,,,929.87,130.18,474.23,Fee Schedule,Medicare APC Fee Schedule
L186015 VIR INOC SHL,87254,CPT,,,,,both,, ,415.68,249.40,Medicare,Medicare,,249.40,,,415.68,58.20,212,Fee Schedule,Medicare APC Fee Schedule
Q17495VIRUS INOCU SH,87254,CPT,,,,,both,, ,415.68,249.40,Medicare,Medicare,,249.40,,,415.68,58.20,212,Fee Schedule,Medicare APC Fee Schedule
VIRUS INOCU SHELL VI,87254,CPT,,,,,both,, ,415.68,249.40,Medicare,Medicare,,249.40,,,415.68,58.20,212,Fee Schedule,Medicare APC Fee Schedule
Q2649 HSV CULT WREF,87255,CPT,,,,,both,, ,470.69,282.41,Medicare,Medicare,,282.41,,,470.69,65.90,240.05,Fee Schedule,Medicare APC Fee Schedule
Q841 HSV CULT HS,87255,CPT,,,,,both,, ,470.69,282.41,Medicare,Medicare,,282.41,,,470.69,65.90,240.05,Fee Schedule,Medicare APC Fee Schedule
VIRUS ISOLATION GEN,87255,CPT,,,,,both,, ,470.69,282.41,Medicare,Medicare,,282.41,,,470.69,65.90,240.05,Fee Schedule,Medicare APC Fee Schedule
"PERTUSSIS AG, IF",87265,CPT,,,,,both,, ,531.32,318.79,Medicare,Medicare,,318.79,,,531.32,74.38,270.97,Fee Schedule,Medicare APC Fee Schedule
"PERTUSSIS AG, IF",87265,CPT,,,,,both,, ,531.32,318.79,Medicare,Medicare,,318.79,,,531.32,74.38,270.97,Fee Schedule,Medicare APC Fee Schedule
INFAGT DT QLSQT CRYP,87272,CPT,,,,,both,, ,525.70,315.42,Medicare,Medicare,,315.42,,,525.70,73.60,268.11,Fee Schedule,Medicare APC Fee Schedule
Q37213 INFAGT DT QLS,87272,CPT,,,,,both,, ,525.70,315.42,Medicare,Medicare,,315.42,,,525.70,73.60,268.11,Fee Schedule,Medicare APC Fee Schedule
Q39480 INFAGT DT QLS,87272,CPT,,,,,both,, ,525.70,315.42,Medicare,Medicare,,315.42,,,525.70,73.60,268.11,Fee Schedule,Medicare APC Fee Schedule
L188227 LEGION PNEUM,87278,CPT,,,,,both,, ,156.00,93.60,Medicare,Medicare,,93.60,,,156.00,21.84,79.56,Fee Schedule,Medicare APC Fee Schedule
"LEGION PNEUMOPH AG,I",87278,CPT,,,,,both,, ,277.86,166.71,Medicare,Medicare,,166.71,,,277.86,38.90,141.71,Fee Schedule,Medicare APC Fee Schedule
"LEGION PNEUMOPH AG,I",87278,CPT,,,,,both,, ,277.86,166.71,Medicare,Medicare,,166.71,,,277.86,38.90,141.71,Fee Schedule,Medicare APC Fee Schedule
PNEUMOCYSTIS CAR AGI,87281,CPT,,,,,both,, ,371.89,223.13,Medicare,Medicare,,223.13,,,371.89,52.06,189.66,Fee Schedule,Medicare APC Fee Schedule
PNEUMOCYSTIS CAR AGI,87281,CPT,,,,,both,, ,371.89,223.13,Medicare,Medicare,,223.13,,,371.89,52.06,189.66,Fee Schedule,Medicare APC Fee Schedule
VARICELLA ZOSTER AGI,87290,CPT,,,,,both,, ,518.69,311.21,Medicare,Medicare,,311.21,,,518.69,72.62,264.53,Fee Schedule,Medicare APC Fee Schedule
"ANTIB DETECT NOS, IF",87299,CPT,,,,,both,, ,159.14,95.48,Medicare,Medicare,,95.48,,,159.14,22.28,81.16,Fee Schedule,Medicare APC Fee Schedule
AG DETECT POLYVAL IF,87300,CPT,,,,,both,, ,122.09,73.25,Medicare,Medicare,,73.25,,,122.09,17.09,62.27,Fee Schedule,Medicare APC Fee Schedule
L185041 ADV 40/41 IA,87301,CPT,,,,,both,, ,123.60,74.16,Medicare,Medicare,,74.16,,,123.60,17.30,63.04,Fee Schedule,Medicare APC Fee Schedule
Q14950ASPE AG EIA IA,87305,CPT,,,,,both,, ,111.70,67.02,Medicare,Medicare,,67.02,,,111.70,15.64,56.97,Fee Schedule,Medicare APC Fee Schedule
CLOSTRIDIUM DIF TOXN,87324,CPT,,,,,both,, ,118.16,70.89,Medicare,Medicare,,70.89,,,118.16,16.54,60.26,Fee Schedule,Medicare APC Fee Schedule
CLOSTRIDIUM DIF TOXN,87324,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
CRYPTOCOCCUS NEOF AG,87327,CPT,,,,,both,, ,1321.42,792.85,Medicare,Medicare,,792.85,,,1321.42,185.00,673.92,Fee Schedule,Medicare APC Fee Schedule
"CRYPTOSPOR AG,EIA",87328,CPT,,,,,both,, ,64.55,38.73,Medicare,Medicare,,38.73,,,64.55,9.04,32.92,Fee Schedule,Medicare APC Fee Schedule
INFAGT DT QLSQT GIAR,87329,CPT,,,,,both,, ,200.12,120.07,Medicare,Medicare,,120.07,,,200.12,28.02,102.06,Fee Schedule,Medicare APC Fee Schedule
INFAGT DT QLSQT GIAR,87329,CPT,,,,,both,, ,200.12,120.07,Medicare,Medicare,,120.07,,,200.12,28.02,102.06,Fee Schedule,Medicare APC Fee Schedule
Q8625 GIARDAG EIA IA,87329,CPT,,,,,both,, ,192.49,115.49,Medicare,Medicare,,115.49,,,192.49,26.95,98.17,Fee Schedule,Medicare APC Fee Schedule
"HPYLORI,STOOL,EIA",87338,CPT,,,,,both,, ,183.56,110.13,Medicare,Medicare,,110.13,,,183.56,25.70,93.62,Fee Schedule,Medicare APC Fee Schedule
"HPYLORI,STOOL,EIA",87338,CPT,,,,,both,, ,183.56,110.13,Medicare,Medicare,,110.13,,,183.56,25.70,93.62,Fee Schedule,Medicare APC Fee Schedule
HBSAG,87340,CPT,,,,,both,,,570.04,570.04,Medicare,Medicare,,570.04,,,570.04,79.81,290.72,Fee Schedule,Medicare APC Fee Schedule
HBSAG,87340,CPT,,,,,both,, ,570.04,342.02,Medicare,Medicare,,342.02,,,570.04,79.81,290.72,Fee Schedule,Medicare APC Fee Schedule
HBEAG,87350,CPT,,,,,both,, ,1003.97,602.38,Medicare,Medicare,,602.38,,,1003.97,140.56,512.02,Fee Schedule,Medicare APC Fee Schedule
HBEAG,87350,CPT,,,,,both,, ,1003.97,602.38,Medicare,Medicare,,602.38,,,1003.97,140.56,512.02,Fee Schedule,Medicare APC Fee Schedule
HISTOPLASM CAPSU AGE,87385,CPT,,,,,both,, ,322.49,193.49,Medicare,Medicare,,193.49,,,322.49,45.15,164.47,Fee Schedule,Medicare APC Fee Schedule
HISTOPLASM CAPSU AGE,87385,CPT,,,,,both,, ,322.49,193.49,Medicare,Medicare,,193.49,,,322.49,45.15,164.47,Fee Schedule,Medicare APC Fee Schedule
"INFLUENZA A AG,EIA",87400,CPT,,,,,both,, ,118.16,70.89,Medicare,Medicare,,70.89,,,118.16,16.54,60.26,Fee Schedule,Medicare APC Fee Schedule
"INFLUENZA A AG,EIA",87400,CPT,,,,,both,, ,959.34,575.60,Medicare,Medicare,,575.60,,,959.34,134.31,489.26,Fee Schedule,Medicare APC Fee Schedule
L6866 ROTAVIRUS DDIA,87425,CPT,,,,,both,, ,123.60,74.16,Medicare,Medicare,,74.16,,,123.60,17.30,63.04,Fee Schedule,Medicare APC Fee Schedule
"ROTAVIRUS AG,EIA",87425,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
COVID19 AG EIA,87426,CPT,,,,,both,, ,84.20,50.52,Medicare,Medicare,,50.52,,,84.20,11.79,42.94,Fee Schedule,Medicare APC Fee Schedule
COVID19 AG EIA,87426,CPT,,,,,both,, ,88.35,53.01,Medicare,Medicare,,53.01,,,88.35,12.37,45.06,Fee Schedule,Medicare APC Fee Schedule
"SHIGA-LIKE TOX AG,EI",87427,CPT,,,,,both,, ,113.10,67.86,Medicare,Medicare,,67.86,,,113.10,15.83,57.68,Fee Schedule,Medicare APC Fee Schedule
"SHIGA-LIKE TOX AG,EI",87427,CPT,,,,,both,, ,156.33,93.79,Medicare,Medicare,,93.79,,,156.33,21.89,79.73,Fee Schedule,Medicare APC Fee Schedule
COVID19AG FLUAB SOF2,87428,CPT,,,,,both,, ,159.00,95.40,Medicare,Medicare,,95.40,,,159.00,22.26,81.09,Fee Schedule,Medicare APC Fee Schedule
"AG DETEC NOS,EIA MUL",87449,CPT,,,,,both,, ,886.09,531.65,Medicare,Medicare,,531.65,,,886.09,124.05,451.91,Fee Schedule,Medicare APC Fee Schedule
OXOID PBP2 MRSA SCRN,87449,CPT,,,,,both,, ,121.98,73.18,Medicare,Medicare,,73.18,,,121.98,17.08,62.21,Fee Schedule,Medicare APC Fee Schedule
OXOID PBP2 MRSA SCRN,87449,CPT,,,,,both,, ,121.98,73.18,Medicare,Medicare,,73.18,,,121.98,17.08,62.21,Fee Schedule,Medicare APC Fee Schedule
Q15544 NOROV EIA IA,87449,CPT,,,,,both,, ,886.09,531.65,Medicare,Medicare,,531.65,,,886.09,124.05,451.91,Fee Schedule,Medicare APC Fee Schedule
Q8856 LEGIO AG U IA,87449,CPT,,,,,both,, ,886.09,531.65,Medicare,Medicare,,531.65,,,886.09,124.05,451.91,Fee Schedule,Medicare APC Fee Schedule
CANDIDA DNA AMP PROB,87481,CPT,,,,,both,, ,281.80,169.08,Medicare,Medicare,,169.08,,,281.80,39.45,143.72,Fee Schedule,Medicare APC Fee Schedule
L183410 M ENCEPH CSF,87483,CPT,,,,,both,, ,1650.00,990.00,Medicare,Medicare,,990.00,,,1650.00,231.00,841.5,Fee Schedule,Medicare APC Fee Schedule
L139650 CPNEU DNA,87486,CPT,,,,,both,, ,175.00,105.00,Medicare,Medicare,,105.00,,,175.00,24.50,89.25,Fee Schedule,Medicare APC Fee Schedule
Q37444 C PNEUMO PCR,87486,CPT,,,,,both,, ,105.27,63.16,Medicare,Medicare,,63.16,,,105.27,14.74,53.69,Fee Schedule,Medicare APC Fee Schedule
CHLMYD TRACH DNA AMP,87491,CPT,,,,,both,,,968.60,968.60,Medicare,Medicare,,968.60,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
CHLMYD TRACH DNA AMP,87491,CPT,,,,,both,, ,968.60,581.16,Medicare,Medicare,,581.16,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
CHLMYD TRACH DNA AMP,87491,CPT,,,,,both,, ,968.60,581.16,Medicare,Medicare,,581.16,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
CHLMYD TRACH DNA AMP,87491,CPT,,,,,both,, ,968.60,581.16,Medicare,Medicare,,581.16,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
CHLMYD TRACH DNA AMP,87491,CPT,,,,,both,, ,968.60,581.16,Medicare,Medicare,,581.16,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
L180021 CTRACH AMPPR,87491,CPT,,,,,both,, ,888.63,533.17,Medicare,Medicare,,533.17,,,888.63,124.41,453.2,Fee Schedule,Medicare APC Fee Schedule
C DIFF AMPLI PROBE,87493,CPT,,,,,both,, ,313.51,188.10,Medicare,Medicare,,188.10,,,313.51,43.89,159.89,Fee Schedule,Medicare APC Fee Schedule
Q10601 CMV QL RT-PCR,87496,CPT,,,,,both,, ,1051.68,631.00,Medicare,Medicare,,631.00,,,1051.68,147.24,536.36,Fee Schedule,Medicare APC Fee Schedule
Q10600 CMV QT RT-PCR,87497,CPT,,,,,both,, ,889.73,533.83,Medicare,Medicare,,533.83,,,889.73,124.56,453.76,Fee Schedule,Medicare APC Fee Schedule
Q15082EVRNA QL RTPCR,87498,CPT,,,,,both,, ,437.85,262.71,Medicare,Medicare,,262.71,,,437.85,61.30,223.3,Fee Schedule,Medicare APC Fee Schedule
INFLU DNA AMP PROBE,87502,CPT,,,,,both,, ,215.11,129.06,Medicare,Medicare,,129.06,,,215.11,30.12,109.71,Fee Schedule,Medicare APC Fee Schedule
INFLU DNA AMP PROBE,87502,CPT,,,,,both,,,887.49,887.49,Medicare,Medicare,,887.49,,,887.49,124.25,452.62,Fee Schedule,Medicare APC Fee Schedule
INFLU DNA AMP PROBE,87502,CPT,,,,,both,, ,887.49,532.49,Medicare,Medicare,,532.49,,,887.49,124.25,452.62,Fee Schedule,Medicare APC Fee Schedule
L183480 GI PRO STOOL,87507,CPT,,,,,both,, ,1090.20,654.12,Medicare,Medicare,,654.12,,,1090.20,152.63,556,Fee Schedule,Medicare APC Fee Schedule
GARDNER VAG DNA QUAN,87512,CPT,,,,,both,, ,335.12,201.07,Medicare,Medicare,,201.07,,,335.12,46.92,170.91,Fee Schedule,Medicare APC Fee Schedule
"HEPATITIS B,DNA QNT",87517,CPT,,,,,both,, ,1011.26,606.75,Medicare,Medicare,,606.75,,,1011.26,141.58,515.74,Fee Schedule,Medicare APC Fee Schedule
"HEPATITIS B,DNA QNT",87517,CPT,,,,,both,, ,1011.26,606.75,Medicare,Medicare,,606.75,,,1011.26,141.58,515.74,Fee Schedule,Medicare APC Fee Schedule
"HEPATITIS C,RNA,AMPP",87521,CPT,,,,,both,, ,728.91,437.34,Medicare,Medicare,,437.34,,,728.91,102.05,371.74,Fee Schedule,Medicare APC Fee Schedule
"HEPATITIS C,RNA,AMPP",87521,CPT,,,,,both,, ,728.91,437.34,Medicare,Medicare,,437.34,,,728.91,102.05,371.74,Fee Schedule,Medicare APC Fee Schedule
"HEPATITIS C,RNA,QUAN",87522,CPT,,,,,both,, ,2133.69,1280.21,Medicare,Medicare,,1280.21,,,2133.69,298.72,1088.18,Fee Schedule,Medicare APC Fee Schedule
"HEPATITIS C,RNA,QUAN",87522,CPT,,,,,both,, ,2133.69,1280.21,Medicare,Medicare,,1280.21,,,2133.69,298.72,1088.18,Fee Schedule,Medicare APC Fee Schedule
Q11348 HCV QT RT-PCR,87522,CPT,,,,,both,, ,1066.84,640.10,Medicare,Medicare,,640.10,,,1066.84,149.36,544.09,Fee Schedule,Medicare APC Fee Schedule
"HSV, DNA, AMP PROBE",87529,CPT,,,,,both,, ,3455.10,2073.06,Medicare,Medicare,,2073.06,,,3455.10,483.71,1762.1,Fee Schedule,Medicare APC Fee Schedule
"Q90570 HSV, DNA, AMP",87529,CPT,,,,,both,, ,968.60,581.16,Medicare,Medicare,,581.16,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
"Q90570 HSV, DNA, AMP",87529,CPT,,,,,both,, ,968.60,581.16,Medicare,Medicare,,581.16,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
"HSV, DNA, QUANT",87530,CPT,,,,,both,, ,512.23,307.33,Medicare,Medicare,,307.33,,,512.23,71.71,261.24,Fee Schedule,Medicare APC Fee Schedule
"HSV, DNA, QUANT",87530,CPT,,,,,both,, ,512.23,307.33,Medicare,Medicare,,307.33,,,512.23,71.71,261.24,Fee Schedule,Medicare APC Fee Schedule
"HIV-1, DNA,AMP PROBE",87535,CPT,,,,,both,, ,1718.85,1031.31,Medicare,Medicare,,1031.31,,,1718.85,240.64,876.61,Fee Schedule,Medicare APC Fee Schedule
"HIV-1, DNA, QUANT",87536,CPT,,,,,both,, ,1804.46,1082.67,Medicare,Medicare,,1082.67,,,1804.46,252.62,920.27,Fee Schedule,Medicare APC Fee Schedule
"HIV-1, DNA, QUANT",87536,CPT,,,,,both,, ,1804.46,1082.67,Medicare,Medicare,,1082.67,,,1804.46,252.62,920.27,Fee Schedule,Medicare APC Fee Schedule
"Q15062 LEGION PNEU,D",87541,CPT,,,,,both,, ,196.98,118.18,Medicare,Medicare,,118.18,,,196.98,27.58,100.46,Fee Schedule,Medicare APC Fee Schedule
"M.TUBERCULO,DNA,AMPP",87556,CPT,,,,,both,, ,815.91,489.54,Medicare,Medicare,,489.54,,,815.91,114.23,416.11,Fee Schedule,Medicare APC Fee Schedule
"M.TUBERCULO,DNA,AMPP",87556,CPT,,,,,both,, ,815.91,489.54,Medicare,Medicare,,489.54,,,815.91,114.23,416.11,Fee Schedule,Medicare APC Fee Schedule
"M.AVIUM-INTR,DNA,AMP",87561,CPT,,,,,both,, ,372.45,223.47,Medicare,Medicare,,223.47,,,372.45,52.14,189.95,Fee Schedule,Medicare APC Fee Schedule
"M.AVIUM-INTR,DNA,AMP",87561,CPT,,,,,both,, ,372.45,223.47,Medicare,Medicare,,223.47,,,372.45,52.14,189.95,Fee Schedule,Medicare APC Fee Schedule
L180076 M GENT NAA,87563,CPT,,,,,both,, ,180.00,108.00,Medicare,Medicare,,108.00,,,180.00,25.20,91.8,Fee Schedule,Medicare APC Fee Schedule
Q15498 MP QL RT-PCR,87581,CPT,,,,,both,, ,197.03,118.21,Medicare,Medicare,,118.21,,,197.03,27.58,100.49,Fee Schedule,Medicare APC Fee Schedule
Q15498 MP QL RT-PCR,87581,CPT,,,,,both,, ,197.03,118.21,Medicare,Medicare,,118.21,,,197.03,27.58,100.49,Fee Schedule,Medicare APC Fee Schedule
Q37444 MP QL RT-PCR,87581,CPT,,,,,both,, ,175.50,105.30,Medicare,Medicare,,105.30,,,175.50,24.57,89.51,Fee Schedule,Medicare APC Fee Schedule
L180021 NG AMP PRB,87591,CPT,,,,,both,, ,888.63,533.17,Medicare,Medicare,,533.17,,,888.63,124.41,453.2,Fee Schedule,Medicare APC Fee Schedule
"N.GONORRHO,DNA,AMPPR",87591,CPT,,,,,both,, ,968.60,581.16,Medicare,Medicare,,581.16,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
"N.GONORRHO,DNA,AMPPR",87591,CPT,,,,,both,, ,968.60,581.16,Medicare,Medicare,,581.16,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
"N.GONORRHO,DNA,AMPPR",87591,CPT,,,,,both,, ,968.60,581.16,Medicare,Medicare,,581.16,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
"N.GONORRHO,DNA,AMPPR",87591,CPT,,,,,both,, ,968.60,581.16,Medicare,Medicare,,581.16,,,968.60,135.60,493.99,Fee Schedule,Medicare APC Fee Schedule
L140230 ORTHOPOX VRS,87593,CPT,,,,,both,, ,308.00,184.80,Medicare,Medicare,,184.80,,,308.00,43.12,157.08,Fee Schedule,Medicare APC Fee Schedule
HPV HIGH RISK TYPES,87624,CPT,,,,,both,, ,241.38,144.82,Medicare,Medicare,,144.82,,,241.38,33.79,123.1,Fee Schedule,Medicare APC Fee Schedule
L199305 HPV HR,87624,CPT,,,,,both,, ,221.45,132.87,Medicare,Medicare,,132.87,,,221.45,31.00,112.94,Fee Schedule,Medicare APC Fee Schedule
Q92090 HPV HIGH RISK,87624,CPT,,,,,both,, ,215.00,129.00,Medicare,Medicare,,129.00,,,215.00,30.10,109.65,Fee Schedule,Medicare APC Fee Schedule
L507460 HPV GEN16 18,87625,CPT,,,,,both,, ,164.80,98.88,Medicare,Medicare,,98.88,,,164.80,23.07,84.05,Fee Schedule,Medicare APC Fee Schedule
RESP VIRUS 3-5 TARG,87631,CPT,,,,,both,, ,570.52,342.31,Medicare,Medicare,,342.31,,,570.52,79.87,290.97,Fee Schedule,Medicare APC Fee Schedule
L139250 RVP PCR,87633,CPT,,,,,both,, ,175.00,105.00,Medicare,Medicare,,105.00,,,175.00,24.50,89.25,Fee Schedule,Medicare APC Fee Schedule
L139250 RVP PCR,87633,CPT,,,,,both,, ,175.00,105.00,Medicare,Medicare,,105.00,,,175.00,24.50,89.25,Fee Schedule,Medicare APC Fee Schedule
Q37444 RESP VIR PCR,87633,CPT,,,,,both,, ,1250.34,750.20,Medicare,Medicare,,750.20,,,1250.34,175.05,637.67,Fee Schedule,Medicare APC Fee Schedule
RSV DNA/ MA AMP PROB,87634,CPT,,,,,both,, ,157.62,94.57,Medicare,Medicare,,94.57,,,157.62,22.07,80.39,Fee Schedule,Medicare APC Fee Schedule
RSV DNA/ MA AMP PROB,87634,CPT,,,,,both,, ,236.44,141.86,Medicare,Medicare,,141.86,,,236.44,33.10,120.58,Fee Schedule,Medicare APC Fee Schedule
COVID19 PRB,87635,CPT,,,,,both,, ,113.30,67.98,Medicare,Medicare,,67.98,,,113.30,15.86,57.78,Fee Schedule,Medicare APC Fee Schedule
COVID19 PRB,87635,CPT,,,,,both,, ,336.81,202.08,Medicare,Medicare,,202.08,,,336.81,47.15,171.77,Fee Schedule,Medicare APC Fee Schedule
"STAPH A,DNA,PROBE",87640,CPT,,,,,both,, ,118.16,70.89,Medicare,Medicare,,70.89,,,118.16,16.54,60.26,Fee Schedule,Medicare APC Fee Schedule
"MR-STAPH,DNA,PROBE",87641,CPT,,,,,both,, ,118.16,70.89,Medicare,Medicare,,70.89,,,118.16,16.54,60.26,Fee Schedule,Medicare APC Fee Schedule
"STREP A,DNA,AMP PROB",87651,CPT,,,,,both,, ,78.78,47.26,Medicare,Medicare,,47.26,,,78.78,11.03,40.18,Fee Schedule,Medicare APC Fee Schedule
"STREP A,DNA,AMP PROB",87651,CPT,,,,,both,, ,118.18,70.90,Medicare,Medicare,,70.90,,,118.18,16.55,60.27,Fee Schedule,Medicare APC Fee Schedule
T VAGINALIS AMP,87661,CPT,,,,,both,,,279.55,279.55,Medicare,Medicare,,279.55,,,279.55,39.14,142.57,Fee Schedule,Medicare APC Fee Schedule
T VAGINALIS AMP,87661,CPT,,,,,both,, ,279.55,167.73,Medicare,Medicare,,167.73,,,279.55,39.14,142.57,Fee Schedule,Medicare APC Fee Schedule
T VAGINALIS AMP,87661,CPT,,,,,both,, ,279.55,167.73,Medicare,Medicare,,167.73,,,279.55,39.14,142.57,Fee Schedule,Medicare APC Fee Schedule
T VAGINALIS AMP,87661,CPT,,,,,both,, ,279.55,167.73,Medicare,Medicare,,167.73,,,279.55,39.14,142.57,Fee Schedule,Medicare APC Fee Schedule
T VAGINALIS AMP,87661,CPT,,,,,both,, ,279.55,167.73,Medicare,Medicare,,167.73,,,279.55,39.14,142.57,Fee Schedule,Medicare APC Fee Schedule
Q93870 ZIKA RNA QL,87662,CPT,,,,,both,, ,295.83,177.49,Medicare,Medicare,,177.49,,,295.83,41.42,150.87,Fee Schedule,Medicare APC Fee Schedule
"DETECT AGNTNOS,DNAAM",87798,CPT,,,,,both,, ,2478.63,1487.17,Medicare,Medicare,,1487.17,,,2478.63,347.01,1264.1,Fee Schedule,Medicare APC Fee Schedule
"DETECT AGNTNOS,DNAAM",87798,CPT,,,,,both,, ,2478.63,1487.17,Medicare,Medicare,,1487.17,,,2478.63,347.01,1264.1,Fee Schedule,Medicare APC Fee Schedule
L139650 DET AGNT DNA,87798,CPT,,,,,both,, ,175.00,105.00,Medicare,Medicare,,105.00,,,175.00,24.50,89.25,Fee Schedule,Medicare APC Fee Schedule
L180021 DET AGT NOS,87798,CPT,,,,,both,, ,696.28,417.76,Medicare,Medicare,,417.76,,,696.28,97.48,355.1,Fee Schedule,Medicare APC Fee Schedule
L180021 DET AGT NOS,87798,CPT,,,,,both,, ,696.28,417.76,Medicare,Medicare,,417.76,,,696.28,97.48,355.1,Fee Schedule,Medicare APC Fee Schedule
L180040 DET AGT NOS,87798,CPT,,,,,both,, ,180.00,108.00,Medicare,Medicare,,108.00,,,180.00,25.20,91.8,Fee Schedule,Medicare APC Fee Schedule
Q10992 WNVRNA RT-PCR,87798,CPT,,,,,both,, ,1011.83,607.09,Medicare,Medicare,,607.09,,,1011.83,141.66,516.03,Fee Schedule,Medicare APC Fee Schedule
Q10992 WNVRNA RT-PCR,87798,CPT,,,,,both,, ,1011.83,607.09,Medicare,Medicare,,607.09,,,1011.83,141.66,516.03,Fee Schedule,Medicare APC Fee Schedule
Q11365DET AGNT DNAAM,87798,CPT,,,,,both,, ,758.95,455.37,Medicare,Medicare,,455.37,,,758.95,106.25,387.06,Fee Schedule,Medicare APC Fee Schedule
Q17220 JCPV QL RTPCR,87798,CPT,,,,,both,, ,1011.83,607.09,Medicare,Medicare,,607.09,,,1011.83,141.66,516.03,Fee Schedule,Medicare APC Fee Schedule
Q17220 JCPV QL RTPCR,87798,CPT,,,,,both,, ,1011.83,607.09,Medicare,Medicare,,607.09,,,1011.83,141.66,516.03,Fee Schedule,Medicare APC Fee Schedule
Q34296 PARVO B19 QL,87798,CPT,,,,,both,, ,1011.83,607.09,Medicare,Medicare,,607.09,,,1011.83,141.66,516.03,Fee Schedule,Medicare APC Fee Schedule
Q34296 PARVO B19 QL,87798,CPT,,,,,both,, ,1011.83,607.09,Medicare,Medicare,,607.09,,,1011.83,141.66,516.03,Fee Schedule,Medicare APC Fee Schedule
Q91475 SURESWAB MYCOPLASMA GENITALIUMPCR,87798,CPT,,,,,both,, ,901.25,540.75,Medicare,Medicare,,540.75,,,901.25,126.18,459.64,Fee Schedule,Medicare APC Fee Schedule
"DETECT AGNT NOS,DNAQ",87799,CPT,,,,,both,, ,454.41,272.64,Medicare,Medicare,,272.64,,,454.41,63.62,231.75,Fee Schedule,Medicare APC Fee Schedule
Q10186 EBV QT RT-PCR,87799,CPT,,,,,both,, ,454.41,272.64,Medicare,Medicare,,272.64,,,454.41,63.62,231.75,Fee Schedule,Medicare APC Fee Schedule
Q11274 BKV QT RT-PCR,87799,CPT,,,,,both,, ,454.41,272.64,Medicare,Medicare,,272.64,,,454.41,63.62,231.75,Fee Schedule,Medicare APC Fee Schedule
"DETECT AGT MULT,DNAA",87801,CPT,,,,,both,, ,715.16,429.09,Medicare,Medicare,,429.09,,,715.16,100.12,364.73,Fee Schedule,Medicare APC Fee Schedule
L180021 DET AGT MULT,87801,CPT,,,,,both,, ,656.11,393.66,Medicare,Medicare,,393.66,,,656.11,91.86,334.62,Fee Schedule,Medicare APC Fee Schedule
Q15564LYME RT-PCR SF,87801,CPT,,,,,both,, ,715.16,429.09,Medicare,Medicare,,429.09,,,715.16,100.12,364.73,Fee Schedule,Medicare APC Fee Schedule
Q15777LYM QL BL RTPC,87801,CPT,,,,,both,, ,715.16,429.09,Medicare,Medicare,,429.09,,,715.16,100.12,364.73,Fee Schedule,Medicare APC Fee Schedule
INFLUENZA ASSAY W-OP,87804,CPT,,,,,both,, ,30.87,18.52,Medicare,Medicare,,18.52,,,30.87,4.32,15.74,Fee Schedule,Medicare APC Fee Schedule
INFLUENZA ASSAY W-OP,87804,CPT,,,,,both,, ,104.12,62.47,Medicare,Medicare,,62.47,,,104.12,14.58,53.1,Fee Schedule,Medicare APC Fee Schedule
RSV ASSAY W-OPTIC,87807,CPT,,,,,both,, ,44.62,26.77,Medicare,Medicare,,26.77,,,44.62,6.25,22.76,Fee Schedule,Medicare APC Fee Schedule
RSV ASSAY W-OPTIC,87807,CPT,,,,,both,, ,277.86,166.71,Medicare,Medicare,,166.71,,,277.86,38.90,141.71,Fee Schedule,Medicare APC Fee Schedule
STREP A ASSAY W-OPTI,87880,CPT,,,,,both,, ,41.25,24.75,Medicare,Medicare,,24.75,,,41.25,5.78,21.04,Fee Schedule,Medicare APC Fee Schedule
STREP A ASSAY W-OPTI,87880,CPT,,,,,both,, ,285.17,171.10,Medicare,Medicare,,171.10,,,285.17,39.92,145.44,Fee Schedule,Medicare APC Fee Schedule
AGENT NOS ASSAY W-OP,87899,CPT,,,,,both,, ,172.90,103.74,Medicare,Medicare,,103.74,,,172.90,24.21,88.18,Fee Schedule,Medicare APC Fee Schedule
L183025 CRYPTO AG,87899,CPT,,,,,both,, ,158.62,95.17,Medicare,Medicare,,95.17,,,158.62,22.21,80.9,Fee Schedule,Medicare APC Fee Schedule
L183025 CRYPTO AG,87899,CPT,,,,,both,, ,158.62,95.17,Medicare,Medicare,,95.17,,,158.62,22.21,80.9,Fee Schedule,Medicare APC Fee Schedule
Q34949 PHENO INF DRG,87900,CPT,,,,,both,, ,773.54,464.12,Medicare,Medicare,,464.12,,,773.54,108.30,394.51,Fee Schedule,Medicare APC Fee Schedule
"GENOTYPE,DNA,HIV REV",87901,CPT,,,,,both,, ,1819.90,1091.94,Medicare,Medicare,,1091.94,,,1819.90,254.79,928.15,Fee Schedule,Medicare APC Fee Schedule
"GENOTYPE,DNA,HIV REV",87901,CPT,,,,,both,, ,1819.90,1091.94,Medicare,Medicare,,1091.94,,,1819.90,254.79,928.15,Fee Schedule,Medicare APC Fee Schedule
"GENOTYPE,DNA,HEPAT C",87902,CPT,,,,,both,, ,1611.91,967.14,Medicare,Medicare,,967.14,,,1611.91,225.67,822.07,Fee Schedule,Medicare APC Fee Schedule
Q37811 HCVRNA GN MPR,87902,CPT,,,,,both,, ,1611.91,967.14,Medicare,Medicare,,967.14,,,1611.91,225.67,822.07,Fee Schedule,Medicare APC Fee Schedule
Q92447 HCVG1 NS5A DR,87902,CPT,,,,,both,, ,1611.91,967.14,Medicare,Medicare,,967.14,,,1611.91,225.67,822.07,Fee Schedule,Medicare APC Fee Schedule
L551690PHENO DNA HIV,87903,CPT,,,,,both,, ,1465.00,879.00,Medicare,Medicare,,879.00,,,1465.00,205.10,747.15,Fee Schedule,Medicare APC Fee Schedule
L551690PHENO DNA HIV,87904,CPT,,,,,both,, ,104.00,62.40,Medicare,Medicare,,62.40,,,104.00,14.56,53.04,Fee Schedule,Medicare APC Fee Schedule
HIV GEN DNA REV OTH,87906,CPT,,,,,both,, ,856.62,513.97,Medicare,Medicare,,513.97,,,856.62,119.93,436.88,Fee Schedule,Medicare APC Fee Schedule
AUTOPSY COMPL WO-CNS,88020,CPT,,,,,both,, ,3310.55,1986.33,Medicare,Medicare,,1986.33,,,3310.55,463.48,1688.38,Fee Schedule,Medicare APC Fee Schedule
CYTOPATH FLD NOT V-C,88104,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,65.84,,,109.74,15.36,55.97,Fee Schedule,Medicare APC Fee Schedule
CYTOPATH FLD FTRW-IN,88106,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,65.84,,,109.74,15.36,55.97,Fee Schedule,Medicare APC Fee Schedule
CYTOPATH CONCENT TEC,88108,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,65.84,,,109.74,15.36,55.97,Fee Schedule,Medicare APC Fee Schedule
CYTOCELL ENH X CR-VG,88112,CPT,,,,,both,, ,237.17,142.30,Medicare,Medicare,,142.30,,,237.17,33.20,120.96,Fee Schedule,Medicare APC Fee Schedule
CYTO UR 3-5PROB EA S,88120,CPT,,,,,both,, ,368.80,221.28,Medicare,Medicare,,221.28,,,368.80,51.63,188.09,Fee Schedule,Medicare APC Fee Schedule
CYTO UR 3-5 PROB CMP,88121,CPT,,,,,both,, ,368.80,221.28,Medicare,Medicare,,221.28,,,368.80,51.63,188.09,Fee Schedule,Medicare APC Fee Schedule
FORENSIC CYTOPATHOLO,88125,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,65.84,,,109.74,15.36,55.97,Fee Schedule,Medicare APC Fee Schedule
SEX CHROMATIN ID BAR,88130,CPT,,,,,both,, ,144.83,86.89,Medicare,Medicare,,86.89,,,144.83,20.28,73.86,Fee Schedule,Medicare APC Fee Schedule
SEX CHROM ID POLYMOR,88140,CPT,,,,,both,, ,76.90,46.14,Medicare,Medicare,,46.14,,,76.90,10.77,39.22,Fee Schedule,Medicare APC Fee Schedule
L192555 PAP LB,88142,CPT,,,,,both,, ,234.07,140.44,Medicare,Medicare,,140.44,,,234.07,32.77,119.38,Fee Schedule,Medicare APC Fee Schedule
PAP THINLAY LIQ DIAG,88142,CPT,,,,,both,, ,189.74,113.84,Medicare,Medicare,,113.84,,,189.74,26.56,96.77,Fee Schedule,Medicare APC Fee Schedule
CYTOPATH C-V THNLYRE,88143,CPT,,,,,both,, ,189.74,113.84,Medicare,Medicare,,113.84,,,189.74,26.56,96.77,Fee Schedule,Medicare APC Fee Schedule
CYTOP C-V AUTOMATED,88147,CPT,,,,,both,, ,101.60,60.96,Medicare,Medicare,,60.96,,,101.60,14.22,51.82,Fee Schedule,Medicare APC Fee Schedule
CYTOP C-V AUTO RESCR,88148,CPT,,,,,both,, ,101.60,60.96,Medicare,Medicare,,60.96,,,101.60,14.22,51.82,Fee Schedule,Medicare APC Fee Schedule
CYTOPATH C-V MANUAL,88150,CPT,,,,,both,, ,101.60,60.96,Medicare,Medicare,,60.96,,,101.60,14.22,51.82,Fee Schedule,Medicare APC Fee Schedule
CYTOP C-V AUTO REDO,88152,CPT,,,,,both,, ,101.60,60.96,Medicare,Medicare,,60.96,,,101.60,14.22,51.82,Fee Schedule,Medicare APC Fee Schedule
CYTOPATH C-V REDO,88153,CPT,,,,,both,, ,101.60,60.96,Medicare,Medicare,,60.96,,,101.60,14.22,51.82,Fee Schedule,Medicare APC Fee Schedule
CYTOP C-V INDX ADDON,88155,CPT,,,,,both,, ,57.81,34.68,Medicare,Medicare,,34.68,,,57.81,8.09,29.48,Fee Schedule,Medicare APC Fee Schedule
CYTOP SMR OTHR SOURC,88160,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,65.84,,,109.74,15.36,55.97,Fee Schedule,Medicare APC Fee Schedule
CYTOP SMR OTH PRE-SC,88161,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,65.84,,,109.74,15.36,55.97,Fee Schedule,Medicare APC Fee Schedule
CYTOP SMR OTH S5SLID,88162,CPT,,,,,both,, ,237.17,142.30,Medicare,Medicare,,142.30,,,237.17,33.20,120.96,Fee Schedule,Medicare APC Fee Schedule
"CYTOP TBS,C-V,MANUAL",88164,CPT,,,,,both,, ,101.60,60.96,Medicare,Medicare,,60.96,,,101.60,14.22,51.82,Fee Schedule,Medicare APC Fee Schedule
"CYTOP TBS,C-V,REDO",88165,CPT,,,,,both,, ,101.60,60.96,Medicare,Medicare,,60.96,,,101.60,14.22,51.82,Fee Schedule,Medicare APC Fee Schedule
"CYTOP TBS,C-V AUTORE",88166,CPT,,,,,both,, ,101.60,60.96,Medicare,Medicare,,60.96,,,101.60,14.22,51.82,Fee Schedule,Medicare APC Fee Schedule
"CYTOP TBS,C-C,SELECT",88167,CPT,,,,,both,, ,101.60,60.96,Medicare,Medicare,,60.96,,,101.60,14.22,51.82,Fee Schedule,Medicare APC Fee Schedule
CYTOPATH EVAL OF FNA,88172,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,65.84,,,109.74,15.36,55.97,Fee Schedule,Medicare APC Fee Schedule
"CYTOP EVAL,FNA,REPOR",88173,CPT,,,,,both,, ,237.17,142.30,Medicare,Medicare,,142.30,,,237.17,33.20,120.96,Fee Schedule,Medicare APC Fee Schedule
CYTO-CERVICALRP CDM,88174,CPT,,,,,both,, ,205.45,123.27,Medicare,Medicare,,123.27,,,205.45,28.76,104.78,Fee Schedule,Medicare APC Fee Schedule
L199305 PAP AU MN RS,88175,CPT,,,,,both,, ,234.07,140.44,Medicare,Medicare,,140.44,,,234.07,32.77,119.38,Fee Schedule,Medicare APC Fee Schedule
PAP DIAG AUTO MAN RS,88175,CPT,,,,,both,, ,255.13,153.07,Medicare,Medicare,,153.07,,,255.13,35.72,130.12,Fee Schedule,Medicare APC Fee Schedule
Q92090 PAP DIAG AUTO,88175,CPT,,,,,both,, ,227.25,136.35,Medicare,Medicare,,136.35,,,227.25,31.82,115.9,Fee Schedule,Medicare APC Fee Schedule
CYTO EVAL FNA ADD,88177,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,43.27,,,72.13,10.10,36.79,Fee Schedule,Medicare APC Fee Schedule
CELL MRK STDY CY-DNA,88182,CPT,,,,,both,, ,69.89,41.93,Medicare,Medicare,,41.93,,,69.89,9.78,35.64,Fee Schedule,Medicare APC Fee Schedule
"FLOWCYTOMET-TC,1 MRK",88184,CPT,,,,,both,, ,203.21,121.92,Medicare,Medicare,,121.92,,,203.21,28.45,103.64,Fee Schedule,Medicare APC Fee Schedule
"FLOWCYTOMET-TC,1 MRK",88184,CPT,,,,,both,, ,203.21,121.92,Medicare,Medicare,,121.92,,,203.21,28.45,103.64,Fee Schedule,Medicare APC Fee Schedule
"FLOWCYTOMETRY-TC,ADD",88185,CPT,,,,,both,, ,195.35,117.21,Medicare,Medicare,,117.21,,,195.35,27.35,99.63,Fee Schedule,Medicare APC Fee Schedule
Q35080 FLOWCY-TC ADD,88185,CPT,,,,,both,, ,60.00,36.00,Medicare,Medicare,,36.00,,,60.00,8.40,30.6,Fee Schedule,Medicare APC Fee Schedule
A3001780 FLWCY 16MRK,88189,CPT,,,,,both,, ,360.00,216.00,Medicare,Medicare,,216.00,,,360.00,50.40,183.6,Fee Schedule,Medicare APC Fee Schedule
CYTOPATHOLOGY PROCED,88199,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,43.27,,,72.13,10.10,36.79,Fee Schedule,Medicare APC Fee Schedule
TISSUE CULT LYMPHOCY,88230,CPT,,,,,both,, ,3469.98,2081.98,Medicare,Medicare,,2081.98,,,3469.98,485.80,1769.69,Fee Schedule,Medicare APC Fee Schedule
TISSUE CULT LYMPHOCY,88230,CPT,,,,,both,, ,3469.98,2081.98,Medicare,Medicare,,2081.98,,,3469.98,485.80,1769.69,Fee Schedule,Medicare APC Fee Schedule
TISSUE CULT SKIN/BIO,88233,CPT,,,,,both,, ,1353.98,812.38,Medicare,Medicare,,812.38,,,1353.98,189.56,690.53,Fee Schedule,Medicare APC Fee Schedule
"TISSUE CULT, PLACENT",88235,CPT,,,,,both,, ,1416.56,849.93,Medicare,Medicare,,849.93,,,1416.56,198.32,722.45,Fee Schedule,Medicare APC Fee Schedule
TISSUE CULT BONEMARR,88237,CPT,,,,,both,, ,849.04,509.42,Medicare,Medicare,,509.42,,,849.04,118.87,433.01,Fee Schedule,Medicare APC Fee Schedule
TISSUE CULT BONEMARR,88237,CPT,,,,,both,, ,849.04,509.42,Medicare,Medicare,,509.42,,,849.04,118.87,433.01,Fee Schedule,Medicare APC Fee Schedule
TISSUE CULTURE TUMOR,88239,CPT,,,,,both,, ,1419.09,851.45,Medicare,Medicare,,851.45,,,1419.09,198.67,723.74,Fee Schedule,Medicare APC Fee Schedule
CELL CRYOPRESERV-STO,88240,CPT,,,,,both,, ,97.11,58.26,Medicare,Medicare,,58.26,,,97.11,13.60,49.53,Fee Schedule,Medicare APC Fee Schedule
FROZEN CELL PREPARAT,88241,CPT,,,,,both,, ,97.11,58.26,Medicare,Medicare,,58.26,,,97.11,13.60,49.53,Fee Schedule,Medicare APC Fee Schedule
CHROMOSOME ANAL20-25,88245,CPT,,,,,both,, ,1397.47,838.48,Medicare,Medicare,,838.48,,,1397.47,195.65,712.71,Fee Schedule,Medicare APC Fee Schedule
CHROMOSOM ANAL50-100,88248,CPT,,,,,both,, ,1666.09,999.65,Medicare,Medicare,,999.65,,,1666.09,233.25,849.71,Fee Schedule,Medicare APC Fee Schedule
CHROMOSOME ANALYS100,88249,CPT,,,,,both,, ,1666.09,999.65,Medicare,Medicare,,999.65,,,1666.09,233.25,849.71,Fee Schedule,Medicare APC Fee Schedule
CHROMOSOME ANALYS  5,88261,CPT,,,,,both,, ,1700.32,1020.19,Medicare,Medicare,,1020.19,,,1700.32,238.04,867.16,Fee Schedule,Medicare APC Fee Schedule
CHROMOSOME ANAL15-20,88262,CPT,,,,,both,, ,4292.64,2575.58,Medicare,Medicare,,2575.58,,,4292.64,600.97,2189.25,Fee Schedule,Medicare APC Fee Schedule
Q14596 CHR AN 15-20,88262,CPT,,,,,both,, ,1010.00,606.00,Medicare,Medicare,,606.00,,,1010.00,141.40,515.1,Fee Schedule,Medicare APC Fee Schedule
CHROMOSOME ANALYS 45,88263,CPT,,,,,both,, ,1445.75,867.45,Medicare,Medicare,,867.45,,,1445.75,202.41,737.33,Fee Schedule,Medicare APC Fee Schedule
CHROMOSOME ANAL20-25,88264,CPT,,,,,both,, ,2107.59,1264.55,Medicare,Medicare,,1264.55,,,2107.59,295.06,1074.87,Fee Schedule,Medicare APC Fee Schedule
CHROMOSOME ANAL20-25,88264,CPT,,,,,both,, ,2107.59,1264.55,Medicare,Medicare,,1264.55,,,2107.59,295.06,1074.87,Fee Schedule,Medicare APC Fee Schedule
CHROMOSOME ANAL-PLAC,88267,CPT,,,,,both,, ,1729.51,1037.70,Medicare,Medicare,,1037.70,,,1729.51,242.13,882.05,Fee Schedule,Medicare APC Fee Schedule
CHROMOSOM ANAL AMNIO,88269,CPT,,,,,both,, ,1600.13,960.07,Medicare,Medicare,,960.07,,,1600.13,224.02,816.07,Fee Schedule,Medicare APC Fee Schedule
CYTOGENETICS DNA-PRO,88271,CPT,,,,,both,, ,525.70,315.42,Medicare,Medicare,,315.42,,,525.70,73.60,268.11,Fee Schedule,Medicare APC Fee Schedule
CYTOGENETICS DNA-PRO,88271,CPT,,,,,both,, ,525.70,315.42,Medicare,Medicare,,315.42,,,525.70,73.60,268.11,Fee Schedule,Medicare APC Fee Schedule
CYTOGENETICS 3-5,88272,CPT,,,,,both,, ,243.63,146.17,Medicare,Medicare,,146.17,,,243.63,34.11,124.25,Fee Schedule,Medicare APC Fee Schedule
CYTOGENETICS 25-99,88274,CPT,,,,,both,, ,336.52,201.91,Medicare,Medicare,,201.91,,,336.52,47.11,171.63,Fee Schedule,Medicare APC Fee Schedule
CYTOGENETICS 100-300,88275,CPT,,,,,both,, ,1078.63,647.17,Medicare,Medicare,,647.17,,,1078.63,151.01,550.1,Fee Schedule,Medicare APC Fee Schedule
CYTOGENETICS 100-300,88275,CPT,,,,,both,, ,1078.63,647.17,Medicare,Medicare,,647.17,,,1078.63,151.01,550.1,Fee Schedule,Medicare APC Fee Schedule
CHROMOSOME KARYOT ST,88280,CPT,,,,,both,, ,962.71,577.62,Medicare,Medicare,,577.62,,,962.71,134.78,490.98,Fee Schedule,Medicare APC Fee Schedule
CHROMOSOM BANDINGSTU,88283,CPT,,,,,both,, ,375.26,225.15,Medicare,Medicare,,225.15,,,375.26,52.54,191.38,Fee Schedule,Medicare APC Fee Schedule
CHROMOSOME CT ADDITI,88285,CPT,,,,,both,, ,182.71,109.62,Medicare,Medicare,,109.62,,,182.71,25.58,93.18,Fee Schedule,Medicare APC Fee Schedule
CHROMOS STDY ADD HIG,88289,CPT,,,,,both,, ,284.04,170.42,Medicare,Medicare,,170.42,,,284.04,39.77,144.86,Fee Schedule,Medicare APC Fee Schedule
CYTOGENETIC STUDY,88299,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,43.27,,,72.13,10.10,36.79,Fee Schedule,Medicare APC Fee Schedule
SURG PATH GROSS LVL1,88300,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,43.27,,,72.13,10.10,36.79,Fee Schedule,Medicare APC Fee Schedule
SURG PATH GROSS LVL2,88302,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,65.84,,,109.74,15.36,55.97,Fee Schedule,Medicare APC Fee Schedule
SURG PATH GROSS LVL3,88304,CPT,,,,,both,, ,237.17,142.30,Medicare,Medicare,,142.30,,,237.17,33.20,120.96,Fee Schedule,Medicare APC Fee Schedule
SURG PATH GROSS LVL4,88305,CPT,,,,,both,, ,398.27,238.96,Medicare,Medicare,,238.96,,,398.27,55.76,203.12,Fee Schedule,Medicare APC Fee Schedule
SURG PATH GROSS LVL5,88307,CPT,,,,,both,, ,368.80,221.28,Medicare,Medicare,,221.28,,,368.80,51.63,188.09,Fee Schedule,Medicare APC Fee Schedule
SURG PATH GROSS LVL6,88309,CPT,,,,,both,, ,368.80,221.28,Medicare,Medicare,,221.28,,,368.80,51.63,188.09,Fee Schedule,Medicare APC Fee Schedule
DECALCIFY TISSUE,88311,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,43.27,,,72.13,10.10,36.79,Fee Schedule,Medicare APC Fee Schedule
SPECIAL STAINS GRP 1,88312,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,65.84,,,109.74,15.36,55.97,Fee Schedule,Medicare APC Fee Schedule
SPECIAL STAINS GRP 2,88313,CPT,,,,,both,, ,33.68,20.20,Medicare,Medicare,,20.20,,,33.68,4.72,17.18,Fee Schedule,Medicare APC Fee Schedule
SPECIAL STAINS GRP 2,88313,CPT,,,,,both,, ,241.94,145.16,Medicare,Medicare,,145.16,,,241.94,33.87,123.39,Fee Schedule,Medicare APC Fee Schedule
HISTOCHEMICAL STAIN,88314,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,65.84,,,109.74,15.36,55.97,Fee Schedule,Medicare APC Fee Schedule
ENZYME HISTOCHEMISTR,88319,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,65.84,,,109.74,15.36,55.97,Fee Schedule,Medicare APC Fee Schedule
MICROSLIDE-CONSULN-P,88321,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,65.84,,,109.74,15.36,55.97,Fee Schedule,Medicare APC Fee Schedule
MICROSLID CONSUL-W-P,88323,CPT,,,,,both,, ,237.17,142.30,Medicare,Medicare,,142.30,,,237.17,33.20,120.96,Fee Schedule,Medicare APC Fee Schedule
COMPRE REVIEW OFDATA,88325,CPT,,,,,both,, ,368.80,221.28,Medicare,Medicare,,221.28,,,368.80,51.63,188.09,Fee Schedule,Medicare APC Fee Schedule
PATH CONSULT INTROP,88329,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,65.84,,,109.74,15.36,55.97,Fee Schedule,Medicare APC Fee Schedule
PATH CONSULT INT-1BL,88331,CPT,,,,,both,, ,237.17,142.30,Medicare,Medicare,,142.30,,,237.17,33.20,120.96,Fee Schedule,Medicare APC Fee Schedule
PATH CONSULT-INTRADD,88332,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,43.27,,,72.13,10.10,36.79,Fee Schedule,Medicare APC Fee Schedule
INOP CYTOPAT CNSLT 1,88333,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,65.84,,,109.74,15.36,55.97,Fee Schedule,Medicare APC Fee Schedule
INOP CYTOPAT CNSLT 2,88334,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,65.84,,,109.74,15.36,55.97,Fee Schedule,Medicare APC Fee Schedule
ICC ADD AB PER SLIDE,88341,CPT,,,,,both,, ,238.01,142.80,Medicare,Medicare,,142.80,,,238.01,33.32,121.39,Fee Schedule,Medicare APC Fee Schedule
1ST SEP ID AB,88342,CPT,,,,,both,, ,238.01,142.80,Medicare,Medicare,,142.80,,,238.01,33.32,121.39,Fee Schedule,Medicare APC Fee Schedule
ICC MLTPX AB ST,88344,CPT,,,,,both,, ,221.17,132.70,Medicare,Medicare,,132.70,,,221.17,30.96,112.8,Fee Schedule,Medicare APC Fee Schedule
IMF SPEC 1ST AB ST,88346,CPT,,,,,both,, ,270.57,162.34,Medicare,Medicare,,162.34,,,270.57,37.88,137.99,Fee Schedule,Medicare APC Fee Schedule
ELECTRON MICROSCOPY,88348,CPT,,,,,both,, ,2028.15,1216.89,Medicare,Medicare,,1216.89,,,2028.15,283.94,1034.36,Fee Schedule,Medicare APC Fee Schedule
IMF/SPEC ADD AB ST,88350,CPT,,,,,both,, ,270.57,162.34,Medicare,Medicare,,162.34,,,270.57,37.88,137.99,Fee Schedule,Medicare APC Fee Schedule
ANALYSIS SKELET MUSC,88355,CPT,,,,,both,, ,237.17,142.30,Medicare,Medicare,,142.30,,,237.17,33.20,120.96,Fee Schedule,Medicare APC Fee Schedule
ANALYSIS NERVE,88356,CPT,,,,,both,, ,368.80,221.28,Medicare,Medicare,,221.28,,,368.80,51.63,188.09,Fee Schedule,Medicare APC Fee Schedule
ANALYSIS TUMOR,88358,CPT,,,,,both,, ,237.17,142.30,Medicare,Medicare,,142.30,,,237.17,33.20,120.96,Fee Schedule,Medicare APC Fee Schedule
TUMOR IHC QT MAN,88360,CPT,,,,,both,, ,1468.77,881.26,Medicare,Medicare,,881.26,,,1468.77,205.63,749.07,Fee Schedule,Medicare APC Fee Schedule
TUMOR IHC QT UTO,88361,CPT,,,,,both,, ,1468.77,881.26,Medicare,Medicare,,881.26,,,1468.77,205.63,749.07,Fee Schedule,Medicare APC Fee Schedule
NERVE TEASING PREPAR,88362,CPT,,,,,both,, ,368.80,221.28,Medicare,Medicare,,221.28,,,368.80,51.63,188.09,Fee Schedule,Medicare APC Fee Schedule
XM ARCHIVE TIS MOLEC,88363,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,43.27,,,72.13,10.10,36.79,Fee Schedule,Medicare APC Fee Schedule
TIS HYBRD AD SNG PRB,88364,CPT,,,,,both,, ,230.71,138.42,Medicare,Medicare,,138.42,,,230.71,32.30,117.66,Fee Schedule,Medicare APC Fee Schedule
TIS HYBRD SPEC INIT,88365,CPT,,,,,both,, ,304.81,182.88,Medicare,Medicare,,182.88,,,304.81,42.67,155.45,Fee Schedule,Medicare APC Fee Schedule
INS HYBR AUT SP INIT,88367,CPT,,,,,both,, ,220.05,132.03,Medicare,Medicare,,132.03,,,220.05,30.81,112.23,Fee Schedule,Medicare APC Fee Schedule
INS HYBRD MAN SP INI,88368,CPT,,,,,both,, ,342.70,205.62,Medicare,Medicare,,205.62,,,342.70,47.98,174.78,Fee Schedule,Medicare APC Fee Schedule
INS HYBRD MAN SNG PR,88369,CPT,,,,,both,, ,342.70,205.62,Medicare,Medicare,,205.62,,,342.70,47.98,174.78,Fee Schedule,Medicare APC Fee Schedule
PROTEIN-WEST BLOTTIS,88371,CPT,,,,,both,, ,209.38,125.62,Medicare,Medicare,,125.62,,,209.38,29.31,106.78,Fee Schedule,Medicare APC Fee Schedule
PROTEIN ANALYSW/PROB,88372,CPT,,,,,both,, ,218.93,131.35,Medicare,Medicare,,131.35,,,218.93,30.65,111.65,Fee Schedule,Medicare APC Fee Schedule
INS HYBR AUT SNG PR,88373,CPT,,,,,both,, ,220.05,132.03,Medicare,Medicare,,132.03,,,220.05,30.81,112.23,Fee Schedule,Medicare APC Fee Schedule
INS HYBR AUT MUL PR,88374,CPT,,,,,both,, ,220.05,132.03,Medicare,Medicare,,132.03,,,220.05,30.81,112.23,Fee Schedule,Medicare APC Fee Schedule
INS HYBR MAN MUL PR,88377,CPT,,,,,both,, ,342.70,205.62,Medicare,Medicare,,205.62,,,342.70,47.98,174.78,Fee Schedule,Medicare APC Fee Schedule
MICRODISSECTION MANU,88381,CPT,,,,,both,, ,424.38,254.62,Medicare,Medicare,,254.62,,,424.38,59.41,216.43,Fee Schedule,Medicare APC Fee Schedule
SURGICAL PATH PROCED,88399,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,43.27,,,72.13,10.10,36.79,Fee Schedule,Medicare APC Fee Schedule
BILIRUBIN TOT TRANS,88720,CPT,,,,,both,, ,75.22,45.13,Medicare,Medicare,,45.13,,,75.22,10.53,38.36,Fee Schedule,Medicare APC Fee Schedule
CELL CTW-DIF BODYFLU,89051,CPT,,,,,both,, ,54.17,32.50,Medicare,Medicare,,32.50,,,54.17,7.58,27.63,Fee Schedule,Medicare APC Fee Schedule
CELL CTW-DIF BODYFLU,89051,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,414.77,,,691.29,96.78,352.56,Fee Schedule,Medicare APC Fee Schedule
LEUKOCY ASSES FEC QL,89055,CPT,,,,,both,, ,109.46,65.67,Medicare,Medicare,,65.67,,,109.46,15.32,55.82,Fee Schedule,Medicare APC Fee Schedule
"CRYSTAL ID,TISSUE,FL",89060,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
"CRYSTAL ID,TISSUE,FL",89060,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,207.47,,,345.79,48.41,176.35,Fee Schedule,Medicare APC Fee Schedule
NASAL SMEAR-EOSINOPH,89190,CPT,,,,,both,, ,518.69,311.21,Medicare,Medicare,,311.21,,,518.69,72.62,264.53,Fee Schedule,Medicare APC Fee Schedule
UNL MISC PATH TEST,89240,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,43.27,,,72.13,10.10,36.79,Fee Schedule,Medicare APC Fee Schedule
SEMEN ANYL PRES-M-S,89321,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,315.75,,,526.26,73.68,268.39,Fee Schedule,Medicare APC Fee Schedule
HEPATITIS B GLOB IM,90371,CPT,,,,,both,, ,679.03,407.41,Medicare,Medicare,,407.41,,,679.03,95.06,346.31,Fee Schedule,Medicare APC Fee Schedule
HEPATITIS B GLOB IM,90371,CPT,,,,,both,1,ML,953.00,571.80,Medicare,Medicare,,571.80,,,953.00,133.42,486.03,Fee Schedule,Medicare APC Fee Schedule
RABIES IG IM/SC 150U,90375,CPT,,,,,both,3,ML,414.33,248.59,Medicare,Medicare,,248.59,,,414.33,58.01,211.31,Fee Schedule,Medicare APC Fee Schedule
RABIES IG IM/SC 150U,90375,CPT,,,,,both,, ,1385.09,831.05,Medicare,Medicare,,831.05,,,1385.09,193.91,706.4,Fee Schedule,Medicare APC Fee Schedule
RABIES IG IM/SC 150U,90375,CPT,,,,,both,, ,1428.35,857.01,Medicare,Medicare,,857.01,,,1428.35,199.97,728.46,Fee Schedule,Medicare APC Fee Schedule
RABIES IG IM/SC 150U,90375,HCPCS,,,,,both,5,ML,1867.13,1120.27,Medicare,Medicare,,1120.27,,,1867.13,261.40,952.24,Fee Schedule,Medicare APC Fee Schedule
RABIES IG IM/SC 150U,90375,HCPCS,,,,,both,1,ML,2044.81,1226.88,Medicare,Medicare,,1226.88,,,2044.81,286.27,1042.85,Fee Schedule,Medicare APC Fee Schedule
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,143.69,86.21,Medicare,Medicare,,86.21,,,143.69,20.12,73.28,Fee Schedule,Medicare APC Fee Schedule
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,230.72,138.43,Medicare,Medicare,,138.43,,,230.72,32.30,117.67,Fee Schedule,Medicare APC Fee Schedule
IMM ADM INJ SINGLE,90471,CPT,,,,,both,, ,162.25,97.35,Medicare,Medicare,,97.35,,,162.25,22.72,82.75,Fee Schedule,Medicare APC Fee Schedule
IMM ADM INJ SINGLE,90471,CPT,,,,,both,, ,162.25,97.35,Medicare,Medicare,,97.35,,,162.25,22.72,82.75,Fee Schedule,Medicare APC Fee Schedule
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,119.22,71.53,Medicare,Medicare,,71.53,,,119.22,16.69,60.8,Fee Schedule,Medicare APC Fee Schedule
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,119.22,71.53,Medicare,Medicare,,71.53,,,119.22,16.69,60.8,Fee Schedule,Medicare APC Fee Schedule
IMM ADM INJ EA ADD,90472,CPT,,,,,both,, ,48.75,29.25,Medicare,Medicare,,29.25,,,48.75,6.83,24.86,Fee Schedule,Medicare APC Fee Schedule
IMM ADM INJ EA ADD,90472,CPT,,,,,both,, ,48.75,29.25,Medicare,Medicare,,29.25,,,48.75,6.83,24.86,Fee Schedule,Medicare APC Fee Schedule
HAEMOPH B TETAN INJ,90648,CPT,,,,,both,, ,131.84,79.10,Medicare,Medicare,,79.10,,,131.84,18.46,67.24,Fee Schedule,Medicare APC Fee Schedule
FLU VAC NOPRSV ANTIG,90662,CPT,,,,,both,0.7,ML,434.66,260.79,Medicare,Medicare,,260.79,,,434.66,60.85,221.68,Fee Schedule,Medicare APC Fee Schedule
PNEUMOCOC 13-VAL IM,90670,CPT,,,,,both,0.5,ML,871.90,523.14,Medicare,Medicare,,523.14,,,871.90,122.07,444.67,Fee Schedule,Medicare APC Fee Schedule
FLU VAC CCIIV4 PF&AB,90674,CPT,,,,,both,0.5,ML,208.06,124.83,Medicare,Medicare,,124.83,,,208.06,29.13,106.11,Fee Schedule,Medicare APC Fee Schedule
RABIES VAC IM,90675,CPT,,,,,both,1,EA,1856.32,1113.79,Medicare,Medicare,,1113.79,,,1856.32,259.88,946.72,Fee Schedule,Medicare APC Fee Schedule
RABIES VAC IM,90675,CPT,,,,,both,, ,1941.04,1164.62,Medicare,Medicare,,1164.62,,,1941.04,271.75,989.93,Fee Schedule,Medicare APC Fee Schedule
FLU VAC QUAD DNA HA,90682,CPT,,,,,both,, ,383.75,230.25,Medicare,Medicare,,230.25,,,383.75,53.73,195.71,Fee Schedule,Medicare APC Fee Schedule
FLU VACIIV4 PF .5ML,90686,CPT,,,,,both,, ,145.23,87.13,Medicare,Medicare,,87.13,,,145.23,20.33,74.07,Fee Schedule,Medicare APC Fee Schedule
FLU VAC IIV4 .25ML,90687,CPT,,,,,both,, ,135.45,81.27,Medicare,Medicare,,81.27,,,135.45,18.96,69.08,Fee Schedule,Medicare APC Fee Schedule
M-M-R II INJ,90707,CPT,,,,,both,1,EA,471.23,282.73,Medicare,Medicare,,282.73,,,471.23,65.97,240.33,Fee Schedule,Medicare APC Fee Schedule
TD IM NO PRSRV GE 7Y,90714,CPT,,,,,both,0.5,ML,210.12,126.07,Medicare,Medicare,,126.07,,,210.12,29.42,107.16,Fee Schedule,Medicare APC Fee Schedule
DIPH/TET/ACPERT .5ML,90715,CPT,,,,,both,0.5,ML,350.20,210.12,Medicare,Medicare,,210.12,,,350.20,49.03,178.6,Fee Schedule,Medicare APC Fee Schedule
DIPH/TET/ACPERT .5ML,90715,CPT,,,,,both,0.5,ML,370.54,222.32,Medicare,Medicare,,222.32,,,370.54,51.88,188.98,Fee Schedule,Medicare APC Fee Schedule
VARICELLA VIR VAC SC,90716,CPT,,,,,both,1,EA,611.56,366.93,Medicare,Medicare,,366.93,,,611.56,85.62,311.9,Fee Schedule,Medicare APC Fee Schedule
PNEUMO-VAC 2YR-ADULT,90732,CPT,,,,,both,0.5,ML,544.10,326.46,Medicare,Medicare,,326.46,,,544.10,76.17,277.49,Fee Schedule,Medicare APC Fee Schedule
HEP B VAC PED,90744,CPT,,,,,both,, ,194.93,116.95,Medicare,Medicare,,116.95,,,194.93,27.29,99.41,Fee Schedule,Medicare APC Fee Schedule
HEP B VAC PED,90744,CPT,,,,,both,0.5,ML,204.97,122.98,Medicare,Medicare,,122.98,,,204.97,28.70,104.53,Fee Schedule,Medicare APC Fee Schedule
INTERACTIVE ADD-ON,90785,CPT,,,,,both,, ,310.80,186.48,Medicare,Medicare,,186.48,,,310.80,43.51,158.51,Fee Schedule,Medicare APC Fee Schedule
PSYCH DIAG EVAL,90791,CPT,,,,,both,, ,249.78,149.86,Medicare,Medicare,,149.86,,,249.78,34.97,127.39,Fee Schedule,Medicare APC Fee Schedule
PSYCH DIAG EVAL,90791,CPT,,,,,both,, ,757.82,454.69,Medicare,Medicare,,454.69,,,757.82,106.09,386.49,Fee Schedule,Medicare APC Fee Schedule
PSYCHOTHERAPY 30 MIN,90832,CPT,,,,,both,, ,238.96,143.37,Medicare,Medicare,,143.37,,,238.96,33.45,121.87,Fee Schedule,Medicare APC Fee Schedule
"Psychotherapy, 30 min",90832,CPT,,,,,both,,,238.96,238.96,Medicare,Medicare,,238.96,,,238.96,33.45,121.87,Fee Schedule,Medicare APC Fee Schedule
PSYCHOTHER 30M W/E&M,90833,CPT,,,,,both,, ,301.75,181.05,Medicare,Medicare,,181.05,,,301.75,42.25,153.89,Fee Schedule,Medicare APC Fee Schedule
PSYCHOTHERAPY 45 MIN,90834,CPT,,,,,both,, ,299.73,179.83,Medicare,Medicare,,179.83,,,299.73,41.96,152.86,Fee Schedule,Medicare APC Fee Schedule
"Psychotherapy, 45 min",90834,CPT,,,,,both,,,299.73,299.73,Medicare,Medicare,,299.73,,,299.73,41.96,152.86,Fee Schedule,Medicare APC Fee Schedule
PSYCHOTHER 45M W/E&M,90836,CPT,,,,,both,, ,312.25,187.35,Medicare,Medicare,,187.35,,,312.25,43.72,159.25,Fee Schedule,Medicare APC Fee Schedule
PSYCHOTHERAPY 60 MIN,90837,CPT,,,,,both,, ,359.73,215.83,Medicare,Medicare,,215.83,,,359.73,50.36,183.46,Fee Schedule,Medicare APC Fee Schedule
"Psychotherapy, 60 min",90837,CPT,,,,,both,,,359.73,359.73,Medicare,Medicare,,359.73,,,359.73,50.36,183.46,Fee Schedule,Medicare APC Fee Schedule
PSYCHOTHER 60M W/E&M,90838,CPT,,,,,both,, ,323.75,194.25,Medicare,Medicare,,194.25,,,323.75,45.33,165.11,Fee Schedule,Medicare APC Fee Schedule
FAM THERAPY W/PATIEN,90847,CPT,,,,,both,, ,842.03,505.21,Medicare,Medicare,,505.21,,,842.03,117.88,429.44,Fee Schedule,Medicare APC Fee Schedule
"Family psychotherapy, including patient, 50 min",90847,CPT,,,,,both,,,842.03,842.03,Medicare,Medicare,,842.03,,,842.03,117.88,429.44,Fee Schedule,Medicare APC Fee Schedule
MULTI-FAM GRP PSYCH,90849,CPT,,,,,both,, ,396.04,237.62,Medicare,Medicare,,237.62,,,396.04,55.45,201.98,Fee Schedule,Medicare APC Fee Schedule
Group psychotherapy,90853,CPT,,,,,both,,,220.94,220.94,Medicare,Medicare,,220.94,,,220.94,30.93,112.68,Fee Schedule,Medicare APC Fee Schedule
PSYCH GROUP THERAPY,90853,CPT,,,,,both,, ,220.94,132.56,Medicare,Medicare,,132.56,,,220.94,30.93,112.68,Fee Schedule,Medicare APC Fee Schedule
PSYCH GROUP THERAPY,90853,CPT,,,,,both,, ,689.33,413.59,Medicare,Medicare,,413.59,,,689.33,96.51,351.56,Fee Schedule,Medicare APC Fee Schedule
MEDICATION MGMT,90863,CPT,,,,,both,, ,294.25,176.55,Medicare,Medicare,,176.55,,,294.25,41.20,150.07,Fee Schedule,Medicare APC Fee Schedule
TMS INITIAL & 1ST TX,90867,CPT,,,,,both,, ,955.84,573.50,Medicare,Medicare,,573.50,,,955.84,133.82,487.48,Fee Schedule,Medicare APC Fee Schedule
TMS SUBSEQUENT TX,90868,CPT,,,,,both,, ,515.04,309.02,Medicare,Medicare,,309.02,,,515.04,72.11,262.67,Fee Schedule,Medicare APC Fee Schedule
TMS REMAPPING & TX,90869,CPT,,,,,both,, ,515.04,309.02,Medicare,Medicare,,309.02,,,515.04,72.11,262.67,Fee Schedule,Medicare APC Fee Schedule
HEMODIALY SING EVAL,90935,CPT,,,,,both,, ,9908.09,5944.85,Medicare,Medicare,,5944.85,,,9908.09,1387.13,5053.13,Fee Schedule,Medicare APC Fee Schedule
OTH DIALY SING EVAL,90945,CPT,,,,,both,, ,4956.88,2974.12,Medicare,Medicare,,2974.12,,,4956.88,693.96,2528.01,Fee Schedule,Medicare APC Fee Schedule
SP AR MCD TRMT 15MIN,92507,CPT,,,,,both,, ,182.25,109.35,Medicare,Medicare,,109.35,,,182.25,25.52,92.95,Fee Schedule,Medicare APC Fee Schedule
SP-HEAR-TX-INDI VIST,92507,CPT,,,,,both,, ,705.29,423.17,Medicare,Medicare,,423.17,,,705.29,98.74,359.7,Fee Schedule,Medicare APC Fee Schedule
SP-HEAR-GROUP-VISIT,92508,CPT,,,,,both,, ,324.19,194.51,Medicare,Medicare,,194.51,,,324.19,45.39,165.34,Fee Schedule,Medicare APC Fee Schedule
EV SP FLUENCY 15,92521,CPT,,,,,both,, ,135.50,81.30,Medicare,Medicare,,81.30,,,135.50,18.97,69.11,Fee Schedule,Medicare APC Fee Schedule
EVAL SPEECH FLUENCY,92521,CPT,,,,,both,, ,814.22,488.53,Medicare,Medicare,,488.53,,,814.22,113.99,415.25,Fee Schedule,Medicare APC Fee Schedule
EV SP PROD 15,92522,CPT,,,,,both,, ,182.25,109.35,Medicare,Medicare,,109.35,,,182.25,25.52,92.95,Fee Schedule,Medicare APC Fee Schedule
EVAL SPEECH SND PROD,92522,CPT,,,,,both,, ,814.22,488.53,Medicare,Medicare,,488.53,,,814.22,113.99,415.25,Fee Schedule,Medicare APC Fee Schedule
EVAL SP SND PROD CMP,92523,CPT,,,,,both,, ,814.22,488.53,Medicare,Medicare,,488.53,,,814.22,113.99,415.25,Fee Schedule,Medicare APC Fee Schedule
SP SOUND LANG CMP 15,92523,CPT,,,,,both,, ,182.25,109.35,Medicare,Medicare,,109.35,,,182.25,25.52,92.95,Fee Schedule,Medicare APC Fee Schedule
BEH QL ANAL VOICE 15,92524,CPT,,,,,both,, ,182.25,109.35,Medicare,Medicare,,109.35,,,182.25,25.52,92.95,Fee Schedule,Medicare APC Fee Schedule
BEHAV QL ANAL VOICE,92524,CPT,,,,,both,, ,814.22,488.53,Medicare,Medicare,,488.53,,,814.22,113.99,415.25,Fee Schedule,Medicare APC Fee Schedule
ORAL FUNC TX-VIS,92526,CPT,,,,,both,, ,705.29,423.17,Medicare,Medicare,,423.17,,,705.29,98.74,359.7,Fee Schedule,Medicare APC Fee Schedule
EVAL VOICE PROS DEV,92597,CPT,,,,,both,, ,390.11,234.06,Medicare,Medicare,,234.06,,,390.11,54.62,198.96,Fee Schedule,Medicare APC Fee Schedule
COCHLE IMP INTIL LT7,92601,CPT,,,,,both,, ,854.90,512.94,Medicare,Medicare,,512.94,,,854.90,119.69,436,Fee Schedule,Medicare APC Fee Schedule
SP-EVAL NSG DEV 1STH,92605,CPT,,,,,both,, ,813.70,488.22,Medicare,Medicare,,488.22,,,813.70,113.92,414.99,Fee Schedule,Medicare APC Fee Schedule
SP-EVAL SP DEV 1STHR,92607,CPT,,,,,both,, ,813.70,488.22,Medicare,Medicare,,488.22,,,813.70,113.92,414.99,Fee Schedule,Medicare APC Fee Schedule
SP-EVAL SP DEV AD30M,92608,CPT,,,,,both,, ,763.23,457.93,Medicare,Medicare,,457.93,,,763.23,106.85,389.25,Fee Schedule,Medicare APC Fee Schedule
SP-THER SVC SPCH DEV,92609,CPT,,,,,both,, ,705.29,423.17,Medicare,Medicare,,423.17,,,705.29,98.74,359.7,Fee Schedule,Medicare APC Fee Schedule
SP-EVAL SWL WO RADOP,92610,CPT,,,,,both,, ,758.08,454.84,Medicare,Medicare,,454.84,,,758.08,106.13,386.62,Fee Schedule,Medicare APC Fee Schedule
SP-EVAL SWL W-RADOPQ,92611,CPT,,,,,both,, ,862.63,517.57,Medicare,Medicare,,517.57,,,862.63,120.77,439.94,Fee Schedule,Medicare APC Fee Schedule
AUD EVOKE HR BRD STM,92651,CPT,,,,,both,, ,567.79,340.67,Medicare,Medicare,,340.67,,,567.79,79.49,289.57,Fee Schedule,Medicare APC Fee Schedule
"IC-PTCA, SINGLE",92920,CPT,,,,,both,, ,65091.11,39054.66,Medicare,Medicare,,39054.66,,,65091.11,9112.76,33196.47,Fee Schedule,Medicare APC Fee Schedule
"IC-PTCA, ADDL",92921,CPT,,,,,both,, ,65091.11,39054.66,Medicare,Medicare,,39054.66,,,65091.11,9112.76,33196.47,Fee Schedule,Medicare APC Fee Schedule
IC-PRQ CRD STN W-ANG,92928,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,53231.43,,,88719.05,12420.67,45246.72,Fee Schedule,Medicare APC Fee Schedule
IC-PRQ STNT W-ANG EA,92929,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,53231.43,,,88719.05,12420.67,45246.72,Fee Schedule,Medicare APC Fee Schedule
IC-PRQ CRD ST-AT-ANG,92933,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,53231.43,,,88719.05,12420.67,45246.72,Fee Schedule,Medicare APC Fee Schedule
IC-PRQ ST-AT-ANG EA,92934,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,53231.43,,,88719.05,12420.67,45246.72,Fee Schedule,Medicare APC Fee Schedule
IC-PRQ RV BYP GRF IN,92937,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,53231.43,,,88719.05,12420.67,45246.72,Fee Schedule,Medicare APC Fee Schedule
IC-PRQ RV BYP GRF AD,92938,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,53231.43,,,88719.05,12420.67,45246.72,Fee Schedule,Medicare APC Fee Schedule
IC-PRQ CARD REV 1 VS,92941,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,53231.43,,,88719.05,12420.67,45246.72,Fee Schedule,Medicare APC Fee Schedule
IC-PRQ REVSC CHR 1VS,92943,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,53231.43,,,88719.05,12420.67,45246.72,Fee Schedule,Medicare APC Fee Schedule
IC-PRQ REVSC CHR ADD,92944,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,53231.43,,,88719.05,12420.67,45246.72,Fee Schedule,Medicare APC Fee Schedule
CPR,92950,CPT,,,,,both,, ,382.90,229.74,Medicare,Medicare,,229.74,,,382.90,53.61,195.28,Fee Schedule,Medicare APC Fee Schedule
CPR,92950,CPT,,,,,both,, ,382.90,229.74,Medicare,Medicare,,229.74,,,382.90,53.61,195.28,Fee Schedule,Medicare APC Fee Schedule
CPR,92950,CPT,,,,,both,, ,6031.42,3618.85,Medicare,Medicare,,3618.85,,,6031.42,844.40,3076.02,Fee Schedule,Medicare APC Fee Schedule
CPR ASSIST (NON ER),92950,CPT,,,,,both,, ,5533.42,3320.05,Medicare,Medicare,,3320.05,,,5533.42,774.68,2822.04,Fee Schedule,Medicare APC Fee Schedule
NI-TEMP EXT PACE,92953,CPT,,,,,both,, ,4462.48,2677.48,Medicare,Medicare,,2677.48,,,4462.48,624.75,2275.86,Fee Schedule,Medicare APC Fee Schedule
NI-TEMP EXT PACE,92953,CPT,,,,,both,, ,4864.09,2918.45,Medicare,Medicare,,2918.45,,,4864.09,680.97,2480.69,Fee Schedule,Medicare APC Fee Schedule
NI-CARDIOVERSION,92960,CPT,,,,,both,, ,4603.59,2762.15,Medicare,Medicare,,2762.15,,,4603.59,644.50,2347.83,Fee Schedule,Medicare APC Fee Schedule
NI-CARDIOVERSION,92960,CPT,,,,,both,, ,5017.90,3010.74,Medicare,Medicare,,3010.74,,,5017.90,702.51,2559.13,Fee Schedule,Medicare APC Fee Schedule
"EP-CARDIOVER,INTERN",92961,CPT,,,,,both,, ,2378.01,1426.80,Medicare,Medicare,,1426.80,,,2378.01,332.92,1212.79,Fee Schedule,Medicare APC Fee Schedule
IC-COR THROMBECTOMY,92973,CPT,,,,,both,, ,29086.43,17451.85,Medicare,Medicare,,17451.85,,,29086.43,4072.10,14834.08,Fee Schedule,Medicare APC Fee Schedule
CC-INTRACOR THROMBO,92975,CPT,,,,,both,, ,18741.62,11244.97,Medicare,Medicare,,11244.97,,,18741.62,2623.83,9558.23,Fee Schedule,Medicare APC Fee Schedule
CC-INTRACOR THROMBO,92975,CPT,,,,,both,, ,18741.62,11244.97,Medicare,Medicare,,11244.97,,,18741.62,2623.83,9558.23,Fee Schedule,Medicare APC Fee Schedule
"THROMBOLY,CORONRY,IV",92977,CPT,,,,,both,, ,4033.02,2419.81,Medicare,Medicare,,2419.81,,,4033.02,564.62,2056.84,Fee Schedule,Medicare APC Fee Schedule
"IC-IVUS, INIT",92978,CPT,,,,,both,, ,537.92,322.75,Medicare,Medicare,,322.75,,,537.92,75.31,274.34,Fee Schedule,Medicare APC Fee Schedule
"IC-IVUS, ADDL",92979,CPT,,,,,both,, ,433.89,260.33,Medicare,Medicare,,260.33,,,433.89,60.74,221.28,Fee Schedule,Medicare APC Fee Schedule
EKG 12 LEAD ED STAFF,93005,CPT,,,,,both,, ,1530.84,918.50,Medicare,Medicare,,918.50,,,1530.84,214.32,780.73,Fee Schedule,Medicare APC Fee Schedule
EKG 12 LEAD UC STAFF,93005,CPT,,,,,both,, ,65.15,39.09,Medicare,Medicare,,39.09,,,65.15,9.12,33.23,Fee Schedule,Medicare APC Fee Schedule
EKG 12 LEAD UC STAFF,93005,CPT,,,,,both,, ,65.15,39.09,Medicare,Medicare,,39.09,,,65.15,9.12,33.23,Fee Schedule,Medicare APC Fee Schedule
"NI-EKG, 12 LEADS",93005,CPT,,,,,both,, ,714.82,428.89,Medicare,Medicare,,428.89,,,714.82,100.07,364.56,Fee Schedule,Medicare APC Fee Schedule
NI-STRESS TEST,93017,CPT,,,,,both,, ,5189.40,3113.64,Medicare,Medicare,,3113.64,,,5189.40,726.52,2646.59,Fee Schedule,Medicare APC Fee Schedule
EP-MICROVOLT T,93025,CPT,,,,,both,, ,1128.62,677.17,Medicare,Medicare,,677.17,,,1128.62,158.01,575.6,Fee Schedule,Medicare APC Fee Schedule
"NI-EKG, 1-3 LEADS",93041,CPT,,,,,both,, ,1999.49,1199.69,Medicare,Medicare,,1199.69,,,1999.49,279.93,1019.74,Fee Schedule,Medicare APC Fee Schedule
NI-HOLT RECRD TO48HR,93225,CPT,,,,,both,, ,9701.06,5820.63,Medicare,Medicare,,5820.63,,,9701.06,1358.15,4947.54,Fee Schedule,Medicare APC Fee Schedule
NI-HOLT WSCAN TO48HR,93226,CPT,,,,,both,, ,1596.24,957.74,Medicare,Medicare,,957.74,,,1596.24,223.47,814.08,Fee Schedule,Medicare APC Fee Schedule
NI-TTE 2D W DOPP,93306,CPT,,,,,both,, ,12135.98,7281.58,Medicare,Medicare,,7281.58,,,12135.98,1699.04,6189.35,Fee Schedule,Medicare APC Fee Schedule
NI-TTE 2D MM COMP WO,93307,CPT,,,,,both,, ,8910.27,5346.16,Medicare,Medicare,,5346.16,,,8910.27,1247.44,4544.24,Fee Schedule,Medicare APC Fee Schedule
NI-TTE 2D MM LTD WO,93308,CPT,,,,,both,, ,4522.73,2713.63,Medicare,Medicare,,2713.63,,,4522.73,633.18,2306.59,Fee Schedule,Medicare APC Fee Schedule
NI-TEE COMP 2D MM WO,93312,CPT,,,,,both,, ,9011.21,5406.72,Medicare,Medicare,,5406.72,,,9011.21,1261.57,4595.72,Fee Schedule,Medicare APC Fee Schedule
US-ECHO DOPP COMP AD,93320,CPT,,,,,both,, ,1635.90,981.54,Medicare,Medicare,,981.54,,,1635.90,229.03,834.31,Fee Schedule,Medicare APC Fee Schedule
NI-ECHO DOP LTD,93321,CPT,,,,,both,, ,541.78,325.06,Medicare,Medicare,,325.06,,,541.78,75.85,276.31,Fee Schedule,Medicare APC Fee Schedule
US-ECHO DOP CO FL AD,93325,CPT,,,,,both,, ,616.46,369.87,Medicare,Medicare,,369.87,,,616.46,86.30,314.39,Fee Schedule,Medicare APC Fee Schedule
US-TTE STRESS WO,93350,CPT,,,,,both,, ,6350.21,3810.12,Medicare,Medicare,,3810.12,,,6350.21,889.03,3238.61,Fee Schedule,Medicare APC Fee Schedule
CC-RHC,93451,CPT,,,,,both,, ,39597.32,23758.39,Medicare,Medicare,,23758.39,,,39597.32,5543.62,20194.63,Fee Schedule,Medicare APC Fee Schedule
CC-LHC VENT PUNC,93452,CPT,,,,,both,, ,43345.75,26007.45,Medicare,Medicare,,26007.45,,,43345.75,6068.41,22106.33,Fee Schedule,Medicare APC Fee Schedule
Insertion of catheter into left heart for diagnosis,93452,CPT,,,,,both,,,43345.75,43345.75,Medicare,Medicare,,43345.75,,,43345.75,6068.41,22106.33,Fee Schedule,Medicare APC Fee Schedule
CC-R-L CATH LV PUNC,93453,CPT,,,,,both,, ,43345.75,26007.45,Medicare,Medicare,,26007.45,,,43345.75,6068.41,22106.33,Fee Schedule,Medicare APC Fee Schedule
CC-ANGIO CORON ONLY,93454,CPT,,,,,both,, ,34667.23,20800.33,Medicare,Medicare,,20800.33,,,34667.23,4853.41,17680.29,Fee Schedule,Medicare APC Fee Schedule
CC-S-I VNT ATR ANGIO,93455,CPT,,,,,both,, ,36140.38,21684.22,Medicare,Medicare,,21684.22,,,36140.38,5059.65,18431.59,Fee Schedule,Medicare APC Fee Schedule
CC-R HRT CORONRY ART,93456,CPT,,,,,both,, ,74264.29,44558.57,Medicare,Medicare,,44558.57,,,74264.29,10397.00,37874.79,Fee Schedule,Medicare APC Fee Schedule
CC-R HRT ART-GRF ANG,93457,CPT,,,,,both,, ,75737.70,45442.62,Medicare,Medicare,,45442.62,,,75737.70,10603.28,38626.23,Fee Schedule,Medicare APC Fee Schedule
CC-L HRT ARTERY-VENT,93458,CPT,,,,,both,, ,49262.84,29557.70,Medicare,Medicare,,29557.70,,,49262.84,6896.80,25124.05,Fee Schedule,Medicare APC Fee Schedule
CC-L HRT ART-GRF ANG,93459,CPT,,,,,both,, ,50736.00,30441.60,Medicare,Medicare,,30441.60,,,50736.00,7103.04,25875.36,Fee Schedule,Medicare APC Fee Schedule
CC-R-L HRT ART-VENT,93460,CPT,,,,,both,, ,49262.84,29557.70,Medicare,Medicare,,29557.70,,,49262.84,6896.80,25124.05,Fee Schedule,Medicare APC Fee Schedule
CC-R-L HRT ART-ANGIO,93461,CPT,,,,,both,, ,50736.00,30441.60,Medicare,Medicare,,30441.60,,,50736.00,7103.04,25875.36,Fee Schedule,Medicare APC Fee Schedule
CC-DRUM ADM-HEMODYNC,93463,CPT,,,,,both,, ,451.91,271.14,Medicare,Medicare,,271.14,,,451.91,63.27,230.47,Fee Schedule,Medicare APC Fee Schedule
INSERTION FLOW CATH,93503,CPT,,,,,both,, ,13163.66,7898.19,Medicare,Medicare,,7898.19,,,13163.66,1842.91,6713.47,Fee Schedule,Medicare APC Fee Schedule
CC-INJ L VENT-ATRIAL,93565,CPT,,,,,both,, ,3748.43,2249.05,Medicare,Medicare,,2249.05,,,3748.43,524.78,1911.7,Fee Schedule,Medicare APC Fee Schedule
CC-INJ R VENT-ATRIAL,93566,CPT,,,,,both,, ,3252.48,1951.48,Medicare,Medicare,,1951.48,,,3252.48,455.35,1658.76,Fee Schedule,Medicare APC Fee Schedule
CC-INJ SUPRV AORTOGR,93567,CPT,,,,,both,, ,5119.62,3071.77,Medicare,Medicare,,3071.77,,,5119.62,716.75,2611.01,Fee Schedule,Medicare APC Fee Schedule
CC-INJ PULM ART HRTC,93568,CPT,,,,,both,, ,5119.62,3071.77,Medicare,Medicare,,3071.77,,,5119.62,716.75,2611.01,Fee Schedule,Medicare APC Fee Schedule
HEART FLOW MEASURE,93571,CPT,,,,,both,, ,709.67,425.80,Medicare,Medicare,,425.80,,,709.67,99.35,361.93,Fee Schedule,Medicare APC Fee Schedule
HEART FLOW MEAS ADD,93572,CPT,,,,,both,, ,709.67,425.80,Medicare,Medicare,,425.80,,,709.67,99.35,361.93,Fee Schedule,Medicare APC Fee Schedule
CC-PDA CLOSE PERC,93582,CPT,,,,,both,, ,68501.18,41100.70,Medicare,Medicare,,41100.70,,,68501.18,9590.17,34935.6,Fee Schedule,Medicare APC Fee Schedule
EP-HIS BUNDLE REC,93600,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,2802.32,,,4670.54,653.88,2381.98,Fee Schedule,Medicare APC Fee Schedule
EP-INTRAATRIAL REC,93602,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,2802.32,,,4670.54,653.88,2381.98,Fee Schedule,Medicare APC Fee Schedule
EP-RV RECORD,93603,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,2802.32,,,4670.54,653.88,2381.98,Fee Schedule,Medicare APC Fee Schedule
EP-MAP TACHY,93609,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,2802.32,,,4670.54,653.88,2381.98,Fee Schedule,Medicare APC Fee Schedule
EP-INTRAATRIAL PAC,93610,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,2802.32,,,4670.54,653.88,2381.98,Fee Schedule,Medicare APC Fee Schedule
EP-INTRAVENT PAC,93612,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,2802.32,,,4670.54,653.88,2381.98,Fee Schedule,Medicare APC Fee Schedule
EP-MAP ADD,93613,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,2802.32,,,4670.54,653.88,2381.98,Fee Schedule,Medicare APC Fee Schedule
EP-ATRI RECORD ESO,93615,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,2802.32,,,4670.54,653.88,2381.98,Fee Schedule,Medicare APC Fee Schedule
EP-ATRI REC-PAC ESO,93616,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,2802.32,,,4670.54,653.88,2381.98,Fee Schedule,Medicare APC Fee Schedule
EP-INDUC ARRY PAC,93618,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,2802.32,,,4670.54,653.88,2381.98,Fee Schedule,Medicare APC Fee Schedule
EP-COMP EP W-O ARRY,93619,CPT,,,,,both,, ,22625.50,13575.30,Medicare,Medicare,,13575.30,,,22625.50,3167.57,11539.01,Fee Schedule,Medicare APC Fee Schedule
EP-COMP EP W- ARRY,93620,CPT,,,,,both,, ,22625.50,13575.30,Medicare,Medicare,,13575.30,,,22625.50,3167.57,11539.01,Fee Schedule,Medicare APC Fee Schedule
"EP-LA PACING, ADD",93621,CPT,,,,,both,, ,22625.50,13575.30,Medicare,Medicare,,13575.30,,,22625.50,3167.57,11539.01,Fee Schedule,Medicare APC Fee Schedule
"EP-LV PACING, ADD",93622,CPT,,,,,both,, ,22625.50,13575.30,Medicare,Medicare,,13575.30,,,22625.50,3167.57,11539.01,Fee Schedule,Medicare APC Fee Schedule
EP-PROG STIM IV DRUG,93623,CPT,,,,,both,, ,22625.50,13575.30,Medicare,Medicare,,13575.30,,,22625.50,3167.57,11539.01,Fee Schedule,Medicare APC Fee Schedule
EP-F-U EPW-ARRY IND,93624,CPT,,,,,both,, ,22625.50,13575.30,Medicare,Medicare,,13575.30,,,22625.50,3167.57,11539.01,Fee Schedule,Medicare APC Fee Schedule
EP-INTRA OP MAPPNG,93631,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,2802.32,,,4670.54,653.88,2381.98,Fee Schedule,Medicare APC Fee Schedule
"EP-EVAL LEAD,INDUC",93640,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,2802.32,,,4670.54,653.88,2381.98,Fee Schedule,Medicare APC Fee Schedule
"EP-EVAL GEN, INDUC",93641,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,2802.32,,,4670.54,653.88,2381.98,Fee Schedule,Medicare APC Fee Schedule
EP-EVAL PREV DEVICE,93642,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,2802.32,,,4670.54,653.88,2381.98,Fee Schedule,Medicare APC Fee Schedule
EP-ABLATE AV NODE,93650,CPT,,,,,both,, ,22625.50,13575.30,Medicare,Medicare,,13575.30,,,22625.50,3167.57,11539.01,Fee Schedule,Medicare APC Fee Schedule
EP-ABLATE SPRVNT ART,93653,CPT,,,,,both,, ,46220.99,27732.59,Medicare,Medicare,,27732.59,,,46220.99,6470.94,23572.7,Fee Schedule,Medicare APC Fee Schedule
EP-ABLATE VENT TACY,93654,CPT,,,,,both,, ,46220.99,27732.59,Medicare,Medicare,,27732.59,,,46220.99,6470.94,23572.7,Fee Schedule,Medicare APC Fee Schedule
EP-ATR FIB PULM VN I,93656,CPT,,,,,both,, ,46220.99,27732.59,Medicare,Medicare,,27732.59,,,46220.99,6470.94,23572.7,Fee Schedule,Medicare APC Fee Schedule
EP-INTCRD ECHO INTER,93662,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,2802.32,,,4670.54,653.88,2381.98,Fee Schedule,Medicare APC Fee Schedule
PAD REHB PER SESSION,93668,CPT,,,,,both,, ,169.18,101.50,Medicare,Medicare,,101.50,,,169.18,23.69,86.28,Fee Schedule,Medicare APC Fee Schedule
NI-CARD REHAB W-O MO,93797,CPT,,,,,both,, ,193.64,116.18,Medicare,Medicare,,116.18,,,193.64,27.11,98.76,Fee Schedule,Medicare APC Fee Schedule
NI-CARDI REHAB W- MO,93798,CPT,,,,,both,, ,296.38,177.82,Medicare,Medicare,,177.82,,,296.38,41.49,151.15,Fee Schedule,Medicare APC Fee Schedule
US-CAROTID DPLX SCAN,93880,CPT,,,,,both,, ,425.13,255.07,Medicare,Medicare,,255.07,,,425.13,59.52,216.82,Fee Schedule,Medicare APC Fee Schedule
US-CAROTID DPLX SCAN,93880,CPT,,,,,both,, ,457.58,274.54,Medicare,Medicare,,274.54,,,457.58,64.06,233.37,Fee Schedule,Medicare APC Fee Schedule
US-CRAN DPLX SCN BIL,93880,CPT,,,,,both,, ,12714.32,7628.59,Medicare,Medicare,,7628.59,,,12714.32,1780.00,6484.3,Fee Schedule,Medicare APC Fee Schedule
US-CAROTID DUP DOPLR,93882,CPT,,,,,both,, ,425.13,255.07,Medicare,Medicare,,255.07,,,425.13,59.52,216.82,Fee Schedule,Medicare APC Fee Schedule
US-CAROTID DUP DOPLR,93882,CPT,,,,,both,, ,457.58,274.54,Medicare,Medicare,,274.54,,,457.58,64.06,233.37,Fee Schedule,Medicare APC Fee Schedule
NI-EXT ARTERIAL LTD,93922,CPT,,,,,both,, ,2456.29,1473.77,Medicare,Medicare,,1473.77,,,2456.29,343.88,1252.71,Fee Schedule,Medicare APC Fee Schedule
US-EXT ARTERIAL LTD,93922,CPT,,,,,both,, ,167.38,100.42,Medicare,Medicare,,100.42,,,167.38,23.43,85.36,Fee Schedule,Medicare APC Fee Schedule
NI-EXT ARTERIAL COMP,93923,CPT,,,,,both,, ,3819.24,2291.54,Medicare,Medicare,,2291.54,,,3819.24,534.69,1947.81,Fee Schedule,Medicare APC Fee Schedule
US-NON INV ARTER EXT,93923,CPT,,,,,both,, ,268.32,160.99,Medicare,Medicare,,160.99,,,268.32,37.56,136.84,Fee Schedule,Medicare APC Fee Schedule
NI-STD LE STRS REST,93924,CPT,,,,,both,, ,5693.84,3416.30,Medicare,Medicare,,3416.30,,,5693.84,797.14,2903.86,Fee Schedule,Medicare APC Fee Schedule
NI-LW EXT DPX ART BI,93925,CPT,,,,,both,, ,5086.40,3051.84,Medicare,Medicare,,3051.84,,,5086.40,712.10,2594.06,Fee Schedule,Medicare APC Fee Schedule
NI-LW EXT DPX ART UN,93926,CPT,,,,,both,, ,2541.53,1524.91,Medicare,Medicare,,1524.91,,,2541.53,355.81,1296.18,Fee Schedule,Medicare APC Fee Schedule
US-LW EXT DPX ART UN,93926,CPT,,,,,both,, ,1560.19,936.11,Medicare,Medicare,,936.11,,,1560.19,218.43,795.7,Fee Schedule,Medicare APC Fee Schedule
NI-UP EXT DPX ART BI,93930,CPT,,,,,both,, ,5083.05,3049.83,Medicare,Medicare,,3049.83,,,5083.05,711.63,2592.36,Fee Schedule,Medicare APC Fee Schedule
NI-UP EXT DPX ART UN,93931,CPT,,,,,both,, ,2541.53,1524.91,Medicare,Medicare,,1524.91,,,2541.53,355.81,1296.18,Fee Schedule,Medicare APC Fee Schedule
US-UP EXT DPX ART UN,93931,CPT,,,,,both,, ,2026.01,1215.60,Medicare,Medicare,,1215.60,,,2026.01,283.64,1033.27,Fee Schedule,Medicare APC Fee Schedule
NI-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,5086.40,3051.84,Medicare,Medicare,,3051.84,,,5086.40,712.10,2594.06,Fee Schedule,Medicare APC Fee Schedule
US-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,425.13,255.07,Medicare,Medicare,,255.07,,,425.13,59.52,216.82,Fee Schedule,Medicare APC Fee Schedule
US-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,457.58,274.54,Medicare,Medicare,,274.54,,,457.58,64.06,233.37,Fee Schedule,Medicare APC Fee Schedule
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,299.73,179.83,Medicare,Medicare,,179.83,,,299.73,41.96,152.86,Fee Schedule,Medicare APC Fee Schedule
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,322.65,193.59,Medicare,Medicare,,193.59,,,322.65,45.17,164.55,Fee Schedule,Medicare APC Fee Schedule
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,2541.53,1524.91,Medicare,Medicare,,1524.91,,,2541.53,355.81,1296.18,Fee Schedule,Medicare APC Fee Schedule
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,425.13,255.07,Medicare,Medicare,,255.07,,,425.13,59.52,216.82,Fee Schedule,Medicare APC Fee Schedule
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,457.58,274.54,Medicare,Medicare,,274.54,,,457.58,64.06,233.37,Fee Schedule,Medicare APC Fee Schedule
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,823.23,493.93,Medicare,Medicare,,493.93,,,823.23,115.25,419.85,Fee Schedule,Medicare APC Fee Schedule
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,425.13,255.07,Medicare,Medicare,,255.07,,,425.13,59.52,216.82,Fee Schedule,Medicare APC Fee Schedule
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,457.58,274.54,Medicare,Medicare,,274.54,,,457.58,64.06,233.37,Fee Schedule,Medicare APC Fee Schedule
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,828.89,497.33,Medicare,Medicare,,497.33,,,828.89,116.04,422.73,Fee Schedule,Medicare APC Fee Schedule
US-DPLXSCN GRFT ARTA,93978,CPT,,,,,both,, ,1665.51,999.30,Medicare,Medicare,,999.30,,,1665.51,233.17,849.41,Fee Schedule,Medicare APC Fee Schedule
NI-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,1292.14,775.28,Medicare,Medicare,,775.28,,,1292.14,180.90,658.99,Fee Schedule,Medicare APC Fee Schedule
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,425.13,255.07,Medicare,Medicare,,255.07,,,425.13,59.52,216.82,Fee Schedule,Medicare APC Fee Schedule
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,457.58,274.54,Medicare,Medicare,,274.54,,,457.58,64.06,233.37,Fee Schedule,Medicare APC Fee Schedule
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,841.51,504.90,Medicare,Medicare,,504.90,,,841.51,117.81,429.17,Fee Schedule,Medicare APC Fee Schedule
VESS MAP HEMO ACC BI,93985,CPT,,,,,both,, ,977.58,586.54,Medicare,Medicare,,586.54,,,977.58,136.86,498.57,Fee Schedule,Medicare APC Fee Schedule
VESS MAP HEMO ACC UN,93986,CPT,,,,,both,, ,977.58,586.54,Medicare,Medicare,,586.54,,,977.58,136.86,498.57,Fee Schedule,Medicare APC Fee Schedule
NI-DUPSCN HEMODIAL,93990,CPT,,,,,both,, ,4623.93,2774.35,Medicare,Medicare,,2774.35,,,4623.93,647.35,2358.2,Fee Schedule,Medicare APC Fee Schedule
MECH VENT INITIAL,94002,CPT,,,,,both,, ,4971.30,2982.78,Medicare,Medicare,,2982.78,,,4971.30,695.98,2535.36,Fee Schedule,Medicare APC Fee Schedule
MECH VENT DAILY SUBS,94003,CPT,,,,,both,, ,4971.30,2982.78,Medicare,Medicare,,2982.78,,,4971.30,695.98,2535.36,Fee Schedule,Medicare APC Fee Schedule
SPIROMETRY,94010,CPT,,,,,both,, ,530.45,318.27,Medicare,Medicare,,318.27,,,530.45,74.26,270.53,Fee Schedule,Medicare APC Fee Schedule
BRONCHO EVAL PRE/PST,94060,CPT,,,,,both,, ,2361.28,1416.76,Medicare,Medicare,,1416.76,,,2361.28,330.58,1204.25,Fee Schedule,Medicare APC Fee Schedule
METHACHOLINE CHALLEN,94070,CPT,,,,,both,, ,961.51,576.90,Medicare,Medicare,,576.90,,,961.51,134.61,490.37,Fee Schedule,Medicare APC Fee Schedule
MAXIMUM VOLUNTARY VE,94200,CPT,,,,,both,, ,306.94,184.16,Medicare,Medicare,,184.16,,,306.94,42.97,156.54,Fee Schedule,Medicare APC Fee Schedule
HAST WITH 02 TITRATE,94453,CPT,,,,,both,, ,1089.74,653.84,Medicare,Medicare,,653.84,,,1089.74,152.56,555.77,Fee Schedule,Medicare APC Fee Schedule
PULM STRESS SIMPLE,94618,CPT,,,,,both,, ,459.12,275.47,Medicare,Medicare,,275.47,,,459.12,64.28,234.15,Fee Schedule,Medicare APC Fee Schedule
PULM REHAB WO OXIMET,94625,CPT,,,,,both,, ,227.40,136.44,Medicare,Medicare,,136.44,,,227.40,31.84,115.97,Fee Schedule,Medicare APC Fee Schedule
PULM REHAB W OXIMET,94626,CPT,,,,,both,, ,227.40,136.44,Medicare,Medicare,,136.44,,,227.40,31.84,115.97,Fee Schedule,Medicare APC Fee Schedule
INHALATION TRTMT INI,94640,CPT,,,,,both,, ,569.50,341.70,Medicare,Medicare,,341.70,,,569.50,79.73,290.45,Fee Schedule,Medicare APC Fee Schedule
INHALATION TRTMT INI,94640,CPT,,,,,both,, ,586.59,351.95,Medicare,Medicare,,351.95,,,586.59,82.12,299.16,Fee Schedule,Medicare APC Fee Schedule
INHALATION TRTMT SUB,94640,CPT,,,,,both,, ,691.75,415.05,Medicare,Medicare,,415.05,,,691.75,96.85,352.79,Fee Schedule,Medicare APC Fee Schedule
INHALATION TRTMT SUB,94640,CPT,,,,,both,, ,712.50,427.50,Medicare,Medicare,,427.50,,,712.50,99.75,363.38,Fee Schedule,Medicare APC Fee Schedule
PENTAMIDINE ARSL INH,94642,CPT,,,,,both,, ,1061.67,637.00,Medicare,Medicare,,637.00,,,1061.67,148.63,541.45,Fee Schedule,Medicare APC Fee Schedule
AEROSOL OBSTRUCT 1HR,94644,CPT,,,,,both,, ,719.71,431.82,Medicare,Medicare,,431.82,,,719.71,100.76,367.05,Fee Schedule,Medicare APC Fee Schedule
CONT INH TX ED 1HR,94644,CPT,,,,,both,, ,698.75,419.25,Medicare,Medicare,,419.25,,,698.75,97.83,356.36,Fee Schedule,Medicare APC Fee Schedule
AEROSOL OBSTR ADD HR,94645,CPT,,,,,both,, ,719.71,431.82,Medicare,Medicare,,431.82,,,719.71,100.76,367.05,Fee Schedule,Medicare APC Fee Schedule
CONT INH TX ED AD HR,94645,CPT,,,,,both,, ,698.75,419.25,Medicare,Medicare,,419.25,,,698.75,97.83,356.36,Fee Schedule,Medicare APC Fee Schedule
BIPAP/CPAP,94660,CPT,,,,,both,, ,2771.47,1662.88,Medicare,Medicare,,1662.88,,,2771.47,388.01,1413.45,Fee Schedule,Medicare APC Fee Schedule
EVAL-DEMO INHL DEVCE,94664,CPT,,,,,both,, ,342.73,205.63,Medicare,Medicare,,205.63,,,342.73,47.98,174.79,Fee Schedule,Medicare APC Fee Schedule
MANIP CHST WALL INIT,94667,CPT,,,,,both,, ,1191.45,714.87,Medicare,Medicare,,714.87,,,1191.45,166.80,607.64,Fee Schedule,Medicare APC Fee Schedule
MANIP CHST WALL SBSQ,94668,CPT,,,,,both,, ,975.15,585.09,Medicare,Medicare,,585.09,,,975.15,136.52,497.33,Fee Schedule,Medicare APC Fee Schedule
MECHAN CHST WALL OSC,94669,CPT,,,,,both,, ,210.89,126.53,Medicare,Medicare,,126.53,,,210.89,29.52,107.55,Fee Schedule,Medicare APC Fee Schedule
PF TST PLETHYSMOGRA,94726,CPT,,,,,both,, ,548.73,329.23,Medicare,Medicare,,329.23,,,548.73,76.82,279.85,Fee Schedule,Medicare APC Fee Schedule
PF TEST BY GAS,94727,CPT,,,,,both,, ,548.73,329.23,Medicare,Medicare,,329.23,,,548.73,76.82,279.85,Fee Schedule,Medicare APC Fee Schedule
PF TEST OSCILLOMETRY,94728,CPT,,,,,both,, ,548.73,329.23,Medicare,Medicare,,329.23,,,548.73,76.82,279.85,Fee Schedule,Medicare APC Fee Schedule
CO2-MEMBANE DIFF CAP,94729,CPT,,,,,both,, ,2800.31,1680.18,Medicare,Medicare,,1680.18,,,2800.31,392.04,1428.16,Fee Schedule,Medicare APC Fee Schedule
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309.00,185.40,Medicare,Medicare,,185.40,,,309.00,43.26,157.59,Fee Schedule,Medicare APC Fee Schedule
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309.00,185.40,Medicare,Medicare,,185.40,,,309.00,43.26,157.59,Fee Schedule,Medicare APC Fee Schedule
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309.00,185.40,Medicare,Medicare,,185.40,,,309.00,43.26,157.59,Fee Schedule,Medicare APC Fee Schedule
PULSE OX MULTI/EXERC,94761,CPT,,,,,both,, ,797.48,478.48,Medicare,Medicare,,478.48,,,797.48,111.65,406.71,Fee Schedule,Medicare APC Fee Schedule
PULSE OX MULTI/EXERC,94761,CPT,,,,,both,, ,797.48,478.48,Medicare,Medicare,,478.48,,,797.48,111.65,406.71,Fee Schedule,Medicare APC Fee Schedule
PULSE OX CONTINUOS,94762,CPT,,,,,both,, ,388.00,232.80,Medicare,Medicare,,232.80,,,388.00,54.32,197.88,Fee Schedule,Medicare APC Fee Schedule
PULSE OX OVERNIGHT,94762,CPT,,,,,both,, ,468.91,281.34,Medicare,Medicare,,281.34,,,468.91,65.65,239.14,Fee Schedule,Medicare APC Fee Schedule
PULSE OX OVERNIGHT,94762,CPT,,,,,both,, ,468.91,281.34,Medicare,Medicare,,281.34,,,468.91,65.65,239.14,Fee Schedule,Medicare APC Fee Schedule
CAR SEAT BED TST 60M,94780,CPT,,,,,both,, ,118.19,70.91,Medicare,Medicare,,70.91,,,118.19,16.55,60.28,Fee Schedule,Medicare APC Fee Schedule
CAR SE-BED TST AD 30,94781,CPT,,,,,both,, ,58.97,35.38,Medicare,Medicare,,35.38,,,58.97,8.26,30.07,Fee Schedule,Medicare APC Fee Schedule
ALLERGY INJ SIM,95115,CPT,,,,,both,, ,70.56,42.33,Medicare,Medicare,,42.33,,,70.56,9.88,35.99,Fee Schedule,Medicare APC Fee Schedule
ALLERGY INJ SIM,95115,CPT,,,,,both,, ,70.81,42.48,Medicare,Medicare,,42.48,,,70.81,9.91,36.11,Fee Schedule,Medicare APC Fee Schedule
ALLERGY INJ MUL,95117,CPT,,,,,both,, ,70.56,42.33,Medicare,Medicare,,42.33,,,70.56,9.88,35.99,Fee Schedule,Medicare APC Fee Schedule
ALLERGY INJ MUL,95117,CPT,,,,,both,, ,70.81,42.48,Medicare,Medicare,,42.48,,,70.81,9.91,36.11,Fee Schedule,Medicare APC Fee Schedule
POLYSOMNO GT4 LT6YO,95782,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,1542.52,,,2570.88,359.92,1311.15,Fee Schedule,Medicare APC Fee Schedule
POLYSOMNO GT4 LT6YO,95782,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,1542.52,,,2570.88,359.92,1311.15,Fee Schedule,Medicare APC Fee Schedule
POLYS-CPAP GT4 LT6YO,95783,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,1542.52,,,2570.88,359.92,1311.15,Fee Schedule,Medicare APC Fee Schedule
POLYS-CPAP GT4 LT6YO,95783,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,1542.52,,,2570.88,359.92,1311.15,Fee Schedule,Medicare APC Fee Schedule
SLPSTDY UNATT AN-ST,95800,CPT,,,,,both,, ,428.48,257.08,Medicare,Medicare,,257.08,,,428.48,59.99,218.52,Fee Schedule,Medicare APC Fee Schedule
SLPSTDY UNATT AN-ST,95800,CPT,,,,,both,, ,625.00,375.00,Medicare,Medicare,,375.00,,,625.00,87.50,318.75,Fee Schedule,Medicare APC Fee Schedule
MULTI SLEEP LAT,95805,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,1542.52,,,2570.88,359.92,1311.15,Fee Schedule,Medicare APC Fee Schedule
MULTI SLEEP LAT,95805,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,1542.52,,,2570.88,359.92,1311.15,Fee Schedule,Medicare APC Fee Schedule
SLPSTDY UNATT RS EFF,95806,CPT,,,,,both,, ,428.48,257.08,Medicare,Medicare,,257.08,,,428.48,59.99,218.52,Fee Schedule,Medicare APC Fee Schedule
SLPSTDY UNATT RS EFF,95806,CPT,,,,,both,, ,625.00,375.00,Medicare,Medicare,,375.00,,,625.00,87.50,318.75,Fee Schedule,Medicare APC Fee Schedule
POLYSOMNO GT4 GE6YO,95810,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,1542.52,,,2570.88,359.92,1311.15,Fee Schedule,Medicare APC Fee Schedule
POLYSOMNO GT4 GE6YO,95810,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,1542.52,,,2570.88,359.92,1311.15,Fee Schedule,Medicare APC Fee Schedule
Sleep study,95810,CPT,,,,,both,,,2570.88,2570.88,Medicare,Medicare,,2570.88,,,2570.88,359.92,1311.15,Fee Schedule,Medicare APC Fee Schedule
POLYS-CPAP GT4 GE6YO,95811,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,1542.52,,,2570.88,359.92,1311.15,Fee Schedule,Medicare APC Fee Schedule
POLYS-CPAP GT4 GE6YO,95811,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,1542.52,,,2570.88,359.92,1311.15,Fee Schedule,Medicare APC Fee Schedule
EEG 41-60 MIN,95812,CPT,,,,,both,, ,1075.58,645.34,Medicare,Medicare,,645.34,,,1075.58,150.58,548.55,Fee Schedule,Medicare APC Fee Schedule
EEG GT 1 HOUR,95813,CPT,,,,,both,, ,1044.25,626.55,Medicare,Medicare,,626.55,,,1044.25,146.20,532.57,Fee Schedule,Medicare APC Fee Schedule
EEG AWAKE DROWSY,95816,CPT,,,,,both,, ,1075.58,645.34,Medicare,Medicare,,645.34,,,1075.58,150.58,548.55,Fee Schedule,Medicare APC Fee Schedule
EEG AWAKE ASLEEP,95819,CPT,,,,,both,, ,3362.50,2017.50,Medicare,Medicare,,2017.50,,,3362.50,470.75,1714.88,Fee Schedule,Medicare APC Fee Schedule
EEG ASLEEP,95822,CPT,,,,,both,, ,4457.07,2674.24,Medicare,Medicare,,2674.24,,,4457.07,623.99,2273.11,Fee Schedule,Medicare APC Fee Schedule
ROM WR EA EX-TRNK OT,95851,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,291.85,,,486.42,68.10,248.07,Fee Schedule,Medicare APC Fee Schedule
ROM WR EA EX-TRNK OT,95851,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,291.85,,,486.42,68.10,248.07,Fee Schedule,Medicare APC Fee Schedule
ROM WR EA EX-TRNK PT,95851,CPT,,,,,both,, ,21.12,12.67,Medicare,Medicare,,12.67,,,21.12,2.96,10.77,Fee Schedule,Medicare APC Fee Schedule
ROM WR EA EX-TRNK PT,95851,CPT,,,,,both,, ,21.12,12.67,Medicare,Medicare,,12.67,,,21.12,2.96,10.77,Fee Schedule,Medicare APC Fee Schedule
ROM WR EA EX-TRNK PT,95851,CPT,,,,,both,, ,21.12,12.67,Medicare,Medicare,,12.67,,,21.12,2.96,10.77,Fee Schedule,Medicare APC Fee Schedule
ROM WR EA EX-TRNK PT,95851,CPT,,,,,both,, ,21.12,12.67,Medicare,Medicare,,12.67,,,21.12,2.96,10.77,Fee Schedule,Medicare APC Fee Schedule
ROM WR EA EX-TRNK PT,95851,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,269.14,,,448.57,62.80,228.77,Fee Schedule,Medicare APC Fee Schedule
ROM WR EA EX-TRNK PT,95851,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,269.14,,,448.57,62.80,228.77,Fee Schedule,Medicare APC Fee Schedule
ROM W-R EA EXT-TRNK,95851,CPT,,,,,both,, ,418.86,251.31,Medicare,Medicare,,251.31,,,418.86,58.64,213.62,Fee Schedule,Medicare APC Fee Schedule
ROM W-R EA EXT-TRNK,95851,CPT,,,,,both,, ,454.13,272.47,Medicare,Medicare,,272.47,,,454.13,63.58,231.61,Fee Schedule,Medicare APC Fee Schedule
ROM W-R HND W-WO COM,95852,CPT,,,,,both,, ,418.86,251.31,Medicare,Medicare,,251.31,,,418.86,58.64,213.62,Fee Schedule,Medicare APC Fee Schedule
ROM W-R HND W-WO COM,95852,CPT,,,,,both,, ,454.13,272.47,Medicare,Medicare,,272.47,,,454.13,63.58,231.61,Fee Schedule,Medicare APC Fee Schedule
ROM W-R HND W-WO OT,95852,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,291.85,,,486.42,68.10,248.07,Fee Schedule,Medicare APC Fee Schedule
ROM W-R HND W-WO OT,95852,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,291.85,,,486.42,68.10,248.07,Fee Schedule,Medicare APC Fee Schedule
ROM W-R HND W-WO PT,95852,CPT,,,,,both,, ,16.22,9.73,Medicare,Medicare,,9.73,,,16.22,2.27,8.27,Fee Schedule,Medicare APC Fee Schedule
ROM W-R HND W-WO PT,95852,CPT,,,,,both,, ,16.22,9.73,Medicare,Medicare,,9.73,,,16.22,2.27,8.27,Fee Schedule,Medicare APC Fee Schedule
ROM W-R HND W-WO PT,95852,CPT,,,,,both,, ,16.22,9.73,Medicare,Medicare,,9.73,,,16.22,2.27,8.27,Fee Schedule,Medicare APC Fee Schedule
ROM W-R HND W-WO PT,95852,CPT,,,,,both,, ,16.22,9.73,Medicare,Medicare,,9.73,,,16.22,2.27,8.27,Fee Schedule,Medicare APC Fee Schedule
ROM W-R HND W-WO PT,95852,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,269.14,,,448.57,62.80,228.77,Fee Schedule,Medicare APC Fee Schedule
ROM W-R HND W-WO PT,95852,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,269.14,,,448.57,62.80,228.77,Fee Schedule,Medicare APC Fee Schedule
"EMG, 1 EXTREM",95860,CPT,,,,,both,, ,3272.05,1963.23,Medicare,Medicare,,1963.23,,,3272.05,458.09,1668.75,Fee Schedule,Medicare APC Fee Schedule
"EMG, 2 EXTREM",95861,CPT,,,,,both,, ,5586.46,3351.87,Medicare,Medicare,,3351.87,,,5586.46,782.10,2849.09,Fee Schedule,Medicare APC Fee Schedule
"EMG, 3 EXTREM",95863,CPT,,,,,both,, ,7162.62,4297.57,Medicare,Medicare,,4297.57,,,7162.62,1002.77,3652.94,Fee Schedule,Medicare APC Fee Schedule
"EMG, 4 EXTREM",95864,CPT,,,,,both,, ,8764.27,5258.56,Medicare,Medicare,,5258.56,,,8764.27,1227.00,4469.78,Fee Schedule,Medicare APC Fee Schedule
"EMG, W-NERVE TEST",95885,CPT,,,,,both,, ,458.87,275.32,Medicare,Medicare,,275.32,,,458.87,64.24,234.02,Fee Schedule,Medicare APC Fee Schedule
EMG W-NRV TST COM,95886,CPT,,,,,both,, ,458.87,275.32,Medicare,Medicare,,275.32,,,458.87,64.24,234.02,Fee Schedule,Medicare APC Fee Schedule
EMG W-NRV TST NON,95887,CPT,,,,,both,, ,242.57,145.54,Medicare,Medicare,,145.54,,,242.57,33.96,123.71,Fee Schedule,Medicare APC Fee Schedule
MTR-SENS 1-2 NRV TST,95907,CPT,,,,,both,, ,821.43,492.85,Medicare,Medicare,,492.85,,,821.43,115.00,418.93,Fee Schedule,Medicare APC Fee Schedule
MTR-SENS 3-4 NRV TST,95908,CPT,,,,,both,, ,821.43,492.85,Medicare,Medicare,,492.85,,,821.43,115.00,418.93,Fee Schedule,Medicare APC Fee Schedule
MTR-SENS 5-6 NRV TST,95909,CPT,,,,,both,, ,821.43,492.85,Medicare,Medicare,,492.85,,,821.43,115.00,418.93,Fee Schedule,Medicare APC Fee Schedule
MTR-SENS 7-8 NRV TST,95910,CPT,,,,,both,, ,821.43,492.85,Medicare,Medicare,,492.85,,,821.43,115.00,418.93,Fee Schedule,Medicare APC Fee Schedule
MTR-SES 9-10 NRV TST,95911,CPT,,,,,both,, ,821.43,492.85,Medicare,Medicare,,492.85,,,821.43,115.00,418.93,Fee Schedule,Medicare APC Fee Schedule
MTR-SES 11-12 NRV TS,95912,CPT,,,,,both,, ,1518.74,911.24,Medicare,Medicare,,911.24,,,1518.74,212.62,774.56,Fee Schedule,Medicare APC Fee Schedule
MTR-SNS 13 OR MORE,95913,CPT,,,,,both,, ,1518.74,911.24,Medicare,Medicare,,911.24,,,1518.74,212.62,774.56,Fee Schedule,Medicare APC Fee Schedule
PARASYMP-SYMP HRT RT,95924,CPT,,,,,both,, ,461.44,276.86,Medicare,Medicare,,276.86,,,461.44,64.60,235.33,Fee Schedule,Medicare APC Fee Schedule
VISUAL EVOK POTENT,95930,CPT,,,,,both,, ,3397.20,2038.32,Medicare,Medicare,,2038.32,,,3397.20,475.61,1732.57,Fee Schedule,Medicare APC Fee Schedule
"REPETIT STIM, EA NE",95937,CPT,,,,,both,, ,3199.95,1919.97,Medicare,Medicare,,1919.97,,,3199.95,447.99,1631.97,Fee Schedule,Medicare APC Fee Schedule
CANALITH PER DAY,95992,CPT,,,,,both,, ,158.07,94.84,Medicare,Medicare,,94.84,,,158.07,22.13,80.62,Fee Schedule,Medicare APC Fee Schedule
CANALITH PER DAY PT,95992,CPT,,,,,both,, ,101.97,61.18,Medicare,Medicare,,61.18,,,101.97,14.28,52,Fee Schedule,Medicare APC Fee Schedule
CANALITH PER DAY PT,95992,CPT,,,,,both,, ,101.97,61.18,Medicare,Medicare,,61.18,,,101.97,14.28,52,Fee Schedule,Medicare APC Fee Schedule
CANALITH PER DAY PT,95992,CPT,,,,,both,, ,169.44,101.66,Medicare,Medicare,,101.66,,,169.44,23.72,86.41,Fee Schedule,Medicare APC Fee Schedule
CANALITH PER DAY PT,95992,CPT,,,,,both,, ,169.44,101.66,Medicare,Medicare,,101.66,,,169.44,23.72,86.41,Fee Schedule,Medicare APC Fee Schedule
APHASIA ASSESS 1HOUR,96105,CPT,,,,,both,, ,813.70,488.22,Medicare,Medicare,,488.22,,,813.70,113.92,414.99,Fee Schedule,Medicare APC Fee Schedule
DEV TEST 1ST HR,96112,CPT,,,,,both,, ,813.70,488.22,Medicare,Medicare,,488.22,,,813.70,113.92,414.99,Fee Schedule,Medicare APC Fee Schedule
DEV TEST ADD 30M,96113,CPT,,,,,both,, ,763.23,457.93,Medicare,Medicare,,457.93,,,763.23,106.85,389.25,Fee Schedule,Medicare APC Fee Schedule
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,253.90,152.34,Medicare,Medicare,,152.34,,,253.90,35.55,129.49,Fee Schedule,Medicare APC Fee Schedule
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,253.90,152.34,Medicare,Medicare,,152.34,,,253.90,35.55,129.49,Fee Schedule,Medicare APC Fee Schedule
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,487.00,292.20,Medicare,Medicare,,292.20,,,487.00,68.18,248.37,Fee Schedule,Medicare APC Fee Schedule
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,487.00,292.20,Medicare,Medicare,,292.20,,,487.00,68.18,248.37,Fee Schedule,Medicare APC Fee Schedule
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,501.61,300.96,Medicare,Medicare,,300.96,,,501.61,70.23,255.82,Fee Schedule,Medicare APC Fee Schedule
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,501.61,300.96,Medicare,Medicare,,300.96,,,501.61,70.23,255.82,Fee Schedule,Medicare APC Fee Schedule
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,1841.23,1104.73,Medicare,Medicare,,1104.73,,,1841.23,257.77,939.03,Fee Schedule,Medicare APC Fee Schedule
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,70.81,42.48,Medicare,Medicare,,42.48,,,70.81,9.91,36.11,Fee Schedule,Medicare APC Fee Schedule
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,70.81,42.48,Medicare,Medicare,,42.48,,,70.81,9.91,36.11,Fee Schedule,Medicare APC Fee Schedule
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,135.75,81.45,Medicare,Medicare,,81.45,,,135.75,19.01,69.23,Fee Schedule,Medicare APC Fee Schedule
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,135.75,81.45,Medicare,Medicare,,81.45,,,135.75,19.01,69.23,Fee Schedule,Medicare APC Fee Schedule
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,139.82,83.89,Medicare,Medicare,,83.89,,,139.82,19.57,71.31,Fee Schedule,Medicare APC Fee Schedule
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,139.82,83.89,Medicare,Medicare,,83.89,,,139.82,19.57,71.31,Fee Schedule,Medicare APC Fee Schedule
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,1841.23,1104.73,Medicare,Medicare,,1104.73,,,1841.23,257.77,939.03,Fee Schedule,Medicare APC Fee Schedule
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,412.77,247.66,Medicare,Medicare,,247.66,,,412.77,57.79,210.51,Fee Schedule,Medicare APC Fee Schedule
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,412.77,247.66,Medicare,Medicare,,247.66,,,412.77,57.79,210.51,Fee Schedule,Medicare APC Fee Schedule
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,928.18,556.90,Medicare,Medicare,,556.90,,,928.18,129.95,473.37,Fee Schedule,Medicare APC Fee Schedule
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1301.75,781.05,Medicare,Medicare,,781.05,,,1301.75,182.25,663.89,Fee Schedule,Medicare APC Fee Schedule
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1301.75,781.05,Medicare,Medicare,,781.05,,,1301.75,182.25,663.89,Fee Schedule,Medicare APC Fee Schedule
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1340.80,804.48,Medicare,Medicare,,804.48,,,1340.80,187.71,683.81,Fee Schedule,Medicare APC Fee Schedule
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1340.80,804.48,Medicare,Medicare,,804.48,,,1340.80,187.71,683.81,Fee Schedule,Medicare APC Fee Schedule
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,70.81,42.48,Medicare,Medicare,,42.48,,,70.81,9.91,36.11,Fee Schedule,Medicare APC Fee Schedule
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,70.81,42.48,Medicare,Medicare,,42.48,,,70.81,9.91,36.11,Fee Schedule,Medicare APC Fee Schedule
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,928.18,556.90,Medicare,Medicare,,556.90,,,928.18,129.95,473.37,Fee Schedule,Medicare APC Fee Schedule
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1301.75,781.05,Medicare,Medicare,,781.05,,,1301.75,182.25,663.89,Fee Schedule,Medicare APC Fee Schedule
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1301.75,781.05,Medicare,Medicare,,781.05,,,1301.75,182.25,663.89,Fee Schedule,Medicare APC Fee Schedule
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1340.80,804.48,Medicare,Medicare,,804.48,,,1340.80,187.71,683.81,Fee Schedule,Medicare APC Fee Schedule
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1340.80,804.48,Medicare,Medicare,,804.48,,,1340.80,187.71,683.81,Fee Schedule,Medicare APC Fee Schedule
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,201.25,120.75,Medicare,Medicare,,120.75,,,201.25,28.18,102.64,Fee Schedule,Medicare APC Fee Schedule
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,201.25,120.75,Medicare,Medicare,,120.75,,,201.25,28.18,102.64,Fee Schedule,Medicare APC Fee Schedule
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,207.29,124.37,Medicare,Medicare,,124.37,,,207.29,29.02,105.72,Fee Schedule,Medicare APC Fee Schedule
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,207.29,124.37,Medicare,Medicare,,124.37,,,207.29,29.02,105.72,Fee Schedule,Medicare APC Fee Schedule
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,928.18,556.90,Medicare,Medicare,,556.90,,,928.18,129.95,473.37,Fee Schedule,Medicare APC Fee Schedule
CONCURRENT IV THER,96368,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
CONCURRENT IV THER,96368,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
CONCURRENT IV THER,96368,CPT,,,,,both,, ,791.25,474.75,Medicare,Medicare,,474.75,,,791.25,110.78,403.54,Fee Schedule,Medicare APC Fee Schedule
CONCURRENT IV THER,96368,CPT,,,,,both,, ,791.25,474.75,Medicare,Medicare,,474.75,,,791.25,110.78,403.54,Fee Schedule,Medicare APC Fee Schedule
CONCURRENT IV THER,96368,CPT,,,,,both,, ,814.99,488.99,Medicare,Medicare,,488.99,,,814.99,114.10,415.64,Fee Schedule,Medicare APC Fee Schedule
CONCURRENT IV THER,96368,CPT,,,,,both,, ,814.99,488.99,Medicare,Medicare,,488.99,,,814.99,114.10,415.64,Fee Schedule,Medicare APC Fee Schedule
CONCURRENT IV THER,96368,CPT,,,,,both,, ,928.18,556.90,Medicare,Medicare,,556.90,,,928.18,129.95,473.37,Fee Schedule,Medicare APC Fee Schedule
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,201.25,120.75,Medicare,Medicare,,120.75,,,201.25,28.18,102.64,Fee Schedule,Medicare APC Fee Schedule
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,201.25,120.75,Medicare,Medicare,,120.75,,,201.25,28.18,102.64,Fee Schedule,Medicare APC Fee Schedule
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,207.29,124.37,Medicare,Medicare,,124.37,,,207.29,29.02,105.72,Fee Schedule,Medicare APC Fee Schedule
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,207.29,124.37,Medicare,Medicare,,124.37,,,207.29,29.02,105.72,Fee Schedule,Medicare APC Fee Schedule
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,301.16,180.69,Medicare,Medicare,,180.69,,,301.16,42.16,153.59,Fee Schedule,Medicare APC Fee Schedule
S-INJ NON CHEMO IA,96373,CPT,,,,,both,, ,1355.48,813.28,Medicare,Medicare,,813.28,,,1355.48,189.77,691.29,Fee Schedule,Medicare APC Fee Schedule
INJECTION IV PUSH,96374,CPT,,,,,both,, ,1477.47,886.48,Medicare,Medicare,,886.48,,,1477.47,206.85,753.51,Fee Schedule,Medicare APC Fee Schedule
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,201.25,120.75,Medicare,Medicare,,120.75,,,201.25,28.18,102.64,Fee Schedule,Medicare APC Fee Schedule
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,201.25,120.75,Medicare,Medicare,,120.75,,,201.25,28.18,102.64,Fee Schedule,Medicare APC Fee Schedule
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,207.29,124.37,Medicare,Medicare,,124.37,,,207.29,29.02,105.72,Fee Schedule,Medicare APC Fee Schedule
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,253.90,152.34,Medicare,Medicare,,152.34,,,253.90,35.55,129.49,Fee Schedule,Medicare APC Fee Schedule
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,253.90,152.34,Medicare,Medicare,,152.34,,,253.90,35.55,129.49,Fee Schedule,Medicare APC Fee Schedule
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,501.61,300.96,Medicare,Medicare,,300.96,,,501.61,70.23,255.82,Fee Schedule,Medicare APC Fee Schedule
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,1355.48,813.28,Medicare,Medicare,,813.28,,,1355.48,189.77,691.29,Fee Schedule,Medicare APC Fee Schedule
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,201.25,120.75,Medicare,Medicare,,120.75,,,201.25,28.18,102.64,Fee Schedule,Medicare APC Fee Schedule
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,201.25,120.75,Medicare,Medicare,,120.75,,,201.25,28.18,102.64,Fee Schedule,Medicare APC Fee Schedule
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,207.29,124.37,Medicare,Medicare,,124.37,,,207.29,29.02,105.72,Fee Schedule,Medicare APC Fee Schedule
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,207.29,124.37,Medicare,Medicare,,124.37,,,207.29,29.02,105.72,Fee Schedule,Medicare APC Fee Schedule
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,668.99,401.39,Medicare,Medicare,,401.39,,,668.99,93.66,341.18,Fee Schedule,Medicare APC Fee Schedule
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,729.19,437.51,Medicare,Medicare,,437.51,,,729.19,102.09,371.89,Fee Schedule,Medicare APC Fee Schedule
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,98.50,59.10,Medicare,Medicare,,59.10,,,98.50,13.79,50.24,Fee Schedule,Medicare APC Fee Schedule
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,98.50,59.10,Medicare,Medicare,,59.10,,,98.50,13.79,50.24,Fee Schedule,Medicare APC Fee Schedule
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,101.46,60.87,Medicare,Medicare,,60.87,,,101.46,14.20,51.74,Fee Schedule,Medicare APC Fee Schedule
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,101.46,60.87,Medicare,Medicare,,60.87,,,101.46,14.20,51.74,Fee Schedule,Medicare APC Fee Schedule
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,729.19,437.51,Medicare,Medicare,,437.51,,,729.19,102.09,371.89,Fee Schedule,Medicare APC Fee Schedule
CHEMO NON HORM IM SC,96401,CPT,,,,,both,, ,476.63,285.97,Medicare,Medicare,,285.97,,,476.63,66.73,243.08,Fee Schedule,Medicare APC Fee Schedule
CHEMO HORMONAL IM SC,96402,CPT,,,,,both,, ,235.36,141.21,Medicare,Medicare,,141.21,,,235.36,32.95,120.03,Fee Schedule,Medicare APC Fee Schedule
CHEMO IV PUSH,96409,CPT,,,,,both,, ,382.65,229.59,Medicare,Medicare,,229.59,,,382.65,53.57,195.15,Fee Schedule,Medicare APC Fee Schedule
CHEMO EA AD IV PUSH,96411,CPT,,,,,both,, ,117.16,70.29,Medicare,Medicare,,70.29,,,117.16,16.40,59.75,Fee Schedule,Medicare APC Fee Schedule
CHEMO IV INFU 1ST HR,96413,CPT,,,,,both,, ,1377.11,826.26,Medicare,Medicare,,826.26,,,1377.11,192.80,702.33,Fee Schedule,Medicare APC Fee Schedule
CHEMO IV IN EA AD HR,96415,CPT,,,,,both,, ,234.58,140.74,Medicare,Medicare,,140.74,,,234.58,32.84,119.64,Fee Schedule,Medicare APC Fee Schedule
CHEMO IV EA SEQ INF,96417,CPT,,,,,both,, ,126.18,75.70,Medicare,Medicare,,75.70,,,126.18,17.67,64.35,Fee Schedule,Medicare APC Fee Schedule
IR-IRR PORT DRUG DEL,96523,CPT,,,,,both,, ,383.16,229.89,Medicare,Medicare,,229.89,,,383.16,53.64,195.41,Fee Schedule,Medicare APC Fee Schedule
HOT-COLD PACKS,97010,CPT,,,,,both,, ,239.27,143.56,Medicare,Medicare,,143.56,,,239.27,33.50,122.03,Fee Schedule,Medicare APC Fee Schedule
HOT-COLD PACKS,97010,CPT,,,,,both,, ,259.41,155.64,Medicare,Medicare,,155.64,,,259.41,36.32,132.3,Fee Schedule,Medicare APC Fee Schedule
HOT-COLD PACKS OT,97010,CPT,,,,,both,, ,277.84,166.70,Medicare,Medicare,,166.70,,,277.84,38.90,141.7,Fee Schedule,Medicare APC Fee Schedule
HOT-COLD PACKS OT,97010,CPT,,,,,both,, ,277.84,166.70,Medicare,Medicare,,166.70,,,277.84,38.90,141.7,Fee Schedule,Medicare APC Fee Schedule
HOT-COLD PACKS PT,97010,CPT,,,,,both,, ,41.20,24.72,Medicare,Medicare,,24.72,,,41.20,5.77,21.01,Fee Schedule,Medicare APC Fee Schedule
HOT-COLD PACKS PT,97010,CPT,,,,,both,, ,41.20,24.72,Medicare,Medicare,,24.72,,,41.20,5.77,21.01,Fee Schedule,Medicare APC Fee Schedule
HOT-COLD PACKS PT,97010,CPT,,,,,both,, ,41.20,24.72,Medicare,Medicare,,24.72,,,41.20,5.77,21.01,Fee Schedule,Medicare APC Fee Schedule
HOT-COLD PACKS PT,97010,CPT,,,,,both,, ,41.20,24.72,Medicare,Medicare,,24.72,,,41.20,5.77,21.01,Fee Schedule,Medicare APC Fee Schedule
HOT-COLD PACKS PT,97010,CPT,,,,,both,, ,256.21,153.72,Medicare,Medicare,,153.72,,,256.21,35.87,130.67,Fee Schedule,Medicare APC Fee Schedule
HOT-COLD PACKS PT,97010,CPT,,,,,both,, ,256.21,153.72,Medicare,Medicare,,153.72,,,256.21,35.87,130.67,Fee Schedule,Medicare APC Fee Schedule
MECH TRACTION-VISIT,97012,CPT,,,,,both,, ,485.24,291.14,Medicare,Medicare,,291.14,,,485.24,67.93,247.47,Fee Schedule,Medicare APC Fee Schedule
MECH TRACTN-VST PT,97012,CPT,,,,,both,, ,39.40,23.64,Medicare,Medicare,,23.64,,,39.40,5.52,20.09,Fee Schedule,Medicare APC Fee Schedule
MECH TRACTN-VST PT,97012,CPT,,,,,both,, ,39.40,23.64,Medicare,Medicare,,23.64,,,39.40,5.52,20.09,Fee Schedule,Medicare APC Fee Schedule
MECH TRACTN-VST PT,97012,CPT,,,,,both,, ,519.89,311.93,Medicare,Medicare,,311.93,,,519.89,72.78,265.14,Fee Schedule,Medicare APC Fee Schedule
MECH TRACTN-VST PT,97012,CPT,,,,,both,, ,519.89,311.93,Medicare,Medicare,,311.93,,,519.89,72.78,265.14,Fee Schedule,Medicare APC Fee Schedule
PARAF BATH-VISIT OT,97018,CPT,,,,,both,, ,41.20,24.72,Medicare,Medicare,,24.72,,,41.20,5.77,21.01,Fee Schedule,Medicare APC Fee Schedule
PARAF BATH-VISIT OT,97018,CPT,,,,,both,, ,41.20,24.72,Medicare,Medicare,,24.72,,,41.20,5.77,21.01,Fee Schedule,Medicare APC Fee Schedule
PARAF BATH-VISIT OT,97018,CPT,,,,,both,, ,347.88,208.72,Medicare,Medicare,,208.72,,,347.88,48.70,177.42,Fee Schedule,Medicare APC Fee Schedule
PARAF BATH-VISIT OT,97018,CPT,,,,,both,, ,347.88,208.72,Medicare,Medicare,,208.72,,,347.88,48.70,177.42,Fee Schedule,Medicare APC Fee Schedule
PARAF BATH-VISIT PT,97018,CPT,,,,,both,, ,18.54,11.12,Medicare,Medicare,,11.12,,,18.54,2.60,9.46,Fee Schedule,Medicare APC Fee Schedule
PARAF BATH-VISIT PT,97018,CPT,,,,,both,, ,18.54,11.12,Medicare,Medicare,,11.12,,,18.54,2.60,9.46,Fee Schedule,Medicare APC Fee Schedule
PARAF BATH-VISIT PT,97018,CPT,,,,,both,, ,320.85,192.51,Medicare,Medicare,,192.51,,,320.85,44.92,163.63,Fee Schedule,Medicare APC Fee Schedule
PARAF BATH-VISIT PT,97018,CPT,,,,,both,, ,320.85,192.51,Medicare,Medicare,,192.51,,,320.85,44.92,163.63,Fee Schedule,Medicare APC Fee Schedule
PARAFFIN BATH-VISIT,97018,CPT,,,,,both,, ,299.53,179.71,Medicare,Medicare,,179.71,,,299.53,41.93,152.76,Fee Schedule,Medicare APC Fee Schedule
PARAFFIN BATH-VISIT,97018,CPT,,,,,both,, ,324.73,194.83,Medicare,Medicare,,194.83,,,324.73,45.46,165.61,Fee Schedule,Medicare APC Fee Schedule
WHIRLPOOL THRPY-VIST,97022,CPT,,,,,both,, ,652.70,391.62,Medicare,Medicare,,391.62,,,652.70,91.38,332.88,Fee Schedule,Medicare APC Fee Schedule
WHIRLPOOL THRPY-VIST,97022,CPT,,,,,both,, ,707.58,424.54,Medicare,Medicare,,424.54,,,707.58,99.06,360.87,Fee Schedule,Medicare APC Fee Schedule
WHRLPL THRPY-VST OT,97022,CPT,,,,,both,, ,758.08,454.84,Medicare,Medicare,,454.84,,,758.08,106.13,386.62,Fee Schedule,Medicare APC Fee Schedule
WHRLPL THRPY-VST OT,97022,CPT,,,,,both,, ,758.08,454.84,Medicare,Medicare,,454.84,,,758.08,106.13,386.62,Fee Schedule,Medicare APC Fee Schedule
WHRLPL THRPY-VST PT,97022,CPT,,,,,both,, ,46.87,28.12,Medicare,Medicare,,28.12,,,46.87,6.56,23.9,Fee Schedule,Medicare APC Fee Schedule
WHRLPL THRPY-VST PT,97022,CPT,,,,,both,, ,46.87,28.12,Medicare,Medicare,,28.12,,,46.87,6.56,23.9,Fee Schedule,Medicare APC Fee Schedule
WHRLPL THRPY-VST PT,97022,CPT,,,,,both,, ,46.87,28.12,Medicare,Medicare,,28.12,,,46.87,6.56,23.9,Fee Schedule,Medicare APC Fee Schedule
WHRLPL THRPY-VST PT,97022,CPT,,,,,both,, ,46.87,28.12,Medicare,Medicare,,28.12,,,46.87,6.56,23.9,Fee Schedule,Medicare APC Fee Schedule
WHRLPL THRPY-VST PT,97022,CPT,,,,,both,, ,699.11,419.46,Medicare,Medicare,,419.46,,,699.11,97.88,356.55,Fee Schedule,Medicare APC Fee Schedule
WHRLPL THRPY-VST PT,97022,CPT,,,,,both,, ,699.11,419.46,Medicare,Medicare,,419.46,,,699.11,97.88,356.55,Fee Schedule,Medicare APC Fee Schedule
ELEC STIM-MAN-15 MIN,97032,CPT,,,,,both,, ,466.32,279.79,Medicare,Medicare,,279.79,,,466.32,65.28,237.82,Fee Schedule,Medicare APC Fee Schedule
ELEC STIM-MAN-15 MIN,97032,CPT,,,,,both,, ,505.50,303.30,Medicare,Medicare,,303.30,,,505.50,70.77,257.81,Fee Schedule,Medicare APC Fee Schedule
ELEC STM-MN-15MN OT,97032,CPT,,,,,both,, ,541.52,324.91,Medicare,Medicare,,324.91,,,541.52,75.81,276.18,Fee Schedule,Medicare APC Fee Schedule
ELEC STM-MN-15MN OT,97032,CPT,,,,,both,, ,541.52,324.91,Medicare,Medicare,,324.91,,,541.52,75.81,276.18,Fee Schedule,Medicare APC Fee Schedule
ELEC STM-MN-15MN PT,97032,CPT,,,,,both,, ,39.40,23.64,Medicare,Medicare,,23.64,,,39.40,5.52,20.09,Fee Schedule,Medicare APC Fee Schedule
ELEC STM-MN-15MN PT,97032,CPT,,,,,both,, ,39.40,23.64,Medicare,Medicare,,23.64,,,39.40,5.52,20.09,Fee Schedule,Medicare APC Fee Schedule
ELEC STM-MN-15MN PT,97032,CPT,,,,,both,, ,39.40,23.64,Medicare,Medicare,,23.64,,,39.40,5.52,20.09,Fee Schedule,Medicare APC Fee Schedule
ELEC STM-MN-15MN PT,97032,CPT,,,,,both,, ,39.40,23.64,Medicare,Medicare,,23.64,,,39.40,5.52,20.09,Fee Schedule,Medicare APC Fee Schedule
ELEC STM-MN-15MN PT,97032,CPT,,,,,both,, ,499.55,299.73,Medicare,Medicare,,299.73,,,499.55,69.94,254.77,Fee Schedule,Medicare APC Fee Schedule
ELEC STM-MN-15MN PT,97032,CPT,,,,,both,, ,499.55,299.73,Medicare,Medicare,,299.73,,,499.55,69.94,254.77,Fee Schedule,Medicare APC Fee Schedule
IONTOPHOR-15 MIN OT,97033,CPT,,,,,both,, ,764.52,458.71,Medicare,Medicare,,458.71,,,764.52,107.03,389.91,Fee Schedule,Medicare APC Fee Schedule
IONTOPHOR-15 MIN OT,97033,CPT,,,,,both,, ,764.52,458.71,Medicare,Medicare,,458.71,,,764.52,107.03,389.91,Fee Schedule,Medicare APC Fee Schedule
IONTOPHOR-15 MIN PT,97033,CPT,,,,,both,, ,54.59,32.75,Medicare,Medicare,,32.75,,,54.59,7.64,27.84,Fee Schedule,Medicare APC Fee Schedule
IONTOPHOR-15 MIN PT,97033,CPT,,,,,both,, ,54.59,32.75,Medicare,Medicare,,32.75,,,54.59,7.64,27.84,Fee Schedule,Medicare APC Fee Schedule
IONTOPHOR-15 MIN PT,97033,CPT,,,,,both,, ,54.59,32.75,Medicare,Medicare,,32.75,,,54.59,7.64,27.84,Fee Schedule,Medicare APC Fee Schedule
IONTOPHOR-15 MIN PT,97033,CPT,,,,,both,, ,54.59,32.75,Medicare,Medicare,,32.75,,,54.59,7.64,27.84,Fee Schedule,Medicare APC Fee Schedule
IONTOPHOR-15 MIN PT,97033,CPT,,,,,both,, ,705.04,423.02,Medicare,Medicare,,423.02,,,705.04,98.71,359.57,Fee Schedule,Medicare APC Fee Schedule
IONTOPHOR-15 MIN PT,97033,CPT,,,,,both,, ,705.04,423.02,Medicare,Medicare,,423.02,,,705.04,98.71,359.57,Fee Schedule,Medicare APC Fee Schedule
IONTOPHORESIS-15 MIN,97033,CPT,,,,,both,, ,658.28,394.96,Medicare,Medicare,,394.96,,,658.28,92.16,335.72,Fee Schedule,Medicare APC Fee Schedule
IONTOPHORESIS-15 MIN,97033,CPT,,,,,both,, ,713.65,428.19,Medicare,Medicare,,428.19,,,713.65,99.91,363.96,Fee Schedule,Medicare APC Fee Schedule
CNTRST BTH-15MIN OT,97034,CPT,,,,,both,, ,514.74,308.84,Medicare,Medicare,,308.84,,,514.74,72.06,262.52,Fee Schedule,Medicare APC Fee Schedule
CNTRST BTH-15MIN OT,97034,CPT,,,,,both,, ,514.74,308.84,Medicare,Medicare,,308.84,,,514.74,72.06,262.52,Fee Schedule,Medicare APC Fee Schedule
CNTRST BTH-15MIN PT,97034,CPT,,,,,both,, ,40.17,24.10,Medicare,Medicare,,24.10,,,40.17,5.62,20.49,Fee Schedule,Medicare APC Fee Schedule
CNTRST BTH-15MIN PT,97034,CPT,,,,,both,, ,40.17,24.10,Medicare,Medicare,,24.10,,,40.17,5.62,20.49,Fee Schedule,Medicare APC Fee Schedule
CNTRST BTH-15MIN PT,97034,CPT,,,,,both,, ,40.17,24.10,Medicare,Medicare,,24.10,,,40.17,5.62,20.49,Fee Schedule,Medicare APC Fee Schedule
CNTRST BTH-15MIN PT,97034,CPT,,,,,both,, ,40.17,24.10,Medicare,Medicare,,24.10,,,40.17,5.62,20.49,Fee Schedule,Medicare APC Fee Schedule
CNTRST BTH-15MIN PT,97034,CPT,,,,,both,, ,474.83,284.89,Medicare,Medicare,,284.89,,,474.83,66.48,242.16,Fee Schedule,Medicare APC Fee Schedule
CNTRST BTH-15MIN PT,97034,CPT,,,,,both,, ,474.83,284.89,Medicare,Medicare,,284.89,,,474.83,66.48,242.16,Fee Schedule,Medicare APC Fee Schedule
CONTRAST BATH-15 MIN,97034,CPT,,,,,both,, ,443.25,265.95,Medicare,Medicare,,265.95,,,443.25,62.06,226.06,Fee Schedule,Medicare APC Fee Schedule
CONTRAST BATH-15 MIN,97034,CPT,,,,,both,, ,480.51,288.30,Medicare,Medicare,,288.30,,,480.51,67.27,245.06,Fee Schedule,Medicare APC Fee Schedule
ULTRASND-15 MIN OT,97035,CPT,,,,,both,, ,611.56,366.93,Medicare,Medicare,,366.93,,,611.56,85.62,311.9,Fee Schedule,Medicare APC Fee Schedule
ULTRASND-15 MIN OT,97035,CPT,,,,,both,, ,611.56,366.93,Medicare,Medicare,,366.93,,,611.56,85.62,311.9,Fee Schedule,Medicare APC Fee Schedule
ULTRASND-15 MIN PT,97035,CPT,,,,,both,, ,36.57,21.94,Medicare,Medicare,,21.94,,,36.57,5.12,18.65,Fee Schedule,Medicare APC Fee Schedule
ULTRASND-15 MIN PT,97035,CPT,,,,,both,, ,36.57,21.94,Medicare,Medicare,,21.94,,,36.57,5.12,18.65,Fee Schedule,Medicare APC Fee Schedule
ULTRASND-15 MIN PT,97035,CPT,,,,,both,, ,36.57,21.94,Medicare,Medicare,,21.94,,,36.57,5.12,18.65,Fee Schedule,Medicare APC Fee Schedule
ULTRASND-15 MIN PT,97035,CPT,,,,,both,, ,36.57,21.94,Medicare,Medicare,,21.94,,,36.57,5.12,18.65,Fee Schedule,Medicare APC Fee Schedule
ULTRASND-15 MIN PT,97035,CPT,,,,,both,, ,564.18,338.50,Medicare,Medicare,,338.50,,,564.18,78.99,287.73,Fee Schedule,Medicare APC Fee Schedule
ULTRASND-15 MIN PT,97035,CPT,,,,,both,, ,564.18,338.50,Medicare,Medicare,,338.50,,,564.18,78.99,287.73,Fee Schedule,Medicare APC Fee Schedule
ULTRASOUND-15 MIN,97035,CPT,,,,,both,, ,526.62,315.97,Medicare,Medicare,,315.97,,,526.62,73.73,268.58,Fee Schedule,Medicare APC Fee Schedule
ULTRASOUND-15 MIN,97035,CPT,,,,,both,, ,570.95,342.57,Medicare,Medicare,,342.57,,,570.95,79.93,291.18,Fee Schedule,Medicare APC Fee Schedule
"Physical therapy, therapeutic exercise .",97110,CPT,,,,,both,,,342.72,342.72,Medicare,Medicare,,342.72,,,342.72,47.98,174.79,Fee Schedule,Medicare APC Fee Schedule
THER EXRCS-15MIN OT,97110,CPT,,,,,both,, ,398.10,238.86,Medicare,Medicare,,238.86,,,398.10,55.73,203.03,Fee Schedule,Medicare APC Fee Schedule
THER EXRCS-15MIN OT,97110,CPT,,,,,both,, ,398.10,238.86,Medicare,Medicare,,238.86,,,398.10,55.73,203.03,Fee Schedule,Medicare APC Fee Schedule
THER EXRCS-15MIN PT,97110,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,48.82,,,81.37,11.39,41.5,Fee Schedule,Medicare APC Fee Schedule
THER EXRCS-15MIN PT,97110,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,48.82,,,81.37,11.39,41.5,Fee Schedule,Medicare APC Fee Schedule
THER EXRCS-15MIN PT,97110,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,48.82,,,81.37,11.39,41.5,Fee Schedule,Medicare APC Fee Schedule
THER EXRCS-15MIN PT,97110,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,48.82,,,81.37,11.39,41.5,Fee Schedule,Medicare APC Fee Schedule
THER EXRCS-15MIN PT,97110,CPT,,,,,both,, ,367.20,220.32,Medicare,Medicare,,220.32,,,367.20,51.41,187.27,Fee Schedule,Medicare APC Fee Schedule
THER EXRCS-15MIN PT,97110,CPT,,,,,both,, ,367.20,220.32,Medicare,Medicare,,220.32,,,367.20,51.41,187.27,Fee Schedule,Medicare APC Fee Schedule
THERAP EXERCS-15 MIN,97110,CPT,,,,,both,, ,342.72,205.63,Medicare,Medicare,,205.63,,,342.72,47.98,174.79,Fee Schedule,Medicare APC Fee Schedule
THERAP EXERCS-15 MIN,97110,CPT,,,,,both,, ,371.55,222.93,Medicare,Medicare,,222.93,,,371.55,52.02,189.49,Fee Schedule,Medicare APC Fee Schedule
NEUR RE-ED-15MIN OT,97112,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,291.85,,,486.42,68.10,248.07,Fee Schedule,Medicare APC Fee Schedule
NEUR RE-ED-15MIN OT,97112,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,291.85,,,486.42,68.10,248.07,Fee Schedule,Medicare APC Fee Schedule
NEUR RE-ED-15MIN PT,97112,CPT,,,,,both,, ,92.19,55.31,Medicare,Medicare,,55.31,,,92.19,12.91,47.02,Fee Schedule,Medicare APC Fee Schedule
NEUR RE-ED-15MIN PT,97112,CPT,,,,,both,, ,92.19,55.31,Medicare,Medicare,,55.31,,,92.19,12.91,47.02,Fee Schedule,Medicare APC Fee Schedule
NEUR RE-ED-15MIN PT,97112,CPT,,,,,both,, ,92.19,55.31,Medicare,Medicare,,55.31,,,92.19,12.91,47.02,Fee Schedule,Medicare APC Fee Schedule
NEUR RE-ED-15MIN PT,97112,CPT,,,,,both,, ,92.19,55.31,Medicare,Medicare,,55.31,,,92.19,12.91,47.02,Fee Schedule,Medicare APC Fee Schedule
NEUR RE-ED-15MIN PT,97112,CPT,,,,,both,, ,367.20,220.32,Medicare,Medicare,,220.32,,,367.20,51.41,187.27,Fee Schedule,Medicare APC Fee Schedule
NEUR RE-ED-15MIN PT,97112,CPT,,,,,both,, ,367.20,220.32,Medicare,Medicare,,220.32,,,367.20,51.41,187.27,Fee Schedule,Medicare APC Fee Schedule
NEURO RE-ED-15 MIN,97112,CPT,,,,,both,, ,342.72,205.63,Medicare,Medicare,,205.63,,,342.72,47.98,174.79,Fee Schedule,Medicare APC Fee Schedule
NEURO RE-ED-15 MIN,97112,CPT,,,,,both,, ,454.13,272.47,Medicare,Medicare,,272.47,,,454.13,63.58,231.61,Fee Schedule,Medicare APC Fee Schedule
GAIT TRAINING-15 MIN,97116,CPT,,,,,both,, ,342.72,205.63,Medicare,Medicare,,205.63,,,342.72,47.98,174.79,Fee Schedule,Medicare APC Fee Schedule
GAIT TRAINING-15 MIN,97116,CPT,,,,,both,, ,454.13,272.47,Medicare,Medicare,,272.47,,,454.13,63.58,231.61,Fee Schedule,Medicare APC Fee Schedule
GAIT TRNNG-15MIN OT,97116,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,291.85,,,486.42,68.10,248.07,Fee Schedule,Medicare APC Fee Schedule
GAIT TRNNG-15MIN OT,97116,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,291.85,,,486.42,68.10,248.07,Fee Schedule,Medicare APC Fee Schedule
GAIT TRNNG-15MIN PT,97116,CPT,,,,,both,, ,80.34,48.20,Medicare,Medicare,,48.20,,,80.34,11.25,40.97,Fee Schedule,Medicare APC Fee Schedule
GAIT TRNNG-15MIN PT,97116,CPT,,,,,both,, ,80.34,48.20,Medicare,Medicare,,48.20,,,80.34,11.25,40.97,Fee Schedule,Medicare APC Fee Schedule
GAIT TRNNG-15MIN PT,97116,CPT,,,,,both,, ,80.34,48.20,Medicare,Medicare,,48.20,,,80.34,11.25,40.97,Fee Schedule,Medicare APC Fee Schedule
GAIT TRNNG-15MIN PT,97116,CPT,,,,,both,, ,80.34,48.20,Medicare,Medicare,,48.20,,,80.34,11.25,40.97,Fee Schedule,Medicare APC Fee Schedule
GAIT TRNNG-15MIN PT,97116,CPT,,,,,both,, ,367.20,220.32,Medicare,Medicare,,220.32,,,367.20,51.41,187.27,Fee Schedule,Medicare APC Fee Schedule
GAIT TRNNG-15MIN PT,97116,CPT,,,,,both,, ,367.20,220.32,Medicare,Medicare,,220.32,,,367.20,51.41,187.27,Fee Schedule,Medicare APC Fee Schedule
MASSAGE THRPY-15 MIN,97124,CPT,,,,,both,, ,294.09,176.45,Medicare,Medicare,,176.45,,,294.09,41.17,149.99,Fee Schedule,Medicare APC Fee Schedule
MASSAGE THRPY-15 MIN,97124,CPT,,,,,both,, ,318.84,191.30,Medicare,Medicare,,191.30,,,318.84,44.64,162.61,Fee Schedule,Medicare APC Fee Schedule
MASSG THRPY-15MN OT,97124,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
MASSG THRPY-15MN OT,97124,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,204.87,,,341.45,47.80,174.14,Fee Schedule,Medicare APC Fee Schedule
MASSG THRPY-15MN PT,97124,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,44.95,,,74.93,10.49,38.21,Fee Schedule,Medicare APC Fee Schedule
MASSG THRPY-15MN PT,97124,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,44.95,,,74.93,10.49,38.21,Fee Schedule,Medicare APC Fee Schedule
MASSG THRPY-15MN PT,97124,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,44.95,,,74.93,10.49,38.21,Fee Schedule,Medicare APC Fee Schedule
MASSG THRPY-15MN PT,97124,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,44.95,,,74.93,10.49,38.21,Fee Schedule,Medicare APC Fee Schedule
MASSG THRPY-15MN PT,97124,CPT,,,,,both,, ,314.92,188.95,Medicare,Medicare,,188.95,,,314.92,44.09,160.61,Fee Schedule,Medicare APC Fee Schedule
MASSG THRPY-15MN PT,97124,CPT,,,,,both,, ,314.92,188.95,Medicare,Medicare,,188.95,,,314.92,44.09,160.61,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV IN15 COTA,97129,CPT,,,,,both,, ,398.10,238.86,Medicare,Medicare,,238.86,,,398.10,55.73,203.03,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV INI15 OT,97129,CPT,,,,,both,, ,398.10,238.86,Medicare,Medicare,,238.86,,,398.10,55.73,203.03,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV INI15 PT,97129,CPT,,,,,both,, ,84.46,50.67,Medicare,Medicare,,50.67,,,84.46,11.82,43.07,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV INI15 PT,97129,CPT,,,,,both,, ,84.46,50.67,Medicare,Medicare,,50.67,,,84.46,11.82,43.07,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV INI15 PT,97129,CPT,,,,,both,, ,84.46,50.67,Medicare,Medicare,,50.67,,,84.46,11.82,43.07,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV INI15 PT,97129,CPT,,,,,both,, ,84.46,50.67,Medicare,Medicare,,50.67,,,84.46,11.82,43.07,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV INI15 PT,97129,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,269.14,,,448.57,62.80,228.77,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV INI15 PT,97129,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,269.14,,,448.57,62.80,228.77,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV INI15 SP,97129,CPT,,,,,both,, ,398.10,238.86,Medicare,Medicare,,238.86,,,398.10,55.73,203.03,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV AD15 COTA,97130,CPT,,,,,both,, ,398.10,238.86,Medicare,Medicare,,238.86,,,398.10,55.73,203.03,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV ADD15 OT,97130,CPT,,,,,both,, ,398.10,238.86,Medicare,Medicare,,238.86,,,398.10,55.73,203.03,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV ADD15 PT,97130,CPT,,,,,both,, ,84.46,50.67,Medicare,Medicare,,50.67,,,84.46,11.82,43.07,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV ADD15 PT,97130,CPT,,,,,both,, ,84.46,50.67,Medicare,Medicare,,50.67,,,84.46,11.82,43.07,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV ADD15 PT,97130,CPT,,,,,both,, ,84.46,50.67,Medicare,Medicare,,50.67,,,84.46,11.82,43.07,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV ADD15 PT,97130,CPT,,,,,both,, ,84.46,50.67,Medicare,Medicare,,50.67,,,84.46,11.82,43.07,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV ADD15 PT,97130,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,269.14,,,448.57,62.80,228.77,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV ADD15 PT,97130,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,269.14,,,448.57,62.80,228.77,Fee Schedule,Medicare APC Fee Schedule
COG SKL DV ADD15 SP,97130,CPT,,,,,both,, ,398.10,238.86,Medicare,Medicare,,238.86,,,398.10,55.73,203.03,Fee Schedule,Medicare APC Fee Schedule
MANUAL THRPY-15 MIN,97140,CPT,,,,,both,, ,342.72,205.63,Medicare,Medicare,,205.63,,,342.72,47.98,174.79,Fee Schedule,Medicare APC Fee Schedule
MANUAL THRPY-15 MIN,97140,CPT,,,,,both,, ,454.13,272.47,Medicare,Medicare,,272.47,,,454.13,63.58,231.61,Fee Schedule,Medicare APC Fee Schedule
MNL THRPY-15 MIN OT,97140,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,291.85,,,486.42,68.10,248.07,Fee Schedule,Medicare APC Fee Schedule
MNL THRPY-15 MIN OT,97140,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,291.85,,,486.42,68.10,248.07,Fee Schedule,Medicare APC Fee Schedule
MNL THRPY-15 MIN PT,97140,CPT,,,,,both,, ,73.65,44.19,Medicare,Medicare,,44.19,,,73.65,10.31,37.56,Fee Schedule,Medicare APC Fee Schedule
MNL THRPY-15 MIN PT,97140,CPT,,,,,both,, ,73.65,44.19,Medicare,Medicare,,44.19,,,73.65,10.31,37.56,Fee Schedule,Medicare APC Fee Schedule
MNL THRPY-15 MIN PT,97140,CPT,,,,,both,, ,73.65,44.19,Medicare,Medicare,,44.19,,,73.65,10.31,37.56,Fee Schedule,Medicare APC Fee Schedule
MNL THRPY-15 MIN PT,97140,CPT,,,,,both,, ,73.65,44.19,Medicare,Medicare,,44.19,,,73.65,10.31,37.56,Fee Schedule,Medicare APC Fee Schedule
MNL THRPY-15 MIN PT,97140,CPT,,,,,both,, ,367.20,220.32,Medicare,Medicare,,220.32,,,367.20,51.41,187.27,Fee Schedule,Medicare APC Fee Schedule
MNL THRPY-15 MIN PT,97140,CPT,,,,,both,, ,367.20,220.32,Medicare,Medicare,,220.32,,,367.20,51.41,187.27,Fee Schedule,Medicare APC Fee Schedule
GROUP THRP PROC-VIST,97150,CPT,,,,,both,, ,341.23,204.73,Medicare,Medicare,,204.73,,,341.23,47.77,174.03,Fee Schedule,Medicare APC Fee Schedule
GROUP THRP PROC-VIST,97150,CPT,,,,,both,, ,369.92,221.95,Medicare,Medicare,,221.95,,,369.92,51.79,188.66,Fee Schedule,Medicare APC Fee Schedule
GRP THRP PRC-VST OT,97150,CPT,,,,,both,, ,396.29,237.77,Medicare,Medicare,,237.77,,,396.29,55.48,202.11,Fee Schedule,Medicare APC Fee Schedule
GRP THRP PRC-VST OT,97150,CPT,,,,,both,, ,396.29,237.77,Medicare,Medicare,,237.77,,,396.29,55.48,202.11,Fee Schedule,Medicare APC Fee Schedule
GRP THRP PRC-VST PT,97150,CPT,,,,,both,, ,48.67,29.20,Medicare,Medicare,,29.20,,,48.67,6.81,24.82,Fee Schedule,Medicare APC Fee Schedule
GRP THRP PRC-VST PT,97150,CPT,,,,,both,, ,48.67,29.20,Medicare,Medicare,,29.20,,,48.67,6.81,24.82,Fee Schedule,Medicare APC Fee Schedule
GRP THRP PRC-VST PT,97150,CPT,,,,,both,, ,48.67,29.20,Medicare,Medicare,,29.20,,,48.67,6.81,24.82,Fee Schedule,Medicare APC Fee Schedule
GRP THRP PRC-VST PT,97150,CPT,,,,,both,, ,48.67,29.20,Medicare,Medicare,,29.20,,,48.67,6.81,24.82,Fee Schedule,Medicare APC Fee Schedule
GRP THRP PRC-VST PT,97150,CPT,,,,,both,, ,365.65,219.39,Medicare,Medicare,,219.39,,,365.65,51.19,186.48,Fee Schedule,Medicare APC Fee Schedule
GRP THRP PRC-VST PT,97150,CPT,,,,,both,, ,365.65,219.39,Medicare,Medicare,,219.39,,,365.65,51.19,186.48,Fee Schedule,Medicare APC Fee Schedule
PT EVAL- LOW CMP PT,97161,CPT,,,,,both,, ,223.77,134.26,Medicare,Medicare,,134.26,,,223.77,31.33,114.12,Fee Schedule,Medicare APC Fee Schedule
PT EVAL- LOW CMP PT,97161,CPT,,,,,both,, ,223.77,134.26,Medicare,Medicare,,134.26,,,223.77,31.33,114.12,Fee Schedule,Medicare APC Fee Schedule
PT EVAL- LOW CMP PT,97161,CPT,,,,,both,, ,721.00,432.60,Medicare,Medicare,,432.60,,,721.00,100.94,367.71,Fee Schedule,Medicare APC Fee Schedule
PT EVAL- LOW CMP PT,97161,CPT,,,,,both,, ,721.00,432.60,Medicare,Medicare,,432.60,,,721.00,100.94,367.71,Fee Schedule,Medicare APC Fee Schedule
PT EVAL- LOW COMP,97161,CPT,,,,,both,, ,673.18,403.90,Medicare,Medicare,,403.90,,,673.18,94.25,343.32,Fee Schedule,Medicare APC Fee Schedule
PT-EVAL LOW 15M MCD,97161,CPT,,,,,both,, ,700.00,420.00,Medicare,Medicare,,420.00,,,700.00,98.00,357,Fee Schedule,Medicare APC Fee Schedule
PT EVAL- MOD CMP PT,97162,CPT,,,,,both,, ,223.77,134.26,Medicare,Medicare,,134.26,,,223.77,31.33,114.12,Fee Schedule,Medicare APC Fee Schedule
PT EVAL- MOD CMP PT,97162,CPT,,,,,both,, ,223.77,134.26,Medicare,Medicare,,134.26,,,223.77,31.33,114.12,Fee Schedule,Medicare APC Fee Schedule
PT EVAL- MOD CMP PT,97162,CPT,,,,,both,, ,360.50,216.30,Medicare,Medicare,,216.30,,,360.50,50.47,183.86,Fee Schedule,Medicare APC Fee Schedule
PT EVAL- MOD CMP PT,97162,CPT,,,,,both,, ,360.50,216.30,Medicare,Medicare,,216.30,,,360.50,50.47,183.86,Fee Schedule,Medicare APC Fee Schedule
PT EVAL- MOD COMP,97162,CPT,,,,,both,, ,673.18,403.90,Medicare,Medicare,,403.90,,,673.18,94.25,343.32,Fee Schedule,Medicare APC Fee Schedule
PT-EVAL MOD 15M MCD,97162,CPT,,,,,both,, ,350.00,210.00,Medicare,Medicare,,210.00,,,350.00,49.00,178.5,Fee Schedule,Medicare APC Fee Schedule
PT EVAL- HGH CMP PT,97163,CPT,,,,,both,, ,224.03,134.41,Medicare,Medicare,,134.41,,,224.03,31.36,114.26,Fee Schedule,Medicare APC Fee Schedule
PT EVAL- HGH CMP PT,97163,CPT,,,,,both,, ,224.03,134.41,Medicare,Medicare,,134.41,,,224.03,31.36,114.26,Fee Schedule,Medicare APC Fee Schedule
PT EVAL- HGH CMP PT,97163,CPT,,,,,both,, ,721.00,432.60,Medicare,Medicare,,432.60,,,721.00,100.94,367.71,Fee Schedule,Medicare APC Fee Schedule
PT EVAL- HGH CMP PT,97163,CPT,,,,,both,, ,721.00,432.60,Medicare,Medicare,,432.60,,,721.00,100.94,367.71,Fee Schedule,Medicare APC Fee Schedule
PT EVAL- HGH COMP,97163,CPT,,,,,both,, ,673.18,403.90,Medicare,Medicare,,403.90,,,673.18,94.25,343.32,Fee Schedule,Medicare APC Fee Schedule
PT-EVAL HGH 15M MCD,97163,CPT,,,,,both,, ,233.25,139.95,Medicare,Medicare,,139.95,,,233.25,32.66,118.96,Fee Schedule,Medicare APC Fee Schedule
PT RE-EVAL-VISIT,97164,CPT,,,,,both,, ,437.36,262.41,Medicare,Medicare,,262.41,,,437.36,61.23,223.05,Fee Schedule,Medicare APC Fee Schedule
PT RE-EVAL-VISIT PT,97164,CPT,,,,,both,, ,151.41,90.84,Medicare,Medicare,,90.84,,,151.41,21.20,77.22,Fee Schedule,Medicare APC Fee Schedule
PT RE-EVAL-VISIT PT,97164,CPT,,,,,both,, ,151.41,90.84,Medicare,Medicare,,90.84,,,151.41,21.20,77.22,Fee Schedule,Medicare APC Fee Schedule
PT RE-EVAL-VISIT PT,97164,CPT,,,,,both,, ,468.39,281.03,Medicare,Medicare,,281.03,,,468.39,65.57,238.88,Fee Schedule,Medicare APC Fee Schedule
PT RE-EVAL-VISIT PT,97164,CPT,,,,,both,, ,468.39,281.03,Medicare,Medicare,,281.03,,,468.39,65.57,238.88,Fee Schedule,Medicare APC Fee Schedule
OT EVAL- LOW CMP OT,97165,CPT,,,,,both,, ,223.77,134.26,Medicare,Medicare,,134.26,,,223.77,31.33,114.12,Fee Schedule,Medicare APC Fee Schedule
OT EVAL- LOW CMP OT,97165,CPT,,,,,both,, ,781.77,469.06,Medicare,Medicare,,469.06,,,781.77,109.45,398.7,Fee Schedule,Medicare APC Fee Schedule
OT EVAL- LOW CMP OT,97165,CPT,,,,,both,, ,781.77,469.06,Medicare,Medicare,,469.06,,,781.77,109.45,398.7,Fee Schedule,Medicare APC Fee Schedule
OT EVAL- LOW COMP,97165,CPT,,,,,both,, ,729.80,437.88,Medicare,Medicare,,437.88,,,729.80,102.17,372.2,Fee Schedule,Medicare APC Fee Schedule
OT-EVAL LOW 15M MCD,97165,CPT,,,,,both,, ,100.00,60.00,Medicare,Medicare,,60.00,,,100.00,14.00,51,Fee Schedule,Medicare APC Fee Schedule
OT-EVAL LOW 15M MCD,97165,CPT,,,,,both,, ,759.00,455.40,Medicare,Medicare,,455.40,,,759.00,106.26,387.09,Fee Schedule,Medicare APC Fee Schedule
OT EVAL- MOD CMP OT,97166,CPT,,,,,both,, ,223.77,134.26,Medicare,Medicare,,134.26,,,223.77,31.33,114.12,Fee Schedule,Medicare APC Fee Schedule
OT EVAL- MOD CMP OT,97166,CPT,,,,,both,, ,390.89,234.53,Medicare,Medicare,,234.53,,,390.89,54.72,199.35,Fee Schedule,Medicare APC Fee Schedule
OT EVAL- MOD CMP OT,97166,CPT,,,,,both,, ,390.89,234.53,Medicare,Medicare,,234.53,,,390.89,54.72,199.35,Fee Schedule,Medicare APC Fee Schedule
OT EVAL- MOD COMP,97166,CPT,,,,,both,, ,729.80,437.88,Medicare,Medicare,,437.88,,,729.80,102.17,372.2,Fee Schedule,Medicare APC Fee Schedule
OT-EVAL MOD 15M MCD,97166,CPT,,,,,both,, ,100.00,60.00,Medicare,Medicare,,60.00,,,100.00,14.00,51,Fee Schedule,Medicare APC Fee Schedule
OT-EVAL MOD 15M MCD,97166,CPT,,,,,both,, ,379.50,227.70,Medicare,Medicare,,227.70,,,379.50,53.13,193.55,Fee Schedule,Medicare APC Fee Schedule
OT EVAL- HGH CMP OT,97167,CPT,,,,,both,, ,223.77,134.26,Medicare,Medicare,,134.26,,,223.77,31.33,114.12,Fee Schedule,Medicare APC Fee Schedule
OT EVAL- HGH CMP OT,97167,CPT,,,,,both,, ,781.77,469.06,Medicare,Medicare,,469.06,,,781.77,109.45,398.7,Fee Schedule,Medicare APC Fee Schedule
OT EVAL- HGH CMP OT,97167,CPT,,,,,both,, ,781.77,469.06,Medicare,Medicare,,469.06,,,781.77,109.45,398.7,Fee Schedule,Medicare APC Fee Schedule
OT EVAL- HGH COMP,97167,CPT,,,,,both,, ,729.80,437.88,Medicare,Medicare,,437.88,,,729.80,102.17,372.2,Fee Schedule,Medicare APC Fee Schedule
OT-EVAL HGH 15M MCD,97167,CPT,,,,,both,, ,100.00,60.00,Medicare,Medicare,,60.00,,,100.00,14.00,51,Fee Schedule,Medicare APC Fee Schedule
OT-EVAL HGH 15M MCD,97167,CPT,,,,,both,, ,253.00,151.80,Medicare,Medicare,,151.80,,,253.00,35.42,129.03,Fee Schedule,Medicare APC Fee Schedule
OT RE-EVAL VISIT OT,97168,CPT,,,,,both,, ,151.41,90.84,Medicare,Medicare,,90.84,,,151.41,21.20,77.22,Fee Schedule,Medicare APC Fee Schedule
OT RE-EVAL VISIT OT,97168,CPT,,,,,both,, ,151.41,90.84,Medicare,Medicare,,90.84,,,151.41,21.20,77.22,Fee Schedule,Medicare APC Fee Schedule
OT RE-EVAL VISIT OT,97168,CPT,,,,,both,, ,507.79,304.67,Medicare,Medicare,,304.67,,,507.79,71.09,258.97,Fee Schedule,Medicare APC Fee Schedule
OT RE-EVAL VISIT OT,97168,CPT,,,,,both,, ,507.79,304.67,Medicare,Medicare,,304.67,,,507.79,71.09,258.97,Fee Schedule,Medicare APC Fee Schedule
OT RE-EVAL-VISIT,97168,CPT,,,,,both,, ,474.13,284.47,Medicare,Medicare,,284.47,,,474.13,66.38,241.81,Fee Schedule,Medicare APC Fee Schedule
THER ACTVT-15MIN OT,97530,CPT,,,,,both,, ,398.10,238.86,Medicare,Medicare,,238.86,,,398.10,55.73,203.03,Fee Schedule,Medicare APC Fee Schedule
THER ACTVT-15MIN OT,97530,CPT,,,,,both,, ,398.10,238.86,Medicare,Medicare,,238.86,,,398.10,55.73,203.03,Fee Schedule,Medicare APC Fee Schedule
THER ACTVT-15MIN PT,97530,CPT,,,,,both,, ,104.29,62.57,Medicare,Medicare,,62.57,,,104.29,14.60,53.19,Fee Schedule,Medicare APC Fee Schedule
THER ACTVT-15MIN PT,97530,CPT,,,,,both,, ,104.29,62.57,Medicare,Medicare,,62.57,,,104.29,14.60,53.19,Fee Schedule,Medicare APC Fee Schedule
THER ACTVT-15MIN PT,97530,CPT,,,,,both,, ,104.29,62.57,Medicare,Medicare,,62.57,,,104.29,14.60,53.19,Fee Schedule,Medicare APC Fee Schedule
THER ACTVT-15MIN PT,97530,CPT,,,,,both,, ,104.29,62.57,Medicare,Medicare,,62.57,,,104.29,14.60,53.19,Fee Schedule,Medicare APC Fee Schedule
THER ACTVT-15MIN PT,97530,CPT,,,,,both,, ,367.20,220.32,Medicare,Medicare,,220.32,,,367.20,51.41,187.27,Fee Schedule,Medicare APC Fee Schedule
THER ACTVT-15MIN PT,97530,CPT,,,,,both,, ,367.20,220.32,Medicare,Medicare,,220.32,,,367.20,51.41,187.27,Fee Schedule,Medicare APC Fee Schedule
THERAP ACTVTS-15 MIN,97530,CPT,,,,,both,, ,342.72,205.63,Medicare,Medicare,,205.63,,,342.72,47.98,174.79,Fee Schedule,Medicare APC Fee Schedule
THERAP ACTVTS-15 MIN,97530,CPT,,,,,both,, ,371.55,222.93,Medicare,Medicare,,222.93,,,371.55,52.02,189.49,Fee Schedule,Medicare APC Fee Schedule
SENS INTG-15 MIN,97533,CPT,,,,,both,, ,167.89,100.73,Medicare,Medicare,,100.73,,,167.89,23.50,85.62,Fee Schedule,Medicare APC Fee Schedule
SENS INTG-15 MIN OT,97533,CPT,,,,,both,, ,90.13,54.07,Medicare,Medicare,,54.07,,,90.13,12.62,45.97,Fee Schedule,Medicare APC Fee Schedule
SENS INTG-15 MIN OT,97533,CPT,,,,,both,, ,90.13,54.07,Medicare,Medicare,,54.07,,,90.13,12.62,45.97,Fee Schedule,Medicare APC Fee Schedule
SENS INTG-15 MIN OT,97533,CPT,,,,,both,, ,687.27,412.36,Medicare,Medicare,,412.36,,,687.27,96.22,350.51,Fee Schedule,Medicare APC Fee Schedule
SENS INTG-15 MIN OT,97533,CPT,,,,,both,, ,687.27,412.36,Medicare,Medicare,,412.36,,,687.27,96.22,350.51,Fee Schedule,Medicare APC Fee Schedule
SENSORY INTEG-15 MIN,97533,CPT,,,,,both,, ,641.59,384.95,Medicare,Medicare,,384.95,,,641.59,89.82,327.21,Fee Schedule,Medicare APC Fee Schedule
SELF CARE MGT-15 MIN,97535,CPT,,,,,both,, ,342.72,205.63,Medicare,Medicare,,205.63,,,342.72,47.98,174.79,Fee Schedule,Medicare APC Fee Schedule
SELF CARE MGT-15 MIN,97535,CPT,,,,,both,, ,371.55,222.93,Medicare,Medicare,,222.93,,,371.55,52.02,189.49,Fee Schedule,Medicare APC Fee Schedule
SLF CRE MGT-15MN OT,97535,CPT,,,,,both,, ,398.10,238.86,Medicare,Medicare,,238.86,,,398.10,55.73,203.03,Fee Schedule,Medicare APC Fee Schedule
SLF CRE MGT-15MN OT,97535,CPT,,,,,both,, ,398.10,238.86,Medicare,Medicare,,238.86,,,398.10,55.73,203.03,Fee Schedule,Medicare APC Fee Schedule
SLF CRE MGT-15MN PT,97535,CPT,,,,,both,, ,90.13,54.07,Medicare,Medicare,,54.07,,,90.13,12.62,45.97,Fee Schedule,Medicare APC Fee Schedule
SLF CRE MGT-15MN PT,97535,CPT,,,,,both,, ,90.13,54.07,Medicare,Medicare,,54.07,,,90.13,12.62,45.97,Fee Schedule,Medicare APC Fee Schedule
SLF CRE MGT-15MN PT,97535,CPT,,,,,both,, ,90.13,54.07,Medicare,Medicare,,54.07,,,90.13,12.62,45.97,Fee Schedule,Medicare APC Fee Schedule
SLF CRE MGT-15MN PT,97535,CPT,,,,,both,, ,90.13,54.07,Medicare,Medicare,,54.07,,,90.13,12.62,45.97,Fee Schedule,Medicare APC Fee Schedule
SLF CRE MGT-15MN PT,97535,CPT,,,,,both,, ,367.20,220.32,Medicare,Medicare,,220.32,,,367.20,51.41,187.27,Fee Schedule,Medicare APC Fee Schedule
SLF CRE MGT-15MN PT,97535,CPT,,,,,both,, ,367.20,220.32,Medicare,Medicare,,220.32,,,367.20,51.41,187.27,Fee Schedule,Medicare APC Fee Schedule
COM-WK REIN-15MN OT,97537,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,291.85,,,486.42,68.10,248.07,Fee Schedule,Medicare APC Fee Schedule
COM-WK REIN-15MN OT,97537,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,291.85,,,486.42,68.10,248.07,Fee Schedule,Medicare APC Fee Schedule
COM-WK REIN-15MN PT,97537,CPT,,,,,both,, ,86.78,52.06,Medicare,Medicare,,52.06,,,86.78,12.15,44.26,Fee Schedule,Medicare APC Fee Schedule
COM-WK REIN-15MN PT,97537,CPT,,,,,both,, ,86.78,52.06,Medicare,Medicare,,52.06,,,86.78,12.15,44.26,Fee Schedule,Medicare APC Fee Schedule
COM-WK REIN-15MN PT,97537,CPT,,,,,both,, ,86.78,52.06,Medicare,Medicare,,52.06,,,86.78,12.15,44.26,Fee Schedule,Medicare APC Fee Schedule
COM-WK REIN-15MN PT,97537,CPT,,,,,both,, ,86.78,52.06,Medicare,Medicare,,52.06,,,86.78,12.15,44.26,Fee Schedule,Medicare APC Fee Schedule
COM-WK REIN-15MN PT,97537,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,269.14,,,448.57,62.80,228.77,Fee Schedule,Medicare APC Fee Schedule
COM-WK REIN-15MN PT,97537,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,269.14,,,448.57,62.80,228.77,Fee Schedule,Medicare APC Fee Schedule
COM-WRK REINT-15 MIN,97537,CPT,,,,,both,, ,418.86,251.31,Medicare,Medicare,,251.31,,,418.86,58.64,213.62,Fee Schedule,Medicare APC Fee Schedule
COM-WRK REINT-15 MIN,97537,CPT,,,,,both,, ,454.13,272.47,Medicare,Medicare,,272.47,,,454.13,63.58,231.61,Fee Schedule,Medicare APC Fee Schedule
WHEELCHR MGT-15 MIN,97542,CPT,,,,,both,, ,418.86,251.31,Medicare,Medicare,,251.31,,,418.86,58.64,213.62,Fee Schedule,Medicare APC Fee Schedule
WHEELCHR MGT-15 MIN,97542,CPT,,,,,both,, ,454.13,272.47,Medicare,Medicare,,272.47,,,454.13,63.58,231.61,Fee Schedule,Medicare APC Fee Schedule
WHLCHR MGT-15 MIN OT,97542,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,291.85,,,486.42,68.10,248.07,Fee Schedule,Medicare APC Fee Schedule
WHLCHR MGT-15 MIN OT,97542,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,291.85,,,486.42,68.10,248.07,Fee Schedule,Medicare APC Fee Schedule
WHLCHR MGT-15 MIN PT,97542,CPT,,,,,both,, ,87.55,52.53,Medicare,Medicare,,52.53,,,87.55,12.26,44.65,Fee Schedule,Medicare APC Fee Schedule
WHLCHR MGT-15 MIN PT,97542,CPT,,,,,both,, ,87.55,52.53,Medicare,Medicare,,52.53,,,87.55,12.26,44.65,Fee Schedule,Medicare APC Fee Schedule
WHLCHR MGT-15 MIN PT,97542,CPT,,,,,both,, ,87.55,52.53,Medicare,Medicare,,52.53,,,87.55,12.26,44.65,Fee Schedule,Medicare APC Fee Schedule
WHLCHR MGT-15 MIN PT,97542,CPT,,,,,both,, ,87.55,52.53,Medicare,Medicare,,52.53,,,87.55,12.26,44.65,Fee Schedule,Medicare APC Fee Schedule
WHLCHR MGT-15 MIN PT,97542,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,269.14,,,448.57,62.80,228.77,Fee Schedule,Medicare APC Fee Schedule
WHLCHR MGT-15 MIN PT,97542,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,269.14,,,448.57,62.80,228.77,Fee Schedule,Medicare APC Fee Schedule
WK HR-CD 1ST 2HR OT,97545,CPT,,,,,both,, ,1215.92,729.55,Medicare,Medicare,,729.55,,,1215.92,170.23,620.12,Fee Schedule,Medicare APC Fee Schedule
WK HR-CD 1ST 2HR OT,97545,CPT,,,,,both,, ,1215.92,729.55,Medicare,Medicare,,729.55,,,1215.92,170.23,620.12,Fee Schedule,Medicare APC Fee Schedule
WK HR-CD 1ST 2HR PT,97545,CPT,,,,,both,, ,206.00,123.60,Medicare,Medicare,,123.60,,,206.00,28.84,105.06,Fee Schedule,Medicare APC Fee Schedule
WK HR-CD 1ST 2HR PT,97545,CPT,,,,,both,, ,206.00,123.60,Medicare,Medicare,,123.60,,,206.00,28.84,105.06,Fee Schedule,Medicare APC Fee Schedule
WK HR-CD 1ST 2HR PT,97545,CPT,,,,,both,, ,1121.67,673.00,Medicare,Medicare,,673.00,,,1121.67,157.03,572.05,Fee Schedule,Medicare APC Fee Schedule
WK HR-CD 1ST 2HR PT,97545,CPT,,,,,both,, ,1121.67,673.00,Medicare,Medicare,,673.00,,,1121.67,157.03,572.05,Fee Schedule,Medicare APC Fee Schedule
WK HR-CD 1ST 2HR PT,97545,CPT,,,,,both,, ,1121.67,673.00,Medicare,Medicare,,673.00,,,1121.67,157.03,572.05,Fee Schedule,Medicare APC Fee Schedule
WK HR-CD 1ST 2HR PT,97545,CPT,,,,,both,, ,1121.67,673.00,Medicare,Medicare,,673.00,,,1121.67,157.03,572.05,Fee Schedule,Medicare APC Fee Schedule
WRK HAR-CND 1ST 2HRS,97545,CPT,,,,,both,, ,1047.07,628.24,Medicare,Medicare,,628.24,,,1047.07,146.59,534.01,Fee Schedule,Medicare APC Fee Schedule
WRK HAR-CND 1ST 2HRS,97545,CPT,,,,,both,, ,1135.14,681.08,Medicare,Medicare,,681.08,,,1135.14,158.92,578.92,Fee Schedule,Medicare APC Fee Schedule
WRK HAR-CND-ADD HR,97546,CPT,,,,,both,, ,460.55,276.33,Medicare,Medicare,,276.33,,,460.55,64.48,234.88,Fee Schedule,Medicare APC Fee Schedule
WRK HAR-CND-ADD HR,97546,CPT,,,,,both,, ,567.57,340.54,Medicare,Medicare,,340.54,,,567.57,79.46,289.46,Fee Schedule,Medicare APC Fee Schedule
WRK HAR-CND-ADHR OT,97546,CPT,,,,,both,, ,607.96,364.77,Medicare,Medicare,,364.77,,,607.96,85.11,310.06,Fee Schedule,Medicare APC Fee Schedule
WRK HAR-CND-ADHR OT,97546,CPT,,,,,both,, ,607.96,364.77,Medicare,Medicare,,364.77,,,607.96,85.11,310.06,Fee Schedule,Medicare APC Fee Schedule
WRK HAR-CND-ADHR PT,97546,CPT,,,,,both,, ,103.00,61.80,Medicare,Medicare,,61.80,,,103.00,14.42,52.53,Fee Schedule,Medicare APC Fee Schedule
WRK HAR-CND-ADHR PT,97546,CPT,,,,,both,, ,103.00,61.80,Medicare,Medicare,,61.80,,,103.00,14.42,52.53,Fee Schedule,Medicare APC Fee Schedule
WRK HAR-CND-ADHR PT,97546,CPT,,,,,both,, ,103.00,61.80,Medicare,Medicare,,61.80,,,103.00,14.42,52.53,Fee Schedule,Medicare APC Fee Schedule
WRK HAR-CND-ADHR PT,97546,CPT,,,,,both,, ,103.00,61.80,Medicare,Medicare,,61.80,,,103.00,14.42,52.53,Fee Schedule,Medicare APC Fee Schedule
WRK HAR-CND-ADHR PT,97546,CPT,,,,,both,, ,493.37,296.02,Medicare,Medicare,,296.02,,,493.37,69.07,251.62,Fee Schedule,Medicare APC Fee Schedule
WRK HAR-CND-ADHR PT,97546,CPT,,,,,both,, ,493.37,296.02,Medicare,Medicare,,296.02,,,493.37,69.07,251.62,Fee Schedule,Medicare APC Fee Schedule
DEBRDE LE 20SQCM OT,97597,CPT,,,,,both,, ,731.82,439.09,Medicare,Medicare,,439.09,,,731.82,102.45,373.23,Fee Schedule,Medicare APC Fee Schedule
DEBRDE LE 20SQCM OT,97597,CPT,,,,,both,, ,731.82,439.09,Medicare,Medicare,,439.09,,,731.82,102.45,373.23,Fee Schedule,Medicare APC Fee Schedule
DEBRDE LE 20SQCM PT,97597,CPT,,,,,both,, ,447.54,268.52,Medicare,Medicare,,268.52,,,447.54,62.66,228.25,Fee Schedule,Medicare APC Fee Schedule
DEBRDE LE 20SQCM PT,97597,CPT,,,,,both,, ,447.54,268.52,Medicare,Medicare,,268.52,,,447.54,62.66,228.25,Fee Schedule,Medicare APC Fee Schedule
DEBRDE LE 20SQCM PT,97597,CPT,,,,,both,, ,447.54,268.52,Medicare,Medicare,,268.52,,,447.54,62.66,228.25,Fee Schedule,Medicare APC Fee Schedule
DEBRDE LE 20SQCM PT,97597,CPT,,,,,both,, ,447.54,268.52,Medicare,Medicare,,268.52,,,447.54,62.66,228.25,Fee Schedule,Medicare APC Fee Schedule
DEBRDE LE 20SQCM PT,97597,CPT,,,,,both,, ,675.17,405.10,Medicare,Medicare,,405.10,,,675.17,94.52,344.34,Fee Schedule,Medicare APC Fee Schedule
DEBRDE LE 20SQCM PT,97597,CPT,,,,,both,, ,675.17,405.10,Medicare,Medicare,,405.10,,,675.17,94.52,344.34,Fee Schedule,Medicare APC Fee Schedule
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,252.25,151.35,Medicare,Medicare,,151.35,,,252.25,35.32,128.65,Fee Schedule,Medicare APC Fee Schedule
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,252.25,151.35,Medicare,Medicare,,151.35,,,252.25,35.32,128.65,Fee Schedule,Medicare APC Fee Schedule
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,259.82,155.89,Medicare,Medicare,,155.89,,,259.82,36.37,132.51,Fee Schedule,Medicare APC Fee Schedule
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,259.82,155.89,Medicare,Medicare,,155.89,,,259.82,36.37,132.51,Fee Schedule,Medicare APC Fee Schedule
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,630.26,378.15,Medicare,Medicare,,378.15,,,630.26,88.24,321.43,Fee Schedule,Medicare APC Fee Schedule
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,683.29,409.97,Medicare,Medicare,,409.97,,,683.29,95.66,348.48,Fee Schedule,Medicare APC Fee Schedule
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,861.67,517.00,Medicare,Medicare,,517.00,,,861.67,120.63,439.45,Fee Schedule,Medicare APC Fee Schedule
SLCTV WND DEB =<20CM,97597,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
DEBRDE EA AD20CM OT,97598,CPT,,,,,both,, ,450.63,270.37,Medicare,Medicare,,270.37,,,450.63,63.09,229.82,Fee Schedule,Medicare APC Fee Schedule
DEBRDE EA AD20CM OT,97598,CPT,,,,,both,, ,450.63,270.37,Medicare,Medicare,,270.37,,,450.63,63.09,229.82,Fee Schedule,Medicare APC Fee Schedule
DEBRDE EA AD20CM OT,97598,CPT,,,,,both,, ,488.48,293.08,Medicare,Medicare,,293.08,,,488.48,68.39,249.12,Fee Schedule,Medicare APC Fee Schedule
DEBRDE EA AD20CM OT,97598,CPT,,,,,both,, ,488.48,293.08,Medicare,Medicare,,293.08,,,488.48,68.39,249.12,Fee Schedule,Medicare APC Fee Schedule
DEBRDE EA AD20CM PT,97598,CPT,,,,,both,, ,450.63,270.37,Medicare,Medicare,,270.37,,,450.63,63.09,229.82,Fee Schedule,Medicare APC Fee Schedule
DEBRDE EA AD20CM PT,97598,CPT,,,,,both,, ,450.63,270.37,Medicare,Medicare,,270.37,,,450.63,63.09,229.82,Fee Schedule,Medicare APC Fee Schedule
DEBRDE EA AD20CM PT,97598,CPT,,,,,both,, ,450.63,270.37,Medicare,Medicare,,270.37,,,450.63,63.09,229.82,Fee Schedule,Medicare APC Fee Schedule
DEBRDE EA AD20CM PT,97598,CPT,,,,,both,, ,450.63,270.37,Medicare,Medicare,,270.37,,,450.63,63.09,229.82,Fee Schedule,Medicare APC Fee Schedule
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,252.25,151.35,Medicare,Medicare,,151.35,,,252.25,35.32,128.65,Fee Schedule,Medicare APC Fee Schedule
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,252.25,151.35,Medicare,Medicare,,151.35,,,252.25,35.32,128.65,Fee Schedule,Medicare APC Fee Schedule
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,259.82,155.89,Medicare,Medicare,,155.89,,,259.82,36.37,132.51,Fee Schedule,Medicare APC Fee Schedule
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,259.82,155.89,Medicare,Medicare,,155.89,,,259.82,36.37,132.51,Fee Schedule,Medicare APC Fee Schedule
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,420.57,252.34,Medicare,Medicare,,252.34,,,420.57,58.88,214.49,Fee Schedule,Medicare APC Fee Schedule
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,455.94,273.56,Medicare,Medicare,,273.56,,,455.94,63.83,232.53,Fee Schedule,Medicare APC Fee Schedule
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,575.10,345.06,Medicare,Medicare,,345.06,,,575.10,80.51,293.3,Fee Schedule,Medicare APC Fee Schedule
SLCTV WND DEB >20 CM,97598,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
DBRD NON-SEL-VIS OT,97602,CPT,,,,,both,, ,521.70,313.02,Medicare,Medicare,,313.02,,,521.70,73.04,266.07,Fee Schedule,Medicare APC Fee Schedule
DBRD NON-SEL-VIS OT,97602,CPT,,,,,both,, ,521.70,313.02,Medicare,Medicare,,313.02,,,521.70,73.04,266.07,Fee Schedule,Medicare APC Fee Schedule
DBRD NON-SEL-VIS PT,97602,CPT,,,,,both,, ,447.54,268.52,Medicare,Medicare,,268.52,,,447.54,62.66,228.25,Fee Schedule,Medicare APC Fee Schedule
DBRD NON-SEL-VIS PT,97602,CPT,,,,,both,, ,447.54,268.52,Medicare,Medicare,,268.52,,,447.54,62.66,228.25,Fee Schedule,Medicare APC Fee Schedule
DBRD NON-SEL-VIS PT,97602,CPT,,,,,both,, ,447.54,268.52,Medicare,Medicare,,268.52,,,447.54,62.66,228.25,Fee Schedule,Medicare APC Fee Schedule
DBRD NON-SEL-VIS PT,97602,CPT,,,,,both,, ,447.54,268.52,Medicare,Medicare,,268.52,,,447.54,62.66,228.25,Fee Schedule,Medicare APC Fee Schedule
DBRD NON-SEL-VIS PT,97602,CPT,,,,,both,, ,481.27,288.76,Medicare,Medicare,,288.76,,,481.27,67.38,245.45,Fee Schedule,Medicare APC Fee Schedule
DBRD NON-SEL-VIS PT,97602,CPT,,,,,both,, ,481.27,288.76,Medicare,Medicare,,288.76,,,481.27,67.38,245.45,Fee Schedule,Medicare APC Fee Schedule
DEBRIDE NON-SELC-VIS,97602,CPT,,,,,both,, ,449.32,269.59,Medicare,Medicare,,269.59,,,449.32,62.90,229.15,Fee Schedule,Medicare APC Fee Schedule
DEBRIDE NON-SELC-VIS,97602,CPT,,,,,both,, ,487.13,292.27,Medicare,Medicare,,292.27,,,487.13,68.20,248.44,Fee Schedule,Medicare APC Fee Schedule
NON SELECTIVE DEBRID,97602,CPT,,,,,both,, ,158.11,94.86,Medicare,Medicare,,94.86,,,158.11,22.14,80.64,Fee Schedule,Medicare APC Fee Schedule
NON SELECTIVE DEBRID,97602,CPT,,,,,both,, ,158.11,94.86,Medicare,Medicare,,94.86,,,158.11,22.14,80.64,Fee Schedule,Medicare APC Fee Schedule
NSW DEB WO A/SESSION,97602,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,146.78,88.06,Medicare,Medicare,,88.06,,,146.78,20.55,74.86,Fee Schedule,Medicare APC Fee Schedule
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,158.11,94.86,Medicare,Medicare,,94.86,,,158.11,22.14,80.64,Fee Schedule,Medicare APC Fee Schedule
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,158.11,94.86,Medicare,Medicare,,94.86,,,158.11,22.14,80.64,Fee Schedule,Medicare APC Fee Schedule
NEG PRESS WND TX <50,97605,CPT,,,,,both,, ,763.00,457.80,Medicare,Medicare,,457.80,,,763.00,106.82,389.13,Fee Schedule,Medicare APC Fee Schedule
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,241.28,144.76,Medicare,Medicare,,144.76,,,241.28,33.78,123.05,Fee Schedule,Medicare APC Fee Schedule
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,259.82,155.89,Medicare,Medicare,,155.89,,,259.82,36.37,132.51,Fee Schedule,Medicare APC Fee Schedule
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,259.82,155.89,Medicare,Medicare,,155.89,,,259.82,36.37,132.51,Fee Schedule,Medicare APC Fee Schedule
NEG PRESS WND TX >50,97606,CPT,,,,,both,, ,1520.00,912.00,Medicare,Medicare,,912.00,,,1520.00,212.80,775.2,Fee Schedule,Medicare APC Fee Schedule
NEG PR WN MD LT 50CM,97607,CPT,,,,,both,, ,463.24,277.94,Medicare,Medicare,,277.94,,,463.24,64.85,236.25,Fee Schedule,Medicare APC Fee Schedule
NEG PR WN MD LT 50CM,97607,CPT,,,,,both,, ,463.24,277.94,Medicare,Medicare,,277.94,,,463.24,64.85,236.25,Fee Schedule,Medicare APC Fee Schedule
NEG PRES WND TX <=50,97607,CPT,,,,,both,, ,1520.00,912.00,Medicare,Medicare,,912.00,,,1520.00,212.80,775.2,Fee Schedule,Medicare APC Fee Schedule
NEG PR WN MD GT 50CM,97608,CPT,,,,,both,, ,919.79,551.87,Medicare,Medicare,,551.87,,,919.79,128.77,469.09,Fee Schedule,Medicare APC Fee Schedule
PHYS PERF-15 MIN OT,97750,CPT,,,,,both,, ,1014.55,608.73,Medicare,Medicare,,608.73,,,1014.55,142.04,517.42,Fee Schedule,Medicare APC Fee Schedule
PHYS PERF-15 MIN OT,97750,CPT,,,,,both,, ,1014.55,608.73,Medicare,Medicare,,608.73,,,1014.55,142.04,517.42,Fee Schedule,Medicare APC Fee Schedule
PHYS PERF-15 MIN PT,97750,CPT,,,,,both,, ,91.93,55.15,Medicare,Medicare,,55.15,,,91.93,12.87,46.88,Fee Schedule,Medicare APC Fee Schedule
PHYS PERF-15 MIN PT,97750,CPT,,,,,both,, ,91.93,55.15,Medicare,Medicare,,55.15,,,91.93,12.87,46.88,Fee Schedule,Medicare APC Fee Schedule
PHYS PERF-15 MIN PT,97750,CPT,,,,,both,, ,91.93,55.15,Medicare,Medicare,,55.15,,,91.93,12.87,46.88,Fee Schedule,Medicare APC Fee Schedule
PHYS PERF-15 MIN PT,97750,CPT,,,,,both,, ,91.93,55.15,Medicare,Medicare,,55.15,,,91.93,12.87,46.88,Fee Schedule,Medicare APC Fee Schedule
PHYS PERF-15 MIN PT,97750,CPT,,,,,both,, ,936.01,561.60,Medicare,Medicare,,561.60,,,936.01,131.04,477.37,Fee Schedule,Medicare APC Fee Schedule
PHYS PERF-15 MIN PT,97750,CPT,,,,,both,, ,936.01,561.60,Medicare,Medicare,,561.60,,,936.01,131.04,477.37,Fee Schedule,Medicare APC Fee Schedule
PHYSICAL PERF-15 MIN,97750,CPT,,,,,both,, ,873.68,524.20,Medicare,Medicare,,524.20,,,873.68,122.32,445.58,Fee Schedule,Medicare APC Fee Schedule
PHYSICAL PERF-15 MIN,97750,CPT,,,,,both,, ,947.11,568.26,Medicare,Medicare,,568.26,,,947.11,132.60,483.03,Fee Schedule,Medicare APC Fee Schedule
ORTH TRAIN INI-15 MI,97760,CPT,,,,,both,, ,342.72,205.63,Medicare,Medicare,,205.63,,,342.72,47.98,174.79,Fee Schedule,Medicare APC Fee Schedule
ORTH TRAIN INI-15 MI,97760,CPT,,,,,both,, ,371.55,222.93,Medicare,Medicare,,222.93,,,371.55,52.02,189.49,Fee Schedule,Medicare APC Fee Schedule
ORTH TRN INI15MI OT,97760,CPT,,,,,both,, ,398.10,238.86,Medicare,Medicare,,238.86,,,398.10,55.73,203.03,Fee Schedule,Medicare APC Fee Schedule
ORTH TRN INI15MI OT,97760,CPT,,,,,both,, ,398.10,238.86,Medicare,Medicare,,238.86,,,398.10,55.73,203.03,Fee Schedule,Medicare APC Fee Schedule
ORTH TRN INI15MI PT,97760,CPT,,,,,both,, ,124.12,74.47,Medicare,Medicare,,74.47,,,124.12,17.38,63.3,Fee Schedule,Medicare APC Fee Schedule
ORTH TRN INI15MI PT,97760,CPT,,,,,both,, ,124.12,74.47,Medicare,Medicare,,74.47,,,124.12,17.38,63.3,Fee Schedule,Medicare APC Fee Schedule
ORTH TRN INI15MI PT,97760,CPT,,,,,both,, ,124.12,74.47,Medicare,Medicare,,74.47,,,124.12,17.38,63.3,Fee Schedule,Medicare APC Fee Schedule
ORTH TRN INI15MI PT,97760,CPT,,,,,both,, ,124.12,74.47,Medicare,Medicare,,74.47,,,124.12,17.38,63.3,Fee Schedule,Medicare APC Fee Schedule
ORTH TRN INI15MI PT,97760,CPT,,,,,both,, ,367.20,220.32,Medicare,Medicare,,220.32,,,367.20,51.41,187.27,Fee Schedule,Medicare APC Fee Schedule
ORTH TRN INI15MI PT,97760,CPT,,,,,both,, ,367.20,220.32,Medicare,Medicare,,220.32,,,367.20,51.41,187.27,Fee Schedule,Medicare APC Fee Schedule
PROS TRAIN INI-15 MI,97761,CPT,,,,,both,, ,342.72,205.63,Medicare,Medicare,,205.63,,,342.72,47.98,174.79,Fee Schedule,Medicare APC Fee Schedule
PROS TRAIN INI-15 MI,97761,CPT,,,,,both,, ,371.55,222.93,Medicare,Medicare,,222.93,,,371.55,52.02,189.49,Fee Schedule,Medicare APC Fee Schedule
PROS TRN INI15MI OT,97761,CPT,,,,,both,, ,398.10,238.86,Medicare,Medicare,,238.86,,,398.10,55.73,203.03,Fee Schedule,Medicare APC Fee Schedule
PROS TRN INI15MI OT,97761,CPT,,,,,both,, ,398.10,238.86,Medicare,Medicare,,238.86,,,398.10,55.73,203.03,Fee Schedule,Medicare APC Fee Schedule
PROS TRN INI15MI PT,97761,CPT,,,,,both,, ,107.38,64.42,Medicare,Medicare,,64.42,,,107.38,15.03,54.76,Fee Schedule,Medicare APC Fee Schedule
PROS TRN INI15MI PT,97761,CPT,,,,,both,, ,107.38,64.42,Medicare,Medicare,,64.42,,,107.38,15.03,54.76,Fee Schedule,Medicare APC Fee Schedule
PROS TRN INI15MI PT,97761,CPT,,,,,both,, ,107.38,64.42,Medicare,Medicare,,64.42,,,107.38,15.03,54.76,Fee Schedule,Medicare APC Fee Schedule
PROS TRN INI15MI PT,97761,CPT,,,,,both,, ,107.38,64.42,Medicare,Medicare,,64.42,,,107.38,15.03,54.76,Fee Schedule,Medicare APC Fee Schedule
PROS TRN INI15MI PT,97761,CPT,,,,,both,, ,367.20,220.32,Medicare,Medicare,,220.32,,,367.20,51.41,187.27,Fee Schedule,Medicare APC Fee Schedule
PROS TRN INI15MI PT,97761,CPT,,,,,both,, ,367.20,220.32,Medicare,Medicare,,220.32,,,367.20,51.41,187.27,Fee Schedule,Medicare APC Fee Schedule
PROS-ORTH SUB-15 MIN,97763,CPT,,,,,both,, ,318.29,190.97,Medicare,Medicare,,190.97,,,318.29,44.56,162.33,Fee Schedule,Medicare APC Fee Schedule
PROS-ORTH SUB-15 MIN,97763,CPT,,,,,both,, ,358.85,215.31,Medicare,Medicare,,215.31,,,358.85,50.24,183.01,Fee Schedule,Medicare APC Fee Schedule
PRS-ORT SUB-15MN OT,97763,CPT,,,,,both,, ,340.93,204.55,Medicare,Medicare,,204.55,,,340.93,47.73,173.87,Fee Schedule,Medicare APC Fee Schedule
PRS-ORT SUB-15MN OT,97763,CPT,,,,,both,, ,340.93,204.55,Medicare,Medicare,,204.55,,,340.93,47.73,173.87,Fee Schedule,Medicare APC Fee Schedule
PRS-ORT SUB-15MN PT,97763,CPT,,,,,both,, ,131.07,78.64,Medicare,Medicare,,78.64,,,131.07,18.35,66.85,Fee Schedule,Medicare APC Fee Schedule
PRS-ORT SUB-15MN PT,97763,CPT,,,,,both,, ,131.07,78.64,Medicare,Medicare,,78.64,,,131.07,18.35,66.85,Fee Schedule,Medicare APC Fee Schedule
PRS-ORT SUB-15MN PT,97763,CPT,,,,,both,, ,131.07,78.64,Medicare,Medicare,,78.64,,,131.07,18.35,66.85,Fee Schedule,Medicare APC Fee Schedule
PRS-ORT SUB-15MN PT,97763,CPT,,,,,both,, ,131.07,78.64,Medicare,Medicare,,78.64,,,131.07,18.35,66.85,Fee Schedule,Medicare APC Fee Schedule
PRS-ORT SUB-15MN PT,97763,CPT,,,,,both,, ,384.45,230.67,Medicare,Medicare,,230.67,,,384.45,53.82,196.07,Fee Schedule,Medicare APC Fee Schedule
PRS-ORT SUB-15MN PT,97763,CPT,,,,,both,, ,384.45,230.67,Medicare,Medicare,,230.67,,,384.45,53.82,196.07,Fee Schedule,Medicare APC Fee Schedule
MNT INITIAL EA 15 MN,97802,CPT,,,,,both,, ,194.41,116.64,Medicare,Medicare,,116.64,,,194.41,27.22,99.15,Fee Schedule,Medicare APC Fee Schedule
MNT REASSES EA 15 MN,97803,CPT,,,,,both,, ,101.46,60.87,Medicare,Medicare,,60.87,,,101.46,14.20,51.74,Fee Schedule,Medicare APC Fee Schedule
MNT GROUP EA 30 MIN,97804,CPT,,,,,both,, ,223.25,133.95,Medicare,Medicare,,133.95,,,223.25,31.26,113.86,Fee Schedule,Medicare APC Fee Schedule
LAB COLLECTION,99000,CPT,,,,,both,, ,70.00,42.00,Medicare,Medicare,,42.00,,,70.00,9.80,35.7,Fee Schedule,Medicare APC Fee Schedule
SPEC CHAIN CUSTODY,99001,CPT,,,,,both,, ,21.33,12.79,Medicare,Medicare,,12.79,,,21.33,2.99,10.88,Fee Schedule,Medicare APC Fee Schedule
MSED SAMEGT5 1ST15,99152,CPT,,,,,both,, ,313.38,188.02,Medicare,Medicare,,188.02,,,313.38,43.87,159.82,Fee Schedule,Medicare APC Fee Schedule
MODSED SAME ADD15MIN,99153,CPT,,,,,both,, ,417.92,250.75,Medicare,Medicare,,250.75,,,417.92,58.51,213.14,Fee Schedule,Medicare APC Fee Schedule
HBO COMM PER SESSION,99183,CPT,,,,,both,, ,990.13,594.07,Medicare,Medicare,,594.07,,,990.13,138.62,504.97,Fee Schedule,Medicare APC Fee Schedule
PHLEBOTOMY THERAPEUT,99195,CPT,,,,,both,, ,266.77,160.06,Medicare,Medicare,,160.06,,,266.77,37.35,136.05,Fee Schedule,Medicare APC Fee Schedule
BRIEF ED VISIT,99281,CPT,,,,,Outpatient,, ,1098.28,658.96,Medicare,Medicare,,658.96,,,1098.28,153.76,560.12,Fee Schedule,Medicare APC Fee Schedule
BRIEF ED VISIT,99281,CPT,,,,,Outpatient,, ,1098.28,658.96,Medicare,Medicare,,658.96,,,1098.28,153.76,560.12,Fee Schedule,Medicare APC Fee Schedule
LIMITED ED VISIT,99282,CPT,,,,,Outpatient,, ,1925.14,1155.08,Medicare,Medicare,,1155.08,,,1925.14,269.52,981.82,Fee Schedule,Medicare APC Fee Schedule
INTERMEDIATE ED VIST,99283,CPT,,,,,Outpatient,, ,3494.12,2096.47,Medicare,Medicare,,2096.47,,,3494.12,489.18,1782,Fee Schedule,Medicare APC Fee Schedule
EXTENDED ED VISIT,99284,CPT,,,,,Outpatient,, ,6509.13,3905.47,Medicare,Medicare,,3905.47,,,6509.13,911.28,3319.66,Fee Schedule,Medicare APC Fee Schedule
COMPREHENSIVE ED VST,99285,CPT,,,,,Outpatient,, ,8592.58,5155.54,Medicare,Medicare,,5155.54,,,8592.58,1202.96,4382.22,Fee Schedule,Medicare APC Fee Schedule
CRITICAL CARE LT 74M,99291,CPT,,,,,both,, ,12285.42,7371.25,Medicare,Medicare,,7371.25,,,12285.42,1719.96,6265.56,Fee Schedule,Medicare APC Fee Schedule
CRIT CARE EA 30 MIN,99292,CPT,,,,,both,, ,4418.38,2651.02,Medicare,Medicare,,2651.02,,,4418.38,618.57,2253.37,Fee Schedule,Medicare APC Fee Schedule
BEHAV CHG SMOKE U 10,99406,CPT,,,,,both,, ,127.46,76.47,Medicare,Medicare,,76.47,,,127.46,17.84,65,Fee Schedule,Medicare APC Fee Schedule
BEHAV CHG SMOKE GR10,99407,CPT,,,,,both,, ,127.46,76.47,Medicare,Medicare,,76.47,,,127.46,17.84,65,Fee Schedule,Medicare APC Fee Schedule
NEWBORN RESUCITATION,99465,CPT,,,,,both,, ,2447.28,1468.36,Medicare,Medicare,,1468.36,,,2447.28,342.62,1248.11,Fee Schedule,Medicare APC Fee Schedule
RESPIRATORY PANEL PCR,0202U,HCPCS,,,,,both,, ,500.00,300.00,Medicare,Medicare,,300.00,,,500.00,70.00,255,Fee Schedule,Medicare APC Fee Schedule
COV19 FLUAB CEPHEID,0240U,CPT,,,,,both,, ,568.00,340.80,Medicare,Medicare,,340.80,,,568.00,79.52,289.68,Fee Schedule,Medicare APC Fee Schedule
COV19 FLUAB RSV CEPH,0241U,CPT,,,,,both,, ,570.52,342.31,Medicare,Medicare,,342.31,,,570.52,79.87,290.97,Fee Schedule,Medicare APC Fee Schedule
MVP MULTIPLEX VAGINAL DNA PROBE,0352U,HCPCS,,,,,both,, ,570.52,342.31,Medicare,Medicare,,342.31,,,570.52,79.87,290.97,Fee Schedule,Medicare APC Fee Schedule
INTRATUBAL OCCLU DEV,A4264,HCPCS,,,,,both,, ,8176.40,4905.84,Medicare,Medicare,,4905.84,,,8176.40,1144.70,4169.96,Fee Schedule,Medicare APC Fee Schedule
TISSUE MARKR IMPLT 1,A4648,HCPCS,,,,,both,, ,179.22,107.53,Medicare,Medicare,,107.53,,,179.22,25.09,91.4,Fee Schedule,Medicare APC Fee Schedule
TISSUE MARKR IMPLT 2,A4648,HCPCS,,,,,both,, ,1195.32,717.19,Medicare,Medicare,,717.19,,,1195.32,167.34,609.61,Fee Schedule,Medicare APC Fee Schedule
TISSUE MARKR IMPLT 3,A4648,HCPCS,,,,,both,, ,2390.63,1434.37,Medicare,Medicare,,1434.37,,,2390.63,334.69,1219.22,Fee Schedule,Medicare APC Fee Schedule
COLLAGEN WITH SILVER (PUROCOL),A6022,HCPCS,,,,,both,, ,28.28,16.96,Medicare,Medicare,,16.96,,,28.28,3.96,14.42,Fee Schedule,Medicare APC Fee Schedule
ENDOFORM ANTIMICROBIAL,A6022,HCPCS,,,,,both,, ,41.56,24.93,Medicare,Medicare,,24.93,,,41.56,5.82,21.2,Fee Schedule,Medicare APC Fee Schedule
COLLAGEN (PUROCOL),A6023,HCPCS,,,,,both,, ,19.80,11.88,Medicare,Medicare,,11.88,,,19.80,2.77,10.1,Fee Schedule,Medicare APC Fee Schedule
CONVAMAX PAD 4X4,A6196,HCPCS,,,,,both,, ,7.68,4.60,Medicare,Medicare,,4.60,,,7.68,1.08,3.92,Fee Schedule,Medicare APC Fee Schedule
CONVAMAX PAD 4X8,A6197,HCPCS,,,,,both,, ,8.88,5.32,Medicare,Medicare,,5.32,,,8.88,1.24,4.53,Fee Schedule,Medicare APC Fee Schedule
CONVAMAX PAD 6X8,A6197,HCPCS,,,,,both,, ,11.76,7.05,Medicare,Medicare,,7.05,,,11.76,1.65,6,Fee Schedule,Medicare APC Fee Schedule
DRSG GRMCDL 45X2CM AQCL AG MIC,A6197,HCPCS,,,,,both,, ,36.48,21.88,Medicare,Medicare,,21.88,,,36.48,5.11,18.6,Fee Schedule,Medicare APC Fee Schedule
DRSG GRMCDL 4X5IN AQCL AG,A6197,HCPCS,,,,,both,, ,31.04,18.62,Medicare,Medicare,,18.62,,,31.04,4.35,15.83,Fee Schedule,Medicare APC Fee Schedule
DRSG WND 5X4IN SQ AQCL X HDRFB,A6198,HCPCS,,,,,both,, ,11.16,6.69,Medicare,Medicare,,6.69,,,11.16,1.56,5.69,Fee Schedule,Medicare APC Fee Schedule
DRSG ALG 18X.75IN AQCL HDRFB,A6199,HCPCS,,,,,both,, ,14.12,8.47,Medicare,Medicare,,8.47,,,14.12,1.98,7.2,Fee Schedule,Medicare APC Fee Schedule
HYDROFERA BLUE TRANSFER 5X4,A6210,HCPCS,,,,,both,, ,24.12,14.47,Medicare,Medicare,,14.47,,,24.12,3.38,12.3,Fee Schedule,Medicare APC Fee Schedule
4X4 AQUACEL FOAM NO ADHESIVE,A6211,HCPCS,,,,,both,, ,7.48,4.48,Medicare,Medicare,,4.48,,,7.48,1.05,3.81,Fee Schedule,Medicare APC Fee Schedule
"DRESSING,ALLEVYN,SACRUM,SMALL",A6212,HCPCS,,,,,both,, ,21.96,13.17,Medicare,Medicare,,13.17,,,21.96,3.07,11.2,Fee Schedule,Medicare APC Fee Schedule
DRSG LG QUADRILOBE 6 1/16INX6,A6212,HCPCS,,,,,both,, ,11.48,6.88,Medicare,Medicare,,6.88,,,11.48,1.61,5.85,Fee Schedule,Medicare APC Fee Schedule
"HEEL,LIFE,ALLEVYN",A6212,HCPCS,,,,,both,, ,29.16,17.49,Medicare,Medicare,,17.49,,,29.16,4.08,14.87,Fee Schedule,Medicare APC Fee Schedule
DRSG MED QUADRILOBE 5 1/16INX5,A6213,HCPCS,,,,,both,, ,9.80,5.88,Medicare,Medicare,,5.88,,,9.80,1.37,5,Fee Schedule,Medicare APC Fee Schedule
SACRAL AQUACEL FOAM WITH ADHESIVE,A6213,HCPCS,,,,,both,, ,17.32,10.39,Medicare,Medicare,,10.39,,,17.32,2.42,8.83,Fee Schedule,Medicare APC Fee Schedule
4X4 AQUACEL FOAM WITH ADHESIVE,A6214,HCPCS,,,,,both,, ,8.12,4.87,Medicare,Medicare,,4.87,,,8.12,1.14,4.14,Fee Schedule,Medicare APC Fee Schedule
DUODERM THIN 4X2,A6237,HCPCS,,,,,both,, ,4.80,2.88,Medicare,Medicare,,2.88,,,4.80,0.67,2.45,Fee Schedule,Medicare APC Fee Schedule
DUODERM THIN 4X4,A6238,HCPCS,,,,,both,, ,4.12,2.47,Medicare,Medicare,,2.47,,,4.12,0.58,2.1,Fee Schedule,Medicare APC Fee Schedule
TRIAD CREAM 2.5 OUNCES,A6240,HCPCS,,,,,both,, ,3.64,2.18,Medicare,Medicare,,2.18,,,3.64,0.51,1.86,Fee Schedule,Medicare APC Fee Schedule
HYDROGEL,A6248,HCPCS,,,,,both,, ,16.76,10.05,Medicare,Medicare,,10.05,,,16.76,2.35,8.55,Fee Schedule,Medicare APC Fee Schedule
NO-RINSE FOAM CLEANSER,A6250,HCPCS,,,,,both,, ,7.96,4.77,Medicare,Medicare,,4.77,,,7.96,1.11,4.06,Fee Schedule,Medicare APC Fee Schedule
ABD PADS 5X9,A6252,HCPCS,,,,,both,, ,0.32,0.19,Medicare,Medicare,,0.19,,,0.32,0.04,0.16,Fee Schedule,Medicare APC Fee Schedule
ABD PADS 8X10,A6253,HCPCS,,,,,both,, ,0.48,0.28,Medicare,Medicare,,0.28,,,0.48,0.07,0.24,Fee Schedule,Medicare APC Fee Schedule
IODOFORM PACKING 1 INCH,A6266,HCPCS,,,,,both,, ,8.76,5.25,Medicare,Medicare,,5.25,,,8.76,1.23,4.47,Fee Schedule,Medicare APC Fee Schedule
IODOFORM PACKING 1/2 INCH,A6266,HCPCS,,,,,both,, ,6.84,4.10,Medicare,Medicare,,4.10,,,6.84,0.96,3.49,Fee Schedule,Medicare APC Fee Schedule
IODOFORM PACKING 1/4 INCH,A6266,HCPCS,,,,,both,, ,6.56,3.93,Medicare,Medicare,,3.93,,,6.56,0.92,3.35,Fee Schedule,Medicare APC Fee Schedule
STERILE 2X2 GAUZE,A6402,HCPCS,,,,,both,, ,0.08,0.04,Medicare,Medicare,,0.04,,,0.08,0.01,0.04,Fee Schedule,Medicare APC Fee Schedule
STERILE 4X4 GAUZE,A6402,HCPCS,,,,,both,, ,0.16,0.09,Medicare,Medicare,,0.09,,,0.16,0.02,0.08,Fee Schedule,Medicare APC Fee Schedule
PLAIN PACKING 1 INCH,A6407,HCPCS,,,,,both,, ,6.88,4.12,Medicare,Medicare,,4.12,,,6.88,0.96,3.51,Fee Schedule,Medicare APC Fee Schedule
PLAIN PACKING 1/2 INCH,A6407,HCPCS,,,,,both,, ,6.28,3.76,Medicare,Medicare,,3.76,,,6.28,0.88,3.2,Fee Schedule,Medicare APC Fee Schedule
PLAIN PACKING 1/4 INCH,A6407,HCPCS,,,,,both,, ,6.40,3.84,Medicare,Medicare,,3.84,,,6.40,0.90,3.26,Fee Schedule,Medicare APC Fee Schedule
ACE WRAP 4 INCH,A6449,HCPCS,,,,,both,, ,1.64,0.98,Medicare,Medicare,,0.98,,,1.64,0.23,0.84,Fee Schedule,Medicare APC Fee Schedule
ACE WRAP 6 INCH,A6450,HCPCS,,,,,both,, ,2.40,1.44,Medicare,Medicare,,1.44,,,2.40,0.34,1.22,Fee Schedule,Medicare APC Fee Schedule
ZINC PASTE TUBES,A6456,HCPCS,,,,,both,, ,8.44,5.06,Medicare,Medicare,,5.06,,,8.44,1.18,4.3,Fee Schedule,Medicare APC Fee Schedule
PICO DRESSING KIT,A9272,HCPCS,,,,,both,, ,3547.64,2128.58,Medicare,Medicare,,2128.58,,,3547.64,496.67,1809.3,Fee Schedule,Medicare APC Fee Schedule
TC-99M SESTA / DOSE,A9500,HCPCS,,,,,both,, ,551.05,330.63,Medicare,Medicare,,330.63,,,551.05,77.15,281.04,Fee Schedule,Medicare APC Fee Schedule
TC-99M TETRO/UNITDOS,A9502,HCPCS,,,,,both,, ,347.11,208.26,Medicare,Medicare,,208.26,,,347.11,48.60,177.03,Fee Schedule,Medicare APC Fee Schedule
TC99M MEDRO TO 30MCI,A9503,HCPCS,,,,,both,, ,69.78,41.86,Medicare,Medicare,,41.86,,,69.78,9.77,35.59,Fee Schedule,Medicare APC Fee Schedule
"TL-201, PER MCI",A9505,HCPCS,,,,,both,, ,95.53,57.31,Medicare,Medicare,,57.31,,,95.53,13.37,48.72,Fee Schedule,Medicare APC Fee Schedule
TC99M PERTECHNET/MCI,A9512,HCPCS,,,,,both,, ,81.89,49.13,Medicare,Medicare,,49.13,,,81.89,11.46,41.76,Fee Schedule,Medicare APC Fee Schedule
"I123 CAP,DX /100UCI",A9516,HCPCS,,,,,both,, ,312.35,187.41,Medicare,Medicare,,187.41,,,312.35,43.73,159.3,Fee Schedule,Medicare APC Fee Schedule
TC99 TILMAN DX .5MCI,A9520,HCPCS,,,,,both,, ,2305.66,1383.39,Medicare,Medicare,,1383.39,,,2305.66,322.79,1175.89,Fee Schedule,Medicare APC Fee Schedule
TC99M EXAME / DOSE,A9521,HCPCS,,,,,both,, ,17205.64,10323.38,Medicare,Medicare,,10323.38,,,17205.64,2408.79,8774.88,Fee Schedule,Medicare APC Fee Schedule
TC99M MEBROF /15MCI,A9537,HCPCS,,,,,both,, ,170.47,102.28,Medicare,Medicare,,102.28,,,170.47,23.87,86.94,Fee Schedule,Medicare APC Fee Schedule
TC99M PYROPHOS/25MCI,A9538,HCPCS,,,,,both,, ,235.61,141.36,Medicare,Medicare,,141.36,,,235.61,32.99,120.16,Fee Schedule,Medicare APC Fee Schedule
TC99M PENTETAT/25MCI,A9539,HCPCS,,,,,both,, ,69.78,41.86,Medicare,Medicare,,41.86,,,69.78,9.77,35.59,Fee Schedule,Medicare APC Fee Schedule
TC99M MAA/10MCI,A9540,HCPCS,,,,,both,, ,62.83,37.69,Medicare,Medicare,,37.69,,,62.83,8.80,32.04,Fee Schedule,Medicare APC Fee Schedule
TC99M SULF COL/20MCI,A9541,HCPCS,,,,,both,, ,83.17,49.90,Medicare,Medicare,,49.90,,,83.17,11.64,42.42,Fee Schedule,Medicare APC Fee Schedule
TC99M SULFCOL2/20MCI,A9541,HCPCS,,,,,both,, ,529.68,317.80,Medicare,Medicare,,317.80,,,529.68,74.16,270.14,Fee Schedule,Medicare APC Fee Schedule
IN111 PENTETAT/.5MCI,A9548,HCPCS,,,,,both,, ,12525.06,7515.03,Medicare,Medicare,,7515.03,,,12525.06,1753.51,6387.78,Fee Schedule,Medicare APC Fee Schedule
GA67 GALLIUM/MCI,A9556,HCPCS,,,,,both,, ,102.23,61.33,Medicare,Medicare,,61.33,,,102.23,14.31,52.14,Fee Schedule,Medicare APC Fee Schedule
XE133 XENON 10MCI,A9558,HCPCS,,,,,both,, ,264.20,158.52,Medicare,Medicare,,158.52,,,264.20,36.99,134.74,Fee Schedule,Medicare APC Fee Schedule
TC99M LABL RBC/30MCI,A9560,HCPCS,,,,,both,, ,69.78,41.86,Medicare,Medicare,,41.86,,,69.78,9.77,35.59,Fee Schedule,Medicare APC Fee Schedule
TC99M OXIDRONA/30MCI,A9561,HCPCS,,,,,both,, ,148.84,89.30,Medicare,Medicare,,89.30,,,148.84,20.84,75.91,Fee Schedule,Medicare APC Fee Schedule
TC99M MERTIATI/15MCI,A9562,HCPCS,,,,,both,, ,938.33,562.99,Medicare,Medicare,,562.99,,,938.33,131.37,478.55,Fee Schedule,Medicare APC Fee Schedule
TC99M AEROSOL 75 MCI,A9567,HCPCS,,,,,both,, ,69.78,41.86,Medicare,Medicare,,41.86,,,69.78,9.77,35.59,Fee Schedule,Medicare APC Fee Schedule
IN-111 PENTETRE/6MCI,A9572,HCPCS,,,,,both,, ,14752.18,8851.30,Medicare,Medicare,,8851.30,,,14752.18,2065.31,7523.61,Fee Schedule,Medicare APC Fee Schedule
INJ GADO DIMEG ML 15,A9577,HCPCS,,,,,both,15,ML,13.75,8.25,Medicare,Medicare,,8.25,,,13.75,1.93,7.01,Fee Schedule,Medicare APC Fee Schedule
INJ GADO DIMEG ML 20,A9577,HCPCS,,,,,both,20,ML,13.75,8.25,Medicare,Medicare,,8.25,,,13.75,1.93,7.01,Fee Schedule,Medicare APC Fee Schedule
INJ MULTIHANCE /ML,A9577,HCPCS,,,,,both,, ,14.16,8.49,Medicare,Medicare,,8.49,,,14.16,1.98,7.22,Fee Schedule,Medicare APC Fee Schedule
INJ MULTIHANCE/ ML,A9577,HCPCS,,,,,both,, ,13.75,8.25,Medicare,Medicare,,8.25,,,13.75,1.93,7.01,Fee Schedule,Medicare APC Fee Schedule
INJ GAD-MR1 CONTR ML,A9579,HCPCS,,,,,both,, ,37.60,22.56,Medicare,Medicare,,22.56,,,37.60,5.26,19.18,Fee Schedule,Medicare APC Fee Schedule
INJ GAD-MR2 CONTR ML,A9579,HCPCS,,,,,both,, ,47.90,28.74,Medicare,Medicare,,28.74,,,47.90,6.71,24.43,Fee Schedule,Medicare APC Fee Schedule
INJ GAD-MR3 CONTR ML,A9579,HCPCS,,,,,both,, ,40.94,24.56,Medicare,Medicare,,24.56,,,40.94,5.73,20.88,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 1,C1713,HCPCS,,,,,both,, ,129.01,77.40,Medicare,Medicare,,77.40,,,129.01,18.06,65.8,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 10,C1713,HCPCS,,,,,both,, ,2873.70,1724.22,Medicare,Medicare,,1724.22,,,2873.70,402.32,1465.59,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 11,C1713,HCPCS,,,,,both,, ,4069.02,2441.41,Medicare,Medicare,,2441.41,,,4069.02,569.66,2075.2,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 12,C1713,HCPCS,,,,,both,, ,4786.15,2871.69,Medicare,Medicare,,2871.69,,,4786.15,670.06,2440.94,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 13,C1713,HCPCS,,,,,both,, ,6684.19,4010.51,Medicare,Medicare,,4010.51,,,6684.19,935.79,3408.94,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 14,C1713,HCPCS,,,,,both,, ,9567.67,5740.60,Medicare,Medicare,,5740.60,,,9567.67,1339.47,4879.51,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 15,C1713,HCPCS,,,,,both,, ,14349.19,8609.51,Medicare,Medicare,,8609.51,,,14349.19,2008.89,7318.09,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 16,C1713,HCPCS,,,,,both,, ,19130.71,11478.42,Medicare,Medicare,,11478.42,,,19130.71,2678.30,9756.66,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 17,C1713,HCPCS,,,,,both,, ,23912.22,14347.33,Medicare,Medicare,,14347.33,,,23912.22,3347.71,12195.23,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 18,C1713,HCPCS,,,,,both,, ,31084.37,18650.62,Medicare,Medicare,,18650.62,,,31084.37,4351.81,15853.03,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 19,C1713,HCPCS,,,,,both,, ,38256.78,22954.06,Medicare,Medicare,,22954.06,,,38256.78,5355.95,19510.96,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 2,C1713,HCPCS,,,,,both,, ,172.01,103.20,Medicare,Medicare,,103.20,,,172.01,24.08,87.73,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 20,C1713,HCPCS,,,,,both,, ,47814.92,28688.95,Medicare,Medicare,,28688.95,,,47814.92,6694.09,24385.61,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 21,C1713,HCPCS,,,,,both,, ,57377.95,34426.77,Medicare,Medicare,,34426.77,,,57377.95,8032.91,29262.75,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 3,C1713,HCPCS,,,,,both,, ,243.85,146.31,Medicare,Medicare,,146.31,,,243.85,34.14,124.36,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 4,C1713,HCPCS,,,,,both,, ,411.23,246.73,Medicare,Medicare,,246.73,,,411.23,57.57,209.73,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 5,C1713,HCPCS,,,,,both,, ,602.55,361.53,Medicare,Medicare,,361.53,,,602.55,84.36,307.3,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 6,C1713,HCPCS,,,,,both,, ,841.51,504.90,Medicare,Medicare,,504.90,,,841.51,117.81,429.17,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 7,C1713,HCPCS,,,,,both,, ,1200.21,720.12,Medicare,Medicare,,720.12,,,1200.21,168.03,612.11,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 8,C1713,HCPCS,,,,,both,, ,1678.39,1007.03,Medicare,Medicare,,1007.03,,,1678.39,234.97,855.98,Fee Schedule,Medicare APC Fee Schedule
ANCHOR/SCRW LEVEL 9,C1713,HCPCS,,,,,both,, ,2156.56,1293.93,Medicare,Medicare,,1293.93,,,2156.56,301.92,1099.85,Fee Schedule,Medicare APC Fee Schedule
BONE CEMENT 1,C1713,HCPCS,,,,,both,, ,884.51,530.70,Medicare,Medicare,,530.70,,,884.51,123.83,451.1,Fee Schedule,Medicare APC Fee Schedule
BONE CEMENT 2,C1713,HCPCS,,,,,both,, ,2467.37,1480.42,Medicare,Medicare,,1480.42,,,2467.37,345.43,1258.36,Fee Schedule,Medicare APC Fee Schedule
CATH TRNS ARTHR DIR1,C1714,HCPCS,,,,,both,, ,5379.18,3227.50,Medicare,Medicare,,3227.50,,,5379.18,753.09,2743.38,Fee Schedule,Medicare APC Fee Schedule
CATH TRNS ARTHR DIR2,C1714,HCPCS,,,,,both,, ,8391.41,5034.84,Medicare,Medicare,,5034.84,,,8391.41,1174.80,4279.62,Fee Schedule,Medicare APC Fee Schedule
AICD DUAL CHAMBER L1,C1721,HCPCS,,,,,both,, ,93836.86,56302.11,Medicare,Medicare,,56302.11,,,93836.86,13137.16,47856.8,Fee Schedule,Medicare APC Fee Schedule
AICD SINGLE CHAMBER1,C1722,HCPCS,,,,,both,, ,99999.00,59999.40,Medicare,Medicare,,59999.40,,,99999.00,13999.86,50999.49,Fee Schedule,Medicare APC Fee Schedule
CATH TRNS ARTHR ROT1,C1724,HCPCS,,,,,both,, ,5379.18,3227.50,Medicare,Medicare,,3227.50,,,5379.18,753.09,2743.38,Fee Schedule,Medicare APC Fee Schedule
CATH TRNS ARTHR ROT2,C1724,HCPCS,,,,,both,, ,16735.18,10041.10,Medicare,Medicare,,10041.10,,,16735.18,2342.93,8534.94,Fee Schedule,Medicare APC Fee Schedule
CATH-ANGIO LEVEL 1,C1725,HCPCS,,,,,both,, ,855.42,513.25,Medicare,Medicare,,513.25,,,855.42,119.76,436.26,Fee Schedule,Medicare APC Fee Schedule
CATH-ANGIO LEVEL 2,C1725,HCPCS,,,,,both,, ,1728.86,1037.31,Medicare,Medicare,,1037.31,,,1728.86,242.04,881.72,Fee Schedule,Medicare APC Fee Schedule
CATH-ANGIO LEVEL 3,C1725,HCPCS,,,,,both,, ,2726.15,1635.69,Medicare,Medicare,,1635.69,,,2726.15,381.66,1390.34,Fee Schedule,Medicare APC Fee Schedule
CATH-ANGIO LEVEL 4,C1725,HCPCS,,,,,both,, ,4234.59,2540.75,Medicare,Medicare,,2540.75,,,4234.59,592.84,2159.64,Fee Schedule,Medicare APC Fee Schedule
CATH-ANGIO LEVEL 5,C1725,HCPCS,,,,,both,, ,6331.93,3799.15,Medicare,Medicare,,3799.15,,,6331.93,886.47,3229.28,Fee Schedule,Medicare APC Fee Schedule
CATH BAL DIL NONVAS1,C1726,HCPCS,,,,,both,, ,1434.53,860.71,Medicare,Medicare,,860.71,,,1434.53,200.83,731.61,Fee Schedule,Medicare APC Fee Schedule
CATH BAL DIL NONVAS2,C1726,HCPCS,,,,,both,, ,2390.63,1434.37,Medicare,Medicare,,1434.37,,,2390.63,334.69,1219.22,Fee Schedule,Medicare APC Fee Schedule
CATH BRACHY SEED AD1,C1728,HCPCS,,,,,both,, ,717.14,430.28,Medicare,Medicare,,430.28,,,717.14,100.40,365.74,Fee Schedule,Medicare APC Fee Schedule
CATH BRACHY SEED AD2,C1728,HCPCS,,,,,both,, ,956.36,573.81,Medicare,Medicare,,573.81,,,956.36,133.89,487.74,Fee Schedule,Medicare APC Fee Schedule
CATH DRAINAG LEVEL11,C1729,HCPCS,,,,,both,, ,11958.56,7175.13,Medicare,Medicare,,7175.13,,,11958.56,1674.20,6098.87,Fee Schedule,Medicare APC Fee Schedule
CATH-DRAINAG LEVEL 1,C1729,HCPCS,,,,,both,, ,84.20,50.52,Medicare,Medicare,,50.52,,,84.20,11.79,42.94,Fee Schedule,Medicare APC Fee Schedule
CATH-DRAINAG LEVEL 2,C1729,HCPCS,,,,,both,, ,247.72,148.63,Medicare,Medicare,,148.63,,,247.72,34.68,126.34,Fee Schedule,Medicare APC Fee Schedule
CATH-DRAINAG LEVEL 3,C1729,HCPCS,,,,,both,, ,727.18,436.30,Medicare,Medicare,,436.30,,,727.18,101.81,370.86,Fee Schedule,Medicare APC Fee Schedule
CATH-DRAINAG LEVEL 4,C1729,HCPCS,,,,,both,, ,1200.21,720.12,Medicare,Medicare,,720.12,,,1200.21,168.03,612.11,Fee Schedule,Medicare APC Fee Schedule
CATH-DRAINAG LEVEL 5,C1729,HCPCS,,,,,both,, ,1917.35,1150.41,Medicare,Medicare,,1150.41,,,1917.35,268.43,977.85,Fee Schedule,Medicare APC Fee Schedule
CATH-DRAINAG LEVEL 6,C1729,HCPCS,,,,,both,, ,2634.48,1580.68,Medicare,Medicare,,1580.68,,,2634.48,368.83,1343.58,Fee Schedule,Medicare APC Fee Schedule
CATH-DRAINAG LEVEL 7,C1729,HCPCS,,,,,both,, ,3351.88,2011.12,Medicare,Medicare,,2011.12,,,3351.88,469.26,1709.46,Fee Schedule,Medicare APC Fee Schedule
CATH-DRAINAG LEVEL 8,C1729,HCPCS,,,,,both,, ,4786.15,2871.69,Medicare,Medicare,,2871.69,,,4786.15,670.06,2440.94,Fee Schedule,Medicare APC Fee Schedule
CATH-DRAINAG LEVEL 9,C1729,HCPCS,,,,,both,, ,7177.04,4306.22,Medicare,Medicare,,4306.22,,,7177.04,1004.79,3660.29,Fee Schedule,Medicare APC Fee Schedule
CATH-DRAINAG LEVEL10,C1729,HCPCS,,,,,both,, ,9567.67,5740.60,Medicare,Medicare,,5740.60,,,9567.67,1339.47,4879.51,Fee Schedule,Medicare APC Fee Schedule
CATH-DRAINAG LEVEL12,C1729,HCPCS,,,,,both,, ,14344.55,8606.73,Medicare,Medicare,,8606.73,,,14344.55,2008.24,7315.72,Fee Schedule,Medicare APC Fee Schedule
CATH EP 19 OR FEW 1,C1730,HCPCS,,,,,both,, ,554.66,332.79,Medicare,Medicare,,332.79,,,554.66,77.65,282.88,Fee Schedule,Medicare APC Fee Schedule
CATH EP 19 OR FEW 2,C1730,HCPCS,,,,,both,, ,1807.39,1084.43,Medicare,Medicare,,1084.43,,,1807.39,253.03,921.77,Fee Schedule,Medicare APC Fee Schedule
CATH EP 20 OR MORE 1,C1731,HCPCS,,,,,both,, ,6185.15,3711.09,Medicare,Medicare,,3711.09,,,6185.15,865.92,3154.43,Fee Schedule,Medicare APC Fee Schedule
CATH EP DIG/ABL 3D 1,C1732,HCPCS,,,,,both,, ,7172.15,4303.29,Medicare,Medicare,,4303.29,,,7172.15,1004.10,3657.8,Fee Schedule,Medicare APC Fee Schedule
CATH EP DIG/ABL 3D 2,C1732,HCPCS,,,,,both,, ,15395.93,9237.55,Medicare,Medicare,,9237.55,,,15395.93,2155.43,7851.92,Fee Schedule,Medicare APC Fee Schedule
CATH HEMODIAL LT 1,C1750,HCPCS,,,,,both,, ,1434.53,860.71,Medicare,Medicare,,860.71,,,1434.53,200.83,731.61,Fee Schedule,Medicare APC Fee Schedule
CATH HEMODIAL LT 2,C1750,HCPCS,,,,,both,, ,1912.71,1147.62,Medicare,Medicare,,1147.62,,,1912.71,267.78,975.48,Fee Schedule,Medicare APC Fee Schedule
CATH-INFUS PERIF 1,C1751,HCPCS,,,,,both,, ,89.61,53.76,Medicare,Medicare,,53.76,,,89.61,12.55,45.7,Fee Schedule,Medicare APC Fee Schedule
CATH-INFUS PERIF 10,C1751,HCPCS,,,,,both,, ,2395.52,1437.31,Medicare,Medicare,,1437.31,,,2395.52,335.37,1221.72,Fee Schedule,Medicare APC Fee Schedule
CATH-INFUS PERIF 11,C1751,HCPCS,,,,,both,, ,3351.88,2011.12,Medicare,Medicare,,2011.12,,,3351.88,469.26,1709.46,Fee Schedule,Medicare APC Fee Schedule
CATH-INFUS PERIF 12,C1751,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,2868.91,,,4781.52,669.41,2438.58,Fee Schedule,Medicare APC Fee Schedule
CATH-INFUS PERIF 2,C1751,HCPCS,,,,,both,, ,124.37,74.62,Medicare,Medicare,,74.62,,,124.37,17.41,63.43,Fee Schedule,Medicare APC Fee Schedule
CATH-INFUS PERIF 3,C1751,HCPCS,,,,,both,, ,243.85,146.31,Medicare,Medicare,,146.31,,,243.85,34.14,124.36,Fee Schedule,Medicare APC Fee Schedule
CATH-INFUS PERIF 4,C1751,HCPCS,,,,,both,, ,722.03,433.21,Medicare,Medicare,,433.21,,,722.03,101.08,368.24,Fee Schedule,Medicare APC Fee Schedule
CATH-INFUS PERIF 5,C1751,HCPCS,,,,,both,, ,960.99,576.59,Medicare,Medicare,,576.59,,,960.99,134.54,490.1,Fee Schedule,Medicare APC Fee Schedule
CATH-INFUS PERIF 5,C1751,HCPCS,,,,,both,, ,960.99,576.59,Medicare,Medicare,,576.59,,,960.99,134.54,490.1,Fee Schedule,Medicare APC Fee Schedule
CATH-INFUS PERIF 7,C1751,HCPCS,,,,,both,, ,1200.21,720.12,Medicare,Medicare,,720.12,,,1200.21,168.03,612.11,Fee Schedule,Medicare APC Fee Schedule
CATH-INFUS PERIF 8,C1751,HCPCS,,,,,both,, ,1439.17,863.50,Medicare,Medicare,,863.50,,,1439.17,201.48,733.98,Fee Schedule,Medicare APC Fee Schedule
CATH-INFUS PERIF 9,C1751,HCPCS,,,,,both,, ,1673.49,1004.09,Medicare,Medicare,,1004.09,,,1673.49,234.29,853.48,Fee Schedule,Medicare APC Fee Schedule
CATH HEMODIAL ST 1,C1752,HCPCS,,,,,both,, ,358.70,215.22,Medicare,Medicare,,215.22,,,358.70,50.22,182.94,Fee Schedule,Medicare APC Fee Schedule
CATH HEMODIAL ST 2,C1752,HCPCS,,,,,both,, ,478.18,286.90,Medicare,Medicare,,286.90,,,478.18,66.95,243.87,Fee Schedule,Medicare APC Fee Schedule
CATH INTRAVAS ULTRA1,C1753,HCPCS,,,,,both,, ,3586.20,2151.72,Medicare,Medicare,,2151.72,,,3586.20,502.07,1828.96,Fee Schedule,Medicare APC Fee Schedule
CATH INTRAVAS ULTRA2,C1753,HCPCS,,,,,both,, ,14344.55,8606.73,Medicare,Medicare,,8606.73,,,14344.55,2008.24,7315.72,Fee Schedule,Medicare APC Fee Schedule
CATHETER INTRASPINAL,C1755,HCPCS,,,,,both,, ,5259.70,3155.82,Medicare,Medicare,,3155.82,,,5259.70,736.36,2682.45,Fee Schedule,Medicare APC Fee Schedule
CATH THRMB/EMBOL 1,C1757,HCPCS,,,,,both,, ,238.96,143.37,Medicare,Medicare,,143.37,,,238.96,33.45,121.87,Fee Schedule,Medicare APC Fee Schedule
CATH THRMB/EMBOL 2,C1757,HCPCS,,,,,both,, ,1792.97,1075.78,Medicare,Medicare,,1075.78,,,1792.97,251.02,914.41,Fee Schedule,Medicare APC Fee Schedule
CATH THRMB/EMBOL 3,C1757,HCPCS,,,,,both,, ,2395.52,1437.31,Medicare,Medicare,,1437.31,,,2395.52,335.37,1221.72,Fee Schedule,Medicare APC Fee Schedule
CATH THRMB/EMBOL 4,C1757,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,2868.91,,,4781.52,669.41,2438.58,Fee Schedule,Medicare APC Fee Schedule
CATH URETERAL 1,C1758,HCPCS,,,,,both,, ,478.18,286.90,Medicare,Medicare,,286.90,,,478.18,66.95,243.87,Fee Schedule,Medicare APC Fee Schedule
CATH URETERAL 2,C1758,HCPCS,,,,,both,, ,717.14,430.28,Medicare,Medicare,,430.28,,,717.14,100.40,365.74,Fee Schedule,Medicare APC Fee Schedule
CATH URETERAL 3,C1758,HCPCS,,,,,both,, ,956.36,573.81,Medicare,Medicare,,573.81,,,956.36,133.89,487.74,Fee Schedule,Medicare APC Fee Schedule
CATH INTRA ECHOCARD1,C1759,HCPCS,,,,,both,, ,7172.15,4303.29,Medicare,Medicare,,4303.29,,,7172.15,1004.10,3657.8,Fee Schedule,Medicare APC Fee Schedule
CATH INTRA ECHOCARD2,C1759,HCPCS,,,,,both,, ,9563.04,5737.82,Medicare,Medicare,,5737.82,,,9563.04,1338.83,4877.15,Fee Schedule,Medicare APC Fee Schedule
CLOSURE DEVIC VASC 1,C1760,HCPCS,,,,,both,, ,1634.61,980.76,Medicare,Medicare,,980.76,,,1634.61,228.85,833.65,Fee Schedule,Medicare APC Fee Schedule
CLOSURE DEVIC VASC 2,C1760,HCPCS,,,,,both,, ,2504.70,1502.82,Medicare,Medicare,,1502.82,,,2504.70,350.66,1277.4,Fee Schedule,Medicare APC Fee Schedule
CONN TISSUE HUMAN 1,C1762,HCPCS,,,,,both,, ,1438.14,862.88,Medicare,Medicare,,862.88,,,1438.14,201.34,733.45,Fee Schedule,Medicare APC Fee Schedule
CONN TISSUE HUMAN 10,C1762,HCPCS,,,,,both,, ,57377.95,34426.77,Medicare,Medicare,,34426.77,,,57377.95,8032.91,29262.75,Fee Schedule,Medicare APC Fee Schedule
CONN TISSUE HUMAN 2,C1762,HCPCS,,,,,both,, ,1917.35,1150.41,Medicare,Medicare,,1150.41,,,1917.35,268.43,977.85,Fee Schedule,Medicare APC Fee Schedule
CONN TISSUE HUMAN 3,C1762,HCPCS,,,,,both,, ,5742.51,3445.50,Medicare,Medicare,,3445.50,,,5742.51,803.95,2928.68,Fee Schedule,Medicare APC Fee Schedule
CONN TISSUE HUMAN 4,C1762,HCPCS,,,,,both,, ,9567.67,5740.60,Medicare,Medicare,,5740.60,,,9567.67,1339.47,4879.51,Fee Schedule,Medicare APC Fee Schedule
CONN TISSUE HUMAN 5,C1762,HCPCS,,,,,both,, ,13393.09,8035.85,Medicare,Medicare,,8035.85,,,13393.09,1875.03,6830.48,Fee Schedule,Medicare APC Fee Schedule
CONN TISSUE HUMAN 6,C1762,HCPCS,,,,,both,, ,17218.25,10330.95,Medicare,Medicare,,10330.95,,,17218.25,2410.56,8781.31,Fee Schedule,Medicare APC Fee Schedule
CONN TISSUE HUMAN 7,C1762,HCPCS,,,,,both,, ,23907.59,14344.55,Medicare,Medicare,,14344.55,,,23907.59,3347.06,12192.87,Fee Schedule,Medicare APC Fee Schedule
CONN TISSUE HUMAN 8,C1762,HCPCS,,,,,both,, ,33475.26,20085.15,Medicare,Medicare,,20085.15,,,33475.26,4686.54,17072.38,Fee Schedule,Medicare APC Fee Schedule
CONN TISSUE HUMAN 9,C1762,HCPCS,,,,,both,, ,43033.40,25820.04,Medicare,Medicare,,25820.04,,,43033.40,6024.68,21947.03,Fee Schedule,Medicare APC Fee Schedule
TISSUE NON-HUMAN 1,C1763,HCPCS,,,,,both,, ,1796.58,1077.94,Medicare,Medicare,,1077.94,,,1796.58,251.52,916.26,Fee Schedule,Medicare APC Fee Schedule
TISSUE NON-HUMAN 10,C1763,HCPCS,,,,,both,, ,43033.40,25820.04,Medicare,Medicare,,25820.04,,,43033.40,6024.68,21947.03,Fee Schedule,Medicare APC Fee Schedule
TISSUE NON-HUMAN 11,C1763,HCPCS,,,,,both,, ,57377.95,34426.77,Medicare,Medicare,,34426.77,,,57377.95,8032.91,29262.75,Fee Schedule,Medicare APC Fee Schedule
TISSUE NON-HUMAN 2,C1763,HCPCS,,,,,both,, ,2395.52,1437.31,Medicare,Medicare,,1437.31,,,2395.52,335.37,1221.72,Fee Schedule,Medicare APC Fee Schedule
TISSUE NON-HUMAN 3,C1763,HCPCS,,,,,both,, ,4786.15,2871.69,Medicare,Medicare,,2871.69,,,4786.15,670.06,2440.94,Fee Schedule,Medicare APC Fee Schedule
TISSUE NON-HUMAN 4,C1763,HCPCS,,,,,both,, ,8611.57,5166.94,Medicare,Medicare,,5166.94,,,8611.57,1205.62,4391.9,Fee Schedule,Medicare APC Fee Schedule
TISSUE NON-HUMAN 5,C1763,HCPCS,,,,,both,, ,12436.74,7462.04,Medicare,Medicare,,7462.04,,,12436.74,1741.14,6342.74,Fee Schedule,Medicare APC Fee Schedule
TISSUE NON-HUMAN 6,C1763,HCPCS,,,,,both,, ,15305.54,9183.32,Medicare,Medicare,,9183.32,,,15305.54,2142.78,7805.83,Fee Schedule,Medicare APC Fee Schedule
TISSUE NON-HUMAN 7,C1763,HCPCS,,,,,both,, ,19130.71,11478.42,Medicare,Medicare,,11478.42,,,19130.71,2678.30,9756.66,Fee Schedule,Medicare APC Fee Schedule
TISSUE NON-HUMAN 8,C1763,HCPCS,,,,,both,, ,23912.22,14347.33,Medicare,Medicare,,14347.33,,,23912.22,3347.71,12195.23,Fee Schedule,Medicare APC Fee Schedule
TISSUE NON-HUMAN 9,C1763,HCPCS,,,,,both,, ,33475.26,20085.15,Medicare,Medicare,,20085.15,,,33475.26,4686.54,17072.38,Fee Schedule,Medicare APC Fee Schedule
EVENT RECRDR CARDIAC,C1764,HCPCS,,,,,both,, ,21590.35,12954.21,Medicare,Medicare,,12954.21,,,21590.35,3022.65,11011.08,Fee Schedule,Medicare APC Fee Schedule
ADHESION BARRIER1,C1765,HCPCS,,,,,both,, ,717.14,430.28,Medicare,Medicare,,430.28,,,717.14,100.40,365.74,Fee Schedule,Medicare APC Fee Schedule
ADHESION BARRIER2,C1765,HCPCS,,,,,both,, ,956.36,573.81,Medicare,Medicare,,573.81,,,956.36,133.89,487.74,Fee Schedule,Medicare APC Fee Schedule
ADHESION BARRIER3,C1765,HCPCS,,,,,both,, ,8466.86,5080.11,Medicare,Medicare,,5080.11,,,8466.86,1185.36,4318.1,Fee Schedule,Medicare APC Fee Schedule
ADHESION BARRIER4,C1765,HCPCS,,,,,both,, ,4456.30,2673.78,Medicare,Medicare,,2673.78,,,4456.30,623.88,2272.71,Fee Schedule,Medicare APC Fee Schedule
GENRATR NEUROSTM 1,C1767,HCPCS,,,,,both,, ,35861.25,21516.75,Medicare,Medicare,,21516.75,,,35861.25,5020.58,18289.24,Fee Schedule,Medicare APC Fee Schedule
GENRATR NEUROSTM 2,C1767,HCPCS,,,,,both,, ,71722.51,43033.50,Medicare,Medicare,,43033.50,,,71722.51,10041.15,36578.48,Fee Schedule,Medicare APC Fee Schedule
GRAFT VASCULAR 1,C1768,HCPCS,,,,,both,, ,1796.58,1077.94,Medicare,Medicare,,1077.94,,,1796.58,251.52,916.26,Fee Schedule,Medicare APC Fee Schedule
GRAFT VASCULAR 2,C1768,HCPCS,,,,,both,, ,2395.52,1437.31,Medicare,Medicare,,1437.31,,,2395.52,335.37,1221.72,Fee Schedule,Medicare APC Fee Schedule
GRAFT VASCULAR 3,C1768,HCPCS,,,,,both,, ,4786.15,2871.69,Medicare,Medicare,,2871.69,,,4786.15,670.06,2440.94,Fee Schedule,Medicare APC Fee Schedule
GRAFT VASCULAR 4,C1768,HCPCS,,,,,both,, ,9567.67,5740.60,Medicare,Medicare,,5740.60,,,9567.67,1339.47,4879.51,Fee Schedule,Medicare APC Fee Schedule
GRAFT VASCULAR 5,C1768,HCPCS,,,,,both,, ,14349.19,8609.51,Medicare,Medicare,,8609.51,,,14349.19,2008.89,7318.09,Fee Schedule,Medicare APC Fee Schedule
GRAFT VASCULAR 6,C1768,HCPCS,,,,,both,, ,19130.71,11478.42,Medicare,Medicare,,11478.42,,,19130.71,2678.30,9756.66,Fee Schedule,Medicare APC Fee Schedule
GRAFT VASCULAR 7,C1768,HCPCS,,,,,both,, ,23912.22,14347.33,Medicare,Medicare,,14347.33,,,23912.22,3347.71,12195.23,Fee Schedule,Medicare APC Fee Schedule
GRAFT VASCULAR 8,C1768,HCPCS,,,,,both,, ,28688.85,17213.31,Medicare,Medicare,,17213.31,,,28688.85,4016.44,14631.31,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 1,C1769,HCPCS,,,,,both,, ,182.83,109.69,Medicare,Medicare,,109.69,,,182.83,25.60,93.24,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 10,C1769,HCPCS,,,,,both,, ,3830.06,2298.03,Medicare,Medicare,,2298.03,,,3830.06,536.21,1953.33,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 11,C1769,HCPCS,,,,,both,, ,4308.23,2584.93,Medicare,Medicare,,2584.93,,,4308.23,603.15,2197.2,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 12,C1769,HCPCS,,,,,both,, ,4786.15,2871.69,Medicare,Medicare,,2871.69,,,4786.15,670.06,2440.94,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 13,C1769,HCPCS,,,,,both,, ,7177.04,4306.22,Medicare,Medicare,,4306.22,,,7177.04,1004.79,3660.29,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 14,C1769,HCPCS,,,,,both,, ,9567.67,5740.60,Medicare,Medicare,,5740.60,,,9567.67,1339.47,4879.51,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 15,C1769,HCPCS,,,,,both,, ,14349.19,8609.51,Medicare,Medicare,,8609.51,,,14349.19,2008.89,7318.09,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 16,C1769,HCPCS,,,,,both,, ,19130.71,11478.42,Medicare,Medicare,,11478.42,,,19130.71,2678.30,9756.66,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 17,C1769,HCPCS,,,,,both,, ,23912.22,14347.33,Medicare,Medicare,,14347.33,,,23912.22,3347.71,12195.23,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 18,C1769,HCPCS,,,,,both,, ,31084.37,18650.62,Medicare,Medicare,,18650.62,,,31084.37,4351.81,15853.03,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 19,C1769,HCPCS,,,,,both,, ,38256.78,22954.06,Medicare,Medicare,,22954.06,,,38256.78,5355.95,19510.96,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 2,C1769,HCPCS,,,,,both,, ,243.85,146.31,Medicare,Medicare,,146.31,,,243.85,34.14,124.36,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 20,C1769,HCPCS,,,,,both,, ,47814.92,28688.95,Medicare,Medicare,,28688.95,,,47814.92,6694.09,24385.61,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 3,C1769,HCPCS,,,,,both,, ,482.81,289.68,Medicare,Medicare,,289.68,,,482.81,67.59,246.23,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 4,C1769,HCPCS,,,,,both,, ,960.99,576.59,Medicare,Medicare,,576.59,,,960.99,134.54,490.1,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 5,C1769,HCPCS,,,,,both,, ,1439.17,863.50,Medicare,Medicare,,863.50,,,1439.17,201.48,733.98,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 6,C1769,HCPCS,,,,,both,, ,1917.35,1150.41,Medicare,Medicare,,1150.41,,,1917.35,268.43,977.85,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 7,C1769,HCPCS,,,,,both,, ,2395.52,1437.31,Medicare,Medicare,,1437.31,,,2395.52,335.37,1221.72,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 8,C1769,HCPCS,,,,,both,, ,3351.88,2011.12,Medicare,Medicare,,2011.12,,,3351.88,469.26,1709.46,Fee Schedule,Medicare APC Fee Schedule
GUIDEWIRE LEVEL 8,C1769,HCPCS,,,,,both,, ,3351.88,2011.12,Medicare,Medicare,,2011.12,,,3351.88,469.26,1709.46,Fee Schedule,Medicare APC Fee Schedule
REP DEV URINRY W/SL1,C1771,HCPCS,,,,,both,, ,2868.81,1721.28,Medicare,Medicare,,1721.28,,,2868.81,401.63,1463.09,Fee Schedule,Medicare APC Fee Schedule
REP DEV URINRY W/SL2,C1771,HCPCS,,,,,both,, ,3825.16,2295.09,Medicare,Medicare,,2295.09,,,3825.16,535.52,1950.83,Fee Schedule,Medicare APC Fee Schedule
REP DEV URINRY W/SL3,C1771,HCPCS,,,,,both,, ,14344.55,8606.73,Medicare,Medicare,,8606.73,,,14344.55,2008.24,7315.72,Fee Schedule,Medicare APC Fee Schedule
INF PUMP PROGRAM LV1,C1772,HCPCS,,,,,both,, ,2774.56,1664.73,Medicare,Medicare,,1664.73,,,2774.56,388.44,1415.03,Fee Schedule,Medicare APC Fee Schedule
INF PUMP PROGRAM LV3,C1772,HCPCS,,,,,both,, ,53552.79,32131.67,Medicare,Medicare,,32131.67,,,53552.79,7497.39,27311.92,Fee Schedule,Medicare APC Fee Schedule
CATH-RETRIEVAL 1,C1773,HCPCS,,,,,both,, ,1338.74,803.24,Medicare,Medicare,,803.24,,,1338.74,187.42,682.76,Fee Schedule,Medicare APC Fee Schedule
CATH-RETRIEVAL 2,C1773,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,2868.91,,,4781.52,669.41,2438.58,Fee Schedule,Medicare APC Fee Schedule
JOINT DEVICE IMPLT 1,C1776,HCPCS,,,,,both,, ,3586.20,2151.72,Medicare,Medicare,,2151.72,,,3586.20,502.07,1828.96,Fee Schedule,Medicare APC Fee Schedule
JOINT DEVICE IMPLT 2,C1776,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,2868.91,,,4781.52,669.41,2438.58,Fee Schedule,Medicare APC Fee Schedule
JOINT DEVICE IMPLT 3,C1776,HCPCS,,,,,both,, ,9567.67,5740.60,Medicare,Medicare,,5740.60,,,9567.67,1339.47,4879.51,Fee Schedule,Medicare APC Fee Schedule
JOINT DEVICE IMPLT 4,C1776,HCPCS,,,,,both,, ,11958.56,7175.13,Medicare,Medicare,,7175.13,,,11958.56,1674.20,6098.87,Fee Schedule,Medicare APC Fee Schedule
JOINT DEVICE IMPLT 5,C1776,HCPCS,,,,,both,, ,19130.71,11478.42,Medicare,Medicare,,11478.42,,,19130.71,2678.30,9756.66,Fee Schedule,Medicare APC Fee Schedule
JOINT DEVICE IMPLT 6,C1776,HCPCS,,,,,both,, ,23912.22,14347.33,Medicare,Medicare,,14347.33,,,23912.22,3347.71,12195.23,Fee Schedule,Medicare APC Fee Schedule
JOINT DEVICE IMPLT 7,C1776,HCPCS,,,,,both,, ,31084.37,18650.62,Medicare,Medicare,,18650.62,,,31084.37,4351.81,15853.03,Fee Schedule,Medicare APC Fee Schedule
JOINT DEVICE IMPLT 8,C1776,HCPCS,,,,,both,, ,38256.78,22954.06,Medicare,Medicare,,22954.06,,,38256.78,5355.95,19510.96,Fee Schedule,Medicare APC Fee Schedule
JOINT DEVICE IMPLT 9,C1776,HCPCS,,,,,both,, ,47819.81,28691.88,Medicare,Medicare,,28691.88,,,47819.81,6694.77,24388.1,Fee Schedule,Medicare APC Fee Schedule
JOINT DEVICE IMPLT10,C1776,HCPCS,,,,,both,, ,71727.14,43036.28,Medicare,Medicare,,43036.28,,,71727.14,10041.80,36580.84,Fee Schedule,Medicare APC Fee Schedule
JOINT DEVICE IMPLT11,C1776,HCPCS,,,,,both,, ,95629.84,57377.90,Medicare,Medicare,,57377.90,,,95629.84,13388.18,48771.22,Fee Schedule,Medicare APC Fee Schedule
JOINT DEVICE IMPLT12,C1776,HCPCS,,,,,both,, ,99999.00,59999.40,Medicare,Medicare,,59999.40,,,99999.00,13999.86,50999.49,Fee Schedule,Medicare APC Fee Schedule
LEAD AICD ENDO SN L1,C1777,HCPCS,,,,,both,, ,23599.62,14159.77,Medicare,Medicare,,14159.77,,,23599.62,3303.95,12035.81,Fee Schedule,Medicare APC Fee Schedule
LEAD NEUROSTIMULAT 1,C1778,HCPCS,,,,,both,, ,9563.04,5737.82,Medicare,Medicare,,5737.82,,,9563.04,1338.83,4877.15,Fee Schedule,Medicare APC Fee Schedule
LEAD NEUROSTIMULAT 2,C1778,HCPCS,,,,,both,, ,3586.20,2151.72,Medicare,Medicare,,2151.72,,,3586.20,502.07,1828.96,Fee Schedule,Medicare APC Fee Schedule
LEAD NEUROSTIMULAT 3,C1778,HCPCS,,,,,both,, ,14344.55,8606.73,Medicare,Medicare,,8606.73,,,14344.55,2008.24,7315.72,Fee Schedule,Medicare APC Fee Schedule
LEAD NEUROSTIMULAT 4,C1778,HCPCS,,,,,both,, ,23907.59,14344.55,Medicare,Medicare,,14344.55,,,23907.59,3347.06,12192.87,Fee Schedule,Medicare APC Fee Schedule
LEAD PMKR TRNSV VDD1,C1779,HCPCS,,,,,both,, ,9194.30,5516.58,Medicare,Medicare,,5516.58,,,9194.30,1287.20,4689.09,Fee Schedule,Medicare APC Fee Schedule
MESH IMPLANTABLE 1,C1781,HCPCS,,,,,both,, ,717.14,430.28,Medicare,Medicare,,430.28,,,717.14,100.40,365.74,Fee Schedule,Medicare APC Fee Schedule
MESH IMPLANTABLE 10,C1781,HCPCS,,,,,both,, ,11958.56,7175.13,Medicare,Medicare,,7175.13,,,11958.56,1674.20,6098.87,Fee Schedule,Medicare APC Fee Schedule
MESH IMPLANTABLE 11,C1781,HCPCS,,,,,both,, ,14349.19,8609.51,Medicare,Medicare,,8609.51,,,14349.19,2008.89,7318.09,Fee Schedule,Medicare APC Fee Schedule
MESH IMPLANTABLE 12,C1781,HCPCS,,,,,both,, ,19130.71,11478.42,Medicare,Medicare,,11478.42,,,19130.71,2678.30,9756.66,Fee Schedule,Medicare APC Fee Schedule
MESH IMPLANTABLE 13,C1781,HCPCS,,,,,both,, ,28693.74,17216.24,Medicare,Medicare,,17216.24,,,28693.74,4017.12,14633.81,Fee Schedule,Medicare APC Fee Schedule
MESH IMPLANTABLE 14,C1781,HCPCS,,,,,both,, ,43038.29,25822.97,Medicare,Medicare,,25822.97,,,43038.29,6025.36,21949.53,Fee Schedule,Medicare APC Fee Schedule
MESH IMPLANTABLE 2,C1781,HCPCS,,,,,both,, ,960.99,576.59,Medicare,Medicare,,576.59,,,960.99,134.54,490.1,Fee Schedule,Medicare APC Fee Schedule
MESH IMPLANTABLE 3,C1781,HCPCS,,,,,both,, ,1917.35,1150.41,Medicare,Medicare,,1150.41,,,1917.35,268.43,977.85,Fee Schedule,Medicare APC Fee Schedule
MESH IMPLANTABLE 4,C1781,HCPCS,,,,,both,, ,2873.70,1724.22,Medicare,Medicare,,1724.22,,,2873.70,402.32,1465.59,Fee Schedule,Medicare APC Fee Schedule
MESH IMPLANTABLE 5,C1781,HCPCS,,,,,both,, ,3830.06,2298.03,Medicare,Medicare,,2298.03,,,3830.06,536.21,1953.33,Fee Schedule,Medicare APC Fee Schedule
MESH IMPLANTABLE 5,C1781,HCPCS,,,,,both,, ,3830.06,2298.03,Medicare,Medicare,,2298.03,,,3830.06,536.21,1953.33,Fee Schedule,Medicare APC Fee Schedule
MESH IMPLANTABLE 7,C1781,HCPCS,,,,,both,, ,6220.69,3732.41,Medicare,Medicare,,3732.41,,,6220.69,870.90,3172.55,Fee Schedule,Medicare APC Fee Schedule
MESH IMPLANTABLE 8,C1781,HCPCS,,,,,both,, ,7655.22,4593.13,Medicare,Medicare,,4593.13,,,7655.22,1071.73,3904.16,Fee Schedule,Medicare APC Fee Schedule
MESH IMPLANTABLE 9,C1781,HCPCS,,,,,both,, ,9567.67,5740.60,Medicare,Medicare,,5740.60,,,9567.67,1339.47,4879.51,Fee Schedule,Medicare APC Fee Schedule
MORCELLATOR 1,C1782,HCPCS,,,,,both,, ,1792.97,1075.78,Medicare,Medicare,,1075.78,,,1792.97,251.02,914.41,Fee Schedule,Medicare APC Fee Schedule
MORCELLATOR 2,C1782,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,2868.91,,,4781.52,669.41,2438.58,Fee Schedule,Medicare APC Fee Schedule
MORCELLATOR 3,C1782,HCPCS,,,,,both,, ,9563.04,5737.82,Medicare,Medicare,,5737.82,,,9563.04,1338.83,4877.15,Fee Schedule,Medicare APC Fee Schedule
OCLR DEV INTROP DTR1,C1784,HCPCS,,,,,both,, ,15780.63,9468.37,Medicare,Medicare,,9468.37,,,15780.63,2209.29,8048.12,Fee Schedule,Medicare APC Fee Schedule
PMKR DUAL RATE-RS L1,C1785,HCPCS,,,,,both,, ,84273.06,50563.83,Medicare,Medicare,,50563.83,,,84273.06,11798.23,42979.26,Fee Schedule,Medicare APC Fee Schedule
PMKR DUAL RATE-RS L2,C1785,HCPCS,,,,,both,, ,28809.36,17285.61,Medicare,Medicare,,17285.61,,,28809.36,4033.31,14692.77,Fee Schedule,Medicare APC Fee Schedule
PMKR SINGL RATE-RSL1,C1786,HCPCS,,,,,both,, ,62664.69,37598.81,Medicare,Medicare,,37598.81,,,62664.69,8773.06,31958.99,Fee Schedule,Medicare APC Fee Schedule
PATIENT PROGR NEURO1,C1787,HCPCS,,,,,both,, ,5302.96,3181.77,Medicare,Medicare,,3181.77,,,5302.96,742.41,2704.51,Fee Schedule,Medicare APC Fee Schedule
PORT 1,C1788,HCPCS,,,,,both,, ,720.74,432.44,Medicare,Medicare,,432.44,,,720.74,100.90,367.58,Fee Schedule,Medicare APC Fee Schedule
PORT 2,C1788,HCPCS,,,,,both,, ,960.99,576.59,Medicare,Medicare,,576.59,,,960.99,134.54,490.1,Fee Schedule,Medicare APC Fee Schedule
PORT 3,C1788,HCPCS,,,,,both,, ,1912.71,1147.62,Medicare,Medicare,,1147.62,,,1912.71,267.78,975.48,Fee Schedule,Medicare APC Fee Schedule
BREAST IMPLANT 1,C1789,HCPCS,,,,,both,, ,7833.15,4699.89,Medicare,Medicare,,4699.89,,,7833.15,1096.64,3994.91,Fee Schedule,Medicare APC Fee Schedule
PRSTHS PENILE INFL 1,C1813,HCPCS,,,,,both,, ,3586.20,2151.72,Medicare,Medicare,,2151.72,,,3586.20,502.07,1828.96,Fee Schedule,Medicare APC Fee Schedule
PRSTHS PENILE INFL 2,C1813,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,2868.91,,,4781.52,669.41,2438.58,Fee Schedule,Medicare APC Fee Schedule
PRSTHS PENILE INFL 3,C1813,HCPCS,,,,,both,, ,14344.55,8606.73,Medicare,Medicare,,8606.73,,,14344.55,2008.24,7315.72,Fee Schedule,Medicare APC Fee Schedule
PRSTHS PENILE INFL 4,C1813,HCPCS,,,,,both,, ,23907.59,14344.55,Medicare,Medicare,,14344.55,,,23907.59,3347.06,12192.87,Fee Schedule,Medicare APC Fee Schedule
TISSUE LOCALZ EXCISI,C1819,HCPCS,,,,,both,, ,1000.00,600.00,Medicare,Medicare,,600.00,,,1000.00,140.00,510,Fee Schedule,Medicare APC Fee Schedule
GENRATE NEURO RECHR,C1820,HCPCS,,,,,both,, ,38545.95,23127.57,Medicare,Medicare,,23127.57,,,38545.95,5396.43,19658.43,Fee Schedule,Medicare APC Fee Schedule
INTERSPINOUS IMPL L1,C1821,HCPCS,,,,,both,, ,31193.29,18715.97,Medicare,Medicare,,18715.97,,,31193.29,4367.06,15908.58,Fee Schedule,Medicare APC Fee Schedule
INTERSPINOUS IMPL L2,C1821,HCPCS,,,,,both,, ,44561.92,26737.15,Medicare,Medicare,,26737.15,,,44561.92,6238.67,22726.58,Fee Schedule,Medicare APC Fee Schedule
STNT COAT/COV W/DEL1,C1874,HCPCS,,,,,both,, ,3586.20,2151.72,Medicare,Medicare,,2151.72,,,3586.20,502.07,1828.96,Fee Schedule,Medicare APC Fee Schedule
STNT COAT/COV W/DEL2,C1874,HCPCS,,,,,both,, ,7172.15,4303.29,Medicare,Medicare,,4303.29,,,7172.15,1004.10,3657.8,Fee Schedule,Medicare APC Fee Schedule
STNT COAT/COV W/DEL3,C1874,HCPCS,,,,,both,, ,14344.55,8606.73,Medicare,Medicare,,8606.73,,,14344.55,2008.24,7315.72,Fee Schedule,Medicare APC Fee Schedule
STNT COAT/COV W/DEL4,C1874,HCPCS,,,,,both,, ,23907.59,14344.55,Medicare,Medicare,,14344.55,,,23907.59,3347.06,12192.87,Fee Schedule,Medicare APC Fee Schedule
STNT NO COCV W/DEL 1,C1876,HCPCS,,,,,both,, ,3589.81,2153.88,Medicare,Medicare,,2153.88,,,3589.81,502.57,1830.8,Fee Schedule,Medicare APC Fee Schedule
STNT NO COCV W/DEL 2,C1876,HCPCS,,,,,both,, ,4786.15,2871.69,Medicare,Medicare,,2871.69,,,4786.15,670.06,2440.94,Fee Schedule,Medicare APC Fee Schedule
STNT NO COCV W/DEL 3,C1876,HCPCS,,,,,both,, ,9567.67,5740.60,Medicare,Medicare,,5740.60,,,9567.67,1339.47,4879.51,Fee Schedule,Medicare APC Fee Schedule
STNT NO COCV W/DEL 4,C1876,HCPCS,,,,,both,, ,14344.55,8606.73,Medicare,Medicare,,8606.73,,,14344.55,2008.24,7315.72,Fee Schedule,Medicare APC Fee Schedule
STNT NO-COA/COV W/O1,C1877,HCPCS,,,,,both,, ,3586.20,2151.72,Medicare,Medicare,,2151.72,,,3586.20,502.07,1828.96,Fee Schedule,Medicare APC Fee Schedule
STNT NO-COA/COV W/O2,C1877,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,2868.91,,,4781.52,669.41,2438.58,Fee Schedule,Medicare APC Fee Schedule
VENA CAVA FILTER 1,C1880,HCPCS,,,,,both,, ,3586.20,2151.72,Medicare,Medicare,,2151.72,,,3586.20,502.07,1828.96,Fee Schedule,Medicare APC Fee Schedule
VENA CAVA FILTER 2,C1880,HCPCS,,,,,both,, ,7172.15,4303.29,Medicare,Medicare,,4303.29,,,7172.15,1004.10,3657.8,Fee Schedule,Medicare APC Fee Schedule
AICD OHR THN SGL/DU1,C1882,HCPCS,,,,,both,, ,99999.00,59999.40,Medicare,Medicare,,59999.40,,,99999.00,13999.86,50999.49,Fee Schedule,Medicare APC Fee Schedule
EMBOLIZ PROTECT SYS1,C1884,HCPCS,,,,,both,, ,6144.21,3686.52,Medicare,Medicare,,3686.52,,,6144.21,860.19,3133.55,Fee Schedule,Medicare APC Fee Schedule
EMBOLIZ PROTECT SYS2,C1884,HCPCS,,,,,both,, ,7172.15,4303.29,Medicare,Medicare,,4303.29,,,7172.15,1004.10,3657.8,Fee Schedule,Medicare APC Fee Schedule
CATH TRNSLUM ANG LA1,C1885,HCPCS,,,,,both,, ,7172.15,4303.29,Medicare,Medicare,,4303.29,,,7172.15,1004.10,3657.8,Fee Schedule,Medicare APC Fee Schedule
CATH TRNSLUM ANG LA2,C1885,HCPCS,,,,,both,, ,9563.04,5737.82,Medicare,Medicare,,5737.82,,,9563.04,1338.83,4877.15,Fee Schedule,Medicare APC Fee Schedule
CATHETER GUIDING 1,C1887,HCPCS,,,,,both,, ,358.70,215.22,Medicare,Medicare,,215.22,,,358.70,50.22,182.94,Fee Schedule,Medicare APC Fee Schedule
CATHETER GUIDING 2,C1887,HCPCS,,,,,both,, ,1195.32,717.19,Medicare,Medicare,,717.19,,,1195.32,167.34,609.61,Fee Schedule,Medicare APC Fee Schedule
CATHETER GUIDING 3,C1887,HCPCS,,,,,both,, ,1912.71,1147.62,Medicare,Medicare,,1147.62,,,1912.71,267.78,975.48,Fee Schedule,Medicare APC Fee Schedule
CATH ABLTN NOCRD ED1,C1888,HCPCS,,,,,both,, ,896.62,537.97,Medicare,Medicare,,537.97,,,896.62,125.53,457.28,Fee Schedule,Medicare APC Fee Schedule
CATH ABLTN NOCRD ED2,C1888,HCPCS,,,,,both,, ,1195.32,717.19,Medicare,Medicare,,717.19,,,1195.32,167.34,609.61,Fee Schedule,Medicare APC Fee Schedule
EAR TUBES DRAINAGE 1,C1889,HCPCS,,,,,both,, ,113.04,67.82,Medicare,Medicare,,67.82,,,113.04,15.83,57.65,Fee Schedule,Medicare APC Fee Schedule
TISSUE EXP NONBREAST,C1889,HCPCS,,,,,both,, ,570.11,342.06,Medicare,Medicare,,342.06,,,570.11,79.82,290.76,Fee Schedule,Medicare APC Fee Schedule
INF PMP NON-PROG LV1,C1891,HCPCS,,,,,both,, ,10237.17,6142.30,Medicare,Medicare,,6142.30,,,10237.17,1433.20,5220.96,Fee Schedule,Medicare APC Fee Schedule
PEEL-AWAY SHEATH 1,C1892,HCPCS,,,,,both,, ,179.22,107.53,Medicare,Medicare,,107.53,,,179.22,25.09,91.4,Fee Schedule,Medicare APC Fee Schedule
PEEL-AWAY SHEATH 2,C1892,HCPCS,,,,,both,, ,478.18,286.90,Medicare,Medicare,,286.90,,,478.18,66.95,243.87,Fee Schedule,Medicare APC Fee Schedule
PEEL-AWAY SHEATH 3,C1892,HCPCS,,,,,both,, ,1434.53,860.71,Medicare,Medicare,,860.71,,,1434.53,200.83,731.61,Fee Schedule,Medicare APC Fee Schedule
INT SHTH FIX NO-PL 1,C1893,HCPCS,,,,,both,, ,611.31,366.78,Medicare,Medicare,,366.78,,,611.31,85.58,311.77,Fee Schedule,Medicare APC Fee Schedule
INT SHTH FIX NO-PL 2,C1893,HCPCS,,,,,both,, ,3048.29,1828.97,Medicare,Medicare,,1828.97,,,3048.29,426.76,1554.63,Fee Schedule,Medicare APC Fee Schedule
SHEATH NON-LASR 1,C1894,HCPCS,,,,,both,, ,717.14,430.28,Medicare,Medicare,,430.28,,,717.14,100.40,365.74,Fee Schedule,Medicare APC Fee Schedule
SHEATH NON-LASR 2,C1894,HCPCS,,,,,both,, ,1434.53,860.71,Medicare,Medicare,,860.71,,,1434.53,200.83,731.61,Fee Schedule,Medicare APC Fee Schedule
SHEATH NON-LASR 3,C1894,HCPCS,,,,,both,, ,2390.63,1434.37,Medicare,Medicare,,1434.37,,,2390.63,334.69,1219.22,Fee Schedule,Medicare APC Fee Schedule
SHEATH NON-LASR 4,C1894,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,2868.91,,,4781.52,669.41,2438.58,Fee Schedule,Medicare APC Fee Schedule
SHEATH NON-LASR 5,C1894,HCPCS,,,,,both,, ,7172.15,4303.29,Medicare,Medicare,,4303.29,,,7172.15,1004.10,3657.8,Fee Schedule,Medicare APC Fee Schedule
SHEATH NON-LASR 6,C1894,HCPCS,,,,,both,, ,9563.04,5737.82,Medicare,Medicare,,5737.82,,,9563.04,1338.83,4877.15,Fee Schedule,Medicare APC Fee Schedule
SHEATH NON-LASR 7,C1894,HCPCS,,,,,both,, ,14344.55,8606.73,Medicare,Medicare,,8606.73,,,14344.55,2008.24,7315.72,Fee Schedule,Medicare APC Fee Schedule
SHEATH NON-LASR 8,C1894,HCPCS,,,,,both,, ,19126.07,11475.64,Medicare,Medicare,,11475.64,,,19126.07,2677.65,9754.3,Fee Schedule,Medicare APC Fee Schedule
LEAD AICD END DUL L1,C1895,HCPCS,,,,,both,, ,76277.94,45766.76,Medicare,Medicare,,45766.76,,,76277.94,10678.91,38901.75,Fee Schedule,Medicare APC Fee Schedule
LEAD AICD END DUL L2,C1895,HCPCS,,,,,both,, ,16735.18,10041.10,Medicare,Medicare,,10041.10,,,16735.18,2342.93,8534.94,Fee Schedule,Medicare APC Fee Schedule
LEAD AICD NO-SING L1,C1896,HCPCS,,,,,both,, ,16206.54,9723.92,Medicare,Medicare,,9723.92,,,16206.54,2268.92,8265.34,Fee Schedule,Medicare APC Fee Schedule
LEAD NEUROSTM TST K1,C1897,HCPCS,,,,,both,, ,3586.20,2151.72,Medicare,Medicare,,2151.72,,,3586.20,502.07,1828.96,Fee Schedule,Medicare APC Fee Schedule
LEAD NEUROSTM TST K2,C1897,HCPCS,,,,,both,, ,6646.33,3987.79,Medicare,Medicare,,3987.79,,,6646.33,930.49,3389.63,Fee Schedule,Medicare APC Fee Schedule
LEAD PMKR NON-TRN L1,C1898,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,2868.91,,,4781.52,669.41,2438.58,Fee Schedule,Medicare APC Fee Schedule
LEAD PMKR/AICD CMBL1,C1899,HCPCS,,,,,both,, ,41218.03,24730.81,Medicare,Medicare,,24730.81,,,41218.03,5770.52,21021.2,Fee Schedule,Medicare APC Fee Schedule
LEAD LT VENT COR LV1,C1900,HCPCS,,,,,both,, ,20278.38,12167.02,Medicare,Medicare,,12167.02,,,20278.38,2838.97,10341.97,Fee Schedule,Medicare APC Fee Schedule
SEALANT PULMNRY LIQD,C2615,HCPCS,,,,,both,, ,5932.54,3559.52,Medicare,Medicare,,3559.52,,,5932.54,830.56,3025.6,Fee Schedule,Medicare APC Fee Schedule
STNT NONCOR TM W/O 1,C2617,HCPCS,,,,,both,, ,2963.83,1778.29,Medicare,Medicare,,1778.29,,,2963.83,414.94,1511.55,Fee Schedule,Medicare APC Fee Schedule
PROBE CRYOABLATION 1,C2618,HCPCS,,,,,both,, ,3586.20,2151.72,Medicare,Medicare,,2151.72,,,3586.20,502.07,1828.96,Fee Schedule,Medicare APC Fee Schedule
PROBE CRYOABLATION 2,C2618,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,2868.91,,,4781.52,669.41,2438.58,Fee Schedule,Medicare APC Fee Schedule
PROBE CRYOABLATION 3,C2618,HCPCS,,,,,both,, ,9563.04,5737.82,Medicare,Medicare,,5737.82,,,9563.04,1338.83,4877.15,Fee Schedule,Medicare APC Fee Schedule
PROBE CRYOABLATION 4,C2618,HCPCS,,,,,both,, ,16735.18,10041.10,Medicare,Medicare,,10041.10,,,16735.18,2342.93,8534.94,Fee Schedule,Medicare APC Fee Schedule
PMKR DUL NON RAT LV1,C2619,HCPCS,,,,,both,, ,73166.31,43899.78,Medicare,Medicare,,43899.78,,,73166.31,10243.28,37314.82,Fee Schedule,Medicare APC Fee Schedule
PMKR SNGL NON RTE-RE,C2620,HCPCS,,,,,both,, ,45918.17,27550.90,Medicare,Medicare,,27550.90,,,45918.17,6428.54,23418.27,Fee Schedule,Medicare APC Fee Schedule
PMKR OTHR TH SNGL L1,C2621,HCPCS,,,,,both,, ,99999.00,59999.40,Medicare,Medicare,,59999.40,,,99999.00,13999.86,50999.49,Fee Schedule,Medicare APC Fee Schedule
PRSTHS PENILE NNINF1,C2622,HCPCS,,,,,both,, ,38894.09,23336.45,Medicare,Medicare,,23336.45,,,38894.09,5445.17,19835.99,Fee Schedule,Medicare APC Fee Schedule
WIRELESS PRESS SENS,C2624,HCPCS,,,,,both,, ,99999.00,59999.40,Medicare,Medicare,,59999.40,,,99999.00,13999.86,50999.49,Fee Schedule,Medicare APC Fee Schedule
STNT NON-COR TM DL 1,C2625,HCPCS,,,,,both,, ,541.52,324.91,Medicare,Medicare,,324.91,,,541.52,75.81,276.18,Fee Schedule,Medicare APC Fee Schedule
STNT NON-COR TM DL 2,C2625,HCPCS,,,,,both,, ,722.03,433.21,Medicare,Medicare,,433.21,,,722.03,101.08,368.24,Fee Schedule,Medicare APC Fee Schedule
STNT NON-COR TM DL 3,C2625,HCPCS,,,,,both,, ,3787.83,2272.69,Medicare,Medicare,,2272.69,,,3787.83,530.30,1931.79,Fee Schedule,Medicare APC Fee Schedule
INF PMP NON-PROG LV1,C2626,HCPCS,,,,,both,, ,545.13,327.07,Medicare,Medicare,,327.07,,,545.13,76.32,278.02,Fee Schedule,Medicare APC Fee Schedule
CATH SUPRPUBC-CYSTO1,C2627,HCPCS,,,,,both,, ,172.01,103.20,Medicare,Medicare,,103.20,,,172.01,24.08,87.73,Fee Schedule,Medicare APC Fee Schedule
CATH SUPRPUBC-CYSTO2,C2627,HCPCS,,,,,both,, ,1075.84,645.50,Medicare,Medicare,,645.50,,,1075.84,150.62,548.68,Fee Schedule,Medicare APC Fee Schedule
CATH OCCLUSION 1,C2628,HCPCS,,,,,both,, ,717.14,430.28,Medicare,Medicare,,430.28,,,717.14,100.40,365.74,Fee Schedule,Medicare APC Fee Schedule
CATH OCCLUSION 2,C2628,HCPCS,,,,,both,, ,1434.53,860.71,Medicare,Medicare,,860.71,,,1434.53,200.83,731.61,Fee Schedule,Medicare APC Fee Schedule
CATH OCCLUSION 3,C2628,HCPCS,,,,,both,, ,2390.63,1434.37,Medicare,Medicare,,1434.37,,,2390.63,334.69,1219.22,Fee Schedule,Medicare APC Fee Schedule
INTRO/SHEATH LASER 1,C2629,HCPCS,,,,,both,, ,5379.18,3227.50,Medicare,Medicare,,3227.50,,,5379.18,753.09,2743.38,Fee Schedule,Medicare APC Fee Schedule
INTRO/SHEATH LASER 2,C2629,HCPCS,,,,,both,, ,7172.15,4303.29,Medicare,Medicare,,4303.29,,,7172.15,1004.10,3657.8,Fee Schedule,Medicare APC Fee Schedule
REP DEV URNRY WO SL1,C2631,HCPCS,,,,,both,, ,8266.27,4959.76,Medicare,Medicare,,4959.76,,,8266.27,1157.28,4215.8,Fee Schedule,Medicare APC Fee Schedule
LC S SUB T/A/L 25S,C5271,HCPCS,,,,,both,, ,2393.60,1436.16,Medicare,Medicare,,1436.16,,,2393.60,335.10,1220.74,Fee Schedule,Medicare APC Fee Schedule
LC S SUB T/A/L ADL,C5272,HCPCS,,,,,both,, ,2393.60,1436.16,Medicare,Medicare,,1436.16,,,2393.60,335.10,1220.74,Fee Schedule,Medicare APC Fee Schedule
LC S SUB T/A/L 100SQ,C5273,HCPCS,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
LC S SUB T/A/L ADL,C5274,HCPCS,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,4170.07,,,6950.12,973.02,3544.56,Fee Schedule,Medicare APC Fee Schedule
LC S SUB F/NK/HF/G,C5275,HCPCS,,,,,both,, ,2393.60,1436.16,Medicare,Medicare,,1436.16,,,2393.60,335.10,1220.74,Fee Schedule,Medicare APC Fee Schedule
LC S SUB F/NK/HF/G EA,C5276,HCPCS,,,,,both,, ,2393.60,1436.16,Medicare,Medicare,,1436.16,,,2393.60,335.10,1220.74,Fee Schedule,Medicare APC Fee Schedule
LC S SUB F/NK/HF/G 100SQ,C5277,HCPCS,,,,,both,, ,2393.60,1436.16,Medicare,Medicare,,1436.16,,,2393.60,335.10,1220.74,Fee Schedule,Medicare APC Fee Schedule
LC S SUB F/NK/HF/G EA,C5278,HCPCS,,,,,both,, ,2393.60,1436.16,Medicare,Medicare,,1436.16,,,2393.60,335.10,1220.74,Fee Schedule,Medicare APC Fee Schedule
MRA-ABDOMEN W,C8900,HCPCS,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,621.41,,,1035.69,145.00,528.2,Fee Schedule,Medicare APC Fee Schedule
MRA-ABDOMEN W,C8900,HCPCS,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,668.73,,,1114.55,156.04,568.42,Fee Schedule,Medicare APC Fee Schedule
MRA-ABDOMEN WO,C8901,HCPCS,,,,,both,, ,715.99,429.59,Medicare,Medicare,,429.59,,,715.99,100.24,365.15,Fee Schedule,Medicare APC Fee Schedule
MRA-ABDOMEN WO,C8901,HCPCS,,,,,both,, ,770.45,462.27,Medicare,Medicare,,462.27,,,770.45,107.86,392.93,Fee Schedule,Medicare APC Fee Schedule
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,718.24,,,1197.08,167.59,610.51,Fee Schedule,Medicare APC Fee Schedule
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,772.97,,,1288.29,180.36,657.03,Fee Schedule,Medicare APC Fee Schedule
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,2669.78,1601.86,Medicare,Medicare,,1601.86,,,2669.78,373.77,1361.59,Fee Schedule,Medicare APC Fee Schedule
MR-BREAST UNI WWO,C8905,HCPCS,,,,,both,, ,3114.65,1868.79,Medicare,Medicare,,1868.79,,,3114.65,436.05,1588.47,Fee Schedule,Medicare APC Fee Schedule
MR-BREAST BI WWO,C8908,HCPCS,,,,,both,, ,3115.20,1869.12,Medicare,Medicare,,1869.12,,,3115.20,436.13,1588.75,Fee Schedule,Medicare APC Fee Schedule
MRA-LW EXTR WWO,C8914,HCPCS,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,718.24,,,1197.08,167.59,610.51,Fee Schedule,Medicare APC Fee Schedule
MRA-LW EXTR WWO,C8914,HCPCS,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,772.97,,,1288.29,180.36,657.03,Fee Schedule,Medicare APC Fee Schedule
MRA-LW EXTR WWO BI,C8914,HCPCS,,,,,both,, ,2394.15,1436.49,Medicare,Medicare,,1436.49,,,2394.15,335.18,1221.02,Fee Schedule,Medicare APC Fee Schedule
MRA-LW EXTR WWO BI,C8914,CPT,,,,,both,, ,2576.60,1545.96,Medicare,Medicare,,1545.96,,,2576.60,360.72,1314.07,Fee Schedule,Medicare APC Fee Schedule
BR-CAD MRI LESION,C8937,HCPCS,,,,,both,, ,50.52,30.31,Medicare,Medicare,,30.31,,,50.52,7.07,25.77,Fee Schedule,Medicare APC Fee Schedule
COCAINE HCL NASL 1MG,C9046,HCPCS,,,,,both,4,ML,8.00,4.80,Medicare,Medicare,,4.80,,,8.00,1.12,4.08,Fee Schedule,Medicare APC Fee Schedule
IDARUCIZU 2.5GM/50ML,C9399,HCPCS,,,,,both,50,ML,10077.78,6046.66,Medicare,Medicare,,6046.66,,,10077.78,1410.89,5139.67,Fee Schedule,Medicare APC Fee Schedule
REMDESIV 5MG/ML 20ML,C9399,HCPCS,,,,,both,, ,2878.85,1727.31,Medicare,Medicare,,1727.31,,,2878.85,403.04,1468.21,Fee Schedule,Medicare APC Fee Schedule
IC-PRQ DE COR STNT,C9600,CPT,,,,,both,, ,42411.02,25446.61,Medicare,Medicare,,25446.61,,,42411.02,5937.54,21629.62,Fee Schedule,Medicare APC Fee Schedule
IC-PRQ DE CR REV CAB,C9604,CPT,,,,,both,, ,29428.39,17657.03,Medicare,Medicare,,17657.03,,,29428.39,4119.97,15008.48,Fee Schedule,Medicare APC Fee Schedule
ADMIN FLU VACCINE,G0008,HCPCS,,,,,both,, ,106.25,63.75,Medicare,Medicare,,63.75,,,106.25,14.88,54.19,Fee Schedule,Medicare APC Fee Schedule
ADMIN FLU VACCINE,G0008,HCPCS,,,,,both,, ,106.25,63.75,Medicare,Medicare,,63.75,,,106.25,14.88,54.19,Fee Schedule,Medicare APC Fee Schedule
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,70.81,42.48,Medicare,Medicare,,42.48,,,70.81,9.91,36.11,Fee Schedule,Medicare APC Fee Schedule
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,70.81,42.48,Medicare,Medicare,,42.48,,,70.81,9.91,36.11,Fee Schedule,Medicare APC Fee Schedule
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,109.18,65.50,Medicare,Medicare,,65.50,,,109.18,15.29,55.68,Fee Schedule,Medicare APC Fee Schedule
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,143.69,86.21,Medicare,Medicare,,86.21,,,143.69,20.12,73.28,Fee Schedule,Medicare APC Fee Schedule
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,184.63,110.77,Medicare,Medicare,,110.77,,,184.63,25.85,94.16,Fee Schedule,Medicare APC Fee Schedule
ADMIN PNEU VACCINE,G0009,HCPCS,,,,,both,, ,106.25,63.75,Medicare,Medicare,,63.75,,,106.25,14.88,54.19,Fee Schedule,Medicare APC Fee Schedule
ADMIN PNEU VACCINE,G0009,HCPCS,,,,,both,, ,106.25,63.75,Medicare,Medicare,,63.75,,,106.25,14.88,54.19,Fee Schedule,Medicare APC Fee Schedule
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,109.18,65.50,Medicare,Medicare,,65.50,,,109.18,15.29,55.68,Fee Schedule,Medicare APC Fee Schedule
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,143.69,86.21,Medicare,Medicare,,86.21,,,143.69,20.12,73.28,Fee Schedule,Medicare APC Fee Schedule
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,184.63,110.77,Medicare,Medicare,,110.77,,,184.63,25.85,94.16,Fee Schedule,Medicare APC Fee Schedule
HEP B VACCINE ADMIN,G0010,HCPCS,,,,,both,, ,106.25,63.75,Medicare,Medicare,,63.75,,,106.25,14.88,54.19,Fee Schedule,Medicare APC Fee Schedule
HEP B VACCINE ADMIN,G0010,HCPCS,,,,,both,, ,106.25,63.75,Medicare,Medicare,,63.75,,,106.25,14.88,54.19,Fee Schedule,Medicare APC Fee Schedule
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,105.06,63.03,Medicare,Medicare,,63.03,,,105.06,14.71,53.58,Fee Schedule,Medicare APC Fee Schedule
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,109.44,65.66,Medicare,Medicare,,65.66,,,109.44,15.32,55.81,Fee Schedule,Medicare APC Fee Schedule
"PSA, SCREENING",G0103,HCPCS,,,,,both,, ,135.85,81.51,Medicare,Medicare,,81.51,,,135.85,19.02,69.28,Fee Schedule,Medicare APC Fee Schedule
"PSA, SCREENING",G0103,HCPCS,,,,,both,,,1036.25,1036.25,Medicare,Medicare,,1036.25,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
"PSA, SCREENING",G0103,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
"PSA, SCREENING",G0103,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
DSMT INDIVIDUAL 30M,G0108,HCPCS,,,,,both,, ,261.62,156.97,Medicare,Medicare,,156.97,,,261.62,36.63,133.43,Fee Schedule,Medicare APC Fee Schedule
PAP THINLAY LIQ SCRN,G0123,HCPCS,,,,,both,, ,195.06,117.03,Medicare,Medicare,,117.03,,,195.06,27.31,99.48,Fee Schedule,Medicare APC Fee Schedule
STRNGTH TRN SLG 15MI,G0237,HCPCS,,,,,both,, ,177.16,106.29,Medicare,Medicare,,106.29,,,177.16,24.80,90.35,Fee Schedule,Medicare APC Fee Schedule
RESP FX TRN SGL 15MN,G0238,HCPCS,,,,,both,, ,177.16,106.29,Medicare,Medicare,,106.29,,,177.16,24.80,90.35,Fee Schedule,Medicare APC Fee Schedule
RESP FX TRAIN GROUP,G0239,HCPCS,,,,,both,, ,177.16,106.29,Medicare,Medicare,,106.29,,,177.16,24.80,90.35,Fee Schedule,Medicare APC Fee Schedule
DIALYSIS  EMERGENT,G0257,HCPCS,,,,,both,, ,9908.34,5945.00,Medicare,Medicare,,5945.00,,,9908.34,1387.17,5053.25,Fee Schedule,Medicare APC Fee Schedule
IR-ARTHROGRAM SI JTS,G0260,HCPCS,,,,,both,, ,2101.41,1260.84,Medicare,Medicare,,1260.84,,,2101.41,294.20,1071.72,Fee Schedule,Medicare APC Fee Schedule
CC-PLACE CLOS DEV,G0269,HCPCS,,,,,both,, ,22097.11,13258.26,Medicare,Medicare,,13258.26,,,22097.11,3093.60,11269.53,Fee Schedule,Medicare APC Fee Schedule
HBO FB 30MN,G0277,HCPCS,,,,,both,, ,265.23,159.13,Medicare,Medicare,,159.13,,,265.23,37.13,135.27,Fee Schedule,Medicare APC Fee Schedule
BR-TOMO MAMMO BI,G0279,HCPCS,,,,,both,,,160.68,160.68,Medicare,Medicare,,160.68,,,160.68,22.50,81.95,Fee Schedule,Medicare APC Fee Schedule
BR-TOMO MAMMO BI,G0279,HCPCS,,,,,both,, ,160.68,96.40,Medicare,Medicare,,96.40,,,160.68,22.50,81.95,Fee Schedule,Medicare APC Fee Schedule
BR-TOMO MAMMO UNI,G0279,HCPCS,,,,,both,,,133.90,133.90,Medicare,Medicare,,133.90,,,133.90,18.75,68.29,Fee Schedule,Medicare APC Fee Schedule
BR-TOMO MAMMO UNI,G0279,HCPCS,,,,,both,, ,133.90,80.34,Medicare,Medicare,,80.34,,,133.90,18.75,68.29,Fee Schedule,Medicare APC Fee Schedule
ELEC STIM-UNATTND-VI,G0283,HCPCS,,,,,both,, ,443.37,266.02,Medicare,Medicare,,266.02,,,443.37,62.07,226.12,Fee Schedule,Medicare APC Fee Schedule
ELEC STIM-UNATTND-VI,G0283,HCPCS,,,,,both,, ,480.68,288.40,Medicare,Medicare,,288.40,,,480.68,67.30,245.15,Fee Schedule,Medicare APC Fee Schedule
ELEC STM-UNAT-VI OT,G0283,HCPCS,,,,,both,, ,515.00,309.00,Medicare,Medicare,,309.00,,,515.00,72.10,262.65,Fee Schedule,Medicare APC Fee Schedule
ELEC STM-UNAT-VI OT,G0283,HCPCS,,,,,both,, ,515.00,309.00,Medicare,Medicare,,309.00,,,515.00,72.10,262.65,Fee Schedule,Medicare APC Fee Schedule
ELEC STM-UNAT-VI PT,G0283,HCPCS,,,,,both,, ,37.08,22.24,Medicare,Medicare,,22.24,,,37.08,5.19,18.91,Fee Schedule,Medicare APC Fee Schedule
ELEC STM-UNAT-VI PT,G0283,HCPCS,,,,,both,, ,37.08,22.24,Medicare,Medicare,,22.24,,,37.08,5.19,18.91,Fee Schedule,Medicare APC Fee Schedule
ELEC STM-UNAT-VI PT,G0283,HCPCS,,,,,both,, ,37.08,22.24,Medicare,Medicare,,22.24,,,37.08,5.19,18.91,Fee Schedule,Medicare APC Fee Schedule
ELEC STM-UNAT-VI PT,G0283,HCPCS,,,,,both,, ,37.08,22.24,Medicare,Medicare,,22.24,,,37.08,5.19,18.91,Fee Schedule,Medicare APC Fee Schedule
ELEC STM-UNAT-VI PT,G0283,HCPCS,,,,,both,, ,474.83,284.89,Medicare,Medicare,,284.89,,,474.83,66.48,242.16,Fee Schedule,Medicare APC Fee Schedule
ELEC STM-UNAT-VI PT,G0283,HCPCS,,,,,both,, ,474.83,284.89,Medicare,Medicare,,284.89,,,474.83,66.48,242.16,Fee Schedule,Medicare APC Fee Schedule
SCR FECAL OC BLD 1-3,G0328,HCPCS,,,,,both,, ,159.42,95.65,Medicare,Medicare,,95.65,,,159.42,22.32,81.3,Fee Schedule,Medicare APC Fee Schedule
OBSERVATION 1ST HOUR,G0378,HCPCS,,,,,both,, ,1189.39,713.63,Medicare,Medicare,,713.63,,,1189.39,166.51,606.59,Fee Schedule,Medicare APC Fee Schedule
OBSERVATION 1ST HOUR,G0378,HCPCS,,,,,both,, ,1189.39,713.63,Medicare,Medicare,,713.63,,,1189.39,166.51,606.59,Fee Schedule,Medicare APC Fee Schedule
OBSRVATION ADDL HOUR,G0378,HCPCS,,,,,both,, ,141.21,84.72,Medicare,Medicare,,84.72,,,141.21,19.77,72.02,Fee Schedule,Medicare APC Fee Schedule
OBSRVATION ADDL HOUR,G0378,HCPCS,,,,,both,, ,151.15,90.69,Medicare,Medicare,,90.69,,,151.15,21.16,77.09,Fee Schedule,Medicare APC Fee Schedule
OBSRVATION ADDL HOUR,G0378,HCPCS,,,,,both,, ,151.15,90.69,Medicare,Medicare,,90.69,,,151.15,21.16,77.09,Fee Schedule,Medicare APC Fee Schedule
DIRECT ADMIT TO OBS,G0379,HCPCS,,,,,both,, ,610.15,366.09,Medicare,Medicare,,366.09,,,610.15,85.42,311.18,Fee Schedule,Medicare APC Fee Schedule
DIRECT ADMIT TO OBS,G0379,HCPCS,,,,,both,, ,653.54,392.12,Medicare,Medicare,,392.12,,,653.54,91.50,333.31,Fee Schedule,Medicare APC Fee Schedule
DIRECT ADMIT TO OBS,G0379,HCPCS,,,,,both,, ,653.54,392.12,Medicare,Medicare,,392.12,,,653.54,91.50,333.31,Fee Schedule,Medicare APC Fee Schedule
HOME SLEEP TYPE 3,G0399,HCPCS,,,,,both,, ,428.48,257.08,Medicare,Medicare,,257.08,,,428.48,59.99,218.52,Fee Schedule,Medicare APC Fee Schedule
HOME SLEEP TYPE 3,G0399,HCPCS,,,,,both,, ,428.48,257.08,Medicare,Medicare,,257.08,,,428.48,59.99,218.52,Fee Schedule,Medicare APC Fee Schedule
PROSTATE NDL BX ANY,G0416,HCPCS,,,,,both,, ,1059.54,635.72,Medicare,Medicare,,635.72,,,1059.54,148.34,540.37,Fee Schedule,Medicare APC Fee Schedule
HIV-1 AB EIA,G0432,HCPCS,,,,,both,, ,113.39,68.03,Medicare,Medicare,,68.03,,,113.39,15.87,57.83,Fee Schedule,Medicare APC Fee Schedule
HIV1 AG HIV1 HIV2 AB,G0433,CPT,,,,,both,, ,165.59,99.35,Medicare,Medicare,,99.35,,,165.59,23.18,84.45,Fee Schedule,Medicare APC Fee Schedule
HIV1-HIV2 AB SNG RES,G0435,CPT,,,,,both,, ,42.66,25.59,Medicare,Medicare,,25.59,,,42.66,5.97,21.76,Fee Schedule,Medicare APC Fee Schedule
HIV1-HIV2 AB SNG RES,G0435,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,621.75,,,1036.25,145.08,528.49,Fee Schedule,Medicare APC Fee Schedule
EVAL & MGMT LEVEL 3,G0463,HCPCS,,,,,both,, ,215.75,129.45,Medicare,Medicare,,129.45,,,215.75,30.21,110.03,Fee Schedule,Medicare APC Fee Schedule
EVAL & MGMT LEVEL 5,G0463,HCPCS,,,,,both,, ,261.00,156.60,Medicare,Medicare,,156.60,,,261.00,36.54,133.11,Fee Schedule,Medicare APC Fee Schedule
HOSPITAL OUTPT VISIT,G0463,HCPCS,,,,,both,, ,520.00,312.00,Medicare,Medicare,,312.00,,,520.00,72.80,265.2,Fee Schedule,Medicare APC Fee Schedule
LEVEL 1 EP,G0463,HCPCS,,,,,both,, ,132.61,79.56,Medicare,Medicare,,79.56,,,132.61,18.57,67.63,Fee Schedule,Medicare APC Fee Schedule
LEVEL 1 EP,G0463,HCPCS,,,,,both,, ,132.61,79.56,Medicare,Medicare,,79.56,,,132.61,18.57,67.63,Fee Schedule,Medicare APC Fee Schedule
LEVEL 1 EP,G0463,HCPCS,,,,,both,, ,249.52,149.71,Medicare,Medicare,,149.71,,,249.52,34.93,127.26,Fee Schedule,Medicare APC Fee Schedule
LEVEL 2 EP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Medicare,Medicare,,113.25,,,188.75,26.43,96.26,Fee Schedule,Medicare APC Fee Schedule
LEVEL 2 NP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Medicare,Medicare,,113.25,,,188.75,26.43,96.26,Fee Schedule,Medicare APC Fee Schedule
LEVEL 3 NP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Medicare,Medicare,,113.25,,,188.75,26.43,96.26,Fee Schedule,Medicare APC Fee Schedule
LEVEL 4 EP,G0463,HCPCS,,,,,both,, ,324.19,194.51,Medicare,Medicare,,194.51,,,324.19,45.39,165.34,Fee Schedule,Medicare APC Fee Schedule
LEVEL 4 EP,G0463,HCPCS,,,,,both,, ,324.19,194.51,Medicare,Medicare,,194.51,,,324.19,45.39,165.34,Fee Schedule,Medicare APC Fee Schedule
LEVEL 5 EP,G0463,HCPCS,,,,,both,, ,425.91,255.54,Medicare,Medicare,,255.54,,,425.91,59.63,217.21,Fee Schedule,Medicare APC Fee Schedule
OB TRIAGE LVL 1 EP,G0463,HCPCS,,,,,both,, ,700.40,420.24,Medicare,Medicare,,420.24,,,700.40,98.06,357.2,Fee Schedule,Medicare APC Fee Schedule
PAT EVAL/MGM LEVEL 2,G0463,HCPCS,,,,,both,, ,325.25,195.15,Medicare,Medicare,,195.15,,,325.25,45.54,165.88,Fee Schedule,Medicare APC Fee Schedule
PAT EVAL/MGM LEVEL 3,G0463,HCPCS,,,,,both,, ,379.50,227.70,Medicare,Medicare,,227.70,,,379.50,53.13,193.55,Fee Schedule,Medicare APC Fee Schedule
PAT EVAL/MGM LEVEL 4,G0463,HCPCS,,,,,both,, ,433.50,260.10,Medicare,Medicare,,260.10,,,433.50,60.69,221.09,Fee Schedule,Medicare APC Fee Schedule
PAT EVAL/MGM LEVEL 5,G0463,HCPCS,,,,,both,, ,487.50,292.50,Medicare,Medicare,,292.50,,,487.50,68.25,248.63,Fee Schedule,Medicare APC Fee Schedule
PHYSICAL-EMPLOYMENT,G0463,HCPCS,,,,,both,, ,55.62,33.37,Medicare,Medicare,,33.37,,,55.62,7.79,28.37,Fee Schedule,Medicare APC Fee Schedule
PHYSICAL-EMPLOYMENT,G0463,HCPCS,,,,,both,, ,55.62,33.37,Medicare,Medicare,,33.37,,,55.62,7.79,28.37,Fee Schedule,Medicare APC Fee Schedule
PHYSICAL-SCHOOL,G0463,HCPCS,,,,,both,, ,66.95,40.17,Medicare,Medicare,,40.17,,,66.95,9.37,34.14,Fee Schedule,Medicare APC Fee Schedule
PHYSICAL-SCHOOL,G0463,HCPCS,,,,,both,, ,66.95,40.17,Medicare,Medicare,,40.17,,,66.95,9.37,34.14,Fee Schedule,Medicare APC Fee Schedule
PSYCH CLINIC TYPE A,G0463,HCPCS,,,,,both,, ,294.25,176.55,Medicare,Medicare,,176.55,,,294.25,41.20,150.07,Fee Schedule,Medicare APC Fee Schedule
URG CARE L1 EP PROF,G0463,HCPCS,,,,,both,, ,60.50,36.30,Medicare,Medicare,,36.30,,,60.50,8.47,30.86,Fee Schedule,Medicare APC Fee Schedule
URG CARE L1 NP PROF,G0463,HCPCS,,,,,both,, ,123.25,73.95,Medicare,Medicare,,73.95,,,123.25,17.26,62.86,Fee Schedule,Medicare APC Fee Schedule
URG CARE L1 NP PROF,G0463,HCPCS,,,,,both,, ,123.25,73.95,Medicare,Medicare,,73.95,,,123.25,17.26,62.86,Fee Schedule,Medicare APC Fee Schedule
URG CARE L2 NP PROF,G0463,HCPCS,,,,,both,, ,213.00,127.80,Medicare,Medicare,,127.80,,,213.00,29.82,108.63,Fee Schedule,Medicare APC Fee Schedule
URG CARE L3 EP PROF,G0463,HCPCS,,,,,both,, ,209.75,125.85,Medicare,Medicare,,125.85,,,209.75,29.37,106.97,Fee Schedule,Medicare APC Fee Schedule
URG CARE L3 NP PROF,G0463,HCPCS,,,,,both,, ,312.50,187.50,Medicare,Medicare,,187.50,,,312.50,43.75,159.38,Fee Schedule,Medicare APC Fee Schedule
URG CARE L4 EP PROF,G0463,HCPCS,,,,,both,, ,309.25,185.55,Medicare,Medicare,,185.55,,,309.25,43.30,157.72,Fee Schedule,Medicare APC Fee Schedule
URG CARE L4 NP PROF,G0463,HCPCS,,,,,both,, ,483.50,290.10,Medicare,Medicare,,290.10,,,483.50,67.69,246.59,Fee Schedule,Medicare APC Fee Schedule
URG CARE L5 EP PROF,G0463,HCPCS,,,,,both,, ,414.25,248.55,Medicare,Medicare,,248.55,,,414.25,58.00,211.27,Fee Schedule,Medicare APC Fee Schedule
URG CARE L5 NP PROF,G0463,HCPCS,,,,,both,, ,602.50,361.50,Medicare,Medicare,,361.50,,,602.50,84.35,307.28,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 1 EP,G0463,HCPCS,,,,,both,, ,239.73,143.83,Medicare,Medicare,,143.83,,,239.73,33.56,122.26,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 1 EP,G0463,HCPCS,,,,,both,, ,239.73,143.83,Medicare,Medicare,,143.83,,,239.73,33.56,122.26,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 1 EP,G0463,HCPCS,,,,,both,, ,239.73,143.83,Medicare,Medicare,,143.83,,,239.73,33.56,122.26,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 1 EP,G0463,HCPCS,,,,,both,, ,239.73,143.83,Medicare,Medicare,,143.83,,,239.73,33.56,122.26,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 2 EP,G0463,HCPCS,,,,,both,, ,251.84,151.10,Medicare,Medicare,,151.10,,,251.84,35.26,128.44,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 2 EP,G0463,HCPCS,,,,,both,, ,251.84,151.10,Medicare,Medicare,,151.10,,,251.84,35.26,128.44,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 2 EP,G0463,HCPCS,,,,,both,, ,251.84,151.10,Medicare,Medicare,,151.10,,,251.84,35.26,128.44,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 2 EP,G0463,HCPCS,,,,,both,, ,251.84,151.10,Medicare,Medicare,,151.10,,,251.84,35.26,128.44,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 2 NP,G0463,HCPCS,,,,,both,, ,234.07,140.44,Medicare,Medicare,,140.44,,,234.07,32.77,119.38,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 2 NP,G0463,HCPCS,,,,,both,, ,234.07,140.44,Medicare,Medicare,,140.44,,,234.07,32.77,119.38,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 3 EP,G0463,HCPCS,,,,,both,, ,281.71,169.02,Medicare,Medicare,,169.02,,,281.71,39.44,143.67,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 3 EP,G0463,HCPCS,,,,,both,, ,281.71,169.02,Medicare,Medicare,,169.02,,,281.71,39.44,143.67,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 3 NP,G0463,HCPCS,,,,,both,, ,261.88,157.12,Medicare,Medicare,,157.12,,,261.88,36.66,133.56,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 3 NP,G0463,HCPCS,,,,,both,, ,261.88,157.12,Medicare,Medicare,,157.12,,,261.88,36.66,133.56,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 4 EP,G0463,HCPCS,,,,,both,, ,311.83,187.09,Medicare,Medicare,,187.09,,,311.83,43.66,159.03,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 4 EP,G0463,HCPCS,,,,,both,, ,311.83,187.09,Medicare,Medicare,,187.09,,,311.83,43.66,159.03,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 4 NP,G0463,HCPCS,,,,,both,, ,289.69,173.81,Medicare,Medicare,,173.81,,,289.69,40.56,147.74,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 4 NP,G0463,HCPCS,,,,,both,, ,289.69,173.81,Medicare,Medicare,,173.81,,,289.69,40.56,147.74,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 5 EP,G0463,HCPCS,,,,,both,, ,317.50,190.50,Medicare,Medicare,,190.50,,,317.50,44.45,161.93,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 5 EP,G0463,HCPCS,,,,,both,, ,317.50,190.50,Medicare,Medicare,,190.50,,,317.50,44.45,161.93,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 5 EP,G0463,HCPCS,,,,,both,, ,317.50,190.50,Medicare,Medicare,,190.50,,,317.50,44.45,161.93,Fee Schedule,Medicare APC Fee Schedule
URGENT CARE LVL 5 EP,G0463,HCPCS,,,,,both,, ,317.50,190.50,Medicare,Medicare,,190.50,,,317.50,44.45,161.93,Fee Schedule,Medicare APC Fee Schedule
EVAL & MGMT LEVEL 4,G0463,HCPCS,,,,,Outpatient,, ,237.25,142.35,Medicare,Medicare,,142.35,,,237.25,33.22,121,Fee Schedule,Medicare APC Fee Schedule
"New patient office of other outpatient visit, typically 60 min",G0463,HCPCS,,,,,Outpatient,,,317.50,317.50,Medicare,Medicare,,317.50,,,317.50,44.45,161.93,Fee Schedule,Medicare APC Fee Schedule
"New patient office of other outpatient visit, typically 45 min",G0463,HCPCS,,,,,Outpatient,,,289.69,289.69,Medicare,Medicare,,289.69,,,289.69,40.56,147.74,Fee Schedule,Medicare APC Fee Schedule
"New patient office or other outpatient visit, typically 30 min",G0463,HCPCS,,,,,Outpatient,,,261.88,261.88,Medicare,Medicare,,261.88,,,261.88,36.66,133.56,Fee Schedule,Medicare APC Fee Schedule
HIV1 AG W HIV 1 2 AB,G0475,HCPCS,,,,,both,, ,166.16,99.69,Medicare,Medicare,,99.69,,,166.16,23.26,84.74,Fee Schedule,Medicare APC Fee Schedule
HEPB SCR HI RSK NPRG,G0499,HCPCS,,,,,both,, ,570.04,342.02,Medicare,Medicare,,342.02,,,570.04,79.81,290.72,Fee Schedule,Medicare APC Fee Schedule
ABCIXIMAB 10MG,J0130,HCPCS,,,,,both,, ,4719.72,2831.83,Medicare,Medicare,,2831.83,,,4719.72,660.76,2407.06,Fee Schedule,Medicare APC Fee Schedule
ACETAMINO 10MG INJ,J0131,HCPCS,,,,,both,100,ML,3.00,1.80,Medicare,Medicare,,1.80,,,3.00,0.42,1.53,Fee Schedule,Medicare APC Fee Schedule
ACTYLCYSTN INJ 100MG,J0132,HCPCS,,,,,both,30,ML,17.77,10.66,Medicare,Medicare,,10.66,,,17.77,2.49,9.06,Fee Schedule,Medicare APC Fee Schedule
ACYCLOVIR 5MG INJ,J0133,HCPCS,,,,,both,, ,0.31,0.18,Medicare,Medicare,,0.18,,,0.31,0.04,0.16,Fee Schedule,Medicare APC Fee Schedule
ACYCLOVIR 5MG INJ,J0133,HCPCS,,,,,both,10,ML,1.03,0.61,Medicare,Medicare,,0.61,,,1.03,0.14,0.53,Fee Schedule,Medicare APC Fee Schedule
ADENOSINE 1MG INJ,J0153,HCPCS,,,,,both,2,ML,15.45,9.27,Medicare,Medicare,,9.27,,,15.45,2.16,7.88,Fee Schedule,Medicare APC Fee Schedule
ADENOSINE 1MG INJ,J0153,HCPCS,,,,,both,2,ML,15.45,9.27,Medicare,Medicare,,9.27,,,15.45,2.16,7.88,Fee Schedule,Medicare APC Fee Schedule
ADRENL/EPINEP 0.1MG,J0171,HCPCS,,,,,both,1,ML,2.68,1.60,Medicare,Medicare,,1.60,,,2.68,0.38,1.37,Fee Schedule,Medicare APC Fee Schedule
ADRENL/EPINEP 0.1MG,J0171,HCPCS,,,,,both,10,ML,8.65,5.19,Medicare,Medicare,,5.19,,,8.65,1.21,4.41,Fee Schedule,Medicare APC Fee Schedule
EPINEPHRINE INJ 30MG/30ML (1 MG/ML),J0171,HCPCS,,,,,both,30,ML,4.00,2.40,Medicare,Medicare,,2.40,,,4.00,0.56,2.04,Fee Schedule,Medicare APC Fee Schedule
REMDESIVIR 1MG INJ,J0248,HCPCS,,,,,both,1,EA,28.00,16.80,Medicare,Medicare,,16.80,,,28.00,3.92,14.28,Fee Schedule,Medicare APC Fee Schedule
AMKCN SULF INJ 100MG,J0278,HCPCS,,,,,both,2,ML,5.56,3.33,Medicare,Medicare,,3.33,,,5.56,0.78,2.84,Fee Schedule,Medicare APC Fee Schedule
AMINOPHYLL 250MG INJ,J0280,HCPCS,,,,,both,20,ML,58.97,35.38,Medicare,Medicare,,35.38,,,58.97,8.26,30.07,Fee Schedule,Medicare APC Fee Schedule
AMINOPHYLL 250MG INJ,J0280,HCPCS,,,,,both,10,ML,96.31,57.78,Medicare,Medicare,,57.78,,,96.31,13.48,49.12,Fee Schedule,Medicare APC Fee Schedule
AMIODARONE 30MG INJ,J0282,HCPCS,,,,,both,18,ML,5.15,3.09,Medicare,Medicare,,3.09,,,5.15,0.72,2.63,Fee Schedule,Medicare APC Fee Schedule
AMIODARONE 30MG INJ,J0282,HCPCS,,,,,both,3,ML,6.39,3.83,Medicare,Medicare,,3.83,,,6.39,0.89,3.26,Fee Schedule,Medicare APC Fee Schedule
AMPHOTER B 50MG INJ,J0285,HCPCS,,,,,both,, ,321.36,192.81,Medicare,Medicare,,192.81,,,321.36,44.99,163.89,Fee Schedule,Medicare APC Fee Schedule
AMPHOTER B LIPO 10MG,J0289,HCPCS,,,,,both,1,EA,211.15,126.69,Medicare,Medicare,,126.69,,,211.15,29.56,107.69,Fee Schedule,Medicare APC Fee Schedule
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,17.00,10.20,Medicare,Medicare,,10.20,,,17.00,2.38,8.67,Fee Schedule,Medicare APC Fee Schedule
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,, ,26.78,16.06,Medicare,Medicare,,16.06,,,26.78,3.75,13.66,Fee Schedule,Medicare APC Fee Schedule
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,, ,26.78,16.06,Medicare,Medicare,,16.06,,,26.78,3.75,13.66,Fee Schedule,Medicare APC Fee Schedule
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,57.94,34.76,Medicare,Medicare,,34.76,,,57.94,8.11,29.55,Fee Schedule,Medicare APC Fee Schedule
AMPICILLIN/SUB 1.5GM,J0295,HCPCS,,,,,both,1,EA,23.69,14.21,Medicare,Medicare,,14.21,,,23.69,3.32,12.08,Fee Schedule,Medicare APC Fee Schedule
AMPICILLIN/SUB 1.5GM,J0295,HCPCS,,,,,both,, ,63.09,37.85,Medicare,Medicare,,37.85,,,63.09,8.83,32.18,Fee Schedule,Medicare APC Fee Schedule
SUCCINYLCHN 20MG INJ,J0330,HCPCS,,,,,both,10,ML,13.00,7.80,Medicare,Medicare,,7.80,,,13.00,1.82,6.63,Fee Schedule,Medicare APC Fee Schedule
SUCCINYLCHN 20MG INJ,J0330,HCPCS,,,,,both,, ,20.34,12.20,Medicare,Medicare,,12.20,,,20.34,2.85,10.37,Fee Schedule,Medicare APC Fee Schedule
HYDRALAZINE 20MG INJ,J0360,HCPCS,,,,,both,1,ML,101.71,61.02,Medicare,Medicare,,61.02,,,101.71,14.24,51.87,Fee Schedule,Medicare APC Fee Schedule
AZITHROMYC 500MG INJ,J0456,HCPCS,,,,,both,1,EA,40.69,24.41,Medicare,Medicare,,24.41,,,40.69,5.70,20.75,Fee Schedule,Medicare APC Fee Schedule
ATROPINE 0.01 MG INJ,J0461,HCPCS,,,,,both,1,ML,2.00,1.20,Medicare,Medicare,,1.20,,,2.00,0.28,1.02,Fee Schedule,Medicare APC Fee Schedule
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,, ,0.62,0.37,Medicare,Medicare,,0.37,,,0.62,0.09,0.32,Fee Schedule,Medicare APC Fee Schedule
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,10,ML,1.03,0.61,Medicare,Medicare,,0.61,,,1.03,0.14,0.53,Fee Schedule,Medicare APC Fee Schedule
DIMERCAPRO 100MG INJ,J0470,HCPCS,,,,,both,, ,198.28,118.96,Medicare,Medicare,,118.96,,,198.28,27.76,101.12,Fee Schedule,Medicare APC Fee Schedule
DICYCLOMINE 20MG INJ,J0500,HCPCS,,,,,both,2,ML,307.46,184.47,Medicare,Medicare,,184.47,,,307.46,43.04,156.8,Fee Schedule,Medicare APC Fee Schedule
BENZTROPN MES 1MGINJ,J0515,HCPCS,,,,,both,2,ML,263.42,158.05,Medicare,Medicare,,158.05,,,263.42,36.88,134.34,Fee Schedule,Medicare APC Fee Schedule
PCN G BENZ/PROC 100K,J0558,HCPCS,,,,,both,, ,34.25,20.55,Medicare,Medicare,,20.55,,,34.25,4.80,17.47,Fee Schedule,Medicare APC Fee Schedule
PCN G BENZ/PROC 100K,J0558,HCPCS,,,,,both,, ,35.54,21.32,Medicare,Medicare,,21.32,,,35.54,4.98,18.13,Fee Schedule,Medicare APC Fee Schedule
PEN G BENZ INJ 100K,J0561,HCPCS,,,,,both,2,ML,43.00,25.80,Medicare,Medicare,,25.80,,,43.00,6.02,21.93,Fee Schedule,Medicare APC Fee Schedule
BIVALIRUDIN 1MG INJ,J0583,HCPCS,,,,,both,1,EA,18.28,10.96,Medicare,Medicare,,10.96,,,18.28,2.56,9.32,Fee Schedule,Medicare APC Fee Schedule
BOTULINUM TOXI A 1U,J0585,HCPCS,,,,,both,1,EA,33.48,20.08,Medicare,Medicare,,20.08,,,33.48,4.69,17.07,Fee Schedule,Medicare APC Fee Schedule
BUTORPHANOL 1MG INJ,J0595,HCPCS,,,,,both,1,ML,17.77,10.66,Medicare,Medicare,,10.66,,,17.77,2.49,9.06,Fee Schedule,Medicare APC Fee Schedule
CINACALC 1MG PO ESRD,J0604,HCPCS,,,,,both,, ,6.18,3.70,Medicare,Medicare,,3.70,,,6.18,0.87,3.15,Fee Schedule,Medicare APC Fee Schedule
CALCITRIOL .1MCG INJ,J0636,HCPCS,,,,,both,, ,4.33,2.59,Medicare,Medicare,,2.59,,,4.33,0.61,2.21,Fee Schedule,Medicare APC Fee Schedule
LEUCOVORIN 50MG INJ,J0640,HCPCS,,,,,both,1,EA,84.46,50.67,Medicare,Medicare,,50.67,,,84.46,11.82,43.07,Fee Schedule,Medicare APC Fee Schedule
MEPIVACAINE 10ML INJ,J0670,HCPCS,,,,,both,30,ML,19.31,11.58,Medicare,Medicare,,11.58,,,19.31,2.70,9.85,Fee Schedule,Medicare APC Fee Schedule
MEPIVACAINE 10ML INJ,J0670,HCPCS,,,,,both,20,ML,21.89,13.13,Medicare,Medicare,,13.13,,,21.89,3.06,11.16,Fee Schedule,Medicare APC Fee Schedule
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,12.88,7.72,Medicare,Medicare,,7.72,,,12.88,1.80,6.57,Fee Schedule,Medicare APC Fee Schedule
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,12.88,7.72,Medicare,Medicare,,7.72,,,12.88,1.80,6.57,Fee Schedule,Medicare APC Fee Schedule
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,, ,14.94,8.96,Medicare,Medicare,,8.96,,,14.94,2.09,7.62,Fee Schedule,Medicare APC Fee Schedule
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,, ,14.94,8.96,Medicare,Medicare,,8.96,,,14.94,2.09,7.62,Fee Schedule,Medicare APC Fee Schedule
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,22.40,13.44,Medicare,Medicare,,13.44,,,22.40,3.14,11.42,Fee Schedule,Medicare APC Fee Schedule
CEFEPIME 500 MG INJ,J0692,CPT,,,,,both,1,EA,9.00,5.40,Medicare,Medicare,,5.40,,,9.00,1.26,4.59,Fee Schedule,Medicare APC Fee Schedule
CEFEPIME 500MG INJ,J0692,HCPCS,,,,,both,, ,19.06,11.43,Medicare,Medicare,,11.43,,,19.06,2.67,9.72,Fee Schedule,Medicare APC Fee Schedule
CEFEPIME 500MG INJ,J0692,HCPCS,,,,,both,1,EA,24.72,14.83,Medicare,Medicare,,14.83,,,24.72,3.46,12.61,Fee Schedule,Medicare APC Fee Schedule
CEFOXITIN 1GM INJ,J0694,HCPCS,,,,,both,1,EA,53.82,32.29,Medicare,Medicare,,32.29,,,53.82,7.53,27.45,Fee Schedule,Medicare APC Fee Schedule
CEFTO50-TAZO25MG INJ,J0695,HCPCS,,,,,both,1,EA,28.84,17.30,Medicare,Medicare,,17.30,,,28.84,4.04,14.71,Fee Schedule,Medicare APC Fee Schedule
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,8.03,4.81,Medicare,Medicare,,4.81,,,8.03,1.12,4.1,Fee Schedule,Medicare APC Fee Schedule
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,11.59,6.95,Medicare,Medicare,,6.95,,,11.59,1.62,5.91,Fee Schedule,Medicare APC Fee Schedule
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,12.88,7.72,Medicare,Medicare,,7.72,,,12.88,1.80,6.57,Fee Schedule,Medicare APC Fee Schedule
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,24.72,14.83,Medicare,Medicare,,14.83,,,24.72,3.46,12.61,Fee Schedule,Medicare APC Fee Schedule
CEFUROXIME 750MG INJ,J0697,HCPCS,,,,,both,, ,23.69,14.21,Medicare,Medicare,,14.21,,,23.69,3.32,12.08,Fee Schedule,Medicare APC Fee Schedule
CEFUROXIME 750MG INJ,J0697,HCPCS,,,,,both,, ,45.06,27.03,Medicare,Medicare,,27.03,,,45.06,6.31,22.98,Fee Schedule,Medicare APC Fee Schedule
BETAM ACE/SOD PHO3MG,J0702,HCPCS,,,,,both,5,ML,56.14,33.68,Medicare,Medicare,,33.68,,,56.14,7.86,28.63,Fee Schedule,Medicare APC Fee Schedule
CEFTAROLIN 10MG INJ,J0712,HCPCS,,,,,both,, ,16.48,9.88,Medicare,Medicare,,9.88,,,16.48,2.31,8.4,Fee Schedule,Medicare APC Fee Schedule
CEFTAROLIN 10MG INJ,J0712,HCPCS,,,,,both,, ,24.72,14.83,Medicare,Medicare,,14.83,,,24.72,3.46,12.61,Fee Schedule,Medicare APC Fee Schedule
COLISTIME UP TO 150M,J0770,CPT,,,,,both,1,EA,236.64,141.98,Medicare,Medicare,,141.98,,,236.64,33.13,120.69,Fee Schedule,Medicare APC Fee Schedule
PROCHLORPE UPTO 10MG,J0780,HCPCS,,,,,both,, ,39.66,23.79,Medicare,Medicare,,23.79,,,39.66,5.55,20.23,Fee Schedule,Medicare APC Fee Schedule
COSYNTROPN .25MG INJ,J0834,HCPCS,,,,,both,1,EA,687.78,412.66,Medicare,Medicare,,412.66,,,687.78,96.29,350.77,Fee Schedule,Medicare APC Fee Schedule
DALBAVANCIN 5MG INJ,J0875,HCPCS,,,,,both,, ,85.75,51.45,Medicare,Medicare,,51.45,,,85.75,12.01,43.73,Fee Schedule,Medicare APC Fee Schedule
DAPTOMYCIN 1 MG INJ,J0878,HCPCS,,,,,both,1,EA,3.50,2.10,Medicare,Medicare,,2.10,,,3.50,0.49,1.79,Fee Schedule,Medicare APC Fee Schedule
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,38.88,23.32,Medicare,Medicare,,23.32,,,38.88,5.44,19.83,Fee Schedule,Medicare APC Fee Schedule
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,38.88,23.32,Medicare,Medicare,,23.32,,,38.88,5.44,19.83,Fee Schedule,Medicare APC Fee Schedule
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Medicare,Medicare,,25.65,,,42.75,5.99,21.8,Fee Schedule,Medicare APC Fee Schedule
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Medicare,Medicare,,25.65,,,42.75,5.99,21.8,Fee Schedule,Medicare APC Fee Schedule
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Medicare,Medicare,,25.65,,,42.75,5.99,21.8,Fee Schedule,Medicare APC Fee Schedule
ARGATROBAN 1MG NESRD,J0883,HCPCS,,,,,both,2.5,ML,18.80,11.28,Medicare,Medicare,,11.28,,,18.80,2.63,9.59,Fee Schedule,Medicare APC Fee Schedule
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,111.50,66.90,Medicare,Medicare,,66.90,,,111.50,15.61,56.87,Fee Schedule,Medicare APC Fee Schedule
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,111.50,66.90,Medicare,Medicare,,66.90,,,111.50,15.61,56.87,Fee Schedule,Medicare APC Fee Schedule
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,124.37,74.62,Medicare,Medicare,,74.62,,,124.37,17.41,63.43,Fee Schedule,Medicare APC Fee Schedule
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Medicare,Medicare,,97.64,,,162.74,22.78,83,Fee Schedule,Medicare APC Fee Schedule
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Medicare,Medicare,,97.64,,,162.74,22.78,83,Fee Schedule,Medicare APC Fee Schedule
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Medicare,Medicare,,97.64,,,162.74,22.78,83,Fee Schedule,Medicare APC Fee Schedule
DEFEROXAMIN 500MGINJ,J0895,HCPCS,,,,,both,1,EA,66.44,39.86,Medicare,Medicare,,39.86,,,66.44,9.30,33.88,Fee Schedule,Medicare APC Fee Schedule
DEFEROXAMIN 500MGINJ,J0895,HCPCS,,,,,both,, ,132.87,79.72,Medicare,Medicare,,79.72,,,132.87,18.60,67.76,Fee Schedule,Medicare APC Fee Schedule
DENOSUMAB 1MG INJ,J0897,HCPCS,,,,,both,1,ML,96.31,57.78,Medicare,Medicare,,57.78,,,96.31,13.48,49.12,Fee Schedule,Medicare APC Fee Schedule
MEDROXYPROG 1MG INJ,J1050,HCPCS,,,,,both,1,ML,4.43,2.65,Medicare,Medicare,,2.65,,,4.43,0.62,2.26,Fee Schedule,Medicare APC Fee Schedule
TESTOSTER CYPION 1MG,J1071,HCPCS,,,,,both,, ,0.93,0.55,Medicare,Medicare,,0.55,,,0.93,0.13,0.47,Fee Schedule,Medicare APC Fee Schedule
TESTOSTER CYPION 1MG,J1071,HCPCS,,,,,both,, ,593.28,355.96,Medicare,Medicare,,355.96,,,593.28,83.06,302.57,Fee Schedule,Medicare APC Fee Schedule
DEXAMETH NA 1MG INJ,J1100,HCPCS,,,,,both,1,ML,6.39,3.83,Medicare,Medicare,,3.83,,,6.39,0.89,3.26,Fee Schedule,Medicare APC Fee Schedule
ACETAZOLAMI 500MGINJ,J1120,HCPCS,,,,,both,1,EA,308.49,185.09,Medicare,Medicare,,185.09,,,308.49,43.19,157.33,Fee Schedule,Medicare APC Fee Schedule
DIGOXIN 0.5MG INJ,J1160,HCPCS,,,,,both,2,ML,47.12,28.27,Medicare,Medicare,,28.27,,,47.12,6.60,24.03,Fee Schedule,Medicare APC Fee Schedule
DIGOXIN IMMUNE FAB,J1162,HCPCS,,,,,both,1,EA,6881.43,4128.85,Medicare,Medicare,,4128.85,,,6881.43,963.40,3509.53,Fee Schedule,Medicare APC Fee Schedule
PHENYTOIN NA 50MGINJ,J1165,HCPCS,,,,,both,5,ML,5.36,3.21,Medicare,Medicare,,3.21,,,5.36,0.75,2.73,Fee Schedule,Medicare APC Fee Schedule
PHENYTOIN NA 50MGINJ,J1165,HCPCS,,,,,both,2,ML,12.88,7.72,Medicare,Medicare,,7.72,,,12.88,1.80,6.57,Fee Schedule,Medicare APC Fee Schedule
DEXRAZOXANE 25OMG IJ,J1190,HCPCS,,,,,both,, ,1352.91,811.74,Medicare,Medicare,,811.74,,,1352.91,189.41,689.98,Fee Schedule,Medicare APC Fee Schedule
DIPHENHYDRAM 50MGINJ,J1200,HCPCS,,,,,both,1,ML,13.91,8.34,Medicare,Medicare,,8.34,,,13.91,1.95,7.09,Fee Schedule,Medicare APC Fee Schedule
DIPYRIDAMOLE 10MGINJ,J1245,HCPCS,,,,,both,, ,26.78,16.06,Medicare,Medicare,,16.06,,,26.78,3.75,13.66,Fee Schedule,Medicare APC Fee Schedule
DOBUTAMINE 250MG INJ,J1250,HCPCS,,,,,both,20,ML,28.84,17.30,Medicare,Medicare,,17.30,,,28.84,4.04,14.71,Fee Schedule,Medicare APC Fee Schedule
DOBUTAMINE 250MG INJ,J1250,HCPCS,,,,,both,250,ML,78.28,46.96,Medicare,Medicare,,46.96,,,78.28,10.96,39.92,Fee Schedule,Medicare APC Fee Schedule
DOPAMIN HCL 40MG INJ,J1265,HCPCS,,,,,both,250,ML,8.55,5.13,Medicare,Medicare,,5.13,,,8.55,1.20,4.36,Fee Schedule,Medicare APC Fee Schedule
EPTIFABITIDE 5MG IJ,J1327,HCPCS,,,,,both,, ,164.80,98.88,Medicare,Medicare,,98.88,,,164.80,23.07,84.05,Fee Schedule,Medicare APC Fee Schedule
ERTAPENEM SOD/500MG,J1335,HCPCS,,,,,both,1,EA,298.96,179.37,Medicare,Medicare,,179.37,,,298.96,41.85,152.47,Fee Schedule,Medicare APC Fee Schedule
ERYTHROMYC 500MG INJ,J1364,HCPCS,,,,,both,1,EA,196.99,118.19,Medicare,Medicare,,118.19,,,196.99,27.58,100.46,Fee Schedule,Medicare APC Fee Schedule
ESTROGEN CNJ 25MGINJ,J1410,HCPCS,,,,,both,, ,1016.61,609.96,Medicare,Medicare,,609.96,,,1016.61,142.33,518.47,Fee Schedule,Medicare APC Fee Schedule
FER CARBOXYM 1MG INJ,J1439,HCPCS,,,,,both,15,ML,7.00,4.20,Medicare,Medicare,,4.20,,,7.00,0.98,3.57,Fee Schedule,Medicare APC Fee Schedule
TBO-FILGRASTIM 1MCG,J1447,HCPCS,,,,,both,0.5,ML,4.53,2.71,Medicare,Medicare,,2.71,,,4.53,0.63,2.31,Fee Schedule,Medicare APC Fee Schedule
TBO-FILGRASTIM 1MCG,J1447,HCPCS,,,,,both,0.5,ML,4.53,2.71,Medicare,Medicare,,2.71,,,4.53,0.63,2.31,Fee Schedule,Medicare APC Fee Schedule
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,200,ML,32.19,19.31,Medicare,Medicare,,19.31,,,32.19,4.51,16.42,Fee Schedule,Medicare APC Fee Schedule
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,50,ML,84.72,50.83,Medicare,Medicare,,50.83,,,84.72,11.86,43.21,Fee Schedule,Medicare APC Fee Schedule
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,100,ML,144.72,86.83,Medicare,Medicare,,86.83,,,144.72,20.26,73.81,Fee Schedule,Medicare APC Fee Schedule
"FOMEPIZOLE, 15 MG",J1451,HCPCS,,,,,both,1.5,ML,43.52,26.11,Medicare,Medicare,,26.11,,,43.52,6.09,22.2,Fee Schedule,Medicare APC Fee Schedule
FOSAPREPITANT 1MG IJ,J1453,HCPCS,,,,,both,1,EA,10.82,6.49,Medicare,Medicare,,6.49,,,10.82,1.51,5.52,Fee Schedule,Medicare APC Fee Schedule
IVIG (PRIVIGEN)500MG,J1459,HCPCS,,,,,both,50,ML,390.89,234.53,Medicare,Medicare,,234.53,,,390.89,54.72,199.35,Fee Schedule,Medicare APC Fee Schedule
IVIG (PRIVIGEN)500MG,J1459,HCPCS,,,,,both,50,ML,390.89,234.53,Medicare,Medicare,,234.53,,,390.89,54.72,199.35,Fee Schedule,Medicare APC Fee Schedule
IMMU GLOB LYO 500MG,J1566,HCPCS,,,,,both,, ,270.89,162.53,Medicare,Medicare,,162.53,,,270.89,37.92,138.15,Fee Schedule,Medicare APC Fee Schedule
IMMU GLOB LYO 500MG,J1566,HCPCS,,,,,both,, ,270.89,162.53,Medicare,Medicare,,162.53,,,270.89,37.92,138.15,Fee Schedule,Medicare APC Fee Schedule
IVIG (OCTAGAM) 500MG,J1568,HCPCS,,,,,both,200,ML,319.82,191.89,Medicare,Medicare,,191.89,,,319.82,44.77,163.11,Fee Schedule,Medicare APC Fee Schedule
IVIG (OCTAGAM) 500MG,J1568,HCPCS,,,,,both,200,ML,319.82,191.89,Medicare,Medicare,,191.89,,,319.82,44.77,163.11,Fee Schedule,Medicare APC Fee Schedule
GANCICLOVI SOD 500MG,J1570,HCPCS,,,,,both,1,EA,615.94,369.56,Medicare,Medicare,,369.56,,,615.94,86.23,314.13,Fee Schedule,Medicare APC Fee Schedule
IVIG (FLEBOGAM)500MG,J1572,HCPCS,,,,,both,100,ML,256.99,154.19,Medicare,Medicare,,154.19,,,256.99,35.98,131.06,Fee Schedule,Medicare APC Fee Schedule
IVIG (FLEBOGAM)500MG,J1572,HCPCS,,,,,both,100,ML,256.99,154.19,Medicare,Medicare,,154.19,,,256.99,35.98,131.06,Fee Schedule,Medicare APC Fee Schedule
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,2,ML,24.72,14.83,Medicare,Medicare,,14.83,,,24.72,3.46,12.61,Fee Schedule,Medicare APC Fee Schedule
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,, ,27.81,16.68,Medicare,Medicare,,16.68,,,27.81,3.89,14.18,Fee Schedule,Medicare APC Fee Schedule
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,2,ML,28.84,17.30,Medicare,Medicare,,17.30,,,28.84,4.04,14.71,Fee Schedule,Medicare APC Fee Schedule
GLUCAGON 1MG INJ,J1610,HCPCS,,,,,both,, ,710.19,426.11,Medicare,Medicare,,426.11,,,710.19,99.43,362.2,Fee Schedule,Medicare APC Fee Schedule
GLUCAGON 1MG INJ,J1610,HCPCS,,,,,both,1,EA,1505.00,903.00,Medicare,Medicare,,903.00,,,1505.00,210.70,767.55,Fee Schedule,Medicare APC Fee Schedule
HALOPERIDOL 5MG INJ,J1630,HCPCS,,,,,both,1,ML,68.50,41.10,Medicare,Medicare,,41.10,,,68.50,9.59,34.94,Fee Schedule,Medicare APC Fee Schedule
HALOPER DEC 50MGINJ,J1631,HCPCS,,,,,both,1,ML,183.08,109.84,Medicare,Medicare,,109.84,,,183.08,25.63,93.37,Fee Schedule,Medicare APC Fee Schedule
HALOPER DEC 50MGINJ,J1631,HCPCS,,,,,both,1,ML,217.33,130.39,Medicare,Medicare,,130.39,,,217.33,30.43,110.84,Fee Schedule,Medicare APC Fee Schedule
HEPARIN NA 10U FLUSH,J1642,HCPCS,,,,,both,5,ML,0.52,0.31,Medicare,Medicare,,0.31,,,0.52,0.07,0.27,Fee Schedule,Medicare APC Fee Schedule
HEPARIN NA 10U FLUSH,J1642,HCPCS,,,,,both,3,ML,0.93,0.55,Medicare,Medicare,,0.55,,,0.93,0.13,0.47,Fee Schedule,Medicare APC Fee Schedule
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,2.16,1.29,Medicare,Medicare,,1.29,,,2.16,0.30,1.1,Fee Schedule,Medicare APC Fee Schedule
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,5.67,3.40,Medicare,Medicare,,3.40,,,5.67,0.79,2.89,Fee Schedule,Medicare APC Fee Schedule
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,6.39,3.83,Medicare,Medicare,,3.83,,,6.39,0.89,3.26,Fee Schedule,Medicare APC Fee Schedule
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,19.57,11.74,Medicare,Medicare,,11.74,,,19.57,2.74,9.98,Fee Schedule,Medicare APC Fee Schedule
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,500,ML,27.81,16.68,Medicare,Medicare,,16.68,,,27.81,3.89,14.18,Fee Schedule,Medicare APC Fee Schedule
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,28.84,17.30,Medicare,Medicare,,17.30,,,28.84,4.04,14.71,Fee Schedule,Medicare APC Fee Schedule
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,41.72,25.03,Medicare,Medicare,,25.03,,,41.72,5.84,21.28,Fee Schedule,Medicare APC Fee Schedule
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,250,ML,76.00,45.60,Medicare,Medicare,,45.60,,,76.00,10.64,38.76,Fee Schedule,Medicare APC Fee Schedule
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.3,ML,57.17,34.30,Medicare,Medicare,,34.30,,,57.17,8.00,29.16,Fee Schedule,Medicare APC Fee Schedule
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,1,ML,57.17,34.30,Medicare,Medicare,,34.30,,,57.17,8.00,29.16,Fee Schedule,Medicare APC Fee Schedule
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.8,ML,57.17,34.30,Medicare,Medicare,,34.30,,,57.17,8.00,29.16,Fee Schedule,Medicare APC Fee Schedule
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.6,ML,57.17,34.30,Medicare,Medicare,,34.30,,,57.17,8.00,29.16,Fee Schedule,Medicare APC Fee Schedule
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.4,ML,57.17,34.30,Medicare,Medicare,,34.30,,,57.17,8.00,29.16,Fee Schedule,Medicare APC Fee Schedule
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,38.37,23.02,Medicare,Medicare,,23.02,,,38.37,5.37,19.57,Fee Schedule,Medicare APC Fee Schedule
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,51.24,30.74,Medicare,Medicare,,30.74,,,51.24,7.17,26.13,Fee Schedule,Medicare APC Fee Schedule
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,76.74,46.04,Medicare,Medicare,,46.04,,,76.74,10.74,39.14,Fee Schedule,Medicare APC Fee Schedule
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,85.49,51.29,Medicare,Medicare,,51.29,,,85.49,11.97,43.6,Fee Schedule,Medicare APC Fee Schedule
TETANUS IG HUM 250U,J1670,HCPCS,,,,,both,1,ML,1976.31,1185.78,Medicare,Medicare,,1185.78,,,1976.31,276.68,1007.92,Fee Schedule,Medicare APC Fee Schedule
HYDROCORTIS 100MGINJ,J1720,HCPCS,,,,,both,1,EA,48.15,28.89,Medicare,Medicare,,28.89,,,48.15,6.74,24.56,Fee Schedule,Medicare APC Fee Schedule
MELOXICAM 1MG INJ,J1738,HCPCS,,,,,both,1,ML,566.00,339.60,Medicare,Medicare,,339.60,,,566.00,79.24,288.66,Fee Schedule,Medicare APC Fee Schedule
IBUTILIDE 1MG INJ,J1742,HCPCS,,,,,both,, ,1612.21,967.32,Medicare,Medicare,,967.32,,,1612.21,225.71,822.23,Fee Schedule,Medicare APC Fee Schedule
INFLIXIMAB 10 MG INJ,J1745,HCPCS,,,,,both,1,EA,560.84,336.50,Medicare,Medicare,,336.50,,,560.84,78.52,286.03,Fee Schedule,Medicare APC Fee Schedule
IRON DEX165 INJ 50MG,J1750,HCPCS,,,,,both,, ,132.87,79.72,Medicare,Medicare,,79.72,,,132.87,18.60,67.76,Fee Schedule,Medicare APC Fee Schedule
IRON SUCROSE 1MG INJ,J1756,HCPCS,,,,,both,, ,4.22,2.53,Medicare,Medicare,,2.53,,,4.22,0.59,2.15,Fee Schedule,Medicare APC Fee Schedule
DROPERIDOL UP TO 5MG,J1790,HCPCS,,,,,both,2,ML,27.81,16.68,Medicare,Medicare,,16.68,,,27.81,3.89,14.18,Fee Schedule,Medicare APC Fee Schedule
INSULIN 1 UNT INJ,J1815,CPT,,,,,both,10,ML,1.00,0.60,Medicare,Medicare,,0.60,,,1.00,0.14,0.51,Fee Schedule,Medicare APC Fee Schedule
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,, ,6.39,3.83,Medicare,Medicare,,3.83,,,6.39,0.89,3.26,Fee Schedule,Medicare APC Fee Schedule
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,1,ML,12.88,7.72,Medicare,Medicare,,7.72,,,12.88,1.80,6.57,Fee Schedule,Medicare APC Fee Schedule
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,1,ML,25.75,15.45,Medicare,Medicare,,15.45,,,25.75,3.61,13.13,Fee Schedule,Medicare APC Fee Schedule
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,10,ML,5.67,3.40,Medicare,Medicare,,3.40,,,5.67,0.79,2.89,Fee Schedule,Medicare APC Fee Schedule
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,4,ML,12.88,7.72,Medicare,Medicare,,7.72,,,12.88,1.80,6.57,Fee Schedule,Medicare APC Fee Schedule
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,2,ML,25.75,15.45,Medicare,Medicare,,15.45,,,25.75,3.61,13.13,Fee Schedule,Medicare APC Fee Schedule
LUPR 3.75FEMALE/PEDS,J1950,HCPCS,,,,,both,1,EA,6029.88,3617.92,Medicare,Medicare,,3617.92,,,6029.88,844.18,3075.24,Fee Schedule,Medicare APC Fee Schedule
LEVETIRACET 10MG INJ,J1953,HCPCS,,,,,both,5,ML,1.18,0.70,Medicare,Medicare,,0.70,,,1.18,0.17,0.6,Fee Schedule,Medicare APC Fee Schedule
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,100,ML,58.45,35.07,Medicare,Medicare,,35.07,,,58.45,8.18,29.81,Fee Schedule,Medicare APC Fee Schedule
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,150,ML,68.24,40.94,Medicare,Medicare,,40.94,,,68.24,9.55,34.8,Fee Schedule,Medicare APC Fee Schedule
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,50,ML,78.28,46.96,Medicare,Medicare,,46.96,,,78.28,10.96,39.92,Fee Schedule,Medicare APC Fee Schedule
LINEZOLID 200 MG,J2020,HCPCS,,,,,both,300,ML,225.31,135.18,Medicare,Medicare,,135.18,,,225.31,31.54,114.91,Fee Schedule,Medicare APC Fee Schedule
LINEZOLID 200 MG,J2020,HCPCS,,,,,both,, ,258.79,155.27,Medicare,Medicare,,155.27,,,258.79,36.23,131.98,Fee Schedule,Medicare APC Fee Schedule
LORAZEPAM 2MG INJ,J2060,HCPCS,,,,,both,1,ML,19.57,11.74,Medicare,Medicare,,11.74,,,19.57,2.74,9.98,Fee Schedule,Medicare APC Fee Schedule
LORAZEPAM INJ 2MG/ML 10 ML MDV,J2060,HCPCS,,,,,both,, ,15.14,9.08,Medicare,Medicare,,9.08,,,15.14,2.12,7.72,Fee Schedule,Medicare APC Fee Schedule
MANNITOL 25% 50MLINJ,J2150,HCPCS,,,,,both,50,ML,24.72,14.83,Medicare,Medicare,,14.83,,,24.72,3.46,12.61,Fee Schedule,Medicare APC Fee Schedule
MEPERID HCL 100MGINJ,J2175,HCPCS,,,,,both,1,ML,16.48,9.88,Medicare,Medicare,,9.88,,,16.48,2.31,8.4,Fee Schedule,Medicare APC Fee Schedule
MEROPENEMBR 100MGINJ,J2184,HCPCS,,,,,both,, ,18.28,10.96,Medicare,Medicare,,10.96,,,18.28,2.56,9.32,Fee Schedule,Medicare APC Fee Schedule
MEROPENEM 100MG INJ,J2185,HCPCS,,,,,both,1,EA,8.96,5.37,Medicare,Medicare,,5.37,,,8.96,1.25,4.57,Fee Schedule,Medicare APC Fee Schedule
MEROPENEM 100MG INJ,J2185,HCPCS,,,,,both,1,EA,8.96,5.37,Medicare,Medicare,,5.37,,,8.96,1.25,4.57,Fee Schedule,Medicare APC Fee Schedule
METHYLERGONV .2MGINJ,J2210,HCPCS,,,,,both,1,ML,47.12,28.27,Medicare,Medicare,,28.27,,,47.12,6.60,24.03,Fee Schedule,Medicare APC Fee Schedule
METHYLNALTR .1MG INJ,J2212,HCPCS,,,,,both,, ,4.33,2.59,Medicare,Medicare,,2.59,,,4.33,0.61,2.21,Fee Schedule,Medicare APC Fee Schedule
MICAFUNGIN 1MG INJ,J2248,HCPCS,,,,,both,1,EA,11.59,6.95,Medicare,Medicare,,6.95,,,11.59,1.62,5.91,Fee Schedule,Medicare APC Fee Schedule
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,10,ML,1.03,0.61,Medicare,Medicare,,0.61,,,1.03,0.14,0.53,Fee Schedule,Medicare APC Fee Schedule
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,5,ML,3.09,1.85,Medicare,Medicare,,1.85,,,3.09,0.43,1.58,Fee Schedule,Medicare APC Fee Schedule
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,2,ML,7.00,4.20,Medicare,Medicare,,4.20,,,7.00,0.98,3.57,Fee Schedule,Medicare APC Fee Schedule
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,, ,8.34,5.00,Medicare,Medicare,,5.00,,,8.34,1.17,4.25,Fee Schedule,Medicare APC Fee Schedule
MIDAZOL HCL WG 1MG,J2251,HCPCS,,,,,both,50,ML,3.25,1.95,Medicare,Medicare,,1.95,,,3.25,0.46,1.66,Fee Schedule,Medicare APC Fee Schedule
MILRINONE 5MG INJ,J2260,HCPCS,,,,,both,100,ML,32.19,19.31,Medicare,Medicare,,19.31,,,32.19,4.51,16.42,Fee Schedule,Medicare APC Fee Schedule
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,1.03,0.61,Medicare,Medicare,,0.61,,,1.03,0.14,0.53,Fee Schedule,Medicare APC Fee Schedule
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,5.15,3.09,Medicare,Medicare,,3.09,,,5.15,0.72,2.63,Fee Schedule,Medicare APC Fee Schedule
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Medicare,Medicare,,8.96,,,14.94,2.09,7.62,Fee Schedule,Medicare APC Fee Schedule
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Medicare,Medicare,,8.96,,,14.94,2.09,7.62,Fee Schedule,Medicare APC Fee Schedule
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Medicare,Medicare,,8.96,,,14.94,2.09,7.62,Fee Schedule,Medicare APC Fee Schedule
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,14.75,8.85,Medicare,Medicare,,8.85,,,14.75,2.07,7.52,Fee Schedule,Medicare APC Fee Schedule
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,14.94,8.96,Medicare,Medicare,,8.96,,,14.94,2.09,7.62,Fee Schedule,Medicare APC Fee Schedule
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,16.00,9.60,Medicare,Medicare,,9.60,,,16.00,2.24,8.16,Fee Schedule,Medicare APC Fee Schedule
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,, ,86.78,52.06,Medicare,Medicare,,52.06,,,86.78,12.15,44.26,Fee Schedule,Medicare APC Fee Schedule
NALBUPHINE 10MG INJ,J2300,HCPCS,,,,,both,1,ML,25.75,15.45,Medicare,Medicare,,15.45,,,25.75,3.61,13.13,Fee Schedule,Medicare APC Fee Schedule
NALOXONE HCL 1MG INJ,J2310,HCPCS,,,,,both,1,ML,133.90,80.34,Medicare,Medicare,,80.34,,,133.90,18.75,68.29,Fee Schedule,Medicare APC Fee Schedule
NALOXONE HCL 1MG INJ,J2310,HCPCS,,,,,both,2,ML,139.31,83.58,Medicare,Medicare,,83.58,,,139.31,19.50,71.05,Fee Schedule,Medicare APC Fee Schedule
OCRELIZUMAB 1MG INJ,J2350,HCPCS,,,,,both,10,ML,133.90,80.34,Medicare,Medicare,,80.34,,,133.90,18.75,68.29,Fee Schedule,Medicare APC Fee Schedule
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,1,ML,21.37,12.82,Medicare,Medicare,,12.82,,,21.37,2.99,10.9,Fee Schedule,Medicare APC Fee Schedule
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,1,ML,42.23,25.33,Medicare,Medicare,,25.33,,,42.23,5.91,21.54,Fee Schedule,Medicare APC Fee Schedule
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,, ,280.16,168.09,Medicare,Medicare,,168.09,,,280.16,39.22,142.88,Fee Schedule,Medicare APC Fee Schedule
ORPHENADR UP TO 60MG,J2360,HCPCS,,,,,both,2,ML,156.30,93.78,Medicare,Medicare,,93.78,,,156.30,21.88,79.71,Fee Schedule,Medicare APC Fee Schedule
CHLOROPR HCL INJ 1MG,J2401,HCPCS,,,,,both,20,ML,0.30,0.18,Medicare,Medicare,,0.18,,,0.30,0.04,0.15,Fee Schedule,Medicare APC Fee Schedule
ONDANSETRON 1MG INJ,J2405,HCPCS,,,,,both,2,ML,42.23,25.33,Medicare,Medicare,,25.33,,,42.23,5.91,21.54,Fee Schedule,Medicare APC Fee Schedule
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.75,ML,42.23,25.33,Medicare,Medicare,,25.33,,,42.23,5.91,21.54,Fee Schedule,Medicare APC Fee Schedule
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.25,ML,58.97,35.38,Medicare,Medicare,,35.38,,,58.97,8.26,30.07,Fee Schedule,Medicare APC Fee Schedule
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,1,ML,58.97,35.38,Medicare,Medicare,,35.38,,,58.97,8.26,30.07,Fee Schedule,Medicare APC Fee Schedule
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,1.5,ML,58.97,35.38,Medicare,Medicare,,35.38,,,58.97,8.26,30.07,Fee Schedule,Medicare APC Fee Schedule
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.5,ML,61.03,36.61,Medicare,Medicare,,36.61,,,61.03,8.54,31.13,Fee Schedule,Medicare APC Fee Schedule
PAMIDRONATE 30MG IJ,J2430,HCPCS,,,,,both,10,ML,193.64,116.18,Medicare,Medicare,,116.18,,,193.64,27.11,98.76,Fee Schedule,Medicare APC Fee Schedule
PAMIDRONATE 30MG IJ,J2430,HCPCS,,,,,both,, ,1208.71,725.22,Medicare,Medicare,,725.22,,,1208.71,169.22,616.44,Fee Schedule,Medicare APC Fee Schedule
PAPAVERINE UPTO 60MG,J2440,HCPCS,,,,,both,, ,302.05,181.23,Medicare,Medicare,,181.23,,,302.05,42.29,154.05,Fee Schedule,Medicare APC Fee Schedule
PALONOSETRON 25MCG,J2469,HCPCS,,,,,both,, ,250.55,150.33,Medicare,Medicare,,150.33,,,250.55,35.08,127.78,Fee Schedule,Medicare APC Fee Schedule
PANTOPRAZOLE SOD VL,J2470,HCPCS,,,,,both,1,EA,41.72,25.03,Medicare,Medicare,,25.03,,,41.72,5.84,21.28,Fee Schedule,Medicare APC Fee Schedule
PARICALCITOL 1MCGINJ,J2501,HCPCS,,,,,both,1,ML,25.75,15.45,Medicare,Medicare,,15.45,,,25.75,3.61,13.13,Fee Schedule,Medicare APC Fee Schedule
PENICI G POT .6MUINJ,J2540,HCPCS,,,,,both,, ,11.33,6.79,Medicare,Medicare,,6.79,,,11.33,1.59,5.78,Fee Schedule,Medicare APC Fee Schedule
PENICI G POT .6MUINJ,J2540,HCPCS,,,,,both,1,EA,11.59,6.95,Medicare,Medicare,,6.95,,,11.59,1.62,5.91,Fee Schedule,Medicare APC Fee Schedule
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,41.97,25.18,Medicare,Medicare,,25.18,,,41.97,5.88,21.4,Fee Schedule,Medicare APC Fee Schedule
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,44.55,26.73,Medicare,Medicare,,26.73,,,44.55,6.24,22.72,Fee Schedule,Medicare APC Fee Schedule
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,48.15,28.89,Medicare,Medicare,,28.89,,,48.15,6.74,24.56,Fee Schedule,Medicare APC Fee Schedule
PROMETHAZI UPTO 50MG,J2550,HCPCS,,,,,both,1,ML,24.72,14.83,Medicare,Medicare,,14.83,,,24.72,3.46,12.61,Fee Schedule,Medicare APC Fee Schedule
PHENOBARB 120MG INJ,J2560,HCPCS,,,,,both,1,ML,167.89,100.73,Medicare,Medicare,,100.73,,,167.89,23.50,85.62,Fee Schedule,Medicare APC Fee Schedule
PHENOBARB 120MG INJ,J2560,HCPCS,,,,,both,, ,232.78,139.66,Medicare,Medicare,,139.66,,,232.78,32.59,118.72,Fee Schedule,Medicare APC Fee Schedule
OXYTOCIN UP TO 10UN,J2590,HCPCS,,,,,both,1,ML,27.81,16.68,Medicare,Medicare,,16.68,,,27.81,3.89,14.18,Fee Schedule,Medicare APC Fee Schedule
DESMOPRESSIN 1MCGINJ,J2597,HCPCS,,,,,both,1,ML,13.91,8.34,Medicare,Medicare,,8.34,,,13.91,1.95,7.09,Fee Schedule,Medicare APC Fee Schedule
FLUPHENZI UP TO 25MG,J2680,HCPCS,,,,,both,5,ML,139.05,83.43,Medicare,Medicare,,83.43,,,139.05,19.47,70.92,Fee Schedule,Medicare APC Fee Schedule
PROCAINAMID UPTO 1GM,J2690,HCPCS,,,,,both,2,ML,95.79,57.47,Medicare,Medicare,,57.47,,,95.79,13.41,48.85,Fee Schedule,Medicare APC Fee Schedule
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,20,ML,1.44,0.86,Medicare,Medicare,,0.86,,,1.44,0.20,0.73,Fee Schedule,Medicare APC Fee Schedule
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,50,ML,2.68,1.60,Medicare,Medicare,,1.60,,,2.68,0.38,1.37,Fee Schedule,Medicare APC Fee Schedule
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,50,ML,2.68,1.60,Medicare,Medicare,,1.60,,,2.68,0.38,1.37,Fee Schedule,Medicare APC Fee Schedule
NEOSTIGMINE .5MG INJ,J2710,HCPCS,,,,,both,10,ML,13.91,8.34,Medicare,Medicare,,8.34,,,13.91,1.95,7.09,Fee Schedule,Medicare APC Fee Schedule
NEOSTIGMINE .5MG INJ,J2710,HCPCS,,,,,both,5,ML,19.57,11.74,Medicare,Medicare,,11.74,,,19.57,2.74,9.98,Fee Schedule,Medicare APC Fee Schedule
PROTAMINE 10MG INJ,J2720,HCPCS,,,,,both,5,ML,12.88,7.72,Medicare,Medicare,,7.72,,,12.88,1.80,6.57,Fee Schedule,Medicare APC Fee Schedule
PHENTOLAMINE 5MG INJ,J2760,HCPCS,,,,,both,1,EA,968.46,581.07,Medicare,Medicare,,581.07,,,968.46,135.58,493.91,Fee Schedule,Medicare APC Fee Schedule
METOCLOPRAM 10MG INJ,J2765,HCPCS,,,,,both,2,ML,24.72,14.83,Medicare,Medicare,,14.83,,,24.72,3.46,12.61,Fee Schedule,Medicare APC Fee Schedule
REGADENOSON 0.1MG IJ,J2785,HCPCS,,,,,both,5,ML,335.01,201.00,Medicare,Medicare,,201.00,,,335.01,46.90,170.86,Fee Schedule,Medicare APC Fee Schedule
RHOPHYLAC 100UNT,J2791,HCPCS,,,,,both,2,ML,62.83,37.69,Medicare,Medicare,,37.69,,,62.83,8.80,32.04,Fee Schedule,Medicare APC Fee Schedule
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,28.33,16.99,Medicare,Medicare,,16.99,,,28.33,3.97,14.45,Fee Schedule,Medicare APC Fee Schedule
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,34.25,20.55,Medicare,Medicare,,20.55,,,34.25,4.80,17.47,Fee Schedule,Medicare APC Fee Schedule
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,37.08,22.24,Medicare,Medicare,,22.24,,,37.08,5.19,18.91,Fee Schedule,Medicare APC Fee Schedule
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,20,ML,1.03,0.61,Medicare,Medicare,,0.61,,,1.03,0.14,0.53,Fee Schedule,Medicare APC Fee Schedule
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,20,ML,1.03,0.61,Medicare,Medicare,,0.61,,,1.03,0.14,0.53,Fee Schedule,Medicare APC Fee Schedule
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,30,ML,1.03,0.61,Medicare,Medicare,,0.61,,,1.03,0.14,0.53,Fee Schedule,Medicare APC Fee Schedule
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,, ,1.65,0.99,Medicare,Medicare,,0.99,,,1.65,0.23,0.84,Fee Schedule,Medicare APC Fee Schedule
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,100,ML,1.96,1.17,Medicare,Medicare,,1.17,,,1.96,0.27,1,Fee Schedule,Medicare APC Fee Schedule
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,10,ML,2.16,1.29,Medicare,Medicare,,1.29,,,2.16,0.30,1.1,Fee Schedule,Medicare APC Fee Schedule
SINCALIDE INJ 5MCG,J2805,HCPCS,,,,,both,1,EA,670.53,402.31,Medicare,Medicare,,402.31,,,670.53,93.87,341.97,Fee Schedule,Medicare APC Fee Schedule
SOD FERRIC 12.5MGINJ,J2916,HCPCS,,,,,both,5,ML,53.56,32.13,Medicare,Medicare,,32.13,,,53.56,7.50,27.32,Fee Schedule,Medicare APC Fee Schedule
RETEPLASE 18.1MG IJ,J2993,HCPCS,,,,,both,, ,7366.00,4419.60,Medicare,Medicare,,4419.60,,,7366.00,1031.24,3756.66,Fee Schedule,Medicare APC Fee Schedule
ALTEPLASE RECOM 1MG,J2997,HCPCS,,,,,both,1,EA,347.11,208.26,Medicare,Medicare,,208.26,,,347.11,48.60,177.03,Fee Schedule,Medicare APC Fee Schedule
ALTEPLASE RECOM 1MG,J2997,HCPCS,,,,,both,1,EA,353.55,212.13,Medicare,Medicare,,212.13,,,353.55,49.50,180.31,Fee Schedule,Medicare APC Fee Schedule
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,5,ML,6.59,3.95,Medicare,Medicare,,3.95,,,6.59,0.92,3.36,Fee Schedule,Medicare APC Fee Schedule
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,2,ML,14.42,8.65,Medicare,Medicare,,8.65,,,14.42,2.02,7.35,Fee Schedule,Medicare APC Fee Schedule
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,1,ML,17.25,10.35,Medicare,Medicare,,10.35,,,17.25,2.42,8.8,Fee Schedule,Medicare APC Fee Schedule
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,100,ML,20.25,12.15,Medicare,Medicare,,12.15,,,20.25,2.84,10.33,Fee Schedule,Medicare APC Fee Schedule
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,20,ML,49.44,29.66,Medicare,Medicare,,29.66,,,49.44,6.92,25.21,Fee Schedule,Medicare APC Fee Schedule
SUMATRIPTAN 6MG INJ,J3030,HCPCS,,,,,both,0.5,ML,631.91,379.14,Medicare,Medicare,,379.14,,,631.91,88.47,322.27,Fee Schedule,Medicare APC Fee Schedule
TENECTEPLASE 1MG INJ,J3101,HCPCS,,,,,both,1,EA,402.47,241.48,Medicare,Medicare,,241.48,,,402.47,56.35,205.26,Fee Schedule,Medicare APC Fee Schedule
TERBUTALINE 1MG INJ,J3105,HCPCS,,,,,both,1,ML,28.84,17.30,Medicare,Medicare,,17.30,,,28.84,4.04,14.71,Fee Schedule,Medicare APC Fee Schedule
CHLORPROM UP TO 50MG,J3230,HCPCS,,,,,both,, ,161.71,97.02,Medicare,Medicare,,97.02,,,161.71,22.64,82.47,Fee Schedule,Medicare APC Fee Schedule
CHLORPROM UP TO 50MG,J3230,HCPCS,,,,,both,2,ML,185.40,111.24,Medicare,Medicare,,111.24,,,185.40,25.96,94.55,Fee Schedule,Medicare APC Fee Schedule
TIGECYCLINE 1 MG INJ,J3243,HCPCS,,,,,both,, ,11.33,6.79,Medicare,Medicare,,6.79,,,11.33,1.59,5.78,Fee Schedule,Medicare APC Fee Schedule
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,250,ML,60.00,36.00,Medicare,Medicare,,36.00,,,60.00,8.40,30.6,Fee Schedule,Medicare APC Fee Schedule
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,100,ML,75.71,45.42,Medicare,Medicare,,45.42,,,75.71,10.60,38.61,Fee Schedule,Medicare APC Fee Schedule
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,15,ML,91.16,54.69,Medicare,Medicare,,54.69,,,91.16,12.76,46.49,Fee Schedule,Medicare APC Fee Schedule
TRIMETHOBEN 200MGINJ,J3250,HCPCS,,,,,both,, ,26.78,16.06,Medicare,Medicare,,16.06,,,26.78,3.75,13.66,Fee Schedule,Medicare APC Fee Schedule
TOBRAMYCIN UPTO 80MG,J3260,HCPCS,,,,,both,1,EA,71.84,43.10,Medicare,Medicare,,43.10,,,71.84,10.06,36.64,Fee Schedule,Medicare APC Fee Schedule
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,4,ML,28.58,17.14,Medicare,Medicare,,17.14,,,28.58,4.00,14.58,Fee Schedule,Medicare APC Fee Schedule
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,20,ML,28.58,17.14,Medicare,Medicare,,17.14,,,28.58,4.00,14.58,Fee Schedule,Medicare APC Fee Schedule
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,10,ML,28.58,17.14,Medicare,Medicare,,17.14,,,28.58,4.00,14.58,Fee Schedule,Medicare APC Fee Schedule
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,1,ML,18.28,10.96,Medicare,Medicare,,10.96,,,18.28,2.56,9.32,Fee Schedule,Medicare APC Fee Schedule
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,1,ML,18.28,10.96,Medicare,Medicare,,10.96,,,18.28,2.56,9.32,Fee Schedule,Medicare APC Fee Schedule
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,, ,18.54,11.12,Medicare,Medicare,,11.12,,,18.54,2.60,9.46,Fee Schedule,Medicare APC Fee Schedule
DIAZEPAM 5MG INJ,J3360,HCPCS,,,,,both,2,ML,100.94,60.56,Medicare,Medicare,,60.56,,,100.94,14.13,51.48,Fee Schedule,Medicare APC Fee Schedule
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,1,EA,58.97,35.38,Medicare,Medicare,,35.38,,,58.97,8.26,30.07,Fee Schedule,Medicare APC Fee Schedule
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,1,EA,58.97,35.38,Medicare,Medicare,,35.38,,,58.97,8.26,30.07,Fee Schedule,Medicare APC Fee Schedule
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,, ,62.32,37.39,Medicare,Medicare,,37.39,,,62.32,8.72,31.78,Fee Schedule,Medicare APC Fee Schedule
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,300,ML,60.00,36.00,Medicare,Medicare,,36.00,,,60.00,8.40,30.6,Fee Schedule,Medicare APC Fee Schedule
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,350,ML,68.00,40.80,Medicare,Medicare,,40.80,,,68.00,9.52,34.68,Fee Schedule,Medicare APC Fee Schedule
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,250,ML,75.00,45.00,Medicare,Medicare,,45.00,,,75.00,10.50,38.25,Fee Schedule,Medicare APC Fee Schedule
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,150,ML,95.00,57.00,Medicare,Medicare,,57.00,,,95.00,13.30,48.45,Fee Schedule,Medicare APC Fee Schedule
VEDOLIZUMAB 1MG INJ,J3380,HCPCS,,,,,both,1,EA,96.31,57.78,Medicare,Medicare,,57.78,,,96.31,13.48,49.12,Fee Schedule,Medicare APC Fee Schedule
HYDROXYZI UP TO 25MG,J3410,HCPCS,,,,,both,, ,13.91,8.34,Medicare,Medicare,,8.34,,,13.91,1.95,7.09,Fee Schedule,Medicare APC Fee Schedule
THIAMINE 100MG INJ,J3411,HCPCS,,,,,both,2,ML,44.03,26.41,Medicare,Medicare,,26.41,,,44.03,6.16,22.46,Fee Schedule,Medicare APC Fee Schedule
PYRIDOXINE 100MG INJ,J3415,HCPCS,,,,,both,1,ML,79.31,47.58,Medicare,Medicare,,47.58,,,79.31,11.10,40.45,Fee Schedule,Medicare APC Fee Schedule
VIT B12 CYAN 1000MCG,J3420,HCPCS,,,,,both,1,ML,84.72,50.83,Medicare,Medicare,,50.83,,,84.72,11.86,43.21,Fee Schedule,Medicare APC Fee Schedule
PHYTONADIONE 1MG INJ,J3430,HCPCS,,,,,both,0.5,ML,27.81,16.68,Medicare,Medicare,,16.68,,,27.81,3.89,14.18,Fee Schedule,Medicare APC Fee Schedule
PHYTONADIONE 1MG INJ,J3430,HCPCS,,,,,both,1,ML,31.93,19.15,Medicare,Medicare,,19.15,,,31.93,4.47,16.28,Fee Schedule,Medicare APC Fee Schedule
HYALURONID RECOM 1UN,J3473,HCPCS,,,,,both,1,ML,3.19,1.91,Medicare,Medicare,,1.91,,,3.19,0.45,1.63,Fee Schedule,Medicare APC Fee Schedule
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,500,ML,1.13,0.67,Medicare,Medicare,,0.67,,,1.13,0.16,0.58,Fee Schedule,Medicare APC Fee Schedule
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,20,ML,2.99,1.79,Medicare,Medicare,,1.79,,,2.99,0.42,1.52,Fee Schedule,Medicare APC Fee Schedule
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,2,ML,12.88,7.72,Medicare,Medicare,,7.72,,,12.88,1.80,6.57,Fee Schedule,Medicare APC Fee Schedule
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,, ,13.91,8.34,Medicare,Medicare,,8.34,,,13.91,1.95,7.09,Fee Schedule,Medicare APC Fee Schedule
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,50,ML,14.94,8.96,Medicare,Medicare,,8.96,,,14.94,2.09,7.62,Fee Schedule,Medicare APC Fee Schedule
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,20,ML,1.03,0.61,Medicare,Medicare,,0.61,,,1.03,0.14,0.53,Fee Schedule,Medicare APC Fee Schedule
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,20,ML,1.03,0.61,Medicare,Medicare,,0.61,,,1.03,0.14,0.53,Fee Schedule,Medicare APC Fee Schedule
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,, ,2.68,1.60,Medicare,Medicare,,1.60,,,2.68,0.38,1.37,Fee Schedule,Medicare APC Fee Schedule
ZIDOVUDINE 10MG INJ,J3485,HCPCS,,,,,both,, ,12.36,7.41,Medicare,Medicare,,7.41,,,12.36,1.73,6.3,Fee Schedule,Medicare APC Fee Schedule
ZIPRSIDNE MESYL 10MG,J3486,HCPCS,,,,,both,1,EA,77.77,46.66,Medicare,Medicare,,46.66,,,77.77,10.89,39.66,Fee Schedule,Medicare APC Fee Schedule
ZOLEDRONIC ACID 1MG,J3489,HCPCS,,,,,both,100,ML,332.69,199.61,Medicare,Medicare,,199.61,,,332.69,46.58,169.67,Fee Schedule,Medicare APC Fee Schedule
ZOLEDRONIC ACID 1MG,J3489,HCPCS,,,,,both,5,ML,1005.80,603.48,Medicare,Medicare,,603.48,,,1005.80,140.81,512.96,Fee Schedule,Medicare APC Fee Schedule
BRIVARACETAM 50MG TB,J3490,HCPCS,,,,,both,60,EA,172.75,103.65,Medicare,Medicare,,103.65,,,172.75,24.19,88.1,Fee Schedule,Medicare APC Fee Schedule
NORM SALIN 1000ML IV,J7030,HCPCS,,,,,both,1000,ML,25.75,15.45,Medicare,Medicare,,15.45,,,25.75,3.61,13.13,Fee Schedule,Medicare APC Fee Schedule
NORM SAL STER500MLIV,J7040,HCPCS,,,,,both,500,ML,25.75,15.45,Medicare,Medicare,,15.45,,,25.75,3.61,13.13,Fee Schedule,Medicare APC Fee Schedule
D5W/SOD CHL.9% 500ML,J7042,HCPCS,,,,,both,1000,ML,12.88,7.72,Medicare,Medicare,,7.72,,,12.88,1.80,6.57,Fee Schedule,Medicare APC Fee Schedule
NORM SALINE 250ML IV,J7050,HCPCS,,,,,both,250,ML,26.78,16.06,Medicare,Medicare,,16.06,,,26.78,3.75,13.66,Fee Schedule,Medicare APC Fee Schedule
SOD CHLOR .9% 100ML,J7050,HCPCS,,,,,both,100,ML,25.75,15.45,Medicare,Medicare,,15.45,,,25.75,3.61,13.13,Fee Schedule,Medicare APC Fee Schedule
SOD CHLOR .9% 100ML,J7050,HCPCS,,,,,both,100,ML,68.50,41.10,Medicare,Medicare,,41.10,,,68.50,9.59,34.94,Fee Schedule,Medicare APC Fee Schedule
SOD CHLOR .9% 150ML,J7050,HCPCS,,,,,both,150,ML,25.75,15.45,Medicare,Medicare,,15.45,,,25.75,3.61,13.13,Fee Schedule,Medicare APC Fee Schedule
SOD CHLOR .9% 50ML,J7050,HCPCS,,,,,both,50,ML,25.75,15.45,Medicare,Medicare,,15.45,,,25.75,3.61,13.13,Fee Schedule,Medicare APC Fee Schedule
SOD CHLOR .9% 50ML,J7050,HCPCS,,,,,both,50,ML,41.72,25.03,Medicare,Medicare,,25.03,,,41.72,5.84,21.28,Fee Schedule,Medicare APC Fee Schedule
DEX 5%/WATER 500ML,J7060,HCPCS,,,,,both,, ,24.72,14.83,Medicare,Medicare,,14.83,,,24.72,3.46,12.61,Fee Schedule,Medicare APC Fee Schedule
DEX 5%/WATER 500ML,J7060,HCPCS,,,,,both,500,ML,25.75,15.45,Medicare,Medicare,,15.45,,,25.75,3.61,13.13,Fee Schedule,Medicare APC Fee Schedule
DEX 5%/WATER 1000ML,J7070,HCPCS,,,,,both,1000,ML,25.75,15.45,Medicare,Medicare,,15.45,,,25.75,3.61,13.13,Fee Schedule,Medicare APC Fee Schedule
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,1000,ML,24.72,14.83,Medicare,Medicare,,14.83,,,24.72,3.46,12.61,Fee Schedule,Medicare APC Fee Schedule
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,500,ML,25.75,15.45,Medicare,Medicare,,15.45,,,25.75,3.61,13.13,Fee Schedule,Medicare APC Fee Schedule
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,, ,28.84,17.30,Medicare,Medicare,,17.30,,,28.84,4.04,14.71,Fee Schedule,Medicare APC Fee Schedule
D5LR UP TO 1000ML,J7121,HCPCS,,,,,both,1000,ML,25.75,15.45,Medicare,Medicare,,15.45,,,25.75,3.61,13.13,Fee Schedule,Medicare APC Fee Schedule
PROTHROMB COM 1UN IX,J7168,HCPCS,,,,,both,1,EA,12.25,7.35,Medicare,Medicare,,7.35,,,12.25,1.72,6.25,Fee Schedule,Medicare APC Fee Schedule
PROTHROMB COM 1UN IX,J7168,CPT,,,,,both,1,EA,12.62,7.57,Medicare,Medicare,,7.57,,,12.62,1.77,6.44,Fee Schedule,Medicare APC Fee Schedule
MOMETA SIN IMP 10MCG,J7402,HCPCS,,,,,both,, ,54.59,32.75,Medicare,Medicare,,32.75,,,54.59,7.64,27.84,Fee Schedule,Medicare APC Fee Schedule
AZATHIOPRINE 50MG TB,J7500,HCPCS,,,,,both,100,EA,20.34,12.20,Medicare,Medicare,,12.20,,,20.34,2.85,10.37,Fee Schedule,Medicare APC Fee Schedule
CYCLOSPORNE 100MG PO,J7502,HCPCS,,,,,both,, ,41.20,24.72,Medicare,Medicare,,24.72,,,41.20,5.77,21.01,Fee Schedule,Medicare APC Fee Schedule
TACROLIMUS 1MG PO,J7507,HCPCS,,,,,both,100,EA,27.30,16.38,Medicare,Medicare,,16.38,,,27.30,3.82,13.92,Fee Schedule,Medicare APC Fee Schedule
METHYLPREDNIS 4MG PO,J7509,HCPCS,,,,,both,, ,8.55,5.13,Medicare,Medicare,,5.13,,,8.55,1.20,4.36,Fee Schedule,Medicare APC Fee Schedule
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.10,0.06,Medicare,Medicare,,0.06,,,0.10,0.01,0.05,Fee Schedule,Medicare APC Fee Schedule
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.31,0.18,Medicare,Medicare,,0.18,,,0.31,0.04,0.16,Fee Schedule,Medicare APC Fee Schedule
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.72,0.43,Medicare,Medicare,,0.43,,,0.72,0.10,0.37,Fee Schedule,Medicare APC Fee Schedule
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,1.34,0.80,Medicare,Medicare,,0.80,,,1.34,0.19,0.68,Fee Schedule,Medicare APC Fee Schedule
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,, ,7.00,4.20,Medicare,Medicare,,4.20,,,7.00,0.98,3.57,Fee Schedule,Medicare APC Fee Schedule
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,, ,107.38,64.42,Medicare,Medicare,,64.42,,,107.38,15.03,54.76,Fee Schedule,Medicare APC Fee Schedule
CYCLOSPORINE 25MG PO,J7515,HCPCS,,,,,both,, ,19.31,11.58,Medicare,Medicare,,11.58,,,19.31,2.70,9.85,Fee Schedule,Medicare APC Fee Schedule
CYCLOSPOR PAREN250MG,J7516,HCPCS,,,,,both,, ,191.84,115.10,Medicare,Medicare,,115.10,,,191.84,26.86,97.84,Fee Schedule,Medicare APC Fee Schedule
MYCOPHE MOF 250MG PO,J7517,HCPCS,,,,,both,100,EA,41.46,24.87,Medicare,Medicare,,24.87,,,41.46,5.80,21.14,Fee Schedule,Medicare APC Fee Schedule
METHACHOL 1MGINH NEB,J7674,HCPCS,,,,,both,1,EA,4.84,2.90,Medicare,Medicare,,2.90,,,4.84,0.68,2.47,Fee Schedule,Medicare APC Fee Schedule
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,, ,13.39,8.03,Medicare,Medicare,,8.03,,,13.39,1.87,6.83,Fee Schedule,Medicare APC Fee Schedule
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,, ,49.18,29.50,Medicare,Medicare,,29.50,,,49.18,6.89,25.08,Fee Schedule,Medicare APC Fee Schedule
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,100,EA,53.56,32.13,Medicare,Medicare,,32.13,,,53.56,7.50,27.32,Fee Schedule,Medicare APC Fee Schedule
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,, ,0.52,0.31,Medicare,Medicare,,0.31,,,0.52,0.07,0.27,Fee Schedule,Medicare APC Fee Schedule
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,100,EA,1.34,0.80,Medicare,Medicare,,0.80,,,1.34,0.19,0.68,Fee Schedule,Medicare APC Fee Schedule
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,, ,3.50,2.10,Medicare,Medicare,,2.10,,,3.50,0.49,1.79,Fee Schedule,Medicare APC Fee Schedule
METHOTREXATE 2.5MGPO,J8610,HCPCS,,,,,both,100,EA,20.34,12.20,Medicare,Medicare,,12.20,,,20.34,2.85,10.37,Fee Schedule,Medicare APC Fee Schedule
LEUCOVOR CAL 25MG TB,J8999,HCPCS,,,,,both,20,EA,78.54,47.12,Medicare,Medicare,,47.12,,,78.54,11.00,40.06,Fee Schedule,Medicare APC Fee Schedule
BENDAMUSTINE 1MG INJ,J9033,HCPCS,,,,,both,, ,147.81,88.68,Medicare,Medicare,,88.68,,,147.81,20.69,75.38,Fee Schedule,Medicare APC Fee Schedule
BENDAMUSTINE 1MG INJ,J9033,HCPCS,,,,,both,, ,147.81,88.68,Medicare,Medicare,,88.68,,,147.81,20.69,75.38,Fee Schedule,Medicare APC Fee Schedule
BORTEZOMIB .1MG INJ,J9041,HCPCS,,,,,both,, ,265.74,159.44,Medicare,Medicare,,159.44,,,265.74,37.20,135.53,Fee Schedule,Medicare APC Fee Schedule
CARBOPLATIN 50MG INJ,J9045,HCPCS,,,,,both,45,ML,61.03,36.61,Medicare,Medicare,,36.61,,,61.03,8.54,31.13,Fee Schedule,Medicare APC Fee Schedule
CISPLAT POW/SOL 10MG,J9060,HCPCS,,,,,both,50,ML,5.36,3.21,Medicare,Medicare,,3.21,,,5.36,0.75,2.73,Fee Schedule,Medicare APC Fee Schedule
DOCETAXEL 1MG INJ,J9171,HCPCS,,,,,both,, ,87.81,52.68,Medicare,Medicare,,52.68,,,87.81,12.29,44.78,Fee Schedule,Medicare APC Fee Schedule
FLUOROURACIL 500MG,J9190,HCPCS,,,,,both,, ,25.75,15.45,Medicare,Medicare,,15.45,,,25.75,3.61,13.13,Fee Schedule,Medicare APC Fee Schedule
GEMCITABIN 200MG INJ,J9201,HCPCS,,,,,both,1,EA,616.97,370.18,Medicare,Medicare,,370.18,,,616.97,86.38,314.65,Fee Schedule,Medicare APC Fee Schedule
GEMCITABIN 200MG INJ,J9201,HCPCS,,,,,both,, ,690.87,414.52,Medicare,Medicare,,414.52,,,690.87,96.72,352.34,Fee Schedule,Medicare APC Fee Schedule
IPILIMUMAB 1MG INJ,J9228,HCPCS,,,,,both,40,ML,777.65,466.59,Medicare,Medicare,,466.59,,,777.65,108.87,396.6,Fee Schedule,Medicare APC Fee Schedule
OXALIPLATIN .5MG INJ,J9263,HCPCS,,,,,both,10,ML,6.39,3.83,Medicare,Medicare,,3.83,,,6.39,0.89,3.26,Fee Schedule,Medicare APC Fee Schedule
PACLITAXEL 1MG INJ,J9267,HCPCS,,,,,both,, ,3.71,2.22,Medicare,Medicare,,2.22,,,3.71,0.52,1.89,Fee Schedule,Medicare APC Fee Schedule
PERTUZUMAB 1MG INJ,J9306,HCPCS,,,,,both,14,ML,61.03,36.61,Medicare,Medicare,,36.61,,,61.03,8.54,31.13,Fee Schedule,Medicare APC Fee Schedule
TRASTUZUMAB 10MG INJ,J9355,HCPCS,,,,,both,, ,531.22,318.73,Medicare,Medicare,,318.73,,,531.22,74.37,270.92,Fee Schedule,Medicare APC Fee Schedule
POST OP SHOES,L3260,HCPCS,,,,,both,, ,12.00,7.20,Medicare,Medicare,,7.20,,,12.00,1.68,6.12,Fee Schedule,Medicare APC Fee Schedule
ADM IV INF CASI IMDV,M0243,HCPCS,,,,,both,, ,851.55,510.93,Medicare,Medicare,,510.93,,,851.55,119.22,434.29,Fee Schedule,Medicare APC Fee Schedule
ADM IV INF CASI IMDV,M0243,HCPCS,,,,,both,, ,1340.29,804.17,Medicare,Medicare,,804.17,,,1340.29,187.64,683.55,Fee Schedule,Medicare APC Fee Schedule
ADM IV INF BAM ETES,M0245,HCPCS,,,,,both,, ,1301.25,780.75,Medicare,Medicare,,780.75,,,1301.25,182.18,663.64,Fee Schedule,Medicare APC Fee Schedule
ADM IV INF SOTROVIM,M0247,HCPCS,,,,,both,, ,1301.25,780.75,Medicare,Medicare,,780.75,,,1301.25,182.18,663.64,Fee Schedule,Medicare APC Fee Schedule
"PAP SMEAR, SCREEN",P3000,HCPCS,,,,,both,, ,101.60,60.96,Medicare,Medicare,,60.96,,,101.60,14.22,51.82,Fee Schedule,Medicare APC Fee Schedule
S-H CRYO EACH UNIT,P9012,HCPCS,,,,,both,, ,283.48,170.08,Medicare,Medicare,,170.08,,,283.48,39.69,144.57,Fee Schedule,Medicare APC Fee Schedule
S-H RBC LEUKO REDU,P9016,HCPCS,,,,,both,, ,884.69,530.81,Medicare,Medicare,,530.81,,,884.69,123.86,451.19,Fee Schedule,Medicare APC Fee Schedule
S-H 1 DONOR FFP,P9017,HCPCS,,,,,both,, ,638.53,383.11,Medicare,Medicare,,383.11,,,638.53,89.39,325.65,Fee Schedule,Medicare APC Fee Schedule
S-H RED BLD-UNIT,P9021,HCPCS,,,,,both,, ,737.05,442.23,Medicare,Medicare,,442.23,,,737.05,103.19,375.9,Fee Schedule,Medicare APC Fee Schedule
S-H PLAT PHERE L-R,P9035,HCPCS,,,,,both,, ,2646.20,1587.72,Medicare,Medicare,,1587.72,,,2646.20,370.47,1349.56,Fee Schedule,Medicare APC Fee Schedule
S-H PLAT A-P L-R IRR,P9037,HCPCS,,,,,both,, ,2796.36,1677.81,Medicare,Medicare,,1677.81,,,2796.36,391.49,1426.14,Fee Schedule,Medicare APC Fee Schedule
S-H RBC IRRAD,P9038,HCPCS,,,,,both,, ,1013.80,608.28,Medicare,Medicare,,608.28,,,1013.80,141.93,517.04,Fee Schedule,Medicare APC Fee Schedule
S-H RBC L-R IRRAD,P9040,HCPCS,,,,,both,, ,1025.03,615.01,Medicare,Medicare,,615.01,,,1025.03,143.50,522.77,Fee Schedule,Medicare APC Fee Schedule
S-H CRYOPRE REDU PLS,P9044,HCPCS,,,,,both,, ,614.12,368.47,Medicare,Medicare,,368.47,,,614.12,85.98,313.2,Fee Schedule,Medicare APC Fee Schedule
ALBUMIN 5% 250ML IV,P9045,HCPCS,,,,,both,250,ML,528.13,316.87,Medicare,Medicare,,316.87,,,528.13,73.94,269.35,Fee Schedule,Medicare APC Fee Schedule
ALBUMIN 25% 50ML IV,P9047,HCPCS,,,,,both,100,ML,408.14,244.88,Medicare,Medicare,,244.88,,,408.14,57.14,208.15,Fee Schedule,Medicare APC Fee Schedule
ALBUMIN 25% 50ML IV,P9047,HCPCS,,,,,both,50,ML,623.92,374.35,Medicare,Medicare,,374.35,,,623.92,87.35,318.2,Fee Schedule,Medicare APC Fee Schedule
S-H BLD L-R CMV- EA,P9051,HCPCS,,,,,both,, ,1025.03,615.01,Medicare,Medicare,,615.01,,,1025.03,143.50,522.77,Fee Schedule,Medicare APC Fee Schedule
S-H FFP BTWN8-24HREA,P9059,HCPCS,,,,,both,, ,634.60,380.76,Medicare,Medicare,,380.76,,,634.60,88.84,323.65,Fee Schedule,Medicare APC Fee Schedule
FERUMOXYTOL1MG NESRD,Q0138,HCPCS,,,,,both,17,ML,9.68,5.80,Medicare,Medicare,,5.80,,,9.68,1.36,4.94,Fee Schedule,Medicare APC Fee Schedule
CHLORPROMAZIN 5MG PO,Q0161,HCPCS,,,,,both,1,EA,4.12,2.47,Medicare,Medicare,,2.47,,,4.12,0.58,2.1,Fee Schedule,Medicare APC Fee Schedule
CHLORPROMAZIN 5MG PO,Q0161,HCPCS,,,,,both,, ,7.52,4.51,Medicare,Medicare,,4.51,,,7.52,1.05,3.84,Fee Schedule,Medicare APC Fee Schedule
ONDANSETRON 1MG PO,Q0162,HCPCS,,,,,both,, ,33.73,20.23,Medicare,Medicare,,20.23,,,33.73,4.72,17.2,Fee Schedule,Medicare APC Fee Schedule
ONDANSETRON 1MG PO,Q0162,HCPCS,,,,,both,50,ML,34.25,20.55,Medicare,Medicare,,20.55,,,34.25,4.80,17.47,Fee Schedule,Medicare APC Fee Schedule
TELEHEALTH IP NEURO,Q3014,HCPCS,,,,,both,, ,83.25,49.95,Medicare,Medicare,,49.95,,,83.25,11.66,42.46,Fee Schedule,Medicare APC Fee Schedule
TOTAL CONTACT CAST 3 INCH,Q4038,HCPCS,,,,,both,, ,456.00,273.60,Medicare,Medicare,,273.60,,,456.00,63.84,232.56,Fee Schedule,Medicare APC Fee Schedule
TOTAL CONTACT CAST 4 INCH,Q4038,HCPCS,,,,,both,, ,469.68,281.80,Medicare,Medicare,,281.80,,,469.68,65.76,239.54,Fee Schedule,Medicare APC Fee Schedule
TOTAL CONTACT CAST BOOT LARGE,Q4038,HCPCS,,,,,both,, ,307.80,184.68,Medicare,Medicare,,184.68,,,307.80,43.09,156.98,Fee Schedule,Medicare APC Fee Schedule
TOTAL CONTACT CAST BOOT X-LARGE,Q4038,HCPCS,,,,,both,, ,323.00,193.80,Medicare,Medicare,,193.80,,,323.00,45.22,164.73,Fee Schedule,Medicare APC Fee Schedule
OASIS WOUND MAT SQCM,Q4102,HCPCS,,,,,both,, ,10.82,6.49,Medicare,Medicare,,6.49,,,10.82,1.51,5.52,Fee Schedule,Medicare APC Fee Schedule
INTEGRA BMWD SQ CM,Q4104,HCPCS,,,,,both,, ,599.72,359.83,Medicare,Medicare,,359.83,,,599.72,83.96,305.86,Fee Schedule,Medicare APC Fee Schedule
INTEGRA SKIN SUB 5X5CM,Q4108,HCPCS,,,,,both,, ,4404.00,2642.40,Medicare,Medicare,,2642.40,,,4404.00,616.56,2246.04,Fee Schedule,Medicare APC Fee Schedule
DERMACELL SQ CM,Q4122,HCPCS,,,,,both,, ,166.86,100.11,Medicare,Medicare,,100.11,,,166.86,23.36,85.1,Fee Schedule,Medicare APC Fee Schedule
OASIS ULTRA TRI SQCM,Q4124,HCPCS,,,,,both,, ,31.93,19.15,Medicare,Medicare,,19.15,,,31.93,4.47,16.28,Fee Schedule,Medicare APC Fee Schedule
ACELL DERM MAT 1SQCM,Q4126,HCPCS,,,,,both,, ,133.90,80.34,Medicare,Medicare,,80.34,,,133.90,18.75,68.29,Fee Schedule,Medicare APC Fee Schedule
1AMNIOEXCEL SKIN 1.5X1.5CM,Q4137,HCPCS,,,,,both,, ,2544.00,1526.40,Medicare,Medicare,,1526.40,,,2544.00,356.16,1297.44,Fee Schedule,Medicare APC Fee Schedule
AMNIOEXCEL SKIN 2X3CM,Q4137,HCPCS,,,,,both,, ,3469.00,2081.40,Medicare,Medicare,,2081.40,,,3469.00,485.66,1769.19,Fee Schedule,Medicare APC Fee Schedule
AMNIOEXCEL SKIN 3.5X3.5CM,Q4137,HCPCS,,,,,both,, ,3745.00,2247.00,Medicare,Medicare,,2247.00,,,3745.00,524.30,1909.95,Fee Schedule,Medicare APC Fee Schedule
AMNIOEXCEL SKIN 4X4CM,Q4137,HCPCS,,,,,both,, ,3928.00,2356.80,Medicare,Medicare,,2356.80,,,3928.00,549.92,2003.28,Fee Schedule,Medicare APC Fee Schedule
ALLOWRAP DS/DRY SQCM,Q4150,HCPCS,,,,,both,, ,347.63,208.57,Medicare,Medicare,,208.57,,,347.63,48.67,177.29,Fee Schedule,Medicare APC Fee Schedule
ALLOWRAP DS/DRY SQCM,Q4150,HCPCS,,,,,both,, ,506.25,303.75,Medicare,Medicare,,303.75,,,506.25,70.88,258.19,Fee Schedule,Medicare APC Fee Schedule
HELICOLL (PER SQ CM),Q4164,HCPCS,,,,,both,, ,6211.00,3726.60,Medicare,Medicare,,3726.60,,,6211.00,869.54,3167.61,Fee Schedule,Medicare APC Fee Schedule
EPIFIX SQ CM,Q4186,HCPCS,,,,,both,, ,570.11,342.06,Medicare,Medicare,,342.06,,,570.11,79.82,290.76,Fee Schedule,Medicare APC Fee Schedule
MEMBRANE GRAFT/WRAP (PER SQ CM),Q4205,HCPCS,,,,,both,, ,5236.00,3141.60,Medicare,Medicare,,3141.60,,,5236.00,733.04,2670.36,Fee Schedule,Medicare APC Fee Schedule
DERM-MAXX (PER SQ CM),Q4238,HCPCS,,,,,both,, ,3534.00,2120.40,Medicare,Medicare,,2120.40,,,3534.00,494.76,1802.34,Fee Schedule,Medicare APC Fee Schedule
AMNIO-MAX (PER SQ CM),Q4239,HCPCS,,,,,both,, ,9540.00,5724.00,Medicare,Medicare,,5724.00,,,9540.00,1335.60,4865.4,Fee Schedule,Medicare APC Fee Schedule
INFLIXIMAB-DYYB 10MG,Q5103,HCPCS,,,,,both,1,EA,545.13,327.07,Medicare,Medicare,,327.07,,,545.13,76.32,278.02,Fee Schedule,Medicare APC Fee Schedule
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,1,ML,70.81,42.48,Medicare,Medicare,,42.48,,,70.81,9.91,36.11,Fee Schedule,Medicare APC Fee Schedule
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,1,ML,93.22,55.93,Medicare,Medicare,,55.93,,,93.22,13.05,47.54,Fee Schedule,Medicare APC Fee Schedule
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,, ,93.22,55.93,Medicare,Medicare,,55.93,,,93.22,13.05,47.54,Fee Schedule,Medicare APC Fee Schedule
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,, ,93.22,55.93,Medicare,Medicare,,55.93,,,93.22,13.05,47.54,Fee Schedule,Medicare APC Fee Schedule
INJ PERFLUTRN LIP ML,Q9957,HCPCS,,,,,both,, ,1184.50,710.70,Medicare,Medicare,,710.70,,,1184.50,165.83,604.1,Fee Schedule,Medicare APC Fee Schedule
HOCM2 250-299MGML ML,Q9961,HCPCS,,,,,both,, ,1.65,0.99,Medicare,Medicare,,0.99,,,1.65,0.23,0.84,Fee Schedule,Medicare APC Fee Schedule
HOCM 350 MG ML 30ML,Q9963,HCPCS,,,,,both,30,ML,49.50,29.70,Medicare,Medicare,,29.70,,,49.50,6.93,25.25,Fee Schedule,Medicare APC Fee Schedule
HOCM 350-399MGML IOD,Q9963,HCPCS,,,,,both,, ,1.65,0.99,Medicare,Medicare,,0.99,,,1.65,0.23,0.84,Fee Schedule,Medicare APC Fee Schedule
LOC2 200-299MG/ML ML,Q9966,HCPCS,,,,,both,, ,27.81,16.68,Medicare,Medicare,,16.68,,,27.81,3.89,14.18,Fee Schedule,Medicare APC Fee Schedule
LOCM 200-299MG/ML ML,Q9966,HCPCS,,,,,both,, ,36.82,22.09,Medicare,Medicare,,22.09,,,36.82,5.15,18.78,Fee Schedule,Medicare APC Fee Schedule
LOCM 200-299MG/ML ML,Q9966,HCPCS,,,,,both,, ,36.82,22.09,Medicare,Medicare,,22.09,,,36.82,5.15,18.78,Fee Schedule,Medicare APC Fee Schedule
LOCM 240MG 100ML,Q9966,HCPCS,,,,,both,100,ML,6.00,3.60,Medicare,Medicare,,3.60,,,6.00,0.84,3.06,Fee Schedule,Medicare APC Fee Schedule
LOCM 240MG 50ML,Q9966,HCPCS,,,,,both,50,ML,6.00,3.60,Medicare,Medicare,,3.60,,,6.00,0.84,3.06,Fee Schedule,Medicare APC Fee Schedule
LOCM 270MG 150ML,Q9966,HCPCS,,,,,both,150,ML,6.00,3.60,Medicare,Medicare,,3.60,,,6.00,0.84,3.06,Fee Schedule,Medicare APC Fee Schedule
LOCM200MG/ML 41% 200,Q9966,HCPCS,,,,,both,200,ML,4.00,2.40,Medicare,Medicare,,2.40,,,4.00,0.56,2.04,Fee Schedule,Medicare APC Fee Schedule
LOC2 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,11.07,6.64,Medicare,Medicare,,6.64,,,11.07,1.55,5.65,Fee Schedule,Medicare APC Fee Schedule
LOC2 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,11.07,6.64,Medicare,Medicare,,6.64,,,11.07,1.55,5.65,Fee Schedule,Medicare APC Fee Schedule
LOC2 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,11.07,6.64,Medicare,Medicare,,6.64,,,11.07,1.55,5.65,Fee Schedule,Medicare APC Fee Schedule
LOC2 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,11.07,6.64,Medicare,Medicare,,6.64,,,11.07,1.55,5.65,Fee Schedule,Medicare APC Fee Schedule
LOC2 300-399MG/ML ML,Q9967,HCPCS,,,,,both,150,ML,1337.97,802.78,Medicare,Medicare,,802.78,,,1337.97,187.32,682.36,Fee Schedule,Medicare APC Fee Schedule
LOCM 300-399MG/ML ML,Q9967,HCPCS,,,,,both,50,ML,12.62,7.57,Medicare,Medicare,,7.57,,,12.62,1.77,6.44,Fee Schedule,Medicare APC Fee Schedule
LOCM 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,1178.84,707.30,Medicare,Medicare,,707.30,,,1178.84,165.04,601.21,Fee Schedule,Medicare APC Fee Schedule
LOCM300MG/ML 61% 100,Q9967,HCPCS,,,,,both,, ,0.60,0.36,Medicare,Medicare,,0.36,,,0.60,0.08,0.31,Fee Schedule,Medicare APC Fee Schedule
LOCM300MG/ML 61% 100,Q9967,HCPCS,,,,,both,, ,0.60,0.36,Medicare,Medicare,,0.36,,,0.60,0.08,0.31,Fee Schedule,Medicare APC Fee Schedule
LOCM300MG/ML 61% 30,Q9967,HCPCS,,,,,both,30,ML,7.40,4.44,Medicare,Medicare,,4.44,,,7.40,1.04,3.77,Fee Schedule,Medicare APC Fee Schedule
LOCM300MG/ML 61% 30,Q9967,HCPCS,,,,,both,30,ML,7.40,4.44,Medicare,Medicare,,4.44,,,7.40,1.04,3.77,Fee Schedule,Medicare APC Fee Schedule
LOCM300MG/ML 61% 30,Q9967,HCPCS,,,,,both,30,ML,7.40,4.44,Medicare,Medicare,,4.44,,,7.40,1.04,3.77,Fee Schedule,Medicare APC Fee Schedule
LOCM300MG/ML 61% 30,Q9967,HCPCS,,,,,both,30,ML,7.40,4.44,Medicare,Medicare,,4.44,,,7.40,1.04,3.77,Fee Schedule,Medicare APC Fee Schedule
LOCM300MG/ML 76% 100,Q9967,HCPCS,,,,,both,, ,0.70,0.42,Medicare,Medicare,,0.42,,,0.70,0.10,0.36,Fee Schedule,Medicare APC Fee Schedule
LOCM300MG/ML 76% 100,Q9967,HCPCS,,,,,both,, ,0.70,0.42,Medicare,Medicare,,0.42,,,0.70,0.10,0.36,Fee Schedule,Medicare APC Fee Schedule
LOCM300MG/ML 76% 125,Q9967,HCPCS,,,,,both,125,ML,4.00,2.40,Medicare,Medicare,,2.40,,,4.00,0.56,2.04,Fee Schedule,Medicare APC Fee Schedule
LOCM300MG/ML M61% 15,Q9967,HCPCS,,,,,both,15,ML,60.50,36.30,Medicare,Medicare,,36.30,,,60.50,8.47,30.86,Fee Schedule,Medicare APC Fee Schedule
LOCM300MG/ML M61% 15,Q9967,HCPCS,,,,,both,15,ML,60.50,36.30,Medicare,Medicare,,36.30,,,60.50,8.47,30.86,Fee Schedule,Medicare APC Fee Schedule
LACTATION CONSULT,S9443,HCPCS,,,,,both,, ,115.88,69.52,Medicare,Medicare,,69.52,,,115.88,16.22,59.1,Fee Schedule,Medicare APC Fee Schedule
NI-CARD REHAB PH 3,S9472,HCPCS,,,,,both,, ,2.58,1.54,Medicare,Medicare,,1.54,,,2.58,0.36,1.32,Fee Schedule,Medicare APC Fee Schedule
NI-PULM REHAB PH 3,S9473,HCPCS,,,,,both,, ,2.58,1.54,Medicare,Medicare,,1.54,,,2.58,0.36,1.32,Fee Schedule,Medicare APC Fee Schedule
IOP PSYCH PER DIEM,S9480,HCPCS,,,,,both,, ,872.41,523.44,Medicare,Medicare,,523.44,,,872.41,122.14,444.93,Fee Schedule,Medicare APC Fee Schedule
CDC COVID19,U0001,HCPCS,,,,,both,, ,120.97,72.58,Medicare,Medicare,,72.58,,,120.97,16.94,61.69,Fee Schedule,Medicare APC Fee Schedule
STATE COVID19,U0002,HCPCS,,,,,both,, ,172.81,103.68,Medicare,Medicare,,103.68,,,172.81,24.19,88.13,Fee Schedule,Medicare APC Fee Schedule