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,6/25/2025,2.0.0,"Granite City, IL",4100 Madison Ave.345645765,6395,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
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,13886.51,13886.51,13886.51,Fee Schedule,29.8%. Base rate X weight
CT-CATH FLUID DRAIN,10030,CPT,,,,,both,, ,1071.33,642.79,Aetna,Commercial,,,,,1071.33,,,,
I&D ABSCS SMPL/SGL,10060,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
I&D ABSCS COMP/MULTI,10061,CPT,,,,,both,, ,1519.68,911.8,Aetna,Commercial,,,,,1519.68,,,,
INC & REM FB SQ SMPL,10120,CPT,,,,,both,, ,1519.68,911.8,Aetna,Commercial,,,,,1519.68,,,,
INC & REM FB SQ COMP,10121,CPT,,,,,both,, ,6179,3707.4,Aetna,Commercial,,,,,6179,,,,
I&D HEMATOMA/FLUID,10140,CPT,,,,,both,, ,6179,3707.4,Aetna,Commercial,,,,,6179,,,,
PNXR ASP ABS HEM CYT,10160,CPT,,,,,both,, ,1519.68,911.8,Aetna,Commercial,,,,,1519.68,,,,
I&D CPLX PO WND INF,10180,CPT,,,,,both,, ,10829.4,6497.64,Aetna,Commercial,,,,,10829.4,,,,
DEBR EXZ/INF SKN <10%,11000,CPT,,,,,both,, ,2393.6,1436.16,Aetna,Commercial,,,,,2393.6,,,,
DEBR EXZ/INF SKN E A,11001,CPT,,,,,both,, ,2393.6,1436.16,Aetna,Commercial,,,,,2393.6,,,,
DEB SKN BONE FX SITE,11012,CPT,,,,,both,, ,10829.4,6497.64,Aetna,Commercial,,,,,10829.4,,,,
DEB SUB TIS 20 SQ CM<,11042,CPT,,,,,both,, ,1519.68,911.8,Aetna,Commercial,,,,,1519.68,,,,
DEB MUSC/FSCA <20 SQ,11043,CPT,,,,,both,, ,2393.6,1436.16,Aetna,Commercial,,,,,2393.6,,,,
DEB BONE 20 SQ CM/<,11044,CPT,,,,,both,, ,6179,3707.4,Aetna,Commercial,,,,,6179,,,,
DEB SUB TISS EA ADDL,11045,CPT,,,,,both,, ,6179,3707.4,Aetna,Commercial,,,,,6179,,,,
DEB MUSC/FSCA EA ADL,11046,CPT,,,,,both,, ,6179,3707.4,Aetna,Commercial,,,,,6179,,,,
DEB BONE EA ADDL,11047,CPT,,,,,both,, ,6179,3707.4,Aetna,Commercial,,,,,6179,,,,
PARG/CUTG B9 SGL LES,11055,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
TRIM SKIN LESION 2-4,11056,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
TRIM SKIN LESIONS >4,11057,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
TNGNTL BX SKN SGL LES,11102,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
TNGNTL BX SKN EA ADD,11103,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
PUNCH BX SKN SGL LES,11104,CPT,,,,,both,, ,1519.68,911.8,Aetna,Commercial,,,,,1519.68,,,,
PUNCH BX SKN EA ADDL,11105,CPT,,,,,both,, ,1519.68,911.8,Aetna,Commercial,,,,,1519.68,,,,
INCIS BX SKN SGL LES,11106,CPT,,,,,both,, ,2393.6,1436.16,Aetna,Commercial,,,,,2393.6,,,,
INCAL BX SKN EA ADDL,11107,CPT,,,,,both,, ,2393.6,1436.16,Aetna,Commercial,,,,,2393.6,,,,
RMV SKN TAGS<=15 LES,11200,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
RMV SKN TAGS EA ADDL,11201,CPT,,,,,both,, ,233.12,139.87,Aetna,Commercial,,,,,233.12,,,,
DEBRIDEMENT NAIL 1-5,11720,CPT,,,,,both,, ,233.12,139.87,Aetna,Commercial,,,,,233.12,,,,
DEBRIDEMENT NAIL >6,11721,CPT,,,,,both,, ,233.12,139.87,Aetna,Commercial,,,,,233.12,,,,
RMV NAIL PLATE SGL,11730,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
RMV NAIL PLATE E ADD,11732,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
EVAC SU HEMATOMA,11740,CPT,,,,,both,, ,486.84,292.1,Aetna,Commercial,,,,,486.84,,,,
TT F/C/M/N/A/G/H/F,14040,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
TT F/C/M/N/A/G/H/F AD,14041,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
WND PR T/A/L 100SQCM,15002,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
WND PR ADL 100 SQCM,15003,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
WND PREP F/N/HF/G,15004,CPT,,,,,both,, ,2393.6,1436.16,Aetna,Commercial,,,,,2393.6,,,,
WND PREP F/N/HF/G ADL,15005,CPT,,,,,both,, ,2393.6,1436.16,Aetna,Commercial,,,,,2393.6,,,,
PINCH GRFT UP TO 2CM,15050,CPT,,,,,both,, ,2393.6,1436.16,Aetna,Commercial,,,,,2393.6,,,,
SKIN SPLT GRFT T/A/L,15100,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
SKN SPLT GRF T/A/L EA,15101,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
EPIDRM AUTOGRFT T/A/L,15110,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
EPIDR AUTGF T/A/L EA,15111,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
EPIDR AGRFT F/N/H/G,15115,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
EPI AGRFT F/N/HF/G ADL,15116,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
SKN SPLT AGRFT F/N/H/G,15120,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,,,,13673.04,,,,
SKN SPLT AGRF F/N/H/G ADD,15121,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,,,,13673.04,,,,
DERM AUTOGRAF T/A/L,15130,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
DERM AGRAF T/A/L ADL,15131,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
DERM AGRF F/N/H/G,15135,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,,,,13673.04,,,,
DERM AGRF F/N/H/G ADD,15136,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,,,,13673.04,,,,
CULT SKN GRF T/A/L,15150,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
CUL SKN GRF T/A/L A,15151,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
CUL SKN GRF T/A/L +%,15152,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
CUL SKN GRF F/N/H/G,15155,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,,,,13673.04,,,,
CUL SKN GRF F/N/H/G ADD,15156,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,,,,13673.04,,,,
CUL EPIDR GRF F/N/HFG +%,15157,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,,,,13673.04,,,,
FTH GRF TRNK 20SQ/<,15200,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
FTH GRF FR TRNK EA AD,15201,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
FTH GF S/A/L 20 SQ/<,15220,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
FTH GF S/A/L 20 SQ E A,15221,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
FTH GR F/C/C/M/N/AX/G/H/F,15240,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
FTH GR F/C/C/M/N/AX/G/H/F EA,15241,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
FTH GR FR N/E/E/L 20SQ/<,15260,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
FTH GR FR N/E/E/L E A,15261,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
SKN SUB GRAFT T/A/L,15271,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
SKN SUB GRFT ADDL,15272,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
SKN S GRFT >100SQ,15273,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,,,,13673.04,,,,
SKN S GR ADD 100SQ,15274,CPT,,,,,both,, ,13673.04,8203.82,Aetna,Commercial,,,,,13673.04,,,,
SKN S GR F/NK/HF/G 25SQCM,15275,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
SKN S GR F/N/HF/G ADL,15276,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
SKN S GR F/N/HF/G CH,15277,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
SKN S GR F/N/HF/G CH ADD,15278,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
INIT TX 1ST DEG BURN,16000,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
DRS DEB PTHICK BRN S,16020,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
DRS DEB PTHICK BRN M,16025,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
DRS DEB PTHICK BRN L,16030,CPT,,,,,both,, ,1519.68,911.8,Aetna,Commercial,,,,,1519.68,,,,
DESTRCT PREMAL LES,17000,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
DESTRCT PREMAL 2-14,17003,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
DESTRCT PREMAL 15+,17004,CPT,,,,,both,, ,1519.68,911.8,Aetna,Commercial,,,,,1519.68,,,,
DESTR CV LES <=10 SQ,17106,CPT,,,,,both,, ,1519.68,911.8,Aetna,Commercial,,,,,1519.68,,,,
DESTR CV LES 10-50 SQ,17107,CPT,,,,,both,, ,2393.6,1436.16,Aetna,Commercial,,,,,2393.6,,,,
DESTR CV LES > 50 SQ,17108,CPT,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
DESTRUCT B9 LES 1-14,17110,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
CHEM CAUT GRANL TISS,17250,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
UNLISTD PROCEDURE,17999,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
S-BRST DUCTOGRM INJ,19030,CPT,,,,,both,, ,289.43,173.65,Aetna,Commercial,,,,,289.43,,,,
BX OF BREAST OPEN,19101,CPT,,,,,both,, ,14527.16,8716.29,Aetna,Commercial,,,,,14527.16,,,,
EXPL P WND EXTREM,20103,CPT,,,,,both,, ,6179,3707.4,Aetna,Commercial,,,,,6179,,,,
NJ TENDON SHEATH/LIG,20550,CPT,,,,,both,, ,1128.8,677.28,Aetna,Commercial,,,,,1128.8,,,,
S-JOINT ASP-INJ SM,20600,CPT,,,,,both,, ,487.45,292.47,Aetna,Commercial,,,,,487.45,,,,
US-DRN INJ SMAL JT W,20604,CPT,,,,,both,, ,726.15,435.69,Aetna,Commercial,,,,,726.15,,,,
S-JOINT ASP-INJ IM,20605,CPT,,,,,both,, ,700.66,420.39,Aetna,Commercial,,,,,700.66,,,,
US-DRN INJ INTM JT W,20606,CPT,,,,,both,, ,1594.18,956.5,Aetna,Commercial,,,,,1594.18,,,,
US-DRN INJ MAJR JT W,20611,CPT,,,,,both,, ,726.15,435.69,Aetna,Commercial,,,,,726.15,,,,
S-INJ TMJ ARTHROGRAM,21116,CPT,,,,,both,, ,289.43,173.65,Aetna,Commercial,,,,,289.43,,,,
S-INJ SHOULDER ARTH,23350,CPT,,,,,both,, ,289.43,173.65,Aetna,Commercial,,,,,289.43,,,,
S-INJ ELBOW ARTHRO,24220,CPT,,,,,both,, ,289.43,173.65,Aetna,Commercial,,,,,289.43,,,,
S-INJ WRIST ARTHRO,25246,CPT,,,,,both,, ,289.43,173.65,Aetna,Commercial,,,,,289.43,,,,
S-INJ HIP ARTHRO,27093,CPT,,,,,both,, ,289.43,173.65,Aetna,Commercial,,,,,289.43,,,,
S-INJ KNEE ARTHRO,27369,CPT,,,,,both,, ,289.43,173.65,Aetna,Commercial,,,,,289.43,,,,
S-INJ ANKLE ARTHRO,27648,CPT,,,,,both,, ,289.43,173.65,Aetna,Commercial,,,,,289.43,,,,
EXPLORE FOOT JOINT,28022,CPT,,,,,both,, ,12336.12,7401.67,Aetna,Commercial,,,,,12336.12,,,,
AMPUT TOE & METATRSL,28810,CPT,,,,,both,, ,12336.12,7401.67,Aetna,Commercial,,,,,12336.12,,,,
AMPUTATE TOE,28820,CPT,,,,,both,, ,12336.12,7401.67,Aetna,Commercial,,,,,12336.12,,,,
SPLNT LNG ARM SH PTA,29105,CPT,,,,,both,, ,1281.32,768.79,Aetna,Commercial,,,,,1281.32,,,,
SPLNT LNG ARM SH PTA,29105,CPT,,,,,both,, ,1281.32,768.79,Aetna,Commercial,,,,,1281.32,,,,
SPLNT LNGARM SH COTA,29105,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
SPLNT LNGARM SH COTA,29105,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
SPLNT LNGARM SH COTA,29105,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
SPLNT LNGARM SH COTA,29105,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
SPLNT LNGARM SH COTA,29105,CPT,,,,,both,, ,1388.96,833.37,Aetna,Commercial,,,,,1388.96,,,,
SPLNT LNGARM SH COTA,29105,CPT,,,,,both,, ,1388.96,833.37,Aetna,Commercial,,,,,1388.96,,,,
SPLNT LONG ARM S-H,29105,CPT,,,,,both,, ,1196.17,717.7,Aetna,Commercial,,,,,1196.17,,,,
SPLNT LONG ARM S-H,29105,CPT,,,,,both,, ,1296.73,778.03,Aetna,Commercial,,,,,1296.73,,,,
SPLNT SHRT ARM STATC,29125,CPT,,,,,both,, ,909.8,545.88,Aetna,Commercial,,,,,909.8,,,,
SPLNT SHRT ARM STATC,29125,CPT,,,,,both,, ,986.3,591.78,Aetna,Commercial,,,,,986.3,,,,
SPLT SHRT ARM ST PTA,29125,CPT,,,,,both,, ,974.64,584.78,Aetna,Commercial,,,,,974.64,,,,
SPLT SHRT ARM ST PTA,29125,CPT,,,,,both,, ,974.64,584.78,Aetna,Commercial,,,,,974.64,,,,
SPLT SHRTARM ST COTA,29125,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,,,,270.12,,,,
SPLT SHRTARM ST COTA,29125,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,,,,270.12,,,,
SPLT SHRTARM ST COTA,29125,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,,,,270.12,,,,
SPLT SHRTARM ST COTA,29125,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,,,,270.12,,,,
SPLT SHRTARM ST COTA,29125,CPT,,,,,both,, ,1056.52,633.91,Aetna,Commercial,,,,,1056.52,,,,
SPLT SHRTARM ST COTA,29125,CPT,,,,,both,, ,1056.52,633.91,Aetna,Commercial,,,,,1056.52,,,,
SPLN SHRT ARM DY PTA,29126,CPT,,,,,both,, ,1486.29,891.77,Aetna,Commercial,,,,,1486.29,,,,
SPLN SHRT ARM DY PTA,29126,CPT,,,,,both,, ,1486.29,891.77,Aetna,Commercial,,,,,1486.29,,,,
SPLNT SHRT ARM DYNAM,29126,CPT,,,,,both,, ,1387.43,832.45,Aetna,Commercial,,,,,1387.43,,,,
SPLNT SHRT ARM DYNAM,29126,CPT,,,,,both,, ,1504.12,902.47,Aetna,Commercial,,,,,1504.12,,,,
SPLT SHRTARM DY COTA,29126,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,,,,270.12,,,,
SPLT SHRTARM DY COTA,29126,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,,,,270.12,,,,
SPLT SHRTARM DY COTA,29126,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,,,,270.12,,,,
SPLT SHRTARM DY COTA,29126,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,,,,270.12,,,,
SPLT SHRTARM DY COTA,29126,CPT,,,,,both,, ,1611.18,966.7,Aetna,Commercial,,,,,1611.18,,,,
SPLT SHRTARM DY COTA,29126,CPT,,,,,both,, ,1611.18,966.7,Aetna,Commercial,,,,,1611.18,,,,
SPLNT FINGER STATIC,29130,CPT,,,,,both,, ,299.22,179.53,Aetna,Commercial,,,,,299.22,,,,
SPLNT FINGER STATIC,29130,CPT,,,,,both,, ,324.42,194.65,Aetna,Commercial,,,,,324.42,,,,
SPLNT FNGR STAT COTA,29130,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,,,,141.88,,,,
SPLNT FNGR STAT COTA,29130,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,,,,141.88,,,,
SPLNT FNGR STAT COTA,29130,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,,,,141.88,,,,
SPLNT FNGR STAT COTA,29130,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,,,,141.88,,,,
SPLNT FNGR STAT COTA,29130,CPT,,,,,both,, ,347.63,208.57,Aetna,Commercial,,,,,347.63,,,,
SPLNT FNGR STAT COTA,29130,CPT,,,,,both,, ,347.63,208.57,Aetna,Commercial,,,,,347.63,,,,
SPLNT FNGR STATC PTA,29130,CPT,,,,,both,, ,320.59,192.35,Aetna,Commercial,,,,,320.59,,,,
SPLNT FNGR STATC PTA,29130,CPT,,,,,both,, ,320.59,192.35,Aetna,Commercial,,,,,320.59,,,,
SPLNT FINGER DYNAM,29131,CPT,,,,,both,, ,453.68,272.2,Aetna,Commercial,,,,,453.68,,,,
SPLNT FINGER DYNAM,29131,CPT,,,,,both,, ,491.82,295.09,Aetna,Commercial,,,,,491.82,,,,
SPLNT FINGR DYNA PTA,29131,CPT,,,,,both,, ,485.9,291.54,Aetna,Commercial,,,,,485.9,,,,
SPLNT FINGR DYNA PTA,29131,CPT,,,,,both,, ,485.9,291.54,Aetna,Commercial,,,,,485.9,,,,
SPLNT FNGR DYNA COTA,29131,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,,,,141.88,,,,
SPLNT FNGR DYNA COTA,29131,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,,,,141.88,,,,
SPLNT FNGR DYNA COTA,29131,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,,,,141.88,,,,
SPLNT FNGR DYNA COTA,29131,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,,,,141.88,,,,
SPLNT FNGR DYNA COTA,29131,CPT,,,,,both,, ,526.85,316.11,Aetna,Commercial,,,,,526.85,,,,
SPLNT FNGR DYNA COTA,29131,CPT,,,,,both,, ,526.85,316.11,Aetna,Commercial,,,,,526.85,,,,
STRAPPING THORAX,29200,CPT,,,,,both,, ,377.17,226.3,Aetna,Commercial,,,,,377.17,,,,
STRAPPING THORAX PTA,29200,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,,,,404.02,,,,
STRAPPING THORAX PTA,29200,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,,,,404.02,,,,
STRAPPING THORX COTA,29200,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
STRAPPING THORX COTA,29200,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
STRAPPING THORX COTA,29200,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
STRAPPING THORX COTA,29200,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
STRAPPING SHOULD PTA,29240,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,,,,270.12,,,,
STRAPPING SHOULD PTA,29240,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,,,,270.12,,,,
STRAPPING SHOULD PTA,29240,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,,,,404.02,,,,
STRAPPING SHOULD PTA,29240,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,,,,404.02,,,,
STRAPPING SHOULDER,29240,CPT,,,,,both,, ,377.17,226.3,Aetna,Commercial,,,,,377.17,,,,
STRAPPING SHOULDER,29240,CPT,,,,,both,, ,408.86,245.31,Aetna,Commercial,,,,,408.86,,,,
STRAPPNG SHOULD COTA,29240,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,,,,81.37,,,,
STRAPPNG SHOULD COTA,29240,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,,,,81.37,,,,
STRAPPNG SHOULD COTA,29240,CPT,,,,,both,, ,438.01,262.8,Aetna,Commercial,,,,,438.01,,,,
STRAPPNG SHOULD COTA,29240,CPT,,,,,both,, ,438.01,262.8,Aetna,Commercial,,,,,438.01,,,,
STRAPPING ELBO-WRIST,29260,CPT,,,,,both,, ,377.17,226.3,Aetna,Commercial,,,,,377.17,,,,
STRAPPING ELBO-WRIST,29260,CPT,,,,,both,, ,408.86,245.31,Aetna,Commercial,,,,,408.86,,,,
STRPNG ELBO-WRST PTA,29260,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,,,,404.02,,,,
STRPNG ELBO-WRST PTA,29260,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,,,,404.02,,,,
STRPNG ELB-WRST COTA,29260,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,,,,81.37,,,,
STRPNG ELB-WRST COTA,29260,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,,,,81.37,,,,
STRPNG ELB-WRST COTA,29260,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,,,,81.37,,,,
STRPNG ELB-WRST COTA,29260,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,,,,81.37,,,,
STRPNG ELB-WRST COTA,29260,CPT,,,,,both,, ,438.01,262.8,Aetna,Commercial,,,,,438.01,,,,
STRPNG ELB-WRST COTA,29260,CPT,,,,,both,, ,438.01,262.8,Aetna,Commercial,,,,,438.01,,,,
STRAPPING HAND-FING,29280,CPT,,,,,both,, ,377.17,226.3,Aetna,Commercial,,,,,377.17,,,,
STRAPPING HAND-FING,29280,CPT,,,,,both,, ,408.86,245.31,Aetna,Commercial,,,,,408.86,,,,
STRPNG HND-FING COTA,29280,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,,,,81.37,,,,
STRPNG HND-FING COTA,29280,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,,,,81.37,,,,
STRPNG HND-FING COTA,29280,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,,,,81.37,,,,
STRPNG HND-FING COTA,29280,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,,,,81.37,,,,
STRPNG HND-FING COTA,29280,CPT,,,,,both,, ,438.01,262.8,Aetna,Commercial,,,,,438.01,,,,
STRPNG HND-FING COTA,29280,CPT,,,,,both,, ,438.01,262.8,Aetna,Commercial,,,,,438.01,,,,
STRPPNG HND-FING PTA,29280,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,,,,404.02,,,,
STRPPNG HND-FING PTA,29280,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,,,,404.02,,,,
APPLY RIGID LEG CAST,29445,CPT,,,,,both,, ,1023.52,614.11,Aetna,Commercial,,,,,1023.52,,,,
AP LNG LEG SPLNT PTA,29505,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
AP LNG LEG SPLNT PTA,29505,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
AP LNG LEG SPLNT PTA,29505,CPT,,,,,both,, ,1486.29,891.77,Aetna,Commercial,,,,,1486.29,,,,
AP LNG LEG SPLNT PTA,29505,CPT,,,,,both,, ,1486.29,891.77,Aetna,Commercial,,,,,1486.29,,,,
APP LNG LEG SPLINT,29505,CPT,,,,,both,, ,1387.43,832.45,Aetna,Commercial,,,,,1387.43,,,,
APPLY LNG LEG SPLNT,29505,CPT,,,,,both,, ,600.52,360.31,Aetna,Commercial,,,,,600.52,,,,
AP SHT LEG SPLNT PTA,29515,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
AP SHT LEG SPLNT PTA,29515,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
AP SHT LEG SPLNT PTA,29515,CPT,,,,,both,, ,974.64,584.78,Aetna,Commercial,,,,,974.64,,,,
AP SHT LEG SPLNT PTA,29515,CPT,,,,,both,, ,974.64,584.78,Aetna,Commercial,,,,,974.64,,,,
APP SHORT LEG SPLINT,29515,CPT,,,,,both,, ,909.8,545.88,Aetna,Commercial,,,,,909.8,,,,
APPLY SHRT LEG SPLNT,29515,CPT,,,,,both,, ,600.52,360.31,Aetna,Commercial,,,,,600.52,,,,
STRAPPING HIP,29520,CPT,,,,,both,, ,377.17,226.3,Aetna,Commercial,,,,,377.17,,,,
STRAPPING HIP PTA,29520,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,,,,141.88,,,,
STRAPPING HIP PTA,29520,CPT,,,,,both,, ,141.88,85.12,Aetna,Commercial,,,,,141.88,,,,
STRAPPING HIP PTA,29520,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,,,,404.02,,,,
STRAPPING HIP PTA,29520,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,,,,404.02,,,,
STRAPPING KNEE,29530,CPT,,,,,both,, ,377.17,226.3,Aetna,Commercial,,,,,377.17,,,,
STRAPPING KNEE PTA,29530,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,,,,270.12,,,,
STRAPPING KNEE PTA,29530,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,,,,270.12,,,,
STRAPPING KNEE PTA,29530,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,,,,404.02,,,,
STRAPPING KNEE PTA,29530,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,,,,404.02,,,,
STRAPPING ANKLE-FOOT,29540,CPT,,,,,both,, ,377.17,226.3,Aetna,Commercial,,,,,377.17,,,,
STRPPNG ANKLE-FT PTA,29540,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
STRPPNG ANKLE-FT PTA,29540,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
STRPPNG ANKLE-FT PTA,29540,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,,,,404.02,,,,
STRPPNG ANKLE-FT PTA,29540,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,,,,404.02,,,,
STRAPPING UNA BOOT,29580,CPT,,,,,both,, ,377.17,226.3,Aetna,Commercial,,,,,377.17,,,,
STRPPNG UNA BOOT PTA,29580,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
STRPPNG UNA BOOT PTA,29580,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
STRPPNG UNA BOOT PTA,29580,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,,,,404.02,,,,
STRPPNG UNA BOOT PTA,29580,CPT,,,,,both,, ,404.02,242.41,Aetna,Commercial,,,,,404.02,,,,
UNNA BOOT STRAPPING,29580,CPT,,,,,both,, ,600.52,360.31,Aetna,Commercial,,,,,600.52,,,,
UNNA WRAP,29580,CPT,,,,,both,, ,19.2,11.52,Aetna,Commercial,,,,,19.2,,,,
AP MULTLY COMP LR LEG,29581,CPT,,,,,both,, ,600.52,360.31,Aetna,Commercial,,,,,600.52,,,,
STRPPNG LOW BCK COTA,29799,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,,,,270.12,,,,
STRPPNG LOW BCK COTA,29799,CPT,,,,,both,, ,270.12,162.07,Aetna,Commercial,,,,,270.12,,,,
SUCTION PROC-NASOTRA,31720,CPT,,,,,both,, ,280.42,168.25,Aetna,Commercial,,,,,280.42,,,,
CT-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914,5948.4,Aetna,Commercial,,,,,9914,,,,
IR-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914,5948.4,Aetna,Commercial,,,,,9914,,,,
IR-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914,5948.4,Aetna,Commercial,,,,,9914,,,,
US-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,5184.63,3110.77,Aetna,Commercial,,,,,5184.63,,,,
CC-PERICARDIO W/IMG,33016,CPT,,,,,both,, ,3443.03,2065.81,Aetna,Commercial,,,,,3443.03,,,,
P-IMPLNT LOOP REC,33285,CPT,,,,,both,, ,27383.32,16429.99,Aetna,Commercial,,,,,27383.32,,,,
P-REMOV LOOP REC,33286,CPT,,,,,both,, ,5044.68,3026.8,Aetna,Commercial,,,,,5044.68,,,,
CC-IMP PRESS SEN ANG,33289,CPT,,,,,both,, ,11332.83,6799.69,Aetna,Commercial,,,,,11332.83,,,,
S-INTRO NDL CATH,36000,CPT,,,,,both,, ,168.75,101.25,Aetna,Commercial,,,,,168.75,,,,
S-INTRO NDL CATH VEI,36000,CPT,,,,,both,, ,173.81,104.28,Aetna,Commercial,,,,,173.81,,,,
S-INJ VENOGRAPHY,36005,CPT,,,,,both,, ,873.46,524.07,Aetna,Commercial,,,,,873.46,,,,
S-INTROCATH SEGPULM,36015,CPT,,,,,both,, ,839.21,503.52,Aetna,Commercial,,,,,839.21,,,,
S-CATH CAROTD VERT,36100,CPT,,,,,both,, ,1013.23,607.93,Aetna,Commercial,,,,,1013.23,,,,
S-CATH EXTREM ART,36140,CPT,,,,,both,, ,399.68,239.8,Aetna,Commercial,,,,,399.68,,,,
S-THORACIC 1ST ORDER,36215,CPT,,,,,both,, ,1839.26,1103.55,Aetna,Commercial,,,,,1839.26,,,,
IR-ANG EXT CRT NS,36221,CPT,,,,,both,, ,12592.76,7555.65,Aetna,Commercial,,,,,12592.76,,,,
IR-ANG CRT EXT CC BI,36222,CPT,,,,,both,, ,31881.02,19128.61,Aetna,Commercial,,,,,31881.02,,,,
IR-ANG CARTD IPS BI,36223,CPT,,,,,both,, ,45998.14,27598.88,Aetna,Commercial,,,,,45998.14,,,,
IR-ANG CARTD IPS UNI,36223,CPT,,,,,both,, ,31746.87,19048.12,Aetna,Commercial,,,,,31746.87,,,,
IR-ANG INT CAR IP BI,36224,CPT,,,,,both,, ,51895.68,31137.4,Aetna,Commercial,,,,,51895.68,,,,
IR-ANG INT CAR IP UN,36224,CPT,,,,,both,, ,32068.51,19241.1,Aetna,Commercial,,,,,32068.51,,,,
IR-ANG SUBCL IPS BI,36225,CPT,,,,,both,, ,24740.1,14844.06,Aetna,Commercial,,,,,24740.1,,,,
IR-ANG SUBCL IPS UNI,36225,CPT,,,,,both,, ,12369.34,7421.6,Aetna,Commercial,,,,,12369.34,,,,
CTH PLC EXT CD W-ANG,36227,CPT,,,,,both,, ,9411.59,5646.95,Aetna,Commercial,,,,,9411.59,,,,
CTH PLC EXT CD W-ANG,36227,CPT,,,,,both,, ,14117.39,8470.43,Aetna,Commercial,,,,,14117.39,,,,
S-ANG EXT CD IPS BI,36227,CPT,,,,,both,, ,8060.51,4836.3,Aetna,Commercial,,,,,8060.51,,,,
S-ANG EXT CD IPS BI,36227,CPT,,,,,both,, ,12090.77,7254.46,Aetna,Commercial,,,,,12090.77,,,,
S-ABDOMEN 1ST ORDER,36245,CPT,,,,,both,, ,1979.03,1187.41,Aetna,Commercial,,,,,1979.03,,,,
S-ABDOMEN 2ND ORDER,36246,CPT,,,,,both,, ,9539.09,5723.45,Aetna,Commercial,,,,,9539.09,,,,
S-ABDOMEN 3RD ORDER,36247,CPT,,,,,both,, ,16382.99,9829.79,Aetna,Commercial,,,,,16382.99,,,,
DNA SPECIMEN COLLECTION VENI,36415,CPT,,,,,both,, ,70,42,Aetna,Commercial,,,,,70,,,,
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,, ,8.19,4.91,Aetna,Commercial,,,,,8.19,,,,
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,,,90.37,90.37,Aetna,Commercial,,63.8,70.6,,90.37,90.37,90.37,Fee Schedule,70.6
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,, ,90.37,54.22,Aetna,Commercial,,,,,90.37,,,,
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,22.73,13.63,Aetna,Commercial,,,,,22.73,,,,
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,46.31,27.78,Aetna,Commercial,,,,,46.31,,,,
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,49.96,29.97,Aetna,Commercial,,,,,49.96,,,,
BLOOD TRANSF 0 2 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Aetna,Commercial,,,,,2260.55,,,,
BLOOD TRANSF 2 4 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Aetna,Commercial,,,,,2260.55,,,,
BLOOD TRANSF 4 6 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Aetna,Commercial,,,,,2260.55,,,,
BLOOD TRANSF 6 8 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Aetna,Commercial,,,,,2260.55,,,,
BLOOD TRANSF 8 10 HR,36430,CPT,,,,,both,, ,2260.55,1356.33,Aetna,Commercial,,,,,2260.55,,,,
BLOOD TRANSFUSION,36430,CPT,,,,,both,, ,3283.64,1970.18,Aetna,Commercial,,,,,3283.64,,,,
BLOOD TRANSFUSION,36430,CPT,,,,,both,, ,3579.17,2147.5,Aetna,Commercial,,,,,3579.17,,,,
BLOOD PUSH TRAN U2YR,36440,CPT,,,,,both,, ,3579.17,2147.5,Aetna,Commercial,,,,,3579.17,,,,
THER APHERESIS WBC,36511,CPT,,,,,both,, ,5560.46,3336.27,Aetna,Commercial,,,,,5560.46,,,,
THER APHERESI PLASMA,36514,CPT,,,,,both,, ,5560.46,3336.27,Aetna,Commercial,,,,,5560.46,,,,
CC-INS NT CVC GT 5YR,36556,CPT,,,,,both,, ,4017.52,2410.51,Aetna,Commercial,,,,,4017.52,,,,
IR-RMV TUN CVC WO SQ,36589,CPT,,,,,both,, ,2370.55,1422.33,Aetna,Commercial,,,,,2370.55,,,,
BLD COLLECT VAD,36591,CPT,,,,,both,, ,445.15,267.09,Aetna,Commercial,,,,,445.15,,,,
BLD DRAW CENTRAL LN,36592,CPT,,,,,both,, ,388.45,233.07,Aetna,Commercial,,,,,388.45,,,,
IR-INJ W FLUR CV DEV,36598,CPT,,,,,both,, ,467.11,280.26,Aetna,Commercial,,,,,467.11,,,,
ARTERIAL PUNCTURE,36600,CPT,,,,,both,, ,327.26,196.35,Aetna,Commercial,,,,,327.26,,,,
S-INS ENDO VENA CAVA,37191,CPT,,,,,both,, ,29440.27,17664.16,Aetna,Commercial,,,,,29440.27,,,,
S-REDO ENDO VENA CAV,37192,CPT,,,,,both,, ,20313.85,12188.31,Aetna,Commercial,,,,,20313.85,,,,
S-REM ENDO VENA CAVA,37193,CPT,,,,,both,, ,20313.85,12188.31,Aetna,Commercial,,,,,20313.85,,,,
S-THROMBOLYSIS CEREB,37195,CPT,,,,,both,, ,860.31,516.18,Aetna,Commercial,,,,,860.31,,,,
S-ID SENTINEL NODE,38792,CPT,,,,,both,, ,1582.72,949.63,Aetna,Commercial,,,,,1582.72,,,,
S-BX NDL LIVER,47000,CPT,,,,,both,, ,1102.87,661.72,Aetna,Commercial,,,,,1102.87,,,,
CT-PERC CHOLECYSTOST,47490,CPT,,,,,both,, ,10295.62,6177.37,Aetna,Commercial,,,,,10295.62,,,,
IR-ABD PARACEN W IMG,49083,CPT,,,,,both,, ,3767.78,2260.66,Aetna,Commercial,,,,,3767.78,,,,
IR-PERITONEAL LAVAGE,49084,CPT,,,,,both,, ,3767.78,2260.66,Aetna,Commercial,,,,,3767.78,,,,
LITHOTRIPSY,50590,CPT,,,,,both,, ,54374.73,32624.83,Aetna,Commercial,,,,,54374.73,,,,
S-URETEROGRM INJ,50684,CPT,,,,,both,, ,323.94,194.36,Aetna,Commercial,,,,,323.94,,,,
S-INJ ILEAL CONDUIT,50690,CPT,,,,,both,, ,323.94,194.36,Aetna,Commercial,,,,,323.94,,,,
S-CORPCAVERNOSGR INJ,54230,CPT,,,,,both,, ,425.39,255.23,Aetna,Commercial,,,,,425.39,,,,
S-INJ CATH HYSTERSO,58340,CPT,,,,,both,, ,336.52,201.91,Aetna,Commercial,,,,,336.52,,,,
FETAL CONTRACTION ST,59020,CPT,,,,,both,, ,2089.1,1253.46,Aetna,Commercial,,,,,2089.1,,,,
FETAL NON STRESS TES,59025,CPT,,,,,both,, ,1169.57,701.74,Aetna,Commercial,,,,,1169.57,,,,
EXTERNAL CEPHALIC VE,59412,CPT,,,,,both,, ,5047.77,3028.66,Aetna,Commercial,,,,,5047.77,,,,
S-THYROID CORE BX,60100,CPT,,,,,both,, ,630.36,378.21,Aetna,Commercial,,,,,630.36,,,,
S-SPINAL TAP DIAGNST,62270,CPT,,,,,both,, ,1417.54,850.52,Aetna,Commercial,,,,,1417.54,,,,
S-INJ EPI BLD PATCH,62273,CPT,,,,,both,, ,1368.1,820.86,Aetna,Commercial,,,,,1368.1,,,,
S-MYELOGRAM INJ,62284,CPT,,,,,both,, ,629.07,377.44,Aetna,Commercial,,,,,629.07,,,,
IR-MYELO CERVICAL,62302,CPT,,,,,both,, ,2078.67,1247.2,Aetna,Commercial,,,,,2078.67,,,,
IR-MYELO THORACIC,62303,CPT,,,,,both,, ,1934.41,1160.64,Aetna,Commercial,,,,,1934.41,,,,
IR-MYELO LUMBAR,62304,CPT,,,,,both,, ,1964.44,1178.66,Aetna,Commercial,,,,,1964.44,,,,
IR-MYELO COMPLETE,62305,CPT,,,,,both,, ,4013.09,2407.85,Aetna,Commercial,,,,,4013.09,,,,
Injection of substance into spinal canal of lower back or sacrum using imaging guidance,62323,CPT,,,,,both,,,2450.37,2450.37,Aetna,Commercial,,1729.96,70.6,,2450.37,2450.37,2450.37,Fee Schedule,70.6
IR-DI L-S INJ W IM,62323,CPT,,,,,both,, ,2450.37,1470.22,Aetna,Commercial,,,,,2450.37,,,,
IR-DI L-S INJ-IN WIM,62327,CPT,,,,,both,, ,2707.1,1624.26,Aetna,Commercial,,,,,2707.1,,,,
SPINAL TAP DIAG W-IM,62328,CPT,,,,,both,, ,1417.54,850.52,Aetna,Commercial,,,,,1417.54,,,,
IR-POSTERIOR FOSSA,70010,CPT,,,,,both,, ,2122.18,1273.3,Aetna,Commercial,,,,,2122.18,,,,
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,1239.46,743.67,Aetna,Commercial,,,,,1239.46,,,,
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,2479.48,1487.68,Aetna,Commercial,,,,,2479.48,,,,
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,,,883.84,883.84,Aetna,Commercial,,623.99,70.6,,883.84,883.84,883.84,Fee Schedule,70.6
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,883.84,530.3,Aetna,Commercial,,,,,883.84,,,,
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,,,,220.61,,,,
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,,,940.82,940.82,Aetna,Commercial,,664.22,70.6,,940.82,940.82,940.82,Fee Schedule,70.6
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,940.82,564.49,Aetna,Commercial,,,,,940.82,,,,
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,,,456.37,456.37,Aetna,Commercial,,322.2,70.6,,456.37,456.37,456.37,Fee Schedule,70.6
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,456.37,273.82,Aetna,Commercial,,,,,456.37,,,,
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,,,782.23,782.23,Aetna,Commercial,,552.25,70.6,,782.23,782.23,782.23,Fee Schedule,70.6
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,782.23,469.33,Aetna,Commercial,,,,,782.23,,,,
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,,,,220.61,,,,
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,,,1128.31,1128.31,Aetna,Commercial,,796.59,70.6,,1128.31,1128.31,1128.31,Fee Schedule,70.6
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,1128.31,676.98,Aetna,Commercial,,,,,1128.31,,,,
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-NASAL BONES CR,70160,CPT,,,,,both,,,782.23,782.23,Aetna,Commercial,,552.25,70.6,,782.23,782.23,782.23,Fee Schedule,70.6
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,782.23,469.33,Aetna,Commercial,,,,,782.23,,,,
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-ORBITS 4V CR,70200,CPT,,,,,both,,,918.37,918.37,Aetna,Commercial,,648.37,70.6,,918.37,918.37,918.37,Fee Schedule,70.6
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,918.37,551.02,Aetna,Commercial,,,,,918.37,,,,
HE-SINUSES LTD CR,70210,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-SINUSES LTD CR,70210,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,,,936.33,936.33,Aetna,Commercial,,661.05,70.6,,936.33,936.33,936.33,Fee Schedule,70.6
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,936.33,561.79,Aetna,Commercial,,,,,936.33,,,,
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-SKULL LIMITED CR,70250,CPT,,,,,both,,,1151.89,1151.89,Aetna,Commercial,,813.23,70.6,,1151.89,1151.89,1151.89,Fee Schedule,70.6
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,1151.89,691.13,Aetna,Commercial,,,,,1151.89,,,,
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,,,,220.61,,,,
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,,,1381.48,1381.48,Aetna,Commercial,,975.32,70.6,,1381.48,1381.48,1381.48,Fee Schedule,70.6
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,1381.48,828.88,Aetna,Commercial,,,,,1381.48,,,,
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,,,538.05,538.05,Aetna,Commercial,,379.86,70.6,,538.05,538.05,538.05,Fee Schedule,70.6
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,538.05,322.83,Aetna,Commercial,,,,,538.05,,,,
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,,,342.7,342.7,Aetna,Commercial,,241.95,70.6,,342.7,342.7,342.7,Fee Schedule,70.6
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,342.7,205.62,Aetna,Commercial,,,,,342.7,,,,
IR-ARTHGRM TMJ BI CR,70332,CPT,,,,,both,, ,2353.18,1411.9,Aetna,Commercial,,,,,2353.18,,,,
IR-ARTHROGRAM TMJ CR,70332,CPT,,,,,both,, ,1176.59,705.95,Aetna,Commercial,,,,,1176.59,,,,
HE-ORTHOPANTOGRAM CR,70355,CPT,,,,,both,, ,692.14,415.28,Aetna,Commercial,,,,,692.14,,,,
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,,,757.53,757.53,Aetna,Commercial,,534.82,70.6,,757.53,757.53,757.53,Fee Schedule,70.6
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,757.53,454.51,Aetna,Commercial,,,,,757.53,,,,
FL-PHX SP EV W CINE,70371,CPT,,,,,both,, ,808.06,484.83,Aetna,Commercial,,,,,808.06,,,,
IR-SIALOGRAM,70390,CPT,,,,,both,, ,1800.52,1080.31,Aetna,Commercial,,,,,1800.52,,,,
"CT scan, head or brain, without contrast",70450,CPT,,,,,both,,,1576.55,1576.55,Aetna,Commercial,,1113.04,70.6,,1576.55,1576.55,1576.55,Fee Schedule,70.6
CT-HEAD WO,70450,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,,,,307.05,,,,
CT-HEAD WO,70450,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,,,,330.63,,,,
CT-HEAD WO,70450,CPT,,,,,both,, ,1576.55,945.93,Aetna,Commercial,,,,,1576.55,,,,
CT-HEAD W,70460,CPT,,,,,both,,,1765.72,1765.72,Aetna,Commercial,,1246.6,70.6,,1765.72,1765.72,1765.72,Fee Schedule,70.6
CT-HEAD W,70460,CPT,,,,,both,, ,1765.72,1059.43,Aetna,Commercial,,,,,1765.72,,,,
CT-HEAD WWO,70470,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,,,,680.91,,,,
CT-HEAD WWO,70470,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,,,,732.83,,,,
CT-HEAD WWO,70470,CPT,,,,,both,,,3726.8,3726.8,Aetna,Commercial,,2631.12,70.6,,3726.8,3726.8,3726.8,Fee Schedule,70.6
CT-HEAD WWO,70470,CPT,,,,,both,, ,3726.8,2236.08,Aetna,Commercial,,,,,3726.8,,,,
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,,,,307.05,,,,
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,,,,330.63,,,,
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,2847.17,1708.3,Aetna,Commercial,,,,,2847.17,,,,
CT-ORBIT EAR W,70481,CPT,,,,,both,, ,556.01,333.6,Aetna,Commercial,,,,,556.01,,,,
CT-ORBIT EAR W,70481,CPT,,,,,both,, ,1643.07,985.84,Aetna,Commercial,,,,,1643.07,,,,
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,,,,680.91,,,,
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,,,,732.83,,,,
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,4001.3,2400.78,Aetna,Commercial,,,,,4001.3,,,,
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,,,,307.05,,,,
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,,,,330.63,,,,
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,,,2847.17,2847.17,Aetna,Commercial,,2010.1,70.6,,2847.17,2847.17,2847.17,Fee Schedule,70.6
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,2847.17,1708.3,Aetna,Commercial,,,,,2847.17,,,,
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,,,,604.85,,,,
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,,,,650.88,,,,
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,,,3178.64,3178.64,Aetna,Commercial,,2244.12,70.6,,3178.64,3178.64,3178.64,Fee Schedule,70.6
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,3178.64,1907.18,Aetna,Commercial,,,,,3178.64,,,,
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,,,,680.91,,,,
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,,,,732.83,,,,
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,,,3726.8,3726.8,Aetna,Commercial,,2631.12,70.6,,3726.8,3726.8,3726.8,Fee Schedule,70.6
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,3726.8,2236.08,Aetna,Commercial,,,,,3726.8,,,,
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,,,,307.05,,,,
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,,,,330.63,,,,
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,,,2737.98,2737.98,Aetna,Commercial,,1933.01,70.6,,2737.98,2737.98,2737.98,Fee Schedule,70.6
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,2737.98,1642.78,Aetna,Commercial,,,,,2737.98,,,,
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,,,,604.85,,,,
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,,,,650.88,,,,
CT-NECK SOFT TIS W,70491,CPT,,,,,both,,,2743.59,2743.59,Aetna,Commercial,,1936.97,70.6,,2743.59,2743.59,2743.59,Fee Schedule,70.6
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,2743.59,1646.15,Aetna,Commercial,,,,,2743.59,,,,
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,,,,680.91,,,,
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,,,,732.83,,,,
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,,,4317.62,4317.62,Aetna,Commercial,,3048.24,70.6,,4317.62,4317.62,4317.62,Fee Schedule,70.6
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,4317.62,2590.57,Aetna,Commercial,,,,,4317.62,,,,
CTA-HEAD,70496,CPT,,,,,both,, ,893.1,535.86,Aetna,Commercial,,,,,893.1,,,,
CTA-HEAD,70496,CPT,,,,,both,,,2355.42,2355.42,Aetna,Commercial,,1662.93,70.6,,2355.42,2355.42,2355.42,Fee Schedule,70.6
CTA-HEAD,70496,CPT,,,,,both,, ,2355.42,1413.25,Aetna,Commercial,,,,,2355.42,,,,
CTA-NECK,70498,CPT,,,,,both,, ,893.1,535.86,Aetna,Commercial,,,,,893.1,,,,
CTA-NECK,70498,CPT,,,,,both,,,2355.42,2355.42,Aetna,Commercial,,1662.93,70.6,,2355.42,2355.42,2355.42,Fee Schedule,70.6
CTA-NECK,70498,CPT,,,,,both,, ,2355.42,1413.25,Aetna,Commercial,,,,,2355.42,,,,
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,,,,715.99,,,,
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,,,,770.45,,,,
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,4042.84,2425.7,Aetna,Commercial,,,,,4042.84,,,,
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,,,,1035.69,,,,
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,,,,1114.55,,,,
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,4293.48,2576.08,Aetna,Commercial,,,,,4293.48,,,,
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,,,,1197.08,,,,
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,,,,1288.29,,,,
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,5197.81,3118.68,Aetna,Commercial,,,,,5197.81,,,,
MRA-HEAD WO,70544,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,,,,715.99,,,,
MRA-HEAD WO,70544,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,,,,770.45,,,,
MRA-HEAD WO,70544,CPT,,,,,both,, ,1631.56,978.93,Aetna,Commercial,,,,,1631.56,,,,
MRA-HEAD W,70545,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,,,,1035.69,,,,
MRA-HEAD W,70545,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,,,,1114.55,,,,
MRA-HEAD W,70545,CPT,,,,,both,, ,1938.34,1163,Aetna,Commercial,,,,,1938.34,,,,
MRA-HEAD WWO,70546,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,,,,1197.08,,,,
MRA-HEAD WWO,70546,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,,,,1288.29,,,,
MRA-HEAD WWO,70546,CPT,,,,,both,, ,2669.78,1601.86,Aetna,Commercial,,,,,2669.78,,,,
MRA-NECK WO,70547,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,,,,715.99,,,,
MRA-NECK WO,70547,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,,,,770.45,,,,
MRA-NECK WO,70547,CPT,,,,,both,, ,1334.89,800.93,Aetna,Commercial,,,,,1334.89,,,,
MRA-NECK W,70548,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,,,,1035.69,,,,
MRA-NECK W,70548,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,,,,1114.55,,,,
MRA-NECK W,70548,CPT,,,,,both,, ,1938.34,1163,Aetna,Commercial,,,,,1938.34,,,,
MRA-NECK WWO,70549,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,,,,1197.08,,,,
MRA-NECK WWO,70549,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,,,,1288.29,,,,
MRA-NECK WWO,70549,CPT,,,,,both,, ,3263.12,1957.87,Aetna,Commercial,,,,,3263.12,,,,
MR-BRAIN WO,70551,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,,,,715.99,,,,
MR-BRAIN WO,70551,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,,,,770.45,,,,
MR-BRAIN WO,70551,CPT,,,,,both,,,4941.28,4941.28,Aetna,Commercial,,3488.54,70.6,,4941.28,4941.28,4941.28,Fee Schedule,70.6
MR-BRAIN WO,70551,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,,,,4941.28,,,,
MR-BRAIN W,70552,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,,,,1035.69,,,,
MR-BRAIN W,70552,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,,,,1114.55,,,,
MR-BRAIN W,70552,CPT,,,,,both,,,2352.06,2352.06,Aetna,Commercial,,1660.55,70.6,,2352.06,2352.06,2352.06,Fee Schedule,70.6
MR-BRAIN W,70552,CPT,,,,,both,, ,2352.06,1411.23,Aetna,Commercial,,,,,2352.06,,,,
MR-BRAIN WWO,70553,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,,,,1197.08,,,,
MR-BRAIN WWO,70553,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,,,,1288.29,,,,
MR-BRAIN WWO,70553,CPT,,,,,both,, ,6352.79,3811.67,Aetna,Commercial,,,,,6352.79,,,,
MRI scan of brain before and after contrast,70553,CPT,,,,,both,,,6352.79,6352.79,Aetna,Commercial,,4485.07,70.6,,6352.79,6352.79,6352.79,Fee Schedule,70.6
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-CHEST 1V CR,71045,CPT,,,,,both,,,495.95,495.95,Aetna,Commercial,,350.14,70.6,,495.95,495.95,495.95,Fee Schedule,70.6
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,495.95,297.57,Aetna,Commercial,,,,,495.95,,,,
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-CHEST 2V CR,71046,CPT,,,,,both,,,750.52,750.52,Aetna,Commercial,,529.87,70.6,,750.52,750.52,750.52,Fee Schedule,70.6
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,750.52,450.31,Aetna,Commercial,,,,,750.52,,,,
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Aetna,Commercial,,,,,143.98,,,,
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Aetna,Commercial,,,,,143.98,,,,
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Aetna,Commercial,,,,,143.98,,,,
CH-CHEST 3V CR,71047,CPT,,,,,both,,,1091.82,1091.82,Aetna,Commercial,,770.82,70.6,,1091.82,1091.82,1091.82,Fee Schedule,70.6
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,1091.82,655.09,Aetna,Commercial,,,,,1091.82,,,,
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,143.98,86.38,Aetna,Commercial,,,,,143.98,,,,
CH-CHEST 4V CR,71048,CPT,,,,,both,,,1652.05,1652.05,Aetna,Commercial,,1166.35,70.6,,1652.05,1652.05,1652.05,Fee Schedule,70.6
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,1652.05,991.23,Aetna,Commercial,,,,,1652.05,,,,
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-RIBS UNILAT CR,71100,CPT,,,,,both,,,876.83,876.83,Aetna,Commercial,,619.04,70.6,,876.83,876.83,876.83,Fee Schedule,70.6
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,876.83,526.09,Aetna,Commercial,,,,,876.83,,,,
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,,,,220.61,,,,
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,260.74,156.44,Aetna,Commercial,,,,,260.74,,,,
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,260.74,156.44,Aetna,Commercial,,,,,260.74,,,,
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,,,1152.17,1152.17,Aetna,Commercial,,813.43,70.6,,1152.17,1152.17,1152.17,Fee Schedule,70.6
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,1152.17,691.3,Aetna,Commercial,,,,,1152.17,,,,
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,,,,220.61,,,,
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,,,1381.48,1381.48,Aetna,Commercial,,975.32,70.6,,1381.48,1381.48,1381.48,Fee Schedule,70.6
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,1381.48,828.88,Aetna,Commercial,,,,,1381.48,,,,
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,,,,220.61,,,,
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,260.74,156.44,Aetna,Commercial,,,,,260.74,,,,
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,260.74,156.44,Aetna,Commercial,,,,,260.74,,,,
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,,,1877.99,1877.99,Aetna,Commercial,,1325.86,70.6,,1877.99,1877.99,1877.99,Fee Schedule,70.6
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,1877.99,1126.79,Aetna,Commercial,,,,,1877.99,,,,
CH-STERNUM CR,71120,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-STERNUM CR,71120,CPT,,,,,both,,,947.27,947.27,Aetna,Commercial,,668.77,70.6,,947.27,947.27,947.27,Fee Schedule,70.6
CH-STERNUM CR,71120,CPT,,,,,both,, ,947.27,568.36,Aetna,Commercial,,,,,947.27,,,,
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,,,989.38,989.38,Aetna,Commercial,,698.5,70.6,,989.38,989.38,989.38,Fee Schedule,70.6
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,989.38,593.62,Aetna,Commercial,,,,,989.38,,,,
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,,,,307.05,,,,
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,,,,330.63,,,,
CT-CHEST DIAG WO,71250,CPT,,,,,both,,,3833.18,3833.18,Aetna,Commercial,,2706.23,70.6,,3833.18,3833.18,3833.18,Fee Schedule,70.6
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,3833.18,2299.9,Aetna,Commercial,,,,,3833.18,,,,
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,,,,604.85,,,,
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,,,,650.88,,,,
CT-CHEST DIAG W,71260,CPT,,,,,both,,,4107.96,4107.96,Aetna,Commercial,,2900.22,70.6,,4107.96,4107.96,4107.96,Fee Schedule,70.6
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,4107.96,2464.77,Aetna,Commercial,,,,,4107.96,,,,
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,,,,680.91,,,,
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,,,,732.83,,,,
CT-CHEST DIAG WWO,71270,CPT,,,,,both,,,3833.18,3833.18,Aetna,Commercial,,2706.23,70.6,,3833.18,3833.18,3833.18,Fee Schedule,70.6
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,3833.18,2299.9,Aetna,Commercial,,,,,3833.18,,,,
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,, ,273.09,163.85,Aetna,Commercial,,,,,273.09,,,,
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,, ,273.09,163.85,Aetna,Commercial,,,,,273.09,,,,
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,,,568.92,568.92,Aetna,Commercial,,401.66,70.6,,568.92,568.92,568.92,Fee Schedule,70.6
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,, ,568.92,341.35,Aetna,Commercial,,,,,568.92,,,,
CTA-CHEST,71275,CPT,,,,,both,, ,708.98,425.38,Aetna,Commercial,,,,,708.98,,,,
CTA-CHEST,71275,CPT,,,,,both,, ,763.15,457.89,Aetna,Commercial,,,,,763.15,,,,
CTA-CHEST,71275,CPT,,,,,both,,,2355.14,2355.14,Aetna,Commercial,,1662.73,70.6,,2355.14,2355.14,2355.14,Fee Schedule,70.6
CTA-CHEST,71275,CPT,,,,,both,, ,2355.14,1413.08,Aetna,Commercial,,,,,2355.14,,,,
MR-CHEST WO,71550,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,,,,715.99,,,,
MR-CHEST WO,71550,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,,,,770.45,,,,
MR-CHEST WO,71550,CPT,,,,,both,,,4042.84,4042.84,Aetna,Commercial,,2854.25,70.6,,4042.84,4042.84,4042.84,Fee Schedule,70.6
MR-CHEST WO,71550,CPT,,,,,both,, ,4042.84,2425.7,Aetna,Commercial,,,,,4042.84,,,,
MR-CHEST W,71551,CPT,,,,,both,,,4293.48,4293.48,Aetna,Commercial,,3031.2,70.6,,4293.48,4293.48,4293.48,Fee Schedule,70.6
MR-CHEST W,71551,CPT,,,,,both,, ,4293.48,2576.08,Aetna,Commercial,,,,,4293.48,,,,
MR-CHEST WWO,71552,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,,,,1197.08,,,,
MR-CHEST WWO,71552,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,,,,1288.29,,,,
MR-CHEST WWO,71552,CPT,,,,,both,,,5197.81,5197.81,Aetna,Commercial,,3669.65,70.6,,5197.81,5197.81,5197.81,Fee Schedule,70.6
MR-CHEST WWO,71552,CPT,,,,,both,, ,5197.81,3118.68,Aetna,Commercial,,,,,5197.81,,,,
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,,,261.02,261.02,Aetna,Commercial,,184.28,70.6,,261.02,261.02,261.02,Fee Schedule,70.6
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,261.02,156.61,Aetna,Commercial,,,,,261.02,,,,
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,,,1085.36,1085.36,Aetna,Commercial,,766.26,70.6,,1085.36,1085.36,1085.36,Fee Schedule,70.6
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,1085.36,651.21,Aetna,Commercial,,,,,1085.36,,,,
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,,,,220.61,,,,
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,1112.87,667.72,Aetna,Commercial,,,,,1112.87,,,,
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,,,,220.61,,,,
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,1471.29,882.77,Aetna,Commercial,,,,,1471.29,,,,
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,,,1181.64,1181.64,Aetna,Commercial,,834.24,70.6,,1181.64,1181.64,1181.64,Fee Schedule,70.6
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,1181.64,708.98,Aetna,Commercial,,,,,1181.64,,,,
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,,,,220.61,,,,
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,,,1444.63,1444.63,Aetna,Commercial,,1019.91,70.6,,1444.63,1444.63,1444.63,Fee Schedule,70.6
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,1444.63,866.77,Aetna,Commercial,,,,,1444.63,,,,
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,,,1444.63,1444.63,Aetna,Commercial,,1019.91,70.6,,1444.63,1444.63,1444.63,Fee Schedule,70.6
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,1444.63,866.77,Aetna,Commercial,,,,,1444.63,,,,
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,139.77,83.86,Aetna,Commercial,,,,,139.77,,,,
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,149.32,89.59,Aetna,Commercial,,,,,149.32,,,,
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,1181.91,709.14,Aetna,Commercial,,,,,1181.91,,,,
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,139.77,83.86,Aetna,Commercial,,,,,139.77,,,,
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,149.32,89.59,Aetna,Commercial,,,,,149.32,,,,
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,230.71,138.42,Aetna,Commercial,,,,,230.71,,,,
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,1181.91,709.14,Aetna,Commercial,,,,,1181.91,,,,
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,230.71,138.42,Aetna,Commercial,,,,,230.71,,,,
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,279.26,167.55,Aetna,Commercial,,,,,279.26,,,,
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,298.64,179.18,Aetna,Commercial,,,,,298.64,,,,
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,2363.84,1418.3,Aetna,Commercial,,,,,2363.84,,,,
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,279.26,167.55,Aetna,Commercial,,,,,279.26,,,,
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,298.64,179.18,Aetna,Commercial,,,,,298.64,,,,
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,2363.84,1418.3,Aetna,Commercial,,,,,2363.84,,,,
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,,,1504.42,1504.42,Aetna,Commercial,,1062.12,70.6,,1504.42,1504.42,1504.42,Fee Schedule,70.6
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,1504.42,902.65,Aetna,Commercial,,,,,1504.42,,,,
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,,,,220.61,,,,
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,1968.65,1181.19,Aetna,Commercial,,,,,1968.65,,,,
"X-Ray, lower back, minimum four views",72110,CPT,,,,,both,,,1968.65,1968.65,Aetna,Commercial,,1389.87,70.6,,1968.65,1968.65,1968.65,Fee Schedule,70.6
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,,,,220.61,,,,
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
SP-LS SPINE W BND CR,72114,CPT,,,,,both,,,2229.96,2229.96,Aetna,Commercial,,1574.35,70.6,,2229.96,2229.96,2229.96,Fee Schedule,70.6
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,2229.96,1337.97,Aetna,Commercial,,,,,2229.96,,,,
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,,,,220.61,,,,
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
SP-LS SPINE BND CR,72120,CPT,,,,,both,,,1765.44,1765.44,Aetna,Commercial,,1246.4,70.6,,1765.44,1765.44,1765.44,Fee Schedule,70.6
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,1765.44,1059.26,Aetna,Commercial,,,,,1765.44,,,,
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,,,,307.05,,,,
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,,,,330.63,,,,
CT-CERV SPINE WO,72125,CPT,,,,,both,,,3833.18,3833.18,Aetna,Commercial,,2706.23,70.6,,3833.18,3833.18,3833.18,Fee Schedule,70.6
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,3833.18,2299.9,Aetna,Commercial,,,,,3833.18,,,,
CT-CERV SPINE W,72126,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,,,,604.85,,,,
CT-CERV SPINE W,72126,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,,,,650.88,,,,
CT-CERV SPINE W,72126,CPT,,,,,both,,,6031.42,6031.42,Aetna,Commercial,,4258.18,70.6,,6031.42,6031.42,6031.42,Fee Schedule,70.6
CT-CERV SPINE W,72126,CPT,,,,,both,, ,6031.42,3618.85,Aetna,Commercial,,,,,6031.42,,,,
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,,,,680.91,,,,
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,,,,732.83,,,,
CT-CERV SPINE WWO,72127,CPT,,,,,both,,,6031.42,6031.42,Aetna,Commercial,,4258.18,70.6,,6031.42,6031.42,6031.42,Fee Schedule,70.6
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,6031.42,3618.85,Aetna,Commercial,,,,,6031.42,,,,
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,,,,307.05,,,,
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,,,,330.63,,,,
CT-THOR SPINE WO,72128,CPT,,,,,both,,,3833.18,3833.18,Aetna,Commercial,,2706.23,70.6,,3833.18,3833.18,3833.18,Fee Schedule,70.6
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,3833.18,2299.9,Aetna,Commercial,,,,,3833.18,,,,
CT-THOR SPINE W,72129,CPT,,,,,both,, ,534.96,320.97,Aetna,Commercial,,,,,534.96,,,,
CT-THOR SPINE W,72129,CPT,,,,,both,,,1786.22,1786.22,Aetna,Commercial,,1261.07,70.6,,1786.22,1786.22,1786.22,Fee Schedule,70.6
CT-THOR SPINE W,72129,CPT,,,,,both,, ,1786.22,1071.73,Aetna,Commercial,,,,,1786.22,,,,
CT-THOR SPINE WWO,72130,CPT,,,,,both,,,2407.63,2407.63,Aetna,Commercial,,1699.79,70.6,,2407.63,2407.63,2407.63,Fee Schedule,70.6
CT-THOR SPINE WWO,72130,CPT,,,,,both,, ,2407.63,1444.57,Aetna,Commercial,,,,,2407.63,,,,
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,,,,307.05,,,,
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,,,,330.63,,,,
CT-LUMB SPINE WO,72131,CPT,,,,,both,,,534.68,534.68,Aetna,Commercial,,377.48,70.6,,534.68,534.68,534.68,Fee Schedule,70.6
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,534.68,320.8,Aetna,Commercial,,,,,534.68,,,,
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,,,,604.85,,,,
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,,,,650.88,,,,
CT-LUMB SPINE W,72132,CPT,,,,,both,,,1653.45,1653.45,Aetna,Commercial,,1167.34,70.6,,1653.45,1653.45,1653.45,Fee Schedule,70.6
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,1653.45,992.07,Aetna,Commercial,,,,,1653.45,,,,
CT-LUMB SPINE WWO,72133,CPT,,,,,both,, ,446.27,267.76,Aetna,Commercial,,,,,446.27,,,,
CT-LUMB SPINE WWO,72133,CPT,,,,,both,,,1126.62,1126.62,Aetna,Commercial,,795.39,70.6,,1126.62,1126.62,1126.62,Fee Schedule,70.6
CT-LUMB SPINE WWO,72133,CPT,,,,,both,, ,1126.62,675.97,Aetna,Commercial,,,,,1126.62,,,,
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,,,,715.99,,,,
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,,,,770.45,,,,
MR-CERV SPINE WO,72141,CPT,,,,,both,,,4941.28,4941.28,Aetna,Commercial,,3488.54,70.6,,4941.28,4941.28,4941.28,Fee Schedule,70.6
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,,,,4941.28,,,,
MR-CERV SPINE W,72142,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,,,,1035.69,,,,
MR-CERV SPINE W,72142,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,,,,1114.55,,,,
MR-CERV SPINE W,72142,CPT,,,,,both,,,2352.06,2352.06,Aetna,Commercial,,1660.55,70.6,,2352.06,2352.06,2352.06,Fee Schedule,70.6
MR-CERV SPINE W,72142,CPT,,,,,both,, ,2352.06,1411.23,Aetna,Commercial,,,,,2352.06,,,,
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,,,,715.99,,,,
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,,,,770.45,,,,
MR-THOR SPINE WO,72146,CPT,,,,,both,,,4941.28,4941.28,Aetna,Commercial,,3488.54,70.6,,4941.28,4941.28,4941.28,Fee Schedule,70.6
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,,,,4941.28,,,,
MR-THOR SPINE W,72147,CPT,,,,,both,, ,1641.24,984.74,Aetna,Commercial,,,,,1641.24,,,,
MR-THOR SPINE W,72147,CPT,,,,,both,,,2351.49,2351.49,Aetna,Commercial,,1660.15,70.6,,2351.49,2351.49,2351.49,Fee Schedule,70.6
MR-THOR SPINE W,72147,CPT,,,,,both,, ,2351.49,1410.89,Aetna,Commercial,,,,,2351.49,,,,
MRI scan of lower spinal canal,72148,CPT,,,,,both,,,4941.28,4941.28,Aetna,Commercial,,3488.54,70.6,,4941.28,4941.28,4941.28,Fee Schedule,70.6
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,,,,715.99,,,,
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,,,,770.45,,,,
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,,,,4941.28,,,,
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,,,,1035.69,,,,
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,,,,1114.55,,,,
MR-LUMB SPINE W,72149,CPT,,,,,both,,,2352.06,2352.06,Aetna,Commercial,,1660.55,70.6,,2352.06,2352.06,2352.06,Fee Schedule,70.6
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,2352.06,1411.23,Aetna,Commercial,,,,,2352.06,,,,
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,,,,1197.08,,,,
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,,,,1288.29,,,,
MR-CERV SPINE WWO,72156,CPT,,,,,both,,,6352.79,6352.79,Aetna,Commercial,,4485.07,70.6,,6352.79,6352.79,6352.79,Fee Schedule,70.6
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,6352.79,3811.67,Aetna,Commercial,,,,,6352.79,,,,
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,,,,1197.08,,,,
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,,,,1288.29,,,,
MR-THOR SPINE WWO,72157,CPT,,,,,both,,,6352.79,6352.79,Aetna,Commercial,,4485.07,70.6,,6352.79,6352.79,6352.79,Fee Schedule,70.6
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,6352.79,3811.67,Aetna,Commercial,,,,,6352.79,,,,
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,,,,1197.08,,,,
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,,,,1288.29,,,,
MR-LUMB SPINE WWO,72158,CPT,,,,,both,,,6352.79,6352.79,Aetna,Commercial,,4485.07,70.6,,6352.79,6352.79,6352.79,Fee Schedule,70.6
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,6352.79,3811.67,Aetna,Commercial,,,,,6352.79,,,,
LE-PELVIS CR,72170,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-PELVIS CR,72170,CPT,,,,,both,,,936.33,936.33,Aetna,Commercial,,661.05,70.6,,936.33,936.33,936.33,Fee Schedule,70.6
LE-PELVIS CR,72170,CPT,,,,,both,, ,936.33,561.79,Aetna,Commercial,,,,,936.33,,,,
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,,,1774.99,1774.99,Aetna,Commercial,,1253.14,70.6,,1774.99,1774.99,1774.99,Fee Schedule,70.6
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,1774.99,1064.99,Aetna,Commercial,,,,,1774.99,,,,
CT-PELVIS WO,72192,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,,,,307.05,,,,
CT-PELVIS WO,72192,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,,,,330.63,,,,
CT-PELVIS WO,72192,CPT,,,,,both,,,3285.58,3285.58,Aetna,Commercial,,2319.62,70.6,,3285.58,3285.58,3285.58,Fee Schedule,70.6
CT-PELVIS WO,72192,CPT,,,,,both,, ,3285.58,1971.34,Aetna,Commercial,,,,,3285.58,,,,
"CT scan, pelvis, with contrast",72193,CPT,,,,,both,,,3726.8,3726.8,Aetna,Commercial,,2631.12,70.6,,3726.8,3726.8,3726.8,Fee Schedule,70.6
CT-PELVIS W,72193,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,,,,604.85,,,,
CT-PELVIS W,72193,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,,,,650.88,,,,
CT-PELVIS W,72193,CPT,,,,,both,, ,3726.8,2236.08,Aetna,Commercial,,,,,3726.8,,,,
CT-PELVIS WWO,72194,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,,,,680.91,,,,
CT-PELVIS WWO,72194,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,,,,732.83,,,,
CT-PELVIS WWO,72194,CPT,,,,,both,,,4047.33,4047.33,Aetna,Commercial,,2857.41,70.6,,4047.33,4047.33,4047.33,Fee Schedule,70.6
CT-PELVIS WWO,72194,CPT,,,,,both,, ,4047.33,2428.39,Aetna,Commercial,,,,,4047.33,,,,
MR-PELVIS WO,72195,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,,,,715.99,,,,
MR-PELVIS WO,72195,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,,,,770.45,,,,
MR-PELVIS WO,72195,CPT,,,,,both,,,4042.84,4042.84,Aetna,Commercial,,2854.25,70.6,,4042.84,4042.84,4042.84,Fee Schedule,70.6
MR-PELVIS WO,72195,CPT,,,,,both,, ,4042.84,2425.7,Aetna,Commercial,,,,,4042.84,,,,
MR-PELVIS W,72196,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,,,,1035.69,,,,
MR-PELVIS W,72196,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,,,,1114.55,,,,
MR-PELVIS W,72196,CPT,,,,,both,,,2940.06,2940.06,Aetna,Commercial,,2075.68,70.6,,2940.06,2940.06,2940.06,Fee Schedule,70.6
MR-PELVIS W,72196,CPT,,,,,both,, ,2940.06,1764.03,Aetna,Commercial,,,,,2940.06,,,,
MR-PELVIS WWO,72197,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,,,,1197.08,,,,
MR-PELVIS WWO,72197,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,,,,1288.29,,,,
MR-PELVIS WWO,72197,CPT,,,,,both,,,5197.81,5197.81,Aetna,Commercial,,3669.65,70.6,,5197.81,5197.81,5197.81,Fee Schedule,70.6
MR-PELVIS WWO,72197,CPT,,,,,both,, ,5197.81,3118.68,Aetna,Commercial,,,,,5197.81,,,,
SP-SI JOINTS 2V CR,72200,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-SI JOINTS 2V CR,72200,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,,,757.53,757.53,Aetna,Commercial,,534.82,70.6,,757.53,757.53,757.53,Fee Schedule,70.6
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,757.53,454.51,Aetna,Commercial,,,,,757.53,,,,
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,,,989.38,989.38,Aetna,Commercial,,698.5,70.6,,989.38,989.38,989.38,Fee Schedule,70.6
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,989.38,593.62,Aetna,Commercial,,,,,989.38,,,,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,,,721.61,721.61,Aetna,Commercial,,509.46,70.6,,721.61,721.61,721.61,Fee Schedule,70.6
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,721.61,432.96,Aetna,Commercial,,,,,721.61,,,,
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-CLAVICLE CR,73000,CPT,,,,,both,,,353.93,353.93,Aetna,Commercial,,249.87,70.6,,353.93,353.93,353.93,Fee Schedule,70.6
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,353.93,212.35,Aetna,Commercial,,,,,353.93,,,,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,273.37,164.02,Aetna,Commercial,,,,,273.37,,,,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,273.37,164.02,Aetna,Commercial,,,,,273.37,,,,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,,,804.69,804.69,Aetna,Commercial,,568.11,70.6,,804.69,804.69,804.69,Fee Schedule,70.6
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,,,,804.69,,,,
UE-SCAPULA CR,73010,CPT,,,,,both,, ,136.68,82,Aetna,Commercial,,,,,136.68,,,,
UE-SCAPULA CR,73010,CPT,,,,,both,, ,136.68,82,Aetna,Commercial,,,,,136.68,,,,
UE-SCAPULA CR,73010,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-SCAPULA CR,73010,CPT,,,,,both,,,402.2,402.2,Aetna,Commercial,,283.95,70.6,,402.2,402.2,402.2,Fee Schedule,70.6
UE-SCAPULA CR,73010,CPT,,,,,both,, ,402.2,241.32,Aetna,Commercial,,,,,402.2,,,,
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,,,978.43,978.43,Aetna,Commercial,,690.77,70.6,,978.43,978.43,978.43,Fee Schedule,70.6
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,978.43,587.05,Aetna,Commercial,,,,,978.43,,,,
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-SHOULDER 1V CR,73020,CPT,,,,,both,,,489.5,489.5,Aetna,Commercial,,345.59,70.6,,489.5,489.5,489.5,Fee Schedule,70.6
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,489.5,293.7,Aetna,Commercial,,,,,489.5,,,,
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,,,863.36,863.36,Aetna,Commercial,,609.53,70.6,,863.36,863.36,863.36,Fee Schedule,70.6
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,863.36,518.01,Aetna,Commercial,,,,,863.36,,,,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,,,1726.71,1726.71,Aetna,Commercial,,1219.06,70.6,,1726.71,1726.71,1726.71,Fee Schedule,70.6
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,1726.71,1036.02,Aetna,Commercial,,,,,1726.71,,,,
IR-ARTHROGM SHLDR CR,73040,CPT,,,,,both,, ,3748.7,2249.22,Aetna,Commercial,,,,,3748.7,,,,
IR-ATHGRM SHLD BI CR,73040,CPT,,,,,both,, ,7497.39,4498.43,Aetna,Commercial,,,,,7497.39,,,,
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-AC JTS BILAT CR,73050,CPT,,,,,both,,,918.37,918.37,Aetna,Commercial,,648.37,70.6,,918.37,918.37,918.37,Fee Schedule,70.6
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,918.37,551.02,Aetna,Commercial,,,,,918.37,,,,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,,,721.61,721.61,Aetna,Commercial,,509.46,70.6,,721.61,721.61,721.61,Fee Schedule,70.6
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,721.61,432.96,Aetna,Commercial,,,,,721.61,,,,
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-HUMERUS CR,73060,CPT,,,,,both,,,1442.95,1442.95,Aetna,Commercial,,1018.72,70.6,,1442.95,1442.95,1442.95,Fee Schedule,70.6
UE-HUMERUS CR,73060,CPT,,,,,both,, ,1442.95,865.77,Aetna,Commercial,,,,,1442.95,,,,
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-ELBOW 2V CR,73070,CPT,,,,,both,,,662.39,662.39,Aetna,Commercial,,467.65,70.6,,662.39,662.39,662.39,Fee Schedule,70.6
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,662.39,397.43,Aetna,Commercial,,,,,662.39,,,,
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,,,1325.06,1325.06,Aetna,Commercial,,935.49,70.6,,1325.06,1325.06,1325.06,Fee Schedule,70.6
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,1325.06,795.03,Aetna,Commercial,,,,,1325.06,,,,
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-ELBOW 3V CR,73080,CPT,,,,,both,,,804.69,804.69,Aetna,Commercial,,568.11,70.6,,804.69,804.69,804.69,Fee Schedule,70.6
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,,,,804.69,,,,
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,,,1609.11,1609.11,Aetna,Commercial,,1136.03,70.6,,1609.11,1609.11,1609.11,Fee Schedule,70.6
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,1609.11,965.46,Aetna,Commercial,,,,,1609.11,,,,
IR-ARTHRGRM ELBOW BI,73085,CPT,,,,,both,, ,3748.7,2249.22,Aetna,Commercial,,,,,3748.7,,,,
IR-ARTHRGRM ELBOW BI,73085,CPT,,,,,both,, ,3748.7,2249.22,Aetna,Commercial,,,,,3748.7,,,,
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-FOREARM 2V CR,73090,CPT,,,,,both,,,662.39,662.39,Aetna,Commercial,,467.65,70.6,,662.39,662.39,662.39,Fee Schedule,70.6
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,662.39,397.43,Aetna,Commercial,,,,,662.39,,,,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,,,1325.06,1325.06,Aetna,Commercial,,935.49,70.6,,1325.06,1325.06,1325.06,Fee Schedule,70.6
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,1325.06,795.03,Aetna,Commercial,,,,,1325.06,,,,
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,,,,220.61,,,,
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
UE-UP EXT INFANT CR,73092,CPT,,,,,both,,,721.61,721.61,Aetna,Commercial,,509.46,70.6,,721.61,721.61,721.61,Fee Schedule,70.6
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,721.61,432.96,Aetna,Commercial,,,,,721.61,,,,
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,441.5,264.9,Aetna,Commercial,,,,,441.5,,,,
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,475.18,285.1,Aetna,Commercial,,,,,475.18,,,,
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,,,1444.91,1444.91,Aetna,Commercial,,1020.11,70.6,,1444.91,1444.91,1444.91,Fee Schedule,70.6
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,1444.91,866.94,Aetna,Commercial,,,,,1444.91,,,,
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-WRIST 2V CR,73100,CPT,,,,,both,,,607.94,607.94,Aetna,Commercial,,429.21,70.6,,607.94,607.94,607.94,Fee Schedule,70.6
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,607.94,364.76,Aetna,Commercial,,,,,607.94,,,,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,,,1216.16,1216.16,Aetna,Commercial,,858.61,70.6,,1216.16,1216.16,1216.16,Fee Schedule,70.6
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,1216.16,729.69,Aetna,Commercial,,,,,1216.16,,,,
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,,,662.39,662.39,Aetna,Commercial,,467.65,70.6,,662.39,662.39,662.39,Fee Schedule,70.6
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,662.39,397.43,Aetna,Commercial,,,,,662.39,,,,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,,,1325.06,1325.06,Aetna,Commercial,,935.49,70.6,,1325.06,1325.06,1325.06,Fee Schedule,70.6
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,1325.06,795.03,Aetna,Commercial,,,,,1325.06,,,,
IR-ARTHRGRM WRIST BI,73115,CPT,,,,,both,, ,3748.7,2249.22,Aetna,Commercial,,,,,3748.7,,,,
IR-ARTHRGRM WRIST BI,73115,CPT,,,,,both,, ,3748.7,2249.22,Aetna,Commercial,,,,,3748.7,,,,
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-HAND 2V CR,73120,CPT,,,,,both,,,662.39,662.39,Aetna,Commercial,,467.65,70.6,,662.39,662.39,662.39,Fee Schedule,70.6
UE-HAND 2V CR,73120,CPT,,,,,both,, ,662.39,397.43,Aetna,Commercial,,,,,662.39,,,,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,,,1325.06,1325.06,Aetna,Commercial,,935.49,70.6,,1325.06,1325.06,1325.06,Fee Schedule,70.6
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,1325.06,795.03,Aetna,Commercial,,,,,1325.06,,,,
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-HAND 3V CR,73130,CPT,,,,,both,,,804.69,804.69,Aetna,Commercial,,568.11,70.6,,804.69,804.69,804.69,Fee Schedule,70.6
UE-HAND 3V CR,73130,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,,,,804.69,,,,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,,,1609.11,1609.11,Aetna,Commercial,,1136.03,70.6,,1609.11,1609.11,1609.11,Fee Schedule,70.6
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,1609.11,965.46,Aetna,Commercial,,,,,1609.11,,,,
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,,,1137.3,1137.3,Aetna,Commercial,,802.93,70.6,,1137.3,1137.3,1137.3,Fee Schedule,70.6
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,1137.3,682.38,Aetna,Commercial,,,,,1137.3,,,,
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,,,568.64,568.64,Aetna,Commercial,,401.46,70.6,,568.64,568.64,568.64,Fee Schedule,70.6
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,568.64,341.18,Aetna,Commercial,,,,,568.64,,,,
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,,,,307.05,,,,
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,,,,330.63,,,,
CT-UPPER EXT WO,73200,CPT,,,,,both,,,3015.85,3015.85,Aetna,Commercial,,2129.19,70.6,,3015.85,3015.85,3015.85,Fee Schedule,70.6
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,3015.85,1809.51,Aetna,Commercial,,,,,3015.85,,,,
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,614.4,368.64,Aetna,Commercial,,,,,614.4,,,,
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,660.98,396.58,Aetna,Commercial,,,,,660.98,,,,
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,6031.42,3618.85,Aetna,Commercial,,,,,6031.42,,,,
CT-UPPER EXT W,73201,CPT,,,,,both,, ,556.01,333.6,Aetna,Commercial,,,,,556.01,,,,
CT-UPPER EXT W,73201,CPT,,,,,both,,,3350.14,3350.14,Aetna,Commercial,,2365.2,70.6,,3350.14,3350.14,3350.14,Fee Schedule,70.6
CT-UPPER EXT W,73201,CPT,,,,,both,, ,3350.14,2010.08,Aetna,Commercial,,,,,3350.14,,,,
CTA-UPPER EXT,73206,CPT,,,,,both,,,1947.6,1947.6,Aetna,Commercial,,1375.01,70.6,,1947.6,1947.6,1947.6,Fee Schedule,70.6
CTA-UPPER EXT,73206,CPT,,,,,both,, ,1947.6,1168.56,Aetna,Commercial,,,,,1947.6,,,,
CTA-UPPER EXT BI,73206,CPT,,,,,both,, ,3895.2,2337.12,Aetna,Commercial,,,,,3895.2,,,,
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,1431.72,859.03,Aetna,Commercial,,,,,1431.72,,,,
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,1540.9,924.54,Aetna,Commercial,,,,,1540.9,,,,
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,4042.84,2425.7,Aetna,Commercial,,,,,4042.84,,,,
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,,,,715.99,,,,
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,,,,770.45,,,,
MR-UPPER EXT WO,73218,CPT,,,,,both,,,2470.5,2470.5,Aetna,Commercial,,1744.17,70.6,,2470.5,2470.5,2470.5,Fee Schedule,70.6
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,2470.5,1482.3,Aetna,Commercial,,,,,2470.5,,,,
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,2394.15,1436.49,Aetna,Commercial,,,,,2394.15,,,,
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,2576.6,1545.96,Aetna,Commercial,,,,,2576.6,,,,
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,5197.81,3118.68,Aetna,Commercial,,,,,5197.81,,,,
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,,,,1197.08,,,,
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,,,,1288.29,,,,
MR-UPPER EXT WWO,73220,CPT,,,,,both,,,2598.76,2598.76,Aetna,Commercial,,1834.72,70.6,,2598.76,2598.76,2598.76,Fee Schedule,70.6
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,2598.76,1559.25,Aetna,Commercial,,,,,2598.76,,,,
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,,,,715.99,,,,
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,,,,770.45,,,,
MR-UPPER JOINT WO,73221,CPT,,,,,both,,,2523.26,2523.26,Aetna,Commercial,,1781.42,70.6,,2523.26,2523.26,2523.26,Fee Schedule,70.6
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,2523.26,1513.95,Aetna,Commercial,,,,,2523.26,,,,
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,,,,1035.69,,,,
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,,,,1114.55,,,,
MR-UPPER JOINT W,73222,CPT,,,,,both,,,4293.48,4293.48,Aetna,Commercial,,3031.2,70.6,,4293.48,4293.48,4293.48,Fee Schedule,70.6
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,4293.48,2576.08,Aetna,Commercial,,,,,4293.48,,,,
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,,,,1197.08,,,,
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,,,,1288.29,,,,
MR-UPPER JOINT WWO,73223,CPT,,,,,both,,,4941.28,4941.28,Aetna,Commercial,,3488.54,70.6,,4941.28,4941.28,4941.28,Fee Schedule,70.6
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,,,,4941.28,,,,
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,,,333.44,333.44,Aetna,Commercial,,235.41,70.6,,333.44,333.44,333.44,Fee Schedule,70.6
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,333.44,200.06,Aetna,Commercial,,,,,333.44,,,,
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,139.77,83.86,Aetna,Commercial,,,,,139.77,,,,
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Aetna,Commercial,,,,,149.32,,,,
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Aetna,Commercial,,,,,149.32,,,,
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Aetna,Commercial,,,,,149.32,,,,
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,887.49,532.49,Aetna,Commercial,,,,,887.49,,,,
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,209.94,125.96,Aetna,Commercial,,,,,209.94,,,,
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Aetna,Commercial,,,,,224.54,,,,
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Aetna,Commercial,,,,,224.54,,,,
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Aetna,Commercial,,,,,224.54,,,,
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,1330.96,798.57,Aetna,Commercial,,,,,1330.96,,,,
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,,,,220.88,,,,
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.8,Aetna,Commercial,,,,,238.01,,,,
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.8,Aetna,Commercial,,,,,238.01,,,,
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.8,Aetna,Commercial,,,,,238.01,,,,
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,,,1774.7,1774.7,Aetna,Commercial,,1252.94,70.6,,1774.7,1774.7,1774.7,Fee Schedule,70.6
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,1774.7,1064.82,Aetna,Commercial,,,,,1774.7,,,,
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,,,,220.88,,,,
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.8,Aetna,Commercial,,,,,238.01,,,,
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.8,Aetna,Commercial,,,,,238.01,,,,
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.8,Aetna,Commercial,,,,,238.01,,,,
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,,,1774.7,1774.7,Aetna,Commercial,,1252.94,70.6,,1774.7,1774.7,1774.7,Fee Schedule,70.6
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,1774.7,1064.82,Aetna,Commercial,,,,,1774.7,,,,
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,442.06,265.23,Aetna,Commercial,,,,,442.06,,,,
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Aetna,Commercial,,,,,476.02,,,,
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Aetna,Commercial,,,,,476.02,,,,
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Aetna,Commercial,,,,,476.02,,,,
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,,,3549.69,3549.69,Aetna,Commercial,,2506.08,70.6,,3549.69,3549.69,3549.69,Fee Schedule,70.6
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,3549.69,2129.81,Aetna,Commercial,,,,,3549.69,,,,
IR-ARTHGRM BI HIP CR,73525,CPT,,,,,both,, ,3760.2,2256.12,Aetna,Commercial,,,,,3760.2,,,,
IR-ARTHGRM BI HIP CR,73525,CPT,,,,,both,, ,3760.2,2256.12,Aetna,Commercial,,,,,3760.2,,,,
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.2,88.92,Aetna,Commercial,,,,,148.2,,,,
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.2,88.92,Aetna,Commercial,,,,,148.2,,,,
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.2,88.92,Aetna,Commercial,,,,,148.2,,,,
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.2,88.92,Aetna,Commercial,,,,,148.2,,,,
LE-FEMUR 1V CR,73551,CPT,,,,,both,,,307.05,307.05,Aetna,Commercial,,216.78,70.6,,307.05,307.05,307.05,Fee Schedule,70.6
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,,,,307.05,,,,
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-FEMUR 2V CR,73552,CPT,,,,,both,,,782.23,782.23,Aetna,Commercial,,552.25,70.6,,782.23,782.23,782.23,Fee Schedule,70.6
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,782.23,469.33,Aetna,Commercial,,,,,782.23,,,,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,,,1564.76,1564.76,Aetna,Commercial,,1104.72,70.6,,1564.76,1564.76,1564.76,Fee Schedule,70.6
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,1564.76,938.85,Aetna,Commercial,,,,,1564.76,,,,
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,,,721.61,721.61,Aetna,Commercial,,509.46,70.6,,721.61,721.61,721.61,Fee Schedule,70.6
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,721.61,432.96,Aetna,Commercial,,,,,721.61,,,,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,,,1442.95,1442.95,Aetna,Commercial,,1018.72,70.6,,1442.95,1442.95,1442.95,Fee Schedule,70.6
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,1442.95,865.77,Aetna,Commercial,,,,,1442.95,,,,
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-KNEE 3V CR,73562,CPT,,,,,both,,,981.24,981.24,Aetna,Commercial,,692.76,70.6,,981.24,981.24,981.24,Fee Schedule,70.6
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,981.24,588.74,Aetna,Commercial,,,,,981.24,,,,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,,,1962.48,1962.48,Aetna,Commercial,,1385.51,70.6,,1962.48,1962.48,1962.48,Fee Schedule,70.6
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,1962.48,1177.48,Aetna,Commercial,,,,,1962.48,,,,
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,,,1070.49,1070.49,Aetna,Commercial,,755.77,70.6,,1070.49,1070.49,1070.49,Fee Schedule,70.6
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,1070.49,642.29,Aetna,Commercial,,,,,1070.49,,,,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,,,2141.27,2141.27,Aetna,Commercial,,1511.74,70.6,,2141.27,2141.27,2141.27,Fee Schedule,70.6
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,2141.27,1284.76,Aetna,Commercial,,,,,2141.27,,,,
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,,,721.61,721.61,Aetna,Commercial,,509.46,70.6,,721.61,721.61,721.61,Fee Schedule,70.6
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,721.61,432.96,Aetna,Commercial,,,,,721.61,,,,
IR-ARTHRGRM KNEE BI,73580,CPT,,,,,both,, ,7520.68,4512.4,Aetna,Commercial,,,,,7520.68,,,,
IR-ARTHROGRAM KNEE,73580,CPT,,,,,both,, ,3760.2,2256.12,Aetna,Commercial,,,,,3760.2,,,,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,,,1442.95,1442.95,Aetna,Commercial,,1018.72,70.6,,1442.95,1442.95,1442.95,Fee Schedule,70.6
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,1442.95,865.77,Aetna,Commercial,,,,,1442.95,,,,
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-TIB FIB 2V CR,73590,CPT,,,,,both,,,721.61,721.61,Aetna,Commercial,,509.46,70.6,,721.61,721.61,721.61,Fee Schedule,70.6
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,721.61,432.96,Aetna,Commercial,,,,,721.61,,,,
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,,,1442.95,1442.95,Aetna,Commercial,,1018.72,70.6,,1442.95,1442.95,1442.95,Fee Schedule,70.6
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,1442.95,865.77,Aetna,Commercial,,,,,1442.95,,,,
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,,,721.61,721.61,Aetna,Commercial,,509.46,70.6,,721.61,721.61,721.61,Fee Schedule,70.6
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,721.61,432.96,Aetna,Commercial,,,,,721.61,,,,
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-ANKLE 2V CR,73600,CPT,,,,,both,,,720.49,720.49,Aetna,Commercial,,508.67,70.6,,720.49,720.49,720.49,Fee Schedule,70.6
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,720.49,432.29,Aetna,Commercial,,,,,720.49,,,,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,,,1107.82,1107.82,Aetna,Commercial,,782.12,70.6,,1107.82,1107.82,1107.82,Fee Schedule,70.6
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,1107.82,664.69,Aetna,Commercial,,,,,1107.82,,,,
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,,,804.69,804.69,Aetna,Commercial,,568.11,70.6,,804.69,804.69,804.69,Fee Schedule,70.6
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,,,,804.69,,,,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,,,1609.11,1609.11,Aetna,Commercial,,1136.03,70.6,,1609.11,1609.11,1609.11,Fee Schedule,70.6
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,1609.11,965.46,Aetna,Commercial,,,,,1609.11,,,,
IR-ARTHRGRM ANKLE BI,73615,CPT,,,,,both,, ,3760.2,2256.12,Aetna,Commercial,,,,,3760.2,,,,
IR-ARTHRGRM ANKLE BI,73615,CPT,,,,,both,, ,3760.2,2256.12,Aetna,Commercial,,,,,3760.2,,,,
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-FOOT 2V CR,73620,CPT,,,,,both,,,553.77,553.77,Aetna,Commercial,,390.96,70.6,,553.77,553.77,553.77,Fee Schedule,70.6
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,553.77,332.26,Aetna,Commercial,,,,,553.77,,,,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,,,1107.82,1107.82,Aetna,Commercial,,782.12,70.6,,1107.82,1107.82,1107.82,Fee Schedule,70.6
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,1107.82,664.69,Aetna,Commercial,,,,,1107.82,,,,
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,,,662.39,662.39,Aetna,Commercial,,467.65,70.6,,662.39,662.39,662.39,Fee Schedule,70.6
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,662.39,397.43,Aetna,Commercial,,,,,662.39,,,,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,,,1250.97,1250.97,Aetna,Commercial,,883.18,70.6,,1250.97,1250.97,1250.97,Fee Schedule,70.6
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,1250.97,750.58,Aetna,Commercial,,,,,1250.97,,,,
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,,,353.93,353.93,Aetna,Commercial,,249.87,70.6,,353.93,353.93,353.93,Fee Schedule,70.6
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,353.93,212.35,Aetna,Commercial,,,,,353.93,,,,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,,,662.39,662.39,Aetna,Commercial,,467.65,70.6,,662.39,662.39,662.39,Fee Schedule,70.6
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,662.39,397.43,Aetna,Commercial,,,,,662.39,,,,
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,,,568.64,568.64,Aetna,Commercial,,401.46,70.6,,568.64,568.64,568.64,Fee Schedule,70.6
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,568.64,341.18,Aetna,Commercial,,,,,568.64,,,,
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,278.43,167.05,Aetna,Commercial,,,,,278.43,,,,
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,299.76,179.85,Aetna,Commercial,,,,,299.76,,,,
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,,,1137.3,1137.3,Aetna,Commercial,,802.93,70.6,,1137.3,1137.3,1137.3,Fee Schedule,70.6
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,1137.3,682.38,Aetna,Commercial,,,,,1137.3,,,,
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,,,,307.05,,,,
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,,,,330.63,,,,
CT-LOWER EXT WO,73700,CPT,,,,,both,,,3013.04,3013.04,Aetna,Commercial,,2127.21,70.6,,3013.04,3013.04,3013.04,Fee Schedule,70.6
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,3013.04,1807.82,Aetna,Commercial,,,,,3013.04,,,,
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,614.4,368.64,Aetna,Commercial,,,,,614.4,,,,
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,660.98,396.58,Aetna,Commercial,,,,,660.98,,,,
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,,,,4941.28,,,,
CT-LOWER EXT W,73701,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,,,,604.85,,,,
CT-LOWER EXT W,73701,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,,,,604.85,,,,
CT-LOWER EXT W,73701,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,,,,650.88,,,,
CT-LOWER EXT W,73701,CPT,,,,,both,,,3013.04,3013.04,Aetna,Commercial,,2127.21,70.6,,3013.04,3013.04,3013.04,Fee Schedule,70.6
CT-LOWER EXT W,73701,CPT,,,,,both,, ,3013.04,1807.82,Aetna,Commercial,,,,,3013.04,,,,
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,,,,680.91,,,,
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,,,,732.83,,,,
CT-LOWER EXT WWO,73702,CPT,,,,,both,,,3013.04,3013.04,Aetna,Commercial,,2127.21,70.6,,3013.04,3013.04,3013.04,Fee Schedule,70.6
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,3013.04,1807.82,Aetna,Commercial,,,,,3013.04,,,,
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,1361.84,817.1,Aetna,Commercial,,,,,1361.84,,,,
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,1465.68,879.4,Aetna,Commercial,,,,,1465.68,,,,
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,,,,4941.28,,,,
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,1540.9,924.54,Aetna,Commercial,,,,,1540.9,,,,
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,,,,4941.28,,,,
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,,,,715.99,,,,
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,,,,715.99,,,,
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,,,,770.45,,,,
MR-LOWER EXTR WO,73718,CPT,,,,,both,,,2470.5,2470.5,Aetna,Commercial,,1744.17,70.6,,2470.5,2470.5,2470.5,Fee Schedule,70.6
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,2470.5,1482.3,Aetna,Commercial,,,,,2470.5,,,,
MR-LOWER EXTR W,73719,CPT,,,,,both,,,832.76,832.76,Aetna,Commercial,,587.93,70.6,,832.76,832.76,832.76,Fee Schedule,70.6
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,832.76,499.65,Aetna,Commercial,,,,,832.76,,,,
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,,,,1035.69,,,,
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,,,,1114.55,,,,
MR-LOWER EXTR BI WWO,73720,CPT,,,,,both,, ,2394.15,1436.49,Aetna,Commercial,,,,,2394.15,,,,
MR-LOWER EXTR BI WWO,73720,CPT,,,,,both,, ,2576.6,1545.96,Aetna,Commercial,,,,,2576.6,,,,
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,,,,1197.08,,,,
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,,,,1288.29,,,,
MR-LOWER EXTR WWO,73720,CPT,,,,,both,,,3084.06,3084.06,Aetna,Commercial,,2177.35,70.6,,3084.06,3084.06,3084.06,Fee Schedule,70.6
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,3084.06,1850.43,Aetna,Commercial,,,,,3084.06,,,,
MRI scan of leg joint,73721,CPT,,,,,both,,,4941.28,4941.28,Aetna,Commercial,,3488.54,70.6,,4941.28,4941.28,4941.28,Fee Schedule,70.6
MR-LW JOINT WO,73721,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,,,,715.99,,,,
MR-LW JOINT WO,73721,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,,,,770.45,,,,
MR-LW JOINT WO,73721,CPT,,,,,both,, ,4941.28,2964.76,Aetna,Commercial,,,,,4941.28,,,,
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,1431.72,859.03,Aetna,Commercial,,,,,1431.72,,,,
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,1540.9,924.54,Aetna,Commercial,,,,,1540.9,,,,
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,9881.44,5928.86,Aetna,Commercial,,,,,9881.44,,,,
MR-LW JOINT W,73722,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,,,,1035.69,,,,
MR-LW JOINT W,73722,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,,,,1114.55,,,,
MR-LW JOINT W,73722,CPT,,,,,both,,,4293.48,4293.48,Aetna,Commercial,,3031.2,70.6,,4293.48,4293.48,4293.48,Fee Schedule,70.6
MR-LW JOINT W,73722,CPT,,,,,both,, ,4293.48,2576.08,Aetna,Commercial,,,,,4293.48,,,,
MR-LW JOINT W BI,73722,CPT,,,,,both,, ,7641.1,4584.66,Aetna,Commercial,,,,,7641.1,,,,
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,,,,1197.08,,,,
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,,,,1288.29,,,,
MR-LW JOINT WWO,73723,CPT,,,,,both,,,5197.81,5197.81,Aetna,Commercial,,3669.65,70.6,,5197.81,5197.81,5197.81,Fee Schedule,70.6
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,5197.81,3118.68,Aetna,Commercial,,,,,5197.81,,,,
MR-LW JOINT WWO BI,73723,CPT,,,,,both,, ,10395.64,6237.38,Aetna,Commercial,,,,,10395.64,,,,
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,,,694.38,694.38,Aetna,Commercial,,490.23,70.6,,694.38,694.38,694.38,Fee Schedule,70.6
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,694.38,416.62,Aetna,Commercial,,,,,694.38,,,,
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,,,1144.03,1144.03,Aetna,Commercial,,807.69,70.6,,1144.03,1144.03,1144.03,Fee Schedule,70.6
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,1144.03,686.41,Aetna,Commercial,,,,,1144.03,,,,
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,,,868.4,868.4,Aetna,Commercial,,613.09,70.6,,868.4,868.4,868.4,Fee Schedule,70.6
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,868.4,521.04,Aetna,Commercial,,,,,868.4,,,,
CH-ABD SER PA CXR CR,74022,CPT,,,,,both,,,970.85,970.85,Aetna,Commercial,,685.42,70.6,,970.85,970.85,970.85,Fee Schedule,70.6
CH-ABD SER PA CXR CR,74022,CPT,,,,,both,, ,970.85,582.51,Aetna,Commercial,,,,,970.85,,,,
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,307.05,184.23,Aetna,Commercial,,,,,307.05,,,,
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,330.63,198.37,Aetna,Commercial,,,,,330.63,,,,
CT-ABDOMEN WO,74150,CPT,,,,,both,,,3285.58,3285.58,Aetna,Commercial,,2319.62,70.6,,3285.58,3285.58,3285.58,Fee Schedule,70.6
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,3285.58,1971.34,Aetna,Commercial,,,,,3285.58,,,,
CT-ABDOMEN W,74160,CPT,,,,,both,, ,604.85,362.91,Aetna,Commercial,,,,,604.85,,,,
CT-ABDOMEN W,74160,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,,,,650.88,,,,
CT-ABDOMEN W,74160,CPT,,,,,both,,,3726.8,3726.8,Aetna,Commercial,,2631.12,70.6,,3726.8,3726.8,3726.8,Fee Schedule,70.6
CT-ABDOMEN W,74160,CPT,,,,,both,, ,3726.8,2236.08,Aetna,Commercial,,,,,3726.8,,,,
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,680.91,408.54,Aetna,Commercial,,,,,680.91,,,,
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,732.83,439.69,Aetna,Commercial,,,,,732.83,,,,
CT-ABDOMEN WWO,74170,CPT,,,,,both,,,4317.62,4317.62,Aetna,Commercial,,3048.24,70.6,,4317.62,4317.62,4317.62,Fee Schedule,70.6
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,4317.62,2590.57,Aetna,Commercial,,,,,4317.62,,,,
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,893.1,535.86,Aetna,Commercial,,,,,893.1,,,,
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,893.1,535.86,Aetna,Commercial,,,,,893.1,,,,
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,,,1894.27,1894.27,Aetna,Commercial,,1337.35,70.6,,1894.27,1894.27,1894.27,Fee Schedule,70.6
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,1894.27,1136.56,Aetna,Commercial,,,,,1894.27,,,,
CTA-ABDOMEN,74175,CPT,,,,,both,, ,893.1,535.86,Aetna,Commercial,,,,,893.1,,,,
CTA-ABDOMEN,74175,CPT,,,,,both,,,1894.27,1894.27,Aetna,Commercial,,1337.35,70.6,,1894.27,1894.27,1894.27,Fee Schedule,70.6
CTA-ABDOMEN,74175,CPT,,,,,both,, ,1894.27,1136.56,Aetna,Commercial,,,,,1894.27,,,,
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,587.17,352.3,Aetna,Commercial,,,,,587.17,,,,
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,632.08,379.24,Aetna,Commercial,,,,,632.08,,,,
CT-ABD PELVIS WO,74176,CPT,,,,,both,,,6571.44,6571.44,Aetna,Commercial,,4639.44,70.6,,6571.44,6571.44,6571.44,Fee Schedule,70.6
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,6571.44,3942.86,Aetna,Commercial,,,,,6571.44,,,,
CT scan of abdomen and pelvis with contrast,74177,CPT,,,,,both,,,7453.61,7453.61,Aetna,Commercial,,5262.25,70.6,,7453.61,7453.61,7453.61,Fee Schedule,70.6
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,947.56,568.53,Aetna,Commercial,,,,,947.56,,,,
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,1019.69,611.81,Aetna,Commercial,,,,,1019.69,,,,
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,7453.61,4472.16,Aetna,Commercial,,,,,7453.61,,,,
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,947.56,568.53,Aetna,Commercial,,,,,947.56,,,,
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,1019.69,611.81,Aetna,Commercial,,,,,1019.69,,,,
CT-ABD PELVIS WWO,74178,CPT,,,,,both,,,8364.95,8364.95,Aetna,Commercial,,5905.65,70.6,,8364.95,8364.95,8364.95,Fee Schedule,70.6
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,8364.95,5018.97,Aetna,Commercial,,,,,8364.95,,,,
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,715.99,429.59,Aetna,Commercial,,,,,715.99,,,,
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,,,,770.45,,,,
MR-ABDOMEN WO,74181,CPT,,,,,both,,,4042.84,4042.84,Aetna,Commercial,,2854.25,70.6,,4042.84,4042.84,4042.84,Fee Schedule,70.6
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,4042.84,2425.7,Aetna,Commercial,,,,,4042.84,,,,
MR-ABDOMEN W,74182,CPT,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,,,,1035.69,,,,
MR-ABDOMEN W,74182,CPT,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,,,,1114.55,,,,
MR-ABDOMEN W,74182,CPT,,,,,both,,,4293.48,4293.48,Aetna,Commercial,,3031.2,70.6,,4293.48,4293.48,4293.48,Fee Schedule,70.6
MR-ABDOMEN W,74182,CPT,,,,,both,, ,4293.48,2576.08,Aetna,Commercial,,,,,4293.48,,,,
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,,,,1197.08,,,,
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,,,,1288.29,,,,
MR-ABDOMEN WWO,74183,CPT,,,,,both,,,5197.81,5197.81,Aetna,Commercial,,3669.65,70.6,,5197.81,5197.81,5197.81,Fee Schedule,70.6
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,5197.81,3118.68,Aetna,Commercial,,,,,5197.81,,,,
FL-ESOPHAGUS,74220,CPT,,,,,both,, ,1227.11,736.26,Aetna,Commercial,,,,,1227.11,,,,
FL-MOD BA SWALLOW,74230,CPT,,,,,both,, ,391.26,234.75,Aetna,Commercial,,,,,391.26,,,,
FL-GI SERIES,74240,CPT,,,,,both,, ,1557.58,934.54,Aetna,Commercial,,,,,1557.58,,,,
FL-UPPER GI SINGLE,74240,CPT,,,,,both,, ,1818.77,1091.26,Aetna,Commercial,,,,,1818.77,,,,
FL-GI SERIES AIR,74246,CPT,,,,,both,, ,1500.93,900.55,Aetna,Commercial,,,,,1500.93,,,,
FL-UPPER GI DOUBLE,74246,CPT,,,,,both,, ,1752.53,1051.51,Aetna,Commercial,,,,,1752.53,,,,
FL-LOWER GI FOLLOW,74248,CPT,,,,,both,, ,3343.68,2006.2,Aetna,Commercial,,,,,3343.68,,,,
FL-SMALL BOWEL CR,74250,CPT,,,,,both,, ,2123.58,1274.14,Aetna,Commercial,,,,,2123.58,,,,
FL-SM BWL ENT TBE CR,74251,CPT,,,,,both,, ,2123.58,1274.14,Aetna,Commercial,,,,,2123.58,,,,
FL-BARIUM ENEMA,74270,CPT,,,,,both,, ,1890.9,1134.54,Aetna,Commercial,,,,,1890.9,,,,
FL-BARIUM ENEMA AIR,74280,CPT,,,,,both,, ,2333.25,1399.95,Aetna,Commercial,,,,,2333.25,,,,
SU-CHOLE W GRAMS DR,74300,CPT,,,,,both,, ,1968.65,1181.19,Aetna,Commercial,,,,,1968.65,,,,
FL-ENDO BILIARY,74328,CPT,,,,,both,, ,3722.58,2233.54,Aetna,Commercial,,,,,3722.58,,,,
FL-ENDO PANCREATIC,74329,CPT,,,,,both,, ,1034.01,620.4,Aetna,Commercial,,,,,1034.01,,,,
FL-ENDO BIL PANC,74330,CPT,,,,,both,, ,1304.29,782.57,Aetna,Commercial,,,,,1304.29,,,,
FL-LONG GI TUBE PLC,74340,CPT,,,,,both,, ,1359.02,815.41,Aetna,Commercial,,,,,1359.02,,,,
FL-ENTEROCLYSIS PLAC,74355,CPT,,,,,both,, ,932.4,559.44,Aetna,Commercial,,,,,932.4,,,,
FL-IVP CR,74400,CPT,,,,,both,, ,1836.17,1101.7,Aetna,Commercial,,,,,1836.17,,,,
FL-UROGRAPH RETRO CR,74420,CPT,,,,,both,, ,2105.34,1263.2,Aetna,Commercial,,,,,2105.34,,,,
FL-UROGRAPHY ANTE CR,74425,CPT,,,,,both,, ,2165.12,1299.07,Aetna,Commercial,,,,,2165.12,,,,
FL-CYSTOGRM 3VPLS CR,74430,CPT,,,,,both,, ,1407.87,844.72,Aetna,Commercial,,,,,1407.87,,,,
FL-CAVERNOSOGRAPH CR,74445,CPT,,,,,both,, ,698.32,418.99,Aetna,Commercial,,,,,698.32,,,,
FL-UCG RETRO CR,74450,CPT,,,,,both,, ,1357.62,814.57,Aetna,Commercial,,,,,1357.62,,,,
FL-UCG VOIDING,74455,CPT,,,,,both,, ,1357.62,814.57,Aetna,Commercial,,,,,1357.62,,,,
FL-UCG VOIDING CR,74455,CPT,,,,,both,, ,1162.77,697.66,Aetna,Commercial,,,,,1162.77,,,,
IR-DILATION GU,74485,CPT,,,,,both,, ,976.75,586.05,Aetna,Commercial,,,,,976.75,,,,
IR-HYSTERSALPINGO CR,74740,CPT,,,,,both,,,1704.21,1704.21,Aetna,Commercial,,1203.17,70.6,,1704.21,1704.21,1704.21,Fee Schedule,70.6
IR-HYSTERSALPINGO CR,74740,CPT,,,,,both,, ,1704.21,1022.52,Aetna,Commercial,,,,,1704.21,,,,
IR-HYSTERSALPINGOGRM,74740,CPT,,,,,both,,,1989.98,1989.98,Aetna,Commercial,,1404.93,70.6,,1989.98,1989.98,1989.98,Fee Schedule,70.6
IR-HYSTERSALPINGOGRM,74740,CPT,,,,,both,, ,1989.98,1193.98,Aetna,Commercial,,,,,1989.98,,,,
IR-PERINEOGRAM CR,74775,CPT,,,,,both,, ,1991.67,1195,Aetna,Commercial,,,,,1991.67,,,,
CT-HT ACC LV RV W,75573,CPT,,,,,both,, ,580.15,348.09,Aetna,Commercial,,,,,580.15,,,,
CT-HT ACC LV RV W,75573,CPT,,,,,both,, ,1696.4,1017.84,Aetna,Commercial,,,,,1696.4,,,,
CT-HT CARD FUNC W,75574,CPT,,,,,both,, ,580.15,348.09,Aetna,Commercial,,,,,580.15,,,,
CT-HT CARD FUNC W,75574,CPT,,,,,both,, ,1696.4,1017.84,Aetna,Commercial,,,,,1696.4,,,,
CATH-ABD AORTA SERIAL,75625,CPT,,,,,both,, ,8483,5089.8,Aetna,Commercial,,,,,8483,,,,
IR-ABD AORTA SERIAL,75625,CPT,,,,,both,, ,9523.86,5714.31,Aetna,Commercial,,,,,9523.86,,,,
CATH-AABF SERIAL     ,75630,CPT,,,,,both,, ,11199.75,6719.85,Aetna,Commercial,,,,,11199.75,,,,
IR-AABF SERIAL,75630,CPT,,,,,both,, ,12573.95,7544.37,Aetna,Commercial,,,,,12573.95,,,,
CTA-ABD ART W RUNOFF,75635,CPT,,,,,both,, ,650.88,390.52,Aetna,Commercial,,,,,650.88,,,,
CTA-ABD ART W RUNOFF,75635,CPT,,,,,both,, ,2355.42,1413.25,Aetna,Commercial,,,,,2355.42,,,,
CATH-ANGIO EXTREM UNI,75710,CPT,,,,,both,, ,7520.75,4512.45,Aetna,Commercial,,,,,7520.75,,,,
IR-ANGIO EXTREM UNI,75710,CPT,,,,,both,, ,8443.54,5066.12,Aetna,Commercial,,,,,8443.54,,,,
CATH-ANGIO EXTREM BI ,75716,CPT,,,,,both,, ,7520.75,4512.45,Aetna,Commercial,,,,,7520.75,,,,
IR-ANGIO EXTREM BI,75716,CPT,,,,,both,, ,8423.33,5053.99,Aetna,Commercial,,,,,8423.33,,,,
IR-ANGIO VISCERAL SE,75726,CPT,,,,,both,, ,13364.62,8018.77,Aetna,Commercial,,,,,13364.62,,,,
IR-ANG PULMONARY UNI,75741,CPT,,,,,both,, ,4237.35,2542.41,Aetna,Commercial,,,,,4237.35,,,,
IR-ANG PULMONARY BI,75743,CPT,,,,,both,, ,12357.84,7414.7,Aetna,Commercial,,,,,12357.84,,,,
IR-SHUNTOGRAM,75809,CPT,,,,,both,, ,386.21,231.72,Aetna,Commercial,,,,,386.21,,,,
CATH-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,7641.75,4585.05,Aetna,Commercial,,,,,7641.75,,,,
IR-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,8579.39,5147.63,Aetna,Commercial,,,,,8579.39,,,,
IR-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,8579.39,5147.63,Aetna,Commercial,,,,,8579.39,,,,
CATH-VENOGRAM EXT BI ,75822,CPT,,,,,both,, ,3510,2106,Aetna,Commercial,,,,,3510,,,,
IR-VENOGRAM EXT BI,75822,CPT,,,,,both,, ,3940.68,2364.4,Aetna,Commercial,,,,,3940.68,,,,
IR-VENACAVAGRAM INF,75825,CPT,,,,,both,, ,8923.22,5353.93,Aetna,Commercial,,,,,8923.22,,,,
IR-VENOUS SAMPL CATH,75893,CPT,,,,,both,, ,3915.41,2349.24,Aetna,Commercial,,,,,3915.41,,,,
IR-ANGIO EXIST CATH,75898,CPT,,,,,both,, ,513.35,308.01,Aetna,Commercial,,,,,513.35,,,,
IR-DRAIN TUBE CHANGE,75984,CPT,,,,,both,, ,2098.33,1258.99,Aetna,Commercial,,,,,2098.33,,,,
CT-ABSC DRN CATH PLA,75989,CPT,,,,,both,, ,2649.01,1589.4,Aetna,Commercial,,,,,2649.01,,,,
US-ABSC DRN CATH PLA,75989,CPT,,,,,both,, ,1120.45,672.27,Aetna,Commercial,,,,,1120.45,,,,
FL-FLUORO 1 HOUR,76000,CPT,,,,,both,, ,553.77,332.26,Aetna,Commercial,,,,,553.77,,,,
FL-FLUORO 1 HOUR CR,76000,CPT,,,,,both,, ,474.31,284.58,Aetna,Commercial,,,,,474.31,,,,
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,756.41,453.84,Aetna,Commercial,,,,,756.41,,,,
IR-FISTULOGRAM CR,76080,CPT,,,,,both,, ,758.66,455.19,Aetna,Commercial,,,,,758.66,,,,
EXAM SURG SPECMN CR,76098,CPT,,,,,both,, ,1190.34,714.2,Aetna,Commercial,,,,,1190.34,,,,
TOMOGRAM ONE PLNE CR,76100,CPT,,,,,both,, ,2030.12,1218.07,Aetna,Commercial,,,,,2030.12,,,,
CT-3D W POSTPROCESS,76377,CPT,,,,,both,, ,528.5,317.1,Aetna,Commercial,,,,,528.5,,,,
CT-3D W POSTPROCESS,76377,CPT,,,,,both,, ,536.93,322.15,Aetna,Commercial,,,,,536.93,,,,
MR-3D W POSTPROCESS,76377,CPT,,,,,both,, ,491.18,294.7,Aetna,Commercial,,,,,491.18,,,,
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,193.1,115.86,Aetna,Commercial,,,,,193.1,,,,
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,207.98,124.78,Aetna,Commercial,,,,,207.98,,,,
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,724.14,434.48,Aetna,Commercial,,,,,724.14,,,,
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,,,2030.68,2030.68,Aetna,Commercial,,1433.66,70.6,,2030.68,2030.68,2030.68,Fee Schedule,70.6
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,2030.68,1218.4,Aetna,Commercial,,,,,2030.68,,,,
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,1602.93,961.75,Aetna,Commercial,,,,,1602.93,,,,
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,218.64,131.18,Aetna,Commercial,,,,,218.64,,,,
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,218.64,131.18,Aetna,Commercial,,,,,218.64,,,,
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,1680.12,1008.07,Aetna,Commercial,,,,,1680.12,,,,
US-BREAST LIMITED,76642,CPT,,,,,both,, ,218.64,131.18,Aetna,Commercial,,,,,218.64,,,,
US-BREAST LIMITED,76642,CPT,,,,,both,, ,218.64,131.18,Aetna,Commercial,,,,,218.64,,,,
US-BREAST LIMITED,76642,CPT,,,,,both,,,1680.12,1680.12,Aetna,Commercial,,1186.16,70.6,,1680.12,1680.12,1680.12,Fee Schedule,70.6
US-BREAST LIMITED,76642,CPT,,,,,both,, ,1680.12,1008.07,Aetna,Commercial,,,,,1680.12,,,,
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,437.29,262.37,Aetna,Commercial,,,,,437.29,,,,
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,437.29,262.37,Aetna,Commercial,,,,,437.29,,,,
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,3359.95,2015.97,Aetna,Commercial,,,,,3359.95,,,,
Ultrasound of abdomen,76700,CPT,,,,,both,,,2330.73,2330.73,Aetna,Commercial,,1645.5,70.6,,2330.73,2330.73,2330.73,Fee Schedule,70.6
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,2330.73,1398.43,Aetna,Commercial,,,,,2330.73,,,,
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-ABDOMEN LTD WO,76705,CPT,,,,,both,,,1908.87,1908.87,Aetna,Commercial,,1347.66,70.6,,1908.87,1908.87,1908.87,Fee Schedule,70.6
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,1908.87,1145.32,Aetna,Commercial,,,,,1908.87,,,,
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-ABDOMEN RETROPER,76770,CPT,,,,,both,,,2030.68,2030.68,Aetna,Commercial,,1433.66,70.6,,2030.68,2030.68,2030.68,Fee Schedule,70.6
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,2030.68,1218.4,Aetna,Commercial,,,,,2030.68,,,,
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,,,1965,1965,Aetna,Commercial,,1387.29,70.6,,1965,1965,1965,Fee Schedule,70.6
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,1965,1179,Aetna,Commercial,,,,,1965,,,,
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-PELV PREG 14 WKS,76801,CPT,,,,,both,,,813.67,813.67,Aetna,Commercial,,574.45,70.6,,813.67,813.67,813.67,Fee Schedule,70.6
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,813.67,488.2,Aetna,Commercial,,,,,813.67,,,,
US-PLV PRG 14 WKS AD,76802,CPT,,,,,both,, ,329.51,197.7,Aetna,Commercial,,,,,329.51,,,,
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,76805,CPT,,,,,both,,,1931.6,1931.6,Aetna,Commercial,,1363.71,70.6,,1931.6,1931.6,1931.6,Fee Schedule,70.6
US-PELVIS PREG,76805,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
US-PELVIS PREG,76805,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-PELVIS PREG,76805,CPT,,,,,both,, ,1931.6,1158.96,Aetna,Commercial,,,,,1931.6,,,,
US-PELVS PREG GESADD,76810,CPT,,,,,both,, ,329.51,197.7,Aetna,Commercial,,,,,329.51,,,,
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,577,346.2,Aetna,Commercial,,,,,577,,,,
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,647.8,388.68,Aetna,Commercial,,,,,647.8,,,,
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,218.64,131.18,Aetna,Commercial,,,,,218.64,,,,
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,235.48,141.28,Aetna,Commercial,,,,,235.48,,,,
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,647.8,388.68,Aetna,Commercial,,,,,647.8,,,,
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-PLV PRG TRNSV,76817,CPT,,,,,both,,,655.09,655.09,Aetna,Commercial,,462.49,70.6,,655.09,655.09,655.09,Fee Schedule,70.6
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,655.09,393.05,Aetna,Commercial,,,,,655.09,,,,
US-FETAL BIO W NST,76818,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-FETAL BIO W NST,76818,CPT,,,,,both,, ,1198.2,718.92,Aetna,Commercial,,,,,1198.2,,,,
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,793.18,475.9,Aetna,Commercial,,,,,793.18,,,,
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,218.64,131.18,Aetna,Commercial,,,,,218.64,,,,
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,235.48,141.28,Aetna,Commercial,,,,,235.48,,,,
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,780.55,468.33,Aetna,Commercial,,,,,780.55,,,,
Ultrasound pelvis through vagina,76830,CPT,,,,,both,,,689.62,689.62,Aetna,Commercial,,486.87,70.6,,689.62,689.62,689.62,Fee Schedule,70.6
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,689.62,413.77,Aetna,Commercial,,,,,689.62,,,,
US-PELVIS NON OB,76856,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
US-PELVIS NON OB,76856,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-PELVIS NON OB,76856,CPT,,,,,both,,,1931.6,1931.6,Aetna,Commercial,,1363.71,70.6,,1931.6,1931.6,1931.6,Fee Schedule,70.6
US-PELVIS NON OB,76856,CPT,,,,,both,, ,1931.6,1158.96,Aetna,Commercial,,,,,1931.6,,,,
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,209.94,125.96,Aetna,Commercial,,,,,209.94,,,,
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,209.94,125.96,Aetna,Commercial,,,,,209.94,,,,
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,437.29,262.37,Aetna,Commercial,,,,,437.29,,,,
US-SCROTUM,76870,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
US-SCROTUM,76870,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-SCROTUM,76870,CPT,,,,,both,,,2005.7,2005.7,Aetna,Commercial,,1416.02,70.6,,2005.7,2005.7,2005.7,Fee Schedule,70.6
US-SCROTUM,76870,CPT,,,,,both,, ,2005.7,1203.42,Aetna,Commercial,,,,,2005.7,,,,
US-TRANSRECTAL,76872,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
US-TRANSRECTAL,76872,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-TRANSRECTAL,76872,CPT,,,,,both,, ,1300.09,780.05,Aetna,Commercial,,,,,1300.09,,,,
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,378.35,227.01,Aetna,Commercial,,,,,378.35,,,,
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,189.17,113.5,Aetna,Commercial,,,,,189.17,,,,
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,218.64,131.18,Aetna,Commercial,,,,,218.64,,,,
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,235.48,141.28,Aetna,Commercial,,,,,235.48,,,,
NI-VAS ACCSS SITES,76937,CPT,,,,,both,, ,797.67,478.6,Aetna,Commercial,,,,,797.67,,,,
NI-VAS ACCSS SITES ,76937,CPT,,,,,both,, ,710.5,426.3,Aetna,Commercial,,,,,710.5,,,,
US-GUIDE NEEDLE PLAC,76942,CPT,,,,,both,, ,2221.26,1332.75,Aetna,Commercial,,,,,2221.26,,,,
US-GUIDE AMNIOCENT,76946,CPT,,,,,both,, ,2221.26,1332.75,Aetna,Commercial,,,,,2221.26,,,,
US-GUIDE INTRAOPERAT,76998,CPT,,,,,both,, ,604.57,362.74,Aetna,Commercial,,,,,604.57,,,,
FL-FLUORO CVAD ANY,77001,CPT,,,,,both,, ,1968.65,1181.19,Aetna,Commercial,,,,,1968.65,,,,
FL-NEDL GUIDE FLUORO,77002,CPT,,,,,both,, ,521.21,312.72,Aetna,Commercial,,,,,521.21,,,,
FL-FLUORO GUIDE SPIN,77003,CPT,,,,,both,, ,553.77,332.26,Aetna,Commercial,,,,,553.77,,,,
CT-GUIDE NEEDLE BX,77012,CPT,,,,,both,, ,2649.01,1589.4,Aetna,Commercial,,,,,2649.01,,,,
CT-GUIDE TISSUE ABLA,77013,CPT,,,,,both,, ,3157.31,1894.38,Aetna,Commercial,,,,,3157.31,,,,
MR-BREAST UNI WO,77046,CPT,,,,,both,, ,674.73,404.83,Aetna,Commercial,,,,,674.73,,,,
MR-BREAST BIL WO,77047,CPT,,,,,both,, ,674.73,404.83,Aetna,Commercial,,,,,674.73,,,,
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,772.13,463.27,Aetna,Commercial,,,,,772.13,,,,
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,830.8,498.48,Aetna,Commercial,,,,,830.8,,,,
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,1469.05,881.43,Aetna,Commercial,,,,,1469.05,,,,
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,772.13,463.27,Aetna,Commercial,,,,,772.13,,,,
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,830.8,498.48,Aetna,Commercial,,,,,830.8,,,,
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,1889.78,1133.86,Aetna,Commercial,,,,,1889.78,,,,
BR-TOMO MAMM SCR BI,77063,CPT,,,,,both,,,107.12,107.12,Aetna,Commercial,,75.63,70.6,,107.12,107.12,107.12,Fee Schedule,70.6
BR-TOMO MAMM SCR BI,77063,CPT,,,,,both,, ,107.12,64.27,Aetna,Commercial,,,,,107.12,,,,
BR-TOMO MAMM SCR UNI,77063,CPT,,,,,both,, ,80.34,48.2,Aetna,Commercial,,,,,80.34,,,,
BR-TOMOSYN SCR AD BI,77063,CPT,,,,,both,, ,100,60,Aetna,Commercial,,,,,100,,,,
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,411.49,246.89,Aetna,Commercial,,,,,411.49,,,,
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,411.49,246.89,Aetna,Commercial,,,,,411.49,,,,
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,439.55,263.73,Aetna,Commercial,,,,,439.55,,,,
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,448.82,269.29,Aetna,Commercial,,,,,448.82,,,,
Mammography of one breast,77065,CPT,,,,,both,,,448.82,448.82,Aetna,Commercial,,316.87,70.6,,448.82,448.82,448.82,Fee Schedule,70.6
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,411.49,246.89,Aetna,Commercial,,,,,411.49,,,,
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,411.49,246.89,Aetna,Commercial,,,,,411.49,,,,
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,439.55,263.73,Aetna,Commercial,,,,,439.55,,,,
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,556.97,334.18,Aetna,Commercial,,,,,556.97,,,,
Mammography of both breasts,77066,CPT,,,,,both,,,556.97,556.97,Aetna,Commercial,,393.22,70.6,,556.97,556.97,556.97,Fee Schedule,70.6
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,345.31,207.18,Aetna,Commercial,,,,,345.31,,,,
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,345.31,207.18,Aetna,Commercial,,,,,345.31,,,,
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,368.23,220.93,Aetna,Commercial,,,,,368.23,,,,
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,488.99,293.39,Aetna,Commercial,,,,,488.99,,,,
BR-DIG MAMMO SCRN UN,77067,CPT,,,,,both,, ,366.68,220,Aetna,Commercial,,,,,366.68,,,,
"Mammography, screening, bilateral",77067,CPT,,,,,both,,,488.99,488.99,Aetna,Commercial,,345.23,70.6,,488.99,488.99,488.99,Fee Schedule,70.6
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
BONE AGE STUDY CR,77072,CPT,,,,,both,,,721.61,721.61,Aetna,Commercial,,509.46,70.6,,721.61,721.61,721.61,Fee Schedule,70.6
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,721.61,432.96,Aetna,Commercial,,,,,721.61,,,,
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
BONE LENGTH STUDY CR,77073,CPT,,,,,both,,,1904.1,1904.1,Aetna,Commercial,,1344.29,70.6,,1904.1,1904.1,1904.1,Fee Schedule,70.6
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,1904.1,1142.46,Aetna,Commercial,,,,,1904.1,,,,
BNE SRVY LTD METS CR,77074,CPT,,,,,both,,,523.46,523.46,Aetna,Commercial,,369.56,70.6,,523.46,523.46,523.46,Fee Schedule,70.6
BNE SRVY LTD METS CR,77074,CPT,,,,,both,, ,523.46,314.07,Aetna,Commercial,,,,,523.46,,,,
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,,,,220.61,,,,
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
BNE SRVY CMP METS CR,77075,CPT,,,,,both,,,418.2,418.2,Aetna,Commercial,,295.25,70.6,,418.2,418.2,418.2,Fee Schedule,70.6
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,418.2,250.92,Aetna,Commercial,,,,,418.2,,,,
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,220.61,132.36,Aetna,Commercial,,,,,220.61,,,,
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Aetna,Commercial,,,,,237.45,,,,
BONE SRVY INFANT CR,77076,CPT,,,,,both,,,833.32,833.32,Aetna,Commercial,,588.32,70.6,,833.32,833.32,833.32,Fee Schedule,70.6
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,833.32,499.99,Aetna,Commercial,,,,,833.32,,,,
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
JOINT SURVEY 1V CR,77077,CPT,,,,,both,,,1387.37,1387.37,Aetna,Commercial,,979.48,70.6,,1387.37,1387.37,1387.37,Fee Schedule,70.6
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,1387.37,832.42,Aetna,Commercial,,,,,1387.37,,,,
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,218.93,131.35,Aetna,Commercial,,,,,218.93,,,,
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,235.77,141.46,Aetna,Commercial,,,,,235.77,,,,
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,613.55,368.13,Aetna,Commercial,,,,,613.55,,,,
DEXA AXIAL,77080,CPT,,,,,both,, ,218.93,131.35,Aetna,Commercial,,,,,218.93,,,,
DEXA AXIAL,77080,CPT,,,,,both,, ,235.77,141.46,Aetna,Commercial,,,,,235.77,,,,
DEXA AXIAL,77080,CPT,,,,,both,,,430.83,430.83,Aetna,Commercial,,304.17,70.6,,430.83,430.83,430.83,Fee Schedule,70.6
DEXA AXIAL,77080,CPT,,,,,both,, ,430.83,258.49,Aetna,Commercial,,,,,430.83,,,,
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,139.21,83.52,Aetna,Commercial,,,,,139.21,,,,
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,149.88,89.92,Aetna,Commercial,,,,,149.88,,,,
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,266.91,160.14,Aetna,Commercial,,,,,266.91,,,,
NM-THYR UPT S-M-SUPP,78012,CPT,,,,,both,, ,1025.37,615.22,Aetna,Commercial,,,,,1025.37,,,,
NM-THYROID IMG W-BF,78013,CPT,,,,,both,, ,1365.27,819.16,Aetna,Commercial,,,,,1365.27,,,,
NM-THY UPT IMG W-BF,78014,CPT,,,,,both,, ,1719.59,1031.75,Aetna,Commercial,,,,,1719.59,,,,
NM-PAR PLAN THY IMG,78070,CPT,,,,,both,, ,1365.27,819.16,Aetna,Commercial,,,,,1365.27,,,,
NM-PARA PLN IMG SPEC,78071,CPT,,,,,both,, ,1884.64,1130.78,Aetna,Commercial,,,,,1884.64,,,,
NM-PAR PL IMG SPE CT,78072,CPT,,,,,both,, ,1884.64,1130.78,Aetna,Commercial,,,,,1884.64,,,,
NM-ADRENAL IMAGING,78075,CPT,,,,,both,, ,5329.74,3197.84,Aetna,Commercial,,,,,5329.74,,,,
NM-BONE MARROW LMTD,78102,CPT,,,,,both,, ,1409.3,845.58,Aetna,Commercial,,,,,1409.3,,,,
NM-BONE MARROW MULT,78103,CPT,,,,,both,, ,1409.3,845.58,Aetna,Commercial,,,,,1409.3,,,,
NM-BONE MARROW BODY,78104,CPT,,,,,both,, ,1409.3,845.58,Aetna,Commercial,,,,,1409.3,,,,
NM-LYMPHATICS NODES,78195,CPT,,,,,both,, ,4917.74,2950.64,Aetna,Commercial,,,,,4917.74,,,,
NM-LIVER,78201,CPT,,,,,both,, ,3830.06,2298.03,Aetna,Commercial,,,,,3830.06,,,,
NM-LIVER AND SPLEEN,78215,CPT,,,,,both,, ,3830.06,2298.03,Aetna,Commercial,,,,,3830.06,,,,
NM-HEPATOBILIARY SYS,78226,CPT,,,,,both,, ,4088.59,2453.15,Aetna,Commercial,,,,,4088.59,,,,
NM-HEPATOBIL W PHARM,78227,CPT,,,,,both,,,4088.59,4088.59,Aetna,Commercial,,2886.54,70.6,,4088.59,4088.59,4088.59,Fee Schedule,70.6
NM-HEPATOBIL W PHARM,78227,CPT,,,,,both,, ,4088.59,2453.15,Aetna,Commercial,,,,,4088.59,,,,
NM-GI REFLUX,78262,CPT,,,,,both,, ,3415.74,2049.44,Aetna,Commercial,,,,,3415.74,,,,
NM-GASTRIC EMPTYING,78264,CPT,,,,,both,,,3415.74,3415.74,Aetna,Commercial,,2411.51,70.6,,3415.74,3415.74,3415.74,Fee Schedule,70.6
NM-GASTRIC EMPTYING,78264,CPT,,,,,both,, ,3415.74,2049.44,Aetna,Commercial,,,,,3415.74,,,,
NM-GAST EMPT SM BWL,78265,CPT,,,,,both,, ,1543.71,926.22,Aetna,Commercial,,,,,1543.71,,,,
NM-GE SM BWL CLN MUL,78266,CPT,,,,,both,, ,2046.87,1228.12,Aetna,Commercial,,,,,2046.87,,,,
NM-GI BLOOD LOSS,78278,CPT,,,,,both,, ,3415.74,2049.44,Aetna,Commercial,,,,,3415.74,,,,
NM-MECKELS SCAN,78290,CPT,,,,,both,, ,3576.68,2146,Aetna,Commercial,,,,,3576.68,,,,
NM-BONE SCAN LMTD,78300,CPT,,,,,both,, ,2526.59,1515.95,Aetna,Commercial,,,,,2526.59,,,,
NM-BONE SCAN MULTI,78305,CPT,,,,,both,, ,2526.59,1515.95,Aetna,Commercial,,,,,2526.59,,,,
NM-BONE SCAN BODY,78306,CPT,,,,,both,,,3512.04,3512.04,Aetna,Commercial,,2479.5,70.6,,3512.04,3512.04,3512.04,Fee Schedule,70.6
NM-BONE SCAN BODY,78306,CPT,,,,,both,, ,3512.04,2107.22,Aetna,Commercial,,,,,3512.04,,,,
NM-BONE SCAN 3 PHASE,78315,CPT,,,,,both,,,2911.81,2911.81,Aetna,Commercial,,2055.74,70.6,,2911.81,2911.81,2911.81,Fee Schedule,70.6
NM-BONE SCAN 3 PHASE,78315,CPT,,,,,both,, ,2911.81,1747.08,Aetna,Commercial,,,,,2911.81,,,,
NM-VASCULAR FLOW,78445,CPT,,,,,both,, ,1719.84,1031.9,Aetna,Commercial,,,,,1719.84,,,,
NM-MYOCRD SPECT SNGL,78451,CPT,,,,,both,, ,3741.73,2245.03,Aetna,Commercial,,,,,3741.73,,,,
NM-MYOCRD SPECT MULT,78452,CPT,,,,,both,,,7071.47,7071.47,Aetna,Commercial,,4992.46,70.6,,7071.47,7071.47,7071.47,Fee Schedule,70.6
NM-MYOCRD SPECT MULT,78452,CPT,,,,,both,, ,7071.47,4242.88,Aetna,Commercial,,,,,7071.47,,,,
NM-MYOCARD SINGLE,78453,CPT,,,,,both,, ,4803.15,2881.89,Aetna,Commercial,,,,,4803.15,,,,
NM-MYOCARD INFARCT,78466,CPT,,,,,both,, ,3415.74,2049.44,Aetna,Commercial,,,,,3415.74,,,,
NM-MYOCARD INF SPECT,78469,CPT,,,,,both,, ,3184.5,1910.7,Aetna,Commercial,,,,,3184.5,,,,
NM-GATED BLD POOL SN,78472,CPT,,,,,both,, ,3415.74,2049.44,Aetna,Commercial,,,,,3415.74,,,,
NM-LUNG VENT IMAGING,78579,CPT,,,,,both,,,4088.59,4088.59,Aetna,Commercial,,2886.54,70.6,,4088.59,4088.59,4088.59,Fee Schedule,70.6
NM-LUNG VENT IMAGING,78579,CPT,,,,,both,, ,4088.59,2453.15,Aetna,Commercial,,,,,4088.59,,,,
NM-LUNG PERF PARTICU,78580,CPT,,,,,both,, ,3590.32,2154.19,Aetna,Commercial,,,,,3590.32,,,,
NM-LUNG VENT PERFUS,78582,CPT,,,,,both,,,6243.6,6243.6,Aetna,Commercial,,4407.98,70.6,,6243.6,6243.6,6243.6,Fee Schedule,70.6
NM-LUNG VENT PERFUS,78582,CPT,,,,,both,, ,6243.6,3746.16,Aetna,Commercial,,,,,6243.6,,,,
NM-LUNG PERFVENT DIF,78598,CPT,,,,,both,, ,8897.66,5338.59,Aetna,Commercial,,,,,8897.66,,,,
NM-BRAIN CSF CISTERN,78630,CPT,,,,,both,, ,1616.07,969.64,Aetna,Commercial,,,,,1616.07,,,,
NM-KIDNEY STATIC,78700,CPT,,,,,both,, ,3590.32,2154.19,Aetna,Commercial,,,,,3590.32,,,,
NM-KIDNEY STATIC FLO,78701,CPT,,,,,both,, ,4802.63,2881.57,Aetna,Commercial,,,,,4802.63,,,,
NM-KIDNEY VF NO PHRM,78707,CPT,,,,,both,, ,4802.63,2881.57,Aetna,Commercial,,,,,4802.63,,,,
NM-KID VF PHRM SNGL,78708,CPT,,,,,both,, ,4802.63,2881.57,Aetna,Commercial,,,,,4802.63,,,,
NM-KIDNEY FUNCTION,78725,CPT,,,,,both,, ,617.74,370.64,Aetna,Commercial,,,,,617.74,,,,
NM-URIN BLDDR REFLUX,78740,CPT,,,,,both,, ,3590.32,2154.19,Aetna,Commercial,,,,,3590.32,,,,
NM-TUMOR LOC LMTD,78800,CPT,,,,,both,, ,4590.83,2754.49,Aetna,Commercial,,,,,4590.83,,,,
NM-TUMOR LOC LMTD 1D,78800,CPT,,,,,both,, ,4917.74,2950.64,Aetna,Commercial,,,,,4917.74,,,,
NM-TUMOR LOC MULTI,78801,CPT,,,,,both,, ,4917.74,2950.64,Aetna,Commercial,,,,,4917.74,,,,
NM-TUMOR LOC BDY 1D,78802,CPT,,,,,both,, ,6129.79,3677.87,Aetna,Commercial,,,,,6129.79,,,,
NM-TUMOR LOC BODY,78802,CPT,,,,,both,, ,4590.83,2754.49,Aetna,Commercial,,,,,4590.83,,,,
NM-TUMR LOC SPECT 1D,78803,CPT,,,,,both,, ,5042.88,3025.72,Aetna,Commercial,,,,,5042.88,,,,
NM-TUMR LOC BDY >1D,78804,CPT,,,,,both,, ,5251.46,3150.87,Aetna,Commercial,,,,,5251.46,,,,
NM-UNLISTED MISC,78999,CPT,,,,,both,, ,593.54,356.12,Aetna,Commercial,,,,,593.54,,,,
NUCLEAR RX IV ADMIN,79101,CPT,,,,,both,, ,1716.5,1029.9,Aetna,Commercial,,,,,1716.5,,,,
BASIC META W-ION CA,80047,CPT,,,,,both,, ,29.19,17.51,Aetna,Commercial,,,,,29.19,,,,
BASIC META W-ION CA,80047,CPT,,,,,both,, ,163.63,98.17,Aetna,Commercial,,,,,163.63,,,,
BASIC METABO CA TOTA,80048,CPT,,,,,both,, ,89.53,53.71,Aetna,Commercial,,,,,89.53,,,,
BASIC METABO CA TOTA,80048,CPT,,,,,both,, ,510.83,306.49,Aetna,Commercial,,,,,510.83,,,,
Basic metabolic panel,80048,CPT,,,,,both,,,510.83,510.83,Aetna,Commercial,,360.65,70.6,,510.83,510.83,510.83,Fee Schedule,70.6
GENERAL HEALTH PANEL,80050,CPT,,,,,both,,,1796.88,1796.88,Aetna,Commercial,,1268.6,70.6,,1796.88,1796.88,1796.88,Fee Schedule,70.6
GENERAL HEALTH PANEL,80050,CPT,,,,,both,, ,1796.88,1078.12,Aetna,Commercial,,,,,1796.88,,,,
ELECTROLYTE PANEL,80051,CPT,,,,,both,, ,74.1,44.46,Aetna,Commercial,,,,,74.1,,,,
ELECTROLYTE PANEL,80051,CPT,,,,,both,, ,390.41,234.24,Aetna,Commercial,,,,,390.41,,,,
"Blood test, comprehensive group of blood chemicals",80053,CPT,,,,,both,,,630.96,630.96,Aetna,Commercial,,445.46,70.6,,630.96,630.96,630.96,Fee Schedule,70.6
COMP METAB PANEL,80053,CPT,,,,,both,, ,111.7,67.02,Aetna,Commercial,,,,,111.7,,,,
COMP METAB PANEL,80053,CPT,,,,,both,, ,630.96,378.57,Aetna,Commercial,,,,,630.96,,,,
Obstetric blood test panel,80055,CPT,,,,,both,,,1727.55,1727.55,Aetna,Commercial,,1219.65,70.6,,1727.55,1727.55,1727.55,Fee Schedule,70.6
OBSTETRIC PANEL,80055,CPT,,,,,both,, ,350.84,210.5,Aetna,Commercial,,,,,350.84,,,,
OBSTETRIC PANEL,80055,CPT,,,,,both,, ,1727.55,1036.53,Aetna,Commercial,,,,,1727.55,,,,
"Blood test, lipids (cholesterol and triglycerides)",80061,CPT,,,,,both,,,565.84,565.84,Aetna,Commercial,,399.48,70.6,,565.84,565.84,565.84,Fee Schedule,70.6
LIPID PANEL,80061,CPT,,,,,both,, ,86.73,52.03,Aetna,Commercial,,,,,86.73,,,,
Q92145 LIPID PANEL,80061,CPT,,,,,both,, ,565.84,339.5,Aetna,Commercial,,,,,565.84,,,,
Q92145 LIPID PANEL,80061,CPT,,,,,both,, ,565.84,339.5,Aetna,Commercial,,,,,565.84,,,,
Kidney function panel test,80069,CPT,,,,,both,,,570.89,570.89,Aetna,Commercial,,403.05,70.6,,570.89,570.89,570.89,Fee Schedule,70.6
RENAL FUNCTION PANEL,80069,CPT,,,,,both,, ,91.77,55.06,Aetna,Commercial,,,,,91.77,,,,
RENAL FUNCTION PANEL,80069,CPT,,,,,both,, ,570.89,342.53,Aetna,Commercial,,,,,570.89,,,,
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,, ,282.08,169.24,Aetna,Commercial,,,,,282.08,,,,
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,,,3484.29,3484.29,Aetna,Commercial,,2459.91,70.6,,3484.29,3484.29,3484.29,Fee Schedule,70.6
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,, ,3484.29,2090.57,Aetna,Commercial,,,,,3484.29,,,,
HEPATIC FUNCTION PAN,80076,CPT,,,,,both,, ,86.45,51.87,Aetna,Commercial,,,,,86.45,,,,
HEPATIC FUNCTION PAN,80076,CPT,,,,,both,, ,450.48,270.28,Aetna,Commercial,,,,,450.48,,,,
Liver function blood test panel,80076,CPT,,,,,both,,,450.48,450.48,Aetna,Commercial,,318.04,70.6,,450.48,450.48,450.48,Fee Schedule,70.6
OBSTETRIC PNL W HIV,80081,CPT,,,,,both,, ,1883.6,1130.16,Aetna,Commercial,,,,,1883.6,,,,
ACETAMINOPHEN QT,80143,CPT,,,,,both,, ,186.06,111.63,Aetna,Commercial,,,,,186.06,,,,
Q36298 ADM LEV IBD,80145,CPT,,,,,both,, ,174.02,104.41,Aetna,Commercial,,,,,174.02,,,,
AMIKACIN,80150,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q36721 AMIOD HPLC/LC,80151,CPT,,,,,both,, ,546.19,327.71,Aetna,Commercial,,,,,546.19,,,,
CARBAMAZEPINE TOTAL,80156,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
Q18948 CBZ FREE LCMS,80157,CPT,,,,,both,, ,88.4,53.04,Aetna,Commercial,,,,,88.4,,,,
CYCLOSPORINE,80158,CPT,,,,,both,, ,91.49,54.89,Aetna,Commercial,,,,,91.49,,,,
CYCLOSPORINE,80158,CPT,,,,,both,, ,1555.5,933.3,Aetna,Commercial,,,,,1555.5,,,,
Q15220CYC A BL LCMSM,80158,CPT,,,,,both,, ,1555.5,933.3,Aetna,Commercial,,,,,1555.5,,,,
Q8812 CYA TRGH BL IA,80158,CPT,,,,,both,, ,1555.5,933.3,Aetna,Commercial,,,,,1555.5,,,,
Q1769 CLOZAP LCMSMS,80159,CPT,,,,,both,, ,95.43,57.25,Aetna,Commercial,,,,,95.43,,,,
Q1769 CLOZAP LCMSMS,80159,CPT,,,,,both,, ,95.43,57.25,Aetna,Commercial,,,,,95.43,,,,
DIGOXIN TOTAL,80162,CPT,,,,,both,, ,130.23,78.13,Aetna,Commercial,,,,,130.23,,,,
DIGOXIN TOTAL,80162,CPT,,,,,both,, ,787.57,472.54,Aetna,Commercial,,,,,787.57,,,,
DIGOXIN FREE,80163,CPT,,,,,both,, ,130.23,78.13,Aetna,Commercial,,,,,130.23,,,,
Q6651 VALP ACID TOT,80164,CPT,,,,,both,, ,691.06,414.63,Aetna,Commercial,,,,,691.06,,,,
VALPROIC ACID TOTAL,80164,CPT,,,,,both,, ,132.76,79.65,Aetna,Commercial,,,,,132.76,,,,
VALPROIC ACID TOTAL,80164,CPT,,,,,both,,,711.79,711.79,Aetna,Commercial,,502.52,70.6,,711.79,711.79,711.79,Fee Schedule,70.6
VALPROIC ACID TOTAL,80164,CPT,,,,,both,, ,711.79,427.07,Aetna,Commercial,,,,,711.79,,,,
Q6651 VALP ACID FREE,80165,CPT,,,,,both,, ,691.06,414.63,Aetna,Commercial,,,,,691.06,,,,
VALPROIC ACID FREE,80165,CPT,,,,,both,, ,132.76,79.65,Aetna,Commercial,,,,,132.76,,,,
VALPROIC ACID FREE,80165,CPT,,,,,both,, ,711.79,427.07,Aetna,Commercial,,,,,711.79,,,,
Q3081 FELBAMATE MS,80167,CPT,,,,,both,, ,191.99,115.19,Aetna,Commercial,,,,,191.99,,,,
ETHOSUXIMIDE,80168,CPT,,,,,both,, ,864.19,518.51,Aetna,Commercial,,,,,864.19,,,,
Q18883 EVEROLI LM/MS,80169,CPT,,,,,both,, ,106.93,64.15,Aetna,Commercial,,,,,106.93,,,,
GENTAMICIN,80170,CPT,,,,,both,, ,900.96,540.57,Aetna,Commercial,,,,,900.96,,,,
GABAPENTIN QT,80171,CPT,,,,,both,, ,105.53,63.31,Aetna,Commercial,,,,,105.53,,,,
L716811 GABAP LCMSMS,80171,CPT,,,,,both,, ,102.46,61.47,Aetna,Commercial,,,,,102.46,,,,
HALOPERIDOL,80173,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,,,,871.22,,,,
Q22060 LAMOTR LCMSMS,80175,CPT,,,,,both,, ,105.53,63.31,Aetna,Commercial,,,,,105.53,,,,
Q22060 LAMOTR LCMSMS,80175,CPT,,,,,both,, ,105.53,63.31,Aetna,Commercial,,,,,105.53,,,,
Q605 LIDOCAINE IA,80176,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,,,,871.22,,,,
Q605 LIDOCAINE IA,80176,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,,,,871.22,,,,
Q15142 LEVE LC/MS/MS,80177,CPT,,,,,both,, ,105.53,63.31,Aetna,Commercial,,,,,105.53,,,,
Lithium,80178,CPT,,,,,both,,,420.72,420.72,Aetna,Commercial,,297.03,70.6,,420.72,420.72,420.72,Fee Schedule,70.6
LITHIUM,80178,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
SALICYLATE QT,80179,CPT,,,,,both,, ,191.99,115.19,Aetna,Commercial,,,,,191.99,,,,
Q10662 MPA LC/MS/MS,80180,CPT,,,,,both,, ,143.71,86.22,Aetna,Commercial,,,,,143.71,,,,
Q36637 OCBZ LC/MS/MS,80183,CPT,,,,,both,, ,122.37,73.42,Aetna,Commercial,,,,,122.37,,,,
Q36637 OCBZ LC/MS/MS,80183,CPT,,,,,both,, ,122.37,73.42,Aetna,Commercial,,,,,122.37,,,,
PHENOBARBITAL,80184,CPT,,,,,both,, ,120.96,72.57,Aetna,Commercial,,,,,120.96,,,,
Q751 PHENOBARBITAL,80184,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,,,,871.22,,,,
Q751 PHENOBARBITAL,80184,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,,,,871.22,,,,
L70706 PHENYTOIN TOT,80185,CPT,,,,,both,, ,847.64,508.58,Aetna,Commercial,,,,,847.64,,,,
L70706 PHENYTOIN TOT,80185,CPT,,,,,both,, ,847.64,508.58,Aetna,Commercial,,,,,847.64,,,,
PHENYTOIN TOTAL,80185,CPT,,,,,both,, ,140.05,84.03,Aetna,Commercial,,,,,140.05,,,,
L70706PHENYTOIN FREE,80186,CPT,,,,,both,, ,91.77,55.06,Aetna,Commercial,,,,,91.77,,,,
L70706PHENYTOIN FREE,80186,CPT,,,,,both,, ,91.77,55.06,Aetna,Commercial,,,,,91.77,,,,
PRIMIDONE,80188,CPT,,,,,both,, ,1757.58,1054.54,Aetna,Commercial,,,,,1757.58,,,,
Q751 PRIMIDONE,80188,CPT,,,,,both,, ,878.79,527.27,Aetna,Commercial,,,,,878.79,,,,
PROCAINAMIDE+NAPA,80192,CPT,,,,,both,, ,900.96,540.57,Aetna,Commercial,,,,,900.96,,,,
QUINIDINE,80194,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,,,,765.96,,,,
SIROLIMUS,80195,CPT,,,,,both,, ,257.1,154.26,Aetna,Commercial,,,,,257.1,,,,
SIROLIMUS,80195,CPT,,,,,both,, ,257.1,154.26,Aetna,Commercial,,,,,257.1,,,,
Q70007 TAC HS LCMSMS,80197,CPT,,,,,both,, ,822.37,493.42,Aetna,Commercial,,,,,822.37,,,,
Q70007 TAC HS LCMSMS,80197,CPT,,,,,both,, ,822.37,493.42,Aetna,Commercial,,,,,822.37,,,,
THEOPHYLLINE,80198,CPT,,,,,both,, ,781.11,468.66,Aetna,Commercial,,,,,781.11,,,,
"THEOPHYLLINE, SERUM",80198,CPT,,,,,both,, ,149.6,89.76,Aetna,Commercial,,,,,149.6,,,,
"THEOPHYLLINE, SERUM",80198,CPT,,,,,both,, ,149.6,89.76,Aetna,Commercial,,,,,149.6,,,,
TIAGABINE QT,80199,CPT,,,,,both,, ,143.71,86.22,Aetna,Commercial,,,,,143.71,,,,
TOBRAMYCIN,80200,CPT,,,,,both,, ,75.5,45.3,Aetna,Commercial,,,,,75.5,,,,
TOPIRAMATE,80201,CPT,,,,,both,, ,445.71,267.42,Aetna,Commercial,,,,,445.71,,,,
VANCOMYCIN,80202,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,,,,765.96,,,,
ZONISAMIDE,80203,CPT,,,,,both,, ,105.53,63.31,Aetna,Commercial,,,,,105.53,,,,
ZONISAMIDE,80203,CPT,,,,,both,, ,105.53,63.31,Aetna,Commercial,,,,,105.53,,,,
Q648 METHOTREXATE IA,80204,CPT,,,,,both,, ,501.1,300.66,Aetna,Commercial,,,,,501.1,,,,
L503870 INFLIXIMAB,80230,CPT,,,,,both,, ,159.65,95.79,Aetna,Commercial,,,,,159.65,,,,
L504567 VEDOLIZUMAB,80280,CPT,,,,,both,, ,198.79,119.27,Aetna,Commercial,,,,,198.79,,,,
DRUG UNSPEC QUANT,80299,CPT,,,,,both,, ,873.46,524.07,Aetna,Commercial,,,,,873.46,,,,
L7609 DOXEPIN LCMSMS,80299,CPT,,,,,both,, ,148.4,89.04,Aetna,Commercial,,,,,148.4,,,,
Q2548 DRUG UNSPEC QT,80299,CPT,,,,,both,, ,546.19,327.71,Aetna,Commercial,,,,,546.19,,,,
Q2548 DRUG UNSPEC QT,80299,CPT,,,,,both,, ,546.19,327.71,Aetna,Commercial,,,,,546.19,,,,
Q29391DEXAMET LCMSMS,80299,CPT,,,,,both,, ,342,205.2,Aetna,Commercial,,,,,342,,,,
Q8389 FLUOXET LCMSMS,80299,CPT,,,,,both,, ,811.42,486.85,Aetna,Commercial,,,,,811.42,,,,
PRS DRG IA VIS,80305,CPT,,,,,both,, ,137.8,82.68,Aetna,Commercial,,,,,137.8,,,,
PRS DRG IA MET,80306,CPT,,,,,both,, ,137.8,82.68,Aetna,Commercial,,,,,137.8,,,,
733726 URINE DRUG PROFILE 14/MEDWATCH,80307,CPT,,,,,both,, ,360,216,Aetna,Commercial,,,,,360,,,,
DRUGPROF ORAL FLD,80307,CPT,,,,,both,, ,116,69.6,Aetna,Commercial,,,,,116,,,,
L074401 AMPH UR SCRN,80307,CPT,,,,,both,, ,60,36,Aetna,Commercial,,,,,60,,,,
L074401 AMPH UR SCRN,80307,CPT,,,,,both,, ,60,36,Aetna,Commercial,,,,,60,,,,
L733740 ULTRM SCR UR,80307,CPT,,,,,both,, ,200,120,Aetna,Commercial,,,,,200,,,,
L790600 DAB SCN PRES,80307,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
L790600 DAB SCN PRES,80307,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
PRS DRG IA ANAZ,80307,CPT,,,,,both,,,1174.34,1174.34,Aetna,Commercial,,829.08,70.6,,1174.34,1174.34,1174.34,Fee Schedule,70.6
Q19027 CONF DRUG 1 U,80307,CPT,,,,,both,, ,1174.34,704.6,Aetna,Commercial,,,,,1174.34,,,,
Q19027 CONF DRUG 1 U,80307,CPT,,,,,both,, ,1174.34,704.6,Aetna,Commercial,,,,,1174.34,,,,
Q643 METHYL ALC BL C,80320,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,,,,728.07,,,,
ALKALOIDS NOS MS,80323,CPT,,,,,both,, ,713.47,428.08,Aetna,Commercial,,,,,713.47,,,,
Q90642NIC&COT S LCMS,80323,CPT,,,,,both,, ,713.47,428.08,Aetna,Commercial,,,,,713.47,,,,
Q90646NIC&COT U LCMS,80323,CPT,,,,,both,, ,713.47,428.08,Aetna,Commercial,,,,,713.47,,,,
Q241Z AMPHET U GC/MS,80324,CPT,,,,,both,, ,184.68,110.8,Aetna,Commercial,,,,,184.68,,,,
Q241Z AMPHET U GC/MS,80324,CPT,,,,,both,, ,184.68,110.8,Aetna,Commercial,,,,,184.68,,,,
L790600 AMPH MS 5P,80326,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
ANABOLC STRD MS 1-2,80327,CPT,,,,,both,, ,269.16,161.49,Aetna,Commercial,,,,,269.16,,,,
L790600 ANLGNO MS 6P,80331,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
ANTIDPRS SERO MS 3-5,80333,CPT,,,,,both,, ,771.01,462.6,Aetna,Commercial,,,,,771.01,,,,
L790600 AD MS 6PL,80334,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
Q272 NORTRI LC/MS/MS,80335,CPT,,,,,both,, ,826.59,495.95,Aetna,Commercial,,,,,826.59,,,,
Q272 NORTRI LC/MS/MS,80335,CPT,,,,,both,, ,826.59,495.95,Aetna,Commercial,,,,,826.59,,,,
Q412 DESIPRAM LCMSMS,80335,CPT,,,,,both,, ,826.59,495.95,Aetna,Commercial,,,,,826.59,,,,
Q412 DESIPRAM LCMSMS,80335,CPT,,,,,both,, ,826.59,495.95,Aetna,Commercial,,,,,826.59,,,,
Q887 IMIPRAM LCMSMS,80335,CPT,,,,,both,, ,826.59,495.95,Aetna,Commercial,,,,,826.59,,,,
Q887 IMIPRAM LCMSMS,80335,CPT,,,,,both,, ,826.59,495.95,Aetna,Commercial,,,,,826.59,,,,
ANTIDPRS TRIC MS 3-5,80336,CPT,,,,,both,, ,571.45,342.87,Aetna,Commercial,,,,,571.45,,,,
L790600 ADEP TRI 6PL,80337,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
ANTIDPRS NOS MS,80338,CPT,,,,,both,, ,928.18,556.9,Aetna,Commercial,,,,,928.18,,,,
L790600 AD NOS MS,80338,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
L790600 AED MS 7P,80341,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
ANTIPSYCH NOS MS 1-3,80342,CPT,,,,,both,, ,811.42,486.85,Aetna,Commercial,,,,,811.42,,,,
L790600 APD MS 7P,80344,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
L809630 FLTZP MS,80346,CPT,,,,,both,, ,600,360,Aetna,Commercial,,,,,600,,,,
Q340 CLONAZEP LCMSMS,80346,CPT,,,,,both,, ,814.24,488.54,Aetna,Commercial,,,,,814.24,,,,
Q340 CLONAZEP LCMSMS,80346,CPT,,,,,both,, ,814.24,488.54,Aetna,Commercial,,,,,814.24,,,,
L790600 BZD MS 13P,80347,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
L790600 BUP MS,80348,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
L790600 BUP MS,80348,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
Q93031 BUPRENOPHINE & METABOLITIES LC/MS,80348,CPT,,,,,both,, ,119.25,71.55,Aetna,Commercial,,,,,119.25,,,,
CANNABINDS NATUR MS,80349,CPT,,,,,both,, ,147.91,88.74,Aetna,Commercial,,,,,147.91,,,,
L790697 SYNCBD WB MS,80352,CPT,,,,,both,, ,300,180,Aetna,Commercial,,,,,300,,,,
L790600 COCAINE MS,80353,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
FENTANYL MS,80354,CPT,,,,,both,, ,534.41,320.64,Aetna,Commercial,,,,,534.41,,,,
L790600 FENT MET MS,80354,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
GABAPENTIN NONBLD MS,80355,CPT,,,,,both,, ,534.41,320.64,Aetna,Commercial,,,,,534.41,,,,
L790600 GPT NBLD MS,80355,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
HEROIN METABOLITE MS,80356,CPT,,,,,both,, ,227.91,136.74,Aetna,Commercial,,,,,227.91,,,,
L790600 KET NKET MS,80357,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
L790600 MTD MS,80358,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
METHADONE MS,80358,CPT,,,,,both,, ,327.54,196.52,Aetna,Commercial,,,,,327.54,,,,
L791194 MDMA MS,80359,CPT,,,,,both,, ,133.38,80.02,Aetna,Commercial,,,,,133.38,,,,
Q84578 MDMA MS,80359,CPT,,,,,both,, ,404.17,242.5,Aetna,Commercial,,,,,404.17,,,,
Q84578 MDMA MS,80359,CPT,,,,,both,, ,404.17,242.5,Aetna,Commercial,,,,,404.17,,,,
L790600 MPH MS,80360,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
L790600 OPI MS 1P,80361,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
OPIATES MS 1 PL,80361,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
Q20907 OPI MS,80361,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
L790600 OPD OPI MS5P,80364,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
L790600 OXY MS,80365,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
Q20907 OXY MS,80365,CPT,,,,,both,, ,428.58,257.14,Aetna,Commercial,,,,,428.58,,,,
Q20907 OXY MS,80365,CPT,,,,,both,, ,428.58,257.14,Aetna,Commercial,,,,,428.58,,,,
L790600 PGB MS,80366,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
PREGABALIN MS,80366,CPT,,,,,both,, ,811.42,486.85,Aetna,Commercial,,,,,811.42,,,,
L790600 PPX MS,80367,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
L790600 SED HYP MS,80368,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
L790600 SM RLX MS3PL,80370,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
L790600 STIM SYN MS,80371,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
L790600 TAPENTADL MS,80372,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
L761019TRAMADOL CONF,80373,CPT,,,,,both,, ,412,247.2,Aetna,Commercial,,,,,412,,,,
L790600 TRA MS,80373,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
DEF DRUG NOS MS 1-3,80375,CPT,,,,,both,, ,546.19,327.71,Aetna,Commercial,,,,,546.19,,,,
DEF DRUG NOS MS 7PL,80377,CPT,,,,,both,, ,571.45,342.87,Aetna,Commercial,,,,,571.45,,,,
L790600 DRGNOS MS 7P,80377,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
Manual urinalysis test with examination using microscope,81001,CPT,,,,,both,,,240.26,240.26,Aetna,Commercial,,169.62,70.6,,240.26,240.26,240.26,Fee Schedule,70.6
"UA, AUTO W-SCOPE",81001,CPT,,,,,both,, ,33.39,20.03,Aetna,Commercial,,,,,33.39,,,,
"UA, AUTO W-SCOPE",81001,CPT,,,,,both,, ,240.26,144.15,Aetna,Commercial,,,,,240.26,,,,
Automated urinalysis test,81003,CPT,,,,,both,,,210.5,210.5,Aetna,Commercial,,148.61,70.6,,210.5,210.5,210.5,Fee Schedule,70.6
"UA, AUTO, W-O SCOPE",81003,CPT,,,,,both,, ,23.85,14.31,Aetna,Commercial,,,,,23.85,,,,
"UA, AUTO, W-O SCOPE",81003,CPT,,,,,both,, ,210.5,126.3,Aetna,Commercial,,,,,210.5,,,,
URINALYSIS,81005,CPT,,,,,both,, ,180.19,108.11,Aetna,Commercial,,,,,180.19,,,,
MICROSCOPIC EX OF UR,81015,CPT,,,,,both,, ,10.55,6.33,Aetna,Commercial,,,,,10.55,,,,
MICROSCOPIC EX OF UR,81015,CPT,,,,,both,, ,180.19,108.11,Aetna,Commercial,,,,,180.19,,,,
URINE PREG TEST QL,81025,CPT,,,,,both,, ,23.58,14.14,Aetna,Commercial,,,,,23.58,,,,
URINE PREG TEST QL,81025,CPT,,,,,both,,,420.72,420.72,Aetna,Commercial,,297.03,70.6,,420.72,420.72,420.72,Fee Schedule,70.6
URINE PREG TEST QL,81025,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
"L910235 URINE VOLUME, TIMED",81050,CPT,,,,,both,, ,30.64,18.38,Aetna,Commercial,,,,,30.64,,,,
Q91863 BRCADVAN COMP,81162,CPT,,,,,both,, ,5261.25,3156.75,Aetna,Commercial,,,,,5261.25,,,,
L480510 BCRABL1 KDMA,81170,CPT,,,,,both,, ,1792,1075.2,Aetna,Commercial,,,,,1792,,,,
Q91065 P210 BCRABL1,81206,CPT,,,,,both,, ,552.22,331.33,Aetna,Commercial,,,,,552.22,,,,
Q91065 P190 BCRABL1,81207,CPT,,,,,both,, ,487.83,292.69,Aetna,Commercial,,,,,487.83,,,,
BRAF GENE ANALY V600,81210,CPT,,,,,both,, ,393.84,236.3,Aetna,Commercial,,,,,393.84,,,,
L489450 CALR MA,81219,CPT,,,,,both,, ,675,405,Aetna,Commercial,,,,,675,,,,
Q10458 CFSCN OLA-PCR,81220,CPT,,,,,both,, ,1100,660,Aetna,Commercial,,,,,1100,,,,
L252900 CF CFTR DD,81222,CPT,,,,,both,, ,930,558,Aetna,Commercial,,,,,930,,,,
L511230 CYT P450 2D6,81226,CPT,,,,,both,, ,600,360,Aetna,Commercial,,,,,600,,,,
Q161608 CYP2C9 GN AN,81227,CPT,,,,,both,, ,610,366,Aetna,Commercial,,,,,610,,,,
EGFR GENE COM VAR,81235,CPT,,,,,both,, ,963.55,578.13,Aetna,Commercial,,,,,963.55,,,,
F2 GEN ANALY 20210GA,81240,CPT,,,,,both,, ,2183.65,1310.19,Aetna,Commercial,,,,,2183.65,,,,
Q17909 PGM HYBEACONS,81240,CPT,,,,,both,, ,1091.82,655.09,Aetna,Commercial,,,,,1091.82,,,,
Q17900 FVLM HYBEACON,81241,CPT,,,,,both,, ,2183.65,1310.19,Aetna,Commercial,,,,,2183.65,,,,
Q17900 FVLM HYBEACON,81241,CPT,,,,,both,, ,2183.65,1310.19,Aetna,Commercial,,,,,2183.65,,,,
FMR1 GENE ANALY AB,81243,CPT,,,,,both,, ,1863.12,1117.87,Aetna,Commercial,,,,,1863.12,,,,
Q35079 HHC FRFLP-PCR,81256,CPT,,,,,both,, ,3396.72,2038.03,Aetna,Commercial,,,,,3396.72,,,,
Q35079 HHC FRFLP-PCR,81256,CPT,,,,,both,, ,3396.72,2038.03,Aetna,Commercial,,,,,3396.72,,,,
Q11175AGLOB MUT PCR,81257,CPT,,,,,both,, ,477.7,286.62,Aetna,Commercial,,,,,477.7,,,,
L489421 JAK2V617F QL,81270,CPT,,,,,both,, ,1306.56,783.93,Aetna,Commercial,,,,,1306.56,,,,
Q16539 JAK2 V617F QL,81270,CPT,,,,,both,, ,1424.14,854.48,Aetna,Commercial,,,,,1424.14,,,,
Q16539 JAK2 V617F QL,81270,CPT,,,,,both,, ,1424.14,854.48,Aetna,Commercial,,,,,1424.14,,,,
L511040 CHRO ANA CMA,81277,CPT,,,,,both,, ,2260,1356,Aetna,Commercial,,,,,2260,,,,
L115101 JAK2 EX12-15,81279,CPT,,,,,both,, ,865.04,519.02,Aetna,Commercial,,,,,865.04,,,,
Q90251 IL28B RT-PCR,81283,CPT,,,,,both,, ,352.24,211.34,Aetna,Commercial,,,,,352.24,,,,
Q17911 MTHFR DNA HYB,81291,CPT,,,,,both,, ,3892.4,2335.44,Aetna,Commercial,,,,,3892.4,,,,
Q17911 MTHFR DNA HYB,81291,CPT,,,,,both,, ,3892.4,2335.44,Aetna,Commercial,,,,,3892.4,,,,
MICROSAT INSTAB VAR,81301,CPT,,,,,both,, ,960.19,576.11,Aetna,Commercial,,,,,960.19,,,,
PCA3 KLK3 RATIO,81313,CPT,,,,,both,, ,636.57,381.94,Aetna,Commercial,,,,,636.57,,,,
Q18041 SMA CAR SCN,81329,CPT,,,,,both,, ,685,411,Aetna,Commercial,,,,,685,,,,
Q15340 ALPHA-1 ANTITRYPSIN (AAT) MUTATIO,81332,CPT,,,,,both,, ,3025.5,1815.3,Aetna,Commercial,,,,,3025.5,,,,
SERPINA1 GENE ANA CV,81332,CPT,,,,,both,, ,3396.72,2038.03,Aetna,Commercial,,,,,3396.72,,,,
L489150 MPL MUT AN,81338,CPT,,,,,both,, ,675,405,Aetna,Commercial,,,,,675,,,,
Q92476 MPL MA QL,81339,CPT,,,,,both,, ,701.97,421.18,Aetna,Commercial,,,,,701.97,,,,
CSI153 UGTIA1 GEN AN,81350,CPT,,,,,both,, ,819.57,491.74,Aetna,Commercial,,,,,819.57,,,,
Q15584 HLA-B27 DETER,81374,CPT,,,,,both,, ,250.36,150.21,Aetna,Commercial,,,,,250.36,,,,
Q17135 HLA2 TYP LR 1,81376,CPT,,,,,both,, ,610.75,366.45,Aetna,Commercial,,,,,610.75,,,,
L167082 HLA2 LR1 AG,81377,CPT,,,,,both,, ,235.1,141.06,Aetna,Commercial,,,,,235.1,,,,
HLA1 TYP HR 1 AL EA,81381,CPT,,,,,both,, ,724.42,434.65,Aetna,Commercial,,,,,724.42,,,,
Q17135 HLA2 TYP HR 1,81382,CPT,,,,,both,, ,618.04,370.82,Aetna,Commercial,,,,,618.04,,,,
L167082 HLA2 HR1 AL,81383,CPT,,,,,both,, ,334.75,200.85,Aetna,Commercial,,,,,334.75,,,,
Q90808 MP L2,81401,CPT,,,,,both,, ,1062.07,637.24,Aetna,Commercial,,,,,1062.07,,,,
Q90808 MP L2,81401,CPT,,,,,both,, ,1062.07,637.24,Aetna,Commercial,,,,,1062.07,,,,
O51115 RHD GENOTYPE,81403,CPT,,,,,both,, ,865.04,519.02,Aetna,Commercial,,,,,865.04,,,,
O51115 RHD GENOTYPE,81403,CPT,,,,,both,, ,865.04,519.02,Aetna,Commercial,,,,,865.04,,,,
L630540 THRB,81405,CPT,,,,,both,, ,4320,2592,Aetna,Commercial,,,,,4320,,,,
B5306-6 ACGH MOL KAR,81406,CPT,,,,,both,, ,2000,1200,Aetna,Commercial,,,,,2000,,,,
BB893-9 UNL MOL PTH,81479,CPT,,,,,both,, ,618,370.8,Aetna,Commercial,,,,,618,,,,
NBS SCID,81479,CPT,,,,,both,, ,109.46,65.67,Aetna,Commercial,,,,,109.46,,,,
UNLIST MOLEC PATH,81479,CPT,,,,,both,, ,1145.43,687.25,Aetna,Commercial,,,,,1145.43,,,,
L140045 OVARIAN MALIGNANCY RISK - ROMA,81500,CPT,,,,,both,, ,600,360,Aetna,Commercial,,,,,600,,,,
FTL CGEN ABN 4 ANAL,81511,CPT,,,,,both,, ,466.48,279.88,Aetna,Commercial,,,,,466.48,,,,
Q30294 QUAD SCREEN,81511,CPT,,,,,both,, ,415.5,249.3,Aetna,Commercial,,,,,415.5,,,,
FTL CGEN ABN 5 ANAL,81512,CPT,,,,,both,, ,791.78,475.06,Aetna,Commercial,,,,,791.78,,,,
L550659 LIVR BIOMRKR,81517,CPT,,,,,both,, ,1143,685.8,Aetna,Commercial,,,,,1143,,,,
Q92688 LIVER FIBROS,81596,CPT,,,,,both,, ,337.09,202.25,Aetna,Commercial,,,,,337.09,,,,
ACETON-KETON SERM QL,82009,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
ACETON-KETON SERM QT,82010,CPT,,,,,both,, ,80.55,48.33,Aetna,Commercial,,,,,80.55,,,,
ACETON-KETON SERM QT,82010,CPT,,,,,both,, ,341.3,204.78,Aetna,Commercial,,,,,341.3,,,,
NBS ACYLCARNITINE QL,82016,CPT,,,,,both,, ,82.79,49.67,Aetna,Commercial,,,,,82.79,,,,
ADRENOCORT ACTH,82024,CPT,,,,,both,, ,2343.07,1405.84,Aetna,Commercial,,,,,2343.07,,,,
Q211 ACTH PL IA,82024,CPT,,,,,both,, ,334,200.4,Aetna,Commercial,,,,,334,,,,
ALBUMIN SERUM,82040,CPT,,,,,both,, ,35.08,21.04,Aetna,Commercial,,,,,35.08,,,,
ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
Q14966 ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
Q70858 ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
Q70858 ALBUMIN FLUID,82042,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
Q70858 ALBUMIN FLUID,82042,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
MICROALB QNT,82043,CPT,,,,,both,, ,77.74,46.64,Aetna,Commercial,,,,,77.74,,,,
MICROALB QNT,82043,CPT,,,,,both,,,660.98,660.98,Aetna,Commercial,,466.65,70.6,,660.98,660.98,660.98,Fee Schedule,70.6
MICROALB QNT,82043,CPT,,,,,both,, ,660.98,396.58,Aetna,Commercial,,,,,660.98,,,,
ETHANOL IA,82077,CPT,,,,,both,, ,177.88,106.72,Aetna,Commercial,,,,,177.88,,,,
Q227 ALDOLASE ENZEMA,82085,CPT,,,,,both,, ,648.35,389.01,Aetna,Commercial,,,,,648.35,,,,
Q227 ALDOLASE ENZEMA,82085,CPT,,,,,both,, ,648.35,389.01,Aetna,Commercial,,,,,648.35,,,,
ALDOSTERONE,82088,CPT,,,,,both,, ,2366.36,1419.81,Aetna,Commercial,,,,,2366.36,,,,
Q16845 ALDOSTERONE,82088,CPT,,,,,both,, ,587.45,352.47,Aetna,Commercial,,,,,587.45,,,,
Q17181 ALDOST LCMSMS,82088,CPT,,,,,both,, ,587.45,352.47,Aetna,Commercial,,,,,587.45,,,,
Q229 ALDOSTERONE U24,82088,CPT,,,,,both,, ,587.45,352.47,Aetna,Commercial,,,,,587.45,,,,
Q235 A1A QT NEPH,82103,CPT,,,,,both,, ,969.17,581.5,Aetna,Commercial,,,,,969.17,,,,
Q235 A1A QT NEPH,82103,CPT,,,,,both,, ,969.17,581.5,Aetna,Commercial,,,,,969.17,,,,
Q853 A1AT PHENO IEF,82104,CPT,,,,,both,, ,1051.68,631,Aetna,Commercial,,,,,1051.68,,,,
Q853 A1AT PHENO IEF,82104,CPT,,,,,both,, ,1051.68,631,Aetna,Commercial,,,,,1051.68,,,,
AFP SERUM,82105,CPT,,,,,both,, ,1142.06,685.23,Aetna,Commercial,,,,,1142.06,,,,
Q237 AFP TUMR MRK IA,82105,CPT,,,,,both,, ,1142.06,685.23,Aetna,Commercial,,,,,1142.06,,,,
Q5059 MAT SER AFP IA,82105,CPT,,,,,both,, ,1142.06,685.23,Aetna,Commercial,,,,,1142.06,,,,
AFP AMNIOTIC FLD,82106,CPT,,,,,both,, ,705.89,423.53,Aetna,Commercial,,,,,705.89,,,,
Q19529 AFP/L3 LIBASY,82107,CPT,,,,,both,, ,530.47,318.28,Aetna,Commercial,,,,,530.47,,,,
Q19529 AFP/L3 LIBASY,82107,CPT,,,,,both,, ,530.47,318.28,Aetna,Commercial,,,,,530.47,,,,
ALUMINUM,82108,CPT,,,,,both,, ,265.51,159.3,Aetna,Commercial,,,,,265.51,,,,
NBS AMINO ACD MUL QL,82128,CPT,,,,,both,, ,82.79,49.67,Aetna,Commercial,,,,,82.79,,,,
Q10947CYSTN U24 LCMS,82131,CPT,,,,,both,, ,175.98,105.58,Aetna,Commercial,,,,,175.98,,,,
AMINO ACID QUAN 6+,82139,CPT,,,,,both,, ,873.74,524.24,Aetna,Commercial,,,,,873.74,,,,
AMMONIA,82140,CPT,,,,,both,, ,154.09,92.45,Aetna,Commercial,,,,,154.09,,,,
AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
L910235 AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q442 AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
AMYLASE,82150,CPT,,,,,both,, ,68.48,41.08,Aetna,Commercial,,,,,68.48,,,,
Q845 AMYLASE,82150,CPT,,,,,both,, ,518.69,311.21,Aetna,Commercial,,,,,518.69,,,,
Q845 AMYLASE,82150,CPT,,,,,both,, ,518.69,311.21,Aetna,Commercial,,,,,518.69,,,,
"ANDROSTENEDIONE, LCMS",82157,CPT,,,,,both,, ,769.33,461.59,Aetna,Commercial,,,,,769.33,,,,
"ANDROSTENEDIONE, LCMS",82157,CPT,,,,,both,, ,769.33,461.59,Aetna,Commercial,,,,,769.33,,,,
ANGIOTENSIN CONV ENZ,82164,CPT,,,,,both,, ,143.71,86.22,Aetna,Commercial,,,,,143.71,,,,
ANGIOTENSIN CONV ENZ,82164,CPT,,,,,both,, ,1081.72,649.03,Aetna,Commercial,,,,,1081.72,,,,
Q34692 ACE CSF KINET,82164,CPT,,,,,both,, ,1081.72,649.03,Aetna,Commercial,,,,,1081.72,,,,
Q683 ACE SP,82164,CPT,,,,,both,, ,1081.72,649.03,Aetna,Commercial,,,,,1081.72,,,,
ANTI-MULLERIAN HORM,82166,CPT,,,,,both,, ,116,69.6,Aetna,Commercial,,,,,116,,,,
Q92145 APOLIPOPROTEI,82172,CPT,,,,,both,, ,467.04,280.22,Aetna,Commercial,,,,,467.04,,,,
Q92145 APOLIPOPROTEI,82172,CPT,,,,,both,, ,467.04,280.22,Aetna,Commercial,,,,,467.04,,,,
ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,,,,751.36,,,,
Q269 AS BL ICP/MS,82175,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,,,,751.36,,,,
Q36438 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,,,,751.36,,,,
Q7507 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,,,,751.36,,,,
Q7655 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,,,,751.36,,,,
Q929 VIT C LC/MS/MS,82180,CPT,,,,,both,, ,67.92,40.75,Aetna,Commercial,,,,,67.92,,,,
Q852 B2M SERUM NEPH,82232,CPT,,,,,both,, ,936.89,562.13,Aetna,Commercial,,,,,936.89,,,,
Q852 B2M SERUM NEPH,82232,CPT,,,,,both,, ,936.89,562.13,Aetna,Commercial,,,,,936.89,,,,
Q14801 BILE AC ENZ,82239,CPT,,,,,both,, ,274.77,164.86,Aetna,Commercial,,,,,274.77,,,,
BILIRUBIN TOTAL,82247,CPT,,,,,both,, ,53.05,31.83,Aetna,Commercial,,,,,53.05,,,,
BILIRUBIN TOTAL,82247,CPT,,,,,both,, ,282.92,169.75,Aetna,Commercial,,,,,282.92,,,,
BILIRUBIN DIRECT,82248,CPT,,,,,both,, ,53.05,31.83,Aetna,Commercial,,,,,53.05,,,,
BILIRUBIN DIRECT,82248,CPT,,,,,both,, ,282.92,169.75,Aetna,Commercial,,,,,282.92,,,,
NBS BIOTINIDASE,82261,CPT,,,,,both,, ,100.75,60.45,Aetna,Commercial,,,,,100.75,,,,
BLD OCCULT FECES 1-3,82270,CPT,,,,,both,, ,31.99,19.19,Aetna,Commercial,,,,,31.99,,,,
BLD OCCULT FECES 1-3,82270,CPT,,,,,both,, ,210.5,126.3,Aetna,Commercial,,,,,210.5,,,,
BLD OCCULT OTHER SRC,82271,CPT,,,,,both,, ,277.59,166.55,Aetna,Commercial,,,,,277.59,,,,
BLD OCC NON CA SCREE,82272,CPT,,,,,both,, ,210.5,126.3,Aetna,Commercial,,,,,210.5,,,,
BLD OCCULT FECES EIA,82274,CPT,,,,,both,, ,165.87,99.52,Aetna,Commercial,,,,,165.87,,,,
Q299CADMIUM BL ICPMS,82300,CPT,,,,,both,, ,536.08,321.64,Aetna,Commercial,,,,,536.08,,,,
Q299CADMIUM BL ICPMS,82300,CPT,,,,,both,, ,536.08,321.64,Aetna,Commercial,,,,,536.08,,,,
Q672 CADMIUM,82300,CPT,,,,,both,, ,125,75,Aetna,Commercial,,,,,125,,,,
L504115VITD 25-OH LC,82306,CPT,,,,,both,, ,651.73,391.03,Aetna,Commercial,,,,,651.73,,,,
VITAMIN D 25OH,82306,CPT,,,,,both,, ,279.26,167.55,Aetna,Commercial,,,,,279.26,,,,
VITAMIN D 25OH,82306,CPT,,,,,both,,,710.38,710.38,Aetna,Commercial,,501.53,70.6,,710.38,710.38,710.38,Fee Schedule,70.6
VITAMIN D 25OH,82306,CPT,,,,,both,, ,710.38,426.22,Aetna,Commercial,,,,,710.38,,,,
CALCITONIN,82308,CPT,,,,,both,, ,297.79,178.67,Aetna,Commercial,,,,,297.79,,,,
Q30742 CALCITONIN IA,82308,CPT,,,,,both,, ,796.27,477.76,Aetna,Commercial,,,,,796.27,,,,
CALCIUM TOTAL,82310,CPT,,,,,both,, ,54.45,32.67,Aetna,Commercial,,,,,54.45,,,,
L54601 CALCIUM TOTAL,82310,CPT,,,,,both,, ,315.48,189.28,Aetna,Commercial,,,,,315.48,,,,
L54601 CALCIUM TOTAL,82310,CPT,,,,,both,, ,315.48,189.28,Aetna,Commercial,,,,,315.48,,,,
CALCIUM IONIZED,82330,CPT,,,,,both,, ,35.36,21.21,Aetna,Commercial,,,,,35.36,,,,
CALCIUM IONIZED,82330,CPT,,,,,both,,,796.27,796.27,Aetna,Commercial,,562.17,70.6,,796.27,796.27,796.27,Fee Schedule,70.6
Q306 ICA ISE,82330,CPT,,,,,both,, ,796.27,477.76,Aetna,Commercial,,,,,796.27,,,,
Q306 ICA ISE,82330,CPT,,,,,both,, ,796.27,477.76,Aetna,Commercial,,,,,796.27,,,,
CALCIUM URI QN TIMED,82340,CPT,,,,,both,,,412.87,412.87,Aetna,Commercial,,291.49,70.6,,412.87,412.87,412.87,Fee Schedule,70.6
CALCIUM URI QN TIMED,82340,CPT,,,,,both,, ,412.87,247.72,Aetna,Commercial,,,,,412.87,,,,
"L910235 CALCIUM, URINE",82340,CPT,,,,,both,, ,412.87,247.72,Aetna,Commercial,,,,,412.87,,,,
Q442 CALCIUM URI QN,82340,CPT,,,,,both,, ,412.87,247.72,Aetna,Commercial,,,,,412.87,,,,
Q30260 STN ANAL NID,82365,CPT,,,,,both,, ,1187.82,712.69,Aetna,Commercial,,,,,1187.82,,,,
Q30260 STN ANAL NID,82365,CPT,,,,,both,, ,1187.82,712.69,Aetna,Commercial,,,,,1187.82,,,,
CARBON DIOXIDE CO2,82374,CPT,,,,,both,, ,47.99,28.79,Aetna,Commercial,,,,,47.99,,,,
CARBON DIOXIDE CO2,82374,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
CARBON MONOXIDE QUAN,82375,CPT,,,,,both,, ,203.49,122.09,Aetna,Commercial,,,,,203.49,,,,
CARBON MONOXIDE QUAN,82375,CPT,,,,,both,, ,203.49,122.09,Aetna,Commercial,,,,,203.49,,,,
CARCINOEMBRYONIC AG,82378,CPT,,,,,both,, ,121.53,72.91,Aetna,Commercial,,,,,121.53,,,,
L480095 CEA SM,82378,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,,,,526.26,,,,
L480095 CEA SM,82378,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,,,,526.26,,,,
CAROTENE,82380,CPT,,,,,both,, ,1171.81,703.08,Aetna,Commercial,,,,,1171.81,,,,
L1529 CAROTENE HPLC,82380,CPT,,,,,both,, ,75.2,45.12,Aetna,Commercial,,,,,75.2,,,,
Q5244 CAT FR UR,82384,CPT,,,,,both,, ,263.27,157.96,Aetna,Commercial,,,,,263.27,,,,
Q5244 CAT FR UR,82384,CPT,,,,,both,, ,263.27,157.96,Aetna,Commercial,,,,,263.27,,,,
Q5244 CAT FR UR,82384,CPT,,,,,both,, ,263.27,157.96,Aetna,Commercial,,,,,263.27,,,,
Q5244 CAT FR UR,82384,CPT,,,,,both,, ,263.27,157.96,Aetna,Commercial,,,,,263.27,,,,
Q326 CERULOP NEPHELO,82390,CPT,,,,,both,, ,859.7,515.82,Aetna,Commercial,,,,,859.7,,,,
Q326 CERULOP NEPHELO,82390,CPT,,,,,both,, ,859.7,515.82,Aetna,Commercial,,,,,859.7,,,,
CHEMILUM ASSAY NOS,82397,CPT,,,,,both,, ,444.59,266.75,Aetna,Commercial,,,,,444.59,,,,
L503870 CHEM ASY NOS,82397,CPT,,,,,both,, ,444.59,266.75,Aetna,Commercial,,,,,444.59,,,,
L504567 CHEM ASY NOS,82397,CPT,,,,,both,, ,407.88,244.72,Aetna,Commercial,,,,,407.88,,,,
Q34445 INHIBIN B CL,82397,CPT,,,,,both,, ,444.59,266.75,Aetna,Commercial,,,,,444.59,,,,
Q37227 ANTI-MULLERIAN HORMONE(AMH)FEMALE,82397,CPT,,,,,both,, ,396,237.6,Aetna,Commercial,,,,,396,,,,
Q37227 ANTI-MULLERIAN HORMONE(AMH)FEMALE,82397,CPT,,,,,both,, ,396,237.6,Aetna,Commercial,,,,,396,,,,
CHLORIDE BLOOD,82435,CPT,,,,,both,, ,38.73,23.23,Aetna,Commercial,,,,,38.73,,,,
CHLORIDE BLOOD,82435,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
"L910235 CHLORIDE, URINE",82436,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
"L910235 CHLORIDE, URINE",82436,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
CHLORIDES OTHER FLD,82438,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
CHOLESTEROL TOTAL,82465,CPT,,,,,both,, ,49.68,29.8,Aetna,Commercial,,,,,49.68,,,,
CHOLESTEROL TOTAL,82465,CPT,,,,,both,, ,315.48,189.28,Aetna,Commercial,,,,,315.48,,,,
CHOLINESTERASE SERUM,82480,CPT,,,,,both,, ,563.6,338.16,Aetna,Commercial,,,,,563.6,,,,
Q338 CHOLINEST SER,82480,CPT,,,,,both,, ,563.6,338.16,Aetna,Commercial,,,,,563.6,,,,
Q7961 CHOLINEST SER,82480,CPT,,,,,both,, ,563.6,338.16,Aetna,Commercial,,,,,563.6,,,,
Q338 CHOLINEST RBC,82482,CPT,,,,,both,, ,676.14,405.68,Aetna,Commercial,,,,,676.14,,,,
Q338 CHOLINEST RBC,82482,CPT,,,,,both,, ,676.14,405.68,Aetna,Commercial,,,,,676.14,,,,
CHROMIUM,82495,CPT,,,,,both,, ,242.5,145.5,Aetna,Commercial,,,,,242.5,,,,
CHROMIUM U,82495,CPT,,,,,both,, ,202.8,121.68,Aetna,Commercial,,,,,202.8,,,,
"L910235 CITRATE, URINE",82507,CPT,,,,,both,, ,242.5,145.5,Aetna,Commercial,,,,,242.5,,,,
Q11315 CIT AC U24 SP,82507,CPT,,,,,both,, ,242.5,145.5,Aetna,Commercial,,,,,242.5,,,,
Q442 CITRATE,82507,CPT,,,,,both,, ,242.5,145.5,Aetna,Commercial,,,,,242.5,,,,
COLLAGEN CROSSLINKS,82523,CPT,,,,,both,, ,280.11,168.06,Aetna,Commercial,,,,,280.11,,,,
L500089 C-TELO ELISA,82523,CPT,,,,,both,, ,529.2,317.52,Aetna,Commercial,,,,,529.2,,,,
"N-TELOPEP (NTX), UR",82523,CPT,,,,,both,, ,186.8,112.08,Aetna,Commercial,,,,,186.8,,,,
Q365 CU U24 ICP/MS,82525,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
Q365 CU U24 ICP/MS,82525,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
Q365 CU U24 ICP/MS,82525,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
Q365 CU U24 ICP/MS,82525,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
Q198978CORTIS LCMSMS,82530,CPT,,,,,both,, ,938.86,563.31,Aetna,Commercial,,,,,938.86,,,,
Q198978CORTIS LCMSMS,82530,CPT,,,,,both,, ,938.86,563.31,Aetna,Commercial,,,,,938.86,,,,
Q36423 CORT FR LCMSM,82530,CPT,,,,,both,, ,939.13,563.47,Aetna,Commercial,,,,,939.13,,,,
CORTISOL TOTAL,82533,CPT,,,,,both,, ,132.19,79.31,Aetna,Commercial,,,,,132.19,,,,
CORTISOL TOTAL,82533,CPT,,,,,both,,,1343.58,1343.58,Aetna,Commercial,,948.57,70.6,,1343.58,1343.58,1343.58,Fee Schedule,70.6
CORTISOL TOTAL,82533,CPT,,,,,both,, ,1343.58,806.14,Aetna,Commercial,,,,,1343.58,,,,
L500179SALIV CORT MS,82533,CPT,,,,,both,, ,335.78,201.46,Aetna,Commercial,,,,,335.78,,,,
L500440 CORTISOL TOT,82533,CPT,,,,,both,, ,163,97.8,Aetna,Commercial,,,,,163,,,,
CREATINE,82540,CPT,,,,,both,, ,38.73,23.23,Aetna,Commercial,,,,,38.73,,,,
L823430 OMEGACHECK (EPA+DPA+DHA),82542,CPT,,,,,both,, ,430,258,Aetna,Commercial,,,,,430,,,,
N-METHLHIST 24H UR,82542,CPT,,,,,both,, ,600,360,Aetna,Commercial,,,,,600,,,,
Q198268 CO-Q10 HPLC,82542,CPT,,,,,both,, ,320.53,192.31,Aetna,Commercial,,,,,320.53,,,,
Q198268 CO-Q10 HPLC,82542,CPT,,,,,both,, ,320.53,192.31,Aetna,Commercial,,,,,320.53,,,,
Q198268 CO-Q10 HPLC,82542,CPT,,,,,both,, ,320.53,192.31,Aetna,Commercial,,,,,320.53,,,,
Q198268 CO-Q10 HPLC,82542,CPT,,,,,both,, ,320.53,192.31,Aetna,Commercial,,,,,320.53,,,,
CPK TOTAL,82550,CPT,,,,,both,, ,64.27,38.56,Aetna,Commercial,,,,,64.27,,,,
CPK TOTAL,82550,CPT,,,,,both,,,282.92,282.92,Aetna,Commercial,,199.74,70.6,,282.92,282.92,282.92,Fee Schedule,70.6
Q6422 CPK TOTAL,82550,CPT,,,,,both,, ,282.92,169.75,Aetna,Commercial,,,,,282.92,,,,
Q6422 CPK TOTAL,82550,CPT,,,,,both,, ,282.92,169.75,Aetna,Commercial,,,,,282.92,,,,
Q6422 CPK ISOENZYMES,82552,CPT,,,,,both,, ,626.18,375.7,Aetna,Commercial,,,,,626.18,,,,
Q6422 CPK ISOENZYMES,82552,CPT,,,,,both,, ,626.18,375.7,Aetna,Commercial,,,,,626.18,,,,
CPK MB FRACTION,82553,CPT,,,,,both,, ,113.67,68.2,Aetna,Commercial,,,,,113.67,,,,
CPK MB FRACTION,82553,CPT,,,,,both,, ,620.56,372.33,Aetna,Commercial,,,,,620.56,,,,
CREATININE BLOOD,82565,CPT,,,,,both,, ,19.09,11.45,Aetna,Commercial,,,,,19.09,,,,
CREATININE BLOOD,82565,CPT,,,,,both,,,285.17,285.17,Aetna,Commercial,,201.33,70.6,,285.17,285.17,285.17,Fee Schedule,70.6
CREATININE BLOOD,82565,CPT,,,,,both,, ,285.17,171.1,Aetna,Commercial,,,,,285.17,,,,
CREATININE UR-OTHER,82570,CPT,,,,,both,, ,32.84,19.7,Aetna,Commercial,,,,,32.84,,,,
CREATININE UR-OTHER,82570,CPT,,,,,both,,,285.17,285.17,Aetna,Commercial,,201.33,70.6,,285.17,285.17,285.17,Fee Schedule,70.6
CREATININE UR-OTHER,82570,CPT,,,,,both,, ,285.17,171.1,Aetna,Commercial,,,,,285.17,,,,
Q1648 CREATININE UR-,82570,CPT,,,,,both,, ,285.17,171.1,Aetna,Commercial,,,,,285.17,,,,
Q17422 CREATIN PTF C,82570,CPT,,,,,both,, ,285.17,171.1,Aetna,Commercial,,,,,285.17,,,,
Q442 CREATININE UR-O,82570,CPT,,,,,both,, ,285.17,171.1,Aetna,Commercial,,,,,285.17,,,,
Q5244 CREAT UR,82570,CPT,,,,,both,, ,261.87,157.12,Aetna,Commercial,,,,,261.87,,,,
Q5244 CREAT UR,82570,CPT,,,,,both,, ,261.87,157.12,Aetna,Commercial,,,,,261.87,,,,
Q682 CREATININE UR-O,82570,CPT,,,,,both,, ,285.17,171.1,Aetna,Commercial,,,,,285.17,,,,
Q7507 CREATIN UR-OTH,82570,CPT,,,,,both,, ,285.17,171.1,Aetna,Commercial,,,,,285.17,,,,
Q8525 CREATININE UR-,82570,CPT,,,,,both,, ,285.17,171.1,Aetna,Commercial,,,,,285.17,,,,
CREATININE CLEARANCE,82575,CPT,,,,,both,,,555.45,555.45,Aetna,Commercial,,392.15,70.6,,555.45,555.45,555.45,Fee Schedule,70.6
CREATININE CLEARANCE,82575,CPT,,,,,both,, ,555.45,333.27,Aetna,Commercial,,,,,555.45,,,,
Q36562 C-GLOB SER VI,82595,CPT,,,,,both,, ,968.6,581.16,Aetna,Commercial,,,,,968.6,,,,
Q36562 C-GLOB SER VI,82595,CPT,,,,,both,, ,968.6,581.16,Aetna,Commercial,,,,,968.6,,,,
VITAMIN B-12,82607,CPT,,,,,both,, ,111.43,66.85,Aetna,Commercial,,,,,111.43,,,,
VITAMIN B-12,82607,CPT,,,,,both,,,641.06,641.06,Aetna,Commercial,,452.59,70.6,,641.06,641.06,641.06,Fee Schedule,70.6
VITAMIN B-12,82607,CPT,,,,,both,, ,641.06,384.63,Aetna,Commercial,,,,,641.06,,,,
VITAMIN B-12 BINDING,82608,CPT,,,,,both,, ,183.56,110.13,Aetna,Commercial,,,,,183.56,,,,
Q10570 CYSTAT C NEPH,82610,CPT,,,,,both,, ,121.25,72.75,Aetna,Commercial,,,,,121.25,,,,
"L910235 CREATININE, URINE",82615,CPT,,,,,both,, ,285.17,171.1,Aetna,Commercial,,,,,285.17,,,,
L910235 CYSTINE/HOMOCYSTINE UR,82615,CPT,,,,,both,, ,50,30,Aetna,Commercial,,,,,50,,,,
Q19894DHEA UN LCMSMS,82626,CPT,,,,,both,, ,263.55,158.13,Aetna,Commercial,,,,,263.55,,,,
Q19894DHEA UN LCMSMS,82626,CPT,,,,,both,, ,263.55,158.13,Aetna,Commercial,,,,,263.55,,,,
Q402 DHEA SULFATE IA,82627,CPT,,,,,both,, ,664.35,398.61,Aetna,Commercial,,,,,664.35,,,,
Q402 DHEA SULFATE IA,82627,CPT,,,,,both,, ,664.35,398.61,Aetna,Commercial,,,,,664.35,,,,
DEOXYCORTISOL,82634,CPT,,,,,both,, ,177.39,106.43,Aetna,Commercial,,,,,177.39,,,,
Q7961 DIBUCAINE NUMB,82638,CPT,,,,,both,, ,270.28,162.16,Aetna,Commercial,,,,,270.28,,,,
Q7961 DIBUCAINE NUMB,82638,CPT,,,,,both,, ,270.28,162.16,Aetna,Commercial,,,,,270.28,,,,
DIHYDROTESTOST (DHT),82642,CPT,,,,,both,, ,151.84,91.1,Aetna,Commercial,,,,,151.84,,,,
DIHYDROXY VITAMIN D,82652,CPT,,,,,both,, ,379.18,227.5,Aetna,Commercial,,,,,379.18,,,,
DIHYDROXY VITAMIN D,82652,CPT,,,,,both,, ,1307.38,784.42,Aetna,Commercial,,,,,1307.38,,,,
Q16558 VITD LCMSMS,82652,CPT,,,,,both,, ,554.89,332.93,Aetna,Commercial,,,,,554.89,,,,
L123234 PE FEC ELISA,82653,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,,,,414.83,,,,
L123234 PE FEC ELISA,82653,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,,,,414.83,,,,
Q14693 PE-1 IA,82656,CPT,,,,,both,, ,228.97,137.38,Aetna,Commercial,,,,,228.97,,,,
Q146938 PE-1 FEC,82656,CPT,,,,,both,, ,267.48,160.48,Aetna,Commercial,,,,,267.48,,,,
Q146938 PE-1 FEC,82656,CPT,,,,,both,, ,267.48,160.48,Aetna,Commercial,,,,,267.48,,,,
Q427 ERYTHROPOIET IA,82668,CPT,,,,,both,, ,1449.41,869.64,Aetna,Commercial,,,,,1449.41,,,,
Q427 ERYTHROPOIET IA,82668,CPT,,,,,both,, ,1449.41,869.64,Aetna,Commercial,,,,,1449.41,,,,
ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Aetna,Commercial,,,,,976.46,,,,
L500649 ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Aetna,Commercial,,,,,976.46,,,,
Q30289 ESTRADIOL US,82670,CPT,,,,,both,, ,976.46,585.87,Aetna,Commercial,,,,,976.46,,,,
Q36169 ESTRA FR DIR,82670,CPT,,,,,both,, ,895.84,537.5,Aetna,Commercial,,,,,895.84,,,,
Q36169 ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Aetna,Commercial,,,,,976.46,,,,
Q4021 ESTRADIOL IA,82670,CPT,,,,,both,, ,976.46,585.87,Aetna,Commercial,,,,,976.46,,,,
Q36742 EST FR LCMSMS,82671,CPT,,,,,both,, ,170.36,102.21,Aetna,Commercial,,,,,170.36,,,,
ESTROGEN TOTAL,82672,CPT,,,,,both,, ,1727.55,1036.53,Aetna,Commercial,,,,,1727.55,,,,
Q439 ESTROG TOT RIA,82672,CPT,,,,,both,, ,304.53,182.71,Aetna,Commercial,,,,,304.53,,,,
Q34883 ESTRIO LCMSMS,82677,CPT,,,,,both,, ,317.44,190.46,Aetna,Commercial,,,,,317.44,,,,
Q34883 ESTRIO LCMSMS,82677,CPT,,,,,both,, ,317.44,190.46,Aetna,Commercial,,,,,317.44,,,,
Q23244 ESTRON LCMSMS,82679,CPT,,,,,both,, ,116.47,69.88,Aetna,Commercial,,,,,116.47,,,,
Q23244 ESTRON LCMSMS,82679,CPT,,,,,both,, ,116.47,69.88,Aetna,Commercial,,,,,116.47,,,,
L500649 ESTRA FR DIR,82681,CPT,,,,,both,, ,251.84,151.1,Aetna,Commercial,,,,,251.84,,,,
ETHYLENE GLYCOL,82693,CPT,,,,,both,,,1577.11,1577.11,Aetna,Commercial,,1113.44,70.6,,1577.11,1577.11,1577.11,Fee Schedule,70.6
ETHYLENE GLYCOL,82693,CPT,,,,,both,, ,1577.11,946.26,Aetna,Commercial,,,,,1577.11,,,,
Q801 ETHYL GLY CHRMT,82693,CPT,,,,,both,, ,935.21,561.12,Aetna,Commercial,,,,,935.21,,,,
Q3967 FEC FT QL MIC,82705,CPT,,,,,both,, ,600.92,360.55,Aetna,Commercial,,,,,600.92,,,,
Q3967 FEC FT QL MIC,82705,CPT,,,,,both,, ,600.92,360.55,Aetna,Commercial,,,,,600.92,,,,
FECAL FAT QUANT 72HR,82710,CPT,,,,,both,, ,122.2,73.32,Aetna,Commercial,,,,,122.2,,,,
Q455 FEC FT QT NMR,82710,CPT,,,,,both,, ,768.2,460.92,Aetna,Commercial,,,,,768.2,,,,
Q455 FEC FT QT NMR,82710,CPT,,,,,both,, ,768.2,460.92,Aetna,Commercial,,,,,768.2,,,,
Q90559 VLCFA,82726,CPT,,,,,both,, ,88.69,53.21,Aetna,Commercial,,,,,88.69,,,,
FERRITIN,82728,CPT,,,,,both,, ,100.75,60.45,Aetna,Commercial,,,,,100.75,,,,
FERRITIN,82728,CPT,,,,,both,,,864.19,864.19,Aetna,Commercial,,610.12,70.6,,864.19,864.19,864.19,Fee Schedule,70.6
FERRITIN,82728,CPT,,,,,both,, ,864.19,518.51,Aetna,Commercial,,,,,864.19,,,,
FETAL FIBRONECTIN,82731,CPT,,,,,both,, ,701.69,421.01,Aetna,Commercial,,,,,701.69,,,,
FOLIC ACID SERUM,82746,CPT,,,,,both,, ,108.61,65.16,Aetna,Commercial,,,,,108.61,,,,
FOLIC ACID SERUM,82746,CPT,,,,,both,,,735.65,735.65,Aetna,Commercial,,519.37,70.6,,735.65,735.65,735.65,Fee Schedule,70.6
FOLIC ACID SERUM,82746,CPT,,,,,both,, ,735.65,441.39,Aetna,Commercial,,,,,735.65,,,,
Q467 FOLATE RBC IA,82747,CPT,,,,,both,, ,627.3,376.38,Aetna,Commercial,,,,,627.3,,,,
Q467 FOLATE RBC IA,82747,CPT,,,,,both,, ,627.3,376.38,Aetna,Commercial,,,,,627.3,,,,
NBS GALACTOSE,82760,CPT,,,,,both,, ,66.8,40.08,Aetna,Commercial,,,,,66.8,,,,
NBS GALACTOSE TRANS,82776,CPT,,,,,both,, ,49.96,29.97,Aetna,Commercial,,,,,49.96,,,,
L165126 GAMMGLB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,,,,220.88,,,,
L165126 GAMMGLB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,,,,220.88,,,,
L165126 GAMMGLB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,,,,220.88,,,,
L165126 GAMMGLB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,,,,220.88,,,,
Q38940 GAMMAGLOB M G A D,82784,CPT,,,,,both,, ,196.75,118.05,Aetna,Commercial,,,,,196.75,,,,
Q545 IGM ITA,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,,,,220.88,,,,
Q545 IGM ITA,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,,,,220.88,,,,
Q545 IGM ITA,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,,,,220.88,,,,
Q545 IGM ITA,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,,,,220.88,,,,
Q7903 GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,,,,220.88,,,,
Q7903 GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,,,,220.88,,,,
Q7903 GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,,,,220.88,,,,
Q7903 GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Aetna,Commercial,,,,,220.88,,,,
GAMMAGLOBULIN IGE,82785,CPT,,,,,both,, ,127.14,76.28,Aetna,Commercial,,,,,127.14,,,,
GAMMAGLOBULIN IGE,82785,CPT,,,,,both,, ,906.3,543.78,Aetna,Commercial,,,,,906.3,,,,
L602635 - GAMMAGLB IGE,82785,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,,,,148.75,,,,
L602635 - GAMMAGLB IGE,82785,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,,,,148.75,,,,
L602635 - GAMMAGLB IGE,82785,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,,,,148.75,,,,
L602635 - GAMMAGLB IGE,82785,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,,,,148.75,,,,
"IGG SUB 1,2,3 OR 4",82787,CPT,,,,,both,, ,389.01,233.4,Aetna,Commercial,,,,,389.01,,,,
Q143422 IGG SUB4 NEP,82787,CPT,,,,,both,, ,389.01,233.4,Aetna,Commercial,,,,,389.01,,,,
"Q7903IGG SUB 1,2,3,4",82787,CPT,,,,,both,, ,389.01,233.4,Aetna,Commercial,,,,,389.01,,,,
BLOOD PH,82800,CPT,,,,,both,, ,618.04,370.82,Aetna,Commercial,,,,,618.04,,,,
BLD GAS W-O2 SAT DIR,82805,CPT,,,,,both,, ,1760.39,1056.23,Aetna,Commercial,,,,,1760.39,,,,
BLD GAS POC/O2 SAT,82810,CPT,,,,,both,, ,100.63,60.37,Aetna,Commercial,,,,,100.63,,,,
BLD GAS POC/O2 SAT,82810,CPT,,,,,both,, ,100.63,60.37,Aetna,Commercial,,,,,100.63,,,,
Q478 GASTRIN IA,82941,CPT,,,,,both,, ,863.91,518.34,Aetna,Commercial,,,,,863.91,,,,
Q478 GASTRIN IA,82941,CPT,,,,,both,, ,863.91,518.34,Aetna,Commercial,,,,,863.91,,,,
Q519 GLUCAG EXT-RIA,82943,CPT,,,,,both,, ,82.51,49.5,Aetna,Commercial,,,,,82.51,,,,
GLUCOSE BODY FLUID,82945,CPT,,,,,both,, ,412.87,247.72,Aetna,Commercial,,,,,412.87,,,,
"GLUCOSE, QUANT",82947,CPT,,,,,both,, ,21.89,13.13,Aetna,Commercial,,,,,21.89,,,,
"GLUCOSE, QUANT",82947,CPT,,,,,both,,,240.26,240.26,Aetna,Commercial,,169.62,70.6,,240.26,240.26,240.26,Fee Schedule,70.6
"GLUCOSE, QUANT",82947,CPT,,,,,both,, ,240.26,144.15,Aetna,Commercial,,,,,240.26,,,,
"GLUCOSE, POST DOSE",82950,CPT,,,,,both,,,450.48,450.48,Aetna,Commercial,,318.04,70.6,,450.48,450.48,450.48,Fee Schedule,70.6
"GLUCOSE, POST DOSE",82950,CPT,,,,,both,, ,450.48,270.28,Aetna,Commercial,,,,,450.48,,,,
GTT 3 SPEC,82951,CPT,,,,,both,, ,758.95,455.37,Aetna,Commercial,,,,,758.95,,,,
GTT ADD SP,82952,CPT,,,,,both,, ,188.05,112.83,Aetna,Commercial,,,,,188.05,,,,
"G6PD, QUANT",82955,CPT,,,,,both,, ,1026.43,615.85,Aetna,Commercial,,,,,1026.43,,,,
"L121003 G6PD, QUANT",82955,CPT,,,,,both,, ,60,36,Aetna,Commercial,,,,,60,,,,
"GLU,HOME USE DIAGNOS",82962,CPT,,,,,both,, ,8.76,5.25,Aetna,Commercial,,,,,8.76,,,,
"GLU,HOME USE DIAGNOS",82962,CPT,,,,,both,, ,99.35,59.61,Aetna,Commercial,,,,,99.35,,,,
GGT,82977,CPT,,,,,both,, ,71.01,42.6,Aetna,Commercial,,,,,71.01,,,,
GGT,82977,CPT,,,,,both,, ,412.87,247.72,Aetna,Commercial,,,,,412.87,,,,
L7700 GSH TOT,82978,CPT,,,,,both,, ,61,36.6,Aetna,Commercial,,,,,61,,,,
GLYCATED PROTEIN,82985,CPT,,,,,both,, ,263.83,158.29,Aetna,Commercial,,,,,263.83,,,,
Q8340 FRUCTOSAMINE C,82985,CPT,,,,,both,, ,298.92,179.35,Aetna,Commercial,,,,,298.92,,,,
FOLLICLE STIM HORM,83001,CPT,,,,,both,, ,137.25,82.35,Aetna,Commercial,,,,,137.25,,,,
L4309 FSH ECLIA,83001,CPT,,,,,both,, ,812.55,487.53,Aetna,Commercial,,,,,812.55,,,,
L4309 FSH ECLIA,83001,CPT,,,,,both,, ,812.55,487.53,Aetna,Commercial,,,,,812.55,,,,
L4283 LH ECLIA,83002,CPT,,,,,both,, ,812.55,487.53,Aetna,Commercial,,,,,812.55,,,,
L4283 LH ECLIA,83002,CPT,,,,,both,, ,812.55,487.53,Aetna,Commercial,,,,,812.55,,,,
LEUTEINIZING HORMONE,83002,CPT,,,,,both,, ,136.97,82.18,Aetna,Commercial,,,,,136.97,,,,
GROWTH HORMONE,83003,CPT,,,,,both,, ,1201.85,721.11,Aetna,Commercial,,,,,1201.85,,,,
Q521 GH IA,83003,CPT,,,,,both,, ,74.86,44.91,Aetna,Commercial,,,,,74.86,,,,
Q91823 GRTH STM GN 2,83006,CPT,,,,,both,, ,189,113.4,Aetna,Commercial,,,,,189,,,,
L1628 HAPTOGLOB IMM,83010,CPT,,,,,both,, ,1109.23,665.53,Aetna,Commercial,,,,,1109.23,,,,
L1628 HAPTOGLOB IMM,83010,CPT,,,,,both,, ,1109.23,665.53,Aetna,Commercial,,,,,1109.23,,,,
Q14839H.PYLO UREA IR,83013,CPT,,,,,both,, ,623.38,374.02,Aetna,Commercial,,,,,623.38,,,,
"HEAVY METALS, QUANT",83018,CPT,,,,,both,, ,175.14,105.08,Aetna,Commercial,,,,,175.14,,,,
L121690 - HEMOGLOBIN ELECTRO,83020,CPT,,,,,both,, ,108.15,64.89,Aetna,Commercial,,,,,108.15,,,,
NBS HGB ELECTRO,83020,CPT,,,,,both,, ,76.9,46.14,Aetna,Commercial,,,,,76.9,,,,
Q35489 HEMOGLO CHROM,83021,CPT,,,,,both,, ,180.6,108.36,Aetna,Commercial,,,,,180.6,,,,
Q35489 HEMOGLO CHROM,83021,CPT,,,,,both,, ,180.6,108.36,Aetna,Commercial,,,,,180.6,,,,
"HEMOGLOB,FETGAL,QUAL",83033,CPT,,,,,both,, ,354.77,212.86,Aetna,Commercial,,,,,354.77,,,,
HEMOGLOBIN A1C,83036,CPT,,,,,both,, ,95.71,57.42,Aetna,Commercial,,,,,95.71,,,,
HEMOGLOBIN A1C,83036,CPT,,,,,both,,,454.97,454.97,Aetna,Commercial,,321.21,70.6,,454.97,454.97,454.97,Fee Schedule,70.6
Q496 HEMOGLO A1C ITA,83036,CPT,,,,,both,, ,454.97,272.98,Aetna,Commercial,,,,,454.97,,,,
Q496 HEMOGLO A1C ITA,83036,CPT,,,,,both,, ,454.97,272.98,Aetna,Commercial,,,,,454.97,,,,
"METHEMOGLOBIN,QUAN",83050,CPT,,,,,both,, ,122.09,73.25,Aetna,Commercial,,,,,122.09,,,,
"HEMOGLOBIN, PLASMA",83051,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
"HEMOSIDERIN, QUAL",83070,CPT,,,,,both,, ,373.57,224.14,Aetna,Commercial,,,,,373.57,,,,
HISTAMINE,83088,CPT,,,,,both,, ,385.09,231.05,Aetna,Commercial,,,,,385.09,,,,
Q36586 HISTAM PL RIA,83088,CPT,,,,,both,, ,385.09,231.05,Aetna,Commercial,,,,,385.09,,,,
Q4946 HISTAM U24 IA,83088,CPT,,,,,both,, ,385.09,231.05,Aetna,Commercial,,,,,385.09,,,,
Q31789 HCYSTEINE ENZ,83090,CPT,,,,,both,, ,227.91,136.74,Aetna,Commercial,,,,,227.91,,,,
Q31789 HCYSTEINE ENZ,83090,CPT,,,,,both,, ,227.91,136.74,Aetna,Commercial,,,,,227.91,,,,
CORTICOSTEROIDS,83491,CPT,,,,,both,, ,1217.28,730.36,Aetna,Commercial,,,,,1217.28,,,,
5-HIAA,83497,CPT,,,,,both,, ,976.46,585.87,Aetna,Commercial,,,,,976.46,,,,
Q1648 5-HIAA,83497,CPT,,,,,both,, ,976.46,585.87,Aetna,Commercial,,,,,976.46,,,,
Q523 5-HIAA U24 HPLC,83497,CPT,,,,,both,, ,976.46,585.87,Aetna,Commercial,,,,,976.46,,,,
HYDROXYPROGES 17-D,83498,CPT,,,,,both,, ,600.92,360.55,Aetna,Commercial,,,,,600.92,,,,
NBS HYDROXYPROG 17-D,83498,CPT,,,,,both,, ,162.23,97.33,Aetna,Commercial,,,,,162.23,,,,
Q17180 17-OHP LCMSMS,83498,CPT,,,,,both,, ,601.2,360.72,Aetna,Commercial,,,,,601.2,,,,
"IMMUNOASSAY, OTHER",83516,CPT,,,,,both,,,765.96,765.96,Aetna,Commercial,,540.77,70.6,,765.96,765.96,765.96,Fee Schedule,70.6
"IMMUNOASSAY, OTHER",83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,,,,765.96,,,,
L162045 IA OTH,83516,CPT,,,,,both,, ,702.72,421.63,Aetna,Commercial,,,,,702.72,,,,
L163061 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,,,,765.96,,,,
L165126 IA OTH,83516,CPT,,,,,both,, ,702.72,421.63,Aetna,Commercial,,,,,702.72,,,,
L341142 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,,,,765.96,,,,
L520057 ANTI-HMGCR,83516,CPT,,,,,both,, ,630,378,Aetna,Commercial,,,,,630,,,,
L520085 IA OTHER,83516,CPT,,,,,both,, ,702.72,421.63,Aetna,Commercial,,,,,702.72,,,,
L520139 ANTI-GP210AB,83516,CPT,,,,,both,, ,300,180,Aetna,Commercial,,,,,300,,,,
L520311 CARP AB,83516,CPT,,,,,both,, ,520,312,Aetna,Commercial,,,,,520,,,,
L6486PARIET AB ELISA,83516,CPT,,,,,both,, ,81.5,48.9,Aetna,Commercial,,,,,81.5,,,,
Q15114PARCL AB ELISA,83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,,,,765.96,,,,
Q18855 KU AUTOANTIBODIES,83516,CPT,,,,,both,, ,682.25,409.35,Aetna,Commercial,,,,,682.25,,,,
Q19899RNA P-III ELIS,83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,,,,765.96,,,,
Q34283 RIBO P AB IA,83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,,,,765.96,,,,
Q36336 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,,,,765.96,,,,
Q37056 HISTON AB EIA,83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,,,,765.96,,,,
Q39226  21OH AB,83516,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,,,,765.96,,,,
L086007 IMMUNOASSAY,83519,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,,,,728.07,,,,
L086007 IMMUNOASSAY,83519,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,,,,728.07,,,,
L086007 IMMUNOASSAY,83519,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,,,,728.07,,,,
L086007 IMMUNOASSAY,83519,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,,,,728.07,,,,
L10421 MSH,83519,CPT,,,,,both,, ,184,110.4,Aetna,Commercial,,,,,184,,,,
L504600 MUSCLE SPECIFIC KINASE,83519,CPT,,,,,both,, ,1200,720,Aetna,Commercial,,,,,1200,,,,
Q34459 ACHR BLKAB IA,83519,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,,,,728.07,,,,
Q34459 ACHR BLKAB IA,83519,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,,,,728.07,,,,
Q34459 ACHR BLKAB IA,83519,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,,,,728.07,,,,
Q34459 ACHR BLKAB IA,83519,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,,,,728.07,,,,
L117021 VEGF SER,83520,CPT,,,,,both,, ,175,105,Aetna,Commercial,,,,,175,,,,
L146712 LEPTIN S EIA,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,,,,414.83,,,,
L146712 LEPTIN S EIA,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,,,,414.83,,,,
L146795INHIBIN B EIA,83520,CPT,,,,,both,, ,380.59,228.35,Aetna,Commercial,,,,,380.59,,,,
L500016PROTHR FR 1+2,83520,CPT,,,,,both,, ,172.7,103.62,Aetna,Commercial,,,,,172.7,,,,
L500124 MMP9,83520,CPT,,,,,both,, ,170,102,Aetna,Commercial,,,,,170,,,,
NBS IMMUNOASSAY NOS,83520,CPT,,,,,both,, ,77.47,46.48,Aetna,Commercial,,,,,77.47,,,,
Q16039 MBL ELISA,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,,,,414.83,,,,
Q16039 MBL ELISA,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,,,,414.83,,,,
Q19509 INTERFERON-BETA (IGG) MAID,83520,CPT,,,,,both,, ,369.5,221.7,Aetna,Commercial,,,,,369.5,,,,
Q19509 INTERFERON-BETA (IGG) MAID,83520,CPT,,,,,both,, ,369.5,221.7,Aetna,Commercial,,,,,369.5,,,,
Q19509 INTERFERON-BETA (IGG) MAID,83520,CPT,,,,,both,, ,369.5,221.7,Aetna,Commercial,,,,,369.5,,,,
Q19509 INTERFERON-BETA (IGG) MAID,83520,CPT,,,,,both,, ,369.5,221.7,Aetna,Commercial,,,,,369.5,,,,
Q257 GBM AB IGG IA,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,,,,414.83,,,,
Q257 GBM AB IGG IA,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,,,,414.83,,,,
Q8658 ALPH SUB ECLIA,83520,CPT,,,,,both,, ,444.59,266.75,Aetna,Commercial,,,,,444.59,,,,
Q8658 ALPH SUB ECLIA,83520,CPT,,,,,both,, ,444.59,266.75,Aetna,Commercial,,,,,444.59,,,,
Q90123 IA NOS,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,,,,414.83,,,,
Q90123 IA NOS,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,,,,414.83,,,,
Q91455 14-3-3 ETA PR,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,,,,414.83,,,,
Q91455 14-3-3 ETA PR,83520,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,,,,414.83,,,,
L121137 LTCHN KAPLAM,83521,CPT,,,,,both,, ,103.62,62.17,Aetna,Commercial,,,,,103.62,,,,
L121137 LTCHN KAPLAM,83521,CPT,,,,,both,, ,103.62,62.17,Aetna,Commercial,,,,,103.62,,,,
Q11233 LTCHN KAP LAM,83521,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
Q11233 LTCHN KAP LAM,83521,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
"INSULIN, TOTAL",83525,CPT,,,,,both,, ,53.89,32.33,Aetna,Commercial,,,,,53.89,,,,
"INSULIN, TOTAL",83525,CPT,,,,,both,, ,600.92,360.55,Aetna,Commercial,,,,,600.92,,,,
Q561 INSULIN IA,83525,CPT,,,,,both,, ,632.36,379.41,Aetna,Commercial,,,,,632.36,,,,
"INSULIN, FREE",83527,CPT,,,,,both,, ,193.94,116.36,Aetna,Commercial,,,,,193.94,,,,
L501561 INSULIN FREE,83527,CPT,,,,,both,, ,193.94,116.36,Aetna,Commercial,,,,,193.94,,,,
Q36700 INSULIN FR IA,83527,CPT,,,,,both,, ,193.94,116.36,Aetna,Commercial,,,,,193.94,,,,
IRON,83540,CPT,,,,,both,, ,63.99,38.39,Aetna,Commercial,,,,,63.99,,,,
IRON,83540,CPT,,,,,both,,,345.79,345.79,Aetna,Commercial,,244.13,70.6,,345.79,345.79,345.79,Fee Schedule,70.6
IRON,83540,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
IRON BINDING CAPACIT,83550,CPT,,,,,both,, ,86.16,51.69,Aetna,Commercial,,,,,86.16,,,,
IRON BINDING CAPACIT,83550,CPT,,,,,both,,,526.26,526.26,Aetna,Commercial,,371.54,70.6,,526.26,526.26,526.26,Fee Schedule,70.6
IRON BINDING CAPACIT,83550,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,,,,526.26,,,,
"17-KETOSTEROIDS, TOT",83586,CPT,,,,,both,, ,164.19,98.51,Aetna,Commercial,,,,,164.19,,,,
LACTIC ACID,83605,CPT,,,,,both,, ,105.25,63.15,Aetna,Commercial,,,,,105.25,,,,
LACTIC ACID,83605,CPT,,,,,both,,,691.29,691.29,Aetna,Commercial,,488.05,70.6,,691.29,691.29,691.29,Fee Schedule,70.6
LACTIC ACID,83605,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
LACTATE DEHYDROGENASE LDH FLUID,83615,CPT,,,,,both,, ,600.92,360.55,Aetna,Commercial,,,,,600.92,,,,
LACTATE DEHYDROGENASE LDH FLUID,83615,CPT,,,,,both,, ,600.92,360.55,Aetna,Commercial,,,,,600.92,,,,
LACTATE DEHYDROLDH,83615,CPT,,,,,both,, ,59.5,35.7,Aetna,Commercial,,,,,59.5,,,,
LDH ISOENZYMES,83625,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q10156 LACTOFER IA,83630,CPT,,,,,both,, ,267.48,160.48,Aetna,Commercial,,,,,267.48,,,,
LEAD,83655,CPT,,,,,both,, ,56.97,34.18,Aetna,Commercial,,,,,56.97,,,,
LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
"Q3058 LEAD, BLOOD (OSHA)",83655,CPT,,,,,both,, ,615.75,369.45,Aetna,Commercial,,,,,615.75,,,,
"Q3058 LEAD, BLOOD (OSHA)",83655,CPT,,,,,both,, ,615.75,369.45,Aetna,Commercial,,,,,615.75,,,,
Q36438 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q36440LEAD U24 ICPMS,83655,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q599 PB BL ICP/MS,83655,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q601 PB U ICP/MS,83655,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q7507 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q7655 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
"FETAL LUNG,L-S RATIO",83661,CPT,,,,,both,, ,175.14,105.08,Aetna,Commercial,,,,,175.14,,,,
"FETAL LUNG, FPIA",83663,CPT,,,,,both,, ,863.91,518.34,Aetna,Commercial,,,,,863.91,,,,
LIPASE,83690,CPT,,,,,both,, ,67.92,40.75,Aetna,Commercial,,,,,67.92,,,,
LIPASE,83690,CPT,,,,,both,,,420.72,420.72,Aetna,Commercial,,297.03,70.6,,420.72,420.72,420.72,Fee Schedule,70.6
LIPASE,83690,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
Q34604 LIPOPRT A ITA,83695,CPT,,,,,both,, ,467.04,280.22,Aetna,Commercial,,,,,467.04,,,,
Q92145 LIPOPROTEIN,83695,CPT,,,,,both,, ,112.27,67.36,Aetna,Commercial,,,,,112.27,,,,
Q92145 LIPOPROTEIN,83695,CPT,,,,,both,, ,112.27,67.36,Aetna,Commercial,,,,,112.27,,,,
Q94220 LP-PLA2,83698,CPT,,,,,both,, ,216.39,129.83,Aetna,Commercial,,,,,216.39,,,,
Q92145 LIPOPROT BLD,83704,CPT,,,,,both,, ,374.69,224.81,Aetna,Commercial,,,,,374.69,,,,
Q92145 LIPOPROT BLD,83704,CPT,,,,,both,, ,374.69,224.81,Aetna,Commercial,,,,,374.69,,,,
"LIPOPROTEIN, HDL",83718,CPT,,,,,both,, ,60.63,36.37,Aetna,Commercial,,,,,60.63,,,,
"LIPOPROTEIN, HDL",83718,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,,,,480.79,,,,
"LIPOPROTEIN, LDL",83721,CPT,,,,,both,, ,570.89,342.53,Aetna,Commercial,,,,,570.89,,,,
L80283 MG RBC AAS-IC,83735,CPT,,,,,both,, ,67,40.2,Aetna,Commercial,,,,,67,,,,
L80283 MG RBC AAS-IC,83735,CPT,,,,,both,, ,67,40.2,Aetna,Commercial,,,,,67,,,,
MAGNESIUM,83735,CPT,,,,,both,, ,49.68,29.8,Aetna,Commercial,,,,,49.68,,,,
MAGNESIUM,83735,CPT,,,,,both,,,344.1,344.1,Aetna,Commercial,,242.93,70.6,,344.1,344.1,344.1,Fee Schedule,70.6
Q442 MAGNESIUM,83735,CPT,,,,,both,, ,344.1,206.46,Aetna,Commercial,,,,,344.1,,,,
Q442 MAGNESIUM,83735,CPT,,,,,both,, ,344.1,206.46,Aetna,Commercial,,,,,344.1,,,,
MANGANESE WHOLE BLOOD,83785,CPT,,,,,both,, ,133,79.8,Aetna,Commercial,,,,,133,,,,
L70034 I S/P ICP/MS,83789,CPT,,,,,both,, ,315,189,Aetna,Commercial,,,,,315,,,,
L70222 I U ICP/MS,83789,CPT,,,,,both,, ,390.49,234.29,Aetna,Commercial,,,,,390.49,,,,
Q91745THIOPUR LCMSMS,83789,CPT,,,,,both,, ,402.2,241.32,Aetna,Commercial,,,,,402.2,,,,
Q91745THIOPUR LCMSMS,83789,CPT,,,,,both,, ,402.2,241.32,Aetna,Commercial,,,,,402.2,,,,
MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,,,,751.36,,,,
Q36438 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,,,,751.36,,,,
Q636 HG BL ICP/MS,83825,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,,,,751.36,,,,
Q7507 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,,,,751.36,,,,
Q7655 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,,,,751.36,,,,
METANEPHRINES,83835,CPT,,,,,both,, ,2599.05,1559.43,Aetna,Commercial,,,,,2599.05,,,,
Q14961 METANEPHRINES,83835,CPT,,,,,both,, ,488.65,293.19,Aetna,Commercial,,,,,488.65,,,,
Q14962MNFR U24 LCMSM,83835,CPT,,,,,both,, ,488.65,293.19,Aetna,Commercial,,,,,488.65,,,,
Q19548 MN FRC LCMSMS,83835,CPT,,,,,both,, ,488.65,293.19,Aetna,Commercial,,,,,488.65,,,,
Q70858 MYELIN BASIC,83873,CPT,,,,,both,, ,509.14,305.48,Aetna,Commercial,,,,,509.14,,,,
Q70858 MYELIN BASIC,83873,CPT,,,,,both,, ,509.14,305.48,Aetna,Commercial,,,,,509.14,,,,
L3079MYOGL QT U ICMA,83874,CPT,,,,,both,, ,627.3,376.38,Aetna,Commercial,,,,,627.3,,,,
L3079MYOGL QT U ICMA,83874,CPT,,,,,both,, ,627.3,376.38,Aetna,Commercial,,,,,627.3,,,,
L143000 NT-PROBNP,83880,CPT,,,,,both,, ,450,270,Aetna,Commercial,,,,,450,,,,
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,, ,279.55,167.73,Aetna,Commercial,,,,,279.55,,,,
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,,,1229.07,1229.07,Aetna,Commercial,,867.72,70.6,,1229.07,1229.07,1229.07,Fee Schedule,70.6
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,, ,1229.07,737.44,Aetna,Commercial,,,,,1229.07,,,,
Q37863 NEPHELOM NOS,83883,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
Q37863 NEPHELOM NOS,83883,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
Q38940 NEPHELOMETRY NOS,83883,CPT,,,,,both,, ,374.75,224.85,Aetna,Commercial,,,,,374.75,,,,
NICKEL,83885,CPT,,,,,both,, ,934.09,560.45,Aetna,Commercial,,,,,934.09,,,,
Q14624 5'NUCLEO C-KN,83915,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,,,,871.22,,,,
Q14624 5'NUCLEO C-KN,83915,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,,,,871.22,,,,
Q70858 OLIGOCLONAL B,83916,CPT,,,,,both,, ,530.75,318.45,Aetna,Commercial,,,,,530.75,,,,
Q70858 OLIGOCLONAL B,83916,CPT,,,,,both,, ,530.75,318.45,Aetna,Commercial,,,,,530.75,,,,
Q34879 MMA MS/MS,83921,CPT,,,,,both,, ,396.02,237.61,Aetna,Commercial,,,,,396.02,,,,
Q34879 MMA MS/MS,83921,CPT,,,,,both,, ,396.02,237.61,Aetna,Commercial,,,,,396.02,,,,
L2071 OSMALALITY FPD,83930,CPT,,,,,both,, ,40.89,24.53,Aetna,Commercial,,,,,40.89,,,,
"OSMOLALITY, BLOOD",83930,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
L3442 OSMOLALI U FPD,83935,CPT,,,,,both,, ,50.9,30.54,Aetna,Commercial,,,,,50.9,,,,
"OSMOLALITY,URINE",83935,CPT,,,,,both,, ,67.07,40.24,Aetna,Commercial,,,,,67.07,,,,
"OSMOLALITY,URINE",83935,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
L10249 OSTREOC ELISA,83937,CPT,,,,,both,, ,203.6,122.16,Aetna,Commercial,,,,,203.6,,,,
OSTEOCALCIN,83937,CPT,,,,,both,, ,447.39,268.43,Aetna,Commercial,,,,,447.39,,,,
LC833603 OXALATE S/P,83945,CPT,,,,,both,, ,660.98,396.58,Aetna,Commercial,,,,,660.98,,,,
LC833603 OXALATE S/P,83945,CPT,,,,,both,, ,660.98,396.58,Aetna,Commercial,,,,,660.98,,,,
LC833603 OXALATE S/P,83945,CPT,,,,,both,, ,660.98,396.58,Aetna,Commercial,,,,,660.98,,,,
LC833603 OXALATE S/P,83945,CPT,,,,,both,, ,660.98,396.58,Aetna,Commercial,,,,,660.98,,,,
L15610 PTH INT ECLIA,83970,CPT,,,,,both,, ,420.49,252.29,Aetna,Commercial,,,,,420.49,,,,
PARATHORMONE PTH,83970,CPT,,,,,both,, ,160.55,96.33,Aetna,Commercial,,,,,160.55,,,,
PARATHORMONE PTH,83970,CPT,,,,,both,, ,1420.49,852.29,Aetna,Commercial,,,,,1420.49,,,,
"L910235 PH FLUID, NOS",83986,CPT,,,,,both,, ,240.26,144.15,Aetna,Commercial,,,,,240.26,,,,
"PH FLUID,NOS",83986,CPT,,,,,both,, ,240.26,144.15,Aetna,Commercial,,,,,240.26,,,,
"Q442 PH FLUID,NOS",83986,CPT,,,,,both,, ,240.26,144.15,Aetna,Commercial,,,,,240.26,,,,
L790600 PCP MS,83992,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
Q16796 CALPRO STL IA,83993,CPT,,,,,both,, ,395.75,237.45,Aetna,Commercial,,,,,395.75,,,,
Q16796 CALPRO STL IA,83993,CPT,,,,,both,, ,395.75,237.45,Aetna,Commercial,,,,,395.75,,,,
Q37356 PNENYLAL HPLC,84030,CPT,,,,,both,, ,32.84,19.7,Aetna,Commercial,,,,,32.84,,,,
Q37356 PNENYLAL HPLC,84030,CPT,,,,,both,, ,32.84,19.7,Aetna,Commercial,,,,,32.84,,,,
"PHOSPHATASE, PROSTAT",84066,CPT,,,,,both,, ,540.85,324.51,Aetna,Commercial,,,,,540.85,,,,
"PHOSPHATASE,ALKALINE",84075,CPT,,,,,both,, ,51.08,30.64,Aetna,Commercial,,,,,51.08,,,,
Q6432 PHOSPHATAS ALK,84075,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
Q6432 PHOSPHATAS ALK,84075,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
Q6432 PHOSPH ALK ISO,84080,CPT,,,,,both,, ,637.41,382.44,Aetna,Commercial,,,,,637.41,,,,
Q6432 PHOSPH ALK ISO,84080,CPT,,,,,both,, ,637.41,382.44,Aetna,Commercial,,,,,637.41,,,,
PHOSPHATIDYLGLYCEROL,84081,CPT,,,,,both,, ,389.01,233.4,Aetna,Commercial,,,,,389.01,,,,
"PHOSPHORUS, BLOOD",84100,CPT,,,,,both,, ,46.87,28.12,Aetna,Commercial,,,,,46.87,,,,
"PHOSPHORUS, BLOOD",84100,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
"L910235 PHOSPHORUS, URINE",84105,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
"PHOSPHORUS, URINE",84105,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
"Q442 PHOSPHORUS, URI",84105,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
"PORPHOBILINOGEN,QUAN",84110,CPT,,,,,both,, ,630.96,378.57,Aetna,Commercial,,,,,630.96,,,,
PAMG-1 QUALITATIVE,84112,CPT,,,,,both,, ,488.09,292.85,Aetna,Commercial,,,,,488.09,,,,
L3194 PORPH QT U24,84120,CPT,,,,,both,, ,811.43,486.85,Aetna,Commercial,,,,,811.43,,,,
"PORPHYRINS,UR,QUAN",84120,CPT,,,,,both,, ,811.42,486.85,Aetna,Commercial,,,,,811.42,,,,
POTASSIUM SER PL WB,84132,CPT,,,,,both,, ,47.15,28.29,Aetna,Commercial,,,,,47.15,,,,
POTASSIUM SER PL WB,84132,CPT,,,,,both,,,240.26,240.26,Aetna,Commercial,,169.62,70.6,,240.26,240.26,240.26,Fee Schedule,70.6
POTASSIUM SER PL WB,84132,CPT,,,,,both,, ,240.26,144.15,Aetna,Commercial,,,,,240.26,,,,
"L910235 POTASSIUM, URINE",84133,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
"POTASSIUM, URINE",84133,CPT,,,,,both,,,345.79,345.79,Aetna,Commercial,,244.13,70.6,,345.79,345.79,345.79,Fee Schedule,70.6
"POTASSIUM, URINE",84133,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
"Q442 POTASSIUM, URIN",84133,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
PREALBUMIN,84134,CPT,,,,,both,, ,105.25,63.15,Aetna,Commercial,,,,,105.25,,,,
PREALBUMIN,84134,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
PREGNENOLONE MS,84140,CPT,,,,,both,, ,164.75,98.85,Aetna,Commercial,,,,,164.75,,,,
PREGNENOLONE MS,84140,CPT,,,,,both,, ,164.75,98.85,Aetna,Commercial,,,,,164.75,,,,
"PREGNENOLONE,17-OH",84143,CPT,,,,,both,, ,387.89,232.73,Aetna,Commercial,,,,,387.89,,,,
L4317 PROGESTE ECLIA,84144,CPT,,,,,both,, ,1217.28,730.36,Aetna,Commercial,,,,,1217.28,,,,
L4317 PROGESTE ECLIA,84144,CPT,,,,,both,, ,1217.28,730.36,Aetna,Commercial,,,,,1217.28,,,,
PROGESTERONE,84144,CPT,,,,,both,, ,62.58,37.54,Aetna,Commercial,,,,,62.58,,,,
Q16265 PROCALCIT IFA,84145,CPT,,,,,both,, ,232.11,139.26,Aetna,Commercial,,,,,232.11,,,,
Q16265 PROCALCIT IFA,84145,CPT,,,,,both,, ,232.11,139.26,Aetna,Commercial,,,,,232.11,,,,
L4465 PROLACTI ECLIA,84146,CPT,,,,,both,, ,628.3,376.98,Aetna,Commercial,,,,,628.3,,,,
PROLACTIN,84146,CPT,,,,,both,, ,143.14,85.88,Aetna,Commercial,,,,,143.14,,,,
PROLACTIN,84146,CPT,,,,,both,, ,1077.5,646.5,Aetna,Commercial,,,,,1077.5,,,,
Q16122 PROLACTIN,84146,CPT,,,,,both,, ,959.75,575.85,Aetna,Commercial,,,,,959.75,,,,
Q16122 PROLACTIN,84146,CPT,,,,,both,, ,959.75,575.85,Aetna,Commercial,,,,,959.75,,,,
Q93958 23BPG UR,84150,CPT,,,,,both,, ,390.13,234.07,Aetna,Commercial,,,,,390.13,,,,
PSA (prostate specific antigen),84153,CPT,,,,,both,,,1036.25,1036.25,Aetna,Commercial,,731.59,70.6,,1036.25,1036.25,1036.25,Fee Schedule,70.6
"PSA, TOTAL",84153,CPT,,,,,both,, ,135.85,81.51,Aetna,Commercial,,,,,135.85,,,,
"Q31348 PSA, TOTAL",84153,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
"Q31348 PSA, TOTAL",84153,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
PSA (prostate specific antigen),84154,CPT,,,,,both,,,1036.25,1036.25,Aetna,Commercial,,731.59,70.6,,1036.25,1036.25,1036.25,Fee Schedule,70.6
"PSA, FREE",84154,CPT,,,,,both,, ,135.85,81.51,Aetna,Commercial,,,,,135.85,,,,
"Q31348 PSA, FREE",84154,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
"Q31348 PSA, FREE",84154,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
L121210 PROT TOT SER,84155,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
L121210 PROT TOT SER,84155,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
L121210 PROT TOT SER,84155,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
L121210 PROT TOT SER,84155,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,35.93,21.55,Aetna,Commercial,,,,,35.93,,,,
Q38940 PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,374.75,224.85,Aetna,Commercial,,,,,374.75,,,,
PROT TOTL RANDOM URI,84156,CPT,,,,,both,,,420.72,420.72,Aetna,Commercial,,297.03,70.6,,420.72,420.72,420.72,Fee Schedule,70.6
Q8525 PROT TOTL RAND,84156,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
Q8525 PROT TOTL RAND,84156,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
PROTEIN TOT OTHR SRC,84157,CPT,,,,,both,, ,35.93,21.55,Aetna,Commercial,,,,,35.93,,,,
Q749 PROT TOT OTH SR,84157,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
L121210 SPE FR QT,84165,CPT,,,,,both,, ,609.34,365.6,Aetna,Commercial,,,,,609.34,,,,
L121210 SPE FR QT,84165,CPT,,,,,both,, ,609.34,365.6,Aetna,Commercial,,,,,609.34,,,,
L121210 SPE FR QT,84165,CPT,,,,,both,, ,609.34,365.6,Aetna,Commercial,,,,,609.34,,,,
L121210 SPE FR QT,84165,CPT,,,,,both,, ,609.34,365.6,Aetna,Commercial,,,,,609.34,,,,
PROTEINELECTR FR-QNT,84165,CPT,,,,,both,, ,105.81,63.48,Aetna,Commercial,,,,,105.81,,,,
Q38940 PROTEINELECTR FR QNT,84165,CPT,,,,,both,, ,542.75,325.65,Aetna,Commercial,,,,,542.75,,,,
PROT E-PHOR-URIN-CSF,84166,CPT,,,,,both,, ,429.71,257.82,Aetna,Commercial,,,,,429.71,,,,
Q749 PROT E-PHOR-URI,84166,CPT,,,,,both,, ,429.71,257.82,Aetna,Commercial,,,,,429.71,,,,
Q8525 PROT E-PHOR-UR,84166,CPT,,,,,both,, ,429.71,257.82,Aetna,Commercial,,,,,429.71,,,,
Q94777 WEST BLOT PRB,84182,CPT,,,,,both,, ,136.4,81.84,Aetna,Commercial,,,,,136.4,,,,
Q94777 WEST BLOT PRB,84182,CPT,,,,,both,, ,136.4,81.84,Aetna,Commercial,,,,,136.4,,,,
Q22996 PROTOPORPH RBC QUAN,84202,CPT,,,,,both,, ,177.5,106.5,Aetna,Commercial,,,,,177.5,,,,
Q948 ZPP HEMATOFLUOR,84202,CPT,,,,,both,, ,199.27,119.56,Aetna,Commercial,,,,,199.27,,,,
Q948 ZPP HEMATOFLUOR,84202,CPT,,,,,both,, ,199.27,119.56,Aetna,Commercial,,,,,199.27,,,,
PROINSULIN,84206,CPT,,,,,both,, ,266.91,160.14,Aetna,Commercial,,,,,266.91,,,,
Q760 PROINSULIN IA,84206,CPT,,,,,both,, ,337.09,202.25,Aetna,Commercial,,,,,337.09,,,,
Q926 B6 PL LC/MS/MS,84207,CPT,,,,,both,, ,738.17,442.9,Aetna,Commercial,,,,,738.17,,,,
Q926 B6 PL LC/MS/MS,84207,CPT,,,,,both,, ,738.17,442.9,Aetna,Commercial,,,,,738.17,,,,
PYRUVATE,84210,CPT,,,,,both,, ,1066.84,640.1,Aetna,Commercial,,,,,1066.84,,,,
Q91031 STFR NEPHELOM,84238,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
Q91031 STFR NEPHELOM,84238,CPT,,,,,both,, ,326.71,196.02,Aetna,Commercial,,,,,326.71,,,,
Q16845 RENIN,84244,CPT,,,,,both,, ,475.46,285.27,Aetna,Commercial,,,,,475.46,,,,
Q16845 RENIN,84244,CPT,,,,,both,, ,475.46,285.27,Aetna,Commercial,,,,,475.46,,,,
RENIN,84244,CPT,,,,,both,, ,1487.01,892.2,Aetna,Commercial,,,,,1487.01,,,,
VITAMIN B-2,84252,CPT,,,,,both,, ,180.75,108.45,Aetna,Commercial,,,,,180.75,,,,
Q5507 SELENIUM AS,84255,CPT,,,,,both,, ,409.5,245.7,Aetna,Commercial,,,,,409.5,,,,
Q5507 SELENIUM AS,84255,CPT,,,,,both,, ,409.5,245.7,Aetna,Commercial,,,,,409.5,,,,
SEROTONIN,84260,CPT,,,,,both,, ,94.58,56.74,Aetna,Commercial,,,,,94.58,,,,
Q14966 SEX HORM BIND,84270,CPT,,,,,both,, ,288.25,172.95,Aetna,Commercial,,,,,288.25,,,,
Q30740 SHBG IA,84270,CPT,,,,,both,, ,288.25,172.95,Aetna,Commercial,,,,,288.25,,,,
SEX HORM BIND GLOB,84270,CPT,,,,,both,, ,288.25,172.95,Aetna,Commercial,,,,,288.25,,,,
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,, ,47.43,28.45,Aetna,Commercial,,,,,47.43,,,,
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,,,345.79,345.79,Aetna,Commercial,,244.13,70.6,,345.79,345.79,345.79,Fee Schedule,70.6
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
"L910235 SODIUM, URINE",84300,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
"Q442 SODIUM, URINE R",84300,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,, ,47.99,28.79,Aetna,Commercial,,,,,47.99,,,,
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,,,345.79,345.79,Aetna,Commercial,,244.13,70.6,,345.79,345.79,345.79,Fee Schedule,70.6
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
SODIUM OTHER SOURCE,84302,CPT,,,,,both,, ,82.51,49.5,Aetna,Commercial,,,,,82.51,,,,
Q16293 IGF-I LC/MS,84305,CPT,,,,,both,, ,870.37,522.22,Aetna,Commercial,,,,,870.37,,,,
Q16293 IGF-I LC/MS,84305,CPT,,,,,both,, ,870.37,522.22,Aetna,Commercial,,,,,870.37,,,,
ADENO DEAMNASE BFLD,84311,CPT,,,,,both,, ,93.74,56.24,Aetna,Commercial,,,,,93.74,,,,
Q175858 CHOLEST PF C,84311,CPT,,,,,both,, ,93.74,56.24,Aetna,Commercial,,,,,93.74,,,,
"SPECTROPHOTO, NOS",84311,CPT,,,,,both,, ,93.74,56.24,Aetna,Commercial,,,,,93.74,,,,
SPECIFIC GRAVITY,84315,CPT,,,,,both,, ,210.5,126.3,Aetna,Commercial,,,,,210.5,,,,
"SUGARS, SING, QUAL",84376,CPT,,,,,both,, ,93.74,56.24,Aetna,Commercial,,,,,93.74,,,,
GLYCOMARK,84378,CPT,,,,,both,, ,224,134.4,Aetna,Commercial,,,,,224,,,,
"Q442 SULFATE, URINE",84392,CPT,,,,,both,, ,31.71,19.02,Aetna,Commercial,,,,,31.71,,,,
"Q442 SULFATE, URINE",84392,CPT,,,,,both,, ,31.71,19.02,Aetna,Commercial,,,,,31.71,,,,
Q18944 TST FREE,84402,CPT,,,,,both,, ,1017.17,610.3,Aetna,Commercial,,,,,1017.17,,,,
Q36170 TESTOST FREE,84402,CPT,,,,,both,,,1017.17,1017.17,Aetna,Commercial,,718.12,70.6,,1017.17,1017.17,1017.17,Fee Schedule,70.6
Q36170 TESTOST FREE,84402,CPT,,,,,both,, ,1017.17,610.3,Aetna,Commercial,,,,,1017.17,,,,
"TESTOSTERONE, FREE",84402,CPT,,,,,both,, ,1017.17,610.3,Aetna,Commercial,,,,,1017.17,,,,
Q14966 TESTOST TOTAL,84403,CPT,,,,,both,, ,968.6,581.16,Aetna,Commercial,,,,,968.6,,,,
Q36170 TESTOST TOTAL,84403,CPT,,,,,both,,,968.6,968.6,Aetna,Commercial,,683.83,70.6,,968.6,968.6,968.6,Fee Schedule,70.6
Q36170 TESTOST TOTAL,84403,CPT,,,,,both,, ,968.6,581.16,Aetna,Commercial,,,,,968.6,,,,
"TESTOSTERONE, TOTAL",84403,CPT,,,,,both,, ,190.86,114.51,Aetna,Commercial,,,,,190.86,,,,
"TESTOSTERONE, TOTAL",84403,CPT,,,,,both,, ,968.6,581.16,Aetna,Commercial,,,,,968.6,,,,
L70282 TEST FR WB T,84410,CPT,,,,,both,, ,211.15,126.69,Aetna,Commercial,,,,,211.15,,,,
L121186VITB1 BL HPLC,84425,CPT,,,,,both,, ,1318.66,791.19,Aetna,Commercial,,,,,1318.66,,,,
Q5042 B1 BL LC/MS/MS,84425,CPT,,,,,both,, ,269.16,161.49,Aetna,Commercial,,,,,269.16,,,,
Q90353 VIT B1 LCMSMS,84425,CPT,,,,,both,, ,303.69,182.21,Aetna,Commercial,,,,,303.69,,,,
VITAMIN B-1,84425,CPT,,,,,both,, ,156.89,94.13,Aetna,Commercial,,,,,156.89,,,,
VITAMIN B-1,84425,CPT,,,,,both,, ,1437.33,862.39,Aetna,Commercial,,,,,1437.33,,,,
THIOCYANATE,84430,CPT,,,,,both,, ,174.57,104.74,Aetna,Commercial,,,,,174.57,,,,
Q30278 THYROGLOBULIN,84432,CPT,,,,,both,, ,255.13,153.07,Aetna,Commercial,,,,,255.13,,,,
Q30278 THYROGLOBULIN,84432,CPT,,,,,both,, ,255.13,153.07,Aetna,Commercial,,,,,255.13,,,,
"THYROXINE T4,TOTAL",84436,CPT,,,,,both,, ,38.73,23.23,Aetna,Commercial,,,,,38.73,,,,
"THYROXINE T4,TOTAL",84436,CPT,,,,,both,, ,405.57,243.34,Aetna,Commercial,,,,,405.57,,,,
Q35167 T4FREE DED-IA,84439,CPT,,,,,both,, ,620.56,372.33,Aetna,Commercial,,,,,620.56,,,,
Q35167 T4FREE DED-IA,84439,CPT,,,,,both,, ,620.56,372.33,Aetna,Commercial,,,,,620.56,,,,
"THYROXINE T4, FREE",84439,CPT,,,,,both,, ,66.52,39.91,Aetna,Commercial,,,,,66.52,,,,
"THYROXINE T4, FREE",84439,CPT,,,,,both,,,620.56,620.56,Aetna,Commercial,,438.12,70.6,,620.56,620.56,620.56,Fee Schedule,70.6
L1735 TBG SER ICMA,84442,CPT,,,,,both,, ,195.7,117.42,Aetna,Commercial,,,,,195.7,,,,
THYROXINE BIND GLOB,84442,CPT,,,,,both,, ,213.31,127.98,Aetna,Commercial,,,,,213.31,,,,
"Blood test, thyroid stimulating hormone (TSH)",84443,CPT,,,,,both,,,737.61,737.61,Aetna,Commercial,,520.75,70.6,,737.61,737.61,737.61,Fee Schedule,70.6
Q90123 TSH,84443,CPT,,,,,both,, ,737.61,442.56,Aetna,Commercial,,,,,737.61,,,,
Q90123 TSH,84443,CPT,,,,,both,, ,737.61,442.56,Aetna,Commercial,,,,,737.61,,,,
THYROID STIM TSH,84443,CPT,,,,,both,, ,124.05,74.43,Aetna,Commercial,,,,,124.05,,,,
Q30551 TSI IA,84445,CPT,,,,,both,, ,733.12,439.87,Aetna,Commercial,,,,,733.12,,,,
THYROID STIM IMMUNO,84445,CPT,,,,,both,, ,1178.27,706.96,Aetna,Commercial,,,,,1178.27,,,,
Q931 VIT E HPLC,84446,CPT,,,,,both,, ,227.62,136.57,Aetna,Commercial,,,,,227.62,,,,
Q931 VIT E HPLC,84446,CPT,,,,,both,, ,227.62,136.57,Aetna,Commercial,,,,,227.62,,,,
L500440 TRANSCORTIN,84449,CPT,,,,,both,, ,180,108,Aetna,Commercial,,,,,180,,,,
TRANSFERASE AST,84450,CPT,,,,,both,, ,38.17,22.9,Aetna,Commercial,,,,,38.17,,,,
TRANSFERASE AST,84450,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
TRANSFERASE ALT,84460,CPT,,,,,both,, ,39.29,23.57,Aetna,Commercial,,,,,39.29,,,,
TRANSFERASE ALT,84460,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
Q891 TRANSFERRI NEPH,84466,CPT,,,,,both,, ,796.55,477.93,Aetna,Commercial,,,,,796.55,,,,
Q891 TRANSFERRI NEPH,84466,CPT,,,,,both,, ,796.55,477.93,Aetna,Commercial,,,,,796.55,,,,
TRANSFERRIN,84466,CPT,,,,,both,, ,94.31,56.58,Aetna,Commercial,,,,,94.31,,,,
TRIGLYCERIDES,84478,CPT,,,,,both,, ,39.29,23.57,Aetna,Commercial,,,,,39.29,,,,
TRIGLYCERIDES,84478,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
T3-T4 UPTAKE,84479,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,,,,526.26,,,,
"T3,TOTAL",84480,CPT,,,,,both,, ,1039.33,623.59,Aetna,Commercial,,,,,1039.33,,,,
"T3,FREE",84481,CPT,,,,,both,, ,858.3,514.98,Aetna,Commercial,,,,,858.3,,,,
Q90963 T3 REV LCMSMS,84482,CPT,,,,,both,, ,858.3,514.98,Aetna,Commercial,,,,,858.3,,,,
"T3,REVERSE",84482,CPT,,,,,both,, ,219.2,131.52,Aetna,Commercial,,,,,219.2,,,,
"TROPONIN,QNT",84484,CPT,,,,,both,, ,133.88,80.32,Aetna,Commercial,,,,,133.88,,,,
"TROPONIN,QNT",84484,CPT,,,,,both,,,713.19,713.19,Aetna,Commercial,,503.51,70.6,,713.19,713.19,713.19,Fee Schedule,70.6
"TROPONIN,QNT",84484,CPT,,,,,both,, ,713.19,427.91,Aetna,Commercial,,,,,713.19,,,,
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,, ,29.19,17.51,Aetna,Commercial,,,,,29.19,,,,
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,,,277.59,277.59,Aetna,Commercial,,195.98,70.6,,277.59,277.59,277.59,Fee Schedule,70.6
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,, ,277.59,166.55,Aetna,Commercial,,,,,277.59,,,,
"L910235 UREA NITROGEN, URINE",84540,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
"L910235 UREA NITROGEN, URINE",84540,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
"UREA NITROGEN,URINE",84540,CPT,,,,,both,,,345.79,345.79,Aetna,Commercial,,244.13,70.6,,345.79,345.79,345.79,Fee Schedule,70.6
"URIC ACID, BLOOD",84550,CPT,,,,,both,, ,44.34,26.6,Aetna,Commercial,,,,,44.34,,,,
"URIC ACID, BLOOD",84550,CPT,,,,,both,,,285.17,285.17,Aetna,Commercial,,201.33,70.6,,285.17,285.17,285.17,Fee Schedule,70.6
"URIC ACID, BLOOD",84550,CPT,,,,,both,, ,285.17,171.1,Aetna,Commercial,,,,,285.17,,,,
"L910235 URIC ACID, URINE",84560,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
"Q442 URIC ACID,URINE",84560,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
"URIC ACID,URINE RAND",84560,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
L4143 VMA U24 LCMSMS,84585,CPT,,,,,both,, ,355.05,213.03,Aetna,Commercial,,,,,355.05,,,,
L4143 VMA U24 LCMSMS,84585,CPT,,,,,both,, ,355.05,213.03,Aetna,Commercial,,,,,355.05,,,,
VANILLYLMANDELIC ACID (VMA) SERUM,84585,CPT,,,,,both,, ,116.7,70.02,Aetna,Commercial,,,,,116.7,,,,
L10397 VIP PL RIA,84586,CPT,,,,,both,, ,338.36,203.01,Aetna,Commercial,,,,,338.36,,,,
VASOINTESTINAL PEP,84586,CPT,,,,,both,, ,368.8,221.28,Aetna,Commercial,,,,,368.8,,,,
Q252 AVP ADH EXT-RIA,84588,CPT,,,,,both,, ,295.83,177.49,Aetna,Commercial,,,,,295.83,,,,
Q252 AVP ADH EXT-RIA,84588,CPT,,,,,both,, ,295.83,177.49,Aetna,Commercial,,,,,295.83,,,,
Q921 VIT A HPLC,84590,CPT,,,,,both,, ,186.08,111.64,Aetna,Commercial,,,,,186.08,,,,
Q921 VIT A HPLC,84590,CPT,,,,,both,, ,186.08,111.64,Aetna,Commercial,,,,,186.08,,,,
"VITAMIN ASSAY, NOS",84591,CPT,,,,,both,, ,197.03,118.21,Aetna,Commercial,,,,,197.03,,,,
Q36585 VITAM K HPLC,84597,CPT,,,,,both,, ,188.89,113.33,Aetna,Commercial,,,,,188.89,,,,
Q36585 VITAM K HPLC,84597,CPT,,,,,both,, ,188.89,113.33,Aetna,Commercial,,,,,188.89,,,,
VOLATILES,84600,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,,,,728.07,,,,
XYLOSE ABSORPTION,84620,CPT,,,,,both,, ,1111.47,666.88,Aetna,Commercial,,,,,1111.47,,,,
Q945 ZN ICP/MS AS,84630,CPT,,,,,both,, ,1081.72,649.03,Aetna,Commercial,,,,,1081.72,,,,
Q945 ZN ICP/MS AS,84630,CPT,,,,,both,, ,1081.72,649.03,Aetna,Commercial,,,,,1081.72,,,,
ZINC WHOLE BLOOD,84630,CPT,,,,,both,, ,80,48,Aetna,Commercial,,,,,80,,,,
Q372 C-PEPTIDE IA,84681,CPT,,,,,both,, ,898.44,539.06,Aetna,Commercial,,,,,898.44,,,,
Q372 C-PEPTIDE IA,84681,CPT,,,,,both,, ,898.44,539.06,Aetna,Commercial,,,,,898.44,,,,
HCG QUANT,84702,CPT,,,,,both,, ,148.47,89.08,Aetna,Commercial,,,,,148.47,,,,
L140450 HCG TUMOR MK,84702,CPT,,,,,both,, ,758.66,455.19,Aetna,Commercial,,,,,758.66,,,,
L140450 HCG TUMOR MK,84702,CPT,,,,,both,, ,758.66,455.19,Aetna,Commercial,,,,,758.66,,,,
"HCG, QUAL",84703,CPT,,,,,both,, ,74.1,44.46,Aetna,Commercial,,,,,74.1,,,,
"HCG, QUAL",84703,CPT,,,,,both,,,420.72,420.72,Aetna,Commercial,,297.03,70.6,,420.72,420.72,420.72,Fee Schedule,70.6
"HCG, QUAL",84703,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
CLIN CHEM TEST NOS,84999,CPT,,,,,both,, ,274.5,164.7,Aetna,Commercial,,,,,274.5,,,,
L820610Z K FEC,84999,CPT,,,,,both,, ,225,135,Aetna,Commercial,,,,,225,,,,
L820610Z K FEC,84999,CPT,,,,,both,, ,225,135,Aetna,Commercial,,,,,225,,,,
BLEEDING TIME,85002,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
AUTO DIFF WBC COUNT,85004,CPT,,,,,both,, ,47.99,28.79,Aetna,Commercial,,,,,47.99,,,,
AUTO DIFF WBC COUNT,85004,CPT,,,,,both,, ,103,61.8,Aetna,Commercial,,,,,103,,,,
"WBC DIFF, MAN",85007,CPT,,,,,both,, ,33.96,20.37,Aetna,Commercial,,,,,33.96,,,,
"WBC DIFF, MAN",85007,CPT,,,,,both,, ,188.33,112.99,Aetna,Commercial,,,,,188.33,,,,
BLOOD SMEAR SCAN,85008,CPT,,,,,both,, ,112.55,67.53,Aetna,Commercial,,,,,112.55,,,,
"HEMATOCRIT, SPUN",85013,CPT,,,,,both,, ,32.84,19.7,Aetna,Commercial,,,,,32.84,,,,
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,, ,13.18,7.9,Aetna,Commercial,,,,,13.18,,,,
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,,,262.99,262.99,Aetna,Commercial,,185.67,70.6,,262.99,262.99,262.99,Fee Schedule,70.6
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,, ,262.99,157.79,Aetna,Commercial,,,,,262.99,,,,
HEMOGLOBIN,85018,CPT,,,,,both,, ,13.18,7.9,Aetna,Commercial,,,,,13.18,,,,
HEMOGLOBIN,85018,CPT,,,,,both,,,262.99,262.99,Aetna,Commercial,,185.67,70.6,,262.99,262.99,262.99,Fee Schedule,70.6
HEMOGLOBIN,85018,CPT,,,,,both,, ,262.99,157.79,Aetna,Commercial,,,,,262.99,,,,
HEMOGLOBIN,85018,CPT,,,,,both,, ,262.99,157.79,Aetna,Commercial,,,,,262.99,,,,
L121003 HEMOGLOBIN,85018,CPT,,,,,both,, ,10,6,Aetna,Commercial,,,,,10,,,,
CBC W-PLT AUTO COMPD,85025,CPT,,,,,both,, ,28.9,17.34,Aetna,Commercial,,,,,28.9,,,,
CBC W-PLT AUTO COMPD,85025,CPT,,,,,both,, ,428.3,256.98,Aetna,Commercial,,,,,428.3,,,,
"Complete blood cell count, with differential white blood cells, automated",85025,CPT,,,,,both,,,428.3,428.3,Aetna,Commercial,,302.38,70.6,,428.3,428.3,428.3,Fee Schedule,70.6
CBC W-PLT,85027,CPT,,,,,both,, ,24.13,14.47,Aetna,Commercial,,,,,24.13,,,,
CBC W-PLT,85027,CPT,,,,,both,, ,412.87,247.72,Aetna,Commercial,,,,,412.87,,,,
"Complete blood count, automated",85027,CPT,,,,,both,,,412.87,412.87,Aetna,Commercial,,291.49,70.6,,412.87,412.87,412.87,Fee Schedule,70.6
MAN CELL CT ELP,85032,CPT,,,,,both,, ,466.48,279.88,Aetna,Commercial,,,,,466.48,,,,
L1917 RBC COUNT,85041,CPT,,,,,both,, ,6.06,3.63,Aetna,Commercial,,,,,6.06,,,,
"RETIC COUNT, MANUAL",85044,CPT,,,,,both,, ,489.78,293.86,Aetna,Commercial,,,,,489.78,,,,
"RETIC COUNT, FLOW",85045,CPT,,,,,both,, ,39.29,23.57,Aetna,Commercial,,,,,39.29,,,,
"RETIC COUNT, FLOW",85045,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
WBC COUNT,85048,CPT,,,,,both,, ,16.55,9.93,Aetna,Commercial,,,,,16.55,,,,
WBC COUNT,85048,CPT,,,,,both,, ,285.17,171.1,Aetna,Commercial,,,,,285.17,,,,
CBC-PLT AUTORP CDM,85049,CPT,,,,,both,, ,16.55,9.93,Aetna,Commercial,,,,,16.55,,,,
CBC-PLT AUTORP CDM,85049,CPT,,,,,both,, ,285.17,171.1,Aetna,Commercial,,,,,285.17,,,,
BONE MARROW INTERPRE,85097,CPT,,,,,both,, ,237.17,142.3,Aetna,Commercial,,,,,237.17,,,,
APIXABAN ANTI-XA,85130,CPT,,,,,both,, ,250,150,Aetna,Commercial,,,,,250,,,,
Q331 FACT II ACT PCD,85210,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,,,,74.93,,,,
FACTOR V ASSAY,85220,CPT,,,,,both,, ,121.53,72.91,Aetna,Commercial,,,,,121.53,,,,
L86249 FACT V ACT CD,85220,CPT,,,,,both,, ,121.53,72.91,Aetna,Commercial,,,,,121.53,,,,
Q344 FACT V CLOT PCD,85220,CPT,,,,,both,, ,121.53,72.91,Aetna,Commercial,,,,,121.53,,,,
L800599FACTVII ACT C,85230,CPT,,,,,both,, ,335.69,201.41,Aetna,Commercial,,,,,335.69,,,,
L800599FACTVII ACT C,85230,CPT,,,,,both,, ,335.69,201.41,Aetna,Commercial,,,,,335.69,,,,
"FACTOR VIII, AHG",85240,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,,,,728.07,,,,
L503333 FAC8 AHG,85240,CPT,,,,,both,, ,706.86,424.11,Aetna,Commercial,,,,,706.86,,,,
FACTOR VIII RISTOCET,85245,CPT,,,,,both,, ,1352.01,811.2,Aetna,Commercial,,,,,1352.01,,,,
L164509 VWF ACTIV PA,85245,CPT,,,,,both,, ,412,247.2,Aetna,Commercial,,,,,412,,,,
Q4919 VWF AG ITA,85246,CPT,,,,,both,, ,1164.52,698.71,Aetna,Commercial,,,,,1164.52,,,,
Q4919 VWF AG ITA,85246,CPT,,,,,both,, ,1164.52,698.71,Aetna,Commercial,,,,,1164.52,,,,
"FACT VIII,VW,MULTIME",85247,CPT,,,,,both,, ,181.59,108.95,Aetna,Commercial,,,,,181.59,,,,
FACTOR IX,85250,CPT,,,,,both,, ,151.56,90.93,Aetna,Commercial,,,,,151.56,,,,
FACTOR X,85260,CPT,,,,,both,, ,142.58,85.54,Aetna,Commercial,,,,,142.58,,,,
FACTOR XI,85270,CPT,,,,,both,, ,142.58,85.54,Aetna,Commercial,,,,,142.58,,,,
ANTITHROMBIN IIIACTI,85300,CPT,,,,,both,, ,1930.76,1158.45,Aetna,Commercial,,,,,1930.76,,,,
L015040 ANTITHROMBIN ACTIVITY,85300,CPT,,,,,both,, ,965.23,579.13,Aetna,Commercial,,,,,965.23,,,,
Q5158 ATIII AG FRNEP,85301,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,,,,72.13,,,,
"PROTEIN C, AG",85302,CPT,,,,,both,, ,1907.47,1144.48,Aetna,Commercial,,,,,1907.47,,,,
Q4948 PROT C AG IA,85302,CPT,,,,,both,, ,1942.55,1165.53,Aetna,Commercial,,,,,1942.55,,,,
Q1777 PROT C ACT,85303,CPT,,,,,both,, ,1261.35,756.81,Aetna,Commercial,,,,,1261.35,,,,
Q1777 PROT C ACT,85303,CPT,,,,,both,, ,1261.35,756.81,Aetna,Commercial,,,,,1261.35,,,,
"Q7942 PROTEIN C, ACT",85303,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
L117754 PROT S TOT,85305,CPT,,,,,both,, ,116.1,69.66,Aetna,Commercial,,,,,116.1,,,,
Q5165 PROT S AG ITA,85305,CPT,,,,,both,, ,1261.35,756.81,Aetna,Commercial,,,,,1261.35,,,,
Q5165 PROT S AG ITA,85305,CPT,,,,,both,, ,1261.35,756.81,Aetna,Commercial,,,,,1261.35,,,,
L117754 PROT S FREE,85306,CPT,,,,,both,, ,153.2,91.92,Aetna,Commercial,,,,,153.2,,,,
"PROTEIN S, FREE",85306,CPT,,,,,both,, ,151,90.6,Aetna,Commercial,,,,,151,,,,
"PROTEIN S, FREE",85306,CPT,,,,,both,, ,939.98,563.98,Aetna,Commercial,,,,,939.98,,,,
Q10170 PROT S AG ITA,85306,CPT,,,,,both,, ,939.98,563.98,Aetna,Commercial,,,,,939.98,,,,
Q1779 PROT S ACT,85306,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
"Q7942 PROTEIN S, FRE",85306,CPT,,,,,both,, ,939.98,563.98,Aetna,Commercial,,,,,939.98,,,,
PROTEIN C ACTIVATED,85307,CPT,,,,,both,, ,239.69,143.81,Aetna,Commercial,,,,,239.69,,,,
Q22 APCR RVVT-BSE AS,85307,CPT,,,,,both,, ,596.43,357.85,Aetna,Commercial,,,,,596.43,,,,
SOLUB LIV AG AB(RDL),85316,CPT,,,,,both,, ,567,340.2,Aetna,Commercial,,,,,567,,,,
COAG TIME ACTIVATED,85347,CPT,,,,,both,, ,167.84,100.7,Aetna,Commercial,,,,,167.84,,,,
FDP-FSP AGG SLIDE,85362,CPT,,,,,both,, ,691.58,414.94,Aetna,Commercial,,,,,691.58,,,,
"D-DIMER, QUANT",85379,CPT,,,,,both,, ,100.48,60.28,Aetna,Commercial,,,,,100.48,,,,
"D-DIMER, QUANT",85379,CPT,,,,,both,,,886.09,886.09,Aetna,Commercial,,625.58,70.6,,886.09,886.09,886.09,Fee Schedule,70.6
"D-DIMER, QUANT",85379,CPT,,,,,both,, ,886.09,531.65,Aetna,Commercial,,,,,886.09,,,,
FIBRINOGEN ACTIVITY,85384,CPT,,,,,both,, ,83.64,50.18,Aetna,Commercial,,,,,83.64,,,,
FIBRINOGEN ACTIVITY,85384,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
Q14532 ADAMTS13 IA,85397,CPT,,,,,both,, ,188.05,112.83,Aetna,Commercial,,,,,188.05,,,,
Q36555 PAI-1 IA,85415,CPT,,,,,both,, ,222.01,133.2,Aetna,Commercial,,,,,222.01,,,,
LSKBFHS FET HGB ST,85460,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,,,,526.26,,,,
LSKBFHS FET HGB ST,85460,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,,,,526.26,,,,
"FETAL HGB, ROSETTE",85461,CPT,,,,,both,, ,349.72,209.83,Aetna,Commercial,,,,,349.72,,,,
HEPARIN ASSAY,85520,CPT,,,,,both,, ,1274.26,764.55,Aetna,Commercial,,,,,1274.26,,,,
L117101 HEPARIN A-XA,85520,CPT,,,,,both,, ,139.05,83.43,Aetna,Commercial,,,,,139.05,,,,
MURAMIDASE,85549,CPT,,,,,both,, ,261.02,156.61,Aetna,Commercial,,,,,261.02,,,,
RBC OSMOTIC FRAGW-IN,85557,CPT,,,,,both,, ,450.48,270.28,Aetna,Commercial,,,,,450.48,,,,
PLATELET AGGREGATION,85576,CPT,,,,,both,, ,344.67,206.8,Aetna,Commercial,,,,,344.67,,,,
QRX143590 DRVVT CONF,85597,CPT,,,,,both,, ,160.55,96.33,Aetna,Commercial,,,,,160.55,,,,
QRX143590 DRVVT CONF,85597,CPT,,,,,both,, ,160.55,96.33,Aetna,Commercial,,,,,160.55,,,,
L117079 HEX PHOS,85598,CPT,,,,,both,, ,179.8,107.88,Aetna,Commercial,,,,,179.8,,,,
Q143583HEXA PHSE CD,85598,CPT,,,,,both,, ,153.52,92.11,Aetna,Commercial,,,,,153.52,,,,
Q143583HEXA PHSE CD,85598,CPT,,,,,both,, ,153.52,92.11,Aetna,Commercial,,,,,153.52,,,,
"Blood test, clotting time",85610,CPT,,,,,both,,,430.27,430.27,Aetna,Commercial,,303.77,70.6,,430.27,430.27,430.27,Fee Schedule,70.6
PROTHROMBIN TIME,85610,CPT,,,,,both,, ,14.6,8.76,Aetna,Commercial,,,,,14.6,,,,
PROTHROMBIN TIME,85610,CPT,,,,,both,, ,430.27,258.16,Aetna,Commercial,,,,,430.27,,,,
"PROTHROMBIN, SUBSTIT",85611,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,,,,728.07,,,,
Q7079 RUSSELL VIPER,85613,CPT,,,,,both,, ,364.88,218.92,Aetna,Commercial,,,,,364.88,,,,
Q7079 RUSSELL VIPER,85613,CPT,,,,,both,, ,364.88,218.92,Aetna,Commercial,,,,,364.88,,,,
"SED RATE, AUTOMATED",85652,CPT,,,,,both,, ,26.66,15.99,Aetna,Commercial,,,,,26.66,,,,
"SED RATE, AUTOMATED",85652,CPT,,,,,both,,,345.79,345.79,Aetna,Commercial,,244.13,70.6,,345.79,345.79,345.79,Fee Schedule,70.6
"SED RATE, AUTOMATED",85652,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
O51226 SICKLE C  SCR,85660,CPT,,,,,both,, ,385.99,231.59,Aetna,Commercial,,,,,385.99,,,,
Q37679 SICKLE CELL SCRN WITH REFLEX HEMO,85660,CPT,,,,,both,, ,374.75,224.85,Aetna,Commercial,,,,,374.75,,,,
Q825 SICKL CL HS SOL,85660,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
Q825 SICKL CL HS SOL,85660,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
Q883 THROMB CLT BCS,85670,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,,,,526.26,,,,
Q883 THROMB CLT BCS,85670,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,,,,526.26,,,,
Coagulation assessment blood test,85730,CPT,,,,,both,,,480.79,480.79,Aetna,Commercial,,339.44,70.6,,480.79,480.79,480.79,Fee Schedule,70.6
Q7079 THROMBOPLAST T,85730,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,,,,480.79,,,,
Q7079 THROMBOPLAST T,85730,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,,,,480.79,,,,
THROMBOPLAST TIMEPTT,85730,CPT,,,,,both,, ,58.94,35.36,Aetna,Commercial,,,,,58.94,,,,
PTT-LA MIX,85732,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,,,,480.79,,,,
PTT-LA MIX,85732,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,,,,480.79,,,,
VISCOSITY EXAM,85810,CPT,,,,,both,, ,80.27,48.16,Aetna,Commercial,,,,,80.27,,,,
Q94609 ALG IGG QT,86001,CPT,,,,,both,, ,66.24,39.74,Aetna,Commercial,,,,,66.24,,,,
Q94609 ALG IGG QT,86001,CPT,,,,,both,, ,66.24,39.74,Aetna,Commercial,,,,,66.24,,,,
ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,51.36,30.81,Aetna,Commercial,,,,,51.36,,,,
ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,,,,148.75,,,,
L602635 - ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,,,,148.75,,,,
Q10643 ALG IGE QT,86003,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,,,,148.75,,,,
Q10659 ALLERGEN IGE,86003,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,,,,148.75,,,,
Q10715 ALLERGEN IGE,86003,CPT,,,,,both,, ,148.75,89.25,Aetna,Commercial,,,,,148.75,,,,
Q91681 ALLERGEN IGE,86008,CPT,,,,,both,, ,103.29,61.97,Aetna,Commercial,,,,,103.29,,,,
Q91681 ALLERGEN IGE,86008,CPT,,,,,both,, ,103.29,61.97,Aetna,Commercial,,,,,103.29,,,,
L6643 ASMA ELISA,86015,CPT,,,,,both,, ,702.72,421.63,Aetna,Commercial,,,,,702.72,,,,
Q15043 ACTIN AB EA,86015,CPT,,,,,both,, ,514.48,308.68,Aetna,Commercial,,,,,514.48,,,,
Q36733 WBC AB IDENT,86021,CPT,,,,,both,, ,500.72,300.43,Aetna,Commercial,,,,,500.72,,,,
Q36733 WBC AB IDENT,86021,CPT,,,,,both,, ,500.72,300.43,Aetna,Commercial,,,,,500.72,,,,
Q36733 WBC AB IDENT,86021,CPT,,,,,both,, ,500.72,300.43,Aetna,Commercial,,,,,500.72,,,,
Q36733 WBC AB IDENT,86021,CPT,,,,,both,, ,500.72,300.43,Aetna,Commercial,,,,,500.72,,,,
PLATELET AB,86022,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,,,,871.22,,,,
Q14627SRA UNF RB-14C,86022,CPT,,,,,both,, ,467.88,280.72,Aetna,Commercial,,,,,467.88,,,,
Q14874 PLATELET AB,86022,CPT,,,,,both,, ,467.88,280.72,Aetna,Commercial,,,,,467.88,,,,
Q414 HEP-IND PLAT AB,86022,CPT,,,,,both,, ,467.88,280.72,Aetna,Commercial,,,,,467.88,,,,
Q91740PLATELT IGG FC,86023,CPT,,,,,both,, ,83.08,49.84,Aetna,Commercial,,,,,83.08,,,,
L162045 FLUORS AB SC,86036,CPT,,,,,both,, ,486.16,291.69,Aetna,Commercial,,,,,486.16,,,,
Q70171 ANCA SCN IA,86036,CPT,,,,,both,, ,500.72,300.43,Aetna,Commercial,,,,,500.72,,,,
L163061 ANCA TITER,86037,CPT,,,,,both,, ,120.5,72.3,Aetna,Commercial,,,,,120.5,,,,
ANA,86038,CPT,,,,,both,, ,91.77,55.06,Aetna,Commercial,,,,,91.77,,,,
ANA,86038,CPT,,,,,both,, ,898.44,539.06,Aetna,Commercial,,,,,898.44,,,,
L164947 ANA IFA,86038,CPT,,,,,both,, ,824.26,494.55,Aetna,Commercial,,,,,824.26,,,,
Q16814 ANA IFA REFIA,86038,CPT,,,,,both,,,898.44,898.44,Aetna,Commercial,,634.3,70.6,,898.44,898.44,898.44,Fee Schedule,70.6
Q16814 ANA IFA REFIA,86038,CPT,,,,,both,, ,898.44,539.06,Aetna,Commercial,,,,,898.44,,,,
Q249 ANA SCRN IFA,86038,CPT,,,,,both,, ,898.44,539.06,Aetna,Commercial,,,,,898.44,,,,
"ANA,TITER",86039,CPT,,,,,both,, ,93.46,56.07,Aetna,Commercial,,,,,93.46,,,,
QRX ANA TITER PATTRN,86039,CPT,,,,,both,, ,547.31,328.38,Aetna,Commercial,,,,,547.31,,,,
QRX ANA TITER PATTRN,86039,CPT,,,,,both,, ,547.31,328.38,Aetna,Commercial,,,,,547.31,,,,
ACETYLCH RCPT BND AB,86041,CPT,,,,,both,, ,55.2,33.12,Aetna,Commercial,,,,,55.2,,,,
ACETYLC RCPT BLCK AB,86042,CPT,,,,,both,, ,55.2,33.12,Aetna,Commercial,,,,,55.2,,,,
ACTYLC RCPT MODL AB,86043,CPT,,,,,both,, ,55.2,33.12,Aetna,Commercial,,,,,55.2,,,,
Q38321 AQP4 NMOIGG,86052,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,,,,529.91,,,,
"ASO,TITER",86060,CPT,,,,,both,, ,71.85,43.11,Aetna,Commercial,,,,,71.85,,,,
"ASO,TITER",86060,CPT,,,,,both,, ,539.45,323.67,Aetna,Commercial,,,,,539.45,,,,
Q265 ASO AB ITA,86060,CPT,,,,,both,, ,189.17,113.5,Aetna,Commercial,,,,,189.17,,,,
PHYS BB SERV TRAN RE,86078,CPT,,,,,both,, ,165.59,99.35,Aetna,Commercial,,,,,165.59,,,,
C-REACTIVE PROTEIN,86140,CPT,,,,,both,, ,51.08,30.64,Aetna,Commercial,,,,,51.08,,,,
C-REACTIVE PROTEIN,86140,CPT,,,,,both,, ,518.69,311.21,Aetna,Commercial,,,,,518.69,,,,
Q10124 HS-CRP NEPHEL,86141,CPT,,,,,both,, ,999.76,599.85,Aetna,Commercial,,,,,999.76,,,,
Q30340 BETA-2 GLYCOP,86146,CPT,,,,,both,, ,252.04,151.22,Aetna,Commercial,,,,,252.04,,,,
Q30340 BETA-2 GLYCOP,86146,CPT,,,,,both,, ,252.04,151.22,Aetna,Commercial,,,,,252.04,,,,
Q36552 B2-GPIAB IGA,86146,CPT,,,,,both,, ,252.04,151.22,Aetna,Commercial,,,,,252.04,,,,
Q36552 B2-GPIAB IGA,86146,CPT,,,,,both,, ,252.04,151.22,Aetna,Commercial,,,,,252.04,,,,
Q36554B-2-GP1 IGG IA,86146,CPT,,,,,both,, ,252.04,151.22,Aetna,Commercial,,,,,252.04,,,,
Q36554B-2-GP1 IGG IA,86146,CPT,,,,,both,, ,252.04,151.22,Aetna,Commercial,,,,,252.04,,,,
L161950CARDIOLIPIN A,86147,CPT,,,,,both,, ,429.43,257.65,Aetna,Commercial,,,,,429.43,,,,
L161950CARDIOLIPIN A,86147,CPT,,,,,both,, ,429.43,257.65,Aetna,Commercial,,,,,429.43,,,,
Q4661 C-LIPIN AB IGA,86147,CPT,,,,,both,, ,429.43,257.65,Aetna,Commercial,,,,,429.43,,,,
Q4661 C-LIPIN AB IGA,86147,CPT,,,,,both,, ,429.43,257.65,Aetna,Commercial,,,,,429.43,,,,
Q4663 C-LIPIN AB IGM,86147,CPT,,,,,both,, ,429.43,257.65,Aetna,Commercial,,,,,429.43,,,,
Q4663 C-LIPIN AB IGM,86147,CPT,,,,,both,, ,429.43,257.65,Aetna,Commercial,,,,,429.43,,,,
PHOSPHATIDYLSERIN AB,86148,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,,,,141.46,,,,
PHOSPHOLIPID AB,86148,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,,,,141.46,,,,
Q14890 PHOSPHOLIPID,86148,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,,,,141.46,,,,
CELL ENUM IS AND ID,86152,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,,,,72.13,,,,
"COLD AGG, TITER",86157,CPT,,,,,both,, ,247.83,148.69,Aetna,Commercial,,,,,247.83,,,,
L6353COLD HEMAGGL QT,86157,CPT,,,,,both,, ,40.7,24.42,Aetna,Commercial,,,,,40.7,,,,
"COMPLEMENT AG, EA",86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q19882 COMP AG,86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q34888 COMPLE C7 RID,86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q34889 COMPLE C8 RID,86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q351 C3 COMPL ITA,86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q353 C4C COMP ITA,86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q354 COMPLEM C5 RID,86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q433 COMPL CP C2 RID,86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q981 COMPL C C1Q RID,86160,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q297 C1 INH FUNC IA,86161,CPT,,,,,both,, ,79.99,47.99,Aetna,Commercial,,,,,79.99,,,,
Q618 COMPL CH50 LIPO,86162,CPT,,,,,both,, ,984.32,590.59,Aetna,Commercial,,,,,984.32,,,,
Q618 COMPL CH50 LIPO,86162,CPT,,,,,both,, ,984.32,590.59,Aetna,Commercial,,,,,984.32,,,,
Q11173 CCP AB IGG IA,86200,CPT,,,,,both,, ,242.5,145.5,Aetna,Commercial,,,,,242.5,,,,
L96286 ADNASE-B NEPH,86215,CPT,,,,,both,, ,198.72,119.23,Aetna,Commercial,,,,,198.72,,,,
L96286 ADNASE-B NEPH,86215,CPT,,,,,both,, ,198.72,119.23,Aetna,Commercial,,,,,198.72,,,,
"DNA AB,NATIVE-DOUBL",86225,CPT,,,,,both,, ,1077.5,646.5,Aetna,Commercial,,,,,1077.5,,,,
L165092 DNA DS AB,86225,CPT,,,,,both,, ,486.16,291.69,Aetna,Commercial,,,,,486.16,,,,
L96346 DSDNA AB IA,86225,CPT,,,,,both,, ,219.1,131.46,Aetna,Commercial,,,,,219.1,,,,
Q19882 DNA DS AB,86225,CPT,,,,,both,, ,1077.5,646.5,Aetna,Commercial,,,,,1077.5,,,,
Q255 DNA DS AB IA,86225,CPT,,,,,both,, ,1077.5,646.5,Aetna,Commercial,,,,,1077.5,,,,
Q14857 SSDNA ANTIBODY (IGG),86226,CPT,,,,,both,, ,923,553.8,Aetna,Commercial,,,,,923,,,,
Q45972 SSDNA IGG EIA,86226,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
Q45972 SSDNA IGG EIA,86226,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
L165126 ENDMYS AB IG,86231,CPT,,,,,both,, ,60.05,36.03,Aetna,Commercial,,,,,60.05,,,,
Q15064 ENDOMYS AB IG,86231,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,,,,529.91,,,,
Q19955 ENDOMYS AB IG,86231,CPT,,,,,both,, ,743.65,446.19,Aetna,Commercial,,,,,743.65,,,,
ANTI-ENA,86235,CPT,,,,,both,, ,174.85,104.91,Aetna,Commercial,,,,,174.85,,,,
ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,,,,274.22,,,,
L165092 ANTI-ENA,86235,CPT,,,,,both,, ,251.58,150.94,Aetna,Commercial,,,,,251.58,,,,
L520085 ANTI-ENS,86235,CPT,,,,,both,, ,548.71,329.22,Aetna,Commercial,,,,,548.71,,,,
L520085 ANTI-ENS,86235,CPT,,,,,both,, ,548.71,329.22,Aetna,Commercial,,,,,548.71,,,,
Q16088 CENTR B AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,,,,274.22,,,,
Q171728MI-2 AAB RIPA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,,,,274.22,,,,
Q19882 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,,,,274.22,,,,
Q19887 RNP AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,,,,274.22,,,,
Q34088 CHROMAT AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,,,,274.22,,,,
Q37923 SM AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,,,,274.22,,,,
Q38568 SS-A IA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,,,,274.22,,,,
Q38569 SS-B IA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,,,,274.22,,,,
Q4942 SCLEROD AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,,,,274.22,,,,
Q5810 JO-1 AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,,,,274.22,,,,
Q7448 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,,,,274.22,,,,
Q94025 PM-SCL AB EIA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,,,,274.22,,,,
Q94685 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,,,,274.22,,,,
Q94777 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Aetna,Commercial,,,,,274.22,,,,
L165126 FLUORS AB SC,86255,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,,,,529.91,,,,
L165126 FLUORS AB SC,86255,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,,,,529.91,,,,
L165126 FLUORS AB SC,86255,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,,,,529.91,,,,
L165126 FLUORS AB SC,86255,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,,,,529.91,,,,
L165620 STRIATIONAL ANTIBODIES,86255,CPT,,,,,both,, ,89.9,53.94,Aetna,Commercial,,,,,89.9,,,,
LC505225 ACETYLCHOLINE RECEPT-MODULAT AB,86255,CPT,,,,,both,, ,260.64,156.38,Aetna,Commercial,,,,,260.64,,,,
Q37520 RETICU IGA IA,86255,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,,,,529.91,,,,
Q37520 RETICU IGA IA,86255,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,,,,529.91,,,,
Q37520 RETICU IGA IA,86255,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,,,,529.91,,,,
Q37520 RETICU IGA IA,86255,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,,,,529.91,,,,
Q91985 ENDOMYSIAL(IGG)ANTIBODY SCRN TITR,86255,CPT,,,,,both,, ,472,283.2,Aetna,Commercial,,,,,472,,,,
"FLUORESCENT AB,TITER",86256,CPT,,,,,both,, ,1217.28,730.36,Aetna,Commercial,,,,,1217.28,,,,
L831723 FLUOR AB TIT,86256,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,,,,529.91,,,,
L831723 FLUOR AB TIT,86256,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,,,,529.91,,,,
L165126 GLIA AB IGA,86258,CPT,,,,,both,, ,57.65,34.59,Aetna,Commercial,,,,,57.65,,,,
Q8889 GLIA AB IGG IA,86258,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,,,,765.96,,,,
Q8889 GLIA AB IGG IA,86258,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,,,,765.96,,,,
L143404 CA15-3 ECLIA,86300,CPT,,,,,both,, ,442.13,265.27,Aetna,Commercial,,,,,442.13,,,,
Q29493 CA 27.29 IA,86300,CPT,,,,,both,, ,481.92,289.15,Aetna,Commercial,,,,,481.92,,,,
TUMR AG CA15-3 27-29,86300,CPT,,,,,both,, ,109.46,65.67,Aetna,Commercial,,,,,109.46,,,,
Q17638 CA 19-9 PERITONEAL FLUID,86301,CPT,,,,,both,, ,716.75,430.05,Aetna,Commercial,,,,,716.75,,,,
Q4698 CA 19-9 IA,86301,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,,,,804.69,,,,
Q4698 CA 19-9 IA,86301,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,,,,804.69,,,,
Q29256 CA 125 IA,86304,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,,,,804.69,,,,
Q91155 TUMR AG CA125,86304,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,,,,804.69,,,,
TUMOR AG CA 125,86304,CPT,,,,,both,, ,804.69,482.81,Aetna,Commercial,,,,,804.69,,,,
Q91155 HE4,86305,CPT,,,,,both,, ,138.65,83.19,Aetna,Commercial,,,,,138.65,,,,
HETEROPHILE AB SCREE,86308,CPT,,,,,both,, ,19.09,11.45,Aetna,Commercial,,,,,19.09,,,,
HETEROPHILE AB SCREE,86308,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,,,,480.79,,,,
Q16379 CGA ECLIA,86316,CPT,,,,,both,, ,481.92,289.15,Aetna,Commercial,,,,,481.92,,,,
Q16379 CGA ECLIA,86316,CPT,,,,,both,, ,481.92,289.15,Aetna,Commercial,,,,,481.92,,,,
Q17410 ALPHA-FETOPROTEIN PERITONEAL FLUI,86316,CPT,,,,,both,, ,429.25,257.55,Aetna,Commercial,,,,,429.25,,,,
Q16963 INF AGENT IMM,86317,CPT,,,,,both,, ,217.52,130.51,Aetna,Commercial,,,,,217.52,,,,
Q16963 INF AGENT IMM,86317,CPT,,,,,both,, ,217.52,130.51,Aetna,Commercial,,,,,217.52,,,,
TETANUS/DIPTHERIA AB,86317,CPT,,,,,both,, ,70,42,Aetna,Commercial,,,,,70,,,,
Q15914 C4 BND PL RID,86329,CPT,,,,,both,, ,81.11,48.66,Aetna,Commercial,,,,,81.11,,,,
Q14978 IMMUNODI OUCN,86331,CPT,,,,,both,, ,69.04,41.42,Aetna,Commercial,,,,,69.04,,,,
Q38940 IMMUNOFIXATION ELECT,86334,CPT,,,,,both,, ,909.75,545.85,Aetna,Commercial,,,,,909.75,,,,
Q549 IFE SERUM,86334,CPT,,,,,both,, ,1021.37,612.82,Aetna,Commercial,,,,,1021.37,,,,
Q549 IFE SERUM,86334,CPT,,,,,both,, ,1021.37,612.82,Aetna,Commercial,,,,,1021.37,,,,
IMM E-PHORS-URIN-CSF,86335,CPT,,,,,both,, ,680.07,408.04,Aetna,Commercial,,,,,680.07,,,,
Q10640 B2TF EL-IF,86335,CPT,,,,,both,, ,680.07,408.04,Aetna,Commercial,,,,,680.07,,,,
Q213 IFE U,86335,CPT,,,,,both,, ,680.07,408.04,Aetna,Commercial,,,,,680.07,,,,
INHIBIN A,86336,CPT,,,,,both,, ,145.66,87.39,Aetna,Commercial,,,,,145.66,,,,
Q36178 INSUL AAB RBA,86337,CPT,,,,,both,, ,207.41,124.44,Aetna,Commercial,,,,,207.41,,,,
Q36178 INSUL AAB RBA,86337,CPT,,,,,both,, ,207.41,124.44,Aetna,Commercial,,,,,207.41,,,,
INTRINSIC FACTOR AB,86340,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
L10413 IFB AB ICMA,86340,CPT,,,,,both,, ,50,30,Aetna,Commercial,,,,,50,,,,
ISLET CELL AB,86341,CPT,,,,,both,, ,296.67,178,Aetna,Commercial,,,,,296.67,,,,
Q34878 GAD-65 AB RBA,86341,CPT,,,,,both,, ,728.07,436.84,Aetna,Commercial,,,,,728.07,,,,
Q36177 IA2 AB,86341,CPT,,,,,both,, ,296.67,178,Aetna,Commercial,,,,,296.67,,,,
Q36741 ISL CL AB IFA,86341,CPT,,,,,both,, ,296.67,178,Aetna,Commercial,,,,,296.67,,,,
Q93022 ZINC TRANSPORTER 8 (ZNT8)ANTIBODY,86341,CPT,,,,,both,, ,264.25,158.55,Aetna,Commercial,,,,,264.25,,,,
Q90123 LEUK HIST REL,86343,CPT,,,,,both,, ,55.95,33.57,Aetna,Commercial,,,,,55.95,,,,
L820022 CHRN URTICAR,86352,CPT,,,,,both,, ,422.3,253.38,Aetna,Commercial,,,,,422.3,,,,
"Q39588 B CELLS, TOTA",86355,CPT,,,,,both,, ,217.52,130.51,Aetna,Commercial,,,,,217.52,,,,
Q10981 RITXN SN CD20,86356,CPT,,,,,both,, ,308.74,185.24,Aetna,Commercial,,,,,308.74,,,,
Q10981 RITXN SN CD20,86356,CPT,,,,,both,, ,308.74,185.24,Aetna,Commercial,,,,,308.74,,,,
Q37088 NK CELLS CF,86357,CPT,,,,,both,, ,217.52,130.51,Aetna,Commercial,,,,,217.52,,,,
"Q39588 T CELLS, TOTA",86359,CPT,,,,,both,, ,217.52,130.51,Aetna,Commercial,,,,,217.52,,,,
Q7924 LYMPH SUBP4 FC,86360,CPT,,,,,both,, ,1515.65,909.39,Aetna,Commercial,,,,,1515.65,,,,
Q7924 LYMPH SUBP4 FC,86360,CPT,,,,,both,, ,1515.65,909.39,Aetna,Commercial,,,,,1515.65,,,,
Q8360 LYMP SUB P5 FC,86361,CPT,,,,,both,, ,822.94,493.76,Aetna,Commercial,,,,,822.94,,,,
"T CELL, ABSO CD4",86361,CPT,,,,,both,, ,878.79,527.27,Aetna,Commercial,,,,,878.79,,,,
Q36952 MOG AB,86362,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,,,,529.91,,,,
L165126TTG AB IGG IA,86364,CPT,,,,,both,, ,57.65,34.59,Aetna,Commercial,,,,,57.65,,,,
Q11070 TTG AB IGG IA,86364,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,,,,765.96,,,,
Q11070 TTG AB IGG IA,86364,CPT,,,,,both,, ,765.96,459.57,Aetna,Commercial,,,,,765.96,,,,
L504600 MSCLSPECKINAB,86366,CPT,,,,,both,, ,180.4,108.24,Aetna,Commercial,,,,,180.4,,,,
Q90123 MICROSOMAL AB,86376,CPT,,,,,both,, ,682.88,409.72,Aetna,Commercial,,,,,682.88,,,,
Q90123 MICROSOMAL AB,86376,CPT,,,,,both,, ,682.88,409.72,Aetna,Commercial,,,,,682.88,,,,
Q90123 MICROSOMAL AB,86376,CPT,,,,,both,, ,682.88,409.72,Aetna,Commercial,,,,,682.88,,,,
Q90123 MICROSOMAL AB,86376,CPT,,,,,both,, ,682.88,409.72,Aetna,Commercial,,,,,682.88,,,,
Q259 MITO AB IA,86381,CPT,,,,,both,, ,529.91,317.94,Aetna,Commercial,,,,,529.91,,,,
Q30321 MM2AB IGG EIA,86381,CPT,,,,,both,, ,414.83,248.89,Aetna,Commercial,,,,,414.83,,,,
Q94106 NEUT TST VIR,86382,CPT,,,,,both,, ,224.54,134.72,Aetna,Commercial,,,,,224.54,,,,
Q94106 NEUT TST VIR,86382,CPT,,,,,both,, ,224.54,134.72,Aetna,Commercial,,,,,224.54,,,,
PART AGGLUT.SCREEN,86403,CPT,,,,,both,, ,547.31,328.38,Aetna,Commercial,,,,,547.31,,,,
Q16786 S.PN AG U LA,86403,CPT,,,,,both,, ,172.9,103.74,Aetna,Commercial,,,,,172.9,,,,
Q16786 S.PN AG U LA,86403,CPT,,,,,both,, ,172.9,103.74,Aetna,Commercial,,,,,172.9,,,,
PART AGGLUT. TITER,86406,CPT,,,,,both,, ,147.91,88.74,Aetna,Commercial,,,,,147.91,,,,
Q37521 RA FACT QT,86431,CPT,,,,,both,, ,401.19,240.71,Aetna,Commercial,,,,,401.19,,,,
RHEUMATOID FACT QUAN,86431,CPT,,,,,both,, ,55.85,33.51,Aetna,Commercial,,,,,55.85,,,,
RHEUMATOID FACT QUAN,86431,CPT,,,,,both,, ,437.29,262.37,Aetna,Commercial,,,,,437.29,,,,
LRX182877 QTFERON TU,86480,CPT,,,,,both,, ,369.77,221.86,Aetna,Commercial,,,,,369.77,,,,
Q19453 TB GOLD BIO A,86480,CPT,,,,,both,,,403.05,403.05,Aetna,Commercial,,284.55,70.6,,403.05,403.05,403.05,Fee Schedule,70.6
Q19453 TB GOLD BIO A,86480,CPT,,,,,both,, ,403.05,241.83,Aetna,Commercial,,,,,403.05,,,,
Q19453 TB GOLD BIO A,86480,CPT,,,,,both,, ,403.05,241.83,Aetna,Commercial,,,,,403.05,,,,
L006099 RFLX RPR,86592,CPT,,,,,both,, ,48.9,29.34,Aetna,Commercial,,,,,48.9,,,,
L12005 RPR CHAR FLOC,86592,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
L12005 RPR CHAR FLOC,86592,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
"SYPHILIS TEST, QUAL",86592,CPT,,,,,both,, ,42.1,25.26,Aetna,Commercial,,,,,42.1,,,,
L6460 RPR QT CHAR FL,86593,CPT,,,,,both,, ,412.88,247.72,Aetna,Commercial,,,,,412.88,,,,
"SYPHILIS TEST, QUANT",86593,CPT,,,,,both,, ,43.5,26.1,Aetna,Commercial,,,,,43.5,,,,
"SYPHILIS TEST, QUANT",86593,CPT,,,,,both,, ,412.87,247.72,Aetna,Commercial,,,,,412.87,,,,
VOLT-GTD CA CHNL AB,86596,CPT,,,,,both,, ,120.5,72.3,Aetna,Commercial,,,,,120.5,,,,
Q94609 ASP AB,86606,CPT,,,,,both,, ,145.95,87.57,Aetna,Commercial,,,,,145.95,,,,
Q94609 ASP AB,86606,CPT,,,,,both,, ,145.95,87.57,Aetna,Commercial,,,,,145.95,,,,
Q34329 LISTERI AB CF,86609,CPT,,,,,both,, ,770.45,462.27,Aetna,Commercial,,,,,770.45,,,,
Q94609 BACTERUIM AB,86609,CPT,,,,,both,, ,154.09,92.45,Aetna,Commercial,,,,,154.09,,,,
Q94609 BACTERUIM AB,86609,CPT,,,,,both,, ,154.09,92.45,Aetna,Commercial,,,,,154.09,,,,
BARTONELLA AB,86611,CPT,,,,,both,, ,348.32,208.99,Aetna,Commercial,,,,,348.32,,,,
Q34251 BARTONELLA AB,86611,CPT,,,,,both,, ,264.11,158.46,Aetna,Commercial,,,,,264.11,,,,
Q932 BLASTOM AB ID S,86612,CPT,,,,,both,, ,600.92,360.55,Aetna,Commercial,,,,,600.92,,,,
Q932 BLASTOM AB ID S,86612,CPT,,,,,both,, ,600.92,360.55,Aetna,Commercial,,,,,600.92,,,,
Q37294 B PERTUS AB,86615,CPT,,,,,both,, ,134.44,80.66,Aetna,Commercial,,,,,134.44,,,,
Q37294 B PERTUS AB,86615,CPT,,,,,both,, ,134.44,80.66,Aetna,Commercial,,,,,134.44,,,,
Q8593 BORRELIA BURG.,86617,CPT,,,,,both,, ,232.11,139.26,Aetna,Commercial,,,,,232.11,,,,
Q8593 BORRELIA BURG.,86617,CPT,,,,,both,, ,232.11,139.26,Aetna,Commercial,,,,,232.11,,,,
LYME DISEASE AB,86618,CPT,,,,,both,, ,167.84,100.7,Aetna,Commercial,,,,,167.84,,,,
Q6646 LYM AB IGG/IGM,86618,CPT,,,,,both,, ,573.13,343.87,Aetna,Commercial,,,,,573.13,,,,
Q6646 LYM AB IGG/IGM,86618,CPT,,,,,both,, ,573.13,343.87,Aetna,Commercial,,,,,573.13,,,,
BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Aetna,Commercial,,,,,405.29,,,,
Q91068 BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Aetna,Commercial,,,,,405.29,,,,
Q91121 BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Aetna,Commercial,,,,,405.29,,,,
CANDIDA AB,86628,CPT,,,,,both,, ,157.18,94.3,Aetna,Commercial,,,,,157.18,,,,
CHLAMYDIA AB,86631,CPT,,,,,both,, ,275.62,165.37,Aetna,Commercial,,,,,275.62,,,,
Q38481 C.PNEU AB IGM,86632,CPT,,,,,both,, ,743.51,446.1,Aetna,Commercial,,,,,743.51,,,,
Q5157 C.TRACH AB IGM,86632,CPT,,,,,both,, ,286.57,171.94,Aetna,Commercial,,,,,286.57,,,,
Q5157 C.TRACH AB IGM,86632,CPT,,,,,both,, ,286.57,171.94,Aetna,Commercial,,,,,286.57,,,,
Q906 COCCIDIO AB CF,86635,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
Q906 COCCIDIO AB CF,86635,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
L806606 Q FEV,86638,CPT,,,,,both,, ,120,72,Aetna,Commercial,,,,,120,,,,
Q37071 COXIELLA BRUN,86638,CPT,,,,,both,, ,69.89,41.93,Aetna,Commercial,,,,,69.89,,,,
Q30430 CRYPTO AB IFA,86641,CPT,,,,,both,, ,74.65,44.79,Aetna,Commercial,,,,,74.65,,,,
L6494 CMV IGG CLIA,86644,CPT,,,,,both,, ,1021.5,612.9,Aetna,Commercial,,,,,1021.5,,,,
Q403 CMV AB IGG IA,86644,CPT,,,,,both,, ,1113.43,668.05,Aetna,Commercial,,,,,1113.43,,,,
Q403 CMV AB IGG IA,86644,CPT,,,,,both,, ,1113.43,668.05,Aetna,Commercial,,,,,1113.43,,,,
"CMV AB, IGM",86645,CPT,,,,,both,, ,1277.07,766.24,Aetna,Commercial,,,,,1277.07,,,,
Q8503 CMV AB IGM IA,86645,CPT,,,,,both,, ,485.84,291.5,Aetna,Commercial,,,,,485.84,,,,
Q37512 DIPTHTHER AB,86648,CPT,,,,,both,, ,101.32,60.79,Aetna,Commercial,,,,,101.32,,,,
ENTEROVIRUS AB,86658,CPT,,,,,both,, ,375.82,225.49,Aetna,Commercial,,,,,375.82,,,,
L830764 ENTEROVIR AB,86658,CPT,,,,,both,, ,212,127.2,Aetna,Commercial,,,,,212,,,,
EBV IGG TO EAD,86663,CPT,,,,,both,, ,210.5,126.3,Aetna,Commercial,,,,,210.5,,,,
EBV IGG TO EAD,86663,CPT,,,,,both,, ,210.5,126.3,Aetna,Commercial,,,,,210.5,,,,
"Q6421EPST-BARR, EBNA",86664,CPT,,,,,both,, ,362.91,217.74,Aetna,Commercial,,,,,362.91,,,,
"Q6421EPST-BARR, EBNA",86664,CPT,,,,,both,, ,362.91,217.74,Aetna,Commercial,,,,,362.91,,,,
"Q6421EPSTE-BARR, VCA",86665,CPT,,,,,both,, ,362.91,217.74,Aetna,Commercial,,,,,362.91,,,,
"Q6421EPSTE-BARR, VCA",86665,CPT,,,,,both,, ,362.91,217.74,Aetna,Commercial,,,,,362.91,,,,
Q8474 EBV VCA IGG IA,86665,CPT,,,,,both,, ,210.5,126.3,Aetna,Commercial,,,,,210.5,,,,
Q8474 EBV VCA IGG IA,86665,CPT,,,,,both,, ,210.5,126.3,Aetna,Commercial,,,,,210.5,,,,
Q34271 EHRLICHIA AB,86666,CPT,,,,,both,, ,511.95,307.17,Aetna,Commercial,,,,,511.95,,,,
Q34464 EHRLICHIA AB,86666,CPT,,,,,both,, ,255.98,153.58,Aetna,Commercial,,,,,255.98,,,,
Q34464 EHRLICHIA AB,86666,CPT,,,,,both,, ,255.98,153.58,Aetna,Commercial,,,,,255.98,,,,
FRANCISELLA TULARENS,86668,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
"FUNGUS AB, NOS",86671,CPT,,,,,both,, ,284.32,170.59,Aetna,Commercial,,,,,284.32,,,,
L162045 FUNG AB NOS,86671,CPT,,,,,both,, ,260.85,156.51,Aetna,Commercial,,,,,260.85,,,,
Q10295 SCAB IGA IA,86671,CPT,,,,,both,, ,568.64,341.18,Aetna,Commercial,,,,,568.64,,,,
Q10295 SCAB IGA IA,86671,CPT,,,,,both,, ,568.64,341.18,Aetna,Commercial,,,,,568.64,,,,
Q37695 H PYLORI AB Q,86677,CPT,,,,,both,, ,56.69,34.01,Aetna,Commercial,,,,,56.69,,,,
L809958 SCHISTO AB G,86682,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,,,,74.93,,,,
L809958 SCHISTO AB G,86682,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,,,,74.93,,,,
L809958 SCHISTO AB G,86682,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,,,,74.93,,,,
L809958 SCHISTO AB G,86682,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,,,,74.93,,,,
"HEPATITIS, DELTA AGE",86692,CPT,,,,,both,, ,1381.76,829.05,Aetna,Commercial,,,,,1381.76,,,,
Q4990 HEP D AB TOTAL,86692,CPT,,,,,both,, ,725.82,435.49,Aetna,Commercial,,,,,725.82,,,,
HERPES SIMP NON-SPEC,86694,CPT,,,,,both,, ,338.21,202.92,Aetna,Commercial,,,,,338.21,,,,
L164806 HSV1/2 IGM,86694,CPT,,,,,both,, ,50.7,30.42,Aetna,Commercial,,,,,50.7,,,,
HERPES SIMP TYPE 1,86695,CPT,,,,,both,, ,129.94,77.96,Aetna,Commercial,,,,,129.94,,,,
Q90849HERPES SMP TP1,86695,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
Q90849HERPES SMP TP1,86695,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
Q90849HERPES SMP TP1,86695,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
Q90849HERPES SMP TP1,86695,CPT,,,,,both,, ,351.68,211,Aetna,Commercial,,,,,351.68,,,,
HERPES SIMP TYPE 2,86696,CPT,,,,,both,, ,190.86,114.51,Aetna,Commercial,,,,,190.86,,,,
L163006 HSV2 AB IG,86696,CPT,,,,,both,, ,300,180,Aetna,Commercial,,,,,300,,,,
Q17170 HERPES SIMPLEX VIRUS 2 (IGG),86696,CPT,,,,,both,, ,230.25,138.15,Aetna,Commercial,,,,,230.25,,,,
Q90849HERPES SMP TP2,86696,CPT,,,,,both,, ,258.5,155.1,Aetna,Commercial,,,,,258.5,,,,
Q90849HERPES SMP TP2,86696,CPT,,,,,both,, ,258.5,155.1,Aetna,Commercial,,,,,258.5,,,,
Q90849HERPES SMP TP2,86696,CPT,,,,,both,, ,258.5,155.1,Aetna,Commercial,,,,,258.5,,,,
Q90849HERPES SMP TP2,86696,CPT,,,,,both,, ,258.5,155.1,Aetna,Commercial,,,,,258.5,,,,
Q938 HISTOPLASMA,86698,CPT,,,,,both,, ,450.48,270.28,Aetna,Commercial,,,,,450.48,,,,
Q938 HISTOPLASMA,86698,CPT,,,,,both,, ,450.48,270.28,Aetna,Commercial,,,,,450.48,,,,
Q501 HBC AB TOT IA,86704,CPT,,,,,both,, ,898.44,539.06,Aetna,Commercial,,,,,898.44,,,,
Q501 HBC AB TOT IA,86704,CPT,,,,,both,, ,898.44,539.06,Aetna,Commercial,,,,,898.44,,,,
"HEP B CORE AB, IGM",86705,CPT,,,,,both,,,1047.19,1047.19,Aetna,Commercial,,739.32,70.6,,1047.19,1047.19,1047.19,Fee Schedule,70.6
"HEP B CORE AB, IGM",86705,CPT,,,,,both,, ,1047.19,628.31,Aetna,Commercial,,,,,1047.19,,,,
L16881 HBC IGM ICMA,86705,CPT,,,,,both,, ,70.33,42.19,Aetna,Commercial,,,,,70.33,,,,
Q556 HBEAB IA,86707,CPT,,,,,both,, ,999.76,599.85,Aetna,Commercial,,,,,999.76,,,,
Q556 HBEAB IA,86707,CPT,,,,,both,, ,999.76,599.85,Aetna,Commercial,,,,,999.76,,,,
"HEP A AB, TOTAL",86708,CPT,,,,,both,, ,547.88,328.72,Aetna,Commercial,,,,,547.88,,,,
L6726HEPA AB TOT ICM,86708,CPT,,,,,both,, ,547.88,328.72,Aetna,Commercial,,,,,547.88,,,,
Q36504 HEPA AB IGM I,86708,CPT,,,,,both,, ,547.88,328.72,Aetna,Commercial,,,,,547.88,,,,
"HEP A AB, IGM",86709,CPT,,,,,both,,,725.82,725.82,Aetna,Commercial,,512.43,70.6,,725.82,725.82,725.82,Fee Schedule,70.6
"HEP A AB, IGM",86709,CPT,,,,,both,, ,725.82,435.49,Aetna,Commercial,,,,,725.82,,,,
L28928 HEP A AB IGM,86709,CPT,,,,,both,, ,70,42,Aetna,Commercial,,,,,70,,,,
L28928 HEP A AB IGM,86709,CPT,,,,,both,, ,70,42,Aetna,Commercial,,,,,70,,,,
Q7250 INFLUENZA VIRU,86710,CPT,,,,,both,, ,295.83,177.49,Aetna,Commercial,,,,,295.83,,,,
Q7250 INFLUENZA VIRU,86710,CPT,,,,,both,, ,295.83,177.49,Aetna,Commercial,,,,,295.83,,,,
Q91665 STRAT JCV AB,86711,CPT,,,,,both,, ,156.06,93.63,Aetna,Commercial,,,,,156.06,,,,
L164616 LEGIONELL AB,86713,CPT,,,,,both,, ,781.12,468.67,Aetna,Commercial,,,,,781.12,,,,
L819877 LEGIONELL AB,86713,CPT,,,,,both,, ,781.11,468.66,Aetna,Commercial,,,,,781.11,,,,
L819877 LEGIONELL AB,86713,CPT,,,,,both,, ,781.11,468.66,Aetna,Commercial,,,,,781.11,,,,
LEPTOSPIRA AB,86720,CPT,,,,,both,, ,329.51,197.7,Aetna,Commercial,,,,,329.51,,,,
L96552MUMPS IGG CLIA,86735,CPT,,,,,both,, ,540.24,324.14,Aetna,Commercial,,,,,540.24,,,,
MUMPS AB,86735,CPT,,,,,both,, ,96.55,57.93,Aetna,Commercial,,,,,96.55,,,,
MUMPS AB,86735,CPT,,,,,both,, ,588.85,353.31,Aetna,Commercial,,,,,588.85,,,,
Q36565 MUMPS IGM IFA,86735,CPT,,,,,both,, ,588.85,353.31,Aetna,Commercial,,,,,588.85,,,,
Q8624 MUMPSAB IGG IA,86735,CPT,,,,,both,, ,588.85,353.31,Aetna,Commercial,,,,,588.85,,,,
Q34127 MYCOPLASMA AB,86738,CPT,,,,,both,, ,566.12,339.67,Aetna,Commercial,,,,,566.12,,,,
Q34127 MYCOPLASMA AB,86738,CPT,,,,,both,, ,566.12,339.67,Aetna,Commercial,,,,,566.12,,,,
Q34127 MYCOPLASMA AB,86738,CPT,,,,,both,, ,566.12,339.67,Aetna,Commercial,,,,,566.12,,,,
Q34127 MYCOPLASMA AB,86738,CPT,,,,,both,, ,566.12,339.67,Aetna,Commercial,,,,,566.12,,,,
Q8946 PARVOVIRUS AB,86747,CPT,,,,,both,, ,242.5,145.5,Aetna,Commercial,,,,,242.5,,,,
Q8946 PARVOVIRUS AB,86747,CPT,,,,,both,, ,242.5,145.5,Aetna,Commercial,,,,,242.5,,,,
Q8946 PARVOVIRUS AB,86747,CPT,,,,,both,, ,242.5,145.5,Aetna,Commercial,,,,,242.5,,,,
Q8946 PARVOVIRUS AB,86747,CPT,,,,,both,, ,242.5,145.5,Aetna,Commercial,,,,,242.5,,,,
Q34278 ENTAB IGG ELI,86753,CPT,,,,,both,, ,64.27,38.56,Aetna,Commercial,,,,,64.27,,,,
Q34300 PROTOZ AB NOS,86753,CPT,,,,,both,, ,64.27,38.56,Aetna,Commercial,,,,,64.27,,,,
Q90827 T CRUZI AB IA,86753,CPT,,,,,both,, ,64.27,38.56,Aetna,Commercial,,,,,64.27,,,,
L96131 RSV AB QT,86756,CPT,,,,,both,, ,95,57,Aetna,Commercial,,,,,95,,,,
Q91121 RICKETTSIA AB,86757,CPT,,,,,both,, ,242.5,145.5,Aetna,Commercial,,,,,242.5,,,,
Q91121 RICKETTSIA AB,86757,CPT,,,,,both,, ,242.5,145.5,Aetna,Commercial,,,,,242.5,,,,
Q91121 RICKETTSIA AB,86757,CPT,,,,,both,, ,242.5,145.5,Aetna,Commercial,,,,,242.5,,,,
Q91121 RICKETTSIA AB,86757,CPT,,,,,both,, ,242.5,145.5,Aetna,Commercial,,,,,242.5,,,,
RUBELLA AB,86762,CPT,,,,,both,, ,88.69,53.21,Aetna,Commercial,,,,,88.69,,,,
RUBELLA AB,86762,CPT,,,,,both,, ,906.3,543.78,Aetna,Commercial,,,,,906.3,,,,
Q34256 MEASAB IGMIA,86765,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,,,,871.22,,,,
Q964 MEAS AB IGG IA,86765,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,,,,871.22,,,,
RUBEOLA AB,86765,CPT,,,,,both,, ,111.15,66.69,Aetna,Commercial,,,,,111.15,,,,
RUBEOLA AB,86765,CPT,,,,,both,, ,871.22,522.73,Aetna,Commercial,,,,,871.22,,,,
Q91121 SALMONELLA AB,86768,CPT,,,,,both,, ,127.7,76.62,Aetna,Commercial,,,,,127.7,,,,
Q91121 SALMONELLA AB,86768,CPT,,,,,both,, ,127.7,76.62,Aetna,Commercial,,,,,127.7,,,,
L164055 COVID19ABIGG,86769,CPT,,,,,both,, ,206,123.6,Aetna,Commercial,,,,,206,,,,
Q39504 COVID19 ABIGG,86769,CPT,,,,,both,, ,224.54,134.72,Aetna,Commercial,,,,,224.54,,,,
Q39504 COVID19 ABIGG,86769,CPT,,,,,both,, ,224.54,134.72,Aetna,Commercial,,,,,224.54,,,,
Q4862 TET ATOX ELISA,86774,CPT,,,,,both,, ,98.51,59.1,Aetna,Commercial,,,,,98.51,,,,
Q3679 TOXOPLAS AB IA,86777,CPT,,,,,both,, ,247.83,148.69,Aetna,Commercial,,,,,247.83,,,,
Q8636 TOXOPLASMA AB,86777,CPT,,,,,both,, ,247.83,148.69,Aetna,Commercial,,,,,247.83,,,,
TOXOPLASMA AB,86777,CPT,,,,,both,, ,247.83,148.69,Aetna,Commercial,,,,,247.83,,,,
Q8636 TOXOPL AB IGM,86778,CPT,,,,,both,, ,247.83,148.69,Aetna,Commercial,,,,,247.83,,,,
Q8636 TOXOPL AB IGM,86778,CPT,,,,,both,, ,247.83,148.69,Aetna,Commercial,,,,,247.83,,,,
L082370 TREP AB IA,86780,CPT,,,,,both,, ,132.4,79.44,Aetna,Commercial,,,,,132.4,,,,
Q4112 FTA-ABS IFA,86780,CPT,,,,,both,, ,172.9,103.74,Aetna,Commercial,,,,,172.9,,,,
Q4112 FTA-ABS IFA,86780,CPT,,,,,both,, ,172.9,103.74,Aetna,Commercial,,,,,172.9,,,,
TREPONEMAL AB,86780,CPT,,,,,both,, ,48.9,29.34,Aetna,Commercial,,,,,48.9,,,,
L96206 VZV IGG CLIA,86787,CPT,,,,,both,, ,831.47,498.88,Aetna,Commercial,,,,,831.47,,,,
Q4439 VZV AB IGG IA,86787,CPT,,,,,both,, ,906.3,543.78,Aetna,Commercial,,,,,906.3,,,,
Q8683 VZV AB IGM IA,86787,CPT,,,,,both,, ,906.3,543.78,Aetna,Commercial,,,,,906.3,,,,
VARICELLA-ZOSTER AB,86787,CPT,,,,,both,, ,111.15,66.69,Aetna,Commercial,,,,,111.15,,,,
VARICELLA-ZOSTER AB,86787,CPT,,,,,both,, ,906.3,543.78,Aetna,Commercial,,,,,906.3,,,,
Q16012 WNVAB IGM EIA,86788,CPT,,,,,both,, ,252.61,151.56,Aetna,Commercial,,,,,252.61,,,,
Q36596 WEST NILE VIR,86788,CPT,,,,,both,, ,252.61,151.56,Aetna,Commercial,,,,,252.61,,,,
WEST NILE VIR AB IGM,86788,CPT,,,,,both,, ,252.61,151.56,Aetna,Commercial,,,,,252.61,,,,
Q36596 WEST NILE VIR,86789,CPT,,,,,both,, ,219.2,131.52,Aetna,Commercial,,,,,219.2,,,,
WEST NILE VIR AB,86789,CPT,,,,,both,, ,215.84,129.5,Aetna,Commercial,,,,,215.84,,,,
L878033 HHV-7 IGM IF,86790,CPT,,,,,both,, ,615,369,Aetna,Commercial,,,,,615,,,,
"Q15085 VIRUS AB, NOS",86790,CPT,,,,,both,, ,124.9,74.94,Aetna,Commercial,,,,,124.9,,,,
"Q15085 VIRUS AB, NOS",86790,CPT,,,,,both,, ,124.9,74.94,Aetna,Commercial,,,,,124.9,,,,
Q94264 ZIKA AB IGM,86794,CPT,,,,,both,, ,97.11,58.26,Aetna,Commercial,,,,,97.11,,,,
Q90123 TG AB,86800,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,,,,751.36,,,,
Q90123 TG AB,86800,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,,,,751.36,,,,
Q90123 TG AB,86800,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,,,,751.36,,,,
Q90123 TG AB,86800,CPT,,,,,both,, ,751.36,450.81,Aetna,Commercial,,,,,751.36,,,,
Q90814 THYROID CANCER (THYROGLOBULIN)MON,86800,CPT,,,,,both,, ,669.25,401.55,Aetna,Commercial,,,,,669.25,,,,
HEPATITIS C AB TEST,86803,CPT,,,,,both,, ,698.32,418.99,Aetna,Commercial,,,,,698.32,,,,
"HEP C AB TEST,CONFIR",86804,CPT,,,,,both,, ,358.42,215.05,Aetna,Commercial,,,,,358.42,,,,
CYTOTOXIC REACTIVE AB SCREEN/STANDARD,86807,CPT,,,,,both,, ,87,52.2,Aetna,Commercial,,,,,87,,,,
Q528 HLA-B27 AG FC,86812,CPT,,,,,both,, ,1449.41,869.64,Aetna,Commercial,,,,,1449.41,,,,
Q528 HLA-B27 AG FC,86812,CPT,,,,,both,, ,1449.41,869.64,Aetna,Commercial,,,,,1449.41,,,,
HLA SOLID PHASE/CALSS I&II AB QUAL,86828,CPT,,,,,both,, ,70,42,Aetna,Commercial,,,,,70,,,,
HLA SOLID PHASE/CLASS 1 AB QUAL HIGHDEF,86832,CPT,,,,,both,, ,356,213.6,Aetna,Commercial,,,,,356,,,,
L117065 PROTH AB IGG,86849,CPT,,,,,both,, ,157,94.2,Aetna,Commercial,,,,,157,,,,
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,, ,61.75,37.05,Aetna,Commercial,,,,,61.75,,,,
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,,,318,318,Aetna,Commercial,,224.51,70.6,,318,318,318,Fee Schedule,70.6
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,, ,318,190.8,Aetna,Commercial,,,,,318,,,,
O51200 AB SCRN,86850,CPT,,,,,both,, ,291.75,175.05,Aetna,Commercial,,,,,291.75,,,,
O51128 AB ELUTION,86860,CPT,,,,,both,, ,174.3,104.58,Aetna,Commercial,,,,,174.3,,,,
O51128 AB ELUTION,86860,CPT,,,,,both,, ,174.3,104.58,Aetna,Commercial,,,,,174.3,,,,
"ANTIBODY ID,EA PANEL",86870,CPT,,,,,both,, ,488.65,293.19,Aetna,Commercial,,,,,488.65,,,,
O51108 AB ID EA PNL,86870,CPT,,,,,both,, ,475.18,285.1,Aetna,Commercial,,,,,475.18,,,,
O51612 DAT,86880,CPT,,,,,both,, ,250.64,150.38,Aetna,Commercial,,,,,250.64,,,,
O51612 DAT,86880,CPT,,,,,both,, ,250.64,150.38,Aetna,Commercial,,,,,250.64,,,,
IDAT QUAL EA RGT RBC,86885,CPT,,,,,both,, ,39.57,23.74,Aetna,Commercial,,,,,39.57,,,,
IDAT EACH AB TITER,86886,CPT,,,,,both,, ,326.14,195.68,Aetna,Commercial,,,,,326.14,,,,
"AUTO COMPONENT,PROCS",86890,CPT,,,,,both,, ,756.41,453.84,Aetna,Commercial,,,,,756.41,,,,
AUTOL BID OP SALV,86891,CPT,,,,,both,, ,3941.23,2364.73,Aetna,Commercial,,,,,3941.23,,,,
BLOOD TYPING ABO,86900,CPT,,,,,both,, ,38.73,23.23,Aetna,Commercial,,,,,38.73,,,,
BLOOD TYPING ABO,86900,CPT,,,,,both,,,97.39,97.39,Aetna,Commercial,,68.76,70.6,,97.39,97.39,97.39,Fee Schedule,70.6
REF  BLD TYPING ABO,86900,CPT,,,,,both,, ,97.39,58.43,Aetna,Commercial,,,,,97.39,,,,
REF  BLD TYPING ABO,86900,CPT,,,,,both,, ,97.39,58.43,Aetna,Commercial,,,,,97.39,,,,
BLOOD TYPING RH D,86901,CPT,,,,,both,, ,38.73,23.23,Aetna,Commercial,,,,,38.73,,,,
BLOOD TYPING RH D,86901,CPT,,,,,both,,,97.39,97.39,Aetna,Commercial,,68.76,70.6,,97.39,97.39,97.39,Fee Schedule,70.6
REF  BLD TYPING RH D,86901,CPT,,,,,both,, ,97.39,58.43,Aetna,Commercial,,,,,97.39,,,,
REF  BLD TYPING RH D,86901,CPT,,,,,both,, ,97.39,58.43,Aetna,Commercial,,,,,97.39,,,,
BLD TYPE DONOR EA AG,86902,CPT,,,,,both,, ,277.86,166.71,Aetna,Commercial,,,,,277.86,,,,
BLD TYPING OTHER AG,86905,CPT,,,,,both,,,217.52,217.52,Aetna,Commercial,,153.57,70.6,,217.52,217.52,217.52,Fee Schedule,70.6
O51232 RBC AG TYP,86905,CPT,,,,,both,, ,217.52,130.51,Aetna,Commercial,,,,,217.52,,,,
O51232 RBC AG TYP,86905,CPT,,,,,both,, ,217.52,130.51,Aetna,Commercial,,,,,217.52,,,,
O51920 RH PHENO,86906,CPT,,,,,both,, ,224,134.4,Aetna,Commercial,,,,,224,,,,
COMPATIB TEST IS,86920,CPT,,,,,both,,,275.62,275.62,Aetna,Commercial,,194.59,70.6,,275.62,275.62,275.62,Fee Schedule,70.6
COMPATIB TEST IS,86920,CPT,,,,,both,, ,275.62,165.37,Aetna,Commercial,,,,,275.62,,,,
COMPATIB TEST INCUB,86921,CPT,,,,,both,,,103,103,Aetna,Commercial,,72.72,70.6,,103,103,103,Fee Schedule,70.6
COMPATIB TEST INCUB,86921,CPT,,,,,both,, ,103,61.8,Aetna,Commercial,,,,,103,,,,
COMPATIB TEST AHG,86922,CPT,,,,,both,,,250.07,250.07,Aetna,Commercial,,176.55,70.6,,250.07,250.07,250.07,Fee Schedule,70.6
COMPATIB TEST AHG,86922,CPT,,,,,both,, ,250.07,150.04,Aetna,Commercial,,,,,250.07,,,,
FFP THAWING,86927,CPT,,,,,both,, ,233.8,140.28,Aetna,Commercial,,,,,233.8,,,,
PLATELETS POOLING,86965,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,,,,141.46,,,,
O51010 CHEM TREATMNT,86970,CPT,,,,,both,, ,212.44,127.46,Aetna,Commercial,,,,,212.44,,,,
RBC PRETREAT CHEM,86970,CPT,,,,,both,, ,231.55,138.93,Aetna,Commercial,,,,,231.55,,,,
O51701 ENZYME TREAT,86971,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,,,,141.46,,,,
O51701 ENZYME TREAT,86971,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,,,,141.46,,,,
O51122 RBC CELL SEP,86972,CPT,,,,,both,, ,246.99,148.19,Aetna,Commercial,,,,,246.99,,,,
"RBC PRETREAT,SER,INC",86975,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,,,,141.46,,,,
"RBC PRETREAT,SER DIL",86976,CPT,,,,,both,, ,61.8,37.08,Aetna,Commercial,,,,,61.8,,,,
RBC PRETREAT W-INHIB,86977,CPT,,,,,both,, ,218.64,131.18,Aetna,Commercial,,,,,218.64,,,,
O51234 ADSORPTION,86978,CPT,,,,,both,, ,149.35,89.61,Aetna,Commercial,,,,,149.35,,,,
RBC PRETREAT DIFF EA,86978,CPT,,,,,both,, ,162.79,97.67,Aetna,Commercial,,,,,162.79,,,,
SPLIT BLOOD OR PROD,86985,CPT,,,,,both,, ,546.75,328.05,Aetna,Commercial,,,,,546.75,,,,
Q34286 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Aetna,Commercial,,,,,177.39,,,,
Q37213 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Aetna,Commercial,,,,,177.39,,,,
Q39480 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Aetna,Commercial,,,,,177.39,,,,
Q4554 SPECIMEN CONCE,87015,CPT,,,,,both,, ,177.39,106.43,Aetna,Commercial,,,,,177.39,,,,
SPECIMEN CONCENTRATI,87015,CPT,,,,,both,, ,177.39,106.43,Aetna,Commercial,,,,,177.39,,,,
CULTURE BLOOD BACTER,87040,CPT,,,,,both,,,691.29,691.29,Aetna,Commercial,,488.05,70.6,,691.29,691.29,691.29,Fee Schedule,70.6
CULTURE BLOOD BACTER,87040,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
CULT STL BACT W-ISOL,87045,CPT,,,,,both,, ,92.9,55.74,Aetna,Commercial,,,,,92.9,,,,
CULT STL BACT W-ISOL,87045,CPT,,,,,both,,,301.72,301.72,Aetna,Commercial,,213.01,70.6,,301.72,301.72,301.72,Fee Schedule,70.6
CULT STL BACT W-ISOL,87045,CPT,,,,,both,, ,301.72,181.03,Aetna,Commercial,,,,,301.72,,,,
CULT STL BACT EA ADD,87046,CPT,,,,,both,, ,92.9,55.74,Aetna,Commercial,,,,,92.9,,,,
CULT STL BACT EA ADD,87046,CPT,,,,,both,, ,94.58,56.74,Aetna,Commercial,,,,,94.58,,,,
CULTURE BACTERIA OTH,87070,CPT,,,,,both,, ,84.76,50.85,Aetna,Commercial,,,,,84.76,,,,
CULTURE BACTERIA OTH,87070,CPT,,,,,both,,,998.91,998.91,Aetna,Commercial,,705.23,70.6,,998.91,998.91,998.91,Fee Schedule,70.6
CULTURE BACTERIA OTH,87070,CPT,,,,,both,, ,998.91,599.34,Aetna,Commercial,,,,,998.91,,,,
L188227 CULTURE BACT,87070,CPT,,,,,both,, ,86.2,51.72,Aetna,Commercial,,,,,86.2,,,,
CULT BAC AEROB OT QT,87071,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
CULT BACT ANA ANY SO,87075,CPT,,,,,both,,,623.38,623.38,Aetna,Commercial,,440.11,70.6,,623.38,623.38,623.38,Fee Schedule,70.6
L8904 ANAEROBIC CULT,87075,CPT,,,,,both,, ,623.38,374.02,Aetna,Commercial,,,,,623.38,,,,
L8904 ANAEROBIC CULT,87075,CPT,,,,,both,, ,623.38,374.02,Aetna,Commercial,,,,,623.38,,,,
CULT ANAERO IDENT EA,87076,CPT,,,,,both,, ,412.87,247.72,Aetna,Commercial,,,,,412.87,,,,
L182345 ORG ID ANAER,87076,CPT,,,,,both,, ,244.44,146.66,Aetna,Commercial,,,,,244.44,,,,
CULT AEROBIC ID REF,87077,CPT,,,,,both,, ,389.01,233.4,Aetna,Commercial,,,,,389.01,,,,
CULT AEROBIC ID REF,87077,CPT,,,,,both,, ,389.01,233.4,Aetna,Commercial,,,,,389.01,,,,
CULTURE SCREEN ONLY,87081,CPT,,,,,both,, ,65.39,39.23,Aetna,Commercial,,,,,65.39,,,,
CULTURE SCREEN ONLY,87081,CPT,,,,,both,,,420.72,420.72,Aetna,Commercial,,297.03,70.6,,420.72,420.72,420.72,Fee Schedule,70.6
CULTURE SCREEN ONLY,87081,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
CULT URINE-COLONY CT,87086,CPT,,,,,both,, ,59.78,35.86,Aetna,Commercial,,,,,59.78,,,,
CULT URINE-COLONY CT,87086,CPT,,,,,both,,,495.95,495.95,Aetna,Commercial,,350.14,70.6,,495.95,495.95,495.95,Fee Schedule,70.6
CULT URINE-COLONY CT,87086,CPT,,,,,both,, ,495.95,297.57,Aetna,Commercial,,,,,495.95,,,,
CULT URINE W-P ID,87088,CPT,,,,,both,, ,42.37,25.42,Aetna,Commercial,,,,,42.37,,,,
L188243CUL SKIN FUNG,87101,CPT,,,,,both,, ,349.99,209.99,Aetna,Commercial,,,,,349.99,,,,
L188243CUL SKIN FUNG,87101,CPT,,,,,both,, ,349.99,209.99,Aetna,Commercial,,,,,349.99,,,,
CULT FUNGUS ISOLATIO,87102,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
Q4553 CULT FUNGUS IS,87102,CPT,,,,,both,, ,525.7,315.42,Aetna,Commercial,,,,,525.7,,,,
CULTURE FUNGUS BLOOD,87103,CPT,,,,,both,, ,518.69,311.21,Aetna,Commercial,,,,,518.69,,,,
Q4606 FUNGUS CULT BL,87103,CPT,,,,,both,, ,478.95,287.37,Aetna,Commercial,,,,,478.95,,,,
Q575 FUNGAL ID EXAM,87106,CPT,,,,,both,, ,123.21,73.92,Aetna,Commercial,,,,,123.21,,,,
Q575 FUNGAL ID EXAM,87106,CPT,,,,,both,, ,123.21,73.92,Aetna,Commercial,,,,,123.21,,,,
L8474 MOLD IDENTIF,87107,CPT,,,,,both,, ,123.21,73.92,Aetna,Commercial,,,,,123.21,,,,
L8474 MOLD IDENTIF,87107,CPT,,,,,both,, ,123.21,73.92,Aetna,Commercial,,,,,123.21,,,,
CULT MYCOPLASMA,87109,CPT,,,,,both,, ,1404.5,842.7,Aetna,Commercial,,,,,1404.5,,,,
UREA-MYCOPLS HOM CULT,87109,CPT,,,,,both,, ,153.9,92.34,Aetna,Commercial,,,,,153.9,,,,
Q690 CULTURE CHLAMYD,87110,CPT,,,,,both,, ,1104.45,662.67,Aetna,Commercial,,,,,1104.45,,,,
Q690 CULTURE CHLAMYD,87110,CPT,,,,,both,, ,1104.45,662.67,Aetna,Commercial,,,,,1104.45,,,,
CULT MYCOBACTERIA,87116,CPT,,,,,both,,,827.43,827.43,Aetna,Commercial,,584.17,70.6,,827.43,827.43,827.43,Fee Schedule,70.6
CULT MYCOBACTERIA,87116,CPT,,,,,both,, ,827.43,496.45,Aetna,Commercial,,,,,827.43,,,,
Q10526MBAC BL CMBCS,87116,CPT,,,,,both,, ,827.43,496.45,Aetna,Commercial,,,,,827.43,,,,
Q4554 CULT MYCOBACTE,87116,CPT,,,,,both,, ,827.43,496.45,Aetna,Commercial,,,,,827.43,,,,
Q690 CULT TYPE IMMUN,87140,CPT,,,,,both,, ,323.34,194,Aetna,Commercial,,,,,323.34,,,,
Q690 CULT TYPE IMMUN,87140,CPT,,,,,both,, ,323.34,194,Aetna,Commercial,,,,,323.34,,,,
"CULT TYPE,IMMUNOLOGI",87147,CPT,,,,,both,, ,547.31,328.38,Aetna,Commercial,,,,,547.31,,,,
"CULT TYPE,NUCLEIC AC",87149,CPT,,,,,both,, ,239.97,143.98,Aetna,Commercial,,,,,239.97,,,,
LRX183755 AFB ID PB,87149,CPT,,,,,both,, ,239.99,143.99,Aetna,Commercial,,,,,239.99,,,,
DNA-RNA AMPLI PROBE,87150,CPT,,,,,both,, ,339.33,203.59,Aetna,Commercial,,,,,339.33,,,,
LRX183327 MOLD ID,87153,CPT,,,,,both,, ,239.99,143.99,Aetna,Commercial,,,,,239.99,,,,
QRX9000010 AFB ID,87153,CPT,,,,,both,, ,388.45,233.07,Aetna,Commercial,,,,,388.45,,,,
MACRO EXAM ARTHROPOD,87168,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,,,,480.79,,,,
MACRO EXAM PARASITE,87169,CPT,,,,,both,, ,207.7,124.62,Aetna,Commercial,,,,,207.7,,,,
PINWORM EXAM,87172,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,,,,480.79,,,,
TISSUE HOMOGENIZ CUL,87176,CPT,,,,,both,, ,300.6,180.36,Aetna,Commercial,,,,,300.6,,,,
OVA-PARASITES SMEARS,87177,CPT,,,,,both,, ,107.21,64.32,Aetna,Commercial,,,,,107.21,,,,
Q681 OVA-PARASITES S,87177,CPT,,,,,both,, ,320.25,192.15,Aetna,Commercial,,,,,320.25,,,,
Q681 OVA-PARASITES S,87177,CPT,,,,,both,, ,320.25,192.15,Aetna,Commercial,,,,,320.25,,,,
MICROB SUSCEP DIFFUS,87181,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,,,,141.46,,,,
Q18869 MOD HODGE DD,87184,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,,,,141.46,,,,
Q18869 MOD HODGE DD,87184,CPT,,,,,both,, ,141.46,84.87,Aetna,Commercial,,,,,141.46,,,,
MICROB SUSCEP ENZYME,87185,CPT,,,,,both,, ,180.19,108.11,Aetna,Commercial,,,,,180.19,,,,
MICROBE SUSCEPT REF,87186,CPT,,,,,both,, ,586.05,351.63,Aetna,Commercial,,,,,586.05,,,,
MICROBE SUSCEPT REF,87186,CPT,,,,,both,, ,586.05,351.63,Aetna,Commercial,,,,,586.05,,,,
"SMEAR,GRAM STAIN",87205,CPT,,,,,both,, ,42.1,25.26,Aetna,Commercial,,,,,42.1,,,,
"SMEAR,GRAM STAIN",87205,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
L188243SMR FLUO-AC S,87206,CPT,,,,,both,, ,507.74,304.64,Aetna,Commercial,,,,,507.74,,,,
L188243SMR FLUO-AC S,87206,CPT,,,,,both,, ,507.74,304.64,Aetna,Commercial,,,,,507.74,,,,
L188243SMR FLUO-AC S,87206,CPT,,,,,both,, ,507.74,304.64,Aetna,Commercial,,,,,507.74,,,,
L188243SMR FLUO-AC S,87206,CPT,,,,,both,, ,507.74,304.64,Aetna,Commercial,,,,,507.74,,,,
"SMEAR,SPECIAL STAIN",87207,CPT,,,,,both,, ,555.45,333.27,Aetna,Commercial,,,,,555.45,,,,
Q681 SMEAR COMPLEX S,87209,CPT,,,,,both,, ,190.86,114.51,Aetna,Commercial,,,,,190.86,,,,
Q681 SMEAR COMPLEX S,87209,CPT,,,,,both,, ,190.86,114.51,Aetna,Commercial,,,,,190.86,,,,
SMEARWET MOUNT SAL-I,87210,CPT,,,,,both,, ,420.72,252.43,Aetna,Commercial,,,,,420.72,,,,
Q8628 SCABIES MIC EX,87220,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,,,,480.79,,,,
Q8628 SCABIES MIC EX,87220,CPT,,,,,both,, ,480.79,288.47,Aetna,Commercial,,,,,480.79,,,,
Q689 VIR CULT IFA-TC,87252,CPT,,,,,both,, ,929.87,557.92,Aetna,Commercial,,,,,929.87,,,,
Q689 VIR CULT IFA-TC,87252,CPT,,,,,both,, ,929.87,557.92,Aetna,Commercial,,,,,929.87,,,,
L186015 VIR INOC SHL,87254,CPT,,,,,both,, ,415.68,249.4,Aetna,Commercial,,,,,415.68,,,,
Q17495VIRUS INOCU SH,87254,CPT,,,,,both,, ,415.68,249.4,Aetna,Commercial,,,,,415.68,,,,
VIRUS INOCU SHELL VI,87254,CPT,,,,,both,, ,415.68,249.4,Aetna,Commercial,,,,,415.68,,,,
Q2649 HSV CULT WREF,87255,CPT,,,,,both,, ,470.69,282.41,Aetna,Commercial,,,,,470.69,,,,
Q841 HSV CULT HS,87255,CPT,,,,,both,, ,470.69,282.41,Aetna,Commercial,,,,,470.69,,,,
VIRUS ISOLATION GEN,87255,CPT,,,,,both,, ,470.69,282.41,Aetna,Commercial,,,,,470.69,,,,
"Q34966 PERTUSSIS AG,",87265,CPT,,,,,both,, ,531.32,318.79,Aetna,Commercial,,,,,531.32,,,,
"Q34966 PERTUSSIS AG,",87265,CPT,,,,,both,, ,531.32,318.79,Aetna,Commercial,,,,,531.32,,,,
INFAGT DT QLSQT CRYP,87272,CPT,,,,,both,, ,525.7,315.42,Aetna,Commercial,,,,,525.7,,,,
Q37213 INFAGT DT QLS,87272,CPT,,,,,both,, ,525.7,315.42,Aetna,Commercial,,,,,525.7,,,,
Q39480 INFAGT DT QLS,87272,CPT,,,,,both,, ,525.7,315.42,Aetna,Commercial,,,,,525.7,,,,
L188227 LEGION PNEUM,87278,CPT,,,,,both,, ,156,93.6,Aetna,Commercial,,,,,156,,,,
Q34475 LEGPNE AG DFA,87278,CPT,,,,,both,, ,277.86,166.71,Aetna,Commercial,,,,,277.86,,,,
Q34475 LEGPNE AG DFA,87278,CPT,,,,,both,, ,277.86,166.71,Aetna,Commercial,,,,,277.86,,,,
Q34286 PNEUMOCYSTIS,87281,CPT,,,,,both,, ,371.89,223.13,Aetna,Commercial,,,,,371.89,,,,
Q34286 PNEUMOCYSTIS,87281,CPT,,,,,both,, ,371.89,223.13,Aetna,Commercial,,,,,371.89,,,,
VARICELLA ZOSTER AGI,87290,CPT,,,,,both,, ,518.69,311.21,Aetna,Commercial,,,,,518.69,,,,
"ANTIB DETECT NOS, IF",87299,CPT,,,,,both,, ,159.14,95.48,Aetna,Commercial,,,,,159.14,,,,
AG DETECT POLYVAL IF,87300,CPT,,,,,both,, ,122.09,73.25,Aetna,Commercial,,,,,122.09,,,,
L185041 ADV 40/41 IA,87301,CPT,,,,,both,, ,123.6,74.16,Aetna,Commercial,,,,,123.6,,,,
Q14950ASPE AG EIA IA,87305,CPT,,,,,both,, ,111.7,67.02,Aetna,Commercial,,,,,111.7,,,,
CLOSTRIDIUM DIF TOXN,87324,CPT,,,,,both,, ,118.16,70.89,Aetna,Commercial,,,,,118.16,,,,
CLOSTRIDIUM DIF TOXN,87324,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
CRYPTOCOCCUS NEOF AG,87327,CPT,,,,,both,, ,1321.42,792.85,Aetna,Commercial,,,,,1321.42,,,,
"CRYPTOSPOR AG,EIA",87328,CPT,,,,,both,, ,64.55,38.73,Aetna,Commercial,,,,,64.55,,,,
Q39480 INFAGT DT QLS,87329,CPT,,,,,both,, ,200.12,120.07,Aetna,Commercial,,,,,200.12,,,,
Q39480 INFAGT DT QLS,87329,CPT,,,,,both,, ,200.12,120.07,Aetna,Commercial,,,,,200.12,,,,
Q8625 GIARDAG EIA IA,87329,CPT,,,,,both,, ,192.49,115.49,Aetna,Commercial,,,,,192.49,,,,
Q34838 HPYLAG EIA IA,87338,CPT,,,,,both,, ,183.56,110.13,Aetna,Commercial,,,,,183.56,,,,
Q34838 HPYLAG EIA IA,87338,CPT,,,,,both,, ,183.56,110.13,Aetna,Commercial,,,,,183.56,,,,
HBSAG,87340,CPT,,,,,both,,,570.04,570.04,Aetna,Commercial,,402.45,70.6,,570.04,570.04,570.04,Fee Schedule,70.6
HBSAG,87340,CPT,,,,,both,, ,570.04,342.02,Aetna,Commercial,,,,,570.04,,,,
Q555 HBEAG IA,87350,CPT,,,,,both,, ,1003.97,602.38,Aetna,Commercial,,,,,1003.97,,,,
Q555 HBEAG IA,87350,CPT,,,,,both,, ,1003.97,602.38,Aetna,Commercial,,,,,1003.97,,,,
Q91212H.GALA AG U IA,87385,CPT,,,,,both,, ,322.49,193.49,Aetna,Commercial,,,,,322.49,,,,
Q91212H.GALA AG U IA,87385,CPT,,,,,both,, ,322.49,193.49,Aetna,Commercial,,,,,322.49,,,,
"INFLUENZA A AG,EIA",87400,CPT,,,,,both,, ,118.16,70.89,Aetna,Commercial,,,,,118.16,,,,
"INFLUENZA A AG,EIA",87400,CPT,,,,,both,, ,959.34,575.6,Aetna,Commercial,,,,,959.34,,,,
L6866 ROTAVIRUS DDIA,87425,CPT,,,,,both,, ,123.6,74.16,Aetna,Commercial,,,,,123.6,,,,
"ROTAVIRUS AG,EIA",87425,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
COVID19 AG EIA,87426,CPT,,,,,both,, ,84.2,50.52,Aetna,Commercial,,,,,84.2,,,,
COVID19 AG EIA,87426,CPT,,,,,both,, ,88.35,53.01,Aetna,Commercial,,,,,88.35,,,,
"SHIGA-LIKE TOX AG,EI",87427,CPT,,,,,both,, ,113.1,67.86,Aetna,Commercial,,,,,113.1,,,,
"SHIGA-LIKE TOX AG,EI",87427,CPT,,,,,both,, ,156.33,93.79,Aetna,Commercial,,,,,156.33,,,,
COVID19AG FLUAB SOF2,87428,CPT,,,,,both,, ,159,95.4,Aetna,Commercial,,,,,159,,,,
"AG DETEC NOS,EIA MUL",87449,CPT,,,,,both,, ,886.09,531.65,Aetna,Commercial,,,,,886.09,,,,
FUNGITELL SERUM,87449,CPT,,,,,both,, ,121.98,73.18,Aetna,Commercial,,,,,121.98,,,,
FUNGITELL SERUM,87449,CPT,,,,,both,, ,121.98,73.18,Aetna,Commercial,,,,,121.98,,,,
Q15544 NOROV EIA IA,87449,CPT,,,,,both,, ,886.09,531.65,Aetna,Commercial,,,,,886.09,,,,
Q8856 LEGIO AG U IA,87449,CPT,,,,,both,, ,886.09,531.65,Aetna,Commercial,,,,,886.09,,,,
CANDIDA DNA AMP PROB,87481,CPT,,,,,both,, ,281.8,169.08,Aetna,Commercial,,,,,281.8,,,,
L183410 M ENCEPH CSF,87483,CPT,,,,,both,, ,1650,990,Aetna,Commercial,,,,,1650,,,,
L139650 CPNEU DNA,87486,CPT,,,,,both,, ,175,105,Aetna,Commercial,,,,,175,,,,
Q37444 C PNEUMO PCR,87486,CPT,,,,,both,, ,105.27,63.16,Aetna,Commercial,,,,,105.27,,,,
CHLMYD TRACH DNA AMP,87491,CPT,,,,,both,,,968.6,968.6,Aetna,Commercial,,683.83,70.6,,968.6,968.6,968.6,Fee Schedule,70.6
L180021 CTRACH AMPPR,87491,CPT,,,,,both,, ,888.63,533.17,Aetna,Commercial,,,,,888.63,,,,
Q70051 CHLMYD TRACH,87491,CPT,,,,,both,, ,968.6,581.16,Aetna,Commercial,,,,,968.6,,,,
Q70051 CHLMYD TRACH,87491,CPT,,,,,both,, ,968.6,581.16,Aetna,Commercial,,,,,968.6,,,,
Q70051 CHLMYD TRACH,87491,CPT,,,,,both,, ,968.6,581.16,Aetna,Commercial,,,,,968.6,,,,
Q70051 CHLMYD TRACH,87491,CPT,,,,,both,, ,968.6,581.16,Aetna,Commercial,,,,,968.6,,,,
C DIFF AMPLI PROBE,87493,CPT,,,,,both,, ,313.51,188.1,Aetna,Commercial,,,,,313.51,,,,
Q10601 CMV QL RT-PCR,87496,CPT,,,,,both,, ,1051.68,631,Aetna,Commercial,,,,,1051.68,,,,
Q10600 CMV QT RT-PCR,87497,CPT,,,,,both,, ,889.73,533.83,Aetna,Commercial,,,,,889.73,,,,
Q15082EVRNA QL RTPCR,87498,CPT,,,,,both,, ,437.85,262.71,Aetna,Commercial,,,,,437.85,,,,
INFLU DNA AMP PROBE,87502,CPT,,,,,both,, ,215.11,129.06,Aetna,Commercial,,,,,215.11,,,,
INFLU DNA AMP PROBE,87502,CPT,,,,,both,,,887.49,887.49,Aetna,Commercial,,626.57,70.6,,887.49,887.49,887.49,Fee Schedule,70.6
INFLU DNA AMP PROBE,87502,CPT,,,,,both,, ,887.49,532.49,Aetna,Commercial,,,,,887.49,,,,
L183480 GI PRO STOOL,87507,CPT,,,,,both,, ,1090.2,654.12,Aetna,Commercial,,,,,1090.2,,,,
GARDNER VAG DNA QUAN,87512,CPT,,,,,both,, ,335.12,201.07,Aetna,Commercial,,,,,335.12,,,,
Q8369 HBV QT RT-PCR,87517,CPT,,,,,both,, ,1011.26,606.75,Aetna,Commercial,,,,,1011.26,,,,
Q8369 HBV QT RT-PCR,87517,CPT,,,,,both,, ,1011.26,606.75,Aetna,Commercial,,,,,1011.26,,,,
Q37273 HCVRNA QL TMA,87521,CPT,,,,,both,, ,728.91,437.34,Aetna,Commercial,,,,,728.91,,,,
Q37273 HCVRNA QL TMA,87521,CPT,,,,,both,, ,728.91,437.34,Aetna,Commercial,,,,,728.91,,,,
Q11348 HCV QT RT-PCR,87522,CPT,,,,,both,, ,1066.84,640.1,Aetna,Commercial,,,,,1066.84,,,,
Q35645 HCV RNAQT RT-,87522,CPT,,,,,both,, ,2133.69,1280.21,Aetna,Commercial,,,,,2133.69,,,,
Q35645 HCV RNAQT RT-,87522,CPT,,,,,both,, ,2133.69,1280.21,Aetna,Commercial,,,,,2133.69,,,,
"HSV, DNA, AMP PROBE",87529,CPT,,,,,both,, ,3455.1,2073.06,Aetna,Commercial,,,,,3455.1,,,,
"Q34257 HSV, DNA, AMP",87529,CPT,,,,,both,, ,968.6,581.16,Aetna,Commercial,,,,,968.6,,,,
"Q34257 HSV, DNA, AMP",87529,CPT,,,,,both,, ,968.6,581.16,Aetna,Commercial,,,,,968.6,,,,
"Q19502 HSV, DNA, QUA",87530,CPT,,,,,both,, ,512.23,307.33,Aetna,Commercial,,,,,512.23,,,,
"Q19502 HSV, DNA, QUA",87530,CPT,,,,,both,, ,512.23,307.33,Aetna,Commercial,,,,,512.23,,,,
"HIV-1, DNA,AMP PROBE",87535,CPT,,,,,both,, ,1718.85,1031.31,Aetna,Commercial,,,,,1718.85,,,,
Q40085 HIV1RNA RTPCR,87536,CPT,,,,,both,, ,1804.46,1082.67,Aetna,Commercial,,,,,1804.46,,,,
Q40085 HIV1RNA RTPCR,87536,CPT,,,,,both,, ,1804.46,1082.67,Aetna,Commercial,,,,,1804.46,,,,
"Q15062 LEGION PNEU,D",87541,CPT,,,,,both,, ,196.98,118.18,Aetna,Commercial,,,,,196.98,,,,
Q30298MTB COMP RTPCR,87556,CPT,,,,,both,, ,815.91,489.54,Aetna,Commercial,,,,,815.91,,,,
Q30298MTB COMP RTPCR,87556,CPT,,,,,both,, ,815.91,489.54,Aetna,Commercial,,,,,815.91,,,,
"Q16064 M.AVIUM-INTR,",87561,CPT,,,,,both,, ,372.45,223.47,Aetna,Commercial,,,,,372.45,,,,
"Q16064 M.AVIUM-INTR,",87561,CPT,,,,,both,, ,372.45,223.47,Aetna,Commercial,,,,,372.45,,,,
L180076 M GENT NAA,87563,CPT,,,,,both,, ,180,108,Aetna,Commercial,,,,,180,,,,
L139650 MPNEU DNA,87581,CPT,,,,,both,, ,197.03,118.21,Aetna,Commercial,,,,,197.03,,,,
L139650 MPNEU DNA,87581,CPT,,,,,both,, ,197.03,118.21,Aetna,Commercial,,,,,197.03,,,,
Q37444 MP QL RT-PCR,87581,CPT,,,,,both,, ,175.5,105.3,Aetna,Commercial,,,,,175.5,,,,
L180021 NG AMP PRB,87591,CPT,,,,,both,, ,888.63,533.17,Aetna,Commercial,,,,,888.63,,,,
"Q70051 N.GONORRHO,DN",87591,CPT,,,,,both,, ,968.6,581.16,Aetna,Commercial,,,,,968.6,,,,
"Q70051 N.GONORRHO,DN",87591,CPT,,,,,both,, ,968.6,581.16,Aetna,Commercial,,,,,968.6,,,,
"Q70051 N.GONORRHO,DN",87591,CPT,,,,,both,, ,968.6,581.16,Aetna,Commercial,,,,,968.6,,,,
"Q70051 N.GONORRHO,DN",87591,CPT,,,,,both,, ,968.6,581.16,Aetna,Commercial,,,,,968.6,,,,
L140230 ORTHOPOX VRS,87593,CPT,,,,,both,, ,308,184.8,Aetna,Commercial,,,,,308,,,,
HPV HIGH RISK TYPES,87624,CPT,,,,,both,, ,241.38,144.82,Aetna,Commercial,,,,,241.38,,,,
L199305 HPV HR,87624,CPT,,,,,both,, ,221.45,132.87,Aetna,Commercial,,,,,221.45,,,,
Q92090 HPV HIGH RISK,87624,CPT,,,,,both,, ,215,129,Aetna,Commercial,,,,,215,,,,
L507460 HPV GEN16 18,87625,CPT,,,,,both,, ,164.8,98.88,Aetna,Commercial,,,,,164.8,,,,
RESP VIRUS 3-5 TARG,87631,CPT,,,,,both,, ,570.52,342.31,Aetna,Commercial,,,,,570.52,,,,
L139650 RES V 12-25,87633,CPT,,,,,both,, ,175,105,Aetna,Commercial,,,,,175,,,,
L139650 RES V 12-25,87633,CPT,,,,,both,, ,175,105,Aetna,Commercial,,,,,175,,,,
Q37444 RESP VIR PCR,87633,CPT,,,,,both,, ,1250.34,750.2,Aetna,Commercial,,,,,1250.34,,,,
RSV DNA/ MA AMP PROB,87634,CPT,,,,,both,, ,157.62,94.57,Aetna,Commercial,,,,,157.62,,,,
RSV DNA/ MA AMP PROB,87634,CPT,,,,,both,, ,236.44,141.86,Aetna,Commercial,,,,,236.44,,,,
COVID19 PRB,87635,CPT,,,,,both,, ,113.3,67.98,Aetna,Commercial,,,,,113.3,,,,
COVID19 PRB,87635,CPT,,,,,both,, ,336.81,202.08,Aetna,Commercial,,,,,336.81,,,,
"STAPH A,DNA,PROBE",87640,CPT,,,,,both,, ,118.16,70.89,Aetna,Commercial,,,,,118.16,,,,
"MR-STAPH,DNA,PROBE",87641,CPT,,,,,both,, ,118.16,70.89,Aetna,Commercial,,,,,118.16,,,,
"STREP A,DNA,AMP PROB",87651,CPT,,,,,both,, ,78.78,47.26,Aetna,Commercial,,,,,78.78,,,,
"STREP A,DNA,AMP PROB",87651,CPT,,,,,both,, ,118.18,70.9,Aetna,Commercial,,,,,118.18,,,,
L180021 TVAG AMP PRB,87661,CPT,,,,,both,, ,279.55,167.73,Aetna,Commercial,,,,,279.55,,,,
L180021 TVAG AMP PRB,87661,CPT,,,,,both,, ,279.55,167.73,Aetna,Commercial,,,,,279.55,,,,
L180021 TVAG AMP PRB,87661,CPT,,,,,both,, ,279.55,167.73,Aetna,Commercial,,,,,279.55,,,,
L180021 TVAG AMP PRB,87661,CPT,,,,,both,, ,279.55,167.73,Aetna,Commercial,,,,,279.55,,,,
T VAGINALIS AMP,87661,CPT,,,,,both,,,279.55,279.55,Aetna,Commercial,,197.36,70.6,,279.55,279.55,279.55,Fee Schedule,70.6
Q93870 ZIKA RNA QL,87662,CPT,,,,,both,, ,295.83,177.49,Aetna,Commercial,,,,,295.83,,,,
L139650 DET AGNT DNA,87798,CPT,,,,,both,, ,175,105,Aetna,Commercial,,,,,175,,,,
L180040 DET AGT NOS,87798,CPT,,,,,both,, ,180,108,Aetna,Commercial,,,,,180,,,,
L180060 DET AGT NOS,87798,CPT,,,,,both,, ,696.28,417.76,Aetna,Commercial,,,,,696.28,,,,
L180060 DET AGT NOS,87798,CPT,,,,,both,, ,696.28,417.76,Aetna,Commercial,,,,,696.28,,,,
Q11068DET AGNT DNAAM,87798,CPT,,,,,both,, ,2478.63,1487.17,Aetna,Commercial,,,,,2478.63,,,,
Q11068DET AGNT DNAAM,87798,CPT,,,,,both,, ,2478.63,1487.17,Aetna,Commercial,,,,,2478.63,,,,
Q11190 WNVR CSF RT-P,87798,CPT,,,,,both,, ,1011.83,607.09,Aetna,Commercial,,,,,1011.83,,,,
Q11190 WNVR CSF RT-P,87798,CPT,,,,,both,, ,1011.83,607.09,Aetna,Commercial,,,,,1011.83,,,,
Q11365DET AGNT DNAAM,87798,CPT,,,,,both,, ,758.95,455.37,Aetna,Commercial,,,,,758.95,,,,
Q15062DET AGNT DNAAM,87798,CPT,,,,,both,, ,1011.83,607.09,Aetna,Commercial,,,,,1011.83,,,,
Q15062DET AGNT DNAAM,87798,CPT,,,,,both,, ,1011.83,607.09,Aetna,Commercial,,,,,1011.83,,,,
Q18835 P.JIRO QL PCR,87798,CPT,,,,,both,, ,1011.83,607.09,Aetna,Commercial,,,,,1011.83,,,,
Q18835 P.JIRO QL PCR,87798,CPT,,,,,both,, ,1011.83,607.09,Aetna,Commercial,,,,,1011.83,,,,
Q91475 SURESWAB MYCOPLASMA GENITALIUMPCR,87798,CPT,,,,,both,, ,901.25,540.75,Aetna,Commercial,,,,,901.25,,,,
"DETECT AGNT NOS,DNAQ",87799,CPT,,,,,both,, ,454.41,272.64,Aetna,Commercial,,,,,454.41,,,,
Q10186 EBV QT RT-PCR,87799,CPT,,,,,both,, ,454.41,272.64,Aetna,Commercial,,,,,454.41,,,,
Q11274 BKV QT RT-PCR,87799,CPT,,,,,both,, ,454.41,272.64,Aetna,Commercial,,,,,454.41,,,,
"DETECT AGT MULT,DNAA",87801,CPT,,,,,both,, ,715.16,429.09,Aetna,Commercial,,,,,715.16,,,,
L180021 DET AGT MULT,87801,CPT,,,,,both,, ,656.11,393.66,Aetna,Commercial,,,,,656.11,,,,
Q15564LYME RT-PCR SF,87801,CPT,,,,,both,, ,715.16,429.09,Aetna,Commercial,,,,,715.16,,,,
Q15777LYM QL BL RTPC,87801,CPT,,,,,both,, ,715.16,429.09,Aetna,Commercial,,,,,715.16,,,,
INFLUENZA ASSAY W-OP,87804,CPT,,,,,both,, ,30.87,18.52,Aetna,Commercial,,,,,30.87,,,,
INFLUENZA ASSAY W-OP,87804,CPT,,,,,both,, ,104.12,62.47,Aetna,Commercial,,,,,104.12,,,,
RSV ASSAY W-OPTIC,87807,CPT,,,,,both,, ,44.62,26.77,Aetna,Commercial,,,,,44.62,,,,
RSV ASSAY W-OPTIC,87807,CPT,,,,,both,, ,277.86,166.71,Aetna,Commercial,,,,,277.86,,,,
STREP A ASSAY W-OPTI,87880,CPT,,,,,both,, ,41.25,24.75,Aetna,Commercial,,,,,41.25,,,,
STREP A ASSAY W-OPTI,87880,CPT,,,,,both,, ,285.17,171.1,Aetna,Commercial,,,,,285.17,,,,
AGENT NOS ASSAY W-OP,87899,CPT,,,,,both,, ,172.9,103.74,Aetna,Commercial,,,,,172.9,,,,
L183009 SPNEU AG U C,87899,CPT,,,,,both,, ,158.62,95.17,Aetna,Commercial,,,,,158.62,,,,
L183009 SPNEU AG U C,87899,CPT,,,,,both,, ,158.62,95.17,Aetna,Commercial,,,,,158.62,,,,
Q34949 PHENO INF DRG,87900,CPT,,,,,both,, ,773.54,464.12,Aetna,Commercial,,,,,773.54,,,,
Q34949 GENO DNA HIV,87901,CPT,,,,,both,, ,1819.9,1091.94,Aetna,Commercial,,,,,1819.9,,,,
Q34949 GENO DNA HIV,87901,CPT,,,,,both,, ,1819.9,1091.94,Aetna,Commercial,,,,,1819.9,,,,
"GENOTYPE,DNA,HEPAT C",87902,CPT,,,,,both,, ,1611.91,967.14,Aetna,Commercial,,,,,1611.91,,,,
Q37811 HCVRNA GN MPR,87902,CPT,,,,,both,, ,1611.91,967.14,Aetna,Commercial,,,,,1611.91,,,,
Q92447 HCVG1 NS5A DR,87902,CPT,,,,,both,, ,1611.91,967.14,Aetna,Commercial,,,,,1611.91,,,,
L551690PHENO DNA HIV,87903,CPT,,,,,both,, ,1465,879,Aetna,Commercial,,,,,1465,,,,
L551690PHENO DNA HIV,87904,CPT,,,,,both,, ,104,62.4,Aetna,Commercial,,,,,104,,,,
HIV GEN DNA REV OTH,87906,CPT,,,,,both,, ,856.62,513.97,Aetna,Commercial,,,,,856.62,,,,
AUTOPSY COMPL WO-CNS,88020,CPT,,,,,both,, ,3310.55,1986.33,Aetna,Commercial,,,,,3310.55,,,,
CYTOPATH FLD NOT V-C,88104,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,,,,109.74,,,,
CYTOPATH FLD FTRW-IN,88106,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,,,,109.74,,,,
CYTOPATH CONCENT TEC,88108,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,,,,109.74,,,,
CYTOCELL ENH X CR-VG,88112,CPT,,,,,both,, ,237.17,142.3,Aetna,Commercial,,,,,237.17,,,,
CYTO UR 3-5PROB EA S,88120,CPT,,,,,both,, ,368.8,221.28,Aetna,Commercial,,,,,368.8,,,,
CYTO UR 3-5 PROB CMP,88121,CPT,,,,,both,, ,368.8,221.28,Aetna,Commercial,,,,,368.8,,,,
FORENSIC CYTOPATHOLO,88125,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,,,,109.74,,,,
SEX CHROMATIN ID BAR,88130,CPT,,,,,both,, ,144.83,86.89,Aetna,Commercial,,,,,144.83,,,,
SEX CHROM ID POLYMOR,88140,CPT,,,,,both,, ,76.9,46.14,Aetna,Commercial,,,,,76.9,,,,
L192555 PAP LB,88142,CPT,,,,,both,, ,234.07,140.44,Aetna,Commercial,,,,,234.07,,,,
PAP THINLAY LIQ DIAG,88142,CPT,,,,,both,, ,189.74,113.84,Aetna,Commercial,,,,,189.74,,,,
CYTOPATH C-V THNLYRE,88143,CPT,,,,,both,, ,189.74,113.84,Aetna,Commercial,,,,,189.74,,,,
CYTOP C-V AUTOMATED,88147,CPT,,,,,both,, ,101.6,60.96,Aetna,Commercial,,,,,101.6,,,,
CYTOP C-V AUTO RESCR,88148,CPT,,,,,both,, ,101.6,60.96,Aetna,Commercial,,,,,101.6,,,,
CYTOPATH C-V MANUAL,88150,CPT,,,,,both,, ,101.6,60.96,Aetna,Commercial,,,,,101.6,,,,
CYTOP C-V AUTO REDO,88152,CPT,,,,,both,, ,101.6,60.96,Aetna,Commercial,,,,,101.6,,,,
CYTOPATH C-V REDO,88153,CPT,,,,,both,, ,101.6,60.96,Aetna,Commercial,,,,,101.6,,,,
CYTOP C-V INDX ADDON,88155,CPT,,,,,both,, ,57.81,34.68,Aetna,Commercial,,,,,57.81,,,,
CYTOP SMR OTHR SOURC,88160,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,,,,109.74,,,,
CYTOP SMR OTH PRE-SC,88161,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,,,,109.74,,,,
CYTOP SMR OTH S5SLID,88162,CPT,,,,,both,, ,237.17,142.3,Aetna,Commercial,,,,,237.17,,,,
"CYTOP TBS,C-V,MANUAL",88164,CPT,,,,,both,, ,101.6,60.96,Aetna,Commercial,,,,,101.6,,,,
"CYTOP TBS,C-V,REDO",88165,CPT,,,,,both,, ,101.6,60.96,Aetna,Commercial,,,,,101.6,,,,
"CYTOP TBS,C-V AUTORE",88166,CPT,,,,,both,, ,101.6,60.96,Aetna,Commercial,,,,,101.6,,,,
"CYTOP TBS,C-C,SELECT",88167,CPT,,,,,both,, ,101.6,60.96,Aetna,Commercial,,,,,101.6,,,,
CYTOPATH EVAL OF FNA,88172,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,,,,109.74,,,,
"CYTOP EVAL,FNA,REPOR",88173,CPT,,,,,both,, ,237.17,142.3,Aetna,Commercial,,,,,237.17,,,,
CYTO-CERVICALRP CDM,88174,CPT,,,,,both,, ,205.45,123.27,Aetna,Commercial,,,,,205.45,,,,
L199305 PAP AU MN RS,88175,CPT,,,,,both,, ,234.07,140.44,Aetna,Commercial,,,,,234.07,,,,
PAP DIAG AUTO MAN RS,88175,CPT,,,,,both,, ,255.13,153.07,Aetna,Commercial,,,,,255.13,,,,
Q92090 PAP DIAG AUTO,88175,CPT,,,,,both,, ,227.25,136.35,Aetna,Commercial,,,,,227.25,,,,
CYTO EVAL FNA ADD,88177,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,,,,72.13,,,,
CELL MRK STDY CY-DNA,88182,CPT,,,,,both,, ,69.89,41.93,Aetna,Commercial,,,,,69.89,,,,
Q35080FLOWCY-TC 1MRK,88184,CPT,,,,,both,, ,203.21,121.92,Aetna,Commercial,,,,,203.21,,,,
Q35080FLOWCY-TC 1MRK,88184,CPT,,,,,both,, ,203.21,121.92,Aetna,Commercial,,,,,203.21,,,,
"FLOWCYTOMETRY-TC,ADD",88185,CPT,,,,,both,, ,195.35,117.21,Aetna,Commercial,,,,,195.35,,,,
Q35080 FLOWCY-TC ADD,88185,CPT,,,,,both,, ,60,36,Aetna,Commercial,,,,,60,,,,
A3001780 FLWCY 16MRK,88189,CPT,,,,,both,, ,360,216,Aetna,Commercial,,,,,360,,,,
CYTOPATHOLOGY PROCED,88199,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,,,,72.13,,,,
Q14596 TISSUE CULT L,88230,CPT,,,,,both,, ,3469.98,2081.98,Aetna,Commercial,,,,,3469.98,,,,
Q14596 TISSUE CULT L,88230,CPT,,,,,both,, ,3469.98,2081.98,Aetna,Commercial,,,,,3469.98,,,,
TISSUE CULT SKIN/BIO,88233,CPT,,,,,both,, ,1353.98,812.38,Aetna,Commercial,,,,,1353.98,,,,
"TISSUE CULT, PLACENT",88235,CPT,,,,,both,, ,1416.56,849.93,Aetna,Commercial,,,,,1416.56,,,,
Q14600 TIS CUL BM,88237,CPT,,,,,both,, ,849.04,509.42,Aetna,Commercial,,,,,849.04,,,,
Q14600 TIS CUL BM,88237,CPT,,,,,both,, ,849.04,509.42,Aetna,Commercial,,,,,849.04,,,,
TISSUE CULTURE TUMOR,88239,CPT,,,,,both,, ,1419.09,851.45,Aetna,Commercial,,,,,1419.09,,,,
CELL CRYOPRESERV-STO,88240,CPT,,,,,both,, ,97.11,58.26,Aetna,Commercial,,,,,97.11,,,,
FROZEN CELL PREPARAT,88241,CPT,,,,,both,, ,97.11,58.26,Aetna,Commercial,,,,,97.11,,,,
CHROMOSOME ANAL20-25,88245,CPT,,,,,both,, ,1397.47,838.48,Aetna,Commercial,,,,,1397.47,,,,
CHROMOSOM ANAL50-100,88248,CPT,,,,,both,, ,1666.09,999.65,Aetna,Commercial,,,,,1666.09,,,,
CHROMOSOME ANALYS100,88249,CPT,,,,,both,, ,1666.09,999.65,Aetna,Commercial,,,,,1666.09,,,,
CHROMOSOME ANALYS  5,88261,CPT,,,,,both,, ,1700.32,1020.19,Aetna,Commercial,,,,,1700.32,,,,
CHROMOSOME ANAL15-20,88262,CPT,,,,,both,, ,4292.64,2575.58,Aetna,Commercial,,,,,4292.64,,,,
Q14596 CHR AN 15-20,88262,CPT,,,,,both,, ,1010,606,Aetna,Commercial,,,,,1010,,,,
CHROMOSOME ANALYS 45,88263,CPT,,,,,both,, ,1445.75,867.45,Aetna,Commercial,,,,,1445.75,,,,
Q14600 CHRM AN 20-25,88264,CPT,,,,,both,, ,2107.59,1264.55,Aetna,Commercial,,,,,2107.59,,,,
Q14600 CHRM AN 20-25,88264,CPT,,,,,both,, ,2107.59,1264.55,Aetna,Commercial,,,,,2107.59,,,,
CHROMOSOME ANAL-PLAC,88267,CPT,,,,,both,, ,1729.51,1037.7,Aetna,Commercial,,,,,1729.51,,,,
CHROMOSOM ANAL AMNIO,88269,CPT,,,,,both,, ,1600.13,960.07,Aetna,Commercial,,,,,1600.13,,,,
Q12070 CYTOGEN PRO,88271,CPT,,,,,both,, ,525.7,315.42,Aetna,Commercial,,,,,525.7,,,,
Q12070 CYTOGEN PRO,88271,CPT,,,,,both,, ,525.7,315.42,Aetna,Commercial,,,,,525.7,,,,
CYTOGENETICS 3-5,88272,CPT,,,,,both,, ,243.63,146.17,Aetna,Commercial,,,,,243.63,,,,
CYTOGENETICS 25-99,88274,CPT,,,,,both,, ,336.52,201.91,Aetna,Commercial,,,,,336.52,,,,
Q12070CYTOGN 100-300,88275,CPT,,,,,both,, ,1078.63,647.17,Aetna,Commercial,,,,,1078.63,,,,
Q12070CYTOGN 100-300,88275,CPT,,,,,both,, ,1078.63,647.17,Aetna,Commercial,,,,,1078.63,,,,
CHROMOSOME KARYOT ST,88280,CPT,,,,,both,, ,962.71,577.62,Aetna,Commercial,,,,,962.71,,,,
CHROMOSOM BANDINGSTU,88283,CPT,,,,,both,, ,375.26,225.15,Aetna,Commercial,,,,,375.26,,,,
CHROMOSOME CT ADDITI,88285,CPT,,,,,both,, ,182.71,109.62,Aetna,Commercial,,,,,182.71,,,,
CHROMOS STDY ADD HIG,88289,CPT,,,,,both,, ,284.04,170.42,Aetna,Commercial,,,,,284.04,,,,
CYTOGENETIC STUDY,88299,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,,,,72.13,,,,
SURG PATH GROSS LVL1,88300,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,,,,72.13,,,,
SURG PATH GROSS LVL2,88302,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,,,,109.74,,,,
SURG PATH GROSS LVL3,88304,CPT,,,,,both,, ,237.17,142.3,Aetna,Commercial,,,,,237.17,,,,
SURG PATH GROSS LVL4,88305,CPT,,,,,both,, ,398.27,238.96,Aetna,Commercial,,,,,398.27,,,,
SURG PATH GROSS LVL5,88307,CPT,,,,,both,, ,368.8,221.28,Aetna,Commercial,,,,,368.8,,,,
SURG PATH GROSS LVL6,88309,CPT,,,,,both,, ,368.8,221.28,Aetna,Commercial,,,,,368.8,,,,
DECALCIFY TISSUE,88311,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,,,,72.13,,,,
SPECIAL STAINS GRP 1,88312,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,,,,109.74,,,,
SPECIAL STAINS GRP 2,88313,CPT,,,,,both,, ,33.68,20.2,Aetna,Commercial,,,,,33.68,,,,
SPECIAL STAINS GRP 2,88313,CPT,,,,,both,, ,241.94,145.16,Aetna,Commercial,,,,,241.94,,,,
HISTOCHEMICAL STAIN,88314,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,,,,109.74,,,,
ENZYME HISTOCHEMISTR,88319,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,,,,109.74,,,,
MICROSLIDE-CONSULN-P,88321,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,,,,109.74,,,,
MICROSLID CONSUL-W-P,88323,CPT,,,,,both,, ,237.17,142.3,Aetna,Commercial,,,,,237.17,,,,
COMPRE REVIEW OFDATA,88325,CPT,,,,,both,, ,368.8,221.28,Aetna,Commercial,,,,,368.8,,,,
PATH CONSULT INTROP,88329,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,,,,109.74,,,,
PATH CONSULT INT-1BL,88331,CPT,,,,,both,, ,237.17,142.3,Aetna,Commercial,,,,,237.17,,,,
PATH CONSULT-INTRADD,88332,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,,,,72.13,,,,
INOP CYTOPAT CNSLT 1,88333,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,,,,109.74,,,,
INOP CYTOPAT CNSLT 2,88334,CPT,,,,,both,, ,109.74,65.84,Aetna,Commercial,,,,,109.74,,,,
ICC ADD AB PER SLIDE,88341,CPT,,,,,both,, ,238.01,142.8,Aetna,Commercial,,,,,238.01,,,,
1ST SEP ID AB,88342,CPT,,,,,both,, ,238.01,142.8,Aetna,Commercial,,,,,238.01,,,,
ICC MLTPX AB ST,88344,CPT,,,,,both,, ,221.17,132.7,Aetna,Commercial,,,,,221.17,,,,
IMF SPEC 1ST AB ST,88346,CPT,,,,,both,, ,270.57,162.34,Aetna,Commercial,,,,,270.57,,,,
ELECTRON MICROSCOPY,88348,CPT,,,,,both,, ,2028.15,1216.89,Aetna,Commercial,,,,,2028.15,,,,
IMF/SPEC ADD AB ST,88350,CPT,,,,,both,, ,270.57,162.34,Aetna,Commercial,,,,,270.57,,,,
ANALYSIS SKELET MUSC,88355,CPT,,,,,both,, ,237.17,142.3,Aetna,Commercial,,,,,237.17,,,,
ANALYSIS NERVE,88356,CPT,,,,,both,, ,368.8,221.28,Aetna,Commercial,,,,,368.8,,,,
ANALYSIS TUMOR,88358,CPT,,,,,both,, ,237.17,142.3,Aetna,Commercial,,,,,237.17,,,,
TUMOR IHC QT MAN,88360,CPT,,,,,both,, ,1468.77,881.26,Aetna,Commercial,,,,,1468.77,,,,
TUMOR IHC QT UTO,88361,CPT,,,,,both,, ,1468.77,881.26,Aetna,Commercial,,,,,1468.77,,,,
NERVE TEASING PREPAR,88362,CPT,,,,,both,, ,368.8,221.28,Aetna,Commercial,,,,,368.8,,,,
XM ARCHIVE TIS MOLEC,88363,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,,,,72.13,,,,
TIS HYBRD AD SNG PRB,88364,CPT,,,,,both,, ,230.71,138.42,Aetna,Commercial,,,,,230.71,,,,
TIS HYBRD SPEC INIT,88365,CPT,,,,,both,, ,304.81,182.88,Aetna,Commercial,,,,,304.81,,,,
INS HYBR AUT SP INIT,88367,CPT,,,,,both,, ,220.05,132.03,Aetna,Commercial,,,,,220.05,,,,
INS HYBRD MAN SP INI,88368,CPT,,,,,both,, ,342.7,205.62,Aetna,Commercial,,,,,342.7,,,,
INS HYBRD MAN SNG PR,88369,CPT,,,,,both,, ,342.7,205.62,Aetna,Commercial,,,,,342.7,,,,
PROTEIN-WEST BLOTTIS,88371,CPT,,,,,both,, ,209.38,125.62,Aetna,Commercial,,,,,209.38,,,,
PROTEIN ANALYSW/PROB,88372,CPT,,,,,both,, ,218.93,131.35,Aetna,Commercial,,,,,218.93,,,,
INS HYBR AUT SNG PR,88373,CPT,,,,,both,, ,220.05,132.03,Aetna,Commercial,,,,,220.05,,,,
INS HYBR AUT MUL PR,88374,CPT,,,,,both,, ,220.05,132.03,Aetna,Commercial,,,,,220.05,,,,
INS HYBR MAN MUL PR,88377,CPT,,,,,both,, ,342.7,205.62,Aetna,Commercial,,,,,342.7,,,,
MICRODISSECTION MANU,88381,CPT,,,,,both,, ,424.38,254.62,Aetna,Commercial,,,,,424.38,,,,
SURGICAL PATH PROCED,88399,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,,,,72.13,,,,
BILIRUBIN TOT TRANS,88720,CPT,,,,,both,, ,75.22,45.13,Aetna,Commercial,,,,,75.22,,,,
CELL CTW-DIF BODYFLU,89051,CPT,,,,,both,, ,54.17,32.5,Aetna,Commercial,,,,,54.17,,,,
CELL CTW-DIF BODYFLU,89051,CPT,,,,,both,, ,691.29,414.77,Aetna,Commercial,,,,,691.29,,,,
LEUKOCY ASSES FEC QL,89055,CPT,,,,,both,, ,109.46,65.67,Aetna,Commercial,,,,,109.46,,,,
CRYSTALS SYNOVIAL FLD,89060,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
CRYSTALS SYNOVIAL FLD,89060,CPT,,,,,both,, ,345.79,207.47,Aetna,Commercial,,,,,345.79,,,,
NASAL SMEAR-EOSINOPH,89190,CPT,,,,,both,, ,518.69,311.21,Aetna,Commercial,,,,,518.69,,,,
UNL MISC PATH TEST,89240,CPT,,,,,both,, ,72.13,43.27,Aetna,Commercial,,,,,72.13,,,,
SEMEN ANYL PRES-M-S,89321,CPT,,,,,both,, ,526.26,315.75,Aetna,Commercial,,,,,526.26,,,,
HEPATITIS B GLOB IM,90371,CPT,,,,,both,, ,679.03,407.41,Aetna,Commercial,,,,,679.03,,,,
HEPATITIS B GLOB IM,90371,CPT,,,,,both,1,ML,953,571.8,Aetna,Commercial,,,,,953,,,,
RABIES IG IM/SC 150U,90375,CPT,,,,,both,3,ML,414.33,248.59,Aetna,Commercial,,,,,414.33,,,,
RABIES IG IM/SC 150U,90375,CPT,,,,,both,, ,1385.09,831.05,Aetna,Commercial,,,,,1385.09,,,,
RABIES IG IM/SC 150U,90375,CPT,,,,,both,, ,1428.35,857.01,Aetna,Commercial,,,,,1428.35,,,,
RABIES IG IM/SC 150U,90375,HCPCS,,,,,both,5,ML,1867.13,1120.27,Aetna,Commercial,,,,,1867.13,,,,
RABIES IG IM/SC 150U,90375,HCPCS,,,,,both,1,ML,2044.81,1226.88,Aetna,Commercial,,,,,2044.81,,,,
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,143.69,86.21,Aetna,Commercial,,,,,143.69,,,,
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,230.72,138.43,Aetna,Commercial,,,,,230.72,,,,
IMM ADM INJ SINGLE,90471,CPT,,,,,both,, ,162.25,97.35,Aetna,Commercial,,,,,162.25,,,,
IMM ADM INJ SINGLE,90471,CPT,,,,,both,, ,162.25,97.35,Aetna,Commercial,,,,,162.25,,,,
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,119.22,71.53,Aetna,Commercial,,,,,119.22,,,,
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,119.22,71.53,Aetna,Commercial,,,,,119.22,,,,
IMM ADM INJ EA ADD,90472,CPT,,,,,both,, ,48.75,29.25,Aetna,Commercial,,,,,48.75,,,,
IMM ADM INJ EA ADD,90472,CPT,,,,,both,, ,48.75,29.25,Aetna,Commercial,,,,,48.75,,,,
HAEMOPH B TETAN INJ,90648,CPT,,,,,both,, ,131.84,79.1,Aetna,Commercial,,,,,131.84,,,,
FLU VAC NOPRSV ANTIG,90662,CPT,,,,,both,0.7,ML,434.66,260.79,Aetna,Commercial,,,,,434.66,,,,
PNEUMOCOC 13-VAL IM,90670,CPT,,,,,both,0.5,ML,871.9,523.14,Aetna,Commercial,,,,,871.9,,,,
FLU VAC CCIIV4 PF&AB,90674,CPT,,,,,both,0.5,ML,208.06,124.83,Aetna,Commercial,,,,,208.06,,,,
RABIES VAC IM,90675,CPT,,,,,both,1,EA,1856.32,1113.79,Aetna,Commercial,,,,,1856.32,,,,
RABIES VAC IM,90675,CPT,,,,,both,, ,1941.04,1164.62,Aetna,Commercial,,,,,1941.04,,,,
FLU VAC QUAD DNA HA,90682,CPT,,,,,both,, ,383.75,230.25,Aetna,Commercial,,,,,383.75,,,,
FLU VACIIV4 PF .5ML,90686,CPT,,,,,both,, ,145.23,87.13,Aetna,Commercial,,,,,145.23,,,,
FLU VAC IIV4 .25ML,90687,CPT,,,,,both,, ,135.45,81.27,Aetna,Commercial,,,,,135.45,,,,
M-M-R II INJ,90707,CPT,,,,,both,1,EA,471.23,282.73,Aetna,Commercial,,,,,471.23,,,,
TD IM NO PRSRV GE 7Y,90714,CPT,,,,,both,0.5,ML,210.12,126.07,Aetna,Commercial,,,,,210.12,,,,
DIPH/TET/ACPERT .5ML,90715,CPT,,,,,both,0.5,ML,350.2,210.12,Aetna,Commercial,,,,,350.2,,,,
DIPH/TET/ACPERT .5ML,90715,CPT,,,,,both,0.5,ML,370.54,222.32,Aetna,Commercial,,,,,370.54,,,,
VARICELLA VIR VAC SC,90716,CPT,,,,,both,1,EA,611.56,366.93,Aetna,Commercial,,,,,611.56,,,,
PNEUMO-VAC 2YR-ADULT,90732,CPT,,,,,both,0.5,ML,544.1,326.46,Aetna,Commercial,,,,,544.1,,,,
HEP B VAC PED,90744,CPT,,,,,both,, ,194.93,116.95,Aetna,Commercial,,,,,194.93,,,,
HEP B VAC PED,90744,CPT,,,,,both,0.5,ML,204.97,122.98,Aetna,Commercial,,,,,204.97,,,,
INTERACTIVE ADD-ON,90785,CPT,,,,,both,, ,310.8,186.48,Aetna,Commercial,,,,,310.8,,,,
PSYCH DIAG EVAL,90791,CPT,,,,,both,, ,249.78,149.86,Aetna,Commercial,,,,,249.78,,,,
PSYCH DIAG EVAL,90791,CPT,,,,,both,, ,757.82,454.69,Aetna,Commercial,,,,,757.82,,,,
PSYCHOTHERAPY 30 MIN,90832,CPT,,,,,both,, ,238.96,143.37,Aetna,Commercial,,,,,238.96,,,,
"Psychotherapy, 30 min",90832,CPT,,,,,both,,,238.96,238.96,Aetna,Commercial,,168.71,70.6,,238.96,238.96,238.96,Fee Schedule,70.6
PSYCHOTHER 30M W/E&M,90833,CPT,,,,,both,, ,301.75,181.05,Aetna,Commercial,,,,,301.75,,,,
PSYCHOTHERAPY 45 MIN,90834,CPT,,,,,both,, ,299.73,179.83,Aetna,Commercial,,,,,299.73,,,,
"Psychotherapy, 45 min",90834,CPT,,,,,both,,,299.73,299.73,Aetna,Commercial,,211.61,70.6,,299.73,299.73,299.73,Fee Schedule,70.6
PSYCHOTHER 45M W/E&M,90836,CPT,,,,,both,, ,312.25,187.35,Aetna,Commercial,,,,,312.25,,,,
PSYCHOTHERAPY 60 MIN,90837,CPT,,,,,both,, ,359.73,215.83,Aetna,Commercial,,,,,359.73,,,,
"Psychotherapy, 60 min",90837,CPT,,,,,both,,,359.73,359.73,Aetna,Commercial,,253.97,70.6,,359.73,359.73,359.73,Fee Schedule,
PSYCHOTHER 60M W/E&M,90838,CPT,,,,,both,, ,323.75,194.25,Aetna,Commercial,,,,,323.75,,,,
FAM THERAPY W/PATIEN,90847,CPT,,,,,both,, ,842.03,505.21,Aetna,Commercial,,,,,842.03,,,,
"Family psychotherapy, including patient, 50 min",90847,CPT,,,,,both,,,842.03,842.03,Aetna,Commercial,,594.47,70.6,,842.03,842.03,842.03,Fee Schedule,70.6
MULTI-FAM GRP PSYCH,90849,CPT,,,,,both,, ,396.04,237.62,Aetna,Commercial,,,,,396.04,,,,
Group psychotherapy,90853,CPT,,,,,both,,,220.94,220.94,Aetna,Commercial,,155.98,70.6,,220.94,220.94,220.94,Fee Schedule,70.6
PSYCH GROUP THERAPY,90853,CPT,,,,,both,, ,220.94,132.56,Aetna,Commercial,,,,,220.94,,,,
PSYCH GROUP THERAPY,90853,CPT,,,,,both,, ,689.33,413.59,Aetna,Commercial,,,,,689.33,,,,
MEDICATION MGMT,90863,CPT,,,,,both,, ,294.25,176.55,Aetna,Commercial,,,,,294.25,,,,
TMS INITIAL & 1ST TX,90867,CPT,,,,,both,, ,955.84,573.5,Aetna,Commercial,,,,,955.84,,,,
TMS SUBSEQUENT TX,90868,CPT,,,,,both,, ,515.04,309.02,Aetna,Commercial,,,,,515.04,,,,
TMS REMAPPING & TX,90869,CPT,,,,,both,, ,515.04,309.02,Aetna,Commercial,,,,,515.04,,,,
HEMODIALY SING EVAL,90935,CPT,,,,,both,, ,9908.09,5944.85,Aetna,Commercial,,,,,9908.09,,,,
OTH DIALY SING EVAL,90945,CPT,,,,,both,, ,4956.88,2974.12,Aetna,Commercial,,,,,4956.88,,,,
SP AR MCD TRMT 15MIN,92507,CPT,,,,,both,, ,182.25,109.35,Aetna,Commercial,,,,,182.25,,,,
SP-HEAR-TX-INDI VIST,92507,CPT,,,,,both,, ,705.29,423.17,Aetna,Commercial,,,,,705.29,,,,
SP-HEAR-GROUP-VISIT,92508,CPT,,,,,both,, ,324.19,194.51,Aetna,Commercial,,,,,324.19,,,,
EV SP FLUENCY 15,92521,CPT,,,,,both,, ,135.5,81.3,Aetna,Commercial,,,,,135.5,,,,
EVAL SPEECH FLUENCY,92521,CPT,,,,,both,, ,814.22,488.53,Aetna,Commercial,,,,,814.22,,,,
EV SP PROD 15,92522,CPT,,,,,both,, ,182.25,109.35,Aetna,Commercial,,,,,182.25,,,,
EVAL SPEECH SND PROD,92522,CPT,,,,,both,, ,814.22,488.53,Aetna,Commercial,,,,,814.22,,,,
EVAL SP SND PROD CMP,92523,CPT,,,,,both,, ,814.22,488.53,Aetna,Commercial,,,,,814.22,,,,
SP SOUND LANG CMP 15,92523,CPT,,,,,both,, ,182.25,109.35,Aetna,Commercial,,,,,182.25,,,,
BEH QL ANAL VOICE 15,92524,CPT,,,,,both,, ,182.25,109.35,Aetna,Commercial,,,,,182.25,,,,
BEHAV QL ANAL VOICE,92524,CPT,,,,,both,, ,814.22,488.53,Aetna,Commercial,,,,,814.22,,,,
ORAL FUNC TX-VIS,92526,CPT,,,,,both,, ,705.29,423.17,Aetna,Commercial,,,,,705.29,,,,
EVAL VOICE PROS DEV,92597,CPT,,,,,both,, ,390.11,234.06,Aetna,Commercial,,,,,390.11,,,,
COCHLE IMP INTIL LT7,92601,CPT,,,,,both,, ,854.9,512.94,Aetna,Commercial,,,,,854.9,,,,
SP-EVAL NSG DEV 1STH,92605,CPT,,,,,both,, ,813.7,488.22,Aetna,Commercial,,,,,813.7,,,,
SP-EVAL SP DEV 1STHR,92607,CPT,,,,,both,, ,813.7,488.22,Aetna,Commercial,,,,,813.7,,,,
SP-EVAL SP DEV AD30M,92608,CPT,,,,,both,, ,763.23,457.93,Aetna,Commercial,,,,,763.23,,,,
SP-THER SVC SPCH DEV,92609,CPT,,,,,both,, ,705.29,423.17,Aetna,Commercial,,,,,705.29,,,,
SP-EVAL SWL WO RADOP,92610,CPT,,,,,both,, ,758.08,454.84,Aetna,Commercial,,,,,758.08,,,,
SP-EVAL SWL W-RADOPQ,92611,CPT,,,,,both,, ,862.63,517.57,Aetna,Commercial,,,,,862.63,,,,
AUD EVOKE HR BRD STM,92651,CPT,,,,,both,, ,567.79,340.67,Aetna,Commercial,,,,,567.79,,,,
"IC-PTCA, SINGLE",92920,CPT,,,,,both,, ,65091.11,39054.66,Aetna,Commercial,,,,,65091.11,,,,
"IC-PTCA, ADDL",92921,CPT,,,,,both,, ,65091.11,39054.66,Aetna,Commercial,,,,,65091.11,,,,
IC-PRQ CRD STN W-ANG,92928,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,,,,88719.05,,,,
IC-PRQ STNT W-ANG EA,92929,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,,,,88719.05,,,,
IC-PRQ CRD ST-AT-ANG,92933,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,,,,88719.05,,,,
IC-PRQ ST-AT-ANG EA,92934,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,,,,88719.05,,,,
IC-PRQ RV BYP GRF IN,92937,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,,,,88719.05,,,,
IC-PRQ RV BYP GRF AD,92938,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,,,,88719.05,,,,
IC-PRQ CARD REV 1 VS,92941,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,,,,88719.05,,,,
IC-PRQ REVSC CHR 1VS,92943,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,,,,88719.05,,,,
IC-PRQ REVSC CHR ADD,92944,CPT,,,,,both,, ,88719.05,53231.43,Aetna,Commercial,,,,,88719.05,,,,
CPR,92950,CPT,,,,,both,, ,382.9,229.74,Aetna,Commercial,,,,,382.9,,,,
CPR,92950,CPT,,,,,both,, ,382.9,229.74,Aetna,Commercial,,,,,382.9,,,,
CPR,92950,CPT,,,,,both,, ,6031.42,3618.85,Aetna,Commercial,,,,,6031.42,,,,
CPR ASSIST (NON ER),92950,CPT,,,,,both,, ,5533.42,3320.05,Aetna,Commercial,,,,,5533.42,,,,
NI-TEMP EXT PACE,92953,CPT,,,,,both,, ,4462.48,2677.48,Aetna,Commercial,,,,,4462.48,,,,
NI-TEMP EXT PACE,92953,CPT,,,,,both,, ,4864.09,2918.45,Aetna,Commercial,,,,,4864.09,,,,
NI-CARDIOVERSION,92960,CPT,,,,,both,, ,4603.59,2762.15,Aetna,Commercial,,,,,4603.59,,,,
NI-CARDIOVERSION,92960,CPT,,,,,both,, ,5017.9,3010.74,Aetna,Commercial,,,,,5017.9,,,,
"EP-CARDIOVER,INTERN",92961,CPT,,,,,both,, ,2378.01,1426.8,Aetna,Commercial,,,,,2378.01,,,,
IC-COR THROMBECTOMY,92973,CPT,,,,,both,, ,29086.43,17451.85,Aetna,Commercial,,,,,29086.43,,,,
IC-INTRCOR THROMBOL,92975,CPT,,,,,both,, ,18741.62,11244.97,Aetna,Commercial,,,,,18741.62,,,,
IC-INTRCOR THROMBOL,92975,CPT,,,,,both,, ,18741.62,11244.97,Aetna,Commercial,,,,,18741.62,,,,
"THROMBOLY,CORONRY,IV",92977,CPT,,,,,both,, ,4033.02,2419.81,Aetna,Commercial,,,,,4033.02,,,,
"IC-IVUS, INIT",92978,CPT,,,,,both,, ,537.92,322.75,Aetna,Commercial,,,,,537.92,,,,
"IC-IVUS, ADDL",92979,CPT,,,,,both,, ,433.89,260.33,Aetna,Commercial,,,,,433.89,,,,
EKG 12 LEAD ED STAFF,93005,CPT,,,,,both,, ,1530.84,918.5,Aetna,Commercial,,,,,1530.84,,,,
EKG 12 LEAD UC STAFF,93005,CPT,,,,,both,, ,65.15,39.09,Aetna,Commercial,,,,,65.15,,,,
EKG 12 LEAD UC STAFF,93005,CPT,,,,,both,, ,65.15,39.09,Aetna,Commercial,,,,,65.15,,,,
"NI-EKG, 12 LEADS",93005,CPT,,,,,both,, ,714.82,428.89,Aetna,Commercial,,,,,714.82,,,,
NI-STRESS TEST,93017,CPT,,,,,both,, ,5189.4,3113.64,Aetna,Commercial,,,,,5189.4,,,,
EP-MICROVOLT T,93025,CPT,,,,,both,, ,1128.62,677.17,Aetna,Commercial,,,,,1128.62,,,,
"NI-EKG, 1-3 LEADS",93041,CPT,,,,,both,, ,1999.49,1199.69,Aetna,Commercial,,,,,1999.49,,,,
NI-HOLT RECRD TO48HR,93225,CPT,,,,,both,, ,9701.06,5820.63,Aetna,Commercial,,,,,9701.06,,,,
NI-HOLT WSCAN TO48HR,93226,CPT,,,,,both,, ,1596.24,957.74,Aetna,Commercial,,,,,1596.24,,,,
NI-TTE 2D W DOPP,93306,CPT,,,,,both,, ,12135.98,7281.58,Aetna,Commercial,,,,,12135.98,,,,
NI-TTE 2D MM COMP WO,93307,CPT,,,,,both,, ,8910.27,5346.16,Aetna,Commercial,,,,,8910.27,,,,
NI-TTE 2D MM LTD WO,93308,CPT,,,,,both,, ,4522.73,2713.63,Aetna,Commercial,,,,,4522.73,,,,
NI-TEE COMP 2D MM WO,93312,CPT,,,,,both,, ,9011.21,5406.72,Aetna,Commercial,,,,,9011.21,,,,
US-ECHO DOPP COMP AD,93320,CPT,,,,,both,, ,1635.9,981.54,Aetna,Commercial,,,,,1635.9,,,,
NI-ECHO DOP LTD,93321,CPT,,,,,both,, ,541.78,325.06,Aetna,Commercial,,,,,541.78,,,,
US-ECHO DOP CO FL AD,93325,CPT,,,,,both,, ,616.46,369.87,Aetna,Commercial,,,,,616.46,,,,
US-TTE STRESS WO,93350,CPT,,,,,both,, ,6350.21,3810.12,Aetna,Commercial,,,,,6350.21,,,,
CC-RHC,93451,CPT,,,,,both,, ,39597.32,23758.39,Aetna,Commercial,,,,,39597.32,,,,
CC-LHC VENT PUNC,93452,CPT,,,,,both,, ,43345.75,26007.45,Aetna,Commercial,,,,,43345.75,,,,
Insertion of catheter into left heart for diagnosis,93452,CPT,,,,,both,,,43345.75,43345.75,Aetna,Commercial,,30602.1,70.6,,43345.75,43345.75,43345.75,Fee Schedule,70.6
CC-R-L CATH LV PUNC,93453,CPT,,,,,both,, ,43345.75,26007.45,Aetna,Commercial,,,,,43345.75,,,,
CC-ANGIO CORON ONLY,93454,CPT,,,,,both,, ,34667.23,20800.33,Aetna,Commercial,,,,,34667.23,,,,
CC-S-I VNT ATR ANGIO,93455,CPT,,,,,both,, ,36140.38,21684.22,Aetna,Commercial,,,,,36140.38,,,,
CC-R HRT CORONRY ART,93456,CPT,,,,,both,, ,74264.29,44558.57,Aetna,Commercial,,,,,74264.29,,,,
CC-R HRT ART-GRF ANG,93457,CPT,,,,,both,, ,75737.7,45442.62,Aetna,Commercial,,,,,75737.7,,,,
CC-L HRT ARTERY-VENT,93458,CPT,,,,,both,, ,49262.84,29557.7,Aetna,Commercial,,,,,49262.84,,,,
CC-L HRT ART-GRF ANG,93459,CPT,,,,,both,, ,50736,30441.6,Aetna,Commercial,,,,,50736,,,,
CC-R-L HRT ART-VENT,93460,CPT,,,,,both,, ,49262.84,29557.7,Aetna,Commercial,,,,,49262.84,,,,
CC-R-L HRT ART-ANGIO,93461,CPT,,,,,both,, ,50736,30441.6,Aetna,Commercial,,,,,50736,,,,
CC-DRUM ADM-HEMODYNC,93463,CPT,,,,,both,, ,451.91,271.14,Aetna,Commercial,,,,,451.91,,,,
INSERTION FLOW CATH,93503,CPT,,,,,both,, ,13163.66,7898.19,Aetna,Commercial,,,,,13163.66,,,,
CC-INJ L VENT-ATRIAL,93565,CPT,,,,,both,, ,3748.43,2249.05,Aetna,Commercial,,,,,3748.43,,,,
CC-INJ R VENT-ATRIAL,93566,CPT,,,,,both,, ,3252.48,1951.48,Aetna,Commercial,,,,,3252.48,,,,
CC-INJ SUPRV AORTOGR,93567,CPT,,,,,both,, ,5119.62,3071.77,Aetna,Commercial,,,,,5119.62,,,,
CC-INJ PULM ART HRTC,93568,CPT,,,,,both,, ,5119.62,3071.77,Aetna,Commercial,,,,,5119.62,,,,
HEART FLOW MEASURE,93571,CPT,,,,,both,, ,709.67,425.8,Aetna,Commercial,,,,,709.67,,,,
HEART FLOW MEAS ADD,93572,CPT,,,,,both,, ,709.67,425.8,Aetna,Commercial,,,,,709.67,,,,
CC-PDA CLOSE PERC,93582,CPT,,,,,both,, ,68501.18,41100.7,Aetna,Commercial,,,,,68501.18,,,,
EP-HIS BUNDLE REC,93600,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,,,,4670.54,,,,
EP-INTRAATRIAL REC,93602,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,,,,4670.54,,,,
EP-RV RECORD,93603,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,,,,4670.54,,,,
EP-MAP TACHY,93609,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,,,,4670.54,,,,
EP-INTRAATRIAL PAC,93610,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,,,,4670.54,,,,
EP-INTRAVENT PAC,93612,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,,,,4670.54,,,,
EP-MAP ADD,93613,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,,,,4670.54,,,,
EP-ATRI RECORD ESO,93615,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,,,,4670.54,,,,
EP-ATRI REC-PAC ESO,93616,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,,,,4670.54,,,,
EP-INDUC ARRY PAC,93618,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,,,,4670.54,,,,
EP-COMP EP W-O ARRY,93619,CPT,,,,,both,, ,22625.5,13575.3,Aetna,Commercial,,,,,22625.5,,,,
EP-COMP EP W- ARRY,93620,CPT,,,,,both,, ,22625.5,13575.3,Aetna,Commercial,,,,,22625.5,,,,
"EP-LA PACING, ADD",93621,CPT,,,,,both,, ,22625.5,13575.3,Aetna,Commercial,,,,,22625.5,,,,
"EP-LV PACING, ADD",93622,CPT,,,,,both,, ,22625.5,13575.3,Aetna,Commercial,,,,,22625.5,,,,
EP-PROG STIM IV DRUG,93623,CPT,,,,,both,, ,22625.5,13575.3,Aetna,Commercial,,,,,22625.5,,,,
EP-F-U EPW-ARRY IND,93624,CPT,,,,,both,, ,22625.5,13575.3,Aetna,Commercial,,,,,22625.5,,,,
EP-INTRA OP MAPPNG,93631,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,,,,4670.54,,,,
"EP-EVAL LEAD,INDUC",93640,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,,,,4670.54,,,,
"EP-EVAL GEN, INDUC",93641,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,,,,4670.54,,,,
EP-EVAL PREV DEVICE,93642,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,,,,4670.54,,,,
EP-ABLATE AV NODE,93650,CPT,,,,,both,, ,22625.5,13575.3,Aetna,Commercial,,,,,22625.5,,,,
EP-ABLATE SPRVNT ART,93653,CPT,,,,,both,, ,46220.99,27732.59,Aetna,Commercial,,,,,46220.99,,,,
EP-ABLATE VENT TACY,93654,CPT,,,,,both,, ,46220.99,27732.59,Aetna,Commercial,,,,,46220.99,,,,
EP-ATR FIB PULM VN I,93656,CPT,,,,,both,, ,46220.99,27732.59,Aetna,Commercial,,,,,46220.99,,,,
EP-INTCRD ECHO INTER,93662,CPT,,,,,both,, ,4670.54,2802.32,Aetna,Commercial,,,,,4670.54,,,,
PAD REHB PER SESSION,93668,CPT,,,,,both,, ,169.18,101.5,Aetna,Commercial,,,,,169.18,,,,
NI-CARD REHAB W-O MO,93797,CPT,,,,,both,, ,193.64,116.18,Aetna,Commercial,,,,,193.64,,,,
NI-CARDI REHAB W- MO,93798,CPT,,,,,both,, ,296.38,177.82,Aetna,Commercial,,,,,296.38,,,,
US-CAROTID DPLX SCAN,93880,CPT,,,,,both,, ,425.13,255.07,Aetna,Commercial,,,,,425.13,,,,
US-CAROTID DPLX SCAN,93880,CPT,,,,,both,, ,457.58,274.54,Aetna,Commercial,,,,,457.58,,,,
US-CRAN DPLX SCN BIL,93880,CPT,,,,,both,, ,12714.32,7628.59,Aetna,Commercial,,,,,12714.32,,,,
US-CAROTID DUP DOPLR,93882,CPT,,,,,both,, ,425.13,255.07,Aetna,Commercial,,,,,425.13,,,,
US-CAROTID DUP DOPLR,93882,CPT,,,,,both,, ,457.58,274.54,Aetna,Commercial,,,,,457.58,,,,
NI-EXT ARTERIAL LTD,93922,CPT,,,,,both,, ,2456.29,1473.77,Aetna,Commercial,,,,,2456.29,,,,
US-EXT ARTERIAL LTD,93922,CPT,,,,,both,, ,167.38,100.42,Aetna,Commercial,,,,,167.38,,,,
NI-EXT ARTERIAL COMP,93923,CPT,,,,,both,, ,3819.24,2291.54,Aetna,Commercial,,,,,3819.24,,,,
US-NON INV ARTER EXT,93923,CPT,,,,,both,, ,268.32,160.99,Aetna,Commercial,,,,,268.32,,,,
NI-STD LE STRS REST,93924,CPT,,,,,both,, ,5693.84,3416.3,Aetna,Commercial,,,,,5693.84,,,,
NI-LW EXT DPX ART BI,93925,CPT,,,,,both,, ,5086.4,3051.84,Aetna,Commercial,,,,,5086.4,,,,
NI-LW EXT DPX ART UN,93926,CPT,,,,,both,, ,2541.53,1524.91,Aetna,Commercial,,,,,2541.53,,,,
US-LW EXT DPX ART UN,93926,CPT,,,,,both,, ,1560.19,936.11,Aetna,Commercial,,,,,1560.19,,,,
NI-UP EXT DPX ART BI,93930,CPT,,,,,both,, ,5083.05,3049.83,Aetna,Commercial,,,,,5083.05,,,,
NI-UP EXT DPX ART UN,93931,CPT,,,,,both,, ,2541.53,1524.91,Aetna,Commercial,,,,,2541.53,,,,
US-UP EXT DPX ART UN,93931,CPT,,,,,both,, ,2026.01,1215.6,Aetna,Commercial,,,,,2026.01,,,,
NI-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,5086.4,3051.84,Aetna,Commercial,,,,,5086.4,,,,
US-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,425.13,255.07,Aetna,Commercial,,,,,425.13,,,,
US-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,457.58,274.54,Aetna,Commercial,,,,,457.58,,,,
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,299.73,179.83,Aetna,Commercial,,,,,299.73,,,,
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,322.65,193.59,Aetna,Commercial,,,,,322.65,,,,
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,2541.53,1524.91,Aetna,Commercial,,,,,2541.53,,,,
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,425.13,255.07,Aetna,Commercial,,,,,425.13,,,,
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,457.58,274.54,Aetna,Commercial,,,,,457.58,,,,
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,823.23,493.93,Aetna,Commercial,,,,,823.23,,,,
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,425.13,255.07,Aetna,Commercial,,,,,425.13,,,,
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,457.58,274.54,Aetna,Commercial,,,,,457.58,,,,
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,828.89,497.33,Aetna,Commercial,,,,,828.89,,,,
US-DPLXSCN GRFT ARTA,93978,CPT,,,,,both,, ,1665.51,999.3,Aetna,Commercial,,,,,1665.51,,,,
NI-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,1292.14,775.28,Aetna,Commercial,,,,,1292.14,,,,
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,425.13,255.07,Aetna,Commercial,,,,,425.13,,,,
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,457.58,274.54,Aetna,Commercial,,,,,457.58,,,,
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,841.51,504.9,Aetna,Commercial,,,,,841.51,,,,
VESS MAP HEMO ACC BI,93985,CPT,,,,,both,, ,977.58,586.54,Aetna,Commercial,,,,,977.58,,,,
VESS MAP HEMO ACC UN,93986,CPT,,,,,both,, ,977.58,586.54,Aetna,Commercial,,,,,977.58,,,,
NI-DUPSCN HEMODIAL,93990,CPT,,,,,both,, ,4623.93,2774.35,Aetna,Commercial,,,,,4623.93,,,,
MECH VENT INITIAL,94002,CPT,,,,,both,, ,4971.3,2982.78,Aetna,Commercial,,,,,4971.3,,,,
MECH VENT DAILY SUBS,94003,CPT,,,,,both,, ,4971.3,2982.78,Aetna,Commercial,,,,,4971.3,,,,
SPIROMETRY,94010,CPT,,,,,both,, ,530.45,318.27,Aetna,Commercial,,,,,530.45,,,,
BRONCHO EVAL PRE/PST,94060,CPT,,,,,both,, ,2361.28,1416.76,Aetna,Commercial,,,,,2361.28,,,,
METHACHOLINE CHALLEN,94070,CPT,,,,,both,, ,961.51,576.9,Aetna,Commercial,,,,,961.51,,,,
MAXIMUM VOLUNTARY VE,94200,CPT,,,,,both,, ,306.94,184.16,Aetna,Commercial,,,,,306.94,,,,
HAST WITH 02 TITRATE,94453,CPT,,,,,both,, ,1089.74,653.84,Aetna,Commercial,,,,,1089.74,,,,
PULM STRESS SIMPLE,94618,CPT,,,,,both,, ,459.12,275.47,Aetna,Commercial,,,,,459.12,,,,
PULM REHAB WO OXIMET,94625,CPT,,,,,both,, ,227.4,136.44,Aetna,Commercial,,,,,227.4,,,,
PULM REHAB W OXIMET,94626,CPT,,,,,both,, ,227.4,136.44,Aetna,Commercial,,,,,227.4,,,,
INHALATION TRTMT INI,94640,CPT,,,,,both,, ,569.5,341.7,Aetna,Commercial,,,,,569.5,,,,
INHALATION TRTMT INI,94640,CPT,,,,,both,, ,586.59,351.95,Aetna,Commercial,,,,,586.59,,,,
INHALATION TRTMT SUB,94640,CPT,,,,,both,, ,691.75,415.05,Aetna,Commercial,,,,,691.75,,,,
INHALATION TRTMT SUB,94640,CPT,,,,,both,, ,712.5,427.5,Aetna,Commercial,,,,,712.5,,,,
PENTAMIDINE ARSL INH,94642,CPT,,,,,both,, ,1061.67,637,Aetna,Commercial,,,,,1061.67,,,,
AEROSOL OBSTRUCT 1HR,94644,CPT,,,,,both,, ,719.71,431.82,Aetna,Commercial,,,,,719.71,,,,
CONT INH TX ED 1HR,94644,CPT,,,,,both,, ,698.75,419.25,Aetna,Commercial,,,,,698.75,,,,
AEROSOL OBSTR ADD HR,94645,CPT,,,,,both,, ,719.71,431.82,Aetna,Commercial,,,,,719.71,,,,
CONT INH TX ED AD HR,94645,CPT,,,,,both,, ,698.75,419.25,Aetna,Commercial,,,,,698.75,,,,
BIPAP/CPAP,94660,CPT,,,,,both,, ,2771.47,1662.88,Aetna,Commercial,,,,,2771.47,,,,
EVAL-DEMO INHL DEVCE,94664,CPT,,,,,both,, ,342.73,205.63,Aetna,Commercial,,,,,342.73,,,,
MANIP CHST WALL INIT,94667,CPT,,,,,both,, ,1191.45,714.87,Aetna,Commercial,,,,,1191.45,,,,
MANIP CHST WALL SBSQ,94668,CPT,,,,,both,, ,975.15,585.09,Aetna,Commercial,,,,,975.15,,,,
MECHAN CHST WALL OSC,94669,CPT,,,,,both,, ,210.89,126.53,Aetna,Commercial,,,,,210.89,,,,
PF TST PLETHYSMOGRA,94726,CPT,,,,,both,, ,548.73,329.23,Aetna,Commercial,,,,,548.73,,,,
PF TEST BY GAS,94727,CPT,,,,,both,, ,548.73,329.23,Aetna,Commercial,,,,,548.73,,,,
PF TEST OSCILLOMETRY,94728,CPT,,,,,both,, ,548.73,329.23,Aetna,Commercial,,,,,548.73,,,,
CO2-MEMBANE DIFF CAP,94729,CPT,,,,,both,, ,2800.31,1680.18,Aetna,Commercial,,,,,2800.31,,,,
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309,185.4,Aetna,Commercial,,,,,309,,,,
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309,185.4,Aetna,Commercial,,,,,309,,,,
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309,185.4,Aetna,Commercial,,,,,309,,,,
PULSE OX NWBRN MULTI,94761,CPT,,,,,both,, ,797.48,478.48,Aetna,Commercial,,,,,797.48,,,,
PULSE OX NWBRN MULTI,94761,CPT,,,,,both,, ,797.48,478.48,Aetna,Commercial,,,,,797.48,,,,
PULSE OX CONTINUOS,94762,CPT,,,,,both,, ,388,232.8,Aetna,Commercial,,,,,388,,,,
PULSE OX CONTINUOS,94762,CPT,,,,,both,, ,468.91,281.34,Aetna,Commercial,,,,,468.91,,,,
PULSE OX CONTINUOS,94762,CPT,,,,,both,, ,468.91,281.34,Aetna,Commercial,,,,,468.91,,,,
CAR SEAT BED TST 60M,94780,CPT,,,,,both,, ,118.19,70.91,Aetna,Commercial,,,,,118.19,,,,
CAR SE-BED TST AD 30,94781,CPT,,,,,both,, ,58.97,35.38,Aetna,Commercial,,,,,58.97,,,,
ALLERGY INJ SIM,95115,CPT,,,,,both,, ,70.56,42.33,Aetna,Commercial,,,,,70.56,,,,
ALLERGY INJ SIM,95115,CPT,,,,,both,, ,70.81,42.48,Aetna,Commercial,,,,,70.81,,,,
ALLERGY INJ MUL,95117,CPT,,,,,both,, ,70.56,42.33,Aetna,Commercial,,,,,70.56,,,,
ALLERGY INJ MUL,95117,CPT,,,,,both,, ,70.81,42.48,Aetna,Commercial,,,,,70.81,,,,
POLYSOMNO GT4 LT6YO,95782,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,,,,2570.88,,,,
POLYSOMNO GT4 LT6YO,95782,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,,,,2570.88,,,,
POLYS-CPAP GT4 LT6YO,95783,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,,,,2570.88,,,,
POLYS-CPAP GT4 LT6YO,95783,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,,,,2570.88,,,,
SLPSTDY UNATT AN-ST,95800,CPT,,,,,both,, ,428.48,257.08,Aetna,Commercial,,,,,428.48,,,,
SLPSTDY UNATT AN-ST,95800,CPT,,,,,both,, ,625,375,Aetna,Commercial,,,,,625,,,,
MULTI SLEEP LAT,95805,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,,,,2570.88,,,,
MULTI SLEEP LAT,95805,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,,,,2570.88,,,,
SLPSTDY UNATT RS EFF,95806,CPT,,,,,both,, ,428.48,257.08,Aetna,Commercial,,,,,428.48,,,,
SLPSTDY UNATT RS EFF,95806,CPT,,,,,both,, ,625,375,Aetna,Commercial,,,,,625,,,,
POLYSOMNO GT4 GE6YO,95810,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,,,,2570.88,,,,
POLYSOMNO GT4 GE6YO,95810,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,,,,2570.88,,,,
Sleep study,95810,CPT,,,,,both,,,2570.88,2570.88,Aetna,Commercial,,1815.04,70.6,,2570.88,2570.88,2570.88,Fee Schedule,70.6
POLYS-CPAP GT4 GE6YO,95811,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,,,,2570.88,,,,
POLYS-CPAP GT4 GE6YO,95811,CPT,,,,,both,, ,2570.88,1542.52,Aetna,Commercial,,,,,2570.88,,,,
EEG 41-60 MIN,95812,CPT,,,,,both,, ,1075.58,645.34,Aetna,Commercial,,,,,1075.58,,,,
EEG GT 1 HOUR,95813,CPT,,,,,both,, ,1044.25,626.55,Aetna,Commercial,,,,,1044.25,,,,
EEG AWAKE DROWSY,95816,CPT,,,,,both,, ,1075.58,645.34,Aetna,Commercial,,,,,1075.58,,,,
EEG AWAKE ASLEEP,95819,CPT,,,,,both,, ,3362.5,2017.5,Aetna,Commercial,,,,,3362.5,,,,
EEG ASLEEP,95822,CPT,,,,,both,, ,4457.07,2674.24,Aetna,Commercial,,,,,4457.07,,,,
ROM WR EA EXTRK COTA,95851,CPT,,,,,both,, ,21.12,12.67,Aetna,Commercial,,,,,21.12,,,,
ROM WR EA EXTRK COTA,95851,CPT,,,,,both,, ,21.12,12.67,Aetna,Commercial,,,,,21.12,,,,
ROM WR EA EXTRK COTA,95851,CPT,,,,,both,, ,21.12,12.67,Aetna,Commercial,,,,,21.12,,,,
ROM WR EA EXTRK COTA,95851,CPT,,,,,both,, ,21.12,12.67,Aetna,Commercial,,,,,21.12,,,,
ROM WR EA EXTRK COTA,95851,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,,,,486.42,,,,
ROM WR EA EXTRK COTA,95851,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,,,,486.42,,,,
ROM WR EA EXTRNK PTA,95851,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,,,,448.57,,,,
ROM WR EA EXTRNK PTA,95851,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,,,,448.57,,,,
ROM W-R EA EXT-TRNK,95851,CPT,,,,,both,, ,418.86,251.31,Aetna,Commercial,,,,,418.86,,,,
ROM W-R EA EXT-TRNK,95851,CPT,,,,,both,, ,454.13,272.47,Aetna,Commercial,,,,,454.13,,,,
ROM W-R HND W-WO COM,95852,CPT,,,,,both,, ,418.86,251.31,Aetna,Commercial,,,,,418.86,,,,
ROM W-R HND W-WO COM,95852,CPT,,,,,both,, ,454.13,272.47,Aetna,Commercial,,,,,454.13,,,,
ROM WR HND W-WO COTA,95852,CPT,,,,,both,, ,16.22,9.73,Aetna,Commercial,,,,,16.22,,,,
ROM WR HND W-WO COTA,95852,CPT,,,,,both,, ,16.22,9.73,Aetna,Commercial,,,,,16.22,,,,
ROM WR HND W-WO COTA,95852,CPT,,,,,both,, ,16.22,9.73,Aetna,Commercial,,,,,16.22,,,,
ROM WR HND W-WO COTA,95852,CPT,,,,,both,, ,16.22,9.73,Aetna,Commercial,,,,,16.22,,,,
ROM WR HND W-WO COTA,95852,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,,,,486.42,,,,
ROM WR HND W-WO COTA,95852,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,,,,486.42,,,,
ROM W-R HND W-WO PTA,95852,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,,,,448.57,,,,
ROM W-R HND W-WO PTA,95852,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,,,,448.57,,,,
"EMG, 1 EXTREM",95860,CPT,,,,,both,, ,3272.05,1963.23,Aetna,Commercial,,,,,3272.05,,,,
"EMG, 2 EXTREM",95861,CPT,,,,,both,, ,5586.46,3351.87,Aetna,Commercial,,,,,5586.46,,,,
"EMG, 3 EXTREM",95863,CPT,,,,,both,, ,7162.62,4297.57,Aetna,Commercial,,,,,7162.62,,,,
"EMG, 4 EXTREM",95864,CPT,,,,,both,, ,8764.27,5258.56,Aetna,Commercial,,,,,8764.27,,,,
"EMG, W-NERVE TEST",95885,CPT,,,,,both,, ,458.87,275.32,Aetna,Commercial,,,,,458.87,,,,
EMG W-NRV TST COM,95886,CPT,,,,,both,, ,458.87,275.32,Aetna,Commercial,,,,,458.87,,,,
EMG W-NRV TST NON,95887,CPT,,,,,both,, ,242.57,145.54,Aetna,Commercial,,,,,242.57,,,,
MTR-SENS 1-2 NRV TST,95907,CPT,,,,,both,, ,821.43,492.85,Aetna,Commercial,,,,,821.43,,,,
MTR-SENS 3-4 NRV TST,95908,CPT,,,,,both,, ,821.43,492.85,Aetna,Commercial,,,,,821.43,,,,
MTR-SENS 5-6 NRV TST,95909,CPT,,,,,both,, ,821.43,492.85,Aetna,Commercial,,,,,821.43,,,,
MTR-SENS 7-8 NRV TST,95910,CPT,,,,,both,, ,821.43,492.85,Aetna,Commercial,,,,,821.43,,,,
MTR-SES 9-10 NRV TST,95911,CPT,,,,,both,, ,821.43,492.85,Aetna,Commercial,,,,,821.43,,,,
MTR-SES 11-12 NRV TS,95912,CPT,,,,,both,, ,1518.74,911.24,Aetna,Commercial,,,,,1518.74,,,,
MTR-SNS 13 OR MORE,95913,CPT,,,,,both,, ,1518.74,911.24,Aetna,Commercial,,,,,1518.74,,,,
PARASYMP-SYMP HRT RT,95924,CPT,,,,,both,, ,461.44,276.86,Aetna,Commercial,,,,,461.44,,,,
VISUAL EVOK POTENT,95930,CPT,,,,,both,, ,3397.2,2038.32,Aetna,Commercial,,,,,3397.2,,,,
"REPETIT STIM, EA NE",95937,CPT,,,,,both,, ,3199.95,1919.97,Aetna,Commercial,,,,,3199.95,,,,
CANALITH PER DAY,95992,CPT,,,,,both,, ,158.07,94.84,Aetna,Commercial,,,,,158.07,,,,
CANALITH PER DAY PTA,95992,CPT,,,,,both,, ,101.97,61.18,Aetna,Commercial,,,,,101.97,,,,
CANALITH PER DAY PTA,95992,CPT,,,,,both,, ,101.97,61.18,Aetna,Commercial,,,,,101.97,,,,
CANALITH PER DAY PTA,95992,CPT,,,,,both,, ,169.44,101.66,Aetna,Commercial,,,,,169.44,,,,
CANALITH PER DAY PTA,95992,CPT,,,,,both,, ,169.44,101.66,Aetna,Commercial,,,,,169.44,,,,
APHASIA ASSESS 1HOUR,96105,CPT,,,,,both,, ,813.7,488.22,Aetna,Commercial,,,,,813.7,,,,
DEV TEST 1ST HR,96112,CPT,,,,,both,, ,813.7,488.22,Aetna,Commercial,,,,,813.7,,,,
DEV TEST ADD 30M,96113,CPT,,,,,both,, ,763.23,457.93,Aetna,Commercial,,,,,763.23,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,253.9,152.34,Aetna,Commercial,,,,,253.9,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,253.9,152.34,Aetna,Commercial,,,,,253.9,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,487,292.2,Aetna,Commercial,,,,,487,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,487,292.2,Aetna,Commercial,,,,,487,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,501.61,300.96,Aetna,Commercial,,,,,501.61,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,501.61,300.96,Aetna,Commercial,,,,,501.61,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,1841.23,1104.73,Aetna,Commercial,,,,,1841.23,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,70.81,42.48,Aetna,Commercial,,,,,70.81,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,70.81,42.48,Aetna,Commercial,,,,,70.81,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,135.75,81.45,Aetna,Commercial,,,,,135.75,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,135.75,81.45,Aetna,Commercial,,,,,135.75,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,139.82,83.89,Aetna,Commercial,,,,,139.82,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,139.82,83.89,Aetna,Commercial,,,,,139.82,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,1841.23,1104.73,Aetna,Commercial,,,,,1841.23,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,412.77,247.66,Aetna,Commercial,,,,,412.77,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,412.77,247.66,Aetna,Commercial,,,,,412.77,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,928.18,556.9,Aetna,Commercial,,,,,928.18,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1301.75,781.05,Aetna,Commercial,,,,,1301.75,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1301.75,781.05,Aetna,Commercial,,,,,1301.75,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1340.8,804.48,Aetna,Commercial,,,,,1340.8,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1340.8,804.48,Aetna,Commercial,,,,,1340.8,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,70.81,42.48,Aetna,Commercial,,,,,70.81,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,70.81,42.48,Aetna,Commercial,,,,,70.81,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,928.18,556.9,Aetna,Commercial,,,,,928.18,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1301.75,781.05,Aetna,Commercial,,,,,1301.75,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1301.75,781.05,Aetna,Commercial,,,,,1301.75,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1340.8,804.48,Aetna,Commercial,,,,,1340.8,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1340.8,804.48,Aetna,Commercial,,,,,1340.8,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,201.25,120.75,Aetna,Commercial,,,,,201.25,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,201.25,120.75,Aetna,Commercial,,,,,201.25,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,207.29,124.37,Aetna,Commercial,,,,,207.29,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,207.29,124.37,Aetna,Commercial,,,,,207.29,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,928.18,556.9,Aetna,Commercial,,,,,928.18,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,791.25,474.75,Aetna,Commercial,,,,,791.25,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,791.25,474.75,Aetna,Commercial,,,,,791.25,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,814.99,488.99,Aetna,Commercial,,,,,814.99,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,814.99,488.99,Aetna,Commercial,,,,,814.99,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,928.18,556.9,Aetna,Commercial,,,,,928.18,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,201.25,120.75,Aetna,Commercial,,,,,201.25,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,201.25,120.75,Aetna,Commercial,,,,,201.25,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,207.29,124.37,Aetna,Commercial,,,,,207.29,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,207.29,124.37,Aetna,Commercial,,,,,207.29,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,301.16,180.69,Aetna,Commercial,,,,,301.16,,,,
S-INJ NON CHEMO IA,96373,CPT,,,,,both,, ,1355.48,813.28,Aetna,Commercial,,,,,1355.48,,,,
INJECTION IV PUSH,96374,CPT,,,,,both,, ,1477.47,886.48,Aetna,Commercial,,,,,1477.47,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,201.25,120.75,Aetna,Commercial,,,,,201.25,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,201.25,120.75,Aetna,Commercial,,,,,201.25,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,207.29,124.37,Aetna,Commercial,,,,,207.29,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,253.9,152.34,Aetna,Commercial,,,,,253.9,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,253.9,152.34,Aetna,Commercial,,,,,253.9,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,501.61,300.96,Aetna,Commercial,,,,,501.61,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,1355.48,813.28,Aetna,Commercial,,,,,1355.48,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,201.25,120.75,Aetna,Commercial,,,,,201.25,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,201.25,120.75,Aetna,Commercial,,,,,201.25,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,207.29,124.37,Aetna,Commercial,,,,,207.29,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,207.29,124.37,Aetna,Commercial,,,,,207.29,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,668.99,401.39,Aetna,Commercial,,,,,668.99,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,729.19,437.51,Aetna,Commercial,,,,,729.19,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,98.5,59.1,Aetna,Commercial,,,,,98.5,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,98.5,59.1,Aetna,Commercial,,,,,98.5,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,101.46,60.87,Aetna,Commercial,,,,,101.46,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,101.46,60.87,Aetna,Commercial,,,,,101.46,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,729.19,437.51,Aetna,Commercial,,,,,729.19,,,,
CHEMO NON HORM IM SC,96401,CPT,,,,,both,, ,476.63,285.97,Aetna,Commercial,,,,,476.63,,,,
CHEMO HORMONAL IM SC,96402,CPT,,,,,both,, ,235.36,141.21,Aetna,Commercial,,,,,235.36,,,,
CHEMO IV PUSH,96409,CPT,,,,,both,, ,382.65,229.59,Aetna,Commercial,,,,,382.65,,,,
CHEMO EA AD IV PUSH,96411,CPT,,,,,both,, ,117.16,70.29,Aetna,Commercial,,,,,117.16,,,,
CHEMO IV INFU 1ST HR,96413,CPT,,,,,both,, ,1377.11,826.26,Aetna,Commercial,,,,,1377.11,,,,
CHEMO IV IN EA AD HR,96415,CPT,,,,,both,, ,234.58,140.74,Aetna,Commercial,,,,,234.58,,,,
CHEMO IV EA SEQ INF,96417,CPT,,,,,both,, ,126.18,75.7,Aetna,Commercial,,,,,126.18,,,,
IR-IRR PORT DRUG DEL,96523,CPT,,,,,both,, ,383.16,229.89,Aetna,Commercial,,,,,383.16,,,,
HOT-COLD PACKS,97010,CPT,,,,,both,, ,239.27,143.56,Aetna,Commercial,,,,,239.27,,,,
HOT-COLD PACKS,97010,CPT,,,,,both,, ,259.41,155.64,Aetna,Commercial,,,,,259.41,,,,
HOT-COLD PACKS COTA,97010,CPT,,,,,both,, ,41.2,24.72,Aetna,Commercial,,,,,41.2,,,,
HOT-COLD PACKS COTA,97010,CPT,,,,,both,, ,41.2,24.72,Aetna,Commercial,,,,,41.2,,,,
HOT-COLD PACKS COTA,97010,CPT,,,,,both,, ,41.2,24.72,Aetna,Commercial,,,,,41.2,,,,
HOT-COLD PACKS COTA,97010,CPT,,,,,both,, ,41.2,24.72,Aetna,Commercial,,,,,41.2,,,,
HOT-COLD PACKS COTA,97010,CPT,,,,,both,, ,277.84,166.7,Aetna,Commercial,,,,,277.84,,,,
HOT-COLD PACKS COTA,97010,CPT,,,,,both,, ,277.84,166.7,Aetna,Commercial,,,,,277.84,,,,
HOT-COLD PACKS PTA,97010,CPT,,,,,both,, ,256.21,153.72,Aetna,Commercial,,,,,256.21,,,,
HOT-COLD PACKS PTA,97010,CPT,,,,,both,, ,256.21,153.72,Aetna,Commercial,,,,,256.21,,,,
MECH TRACTION-VISIT,97012,CPT,,,,,both,, ,485.24,291.14,Aetna,Commercial,,,,,485.24,,,,
MECH TRACTN-VST PTA,97012,CPT,,,,,both,, ,39.4,23.64,Aetna,Commercial,,,,,39.4,,,,
MECH TRACTN-VST PTA,97012,CPT,,,,,both,, ,39.4,23.64,Aetna,Commercial,,,,,39.4,,,,
MECH TRACTN-VST PTA,97012,CPT,,,,,both,, ,519.89,311.93,Aetna,Commercial,,,,,519.89,,,,
MECH TRACTN-VST PTA,97012,CPT,,,,,both,, ,519.89,311.93,Aetna,Commercial,,,,,519.89,,,,
PARAF BATH-VISIT PTA,97018,CPT,,,,,both,, ,18.54,11.12,Aetna,Commercial,,,,,18.54,,,,
PARAF BATH-VISIT PTA,97018,CPT,,,,,both,, ,18.54,11.12,Aetna,Commercial,,,,,18.54,,,,
PARAF BATH-VISIT PTA,97018,CPT,,,,,both,, ,320.85,192.51,Aetna,Commercial,,,,,320.85,,,,
PARAF BATH-VISIT PTA,97018,CPT,,,,,both,, ,320.85,192.51,Aetna,Commercial,,,,,320.85,,,,
PARAF BTH-VISIT COTA,97018,CPT,,,,,both,, ,41.2,24.72,Aetna,Commercial,,,,,41.2,,,,
PARAF BTH-VISIT COTA,97018,CPT,,,,,both,, ,41.2,24.72,Aetna,Commercial,,,,,41.2,,,,
PARAF BTH-VISIT COTA,97018,CPT,,,,,both,, ,347.88,208.72,Aetna,Commercial,,,,,347.88,,,,
PARAF BTH-VISIT COTA,97018,CPT,,,,,both,, ,347.88,208.72,Aetna,Commercial,,,,,347.88,,,,
PARAFFIN BATH-VISIT,97018,CPT,,,,,both,, ,299.53,179.71,Aetna,Commercial,,,,,299.53,,,,
PARAFFIN BATH-VISIT,97018,CPT,,,,,both,, ,324.73,194.83,Aetna,Commercial,,,,,324.73,,,,
WHIRLPOOL THRPY-VIST,97022,CPT,,,,,both,, ,652.7,391.62,Aetna,Commercial,,,,,652.7,,,,
WHIRLPOOL THRPY-VIST,97022,CPT,,,,,both,, ,707.58,424.54,Aetna,Commercial,,,,,707.58,,,,
WHRLPL THPY-VST COTA,97022,CPT,,,,,both,, ,46.87,28.12,Aetna,Commercial,,,,,46.87,,,,
WHRLPL THPY-VST COTA,97022,CPT,,,,,both,, ,46.87,28.12,Aetna,Commercial,,,,,46.87,,,,
WHRLPL THPY-VST COTA,97022,CPT,,,,,both,, ,46.87,28.12,Aetna,Commercial,,,,,46.87,,,,
WHRLPL THPY-VST COTA,97022,CPT,,,,,both,, ,46.87,28.12,Aetna,Commercial,,,,,46.87,,,,
WHRLPL THPY-VST COTA,97022,CPT,,,,,both,, ,758.08,454.84,Aetna,Commercial,,,,,758.08,,,,
WHRLPL THPY-VST COTA,97022,CPT,,,,,both,, ,758.08,454.84,Aetna,Commercial,,,,,758.08,,,,
WHRLPL THRPY-VST PTA,97022,CPT,,,,,both,, ,699.11,419.46,Aetna,Commercial,,,,,699.11,,,,
WHRLPL THRPY-VST PTA,97022,CPT,,,,,both,, ,699.11,419.46,Aetna,Commercial,,,,,699.11,,,,
ELE STM-MN-15MN COTA,97032,CPT,,,,,both,, ,39.4,23.64,Aetna,Commercial,,,,,39.4,,,,
ELE STM-MN-15MN COTA,97032,CPT,,,,,both,, ,39.4,23.64,Aetna,Commercial,,,,,39.4,,,,
ELE STM-MN-15MN COTA,97032,CPT,,,,,both,, ,39.4,23.64,Aetna,Commercial,,,,,39.4,,,,
ELE STM-MN-15MN COTA,97032,CPT,,,,,both,, ,39.4,23.64,Aetna,Commercial,,,,,39.4,,,,
ELE STM-MN-15MN COTA,97032,CPT,,,,,both,, ,541.52,324.91,Aetna,Commercial,,,,,541.52,,,,
ELE STM-MN-15MN COTA,97032,CPT,,,,,both,, ,541.52,324.91,Aetna,Commercial,,,,,541.52,,,,
ELEC STIM-MAN-15 MIN,97032,CPT,,,,,both,, ,466.32,279.79,Aetna,Commercial,,,,,466.32,,,,
ELEC STIM-MAN-15 MIN,97032,CPT,,,,,both,, ,505.5,303.3,Aetna,Commercial,,,,,505.5,,,,
ELEC STM-MN-15MN PTA,97032,CPT,,,,,both,, ,499.55,299.73,Aetna,Commercial,,,,,499.55,,,,
ELEC STM-MN-15MN PTA,97032,CPT,,,,,both,, ,499.55,299.73,Aetna,Commercial,,,,,499.55,,,,
IONTOPHO-15 MIN COTA,97033,CPT,,,,,both,, ,54.59,32.75,Aetna,Commercial,,,,,54.59,,,,
IONTOPHO-15 MIN COTA,97033,CPT,,,,,both,, ,54.59,32.75,Aetna,Commercial,,,,,54.59,,,,
IONTOPHO-15 MIN COTA,97033,CPT,,,,,both,, ,54.59,32.75,Aetna,Commercial,,,,,54.59,,,,
IONTOPHO-15 MIN COTA,97033,CPT,,,,,both,, ,54.59,32.75,Aetna,Commercial,,,,,54.59,,,,
IONTOPHO-15 MIN COTA,97033,CPT,,,,,both,, ,764.52,458.71,Aetna,Commercial,,,,,764.52,,,,
IONTOPHO-15 MIN COTA,97033,CPT,,,,,both,, ,764.52,458.71,Aetna,Commercial,,,,,764.52,,,,
IONTOPHOR-15 MIN PTA,97033,CPT,,,,,both,, ,705.04,423.02,Aetna,Commercial,,,,,705.04,,,,
IONTOPHOR-15 MIN PTA,97033,CPT,,,,,both,, ,705.04,423.02,Aetna,Commercial,,,,,705.04,,,,
IONTOPHORESIS-15 MIN,97033,CPT,,,,,both,, ,658.28,394.96,Aetna,Commercial,,,,,658.28,,,,
IONTOPHORESIS-15 MIN,97033,CPT,,,,,both,, ,713.65,428.19,Aetna,Commercial,,,,,713.65,,,,
CNTRST BTH-15MIN PTA,97034,CPT,,,,,both,, ,474.83,284.89,Aetna,Commercial,,,,,474.83,,,,
CNTRST BTH-15MIN PTA,97034,CPT,,,,,both,, ,474.83,284.89,Aetna,Commercial,,,,,474.83,,,,
CNTRST BTH-15MN COTA,97034,CPT,,,,,both,, ,40.17,24.1,Aetna,Commercial,,,,,40.17,,,,
CNTRST BTH-15MN COTA,97034,CPT,,,,,both,, ,40.17,24.1,Aetna,Commercial,,,,,40.17,,,,
CNTRST BTH-15MN COTA,97034,CPT,,,,,both,, ,40.17,24.1,Aetna,Commercial,,,,,40.17,,,,
CNTRST BTH-15MN COTA,97034,CPT,,,,,both,, ,40.17,24.1,Aetna,Commercial,,,,,40.17,,,,
CNTRST BTH-15MN COTA,97034,CPT,,,,,both,, ,514.74,308.84,Aetna,Commercial,,,,,514.74,,,,
CNTRST BTH-15MN COTA,97034,CPT,,,,,both,, ,514.74,308.84,Aetna,Commercial,,,,,514.74,,,,
CONTRAST BATH-15 MIN,97034,CPT,,,,,both,, ,443.25,265.95,Aetna,Commercial,,,,,443.25,,,,
CONTRAST BATH-15 MIN,97034,CPT,,,,,both,, ,480.51,288.3,Aetna,Commercial,,,,,480.51,,,,
ULTRASND-15 MIN COTA,97035,CPT,,,,,both,, ,36.57,21.94,Aetna,Commercial,,,,,36.57,,,,
ULTRASND-15 MIN COTA,97035,CPT,,,,,both,, ,36.57,21.94,Aetna,Commercial,,,,,36.57,,,,
ULTRASND-15 MIN COTA,97035,CPT,,,,,both,, ,36.57,21.94,Aetna,Commercial,,,,,36.57,,,,
ULTRASND-15 MIN COTA,97035,CPT,,,,,both,, ,36.57,21.94,Aetna,Commercial,,,,,36.57,,,,
ULTRASND-15 MIN COTA,97035,CPT,,,,,both,, ,611.56,366.93,Aetna,Commercial,,,,,611.56,,,,
ULTRASND-15 MIN COTA,97035,CPT,,,,,both,, ,611.56,366.93,Aetna,Commercial,,,,,611.56,,,,
ULTRASND-15 MIN PTA,97035,CPT,,,,,both,, ,564.18,338.5,Aetna,Commercial,,,,,564.18,,,,
ULTRASND-15 MIN PTA,97035,CPT,,,,,both,, ,564.18,338.5,Aetna,Commercial,,,,,564.18,,,,
ULTRASOUND-15 MIN,97035,CPT,,,,,both,, ,526.62,315.97,Aetna,Commercial,,,,,526.62,,,,
ULTRASOUND-15 MIN,97035,CPT,,,,,both,, ,570.95,342.57,Aetna,Commercial,,,,,570.95,,,,
"Physical therapy, therapeutic exercise .",97110,CPT,,,,,both,,,342.72,342.72,Aetna,Commercial,,241.96,70.6,,342.72,342.72,342.72,Fee Schedule,70.6
THER EXRCS-15MIN PTA,97110,CPT,,,,,both,, ,367.2,220.32,Aetna,Commercial,,,,,367.2,,,,
THER EXRCS-15MIN PTA,97110,CPT,,,,,both,, ,367.2,220.32,Aetna,Commercial,,,,,367.2,,,,
THER EXRCS-15MN COTA,97110,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,,,,81.37,,,,
THER EXRCS-15MN COTA,97110,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,,,,81.37,,,,
THER EXRCS-15MN COTA,97110,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,,,,81.37,,,,
THER EXRCS-15MN COTA,97110,CPT,,,,,both,, ,81.37,48.82,Aetna,Commercial,,,,,81.37,,,,
THER EXRCS-15MN COTA,97110,CPT,,,,,both,, ,398.1,238.86,Aetna,Commercial,,,,,398.1,,,,
THER EXRCS-15MN COTA,97110,CPT,,,,,both,, ,398.1,238.86,Aetna,Commercial,,,,,398.1,,,,
THERAP EXERCS-15 MIN,97110,CPT,,,,,both,, ,342.72,205.63,Aetna,Commercial,,,,,342.72,,,,
THERAP EXERCS-15 MIN,97110,CPT,,,,,both,, ,371.55,222.93,Aetna,Commercial,,,,,371.55,,,,
NEUR RE-ED-15MIN PTA,97112,CPT,,,,,both,, ,367.2,220.32,Aetna,Commercial,,,,,367.2,,,,
NEUR RE-ED-15MIN PTA,97112,CPT,,,,,both,, ,367.2,220.32,Aetna,Commercial,,,,,367.2,,,,
NEUR RE-ED-15MN COTA,97112,CPT,,,,,both,, ,92.19,55.31,Aetna,Commercial,,,,,92.19,,,,
NEUR RE-ED-15MN COTA,97112,CPT,,,,,both,, ,92.19,55.31,Aetna,Commercial,,,,,92.19,,,,
NEUR RE-ED-15MN COTA,97112,CPT,,,,,both,, ,92.19,55.31,Aetna,Commercial,,,,,92.19,,,,
NEUR RE-ED-15MN COTA,97112,CPT,,,,,both,, ,92.19,55.31,Aetna,Commercial,,,,,92.19,,,,
NEUR RE-ED-15MN COTA,97112,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,,,,486.42,,,,
NEUR RE-ED-15MN COTA,97112,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,,,,486.42,,,,
NEURO RE-ED-15 MIN,97112,CPT,,,,,both,, ,342.72,205.63,Aetna,Commercial,,,,,342.72,,,,
NEURO RE-ED-15 MIN,97112,CPT,,,,,both,, ,454.13,272.47,Aetna,Commercial,,,,,454.13,,,,
GAIT TRAINING-15 MIN,97116,CPT,,,,,both,, ,342.72,205.63,Aetna,Commercial,,,,,342.72,,,,
GAIT TRAINING-15 MIN,97116,CPT,,,,,both,, ,454.13,272.47,Aetna,Commercial,,,,,454.13,,,,
GAIT TRNG-15MIN COTA,97116,CPT,,,,,both,, ,80.34,48.2,Aetna,Commercial,,,,,80.34,,,,
GAIT TRNG-15MIN COTA,97116,CPT,,,,,both,, ,80.34,48.2,Aetna,Commercial,,,,,80.34,,,,
GAIT TRNG-15MIN COTA,97116,CPT,,,,,both,, ,80.34,48.2,Aetna,Commercial,,,,,80.34,,,,
GAIT TRNG-15MIN COTA,97116,CPT,,,,,both,, ,80.34,48.2,Aetna,Commercial,,,,,80.34,,,,
GAIT TRNG-15MIN COTA,97116,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,,,,486.42,,,,
GAIT TRNG-15MIN COTA,97116,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,,,,486.42,,,,
GAIT TRNNG-15MIN PTA,97116,CPT,,,,,both,, ,367.2,220.32,Aetna,Commercial,,,,,367.2,,,,
GAIT TRNNG-15MIN PTA,97116,CPT,,,,,both,, ,367.2,220.32,Aetna,Commercial,,,,,367.2,,,,
MASSAGE THRPY-15 MIN,97124,CPT,,,,,both,, ,294.09,176.45,Aetna,Commercial,,,,,294.09,,,,
MASSAGE THRPY-15 MIN,97124,CPT,,,,,both,, ,318.84,191.3,Aetna,Commercial,,,,,318.84,,,,
MASSG THRP-15MN COTA,97124,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,,,,74.93,,,,
MASSG THRP-15MN COTA,97124,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,,,,74.93,,,,
MASSG THRP-15MN COTA,97124,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,,,,74.93,,,,
MASSG THRP-15MN COTA,97124,CPT,,,,,both,, ,74.93,44.95,Aetna,Commercial,,,,,74.93,,,,
MASSG THRP-15MN COTA,97124,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
MASSG THRP-15MN COTA,97124,CPT,,,,,both,, ,341.45,204.87,Aetna,Commercial,,,,,341.45,,,,
MASSG THRPY-15MN PTA,97124,CPT,,,,,both,, ,314.92,188.95,Aetna,Commercial,,,,,314.92,,,,
MASSG THRPY-15MN PTA,97124,CPT,,,,,both,, ,314.92,188.95,Aetna,Commercial,,,,,314.92,,,,
COG SKL DV IN15 COTA,97129,CPT,,,,,both,, ,84.46,50.67,Aetna,Commercial,,,,,84.46,,,,
COG SKL DV IN15 COTA,97129,CPT,,,,,both,, ,84.46,50.67,Aetna,Commercial,,,,,84.46,,,,
COG SKL DV IN15 COTA,97129,CPT,,,,,both,, ,84.46,50.67,Aetna,Commercial,,,,,84.46,,,,
COG SKL DV IN15 COTA,97129,CPT,,,,,both,, ,84.46,50.67,Aetna,Commercial,,,,,84.46,,,,
COG SKL DV IN15 COTA,97129,CPT,,,,,both,, ,398.1,238.86,Aetna,Commercial,,,,,398.1,,,,
COG SKL DV INI15 OT,97129,CPT,,,,,both,, ,398.1,238.86,Aetna,Commercial,,,,,398.1,,,,
COG SKL DV INI15 PTA,97129,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,,,,448.57,,,,
COG SKL DV INI15 PTA,97129,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,,,,448.57,,,,
COG SKL DV INI15 SP,97129,CPT,,,,,both,, ,398.1,238.86,Aetna,Commercial,,,,,398.1,,,,
COG SKL DV AD15 COTA,97130,CPT,,,,,both,, ,84.46,50.67,Aetna,Commercial,,,,,84.46,,,,
COG SKL DV AD15 COTA,97130,CPT,,,,,both,, ,84.46,50.67,Aetna,Commercial,,,,,84.46,,,,
COG SKL DV AD15 COTA,97130,CPT,,,,,both,, ,84.46,50.67,Aetna,Commercial,,,,,84.46,,,,
COG SKL DV AD15 COTA,97130,CPT,,,,,both,, ,84.46,50.67,Aetna,Commercial,,,,,84.46,,,,
COG SKL DV AD15 COTA,97130,CPT,,,,,both,, ,398.1,238.86,Aetna,Commercial,,,,,398.1,,,,
COG SKL DV ADD15 OT,97130,CPT,,,,,both,, ,398.1,238.86,Aetna,Commercial,,,,,398.1,,,,
COG SKL DV ADD15 PTA,97130,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,,,,448.57,,,,
COG SKL DV ADD15 PTA,97130,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,,,,448.57,,,,
COG SKL DV ADD15 SP,97130,CPT,,,,,both,, ,398.1,238.86,Aetna,Commercial,,,,,398.1,,,,
MANUAL THRPY-15 MIN,97140,CPT,,,,,both,, ,342.72,205.63,Aetna,Commercial,,,,,342.72,,,,
MANUAL THRPY-15 MIN,97140,CPT,,,,,both,, ,454.13,272.47,Aetna,Commercial,,,,,454.13,,,,
MNL THRPY-15 MIN PTA,97140,CPT,,,,,both,, ,367.2,220.32,Aetna,Commercial,,,,,367.2,,,,
MNL THRPY-15 MIN PTA,97140,CPT,,,,,both,, ,367.2,220.32,Aetna,Commercial,,,,,367.2,,,,
MNL THRPY-15MIN COTA,97140,CPT,,,,,both,, ,73.65,44.19,Aetna,Commercial,,,,,73.65,,,,
MNL THRPY-15MIN COTA,97140,CPT,,,,,both,, ,73.65,44.19,Aetna,Commercial,,,,,73.65,,,,
MNL THRPY-15MIN COTA,97140,CPT,,,,,both,, ,73.65,44.19,Aetna,Commercial,,,,,73.65,,,,
MNL THRPY-15MIN COTA,97140,CPT,,,,,both,, ,73.65,44.19,Aetna,Commercial,,,,,73.65,,,,
MNL THRPY-15MIN COTA,97140,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,,,,486.42,,,,
MNL THRPY-15MIN COTA,97140,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,,,,486.42,,,,
GROUP THRP PROC-VIST,97150,CPT,,,,,both,, ,341.23,204.73,Aetna,Commercial,,,,,341.23,,,,
GROUP THRP PROC-VIST,97150,CPT,,,,,both,, ,369.92,221.95,Aetna,Commercial,,,,,369.92,,,,
GRP THR PRC-VST COTA,97150,CPT,,,,,both,, ,48.67,29.2,Aetna,Commercial,,,,,48.67,,,,
GRP THR PRC-VST COTA,97150,CPT,,,,,both,, ,48.67,29.2,Aetna,Commercial,,,,,48.67,,,,
GRP THR PRC-VST COTA,97150,CPT,,,,,both,, ,48.67,29.2,Aetna,Commercial,,,,,48.67,,,,
GRP THR PRC-VST COTA,97150,CPT,,,,,both,, ,48.67,29.2,Aetna,Commercial,,,,,48.67,,,,
GRP THR PRC-VST COTA,97150,CPT,,,,,both,, ,396.29,237.77,Aetna,Commercial,,,,,396.29,,,,
GRP THR PRC-VST COTA,97150,CPT,,,,,both,, ,396.29,237.77,Aetna,Commercial,,,,,396.29,,,,
GRP THRP PRC-VST PTA,97150,CPT,,,,,both,, ,365.65,219.39,Aetna,Commercial,,,,,365.65,,,,
GRP THRP PRC-VST PTA,97150,CPT,,,,,both,, ,365.65,219.39,Aetna,Commercial,,,,,365.65,,,,
PT EVAL- LOW CMP PTA,97161,CPT,,,,,both,, ,223.77,134.26,Aetna,Commercial,,,,,223.77,,,,
PT EVAL- LOW CMP PTA,97161,CPT,,,,,both,, ,223.77,134.26,Aetna,Commercial,,,,,223.77,,,,
PT EVAL- LOW CMP PTA,97161,CPT,,,,,both,, ,721,432.6,Aetna,Commercial,,,,,721,,,,
PT EVAL- LOW CMP PTA,97161,CPT,,,,,both,, ,721,432.6,Aetna,Commercial,,,,,721,,,,
PT EVAL- LOW COMP,97161,CPT,,,,,both,, ,673.18,403.9,Aetna,Commercial,,,,,673.18,,,,
PT-EVAL LOW 15M MCD,97161,CPT,,,,,both,, ,700,420,Aetna,Commercial,,,,,700,,,,
PT EVAL- MOD CMP PTA,97162,CPT,,,,,both,, ,223.77,134.26,Aetna,Commercial,,,,,223.77,,,,
PT EVAL- MOD CMP PTA,97162,CPT,,,,,both,, ,223.77,134.26,Aetna,Commercial,,,,,223.77,,,,
PT EVAL- MOD CMP PTA,97162,CPT,,,,,both,, ,360.5,216.3,Aetna,Commercial,,,,,360.5,,,,
PT EVAL- MOD CMP PTA,97162,CPT,,,,,both,, ,360.5,216.3,Aetna,Commercial,,,,,360.5,,,,
PT EVAL- MOD COMP,97162,CPT,,,,,both,, ,673.18,403.9,Aetna,Commercial,,,,,673.18,,,,
PT-EVAL MOD 15M MCD,97162,CPT,,,,,both,, ,350,210,Aetna,Commercial,,,,,350,,,,
PT EVAL- HGH CMP PTA,97163,CPT,,,,,both,, ,224.03,134.41,Aetna,Commercial,,,,,224.03,,,,
PT EVAL- HGH CMP PTA,97163,CPT,,,,,both,, ,224.03,134.41,Aetna,Commercial,,,,,224.03,,,,
PT EVAL- HGH CMP PTA,97163,CPT,,,,,both,, ,721,432.6,Aetna,Commercial,,,,,721,,,,
PT EVAL- HGH CMP PTA,97163,CPT,,,,,both,, ,721,432.6,Aetna,Commercial,,,,,721,,,,
PT EVAL- HGH COMP,97163,CPT,,,,,both,, ,673.18,403.9,Aetna,Commercial,,,,,673.18,,,,
PT-EVAL HGH 15M MCD,97163,CPT,,,,,both,, ,233.25,139.95,Aetna,Commercial,,,,,233.25,,,,
PT RE-EVAL-VISIT,97164,CPT,,,,,both,, ,437.36,262.41,Aetna,Commercial,,,,,437.36,,,,
PT RE-EVAL-VISIT PTA,97164,CPT,,,,,both,, ,151.41,90.84,Aetna,Commercial,,,,,151.41,,,,
PT RE-EVAL-VISIT PTA,97164,CPT,,,,,both,, ,151.41,90.84,Aetna,Commercial,,,,,151.41,,,,
PT RE-EVAL-VISIT PTA,97164,CPT,,,,,both,, ,468.39,281.03,Aetna,Commercial,,,,,468.39,,,,
PT RE-EVAL-VISIT PTA,97164,CPT,,,,,both,, ,468.39,281.03,Aetna,Commercial,,,,,468.39,,,,
OT EVAL- LOW CMP OT,97165,CPT,,,,,both,, ,223.77,134.26,Aetna,Commercial,,,,,223.77,,,,
OT EVAL- LOW COMP,97165,CPT,,,,,both,, ,729.8,437.88,Aetna,Commercial,,,,,729.8,,,,
OT EVAL-LOW CMP COTA,97165,CPT,,,,,both,, ,781.77,469.06,Aetna,Commercial,,,,,781.77,,,,
OT EVAL-LOW CMP COTA,97165,CPT,,,,,both,, ,781.77,469.06,Aetna,Commercial,,,,,781.77,,,,
OT-EVAL LOW 15M MCD,97165,CPT,,,,,both,, ,100,60,Aetna,Commercial,,,,,100,,,,
OT-EVAL LOW 15M MCD,97165,CPT,,,,,both,, ,759,455.4,Aetna,Commercial,,,,,759,,,,
OT EVAL- MOD CMP OT,97166,CPT,,,,,both,, ,223.77,134.26,Aetna,Commercial,,,,,223.77,,,,
OT EVAL- MOD COMP,97166,CPT,,,,,both,, ,729.8,437.88,Aetna,Commercial,,,,,729.8,,,,
OT EVAL-MOD CMP COTA,97166,CPT,,,,,both,, ,390.89,234.53,Aetna,Commercial,,,,,390.89,,,,
OT EVAL-MOD CMP COTA,97166,CPT,,,,,both,, ,390.89,234.53,Aetna,Commercial,,,,,390.89,,,,
OT-EVAL MOD 15M MCD,97166,CPT,,,,,both,, ,100,60,Aetna,Commercial,,,,,100,,,,
OT-EVAL MOD 15M MCD,97166,CPT,,,,,both,, ,379.5,227.7,Aetna,Commercial,,,,,379.5,,,,
OT EVAL- HGH CMP OT,97167,CPT,,,,,both,, ,223.77,134.26,Aetna,Commercial,,,,,223.77,,,,
OT EVAL- HGH COMP,97167,CPT,,,,,both,, ,729.8,437.88,Aetna,Commercial,,,,,729.8,,,,
OT EVAL-HGH CMP COTA,97167,CPT,,,,,both,, ,781.77,469.06,Aetna,Commercial,,,,,781.77,,,,
OT EVAL-HGH CMP COTA,97167,CPT,,,,,both,, ,781.77,469.06,Aetna,Commercial,,,,,781.77,,,,
OT-EVAL HGH 15M MCD,97167,CPT,,,,,both,, ,100,60,Aetna,Commercial,,,,,100,,,,
OT-EVAL HGH 15M MCD,97167,CPT,,,,,both,, ,253,151.8,Aetna,Commercial,,,,,253,,,,
OT RE-EVAL VIST COTA,97168,CPT,,,,,both,, ,151.41,90.84,Aetna,Commercial,,,,,151.41,,,,
OT RE-EVAL VIST COTA,97168,CPT,,,,,both,, ,151.41,90.84,Aetna,Commercial,,,,,151.41,,,,
OT RE-EVAL VIST COTA,97168,CPT,,,,,both,, ,507.79,304.67,Aetna,Commercial,,,,,507.79,,,,
OT RE-EVAL VIST COTA,97168,CPT,,,,,both,, ,507.79,304.67,Aetna,Commercial,,,,,507.79,,,,
OT RE-EVAL-VISIT,97168,CPT,,,,,both,, ,474.13,284.47,Aetna,Commercial,,,,,474.13,,,,
THER ACTV-15MIN COTA,97530,CPT,,,,,both,, ,104.29,62.57,Aetna,Commercial,,,,,104.29,,,,
THER ACTV-15MIN COTA,97530,CPT,,,,,both,, ,104.29,62.57,Aetna,Commercial,,,,,104.29,,,,
THER ACTV-15MIN COTA,97530,CPT,,,,,both,, ,104.29,62.57,Aetna,Commercial,,,,,104.29,,,,
THER ACTV-15MIN COTA,97530,CPT,,,,,both,, ,104.29,62.57,Aetna,Commercial,,,,,104.29,,,,
THER ACTV-15MIN COTA,97530,CPT,,,,,both,, ,398.1,238.86,Aetna,Commercial,,,,,398.1,,,,
THER ACTV-15MIN COTA,97530,CPT,,,,,both,, ,398.1,238.86,Aetna,Commercial,,,,,398.1,,,,
THER ACTVT-15MIN PTA,97530,CPT,,,,,both,, ,367.2,220.32,Aetna,Commercial,,,,,367.2,,,,
THER ACTVT-15MIN PTA,97530,CPT,,,,,both,, ,367.2,220.32,Aetna,Commercial,,,,,367.2,,,,
THERAP ACTVTS-15 MIN,97530,CPT,,,,,both,, ,342.72,205.63,Aetna,Commercial,,,,,342.72,,,,
THERAP ACTVTS-15 MIN,97530,CPT,,,,,both,, ,371.55,222.93,Aetna,Commercial,,,,,371.55,,,,
SENS INTG-15 MIN,97533,CPT,,,,,both,, ,167.89,100.73,Aetna,Commercial,,,,,167.89,,,,
SENS INTG-15MIN COTA,97533,CPT,,,,,both,, ,90.13,54.07,Aetna,Commercial,,,,,90.13,,,,
SENS INTG-15MIN COTA,97533,CPT,,,,,both,, ,90.13,54.07,Aetna,Commercial,,,,,90.13,,,,
SENS INTG-15MIN COTA,97533,CPT,,,,,both,, ,687.27,412.36,Aetna,Commercial,,,,,687.27,,,,
SENS INTG-15MIN COTA,97533,CPT,,,,,both,, ,687.27,412.36,Aetna,Commercial,,,,,687.27,,,,
SENSORY INTEG-15 MIN,97533,CPT,,,,,both,, ,641.59,384.95,Aetna,Commercial,,,,,641.59,,,,
SELF CARE MGT-15 MIN,97535,CPT,,,,,both,, ,342.72,205.63,Aetna,Commercial,,,,,342.72,,,,
SELF CARE MGT-15 MIN,97535,CPT,,,,,both,, ,371.55,222.93,Aetna,Commercial,,,,,371.55,,,,
SLF CR MGT-15MN COTA,97535,CPT,,,,,both,, ,90.13,54.07,Aetna,Commercial,,,,,90.13,,,,
SLF CR MGT-15MN COTA,97535,CPT,,,,,both,, ,90.13,54.07,Aetna,Commercial,,,,,90.13,,,,
SLF CR MGT-15MN COTA,97535,CPT,,,,,both,, ,90.13,54.07,Aetna,Commercial,,,,,90.13,,,,
SLF CR MGT-15MN COTA,97535,CPT,,,,,both,, ,90.13,54.07,Aetna,Commercial,,,,,90.13,,,,
SLF CR MGT-15MN COTA,97535,CPT,,,,,both,, ,398.1,238.86,Aetna,Commercial,,,,,398.1,,,,
SLF CR MGT-15MN COTA,97535,CPT,,,,,both,, ,398.1,238.86,Aetna,Commercial,,,,,398.1,,,,
SLF CRE MGT-15MN PTA,97535,CPT,,,,,both,, ,367.2,220.32,Aetna,Commercial,,,,,367.2,,,,
SLF CRE MGT-15MN PTA,97535,CPT,,,,,both,, ,367.2,220.32,Aetna,Commercial,,,,,367.2,,,,
CM-WK REIN-15MN COTA,97537,CPT,,,,,both,, ,86.78,52.06,Aetna,Commercial,,,,,86.78,,,,
CM-WK REIN-15MN COTA,97537,CPT,,,,,both,, ,86.78,52.06,Aetna,Commercial,,,,,86.78,,,,
CM-WK REIN-15MN COTA,97537,CPT,,,,,both,, ,86.78,52.06,Aetna,Commercial,,,,,86.78,,,,
CM-WK REIN-15MN COTA,97537,CPT,,,,,both,, ,86.78,52.06,Aetna,Commercial,,,,,86.78,,,,
CM-WK REIN-15MN COTA,97537,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,,,,486.42,,,,
CM-WK REIN-15MN COTA,97537,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,,,,486.42,,,,
COM-WK REIN-15MN PTA,97537,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,,,,448.57,,,,
COM-WK REIN-15MN PTA,97537,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,,,,448.57,,,,
COM-WRK REINT-15 MIN,97537,CPT,,,,,both,, ,418.86,251.31,Aetna,Commercial,,,,,418.86,,,,
COM-WRK REINT-15 MIN,97537,CPT,,,,,both,, ,454.13,272.47,Aetna,Commercial,,,,,454.13,,,,
WHEELCHR MGT-15 MIN,97542,CPT,,,,,both,, ,418.86,251.31,Aetna,Commercial,,,,,418.86,,,,
WHEELCHR MGT-15 MIN,97542,CPT,,,,,both,, ,454.13,272.47,Aetna,Commercial,,,,,454.13,,,,
WHLCHR MGT-15MIN PTA,97542,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,,,,448.57,,,,
WHLCHR MGT-15MIN PTA,97542,CPT,,,,,both,, ,448.57,269.14,Aetna,Commercial,,,,,448.57,,,,
WHLCHR MGT-15MN COTA,97542,CPT,,,,,both,, ,87.55,52.53,Aetna,Commercial,,,,,87.55,,,,
WHLCHR MGT-15MN COTA,97542,CPT,,,,,both,, ,87.55,52.53,Aetna,Commercial,,,,,87.55,,,,
WHLCHR MGT-15MN COTA,97542,CPT,,,,,both,, ,87.55,52.53,Aetna,Commercial,,,,,87.55,,,,
WHLCHR MGT-15MN COTA,97542,CPT,,,,,both,, ,87.55,52.53,Aetna,Commercial,,,,,87.55,,,,
WHLCHR MGT-15MN COTA,97542,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,,,,486.42,,,,
WHLCHR MGT-15MN COTA,97542,CPT,,,,,both,, ,486.42,291.85,Aetna,Commercial,,,,,486.42,,,,
WK HR-CD 1ST 2HR PTA,97545,CPT,,,,,both,, ,206,123.6,Aetna,Commercial,,,,,206,,,,
WK HR-CD 1ST 2HR PTA,97545,CPT,,,,,both,, ,206,123.6,Aetna,Commercial,,,,,206,,,,
WK HR-CD IN 2HR COTA,97545,CPT,,,,,both,, ,1121.67,673,Aetna,Commercial,,,,,1121.67,,,,
WK HR-CD IN 2HR COTA,97545,CPT,,,,,both,, ,1121.67,673,Aetna,Commercial,,,,,1121.67,,,,
WK HR-CD IN 2HR COTA,97545,CPT,,,,,both,, ,1121.67,673,Aetna,Commercial,,,,,1121.67,,,,
WK HR-CD IN 2HR COTA,97545,CPT,,,,,both,, ,1121.67,673,Aetna,Commercial,,,,,1121.67,,,,
WK HR-CD IN 2HR COTA,97545,CPT,,,,,both,, ,1215.92,729.55,Aetna,Commercial,,,,,1215.92,,,,
WK HR-CD IN 2HR COTA,97545,CPT,,,,,both,, ,1215.92,729.55,Aetna,Commercial,,,,,1215.92,,,,
WRK HAR-CND 1ST 2HRS,97545,CPT,,,,,both,, ,1047.07,628.24,Aetna,Commercial,,,,,1047.07,,,,
WRK HAR-CND 1ST 2HRS,97545,CPT,,,,,both,, ,1135.14,681.08,Aetna,Commercial,,,,,1135.14,,,,
WK HAR-CND-ADHR COTA,97546,CPT,,,,,both,, ,103,61.8,Aetna,Commercial,,,,,103,,,,
WK HAR-CND-ADHR COTA,97546,CPT,,,,,both,, ,103,61.8,Aetna,Commercial,,,,,103,,,,
WK HAR-CND-ADHR COTA,97546,CPT,,,,,both,, ,103,61.8,Aetna,Commercial,,,,,103,,,,
WK HAR-CND-ADHR COTA,97546,CPT,,,,,both,, ,103,61.8,Aetna,Commercial,,,,,103,,,,
WK HAR-CND-ADHR COTA,97546,CPT,,,,,both,, ,607.96,364.77,Aetna,Commercial,,,,,607.96,,,,
WK HAR-CND-ADHR COTA,97546,CPT,,,,,both,, ,607.96,364.77,Aetna,Commercial,,,,,607.96,,,,
WRK HAR-CND-ADD HR,97546,CPT,,,,,both,, ,460.55,276.33,Aetna,Commercial,,,,,460.55,,,,
WRK HAR-CND-ADD HR,97546,CPT,,,,,both,, ,567.57,340.54,Aetna,Commercial,,,,,567.57,,,,
WRK HAR-CND-ADHR PTA,97546,CPT,,,,,both,, ,493.37,296.02,Aetna,Commercial,,,,,493.37,,,,
WRK HAR-CND-ADHR PTA,97546,CPT,,,,,both,, ,493.37,296.02,Aetna,Commercial,,,,,493.37,,,,
DEBRD LE 20SQCM COTA,97597,CPT,,,,,both,, ,447.54,268.52,Aetna,Commercial,,,,,447.54,,,,
DEBRD LE 20SQCM COTA,97597,CPT,,,,,both,, ,447.54,268.52,Aetna,Commercial,,,,,447.54,,,,
DEBRD LE 20SQCM COTA,97597,CPT,,,,,both,, ,447.54,268.52,Aetna,Commercial,,,,,447.54,,,,
DEBRD LE 20SQCM COTA,97597,CPT,,,,,both,, ,447.54,268.52,Aetna,Commercial,,,,,447.54,,,,
DEBRD LE 20SQCM COTA,97597,CPT,,,,,both,, ,731.82,439.09,Aetna,Commercial,,,,,731.82,,,,
DEBRD LE 20SQCM COTA,97597,CPT,,,,,both,, ,731.82,439.09,Aetna,Commercial,,,,,731.82,,,,
DEBRDE LE 20SQCM PTA,97597,CPT,,,,,both,, ,675.17,405.1,Aetna,Commercial,,,,,675.17,,,,
DEBRDE LE 20SQCM PTA,97597,CPT,,,,,both,, ,675.17,405.1,Aetna,Commercial,,,,,675.17,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,252.25,151.35,Aetna,Commercial,,,,,252.25,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,252.25,151.35,Aetna,Commercial,,,,,252.25,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,259.82,155.89,Aetna,Commercial,,,,,259.82,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,259.82,155.89,Aetna,Commercial,,,,,259.82,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,630.26,378.15,Aetna,Commercial,,,,,630.26,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,683.29,409.97,Aetna,Commercial,,,,,683.29,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,861.67,517,Aetna,Commercial,,,,,861.67,,,,
SLCTV WND DEB =<20CM,97597,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
DEBRD EA AD20CM COTA,97598,CPT,,,,,both,, ,450.63,270.37,Aetna,Commercial,,,,,450.63,,,,
DEBRD EA AD20CM COTA,97598,CPT,,,,,both,, ,450.63,270.37,Aetna,Commercial,,,,,450.63,,,,
DEBRD EA AD20CM COTA,97598,CPT,,,,,both,, ,488.48,293.08,Aetna,Commercial,,,,,488.48,,,,
DEBRD EA AD20CM COTA,97598,CPT,,,,,both,, ,488.48,293.08,Aetna,Commercial,,,,,488.48,,,,
DEBRDE EA AD20CM PTA,97598,CPT,,,,,both,, ,450.63,270.37,Aetna,Commercial,,,,,450.63,,,,
DEBRDE EA AD20CM PTA,97598,CPT,,,,,both,, ,450.63,270.37,Aetna,Commercial,,,,,450.63,,,,
DEBRDE EA AD20CM PTA,97598,CPT,,,,,both,, ,450.63,270.37,Aetna,Commercial,,,,,450.63,,,,
DEBRDE EA AD20CM PTA,97598,CPT,,,,,both,, ,450.63,270.37,Aetna,Commercial,,,,,450.63,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,252.25,151.35,Aetna,Commercial,,,,,252.25,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,252.25,151.35,Aetna,Commercial,,,,,252.25,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,259.82,155.89,Aetna,Commercial,,,,,259.82,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,259.82,155.89,Aetna,Commercial,,,,,259.82,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,420.57,252.34,Aetna,Commercial,,,,,420.57,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,455.94,273.56,Aetna,Commercial,,,,,455.94,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,575.1,345.06,Aetna,Commercial,,,,,575.1,,,,
SLCTV WND DEB >20 CM,97598,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
DBRD NONSEL-VIS COTA,97602,CPT,,,,,both,, ,447.54,268.52,Aetna,Commercial,,,,,447.54,,,,
DBRD NONSEL-VIS COTA,97602,CPT,,,,,both,, ,447.54,268.52,Aetna,Commercial,,,,,447.54,,,,
DBRD NONSEL-VIS COTA,97602,CPT,,,,,both,, ,447.54,268.52,Aetna,Commercial,,,,,447.54,,,,
DBRD NONSEL-VIS COTA,97602,CPT,,,,,both,, ,447.54,268.52,Aetna,Commercial,,,,,447.54,,,,
DBRD NONSEL-VIS COTA,97602,CPT,,,,,both,, ,521.7,313.02,Aetna,Commercial,,,,,521.7,,,,
DBRD NONSEL-VIS COTA,97602,CPT,,,,,both,, ,521.7,313.02,Aetna,Commercial,,,,,521.7,,,,
DBRD NON-SEL-VIS PTA,97602,CPT,,,,,both,, ,481.27,288.76,Aetna,Commercial,,,,,481.27,,,,
DBRD NON-SEL-VIS PTA,97602,CPT,,,,,both,, ,481.27,288.76,Aetna,Commercial,,,,,481.27,,,,
DEBRIDE NON-SELC-VIS,97602,CPT,,,,,both,, ,449.32,269.59,Aetna,Commercial,,,,,449.32,,,,
DEBRIDE NON-SELC-VIS,97602,CPT,,,,,both,, ,487.13,292.27,Aetna,Commercial,,,,,487.13,,,,
NON SELECTIVE DEBRID,97602,CPT,,,,,both,, ,158.11,94.86,Aetna,Commercial,,,,,158.11,,,,
NON SELECTIVE DEBRID,97602,CPT,,,,,both,, ,158.11,94.86,Aetna,Commercial,,,,,158.11,,,,
NSW DEB WO A/SESSION,97602,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,146.78,88.06,Aetna,Commercial,,,,,146.78,,,,
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,158.11,94.86,Aetna,Commercial,,,,,158.11,,,,
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,158.11,94.86,Aetna,Commercial,,,,,158.11,,,,
NEG PRESS WND TX <50,97605,CPT,,,,,both,, ,763,457.8,Aetna,Commercial,,,,,763,,,,
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,241.28,144.76,Aetna,Commercial,,,,,241.28,,,,
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,259.82,155.89,Aetna,Commercial,,,,,259.82,,,,
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,259.82,155.89,Aetna,Commercial,,,,,259.82,,,,
NEG PRESS WND TX >50,97606,CPT,,,,,both,, ,1520,912,Aetna,Commercial,,,,,1520,,,,
NEG PR WN MD LT 50CM,97607,CPT,,,,,both,, ,463.24,277.94,Aetna,Commercial,,,,,463.24,,,,
NEG PR WN MD LT 50CM,97607,CPT,,,,,both,, ,463.24,277.94,Aetna,Commercial,,,,,463.24,,,,
NEG PRES WND TX <=50,97607,CPT,,,,,both,, ,1520,912,Aetna,Commercial,,,,,1520,,,,
NEG PR WN MD GT 50CM,97608,CPT,,,,,both,, ,919.79,551.87,Aetna,Commercial,,,,,919.79,,,,
PHYS PERF-15 MIN PTA,97750,CPT,,,,,both,, ,936.01,561.6,Aetna,Commercial,,,,,936.01,,,,
PHYS PERF-15 MIN PTA,97750,CPT,,,,,both,, ,936.01,561.6,Aetna,Commercial,,,,,936.01,,,,
PHYS PERF-15MIN COTA,97750,CPT,,,,,both,, ,91.93,55.15,Aetna,Commercial,,,,,91.93,,,,
PHYS PERF-15MIN COTA,97750,CPT,,,,,both,, ,91.93,55.15,Aetna,Commercial,,,,,91.93,,,,
PHYS PERF-15MIN COTA,97750,CPT,,,,,both,, ,91.93,55.15,Aetna,Commercial,,,,,91.93,,,,
PHYS PERF-15MIN COTA,97750,CPT,,,,,both,, ,91.93,55.15,Aetna,Commercial,,,,,91.93,,,,
PHYS PERF-15MIN COTA,97750,CPT,,,,,both,, ,1014.55,608.73,Aetna,Commercial,,,,,1014.55,,,,
PHYS PERF-15MIN COTA,97750,CPT,,,,,both,, ,1014.55,608.73,Aetna,Commercial,,,,,1014.55,,,,
PHYSICAL PERF-15 MIN,97750,CPT,,,,,both,, ,873.68,524.2,Aetna,Commercial,,,,,873.68,,,,
PHYSICAL PERF-15 MIN,97750,CPT,,,,,both,, ,947.11,568.26,Aetna,Commercial,,,,,947.11,,,,
ORTH TRAIN INI-15 MI,97760,CPT,,,,,both,, ,342.72,205.63,Aetna,Commercial,,,,,342.72,,,,
ORTH TRAIN INI-15 MI,97760,CPT,,,,,both,, ,371.55,222.93,Aetna,Commercial,,,,,371.55,,,,
ORTH TRN IN15MI COTA,97760,CPT,,,,,both,, ,124.12,74.47,Aetna,Commercial,,,,,124.12,,,,
ORTH TRN IN15MI COTA,97760,CPT,,,,,both,, ,124.12,74.47,Aetna,Commercial,,,,,124.12,,,,
ORTH TRN IN15MI COTA,97760,CPT,,,,,both,, ,124.12,74.47,Aetna,Commercial,,,,,124.12,,,,
ORTH TRN IN15MI COTA,97760,CPT,,,,,both,, ,124.12,74.47,Aetna,Commercial,,,,,124.12,,,,
ORTH TRN IN15MI COTA,97760,CPT,,,,,both,, ,398.1,238.86,Aetna,Commercial,,,,,398.1,,,,
ORTH TRN IN15MI COTA,97760,CPT,,,,,both,, ,398.1,238.86,Aetna,Commercial,,,,,398.1,,,,
ORTH TRN INI15MI PTA,97760,CPT,,,,,both,, ,367.2,220.32,Aetna,Commercial,,,,,367.2,,,,
ORTH TRN INI15MI PTA,97760,CPT,,,,,both,, ,367.2,220.32,Aetna,Commercial,,,,,367.2,,,,
PROS TRAIN INI-15 MI,97761,CPT,,,,,both,, ,342.72,205.63,Aetna,Commercial,,,,,342.72,,,,
PROS TRAIN INI-15 MI,97761,CPT,,,,,both,, ,371.55,222.93,Aetna,Commercial,,,,,371.55,,,,
PROS TRN IN15MI COTA,97761,CPT,,,,,both,, ,107.38,64.42,Aetna,Commercial,,,,,107.38,,,,
PROS TRN IN15MI COTA,97761,CPT,,,,,both,, ,107.38,64.42,Aetna,Commercial,,,,,107.38,,,,
PROS TRN IN15MI COTA,97761,CPT,,,,,both,, ,107.38,64.42,Aetna,Commercial,,,,,107.38,,,,
PROS TRN IN15MI COTA,97761,CPT,,,,,both,, ,107.38,64.42,Aetna,Commercial,,,,,107.38,,,,
PROS TRN IN15MI COTA,97761,CPT,,,,,both,, ,398.1,238.86,Aetna,Commercial,,,,,398.1,,,,
PROS TRN IN15MI COTA,97761,CPT,,,,,both,, ,398.1,238.86,Aetna,Commercial,,,,,398.1,,,,
PROS TRN INI15MI PTA,97761,CPT,,,,,both,, ,367.2,220.32,Aetna,Commercial,,,,,367.2,,,,
PROS TRN INI15MI PTA,97761,CPT,,,,,both,, ,367.2,220.32,Aetna,Commercial,,,,,367.2,,,,
PROS-ORTH SUB-15 MIN,97763,CPT,,,,,both,, ,318.29,190.97,Aetna,Commercial,,,,,318.29,,,,
PROS-ORTH SUB-15 MIN,97763,CPT,,,,,both,, ,358.85,215.31,Aetna,Commercial,,,,,358.85,,,,
PRS-ORT SUB15MN COTA,97763,CPT,,,,,both,, ,131.07,78.64,Aetna,Commercial,,,,,131.07,,,,
PRS-ORT SUB15MN COTA,97763,CPT,,,,,both,, ,131.07,78.64,Aetna,Commercial,,,,,131.07,,,,
PRS-ORT SUB15MN COTA,97763,CPT,,,,,both,, ,131.07,78.64,Aetna,Commercial,,,,,131.07,,,,
PRS-ORT SUB15MN COTA,97763,CPT,,,,,both,, ,131.07,78.64,Aetna,Commercial,,,,,131.07,,,,
PRS-ORT SUB15MN COTA,97763,CPT,,,,,both,, ,340.93,204.55,Aetna,Commercial,,,,,340.93,,,,
PRS-ORT SUB15MN COTA,97763,CPT,,,,,both,, ,340.93,204.55,Aetna,Commercial,,,,,340.93,,,,
PRS-ORT SUB-15MN PTA,97763,CPT,,,,,both,, ,384.45,230.67,Aetna,Commercial,,,,,384.45,,,,
PRS-ORT SUB-15MN PTA,97763,CPT,,,,,both,, ,384.45,230.67,Aetna,Commercial,,,,,384.45,,,,
MNT INITIAL EA 15 MN,97802,CPT,,,,,both,, ,194.41,116.64,Aetna,Commercial,,,,,194.41,,,,
MNT REASSES EA 15 MN,97803,CPT,,,,,both,, ,101.46,60.87,Aetna,Commercial,,,,,101.46,,,,
MNT GROUP EA 30 MIN,97804,CPT,,,,,both,, ,223.25,133.95,Aetna,Commercial,,,,,223.25,,,,
LAB COLLECTION,99000,CPT,,,,,both,, ,70,42,Aetna,Commercial,,,,,70,,,,
SPEC CHAIN CUSTODY,99001,CPT,,,,,both,, ,21.33,12.79,Aetna,Commercial,,,,,21.33,,,,
MSED SAMEGT5 1ST15,99152,CPT,,,,,both,, ,313.38,188.02,Aetna,Commercial,,,,,313.38,,,,
MODSED SAME ADD15MIN,99153,CPT,,,,,both,, ,417.92,250.75,Aetna,Commercial,,,,,417.92,,,,
HBO COMM PER SESSION,99183,CPT,,,,,both,, ,990.13,594.07,Aetna,Commercial,,,,,990.13,,,,
PHLEBOTOMY THERAPEUT,99195,CPT,,,,,both,, ,266.77,160.06,Aetna,Commercial,,,,,266.77,,,,
SUTURE REMOVAL/RECHE,99281,CPT,,,,,Outpatient,, ,1098.28,658.96,Aetna,Commercial,,,,,1098.28,,,,
SUTURE REMOVAL/RECHE,99281,CPT,,,,,Outpatient,, ,1098.28,658.96,Aetna,Commercial,,,,,1098.28,,,,
LIMITED ED VISIT,99282,CPT,,,,,Outpatient,, ,1925.14,1155.08,Aetna,Commercial,,,,,1925.14,,,,
INTERMEDIATE ED VIST,99283,CPT,,,,,Outpatient,, ,3494.12,2096.47,Aetna,Commercial,,,,,3494.12,,,,
EXTENDED ED VISIT,99284,CPT,,,,,Outpatient,, ,6509.13,3905.47,Aetna,Commercial,,,,,6509.13,,,,
COMPREHENSIVE ED VST,99285,CPT,,,,,Outpatient,, ,8592.58,5155.54,Aetna,Commercial,,,,,8592.58,,,,
CRITICAL CARE LT 74M,99291,CPT,,,,,both,, ,12285.42,7371.25,Aetna,Commercial,,,,,12285.42,,,,
CRIT CARE EA 30 MIN,99292,CPT,,,,,both,, ,4418.38,2651.02,Aetna,Commercial,,,,,4418.38,,,,
BEHAV CHG SMOKE U 10,99406,CPT,,,,,both,, ,127.46,76.47,Aetna,Commercial,,,,,127.46,,,,
BEHAV CHG SMOKE GR10,99407,CPT,,,,,both,, ,127.46,76.47,Aetna,Commercial,,,,,127.46,,,,
NEWBORN RESUCITATION,99465,CPT,,,,,both,, ,2447.28,1468.36,Aetna,Commercial,,,,,2447.28,,,,
RESPIRATORY PANEL PCR,0202U,HCPCS,,,,,both,, ,500,300,Aetna,Commercial,,,,,500,,,,
COV19 FLUAB CEPHEID,0240U,CPT,,,,,both,, ,568,340.8,Aetna,Commercial,,,,,568,,,,
COV19 FLUAB RSV CEPH,0241U,CPT,,,,,both,, ,570.52,342.31,Aetna,Commercial,,,,,570.52,,,,
MVP MULTIPLEX VAGINAL DNA PROBE,0352U,HCPCS,,,,,both,, ,570.52,342.31,Aetna,Commercial,,,,,570.52,,,,
INTRATUBAL OCCLU DEV,A4264,HCPCS,,,,,both,, ,8176.4,4905.84,Aetna,Commercial,,,,,8176.4,,,,
TISSUE MARKR IMPLT 1,A4648,HCPCS,,,,,both,, ,179.22,107.53,Aetna,Commercial,,,,,179.22,,,,
TISSUE MARKR IMPLT 2,A4648,HCPCS,,,,,both,, ,1195.32,717.19,Aetna,Commercial,,,,,1195.32,,,,
TISSUE MARKR IMPLT 3,A4648,HCPCS,,,,,both,, ,2390.63,1434.37,Aetna,Commercial,,,,,2390.63,,,,
COLLAGEN WITH SILVER (PUROCOL),A6022,HCPCS,,,,,both,, ,28.28,16.96,Aetna,Commercial,,,,,28.28,,,,
ENDOFORM ANTIMICROBIAL,A6022,HCPCS,,,,,both,, ,41.56,24.93,Aetna,Commercial,,,,,41.56,,,,
COLLAGEN (PUROCOL),A6023,HCPCS,,,,,both,, ,19.8,11.88,Aetna,Commercial,,,,,19.8,,,,
CONVAMAX PAD 4X4,A6196,HCPCS,,,,,both,, ,7.68,4.6,Aetna,Commercial,,,,,7.68,,,,
CONVAMAX PAD 4X8,A6197,HCPCS,,,,,both,, ,8.88,5.32,Aetna,Commercial,,,,,8.88,,,,
CONVAMAX PAD 6X8,A6197,HCPCS,,,,,both,, ,11.76,7.05,Aetna,Commercial,,,,,11.76,,,,
DRSG GRMCDL 45X2CM AQCL AG MIC,A6197,HCPCS,,,,,both,, ,36.48,21.88,Aetna,Commercial,,,,,36.48,,,,
DRSG GRMCDL 4X5IN AQCL AG,A6197,HCPCS,,,,,both,, ,31.04,18.62,Aetna,Commercial,,,,,31.04,,,,
DRSG WND 5X4IN SQ AQCL X HDRFB,A6198,HCPCS,,,,,both,, ,11.16,6.69,Aetna,Commercial,,,,,11.16,,,,
DRSG ALG 18X.75IN AQCL HDRFB,A6199,HCPCS,,,,,both,, ,14.12,8.47,Aetna,Commercial,,,,,14.12,,,,
HYDROFERA BLUE TRANSFER 5X4,A6210,HCPCS,,,,,both,, ,24.12,14.47,Aetna,Commercial,,,,,24.12,,,,
4X4 AQUACEL FOAM NO ADHESIVE,A6211,HCPCS,,,,,both,, ,7.48,4.48,Aetna,Commercial,,,,,7.48,,,,
"DRESSING,ALLEVYN,SACRUM,SMALL",A6212,HCPCS,,,,,both,, ,21.96,13.17,Aetna,Commercial,,,,,21.96,,,,
DRSG LG QUADRILOBE 6 1/16INX6,A6212,HCPCS,,,,,both,, ,11.48,6.88,Aetna,Commercial,,,,,11.48,,,,
"HEEL,LIFE,ALLEVYN",A6212,HCPCS,,,,,both,, ,29.16,17.49,Aetna,Commercial,,,,,29.16,,,,
DRSG MED QUADRILOBE 5 1/16INX5,A6213,HCPCS,,,,,both,, ,9.8,5.88,Aetna,Commercial,,,,,9.8,,,,
SACRAL AQUACEL FOAM WITH ADHESIVE,A6213,HCPCS,,,,,both,, ,17.32,10.39,Aetna,Commercial,,,,,17.32,,,,
4X4 AQUACEL FOAM WITH ADHESIVE,A6214,HCPCS,,,,,both,, ,8.12,4.87,Aetna,Commercial,,,,,8.12,,,,
DUODERM THIN 4X2,A6237,HCPCS,,,,,both,, ,4.8,2.88,Aetna,Commercial,,,,,4.8,,,,
DUODERM THIN 4X4,A6238,HCPCS,,,,,both,, ,4.12,2.47,Aetna,Commercial,,,,,4.12,,,,
TRIAD CREAM 2.5 OUNCES,A6240,HCPCS,,,,,both,, ,3.64,2.18,Aetna,Commercial,,,,,3.64,,,,
HYDROGEL,A6248,HCPCS,,,,,both,, ,16.76,10.05,Aetna,Commercial,,,,,16.76,,,,
NO-RINSE FOAM CLEANSER,A6250,HCPCS,,,,,both,, ,7.96,4.77,Aetna,Commercial,,,,,7.96,,,,
ABD PADS 5X9,A6252,HCPCS,,,,,both,, ,0.32,0.19,Aetna,Commercial,,,,,0.32,,,,
ABD PADS 8X10,A6253,HCPCS,,,,,both,, ,0.48,0.28,Aetna,Commercial,,,,,0.48,,,,
IODOFORM PACKING 1 INCH,A6266,HCPCS,,,,,both,, ,8.76,5.25,Aetna,Commercial,,,,,8.76,,,,
IODOFORM PACKING 1/2 INCH,A6266,HCPCS,,,,,both,, ,6.84,4.1,Aetna,Commercial,,,,,6.84,,,,
IODOFORM PACKING 1/4 INCH,A6266,HCPCS,,,,,both,, ,6.56,3.93,Aetna,Commercial,,,,,6.56,,,,
STERILE 2X2 GAUZE,A6402,HCPCS,,,,,both,, ,0.08,0.04,Aetna,Commercial,,,,,0.08,,,,
STERILE 4X4 GAUZE,A6402,HCPCS,,,,,both,, ,0.16,0.09,Aetna,Commercial,,,,,0.16,,,,
PLAIN PACKING 1 INCH,A6407,HCPCS,,,,,both,, ,6.88,4.12,Aetna,Commercial,,,,,6.88,,,,
PLAIN PACKING 1/2 INCH,A6407,HCPCS,,,,,both,, ,6.28,3.76,Aetna,Commercial,,,,,6.28,,,,
PLAIN PACKING 1/4 INCH,A6407,HCPCS,,,,,both,, ,6.4,3.84,Aetna,Commercial,,,,,6.4,,,,
ACE WRAP 4 INCH,A6449,HCPCS,,,,,both,, ,1.64,0.98,Aetna,Commercial,,,,,1.64,,,,
ACE WRAP 6 INCH,A6450,HCPCS,,,,,both,, ,2.4,1.44,Aetna,Commercial,,,,,2.4,,,,
ZINC PASTE TUBES,A6456,HCPCS,,,,,both,, ,8.44,5.06,Aetna,Commercial,,,,,8.44,,,,
PICO DRESSING KIT,A9272,HCPCS,,,,,both,, ,3547.64,2128.58,Aetna,Commercial,,,,,3547.64,,,,
TC-99M SESTA / DOSE,A9500,HCPCS,,,,,both,, ,551.05,330.63,Aetna,Commercial,,,,,551.05,,,,
TC-99M TETRO/UNITDOS,A9502,HCPCS,,,,,both,, ,347.11,208.26,Aetna,Commercial,,,,,347.11,,,,
TC99M MEDRO TO 30MCI,A9503,HCPCS,,,,,both,, ,69.78,41.86,Aetna,Commercial,,,,,69.78,,,,
"TL-201, PER MCI",A9505,HCPCS,,,,,both,, ,95.53,57.31,Aetna,Commercial,,,,,95.53,,,,
TC99M PERTECHNET/MCI,A9512,HCPCS,,,,,both,, ,81.89,49.13,Aetna,Commercial,,,,,81.89,,,,
"I123 CAP,DX /100UCI",A9516,HCPCS,,,,,both,, ,312.35,187.41,Aetna,Commercial,,,,,312.35,,,,
TC99 TILMAN DX .5MCI,A9520,HCPCS,,,,,both,, ,2305.66,1383.39,Aetna,Commercial,,,,,2305.66,,,,
TC99M EXAME / DOSE,A9521,HCPCS,,,,,both,, ,17205.64,10323.38,Aetna,Commercial,,,,,17205.64,,,,
TC99M MEBROF /15MCI,A9537,HCPCS,,,,,both,, ,170.47,102.28,Aetna,Commercial,,,,,170.47,,,,
TC99M PYROPHOS/25MCI,A9538,HCPCS,,,,,both,, ,235.61,141.36,Aetna,Commercial,,,,,235.61,,,,
TC99M PENTETAT/25MCI,A9539,HCPCS,,,,,both,, ,69.78,41.86,Aetna,Commercial,,,,,69.78,,,,
TC99M MAA/10MCI,A9540,HCPCS,,,,,both,, ,62.83,37.69,Aetna,Commercial,,,,,62.83,,,,
TC99M SULF COL/20MCI,A9541,HCPCS,,,,,both,, ,83.17,49.9,Aetna,Commercial,,,,,83.17,,,,
TC99M SULFCOL2/20MCI,A9541,HCPCS,,,,,both,, ,529.68,317.8,Aetna,Commercial,,,,,529.68,,,,
IN111 PENTETAT/.5MCI,A9548,HCPCS,,,,,both,, ,12525.06,7515.03,Aetna,Commercial,,,,,12525.06,,,,
GA67 GALLIUM/MCI,A9556,HCPCS,,,,,both,, ,102.23,61.33,Aetna,Commercial,,,,,102.23,,,,
XE133 XENON 10MCI,A9558,HCPCS,,,,,both,, ,264.2,158.52,Aetna,Commercial,,,,,264.2,,,,
TC99M LABL RBC/30MCI,A9560,HCPCS,,,,,both,, ,69.78,41.86,Aetna,Commercial,,,,,69.78,,,,
TC99M OXIDRONA/30MCI,A9561,HCPCS,,,,,both,, ,148.84,89.3,Aetna,Commercial,,,,,148.84,,,,
TC99M MERTIATI/15MCI,A9562,HCPCS,,,,,both,, ,938.33,562.99,Aetna,Commercial,,,,,938.33,,,,
TC99M AEROSOL 75 MCI,A9567,HCPCS,,,,,both,, ,69.78,41.86,Aetna,Commercial,,,,,69.78,,,,
IN-111 PENTETRE/6MCI,A9572,HCPCS,,,,,both,, ,14752.18,8851.3,Aetna,Commercial,,,,,14752.18,,,,
INJ GADO DIMEG ML 15,A9577,HCPCS,,,,,both,15,ML,13.75,8.25,Aetna,Commercial,,,,,13.75,,,,
INJ GADO DIMEG ML 20,A9577,HCPCS,,,,,both,20,ML,13.75,8.25,Aetna,Commercial,,,,,13.75,,,,
INJ MULTIHANCE /ML,A9577,HCPCS,,,,,both,, ,14.16,8.49,Aetna,Commercial,,,,,14.16,,,,
INJ MULTIHANCE/ ML,A9577,HCPCS,,,,,both,, ,13.75,8.25,Aetna,Commercial,,,,,13.75,,,,
INJ GAD-MR1 CONTR ML,A9579,HCPCS,,,,,both,, ,37.6,22.56,Aetna,Commercial,,,,,37.6,,,,
INJ GAD-MR2 CONTR ML,A9579,HCPCS,,,,,both,, ,47.9,28.74,Aetna,Commercial,,,,,47.9,,,,
INJ GAD-MR3 CONTR ML,A9579,HCPCS,,,,,both,, ,40.94,24.56,Aetna,Commercial,,,,,40.94,,,,
ANCHOR/SCRW LEVEL 1,C1713,HCPCS,,,,,both,, ,129.01,77.4,Aetna,Commercial,,,,,129.01,,,,
ANCHOR/SCRW LEVEL 10,C1713,HCPCS,,,,,both,, ,2873.7,1724.22,Aetna,Commercial,,,,,2873.7,,,,
ANCHOR/SCRW LEVEL 11,C1713,HCPCS,,,,,both,, ,4069.02,2441.41,Aetna,Commercial,,,,,4069.02,,,,
ANCHOR/SCRW LEVEL 12,C1713,HCPCS,,,,,both,, ,4786.15,2871.69,Aetna,Commercial,,,,,4786.15,,,,
ANCHOR/SCRW LEVEL 13,C1713,HCPCS,,,,,both,, ,6684.19,4010.51,Aetna,Commercial,,,,,6684.19,,,,
ANCHOR/SCRW LEVEL 14,C1713,HCPCS,,,,,both,, ,9567.67,5740.6,Aetna,Commercial,,,,,9567.67,,,,
ANCHOR/SCRW LEVEL 15,C1713,HCPCS,,,,,both,, ,14349.19,8609.51,Aetna,Commercial,,,,,14349.19,,,,
ANCHOR/SCRW LEVEL 16,C1713,HCPCS,,,,,both,, ,19130.71,11478.42,Aetna,Commercial,,,,,19130.71,,,,
ANCHOR/SCRW LEVEL 17,C1713,HCPCS,,,,,both,, ,23912.22,14347.33,Aetna,Commercial,,,,,23912.22,,,,
ANCHOR/SCRW LEVEL 18,C1713,HCPCS,,,,,both,, ,31084.37,18650.62,Aetna,Commercial,,,,,31084.37,,,,
ANCHOR/SCRW LEVEL 19,C1713,HCPCS,,,,,both,, ,38256.78,22954.06,Aetna,Commercial,,,,,38256.78,,,,
ANCHOR/SCRW LEVEL 2,C1713,HCPCS,,,,,both,, ,172.01,103.2,Aetna,Commercial,,,,,172.01,,,,
ANCHOR/SCRW LEVEL 20,C1713,HCPCS,,,,,both,, ,47814.92,28688.95,Aetna,Commercial,,,,,47814.92,,,,
ANCHOR/SCRW LEVEL 21,C1713,HCPCS,,,,,both,, ,57377.95,34426.77,Aetna,Commercial,,,,,57377.95,,,,
ANCHOR/SCRW LEVEL 3,C1713,HCPCS,,,,,both,, ,243.85,146.31,Aetna,Commercial,,,,,243.85,,,,
ANCHOR/SCRW LEVEL 4,C1713,HCPCS,,,,,both,, ,411.23,246.73,Aetna,Commercial,,,,,411.23,,,,
ANCHOR/SCRW LEVEL 5,C1713,HCPCS,,,,,both,, ,602.55,361.53,Aetna,Commercial,,,,,602.55,,,,
ANCHOR/SCRW LEVEL 6,C1713,HCPCS,,,,,both,, ,841.51,504.9,Aetna,Commercial,,,,,841.51,,,,
ANCHOR/SCRW LEVEL 7,C1713,HCPCS,,,,,both,, ,1200.21,720.12,Aetna,Commercial,,,,,1200.21,,,,
ANCHOR/SCRW LEVEL 8,C1713,HCPCS,,,,,both,, ,1678.39,1007.03,Aetna,Commercial,,,,,1678.39,,,,
ANCHOR/SCRW LEVEL 9,C1713,HCPCS,,,,,both,, ,2156.56,1293.93,Aetna,Commercial,,,,,2156.56,,,,
BONE CEMENT 1,C1713,HCPCS,,,,,both,, ,884.51,530.7,Aetna,Commercial,,,,,884.51,,,,
BONE CEMENT 2,C1713,HCPCS,,,,,both,, ,2467.37,1480.42,Aetna,Commercial,,,,,2467.37,,,,
CATH TRNS ARTHR DIR1,C1714,HCPCS,,,,,both,, ,5379.18,3227.5,Aetna,Commercial,,,,,5379.18,,,,
CATH TRNS ARTHR DIR2,C1714,HCPCS,,,,,both,, ,8391.41,5034.84,Aetna,Commercial,,,,,8391.41,,,,
AICD DUAL CHAMBER L1,C1721,HCPCS,,,,,both,, ,93836.86,56302.11,Aetna,Commercial,,,,,93836.86,,,,
AICD SINGLE CHAMBER1,C1722,HCPCS,,,,,both,, ,99999,59999.4,Aetna,Commercial,,,,,99999,,,,
CATH TRNS ARTHR ROT1,C1724,HCPCS,,,,,both,, ,5379.18,3227.5,Aetna,Commercial,,,,,5379.18,,,,
CATH TRNS ARTHR ROT2,C1724,HCPCS,,,,,both,, ,16735.18,10041.1,Aetna,Commercial,,,,,16735.18,,,,
CATH-ANGIO LEVEL 1,C1725,HCPCS,,,,,both,, ,855.42,513.25,Aetna,Commercial,,,,,855.42,,,,
CATH-ANGIO LEVEL 2,C1725,HCPCS,,,,,both,, ,1728.86,1037.31,Aetna,Commercial,,,,,1728.86,,,,
CATH-ANGIO LEVEL 3,C1725,HCPCS,,,,,both,, ,2726.15,1635.69,Aetna,Commercial,,,,,2726.15,,,,
CATH-ANGIO LEVEL 4,C1725,HCPCS,,,,,both,, ,4234.59,2540.75,Aetna,Commercial,,,,,4234.59,,,,
CATH-ANGIO LEVEL 5,C1725,HCPCS,,,,,both,, ,6331.93,3799.15,Aetna,Commercial,,,,,6331.93,,,,
CATH BAL DIL NONVAS1,C1726,HCPCS,,,,,both,, ,1434.53,860.71,Aetna,Commercial,,,,,1434.53,,,,
CATH BAL DIL NONVAS2,C1726,HCPCS,,,,,both,, ,2390.63,1434.37,Aetna,Commercial,,,,,2390.63,,,,
CATH BRACHY SEED AD1,C1728,HCPCS,,,,,both,, ,717.14,430.28,Aetna,Commercial,,,,,717.14,,,,
CATH BRACHY SEED AD2,C1728,HCPCS,,,,,both,, ,956.36,573.81,Aetna,Commercial,,,,,956.36,,,,
CATH DRAINAG LEVEL11,C1729,HCPCS,,,,,both,, ,11958.56,7175.13,Aetna,Commercial,,,,,11958.56,,,,
CATH-DRAINAG LEVEL 1,C1729,HCPCS,,,,,both,, ,84.2,50.52,Aetna,Commercial,,,,,84.2,,,,
CATH-DRAINAG LEVEL 2,C1729,HCPCS,,,,,both,, ,247.72,148.63,Aetna,Commercial,,,,,247.72,,,,
CATH-DRAINAG LEVEL 3,C1729,HCPCS,,,,,both,, ,727.18,436.3,Aetna,Commercial,,,,,727.18,,,,
CATH-DRAINAG LEVEL 4,C1729,HCPCS,,,,,both,, ,1200.21,720.12,Aetna,Commercial,,,,,1200.21,,,,
CATH-DRAINAG LEVEL 5,C1729,HCPCS,,,,,both,, ,1917.35,1150.41,Aetna,Commercial,,,,,1917.35,,,,
CATH-DRAINAG LEVEL 6,C1729,HCPCS,,,,,both,, ,2634.48,1580.68,Aetna,Commercial,,,,,2634.48,,,,
CATH-DRAINAG LEVEL 7,C1729,HCPCS,,,,,both,, ,3351.88,2011.12,Aetna,Commercial,,,,,3351.88,,,,
CATH-DRAINAG LEVEL 8,C1729,HCPCS,,,,,both,, ,4786.15,2871.69,Aetna,Commercial,,,,,4786.15,,,,
CATH-DRAINAG LEVEL 9,C1729,HCPCS,,,,,both,, ,7177.04,4306.22,Aetna,Commercial,,,,,7177.04,,,,
CATH-DRAINAG LEVEL10,C1729,HCPCS,,,,,both,, ,9567.67,5740.6,Aetna,Commercial,,,,,9567.67,,,,
CATH-DRAINAG LEVEL12,C1729,HCPCS,,,,,both,, ,14344.55,8606.73,Aetna,Commercial,,,,,14344.55,,,,
CATH EP 19 OR FEW 1,C1730,HCPCS,,,,,both,, ,554.66,332.79,Aetna,Commercial,,,,,554.66,,,,
CATH EP 19 OR FEW 2,C1730,HCPCS,,,,,both,, ,1807.39,1084.43,Aetna,Commercial,,,,,1807.39,,,,
CATH EP 20 OR MORE 1,C1731,HCPCS,,,,,both,, ,6185.15,3711.09,Aetna,Commercial,,,,,6185.15,,,,
CATH EP DIG/ABL 3D 1,C1732,HCPCS,,,,,both,, ,7172.15,4303.29,Aetna,Commercial,,,,,7172.15,,,,
CATH EP DIG/ABL 3D 2,C1732,HCPCS,,,,,both,, ,15395.93,9237.55,Aetna,Commercial,,,,,15395.93,,,,
CATH HEMODIAL LT 1,C1750,HCPCS,,,,,both,, ,1434.53,860.71,Aetna,Commercial,,,,,1434.53,,,,
CATH HEMODIAL LT 2,C1750,HCPCS,,,,,both,, ,1912.71,1147.62,Aetna,Commercial,,,,,1912.71,,,,
CATH-INFUS PERIF 1,C1751,HCPCS,,,,,both,, ,89.61,53.76,Aetna,Commercial,,,,,89.61,,,,
CATH-INFUS PERIF 10,C1751,HCPCS,,,,,both,, ,2395.52,1437.31,Aetna,Commercial,,,,,2395.52,,,,
CATH-INFUS PERIF 11,C1751,HCPCS,,,,,both,, ,3351.88,2011.12,Aetna,Commercial,,,,,3351.88,,,,
CATH-INFUS PERIF 12,C1751,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,,,,4781.52,,,,
CATH-INFUS PERIF 2,C1751,HCPCS,,,,,both,, ,124.37,74.62,Aetna,Commercial,,,,,124.37,,,,
CATH-INFUS PERIF 3,C1751,HCPCS,,,,,both,, ,243.85,146.31,Aetna,Commercial,,,,,243.85,,,,
CATH-INFUS PERIF 4,C1751,HCPCS,,,,,both,, ,722.03,433.21,Aetna,Commercial,,,,,722.03,,,,
CATH-INFUS PERIF 6,C1751,HCPCS,,,,,both,, ,960.99,576.59,Aetna,Commercial,,,,,960.99,,,,
CATH-INFUS PERIF 6,C1751,HCPCS,,,,,both,, ,960.99,576.59,Aetna,Commercial,,,,,960.99,,,,
CATH-INFUS PERIF 7,C1751,HCPCS,,,,,both,, ,1200.21,720.12,Aetna,Commercial,,,,,1200.21,,,,
CATH-INFUS PERIF 8,C1751,HCPCS,,,,,both,, ,1439.17,863.5,Aetna,Commercial,,,,,1439.17,,,,
CATH-INFUS PERIF 9,C1751,HCPCS,,,,,both,, ,1673.49,1004.09,Aetna,Commercial,,,,,1673.49,,,,
CATH HEMODIAL ST 1,C1752,HCPCS,,,,,both,, ,358.7,215.22,Aetna,Commercial,,,,,358.7,,,,
CATH HEMODIAL ST 2,C1752,HCPCS,,,,,both,, ,478.18,286.9,Aetna,Commercial,,,,,478.18,,,,
CATH INTRAVAS ULTRA1,C1753,HCPCS,,,,,both,, ,3586.2,2151.72,Aetna,Commercial,,,,,3586.2,,,,
CATH INTRAVAS ULTRA2,C1753,HCPCS,,,,,both,, ,14344.55,8606.73,Aetna,Commercial,,,,,14344.55,,,,
CATHETER INTRASPINAL,C1755,HCPCS,,,,,both,, ,5259.7,3155.82,Aetna,Commercial,,,,,5259.7,,,,
CATH THRMB/EMBOL 1,C1757,HCPCS,,,,,both,, ,238.96,143.37,Aetna,Commercial,,,,,238.96,,,,
CATH THRMB/EMBOL 2,C1757,HCPCS,,,,,both,, ,1792.97,1075.78,Aetna,Commercial,,,,,1792.97,,,,
CATH THRMB/EMBOL 3,C1757,HCPCS,,,,,both,, ,2395.52,1437.31,Aetna,Commercial,,,,,2395.52,,,,
CATH THRMB/EMBOL 4,C1757,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,,,,4781.52,,,,
CATH URETERAL 1,C1758,HCPCS,,,,,both,, ,478.18,286.9,Aetna,Commercial,,,,,478.18,,,,
CATH URETERAL 2,C1758,HCPCS,,,,,both,, ,717.14,430.28,Aetna,Commercial,,,,,717.14,,,,
CATH URETERAL 3,C1758,HCPCS,,,,,both,, ,956.36,573.81,Aetna,Commercial,,,,,956.36,,,,
CATH INTRA ECHOCARD1,C1759,HCPCS,,,,,both,, ,7172.15,4303.29,Aetna,Commercial,,,,,7172.15,,,,
CATH INTRA ECHOCARD2,C1759,HCPCS,,,,,both,, ,9563.04,5737.82,Aetna,Commercial,,,,,9563.04,,,,
CLOSURE DEVIC VASC 1,C1760,HCPCS,,,,,both,, ,1634.61,980.76,Aetna,Commercial,,,,,1634.61,,,,
CLOSURE DEVIC VASC 2,C1760,HCPCS,,,,,both,, ,2504.7,1502.82,Aetna,Commercial,,,,,2504.7,,,,
CONN TISSUE HUMAN 1,C1762,HCPCS,,,,,both,, ,1438.14,862.88,Aetna,Commercial,,,,,1438.14,,,,
CONN TISSUE HUMAN 10,C1762,HCPCS,,,,,both,, ,57377.95,34426.77,Aetna,Commercial,,,,,57377.95,,,,
CONN TISSUE HUMAN 2,C1762,HCPCS,,,,,both,, ,1917.35,1150.41,Aetna,Commercial,,,,,1917.35,,,,
CONN TISSUE HUMAN 3,C1762,HCPCS,,,,,both,, ,5742.51,3445.5,Aetna,Commercial,,,,,5742.51,,,,
CONN TISSUE HUMAN 4,C1762,HCPCS,,,,,both,, ,9567.67,5740.6,Aetna,Commercial,,,,,9567.67,,,,
CONN TISSUE HUMAN 5,C1762,HCPCS,,,,,both,, ,13393.09,8035.85,Aetna,Commercial,,,,,13393.09,,,,
CONN TISSUE HUMAN 6,C1762,HCPCS,,,,,both,, ,17218.25,10330.95,Aetna,Commercial,,,,,17218.25,,,,
CONN TISSUE HUMAN 7,C1762,HCPCS,,,,,both,, ,23907.59,14344.55,Aetna,Commercial,,,,,23907.59,,,,
CONN TISSUE HUMAN 8,C1762,HCPCS,,,,,both,, ,33475.26,20085.15,Aetna,Commercial,,,,,33475.26,,,,
CONN TISSUE HUMAN 9,C1762,HCPCS,,,,,both,, ,43033.4,25820.04,Aetna,Commercial,,,,,43033.4,,,,
TISSUE NON-HUMAN 1,C1763,HCPCS,,,,,both,, ,1796.58,1077.94,Aetna,Commercial,,,,,1796.58,,,,
TISSUE NON-HUMAN 10,C1763,HCPCS,,,,,both,, ,43033.4,25820.04,Aetna,Commercial,,,,,43033.4,,,,
TISSUE NON-HUMAN 11,C1763,HCPCS,,,,,both,, ,57377.95,34426.77,Aetna,Commercial,,,,,57377.95,,,,
TISSUE NON-HUMAN 2,C1763,HCPCS,,,,,both,, ,2395.52,1437.31,Aetna,Commercial,,,,,2395.52,,,,
TISSUE NON-HUMAN 3,C1763,HCPCS,,,,,both,, ,4786.15,2871.69,Aetna,Commercial,,,,,4786.15,,,,
TISSUE NON-HUMAN 4,C1763,HCPCS,,,,,both,, ,8611.57,5166.94,Aetna,Commercial,,,,,8611.57,,,,
TISSUE NON-HUMAN 5,C1763,HCPCS,,,,,both,, ,12436.74,7462.04,Aetna,Commercial,,,,,12436.74,,,,
TISSUE NON-HUMAN 6,C1763,HCPCS,,,,,both,, ,15305.54,9183.32,Aetna,Commercial,,,,,15305.54,,,,
TISSUE NON-HUMAN 7,C1763,HCPCS,,,,,both,, ,19130.71,11478.42,Aetna,Commercial,,,,,19130.71,,,,
TISSUE NON-HUMAN 8,C1763,HCPCS,,,,,both,, ,23912.22,14347.33,Aetna,Commercial,,,,,23912.22,,,,
TISSUE NON-HUMAN 9,C1763,HCPCS,,,,,both,, ,33475.26,20085.15,Aetna,Commercial,,,,,33475.26,,,,
EVENT RECRDR CARDIAC,C1764,HCPCS,,,,,both,, ,21590.35,12954.21,Aetna,Commercial,,,,,21590.35,,,,
ADHESION BARRIER1,C1765,HCPCS,,,,,both,, ,717.14,430.28,Aetna,Commercial,,,,,717.14,,,,
ADHESION BARRIER2,C1765,HCPCS,,,,,both,, ,956.36,573.81,Aetna,Commercial,,,,,956.36,,,,
ADHESION BARRIER3,C1765,HCPCS,,,,,both,, ,8466.86,5080.11,Aetna,Commercial,,,,,8466.86,,,,
ADHESION BARRIER4,C1765,HCPCS,,,,,both,, ,4456.3,2673.78,Aetna,Commercial,,,,,4456.3,,,,
GENRATR NEUROSTM 1,C1767,HCPCS,,,,,both,, ,35861.25,21516.75,Aetna,Commercial,,,,,35861.25,,,,
GENRATR NEUROSTM 2,C1767,HCPCS,,,,,both,, ,71722.51,43033.5,Aetna,Commercial,,,,,71722.51,,,,
GRAFT VASCULAR 1,C1768,HCPCS,,,,,both,, ,1796.58,1077.94,Aetna,Commercial,,,,,1796.58,,,,
GRAFT VASCULAR 2,C1768,HCPCS,,,,,both,, ,2395.52,1437.31,Aetna,Commercial,,,,,2395.52,,,,
GRAFT VASCULAR 3,C1768,HCPCS,,,,,both,, ,4786.15,2871.69,Aetna,Commercial,,,,,4786.15,,,,
GRAFT VASCULAR 4,C1768,HCPCS,,,,,both,, ,9567.67,5740.6,Aetna,Commercial,,,,,9567.67,,,,
GRAFT VASCULAR 5,C1768,HCPCS,,,,,both,, ,14349.19,8609.51,Aetna,Commercial,,,,,14349.19,,,,
GRAFT VASCULAR 6,C1768,HCPCS,,,,,both,, ,19130.71,11478.42,Aetna,Commercial,,,,,19130.71,,,,
GRAFT VASCULAR 7,C1768,HCPCS,,,,,both,, ,23912.22,14347.33,Aetna,Commercial,,,,,23912.22,,,,
GRAFT VASCULAR 8,C1768,HCPCS,,,,,both,, ,28688.85,17213.31,Aetna,Commercial,,,,,28688.85,,,,
GUIDEWIRE LEVEL 1,C1769,HCPCS,,,,,both,, ,182.83,109.69,Aetna,Commercial,,,,,182.83,,,,
GUIDEWIRE LEVEL 10,C1769,HCPCS,,,,,both,, ,3830.06,2298.03,Aetna,Commercial,,,,,3830.06,,,,
GUIDEWIRE LEVEL 11,C1769,HCPCS,,,,,both,, ,4308.23,2584.93,Aetna,Commercial,,,,,4308.23,,,,
GUIDEWIRE LEVEL 12,C1769,HCPCS,,,,,both,, ,4786.15,2871.69,Aetna,Commercial,,,,,4786.15,,,,
GUIDEWIRE LEVEL 13,C1769,HCPCS,,,,,both,, ,7177.04,4306.22,Aetna,Commercial,,,,,7177.04,,,,
GUIDEWIRE LEVEL 14,C1769,HCPCS,,,,,both,, ,9567.67,5740.6,Aetna,Commercial,,,,,9567.67,,,,
GUIDEWIRE LEVEL 15,C1769,HCPCS,,,,,both,, ,14349.19,8609.51,Aetna,Commercial,,,,,14349.19,,,,
GUIDEWIRE LEVEL 16,C1769,HCPCS,,,,,both,, ,19130.71,11478.42,Aetna,Commercial,,,,,19130.71,,,,
GUIDEWIRE LEVEL 17,C1769,HCPCS,,,,,both,, ,23912.22,14347.33,Aetna,Commercial,,,,,23912.22,,,,
GUIDEWIRE LEVEL 18,C1769,HCPCS,,,,,both,, ,31084.37,18650.62,Aetna,Commercial,,,,,31084.37,,,,
GUIDEWIRE LEVEL 19,C1769,HCPCS,,,,,both,, ,38256.78,22954.06,Aetna,Commercial,,,,,38256.78,,,,
GUIDEWIRE LEVEL 2,C1769,HCPCS,,,,,both,, ,243.85,146.31,Aetna,Commercial,,,,,243.85,,,,
GUIDEWIRE LEVEL 20,C1769,HCPCS,,,,,both,, ,47814.92,28688.95,Aetna,Commercial,,,,,47814.92,,,,
GUIDEWIRE LEVEL 3,C1769,HCPCS,,,,,both,, ,482.81,289.68,Aetna,Commercial,,,,,482.81,,,,
GUIDEWIRE LEVEL 4,C1769,HCPCS,,,,,both,, ,960.99,576.59,Aetna,Commercial,,,,,960.99,,,,
GUIDEWIRE LEVEL 5,C1769,HCPCS,,,,,both,, ,1439.17,863.5,Aetna,Commercial,,,,,1439.17,,,,
GUIDEWIRE LEVEL 6,C1769,HCPCS,,,,,both,, ,1917.35,1150.41,Aetna,Commercial,,,,,1917.35,,,,
GUIDEWIRE LEVEL 7,C1769,HCPCS,,,,,both,, ,2395.52,1437.31,Aetna,Commercial,,,,,2395.52,,,,
GUIDEWIRE LEVEL 9,C1769,HCPCS,,,,,both,, ,3351.88,2011.12,Aetna,Commercial,,,,,3351.88,,,,
GUIDEWIRE LEVEL 9,C1769,HCPCS,,,,,both,, ,3351.88,2011.12,Aetna,Commercial,,,,,3351.88,,,,
REP DEV URINRY W/SL1,C1771,HCPCS,,,,,both,, ,2868.81,1721.28,Aetna,Commercial,,,,,2868.81,,,,
REP DEV URINRY W/SL2,C1771,HCPCS,,,,,both,, ,3825.16,2295.09,Aetna,Commercial,,,,,3825.16,,,,
REP DEV URINRY W/SL3,C1771,HCPCS,,,,,both,, ,14344.55,8606.73,Aetna,Commercial,,,,,14344.55,,,,
INF PUMP PROGRAM LV1,C1772,HCPCS,,,,,both,, ,2774.56,1664.73,Aetna,Commercial,,,,,2774.56,,,,
INF PUMP PROGRAM LV3,C1772,HCPCS,,,,,both,, ,53552.79,32131.67,Aetna,Commercial,,,,,53552.79,,,,
CATH-RETRIEVAL 1,C1773,HCPCS,,,,,both,, ,1338.74,803.24,Aetna,Commercial,,,,,1338.74,,,,
CATH-RETRIEVAL 2,C1773,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,,,,4781.52,,,,
JOINT DEVICE IMPLT 1,C1776,HCPCS,,,,,both,, ,3586.2,2151.72,Aetna,Commercial,,,,,3586.2,,,,
JOINT DEVICE IMPLT 2,C1776,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,,,,4781.52,,,,
JOINT DEVICE IMPLT 3,C1776,HCPCS,,,,,both,, ,9567.67,5740.6,Aetna,Commercial,,,,,9567.67,,,,
JOINT DEVICE IMPLT 4,C1776,HCPCS,,,,,both,, ,11958.56,7175.13,Aetna,Commercial,,,,,11958.56,,,,
JOINT DEVICE IMPLT 5,C1776,HCPCS,,,,,both,, ,19130.71,11478.42,Aetna,Commercial,,,,,19130.71,,,,
JOINT DEVICE IMPLT 6,C1776,HCPCS,,,,,both,, ,23912.22,14347.33,Aetna,Commercial,,,,,23912.22,,,,
JOINT DEVICE IMPLT 7,C1776,HCPCS,,,,,both,, ,31084.37,18650.62,Aetna,Commercial,,,,,31084.37,,,,
JOINT DEVICE IMPLT 8,C1776,HCPCS,,,,,both,, ,38256.78,22954.06,Aetna,Commercial,,,,,38256.78,,,,
JOINT DEVICE IMPLT 9,C1776,HCPCS,,,,,both,, ,47819.81,28691.88,Aetna,Commercial,,,,,47819.81,,,,
JOINT DEVICE IMPLT10,C1776,HCPCS,,,,,both,, ,71727.14,43036.28,Aetna,Commercial,,,,,71727.14,,,,
JOINT DEVICE IMPLT11,C1776,HCPCS,,,,,both,, ,95629.84,57377.9,Aetna,Commercial,,,,,95629.84,,,,
JOINT DEVICE IMPLT12,C1776,HCPCS,,,,,both,, ,99999,59999.4,Aetna,Commercial,,,,,99999,,,,
LEAD AICD ENDO SN L1,C1777,HCPCS,,,,,both,, ,23599.62,14159.77,Aetna,Commercial,,,,,23599.62,,,,
LEAD NEUROSTIMULAT 1,C1778,HCPCS,,,,,both,, ,9563.04,5737.82,Aetna,Commercial,,,,,9563.04,,,,
LEAD NEUROSTIMULAT 2,C1778,HCPCS,,,,,both,, ,3586.2,2151.72,Aetna,Commercial,,,,,3586.2,,,,
LEAD NEUROSTIMULAT 3,C1778,HCPCS,,,,,both,, ,14344.55,8606.73,Aetna,Commercial,,,,,14344.55,,,,
LEAD NEUROSTIMULAT 4,C1778,HCPCS,,,,,both,, ,23907.59,14344.55,Aetna,Commercial,,,,,23907.59,,,,
LEAD PMKR TRNSV VDD1,C1779,HCPCS,,,,,both,, ,9194.3,5516.58,Aetna,Commercial,,,,,9194.3,,,,
MESH IMPLANTABLE 1,C1781,HCPCS,,,,,both,, ,717.14,430.28,Aetna,Commercial,,,,,717.14,,,,
MESH IMPLANTABLE 10,C1781,HCPCS,,,,,both,, ,11958.56,7175.13,Aetna,Commercial,,,,,11958.56,,,,
MESH IMPLANTABLE 11,C1781,HCPCS,,,,,both,, ,14349.19,8609.51,Aetna,Commercial,,,,,14349.19,,,,
MESH IMPLANTABLE 12,C1781,HCPCS,,,,,both,, ,19130.71,11478.42,Aetna,Commercial,,,,,19130.71,,,,
MESH IMPLANTABLE 13,C1781,HCPCS,,,,,both,, ,28693.74,17216.24,Aetna,Commercial,,,,,28693.74,,,,
MESH IMPLANTABLE 14,C1781,HCPCS,,,,,both,, ,43038.29,25822.97,Aetna,Commercial,,,,,43038.29,,,,
MESH IMPLANTABLE 2,C1781,HCPCS,,,,,both,, ,960.99,576.59,Aetna,Commercial,,,,,960.99,,,,
MESH IMPLANTABLE 3,C1781,HCPCS,,,,,both,, ,1917.35,1150.41,Aetna,Commercial,,,,,1917.35,,,,
MESH IMPLANTABLE 4,C1781,HCPCS,,,,,both,, ,2873.7,1724.22,Aetna,Commercial,,,,,2873.7,,,,
MESH IMPLANTABLE 6,C1781,HCPCS,,,,,both,, ,3830.06,2298.03,Aetna,Commercial,,,,,3830.06,,,,
MESH IMPLANTABLE 6,C1781,HCPCS,,,,,both,, ,3830.06,2298.03,Aetna,Commercial,,,,,3830.06,,,,
MESH IMPLANTABLE 7,C1781,HCPCS,,,,,both,, ,6220.69,3732.41,Aetna,Commercial,,,,,6220.69,,,,
MESH IMPLANTABLE 8,C1781,HCPCS,,,,,both,, ,7655.22,4593.13,Aetna,Commercial,,,,,7655.22,,,,
MESH IMPLANTABLE 9,C1781,HCPCS,,,,,both,, ,9567.67,5740.6,Aetna,Commercial,,,,,9567.67,,,,
MORCELLATOR 1,C1782,HCPCS,,,,,both,, ,1792.97,1075.78,Aetna,Commercial,,,,,1792.97,,,,
MORCELLATOR 2,C1782,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,,,,4781.52,,,,
MORCELLATOR 3,C1782,HCPCS,,,,,both,, ,9563.04,5737.82,Aetna,Commercial,,,,,9563.04,,,,
OCLR DEV INTROP DTR1,C1784,HCPCS,,,,,both,, ,15780.63,9468.37,Aetna,Commercial,,,,,15780.63,,,,
PMKR DUAL RATE-RS L1,C1785,HCPCS,,,,,both,, ,84273.06,50563.83,Aetna,Commercial,,,,,84273.06,,,,
PMKR DUAL RATE-RS L2,C1785,HCPCS,,,,,both,, ,28809.36,17285.61,Aetna,Commercial,,,,,28809.36,,,,
PMKR SINGL RATE-RSL1,C1786,HCPCS,,,,,both,, ,62664.69,37598.81,Aetna,Commercial,,,,,62664.69,,,,
PATIENT PROGR NEURO1,C1787,HCPCS,,,,,both,, ,5302.96,3181.77,Aetna,Commercial,,,,,5302.96,,,,
PORT 1,C1788,HCPCS,,,,,both,, ,720.74,432.44,Aetna,Commercial,,,,,720.74,,,,
PORT 2,C1788,HCPCS,,,,,both,, ,960.99,576.59,Aetna,Commercial,,,,,960.99,,,,
PORT 3,C1788,HCPCS,,,,,both,, ,1912.71,1147.62,Aetna,Commercial,,,,,1912.71,,,,
BREAST IMPLANT 1,C1789,HCPCS,,,,,both,, ,7833.15,4699.89,Aetna,Commercial,,,,,7833.15,,,,
PRSTHS PENILE INFL 1,C1813,HCPCS,,,,,both,, ,3586.2,2151.72,Aetna,Commercial,,,,,3586.2,,,,
PRSTHS PENILE INFL 2,C1813,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,,,,4781.52,,,,
PRSTHS PENILE INFL 3,C1813,HCPCS,,,,,both,, ,14344.55,8606.73,Aetna,Commercial,,,,,14344.55,,,,
PRSTHS PENILE INFL 4,C1813,HCPCS,,,,,both,, ,23907.59,14344.55,Aetna,Commercial,,,,,23907.59,,,,
TISSUE LOCALZ EXCISI,C1819,HCPCS,,,,,both,, ,1000,600,Aetna,Commercial,,,,,1000,,,,
GENRATE NEURO RECHR,C1820,HCPCS,,,,,both,, ,38545.95,23127.57,Aetna,Commercial,,,,,38545.95,,,,
INTERSPINOUS IMPL L1,C1821,HCPCS,,,,,both,, ,31193.29,18715.97,Aetna,Commercial,,,,,31193.29,,,,
INTERSPINOUS IMPL L2,C1821,HCPCS,,,,,both,, ,44561.92,26737.15,Aetna,Commercial,,,,,44561.92,,,,
STNT COAT/COV W/DEL1,C1874,HCPCS,,,,,both,, ,3586.2,2151.72,Aetna,Commercial,,,,,3586.2,,,,
STNT COAT/COV W/DEL2,C1874,HCPCS,,,,,both,, ,7172.15,4303.29,Aetna,Commercial,,,,,7172.15,,,,
STNT COAT/COV W/DEL3,C1874,HCPCS,,,,,both,, ,14344.55,8606.73,Aetna,Commercial,,,,,14344.55,,,,
STNT COAT/COV W/DEL4,C1874,HCPCS,,,,,both,, ,23907.59,14344.55,Aetna,Commercial,,,,,23907.59,,,,
STNT NO COCV W/DEL 1,C1876,HCPCS,,,,,both,, ,3589.81,2153.88,Aetna,Commercial,,,,,3589.81,,,,
STNT NO COCV W/DEL 2,C1876,HCPCS,,,,,both,, ,4786.15,2871.69,Aetna,Commercial,,,,,4786.15,,,,
STNT NO COCV W/DEL 3,C1876,HCPCS,,,,,both,, ,9567.67,5740.6,Aetna,Commercial,,,,,9567.67,,,,
STNT NO COCV W/DEL 4,C1876,HCPCS,,,,,both,, ,14344.55,8606.73,Aetna,Commercial,,,,,14344.55,,,,
STNT NO-COA/COV W/O1,C1877,HCPCS,,,,,both,, ,3586.2,2151.72,Aetna,Commercial,,,,,3586.2,,,,
STNT NO-COA/COV W/O2,C1877,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,,,,4781.52,,,,
VENA CAVA FILTER 1,C1880,HCPCS,,,,,both,, ,3586.2,2151.72,Aetna,Commercial,,,,,3586.2,,,,
VENA CAVA FILTER 2,C1880,HCPCS,,,,,both,, ,7172.15,4303.29,Aetna,Commercial,,,,,7172.15,,,,
AICD OHR THN SGL/DU1,C1882,HCPCS,,,,,both,, ,99999,59999.4,Aetna,Commercial,,,,,99999,,,,
EMBOLIZ PROTECT SYS1,C1884,HCPCS,,,,,both,, ,6144.21,3686.52,Aetna,Commercial,,,,,6144.21,,,,
EMBOLIZ PROTECT SYS2,C1884,HCPCS,,,,,both,, ,7172.15,4303.29,Aetna,Commercial,,,,,7172.15,,,,
CATH TRNSLUM ANG LA1,C1885,HCPCS,,,,,both,, ,7172.15,4303.29,Aetna,Commercial,,,,,7172.15,,,,
CATH TRNSLUM ANG LA2,C1885,HCPCS,,,,,both,, ,9563.04,5737.82,Aetna,Commercial,,,,,9563.04,,,,
CATHETER GUIDING 1,C1887,HCPCS,,,,,both,, ,358.7,215.22,Aetna,Commercial,,,,,358.7,,,,
CATHETER GUIDING 2,C1887,HCPCS,,,,,both,, ,1195.32,717.19,Aetna,Commercial,,,,,1195.32,,,,
CATHETER GUIDING 3,C1887,HCPCS,,,,,both,, ,1912.71,1147.62,Aetna,Commercial,,,,,1912.71,,,,
CATH ABLTN NOCRD ED1,C1888,HCPCS,,,,,both,, ,896.62,537.97,Aetna,Commercial,,,,,896.62,,,,
CATH ABLTN NOCRD ED2,C1888,HCPCS,,,,,both,, ,1195.32,717.19,Aetna,Commercial,,,,,1195.32,,,,
EAR TUBES DRAINAGE 1,C1889,HCPCS,,,,,both,, ,113.04,67.82,Aetna,Commercial,,,,,113.04,,,,
TISSUE EXP NONBREAST,C1889,HCPCS,,,,,both,, ,570.11,342.06,Aetna,Commercial,,,,,570.11,,,,
INF PMP NON-PROG LV1,C1891,HCPCS,,,,,both,, ,10237.17,6142.3,Aetna,Commercial,,,,,10237.17,,,,
PEEL-AWAY SHEATH 1,C1892,HCPCS,,,,,both,, ,179.22,107.53,Aetna,Commercial,,,,,179.22,,,,
PEEL-AWAY SHEATH 2,C1892,HCPCS,,,,,both,, ,478.18,286.9,Aetna,Commercial,,,,,478.18,,,,
PEEL-AWAY SHEATH 3,C1892,HCPCS,,,,,both,, ,1434.53,860.71,Aetna,Commercial,,,,,1434.53,,,,
INT SHTH FIX NO-PL 1,C1893,HCPCS,,,,,both,, ,611.31,366.78,Aetna,Commercial,,,,,611.31,,,,
INT SHTH FIX NO-PL 2,C1893,HCPCS,,,,,both,, ,3048.29,1828.97,Aetna,Commercial,,,,,3048.29,,,,
SHEATH NON-LASR 1,C1894,HCPCS,,,,,both,, ,717.14,430.28,Aetna,Commercial,,,,,717.14,,,,
SHEATH NON-LASR 2,C1894,HCPCS,,,,,both,, ,1434.53,860.71,Aetna,Commercial,,,,,1434.53,,,,
SHEATH NON-LASR 3,C1894,HCPCS,,,,,both,, ,2390.63,1434.37,Aetna,Commercial,,,,,2390.63,,,,
SHEATH NON-LASR 4,C1894,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,,,,4781.52,,,,
SHEATH NON-LASR 5,C1894,HCPCS,,,,,both,, ,7172.15,4303.29,Aetna,Commercial,,,,,7172.15,,,,
SHEATH NON-LASR 6,C1894,HCPCS,,,,,both,, ,9563.04,5737.82,Aetna,Commercial,,,,,9563.04,,,,
SHEATH NON-LASR 7,C1894,HCPCS,,,,,both,, ,14344.55,8606.73,Aetna,Commercial,,,,,14344.55,,,,
SHEATH NON-LASR 8,C1894,HCPCS,,,,,both,, ,19126.07,11475.64,Aetna,Commercial,,,,,19126.07,,,,
LEAD AICD END DUL L1,C1895,HCPCS,,,,,both,, ,76277.94,45766.76,Aetna,Commercial,,,,,76277.94,,,,
LEAD AICD END DUL L2,C1895,HCPCS,,,,,both,, ,16735.18,10041.1,Aetna,Commercial,,,,,16735.18,,,,
LEAD AICD NO-SING L1,C1896,HCPCS,,,,,both,, ,16206.54,9723.92,Aetna,Commercial,,,,,16206.54,,,,
LEAD NEUROSTM TST K1,C1897,HCPCS,,,,,both,, ,3586.2,2151.72,Aetna,Commercial,,,,,3586.2,,,,
LEAD NEUROSTM TST K2,C1897,HCPCS,,,,,both,, ,6646.33,3987.79,Aetna,Commercial,,,,,6646.33,,,,
LEAD PMKR NON-TRN L1,C1898,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,,,,4781.52,,,,
LEAD PMKR/AICD CMBL1,C1899,HCPCS,,,,,both,, ,41218.03,24730.81,Aetna,Commercial,,,,,41218.03,,,,
LEAD LT VENT COR LV1,C1900,HCPCS,,,,,both,, ,20278.38,12167.02,Aetna,Commercial,,,,,20278.38,,,,
SEALANT PULMNRY LIQD,C2615,HCPCS,,,,,both,, ,5932.54,3559.52,Aetna,Commercial,,,,,5932.54,,,,
STNT NONCOR TM W/O 1,C2617,HCPCS,,,,,both,, ,2963.83,1778.29,Aetna,Commercial,,,,,2963.83,,,,
PROBE CRYOABLATION 1,C2618,HCPCS,,,,,both,, ,3586.2,2151.72,Aetna,Commercial,,,,,3586.2,,,,
PROBE CRYOABLATION 2,C2618,HCPCS,,,,,both,, ,4781.52,2868.91,Aetna,Commercial,,,,,4781.52,,,,
PROBE CRYOABLATION 3,C2618,HCPCS,,,,,both,, ,9563.04,5737.82,Aetna,Commercial,,,,,9563.04,,,,
PROBE CRYOABLATION 4,C2618,HCPCS,,,,,both,, ,16735.18,10041.1,Aetna,Commercial,,,,,16735.18,,,,
PMKR DUL NON RAT LV1,C2619,HCPCS,,,,,both,, ,73166.31,43899.78,Aetna,Commercial,,,,,73166.31,,,,
PMKR SNGL NON RTE-RE,C2620,HCPCS,,,,,both,, ,45918.17,27550.9,Aetna,Commercial,,,,,45918.17,,,,
PMKR OTHR TH SNGL L1,C2621,HCPCS,,,,,both,, ,99999,59999.4,Aetna,Commercial,,,,,99999,,,,
PRSTHS PENILE NNINF1,C2622,HCPCS,,,,,both,, ,38894.09,23336.45,Aetna,Commercial,,,,,38894.09,,,,
WIRELESS PRESS SENS,C2624,HCPCS,,,,,both,, ,99999,59999.4,Aetna,Commercial,,,,,99999,,,,
STNT NON-COR TM DL 1,C2625,HCPCS,,,,,both,, ,541.52,324.91,Aetna,Commercial,,,,,541.52,,,,
STNT NON-COR TM DL 2,C2625,HCPCS,,,,,both,, ,722.03,433.21,Aetna,Commercial,,,,,722.03,,,,
STNT NON-COR TM DL 3,C2625,HCPCS,,,,,both,, ,3787.83,2272.69,Aetna,Commercial,,,,,3787.83,,,,
INF PMP NON-PROG LV1,C2626,HCPCS,,,,,both,, ,545.13,327.07,Aetna,Commercial,,,,,545.13,,,,
CATH SUPRPUBC-CYSTO1,C2627,HCPCS,,,,,both,, ,172.01,103.2,Aetna,Commercial,,,,,172.01,,,,
CATH SUPRPUBC-CYSTO2,C2627,HCPCS,,,,,both,, ,1075.84,645.5,Aetna,Commercial,,,,,1075.84,,,,
CATH OCCLUSION 1,C2628,HCPCS,,,,,both,, ,717.14,430.28,Aetna,Commercial,,,,,717.14,,,,
CATH OCCLUSION 2,C2628,HCPCS,,,,,both,, ,1434.53,860.71,Aetna,Commercial,,,,,1434.53,,,,
CATH OCCLUSION 3,C2628,HCPCS,,,,,both,, ,2390.63,1434.37,Aetna,Commercial,,,,,2390.63,,,,
INTRO/SHEATH LASER 1,C2629,HCPCS,,,,,both,, ,5379.18,3227.5,Aetna,Commercial,,,,,5379.18,,,,
INTRO/SHEATH LASER 2,C2629,HCPCS,,,,,both,, ,7172.15,4303.29,Aetna,Commercial,,,,,7172.15,,,,
REP DEV URNRY WO SL1,C2631,HCPCS,,,,,both,, ,8266.27,4959.76,Aetna,Commercial,,,,,8266.27,,,,
LC S SUB T/A/L 25S,C5271,HCPCS,,,,,both,, ,2393.6,1436.16,Aetna,Commercial,,,,,2393.6,,,,
LC S SUB T/A/L ADL,C5272,HCPCS,,,,,both,, ,2393.6,1436.16,Aetna,Commercial,,,,,2393.6,,,,
LC S SUB T/A/L 100SQ,C5273,HCPCS,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
LC S SUB T/A/L ADL,C5274,HCPCS,,,,,both,, ,6950.12,4170.07,Aetna,Commercial,,,,,6950.12,,,,
LC S SUB F/NK/HF/G,C5275,HCPCS,,,,,both,, ,2393.6,1436.16,Aetna,Commercial,,,,,2393.6,,,,
LC S SUB F/NK/HF/G EA,C5276,HCPCS,,,,,both,, ,2393.6,1436.16,Aetna,Commercial,,,,,2393.6,,,,
LC S SUB F/NK/HF/G 100SQ,C5277,HCPCS,,,,,both,, ,2393.6,1436.16,Aetna,Commercial,,,,,2393.6,,,,
LC S SUB F/NK/HF/G EA,C5278,HCPCS,,,,,both,, ,2393.6,1436.16,Aetna,Commercial,,,,,2393.6,,,,
MRA-ABDOMEN W,C8900,HCPCS,,,,,both,, ,1035.69,621.41,Aetna,Commercial,,,,,1035.69,,,,
MRA-ABDOMEN W,C8900,HCPCS,,,,,both,, ,1114.55,668.73,Aetna,Commercial,,,,,1114.55,,,,
MRA-ABDOMEN WO,C8901,HCPCS,,,,,both,, ,715.99,429.59,Aetna,Commercial,,,,,715.99,,,,
MRA-ABDOMEN WO,C8901,HCPCS,,,,,both,, ,770.45,462.27,Aetna,Commercial,,,,,770.45,,,,
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,,,,1197.08,,,,
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,,,,1288.29,,,,
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,2669.78,1601.86,Aetna,Commercial,,,,,2669.78,,,,
MR-BREAST UNI WWO,C8905,HCPCS,,,,,both,, ,3114.65,1868.79,Aetna,Commercial,,,,,3114.65,,,,
MR-BREAST BI WWO,C8908,HCPCS,,,,,both,, ,3115.2,1869.12,Aetna,Commercial,,,,,3115.2,,,,
MRA-LW EXTR WWO,C8914,HCPCS,,,,,both,, ,1197.08,718.24,Aetna,Commercial,,,,,1197.08,,,,
MRA-LW EXTR WWO,C8914,HCPCS,,,,,both,, ,1288.29,772.97,Aetna,Commercial,,,,,1288.29,,,,
MRA-LW EXTR WWO BI,C8914,HCPCS,,,,,both,, ,2394.15,1436.49,Aetna,Commercial,,,,,2394.15,,,,
MRA-LW EXTR WWO BI,C8914,CPT,,,,,both,, ,2576.6,1545.96,Aetna,Commercial,,,,,2576.6,,,,
BR-CAD MRI LESION,C8937,HCPCS,,,,,both,, ,50.52,30.31,Aetna,Commercial,,,,,50.52,,,,
COCAINE HCL NASL 1MG,C9046,HCPCS,,,,,both,4,ML,8,4.8,Aetna,Commercial,,,,,8,,,,
IDARUCIZU 2.5GM/50ML,C9399,HCPCS,,,,,both,50,ML,10077.78,6046.66,Aetna,Commercial,,,,,10077.78,,,,
REMDESIV 5MG/ML 20ML,C9399,HCPCS,,,,,both,, ,2878.85,1727.31,Aetna,Commercial,,,,,2878.85,,,,
IC-PRQ DE COR STNT,C9600,CPT,,,,,both,, ,42411.02,25446.61,Aetna,Commercial,,,,,42411.02,,,,
IC-PRQ DE CR REV CAB,C9604,CPT,,,,,both,, ,29428.39,17657.03,Aetna,Commercial,,,,,29428.39,,,,
ADMIN FLU VACCINE,G0008,HCPCS,,,,,both,, ,106.25,63.75,Aetna,Commercial,,,,,106.25,,,,
ADMIN FLU VACCINE,G0008,HCPCS,,,,,both,, ,106.25,63.75,Aetna,Commercial,,,,,106.25,,,,
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,70.81,42.48,Aetna,Commercial,,,,,70.81,,,,
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,70.81,42.48,Aetna,Commercial,,,,,70.81,,,,
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,109.18,65.5,Aetna,Commercial,,,,,109.18,,,,
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,143.69,86.21,Aetna,Commercial,,,,,143.69,,,,
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,184.63,110.77,Aetna,Commercial,,,,,184.63,,,,
ADMIN PNEU VACCINE,G0009,HCPCS,,,,,both,, ,106.25,63.75,Aetna,Commercial,,,,,106.25,,,,
ADMIN PNEU VACCINE,G0009,HCPCS,,,,,both,, ,106.25,63.75,Aetna,Commercial,,,,,106.25,,,,
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,109.18,65.5,Aetna,Commercial,,,,,109.18,,,,
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,143.69,86.21,Aetna,Commercial,,,,,143.69,,,,
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,184.63,110.77,Aetna,Commercial,,,,,184.63,,,,
HEP B VACCINE ADMIN,G0010,HCPCS,,,,,both,, ,106.25,63.75,Aetna,Commercial,,,,,106.25,,,,
HEP B VACCINE ADMIN,G0010,HCPCS,,,,,both,, ,106.25,63.75,Aetna,Commercial,,,,,106.25,,,,
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,105.06,63.03,Aetna,Commercial,,,,,105.06,,,,
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,109.44,65.66,Aetna,Commercial,,,,,109.44,,,,
PSA SCRN TO LABCORP,G0103,HCPCS,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
PSA SCRN TO LABCORP,G0103,HCPCS,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
"PSA, SCREENING",G0103,HCPCS,,,,,both,, ,135.85,81.51,Aetna,Commercial,,,,,135.85,,,,
"PSA, SCREENING",G0103,HCPCS,,,,,both,,,1036.25,1036.25,Aetna,Commercial,,731.59,70.6,,1036.25,1036.25,1036.25,Fee Schedule,70.6
DSMT INDIVIDUAL 30M,G0108,HCPCS,,,,,both,, ,261.62,156.97,Aetna,Commercial,,,,,261.62,,,,
PAP THINLAY LIQ SCRN,G0123,HCPCS,,,,,both,, ,195.06,117.03,Aetna,Commercial,,,,,195.06,,,,
STRNGTH TRN SLG 15MI,G0237,HCPCS,,,,,both,, ,177.16,106.29,Aetna,Commercial,,,,,177.16,,,,
RESP FX TRN SGL 15MN,G0238,HCPCS,,,,,both,, ,177.16,106.29,Aetna,Commercial,,,,,177.16,,,,
RESP FX TRAIN GROUP,G0239,HCPCS,,,,,both,, ,177.16,106.29,Aetna,Commercial,,,,,177.16,,,,
DIALYSIS  EMERGENT,G0257,HCPCS,,,,,both,, ,9908.34,5945,Aetna,Commercial,,,,,9908.34,,,,
IR-ARTHROGRAM SI JTS,G0260,HCPCS,,,,,both,, ,2101.41,1260.84,Aetna,Commercial,,,,,2101.41,,,,
CC-PLACE CLOS DEV,G0269,HCPCS,,,,,both,, ,22097.11,13258.26,Aetna,Commercial,,,,,22097.11,,,,
HBO FB 30MN,G0277,HCPCS,,,,,both,, ,265.23,159.13,Aetna,Commercial,,,,,265.23,,,,
BR-TOMO MAMMO BI,G0279,HCPCS,,,,,both,,,160.68,160.68,Aetna,Commercial,,113.44,70.6,,160.68,160.68,160.68,Fee Schedule,70.6
BR-TOMO MAMMO BI,G0279,HCPCS,,,,,both,, ,160.68,96.4,Aetna,Commercial,,,,,160.68,,,,
BR-TOMO MAMMO UNI,G0279,HCPCS,,,,,both,,,133.9,133.9,Aetna,Commercial,,94.53,70.6,,133.9,133.9,133.9,Fee Schedule,70.6
BR-TOMO MAMMO UNI,G0279,HCPCS,,,,,both,, ,133.9,80.34,Aetna,Commercial,,,,,133.9,,,,
ELEC STIM-UNATTND-VI,G0283,HCPCS,,,,,both,, ,443.37,266.02,Aetna,Commercial,,,,,443.37,,,,
ELEC STIM-UNATTND-VI,G0283,HCPCS,,,,,both,, ,480.68,288.4,Aetna,Commercial,,,,,480.68,,,,
ELEC STM-UNATVI COTA,G0283,HCPCS,,,,,both,, ,37.08,22.24,Aetna,Commercial,,,,,37.08,,,,
ELEC STM-UNATVI COTA,G0283,HCPCS,,,,,both,, ,37.08,22.24,Aetna,Commercial,,,,,37.08,,,,
ELEC STM-UNATVI COTA,G0283,HCPCS,,,,,both,, ,37.08,22.24,Aetna,Commercial,,,,,37.08,,,,
ELEC STM-UNATVI COTA,G0283,HCPCS,,,,,both,, ,37.08,22.24,Aetna,Commercial,,,,,37.08,,,,
ELEC STM-UNATVI COTA,G0283,HCPCS,,,,,both,, ,515,309,Aetna,Commercial,,,,,515,,,,
ELEC STM-UNATVI COTA,G0283,HCPCS,,,,,both,, ,515,309,Aetna,Commercial,,,,,515,,,,
ELEC STM-UNAT-VI PTA,G0283,HCPCS,,,,,both,, ,474.83,284.89,Aetna,Commercial,,,,,474.83,,,,
ELEC STM-UNAT-VI PTA,G0283,HCPCS,,,,,both,, ,474.83,284.89,Aetna,Commercial,,,,,474.83,,,,
SCR FECAL OC BLD 1-3,G0328,HCPCS,,,,,both,, ,159.42,95.65,Aetna,Commercial,,,,,159.42,,,,
L&D OBSERV 1ST HOUR,G0378,CPT,,,,,both,, ,1189.39,713.63,Aetna,Commercial,,,,,1189.39,,,,
L&D OBSERV 1ST HOUR,G0378,CPT,,,,,both,, ,1189.39,713.63,Aetna,Commercial,,,,,1189.39,,,,
L&D OBSERV ADDL HOUR,G0378,CPT,,,,,both,, ,151.15,90.69,Aetna,Commercial,,,,,151.15,,,,
L&D OBSERV ADDL HOUR,G0378,CPT,,,,,both,, ,151.15,90.69,Aetna,Commercial,,,,,151.15,,,,
OBSRVATION ADDL HOUR,G0378,HCPCS,,,,,both,, ,141.21,84.72,Aetna,Commercial,,,,,141.21,,,,
DIRECT ADMIT TO OBS,G0379,HCPCS,,,,,both,, ,610.15,366.09,Aetna,Commercial,,,,,610.15,,,,
L&D DIRECT ADMIT OBS,G0379,HCPCS,,,,,both,, ,653.54,392.12,Aetna,Commercial,,,,,653.54,,,,
L&D DIRECT ADMIT OBS,G0379,HCPCS,,,,,both,, ,653.54,392.12,Aetna,Commercial,,,,,653.54,,,,
HOME SLEEP TYPE 3,G0399,HCPCS,,,,,both,, ,428.48,257.08,Aetna,Commercial,,,,,428.48,,,,
HOME SLEEP TYPE 3,G0399,HCPCS,,,,,both,, ,428.48,257.08,Aetna,Commercial,,,,,428.48,,,,
PROSTATE NDL BX ANY,G0416,HCPCS,,,,,both,, ,1059.54,635.72,Aetna,Commercial,,,,,1059.54,,,,
HIV-1 AB EIA,G0432,HCPCS,,,,,both,, ,113.39,68.03,Aetna,Commercial,,,,,113.39,,,,
HIV1 AG HIV1 HIV2 AB,G0433,CPT,,,,,both,, ,165.59,99.35,Aetna,Commercial,,,,,165.59,,,,
HIV1-HIV2 AB SNG RES,G0435,CPT,,,,,both,, ,42.66,25.59,Aetna,Commercial,,,,,42.66,,,,
HIV1-HIV2 AB SNG RES,G0435,CPT,,,,,both,, ,1036.25,621.75,Aetna,Commercial,,,,,1036.25,,,,
EVAL & MGMT LEVEL 3,G0463,HCPCS,,,,,both,, ,215.75,129.45,Aetna,Commercial,,,,,215.75,,,,
EVAL & MGMT LEVEL 5,G0463,HCPCS,,,,,both,, ,261,156.6,Aetna,Commercial,,,,,261,,,,
HOSPITAL OUTPT VISIT,G0463,HCPCS,,,,,both,, ,520,312,Aetna,Commercial,,,,,520,,,,
LEVEL 1 EP,G0463,HCPCS,,,,,both,, ,249.52,149.71,Aetna,Commercial,,,,,249.52,,,,
LEVEL 2 EP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Aetna,Commercial,,,,,188.75,,,,
LEVEL 2 NP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Aetna,Commercial,,,,,188.75,,,,
LEVEL 3 NP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Aetna,Commercial,,,,,188.75,,,,
LEVEL 4 NP,G0463,HCPCS,,,,,both,, ,251.84,151.1,Aetna,Commercial,,,,,251.84,,,,
LEVEL 4 NP,G0463,HCPCS,,,,,both,, ,251.84,151.1,Aetna,Commercial,,,,,251.84,,,,
LEVEL 4 NP,G0463,HCPCS,,,,,both,, ,251.84,151.1,Aetna,Commercial,,,,,251.84,,,,
LEVEL 4 NP,G0463,HCPCS,,,,,both,, ,251.84,151.1,Aetna,Commercial,,,,,251.84,,,,
LEVEL 5 EP,G0463,HCPCS,,,,,both,, ,425.91,255.54,Aetna,Commercial,,,,,425.91,,,,
LEVEL 5 NP,G0463,HCPCS,,,,,both,, ,324.19,194.51,Aetna,Commercial,,,,,324.19,,,,
LEVEL 5 NP,G0463,HCPCS,,,,,both,, ,324.19,194.51,Aetna,Commercial,,,,,324.19,,,,
OB TRIAGE LVL 1 EP,G0463,HCPCS,,,,,both,, ,700.4,420.24,Aetna,Commercial,,,,,700.4,,,,
PAT EVAL/MGM LEVEL 2,G0463,HCPCS,,,,,both,, ,325.25,195.15,Aetna,Commercial,,,,,325.25,,,,
PAT EVAL/MGM LEVEL 3,G0463,HCPCS,,,,,both,, ,379.5,227.7,Aetna,Commercial,,,,,379.5,,,,
PAT EVAL/MGM LEVEL 4,G0463,HCPCS,,,,,both,, ,433.5,260.1,Aetna,Commercial,,,,,433.5,,,,
PAT EVAL/MGM LEVEL 5,G0463,HCPCS,,,,,both,, ,487.5,292.5,Aetna,Commercial,,,,,487.5,,,,
PHYSICAL-EMPLOYMENT,G0463,HCPCS,,,,,both,, ,55.62,33.37,Aetna,Commercial,,,,,55.62,,,,
PHYSICAL-EMPLOYMENT,G0463,HCPCS,,,,,both,, ,55.62,33.37,Aetna,Commercial,,,,,55.62,,,,
PHYSICAL-SCHOOL,G0463,HCPCS,,,,,both,, ,66.95,40.17,Aetna,Commercial,,,,,66.95,,,,
PHYSICAL-SCHOOL,G0463,HCPCS,,,,,both,, ,66.95,40.17,Aetna,Commercial,,,,,66.95,,,,
PSYCH CLINIC TYPE A,G0463,HCPCS,,,,,both,, ,294.25,176.55,Aetna,Commercial,,,,,294.25,,,,
SUTURE REMOVAL,G0463,HCPCS,,,,,both,, ,132.61,79.56,Aetna,Commercial,,,,,132.61,,,,
SUTURE REMOVAL,G0463,HCPCS,,,,,both,, ,132.61,79.56,Aetna,Commercial,,,,,132.61,,,,
URG CARE L1 EP PROF,G0463,HCPCS,,,,,both,, ,60.5,36.3,Aetna,Commercial,,,,,60.5,,,,
URG CARE L2 EP PROF,G0463,HCPCS,,,,,both,, ,123.25,73.95,Aetna,Commercial,,,,,123.25,,,,
URG CARE L2 EP PROF,G0463,HCPCS,,,,,both,, ,123.25,73.95,Aetna,Commercial,,,,,123.25,,,,
URG CARE L2 NP PROF,G0463,HCPCS,,,,,both,, ,213,127.8,Aetna,Commercial,,,,,213,,,,
URG CARE L3 EP PROF,G0463,HCPCS,,,,,both,, ,209.75,125.85,Aetna,Commercial,,,,,209.75,,,,
URG CARE L3 NP PROF,G0463,HCPCS,,,,,both,, ,312.5,187.5,Aetna,Commercial,,,,,312.5,,,,
URG CARE L4 EP PROF,G0463,HCPCS,,,,,both,, ,309.25,185.55,Aetna,Commercial,,,,,309.25,,,,
URG CARE L4 NP PROF,G0463,HCPCS,,,,,both,, ,483.5,290.1,Aetna,Commercial,,,,,483.5,,,,
URG CARE L5 EP PROF,G0463,HCPCS,,,,,both,, ,414.25,248.55,Aetna,Commercial,,,,,414.25,,,,
URG CARE L5 NP PROF,G0463,HCPCS,,,,,both,, ,602.5,361.5,Aetna,Commercial,,,,,602.5,,,,
URGENT CARE LVL 2 NP,G0463,HCPCS,,,,,both,, ,234.07,140.44,Aetna,Commercial,,,,,234.07,,,,
URGENT CARE LVL 2 NP,G0463,HCPCS,,,,,both,, ,234.07,140.44,Aetna,Commercial,,,,,234.07,,,,
URGENT CARE LVL 3 EP,G0463,HCPCS,,,,,both,, ,281.71,169.02,Aetna,Commercial,,,,,281.71,,,,
URGENT CARE LVL 3 EP,G0463,HCPCS,,,,,both,, ,281.71,169.02,Aetna,Commercial,,,,,281.71,,,,
URGENT CARE LVL 3 NP,G0463,HCPCS,,,,,both,, ,261.88,157.12,Aetna,Commercial,,,,,261.88,,,,
URGENT CARE LVL 3 NP,G0463,HCPCS,,,,,both,, ,261.88,157.12,Aetna,Commercial,,,,,261.88,,,,
URGENT CARE LVL 4 EP,G0463,HCPCS,,,,,both,, ,311.83,187.09,Aetna,Commercial,,,,,311.83,,,,
URGENT CARE LVL 4 EP,G0463,HCPCS,,,,,both,, ,311.83,187.09,Aetna,Commercial,,,,,311.83,,,,
URGENT CARE LVL 4 NP,G0463,HCPCS,,,,,both,, ,289.69,173.81,Aetna,Commercial,,,,,289.69,,,,
URGENT CARE LVL 4 NP,G0463,HCPCS,,,,,both,, ,289.69,173.81,Aetna,Commercial,,,,,289.69,,,,
URGENT CARE LVL 5 NP,G0463,HCPCS,,,,,both,, ,317.5,190.5,Aetna,Commercial,,,,,317.5,,,,
URGENT CARE LVL 5 NP,G0463,HCPCS,,,,,both,, ,317.5,190.5,Aetna,Commercial,,,,,317.5,,,,
URGENT CARE LVL 5 NP,G0463,HCPCS,,,,,both,, ,317.5,190.5,Aetna,Commercial,,,,,317.5,,,,
URGENT CARE LVL 5 NP,G0463,HCPCS,,,,,both,, ,317.5,190.5,Aetna,Commercial,,,,,317.5,,,,
URGENT CARE- SUT REM,G0463,HCPCS,,,,,both,, ,239.73,143.83,Aetna,Commercial,,,,,239.73,,,,
URGENT CARE- SUT REM,G0463,HCPCS,,,,,both,, ,239.73,143.83,Aetna,Commercial,,,,,239.73,,,,
URGENT CARE- SUT REM,G0463,HCPCS,,,,,both,, ,239.73,143.83,Aetna,Commercial,,,,,239.73,,,,
URGENT CARE- SUT REM,G0463,HCPCS,,,,,both,, ,239.73,143.83,Aetna,Commercial,,,,,239.73,,,,
EVAL & MGMT LEVEL 4,G0463,HCPCS,,,,,Outpatient,, ,237.25,142.35,Aetna,Commercial,,,,,237.25,,,,
"New patient office of other outpatient visit, typically 60 min",G0463,HCPCS,,,,,Outpatient,,,317.5,317.5,Aetna,Commercial,,224.16,70.6,,317.5,317.5,317.5,Fee Schedule,70.6
"New patient office of other outpatient visit, typically 45 min",G0463,HCPCS,,,,,Outpatient,,,289.69,289.69,Aetna,Commercial,,204.52,70.6,,289.69,289.69,289.69,Fee Schedule,70.6
"New patient office or other outpatient visit, typically 30 min",G0463,HCPCS,,,,,Outpatient,,,261.88,261.88,Aetna,Commercial,,184.89,70.6,,261.88,261.88,261.88,Fee Schedule,70.6
HIV1 AG W HIV 1 2 AB,G0475,HCPCS,,,,,both,, ,166.16,99.69,Aetna,Commercial,,,,,166.16,,,,
HEPB SCR HI RSK NPRG,G0499,HCPCS,,,,,both,, ,570.04,342.02,Aetna,Commercial,,,,,570.04,,,,
ABCIXIMAB 10MG,J0130,HCPCS,,,,,both,, ,4719.72,2831.83,Aetna,Commercial,,,,,4719.72,,,,
ACETAMINO 10MG INJ,J0131,HCPCS,,,,,both,100,ML,3,1.8,Aetna,Commercial,,,,,3,,,,
ACTYLCYSTN INJ 100MG,J0132,HCPCS,,,,,both,30,ML,17.77,10.66,Aetna,Commercial,,,,,17.77,,,,
ACYCLOVIR 5MG INJ,J0133,HCPCS,,,,,both,, ,0.31,0.18,Aetna,Commercial,,,,,0.31,,,,
ACYCLOVIR 5MG INJ,J0133,HCPCS,,,,,both,10,ML,1.03,0.61,Aetna,Commercial,,,,,1.03,,,,
ADENOSINE 1MG INJ,J0153,HCPCS,,,,,both,4,ML,15.45,9.27,Aetna,Commercial,,,,,15.45,,,,
ADENOSINE 1MG INJ,J0153,HCPCS,,,,,both,4,ML,15.45,9.27,Aetna,Commercial,,,,,15.45,,,,
ADRENL/EPINEP 0.1MG,J0171,HCPCS,,,,,both,1,ML,2.68,1.6,Aetna,Commercial,,,,,2.68,,,,
ADRENL/EPINEP 0.1MG,J0171,HCPCS,,,,,both,10,ML,8.65,5.19,Aetna,Commercial,,,,,8.65,,,,
EPINEPHRINE INJ 30MG/30ML (1 MG/ML),J0171,HCPCS,,,,,both,30,ML,4,2.4,Aetna,Commercial,,,,,4,,,,
REMDESIVIR 1MG INJ,J0248,HCPCS,,,,,both,1,EA,28,16.8,Aetna,Commercial,,,,,28,,,,
AMKCN SULF INJ 100MG,J0278,HCPCS,,,,,both,2,ML,5.56,3.33,Aetna,Commercial,,,,,5.56,,,,
AMINOPHYLL 250MG INJ,J0280,HCPCS,,,,,both,20,ML,58.97,35.38,Aetna,Commercial,,,,,58.97,,,,
AMINOPHYLL 250MG INJ,J0280,HCPCS,,,,,both,10,ML,96.31,57.78,Aetna,Commercial,,,,,96.31,,,,
AMIODARONE 30MG INJ,J0282,HCPCS,,,,,both,18,ML,5.15,3.09,Aetna,Commercial,,,,,5.15,,,,
AMIODARONE 30MG INJ,J0282,HCPCS,,,,,both,3,ML,6.39,3.83,Aetna,Commercial,,,,,6.39,,,,
AMPHOTER B 50MG INJ,J0285,HCPCS,,,,,both,, ,321.36,192.81,Aetna,Commercial,,,,,321.36,,,,
AMPHOTER B LIPO 10MG,J0289,HCPCS,,,,,both,1,EA,211.15,126.69,Aetna,Commercial,,,,,211.15,,,,
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,17,10.2,Aetna,Commercial,,,,,17,,,,
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,26.78,16.06,Aetna,Commercial,,,,,26.78,,,,
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,26.78,16.06,Aetna,Commercial,,,,,26.78,,,,
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,57.94,34.76,Aetna,Commercial,,,,,57.94,,,,
AMPICILLIN/SUB 1.5GM,J0295,HCPCS,,,,,both,1,EA,23.69,14.21,Aetna,Commercial,,,,,23.69,,,,
AMPICILLIN/SUB 1.5GM,J0295,HCPCS,,,,,both,, ,63.09,37.85,Aetna,Commercial,,,,,63.09,,,,
SUCCINYLCHN 20MG INJ,J0330,HCPCS,,,,,both,10,ML,13,7.8,Aetna,Commercial,,,,,13,,,,
SUCCINYLCHN 20MG INJ,J0330,HCPCS,,,,,both,, ,20.34,12.2,Aetna,Commercial,,,,,20.34,,,,
HYDRALAZINE 20MG INJ,J0360,HCPCS,,,,,both,1,ML,101.71,61.02,Aetna,Commercial,,,,,101.71,,,,
AZITHROMYC 500MG INJ,J0456,HCPCS,,,,,both,1,EA,40.69,24.41,Aetna,Commercial,,,,,40.69,,,,
ATROPINE 0.01 MG INJ,J0461,HCPCS,,,,,both,1,ML,2,1.2,Aetna,Commercial,,,,,2,,,,
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,, ,0.03,0.01,Aetna,Commercial,,,,,0.03,,,,
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,, ,0.62,0.37,Aetna,Commercial,,,,,0.62,,,,
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,10,ML,1.03,0.61,Aetna,Commercial,,,,,1.03,,,,
DIMERCAPRO 100MG INJ,J0470,HCPCS,,,,,both,, ,198.28,118.96,Aetna,Commercial,,,,,198.28,,,,
DICYCLOMINE 20MG INJ,J0500,HCPCS,,,,,both,2,ML,307.46,184.47,Aetna,Commercial,,,,,307.46,,,,
BENZTROPN MES 1MGINJ,J0515,HCPCS,,,,,both,2,ML,263.42,158.05,Aetna,Commercial,,,,,263.42,,,,
PCN G BENZ/PROC 100K,J0558,HCPCS,,,,,both,, ,34.25,20.55,Aetna,Commercial,,,,,34.25,,,,
PCN G BENZ/PROC 100K,J0558,HCPCS,,,,,both,, ,35.54,21.32,Aetna,Commercial,,,,,35.54,,,,
PEN G BENZ INJ 100K,J0561,HCPCS,,,,,both,2,ML,43,25.8,Aetna,Commercial,,,,,43,,,,
BIVALIRUDIN 1MG INJ,J0583,HCPCS,,,,,both,1,EA,18.28,10.96,Aetna,Commercial,,,,,18.28,,,,
BOTULINUM TOXI A 1U,J0585,HCPCS,,,,,both,1,EA,33.48,20.08,Aetna,Commercial,,,,,33.48,,,,
BUTORPHANOL 1MG INJ,J0595,HCPCS,,,,,both,1,ML,17.77,10.66,Aetna,Commercial,,,,,17.77,,,,
CINACALC 1MG PO ESRD,J0604,HCPCS,,,,,both,, ,6.18,3.7,Aetna,Commercial,,,,,6.18,,,,
CALCITRIOL .1MCG INJ,J0636,HCPCS,,,,,both,, ,4.33,2.59,Aetna,Commercial,,,,,4.33,,,,
LEUCOVORIN 50MG INJ,J0640,HCPCS,,,,,both,1,EA,84.46,50.67,Aetna,Commercial,,,,,84.46,,,,
MEPIVACAINE 10ML INJ,J0670,HCPCS,,,,,both,30,ML,19.31,11.58,Aetna,Commercial,,,,,19.31,,,,
MEPIVACAINE 10ML INJ,J0670,HCPCS,,,,,both,20,ML,21.89,13.13,Aetna,Commercial,,,,,21.89,,,,
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,12.88,7.72,Aetna,Commercial,,,,,12.88,,,,
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,12.88,7.72,Aetna,Commercial,,,,,12.88,,,,
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,, ,14.94,8.96,Aetna,Commercial,,,,,14.94,,,,
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,, ,14.94,8.96,Aetna,Commercial,,,,,14.94,,,,
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,22.4,13.44,Aetna,Commercial,,,,,22.4,,,,
CEFEPIME 500 MG INJ,J0692,CPT,,,,,both,1,EA,9,5.4,Aetna,Commercial,,,,,9,,,,
CEFEPIME 500MG INJ,J0692,HCPCS,,,,,both,, ,19.06,11.43,Aetna,Commercial,,,,,19.06,,,,
CEFEPIME 500MG INJ,J0692,HCPCS,,,,,both,1,EA,24.72,14.83,Aetna,Commercial,,,,,24.72,,,,
CEFOXITIN 1GM INJ,J0694,HCPCS,,,,,both,1,EA,53.82,32.29,Aetna,Commercial,,,,,53.82,,,,
CEFTO50-TAZO25MG INJ,J0695,HCPCS,,,,,both,1,EA,28.84,17.3,Aetna,Commercial,,,,,28.84,,,,
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,8.03,4.81,Aetna,Commercial,,,,,8.03,,,,
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,11.59,6.95,Aetna,Commercial,,,,,11.59,,,,
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,12.88,7.72,Aetna,Commercial,,,,,12.88,,,,
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,24.72,14.83,Aetna,Commercial,,,,,24.72,,,,
CEFUROXIME 750MG INJ,J0697,HCPCS,,,,,both,, ,23.69,14.21,Aetna,Commercial,,,,,23.69,,,,
CEFUROXIME 750MG INJ,J0697,HCPCS,,,,,both,, ,45.06,27.03,Aetna,Commercial,,,,,45.06,,,,
BETAM ACE/SOD PHO3MG,J0702,HCPCS,,,,,both,5,ML,56.14,33.68,Aetna,Commercial,,,,,56.14,,,,
CEFTAROLIN 10MG INJ,J0712,HCPCS,,,,,both,, ,16.48,9.88,Aetna,Commercial,,,,,16.48,,,,
CEFTAROLIN 10MG INJ,J0712,HCPCS,,,,,both,, ,24.72,14.83,Aetna,Commercial,,,,,24.72,,,,
COLISTIME UP TO 150M,J0770,CPT,,,,,both,1,EA,236.64,141.98,Aetna,Commercial,,,,,236.64,,,,
PROCHLORPE UPTO 10MG,J0780,HCPCS,,,,,both,, ,39.66,23.79,Aetna,Commercial,,,,,39.66,,,,
COSYNTROPN .25MG INJ,J0834,HCPCS,,,,,both,1,EA,687.78,412.66,Aetna,Commercial,,,,,687.78,,,,
DALBAVANCIN 5MG INJ,J0875,HCPCS,,,,,both,, ,85.75,51.45,Aetna,Commercial,,,,,85.75,,,,
DAPTOMYCIN 1 MG INJ,J0878,HCPCS,,,,,both,1,EA,3.5,2.1,Aetna,Commercial,,,,,3.5,,,,
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,38.88,23.32,Aetna,Commercial,,,,,38.88,,,,
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,38.88,23.32,Aetna,Commercial,,,,,38.88,,,,
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Aetna,Commercial,,,,,42.75,,,,
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Aetna,Commercial,,,,,42.75,,,,
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Aetna,Commercial,,,,,42.75,,,,
ARGATROBAN 1MG NESRD,J0883,HCPCS,,,,,both,2.5,ML,18.8,11.28,Aetna,Commercial,,,,,18.8,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,111.5,66.9,Aetna,Commercial,,,,,111.5,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,111.5,66.9,Aetna,Commercial,,,,,111.5,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,124.37,74.62,Aetna,Commercial,,,,,124.37,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Aetna,Commercial,,,,,162.74,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Aetna,Commercial,,,,,162.74,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Aetna,Commercial,,,,,162.74,,,,
DEFEROXAMIN 500MGINJ,J0895,HCPCS,,,,,both,1,EA,66.44,39.86,Aetna,Commercial,,,,,66.44,,,,
DEFEROXAMIN 500MGINJ,J0895,HCPCS,,,,,both,, ,132.87,79.72,Aetna,Commercial,,,,,132.87,,,,
DENOSUMAB 1MG INJ,J0897,HCPCS,,,,,both,1,ML,96.31,57.78,Aetna,Commercial,,,,,96.31,,,,
MEDROXYPROG 1MG INJ,J1050,HCPCS,,,,,both,1,ML,4.43,2.65,Aetna,Commercial,,,,,4.43,,,,
TESTOSTER CYPION 1MG,J1071,HCPCS,,,,,both,, ,0.93,0.55,Aetna,Commercial,,,,,0.93,,,,
TESTOSTER CYPION 1MG,J1071,HCPCS,,,,,both,, ,593.28,355.96,Aetna,Commercial,,,,,593.28,,,,
DEXAMETH NA 1MG INJ,J1100,HCPCS,,,,,both,1,ML,6.39,3.83,Aetna,Commercial,,,,,6.39,,,,
ACETAZOLAMI 500MGINJ,J1120,HCPCS,,,,,both,1,EA,308.49,185.09,Aetna,Commercial,,,,,308.49,,,,
DIGOXIN 0.5MG INJ,J1160,HCPCS,,,,,both,2,ML,47.12,28.27,Aetna,Commercial,,,,,47.12,,,,
DIGOXIN IMMUNE FAB,J1162,HCPCS,,,,,both,1,EA,6881.43,4128.85,Aetna,Commercial,,,,,6881.43,,,,
PHENYTOIN NA 50MGINJ,J1165,HCPCS,,,,,both,5,ML,5.36,3.21,Aetna,Commercial,,,,,5.36,,,,
PHENYTOIN NA 50MGINJ,J1165,HCPCS,,,,,both,2,ML,12.88,7.72,Aetna,Commercial,,,,,12.88,,,,
DEXRAZOXANE 25OMG IJ,J1190,HCPCS,,,,,both,, ,1352.91,811.74,Aetna,Commercial,,,,,1352.91,,,,
DIPHENHYDRAM 50MGINJ,J1200,HCPCS,,,,,both,1,ML,13.91,8.34,Aetna,Commercial,,,,,13.91,,,,
DIPYRIDAMOLE 10MGINJ,J1245,HCPCS,,,,,both,, ,26.78,16.06,Aetna,Commercial,,,,,26.78,,,,
DOBUTAMINE 250MG INJ,J1250,HCPCS,,,,,both,20,ML,28.84,17.3,Aetna,Commercial,,,,,28.84,,,,
DOBUTAMINE 250MG INJ,J1250,HCPCS,,,,,both,250,ML,78.28,46.96,Aetna,Commercial,,,,,78.28,,,,
DOPAMIN HCL 40MG INJ,J1265,HCPCS,,,,,both,250,ML,8.55,5.13,Aetna,Commercial,,,,,8.55,,,,
EPTIFABITIDE 5MG IJ,J1327,HCPCS,,,,,both,, ,164.8,98.88,Aetna,Commercial,,,,,164.8,,,,
ERTAPENEM SOD/500MG,J1335,HCPCS,,,,,both,1,EA,298.96,179.37,Aetna,Commercial,,,,,298.96,,,,
ERYTHROMYC 500MG INJ,J1364,HCPCS,,,,,both,1,EA,196.99,118.19,Aetna,Commercial,,,,,196.99,,,,
ESTROGEN CNJ 25MGINJ,J1410,HCPCS,,,,,both,, ,1016.61,609.96,Aetna,Commercial,,,,,1016.61,,,,
FER CARBOXYM 1MG INJ,J1439,HCPCS,,,,,both,15,ML,7,4.2,Aetna,Commercial,,,,,7,,,,
TBO-FILGRASTIM 1MCG,J1447,HCPCS,,,,,both,0.8,ML,4.53,2.71,Aetna,Commercial,,,,,4.53,,,,
TBO-FILGRASTIM 1MCG,J1447,HCPCS,,,,,both,0.8,ML,4.53,2.71,Aetna,Commercial,,,,,4.53,,,,
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,200,ML,32.19,19.31,Aetna,Commercial,,,,,32.19,,,,
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,50,ML,84.72,50.83,Aetna,Commercial,,,,,84.72,,,,
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,100,ML,144.72,86.83,Aetna,Commercial,,,,,144.72,,,,
"FOMEPIZOLE, 15 MG",J1451,HCPCS,,,,,both,1.5,ML,43.52,26.11,Aetna,Commercial,,,,,43.52,,,,
FOSAPREPITANT 1MG IJ,J1453,HCPCS,,,,,both,1,EA,10.82,6.49,Aetna,Commercial,,,,,10.82,,,,
IVIG (PRIVIGEN)500MG,J1459,HCPCS,,,,,both,200,ML,390.89,234.53,Aetna,Commercial,,,,,390.89,,,,
IVIG (PRIVIGEN)500MG,J1459,HCPCS,,,,,both,200,ML,390.89,234.53,Aetna,Commercial,,,,,390.89,,,,
IMMU GLOB LYO 500MG,J1566,HCPCS,,,,,both,, ,270.89,162.53,Aetna,Commercial,,,,,270.89,,,,
IMMU GLOB LYO 500MG,J1566,HCPCS,,,,,both,, ,270.89,162.53,Aetna,Commercial,,,,,270.89,,,,
IVIG (OCTAGAM) 500MG,J1568,HCPCS,,,,,both,100,ML,319.82,191.89,Aetna,Commercial,,,,,319.82,,,,
IVIG (OCTAGAM) 500MG,J1568,HCPCS,,,,,both,100,ML,319.82,191.89,Aetna,Commercial,,,,,319.82,,,,
GANCICLOVI SOD 500MG,J1570,HCPCS,,,,,both,1,EA,615.94,369.56,Aetna,Commercial,,,,,615.94,,,,
IVIG (FLEBOGAM)500MG,J1572,HCPCS,,,,,both,200,ML,256.99,154.19,Aetna,Commercial,,,,,256.99,,,,
IVIG (FLEBOGAM)500MG,J1572,HCPCS,,,,,both,200,ML,256.99,154.19,Aetna,Commercial,,,,,256.99,,,,
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,2,ML,24.72,14.83,Aetna,Commercial,,,,,24.72,,,,
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,, ,27.81,16.68,Aetna,Commercial,,,,,27.81,,,,
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,2,ML,28.84,17.3,Aetna,Commercial,,,,,28.84,,,,
GLUCAGON 1MG INJ,J1610,HCPCS,,,,,both,, ,710.19,426.11,Aetna,Commercial,,,,,710.19,,,,
GLUCAGON 1MG INJ,J1610,HCPCS,,,,,both,1,EA,1505,903,Aetna,Commercial,,,,,1505,,,,
HALOPERIDOL 5MG INJ,J1630,HCPCS,,,,,both,1,ML,68.5,41.1,Aetna,Commercial,,,,,68.5,,,,
HALOPER DEC 50MGINJ,J1631,HCPCS,,,,,both,1,ML,183.08,109.84,Aetna,Commercial,,,,,183.08,,,,
HALOPER DEC 50MGINJ,J1631,HCPCS,,,,,both,1,ML,217.33,130.39,Aetna,Commercial,,,,,217.33,,,,
HEPARIN NA 10U FLUSH,J1642,HCPCS,,,,,both,5,ML,0.52,0.31,Aetna,Commercial,,,,,0.52,,,,
HEPARIN NA 10U FLUSH,J1642,HCPCS,,,,,both,3,ML,0.93,0.55,Aetna,Commercial,,,,,0.93,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,2.16,1.29,Aetna,Commercial,,,,,2.16,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,5.67,3.4,Aetna,Commercial,,,,,5.67,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,6.39,3.83,Aetna,Commercial,,,,,6.39,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,19.57,11.74,Aetna,Commercial,,,,,19.57,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,500,ML,27.81,16.68,Aetna,Commercial,,,,,27.81,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,28.84,17.3,Aetna,Commercial,,,,,28.84,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,41.72,25.03,Aetna,Commercial,,,,,41.72,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,250,ML,76,45.6,Aetna,Commercial,,,,,76,,,,
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.8,ML,57.17,34.3,Aetna,Commercial,,,,,57.17,,,,
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.6,ML,57.17,34.3,Aetna,Commercial,,,,,57.17,,,,
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.4,ML,57.17,34.3,Aetna,Commercial,,,,,57.17,,,,
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.3,ML,57.17,34.3,Aetna,Commercial,,,,,57.17,,,,
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,1,ML,57.17,34.3,Aetna,Commercial,,,,,57.17,,,,
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,38.37,23.02,Aetna,Commercial,,,,,38.37,,,,
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,51.24,30.74,Aetna,Commercial,,,,,51.24,,,,
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,76.74,46.04,Aetna,Commercial,,,,,76.74,,,,
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,85.49,51.29,Aetna,Commercial,,,,,85.49,,,,
TETANUS IG HUM 250U,J1670,HCPCS,,,,,both,1,ML,1976.31,1185.78,Aetna,Commercial,,,,,1976.31,,,,
HYDROCORTIS 100MGINJ,J1720,HCPCS,,,,,both,1,EA,48.15,28.89,Aetna,Commercial,,,,,48.15,,,,
MELOXICAM 1MG INJ,J1738,HCPCS,,,,,both,1,ML,566,339.6,Aetna,Commercial,,,,,566,,,,
IBUTILIDE 1MG INJ,J1742,HCPCS,,,,,both,, ,1612.21,967.32,Aetna,Commercial,,,,,1612.21,,,,
INFLIXIMAB 10 MG INJ,J1745,HCPCS,,,,,both,1,EA,560.84,336.5,Aetna,Commercial,,,,,560.84,,,,
IRON DEX165 INJ 50MG,J1750,HCPCS,,,,,both,, ,132.87,79.72,Aetna,Commercial,,,,,132.87,,,,
IRON SUCROSE 1MG INJ,J1756,HCPCS,,,,,both,, ,4.22,2.53,Aetna,Commercial,,,,,4.22,,,,
DROPERIDOL UP TO 5MG,J1790,HCPCS,,,,,both,2,ML,27.81,16.68,Aetna,Commercial,,,,,27.81,,,,
INSULIN 1 UNT INJ,J1815,CPT,,,,,both,10,ML,1,0.6,Aetna,Commercial,,,,,1,,,,
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,, ,6.39,3.83,Aetna,Commercial,,,,,6.39,,,,
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,1,ML,12.88,7.72,Aetna,Commercial,,,,,12.88,,,,
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,1,ML,25.75,15.45,Aetna,Commercial,,,,,25.75,,,,
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,10,ML,5.67,3.4,Aetna,Commercial,,,,,5.67,,,,
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,4,ML,12.88,7.72,Aetna,Commercial,,,,,12.88,,,,
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,2,ML,25.75,15.45,Aetna,Commercial,,,,,25.75,,,,
LUPR 3.75FEMALE/PEDS,J1950,HCPCS,,,,,both,1,EA,6029.88,3617.92,Aetna,Commercial,,,,,6029.88,,,,
LEVETIRACET 10MG INJ,J1953,HCPCS,,,,,both,5,ML,1.18,0.7,Aetna,Commercial,,,,,1.18,,,,
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,100,ML,58.45,35.07,Aetna,Commercial,,,,,58.45,,,,
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,150,ML,68.24,40.94,Aetna,Commercial,,,,,68.24,,,,
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,50,ML,78.28,46.96,Aetna,Commercial,,,,,78.28,,,,
LINEZOLID 200 MG,J2020,HCPCS,,,,,both,300,ML,225.31,135.18,Aetna,Commercial,,,,,225.31,,,,
LINEZOLID 200 MG,J2020,HCPCS,,,,,both,, ,258.79,155.27,Aetna,Commercial,,,,,258.79,,,,
LORAZEPAM 2MG INJ,J2060,HCPCS,,,,,both,1,ML,19.57,11.74,Aetna,Commercial,,,,,19.57,,,,
LORAZEPAM INJ 2MG/ML 10 ML MDV,J2060,HCPCS,,,,,both,, ,15.14,9.08,Aetna,Commercial,,,,,15.14,,,,
MANNITOL 25% 50MLINJ,J2150,HCPCS,,,,,both,50,ML,24.72,14.83,Aetna,Commercial,,,,,24.72,,,,
MEPERID HCL 100MGINJ,J2175,HCPCS,,,,,both,1,ML,16.48,9.88,Aetna,Commercial,,,,,16.48,,,,
MEROPENEMBR 100MGINJ,J2184,HCPCS,,,,,both,, ,18.28,10.96,Aetna,Commercial,,,,,18.28,,,,
MEROPENEM 100MG INJ,J2185,HCPCS,,,,,both,1,EA,8.96,5.37,Aetna,Commercial,,,,,8.96,,,,
MEROPENEM 100MG INJ,J2185,HCPCS,,,,,both,1,EA,8.96,5.37,Aetna,Commercial,,,,,8.96,,,,
METHYLERGONV .2MGINJ,J2210,HCPCS,,,,,both,1,ML,47.12,28.27,Aetna,Commercial,,,,,47.12,,,,
METHYLNALTR .1MG INJ,J2212,HCPCS,,,,,both,, ,4.33,2.59,Aetna,Commercial,,,,,4.33,,,,
MICAFUNGIN 1MG INJ,J2248,HCPCS,,,,,both,1,EA,11.59,6.95,Aetna,Commercial,,,,,11.59,,,,
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,10,ML,1.03,0.61,Aetna,Commercial,,,,,1.03,,,,
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,5,ML,3.09,1.85,Aetna,Commercial,,,,,3.09,,,,
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,2,ML,7,4.2,Aetna,Commercial,,,,,7,,,,
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,, ,8.34,5,Aetna,Commercial,,,,,8.34,,,,
MIDAZOL HCL WG 1MG,J2251,HCPCS,,,,,both,50,ML,3.25,1.95,Aetna,Commercial,,,,,3.25,,,,
MILRINONE 5MG INJ,J2260,HCPCS,,,,,both,100,ML,32.19,19.31,Aetna,Commercial,,,,,32.19,,,,
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,1.03,0.61,Aetna,Commercial,,,,,1.03,,,,
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,5.15,3.09,Aetna,Commercial,,,,,5.15,,,,
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Aetna,Commercial,,,,,14.94,,,,
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Aetna,Commercial,,,,,14.94,,,,
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Aetna,Commercial,,,,,14.94,,,,
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,14.75,8.85,Aetna,Commercial,,,,,14.75,,,,
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,14.94,8.96,Aetna,Commercial,,,,,14.94,,,,
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,16,9.6,Aetna,Commercial,,,,,16,,,,
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,, ,86.78,52.06,Aetna,Commercial,,,,,86.78,,,,
NALBUPHINE 10MG INJ,J2300,HCPCS,,,,,both,1,ML,25.75,15.45,Aetna,Commercial,,,,,25.75,,,,
NALOXONE HCL 1MG INJ,J2310,HCPCS,,,,,both,1,ML,133.9,80.34,Aetna,Commercial,,,,,133.9,,,,
NALOXONE HCL 1MG INJ,J2310,HCPCS,,,,,both,2,ML,139.31,83.58,Aetna,Commercial,,,,,139.31,,,,
OCRELIZUMAB 1MG INJ,J2350,HCPCS,,,,,both,10,ML,133.9,80.34,Aetna,Commercial,,,,,133.9,,,,
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,1,ML,21.37,12.82,Aetna,Commercial,,,,,21.37,,,,
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,1,ML,42.23,25.33,Aetna,Commercial,,,,,42.23,,,,
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,, ,280.16,168.09,Aetna,Commercial,,,,,280.16,,,,
ORPHENADR UP TO 60MG,J2360,HCPCS,,,,,both,2,ML,156.3,93.78,Aetna,Commercial,,,,,156.3,,,,
CHLOROPR HCL INJ 1MG,J2401,HCPCS,,,,,both,20,ML,0.3,0.18,Aetna,Commercial,,,,,0.3,,,,
ONDANSETRON 1MG INJ,J2405,HCPCS,,,,,both,2,ML,42.23,25.33,Aetna,Commercial,,,,,42.23,,,,
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.75,ML,42.23,25.33,Aetna,Commercial,,,,,42.23,,,,
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.25,ML,58.97,35.38,Aetna,Commercial,,,,,58.97,,,,
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,1,ML,58.97,35.38,Aetna,Commercial,,,,,58.97,,,,
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,1.5,ML,58.97,35.38,Aetna,Commercial,,,,,58.97,,,,
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.5,ML,61.03,36.61,Aetna,Commercial,,,,,61.03,,,,
PAMIDRONATE 30MG IJ,J2430,HCPCS,,,,,both,10,ML,193.64,116.18,Aetna,Commercial,,,,,193.64,,,,
PAMIDRONATE 30MG IJ,J2430,HCPCS,,,,,both,, ,1208.71,725.22,Aetna,Commercial,,,,,1208.71,,,,
PAPAVERINE UPTO 60MG,J2440,HCPCS,,,,,both,, ,302.05,181.23,Aetna,Commercial,,,,,302.05,,,,
PALONOSETRON 25MCG,J2469,HCPCS,,,,,both,, ,250.55,150.33,Aetna,Commercial,,,,,250.55,,,,
PANTOPRAZOLE SOD VL,J2470,HCPCS,,,,,both,1,EA,41.72,25.03,Aetna,Commercial,,,,,41.72,,,,
PARICALCITOL 1MCGINJ,J2501,HCPCS,,,,,both,1,ML,25.75,15.45,Aetna,Commercial,,,,,25.75,,,,
PENICI G POT .6MUINJ,J2540,HCPCS,,,,,both,, ,11.33,6.79,Aetna,Commercial,,,,,11.33,,,,
PENICI G POT .6MUINJ,J2540,HCPCS,,,,,both,1,EA,11.59,6.95,Aetna,Commercial,,,,,11.59,,,,
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,41.97,25.18,Aetna,Commercial,,,,,41.97,,,,
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,44.55,26.73,Aetna,Commercial,,,,,44.55,,,,
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,48.15,28.89,Aetna,Commercial,,,,,48.15,,,,
PROMETHAZI UPTO 50MG,J2550,HCPCS,,,,,both,1,ML,24.72,14.83,Aetna,Commercial,,,,,24.72,,,,
PHENOBARB 120MG INJ,J2560,HCPCS,,,,,both,1,ML,167.89,100.73,Aetna,Commercial,,,,,167.89,,,,
PHENOBARB 120MG INJ,J2560,HCPCS,,,,,both,, ,232.78,139.66,Aetna,Commercial,,,,,232.78,,,,
OXYTOCIN UP TO 10UN,J2590,HCPCS,,,,,both,1,ML,27.81,16.68,Aetna,Commercial,,,,,27.81,,,,
DESMOPRESSIN 1MCGINJ,J2597,HCPCS,,,,,both,1,ML,13.91,8.34,Aetna,Commercial,,,,,13.91,,,,
FLUPHENZI UP TO 25MG,J2680,HCPCS,,,,,both,5,ML,139.05,83.43,Aetna,Commercial,,,,,139.05,,,,
PROCAINAMID UPTO 1GM,J2690,HCPCS,,,,,both,2,ML,95.79,57.47,Aetna,Commercial,,,,,95.79,,,,
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,20,ML,1.44,0.86,Aetna,Commercial,,,,,1.44,,,,
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,100,ML,2.68,1.6,Aetna,Commercial,,,,,2.68,,,,
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,100,ML,2.68,1.6,Aetna,Commercial,,,,,2.68,,,,
NEOSTIGMINE .5MG INJ,J2710,HCPCS,,,,,both,10,ML,13.91,8.34,Aetna,Commercial,,,,,13.91,,,,
NEOSTIGMINE .5MG INJ,J2710,HCPCS,,,,,both,5,ML,19.57,11.74,Aetna,Commercial,,,,,19.57,,,,
PROTAMINE 10MG INJ,J2720,HCPCS,,,,,both,5,ML,12.88,7.72,Aetna,Commercial,,,,,12.88,,,,
PHENTOLAMINE 5MG INJ,J2760,HCPCS,,,,,both,1,EA,968.46,581.07,Aetna,Commercial,,,,,968.46,,,,
METOCLOPRAM 10MG INJ,J2765,HCPCS,,,,,both,2,ML,24.72,14.83,Aetna,Commercial,,,,,24.72,,,,
REGADENOSON 0.1MG IJ,J2785,HCPCS,,,,,both,5,ML,335.01,201,Aetna,Commercial,,,,,335.01,,,,
RHOPHYLAC 100UNT,J2791,HCPCS,,,,,both,2,ML,62.83,37.69,Aetna,Commercial,,,,,62.83,,,,
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,28.33,16.99,Aetna,Commercial,,,,,28.33,,,,
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,34.25,20.55,Aetna,Commercial,,,,,34.25,,,,
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,37.08,22.24,Aetna,Commercial,,,,,37.08,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,20,ML,1.03,0.61,Aetna,Commercial,,,,,1.03,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,20,ML,1.03,0.61,Aetna,Commercial,,,,,1.03,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,30,ML,1.03,0.61,Aetna,Commercial,,,,,1.03,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,, ,1.65,0.99,Aetna,Commercial,,,,,1.65,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,100,ML,1.96,1.17,Aetna,Commercial,,,,,1.96,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,10,ML,2.16,1.29,Aetna,Commercial,,,,,2.16,,,,
SINCALIDE INJ 5MCG,J2805,HCPCS,,,,,both,1,EA,670.53,402.31,Aetna,Commercial,,,,,670.53,,,,
SOD FERRIC 12.5MGINJ,J2916,HCPCS,,,,,both,5,ML,53.56,32.13,Aetna,Commercial,,,,,53.56,,,,
RETEPLASE 18.1MG IJ,J2993,HCPCS,,,,,both,, ,7366,4419.6,Aetna,Commercial,,,,,7366,,,,
ALTEPLASE RECOM 1MG,J2997,HCPCS,,,,,both,1,EA,347.11,208.26,Aetna,Commercial,,,,,347.11,,,,
ALTEPLASE RECOM 1MG,J2997,HCPCS,,,,,both,1,EA,353.55,212.13,Aetna,Commercial,,,,,353.55,,,,
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,5,ML,6.59,3.95,Aetna,Commercial,,,,,6.59,,,,
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,2,ML,14.42,8.65,Aetna,Commercial,,,,,14.42,,,,
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,1,ML,17.25,10.35,Aetna,Commercial,,,,,17.25,,,,
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,100,ML,20.25,12.15,Aetna,Commercial,,,,,20.25,,,,
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,20,ML,49.44,29.66,Aetna,Commercial,,,,,49.44,,,,
SUMATRIPTAN 6MG INJ,J3030,HCPCS,,,,,both,0.5,ML,631.91,379.14,Aetna,Commercial,,,,,631.91,,,,
TENECTEPLASE 1MG INJ,J3101,HCPCS,,,,,both,1,EA,402.47,241.48,Aetna,Commercial,,,,,402.47,,,,
TERBUTALINE 1MG INJ,J3105,HCPCS,,,,,both,1,ML,28.84,17.3,Aetna,Commercial,,,,,28.84,,,,
CHLORPROM UP TO 50MG,J3230,HCPCS,,,,,both,, ,161.71,97.02,Aetna,Commercial,,,,,161.71,,,,
CHLORPROM UP TO 50MG,J3230,HCPCS,,,,,both,2,ML,185.4,111.24,Aetna,Commercial,,,,,185.4,,,,
TIGECYCLINE 1 MG INJ,J3243,HCPCS,,,,,both,, ,11.33,6.79,Aetna,Commercial,,,,,11.33,,,,
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,250,ML,60,36,Aetna,Commercial,,,,,60,,,,
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,100,ML,75.71,45.42,Aetna,Commercial,,,,,75.71,,,,
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,15,ML,91.16,54.69,Aetna,Commercial,,,,,91.16,,,,
TRIMETHOBEN 200MGINJ,J3250,HCPCS,,,,,both,, ,26.78,16.06,Aetna,Commercial,,,,,26.78,,,,
TOBRAMYCIN UPTO 80MG,J3260,HCPCS,,,,,both,1,EA,71.84,43.1,Aetna,Commercial,,,,,71.84,,,,
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,4,ML,28.58,17.14,Aetna,Commercial,,,,,28.58,,,,
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,20,ML,28.58,17.14,Aetna,Commercial,,,,,28.58,,,,
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,10,ML,28.58,17.14,Aetna,Commercial,,,,,28.58,,,,
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,, ,18.28,10.96,Aetna,Commercial,,,,,18.28,,,,
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,, ,18.28,10.96,Aetna,Commercial,,,,,18.28,,,,
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,, ,18.54,11.12,Aetna,Commercial,,,,,18.54,,,,
DIAZEPAM 5MG INJ,J3360,HCPCS,,,,,both,2,ML,100.94,60.56,Aetna,Commercial,,,,,100.94,,,,
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,1,EA,58.97,35.38,Aetna,Commercial,,,,,58.97,,,,
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,1,EA,58.97,35.38,Aetna,Commercial,,,,,58.97,,,,
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,, ,62.32,37.39,Aetna,Commercial,,,,,62.32,,,,
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,300,ML,60,36,Aetna,Commercial,,,,,60,,,,
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,350,ML,68,40.8,Aetna,Commercial,,,,,68,,,,
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,250,ML,75,45,Aetna,Commercial,,,,,75,,,,
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,150,ML,95,57,Aetna,Commercial,,,,,95,,,,
VEDOLIZUMAB 1MG INJ,J3380,HCPCS,,,,,both,1,EA,96.31,57.78,Aetna,Commercial,,,,,96.31,,,,
HYDROXYZI UP TO 25MG,J3410,HCPCS,,,,,both,, ,13.91,8.34,Aetna,Commercial,,,,,13.91,,,,
THIAMINE 100MG INJ,J3411,HCPCS,,,,,both,2,ML,44.03,26.41,Aetna,Commercial,,,,,44.03,,,,
PYRIDOXINE 100MG INJ,J3415,HCPCS,,,,,both,1,ML,79.31,47.58,Aetna,Commercial,,,,,79.31,,,,
VIT B12 CYAN 1000MCG,J3420,HCPCS,,,,,both,1,ML,84.72,50.83,Aetna,Commercial,,,,,84.72,,,,
PHYTONADIONE 1MG INJ,J3430,HCPCS,,,,,both,0.5,ML,27.81,16.68,Aetna,Commercial,,,,,27.81,,,,
PHYTONADIONE 1MG INJ,J3430,HCPCS,,,,,both,1,ML,31.93,19.15,Aetna,Commercial,,,,,31.93,,,,
HYALURONID RECOM 1UN,J3473,HCPCS,,,,,both,1,ML,3.19,1.91,Aetna,Commercial,,,,,3.19,,,,
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,500,ML,1.13,0.67,Aetna,Commercial,,,,,1.13,,,,
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,20,ML,2.99,1.79,Aetna,Commercial,,,,,2.99,,,,
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,2,ML,12.88,7.72,Aetna,Commercial,,,,,12.88,,,,
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,, ,13.91,8.34,Aetna,Commercial,,,,,13.91,,,,
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,50,ML,14.94,8.96,Aetna,Commercial,,,,,14.94,,,,
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,100,ML,1.03,0.61,Aetna,Commercial,,,,,1.03,,,,
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,100,ML,1.03,0.61,Aetna,Commercial,,,,,1.03,,,,
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,, ,2.68,1.6,Aetna,Commercial,,,,,2.68,,,,
ZIDOVUDINE 10MG INJ,J3485,HCPCS,,,,,both,, ,12.36,7.41,Aetna,Commercial,,,,,12.36,,,,
ZIPRSIDNE MESYL 10MG,J3486,HCPCS,,,,,both,1,EA,77.77,46.66,Aetna,Commercial,,,,,77.77,,,,
ZOLEDRONIC ACID 1MG,J3489,HCPCS,,,,,both,100,ML,332.69,199.61,Aetna,Commercial,,,,,332.69,,,,
ZOLEDRONIC ACID 1MG,J3489,HCPCS,,,,,both,5,ML,1005.8,603.48,Aetna,Commercial,,,,,1005.8,,,,
BRIVARACETAM 50MG TB,J3490,HCPCS,,,,,both,60,EA,172.75,103.65,Aetna,Commercial,,,,,172.75,,,,
NORM SALIN 1000ML IV,J7030,HCPCS,,,,,both,1000,ML,25.75,15.45,Aetna,Commercial,,,,,25.75,,,,
NORM SAL STER500MLIV,J7040,HCPCS,,,,,both,500,ML,25.75,15.45,Aetna,Commercial,,,,,25.75,,,,
D5W/SOD CHL.9% 500ML,J7042,HCPCS,,,,,both,1000,ML,12.88,7.72,Aetna,Commercial,,,,,12.88,,,,
NORM SALINE 250ML IV,J7050,HCPCS,,,,,both,250,ML,26.78,16.06,Aetna,Commercial,,,,,26.78,,,,
SOD CHLOR .9% 100ML,J7050,HCPCS,,,,,both,100,ML,25.75,15.45,Aetna,Commercial,,,,,25.75,,,,
SOD CHLOR .9% 100ML,J7050,HCPCS,,,,,both,100,ML,68.5,41.1,Aetna,Commercial,,,,,68.5,,,,
SOD CHLOR .9% 150ML,J7050,HCPCS,,,,,both,150,ML,25.75,15.45,Aetna,Commercial,,,,,25.75,,,,
SOD CHLOR .9% 50ML,J7050,HCPCS,,,,,both,50,ML,25.75,15.45,Aetna,Commercial,,,,,25.75,,,,
SOD CHLOR .9% 50ML,J7050,HCPCS,,,,,both,50,ML,41.72,25.03,Aetna,Commercial,,,,,41.72,,,,
DEX 5%/WATER 500ML,J7060,HCPCS,,,,,both,, ,24.72,14.83,Aetna,Commercial,,,,,24.72,,,,
DEX 5%/WATER 500ML,J7060,HCPCS,,,,,both,500,ML,25.75,15.45,Aetna,Commercial,,,,,25.75,,,,
DEX 5%/WATER 1000ML,J7070,HCPCS,,,,,both,1000,ML,25.75,15.45,Aetna,Commercial,,,,,25.75,,,,
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,1000,ML,24.72,14.83,Aetna,Commercial,,,,,24.72,,,,
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,500,ML,25.75,15.45,Aetna,Commercial,,,,,25.75,,,,
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,, ,28.84,17.3,Aetna,Commercial,,,,,28.84,,,,
D5LR UP TO 1000ML,J7121,HCPCS,,,,,both,1000,ML,25.75,15.45,Aetna,Commercial,,,,,25.75,,,,
PROTHROMB COM 1UN IX,J7168,HCPCS,,,,,both,1,EA,12.25,7.35,Aetna,Commercial,,,,,12.25,,,,
PROTHROMB COM 1UN IX,J7168,CPT,,,,,both,1,EA,12.62,7.57,Aetna,Commercial,,,,,12.62,,,,
MOMETA SIN IMP 10MCG,J7402,HCPCS,,,,,both,, ,54.59,32.75,Aetna,Commercial,,,,,54.59,,,,
AZATHIOPRINE 50MG TB,J7500,HCPCS,,,,,both,100,EA,20.34,12.2,Aetna,Commercial,,,,,20.34,,,,
CYCLOSPORNE 100MG PO,J7502,HCPCS,,,,,both,, ,41.2,24.72,Aetna,Commercial,,,,,41.2,,,,
TACROLIMUS 1MG PO,J7507,HCPCS,,,,,both,100,EA,27.3,16.38,Aetna,Commercial,,,,,27.3,,,,
METHYLPREDNIS 4MG PO,J7509,HCPCS,,,,,both,, ,8.55,5.13,Aetna,Commercial,,,,,8.55,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.1,0.06,Aetna,Commercial,,,,,0.1,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.31,0.18,Aetna,Commercial,,,,,0.31,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.72,0.43,Aetna,Commercial,,,,,0.72,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,1.34,0.8,Aetna,Commercial,,,,,1.34,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,, ,7,4.2,Aetna,Commercial,,,,,7,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,, ,107.38,64.42,Aetna,Commercial,,,,,107.38,,,,
CYCLOSPORINE 25MG PO,J7515,HCPCS,,,,,both,, ,19.31,11.58,Aetna,Commercial,,,,,19.31,,,,
CYCLOSPOR PAREN250MG,J7516,HCPCS,,,,,both,, ,191.84,115.1,Aetna,Commercial,,,,,191.84,,,,
MYCOPHE MOF 250MG PO,J7517,HCPCS,,,,,both,100,EA,41.46,24.87,Aetna,Commercial,,,,,41.46,,,,
METHACHOL 1MGINH NEB,J7674,HCPCS,,,,,both,1,EA,4.84,2.9,Aetna,Commercial,,,,,4.84,,,,
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,, ,13.39,8.03,Aetna,Commercial,,,,,13.39,,,,
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,, ,49.18,29.5,Aetna,Commercial,,,,,49.18,,,,
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,100,EA,53.56,32.13,Aetna,Commercial,,,,,53.56,,,,
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,, ,0.52,0.31,Aetna,Commercial,,,,,0.52,,,,
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,100,EA,1.34,0.8,Aetna,Commercial,,,,,1.34,,,,
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,, ,3.5,2.1,Aetna,Commercial,,,,,3.5,,,,
METHOTREXATE 2.5MGPO,J8610,HCPCS,,,,,both,100,EA,20.34,12.2,Aetna,Commercial,,,,,20.34,,,,
LEUCOVOR CAL 25MG TB,J8999,HCPCS,,,,,both,20,EA,78.54,47.12,Aetna,Commercial,,,,,78.54,,,,
BENDAMUSTINE 1MG INJ,J9033,HCPCS,,,,,both,, ,147.81,88.68,Aetna,Commercial,,,,,147.81,,,,
BENDAMUSTINE 1MG INJ,J9033,HCPCS,,,,,both,, ,147.81,88.68,Aetna,Commercial,,,,,147.81,,,,
BORTEZOMIB .1MG INJ,J9041,HCPCS,,,,,both,, ,265.74,159.44,Aetna,Commercial,,,,,265.74,,,,
CARBOPLATIN 50MG INJ,J9045,HCPCS,,,,,both,45,ML,61.03,36.61,Aetna,Commercial,,,,,61.03,,,,
CISPLAT POW/SOL 10MG,J9060,HCPCS,,,,,both,50,ML,5.36,3.21,Aetna,Commercial,,,,,5.36,,,,
DOCETAXEL 1MG INJ,J9171,HCPCS,,,,,both,, ,87.81,52.68,Aetna,Commercial,,,,,87.81,,,,
FLUOROURACIL 500MG,J9190,HCPCS,,,,,both,, ,25.75,15.45,Aetna,Commercial,,,,,25.75,,,,
GEMCITABIN 200MG INJ,J9201,HCPCS,,,,,both,1,EA,616.97,370.18,Aetna,Commercial,,,,,616.97,,,,
GEMCITABIN 200MG INJ,J9201,HCPCS,,,,,both,, ,690.87,414.52,Aetna,Commercial,,,,,690.87,,,,
IPILIMUMAB 1MG INJ,J9228,HCPCS,,,,,both,40,ML,777.65,466.59,Aetna,Commercial,,,,,777.65,,,,
OXALIPLATIN .5MG INJ,J9263,HCPCS,,,,,both,10,ML,6.39,3.83,Aetna,Commercial,,,,,6.39,,,,
PACLITAXEL 1MG INJ,J9267,HCPCS,,,,,both,, ,3.71,2.22,Aetna,Commercial,,,,,3.71,,,,
PERTUZUMAB 1MG INJ,J9306,HCPCS,,,,,both,14,ML,61.03,36.61,Aetna,Commercial,,,,,61.03,,,,
TRASTUZUMAB 10MG INJ,J9355,HCPCS,,,,,both,, ,531.22,318.73,Aetna,Commercial,,,,,531.22,,,,
POST OP SHOES,L3260,HCPCS,,,,,both,, ,12,7.2,Aetna,Commercial,,,,,12,,,,
ADM IV INF CASI IMDV,M0243,HCPCS,,,,,both,, ,851.55,510.93,Aetna,Commercial,,,,,851.55,,,,
ADM IV INF CASI IMDV,M0243,HCPCS,,,,,both,, ,1340.29,804.17,Aetna,Commercial,,,,,1340.29,,,,
ADM IV INF BAM ETES,M0245,HCPCS,,,,,both,, ,1301.25,780.75,Aetna,Commercial,,,,,1301.25,,,,
ADM IV INF SOTROVIM,M0247,HCPCS,,,,,both,, ,1301.25,780.75,Aetna,Commercial,,,,,1301.25,,,,
"PAP SMEAR, SCREEN",P3000,HCPCS,,,,,both,, ,101.6,60.96,Aetna,Commercial,,,,,101.6,,,,
S-H CRYO EACH UNIT,P9012,HCPCS,,,,,both,, ,283.48,170.08,Aetna,Commercial,,,,,283.48,,,,
S-H RBC LEUKO REDU,P9016,HCPCS,,,,,both,, ,884.69,530.81,Aetna,Commercial,,,,,884.69,,,,
S-H 1 DONOR FFP,P9017,HCPCS,,,,,both,, ,638.53,383.11,Aetna,Commercial,,,,,638.53,,,,
S-H RED BLD-UNIT,P9021,HCPCS,,,,,both,, ,737.05,442.23,Aetna,Commercial,,,,,737.05,,,,
S-H PLAT PHERE L-R,P9035,HCPCS,,,,,both,, ,2646.2,1587.72,Aetna,Commercial,,,,,2646.2,,,,
S-H PLAT A-P L-R IRR,P9037,HCPCS,,,,,both,, ,2796.36,1677.81,Aetna,Commercial,,,,,2796.36,,,,
S-H RBC IRRAD,P9038,HCPCS,,,,,both,, ,1013.8,608.28,Aetna,Commercial,,,,,1013.8,,,,
S-H RBC L-R IRRAD,P9040,HCPCS,,,,,both,, ,1025.03,615.01,Aetna,Commercial,,,,,1025.03,,,,
S-H CRYOPRE REDU PLS,P9044,HCPCS,,,,,both,, ,614.12,368.47,Aetna,Commercial,,,,,614.12,,,,
ALBUMIN 5% 250ML IV,P9045,HCPCS,,,,,both,250,ML,528.13,316.87,Aetna,Commercial,,,,,528.13,,,,
ALBUMIN 25% 50ML IV,P9047,HCPCS,,,,,both,100,ML,408.14,244.88,Aetna,Commercial,,,,,408.14,,,,
ALBUMIN 25% 50ML IV,P9047,HCPCS,,,,,both,50,ML,623.92,374.35,Aetna,Commercial,,,,,623.92,,,,
S-H BLD L-R CMV- EA,P9051,HCPCS,,,,,both,, ,1025.03,615.01,Aetna,Commercial,,,,,1025.03,,,,
S-H FFP BTWN8-24HREA,P9059,HCPCS,,,,,both,, ,634.6,380.76,Aetna,Commercial,,,,,634.6,,,,
FERUMOXYTOL1MG NESRD,Q0138,HCPCS,,,,,both,17,ML,9.68,5.8,Aetna,Commercial,,,,,9.68,,,,
CHLORPROMAZIN 5MG PO,Q0161,HCPCS,,,,,both,1,EA,4.12,2.47,Aetna,Commercial,,,,,4.12,,,,
CHLORPROMAZIN 5MG PO,Q0161,HCPCS,,,,,both,, ,7.52,4.51,Aetna,Commercial,,,,,7.52,,,,
ONDANSETRON 1MG PO,Q0162,HCPCS,,,,,both,, ,33.73,20.23,Aetna,Commercial,,,,,33.73,,,,
ONDANSETRON 1MG PO,Q0162,HCPCS,,,,,both,50,ML,34.25,20.55,Aetna,Commercial,,,,,34.25,,,,
TELEHEALTH IP NEURO,Q3014,HCPCS,,,,,both,, ,83.25,49.95,Aetna,Commercial,,,,,83.25,,,,
TOTAL CONTACT CAST 3 INCH,Q4038,HCPCS,,,,,both,, ,456,273.6,Aetna,Commercial,,,,,456,,,,
TOTAL CONTACT CAST 4 INCH,Q4038,HCPCS,,,,,both,, ,469.68,281.8,Aetna,Commercial,,,,,469.68,,,,
TOTAL CONTACT CAST BOOT LARGE,Q4038,HCPCS,,,,,both,, ,307.8,184.68,Aetna,Commercial,,,,,307.8,,,,
TOTAL CONTACT CAST BOOT X-LARGE,Q4038,HCPCS,,,,,both,, ,323,193.8,Aetna,Commercial,,,,,323,,,,
OASIS WOUND MAT SQCM,Q4102,HCPCS,,,,,both,, ,10.82,6.49,Aetna,Commercial,,,,,10.82,,,,
INTEGRA BMWD SQ CM,Q4104,HCPCS,,,,,both,, ,599.72,359.83,Aetna,Commercial,,,,,599.72,,,,
INTEGRA SKIN SUB 5X5CM,Q4108,HCPCS,,,,,both,, ,4404,2642.4,Aetna,Commercial,,,,,4404,,,,
DERMACELL SQ CM,Q4122,HCPCS,,,,,both,, ,166.86,100.11,Aetna,Commercial,,,,,166.86,,,,
OASIS ULTRA TRI SQCM,Q4124,HCPCS,,,,,both,, ,31.93,19.15,Aetna,Commercial,,,,,31.93,,,,
ACELL DERM MAT 1SQCM,Q4126,HCPCS,,,,,both,, ,133.9,80.34,Aetna,Commercial,,,,,133.9,,,,
1AMNIOEXCEL SKIN 1.5X1.5CM,Q4137,HCPCS,,,,,both,, ,2544,1526.4,Aetna,Commercial,,,,,2544,,,,
AMNIOEXCEL SKIN 2X3CM,Q4137,HCPCS,,,,,both,, ,3469,2081.4,Aetna,Commercial,,,,,3469,,,,
AMNIOEXCEL SKIN 3.5X3.5CM,Q4137,HCPCS,,,,,both,, ,3745,2247,Aetna,Commercial,,,,,3745,,,,
AMNIOEXCEL SKIN 4X4CM,Q4137,HCPCS,,,,,both,, ,3928,2356.8,Aetna,Commercial,,,,,3928,,,,
ALLOWRAP DS/DRY SQCM,Q4150,HCPCS,,,,,both,, ,347.63,208.57,Aetna,Commercial,,,,,347.63,,,,
ALLOWRAP DS/DRY SQCM,Q4150,HCPCS,,,,,both,, ,506.25,303.75,Aetna,Commercial,,,,,506.25,,,,
HELICOLL (PER SQ CM),Q4164,HCPCS,,,,,both,, ,6211,3726.6,Aetna,Commercial,,,,,6211,,,,
EPIFIX SQ CM,Q4186,HCPCS,,,,,both,, ,570.11,342.06,Aetna,Commercial,,,,,570.11,,,,
MEMBRANE GRAFT/WRAP (PER SQ CM),Q4205,HCPCS,,,,,both,, ,5236,3141.6,Aetna,Commercial,,,,,5236,,,,
DERM-MAXX (PER SQ CM),Q4238,HCPCS,,,,,both,, ,3534,2120.4,Aetna,Commercial,,,,,3534,,,,
AMNIO-MAX (PER SQ CM),Q4239,HCPCS,,,,,both,, ,9540,5724,Aetna,Commercial,,,,,9540,,,,
INFLIXIMAB-DYYB 10MG,Q5103,HCPCS,,,,,both,1,EA,545.13,327.07,Aetna,Commercial,,,,,545.13,,,,
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,1,ML,70.81,42.48,Aetna,Commercial,,,,,70.81,,,,
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,1,ML,93.22,55.93,Aetna,Commercial,,,,,93.22,,,,
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,, ,93.22,55.93,Aetna,Commercial,,,,,93.22,,,,
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,, ,93.22,55.93,Aetna,Commercial,,,,,93.22,,,,
INJ PERFLUTRN LIP ML,Q9957,HCPCS,,,,,both,, ,1184.5,710.7,Aetna,Commercial,,,,,1184.5,,,,
HOCM2 250-299MGML ML,Q9961,HCPCS,,,,,both,, ,1.65,0.99,Aetna,Commercial,,,,,1.65,,,,
HOCM 350 MG ML 30ML,Q9963,HCPCS,,,,,both,30,ML,49.5,29.7,Aetna,Commercial,,,,,49.5,,,,
HOCM 350-399MGML IOD,Q9963,HCPCS,,,,,both,, ,1.65,0.99,Aetna,Commercial,,,,,1.65,,,,
LOC2 200-299MG/ML ML,Q9966,HCPCS,,,,,both,, ,27.81,16.68,Aetna,Commercial,,,,,27.81,,,,
LOCM 240MG 100ML,Q9966,HCPCS,,,,,both,100,ML,6,3.6,Aetna,Commercial,,,,,6,,,,
LOCM 240MG 50ML,Q9966,HCPCS,,,,,both,50,ML,6,3.6,Aetna,Commercial,,,,,6,,,,
LOCM 270MG 150ML,Q9966,HCPCS,,,,,both,150,ML,6,3.6,Aetna,Commercial,,,,,6,,,,
LOCM200MG/ML 41% 200,Q9966,HCPCS,,,,,both,200,ML,4,2.4,Aetna,Commercial,,,,,4,,,,
LOCM200MG/ML M41% 10,Q9966,HCPCS,,,,,both,20,ML,36.82,22.09,Aetna,Commercial,,,,,36.82,,,,
LOCM200MG/ML M41% 10,Q9966,HCPCS,,,,,both,20,ML,36.82,22.09,Aetna,Commercial,,,,,36.82,,,,
LOC2 300-399MG/ML ML,Q9967,HCPCS,,,,,both,150,ML,1337.97,802.78,Aetna,Commercial,,,,,1337.97,,,,
LOC3 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,60.5,36.3,Aetna,Commercial,,,,,60.5,,,,
LOC3 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,60.5,36.3,Aetna,Commercial,,,,,60.5,,,,
LOC4 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,7.4,4.44,Aetna,Commercial,,,,,7.4,,,,
LOC4 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,7.4,4.44,Aetna,Commercial,,,,,7.4,,,,
LOC4 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,7.4,4.44,Aetna,Commercial,,,,,7.4,,,,
LOC4 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,7.4,4.44,Aetna,Commercial,,,,,7.4,,,,
LOC5 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,0.7,0.42,Aetna,Commercial,,,,,0.7,,,,
LOC5 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,0.7,0.42,Aetna,Commercial,,,,,0.7,,,,
LOC6 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,0.6,0.36,Aetna,Commercial,,,,,0.6,,,,
LOC6 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,0.6,0.36,Aetna,Commercial,,,,,0.6,,,,
LOCM 300-399MG/ML ML,Q9967,HCPCS,,,,,both,50,ML,12.62,7.57,Aetna,Commercial,,,,,12.62,,,,
LOCM 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,1178.84,707.3,Aetna,Commercial,,,,,1178.84,,,,
LOCM300MG/ML 76% 125,Q9967,HCPCS,,,,,both,125,ML,4,2.4,Aetna,Commercial,,,,,4,,,,
LOCM300MG/ML 76% 200,Q9967,HCPCS,,,,,both,200,ML,11.07,6.64,Aetna,Commercial,,,,,11.07,,,,
LOCM300MG/ML 76% 200,Q9967,HCPCS,,,,,both,200,ML,11.07,6.64,Aetna,Commercial,,,,,11.07,,,,
LOCM300MG/ML 76% 200,Q9967,HCPCS,,,,,both,200,ML,11.07,6.64,Aetna,Commercial,,,,,11.07,,,,
LOCM300MG/ML 76% 200,Q9967,HCPCS,,,,,both,200,ML,11.07,6.64,Aetna,Commercial,,,,,11.07,,,,
LACTATION CONSULT,S9443,HCPCS,,,,,both,, ,115.88,69.52,Aetna,Commercial,,,,,115.88,,,,
NI-CARD REHAB PH 3,S9472,HCPCS,,,,,both,, ,2.58,1.54,Aetna,Commercial,,,,,2.58,,,,
NI-PULM REHAB PH 3,S9473,HCPCS,,,,,both,, ,2.58,1.54,Aetna,Commercial,,,,,2.58,,,,
IOP PSYCH PER DIEM,S9480,HCPCS,,,,,both,, ,872.41,523.44,Aetna,Commercial,,,,,872.41,,,,
CDC COVID19,U0001,HCPCS,,,,,both,, ,120.97,72.58,Aetna,Commercial,,,,,120.97,,,,
STATE COVID19,U0002,HCPCS,,,,,both,, ,172.81,103.68,Aetna,Commercial,,,,,172.81,,,,
CT-CATH FLUID DRAIN,10030,CPT,,,,,both,, ,1071.33,1071.33,Blue Cross and Blue Shield,Traditional,,414.6,38.7,38.7,1071.33,41.78,546.38,percent of total billed charges,38.7
I&D ABSCS SMPL/SGL,10060,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,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,,588.12,38.7,38.7,1519.68,59.27,775.04,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,,588.12,38.7,38.7,1519.68,59.27,775.04,percent of total billed charges,38.7
INC & REM FB SQ COMP,10121,CPT,,,,,both,, ,6179,6179,Blue Cross and Blue Shield,Traditional,,2391.27,38.7,38.7,6179,240.98,3151.29,percent of total billed charges,38.7
I&D HEMATOMA/FLUID,10140,CPT,,,,,both,, ,6179,6179,Blue Cross and Blue Shield,Traditional,,2391.27,38.7,38.7,6179,240.98,3151.29,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,,588.12,38.7,38.7,1519.68,59.27,775.04,percent of total billed charges,38.7
I&D CPLX PO WND INF,10180,CPT,,,,,both,, ,10829.4,10829.4,Blue Cross and Blue Shield,Traditional,,4190.98,38.7,38.7,10829.4,422.35,5522.99,percent of total billed charges,38.7
DEBR EXZ/INF SKN <10%,11000,CPT,,,,,both,, ,2393.6,2393.6,Blue Cross and Blue Shield,Traditional,,926.32,38.7,38.7,2393.6,93.35,1220.74,percent of total billed charges,38.7
DEBR EXZ/INF SKN E A,11001,CPT,,,,,both,, ,2393.6,2393.6,Blue Cross and Blue Shield,Traditional,,926.32,38.7,38.7,2393.6,93.35,1220.74,percent of total billed charges,38.7
DEB SKN BONE FX SITE,11012,CPT,,,,,both,, ,10829.4,10829.4,Blue Cross and Blue Shield,Traditional,,4190.98,38.7,38.7,10829.4,422.35,5522.99,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,,588.12,38.7,38.7,1519.68,59.27,775.04,percent of total billed charges,38.7
DEB MUSC/FSCA <20 SQ,11043,CPT,,,,,both,, ,2393.6,2393.6,Blue Cross and Blue Shield,Traditional,,926.32,38.7,38.7,2393.6,93.35,1220.74,percent of total billed charges,38.7
DEB BONE 20 SQ CM/<,11044,CPT,,,,,both,, ,6179,6179,Blue Cross and Blue Shield,Traditional,,2391.27,38.7,38.7,6179,240.98,3151.29,percent of total billed charges,38.7
DEB SUB TISS EA ADDL,11045,CPT,,,,,both,, ,6179,6179,Blue Cross and Blue Shield,Traditional,,2391.27,38.7,38.7,6179,240.98,3151.29,percent of total billed charges,38.7
DEB MUSC/FSCA EA ADL,11046,CPT,,,,,both,, ,6179,6179,Blue Cross and Blue Shield,Traditional,,2391.27,38.7,38.7,6179,240.98,3151.29,percent of total billed charges,38.7
DEB BONE EA ADDL,11047,CPT,,,,,both,, ,6179,6179,Blue Cross and Blue Shield,Traditional,,2391.27,38.7,38.7,6179,240.98,3151.29,percent of total billed charges,38.7
PARG/CUTG B9 SGL LES,11055,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,percent of total billed charges,38.7
TRIM SKIN LESION 2-4,11056,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,percent of total billed charges,38.7
TRIM SKIN LESIONS >4,11057,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,percent of total billed charges,38.7
TNGNTL BX SKN SGL LES,11102,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,percent of total billed charges,38.7
TNGNTL BX SKN EA ADD,11103,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,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,,588.12,38.7,38.7,1519.68,59.27,775.04,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,,588.12,38.7,38.7,1519.68,59.27,775.04,percent of total billed charges,38.7
INCIS BX SKN SGL LES,11106,CPT,,,,,both,, ,2393.6,2393.6,Blue Cross and Blue Shield,Traditional,,926.32,38.7,38.7,2393.6,93.35,1220.74,percent of total billed charges,38.7
INCAL BX SKN EA ADDL,11107,CPT,,,,,both,, ,2393.6,2393.6,Blue Cross and Blue Shield,Traditional,,926.32,38.7,38.7,2393.6,93.35,1220.74,percent of total billed charges,38.7
RMV SKN TAGS<=15 LES,11200,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,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,,90.22,38.7,38.7,233.12,9.09,118.89,percent of total billed charges,38.7
DEBRIDEMENT NAIL 1-5,11720,CPT,,,,,both,, ,233.12,233.12,Blue Cross and Blue Shield,Traditional,,90.22,38.7,38.7,233.12,9.09,118.89,percent of total billed charges,38.7
DEBRIDEMENT NAIL >6,11721,CPT,,,,,both,, ,233.12,233.12,Blue Cross and Blue Shield,Traditional,,90.22,38.7,38.7,233.12,9.09,118.89,percent of total billed charges,38.7
RMV NAIL PLATE SGL,11730,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,percent of total billed charges,38.7
RMV NAIL PLATE E ADD,11732,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,percent of total billed charges,38.7
EVAC SU HEMATOMA,11740,CPT,,,,,both,, ,486.84,486.84,Blue Cross and Blue Shield,Traditional,,188.41,38.7,38.7,486.84,18.99,248.29,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,percent of total billed charges,38.7
WND PREP F/N/HF/G,15004,CPT,,,,,both,, ,2393.6,2393.6,Blue Cross and Blue Shield,Traditional,,926.32,38.7,38.7,2393.6,93.35,1220.74,percent of total billed charges,38.7
WND PREP F/N/HF/G ADL,15005,CPT,,,,,both,, ,2393.6,2393.6,Blue Cross and Blue Shield,Traditional,,926.32,38.7,38.7,2393.6,93.35,1220.74,percent of total billed charges,38.7
PINCH GRFT UP TO 2CM,15050,CPT,,,,,both,, ,2393.6,2393.6,Blue Cross and Blue Shield,Traditional,,926.32,38.7,38.7,2393.6,93.35,1220.74,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,5291.47,38.7,38.7,13673.04,533.25,6973.25,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,,5291.47,38.7,38.7,13673.04,533.25,6973.25,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,5291.47,38.7,38.7,13673.04,533.25,6973.25,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,,5291.47,38.7,38.7,13673.04,533.25,6973.25,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,5291.47,38.7,38.7,13673.04,533.25,6973.25,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,,5291.47,38.7,38.7,13673.04,533.25,6973.25,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,,5291.47,38.7,38.7,13673.04,533.25,6973.25,percent of total billed charges,38.7
FTH GRF TRNK 20SQ/<,15200,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,percent of total billed charges,38.7
SKN SUB GRFT ADDL,15272,CPT,,,,,both,, ,6950.12,6950.12,Blue Cross and Blue Shield,Traditional,,2689.7,38.7,38.7,6950.12,271.05,3544.56,percent of total billed charges,38.7
SKN S GRFT >100SQ,15273,CPT,,,,,both,, ,13673.04,13673.04,Blue Cross and Blue Shield,Traditional,,5291.47,38.7,38.7,13673.04,533.25,6973.25,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,,5291.47,38.7,38.7,13673.04,533.25,6973.25,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,percent of total billed charges,38.7
INIT TX 1ST DEG BURN,16000,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,percent of total billed charges,38.7
DRS DEB PTHICK BRN S,16020,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,percent of total billed charges,38.7
DRS DEB PTHICK BRN M,16025,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,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,,588.12,38.7,38.7,1519.68,59.27,775.04,percent of total billed charges,38.7
DESTRCT PREMAL LES,17000,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,percent of total billed charges,38.7
DESTRCT PREMAL 2-14,17003,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,percent of total billed charges,38.7
DESTRCT PREMAL 15+,17004,CPT,,,,,both,, ,1519.68,1519.68,Blue Cross and Blue Shield,Traditional,,588.12,38.7,38.7,1519.68,59.27,775.04,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,,588.12,38.7,38.7,1519.68,59.27,775.04,percent of total billed charges,38.7
DESTR CV LES 10-50 SQ,17107,CPT,,,,,both,, ,2393.6,2393.6,Blue Cross and Blue Shield,Traditional,,926.32,38.7,38.7,2393.6,93.35,1220.74,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,,2689.7,38.7,38.7,6950.12,271.05,3544.56,percent of total billed charges,38.7
DESTRUCT B9 LES 1-14,17110,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,percent of total billed charges,38.7
CHEM CAUT GRANL TISS,17250,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,percent of total billed charges,38.7
UNLISTD PROCEDURE,17999,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,29.76,389.13,percent of total billed charges,38.7
S-BRST DUCTOGRM INJ,19030,CPT,,,,,both,, ,289.43,289.43,Blue Cross and Blue Shield,Traditional,,112.01,38.7,38.7,289.43,11.29,147.61,percent of total billed charges,38.7
BX OF BREAST OPEN,19101,CPT,,,,,both,, ,14527.16,14527.16,Blue Cross and Blue Shield,Traditional,,5622.01,38.7,38.7,14527.16,566.56,7408.85,percent of total billed charges,38.7
EXPL P WND EXTREM,20103,CPT,,,,,both,, ,6179,6179,Blue Cross and Blue Shield,Traditional,,2391.27,38.7,38.7,6179,240.98,3151.29,percent of total billed charges,38.7
NJ TENDON SHEATH/LIG,20550,CPT,,,,,both,, ,1128.8,1128.8,Blue Cross and Blue Shield,Traditional,,436.85,38.7,38.7,1128.8,44.02,575.69,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,,188.64,38.7,38.7,487.45,19.01,248.6,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,,281.02,38.7,38.7,726.15,28.32,370.34,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,,271.16,38.7,38.7,700.66,27.33,357.34,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,,616.95,38.7,38.7,1594.18,62.17,813.03,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,,281.02,38.7,38.7,726.15,28.32,370.34,percent of total billed charges,38.7
S-INJ TMJ ARTHROGRAM,21116,CPT,,,,,both,, ,289.43,289.43,Blue Cross and Blue Shield,Traditional,,112.01,38.7,38.7,289.43,11.29,147.61,percent of total billed charges,38.7
S-INJ SHOULDER ARTH,23350,CPT,,,,,both,, ,289.43,289.43,Blue Cross and Blue Shield,Traditional,,112.01,38.7,38.7,289.43,11.29,147.61,percent of total billed charges,38.7
S-INJ ELBOW ARTHRO,24220,CPT,,,,,both,, ,289.43,289.43,Blue Cross and Blue Shield,Traditional,,112.01,38.7,38.7,289.43,11.29,147.61,percent of total billed charges,38.7
S-INJ WRIST ARTHRO,25246,CPT,,,,,both,, ,289.43,289.43,Blue Cross and Blue Shield,Traditional,,112.01,38.7,38.7,289.43,11.29,147.61,percent of total billed charges,38.7
S-INJ HIP ARTHRO,27093,CPT,,,,,both,, ,289.43,289.43,Blue Cross and Blue Shield,Traditional,,112.01,38.7,38.7,289.43,11.29,147.61,percent of total billed charges,38.7
S-INJ KNEE ARTHRO,27369,CPT,,,,,both,, ,289.43,289.43,Blue Cross and Blue Shield,Traditional,,112.01,38.7,38.7,289.43,11.29,147.61,percent of total billed charges,38.7
S-INJ ANKLE ARTHRO,27648,CPT,,,,,both,, ,289.43,289.43,Blue Cross and Blue Shield,Traditional,,112.01,38.7,38.7,289.43,11.29,147.61,percent of total billed charges,38.7
EXPLORE FOOT JOINT,28022,CPT,,,,,both,, ,12336.12,12336.12,Blue Cross and Blue Shield,Traditional,,4774.08,38.7,38.7,12336.12,481.11,6291.42,percent of total billed charges,38.7
AMPUT TOE & METATRSL,28810,CPT,,,,,both,, ,12336.12,12336.12,Blue Cross and Blue Shield,Traditional,,4774.08,38.7,38.7,12336.12,481.11,6291.42,percent of total billed charges,38.7
AMPUTATE TOE,28820,CPT,,,,,both,, ,12336.12,12336.12,Blue Cross and Blue Shield,Traditional,,4774.08,38.7,38.7,12336.12,481.11,6291.42,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,,132.14,38.7,38.7,341.45,13.32,174.14,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,,132.14,38.7,38.7,341.45,13.32,174.14,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,,132.14,38.7,38.7,341.45,13.32,174.14,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,,132.14,38.7,38.7,341.45,13.32,174.14,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,,537.53,38.7,38.7,1388.96,54.17,708.37,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,,537.53,38.7,38.7,1388.96,54.17,708.37,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,,495.87,38.7,38.7,1281.32,49.97,653.47,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,,495.87,38.7,38.7,1281.32,49.97,653.47,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,,462.92,38.7,38.7,1196.17,46.65,610.05,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,,501.83,38.7,38.7,1296.73,50.57,661.33,percent of total billed charges,38.7
SPLNT SHRT ARM STATC,29125,CPT,,,,,both,, ,909.8,909.8,Blue Cross and Blue Shield,Traditional,,352.09,38.7,38.7,909.8,35.48,464,percent of total billed charges,38.7
SPLNT SHRT ARM STATC,29125,CPT,,,,,both,, ,986.3,986.3,Blue Cross and Blue Shield,Traditional,,381.7,38.7,38.7,986.3,38.47,503.01,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,,104.54,38.7,38.7,270.12,10.53,137.76,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,,104.54,38.7,38.7,270.12,10.53,137.76,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,,104.54,38.7,38.7,270.12,10.53,137.76,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,,104.54,38.7,38.7,270.12,10.53,137.76,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,,408.87,38.7,38.7,1056.52,41.2,538.83,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,,408.87,38.7,38.7,1056.52,41.2,538.83,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,,377.19,38.7,38.7,974.64,38.01,497.07,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,,377.19,38.7,38.7,974.64,38.01,497.07,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,,104.54,38.7,38.7,270.12,10.53,137.76,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,,104.54,38.7,38.7,270.12,10.53,137.76,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,,104.54,38.7,38.7,270.12,10.53,137.76,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,,104.54,38.7,38.7,270.12,10.53,137.76,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,,623.53,38.7,38.7,1611.18,62.84,821.7,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,,623.53,38.7,38.7,1611.18,62.84,821.7,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,,575.19,38.7,38.7,1486.29,57.97,758.01,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,,575.19,38.7,38.7,1486.29,57.97,758.01,percent of total billed charges,38.7
SPLNT SHRT ARM DYNAM,29126,CPT,,,,,both,, ,1387.43,1387.43,Blue Cross and Blue Shield,Traditional,,536.94,38.7,38.7,1387.43,54.11,707.59,percent of total billed charges,38.7
SPLNT SHRT ARM DYNAM,29126,CPT,,,,,both,, ,1504.12,1504.12,Blue Cross and Blue Shield,Traditional,,582.09,38.7,38.7,1504.12,58.66,767.1,percent of total billed charges,38.7
SPLNT FINGER STATIC,29130,CPT,,,,,both,, ,299.22,299.22,Blue Cross and Blue Shield,Traditional,,115.8,38.7,38.7,299.22,11.67,152.6,percent of total billed charges,38.7
SPLNT FINGER STATIC,29130,CPT,,,,,both,, ,324.42,324.42,Blue Cross and Blue Shield,Traditional,,125.55,38.7,38.7,324.42,12.65,165.45,percent of total billed charges,38.7
SPLNT FNGR STATC OT,29130,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,38.7,141.88,5.53,72.36,percent of total billed charges,38.7
SPLNT FNGR STATC OT,29130,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,38.7,141.88,5.53,72.36,percent of total billed charges,38.7
SPLNT FNGR STATC OT,29130,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,38.7,141.88,5.53,72.36,percent of total billed charges,38.7
SPLNT FNGR STATC OT,29130,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,38.7,141.88,5.53,72.36,percent of total billed charges,38.7
SPLNT FNGR STATC OT,29130,CPT,,,,,both,, ,347.63,347.63,Blue Cross and Blue Shield,Traditional,,134.53,38.7,38.7,347.63,13.56,177.29,percent of total billed charges,38.7
SPLNT FNGR STATC OT,29130,CPT,,,,,both,, ,347.63,347.63,Blue Cross and Blue Shield,Traditional,,134.53,38.7,38.7,347.63,13.56,177.29,percent of total billed charges,38.7
SPLNT FNGR STATC PT,29130,CPT,,,,,both,, ,320.59,320.59,Blue Cross and Blue Shield,Traditional,,124.07,38.7,38.7,320.59,12.5,163.5,percent of total billed charges,38.7
SPLNT FNGR STATC PT,29130,CPT,,,,,both,, ,320.59,320.59,Blue Cross and Blue Shield,Traditional,,124.07,38.7,38.7,320.59,12.5,163.5,percent of total billed charges,38.7
SPLNT FINGER DYNAM,29131,CPT,,,,,both,, ,453.68,453.68,Blue Cross and Blue Shield,Traditional,,175.57,38.7,38.7,453.68,17.69,231.38,percent of total billed charges,38.7
SPLNT FINGER DYNAM,29131,CPT,,,,,both,, ,491.82,491.82,Blue Cross and Blue Shield,Traditional,,190.33,38.7,38.7,491.82,19.18,250.83,percent of total billed charges,38.7
SPLNT FINGR DYNA OT,29131,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,38.7,141.88,5.53,72.36,percent of total billed charges,38.7
SPLNT FINGR DYNA OT,29131,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,38.7,141.88,5.53,72.36,percent of total billed charges,38.7
SPLNT FINGR DYNA OT,29131,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,38.7,141.88,5.53,72.36,percent of total billed charges,38.7
SPLNT FINGR DYNA OT,29131,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,38.7,141.88,5.53,72.36,percent of total billed charges,38.7
SPLNT FINGR DYNA OT,29131,CPT,,,,,both,, ,526.85,526.85,Blue Cross and Blue Shield,Traditional,,203.89,38.7,38.7,526.85,20.55,268.69,percent of total billed charges,38.7
SPLNT FINGR DYNA OT,29131,CPT,,,,,both,, ,526.85,526.85,Blue Cross and Blue Shield,Traditional,,203.89,38.7,38.7,526.85,20.55,268.69,percent of total billed charges,38.7
SPLNT FINGR DYNA PT,29131,CPT,,,,,both,, ,485.9,485.9,Blue Cross and Blue Shield,Traditional,,188.04,38.7,38.7,485.9,18.95,247.81,percent of total billed charges,38.7
SPLNT FINGR DYNA PT,29131,CPT,,,,,both,, ,485.9,485.9,Blue Cross and Blue Shield,Traditional,,188.04,38.7,38.7,485.9,18.95,247.81,percent of total billed charges,38.7
STRAPPING THORAX,29200,CPT,,,,,both,, ,377.17,377.17,Blue Cross and Blue Shield,Traditional,,145.96,38.7,38.7,377.17,14.71,192.36,percent of total billed charges,38.7
STRAPPING THORAX OT,29200,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,38.7,341.45,13.32,174.14,percent of total billed charges,38.7
STRAPPING THORAX OT,29200,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,38.7,341.45,13.32,174.14,percent of total billed charges,38.7
STRAPPING THORAX OT,29200,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,38.7,341.45,13.32,174.14,percent of total billed charges,38.7
STRAPPING THORAX OT,29200,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,38.7,341.45,13.32,174.14,percent of total billed charges,38.7
STRAPPING THORAX PT,29200,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,38.7,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING THORAX PT,29200,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,38.7,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING SHOULD OT,29240,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,38.7,81.37,3.17,41.5,percent of total billed charges,38.7
STRAPPING SHOULD OT,29240,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,38.7,81.37,3.17,41.5,percent of total billed charges,38.7
STRAPPING SHOULD OT,29240,CPT,,,,,both,, ,438.01,438.01,Blue Cross and Blue Shield,Traditional,,169.51,38.7,38.7,438.01,17.08,223.39,percent of total billed charges,38.7
STRAPPING SHOULD OT,29240,CPT,,,,,both,, ,438.01,438.01,Blue Cross and Blue Shield,Traditional,,169.51,38.7,38.7,438.01,17.08,223.39,percent of total billed charges,38.7
STRAPPING SHOULD PT,29240,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,38.7,270.12,10.53,137.76,percent of total billed charges,38.7
STRAPPING SHOULD PT,29240,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,38.7,270.12,10.53,137.76,percent of total billed charges,38.7
STRAPPING SHOULD PT,29240,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,38.7,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING SHOULD PT,29240,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,38.7,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING SHOULDER,29240,CPT,,,,,both,, ,377.17,377.17,Blue Cross and Blue Shield,Traditional,,145.96,38.7,38.7,377.17,14.71,192.36,percent of total billed charges,38.7
STRAPPING SHOULDER,29240,CPT,,,,,both,, ,408.86,408.86,Blue Cross and Blue Shield,Traditional,,158.23,38.7,38.7,408.86,15.95,208.52,percent of total billed charges,38.7
STRAPPING ELBO-WRIST,29260,CPT,,,,,both,, ,377.17,377.17,Blue Cross and Blue Shield,Traditional,,145.96,38.7,38.7,377.17,14.71,192.36,percent of total billed charges,38.7
STRAPPING ELBO-WRIST,29260,CPT,,,,,both,, ,408.86,408.86,Blue Cross and Blue Shield,Traditional,,158.23,38.7,38.7,408.86,15.95,208.52,percent of total billed charges,38.7
STRPNG ELBO-WRST OT,29260,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,38.7,81.37,3.17,41.5,percent of total billed charges,38.7
STRPNG ELBO-WRST OT,29260,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,38.7,81.37,3.17,41.5,percent of total billed charges,38.7
STRPNG ELBO-WRST OT,29260,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,38.7,81.37,3.17,41.5,percent of total billed charges,38.7
STRPNG ELBO-WRST OT,29260,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,38.7,81.37,3.17,41.5,percent of total billed charges,38.7
STRPNG ELBO-WRST OT,29260,CPT,,,,,both,, ,438.01,438.01,Blue Cross and Blue Shield,Traditional,,169.51,38.7,38.7,438.01,17.08,223.39,percent of total billed charges,38.7
STRPNG ELBO-WRST OT,29260,CPT,,,,,both,, ,438.01,438.01,Blue Cross and Blue Shield,Traditional,,169.51,38.7,38.7,438.01,17.08,223.39,percent of total billed charges,38.7
STRPNG ELBO-WRST PT,29260,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,38.7,404.02,15.76,206.05,percent of total billed charges,38.7
STRPNG ELBO-WRST PT,29260,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,38.7,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING HAND-FING,29280,CPT,,,,,both,, ,377.17,377.17,Blue Cross and Blue Shield,Traditional,,145.96,38.7,38.7,377.17,14.71,192.36,percent of total billed charges,38.7
STRAPPING HAND-FING,29280,CPT,,,,,both,, ,408.86,408.86,Blue Cross and Blue Shield,Traditional,,158.23,38.7,38.7,408.86,15.95,208.52,percent of total billed charges,38.7
STRPPNG HND-FING OT,29280,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,38.7,81.37,3.17,41.5,percent of total billed charges,38.7
STRPPNG HND-FING OT,29280,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,38.7,81.37,3.17,41.5,percent of total billed charges,38.7
STRPPNG HND-FING OT,29280,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,38.7,81.37,3.17,41.5,percent of total billed charges,38.7
STRPPNG HND-FING OT,29280,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,38.7,81.37,3.17,41.5,percent of total billed charges,38.7
STRPPNG HND-FING OT,29280,CPT,,,,,both,, ,438.01,438.01,Blue Cross and Blue Shield,Traditional,,169.51,38.7,38.7,438.01,17.08,223.39,percent of total billed charges,38.7
STRPPNG HND-FING OT,29280,CPT,,,,,both,, ,438.01,438.01,Blue Cross and Blue Shield,Traditional,,169.51,38.7,38.7,438.01,17.08,223.39,percent of total billed charges,38.7
STRPPNG HND-FING PT,29280,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,38.7,404.02,15.76,206.05,percent of total billed charges,38.7
STRPPNG HND-FING PT,29280,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,38.7,404.02,15.76,206.05,percent of total billed charges,38.7
APPLY RIGID LEG CAST,29445,CPT,,,,,both,, ,1023.52,1023.52,Blue Cross and Blue Shield,Traditional,,396.1,38.7,38.7,1023.52,39.92,522,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,,132.14,38.7,38.7,341.45,13.32,174.14,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,,132.14,38.7,38.7,341.45,13.32,174.14,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,,575.19,38.7,38.7,1486.29,57.97,758.01,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,,575.19,38.7,38.7,1486.29,57.97,758.01,percent of total billed charges,38.7
APP LNG LEG SPLINT,29505,CPT,,,,,both,, ,1387.43,1387.43,Blue Cross and Blue Shield,Traditional,,536.94,38.7,38.7,1387.43,54.11,707.59,percent of total billed charges,38.7
APPLY LNG LEG SPLNT,29505,CPT,,,,,both,, ,600.52,600.52,Blue Cross and Blue Shield,Traditional,,232.4,38.7,38.7,600.52,23.42,306.27,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,,132.14,38.7,38.7,341.45,13.32,174.14,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,,132.14,38.7,38.7,341.45,13.32,174.14,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,,377.19,38.7,38.7,974.64,38.01,497.07,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,,377.19,38.7,38.7,974.64,38.01,497.07,percent of total billed charges,38.7
APP SHORT LEG SPLINT,29515,CPT,,,,,both,, ,909.8,909.8,Blue Cross and Blue Shield,Traditional,,352.09,38.7,38.7,909.8,35.48,464,percent of total billed charges,38.7
APPLY SHRT LEG SPLNT,29515,CPT,,,,,both,, ,600.52,600.52,Blue Cross and Blue Shield,Traditional,,232.4,38.7,38.7,600.52,23.42,306.27,percent of total billed charges,38.7
STRAPPING HIP,29520,CPT,,,,,both,, ,377.17,377.17,Blue Cross and Blue Shield,Traditional,,145.96,38.7,38.7,377.17,14.71,192.36,percent of total billed charges,38.7
STRAPPING HIP PT,29520,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,38.7,141.88,5.53,72.36,percent of total billed charges,38.7
STRAPPING HIP PT,29520,CPT,,,,,both,, ,141.88,141.88,Blue Cross and Blue Shield,Traditional,,54.91,38.7,38.7,141.88,5.53,72.36,percent of total billed charges,38.7
STRAPPING HIP PT,29520,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,38.7,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING HIP PT,29520,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,38.7,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING KNEE,29530,CPT,,,,,both,, ,377.17,377.17,Blue Cross and Blue Shield,Traditional,,145.96,38.7,38.7,377.17,14.71,192.36,percent of total billed charges,38.7
STRAPPING KNEE PT,29530,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,38.7,270.12,10.53,137.76,percent of total billed charges,38.7
STRAPPING KNEE PT,29530,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,38.7,270.12,10.53,137.76,percent of total billed charges,38.7
STRAPPING KNEE PT,29530,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,38.7,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING KNEE PT,29530,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,38.7,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING ANKLE-FOOT,29540,CPT,,,,,both,, ,377.17,377.17,Blue Cross and Blue Shield,Traditional,,145.96,38.7,38.7,377.17,14.71,192.36,percent of total billed charges,38.7
STRPPNG ANKLE-FT PT,29540,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,38.7,341.45,13.32,174.14,percent of total billed charges,38.7
STRPPNG ANKLE-FT PT,29540,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,38.7,341.45,13.32,174.14,percent of total billed charges,38.7
STRPPNG ANKLE-FT PT,29540,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,38.7,404.02,15.76,206.05,percent of total billed charges,38.7
STRPPNG ANKLE-FT PT,29540,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,38.7,404.02,15.76,206.05,percent of total billed charges,38.7
STRAPPING UNA BOOT,29580,CPT,,,,,both,, ,377.17,377.17,Blue Cross and Blue Shield,Traditional,,145.96,38.7,38.7,377.17,14.71,192.36,percent of total billed charges,38.7
STRPPNG UNA BOOT PT,29580,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,38.7,341.45,13.32,174.14,percent of total billed charges,38.7
STRPPNG UNA BOOT PT,29580,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,38.7,341.45,13.32,174.14,percent of total billed charges,38.7
STRPPNG UNA BOOT PT,29580,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,38.7,404.02,15.76,206.05,percent of total billed charges,38.7
STRPPNG UNA BOOT PT,29580,CPT,,,,,both,, ,404.02,404.02,Blue Cross and Blue Shield,Traditional,,156.36,38.7,38.7,404.02,15.76,206.05,percent of total billed charges,38.7
UNNA BOOT STRAPPING,29580,CPT,,,,,both,, ,600.52,600.52,Blue Cross and Blue Shield,Traditional,,232.4,38.7,38.7,600.52,23.42,306.27,percent of total billed charges,38.7
UNNA WRAP,29580,CPT,,,,,both,, ,19.2,19.2,Blue Cross and Blue Shield,Traditional,,7.43,38.7,38.7,19.2,0.75,9.79,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,,232.4,38.7,38.7,600.52,23.42,306.27,percent of total billed charges,38.7
STRPPNG LOW BACK OT,29799,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,38.7,270.12,10.53,137.76,percent of total billed charges,38.7
STRPPNG LOW BACK OT,29799,CPT,,,,,both,, ,270.12,270.12,Blue Cross and Blue Shield,Traditional,,104.54,38.7,38.7,270.12,10.53,137.76,percent of total billed charges,38.7
SUCTION PROC-NASOTRA,31720,CPT,,,,,both,, ,280.42,280.42,Blue Cross and Blue Shield,Traditional,,108.52,38.7,38.7,280.42,10.94,143.01,percent of total billed charges,38.7
CT-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914,9914,Blue Cross and Blue Shield,Traditional,,3836.72,38.7,38.7,9914,386.65,5056.14,percent of total billed charges,38.7
IR-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914,9914,Blue Cross and Blue Shield,Traditional,,3836.72,38.7,38.7,9914,386.65,5056.14,percent of total billed charges,38.7
IR-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914,9914,Blue Cross and Blue Shield,Traditional,,3836.72,38.7,38.7,9914,386.65,5056.14,percent of total billed charges,38.7
US-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,5184.63,5184.63,Blue Cross and Blue Shield,Traditional,,2006.45,38.7,38.7,5184.63,202.2,2644.16,percent of total billed charges,38.7
CC-PERICARDIO W/IMG,33016,CPT,,,,,both,, ,3443.03,3443.03,Blue Cross and Blue Shield,Traditional,,1332.45,38.7,38.7,3443.03,134.28,1755.95,percent of total billed charges,38.7
P-IMPLNT LOOP REC,33285,CPT,,,,,both,, ,27383.32,27383.32,Blue Cross and Blue Shield,Traditional,,10597.34,38.7,38.7,27383.32,1067.95,13965.49,percent of total billed charges,38.7
P-REMOV LOOP REC,33286,CPT,,,,,both,, ,5044.68,5044.68,Blue Cross and Blue Shield,Traditional,,1952.29,38.7,38.7,5044.68,196.74,2572.79,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,,4385.81,38.7,38.7,11332.83,441.98,5779.74,percent of total billed charges,38.7
S-INTRO NDL CATH,36000,CPT,,,,,both,, ,168.75,168.75,Blue Cross and Blue Shield,Traditional,,65.31,38.7,38.7,168.75,6.58,86.06,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,,67.26,38.7,38.7,173.81,6.78,88.64,percent of total billed charges,38.7
S-INJ VENOGRAPHY,36005,CPT,,,,,both,, ,873.46,873.46,Blue Cross and Blue Shield,Traditional,,338.03,38.7,38.7,873.46,34.06,445.46,percent of total billed charges,38.7
S-INTROCATH SEGPULM,36015,CPT,,,,,both,, ,839.21,839.21,Blue Cross and Blue Shield,Traditional,,324.77,38.7,38.7,839.21,32.73,428,percent of total billed charges,38.7
S-CATH CAROTD VERT,36100,CPT,,,,,both,, ,1013.23,1013.23,Blue Cross and Blue Shield,Traditional,,392.12,38.7,38.7,1013.23,39.52,516.75,percent of total billed charges,38.7
S-CATH EXTREM ART,36140,CPT,,,,,both,, ,399.68,399.68,Blue Cross and Blue Shield,Traditional,,154.68,38.7,38.7,399.68,15.59,203.84,percent of total billed charges,38.7
S-THORACIC 1ST ORDER,36215,CPT,,,,,both,, ,1839.26,1839.26,Blue Cross and Blue Shield,Traditional,,711.79,38.7,38.7,1839.26,71.73,938.02,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,,4873.4,38.7,38.7,12592.76,491.12,6422.31,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,,12337.95,38.7,38.7,31881.02,1243.36,16259.32,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,,17801.28,38.7,38.7,45998.14,1793.93,23459.05,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,,12286.04,38.7,38.7,31746.87,1238.13,16190.9,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,,20083.63,38.7,38.7,51895.68,2023.93,26466.8,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,,12410.51,38.7,38.7,32068.51,1250.67,16354.94,percent of total billed charges,38.7
IR-ANG SUBCL IPS BI,36225,CPT,,,,,both,, ,24740.1,24740.1,Blue Cross and Blue Shield,Traditional,,9574.42,38.7,38.7,24740.1,964.86,12617.45,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,,4786.93,38.7,38.7,12369.34,482.4,6308.36,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,,3642.29,38.7,38.7,9411.59,367.05,4799.91,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,,5463.43,38.7,38.7,14117.39,550.58,7199.87,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,,3119.42,38.7,38.7,8060.51,314.36,4110.86,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,,4679.13,38.7,38.7,12090.77,471.54,6166.29,percent of total billed charges,38.7
S-ABDOMEN 1ST ORDER,36245,CPT,,,,,both,, ,1979.03,1979.03,Blue Cross and Blue Shield,Traditional,,765.88,38.7,38.7,1979.03,77.18,1009.31,percent of total billed charges,38.7
S-ABDOMEN 2ND ORDER,36246,CPT,,,,,both,, ,9539.09,9539.09,Blue Cross and Blue Shield,Traditional,,3691.63,38.7,38.7,9539.09,372.02,4864.94,percent of total billed charges,38.7
S-ABDOMEN 3RD ORDER,36247,CPT,,,,,both,, ,16382.99,16382.99,Blue Cross and Blue Shield,Traditional,,6340.22,38.7,38.7,16382.99,638.94,8355.32,percent of total billed charges,38.7
DNA SPECIMEN COLLECTION VENI,36415,CPT,,,,,both,, ,70,70,Blue Cross and Blue Shield,Traditional,,27.09,38.7,38.7,70,2.73,35.7,percent of total billed charges,38.7
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,, ,8.19,8.19,Blue Cross and Blue Shield,Traditional,,3.17,38.7,38.7,8.19,0.32,4.18,percent of total billed charges,38.7
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,,,90.37,90.37,Blue Cross and Blue Shield,Traditional,,34.97,38.7,38.7,90.37,3.52,46.09,percent of total billed charges,38.7
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,, ,90.37,90.37,Blue Cross and Blue Shield,Traditional,,34.97,38.7,38.7,90.37,3.52,46.09,percent of total billed charges,38.7
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,22.73,22.73,Blue Cross and Blue Shield,Traditional,,8.8,38.7,38.7,22.73,0.89,11.59,percent of total billed charges,38.7
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,46.31,46.31,Blue Cross and Blue Shield,Traditional,,17.92,38.7,38.7,46.31,1.81,23.62,percent of total billed charges,38.7
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,49.96,49.96,Blue Cross and Blue Shield,Traditional,,19.33,38.7,38.7,49.96,1.95,25.48,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,,874.83,38.7,38.7,2260.55,88.16,1152.88,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,,874.83,38.7,38.7,2260.55,88.16,1152.88,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,,874.83,38.7,38.7,2260.55,88.16,1152.88,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,,874.83,38.7,38.7,2260.55,88.16,1152.88,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,,874.83,38.7,38.7,2260.55,88.16,1152.88,percent of total billed charges,38.7
BLOOD TRANSFUSION,36430,CPT,,,,,both,, ,3283.64,3283.64,Blue Cross and Blue Shield,Traditional,,1270.77,38.7,38.7,3283.64,128.06,1674.66,percent of total billed charges,38.7
BLOOD TRANSFUSION,36430,CPT,,,,,both,, ,3579.17,3579.17,Blue Cross and Blue Shield,Traditional,,1385.14,38.7,38.7,3579.17,139.59,1825.38,percent of total billed charges,38.7
BLOOD PUSH TRAN U2YR,36440,CPT,,,,,both,, ,3579.17,3579.17,Blue Cross and Blue Shield,Traditional,,1385.14,38.7,38.7,3579.17,139.59,1825.38,percent of total billed charges,38.7
THER APHERESIS WBC,36511,CPT,,,,,both,, ,5560.46,5560.46,Blue Cross and Blue Shield,Traditional,,2151.9,38.7,38.7,5560.46,216.86,2835.83,percent of total billed charges,38.7
THER APHERESI PLASMA,36514,CPT,,,,,both,, ,5560.46,5560.46,Blue Cross and Blue Shield,Traditional,,2151.9,38.7,38.7,5560.46,216.86,2835.83,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,,1554.78,38.7,38.7,4017.52,156.68,2048.94,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,,917.4,38.7,38.7,2370.55,92.45,1208.98,percent of total billed charges,38.7
BLD COLLECT VAD,36591,CPT,,,,,both,, ,445.15,445.15,Blue Cross and Blue Shield,Traditional,,172.27,38.7,38.7,445.15,17.36,227.03,percent of total billed charges,38.7
BLD DRAW CENTRAL LN,36592,CPT,,,,,both,, ,388.45,388.45,Blue Cross and Blue Shield,Traditional,,150.33,38.7,38.7,388.45,15.15,198.11,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,,180.77,38.7,38.7,467.11,18.22,238.23,percent of total billed charges,38.7
ARTERIAL PUNCTURE,36600,CPT,,,,,both,, ,327.26,327.26,Blue Cross and Blue Shield,Traditional,,126.65,38.7,38.7,327.26,12.76,166.9,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,,11393.38,38.7,38.7,29440.27,1148.17,15014.54,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,,7861.46,38.7,38.7,20313.85,792.24,10360.06,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,,7861.46,38.7,38.7,20313.85,792.24,10360.06,percent of total billed charges,38.7
S-THROMBOLYSIS CEREB,37195,CPT,,,,,both,, ,860.31,860.31,Blue Cross and Blue Shield,Traditional,,332.94,38.7,38.7,860.31,33.55,438.76,percent of total billed charges,38.7
S-ID SENTINEL NODE,38792,CPT,,,,,both,, ,1582.72,1582.72,Blue Cross and Blue Shield,Traditional,,612.51,38.7,38.7,1582.72,61.73,807.19,percent of total billed charges,38.7
S-BX NDL LIVER,47000,CPT,,,,,both,, ,1102.87,1102.87,Blue Cross and Blue Shield,Traditional,,426.81,38.7,38.7,1102.87,43.01,562.46,percent of total billed charges,38.7
CT-PERC CHOLECYSTOST,47490,CPT,,,,,both,, ,10295.62,10295.62,Blue Cross and Blue Shield,Traditional,,3984.4,38.7,38.7,10295.62,401.53,5250.77,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,,1458.13,38.7,38.7,3767.78,146.94,1921.57,percent of total billed charges,38.7
IR-PERITONEAL LAVAGE,49084,CPT,,,,,both,, ,3767.78,3767.78,Blue Cross and Blue Shield,Traditional,,1458.13,38.7,38.7,3767.78,146.94,1921.57,percent of total billed charges,38.7
LITHOTRIPSY,50590,CPT,,,,,both,, ,54374.73,54374.73,Blue Cross and Blue Shield,Traditional,,21043.02,38.7,38.7,54374.73,2120.61,27731.11,percent of total billed charges,38.7
S-URETEROGRM INJ,50684,CPT,,,,,both,, ,323.94,323.94,Blue Cross and Blue Shield,Traditional,,125.36,38.7,38.7,323.94,12.63,165.21,percent of total billed charges,38.7
S-INJ ILEAL CONDUIT,50690,CPT,,,,,both,, ,323.94,323.94,Blue Cross and Blue Shield,Traditional,,125.36,38.7,38.7,323.94,12.63,165.21,percent of total billed charges,38.7
S-CORPCAVERNOSGR INJ,54230,CPT,,,,,both,, ,425.39,425.39,Blue Cross and Blue Shield,Traditional,,164.63,38.7,38.7,425.39,16.59,216.95,percent of total billed charges,38.7
S-INJ CATH HYSTERSO,58340,CPT,,,,,both,, ,336.52,336.52,Blue Cross and Blue Shield,Traditional,,130.23,38.7,38.7,336.52,13.12,171.63,percent of total billed charges,38.7
FETAL CONTRACTION ST,59020,CPT,,,,,both,, ,2089.1,2089.1,Blue Cross and Blue Shield,Traditional,,808.48,38.7,38.7,2089.1,81.47,1065.44,percent of total billed charges,38.7
FETAL NON STRESS TES,59025,CPT,,,,,both,, ,1169.57,1169.57,Blue Cross and Blue Shield,Traditional,,452.62,38.7,38.7,1169.57,45.61,596.48,percent of total billed charges,38.7
EXTERNAL CEPHALIC VE,59412,CPT,,,,,both,, ,5047.77,5047.77,Blue Cross and Blue Shield,Traditional,,1953.49,38.7,38.7,5047.77,196.86,2574.36,percent of total billed charges,38.7
S-THYROID CORE BX,60100,CPT,,,,,both,, ,630.36,630.36,Blue Cross and Blue Shield,Traditional,,243.95,38.7,38.7,630.36,24.58,321.48,percent of total billed charges,38.7
S-SPINAL TAP DIAGNST,62270,CPT,,,,,both,, ,1417.54,1417.54,Blue Cross and Blue Shield,Traditional,,548.59,38.7,38.7,1417.54,55.28,722.95,percent of total billed charges,38.7
S-INJ EPI BLD PATCH,62273,CPT,,,,,both,, ,1368.1,1368.1,Blue Cross and Blue Shield,Traditional,,529.45,38.7,38.7,1368.1,53.36,697.73,percent of total billed charges,38.7
S-MYELOGRAM INJ,62284,CPT,,,,,both,, ,629.07,629.07,Blue Cross and Blue Shield,Traditional,,243.45,38.7,38.7,629.07,24.53,320.83,percent of total billed charges,38.7
IR-MYELO CERVICAL,62302,CPT,,,,,both,, ,2078.67,2078.67,Blue Cross and Blue Shield,Traditional,,804.45,38.7,38.7,2078.67,81.07,1060.12,percent of total billed charges,38.7
IR-MYELO THORACIC,62303,CPT,,,,,both,, ,1934.41,1934.41,Blue Cross and Blue Shield,Traditional,,748.62,38.7,38.7,1934.41,75.44,986.55,percent of total billed charges,38.7
IR-MYELO LUMBAR,62304,CPT,,,,,both,, ,1964.44,1964.44,Blue Cross and Blue Shield,Traditional,,760.24,38.7,38.7,1964.44,76.61,1001.86,percent of total billed charges,38.7
IR-MYELO COMPLETE,62305,CPT,,,,,both,, ,4013.09,4013.09,Blue Cross and Blue Shield,Traditional,,1553.07,38.7,38.7,4013.09,156.51,2046.68,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,,948.29,38.7,38.7,2450.37,95.56,1249.69,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,,948.29,38.7,38.7,2450.37,95.56,1249.69,percent of total billed charges,38.7
IR-DI L-S INJ-IN WIM,62327,CPT,,,,,both,, ,2707.1,2707.1,Blue Cross and Blue Shield,Traditional,,1047.65,38.7,38.7,2707.1,105.58,1380.62,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,,548.59,38.7,38.7,1417.54,55.28,722.95,percent of total billed charges,38.7
IR-POSTERIOR FOSSA,70010,CPT,,,,,both,, ,2122.18,2122.18,Blue Cross and Blue Shield,Traditional,,821.28,38.7,38.7,2122.18,82.77,1082.31,percent of total billed charges,38.7
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,1239.46,1239.46,Blue Cross and Blue Shield,Traditional,,479.67,38.7,38.7,1239.46,48.34,632.12,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,959.56,38.7,38.7,2479.48,96.7,1264.53,percent of total billed charges,38.7
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,,,883.84,883.84,Blue Cross and Blue Shield,Traditional,,342.05,38.7,38.7,883.84,34.47,450.76,percent of total billed charges,38.7
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,883.84,883.84,Blue Cross and Blue Shield,Traditional,,342.05,38.7,38.7,883.84,34.47,450.76,percent of total billed charges,38.7
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,38.7,220.61,8.6,112.51,percent of total billed charges,38.7
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,38.7,237.45,9.26,121.1,percent of total billed charges,38.7
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,38.7,237.45,9.26,121.1,percent of total billed charges,38.7
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,38.7,237.45,9.26,121.1,percent of total billed charges,38.7
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,,,940.82,940.82,Blue Cross and Blue Shield,Traditional,,364.1,38.7,38.7,940.82,36.69,479.82,percent of total billed charges,38.7
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,940.82,940.82,Blue Cross and Blue Shield,Traditional,,364.1,38.7,38.7,940.82,36.69,479.82,percent of total billed charges,38.7
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,,,456.37,456.37,Blue Cross and Blue Shield,Traditional,,176.62,38.7,38.7,456.37,17.8,232.75,percent of total billed charges,38.7
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,456.37,456.37,Blue Cross and Blue Shield,Traditional,,176.62,38.7,38.7,456.37,17.8,232.75,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,302.72,38.7,38.7,782.23,30.51,398.94,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,,302.72,38.7,38.7,782.23,30.51,398.94,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,,85.38,38.7,38.7,220.61,8.6,112.51,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,436.66,38.7,38.7,1128.31,44,575.44,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,,436.66,38.7,38.7,1128.31,44,575.44,percent of total billed charges,38.7
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-NASAL BONES CR,70160,CPT,,,,,both,,,782.23,782.23,Blue Cross and Blue Shield,Traditional,,302.72,38.7,38.7,782.23,30.51,398.94,percent of total billed charges,38.7
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,782.23,782.23,Blue Cross and Blue Shield,Traditional,,302.72,38.7,38.7,782.23,30.51,398.94,percent of total billed charges,38.7
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-ORBITS 4V CR,70200,CPT,,,,,both,,,918.37,918.37,Blue Cross and Blue Shield,Traditional,,355.41,38.7,38.7,918.37,35.82,468.37,percent of total billed charges,38.7
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,918.37,918.37,Blue Cross and Blue Shield,Traditional,,355.41,38.7,38.7,918.37,35.82,468.37,percent of total billed charges,38.7
HE-SINUSES LTD CR,70210,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-SINUSES LTD CR,70210,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,,,936.33,936.33,Blue Cross and Blue Shield,Traditional,,362.36,38.7,38.7,936.33,36.52,477.53,percent of total billed charges,38.7
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,936.33,936.33,Blue Cross and Blue Shield,Traditional,,362.36,38.7,38.7,936.33,36.52,477.53,percent of total billed charges,38.7
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-SKULL LIMITED CR,70250,CPT,,,,,both,,,1151.89,1151.89,Blue Cross and Blue Shield,Traditional,,445.78,38.7,38.7,1151.89,44.92,587.46,percent of total billed charges,38.7
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,1151.89,1151.89,Blue Cross and Blue Shield,Traditional,,445.78,38.7,38.7,1151.89,44.92,587.46,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,,85.38,38.7,38.7,220.61,8.6,112.51,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,534.63,38.7,38.7,1381.48,53.88,704.55,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,,534.63,38.7,38.7,1381.48,53.88,704.55,percent of total billed charges,38.7
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,,,538.05,538.05,Blue Cross and Blue Shield,Traditional,,208.23,38.7,38.7,538.05,20.98,274.41,percent of total billed charges,38.7
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,538.05,538.05,Blue Cross and Blue Shield,Traditional,,208.23,38.7,38.7,538.05,20.98,274.41,percent of total billed charges,38.7
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,,,342.7,342.7,Blue Cross and Blue Shield,Traditional,,132.62,38.7,38.7,342.7,13.37,174.78,percent of total billed charges,38.7
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,342.7,342.7,Blue Cross and Blue Shield,Traditional,,132.62,38.7,38.7,342.7,13.37,174.78,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,,910.68,38.7,38.7,2353.18,91.77,1200.12,percent of total billed charges,38.7
IR-ARTHROGRAM TMJ CR,70332,CPT,,,,,both,, ,1176.59,1176.59,Blue Cross and Blue Shield,Traditional,,455.34,38.7,38.7,1176.59,45.89,600.06,percent of total billed charges,38.7
HE-ORTHOPANTOGRAM CR,70355,CPT,,,,,both,, ,692.14,692.14,Blue Cross and Blue Shield,Traditional,,267.86,38.7,38.7,692.14,26.99,352.99,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,293.16,38.7,38.7,757.53,29.54,386.34,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,,293.16,38.7,38.7,757.53,29.54,386.34,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,,312.72,38.7,38.7,808.06,31.51,412.11,percent of total billed charges,38.7
IR-SIALOGRAM,70390,CPT,,,,,both,, ,1800.52,1800.52,Blue Cross and Blue Shield,Traditional,,696.8,38.7,38.7,1800.52,70.22,918.27,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,,610.12,38.7,38.7,1576.55,61.49,804.04,percent of total billed charges,38.7
CT-HEAD WO,70450,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,38.7,307.05,11.97,156.6,percent of total billed charges,38.7
CT-HEAD WO,70450,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,38.7,330.63,12.89,168.62,percent of total billed charges,38.7
CT-HEAD WO,70450,CPT,,,,,both,, ,1576.55,1576.55,Blue Cross and Blue Shield,Traditional,,610.12,38.7,38.7,1576.55,61.49,804.04,percent of total billed charges,38.7
CT-HEAD W,70460,CPT,,,,,both,,,1765.72,1765.72,Blue Cross and Blue Shield,Traditional,,683.33,38.7,38.7,1765.72,68.86,900.52,percent of total billed charges,38.7
CT-HEAD W,70460,CPT,,,,,both,, ,1765.72,1765.72,Blue Cross and Blue Shield,Traditional,,683.33,38.7,38.7,1765.72,68.86,900.52,percent of total billed charges,38.7
CT-HEAD WWO,70470,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,38.7,680.91,26.56,347.26,percent of total billed charges,38.7
CT-HEAD WWO,70470,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,38.7,732.83,28.58,373.74,percent of total billed charges,38.7
CT-HEAD WWO,70470,CPT,,,,,both,,,3726.8,3726.8,Blue Cross and Blue Shield,Traditional,,1442.27,38.7,38.7,3726.8,145.35,1900.67,percent of total billed charges,38.7
CT-HEAD WWO,70470,CPT,,,,,both,, ,3726.8,3726.8,Blue Cross and Blue Shield,Traditional,,1442.27,38.7,38.7,3726.8,145.35,1900.67,percent of total billed charges,38.7
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,38.7,307.05,11.97,156.6,percent of total billed charges,38.7
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,38.7,330.63,12.89,168.62,percent of total billed charges,38.7
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,2847.17,2847.17,Blue Cross and Blue Shield,Traditional,,1101.85,38.7,38.7,2847.17,111.04,1452.06,percent of total billed charges,38.7
CT-ORBIT EAR W,70481,CPT,,,,,both,, ,556.01,556.01,Blue Cross and Blue Shield,Traditional,,215.18,38.7,38.7,556.01,21.68,283.57,percent of total billed charges,38.7
CT-ORBIT EAR W,70481,CPT,,,,,both,, ,1643.07,1643.07,Blue Cross and Blue Shield,Traditional,,635.87,38.7,38.7,1643.07,64.08,837.97,percent of total billed charges,38.7
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,38.7,680.91,26.56,347.26,percent of total billed charges,38.7
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,38.7,732.83,28.58,373.74,percent of total billed charges,38.7
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,4001.3,4001.3,Blue Cross and Blue Shield,Traditional,,1548.5,38.7,38.7,4001.3,156.05,2040.66,percent of total billed charges,38.7
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,38.7,307.05,11.97,156.6,percent of total billed charges,38.7
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,38.7,330.63,12.89,168.62,percent of total billed charges,38.7
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,,,2847.17,2847.17,Blue Cross and Blue Shield,Traditional,,1101.85,38.7,38.7,2847.17,111.04,1452.06,percent of total billed charges,38.7
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,2847.17,2847.17,Blue Cross and Blue Shield,Traditional,,1101.85,38.7,38.7,2847.17,111.04,1452.06,percent of total billed charges,38.7
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,604.85,604.85,Blue Cross and Blue Shield,Traditional,,234.08,38.7,38.7,604.85,23.59,308.47,percent of total billed charges,38.7
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,650.88,650.88,Blue Cross and Blue Shield,Traditional,,251.89,38.7,38.7,650.88,25.38,331.95,percent of total billed charges,38.7
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,,,3178.64,3178.64,Blue Cross and Blue Shield,Traditional,,1230.13,38.7,38.7,3178.64,123.97,1621.11,percent of total billed charges,38.7
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,3178.64,3178.64,Blue Cross and Blue Shield,Traditional,,1230.13,38.7,38.7,3178.64,123.97,1621.11,percent of total billed charges,38.7
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,38.7,680.91,26.56,347.26,percent of total billed charges,38.7
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,38.7,732.83,28.58,373.74,percent of total billed charges,38.7
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,,,3726.8,3726.8,Blue Cross and Blue Shield,Traditional,,1442.27,38.7,38.7,3726.8,145.35,1900.67,percent of total billed charges,38.7
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,3726.8,3726.8,Blue Cross and Blue Shield,Traditional,,1442.27,38.7,38.7,3726.8,145.35,1900.67,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,,118.83,38.7,38.7,307.05,11.97,156.6,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,,127.95,38.7,38.7,330.63,12.89,168.62,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,,1059.6,38.7,38.7,2737.98,106.78,1396.37,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,,1059.6,38.7,38.7,2737.98,106.78,1396.37,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,,234.08,38.7,38.7,604.85,23.59,308.47,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,,251.89,38.7,38.7,650.88,25.38,331.95,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,,1061.77,38.7,38.7,2743.59,107,1399.23,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,,1061.77,38.7,38.7,2743.59,107,1399.23,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,,263.51,38.7,38.7,680.91,26.56,347.26,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,,283.61,38.7,38.7,732.83,28.58,373.74,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,,1670.92,38.7,38.7,4317.62,168.39,2201.99,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,,1670.92,38.7,38.7,4317.62,168.39,2201.99,percent of total billed charges,38.7
CTA-HEAD,70496,CPT,,,,,both,, ,893.1,893.1,Blue Cross and Blue Shield,Traditional,,345.63,38.7,38.7,893.1,34.83,455.48,percent of total billed charges,38.7
CTA-HEAD,70496,CPT,,,,,both,,,2355.42,2355.42,Blue Cross and Blue Shield,Traditional,,911.55,38.7,38.7,2355.42,91.86,1201.26,percent of total billed charges,38.7
CTA-HEAD,70496,CPT,,,,,both,, ,2355.42,2355.42,Blue Cross and Blue Shield,Traditional,,911.55,38.7,38.7,2355.42,91.86,1201.26,percent of total billed charges,38.7
CTA-NECK,70498,CPT,,,,,both,, ,893.1,893.1,Blue Cross and Blue Shield,Traditional,,345.63,38.7,38.7,893.1,34.83,455.48,percent of total billed charges,38.7
CTA-NECK,70498,CPT,,,,,both,,,2355.42,2355.42,Blue Cross and Blue Shield,Traditional,,911.55,38.7,38.7,2355.42,91.86,1201.26,percent of total billed charges,38.7
CTA-NECK,70498,CPT,,,,,both,, ,2355.42,2355.42,Blue Cross and Blue Shield,Traditional,,911.55,38.7,38.7,2355.42,91.86,1201.26,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,,277.09,38.7,38.7,715.99,27.92,365.15,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,,298.16,38.7,38.7,770.45,30.05,392.93,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,,1564.58,38.7,38.7,4042.84,157.67,2061.85,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,,400.81,38.7,38.7,1035.69,40.39,528.2,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,,431.33,38.7,38.7,1114.55,43.47,568.42,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,,1661.58,38.7,38.7,4293.48,167.45,2189.67,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,,463.27,38.7,38.7,1197.08,46.69,610.51,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,,498.57,38.7,38.7,1288.29,50.24,657.03,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,,2011.55,38.7,38.7,5197.81,202.71,2650.88,percent of total billed charges,38.7
MRA-HEAD WO,70544,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,38.7,715.99,27.92,365.15,percent of total billed charges,38.7
MRA-HEAD WO,70544,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,38.7,770.45,30.05,392.93,percent of total billed charges,38.7
MRA-HEAD WO,70544,CPT,,,,,both,, ,1631.56,1631.56,Blue Cross and Blue Shield,Traditional,,631.41,38.7,38.7,1631.56,63.63,832.1,percent of total billed charges,38.7
MRA-HEAD W,70545,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,38.7,1035.69,40.39,528.2,percent of total billed charges,38.7
MRA-HEAD W,70545,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,38.7,1114.55,43.47,568.42,percent of total billed charges,38.7
MRA-HEAD W,70545,CPT,,,,,both,, ,1938.34,1938.34,Blue Cross and Blue Shield,Traditional,,750.14,38.7,38.7,1938.34,75.6,988.55,percent of total billed charges,38.7
MRA-HEAD WWO,70546,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,38.7,1197.08,46.69,610.51,percent of total billed charges,38.7
MRA-HEAD WWO,70546,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,38.7,1288.29,50.24,657.03,percent of total billed charges,38.7
MRA-HEAD WWO,70546,CPT,,,,,both,, ,2669.78,2669.78,Blue Cross and Blue Shield,Traditional,,1033.2,38.7,38.7,2669.78,104.12,1361.59,percent of total billed charges,38.7
MRA-NECK WO,70547,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,38.7,715.99,27.92,365.15,percent of total billed charges,38.7
MRA-NECK WO,70547,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,38.7,770.45,30.05,392.93,percent of total billed charges,38.7
MRA-NECK WO,70547,CPT,,,,,both,, ,1334.89,1334.89,Blue Cross and Blue Shield,Traditional,,516.6,38.7,38.7,1334.89,52.06,680.79,percent of total billed charges,38.7
MRA-NECK W,70548,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,38.7,1035.69,40.39,528.2,percent of total billed charges,38.7
MRA-NECK W,70548,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,38.7,1114.55,43.47,568.42,percent of total billed charges,38.7
MRA-NECK W,70548,CPT,,,,,both,, ,1938.34,1938.34,Blue Cross and Blue Shield,Traditional,,750.14,38.7,38.7,1938.34,75.6,988.55,percent of total billed charges,38.7
MRA-NECK WWO,70549,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,38.7,1197.08,46.69,610.51,percent of total billed charges,38.7
MRA-NECK WWO,70549,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,38.7,1288.29,50.24,657.03,percent of total billed charges,38.7
MRA-NECK WWO,70549,CPT,,,,,both,, ,3263.12,3263.12,Blue Cross and Blue Shield,Traditional,,1262.83,38.7,38.7,3263.12,127.26,1664.19,percent of total billed charges,38.7
MR-BRAIN WO,70551,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,38.7,715.99,27.92,365.15,percent of total billed charges,38.7
MR-BRAIN WO,70551,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,38.7,770.45,30.05,392.93,percent of total billed charges,38.7
MR-BRAIN WO,70551,CPT,,,,,both,,,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,38.7,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-BRAIN WO,70551,CPT,,,,,both,, ,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,38.7,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-BRAIN W,70552,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,38.7,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-BRAIN W,70552,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,38.7,1114.55,43.47,568.42,percent of total billed charges,38.7
MR-BRAIN W,70552,CPT,,,,,both,,,2352.06,2352.06,Blue Cross and Blue Shield,Traditional,,910.25,38.7,38.7,2352.06,91.73,1199.55,percent of total billed charges,38.7
MR-BRAIN W,70552,CPT,,,,,both,, ,2352.06,2352.06,Blue Cross and Blue Shield,Traditional,,910.25,38.7,38.7,2352.06,91.73,1199.55,percent of total billed charges,38.7
MR-BRAIN WWO,70553,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,38.7,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-BRAIN WWO,70553,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,38.7,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-BRAIN WWO,70553,CPT,,,,,both,, ,6352.79,6352.79,Blue Cross and Blue Shield,Traditional,,2458.53,38.7,38.7,6352.79,247.76,3239.92,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,,2458.53,38.7,38.7,6352.79,247.76,3239.92,percent of total billed charges,38.7
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-CHEST 1V CR,71045,CPT,,,,,both,,,495.95,495.95,Blue Cross and Blue Shield,Traditional,,191.93,38.7,38.7,495.95,19.34,252.93,percent of total billed charges,38.7
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,495.95,495.95,Blue Cross and Blue Shield,Traditional,,191.93,38.7,38.7,495.95,19.34,252.93,percent of total billed charges,38.7
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-CHEST 2V CR,71046,CPT,,,,,both,,,750.52,750.52,Blue Cross and Blue Shield,Traditional,,290.45,38.7,38.7,750.52,29.27,382.77,percent of total billed charges,38.7
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,750.52,750.52,Blue Cross and Blue Shield,Traditional,,290.45,38.7,38.7,750.52,29.27,382.77,percent of total billed charges,38.7
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,143.98,Blue Cross and Blue Shield,Traditional,,55.72,38.7,38.7,143.98,5.62,73.43,percent of total billed charges,38.7
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,143.98,Blue Cross and Blue Shield,Traditional,,55.72,38.7,38.7,143.98,5.62,73.43,percent of total billed charges,38.7
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,143.98,Blue Cross and Blue Shield,Traditional,,55.72,38.7,38.7,143.98,5.62,73.43,percent of total billed charges,38.7
CH-CHEST 3V CR,71047,CPT,,,,,both,,,1091.82,1091.82,Blue Cross and Blue Shield,Traditional,,422.53,38.7,38.7,1091.82,42.58,556.83,percent of total billed charges,38.7
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,1091.82,1091.82,Blue Cross and Blue Shield,Traditional,,422.53,38.7,38.7,1091.82,42.58,556.83,percent of total billed charges,38.7
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,143.98,143.98,Blue Cross and Blue Shield,Traditional,,55.72,38.7,38.7,143.98,5.62,73.43,percent of total billed charges,38.7
CH-CHEST 4V CR,71048,CPT,,,,,both,,,1652.05,1652.05,Blue Cross and Blue Shield,Traditional,,639.34,38.7,38.7,1652.05,64.43,842.55,percent of total billed charges,38.7
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,1652.05,1652.05,Blue Cross and Blue Shield,Traditional,,639.34,38.7,38.7,1652.05,64.43,842.55,percent of total billed charges,38.7
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-RIBS UNILAT CR,71100,CPT,,,,,both,,,876.83,876.83,Blue Cross and Blue Shield,Traditional,,339.33,38.7,38.7,876.83,34.2,447.18,percent of total billed charges,38.7
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,876.83,876.83,Blue Cross and Blue Shield,Traditional,,339.33,38.7,38.7,876.83,34.2,447.18,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,,85.38,38.7,38.7,220.61,8.6,112.51,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,100.91,38.7,38.7,260.74,10.17,132.98,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,,100.91,38.7,38.7,260.74,10.17,132.98,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,,445.89,38.7,38.7,1152.17,44.93,587.61,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,,445.89,38.7,38.7,1152.17,44.93,587.61,percent of total billed charges,38.7
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,38.7,220.61,8.6,112.51,percent of total billed charges,38.7
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,38.7,237.45,9.26,121.1,percent of total billed charges,38.7
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,38.7,237.45,9.26,121.1,percent of total billed charges,38.7
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,38.7,237.45,9.26,121.1,percent of total billed charges,38.7
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,,,1381.48,1381.48,Blue Cross and Blue Shield,Traditional,,534.63,38.7,38.7,1381.48,53.88,704.55,percent of total billed charges,38.7
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,1381.48,1381.48,Blue Cross and Blue Shield,Traditional,,534.63,38.7,38.7,1381.48,53.88,704.55,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,,85.38,38.7,38.7,220.61,8.6,112.51,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,100.91,38.7,38.7,260.74,10.17,132.98,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,,100.91,38.7,38.7,260.74,10.17,132.98,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,,726.78,38.7,38.7,1877.99,73.24,957.77,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,,726.78,38.7,38.7,1877.99,73.24,957.77,percent of total billed charges,38.7
CH-STERNUM CR,71120,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-STERNUM CR,71120,CPT,,,,,both,,,947.27,947.27,Blue Cross and Blue Shield,Traditional,,366.59,38.7,38.7,947.27,36.94,483.11,percent of total billed charges,38.7
CH-STERNUM CR,71120,CPT,,,,,both,, ,947.27,947.27,Blue Cross and Blue Shield,Traditional,,366.59,38.7,38.7,947.27,36.94,483.11,percent of total billed charges,38.7
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,,,989.38,989.38,Blue Cross and Blue Shield,Traditional,,382.89,38.7,38.7,989.38,38.59,504.58,percent of total billed charges,38.7
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,989.38,989.38,Blue Cross and Blue Shield,Traditional,,382.89,38.7,38.7,989.38,38.59,504.58,percent of total billed charges,38.7
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,38.7,307.05,11.97,156.6,percent of total billed charges,38.7
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,38.7,330.63,12.89,168.62,percent of total billed charges,38.7
CT-CHEST DIAG WO,71250,CPT,,,,,both,,,3833.18,3833.18,Blue Cross and Blue Shield,Traditional,,1483.44,38.7,38.7,3833.18,149.49,1954.92,percent of total billed charges,38.7
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,3833.18,3833.18,Blue Cross and Blue Shield,Traditional,,1483.44,38.7,38.7,3833.18,149.49,1954.92,percent of total billed charges,38.7
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,604.85,604.85,Blue Cross and Blue Shield,Traditional,,234.08,38.7,38.7,604.85,23.59,308.47,percent of total billed charges,38.7
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,650.88,650.88,Blue Cross and Blue Shield,Traditional,,251.89,38.7,38.7,650.88,25.38,331.95,percent of total billed charges,38.7
CT-CHEST DIAG W,71260,CPT,,,,,both,,,4107.96,4107.96,Blue Cross and Blue Shield,Traditional,,1589.78,38.7,38.7,4107.96,160.21,2095.06,percent of total billed charges,38.7
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,4107.96,4107.96,Blue Cross and Blue Shield,Traditional,,1589.78,38.7,38.7,4107.96,160.21,2095.06,percent of total billed charges,38.7
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,38.7,680.91,26.56,347.26,percent of total billed charges,38.7
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,38.7,732.83,28.58,373.74,percent of total billed charges,38.7
CT-CHEST DIAG WWO,71270,CPT,,,,,both,,,3833.18,3833.18,Blue Cross and Blue Shield,Traditional,,1483.44,38.7,38.7,3833.18,149.49,1954.92,percent of total billed charges,38.7
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,3833.18,3833.18,Blue Cross and Blue Shield,Traditional,,1483.44,38.7,38.7,3833.18,149.49,1954.92,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,,105.69,38.7,38.7,273.09,10.65,139.28,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,,105.69,38.7,38.7,273.09,10.65,139.28,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,,220.17,38.7,38.7,568.92,22.19,290.15,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,,220.17,38.7,38.7,568.92,22.19,290.15,percent of total billed charges,38.7
CTA-CHEST,71275,CPT,,,,,both,, ,708.98,708.98,Blue Cross and Blue Shield,Traditional,,274.38,38.7,38.7,708.98,27.65,361.58,percent of total billed charges,38.7
CTA-CHEST,71275,CPT,,,,,both,, ,763.15,763.15,Blue Cross and Blue Shield,Traditional,,295.34,38.7,38.7,763.15,29.76,389.21,percent of total billed charges,38.7
CTA-CHEST,71275,CPT,,,,,both,,,2355.14,2355.14,Blue Cross and Blue Shield,Traditional,,911.44,38.7,38.7,2355.14,91.85,1201.12,percent of total billed charges,38.7
CTA-CHEST,71275,CPT,,,,,both,, ,2355.14,2355.14,Blue Cross and Blue Shield,Traditional,,911.44,38.7,38.7,2355.14,91.85,1201.12,percent of total billed charges,38.7
MR-CHEST WO,71550,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,38.7,715.99,27.92,365.15,percent of total billed charges,38.7
MR-CHEST WO,71550,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,38.7,770.45,30.05,392.93,percent of total billed charges,38.7
MR-CHEST WO,71550,CPT,,,,,both,,,4042.84,4042.84,Blue Cross and Blue Shield,Traditional,,1564.58,38.7,38.7,4042.84,157.67,2061.85,percent of total billed charges,38.7
MR-CHEST WO,71550,CPT,,,,,both,, ,4042.84,4042.84,Blue Cross and Blue Shield,Traditional,,1564.58,38.7,38.7,4042.84,157.67,2061.85,percent of total billed charges,38.7
MR-CHEST W,71551,CPT,,,,,both,,,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,38.7,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-CHEST W,71551,CPT,,,,,both,, ,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,38.7,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-CHEST WWO,71552,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,38.7,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-CHEST WWO,71552,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,38.7,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-CHEST WWO,71552,CPT,,,,,both,,,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,38.7,5197.81,202.71,2650.88,percent of total billed charges,38.7
MR-CHEST WWO,71552,CPT,,,,,both,, ,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,38.7,5197.81,202.71,2650.88,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,101.01,38.7,38.7,261.02,10.18,133.12,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,,101.01,38.7,38.7,261.02,10.18,133.12,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,420.03,38.7,38.7,1085.36,42.33,553.53,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,,420.03,38.7,38.7,1085.36,42.33,553.53,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,,85.38,38.7,38.7,220.61,8.6,112.51,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,430.68,38.7,38.7,1112.87,43.4,567.56,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,,85.38,38.7,38.7,220.61,8.6,112.51,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,569.39,38.7,38.7,1471.29,57.38,750.36,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,457.29,38.7,38.7,1181.64,46.08,602.64,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,,457.29,38.7,38.7,1181.64,46.08,602.64,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,,85.38,38.7,38.7,220.61,8.6,112.51,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,559.07,38.7,38.7,1444.63,56.34,736.76,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,,559.07,38.7,38.7,1444.63,56.34,736.76,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,559.07,38.7,38.7,1444.63,56.34,736.76,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,,559.07,38.7,38.7,1444.63,56.34,736.76,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,,54.09,38.7,38.7,139.77,5.45,71.28,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,,57.79,38.7,38.7,149.32,5.82,76.15,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,,457.4,38.7,38.7,1181.91,46.09,602.77,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,,54.09,38.7,38.7,139.77,5.45,71.28,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,,57.79,38.7,38.7,149.32,5.82,76.15,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,,89.28,38.7,38.7,230.71,9,117.66,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,,457.4,38.7,38.7,1181.91,46.09,602.77,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,,89.28,38.7,38.7,230.71,9,117.66,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,,108.07,38.7,38.7,279.26,10.89,142.42,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,,115.57,38.7,38.7,298.64,11.65,152.31,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,,914.81,38.7,38.7,2363.84,92.19,1205.56,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,,108.07,38.7,38.7,279.26,10.89,142.42,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,,115.57,38.7,38.7,298.64,11.65,152.31,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,,914.81,38.7,38.7,2363.84,92.19,1205.56,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,,53.87,38.7,38.7,139.21,5.43,71,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,,53.87,38.7,38.7,139.21,5.43,71,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,582.21,38.7,38.7,1504.42,58.67,767.25,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,,582.21,38.7,38.7,1504.42,58.67,767.25,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,,85.38,38.7,38.7,220.61,8.6,112.51,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,761.87,38.7,38.7,1968.65,76.78,1004.01,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,,761.87,38.7,38.7,1968.65,76.78,1004.01,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,,85.38,38.7,38.7,220.61,8.6,112.51,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,862.99,38.7,38.7,2229.96,86.97,1137.28,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,,862.99,38.7,38.7,2229.96,86.97,1137.28,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,,85.38,38.7,38.7,220.61,8.6,112.51,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,683.23,38.7,38.7,1765.44,68.85,900.37,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,,683.23,38.7,38.7,1765.44,68.85,900.37,percent of total billed charges,38.7
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,38.7,307.05,11.97,156.6,percent of total billed charges,38.7
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,38.7,330.63,12.89,168.62,percent of total billed charges,38.7
CT-CERV SPINE WO,72125,CPT,,,,,both,,,3833.18,3833.18,Blue Cross and Blue Shield,Traditional,,1483.44,38.7,38.7,3833.18,149.49,1954.92,percent of total billed charges,38.7
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,3833.18,3833.18,Blue Cross and Blue Shield,Traditional,,1483.44,38.7,38.7,3833.18,149.49,1954.92,percent of total billed charges,38.7
CT-CERV SPINE W,72126,CPT,,,,,both,, ,604.85,604.85,Blue Cross and Blue Shield,Traditional,,234.08,38.7,38.7,604.85,23.59,308.47,percent of total billed charges,38.7
CT-CERV SPINE W,72126,CPT,,,,,both,, ,650.88,650.88,Blue Cross and Blue Shield,Traditional,,251.89,38.7,38.7,650.88,25.38,331.95,percent of total billed charges,38.7
CT-CERV SPINE W,72126,CPT,,,,,both,,,6031.42,6031.42,Blue Cross and Blue Shield,Traditional,,2334.16,38.7,38.7,6031.42,235.23,3076.02,percent of total billed charges,38.7
CT-CERV SPINE W,72126,CPT,,,,,both,, ,6031.42,6031.42,Blue Cross and Blue Shield,Traditional,,2334.16,38.7,38.7,6031.42,235.23,3076.02,percent of total billed charges,38.7
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,38.7,680.91,26.56,347.26,percent of total billed charges,38.7
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,38.7,732.83,28.58,373.74,percent of total billed charges,38.7
CT-CERV SPINE WWO,72127,CPT,,,,,both,,,6031.42,6031.42,Blue Cross and Blue Shield,Traditional,,2334.16,38.7,38.7,6031.42,235.23,3076.02,percent of total billed charges,38.7
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,6031.42,6031.42,Blue Cross and Blue Shield,Traditional,,2334.16,38.7,38.7,6031.42,235.23,3076.02,percent of total billed charges,38.7
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,38.7,307.05,11.97,156.6,percent of total billed charges,38.7
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,38.7,330.63,12.89,168.62,percent of total billed charges,38.7
CT-THOR SPINE WO,72128,CPT,,,,,both,,,3833.18,3833.18,Blue Cross and Blue Shield,Traditional,,1483.44,38.7,38.7,3833.18,149.49,1954.92,percent of total billed charges,38.7
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,3833.18,3833.18,Blue Cross and Blue Shield,Traditional,,1483.44,38.7,38.7,3833.18,149.49,1954.92,percent of total billed charges,38.7
CT-THOR SPINE W,72129,CPT,,,,,both,, ,534.96,534.96,Blue Cross and Blue Shield,Traditional,,207.03,38.7,38.7,534.96,20.86,272.83,percent of total billed charges,38.7
CT-THOR SPINE W,72129,CPT,,,,,both,,,1786.22,1786.22,Blue Cross and Blue Shield,Traditional,,691.27,38.7,38.7,1786.22,69.66,910.97,percent of total billed charges,38.7
CT-THOR SPINE W,72129,CPT,,,,,both,, ,1786.22,1786.22,Blue Cross and Blue Shield,Traditional,,691.27,38.7,38.7,1786.22,69.66,910.97,percent of total billed charges,38.7
CT-THOR SPINE WWO,72130,CPT,,,,,both,,,2407.63,2407.63,Blue Cross and Blue Shield,Traditional,,931.75,38.7,38.7,2407.63,93.9,1227.89,percent of total billed charges,38.7
CT-THOR SPINE WWO,72130,CPT,,,,,both,, ,2407.63,2407.63,Blue Cross and Blue Shield,Traditional,,931.75,38.7,38.7,2407.63,93.9,1227.89,percent of total billed charges,38.7
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,38.7,307.05,11.97,156.6,percent of total billed charges,38.7
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,38.7,330.63,12.89,168.62,percent of total billed charges,38.7
CT-LUMB SPINE WO,72131,CPT,,,,,both,,,534.68,534.68,Blue Cross and Blue Shield,Traditional,,206.92,38.7,38.7,534.68,20.85,272.69,percent of total billed charges,38.7
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,534.68,534.68,Blue Cross and Blue Shield,Traditional,,206.92,38.7,38.7,534.68,20.85,272.69,percent of total billed charges,38.7
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,604.85,604.85,Blue Cross and Blue Shield,Traditional,,234.08,38.7,38.7,604.85,23.59,308.47,percent of total billed charges,38.7
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,650.88,650.88,Blue Cross and Blue Shield,Traditional,,251.89,38.7,38.7,650.88,25.38,331.95,percent of total billed charges,38.7
CT-LUMB SPINE W,72132,CPT,,,,,both,,,1653.45,1653.45,Blue Cross and Blue Shield,Traditional,,639.89,38.7,38.7,1653.45,64.48,843.26,percent of total billed charges,38.7
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,1653.45,1653.45,Blue Cross and Blue Shield,Traditional,,639.89,38.7,38.7,1653.45,64.48,843.26,percent of total billed charges,38.7
CT-LUMB SPINE WWO,72133,CPT,,,,,both,, ,446.27,446.27,Blue Cross and Blue Shield,Traditional,,172.71,38.7,38.7,446.27,17.4,227.6,percent of total billed charges,38.7
CT-LUMB SPINE WWO,72133,CPT,,,,,both,,,1126.62,1126.62,Blue Cross and Blue Shield,Traditional,,436,38.7,38.7,1126.62,43.94,574.58,percent of total billed charges,38.7
CT-LUMB SPINE WWO,72133,CPT,,,,,both,, ,1126.62,1126.62,Blue Cross and Blue Shield,Traditional,,436,38.7,38.7,1126.62,43.94,574.58,percent of total billed charges,38.7
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,38.7,715.99,27.92,365.15,percent of total billed charges,38.7
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,38.7,770.45,30.05,392.93,percent of total billed charges,38.7
MR-CERV SPINE WO,72141,CPT,,,,,both,,,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,38.7,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,38.7,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-CERV SPINE W,72142,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,38.7,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-CERV SPINE W,72142,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,38.7,1114.55,43.47,568.42,percent of total billed charges,38.7
MR-CERV SPINE W,72142,CPT,,,,,both,,,2352.06,2352.06,Blue Cross and Blue Shield,Traditional,,910.25,38.7,38.7,2352.06,91.73,1199.55,percent of total billed charges,38.7
MR-CERV SPINE W,72142,CPT,,,,,both,, ,2352.06,2352.06,Blue Cross and Blue Shield,Traditional,,910.25,38.7,38.7,2352.06,91.73,1199.55,percent of total billed charges,38.7
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,38.7,715.99,27.92,365.15,percent of total billed charges,38.7
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,38.7,770.45,30.05,392.93,percent of total billed charges,38.7
MR-THOR SPINE WO,72146,CPT,,,,,both,,,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,38.7,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,38.7,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-THOR SPINE W,72147,CPT,,,,,both,, ,1641.24,1641.24,Blue Cross and Blue Shield,Traditional,,635.16,38.7,38.7,1641.24,64.01,837.03,percent of total billed charges,38.7
MR-THOR SPINE W,72147,CPT,,,,,both,,,2351.49,2351.49,Blue Cross and Blue Shield,Traditional,,910.03,38.7,38.7,2351.49,91.71,1199.26,percent of total billed charges,38.7
MR-THOR SPINE W,72147,CPT,,,,,both,, ,2351.49,2351.49,Blue Cross and Blue Shield,Traditional,,910.03,38.7,38.7,2351.49,91.71,1199.26,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,,1912.28,38.7,38.7,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,38.7,715.99,27.92,365.15,percent of total billed charges,38.7
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,38.7,770.45,30.05,392.93,percent of total billed charges,38.7
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,38.7,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,38.7,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,38.7,1114.55,43.47,568.42,percent of total billed charges,38.7
MR-LUMB SPINE W,72149,CPT,,,,,both,,,2352.06,2352.06,Blue Cross and Blue Shield,Traditional,,910.25,38.7,38.7,2352.06,91.73,1199.55,percent of total billed charges,38.7
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,2352.06,2352.06,Blue Cross and Blue Shield,Traditional,,910.25,38.7,38.7,2352.06,91.73,1199.55,percent of total billed charges,38.7
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,38.7,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,38.7,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-CERV SPINE WWO,72156,CPT,,,,,both,,,6352.79,6352.79,Blue Cross and Blue Shield,Traditional,,2458.53,38.7,38.7,6352.79,247.76,3239.92,percent of total billed charges,38.7
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,6352.79,6352.79,Blue Cross and Blue Shield,Traditional,,2458.53,38.7,38.7,6352.79,247.76,3239.92,percent of total billed charges,38.7
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,38.7,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,38.7,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-THOR SPINE WWO,72157,CPT,,,,,both,,,6352.79,6352.79,Blue Cross and Blue Shield,Traditional,,2458.53,38.7,38.7,6352.79,247.76,3239.92,percent of total billed charges,38.7
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,6352.79,6352.79,Blue Cross and Blue Shield,Traditional,,2458.53,38.7,38.7,6352.79,247.76,3239.92,percent of total billed charges,38.7
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,38.7,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,38.7,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-LUMB SPINE WWO,72158,CPT,,,,,both,,,6352.79,6352.79,Blue Cross and Blue Shield,Traditional,,2458.53,38.7,38.7,6352.79,247.76,3239.92,percent of total billed charges,38.7
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,6352.79,6352.79,Blue Cross and Blue Shield,Traditional,,2458.53,38.7,38.7,6352.79,247.76,3239.92,percent of total billed charges,38.7
LE-PELVIS CR,72170,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-PELVIS CR,72170,CPT,,,,,both,,,936.33,936.33,Blue Cross and Blue Shield,Traditional,,362.36,38.7,38.7,936.33,36.52,477.53,percent of total billed charges,38.7
LE-PELVIS CR,72170,CPT,,,,,both,, ,936.33,936.33,Blue Cross and Blue Shield,Traditional,,362.36,38.7,38.7,936.33,36.52,477.53,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,686.92,38.7,38.7,1774.99,69.22,905.24,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,,686.92,38.7,38.7,1774.99,69.22,905.24,percent of total billed charges,38.7
CT-PELVIS WO,72192,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,38.7,307.05,11.97,156.6,percent of total billed charges,38.7
CT-PELVIS WO,72192,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,38.7,330.63,12.89,168.62,percent of total billed charges,38.7
CT-PELVIS WO,72192,CPT,,,,,both,,,3285.58,3285.58,Blue Cross and Blue Shield,Traditional,,1271.52,38.7,38.7,3285.58,128.14,1675.65,percent of total billed charges,38.7
CT-PELVIS WO,72192,CPT,,,,,both,, ,3285.58,3285.58,Blue Cross and Blue Shield,Traditional,,1271.52,38.7,38.7,3285.58,128.14,1675.65,percent of total billed charges,38.7
"CT scan, pelvis, with contrast",72193,CPT,,,,,both,,,3726.8,3726.8,Blue Cross and Blue Shield,Traditional,,1442.27,38.7,38.7,3726.8,145.35,1900.67,percent of total billed charges,38.7
CT-PELVIS W,72193,CPT,,,,,both,, ,604.85,604.85,Blue Cross and Blue Shield,Traditional,,234.08,38.7,38.7,604.85,23.59,308.47,percent of total billed charges,38.7
CT-PELVIS W,72193,CPT,,,,,both,, ,650.88,650.88,Blue Cross and Blue Shield,Traditional,,251.89,38.7,38.7,650.88,25.38,331.95,percent of total billed charges,38.7
CT-PELVIS W,72193,CPT,,,,,both,, ,3726.8,3726.8,Blue Cross and Blue Shield,Traditional,,1442.27,38.7,38.7,3726.8,145.35,1900.67,percent of total billed charges,38.7
CT-PELVIS WWO,72194,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,38.7,680.91,26.56,347.26,percent of total billed charges,38.7
CT-PELVIS WWO,72194,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,38.7,732.83,28.58,373.74,percent of total billed charges,38.7
CT-PELVIS WWO,72194,CPT,,,,,both,,,4047.33,4047.33,Blue Cross and Blue Shield,Traditional,,1566.32,38.7,38.7,4047.33,157.85,2064.14,percent of total billed charges,38.7
CT-PELVIS WWO,72194,CPT,,,,,both,, ,4047.33,4047.33,Blue Cross and Blue Shield,Traditional,,1566.32,38.7,38.7,4047.33,157.85,2064.14,percent of total billed charges,38.7
MR-PELVIS WO,72195,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,38.7,715.99,27.92,365.15,percent of total billed charges,38.7
MR-PELVIS WO,72195,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,38.7,770.45,30.05,392.93,percent of total billed charges,38.7
MR-PELVIS WO,72195,CPT,,,,,both,,,4042.84,4042.84,Blue Cross and Blue Shield,Traditional,,1564.58,38.7,38.7,4042.84,157.67,2061.85,percent of total billed charges,38.7
MR-PELVIS WO,72195,CPT,,,,,both,, ,4042.84,4042.84,Blue Cross and Blue Shield,Traditional,,1564.58,38.7,38.7,4042.84,157.67,2061.85,percent of total billed charges,38.7
MR-PELVIS W,72196,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,38.7,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-PELVIS W,72196,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,38.7,1114.55,43.47,568.42,percent of total billed charges,38.7
MR-PELVIS W,72196,CPT,,,,,both,,,2940.06,2940.06,Blue Cross and Blue Shield,Traditional,,1137.8,38.7,38.7,2940.06,114.66,1499.43,percent of total billed charges,38.7
MR-PELVIS W,72196,CPT,,,,,both,, ,2940.06,2940.06,Blue Cross and Blue Shield,Traditional,,1137.8,38.7,38.7,2940.06,114.66,1499.43,percent of total billed charges,38.7
MR-PELVIS WWO,72197,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,38.7,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-PELVIS WWO,72197,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,38.7,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-PELVIS WWO,72197,CPT,,,,,both,,,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,38.7,5197.81,202.71,2650.88,percent of total billed charges,38.7
MR-PELVIS WWO,72197,CPT,,,,,both,, ,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,38.7,5197.81,202.71,2650.88,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,293.16,38.7,38.7,757.53,29.54,386.34,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,,293.16,38.7,38.7,757.53,29.54,386.34,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,382.89,38.7,38.7,989.38,38.59,504.58,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,,382.89,38.7,38.7,989.38,38.59,504.58,percent of total billed charges,38.7
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,38.7,299.76,11.69,152.88,percent of total billed charges,38.7
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,38.7,299.76,11.69,152.88,percent of total billed charges,38.7
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,38.7,299.76,11.69,152.88,percent of total billed charges,38.7
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,,,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,38.7,721.61,28.14,368.02,percent of total billed charges,38.7
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,38.7,721.61,28.14,368.02,percent of total billed charges,38.7
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
UE-CLAVICLE CR,73000,CPT,,,,,both,,,353.93,353.93,Blue Cross and Blue Shield,Traditional,,136.97,38.7,38.7,353.93,13.8,180.5,percent of total billed charges,38.7
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,353.93,353.93,Blue Cross and Blue Shield,Traditional,,136.97,38.7,38.7,353.93,13.8,180.5,percent of total billed charges,38.7
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,273.37,273.37,Blue Cross and Blue Shield,Traditional,,105.79,38.7,38.7,273.37,10.66,139.42,percent of total billed charges,38.7
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,273.37,273.37,Blue Cross and Blue Shield,Traditional,,105.79,38.7,38.7,273.37,10.66,139.42,percent of total billed charges,38.7
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,38.7,299.76,11.69,152.88,percent of total billed charges,38.7
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,,,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,38.7,804.69,31.38,410.39,percent of total billed charges,38.7
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,38.7,804.69,31.38,410.39,percent of total billed charges,38.7
UE-SCAPULA CR,73010,CPT,,,,,both,, ,136.68,136.68,Blue Cross and Blue Shield,Traditional,,52.9,38.7,38.7,136.68,5.33,69.71,percent of total billed charges,38.7
UE-SCAPULA CR,73010,CPT,,,,,both,, ,136.68,136.68,Blue Cross and Blue Shield,Traditional,,52.9,38.7,38.7,136.68,5.33,69.71,percent of total billed charges,38.7
UE-SCAPULA CR,73010,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-SCAPULA CR,73010,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
UE-SCAPULA CR,73010,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
UE-SCAPULA CR,73010,CPT,,,,,both,,,402.2,402.2,Blue Cross and Blue Shield,Traditional,,155.65,38.7,38.7,402.2,15.69,205.12,percent of total billed charges,38.7
UE-SCAPULA CR,73010,CPT,,,,,both,, ,402.2,402.2,Blue Cross and Blue Shield,Traditional,,155.65,38.7,38.7,402.2,15.69,205.12,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,,107.75,38.7,38.7,278.43,10.86,142,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,378.65,38.7,38.7,978.43,38.16,499,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,,378.65,38.7,38.7,978.43,38.16,499,percent of total billed charges,38.7
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-SHOULDER 1V CR,73020,CPT,,,,,both,,,489.5,489.5,Blue Cross and Blue Shield,Traditional,,189.44,38.7,38.7,489.5,19.09,249.65,percent of total billed charges,38.7
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,489.5,489.5,Blue Cross and Blue Shield,Traditional,,189.44,38.7,38.7,489.5,19.09,249.65,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,107.75,38.7,38.7,278.43,10.86,142,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,,107.75,38.7,38.7,278.43,10.86,142,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,,334.12,38.7,38.7,863.36,33.67,440.31,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,,334.12,38.7,38.7,863.36,33.67,440.31,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,668.24,38.7,38.7,1726.71,67.34,880.62,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,,668.24,38.7,38.7,1726.71,67.34,880.62,percent of total billed charges,38.7
IR-ARTHROGM SHLDR CR,73040,CPT,,,,,both,, ,3748.7,3748.7,Blue Cross and Blue Shield,Traditional,,1450.75,38.7,38.7,3748.7,146.2,1911.84,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,,2901.49,38.7,38.7,7497.39,292.4,3823.67,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,355.41,38.7,38.7,918.37,35.82,468.37,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,,355.41,38.7,38.7,918.37,35.82,468.37,percent of total billed charges,38.7
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,38.7,299.76,11.69,152.88,percent of total billed charges,38.7
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,38.7,299.76,11.69,152.88,percent of total billed charges,38.7
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,299.76,Blue Cross and Blue Shield,Traditional,,116.01,38.7,38.7,299.76,11.69,152.88,percent of total billed charges,38.7
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,,,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,38.7,721.61,28.14,368.02,percent of total billed charges,38.7
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,38.7,721.61,28.14,368.02,percent of total billed charges,38.7
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HUMERUS CR,73060,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
UE-HUMERUS CR,73060,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
UE-HUMERUS CR,73060,CPT,,,,,both,,,1442.95,1442.95,Blue Cross and Blue Shield,Traditional,,558.42,38.7,38.7,1442.95,56.28,735.9,percent of total billed charges,38.7
UE-HUMERUS CR,73060,CPT,,,,,both,, ,1442.95,1442.95,Blue Cross and Blue Shield,Traditional,,558.42,38.7,38.7,1442.95,56.28,735.9,percent of total billed charges,38.7
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
UE-ELBOW 2V CR,73070,CPT,,,,,both,,,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,38.7,662.39,25.83,337.82,percent of total billed charges,38.7
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,38.7,662.39,25.83,337.82,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,512.8,38.7,38.7,1325.06,51.68,675.78,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,,512.8,38.7,38.7,1325.06,51.68,675.78,percent of total billed charges,38.7
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-ELBOW 3V CR,73080,CPT,,,,,both,,,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,38.7,804.69,31.38,410.39,percent of total billed charges,38.7
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,38.7,804.69,31.38,410.39,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,622.73,38.7,38.7,1609.11,62.76,820.65,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,,622.73,38.7,38.7,1609.11,62.76,820.65,percent of total billed charges,38.7
IR-ARTHROGRAM ELBOW,73085,CPT,,,,,both,, ,3748.7,3748.7,Blue Cross and Blue Shield,Traditional,,1450.75,38.7,38.7,3748.7,146.2,1911.84,percent of total billed charges,38.7
IR-ARTHROGRAM ELBOW,73085,CPT,,,,,both,, ,3748.7,3748.7,Blue Cross and Blue Shield,Traditional,,1450.75,38.7,38.7,3748.7,146.2,1911.84,percent of total billed charges,38.7
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
UE-FOREARM 2V CR,73090,CPT,,,,,both,,,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,38.7,662.39,25.83,337.82,percent of total billed charges,38.7
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,38.7,662.39,25.83,337.82,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,512.8,38.7,38.7,1325.06,51.68,675.78,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,,512.8,38.7,38.7,1325.06,51.68,675.78,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,,85.38,38.7,38.7,220.61,8.6,112.51,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,91.89,38.7,38.7,237.45,9.26,121.1,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,,279.26,38.7,38.7,721.61,28.14,368.02,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,,279.26,38.7,38.7,721.61,28.14,368.02,percent of total billed charges,38.7
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,441.5,441.5,Blue Cross and Blue Shield,Traditional,,170.86,38.7,38.7,441.5,17.22,225.17,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,,183.89,38.7,38.7,475.18,18.53,242.34,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,,559.18,38.7,38.7,1444.91,56.35,736.9,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,,559.18,38.7,38.7,1444.91,56.35,736.9,percent of total billed charges,38.7
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
UE-WRIST 2V CR,73100,CPT,,,,,both,,,607.94,607.94,Blue Cross and Blue Shield,Traditional,,235.27,38.7,38.7,607.94,23.71,310.05,percent of total billed charges,38.7
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,607.94,607.94,Blue Cross and Blue Shield,Traditional,,235.27,38.7,38.7,607.94,23.71,310.05,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,470.65,38.7,38.7,1216.16,47.43,620.24,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,,470.65,38.7,38.7,1216.16,47.43,620.24,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,107.75,38.7,38.7,278.43,10.86,142,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,,107.75,38.7,38.7,278.43,10.86,142,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,,256.34,38.7,38.7,662.39,25.83,337.82,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,,256.34,38.7,38.7,662.39,25.83,337.82,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,512.8,38.7,38.7,1325.06,51.68,675.78,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,,512.8,38.7,38.7,1325.06,51.68,675.78,percent of total billed charges,38.7
IR-ARTHROGRAM WRIST,73115,CPT,,,,,both,, ,3748.7,3748.7,Blue Cross and Blue Shield,Traditional,,1450.75,38.7,38.7,3748.7,146.2,1911.84,percent of total billed charges,38.7
IR-ARTHROGRAM WRIST,73115,CPT,,,,,both,, ,3748.7,3748.7,Blue Cross and Blue Shield,Traditional,,1450.75,38.7,38.7,3748.7,146.2,1911.84,percent of total billed charges,38.7
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HAND 2V CR,73120,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
UE-HAND 2V CR,73120,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
UE-HAND 2V CR,73120,CPT,,,,,both,,,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,38.7,662.39,25.83,337.82,percent of total billed charges,38.7
UE-HAND 2V CR,73120,CPT,,,,,both,, ,662.39,662.39,Blue Cross and Blue Shield,Traditional,,256.34,38.7,38.7,662.39,25.83,337.82,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,512.8,38.7,38.7,1325.06,51.68,675.78,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,,512.8,38.7,38.7,1325.06,51.68,675.78,percent of total billed charges,38.7
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
UE-HAND 3V CR,73130,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
UE-HAND 3V CR,73130,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
UE-HAND 3V CR,73130,CPT,,,,,both,,,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,38.7,804.69,31.38,410.39,percent of total billed charges,38.7
UE-HAND 3V CR,73130,CPT,,,,,both,, ,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,38.7,804.69,31.38,410.39,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,622.73,38.7,38.7,1609.11,62.76,820.65,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,,622.73,38.7,38.7,1609.11,62.76,820.65,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,,116.01,38.7,38.7,299.76,11.69,152.88,percent of total billed charges,38.7
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,,,1137.3,1137.3,Blue Cross and Blue Shield,Traditional,,440.14,38.7,38.7,1137.3,44.35,580.02,percent of total billed charges,38.7
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,1137.3,1137.3,Blue Cross and Blue Shield,Traditional,,440.14,38.7,38.7,1137.3,44.35,580.02,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,107.75,38.7,38.7,278.43,10.86,142,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,,107.75,38.7,38.7,278.43,10.86,142,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,,220.06,38.7,38.7,568.64,22.18,290.01,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,,220.06,38.7,38.7,568.64,22.18,290.01,percent of total billed charges,38.7
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,38.7,307.05,11.97,156.6,percent of total billed charges,38.7
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,38.7,330.63,12.89,168.62,percent of total billed charges,38.7
CT-UPPER EXT WO,73200,CPT,,,,,both,,,3015.85,3015.85,Blue Cross and Blue Shield,Traditional,,1167.13,38.7,38.7,3015.85,117.62,1538.08,percent of total billed charges,38.7
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,3015.85,3015.85,Blue Cross and Blue Shield,Traditional,,1167.13,38.7,38.7,3015.85,117.62,1538.08,percent of total billed charges,38.7
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,614.4,614.4,Blue Cross and Blue Shield,Traditional,,237.77,38.7,38.7,614.4,23.96,313.34,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,,255.8,38.7,38.7,660.98,25.78,337.1,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,,2334.16,38.7,38.7,6031.42,235.23,3076.02,percent of total billed charges,38.7
CT-UPPER EXT W,73201,CPT,,,,,both,, ,556.01,556.01,Blue Cross and Blue Shield,Traditional,,215.18,38.7,38.7,556.01,21.68,283.57,percent of total billed charges,38.7
CT-UPPER EXT W,73201,CPT,,,,,both,,,3350.14,3350.14,Blue Cross and Blue Shield,Traditional,,1296.5,38.7,38.7,3350.14,130.66,1708.57,percent of total billed charges,38.7
CT-UPPER EXT W,73201,CPT,,,,,both,, ,3350.14,3350.14,Blue Cross and Blue Shield,Traditional,,1296.5,38.7,38.7,3350.14,130.66,1708.57,percent of total billed charges,38.7
CTA-UPPER EXT,73206,CPT,,,,,both,,,1947.6,1947.6,Blue Cross and Blue Shield,Traditional,,753.72,38.7,38.7,1947.6,75.96,993.28,percent of total billed charges,38.7
CTA-UPPER EXT,73206,CPT,,,,,both,, ,1947.6,1947.6,Blue Cross and Blue Shield,Traditional,,753.72,38.7,38.7,1947.6,75.96,993.28,percent of total billed charges,38.7
CTA-UPPER EXT BI,73206,CPT,,,,,both,, ,3895.2,3895.2,Blue Cross and Blue Shield,Traditional,,1507.44,38.7,38.7,3895.2,151.91,1986.55,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,,554.08,38.7,38.7,1431.72,55.84,730.18,percent of total billed charges,38.7
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,1540.9,1540.9,Blue Cross and Blue Shield,Traditional,,596.33,38.7,38.7,1540.9,60.1,785.86,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,,1564.58,38.7,38.7,4042.84,157.67,2061.85,percent of total billed charges,38.7
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,38.7,715.99,27.92,365.15,percent of total billed charges,38.7
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,38.7,770.45,30.05,392.93,percent of total billed charges,38.7
MR-UPPER EXT WO,73218,CPT,,,,,both,,,2470.5,2470.5,Blue Cross and Blue Shield,Traditional,,956.08,38.7,38.7,2470.5,96.35,1259.96,percent of total billed charges,38.7
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,2470.5,2470.5,Blue Cross and Blue Shield,Traditional,,956.08,38.7,38.7,2470.5,96.35,1259.96,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,,926.54,38.7,38.7,2394.15,93.37,1221.02,percent of total billed charges,38.7
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,2576.6,2576.6,Blue Cross and Blue Shield,Traditional,,997.14,38.7,38.7,2576.6,100.49,1314.07,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,,2011.55,38.7,38.7,5197.81,202.71,2650.88,percent of total billed charges,38.7
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,38.7,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,38.7,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-UPPER EXT WWO,73220,CPT,,,,,both,,,2598.76,2598.76,Blue Cross and Blue Shield,Traditional,,1005.72,38.7,38.7,2598.76,101.35,1325.37,percent of total billed charges,38.7
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,2598.76,2598.76,Blue Cross and Blue Shield,Traditional,,1005.72,38.7,38.7,2598.76,101.35,1325.37,percent of total billed charges,38.7
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,38.7,715.99,27.92,365.15,percent of total billed charges,38.7
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,38.7,770.45,30.05,392.93,percent of total billed charges,38.7
MR-UPPER JOINT WO,73221,CPT,,,,,both,,,2523.26,2523.26,Blue Cross and Blue Shield,Traditional,,976.5,38.7,38.7,2523.26,98.41,1286.86,percent of total billed charges,38.7
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,2523.26,2523.26,Blue Cross and Blue Shield,Traditional,,976.5,38.7,38.7,2523.26,98.41,1286.86,percent of total billed charges,38.7
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,38.7,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,38.7,1114.55,43.47,568.42,percent of total billed charges,38.7
MR-UPPER JOINT W,73222,CPT,,,,,both,,,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,38.7,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,38.7,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,38.7,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,38.7,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-UPPER JOINT WWO,73223,CPT,,,,,both,,,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,38.7,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,38.7,4941.28,192.71,2520.05,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,129.04,38.7,38.7,333.44,13,170.05,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,,129.04,38.7,38.7,333.44,13,170.05,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,,54.09,38.7,38.7,139.77,5.45,71.28,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,,57.79,38.7,38.7,149.32,5.82,76.15,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,,57.79,38.7,38.7,149.32,5.82,76.15,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,,57.79,38.7,38.7,149.32,5.82,76.15,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,,343.46,38.7,38.7,887.49,34.61,452.62,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,,81.25,38.7,38.7,209.94,8.19,107.07,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,,86.9,38.7,38.7,224.54,8.76,114.52,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,,86.9,38.7,38.7,224.54,8.76,114.52,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,,86.9,38.7,38.7,224.54,8.76,114.52,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,,515.08,38.7,38.7,1330.96,51.91,678.79,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,,85.48,38.7,38.7,220.88,8.61,112.65,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,,92.11,38.7,38.7,238.01,9.28,121.39,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,,92.11,38.7,38.7,238.01,9.28,121.39,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,,92.11,38.7,38.7,238.01,9.28,121.39,percent of total billed charges,38.7
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,,,1774.7,1774.7,Blue Cross and Blue Shield,Traditional,,686.81,38.7,38.7,1774.7,69.21,905.1,percent of total billed charges,38.7
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,1774.7,1774.7,Blue Cross and Blue Shield,Traditional,,686.81,38.7,38.7,1774.7,69.21,905.1,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,,85.48,38.7,38.7,220.88,8.61,112.65,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,,92.11,38.7,38.7,238.01,9.28,121.39,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,,92.11,38.7,38.7,238.01,9.28,121.39,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,,92.11,38.7,38.7,238.01,9.28,121.39,percent of total billed charges,38.7
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,,,1774.7,1774.7,Blue Cross and Blue Shield,Traditional,,686.81,38.7,38.7,1774.7,69.21,905.1,percent of total billed charges,38.7
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,1774.7,1774.7,Blue Cross and Blue Shield,Traditional,,686.81,38.7,38.7,1774.7,69.21,905.1,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,,171.08,38.7,38.7,442.06,17.24,225.45,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,,184.22,38.7,38.7,476.02,18.56,242.77,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,,184.22,38.7,38.7,476.02,18.56,242.77,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,,184.22,38.7,38.7,476.02,18.56,242.77,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,,1373.73,38.7,38.7,3549.69,138.44,1810.34,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,,1373.73,38.7,38.7,3549.69,138.44,1810.34,percent of total billed charges,38.7
IR-ARTHROGRAM HIP CR,73525,CPT,,,,,both,, ,3760.2,3760.2,Blue Cross and Blue Shield,Traditional,,1455.2,38.7,38.7,3760.2,146.65,1917.7,percent of total billed charges,38.7
IR-ARTHROGRAM HIP CR,73525,CPT,,,,,both,, ,3760.2,3760.2,Blue Cross and Blue Shield,Traditional,,1455.2,38.7,38.7,3760.2,146.65,1917.7,percent of total billed charges,38.7
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.2,148.2,Blue Cross and Blue Shield,Traditional,,57.35,38.7,38.7,148.2,5.78,75.58,percent of total billed charges,38.7
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.2,148.2,Blue Cross and Blue Shield,Traditional,,57.35,38.7,38.7,148.2,5.78,75.58,percent of total billed charges,38.7
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.2,148.2,Blue Cross and Blue Shield,Traditional,,57.35,38.7,38.7,148.2,5.78,75.58,percent of total billed charges,38.7
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.2,148.2,Blue Cross and Blue Shield,Traditional,,57.35,38.7,38.7,148.2,5.78,75.58,percent of total billed charges,38.7
LE-FEMUR 1V CR,73551,CPT,,,,,both,,,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,38.7,307.05,11.97,156.6,percent of total billed charges,38.7
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,38.7,307.05,11.97,156.6,percent of total billed charges,38.7
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
LE-FEMUR 2V CR,73552,CPT,,,,,both,,,782.23,782.23,Blue Cross and Blue Shield,Traditional,,302.72,38.7,38.7,782.23,30.51,398.94,percent of total billed charges,38.7
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,782.23,782.23,Blue Cross and Blue Shield,Traditional,,302.72,38.7,38.7,782.23,30.51,398.94,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,605.56,38.7,38.7,1564.76,61.03,798.03,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,,605.56,38.7,38.7,1564.76,61.03,798.03,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,107.75,38.7,38.7,278.43,10.86,142,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,,107.75,38.7,38.7,278.43,10.86,142,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,,279.26,38.7,38.7,721.61,28.14,368.02,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,,279.26,38.7,38.7,721.61,28.14,368.02,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,558.42,38.7,38.7,1442.95,56.28,735.9,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,,558.42,38.7,38.7,1442.95,56.28,735.9,percent of total billed charges,38.7
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
LE-KNEE 3V CR,73562,CPT,,,,,both,,,981.24,981.24,Blue Cross and Blue Shield,Traditional,,379.74,38.7,38.7,981.24,38.27,500.43,percent of total billed charges,38.7
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,981.24,981.24,Blue Cross and Blue Shield,Traditional,,379.74,38.7,38.7,981.24,38.27,500.43,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,759.48,38.7,38.7,1962.48,76.54,1000.86,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,,759.48,38.7,38.7,1962.48,76.54,1000.86,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,107.75,38.7,38.7,278.43,10.86,142,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,,107.75,38.7,38.7,278.43,10.86,142,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,,414.28,38.7,38.7,1070.49,41.75,545.95,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,,414.28,38.7,38.7,1070.49,41.75,545.95,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,828.67,38.7,38.7,2141.27,83.51,1092.05,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,,828.67,38.7,38.7,2141.27,83.51,1092.05,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,279.26,38.7,38.7,721.61,28.14,368.02,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,,279.26,38.7,38.7,721.61,28.14,368.02,percent of total billed charges,38.7
IR-ARTHRGRM KNEE BI,73580,CPT,,,,,both,, ,7520.68,7520.68,Blue Cross and Blue Shield,Traditional,,2910.5,38.7,38.7,7520.68,293.31,3835.55,percent of total billed charges,38.7
IR-ARTHROGRAM KNEE,73580,CPT,,,,,both,, ,3760.2,3760.2,Blue Cross and Blue Shield,Traditional,,1455.2,38.7,38.7,3760.2,146.65,1917.7,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,558.42,38.7,38.7,1442.95,56.28,735.9,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,,558.42,38.7,38.7,1442.95,56.28,735.9,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,107.75,38.7,38.7,278.43,10.86,142,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,,107.75,38.7,38.7,278.43,10.86,142,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,,279.26,38.7,38.7,721.61,28.14,368.02,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,,279.26,38.7,38.7,721.61,28.14,368.02,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,,107.75,38.7,38.7,278.43,10.86,142,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,558.42,38.7,38.7,1442.95,56.28,735.9,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,,558.42,38.7,38.7,1442.95,56.28,735.9,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,279.26,38.7,38.7,721.61,28.14,368.02,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,,279.26,38.7,38.7,721.61,28.14,368.02,percent of total billed charges,38.7
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
LE-ANKLE 2V CR,73600,CPT,,,,,both,,,720.49,720.49,Blue Cross and Blue Shield,Traditional,,278.83,38.7,38.7,720.49,28.1,367.45,percent of total billed charges,38.7
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,720.49,720.49,Blue Cross and Blue Shield,Traditional,,278.83,38.7,38.7,720.49,28.1,367.45,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,428.73,38.7,38.7,1107.82,43.2,564.99,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,,428.73,38.7,38.7,1107.82,43.2,564.99,percent of total billed charges,38.7
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,,,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,38.7,804.69,31.38,410.39,percent of total billed charges,38.7
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,38.7,804.69,31.38,410.39,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,622.73,38.7,38.7,1609.11,62.76,820.65,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,,622.73,38.7,38.7,1609.11,62.76,820.65,percent of total billed charges,38.7
IR-ARTHROGRAM ANKLE,73615,CPT,,,,,both,, ,3760.2,3760.2,Blue Cross and Blue Shield,Traditional,,1455.2,38.7,38.7,3760.2,146.65,1917.7,percent of total billed charges,38.7
IR-ARTHROGRAM ANKLE,73615,CPT,,,,,both,, ,3760.2,3760.2,Blue Cross and Blue Shield,Traditional,,1455.2,38.7,38.7,3760.2,146.65,1917.7,percent of total billed charges,38.7
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
LE-FOOT 2V CR,73620,CPT,,,,,both,,,553.77,553.77,Blue Cross and Blue Shield,Traditional,,214.31,38.7,38.7,553.77,21.6,282.42,percent of total billed charges,38.7
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,553.77,553.77,Blue Cross and Blue Shield,Traditional,,214.31,38.7,38.7,553.77,21.6,282.42,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,428.73,38.7,38.7,1107.82,43.2,564.99,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,,428.73,38.7,38.7,1107.82,43.2,564.99,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,107.75,38.7,38.7,278.43,10.86,142,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,,107.75,38.7,38.7,278.43,10.86,142,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,,256.34,38.7,38.7,662.39,25.83,337.82,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,,256.34,38.7,38.7,662.39,25.83,337.82,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,484.13,38.7,38.7,1250.97,48.79,637.99,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,,484.13,38.7,38.7,1250.97,48.79,637.99,percent of total billed charges,38.7
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,278.43,278.43,Blue Cross and Blue Shield,Traditional,,107.75,38.7,38.7,278.43,10.86,142,percent of total billed charges,38.7
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,,,353.93,353.93,Blue Cross and Blue Shield,Traditional,,136.97,38.7,38.7,353.93,13.8,180.5,percent of total billed charges,38.7
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,353.93,353.93,Blue Cross and Blue Shield,Traditional,,136.97,38.7,38.7,353.93,13.8,180.5,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,116.01,38.7,38.7,299.76,11.69,152.88,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,,256.34,38.7,38.7,662.39,25.83,337.82,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,,256.34,38.7,38.7,662.39,25.83,337.82,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,107.75,38.7,38.7,278.43,10.86,142,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,,107.75,38.7,38.7,278.43,10.86,142,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,,220.06,38.7,38.7,568.64,22.18,290.01,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,,220.06,38.7,38.7,568.64,22.18,290.01,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,,116.01,38.7,38.7,299.76,11.69,152.88,percent of total billed charges,38.7
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,,,1137.3,1137.3,Blue Cross and Blue Shield,Traditional,,440.14,38.7,38.7,1137.3,44.35,580.02,percent of total billed charges,38.7
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,1137.3,1137.3,Blue Cross and Blue Shield,Traditional,,440.14,38.7,38.7,1137.3,44.35,580.02,percent of total billed charges,38.7
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,38.7,307.05,11.97,156.6,percent of total billed charges,38.7
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,38.7,330.63,12.89,168.62,percent of total billed charges,38.7
CT-LOWER EXT WO,73700,CPT,,,,,both,,,3013.04,3013.04,Blue Cross and Blue Shield,Traditional,,1166.05,38.7,38.7,3013.04,117.51,1536.65,percent of total billed charges,38.7
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,3013.04,3013.04,Blue Cross and Blue Shield,Traditional,,1166.05,38.7,38.7,3013.04,117.51,1536.65,percent of total billed charges,38.7
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,614.4,614.4,Blue Cross and Blue Shield,Traditional,,237.77,38.7,38.7,614.4,23.96,313.34,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,,255.8,38.7,38.7,660.98,25.78,337.1,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,,1912.28,38.7,38.7,4941.28,192.71,2520.05,percent of total billed charges,38.7
CT-LOWER EXT W,73701,CPT,,,,,both,, ,650.88,650.88,Blue Cross and Blue Shield,Traditional,,251.89,38.7,38.7,650.88,25.38,331.95,percent of total billed charges,38.7
CT-LOWER EXT W,73701,CPT,,,,,both,,,3013.04,3013.04,Blue Cross and Blue Shield,Traditional,,1166.05,38.7,38.7,3013.04,117.51,1536.65,percent of total billed charges,38.7
CT-LOWER EXT W,73701,CPT,,,,,both,, ,3013.04,3013.04,Blue Cross and Blue Shield,Traditional,,1166.05,38.7,38.7,3013.04,117.51,1536.65,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,,234.08,38.7,38.7,604.85,23.59,308.47,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,,234.08,38.7,38.7,604.85,23.59,308.47,percent of total billed charges,38.7
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,38.7,680.91,26.56,347.26,percent of total billed charges,38.7
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,38.7,732.83,28.58,373.74,percent of total billed charges,38.7
CT-LOWER EXT WWO,73702,CPT,,,,,both,,,3013.04,3013.04,Blue Cross and Blue Shield,Traditional,,1166.05,38.7,38.7,3013.04,117.51,1536.65,percent of total billed charges,38.7
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,3013.04,3013.04,Blue Cross and Blue Shield,Traditional,,1166.05,38.7,38.7,3013.04,117.51,1536.65,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,,527.03,38.7,38.7,1361.84,53.11,694.54,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,,567.22,38.7,38.7,1465.68,57.16,747.5,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,,1912.28,38.7,38.7,4941.28,192.71,2520.05,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,,277.09,38.7,38.7,715.99,27.92,365.15,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,,277.09,38.7,38.7,715.99,27.92,365.15,percent of total billed charges,38.7
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,1540.9,1540.9,Blue Cross and Blue Shield,Traditional,,596.33,38.7,38.7,1540.9,60.1,785.86,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,,1912.28,38.7,38.7,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,38.7,770.45,30.05,392.93,percent of total billed charges,38.7
MR-LOWER EXTR WO,73718,CPT,,,,,both,,,2470.5,2470.5,Blue Cross and Blue Shield,Traditional,,956.08,38.7,38.7,2470.5,96.35,1259.96,percent of total billed charges,38.7
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,2470.5,2470.5,Blue Cross and Blue Shield,Traditional,,956.08,38.7,38.7,2470.5,96.35,1259.96,percent of total billed charges,38.7
MR-LOWER EXTR W,73719,CPT,,,,,both,,,832.76,832.76,Blue Cross and Blue Shield,Traditional,,322.28,38.7,38.7,832.76,32.48,424.71,percent of total billed charges,38.7
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,832.76,832.76,Blue Cross and Blue Shield,Traditional,,322.28,38.7,38.7,832.76,32.48,424.71,percent of total billed charges,38.7
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,38.7,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,38.7,1114.55,43.47,568.42,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,,926.54,38.7,38.7,2394.15,93.37,1221.02,percent of total billed charges,38.7
MR-LOWER EXTR BI WWO,73720,CPT,,,,,both,, ,2576.6,2576.6,Blue Cross and Blue Shield,Traditional,,997.14,38.7,38.7,2576.6,100.49,1314.07,percent of total billed charges,38.7
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,38.7,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,38.7,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-LOWER EXTR WWO,73720,CPT,,,,,both,,,3084.06,3084.06,Blue Cross and Blue Shield,Traditional,,1193.53,38.7,38.7,3084.06,120.28,1572.87,percent of total billed charges,38.7
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,3084.06,3084.06,Blue Cross and Blue Shield,Traditional,,1193.53,38.7,38.7,3084.06,120.28,1572.87,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,,1912.28,38.7,38.7,4941.28,192.71,2520.05,percent of total billed charges,38.7
MR-LW JOINT WO,73721,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,38.7,715.99,27.92,365.15,percent of total billed charges,38.7
MR-LW JOINT WO,73721,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,38.7,770.45,30.05,392.93,percent of total billed charges,38.7
MR-LW JOINT WO,73721,CPT,,,,,both,, ,4941.28,4941.28,Blue Cross and Blue Shield,Traditional,,1912.28,38.7,38.7,4941.28,192.71,2520.05,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,,554.08,38.7,38.7,1431.72,55.84,730.18,percent of total billed charges,38.7
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,1540.9,1540.9,Blue Cross and Blue Shield,Traditional,,596.33,38.7,38.7,1540.9,60.1,785.86,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,,3824.12,38.7,38.7,9881.44,385.38,5039.53,percent of total billed charges,38.7
MR-LW JOINT W,73722,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,38.7,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-LW JOINT W,73722,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,38.7,1114.55,43.47,568.42,percent of total billed charges,38.7
MR-LW JOINT W,73722,CPT,,,,,both,,,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,38.7,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-LW JOINT W,73722,CPT,,,,,both,, ,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,38.7,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-LW JOINT W BI,73722,CPT,,,,,both,, ,7641.1,7641.1,Blue Cross and Blue Shield,Traditional,,2957.11,38.7,38.7,7641.1,298,3896.96,percent of total billed charges,38.7
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,38.7,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,38.7,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-LW JOINT WWO,73723,CPT,,,,,both,,,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,38.7,5197.81,202.71,2650.88,percent of total billed charges,38.7
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,38.7,5197.81,202.71,2650.88,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,,4023.11,38.7,38.7,10395.64,405.43,5301.78,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,58,38.7,38.7,149.88,5.85,76.44,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,,268.73,38.7,38.7,694.38,27.08,354.13,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,,268.73,38.7,38.7,694.38,27.08,354.13,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,442.74,38.7,38.7,1144.03,44.62,583.46,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,,442.74,38.7,38.7,1144.03,44.62,583.46,percent of total billed charges,38.7
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,,,868.4,868.4,Blue Cross and Blue Shield,Traditional,,336.07,38.7,38.7,868.4,33.87,442.88,percent of total billed charges,38.7
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,868.4,868.4,Blue Cross and Blue Shield,Traditional,,336.07,38.7,38.7,868.4,33.87,442.88,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,,375.72,38.7,38.7,970.85,37.86,495.13,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,,375.72,38.7,38.7,970.85,37.86,495.13,percent of total billed charges,38.7
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,307.05,307.05,Blue Cross and Blue Shield,Traditional,,118.83,38.7,38.7,307.05,11.97,156.6,percent of total billed charges,38.7
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,330.63,330.63,Blue Cross and Blue Shield,Traditional,,127.95,38.7,38.7,330.63,12.89,168.62,percent of total billed charges,38.7
CT-ABDOMEN WO,74150,CPT,,,,,both,,,3285.58,3285.58,Blue Cross and Blue Shield,Traditional,,1271.52,38.7,38.7,3285.58,128.14,1675.65,percent of total billed charges,38.7
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,3285.58,3285.58,Blue Cross and Blue Shield,Traditional,,1271.52,38.7,38.7,3285.58,128.14,1675.65,percent of total billed charges,38.7
CT-ABDOMEN W,74160,CPT,,,,,both,, ,604.85,604.85,Blue Cross and Blue Shield,Traditional,,234.08,38.7,38.7,604.85,23.59,308.47,percent of total billed charges,38.7
CT-ABDOMEN W,74160,CPT,,,,,both,, ,650.88,650.88,Blue Cross and Blue Shield,Traditional,,251.89,38.7,38.7,650.88,25.38,331.95,percent of total billed charges,38.7
CT-ABDOMEN W,74160,CPT,,,,,both,,,3726.8,3726.8,Blue Cross and Blue Shield,Traditional,,1442.27,38.7,38.7,3726.8,145.35,1900.67,percent of total billed charges,38.7
CT-ABDOMEN W,74160,CPT,,,,,both,, ,3726.8,3726.8,Blue Cross and Blue Shield,Traditional,,1442.27,38.7,38.7,3726.8,145.35,1900.67,percent of total billed charges,38.7
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,680.91,680.91,Blue Cross and Blue Shield,Traditional,,263.51,38.7,38.7,680.91,26.56,347.26,percent of total billed charges,38.7
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,732.83,732.83,Blue Cross and Blue Shield,Traditional,,283.61,38.7,38.7,732.83,28.58,373.74,percent of total billed charges,38.7
CT-ABDOMEN WWO,74170,CPT,,,,,both,,,4317.62,4317.62,Blue Cross and Blue Shield,Traditional,,1670.92,38.7,38.7,4317.62,168.39,2201.99,percent of total billed charges,38.7
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,4317.62,4317.62,Blue Cross and Blue Shield,Traditional,,1670.92,38.7,38.7,4317.62,168.39,2201.99,percent of total billed charges,38.7
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,893.1,893.1,Blue Cross and Blue Shield,Traditional,,345.63,38.7,38.7,893.1,34.83,455.48,percent of total billed charges,38.7
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,893.1,893.1,Blue Cross and Blue Shield,Traditional,,345.63,38.7,38.7,893.1,34.83,455.48,percent of total billed charges,38.7
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,,,1894.27,1894.27,Blue Cross and Blue Shield,Traditional,,733.08,38.7,38.7,1894.27,73.88,966.08,percent of total billed charges,38.7
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,1894.27,1894.27,Blue Cross and Blue Shield,Traditional,,733.08,38.7,38.7,1894.27,73.88,966.08,percent of total billed charges,38.7
CTA-ABDOMEN,74175,CPT,,,,,both,, ,893.1,893.1,Blue Cross and Blue Shield,Traditional,,345.63,38.7,38.7,893.1,34.83,455.48,percent of total billed charges,38.7
CTA-ABDOMEN,74175,CPT,,,,,both,,,1894.27,1894.27,Blue Cross and Blue Shield,Traditional,,733.08,38.7,38.7,1894.27,73.88,966.08,percent of total billed charges,38.7
CTA-ABDOMEN,74175,CPT,,,,,both,, ,1894.27,1894.27,Blue Cross and Blue Shield,Traditional,,733.08,38.7,38.7,1894.27,73.88,966.08,percent of total billed charges,38.7
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,587.17,587.17,Blue Cross and Blue Shield,Traditional,,227.23,38.7,38.7,587.17,22.9,299.46,percent of total billed charges,38.7
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,632.08,632.08,Blue Cross and Blue Shield,Traditional,,244.61,38.7,38.7,632.08,24.65,322.36,percent of total billed charges,38.7
CT-ABD PELVIS WO,74176,CPT,,,,,both,,,6571.44,6571.44,Blue Cross and Blue Shield,Traditional,,2543.15,38.7,38.7,6571.44,256.29,3351.43,percent of total billed charges,38.7
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,6571.44,6571.44,Blue Cross and Blue Shield,Traditional,,2543.15,38.7,38.7,6571.44,256.29,3351.43,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,,2884.55,38.7,38.7,7453.61,290.69,3801.34,percent of total billed charges,38.7
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,947.56,947.56,Blue Cross and Blue Shield,Traditional,,366.71,38.7,38.7,947.56,36.95,483.26,percent of total billed charges,38.7
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,1019.69,1019.69,Blue Cross and Blue Shield,Traditional,,394.62,38.7,38.7,1019.69,39.77,520.04,percent of total billed charges,38.7
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,7453.61,7453.61,Blue Cross and Blue Shield,Traditional,,2884.55,38.7,38.7,7453.61,290.69,3801.34,percent of total billed charges,38.7
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,947.56,947.56,Blue Cross and Blue Shield,Traditional,,366.71,38.7,38.7,947.56,36.95,483.26,percent of total billed charges,38.7
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,1019.69,1019.69,Blue Cross and Blue Shield,Traditional,,394.62,38.7,38.7,1019.69,39.77,520.04,percent of total billed charges,38.7
CT-ABD PELVIS WWO,74178,CPT,,,,,both,,,8364.95,8364.95,Blue Cross and Blue Shield,Traditional,,3237.24,38.7,38.7,8364.95,326.23,4266.12,percent of total billed charges,38.7
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,8364.95,8364.95,Blue Cross and Blue Shield,Traditional,,3237.24,38.7,38.7,8364.95,326.23,4266.12,percent of total billed charges,38.7
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,715.99,715.99,Blue Cross and Blue Shield,Traditional,,277.09,38.7,38.7,715.99,27.92,365.15,percent of total billed charges,38.7
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,38.7,770.45,30.05,392.93,percent of total billed charges,38.7
MR-ABDOMEN WO,74181,CPT,,,,,both,,,4042.84,4042.84,Blue Cross and Blue Shield,Traditional,,1564.58,38.7,38.7,4042.84,157.67,2061.85,percent of total billed charges,38.7
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,4042.84,4042.84,Blue Cross and Blue Shield,Traditional,,1564.58,38.7,38.7,4042.84,157.67,2061.85,percent of total billed charges,38.7
MR-ABDOMEN W,74182,CPT,,,,,both,, ,1035.69,1035.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,38.7,1035.69,40.39,528.2,percent of total billed charges,38.7
MR-ABDOMEN W,74182,CPT,,,,,both,, ,1114.55,1114.55,Blue Cross and Blue Shield,Traditional,,431.33,38.7,38.7,1114.55,43.47,568.42,percent of total billed charges,38.7
MR-ABDOMEN W,74182,CPT,,,,,both,,,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,38.7,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-ABDOMEN W,74182,CPT,,,,,both,, ,4293.48,4293.48,Blue Cross and Blue Shield,Traditional,,1661.58,38.7,38.7,4293.48,167.45,2189.67,percent of total billed charges,38.7
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,1197.08,1197.08,Blue Cross and Blue Shield,Traditional,,463.27,38.7,38.7,1197.08,46.69,610.51,percent of total billed charges,38.7
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,1288.29,1288.29,Blue Cross and Blue Shield,Traditional,,498.57,38.7,38.7,1288.29,50.24,657.03,percent of total billed charges,38.7
MR-ABDOMEN WWO,74183,CPT,,,,,both,,,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,38.7,5197.81,202.71,2650.88,percent of total billed charges,38.7
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,5197.81,5197.81,Blue Cross and Blue Shield,Traditional,,2011.55,38.7,38.7,5197.81,202.71,2650.88,percent of total billed charges,38.7
FL-ESOPHAGUS,74220,CPT,,,,,both,, ,1227.11,1227.11,Blue Cross and Blue Shield,Traditional,,474.89,38.7,38.7,1227.11,47.86,625.83,percent of total billed charges,38.7
FL-MOD BA SWALLOW,74230,CPT,,,,,both,, ,391.26,391.26,Blue Cross and Blue Shield,Traditional,,151.42,38.7,38.7,391.26,15.26,199.54,percent of total billed charges,38.7
FL-GI SERIES,74240,CPT,,,,,both,, ,1557.58,1557.58,Blue Cross and Blue Shield,Traditional,,602.78,38.7,38.7,1557.58,60.75,794.37,percent of total billed charges,38.7
FL-UPPER GI SINGLE,74240,CPT,,,,,both,, ,1818.77,1818.77,Blue Cross and Blue Shield,Traditional,,703.86,38.7,38.7,1818.77,70.93,927.57,percent of total billed charges,38.7
FL-GI SERIES AIR,74246,CPT,,,,,both,, ,1500.93,1500.93,Blue Cross and Blue Shield,Traditional,,580.86,38.7,38.7,1500.93,58.54,765.47,percent of total billed charges,38.7
FL-UPPER GI DOUBLE,74246,CPT,,,,,both,, ,1752.53,1752.53,Blue Cross and Blue Shield,Traditional,,678.23,38.7,38.7,1752.53,68.35,893.79,percent of total billed charges,38.7
FL-LOWER GI FOLLOW,74248,CPT,,,,,both,, ,3343.68,3343.68,Blue Cross and Blue Shield,Traditional,,1294,38.7,38.7,3343.68,130.4,1705.28,percent of total billed charges,38.7
FL-SMALL BOWEL CR,74250,CPT,,,,,both,, ,2123.58,2123.58,Blue Cross and Blue Shield,Traditional,,821.83,38.7,38.7,2123.58,82.82,1083.03,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,,821.83,38.7,38.7,2123.58,82.82,1083.03,percent of total billed charges,38.7
FL-BARIUM ENEMA,74270,CPT,,,,,both,, ,1890.9,1890.9,Blue Cross and Blue Shield,Traditional,,731.78,38.7,38.7,1890.9,73.75,964.36,percent of total billed charges,38.7
FL-BARIUM ENEMA AIR,74280,CPT,,,,,both,, ,2333.25,2333.25,Blue Cross and Blue Shield,Traditional,,902.97,38.7,38.7,2333.25,91,1189.96,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,,761.87,38.7,38.7,1968.65,76.78,1004.01,percent of total billed charges,38.7
FL-ENDO BILIARY,74328,CPT,,,,,both,, ,3722.58,3722.58,Blue Cross and Blue Shield,Traditional,,1440.64,38.7,38.7,3722.58,145.18,1898.52,percent of total billed charges,38.7
FL-ENDO PANCREATIC,74329,CPT,,,,,both,, ,1034.01,1034.01,Blue Cross and Blue Shield,Traditional,,400.16,38.7,38.7,1034.01,40.33,527.35,percent of total billed charges,38.7
FL-ENDO BIL PANC,74330,CPT,,,,,both,, ,1304.29,1304.29,Blue Cross and Blue Shield,Traditional,,504.76,38.7,38.7,1304.29,50.87,665.19,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,,525.94,38.7,38.7,1359.02,53,693.1,percent of total billed charges,38.7
FL-ENTEROCLYSIS PLAC,74355,CPT,,,,,both,, ,932.4,932.4,Blue Cross and Blue Shield,Traditional,,360.84,38.7,38.7,932.4,36.36,475.52,percent of total billed charges,38.7
FL-IVP CR,74400,CPT,,,,,both,, ,1836.17,1836.17,Blue Cross and Blue Shield,Traditional,,710.6,38.7,38.7,1836.17,71.61,936.45,percent of total billed charges,38.7
FL-UROGRAPH RETRO CR,74420,CPT,,,,,both,, ,2105.34,2105.34,Blue Cross and Blue Shield,Traditional,,814.77,38.7,38.7,2105.34,82.11,1073.72,percent of total billed charges,38.7
FL-UROGRAPHY ANTE CR,74425,CPT,,,,,both,, ,2165.12,2165.12,Blue Cross and Blue Shield,Traditional,,837.9,38.7,38.7,2165.12,84.44,1104.21,percent of total billed charges,38.7
FL-CYSTOGRM 3VPLS CR,74430,CPT,,,,,both,, ,1407.87,1407.87,Blue Cross and Blue Shield,Traditional,,544.85,38.7,38.7,1407.87,54.91,718.01,percent of total billed charges,38.7
FL-CAVERNOSOGRAPH CR,74445,CPT,,,,,both,, ,698.32,698.32,Blue Cross and Blue Shield,Traditional,,270.25,38.7,38.7,698.32,27.23,356.14,percent of total billed charges,38.7
FL-UCG RETRO CR,74450,CPT,,,,,both,, ,1357.62,1357.62,Blue Cross and Blue Shield,Traditional,,525.4,38.7,38.7,1357.62,52.95,692.39,percent of total billed charges,38.7
FL-UCG VOIDING,74455,CPT,,,,,both,, ,1357.62,1357.62,Blue Cross and Blue Shield,Traditional,,525.4,38.7,38.7,1357.62,52.95,692.39,percent of total billed charges,38.7
FL-UCG VOIDING CR,74455,CPT,,,,,both,, ,1162.77,1162.77,Blue Cross and Blue Shield,Traditional,,449.99,38.7,38.7,1162.77,45.35,593.01,percent of total billed charges,38.7
IR-DILATION GU,74485,CPT,,,,,both,, ,976.75,976.75,Blue Cross and Blue Shield,Traditional,,378,38.7,38.7,976.75,38.09,498.14,percent of total billed charges,38.7
IR-HYSTERSALPINGO CR,74740,CPT,,,,,both,,,1704.21,1704.21,Blue Cross and Blue Shield,Traditional,,659.53,38.7,38.7,1704.21,66.46,869.15,percent of total billed charges,38.7
IR-HYSTERSALPINGO CR,74740,CPT,,,,,both,, ,1704.21,1704.21,Blue Cross and Blue Shield,Traditional,,659.53,38.7,38.7,1704.21,66.46,869.15,percent of total billed charges,38.7
IR-HYSTERSALPINGOGRM,74740,CPT,,,,,both,,,1989.98,1989.98,Blue Cross and Blue Shield,Traditional,,770.12,38.7,38.7,1989.98,77.61,1014.89,percent of total billed charges,38.7
IR-HYSTERSALPINGOGRM,74740,CPT,,,,,both,, ,1989.98,1989.98,Blue Cross and Blue Shield,Traditional,,770.12,38.7,38.7,1989.98,77.61,1014.89,percent of total billed charges,38.7
IR-PERINEOGRAM CR,74775,CPT,,,,,both,, ,1991.67,1991.67,Blue Cross and Blue Shield,Traditional,,770.78,38.7,38.7,1991.67,77.68,1015.75,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,,224.52,38.7,38.7,580.15,22.63,295.88,percent of total billed charges,38.7
CT-HT ACC LV RV W,75573,CPT,,,,,both,, ,1696.4,1696.4,Blue Cross and Blue Shield,Traditional,,656.51,38.7,38.7,1696.4,66.16,865.16,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,,224.52,38.7,38.7,580.15,22.63,295.88,percent of total billed charges,38.7
CT-HT CARD FUNC W,75574,CPT,,,,,both,, ,1696.4,1696.4,Blue Cross and Blue Shield,Traditional,,656.51,38.7,38.7,1696.4,66.16,865.16,percent of total billed charges,38.7
CATH-ABD AORTA SERIAL,75625,CPT,,,,,both,, ,8483,8483,Blue Cross and Blue Shield,Traditional,,3282.92,38.7,38.7,8483,330.84,4326.33,percent of total billed charges,38.7
IR-ABD AORTA SERIAL,75625,CPT,,,,,both,, ,9523.86,9523.86,Blue Cross and Blue Shield,Traditional,,3685.73,38.7,38.7,9523.86,371.43,4857.17,percent of total billed charges,38.7
CATH-AABF SERIAL     ,75630,CPT,,,,,both,, ,11199.75,11199.75,Blue Cross and Blue Shield,Traditional,,4334.3,38.7,38.7,11199.75,436.79,5711.87,percent of total billed charges,38.7
IR-AABF SERIAL,75630,CPT,,,,,both,, ,12573.95,12573.95,Blue Cross and Blue Shield,Traditional,,4866.12,38.7,38.7,12573.95,490.38,6412.71,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,,251.89,38.7,38.7,650.88,25.38,331.95,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,,911.55,38.7,38.7,2355.42,91.86,1201.26,percent of total billed charges,38.7
CATH-ANGIO EXTREM UNI,75710,CPT,,,,,both,, ,7520.75,7520.75,Blue Cross and Blue Shield,Traditional,,2910.53,38.7,38.7,7520.75,293.31,3835.58,percent of total billed charges,38.7
IR-ANGIO EXTREM UNI,75710,CPT,,,,,both,, ,8443.54,8443.54,Blue Cross and Blue Shield,Traditional,,3267.65,38.7,38.7,8443.54,329.3,4306.21,percent of total billed charges,38.7
CATH-ANGIO EXTREM BI ,75716,CPT,,,,,both,, ,7520.75,7520.75,Blue Cross and Blue Shield,Traditional,,2910.53,38.7,38.7,7520.75,293.31,3835.58,percent of total billed charges,38.7
IR-ANGIO EXTREM BI,75716,CPT,,,,,both,, ,8423.33,8423.33,Blue Cross and Blue Shield,Traditional,,3259.83,38.7,38.7,8423.33,328.51,4295.9,percent of total billed charges,38.7
IR-ANGIO VISCERAL SE,75726,CPT,,,,,both,, ,13364.62,13364.62,Blue Cross and Blue Shield,Traditional,,5172.11,38.7,38.7,13364.62,521.22,6815.96,percent of total billed charges,38.7
IR-ANG PULMONARY UNI,75741,CPT,,,,,both,, ,4237.35,4237.35,Blue Cross and Blue Shield,Traditional,,1639.85,38.7,38.7,4237.35,165.26,2161.05,percent of total billed charges,38.7
IR-ANG PULMONARY BI,75743,CPT,,,,,both,, ,12357.84,12357.84,Blue Cross and Blue Shield,Traditional,,4782.48,38.7,38.7,12357.84,481.96,6302.5,percent of total billed charges,38.7
IR-SHUNTOGRAM,75809,CPT,,,,,both,, ,386.21,386.21,Blue Cross and Blue Shield,Traditional,,149.46,38.7,38.7,386.21,15.06,196.97,percent of total billed charges,38.7
CATH-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,7641.75,7641.75,Blue Cross and Blue Shield,Traditional,,2957.36,38.7,38.7,7641.75,298.03,3897.29,percent of total billed charges,38.7
IR-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,8579.39,8579.39,Blue Cross and Blue Shield,Traditional,,3320.22,38.7,38.7,8579.39,334.6,4375.49,percent of total billed charges,38.7
IR-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,8579.39,8579.39,Blue Cross and Blue Shield,Traditional,,3320.22,38.7,38.7,8579.39,334.6,4375.49,percent of total billed charges,38.7
CATH-VENOGRAM EXT BI ,75822,CPT,,,,,both,, ,3510,3510,Blue Cross and Blue Shield,Traditional,,1358.37,38.7,38.7,3510,136.89,1790.1,percent of total billed charges,38.7
IR-VENOGRAM EXT BI,75822,CPT,,,,,both,, ,3940.68,3940.68,Blue Cross and Blue Shield,Traditional,,1525.04,38.7,38.7,3940.68,153.69,2009.75,percent of total billed charges,38.7
IR-VENACAVAGRAM INF,75825,CPT,,,,,both,, ,8923.22,8923.22,Blue Cross and Blue Shield,Traditional,,3453.29,38.7,38.7,8923.22,348.01,4550.84,percent of total billed charges,38.7
IR-VENOUS SAMPL CATH,75893,CPT,,,,,both,, ,3915.41,3915.41,Blue Cross and Blue Shield,Traditional,,1515.26,38.7,38.7,3915.41,152.7,1996.86,percent of total billed charges,38.7
IR-ANGIO EXIST CATH,75898,CPT,,,,,both,, ,513.35,513.35,Blue Cross and Blue Shield,Traditional,,198.67,38.7,38.7,513.35,20.02,261.81,percent of total billed charges,38.7
IR-DRAIN TUBE CHANGE,75984,CPT,,,,,both,, ,2098.33,2098.33,Blue Cross and Blue Shield,Traditional,,812.05,38.7,38.7,2098.33,81.83,1070.15,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,,1025.17,38.7,38.7,2649.01,103.31,1351,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,,433.61,38.7,38.7,1120.45,43.7,571.43,percent of total billed charges,38.7
FL-FLUORO 1 HOUR,76000,CPT,,,,,both,, ,553.77,553.77,Blue Cross and Blue Shield,Traditional,,214.31,38.7,38.7,553.77,21.6,282.42,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,,183.56,38.7,38.7,474.31,18.5,241.9,percent of total billed charges,38.7
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,756.41,756.41,Blue Cross and Blue Shield,Traditional,,292.73,38.7,38.7,756.41,29.5,385.77,percent of total billed charges,38.7
IR-FISTULOGRAM CR,76080,CPT,,,,,both,, ,758.66,758.66,Blue Cross and Blue Shield,Traditional,,293.6,38.7,38.7,758.66,29.59,386.92,percent of total billed charges,38.7
EXAM SURG SPECMN CR,76098,CPT,,,,,both,, ,1190.34,1190.34,Blue Cross and Blue Shield,Traditional,,460.66,38.7,38.7,1190.34,46.42,607.07,percent of total billed charges,38.7
TOMOGRAM ONE PLNE CR,76100,CPT,,,,,both,, ,2030.12,2030.12,Blue Cross and Blue Shield,Traditional,,785.66,38.7,38.7,2030.12,79.17,1035.36,percent of total billed charges,38.7
CT-3D W POSTPROCESS,76377,CPT,,,,,both,, ,528.5,528.5,Blue Cross and Blue Shield,Traditional,,204.53,38.7,38.7,528.5,20.61,269.54,percent of total billed charges,38.7
CT-3D W POSTPROCESS,76377,CPT,,,,,both,, ,536.93,536.93,Blue Cross and Blue Shield,Traditional,,207.79,38.7,38.7,536.93,20.94,273.83,percent of total billed charges,38.7
MR-3D W POSTPROCESS,76377,CPT,,,,,both,, ,491.18,491.18,Blue Cross and Blue Shield,Traditional,,190.09,38.7,38.7,491.18,19.16,250.5,percent of total billed charges,38.7
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,193.1,193.1,Blue Cross and Blue Shield,Traditional,,74.73,38.7,38.7,193.1,7.53,98.48,percent of total billed charges,38.7
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,207.98,207.98,Blue Cross and Blue Shield,Traditional,,80.49,38.7,38.7,207.98,8.11,106.07,percent of total billed charges,38.7
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,724.14,724.14,Blue Cross and Blue Shield,Traditional,,280.24,38.7,38.7,724.14,28.24,369.31,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,,126.44,38.7,38.7,326.71,12.74,166.62,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,,136.1,38.7,38.7,351.68,13.72,179.36,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,,785.87,38.7,38.7,2030.68,79.2,1035.65,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,,785.87,38.7,38.7,2030.68,79.2,1035.65,percent of total billed charges,38.7
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,38.7,326.71,12.74,166.62,percent of total billed charges,38.7
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,1602.93,1602.93,Blue Cross and Blue Shield,Traditional,,620.33,38.7,38.7,1602.93,62.51,817.49,percent of total billed charges,38.7
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,218.64,218.64,Blue Cross and Blue Shield,Traditional,,84.61,38.7,38.7,218.64,8.53,111.51,percent of total billed charges,38.7
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,218.64,218.64,Blue Cross and Blue Shield,Traditional,,84.61,38.7,38.7,218.64,8.53,111.51,percent of total billed charges,38.7
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,1680.12,1680.12,Blue Cross and Blue Shield,Traditional,,650.21,38.7,38.7,1680.12,65.52,856.86,percent of total billed charges,38.7
US-BREAST LIMITED,76642,CPT,,,,,both,, ,218.64,218.64,Blue Cross and Blue Shield,Traditional,,84.61,38.7,38.7,218.64,8.53,111.51,percent of total billed charges,38.7
US-BREAST LIMITED,76642,CPT,,,,,both,, ,218.64,218.64,Blue Cross and Blue Shield,Traditional,,84.61,38.7,38.7,218.64,8.53,111.51,percent of total billed charges,38.7
US-BREAST LIMITED,76642,CPT,,,,,both,,,1680.12,1680.12,Blue Cross and Blue Shield,Traditional,,650.21,38.7,38.7,1680.12,65.52,856.86,percent of total billed charges,38.7
US-BREAST LIMITED,76642,CPT,,,,,both,, ,1680.12,1680.12,Blue Cross and Blue Shield,Traditional,,650.21,38.7,38.7,1680.12,65.52,856.86,percent of total billed charges,38.7
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,437.29,437.29,Blue Cross and Blue Shield,Traditional,,169.23,38.7,38.7,437.29,17.05,223.02,percent of total billed charges,38.7
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,437.29,437.29,Blue Cross and Blue Shield,Traditional,,169.23,38.7,38.7,437.29,17.05,223.02,percent of total billed charges,38.7
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,3359.95,3359.95,Blue Cross and Blue Shield,Traditional,,1300.3,38.7,38.7,3359.95,131.04,1713.57,percent of total billed charges,38.7
Ultrasound of abdomen,76700,CPT,,,,,both,,,2330.73,2330.73,Blue Cross and Blue Shield,Traditional,,901.99,38.7,38.7,2330.73,90.9,1188.67,percent of total billed charges,38.7
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,38.7,326.71,12.74,166.62,percent of total billed charges,38.7
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,2330.73,2330.73,Blue Cross and Blue Shield,Traditional,,901.99,38.7,38.7,2330.73,90.9,1188.67,percent of total billed charges,38.7
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,38.7,326.71,12.74,166.62,percent of total billed charges,38.7
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
US-ABDOMEN LTD WO,76705,CPT,,,,,both,,,1908.87,1908.87,Blue Cross and Blue Shield,Traditional,,738.73,38.7,38.7,1908.87,74.45,973.52,percent of total billed charges,38.7
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,1908.87,1908.87,Blue Cross and Blue Shield,Traditional,,738.73,38.7,38.7,1908.87,74.45,973.52,percent of total billed charges,38.7
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,38.7,326.71,12.74,166.62,percent of total billed charges,38.7
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
US-ABDOMEN RETROPER,76770,CPT,,,,,both,,,2030.68,2030.68,Blue Cross and Blue Shield,Traditional,,785.87,38.7,38.7,2030.68,79.2,1035.65,percent of total billed charges,38.7
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,2030.68,2030.68,Blue Cross and Blue Shield,Traditional,,785.87,38.7,38.7,2030.68,79.2,1035.65,percent of total billed charges,38.7
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,38.7,326.71,12.74,166.62,percent of total billed charges,38.7
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,,,1965,1965,Blue Cross and Blue Shield,Traditional,,760.46,38.7,38.7,1965,76.64,1002.15,percent of total billed charges,38.7
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,1965,1965,Blue Cross and Blue Shield,Traditional,,760.46,38.7,38.7,1965,76.64,1002.15,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,,126.44,38.7,38.7,326.71,12.74,166.62,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,,136.1,38.7,38.7,351.68,13.72,179.36,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,,314.89,38.7,38.7,813.67,31.73,414.97,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,,314.89,38.7,38.7,813.67,31.73,414.97,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,,127.52,38.7,38.7,329.51,12.85,168.05,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,,,1931.6,1931.6,Blue Cross and Blue Shield,Traditional,,747.53,38.7,38.7,1931.6,75.33,985.12,percent of total billed charges,38.7
US-PELVIS PREG,76805,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,38.7,326.71,12.74,166.62,percent of total billed charges,38.7
US-PELVIS PREG,76805,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
US-PELVIS PREG,76805,CPT,,,,,both,, ,1931.6,1931.6,Blue Cross and Blue Shield,Traditional,,747.53,38.7,38.7,1931.6,75.33,985.12,percent of total billed charges,38.7
US-PELVS PREG GESADD,76810,CPT,,,,,both,, ,329.51,329.51,Blue Cross and Blue Shield,Traditional,,127.52,38.7,38.7,329.51,12.85,168.05,percent of total billed charges,38.7
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,38.7,326.71,12.74,166.62,percent of total billed charges,38.7
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,577,577,Blue Cross and Blue Shield,Traditional,,223.3,38.7,38.7,577,22.5,294.27,percent of total billed charges,38.7
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,647.8,647.8,Blue Cross and Blue Shield,Traditional,,250.7,38.7,38.7,647.8,25.26,330.38,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,,84.61,38.7,38.7,218.64,8.53,111.51,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,,91.13,38.7,38.7,235.48,9.18,120.09,percent of total billed charges,38.7
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,647.8,647.8,Blue Cross and Blue Shield,Traditional,,250.7,38.7,38.7,647.8,25.26,330.38,percent of total billed charges,38.7
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,38.7,326.71,12.74,166.62,percent of total billed charges,38.7
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
US-PLV PRG TRNSV,76817,CPT,,,,,both,,,655.09,655.09,Blue Cross and Blue Shield,Traditional,,253.52,38.7,38.7,655.09,25.55,334.1,percent of total billed charges,38.7
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,655.09,655.09,Blue Cross and Blue Shield,Traditional,,253.52,38.7,38.7,655.09,25.55,334.1,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,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
US-FETAL BIO W NST,76818,CPT,,,,,both,, ,1198.2,1198.2,Blue Cross and Blue Shield,Traditional,,463.7,38.7,38.7,1198.2,46.73,611.08,percent of total billed charges,38.7
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,38.7,326.71,12.74,166.62,percent of total billed charges,38.7
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,793.18,793.18,Blue Cross and Blue Shield,Traditional,,306.96,38.7,38.7,793.18,30.93,404.52,percent of total billed charges,38.7
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,218.64,218.64,Blue Cross and Blue Shield,Traditional,,84.61,38.7,38.7,218.64,8.53,111.51,percent of total billed charges,38.7
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,235.48,235.48,Blue Cross and Blue Shield,Traditional,,91.13,38.7,38.7,235.48,9.18,120.09,percent of total billed charges,38.7
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,780.55,780.55,Blue Cross and Blue Shield,Traditional,,302.07,38.7,38.7,780.55,30.44,398.08,percent of total billed charges,38.7
Ultrasound pelvis through vagina,76830,CPT,,,,,both,,,689.62,689.62,Blue Cross and Blue Shield,Traditional,,266.88,38.7,38.7,689.62,26.9,351.71,percent of total billed charges,38.7
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,38.7,326.71,12.74,166.62,percent of total billed charges,38.7
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,689.62,689.62,Blue Cross and Blue Shield,Traditional,,266.88,38.7,38.7,689.62,26.9,351.71,percent of total billed charges,38.7
US-PELVIS NON OB,76856,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,38.7,326.71,12.74,166.62,percent of total billed charges,38.7
US-PELVIS NON OB,76856,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
US-PELVIS NON OB,76856,CPT,,,,,both,,,1931.6,1931.6,Blue Cross and Blue Shield,Traditional,,747.53,38.7,38.7,1931.6,75.33,985.12,percent of total billed charges,38.7
US-PELVIS NON OB,76856,CPT,,,,,both,, ,1931.6,1931.6,Blue Cross and Blue Shield,Traditional,,747.53,38.7,38.7,1931.6,75.33,985.12,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,,81.25,38.7,38.7,209.94,8.19,107.07,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,,81.25,38.7,38.7,209.94,8.19,107.07,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,,169.23,38.7,38.7,437.29,17.05,223.02,percent of total billed charges,38.7
US-SCROTUM,76870,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,38.7,326.71,12.74,166.62,percent of total billed charges,38.7
US-SCROTUM,76870,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
US-SCROTUM,76870,CPT,,,,,both,,,2005.7,2005.7,Blue Cross and Blue Shield,Traditional,,776.21,38.7,38.7,2005.7,78.22,1022.91,percent of total billed charges,38.7
US-SCROTUM,76870,CPT,,,,,both,, ,2005.7,2005.7,Blue Cross and Blue Shield,Traditional,,776.21,38.7,38.7,2005.7,78.22,1022.91,percent of total billed charges,38.7
US-TRANSRECTAL,76872,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,38.7,326.71,12.74,166.62,percent of total billed charges,38.7
US-TRANSRECTAL,76872,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
US-TRANSRECTAL,76872,CPT,,,,,both,, ,1300.09,1300.09,Blue Cross and Blue Shield,Traditional,,503.13,38.7,38.7,1300.09,50.7,663.05,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,,126.44,38.7,38.7,326.71,12.74,166.62,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,,136.1,38.7,38.7,351.68,13.72,179.36,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,,146.42,38.7,38.7,378.35,14.76,192.96,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,,73.21,38.7,38.7,189.17,7.38,96.48,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,,84.61,38.7,38.7,218.64,8.53,111.51,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,,91.13,38.7,38.7,235.48,9.18,120.09,percent of total billed charges,38.7
NI-VAS ACCSS SITES,76937,CPT,,,,,both,, ,797.67,797.67,Blue Cross and Blue Shield,Traditional,,308.7,38.7,38.7,797.67,31.11,406.81,percent of total billed charges,38.7
NI-VAS ACCSS SITES ,76937,CPT,,,,,both,, ,710.5,710.5,Blue Cross and Blue Shield,Traditional,,274.96,38.7,38.7,710.5,27.71,362.36,percent of total billed charges,38.7
US-GUIDE NEEDLE PLAC,76942,CPT,,,,,both,, ,2221.26,2221.26,Blue Cross and Blue Shield,Traditional,,859.63,38.7,38.7,2221.26,86.63,1132.84,percent of total billed charges,38.7
US-GUIDE AMNIOCENT,76946,CPT,,,,,both,, ,2221.26,2221.26,Blue Cross and Blue Shield,Traditional,,859.63,38.7,38.7,2221.26,86.63,1132.84,percent of total billed charges,38.7
US-GUIDE INTRAOPERAT,76998,CPT,,,,,both,, ,604.57,604.57,Blue Cross and Blue Shield,Traditional,,233.97,38.7,38.7,604.57,23.58,308.33,percent of total billed charges,38.7
FL-FLUORO CVAD ANY,77001,CPT,,,,,both,, ,1968.65,1968.65,Blue Cross and Blue Shield,Traditional,,761.87,38.7,38.7,1968.65,76.78,1004.01,percent of total billed charges,38.7
FL-NEDL GUIDE FLUORO,77002,CPT,,,,,both,, ,521.21,521.21,Blue Cross and Blue Shield,Traditional,,201.71,38.7,38.7,521.21,20.33,265.82,percent of total billed charges,38.7
FL-FLUORO GUIDE SPIN,77003,CPT,,,,,both,, ,553.77,553.77,Blue Cross and Blue Shield,Traditional,,214.31,38.7,38.7,553.77,21.6,282.42,percent of total billed charges,38.7
CT-GUIDE NEEDLE BX,77012,CPT,,,,,both,, ,2649.01,2649.01,Blue Cross and Blue Shield,Traditional,,1025.17,38.7,38.7,2649.01,103.31,1351,percent of total billed charges,38.7
CT-GUIDE TISSUE ABLA,77013,CPT,,,,,both,, ,3157.31,3157.31,Blue Cross and Blue Shield,Traditional,,1221.88,38.7,38.7,3157.31,123.14,1610.23,percent of total billed charges,38.7
MR-BREAST UNI WO,77046,CPT,,,,,both,, ,674.73,674.73,Blue Cross and Blue Shield,Traditional,,261.12,38.7,38.7,674.73,26.31,344.11,percent of total billed charges,38.7
MR-BREAST BIL WO,77047,CPT,,,,,both,, ,674.73,674.73,Blue Cross and Blue Shield,Traditional,,261.12,38.7,38.7,674.73,26.31,344.11,percent of total billed charges,38.7
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,772.13,772.13,Blue Cross and Blue Shield,Traditional,,298.81,38.7,38.7,772.13,30.11,393.79,percent of total billed charges,38.7
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,830.8,830.8,Blue Cross and Blue Shield,Traditional,,321.52,38.7,38.7,830.8,32.4,423.71,percent of total billed charges,38.7
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,1469.05,1469.05,Blue Cross and Blue Shield,Traditional,,568.52,38.7,38.7,1469.05,57.29,749.22,percent of total billed charges,38.7
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,772.13,772.13,Blue Cross and Blue Shield,Traditional,,298.81,38.7,38.7,772.13,30.11,393.79,percent of total billed charges,38.7
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,830.8,830.8,Blue Cross and Blue Shield,Traditional,,321.52,38.7,38.7,830.8,32.4,423.71,percent of total billed charges,38.7
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,1889.78,1889.78,Blue Cross and Blue Shield,Traditional,,731.34,38.7,38.7,1889.78,73.7,963.79,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,,41.46,38.7,38.7,107.12,4.18,54.63,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,,41.46,38.7,38.7,107.12,4.18,54.63,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,,31.09,38.7,38.7,80.34,3.13,40.97,percent of total billed charges,38.7
BR-TOMOSYN SCR AD BI,77063,CPT,,,,,both,, ,100,100,Blue Cross and Blue Shield,Traditional,,38.7,38.7,38.7,100,3.9,51,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,,159.25,38.7,38.7,411.49,16.05,209.86,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,,159.25,38.7,38.7,411.49,16.05,209.86,percent of total billed charges,38.7
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,439.55,439.55,Blue Cross and Blue Shield,Traditional,,170.11,38.7,38.7,439.55,17.14,224.17,percent of total billed charges,38.7
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,448.82,448.82,Blue Cross and Blue Shield,Traditional,,173.69,38.7,38.7,448.82,17.5,228.9,percent of total billed charges,38.7
Mammography of one breast,77065,CPT,,,,,both,,,448.82,448.82,Blue Cross and Blue Shield,Traditional,,173.69,38.7,38.7,448.82,17.5,228.9,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,,159.25,38.7,38.7,411.49,16.05,209.86,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,,159.25,38.7,38.7,411.49,16.05,209.86,percent of total billed charges,38.7
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,439.55,439.55,Blue Cross and Blue Shield,Traditional,,170.11,38.7,38.7,439.55,17.14,224.17,percent of total billed charges,38.7
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,556.97,556.97,Blue Cross and Blue Shield,Traditional,,215.55,38.7,38.7,556.97,21.72,284.05,percent of total billed charges,38.7
Mammography of both breasts,77066,CPT,,,,,both,,,556.97,556.97,Blue Cross and Blue Shield,Traditional,,215.55,38.7,38.7,556.97,21.72,284.05,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,,142.51,38.7,38.7,368.23,14.36,187.8,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,,189.24,38.7,38.7,488.99,19.07,249.38,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,,133.63,38.7,38.7,345.31,13.47,176.11,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,,133.63,38.7,38.7,345.31,13.47,176.11,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,,141.91,38.7,38.7,366.68,14.3,187.01,percent of total billed charges,38.7
"Mammography, screening, bilateral",77067,CPT,,,,,both,,,488.99,488.99,Blue Cross and Blue Shield,Traditional,,189.24,38.7,38.7,488.99,19.07,249.38,percent of total billed charges,38.7
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
BONE AGE STUDY CR,77072,CPT,,,,,both,,,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,38.7,721.61,28.14,368.02,percent of total billed charges,38.7
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,721.61,721.61,Blue Cross and Blue Shield,Traditional,,279.26,38.7,38.7,721.61,28.14,368.02,percent of total billed charges,38.7
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
BONE LENGTH STUDY CR,77073,CPT,,,,,both,,,1904.1,1904.1,Blue Cross and Blue Shield,Traditional,,736.89,38.7,38.7,1904.1,74.26,971.09,percent of total billed charges,38.7
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,1904.1,1904.1,Blue Cross and Blue Shield,Traditional,,736.89,38.7,38.7,1904.1,74.26,971.09,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,,202.58,38.7,38.7,523.46,20.41,266.96,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,,202.58,38.7,38.7,523.46,20.41,266.96,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,,85.38,38.7,38.7,220.61,8.6,112.51,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,,91.89,38.7,38.7,237.45,9.26,121.1,percent of total billed charges,38.7
BNE SRVY CMP METS CR,77075,CPT,,,,,both,,,418.2,418.2,Blue Cross and Blue Shield,Traditional,,161.84,38.7,38.7,418.2,16.31,213.28,percent of total billed charges,38.7
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,418.2,418.2,Blue Cross and Blue Shield,Traditional,,161.84,38.7,38.7,418.2,16.31,213.28,percent of total billed charges,38.7
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,220.61,220.61,Blue Cross and Blue Shield,Traditional,,85.38,38.7,38.7,220.61,8.6,112.51,percent of total billed charges,38.7
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,38.7,237.45,9.26,121.1,percent of total billed charges,38.7
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,38.7,237.45,9.26,121.1,percent of total billed charges,38.7
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,237.45,Blue Cross and Blue Shield,Traditional,,91.89,38.7,38.7,237.45,9.26,121.1,percent of total billed charges,38.7
BONE SRVY INFANT CR,77076,CPT,,,,,both,,,833.32,833.32,Blue Cross and Blue Shield,Traditional,,322.49,38.7,38.7,833.32,32.5,424.99,percent of total billed charges,38.7
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,833.32,833.32,Blue Cross and Blue Shield,Traditional,,322.49,38.7,38.7,833.32,32.5,424.99,percent of total billed charges,38.7
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,139.21,139.21,Blue Cross and Blue Shield,Traditional,,53.87,38.7,38.7,139.21,5.43,71,percent of total billed charges,38.7
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,149.88,149.88,Blue Cross and Blue Shield,Traditional,,58,38.7,38.7,149.88,5.85,76.44,percent of total billed charges,38.7
JOINT SURVEY 1V CR,77077,CPT,,,,,both,,,1387.37,1387.37,Blue Cross and Blue Shield,Traditional,,536.91,38.7,38.7,1387.37,54.11,707.56,percent of total billed charges,38.7
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,1387.37,1387.37,Blue Cross and Blue Shield,Traditional,,536.91,38.7,38.7,1387.37,54.11,707.56,percent of total billed charges,38.7
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,218.93,218.93,Blue Cross and Blue Shield,Traditional,,84.73,38.7,38.7,218.93,8.54,111.65,percent of total billed charges,38.7
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,235.77,235.77,Blue Cross and Blue Shield,Traditional,,91.24,38.7,38.7,235.77,9.2,120.24,percent of total billed charges,38.7
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,613.55,613.55,Blue Cross and Blue Shield,Traditional,,237.44,38.7,38.7,613.55,23.93,312.91,percent of total billed charges,38.7
DEXA AXIAL,77080,CPT,,,,,both,, ,218.93,218.93,Blue Cross and Blue Shield,Traditional,,84.73,38.7,38.7,218.93,8.54,111.65,percent of total billed charges,38.7
DEXA AXIAL,77080,CPT,,,,,both,, ,235.77,235.77,Blue Cross and Blue Shield,Traditional,,91.24,38.7,38.7,235.77,9.2,120.24,percent of total billed charges,38.7
DEXA AXIAL,77080,CPT,,,,,both,,,430.83,430.83,Blue Cross and Blue Shield,Traditional,,166.73,38.7,38.7,430.83,16.8,219.72,percent of total billed charges,38.7
DEXA AXIAL,77080,CPT,,,,,both,, ,430.83,430.83,Blue Cross and Blue Shield,Traditional,,166.73,38.7,38.7,430.83,16.8,219.72,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,,53.87,38.7,38.7,139.21,5.43,71,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,,58,38.7,38.7,149.88,5.85,76.44,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,,103.29,38.7,38.7,266.91,10.41,136.12,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,,396.82,38.7,38.7,1025.37,39.99,522.94,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,,528.36,38.7,38.7,1365.27,53.25,696.29,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,,665.48,38.7,38.7,1719.59,67.06,876.99,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,,528.36,38.7,38.7,1365.27,53.25,696.29,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,,729.36,38.7,38.7,1884.64,73.5,961.17,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,,729.36,38.7,38.7,1884.64,73.5,961.17,percent of total billed charges,38.7
NM-ADRENAL IMAGING,78075,CPT,,,,,both,, ,5329.74,5329.74,Blue Cross and Blue Shield,Traditional,,2062.61,38.7,38.7,5329.74,207.86,2718.17,percent of total billed charges,38.7
NM-BONE MARROW LMTD,78102,CPT,,,,,both,, ,1409.3,1409.3,Blue Cross and Blue Shield,Traditional,,545.4,38.7,38.7,1409.3,54.96,718.74,percent of total billed charges,38.7
NM-BONE MARROW MULT,78103,CPT,,,,,both,, ,1409.3,1409.3,Blue Cross and Blue Shield,Traditional,,545.4,38.7,38.7,1409.3,54.96,718.74,percent of total billed charges,38.7
NM-BONE MARROW BODY,78104,CPT,,,,,both,, ,1409.3,1409.3,Blue Cross and Blue Shield,Traditional,,545.4,38.7,38.7,1409.3,54.96,718.74,percent of total billed charges,38.7
NM-LYMPHATICS NODES,78195,CPT,,,,,both,, ,4917.74,4917.74,Blue Cross and Blue Shield,Traditional,,1903.17,38.7,38.7,4917.74,191.79,2508.05,percent of total billed charges,38.7
NM-LIVER,78201,CPT,,,,,both,, ,3830.06,3830.06,Blue Cross and Blue Shield,Traditional,,1482.23,38.7,38.7,3830.06,149.37,1953.33,percent of total billed charges,38.7
NM-LIVER AND SPLEEN,78215,CPT,,,,,both,, ,3830.06,3830.06,Blue Cross and Blue Shield,Traditional,,1482.23,38.7,38.7,3830.06,149.37,1953.33,percent of total billed charges,38.7
NM-HEPATOBILIARY SYS,78226,CPT,,,,,both,, ,4088.59,4088.59,Blue Cross and Blue Shield,Traditional,,1582.28,38.7,38.7,4088.59,159.46,2085.18,percent of total billed charges,38.7
NM-HEPATOBIL W PHARM,78227,CPT,,,,,both,,,4088.59,4088.59,Blue Cross and Blue Shield,Traditional,,1582.28,38.7,38.7,4088.59,159.46,2085.18,percent of total billed charges,38.7
NM-HEPATOBIL W PHARM,78227,CPT,,,,,both,, ,4088.59,4088.59,Blue Cross and Blue Shield,Traditional,,1582.28,38.7,38.7,4088.59,159.46,2085.18,percent of total billed charges,38.7
NM-GI REFLUX,78262,CPT,,,,,both,, ,3415.74,3415.74,Blue Cross and Blue Shield,Traditional,,1321.89,38.7,38.7,3415.74,133.21,1742.03,percent of total billed charges,38.7
NM-GASTRIC EMPTYING,78264,CPT,,,,,both,,,3415.74,3415.74,Blue Cross and Blue Shield,Traditional,,1321.89,38.7,38.7,3415.74,133.21,1742.03,percent of total billed charges,38.7
NM-GASTRIC EMPTYING,78264,CPT,,,,,both,, ,3415.74,3415.74,Blue Cross and Blue Shield,Traditional,,1321.89,38.7,38.7,3415.74,133.21,1742.03,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,,597.42,38.7,38.7,1543.71,60.2,787.29,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,,792.14,38.7,38.7,2046.87,79.83,1043.9,percent of total billed charges,38.7
NM-GI BLOOD LOSS,78278,CPT,,,,,both,, ,3415.74,3415.74,Blue Cross and Blue Shield,Traditional,,1321.89,38.7,38.7,3415.74,133.21,1742.03,percent of total billed charges,38.7
NM-MECKELS SCAN,78290,CPT,,,,,both,, ,3576.68,3576.68,Blue Cross and Blue Shield,Traditional,,1384.18,38.7,38.7,3576.68,139.49,1824.11,percent of total billed charges,38.7
NM-BONE SCAN LMTD,78300,CPT,,,,,both,, ,2526.59,2526.59,Blue Cross and Blue Shield,Traditional,,977.79,38.7,38.7,2526.59,98.54,1288.56,percent of total billed charges,38.7
NM-BONE SCAN MULTI,78305,CPT,,,,,both,, ,2526.59,2526.59,Blue Cross and Blue Shield,Traditional,,977.79,38.7,38.7,2526.59,98.54,1288.56,percent of total billed charges,38.7
NM-BONE SCAN BODY,78306,CPT,,,,,both,,,3512.04,3512.04,Blue Cross and Blue Shield,Traditional,,1359.16,38.7,38.7,3512.04,136.97,1791.14,percent of total billed charges,38.7
NM-BONE SCAN BODY,78306,CPT,,,,,both,, ,3512.04,3512.04,Blue Cross and Blue Shield,Traditional,,1359.16,38.7,38.7,3512.04,136.97,1791.14,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,,1126.87,38.7,38.7,2911.81,113.56,1485.02,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,,1126.87,38.7,38.7,2911.81,113.56,1485.02,percent of total billed charges,38.7
NM-VASCULAR FLOW,78445,CPT,,,,,both,, ,1719.84,1719.84,Blue Cross and Blue Shield,Traditional,,665.58,38.7,38.7,1719.84,67.07,877.12,percent of total billed charges,38.7
NM-MYOCRD SPECT SNGL,78451,CPT,,,,,both,, ,3741.73,3741.73,Blue Cross and Blue Shield,Traditional,,1448.05,38.7,38.7,3741.73,145.93,1908.28,percent of total billed charges,38.7
NM-MYOCRD SPECT MULT,78452,CPT,,,,,both,,,7071.47,7071.47,Blue Cross and Blue Shield,Traditional,,2736.66,38.7,38.7,7071.47,275.79,3606.45,percent of total billed charges,38.7
NM-MYOCRD SPECT MULT,78452,CPT,,,,,both,, ,7071.47,7071.47,Blue Cross and Blue Shield,Traditional,,2736.66,38.7,38.7,7071.47,275.79,3606.45,percent of total billed charges,38.7
NM-MYOCARD SINGLE,78453,CPT,,,,,both,, ,4803.15,4803.15,Blue Cross and Blue Shield,Traditional,,1858.82,38.7,38.7,4803.15,187.32,2449.61,percent of total billed charges,38.7
NM-MYOCARD INFARCT,78466,CPT,,,,,both,, ,3415.74,3415.74,Blue Cross and Blue Shield,Traditional,,1321.89,38.7,38.7,3415.74,133.21,1742.03,percent of total billed charges,38.7
NM-MYOCARD INF SPECT,78469,CPT,,,,,both,, ,3184.5,3184.5,Blue Cross and Blue Shield,Traditional,,1232.4,38.7,38.7,3184.5,124.2,1624.1,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,,1321.89,38.7,38.7,3415.74,133.21,1742.03,percent of total billed charges,38.7
NM-LUNG VENT IMAGING,78579,CPT,,,,,both,,,4088.59,4088.59,Blue Cross and Blue Shield,Traditional,,1582.28,38.7,38.7,4088.59,159.46,2085.18,percent of total billed charges,38.7
NM-LUNG VENT IMAGING,78579,CPT,,,,,both,, ,4088.59,4088.59,Blue Cross and Blue Shield,Traditional,,1582.28,38.7,38.7,4088.59,159.46,2085.18,percent of total billed charges,38.7
NM-LUNG PERF PARTICU,78580,CPT,,,,,both,, ,3590.32,3590.32,Blue Cross and Blue Shield,Traditional,,1389.45,38.7,38.7,3590.32,140.02,1831.06,percent of total billed charges,38.7
NM-LUNG VENT PERFUS,78582,CPT,,,,,both,,,6243.6,6243.6,Blue Cross and Blue Shield,Traditional,,2416.27,38.7,38.7,6243.6,243.5,3184.24,percent of total billed charges,38.7
NM-LUNG VENT PERFUS,78582,CPT,,,,,both,, ,6243.6,6243.6,Blue Cross and Blue Shield,Traditional,,2416.27,38.7,38.7,6243.6,243.5,3184.24,percent of total billed charges,38.7
NM-LUNG PERFVENT DIF,78598,CPT,,,,,both,, ,8897.66,8897.66,Blue Cross and Blue Shield,Traditional,,3443.39,38.7,38.7,8897.66,347.01,4537.81,percent of total billed charges,38.7
NM-BRAIN CSF CISTERN,78630,CPT,,,,,both,, ,1616.07,1616.07,Blue Cross and Blue Shield,Traditional,,625.42,38.7,38.7,1616.07,63.03,824.2,percent of total billed charges,38.7
NM-KIDNEY STATIC,78700,CPT,,,,,both,, ,3590.32,3590.32,Blue Cross and Blue Shield,Traditional,,1389.45,38.7,38.7,3590.32,140.02,1831.06,percent of total billed charges,38.7
NM-KIDNEY STATIC FLO,78701,CPT,,,,,both,, ,4802.63,4802.63,Blue Cross and Blue Shield,Traditional,,1858.62,38.7,38.7,4802.63,187.3,2449.34,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,,1858.62,38.7,38.7,4802.63,187.3,2449.34,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,,1858.62,38.7,38.7,4802.63,187.3,2449.34,percent of total billed charges,38.7
NM-KIDNEY FUNCTION,78725,CPT,,,,,both,, ,617.74,617.74,Blue Cross and Blue Shield,Traditional,,239.07,38.7,38.7,617.74,24.09,315.05,percent of total billed charges,38.7
NM-URIN BLDDR REFLUX,78740,CPT,,,,,both,, ,3590.32,3590.32,Blue Cross and Blue Shield,Traditional,,1389.45,38.7,38.7,3590.32,140.02,1831.06,percent of total billed charges,38.7
NM-TUMOR LOC LMTD,78800,CPT,,,,,both,, ,4590.83,4590.83,Blue Cross and Blue Shield,Traditional,,1776.65,38.7,38.7,4590.83,179.04,2341.32,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,,1903.17,38.7,38.7,4917.74,191.79,2508.05,percent of total billed charges,38.7
NM-TUMOR LOC MULTI,78801,CPT,,,,,both,, ,4917.74,4917.74,Blue Cross and Blue Shield,Traditional,,1903.17,38.7,38.7,4917.74,191.79,2508.05,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,,2372.23,38.7,38.7,6129.79,239.06,3126.19,percent of total billed charges,38.7
NM-TUMOR LOC BODY,78802,CPT,,,,,both,, ,4590.83,4590.83,Blue Cross and Blue Shield,Traditional,,1776.65,38.7,38.7,4590.83,179.04,2341.32,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,,1951.59,38.7,38.7,5042.88,196.67,2571.87,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,,2032.32,38.7,38.7,5251.46,204.81,2678.24,percent of total billed charges,38.7
NM-UNLISTED MISC,78999,CPT,,,,,both,, ,593.54,593.54,Blue Cross and Blue Shield,Traditional,,229.7,38.7,38.7,593.54,23.15,302.71,percent of total billed charges,38.7
NUCLEAR RX IV ADMIN,79101,CPT,,,,,both,, ,1716.5,1716.5,Blue Cross and Blue Shield,Traditional,,664.29,38.7,38.7,1716.5,66.94,875.42,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,,11.3,38.7,38.7,29.19,1.14,14.89,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,,63.32,38.7,38.7,163.63,6.38,83.45,percent of total billed charges,38.7
BASIC METABO CA TOTA,80048,CPT,,,,,both,, ,89.53,89.53,Blue Cross and Blue Shield,Traditional,,34.65,38.7,38.7,89.53,3.49,45.66,percent of total billed charges,38.7
BASIC METABO CA TOTA,80048,CPT,,,,,both,, ,510.83,510.83,Blue Cross and Blue Shield,Traditional,,197.69,38.7,38.7,510.83,19.92,260.52,percent of total billed charges,38.7
Basic metabolic panel,80048,CPT,,,,,both,,,510.83,510.83,Blue Cross and Blue Shield,Traditional,,197.69,38.7,38.7,510.83,19.92,260.52,percent of total billed charges,38.7
GENERAL HEALTH PANEL,80050,CPT,,,,,both,,,1796.88,1796.88,Blue Cross and Blue Shield,Traditional,,695.39,38.7,38.7,1796.88,70.08,916.41,percent of total billed charges,38.7
GENERAL HEALTH PANEL,80050,CPT,,,,,both,, ,1796.88,1796.88,Blue Cross and Blue Shield,Traditional,,695.39,38.7,38.7,1796.88,70.08,916.41,percent of total billed charges,38.7
ELECTROLYTE PANEL,80051,CPT,,,,,both,, ,74.1,74.1,Blue Cross and Blue Shield,Traditional,,28.68,38.7,38.7,74.1,2.89,37.79,percent of total billed charges,38.7
ELECTROLYTE PANEL,80051,CPT,,,,,both,, ,390.41,390.41,Blue Cross and Blue Shield,Traditional,,151.09,38.7,38.7,390.41,15.23,199.11,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,,244.18,38.7,38.7,630.96,24.61,321.79,percent of total billed charges,38.7
COMP METAB PANEL,80053,CPT,,,,,both,, ,111.7,111.7,Blue Cross and Blue Shield,Traditional,,43.23,38.7,38.7,111.7,4.36,56.97,percent of total billed charges,38.7
COMP METAB PANEL,80053,CPT,,,,,both,, ,630.96,630.96,Blue Cross and Blue Shield,Traditional,,244.18,38.7,38.7,630.96,24.61,321.79,percent of total billed charges,38.7
Obstetric blood test panel,80055,CPT,,,,,both,,,1727.55,1727.55,Blue Cross and Blue Shield,Traditional,,668.56,38.7,38.7,1727.55,67.37,881.05,percent of total billed charges,38.7
OBSTETRIC PANEL,80055,CPT,,,,,both,, ,350.84,350.84,Blue Cross and Blue Shield,Traditional,,135.78,38.7,38.7,350.84,13.68,178.93,percent of total billed charges,38.7
OBSTETRIC PANEL,80055,CPT,,,,,both,, ,1727.55,1727.55,Blue Cross and Blue Shield,Traditional,,668.56,38.7,38.7,1727.55,67.37,881.05,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,,218.98,38.7,38.7,565.84,22.07,288.58,percent of total billed charges,38.7
LIPID PANEL,80061,CPT,,,,,both,, ,86.73,86.73,Blue Cross and Blue Shield,Traditional,,33.56,38.7,38.7,86.73,3.38,44.23,percent of total billed charges,38.7
LIPID PANEL,80061,CPT,,,,,both,, ,565.84,565.84,Blue Cross and Blue Shield,Traditional,,218.98,38.7,38.7,565.84,22.07,288.58,percent of total billed charges,38.7
LIPID PANEL,80061,CPT,,,,,both,, ,565.84,565.84,Blue Cross and Blue Shield,Traditional,,218.98,38.7,38.7,565.84,22.07,288.58,percent of total billed charges,38.7
Kidney function panel test,80069,CPT,,,,,both,,,570.89,570.89,Blue Cross and Blue Shield,Traditional,,220.93,38.7,38.7,570.89,22.26,291.15,percent of total billed charges,38.7
RENAL FUNCTION PANEL,80069,CPT,,,,,both,, ,91.77,91.77,Blue Cross and Blue Shield,Traditional,,35.51,38.7,38.7,91.77,3.58,46.8,percent of total billed charges,38.7
RENAL FUNCTION PANEL,80069,CPT,,,,,both,, ,570.89,570.89,Blue Cross and Blue Shield,Traditional,,220.93,38.7,38.7,570.89,22.26,291.15,percent of total billed charges,38.7
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,, ,282.08,282.08,Blue Cross and Blue Shield,Traditional,,109.16,38.7,38.7,282.08,11,143.86,percent of total billed charges,38.7
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,,,3484.29,3484.29,Blue Cross and Blue Shield,Traditional,,1348.42,38.7,38.7,3484.29,135.89,1776.99,percent of total billed charges,38.7
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,, ,3484.29,3484.29,Blue Cross and Blue Shield,Traditional,,1348.42,38.7,38.7,3484.29,135.89,1776.99,percent of total billed charges,38.7
HEPATIC FUNCTION PAN,80076,CPT,,,,,both,, ,86.45,86.45,Blue Cross and Blue Shield,Traditional,,33.46,38.7,38.7,86.45,3.37,44.09,percent of total billed charges,38.7
HEPATIC FUNCTION PAN,80076,CPT,,,,,both,, ,450.48,450.48,Blue Cross and Blue Shield,Traditional,,174.34,38.7,38.7,450.48,17.57,229.74,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,,174.34,38.7,38.7,450.48,17.57,229.74,percent of total billed charges,38.7
OBSTETRIC PNL W HIV,80081,CPT,,,,,both,, ,1883.6,1883.6,Blue Cross and Blue Shield,Traditional,,728.95,38.7,38.7,1883.6,73.46,960.64,percent of total billed charges,38.7
ACETAMINOPHEN QT,80143,CPT,,,,,both,, ,186.06,186.06,Blue Cross and Blue Shield,Traditional,,72.01,38.7,38.7,186.06,7.26,94.89,percent of total billed charges,38.7
Q36298 ADM LEV IBD,80145,CPT,,,,,both,, ,174.02,174.02,Blue Cross and Blue Shield,Traditional,,67.35,38.7,38.7,174.02,6.79,88.75,percent of total billed charges,38.7
AMIKACIN,80150,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
Q36721 AMIOD HPLC/LC,80151,CPT,,,,,both,, ,546.19,546.19,Blue Cross and Blue Shield,Traditional,,211.38,38.7,38.7,546.19,21.3,278.56,percent of total billed charges,38.7
CARBAMAZEPINE TOTAL,80156,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,38.7,1036.25,40.41,528.49,percent of total billed charges,38.7
Q18948 CBZ FREE LCMS,80157,CPT,,,,,both,, ,88.4,88.4,Blue Cross and Blue Shield,Traditional,,34.21,38.7,38.7,88.4,3.45,45.08,percent of total billed charges,38.7
CYCLOSPORINE,80158,CPT,,,,,both,, ,91.49,91.49,Blue Cross and Blue Shield,Traditional,,35.41,38.7,38.7,91.49,3.57,46.66,percent of total billed charges,38.7
CYCLOSPORINE,80158,CPT,,,,,both,, ,1555.5,1555.5,Blue Cross and Blue Shield,Traditional,,601.98,38.7,38.7,1555.5,60.66,793.31,percent of total billed charges,38.7
Q15220CYC A BL LCMSM,80158,CPT,,,,,both,, ,1555.5,1555.5,Blue Cross and Blue Shield,Traditional,,601.98,38.7,38.7,1555.5,60.66,793.31,percent of total billed charges,38.7
Q8812 CYA TRGH BL IA,80158,CPT,,,,,both,, ,1555.5,1555.5,Blue Cross and Blue Shield,Traditional,,601.98,38.7,38.7,1555.5,60.66,793.31,percent of total billed charges,38.7
CLOZAPINE QT,80159,CPT,,,,,both,, ,95.43,95.43,Blue Cross and Blue Shield,Traditional,,36.93,38.7,38.7,95.43,3.72,48.67,percent of total billed charges,38.7
CLOZAPINE QT,80159,CPT,,,,,both,, ,95.43,95.43,Blue Cross and Blue Shield,Traditional,,36.93,38.7,38.7,95.43,3.72,48.67,percent of total billed charges,38.7
DIGOXIN TOTAL,80162,CPT,,,,,both,, ,130.23,130.23,Blue Cross and Blue Shield,Traditional,,50.4,38.7,38.7,130.23,5.08,66.42,percent of total billed charges,38.7
DIGOXIN TOTAL,80162,CPT,,,,,both,, ,787.57,787.57,Blue Cross and Blue Shield,Traditional,,304.79,38.7,38.7,787.57,30.72,401.66,percent of total billed charges,38.7
DIGOXIN FREE,80163,CPT,,,,,both,, ,130.23,130.23,Blue Cross and Blue Shield,Traditional,,50.4,38.7,38.7,130.23,5.08,66.42,percent of total billed charges,38.7
Q6651 VALP ACID TOT,80164,CPT,,,,,both,, ,691.06,691.06,Blue Cross and Blue Shield,Traditional,,267.44,38.7,38.7,691.06,26.95,352.44,percent of total billed charges,38.7
VALPROIC ACID TOTAL,80164,CPT,,,,,both,, ,132.76,132.76,Blue Cross and Blue Shield,Traditional,,51.38,38.7,38.7,132.76,5.18,67.71,percent of total billed charges,38.7
VALPROIC ACID TOTAL,80164,CPT,,,,,both,,,711.79,711.79,Blue Cross and Blue Shield,Traditional,,275.46,38.7,38.7,711.79,27.76,363.01,percent of total billed charges,38.7
VALPROIC ACID TOTAL,80164,CPT,,,,,both,, ,711.79,711.79,Blue Cross and Blue Shield,Traditional,,275.46,38.7,38.7,711.79,27.76,363.01,percent of total billed charges,38.7
Q6651 VALP ACID FREE,80165,CPT,,,,,both,, ,691.06,691.06,Blue Cross and Blue Shield,Traditional,,267.44,38.7,38.7,691.06,26.95,352.44,percent of total billed charges,38.7
VALPROIC ACID FREE,80165,CPT,,,,,both,, ,132.76,132.76,Blue Cross and Blue Shield,Traditional,,51.38,38.7,38.7,132.76,5.18,67.71,percent of total billed charges,38.7
VALPROIC ACID FREE,80165,CPT,,,,,both,, ,711.79,711.79,Blue Cross and Blue Shield,Traditional,,275.46,38.7,38.7,711.79,27.76,363.01,percent of total billed charges,38.7
Q3081 FELBAMATE MS,80167,CPT,,,,,both,, ,191.99,191.99,Blue Cross and Blue Shield,Traditional,,74.3,38.7,38.7,191.99,7.49,97.91,percent of total billed charges,38.7
ETHOSUXIMIDE,80168,CPT,,,,,both,, ,864.19,864.19,Blue Cross and Blue Shield,Traditional,,334.44,38.7,38.7,864.19,33.7,440.74,percent of total billed charges,38.7
Q18883 EVEROLI LM/MS,80169,CPT,,,,,both,, ,106.93,106.93,Blue Cross and Blue Shield,Traditional,,41.38,38.7,38.7,106.93,4.17,54.53,percent of total billed charges,38.7
GENTAMICIN,80170,CPT,,,,,both,, ,900.96,900.96,Blue Cross and Blue Shield,Traditional,,348.67,38.7,38.7,900.96,35.14,459.49,percent of total billed charges,38.7
GABAPENTIN QT,80171,CPT,,,,,both,, ,105.53,105.53,Blue Cross and Blue Shield,Traditional,,40.84,38.7,38.7,105.53,4.12,53.82,percent of total billed charges,38.7
L716811 GABAP LCMSMS,80171,CPT,,,,,both,, ,102.46,102.46,Blue Cross and Blue Shield,Traditional,,39.65,38.7,38.7,102.46,4,52.25,percent of total billed charges,38.7
HALOPERIDOL,80173,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,38.7,871.22,33.98,444.32,percent of total billed charges,38.7
LAMOTRIGINE QT,80175,CPT,,,,,both,, ,105.53,105.53,Blue Cross and Blue Shield,Traditional,,40.84,38.7,38.7,105.53,4.12,53.82,percent of total billed charges,38.7
LAMOTRIGINE QT,80175,CPT,,,,,both,, ,105.53,105.53,Blue Cross and Blue Shield,Traditional,,40.84,38.7,38.7,105.53,4.12,53.82,percent of total billed charges,38.7
LIDOCAINE,80176,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,38.7,871.22,33.98,444.32,percent of total billed charges,38.7
LIDOCAINE,80176,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,38.7,871.22,33.98,444.32,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,,40.84,38.7,38.7,105.53,4.12,53.82,percent of total billed charges,38.7
Lithium,80178,CPT,,,,,both,,,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
LITHIUM,80178,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
SALICYLATE QT,80179,CPT,,,,,both,, ,191.99,191.99,Blue Cross and Blue Shield,Traditional,,74.3,38.7,38.7,191.99,7.49,97.91,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,,55.62,38.7,38.7,143.71,5.6,73.29,percent of total billed charges,38.7
OXCARBAEPINE QT,80183,CPT,,,,,both,, ,122.37,122.37,Blue Cross and Blue Shield,Traditional,,47.36,38.7,38.7,122.37,4.77,62.41,percent of total billed charges,38.7
OXCARBAEPINE QT,80183,CPT,,,,,both,, ,122.37,122.37,Blue Cross and Blue Shield,Traditional,,47.36,38.7,38.7,122.37,4.77,62.41,percent of total billed charges,38.7
PHENOBARBITAL,80184,CPT,,,,,both,, ,120.96,120.96,Blue Cross and Blue Shield,Traditional,,46.81,38.7,38.7,120.96,4.72,61.69,percent of total billed charges,38.7
PHENOBARBITAL,80184,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,38.7,871.22,33.98,444.32,percent of total billed charges,38.7
PHENOBARBITAL,80184,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,38.7,871.22,33.98,444.32,percent of total billed charges,38.7
PHENYTOIN TOTAL,80185,CPT,,,,,both,, ,140.05,140.05,Blue Cross and Blue Shield,Traditional,,54.2,38.7,38.7,140.05,5.46,71.43,percent of total billed charges,38.7
PHENYTOIN TOTAL,80185,CPT,,,,,both,, ,847.64,847.64,Blue Cross and Blue Shield,Traditional,,328.04,38.7,38.7,847.64,33.06,432.3,percent of total billed charges,38.7
PHENYTOIN TOTAL,80185,CPT,,,,,both,, ,847.64,847.64,Blue Cross and Blue Shield,Traditional,,328.04,38.7,38.7,847.64,33.06,432.3,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,,35.51,38.7,38.7,91.77,3.58,46.8,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,,35.51,38.7,38.7,91.77,3.58,46.8,percent of total billed charges,38.7
PRIMIDONE,80188,CPT,,,,,both,, ,1757.58,1757.58,Blue Cross and Blue Shield,Traditional,,680.18,38.7,38.7,1757.58,68.55,896.37,percent of total billed charges,38.7
Q751 PRIMIDONE,80188,CPT,,,,,both,, ,878.79,878.79,Blue Cross and Blue Shield,Traditional,,340.09,38.7,38.7,878.79,34.27,448.18,percent of total billed charges,38.7
PROCAINAMIDE+NAPA,80192,CPT,,,,,both,, ,900.96,900.96,Blue Cross and Blue Shield,Traditional,,348.67,38.7,38.7,900.96,35.14,459.49,percent of total billed charges,38.7
QUINIDINE,80194,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,38.7,765.96,29.87,390.64,percent of total billed charges,38.7
SIROLIMUS,80195,CPT,,,,,both,, ,257.1,257.1,Blue Cross and Blue Shield,Traditional,,99.5,38.7,38.7,257.1,10.03,131.12,percent of total billed charges,38.7
SIROLIMUS,80195,CPT,,,,,both,, ,257.1,257.1,Blue Cross and Blue Shield,Traditional,,99.5,38.7,38.7,257.1,10.03,131.12,percent of total billed charges,38.7
TACROLIMUS,80197,CPT,,,,,both,, ,822.37,822.37,Blue Cross and Blue Shield,Traditional,,318.26,38.7,38.7,822.37,32.07,419.41,percent of total billed charges,38.7
TACROLIMUS,80197,CPT,,,,,both,, ,822.37,822.37,Blue Cross and Blue Shield,Traditional,,318.26,38.7,38.7,822.37,32.07,419.41,percent of total billed charges,38.7
THEOPHYLLINE,80198,CPT,,,,,both,, ,149.6,149.6,Blue Cross and Blue Shield,Traditional,,57.9,38.7,38.7,149.6,5.83,76.3,percent of total billed charges,38.7
THEOPHYLLINE,80198,CPT,,,,,both,, ,149.6,149.6,Blue Cross and Blue Shield,Traditional,,57.9,38.7,38.7,149.6,5.83,76.3,percent of total billed charges,38.7
THEOPHYLLINE,80198,CPT,,,,,both,, ,781.11,781.11,Blue Cross and Blue Shield,Traditional,,302.29,38.7,38.7,781.11,30.46,398.37,percent of total billed charges,38.7
TIAGABINE QT,80199,CPT,,,,,both,, ,143.71,143.71,Blue Cross and Blue Shield,Traditional,,55.62,38.7,38.7,143.71,5.6,73.29,percent of total billed charges,38.7
TOBRAMYCIN,80200,CPT,,,,,both,, ,75.5,75.5,Blue Cross and Blue Shield,Traditional,,29.22,38.7,38.7,75.5,2.94,38.51,percent of total billed charges,38.7
TOPIRAMATE,80201,CPT,,,,,both,, ,445.71,445.71,Blue Cross and Blue Shield,Traditional,,172.49,38.7,38.7,445.71,17.38,227.31,percent of total billed charges,38.7
VANCOMYCIN,80202,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,38.7,765.96,29.87,390.64,percent of total billed charges,38.7
ZONISAMIDE QT,80203,CPT,,,,,both,, ,105.53,105.53,Blue Cross and Blue Shield,Traditional,,40.84,38.7,38.7,105.53,4.12,53.82,percent of total billed charges,38.7
ZONISAMIDE QT,80203,CPT,,,,,both,, ,105.53,105.53,Blue Cross and Blue Shield,Traditional,,40.84,38.7,38.7,105.53,4.12,53.82,percent of total billed charges,38.7
Q648 METHOTREXATE IA,80204,CPT,,,,,both,, ,501.1,501.1,Blue Cross and Blue Shield,Traditional,,193.93,38.7,38.7,501.1,19.54,255.56,percent of total billed charges,38.7
L503870 INFLIXIMAB,80230,CPT,,,,,both,, ,159.65,159.65,Blue Cross and Blue Shield,Traditional,,61.78,38.7,38.7,159.65,6.23,81.42,percent of total billed charges,38.7
L504567 VEDOLIZUMAB,80280,CPT,,,,,both,, ,198.79,198.79,Blue Cross and Blue Shield,Traditional,,76.93,38.7,38.7,198.79,7.75,101.38,percent of total billed charges,38.7
DRUG UNSPEC QUANT,80299,CPT,,,,,both,, ,873.46,873.46,Blue Cross and Blue Shield,Traditional,,338.03,38.7,38.7,873.46,34.06,445.46,percent of total billed charges,38.7
L7609 DOXEPIN LCMSMS,80299,CPT,,,,,both,, ,148.4,148.4,Blue Cross and Blue Shield,Traditional,,57.43,38.7,38.7,148.4,5.79,75.68,percent of total billed charges,38.7
Q29391DEXAMET LCMSMS,80299,CPT,,,,,both,, ,342,342,Blue Cross and Blue Shield,Traditional,,132.35,38.7,38.7,342,13.34,174.42,percent of total billed charges,38.7
Q78222DEXAMET LCMSMS,80299,CPT,,,,,both,, ,546.19,546.19,Blue Cross and Blue Shield,Traditional,,211.38,38.7,38.7,546.19,21.3,278.56,percent of total billed charges,38.7
Q78222DEXAMET LCMSMS,80299,CPT,,,,,both,, ,546.19,546.19,Blue Cross and Blue Shield,Traditional,,211.38,38.7,38.7,546.19,21.3,278.56,percent of total billed charges,38.7
Q8389 FLUOXET LCMSMS,80299,CPT,,,,,both,, ,811.42,811.42,Blue Cross and Blue Shield,Traditional,,314.02,38.7,38.7,811.42,31.65,413.82,percent of total billed charges,38.7
PRS DRG IA VIS,80305,CPT,,,,,both,, ,137.8,137.8,Blue Cross and Blue Shield,Traditional,,53.33,38.7,38.7,137.8,5.37,70.28,percent of total billed charges,38.7
PRS DRG IA MET,80306,CPT,,,,,both,, ,137.8,137.8,Blue Cross and Blue Shield,Traditional,,53.33,38.7,38.7,137.8,5.37,70.28,percent of total billed charges,38.7
733726 URINE DRUG PROFILE 14/MEDWATCH,80307,CPT,,,,,both,, ,360,360,Blue Cross and Blue Shield,Traditional,,139.32,38.7,38.7,360,14.04,183.6,percent of total billed charges,38.7
DRUGPROF ORAL FLD,80307,CPT,,,,,both,, ,116,116,Blue Cross and Blue Shield,Traditional,,44.89,38.7,38.7,116,4.52,59.16,percent of total billed charges,38.7
ETHANOL UR QUAL,80307,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
ETHANOL UR QUAL,80307,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
L074401 AMPH UR SCRN,80307,CPT,,,,,both,, ,60,60,Blue Cross and Blue Shield,Traditional,,23.22,38.7,38.7,60,2.34,30.6,percent of total billed charges,38.7
L074401 AMPH UR SCRN,80307,CPT,,,,,both,, ,60,60,Blue Cross and Blue Shield,Traditional,,23.22,38.7,38.7,60,2.34,30.6,percent of total billed charges,38.7
L733740 ULTRM SCR UR,80307,CPT,,,,,both,, ,200,200,Blue Cross and Blue Shield,Traditional,,77.4,38.7,38.7,200,7.8,102,percent of total billed charges,38.7
PRS DRG IA ANAZ,80307,CPT,,,,,both,,,1174.34,1174.34,Blue Cross and Blue Shield,Traditional,,454.47,38.7,38.7,1174.34,45.8,598.91,percent of total billed charges,38.7
PRS DRG IA ANAZ,80307,CPT,,,,,both,, ,1174.34,1174.34,Blue Cross and Blue Shield,Traditional,,454.47,38.7,38.7,1174.34,45.8,598.91,percent of total billed charges,38.7
PRS DRG IA ANAZ,80307,CPT,,,,,both,, ,1174.34,1174.34,Blue Cross and Blue Shield,Traditional,,454.47,38.7,38.7,1174.34,45.8,598.91,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,,281.76,38.7,38.7,728.07,28.39,371.32,percent of total billed charges,38.7
ALKALOIDS NOS MS,80323,CPT,,,,,both,, ,713.47,713.47,Blue Cross and Blue Shield,Traditional,,276.11,38.7,38.7,713.47,27.83,363.87,percent of total billed charges,38.7
Q90642NIC&COT S LCMS,80323,CPT,,,,,both,, ,713.47,713.47,Blue Cross and Blue Shield,Traditional,,276.11,38.7,38.7,713.47,27.83,363.87,percent of total billed charges,38.7
Q90646NIC&COT U LCMS,80323,CPT,,,,,both,, ,713.47,713.47,Blue Cross and Blue Shield,Traditional,,276.11,38.7,38.7,713.47,27.83,363.87,percent of total billed charges,38.7
AMPHETAMINES MS 1-2,80324,CPT,,,,,both,, ,184.68,184.68,Blue Cross and Blue Shield,Traditional,,71.47,38.7,38.7,184.68,7.2,94.19,percent of total billed charges,38.7
AMPHETAMINES MS 1-2,80324,CPT,,,,,both,, ,184.68,184.68,Blue Cross and Blue Shield,Traditional,,71.47,38.7,38.7,184.68,7.2,94.19,percent of total billed charges,38.7
L790600 AMPH MS 5P,80326,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,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,,104.16,38.7,38.7,269.16,10.5,137.27,percent of total billed charges,38.7
L790600 ANLGNO MS 6P,80331,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,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,,298.38,38.7,38.7,771.01,30.07,393.22,percent of total billed charges,38.7
L790600 AD MS 6PL,80334,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,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,,319.89,38.7,38.7,826.59,32.24,421.56,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,,319.89,38.7,38.7,826.59,32.24,421.56,percent of total billed charges,38.7
Q30013 CLOMIPRA LCMS,80335,CPT,,,,,both,, ,826.59,826.59,Blue Cross and Blue Shield,Traditional,,319.89,38.7,38.7,826.59,32.24,421.56,percent of total billed charges,38.7
Q30013 CLOMIPRA LCMS,80335,CPT,,,,,both,, ,826.59,826.59,Blue Cross and Blue Shield,Traditional,,319.89,38.7,38.7,826.59,32.24,421.56,percent of total billed charges,38.7
Q423AMITRIP HPLC/LCM,80335,CPT,,,,,both,, ,826.59,826.59,Blue Cross and Blue Shield,Traditional,,319.89,38.7,38.7,826.59,32.24,421.56,percent of total billed charges,38.7
Q423AMITRIP HPLC/LCM,80335,CPT,,,,,both,, ,826.59,826.59,Blue Cross and Blue Shield,Traditional,,319.89,38.7,38.7,826.59,32.24,421.56,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,,221.15,38.7,38.7,571.45,22.29,291.44,percent of total billed charges,38.7
L790600 ADEP TRI 6PL,80337,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
ANTIDPRS NOS MS,80338,CPT,,,,,both,, ,928.18,928.18,Blue Cross and Blue Shield,Traditional,,359.21,38.7,38.7,928.18,36.2,473.37,percent of total billed charges,38.7
L790600 AD NOS MS,80338,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 AED MS 7P,80341,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,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,,314.02,38.7,38.7,811.42,31.65,413.82,percent of total billed charges,38.7
L790600 APD MS 7P,80344,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
BENZODIAZ MS 1-12,80346,CPT,,,,,both,, ,814.24,814.24,Blue Cross and Blue Shield,Traditional,,315.11,38.7,38.7,814.24,31.76,415.26,percent of total billed charges,38.7
BENZODIAZ MS 1-12,80346,CPT,,,,,both,, ,814.24,814.24,Blue Cross and Blue Shield,Traditional,,315.11,38.7,38.7,814.24,31.76,415.26,percent of total billed charges,38.7
L809630 FLTZP MS,80346,CPT,,,,,both,, ,600,600,Blue Cross and Blue Shield,Traditional,,232.2,38.7,38.7,600,23.4,306,percent of total billed charges,38.7
L790600 BZD MS 13P,80347,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
BUPRENORPHINE MS,80348,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
BUPRENORPHINE MS,80348,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,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,,46.15,38.7,38.7,119.25,4.65,60.82,percent of total billed charges,38.7
CANNABINDS NATUR MS,80349,CPT,,,,,both,, ,147.91,147.91,Blue Cross and Blue Shield,Traditional,,57.24,38.7,38.7,147.91,5.77,75.43,percent of total billed charges,38.7
L790697 SYNCBD WB MS,80352,CPT,,,,,both,, ,300,300,Blue Cross and Blue Shield,Traditional,,116.1,38.7,38.7,300,11.7,153,percent of total billed charges,38.7
L790600 COCAINE MS,80353,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
FENTANYL MS,80354,CPT,,,,,both,, ,534.41,534.41,Blue Cross and Blue Shield,Traditional,,206.82,38.7,38.7,534.41,20.84,272.55,percent of total billed charges,38.7
L790600 FENT MET MS,80354,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
GABAPENTIN NONBLD MS,80355,CPT,,,,,both,, ,534.41,534.41,Blue Cross and Blue Shield,Traditional,,206.82,38.7,38.7,534.41,20.84,272.55,percent of total billed charges,38.7
L790600 GPT NBLD MS,80355,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
HEROIN METABOLITE MS,80356,CPT,,,,,both,, ,227.91,227.91,Blue Cross and Blue Shield,Traditional,,88.2,38.7,38.7,227.91,8.89,116.23,percent of total billed charges,38.7
L790600 KET NKET MS,80357,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 MTD MS,80358,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
METHADONE MS,80358,CPT,,,,,both,, ,327.54,327.54,Blue Cross and Blue Shield,Traditional,,126.76,38.7,38.7,327.54,12.77,167.05,percent of total billed charges,38.7
L791194 MDMA MS,80359,CPT,,,,,both,, ,133.38,133.38,Blue Cross and Blue Shield,Traditional,,51.62,38.7,38.7,133.38,5.2,68.02,percent of total billed charges,38.7
MDA MDEA MOMA MS,80359,CPT,,,,,both,, ,404.17,404.17,Blue Cross and Blue Shield,Traditional,,156.41,38.7,38.7,404.17,15.76,206.13,percent of total billed charges,38.7
MDA MDEA MOMA MS,80359,CPT,,,,,both,, ,404.17,404.17,Blue Cross and Blue Shield,Traditional,,156.41,38.7,38.7,404.17,15.76,206.13,percent of total billed charges,38.7
L790600 MPH MS,80360,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 OPI MS 1P,80361,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
OPIATES MS 1 PL,80361,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
Q20907 OPI MS,80361,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 OPD OPI MS5P,80364,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 OXY MS,80365,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
OXYCODONE MS,80365,CPT,,,,,both,, ,428.58,428.58,Blue Cross and Blue Shield,Traditional,,165.86,38.7,38.7,428.58,16.71,218.58,percent of total billed charges,38.7
OXYCODONE MS,80365,CPT,,,,,both,, ,428.58,428.58,Blue Cross and Blue Shield,Traditional,,165.86,38.7,38.7,428.58,16.71,218.58,percent of total billed charges,38.7
L790600 PGB MS,80366,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
PREGABALIN MS,80366,CPT,,,,,both,, ,811.42,811.42,Blue Cross and Blue Shield,Traditional,,314.02,38.7,38.7,811.42,31.65,413.82,percent of total billed charges,38.7
L790600 PPX MS,80367,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 SED HYP MS,80368,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 SM RLX MS3PL,80370,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 STIM SYN MS,80371,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
L790600 TAPENTADL MS,80372,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
L761019TRAMADOL CONF,80373,CPT,,,,,both,, ,412,412,Blue Cross and Blue Shield,Traditional,,159.44,38.7,38.7,412,16.07,210.12,percent of total billed charges,38.7
L790600 TRA MS,80373,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,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,,211.38,38.7,38.7,546.19,21.3,278.56,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,,221.15,38.7,38.7,571.45,22.29,291.44,percent of total billed charges,38.7
L790600 DRGNOS MS 7P,80377,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,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,,92.98,38.7,38.7,240.26,9.37,122.53,percent of total billed charges,38.7
"UA, AUTO W-SCOPE",81001,CPT,,,,,both,, ,33.39,33.39,Blue Cross and Blue Shield,Traditional,,12.92,38.7,38.7,33.39,1.3,17.03,percent of total billed charges,38.7
"UA, AUTO W-SCOPE",81001,CPT,,,,,both,, ,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,38.7,240.26,9.37,122.53,percent of total billed charges,38.7
Automated urinalysis test,81003,CPT,,,,,both,,,210.5,210.5,Blue Cross and Blue Shield,Traditional,,81.46,38.7,38.7,210.5,8.21,107.36,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,,9.23,38.7,38.7,23.85,0.93,12.16,percent of total billed charges,38.7
"UA, AUTO, W-O SCOPE",81003,CPT,,,,,both,, ,210.5,210.5,Blue Cross and Blue Shield,Traditional,,81.46,38.7,38.7,210.5,8.21,107.36,percent of total billed charges,38.7
URINALYSIS,81005,CPT,,,,,both,, ,180.19,180.19,Blue Cross and Blue Shield,Traditional,,69.73,38.7,38.7,180.19,7.03,91.9,percent of total billed charges,38.7
MICROSCOPIC EX OF UR,81015,CPT,,,,,both,, ,10.55,10.55,Blue Cross and Blue Shield,Traditional,,4.08,38.7,38.7,10.55,0.41,5.38,percent of total billed charges,38.7
MICROSCOPIC EX OF UR,81015,CPT,,,,,both,, ,180.19,180.19,Blue Cross and Blue Shield,Traditional,,69.73,38.7,38.7,180.19,7.03,91.9,percent of total billed charges,38.7
URINE PREG TEST QL,81025,CPT,,,,,both,, ,23.58,23.58,Blue Cross and Blue Shield,Traditional,,9.13,38.7,38.7,23.58,0.92,12.03,percent of total billed charges,38.7
URINE PREG TEST QL,81025,CPT,,,,,both,,,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
URINE PREG TEST QL,81025,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
"L910235 URINE VOLUME, TIMED",81050,CPT,,,,,both,, ,30.64,30.64,Blue Cross and Blue Shield,Traditional,,11.86,38.7,38.7,30.64,1.19,15.63,percent of total billed charges,38.7
Q91863 BRCADVAN COMP,81162,CPT,,,,,both,, ,5261.25,5261.25,Blue Cross and Blue Shield,Traditional,,2036.1,38.7,38.7,5261.25,205.19,2683.24,percent of total billed charges,38.7
L480510 BCRABL1 KDMA,81170,CPT,,,,,both,, ,1792,1792,Blue Cross and Blue Shield,Traditional,,693.5,38.7,38.7,1792,69.89,913.92,percent of total billed charges,38.7
Q91065 P210 BCRABL1,81206,CPT,,,,,both,, ,552.22,552.22,Blue Cross and Blue Shield,Traditional,,213.71,38.7,38.7,552.22,21.54,281.63,percent of total billed charges,38.7
Q91065 P190 BCRABL1,81207,CPT,,,,,both,, ,487.83,487.83,Blue Cross and Blue Shield,Traditional,,188.79,38.7,38.7,487.83,19.03,248.79,percent of total billed charges,38.7
BRAF GENE ANALY V600,81210,CPT,,,,,both,, ,393.84,393.84,Blue Cross and Blue Shield,Traditional,,152.42,38.7,38.7,393.84,15.36,200.86,percent of total billed charges,38.7
L489450 CALR MA,81219,CPT,,,,,both,, ,675,675,Blue Cross and Blue Shield,Traditional,,261.23,38.7,38.7,675,26.33,344.25,percent of total billed charges,38.7
Q10458 CFSCN OLA-PCR,81220,CPT,,,,,both,, ,1100,1100,Blue Cross and Blue Shield,Traditional,,425.7,38.7,38.7,1100,42.9,561,percent of total billed charges,38.7
L252900 CF CFTR DD,81222,CPT,,,,,both,, ,930,930,Blue Cross and Blue Shield,Traditional,,359.91,38.7,38.7,930,36.27,474.3,percent of total billed charges,38.7
L511230 CYT P450 2D6,81226,CPT,,,,,both,, ,600,600,Blue Cross and Blue Shield,Traditional,,232.2,38.7,38.7,600,23.4,306,percent of total billed charges,38.7
Q161608 CYP2C9 GN AN,81227,CPT,,,,,both,, ,610,610,Blue Cross and Blue Shield,Traditional,,236.07,38.7,38.7,610,23.79,311.1,percent of total billed charges,38.7
EGFR GENE COM VAR,81235,CPT,,,,,both,, ,963.55,963.55,Blue Cross and Blue Shield,Traditional,,372.89,38.7,38.7,963.55,37.58,491.41,percent of total billed charges,38.7
F2 GEN ANALY 20210GA,81240,CPT,,,,,both,, ,2183.65,2183.65,Blue Cross and Blue Shield,Traditional,,845.07,38.7,38.7,2183.65,85.16,1113.66,percent of total billed charges,38.7
Q17909 PGM HYBEACONS,81240,CPT,,,,,both,, ,1091.82,1091.82,Blue Cross and Blue Shield,Traditional,,422.53,38.7,38.7,1091.82,42.58,556.83,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,,845.07,38.7,38.7,2183.65,85.16,1113.66,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,,845.07,38.7,38.7,2183.65,85.16,1113.66,percent of total billed charges,38.7
FMR1 GENE ANALY AB,81243,CPT,,,,,both,, ,1863.12,1863.12,Blue Cross and Blue Shield,Traditional,,721.03,38.7,38.7,1863.12,72.66,950.19,percent of total billed charges,38.7
HFE GENE ANALY CV,81256,CPT,,,,,both,, ,3396.72,3396.72,Blue Cross and Blue Shield,Traditional,,1314.53,38.7,38.7,3396.72,132.47,1732.33,percent of total billed charges,38.7
HFE GENE ANALY CV,81256,CPT,,,,,both,, ,3396.72,3396.72,Blue Cross and Blue Shield,Traditional,,1314.53,38.7,38.7,3396.72,132.47,1732.33,percent of total billed charges,38.7
Q11175AGLOB MUT PCR,81257,CPT,,,,,both,, ,477.7,477.7,Blue Cross and Blue Shield,Traditional,,184.87,38.7,38.7,477.7,18.63,243.63,percent of total billed charges,38.7
JAK2 GEN ANALY V617F,81270,CPT,,,,,both,, ,1424.14,1424.14,Blue Cross and Blue Shield,Traditional,,551.14,38.7,38.7,1424.14,55.54,726.31,percent of total billed charges,38.7
JAK2 GEN ANALY V617F,81270,CPT,,,,,both,, ,1424.14,1424.14,Blue Cross and Blue Shield,Traditional,,551.14,38.7,38.7,1424.14,55.54,726.31,percent of total billed charges,38.7
L489421 JAK2V617F QL,81270,CPT,,,,,both,, ,1306.56,1306.56,Blue Cross and Blue Shield,Traditional,,505.64,38.7,38.7,1306.56,50.96,666.35,percent of total billed charges,38.7
L511040 CHRO ANA CMA,81277,CPT,,,,,both,, ,2260,2260,Blue Cross and Blue Shield,Traditional,,874.62,38.7,38.7,2260,88.14,1152.6,percent of total billed charges,38.7
L115101 JAK2 EX12-15,81279,CPT,,,,,both,, ,865.04,865.04,Blue Cross and Blue Shield,Traditional,,334.77,38.7,38.7,865.04,33.74,441.17,percent of total billed charges,38.7
Q90251 IL28B RT-PCR,81283,CPT,,,,,both,, ,352.24,352.24,Blue Cross and Blue Shield,Traditional,,136.32,38.7,38.7,352.24,13.74,179.64,percent of total billed charges,38.7
MTHFR GENE ANALY CV,81291,CPT,,,,,both,, ,3892.4,3892.4,Blue Cross and Blue Shield,Traditional,,1506.36,38.7,38.7,3892.4,151.8,1985.12,percent of total billed charges,38.7
MTHFR GENE ANALY CV,81291,CPT,,,,,both,, ,3892.4,3892.4,Blue Cross and Blue Shield,Traditional,,1506.36,38.7,38.7,3892.4,151.8,1985.12,percent of total billed charges,38.7
MICROSAT INSTAB VAR,81301,CPT,,,,,both,, ,960.19,960.19,Blue Cross and Blue Shield,Traditional,,371.59,38.7,38.7,960.19,37.45,489.7,percent of total billed charges,38.7
PCA3 KLK3 RATIO,81313,CPT,,,,,both,, ,636.57,636.57,Blue Cross and Blue Shield,Traditional,,246.35,38.7,38.7,636.57,24.83,324.65,percent of total billed charges,38.7
Q18041 SMA CAR SCN,81329,CPT,,,,,both,, ,685,685,Blue Cross and Blue Shield,Traditional,,265.1,38.7,38.7,685,26.72,349.35,percent of total billed charges,38.7
Q15340 ALPHA-1 ANTITRYPSIN (AAT) MUTATIO,81332,CPT,,,,,both,, ,3025.5,3025.5,Blue Cross and Blue Shield,Traditional,,1170.87,38.7,38.7,3025.5,117.99,1543.01,percent of total billed charges,38.7
SERPINA1 GENE ANA CV,81332,CPT,,,,,both,, ,3396.72,3396.72,Blue Cross and Blue Shield,Traditional,,1314.53,38.7,38.7,3396.72,132.47,1732.33,percent of total billed charges,38.7
L489150 MPL MUT AN,81338,CPT,,,,,both,, ,675,675,Blue Cross and Blue Shield,Traditional,,261.23,38.7,38.7,675,26.33,344.25,percent of total billed charges,38.7
Q92476 MPL MA QL,81339,CPT,,,,,both,, ,701.97,701.97,Blue Cross and Blue Shield,Traditional,,271.66,38.7,38.7,701.97,27.38,358,percent of total billed charges,38.7
CSI153 UGTIA1 GEN AN,81350,CPT,,,,,both,, ,819.57,819.57,Blue Cross and Blue Shield,Traditional,,317.17,38.7,38.7,819.57,31.96,417.98,percent of total billed charges,38.7
Q15584 HLA-B27 DETER,81374,CPT,,,,,both,, ,250.36,250.36,Blue Cross and Blue Shield,Traditional,,96.89,38.7,38.7,250.36,9.76,127.68,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,,236.36,38.7,38.7,610.75,23.82,311.48,percent of total billed charges,38.7
L167082 HLA2 LR1 AG,81377,CPT,,,,,both,, ,235.1,235.1,Blue Cross and Blue Shield,Traditional,,90.98,38.7,38.7,235.1,9.17,119.9,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,,280.35,38.7,38.7,724.42,28.25,369.45,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,,239.18,38.7,38.7,618.04,24.1,315.2,percent of total billed charges,38.7
L167082 HLA2 HR1 AL,81383,CPT,,,,,both,, ,334.75,334.75,Blue Cross and Blue Shield,Traditional,,129.55,38.7,38.7,334.75,13.06,170.72,percent of total billed charges,38.7
MOLEC PATH LEV 2,81401,CPT,,,,,both,, ,1062.07,1062.07,Blue Cross and Blue Shield,Traditional,,411.02,38.7,38.7,1062.07,41.42,541.66,percent of total billed charges,38.7
MOLEC PATH LEV 2,81401,CPT,,,,,both,, ,1062.07,1062.07,Blue Cross and Blue Shield,Traditional,,411.02,38.7,38.7,1062.07,41.42,541.66,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,,334.77,38.7,38.7,865.04,33.74,441.17,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,,334.77,38.7,38.7,865.04,33.74,441.17,percent of total billed charges,38.7
L630540 THRB,81405,CPT,,,,,both,, ,4320,4320,Blue Cross and Blue Shield,Traditional,,1671.84,38.7,38.7,4320,168.48,2203.2,percent of total billed charges,38.7
B5306-6 ACGH MOL KAR,81406,CPT,,,,,both,, ,2000,2000,Blue Cross and Blue Shield,Traditional,,774,38.7,38.7,2000,78,1020,percent of total billed charges,38.7
BB893-9 UNL MOL PTH,81479,CPT,,,,,both,, ,618,618,Blue Cross and Blue Shield,Traditional,,239.17,38.7,38.7,618,24.1,315.18,percent of total billed charges,38.7
NBS SCID,81479,CPT,,,,,both,, ,109.46,109.46,Blue Cross and Blue Shield,Traditional,,42.36,38.7,38.7,109.46,4.27,55.82,percent of total billed charges,38.7
UNLIST MOLEC PATH,81479,CPT,,,,,both,, ,1145.43,1145.43,Blue Cross and Blue Shield,Traditional,,443.28,38.7,38.7,1145.43,44.67,584.17,percent of total billed charges,38.7
L140045 OVARIAN MALIGNANCY RISK - ROMA,81500,CPT,,,,,both,, ,600,600,Blue Cross and Blue Shield,Traditional,,232.2,38.7,38.7,600,23.4,306,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,,180.53,38.7,38.7,466.48,18.19,237.9,percent of total billed charges,38.7
Q30294 QUAD SCREEN,81511,CPT,,,,,both,, ,415.5,415.5,Blue Cross and Blue Shield,Traditional,,160.8,38.7,38.7,415.5,16.2,211.91,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,,306.42,38.7,38.7,791.78,30.88,403.81,percent of total billed charges,38.7
L550659 LIVR BIOMRKR,81517,CPT,,,,,both,, ,1143,1143,Blue Cross and Blue Shield,Traditional,,442.34,38.7,38.7,1143,44.58,582.93,percent of total billed charges,38.7
Q92688 LIVER FIBROS,81596,CPT,,,,,both,, ,337.09,337.09,Blue Cross and Blue Shield,Traditional,,130.45,38.7,38.7,337.09,13.15,171.92,percent of total billed charges,38.7
ACETON-KETON SERM QL,82009,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
ACETON-KETON SERM QT,82010,CPT,,,,,both,, ,80.55,80.55,Blue Cross and Blue Shield,Traditional,,31.17,38.7,38.7,80.55,3.14,41.08,percent of total billed charges,38.7
ACETON-KETON SERM QT,82010,CPT,,,,,both,, ,341.3,341.3,Blue Cross and Blue Shield,Traditional,,132.08,38.7,38.7,341.3,13.31,174.06,percent of total billed charges,38.7
NBS ACYLCARNITINE QL,82016,CPT,,,,,both,, ,82.79,82.79,Blue Cross and Blue Shield,Traditional,,32.04,38.7,38.7,82.79,3.23,42.22,percent of total billed charges,38.7
ADRENOCORT ACTH,82024,CPT,,,,,both,, ,2343.07,2343.07,Blue Cross and Blue Shield,Traditional,,906.77,38.7,38.7,2343.07,91.38,1194.97,percent of total billed charges,38.7
Q211 ACTH PL IA,82024,CPT,,,,,both,, ,334,334,Blue Cross and Blue Shield,Traditional,,129.26,38.7,38.7,334,13.03,170.34,percent of total billed charges,38.7
ALBUMIN SERUM,82040,CPT,,,,,both,, ,35.08,35.08,Blue Cross and Blue Shield,Traditional,,13.58,38.7,38.7,35.08,1.37,17.89,percent of total billed charges,38.7
ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
Q14966 ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
Q70858 ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
ALBUMIN FLUID,82042,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
ALBUMIN FLUID,82042,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
MICROALB QNT,82043,CPT,,,,,both,, ,77.74,77.74,Blue Cross and Blue Shield,Traditional,,30.09,38.7,38.7,77.74,3.03,39.65,percent of total billed charges,38.7
MICROALB QNT,82043,CPT,,,,,both,,,660.98,660.98,Blue Cross and Blue Shield,Traditional,,255.8,38.7,38.7,660.98,25.78,337.1,percent of total billed charges,38.7
MICROALB QNT,82043,CPT,,,,,both,, ,660.98,660.98,Blue Cross and Blue Shield,Traditional,,255.8,38.7,38.7,660.98,25.78,337.1,percent of total billed charges,38.7
ETHANOL IA,82077,CPT,,,,,both,, ,177.88,177.88,Blue Cross and Blue Shield,Traditional,,68.84,38.7,38.7,177.88,6.94,90.72,percent of total billed charges,38.7
ALDOLASE,82085,CPT,,,,,both,, ,648.35,648.35,Blue Cross and Blue Shield,Traditional,,250.91,38.7,38.7,648.35,25.29,330.66,percent of total billed charges,38.7
ALDOLASE,82085,CPT,,,,,both,, ,648.35,648.35,Blue Cross and Blue Shield,Traditional,,250.91,38.7,38.7,648.35,25.29,330.66,percent of total billed charges,38.7
ALDOSTERONE,82088,CPT,,,,,both,, ,2366.36,2366.36,Blue Cross and Blue Shield,Traditional,,915.78,38.7,38.7,2366.36,92.29,1206.84,percent of total billed charges,38.7
Q16845 ALDOSTERONE,82088,CPT,,,,,both,, ,587.45,587.45,Blue Cross and Blue Shield,Traditional,,227.34,38.7,38.7,587.45,22.91,299.6,percent of total billed charges,38.7
Q17181 ALDOST LCMSMS,82088,CPT,,,,,both,, ,587.45,587.45,Blue Cross and Blue Shield,Traditional,,227.34,38.7,38.7,587.45,22.91,299.6,percent of total billed charges,38.7
Q229 ALDOSTERONE U24,82088,CPT,,,,,both,, ,587.45,587.45,Blue Cross and Blue Shield,Traditional,,227.34,38.7,38.7,587.45,22.91,299.6,percent of total billed charges,38.7
ALPHA 1-ANTITRYP TOT,82103,CPT,,,,,both,, ,969.17,969.17,Blue Cross and Blue Shield,Traditional,,375.07,38.7,38.7,969.17,37.8,494.28,percent of total billed charges,38.7
ALPHA 1-ANTITRYP TOT,82103,CPT,,,,,both,, ,969.17,969.17,Blue Cross and Blue Shield,Traditional,,375.07,38.7,38.7,969.17,37.8,494.28,percent of total billed charges,38.7
ALPHA 1-ANTITRYP PHE,82104,CPT,,,,,both,, ,1051.68,1051.68,Blue Cross and Blue Shield,Traditional,,407,38.7,38.7,1051.68,41.02,536.36,percent of total billed charges,38.7
ALPHA 1-ANTITRYP PHE,82104,CPT,,,,,both,, ,1051.68,1051.68,Blue Cross and Blue Shield,Traditional,,407,38.7,38.7,1051.68,41.02,536.36,percent of total billed charges,38.7
AFP SERUM,82105,CPT,,,,,both,, ,1142.06,1142.06,Blue Cross and Blue Shield,Traditional,,441.98,38.7,38.7,1142.06,44.54,582.45,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,,441.98,38.7,38.7,1142.06,44.54,582.45,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,,441.98,38.7,38.7,1142.06,44.54,582.45,percent of total billed charges,38.7
AFP AMNIOTIC FLD,82106,CPT,,,,,both,, ,705.89,705.89,Blue Cross and Blue Shield,Traditional,,273.18,38.7,38.7,705.89,27.53,360,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,,205.29,38.7,38.7,530.47,20.69,270.54,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,,205.29,38.7,38.7,530.47,20.69,270.54,percent of total billed charges,38.7
ALUMINUM,82108,CPT,,,,,both,, ,265.51,265.51,Blue Cross and Blue Shield,Traditional,,102.75,38.7,38.7,265.51,10.35,135.41,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,,32.04,38.7,38.7,82.79,3.23,42.22,percent of total billed charges,38.7
Q10947CYSTN U24 LCMS,82131,CPT,,,,,both,, ,175.98,175.98,Blue Cross and Blue Shield,Traditional,,68.1,38.7,38.7,175.98,6.86,89.75,percent of total billed charges,38.7
AMINO ACID QUAN 6+,82139,CPT,,,,,both,, ,873.74,873.74,Blue Cross and Blue Shield,Traditional,,338.14,38.7,38.7,873.74,34.08,445.61,percent of total billed charges,38.7
AMMONIA,82140,CPT,,,,,both,, ,154.09,154.09,Blue Cross and Blue Shield,Traditional,,59.63,38.7,38.7,154.09,6.01,78.59,percent of total billed charges,38.7
AMMONIA,82140,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
L910235 AMMONIA,82140,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
Q442 AMMONIA,82140,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
AMYLASE,82150,CPT,,,,,both,, ,68.48,68.48,Blue Cross and Blue Shield,Traditional,,26.5,38.7,38.7,68.48,2.67,34.92,percent of total billed charges,38.7
AMYLASE,82150,CPT,,,,,both,, ,518.69,518.69,Blue Cross and Blue Shield,Traditional,,200.73,38.7,38.7,518.69,20.23,264.53,percent of total billed charges,38.7
AMYLASE,82150,CPT,,,,,both,, ,518.69,518.69,Blue Cross and Blue Shield,Traditional,,200.73,38.7,38.7,518.69,20.23,264.53,percent of total billed charges,38.7
ANDROSTENEDIONE,82157,CPT,,,,,both,, ,769.33,769.33,Blue Cross and Blue Shield,Traditional,,297.73,38.7,38.7,769.33,30,392.36,percent of total billed charges,38.7
ANDROSTENEDIONE,82157,CPT,,,,,both,, ,769.33,769.33,Blue Cross and Blue Shield,Traditional,,297.73,38.7,38.7,769.33,30,392.36,percent of total billed charges,38.7
ANGIOTENSIN CONV ENZ,82164,CPT,,,,,both,, ,143.71,143.71,Blue Cross and Blue Shield,Traditional,,55.62,38.7,38.7,143.71,5.6,73.29,percent of total billed charges,38.7
ANGIOTENSIN CONV ENZ,82164,CPT,,,,,both,, ,1081.72,1081.72,Blue Cross and Blue Shield,Traditional,,418.63,38.7,38.7,1081.72,42.19,551.68,percent of total billed charges,38.7
Q34692 ACE CSF KINET,82164,CPT,,,,,both,, ,1081.72,1081.72,Blue Cross and Blue Shield,Traditional,,418.63,38.7,38.7,1081.72,42.19,551.68,percent of total billed charges,38.7
Q683 ACE SP,82164,CPT,,,,,both,, ,1081.72,1081.72,Blue Cross and Blue Shield,Traditional,,418.63,38.7,38.7,1081.72,42.19,551.68,percent of total billed charges,38.7
ANTI-MULLERIAN HORM,82166,CPT,,,,,both,, ,116,116,Blue Cross and Blue Shield,Traditional,,44.89,38.7,38.7,116,4.52,59.16,percent of total billed charges,38.7
APOLIPOPROTEIN EACH,82172,CPT,,,,,both,, ,467.04,467.04,Blue Cross and Blue Shield,Traditional,,180.74,38.7,38.7,467.04,18.21,238.19,percent of total billed charges,38.7
APOLIPOPROTEIN EACH,82172,CPT,,,,,both,, ,467.04,467.04,Blue Cross and Blue Shield,Traditional,,180.74,38.7,38.7,467.04,18.21,238.19,percent of total billed charges,38.7
ARSENIC,82175,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,38.7,751.36,29.3,383.19,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,,290.78,38.7,38.7,751.36,29.3,383.19,percent of total billed charges,38.7
Q36438 ARSENIC,82175,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,38.7,751.36,29.3,383.19,percent of total billed charges,38.7
Q7507 ARSENIC,82175,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,38.7,751.36,29.3,383.19,percent of total billed charges,38.7
Q7655 ARSENIC,82175,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,38.7,751.36,29.3,383.19,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,,26.29,38.7,38.7,67.92,2.65,34.64,percent of total billed charges,38.7
BETA-2 MICROGLOBULIN,82232,CPT,,,,,both,, ,936.89,936.89,Blue Cross and Blue Shield,Traditional,,362.58,38.7,38.7,936.89,36.54,477.81,percent of total billed charges,38.7
BETA-2 MICROGLOBULIN,82232,CPT,,,,,both,, ,936.89,936.89,Blue Cross and Blue Shield,Traditional,,362.58,38.7,38.7,936.89,36.54,477.81,percent of total billed charges,38.7
Q14801 BILE AC ENZ,82239,CPT,,,,,both,, ,274.77,274.77,Blue Cross and Blue Shield,Traditional,,106.34,38.7,38.7,274.77,10.72,140.13,percent of total billed charges,38.7
BILIRUBIN TOTAL,82247,CPT,,,,,both,, ,53.05,53.05,Blue Cross and Blue Shield,Traditional,,20.53,38.7,38.7,53.05,2.07,27.06,percent of total billed charges,38.7
BILIRUBIN TOTAL,82247,CPT,,,,,both,, ,282.92,282.92,Blue Cross and Blue Shield,Traditional,,109.49,38.7,38.7,282.92,11.03,144.29,percent of total billed charges,38.7
BILIRUBIN DIRECT,82248,CPT,,,,,both,, ,53.05,53.05,Blue Cross and Blue Shield,Traditional,,20.53,38.7,38.7,53.05,2.07,27.06,percent of total billed charges,38.7
BILIRUBIN DIRECT,82248,CPT,,,,,both,, ,282.92,282.92,Blue Cross and Blue Shield,Traditional,,109.49,38.7,38.7,282.92,11.03,144.29,percent of total billed charges,38.7
NBS BIOTINIDASE,82261,CPT,,,,,both,, ,100.75,100.75,Blue Cross and Blue Shield,Traditional,,38.99,38.7,38.7,100.75,3.93,51.38,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,,12.38,38.7,38.7,31.99,1.25,16.31,percent of total billed charges,38.7
BLD OCCULT FECES 1-3,82270,CPT,,,,,both,, ,210.5,210.5,Blue Cross and Blue Shield,Traditional,,81.46,38.7,38.7,210.5,8.21,107.36,percent of total billed charges,38.7
BLD OCCULT OTHER SRC,82271,CPT,,,,,both,, ,277.59,277.59,Blue Cross and Blue Shield,Traditional,,107.43,38.7,38.7,277.59,10.83,141.57,percent of total billed charges,38.7
BLD OCC NON CA SCREE,82272,CPT,,,,,both,, ,210.5,210.5,Blue Cross and Blue Shield,Traditional,,81.46,38.7,38.7,210.5,8.21,107.36,percent of total billed charges,38.7
BLD OCCULT FECES EIA,82274,CPT,,,,,both,, ,165.87,165.87,Blue Cross and Blue Shield,Traditional,,64.19,38.7,38.7,165.87,6.47,84.59,percent of total billed charges,38.7
CADMIUM,82300,CPT,,,,,both,, ,536.08,536.08,Blue Cross and Blue Shield,Traditional,,207.46,38.7,38.7,536.08,20.91,273.4,percent of total billed charges,38.7
CADMIUM,82300,CPT,,,,,both,, ,536.08,536.08,Blue Cross and Blue Shield,Traditional,,207.46,38.7,38.7,536.08,20.91,273.4,percent of total billed charges,38.7
Q672 CADMIUM,82300,CPT,,,,,both,, ,125,125,Blue Cross and Blue Shield,Traditional,,48.38,38.7,38.7,125,4.88,63.75,percent of total billed charges,38.7
L504115VITD 25-OH LC,82306,CPT,,,,,both,, ,651.73,651.73,Blue Cross and Blue Shield,Traditional,,252.22,38.7,38.7,651.73,25.42,332.38,percent of total billed charges,38.7
VITAMIN D 25OH,82306,CPT,,,,,both,, ,279.26,279.26,Blue Cross and Blue Shield,Traditional,,108.07,38.7,38.7,279.26,10.89,142.42,percent of total billed charges,38.7
VITAMIN D 25OH,82306,CPT,,,,,both,,,710.38,710.38,Blue Cross and Blue Shield,Traditional,,274.92,38.7,38.7,710.38,27.7,362.29,percent of total billed charges,38.7
VITAMIN D 25OH,82306,CPT,,,,,both,, ,710.38,710.38,Blue Cross and Blue Shield,Traditional,,274.92,38.7,38.7,710.38,27.7,362.29,percent of total billed charges,38.7
CALCITONIN,82308,CPT,,,,,both,, ,297.79,297.79,Blue Cross and Blue Shield,Traditional,,115.24,38.7,38.7,297.79,11.61,151.87,percent of total billed charges,38.7
Q30742 CALCITONIN IA,82308,CPT,,,,,both,, ,796.27,796.27,Blue Cross and Blue Shield,Traditional,,308.16,38.7,38.7,796.27,31.05,406.1,percent of total billed charges,38.7
CALCIUM TOTAL,82310,CPT,,,,,both,, ,54.45,54.45,Blue Cross and Blue Shield,Traditional,,21.07,38.7,38.7,54.45,2.12,27.77,percent of total billed charges,38.7
CALCIUM TOTAL,82310,CPT,,,,,both,, ,315.48,315.48,Blue Cross and Blue Shield,Traditional,,122.09,38.7,38.7,315.48,12.3,160.89,percent of total billed charges,38.7
CALCIUM TOTAL,82310,CPT,,,,,both,, ,315.48,315.48,Blue Cross and Blue Shield,Traditional,,122.09,38.7,38.7,315.48,12.3,160.89,percent of total billed charges,38.7
CALCIUM IONIZED,82330,CPT,,,,,both,, ,35.36,35.36,Blue Cross and Blue Shield,Traditional,,13.68,38.7,38.7,35.36,1.38,18.03,percent of total billed charges,38.7
CALCIUM IONIZED,82330,CPT,,,,,both,,,796.27,796.27,Blue Cross and Blue Shield,Traditional,,308.16,38.7,38.7,796.27,31.05,406.1,percent of total billed charges,38.7
CALCIUM IONIZED,82330,CPT,,,,,both,, ,796.27,796.27,Blue Cross and Blue Shield,Traditional,,308.16,38.7,38.7,796.27,31.05,406.1,percent of total billed charges,38.7
CALCIUM IONIZED,82330,CPT,,,,,both,, ,796.27,796.27,Blue Cross and Blue Shield,Traditional,,308.16,38.7,38.7,796.27,31.05,406.1,percent of total billed charges,38.7
CALCIUM URI QN TIMED,82340,CPT,,,,,both,,,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,38.7,412.87,16.1,210.56,percent of total billed charges,38.7
CALCIUM URI QN TIMED,82340,CPT,,,,,both,, ,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,38.7,412.87,16.1,210.56,percent of total billed charges,38.7
"L910235 CALCIUM, URINE",82340,CPT,,,,,both,, ,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,38.7,412.87,16.1,210.56,percent of total billed charges,38.7
Q442 CALCIUM URI QN,82340,CPT,,,,,both,, ,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,38.7,412.87,16.1,210.56,percent of total billed charges,38.7
CALCULUS INFRARED,82365,CPT,,,,,both,, ,1187.82,1187.82,Blue Cross and Blue Shield,Traditional,,459.69,38.7,38.7,1187.82,46.32,605.79,percent of total billed charges,38.7
CALCULUS INFRARED,82365,CPT,,,,,both,, ,1187.82,1187.82,Blue Cross and Blue Shield,Traditional,,459.69,38.7,38.7,1187.82,46.32,605.79,percent of total billed charges,38.7
CARBON DIOXIDE CO2,82374,CPT,,,,,both,, ,47.99,47.99,Blue Cross and Blue Shield,Traditional,,18.57,38.7,38.7,47.99,1.87,24.47,percent of total billed charges,38.7
CARBON DIOXIDE CO2,82374,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
CARBON MONOXIDE QUAN,82375,CPT,,,,,both,, ,203.49,203.49,Blue Cross and Blue Shield,Traditional,,78.75,38.7,38.7,203.49,7.94,103.78,percent of total billed charges,38.7
CARBON MONOXIDE QUAN,82375,CPT,,,,,both,, ,203.49,203.49,Blue Cross and Blue Shield,Traditional,,78.75,38.7,38.7,203.49,7.94,103.78,percent of total billed charges,38.7
CARCINOEMBRYONIC AG,82378,CPT,,,,,both,, ,121.53,121.53,Blue Cross and Blue Shield,Traditional,,47.03,38.7,38.7,121.53,4.74,61.98,percent of total billed charges,38.7
CARCINOEMBRYONIC AG,82378,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,38.7,526.26,20.52,268.39,percent of total billed charges,38.7
CARCINOEMBRYONIC AG,82378,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,38.7,526.26,20.52,268.39,percent of total billed charges,38.7
CAROTENE,82380,CPT,,,,,both,, ,1171.81,1171.81,Blue Cross and Blue Shield,Traditional,,453.49,38.7,38.7,1171.81,45.7,597.62,percent of total billed charges,38.7
L1529 CAROTENE HPLC,82380,CPT,,,,,both,, ,75.2,75.2,Blue Cross and Blue Shield,Traditional,,29.1,38.7,38.7,75.2,2.93,38.35,percent of total billed charges,38.7
Q314 CAT FR PL,82384,CPT,,,,,both,, ,263.27,263.27,Blue Cross and Blue Shield,Traditional,,101.89,38.7,38.7,263.27,10.27,134.27,percent of total billed charges,38.7
Q314 CAT FR PL,82384,CPT,,,,,both,, ,263.27,263.27,Blue Cross and Blue Shield,Traditional,,101.89,38.7,38.7,263.27,10.27,134.27,percent of total billed charges,38.7
Q314 CAT FR PL,82384,CPT,,,,,both,, ,263.27,263.27,Blue Cross and Blue Shield,Traditional,,101.89,38.7,38.7,263.27,10.27,134.27,percent of total billed charges,38.7
Q314 CAT FR PL,82384,CPT,,,,,both,, ,263.27,263.27,Blue Cross and Blue Shield,Traditional,,101.89,38.7,38.7,263.27,10.27,134.27,percent of total billed charges,38.7
CERULOPLASMIN,82390,CPT,,,,,both,, ,859.7,859.7,Blue Cross and Blue Shield,Traditional,,332.7,38.7,38.7,859.7,33.53,438.45,percent of total billed charges,38.7
CERULOPLASMIN,82390,CPT,,,,,both,, ,859.7,859.7,Blue Cross and Blue Shield,Traditional,,332.7,38.7,38.7,859.7,33.53,438.45,percent of total billed charges,38.7
CHEMILUM ASSAY NOS,82397,CPT,,,,,both,, ,444.59,444.59,Blue Cross and Blue Shield,Traditional,,172.06,38.7,38.7,444.59,17.34,226.74,percent of total billed charges,38.7
L503870 CHEM ASY NOS,82397,CPT,,,,,both,, ,444.59,444.59,Blue Cross and Blue Shield,Traditional,,172.06,38.7,38.7,444.59,17.34,226.74,percent of total billed charges,38.7
L504567 CHEM ASY NOS,82397,CPT,,,,,both,, ,407.88,407.88,Blue Cross and Blue Shield,Traditional,,157.85,38.7,38.7,407.88,15.91,208.02,percent of total billed charges,38.7
Q34445 INHIBIN B CL,82397,CPT,,,,,both,, ,444.59,444.59,Blue Cross and Blue Shield,Traditional,,172.06,38.7,38.7,444.59,17.34,226.74,percent of total billed charges,38.7
Q37226 ANTI-MULLERIAN HORMONE (AMH) MALE,82397,CPT,,,,,both,, ,396,396,Blue Cross and Blue Shield,Traditional,,153.25,38.7,38.7,396,15.44,201.96,percent of total billed charges,38.7
Q37226 ANTI-MULLERIAN HORMONE (AMH) MALE,82397,CPT,,,,,both,, ,396,396,Blue Cross and Blue Shield,Traditional,,153.25,38.7,38.7,396,15.44,201.96,percent of total billed charges,38.7
CHLORIDE BLOOD,82435,CPT,,,,,both,, ,38.73,38.73,Blue Cross and Blue Shield,Traditional,,14.99,38.7,38.7,38.73,1.51,19.75,percent of total billed charges,38.7
CHLORIDE BLOOD,82435,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
CHLORIDE URINE RAN,82436,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
CHLORIDE URINE RAN,82436,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
CHLORIDES OTHER FLD,82438,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
CHOLESTEROL TOTAL,82465,CPT,,,,,both,, ,49.68,49.68,Blue Cross and Blue Shield,Traditional,,19.23,38.7,38.7,49.68,1.94,25.34,percent of total billed charges,38.7
CHOLESTEROL TOTAL,82465,CPT,,,,,both,, ,315.48,315.48,Blue Cross and Blue Shield,Traditional,,122.09,38.7,38.7,315.48,12.3,160.89,percent of total billed charges,38.7
CHOLINESTERASE SERUM,82480,CPT,,,,,both,, ,563.6,563.6,Blue Cross and Blue Shield,Traditional,,218.11,38.7,38.7,563.6,21.98,287.44,percent of total billed charges,38.7
Q338 CHOLINEST SER,82480,CPT,,,,,both,, ,563.6,563.6,Blue Cross and Blue Shield,Traditional,,218.11,38.7,38.7,563.6,21.98,287.44,percent of total billed charges,38.7
Q7961 CHOLINEST SER,82480,CPT,,,,,both,, ,563.6,563.6,Blue Cross and Blue Shield,Traditional,,218.11,38.7,38.7,563.6,21.98,287.44,percent of total billed charges,38.7
CHOLINESTERASE RBC,82482,CPT,,,,,both,, ,676.14,676.14,Blue Cross and Blue Shield,Traditional,,261.67,38.7,38.7,676.14,26.37,344.83,percent of total billed charges,38.7
CHOLINESTERASE RBC,82482,CPT,,,,,both,, ,676.14,676.14,Blue Cross and Blue Shield,Traditional,,261.67,38.7,38.7,676.14,26.37,344.83,percent of total billed charges,38.7
CHROMIUM,82495,CPT,,,,,both,, ,242.5,242.5,Blue Cross and Blue Shield,Traditional,,93.85,38.7,38.7,242.5,9.46,123.68,percent of total billed charges,38.7
CHROMIUM U,82495,CPT,,,,,both,, ,202.8,202.8,Blue Cross and Blue Shield,Traditional,,78.48,38.7,38.7,202.8,7.91,103.43,percent of total billed charges,38.7
"L910235 CITRATE, URINE",82507,CPT,,,,,both,, ,242.5,242.5,Blue Cross and Blue Shield,Traditional,,93.85,38.7,38.7,242.5,9.46,123.68,percent of total billed charges,38.7
Q11315 CIT AC U24 SP,82507,CPT,,,,,both,, ,242.5,242.5,Blue Cross and Blue Shield,Traditional,,93.85,38.7,38.7,242.5,9.46,123.68,percent of total billed charges,38.7
Q442 CITRATE,82507,CPT,,,,,both,, ,242.5,242.5,Blue Cross and Blue Shield,Traditional,,93.85,38.7,38.7,242.5,9.46,123.68,percent of total billed charges,38.7
COLLAGEN CROSSLINKS,82523,CPT,,,,,both,, ,280.11,280.11,Blue Cross and Blue Shield,Traditional,,108.4,38.7,38.7,280.11,10.92,142.86,percent of total billed charges,38.7
L500089 C-TELO ELISA,82523,CPT,,,,,both,, ,529.2,529.2,Blue Cross and Blue Shield,Traditional,,204.8,38.7,38.7,529.2,20.64,269.89,percent of total billed charges,38.7
"N-TELOPEP (NTX), UR",82523,CPT,,,,,both,, ,186.8,186.8,Blue Cross and Blue Shield,Traditional,,72.29,38.7,38.7,186.8,7.29,95.27,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,,401.03,38.7,38.7,1036.25,40.41,528.49,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,,401.03,38.7,38.7,1036.25,40.41,528.49,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,,401.03,38.7,38.7,1036.25,40.41,528.49,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,,401.03,38.7,38.7,1036.25,40.41,528.49,percent of total billed charges,38.7
Q11280CORTU24 LCMSMS,82530,CPT,,,,,both,, ,938.86,938.86,Blue Cross and Blue Shield,Traditional,,363.34,38.7,38.7,938.86,36.62,478.82,percent of total billed charges,38.7
Q11280CORTU24 LCMSMS,82530,CPT,,,,,both,, ,938.86,938.86,Blue Cross and Blue Shield,Traditional,,363.34,38.7,38.7,938.86,36.62,478.82,percent of total billed charges,38.7
Q36423 CORT FR LCMSM,82530,CPT,,,,,both,, ,939.13,939.13,Blue Cross and Blue Shield,Traditional,,363.44,38.7,38.7,939.13,36.63,478.96,percent of total billed charges,38.7
CORTISOL TOTAL,82533,CPT,,,,,both,, ,132.19,132.19,Blue Cross and Blue Shield,Traditional,,51.16,38.7,38.7,132.19,5.16,67.42,percent of total billed charges,38.7
CORTISOL TOTAL,82533,CPT,,,,,both,,,1343.58,1343.58,Blue Cross and Blue Shield,Traditional,,519.97,38.7,38.7,1343.58,52.4,685.23,percent of total billed charges,38.7
CORTISOL TOTAL,82533,CPT,,,,,both,, ,1343.58,1343.58,Blue Cross and Blue Shield,Traditional,,519.97,38.7,38.7,1343.58,52.4,685.23,percent of total billed charges,38.7
L500179SALIV CORT MS,82533,CPT,,,,,both,, ,335.78,335.78,Blue Cross and Blue Shield,Traditional,,129.95,38.7,38.7,335.78,13.1,171.25,percent of total billed charges,38.7
L500440 CORTISOL TOT,82533,CPT,,,,,both,, ,163,163,Blue Cross and Blue Shield,Traditional,,63.08,38.7,38.7,163,6.36,83.13,percent of total billed charges,38.7
CREATINE,82540,CPT,,,,,both,, ,38.73,38.73,Blue Cross and Blue Shield,Traditional,,14.99,38.7,38.7,38.73,1.51,19.75,percent of total billed charges,38.7
L823430 OMEGACHECK (EPA+DPA+DHA),82542,CPT,,,,,both,, ,430,430,Blue Cross and Blue Shield,Traditional,,166.41,38.7,38.7,430,16.77,219.3,percent of total billed charges,38.7
N-METHLHIST 24H UR,82542,CPT,,,,,both,, ,600,600,Blue Cross and Blue Shield,Traditional,,232.2,38.7,38.7,600,23.4,306,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,,124.05,38.7,38.7,320.53,12.5,163.47,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,,124.05,38.7,38.7,320.53,12.5,163.47,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,,124.05,38.7,38.7,320.53,12.5,163.47,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,,124.05,38.7,38.7,320.53,12.5,163.47,percent of total billed charges,38.7
CPK TOTAL,82550,CPT,,,,,both,, ,64.27,64.27,Blue Cross and Blue Shield,Traditional,,24.87,38.7,38.7,64.27,2.51,32.78,percent of total billed charges,38.7
CPK TOTAL,82550,CPT,,,,,both,,,282.92,282.92,Blue Cross and Blue Shield,Traditional,,109.49,38.7,38.7,282.92,11.03,144.29,percent of total billed charges,38.7
CPK TOTAL,82550,CPT,,,,,both,, ,282.92,282.92,Blue Cross and Blue Shield,Traditional,,109.49,38.7,38.7,282.92,11.03,144.29,percent of total billed charges,38.7
CPK TOTAL,82550,CPT,,,,,both,, ,282.92,282.92,Blue Cross and Blue Shield,Traditional,,109.49,38.7,38.7,282.92,11.03,144.29,percent of total billed charges,38.7
CPK ISOENZYMES,82552,CPT,,,,,both,, ,626.18,626.18,Blue Cross and Blue Shield,Traditional,,242.33,38.7,38.7,626.18,24.42,319.35,percent of total billed charges,38.7
CPK ISOENZYMES,82552,CPT,,,,,both,, ,626.18,626.18,Blue Cross and Blue Shield,Traditional,,242.33,38.7,38.7,626.18,24.42,319.35,percent of total billed charges,38.7
CPK MB FRACTION,82553,CPT,,,,,both,, ,113.67,113.67,Blue Cross and Blue Shield,Traditional,,43.99,38.7,38.7,113.67,4.43,57.97,percent of total billed charges,38.7
CPK MB FRACTION,82553,CPT,,,,,both,, ,620.56,620.56,Blue Cross and Blue Shield,Traditional,,240.16,38.7,38.7,620.56,24.2,316.49,percent of total billed charges,38.7
CREATININE BLOOD,82565,CPT,,,,,both,, ,19.09,19.09,Blue Cross and Blue Shield,Traditional,,7.39,38.7,38.7,19.09,0.74,9.74,percent of total billed charges,38.7
CREATININE BLOOD,82565,CPT,,,,,both,,,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,38.7,285.17,11.12,145.44,percent of total billed charges,38.7
CREATININE BLOOD,82565,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,38.7,285.17,11.12,145.44,percent of total billed charges,38.7
CREATININE UR-OTHER,82570,CPT,,,,,both,, ,32.84,32.84,Blue Cross and Blue Shield,Traditional,,12.71,38.7,38.7,32.84,1.28,16.75,percent of total billed charges,38.7
CREATININE UR-OTHER,82570,CPT,,,,,both,,,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,38.7,285.17,11.12,145.44,percent of total billed charges,38.7
CREATININE UR-OTHER,82570,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,38.7,285.17,11.12,145.44,percent of total billed charges,38.7
Q14961 CREATININE UR,82570,CPT,,,,,both,, ,261.87,261.87,Blue Cross and Blue Shield,Traditional,,101.34,38.7,38.7,261.87,10.21,133.55,percent of total billed charges,38.7
Q14961 CREATININE UR,82570,CPT,,,,,both,, ,261.87,261.87,Blue Cross and Blue Shield,Traditional,,101.34,38.7,38.7,261.87,10.21,133.55,percent of total billed charges,38.7
Q1648 CREATININE UR-,82570,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,38.7,285.17,11.12,145.44,percent of total billed charges,38.7
Q17422 CREATIN PTF C,82570,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,38.7,285.17,11.12,145.44,percent of total billed charges,38.7
Q442 CREATININE UR-O,82570,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,38.7,285.17,11.12,145.44,percent of total billed charges,38.7
Q682 CREATININE UR-O,82570,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,38.7,285.17,11.12,145.44,percent of total billed charges,38.7
Q7507 CREATIN UR-OTH,82570,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,38.7,285.17,11.12,145.44,percent of total billed charges,38.7
Q8525 CREATININE UR-,82570,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,38.7,285.17,11.12,145.44,percent of total billed charges,38.7
CREATININE CLEARANCE,82575,CPT,,,,,both,,,555.45,555.45,Blue Cross and Blue Shield,Traditional,,214.96,38.7,38.7,555.45,21.66,283.28,percent of total billed charges,38.7
CREATININE CLEARANCE,82575,CPT,,,,,both,, ,555.45,555.45,Blue Cross and Blue Shield,Traditional,,214.96,38.7,38.7,555.45,21.66,283.28,percent of total billed charges,38.7
CRYOGLOBULIN,82595,CPT,,,,,both,, ,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,percent of total billed charges,38.7
CRYOGLOBULIN,82595,CPT,,,,,both,, ,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,percent of total billed charges,38.7
VITAMIN B-12,82607,CPT,,,,,both,, ,111.43,111.43,Blue Cross and Blue Shield,Traditional,,43.12,38.7,38.7,111.43,4.35,56.83,percent of total billed charges,38.7
VITAMIN B-12,82607,CPT,,,,,both,,,641.06,641.06,Blue Cross and Blue Shield,Traditional,,248.09,38.7,38.7,641.06,25,326.94,percent of total billed charges,38.7
VITAMIN B-12,82607,CPT,,,,,both,, ,641.06,641.06,Blue Cross and Blue Shield,Traditional,,248.09,38.7,38.7,641.06,25,326.94,percent of total billed charges,38.7
VITAMIN B-12 BINDING,82608,CPT,,,,,both,, ,183.56,183.56,Blue Cross and Blue Shield,Traditional,,71.04,38.7,38.7,183.56,7.16,93.62,percent of total billed charges,38.7
Q10570 CYSTAT C NEPH,82610,CPT,,,,,both,, ,121.25,121.25,Blue Cross and Blue Shield,Traditional,,46.92,38.7,38.7,121.25,4.73,61.84,percent of total billed charges,38.7
"L910235 CREATININE, URINE",82615,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,38.7,285.17,11.12,145.44,percent of total billed charges,38.7
L910235 CYSTINE/HOMOCYSTINE UR,82615,CPT,,,,,both,, ,50,50,Blue Cross and Blue Shield,Traditional,,19.35,38.7,38.7,50,1.95,25.5,percent of total billed charges,38.7
DHEA,82626,CPT,,,,,both,, ,263.55,263.55,Blue Cross and Blue Shield,Traditional,,101.99,38.7,38.7,263.55,10.28,134.41,percent of total billed charges,38.7
DHEA,82626,CPT,,,,,both,, ,263.55,263.55,Blue Cross and Blue Shield,Traditional,,101.99,38.7,38.7,263.55,10.28,134.41,percent of total billed charges,38.7
DHEA-S,82627,CPT,,,,,both,, ,664.35,664.35,Blue Cross and Blue Shield,Traditional,,257.1,38.7,38.7,664.35,25.91,338.82,percent of total billed charges,38.7
DHEA-S,82627,CPT,,,,,both,, ,664.35,664.35,Blue Cross and Blue Shield,Traditional,,257.1,38.7,38.7,664.35,25.91,338.82,percent of total billed charges,38.7
DEOXYCORTISOL,82634,CPT,,,,,both,, ,177.39,177.39,Blue Cross and Blue Shield,Traditional,,68.65,38.7,38.7,177.39,6.92,90.47,percent of total billed charges,38.7
DIBUCAINE NUMBER,82638,CPT,,,,,both,, ,270.28,270.28,Blue Cross and Blue Shield,Traditional,,104.6,38.7,38.7,270.28,10.54,137.84,percent of total billed charges,38.7
DIBUCAINE NUMBER,82638,CPT,,,,,both,, ,270.28,270.28,Blue Cross and Blue Shield,Traditional,,104.6,38.7,38.7,270.28,10.54,137.84,percent of total billed charges,38.7
DIHYDROTESTOST (DHT),82642,CPT,,,,,both,, ,151.84,151.84,Blue Cross and Blue Shield,Traditional,,58.76,38.7,38.7,151.84,5.92,77.44,percent of total billed charges,38.7
DIHYDROXY VITAMIN D,82652,CPT,,,,,both,, ,379.18,379.18,Blue Cross and Blue Shield,Traditional,,146.74,38.7,38.7,379.18,14.79,193.38,percent of total billed charges,38.7
DIHYDROXY VITAMIN D,82652,CPT,,,,,both,, ,1307.38,1307.38,Blue Cross and Blue Shield,Traditional,,505.96,38.7,38.7,1307.38,50.99,666.76,percent of total billed charges,38.7
Q16558 VITD LCMSMS,82652,CPT,,,,,both,, ,554.89,554.89,Blue Cross and Blue Shield,Traditional,,214.74,38.7,38.7,554.89,21.64,282.99,percent of total billed charges,38.7
Q14693 ELAST PANC QT,82653,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,38.7,414.83,16.18,211.56,percent of total billed charges,38.7
Q14693 ELAST PANC QT,82653,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,38.7,414.83,16.18,211.56,percent of total billed charges,38.7
"PANCREA ELASTAS,FEC",82656,CPT,,,,,both,, ,267.48,267.48,Blue Cross and Blue Shield,Traditional,,103.51,38.7,38.7,267.48,10.43,136.41,percent of total billed charges,38.7
"PANCREA ELASTAS,FEC",82656,CPT,,,,,both,, ,267.48,267.48,Blue Cross and Blue Shield,Traditional,,103.51,38.7,38.7,267.48,10.43,136.41,percent of total billed charges,38.7
Q14693 PE-1 IA,82656,CPT,,,,,both,, ,228.97,228.97,Blue Cross and Blue Shield,Traditional,,88.61,38.7,38.7,228.97,8.93,116.77,percent of total billed charges,38.7
ERYTHROPOIETIN,82668,CPT,,,,,both,, ,1449.41,1449.41,Blue Cross and Blue Shield,Traditional,,560.92,38.7,38.7,1449.41,56.53,739.2,percent of total billed charges,38.7
ERYTHROPOIETIN,82668,CPT,,,,,both,, ,1449.41,1449.41,Blue Cross and Blue Shield,Traditional,,560.92,38.7,38.7,1449.41,56.53,739.2,percent of total billed charges,38.7
ESTRADIOL,82670,CPT,,,,,both,, ,976.46,976.46,Blue Cross and Blue Shield,Traditional,,377.89,38.7,38.7,976.46,38.08,497.99,percent of total billed charges,38.7
L500649 ESTRADIOL,82670,CPT,,,,,both,, ,976.46,976.46,Blue Cross and Blue Shield,Traditional,,377.89,38.7,38.7,976.46,38.08,497.99,percent of total billed charges,38.7
Q30289 ESTRADIOL US,82670,CPT,,,,,both,, ,976.46,976.46,Blue Cross and Blue Shield,Traditional,,377.89,38.7,38.7,976.46,38.08,497.99,percent of total billed charges,38.7
Q36169 ESTRA FR DIR,82670,CPT,,,,,both,, ,895.84,895.84,Blue Cross and Blue Shield,Traditional,,346.69,38.7,38.7,895.84,34.94,456.88,percent of total billed charges,38.7
Q36169 ESTRADIOL,82670,CPT,,,,,both,, ,976.46,976.46,Blue Cross and Blue Shield,Traditional,,377.89,38.7,38.7,976.46,38.08,497.99,percent of total billed charges,38.7
Q4021 ESTRADIOL IA,82670,CPT,,,,,both,, ,976.46,976.46,Blue Cross and Blue Shield,Traditional,,377.89,38.7,38.7,976.46,38.08,497.99,percent of total billed charges,38.7
Q36742 EST FR LCMSMS,82671,CPT,,,,,both,, ,170.36,170.36,Blue Cross and Blue Shield,Traditional,,65.93,38.7,38.7,170.36,6.64,86.88,percent of total billed charges,38.7
ESTROGEN TOTAL,82672,CPT,,,,,both,, ,1727.55,1727.55,Blue Cross and Blue Shield,Traditional,,668.56,38.7,38.7,1727.55,67.37,881.05,percent of total billed charges,38.7
Q439 ESTROG TOT RIA,82672,CPT,,,,,both,, ,304.53,304.53,Blue Cross and Blue Shield,Traditional,,117.85,38.7,38.7,304.53,11.88,155.31,percent of total billed charges,38.7
ESTRIOL,82677,CPT,,,,,both,, ,317.44,317.44,Blue Cross and Blue Shield,Traditional,,122.85,38.7,38.7,317.44,12.38,161.89,percent of total billed charges,38.7
ESTRIOL,82677,CPT,,,,,both,, ,317.44,317.44,Blue Cross and Blue Shield,Traditional,,122.85,38.7,38.7,317.44,12.38,161.89,percent of total billed charges,38.7
ESTRONE,82679,CPT,,,,,both,, ,116.47,116.47,Blue Cross and Blue Shield,Traditional,,45.07,38.7,38.7,116.47,4.54,59.4,percent of total billed charges,38.7
ESTRONE,82679,CPT,,,,,both,, ,116.47,116.47,Blue Cross and Blue Shield,Traditional,,45.07,38.7,38.7,116.47,4.54,59.4,percent of total billed charges,38.7
L500649 ESTRA FR DIR,82681,CPT,,,,,both,, ,251.84,251.84,Blue Cross and Blue Shield,Traditional,,97.46,38.7,38.7,251.84,9.82,128.44,percent of total billed charges,38.7
ETHYLENE GLYCOL,82693,CPT,,,,,both,,,1577.11,1577.11,Blue Cross and Blue Shield,Traditional,,610.34,38.7,38.7,1577.11,61.51,804.33,percent of total billed charges,38.7
ETHYLENE GLYCOL,82693,CPT,,,,,both,, ,1577.11,1577.11,Blue Cross and Blue Shield,Traditional,,610.34,38.7,38.7,1577.11,61.51,804.33,percent of total billed charges,38.7
Q801 ETHYL GLY CHRMT,82693,CPT,,,,,both,, ,935.21,935.21,Blue Cross and Blue Shield,Traditional,,361.93,38.7,38.7,935.21,36.47,476.96,percent of total billed charges,38.7
FAT-LIPID FECES QUAL,82705,CPT,,,,,both,, ,600.92,600.92,Blue Cross and Blue Shield,Traditional,,232.56,38.7,38.7,600.92,23.44,306.47,percent of total billed charges,38.7
FAT-LIPID FECES QUAL,82705,CPT,,,,,both,, ,600.92,600.92,Blue Cross and Blue Shield,Traditional,,232.56,38.7,38.7,600.92,23.44,306.47,percent of total billed charges,38.7
FAT-LIPID FECES QUAN,82710,CPT,,,,,both,, ,768.2,768.2,Blue Cross and Blue Shield,Traditional,,297.29,38.7,38.7,768.2,29.96,391.78,percent of total billed charges,38.7
FAT-LIPID FECES QUAN,82710,CPT,,,,,both,, ,768.2,768.2,Blue Cross and Blue Shield,Traditional,,297.29,38.7,38.7,768.2,29.96,391.78,percent of total billed charges,38.7
FECAL FAT QUANT 72HR,82710,CPT,,,,,both,, ,122.2,122.2,Blue Cross and Blue Shield,Traditional,,47.29,38.7,38.7,122.2,4.77,62.32,percent of total billed charges,38.7
Q90559 VLCFA,82726,CPT,,,,,both,, ,88.69,88.69,Blue Cross and Blue Shield,Traditional,,34.32,38.7,38.7,88.69,3.46,45.23,percent of total billed charges,38.7
FERRITIN,82728,CPT,,,,,both,, ,100.75,100.75,Blue Cross and Blue Shield,Traditional,,38.99,38.7,38.7,100.75,3.93,51.38,percent of total billed charges,38.7
FERRITIN,82728,CPT,,,,,both,,,864.19,864.19,Blue Cross and Blue Shield,Traditional,,334.44,38.7,38.7,864.19,33.7,440.74,percent of total billed charges,38.7
FERRITIN,82728,CPT,,,,,both,, ,864.19,864.19,Blue Cross and Blue Shield,Traditional,,334.44,38.7,38.7,864.19,33.7,440.74,percent of total billed charges,38.7
FETAL FIBRONECTIN,82731,CPT,,,,,both,, ,701.69,701.69,Blue Cross and Blue Shield,Traditional,,271.55,38.7,38.7,701.69,27.37,357.86,percent of total billed charges,38.7
FOLIC ACID SERUM,82746,CPT,,,,,both,, ,108.61,108.61,Blue Cross and Blue Shield,Traditional,,42.03,38.7,38.7,108.61,4.24,55.39,percent of total billed charges,38.7
FOLIC ACID SERUM,82746,CPT,,,,,both,,,735.65,735.65,Blue Cross and Blue Shield,Traditional,,284.7,38.7,38.7,735.65,28.69,375.18,percent of total billed charges,38.7
FOLIC ACID SERUM,82746,CPT,,,,,both,, ,735.65,735.65,Blue Cross and Blue Shield,Traditional,,284.7,38.7,38.7,735.65,28.69,375.18,percent of total billed charges,38.7
FOLIC ACID RBC,82747,CPT,,,,,both,, ,627.3,627.3,Blue Cross and Blue Shield,Traditional,,242.77,38.7,38.7,627.3,24.46,319.92,percent of total billed charges,38.7
FOLIC ACID RBC,82747,CPT,,,,,both,, ,627.3,627.3,Blue Cross and Blue Shield,Traditional,,242.77,38.7,38.7,627.3,24.46,319.92,percent of total billed charges,38.7
NBS GALACTOSE,82760,CPT,,,,,both,, ,66.8,66.8,Blue Cross and Blue Shield,Traditional,,25.85,38.7,38.7,66.8,2.61,34.07,percent of total billed charges,38.7
NBS GALACTOSE TRANS,82776,CPT,,,,,both,, ,49.96,49.96,Blue Cross and Blue Shield,Traditional,,19.33,38.7,38.7,49.96,1.95,25.48,percent of total billed charges,38.7
L341142GAMMAGLO MGAD,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,38.7,220.88,8.61,112.65,percent of total billed charges,38.7
L341142GAMMAGLO MGAD,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,38.7,220.88,8.61,112.65,percent of total billed charges,38.7
L341142GAMMAGLO MGAD,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,38.7,220.88,8.61,112.65,percent of total billed charges,38.7
L341142GAMMAGLO MGAD,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,38.7,220.88,8.61,112.65,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,,76.14,38.7,38.7,196.75,7.67,100.34,percent of total billed charges,38.7
Q543 IGG ITA,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,38.7,220.88,8.61,112.65,percent of total billed charges,38.7
Q543 IGG ITA,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,38.7,220.88,8.61,112.65,percent of total billed charges,38.7
Q543 IGG ITA,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,38.7,220.88,8.61,112.65,percent of total billed charges,38.7
Q543 IGG ITA,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,38.7,220.88,8.61,112.65,percent of total billed charges,38.7
Q7083GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,38.7,220.88,8.61,112.65,percent of total billed charges,38.7
Q7083GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,38.7,220.88,8.61,112.65,percent of total billed charges,38.7
Q7083GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,38.7,220.88,8.61,112.65,percent of total billed charges,38.7
Q7083GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,220.88,Blue Cross and Blue Shield,Traditional,,85.48,38.7,38.7,220.88,8.61,112.65,percent of total billed charges,38.7
GAMMAGLOBULIN IGE,82785,CPT,,,,,both,, ,127.14,127.14,Blue Cross and Blue Shield,Traditional,,49.2,38.7,38.7,127.14,4.96,64.84,percent of total billed charges,38.7
GAMMAGLOBULIN IGE,82785,CPT,,,,,both,, ,906.3,906.3,Blue Cross and Blue Shield,Traditional,,350.74,38.7,38.7,906.3,35.35,462.21,percent of total billed charges,38.7
Q10643 GAMMAGLOB IGE,82785,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,38.7,148.75,5.8,75.86,percent of total billed charges,38.7
Q10643 GAMMAGLOB IGE,82785,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,38.7,148.75,5.8,75.86,percent of total billed charges,38.7
Q10643 GAMMAGLOB IGE,82785,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,38.7,148.75,5.8,75.86,percent of total billed charges,38.7
Q10643 GAMMAGLOB IGE,82785,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,38.7,148.75,5.8,75.86,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,,150.55,38.7,38.7,389.01,15.17,198.4,percent of total billed charges,38.7
Q143422 IGG SUB4 NEP,82787,CPT,,,,,both,, ,389.01,389.01,Blue Cross and Blue Shield,Traditional,,150.55,38.7,38.7,389.01,15.17,198.4,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,,150.55,38.7,38.7,389.01,15.17,198.4,percent of total billed charges,38.7
BLOOD PH,82800,CPT,,,,,both,, ,618.04,618.04,Blue Cross and Blue Shield,Traditional,,239.18,38.7,38.7,618.04,24.1,315.2,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,,681.27,38.7,38.7,1760.39,68.66,897.8,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,,38.94,38.7,38.7,100.63,3.92,51.32,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,,38.94,38.7,38.7,100.63,3.92,51.32,percent of total billed charges,38.7
GASTRIN,82941,CPT,,,,,both,, ,863.91,863.91,Blue Cross and Blue Shield,Traditional,,334.33,38.7,38.7,863.91,33.69,440.59,percent of total billed charges,38.7
GASTRIN,82941,CPT,,,,,both,, ,863.91,863.91,Blue Cross and Blue Shield,Traditional,,334.33,38.7,38.7,863.91,33.69,440.59,percent of total billed charges,38.7
Q519 GLUCAG EXT-RIA,82943,CPT,,,,,both,, ,82.51,82.51,Blue Cross and Blue Shield,Traditional,,31.93,38.7,38.7,82.51,3.22,42.08,percent of total billed charges,38.7
GLUCOSE BODY FLUID,82945,CPT,,,,,both,, ,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,38.7,412.87,16.1,210.56,percent of total billed charges,38.7
"GLUCOSE, QUANT",82947,CPT,,,,,both,, ,21.89,21.89,Blue Cross and Blue Shield,Traditional,,8.47,38.7,38.7,21.89,0.85,11.16,percent of total billed charges,38.7
"GLUCOSE, QUANT",82947,CPT,,,,,both,,,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,38.7,240.26,9.37,122.53,percent of total billed charges,38.7
"GLUCOSE, QUANT",82947,CPT,,,,,both,, ,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,38.7,240.26,9.37,122.53,percent of total billed charges,38.7
"GLUCOSE, POST DOSE",82950,CPT,,,,,both,,,450.48,450.48,Blue Cross and Blue Shield,Traditional,,174.34,38.7,38.7,450.48,17.57,229.74,percent of total billed charges,38.7
"GLUCOSE, POST DOSE",82950,CPT,,,,,both,, ,450.48,450.48,Blue Cross and Blue Shield,Traditional,,174.34,38.7,38.7,450.48,17.57,229.74,percent of total billed charges,38.7
GTT 3 SPEC,82951,CPT,,,,,both,, ,758.95,758.95,Blue Cross and Blue Shield,Traditional,,293.71,38.7,38.7,758.95,29.6,387.06,percent of total billed charges,38.7
GTT ADD SP,82952,CPT,,,,,both,, ,188.05,188.05,Blue Cross and Blue Shield,Traditional,,72.78,38.7,38.7,188.05,7.33,95.91,percent of total billed charges,38.7
"G6PD, QUANT",82955,CPT,,,,,both,, ,1026.43,1026.43,Blue Cross and Blue Shield,Traditional,,397.23,38.7,38.7,1026.43,40.03,523.48,percent of total billed charges,38.7
"L121003 G6PD, QUANT",82955,CPT,,,,,both,, ,60,60,Blue Cross and Blue Shield,Traditional,,23.22,38.7,38.7,60,2.34,30.6,percent of total billed charges,38.7
"GLU,HOME USE DIAGNOS",82962,CPT,,,,,both,, ,8.76,8.76,Blue Cross and Blue Shield,Traditional,,3.39,38.7,38.7,8.76,0.34,4.47,percent of total billed charges,38.7
"GLU,HOME USE DIAGNOS",82962,CPT,,,,,both,, ,99.35,99.35,Blue Cross and Blue Shield,Traditional,,38.45,38.7,38.7,99.35,3.87,50.67,percent of total billed charges,38.7
GGT,82977,CPT,,,,,both,, ,71.01,71.01,Blue Cross and Blue Shield,Traditional,,27.48,38.7,38.7,71.01,2.77,36.22,percent of total billed charges,38.7
GGT,82977,CPT,,,,,both,, ,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,38.7,412.87,16.1,210.56,percent of total billed charges,38.7
L7700 GSH TOT,82978,CPT,,,,,both,, ,61,61,Blue Cross and Blue Shield,Traditional,,23.61,38.7,38.7,61,2.38,31.11,percent of total billed charges,38.7
GLYCATED PROTEIN,82985,CPT,,,,,both,, ,263.83,263.83,Blue Cross and Blue Shield,Traditional,,102.1,38.7,38.7,263.83,10.29,134.55,percent of total billed charges,38.7
Q8340 FRUCTOSAMINE C,82985,CPT,,,,,both,, ,298.92,298.92,Blue Cross and Blue Shield,Traditional,,115.68,38.7,38.7,298.92,11.66,152.45,percent of total billed charges,38.7
FOLLICLE STIM HORM,83001,CPT,,,,,both,, ,137.25,137.25,Blue Cross and Blue Shield,Traditional,,53.12,38.7,38.7,137.25,5.35,70,percent of total billed charges,38.7
FOLLICLE STIM HORM,83001,CPT,,,,,both,, ,812.55,812.55,Blue Cross and Blue Shield,Traditional,,314.46,38.7,38.7,812.55,31.69,414.4,percent of total billed charges,38.7
FOLLICLE STIM HORM,83001,CPT,,,,,both,, ,812.55,812.55,Blue Cross and Blue Shield,Traditional,,314.46,38.7,38.7,812.55,31.69,414.4,percent of total billed charges,38.7
LEUTEINIZING HORMONE,83002,CPT,,,,,both,, ,136.97,136.97,Blue Cross and Blue Shield,Traditional,,53.01,38.7,38.7,136.97,5.34,69.85,percent of total billed charges,38.7
LEUTEINIZING HORMONE,83002,CPT,,,,,both,, ,812.55,812.55,Blue Cross and Blue Shield,Traditional,,314.46,38.7,38.7,812.55,31.69,414.4,percent of total billed charges,38.7
LEUTEINIZING HORMONE,83002,CPT,,,,,both,, ,812.55,812.55,Blue Cross and Blue Shield,Traditional,,314.46,38.7,38.7,812.55,31.69,414.4,percent of total billed charges,38.7
GROWTH HORMONE,83003,CPT,,,,,both,, ,1201.85,1201.85,Blue Cross and Blue Shield,Traditional,,465.12,38.7,38.7,1201.85,46.87,612.94,percent of total billed charges,38.7
Q521 GH IA,83003,CPT,,,,,both,, ,74.86,74.86,Blue Cross and Blue Shield,Traditional,,28.97,38.7,38.7,74.86,2.92,38.18,percent of total billed charges,38.7
Q91823 GRTH STM GN 2,83006,CPT,,,,,both,, ,189,189,Blue Cross and Blue Shield,Traditional,,73.14,38.7,38.7,189,7.37,96.39,percent of total billed charges,38.7
"HAPTOGLOBIN, QUANT",83010,CPT,,,,,both,, ,1109.23,1109.23,Blue Cross and Blue Shield,Traditional,,429.27,38.7,38.7,1109.23,43.26,565.71,percent of total billed charges,38.7
"HAPTOGLOBIN, QUANT",83010,CPT,,,,,both,, ,1109.23,1109.23,Blue Cross and Blue Shield,Traditional,,429.27,38.7,38.7,1109.23,43.26,565.71,percent of total billed charges,38.7
Q14839H.PYLO UREA IR,83013,CPT,,,,,both,, ,623.38,623.38,Blue Cross and Blue Shield,Traditional,,241.25,38.7,38.7,623.38,24.31,317.92,percent of total billed charges,38.7
"HEAVY METALS, QUANT",83018,CPT,,,,,both,, ,175.14,175.14,Blue Cross and Blue Shield,Traditional,,67.78,38.7,38.7,175.14,6.83,89.32,percent of total billed charges,38.7
L121690 - HEMOGLOBIN ELECTRO,83020,CPT,,,,,both,, ,108.15,108.15,Blue Cross and Blue Shield,Traditional,,41.85,38.7,38.7,108.15,4.22,55.16,percent of total billed charges,38.7
NBS HGB ELECTRO,83020,CPT,,,,,both,, ,76.9,76.9,Blue Cross and Blue Shield,Traditional,,29.76,38.7,38.7,76.9,3,39.22,percent of total billed charges,38.7
"HEMOGLOBIN, CHROMA",83021,CPT,,,,,both,, ,180.6,180.6,Blue Cross and Blue Shield,Traditional,,69.89,38.7,38.7,180.6,7.04,92.11,percent of total billed charges,38.7
"HEMOGLOBIN, CHROMA",83021,CPT,,,,,both,, ,180.6,180.6,Blue Cross and Blue Shield,Traditional,,69.89,38.7,38.7,180.6,7.04,92.11,percent of total billed charges,38.7
"HEMOGLOB,FETGAL,QUAL",83033,CPT,,,,,both,, ,354.77,354.77,Blue Cross and Blue Shield,Traditional,,137.3,38.7,38.7,354.77,13.84,180.93,percent of total billed charges,38.7
HEMOGLOBIN A1C,83036,CPT,,,,,both,, ,95.71,95.71,Blue Cross and Blue Shield,Traditional,,37.04,38.7,38.7,95.71,3.73,48.81,percent of total billed charges,38.7
HEMOGLOBIN A1C,83036,CPT,,,,,both,,,454.97,454.97,Blue Cross and Blue Shield,Traditional,,176.07,38.7,38.7,454.97,17.74,232.03,percent of total billed charges,38.7
HEMOGLOBIN A1C,83036,CPT,,,,,both,, ,454.97,454.97,Blue Cross and Blue Shield,Traditional,,176.07,38.7,38.7,454.97,17.74,232.03,percent of total billed charges,38.7
HEMOGLOBIN A1C,83036,CPT,,,,,both,, ,454.97,454.97,Blue Cross and Blue Shield,Traditional,,176.07,38.7,38.7,454.97,17.74,232.03,percent of total billed charges,38.7
"METHEMOGLOBIN,QUAN",83050,CPT,,,,,both,, ,122.09,122.09,Blue Cross and Blue Shield,Traditional,,47.25,38.7,38.7,122.09,4.76,62.27,percent of total billed charges,38.7
"HEMOGLOBIN, PLASMA",83051,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
"HEMOSIDERIN, QUAL",83070,CPT,,,,,both,, ,373.57,373.57,Blue Cross and Blue Shield,Traditional,,144.57,38.7,38.7,373.57,14.57,190.52,percent of total billed charges,38.7
HISTAMINE,83088,CPT,,,,,both,, ,385.09,385.09,Blue Cross and Blue Shield,Traditional,,149.03,38.7,38.7,385.09,15.02,196.4,percent of total billed charges,38.7
Q36586 HISTAM PL RIA,83088,CPT,,,,,both,, ,385.09,385.09,Blue Cross and Blue Shield,Traditional,,149.03,38.7,38.7,385.09,15.02,196.4,percent of total billed charges,38.7
Q4946 HISTAM U24 IA,83088,CPT,,,,,both,, ,385.09,385.09,Blue Cross and Blue Shield,Traditional,,149.03,38.7,38.7,385.09,15.02,196.4,percent of total billed charges,38.7
HOMOCYSTEINE,83090,CPT,,,,,both,, ,227.91,227.91,Blue Cross and Blue Shield,Traditional,,88.2,38.7,38.7,227.91,8.89,116.23,percent of total billed charges,38.7
HOMOCYSTEINE,83090,CPT,,,,,both,, ,227.91,227.91,Blue Cross and Blue Shield,Traditional,,88.2,38.7,38.7,227.91,8.89,116.23,percent of total billed charges,38.7
CORTICOSTEROIDS,83491,CPT,,,,,both,, ,1217.28,1217.28,Blue Cross and Blue Shield,Traditional,,471.09,38.7,38.7,1217.28,47.47,620.81,percent of total billed charges,38.7
5-HIAA,83497,CPT,,,,,both,, ,976.46,976.46,Blue Cross and Blue Shield,Traditional,,377.89,38.7,38.7,976.46,38.08,497.99,percent of total billed charges,38.7
Q1648 5-HIAA,83497,CPT,,,,,both,, ,976.46,976.46,Blue Cross and Blue Shield,Traditional,,377.89,38.7,38.7,976.46,38.08,497.99,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,,377.89,38.7,38.7,976.46,38.08,497.99,percent of total billed charges,38.7
HYDROXYPROGES 17-D,83498,CPT,,,,,both,, ,600.92,600.92,Blue Cross and Blue Shield,Traditional,,232.56,38.7,38.7,600.92,23.44,306.47,percent of total billed charges,38.7
NBS HYDROXYPROG 17-D,83498,CPT,,,,,both,, ,162.23,162.23,Blue Cross and Blue Shield,Traditional,,62.78,38.7,38.7,162.23,6.33,82.74,percent of total billed charges,38.7
Q17180 17-OHP LCMSMS,83498,CPT,,,,,both,, ,601.2,601.2,Blue Cross and Blue Shield,Traditional,,232.66,38.7,38.7,601.2,23.45,306.61,percent of total billed charges,38.7
"IMMUNOASSAY, OTHER",83516,CPT,,,,,both,,,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,38.7,765.96,29.87,390.64,percent of total billed charges,38.7
"IMMUNOASSAY, OTHER",83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,38.7,765.96,29.87,390.64,percent of total billed charges,38.7
L162045 IA OTH,83516,CPT,,,,,both,, ,702.72,702.72,Blue Cross and Blue Shield,Traditional,,271.95,38.7,38.7,702.72,27.41,358.39,percent of total billed charges,38.7
L163061 IA OTHER,83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,38.7,765.96,29.87,390.64,percent of total billed charges,38.7
L165126 IA OTH,83516,CPT,,,,,both,, ,702.72,702.72,Blue Cross and Blue Shield,Traditional,,271.95,38.7,38.7,702.72,27.41,358.39,percent of total billed charges,38.7
L341142 IA OTHER,83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,38.7,765.96,29.87,390.64,percent of total billed charges,38.7
L520057 ANTI-HMGCR,83516,CPT,,,,,both,, ,630,630,Blue Cross and Blue Shield,Traditional,,243.81,38.7,38.7,630,24.57,321.3,percent of total billed charges,38.7
L520085 IA OTHER,83516,CPT,,,,,both,, ,702.72,702.72,Blue Cross and Blue Shield,Traditional,,271.95,38.7,38.7,702.72,27.41,358.39,percent of total billed charges,38.7
L520139 ANTI-GP210AB,83516,CPT,,,,,both,, ,300,300,Blue Cross and Blue Shield,Traditional,,116.1,38.7,38.7,300,11.7,153,percent of total billed charges,38.7
L520311 CARP AB,83516,CPT,,,,,both,, ,520,520,Blue Cross and Blue Shield,Traditional,,201.24,38.7,38.7,520,20.28,265.2,percent of total billed charges,38.7
L6486PARIET AB ELISA,83516,CPT,,,,,both,, ,81.5,81.5,Blue Cross and Blue Shield,Traditional,,31.54,38.7,38.7,81.5,3.18,41.57,percent of total billed charges,38.7
Q15114PARCL AB ELISA,83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,38.7,765.96,29.87,390.64,percent of total billed charges,38.7
Q18855 KU AUTOANTIBODIES,83516,CPT,,,,,both,, ,682.25,682.25,Blue Cross and Blue Shield,Traditional,,264.03,38.7,38.7,682.25,26.61,347.95,percent of total billed charges,38.7
Q19899RNA P-III ELIS,83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,38.7,765.96,29.87,390.64,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,,296.43,38.7,38.7,765.96,29.87,390.64,percent of total billed charges,38.7
Q36336 IA OTHER,83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,38.7,765.96,29.87,390.64,percent of total billed charges,38.7
Q37056 HISTON AB EIA,83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,38.7,765.96,29.87,390.64,percent of total billed charges,38.7
Q39226  21OH AB,83516,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,38.7,765.96,29.87,390.64,percent of total billed charges,38.7
L10421 MSH,83519,CPT,,,,,both,, ,184,184,Blue Cross and Blue Shield,Traditional,,71.21,38.7,38.7,184,7.18,93.84,percent of total billed charges,38.7
L504600 MUSCLE SPECIFIC KINASE,83519,CPT,,,,,both,, ,1200,1200,Blue Cross and Blue Shield,Traditional,,464.4,38.7,38.7,1200,46.8,612,percent of total billed charges,38.7
Q26474 ACHRMAB RBA,83519,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,38.7,728.07,28.39,371.32,percent of total billed charges,38.7
Q26474 ACHRMAB RBA,83519,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,38.7,728.07,28.39,371.32,percent of total billed charges,38.7
Q26474 ACHRMAB RBA,83519,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,38.7,728.07,28.39,371.32,percent of total billed charges,38.7
Q26474 ACHRMAB RBA,83519,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,38.7,728.07,28.39,371.32,percent of total billed charges,38.7
Q5738 TBII RRA,83519,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,38.7,728.07,28.39,371.32,percent of total billed charges,38.7
Q5738 TBII RRA,83519,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,38.7,728.07,28.39,371.32,percent of total billed charges,38.7
Q5738 TBII RRA,83519,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,38.7,728.07,28.39,371.32,percent of total billed charges,38.7
Q5738 TBII RRA,83519,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,38.7,728.07,28.39,371.32,percent of total billed charges,38.7
"IMMUNOASSAY, NOS",83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,38.7,414.83,16.18,211.56,percent of total billed charges,38.7
"IMMUNOASSAY, NOS",83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,38.7,414.83,16.18,211.56,percent of total billed charges,38.7
L117021 VEGF SER,83520,CPT,,,,,both,, ,175,175,Blue Cross and Blue Shield,Traditional,,67.73,38.7,38.7,175,6.83,89.25,percent of total billed charges,38.7
L146795INHIBIN B EIA,83520,CPT,,,,,both,, ,380.59,380.59,Blue Cross and Blue Shield,Traditional,,147.29,38.7,38.7,380.59,14.84,194.1,percent of total billed charges,38.7
L500016PROTHR FR 1+2,83520,CPT,,,,,both,, ,172.7,172.7,Blue Cross and Blue Shield,Traditional,,66.83,38.7,38.7,172.7,6.74,88.08,percent of total billed charges,38.7
L500124 MMP9,83520,CPT,,,,,both,, ,170,170,Blue Cross and Blue Shield,Traditional,,65.79,38.7,38.7,170,6.63,86.7,percent of total billed charges,38.7
L520085 IA NOS,83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,38.7,414.83,16.18,211.56,percent of total billed charges,38.7
L520085 IA NOS,83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,38.7,414.83,16.18,211.56,percent of total billed charges,38.7
NBS IMMUNOASSAY NOS,83520,CPT,,,,,both,, ,77.47,77.47,Blue Cross and Blue Shield,Traditional,,29.98,38.7,38.7,77.47,3.02,39.51,percent of total billed charges,38.7
Q113354 IA NOS,83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,38.7,414.83,16.18,211.56,percent of total billed charges,38.7
Q113354 IA NOS,83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,38.7,414.83,16.18,211.56,percent of total billed charges,38.7
Q145128 VEGF ELISA,83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,38.7,414.83,16.18,211.56,percent of total billed charges,38.7
Q145128 VEGF ELISA,83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,38.7,414.83,16.18,211.56,percent of total billed charges,38.7
Q34458 IGFBP-3 IA,83520,CPT,,,,,both,, ,444.59,444.59,Blue Cross and Blue Shield,Traditional,,172.06,38.7,38.7,444.59,17.34,226.74,percent of total billed charges,38.7
Q34458 IGFBP-3 IA,83520,CPT,,,,,both,, ,444.59,444.59,Blue Cross and Blue Shield,Traditional,,172.06,38.7,38.7,444.59,17.34,226.74,percent of total billed charges,38.7
Q34484 TRYPTASE FIA,83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,38.7,414.83,16.18,211.56,percent of total billed charges,38.7
Q34484 TRYPTASE FIA,83520,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,38.7,414.83,16.18,211.56,percent of total billed charges,38.7
Q38928 SOLUBLE LIVER ANTIGEN(SLA) AUTOAN,83520,CPT,,,,,both,, ,369.5,369.5,Blue Cross and Blue Shield,Traditional,,143,38.7,38.7,369.5,14.41,188.45,percent of total billed charges,38.7
Q38928 SOLUBLE LIVER ANTIGEN(SLA) AUTOAN,83520,CPT,,,,,both,, ,369.5,369.5,Blue Cross and Blue Shield,Traditional,,143,38.7,38.7,369.5,14.41,188.45,percent of total billed charges,38.7
Q38928 SOLUBLE LIVER ANTIGEN(SLA) AUTOAN,83520,CPT,,,,,both,, ,369.5,369.5,Blue Cross and Blue Shield,Traditional,,143,38.7,38.7,369.5,14.41,188.45,percent of total billed charges,38.7
Q38928 SOLUBLE LIVER ANTIGEN(SLA) AUTOAN,83520,CPT,,,,,both,, ,369.5,369.5,Blue Cross and Blue Shield,Traditional,,143,38.7,38.7,369.5,14.41,188.45,percent of total billed charges,38.7
L121210 LTCHN KAPLAM,83521,CPT,,,,,both,, ,103.62,103.62,Blue Cross and Blue Shield,Traditional,,40.1,38.7,38.7,103.62,4.04,52.85,percent of total billed charges,38.7
L121210 LTCHN KAPLAM,83521,CPT,,,,,both,, ,103.62,103.62,Blue Cross and Blue Shield,Traditional,,40.1,38.7,38.7,103.62,4.04,52.85,percent of total billed charges,38.7
Q11234 LTCHN KAP LAM,83521,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
Q11234 LTCHN KAP LAM,83521,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
"INSULIN, TOTAL",83525,CPT,,,,,both,, ,53.89,53.89,Blue Cross and Blue Shield,Traditional,,20.86,38.7,38.7,53.89,2.1,27.48,percent of total billed charges,38.7
"INSULIN, TOTAL",83525,CPT,,,,,both,, ,600.92,600.92,Blue Cross and Blue Shield,Traditional,,232.56,38.7,38.7,600.92,23.44,306.47,percent of total billed charges,38.7
Q561 INSULIN IA,83525,CPT,,,,,both,, ,632.36,632.36,Blue Cross and Blue Shield,Traditional,,244.72,38.7,38.7,632.36,24.66,322.5,percent of total billed charges,38.7
"INSULIN, FREE",83527,CPT,,,,,both,, ,193.94,193.94,Blue Cross and Blue Shield,Traditional,,75.05,38.7,38.7,193.94,7.56,98.91,percent of total billed charges,38.7
L501561 INSULIN FREE,83527,CPT,,,,,both,, ,193.94,193.94,Blue Cross and Blue Shield,Traditional,,75.05,38.7,38.7,193.94,7.56,98.91,percent of total billed charges,38.7
Q36700 INSULIN FR IA,83527,CPT,,,,,both,, ,193.94,193.94,Blue Cross and Blue Shield,Traditional,,75.05,38.7,38.7,193.94,7.56,98.91,percent of total billed charges,38.7
IRON,83540,CPT,,,,,both,, ,63.99,63.99,Blue Cross and Blue Shield,Traditional,,24.76,38.7,38.7,63.99,2.5,32.63,percent of total billed charges,38.7
IRON,83540,CPT,,,,,both,,,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
IRON,83540,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
IRON BINDING CAPACIT,83550,CPT,,,,,both,, ,86.16,86.16,Blue Cross and Blue Shield,Traditional,,33.34,38.7,38.7,86.16,3.36,43.94,percent of total billed charges,38.7
IRON BINDING CAPACIT,83550,CPT,,,,,both,,,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,38.7,526.26,20.52,268.39,percent of total billed charges,38.7
IRON BINDING CAPACIT,83550,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,38.7,526.26,20.52,268.39,percent of total billed charges,38.7
"17-KETOSTEROIDS, TOT",83586,CPT,,,,,both,, ,164.19,164.19,Blue Cross and Blue Shield,Traditional,,63.54,38.7,38.7,164.19,6.4,83.74,percent of total billed charges,38.7
LACTIC ACID,83605,CPT,,,,,both,, ,105.25,105.25,Blue Cross and Blue Shield,Traditional,,40.73,38.7,38.7,105.25,4.1,53.68,percent of total billed charges,38.7
LACTIC ACID,83605,CPT,,,,,both,,,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
LACTIC ACID,83605,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
LACTATE DEHYDROLDH,83615,CPT,,,,,both,, ,59.5,59.5,Blue Cross and Blue Shield,Traditional,,23.03,38.7,38.7,59.5,2.32,30.35,percent of total billed charges,38.7
LACTATE DEHYDROLDH,83615,CPT,,,,,both,, ,600.92,600.92,Blue Cross and Blue Shield,Traditional,,232.56,38.7,38.7,600.92,23.44,306.47,percent of total billed charges,38.7
LACTATE DEHYDROLDH,83615,CPT,,,,,both,, ,600.92,600.92,Blue Cross and Blue Shield,Traditional,,232.56,38.7,38.7,600.92,23.44,306.47,percent of total billed charges,38.7
LDH ISOENZYMES,83625,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
Q10156 LACTOFER IA,83630,CPT,,,,,both,, ,267.48,267.48,Blue Cross and Blue Shield,Traditional,,103.51,38.7,38.7,267.48,10.43,136.41,percent of total billed charges,38.7
LEAD,83655,CPT,,,,,both,, ,56.97,56.97,Blue Cross and Blue Shield,Traditional,,22.05,38.7,38.7,56.97,2.22,29.05,percent of total billed charges,38.7
LEAD,83655,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
Q22996 LEAD,83655,CPT,,,,,both,, ,615.75,615.75,Blue Cross and Blue Shield,Traditional,,238.3,38.7,38.7,615.75,24.01,314.03,percent of total billed charges,38.7
Q22996 LEAD,83655,CPT,,,,,both,, ,615.75,615.75,Blue Cross and Blue Shield,Traditional,,238.3,38.7,38.7,615.75,24.01,314.03,percent of total billed charges,38.7
Q36438 LEAD,83655,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
Q36440LEAD U24 ICPMS,83655,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,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,,267.53,38.7,38.7,691.29,26.96,352.56,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,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
Q7507 LEAD,83655,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
Q7655 LEAD,83655,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,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,,67.78,38.7,38.7,175.14,6.83,89.32,percent of total billed charges,38.7
"FETAL LUNG, FPIA",83663,CPT,,,,,both,, ,863.91,863.91,Blue Cross and Blue Shield,Traditional,,334.33,38.7,38.7,863.91,33.69,440.59,percent of total billed charges,38.7
LIPASE,83690,CPT,,,,,both,, ,67.92,67.92,Blue Cross and Blue Shield,Traditional,,26.29,38.7,38.7,67.92,2.65,34.64,percent of total billed charges,38.7
LIPASE,83690,CPT,,,,,both,,,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
LIPASE,83690,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
LIPOPROTEIN A,83695,CPT,,,,,both,, ,112.27,112.27,Blue Cross and Blue Shield,Traditional,,43.45,38.7,38.7,112.27,4.38,57.26,percent of total billed charges,38.7
LIPOPROTEIN A,83695,CPT,,,,,both,, ,112.27,112.27,Blue Cross and Blue Shield,Traditional,,43.45,38.7,38.7,112.27,4.38,57.26,percent of total billed charges,38.7
Q34604 LIPOPRT A ITA,83695,CPT,,,,,both,, ,467.04,467.04,Blue Cross and Blue Shield,Traditional,,180.74,38.7,38.7,467.04,18.21,238.19,percent of total billed charges,38.7
Q94220 LP-PLA2,83698,CPT,,,,,both,, ,216.39,216.39,Blue Cross and Blue Shield,Traditional,,83.74,38.7,38.7,216.39,8.44,110.36,percent of total billed charges,38.7
LIPOPROT BLD BY NMR,83704,CPT,,,,,both,, ,374.69,374.69,Blue Cross and Blue Shield,Traditional,,145.01,38.7,38.7,374.69,14.61,191.09,percent of total billed charges,38.7
LIPOPROT BLD BY NMR,83704,CPT,,,,,both,, ,374.69,374.69,Blue Cross and Blue Shield,Traditional,,145.01,38.7,38.7,374.69,14.61,191.09,percent of total billed charges,38.7
"LIPOPROTEIN, HDL",83718,CPT,,,,,both,, ,60.63,60.63,Blue Cross and Blue Shield,Traditional,,23.46,38.7,38.7,60.63,2.36,30.92,percent of total billed charges,38.7
"LIPOPROTEIN, HDL",83718,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,38.7,480.79,18.75,245.2,percent of total billed charges,38.7
"LIPOPROTEIN, LDL",83721,CPT,,,,,both,, ,570.89,570.89,Blue Cross and Blue Shield,Traditional,,220.93,38.7,38.7,570.89,22.26,291.15,percent of total billed charges,38.7
"L910235 MAGNESIUM, URINE",83735,CPT,,,,,both,, ,67,67,Blue Cross and Blue Shield,Traditional,,25.93,38.7,38.7,67,2.61,34.17,percent of total billed charges,38.7
"L910235 MAGNESIUM, URINE",83735,CPT,,,,,both,, ,67,67,Blue Cross and Blue Shield,Traditional,,25.93,38.7,38.7,67,2.61,34.17,percent of total billed charges,38.7
MAGNESIUM,83735,CPT,,,,,both,, ,49.68,49.68,Blue Cross and Blue Shield,Traditional,,19.23,38.7,38.7,49.68,1.94,25.34,percent of total billed charges,38.7
MAGNESIUM,83735,CPT,,,,,both,,,344.1,344.1,Blue Cross and Blue Shield,Traditional,,133.17,38.7,38.7,344.1,13.42,175.49,percent of total billed charges,38.7
MAGNESIUM,83735,CPT,,,,,both,, ,344.1,344.1,Blue Cross and Blue Shield,Traditional,,133.17,38.7,38.7,344.1,13.42,175.49,percent of total billed charges,38.7
MAGNESIUM,83735,CPT,,,,,both,, ,344.1,344.1,Blue Cross and Blue Shield,Traditional,,133.17,38.7,38.7,344.1,13.42,175.49,percent of total billed charges,38.7
MANGANESE WHOLE BLOOD,83785,CPT,,,,,both,, ,133,133,Blue Cross and Blue Shield,Traditional,,51.47,38.7,38.7,133,5.19,67.83,percent of total billed charges,38.7
L70034 I S/P ICP/MS,83789,CPT,,,,,both,, ,315,315,Blue Cross and Blue Shield,Traditional,,121.91,38.7,38.7,315,12.29,160.65,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,,151.12,38.7,38.7,390.49,15.23,199.15,percent of total billed charges,38.7
MASS SPECTRO QUANT,83789,CPT,,,,,both,, ,402.2,402.2,Blue Cross and Blue Shield,Traditional,,155.65,38.7,38.7,402.2,15.69,205.12,percent of total billed charges,38.7
MASS SPECTRO QUANT,83789,CPT,,,,,both,, ,402.2,402.2,Blue Cross and Blue Shield,Traditional,,155.65,38.7,38.7,402.2,15.69,205.12,percent of total billed charges,38.7
MERCURY,83825,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,38.7,751.36,29.3,383.19,percent of total billed charges,38.7
Q36438 MERCURY,83825,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,38.7,751.36,29.3,383.19,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,,290.78,38.7,38.7,751.36,29.3,383.19,percent of total billed charges,38.7
Q7507 MERCURY,83825,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,38.7,751.36,29.3,383.19,percent of total billed charges,38.7
Q7655 MERCURY,83825,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,38.7,751.36,29.3,383.19,percent of total billed charges,38.7
METANEPHRINES,83835,CPT,,,,,both,, ,2599.05,2599.05,Blue Cross and Blue Shield,Traditional,,1005.83,38.7,38.7,2599.05,101.36,1325.52,percent of total billed charges,38.7
Q14961 METANEPHRINES,83835,CPT,,,,,both,, ,488.65,488.65,Blue Cross and Blue Shield,Traditional,,189.11,38.7,38.7,488.65,19.06,249.21,percent of total billed charges,38.7
Q14962MNFR U24 LCMSM,83835,CPT,,,,,both,, ,488.65,488.65,Blue Cross and Blue Shield,Traditional,,189.11,38.7,38.7,488.65,19.06,249.21,percent of total billed charges,38.7
Q19548 MN FRC LCMSMS,83835,CPT,,,,,both,, ,488.65,488.65,Blue Cross and Blue Shield,Traditional,,189.11,38.7,38.7,488.65,19.06,249.21,percent of total billed charges,38.7
MYELIN BASIC PROTEIN,83873,CPT,,,,,both,, ,509.14,509.14,Blue Cross and Blue Shield,Traditional,,197.04,38.7,38.7,509.14,19.86,259.66,percent of total billed charges,38.7
MYELIN BASIC PROTEIN,83873,CPT,,,,,both,, ,509.14,509.14,Blue Cross and Blue Shield,Traditional,,197.04,38.7,38.7,509.14,19.86,259.66,percent of total billed charges,38.7
MYOGLOBIN,83874,CPT,,,,,both,, ,627.3,627.3,Blue Cross and Blue Shield,Traditional,,242.77,38.7,38.7,627.3,24.46,319.92,percent of total billed charges,38.7
MYOGLOBIN,83874,CPT,,,,,both,, ,627.3,627.3,Blue Cross and Blue Shield,Traditional,,242.77,38.7,38.7,627.3,24.46,319.92,percent of total billed charges,38.7
L143000 NT-PROBNP,83880,CPT,,,,,both,, ,450,450,Blue Cross and Blue Shield,Traditional,,174.15,38.7,38.7,450,17.55,229.5,percent of total billed charges,38.7
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,, ,279.55,279.55,Blue Cross and Blue Shield,Traditional,,108.19,38.7,38.7,279.55,10.9,142.57,percent of total billed charges,38.7
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,,,1229.07,1229.07,Blue Cross and Blue Shield,Traditional,,475.65,38.7,38.7,1229.07,47.93,626.83,percent of total billed charges,38.7
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,, ,1229.07,1229.07,Blue Cross and Blue Shield,Traditional,,475.65,38.7,38.7,1229.07,47.93,626.83,percent of total billed charges,38.7
"NEPHELOMETRY, NOS",83883,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
"NEPHELOMETRY, NOS",83883,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
Q38940 NEPHELOMETRY NOS,83883,CPT,,,,,both,, ,374.75,374.75,Blue Cross and Blue Shield,Traditional,,145.03,38.7,38.7,374.75,14.62,191.12,percent of total billed charges,38.7
NICKEL,83885,CPT,,,,,both,, ,934.09,934.09,Blue Cross and Blue Shield,Traditional,,361.49,38.7,38.7,934.09,36.43,476.39,percent of total billed charges,38.7
NUCLEOTIDASE 5',83915,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,38.7,871.22,33.98,444.32,percent of total billed charges,38.7
NUCLEOTIDASE 5',83915,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,38.7,871.22,33.98,444.32,percent of total billed charges,38.7
OLIGOCLONAL BANDS,83916,CPT,,,,,both,, ,530.75,530.75,Blue Cross and Blue Shield,Traditional,,205.4,38.7,38.7,530.75,20.7,270.68,percent of total billed charges,38.7
OLIGOCLONAL BANDS,83916,CPT,,,,,both,, ,530.75,530.75,Blue Cross and Blue Shield,Traditional,,205.4,38.7,38.7,530.75,20.7,270.68,percent of total billed charges,38.7
"ORGAN ACID,SIN,QUAN",83921,CPT,,,,,both,, ,396.02,396.02,Blue Cross and Blue Shield,Traditional,,153.26,38.7,38.7,396.02,15.44,201.97,percent of total billed charges,38.7
"ORGAN ACID,SIN,QUAN",83921,CPT,,,,,both,, ,396.02,396.02,Blue Cross and Blue Shield,Traditional,,153.26,38.7,38.7,396.02,15.44,201.97,percent of total billed charges,38.7
L2071 OSMALALITY FPD,83930,CPT,,,,,both,, ,40.89,40.89,Blue Cross and Blue Shield,Traditional,,15.82,38.7,38.7,40.89,1.59,20.85,percent of total billed charges,38.7
"OSMOLALITY, BLOOD",83930,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
L3442 OSMOLALI U FPD,83935,CPT,,,,,both,, ,50.9,50.9,Blue Cross and Blue Shield,Traditional,,19.7,38.7,38.7,50.9,1.99,25.96,percent of total billed charges,38.7
"OSMOLALITY,URINE",83935,CPT,,,,,both,, ,67.07,67.07,Blue Cross and Blue Shield,Traditional,,25.96,38.7,38.7,67.07,2.62,34.21,percent of total billed charges,38.7
"OSMOLALITY,URINE",83935,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
L10249 OSTREOC ELISA,83937,CPT,,,,,both,, ,203.6,203.6,Blue Cross and Blue Shield,Traditional,,78.79,38.7,38.7,203.6,7.94,103.84,percent of total billed charges,38.7
OSTEOCALCIN,83937,CPT,,,,,both,, ,447.39,447.39,Blue Cross and Blue Shield,Traditional,,173.14,38.7,38.7,447.39,17.45,228.17,percent of total billed charges,38.7
"L910235 OXALATE, URINE",83945,CPT,,,,,both,, ,660.98,660.98,Blue Cross and Blue Shield,Traditional,,255.8,38.7,38.7,660.98,25.78,337.1,percent of total billed charges,38.7
"L910235 OXALATE, URINE",83945,CPT,,,,,both,, ,660.98,660.98,Blue Cross and Blue Shield,Traditional,,255.8,38.7,38.7,660.98,25.78,337.1,percent of total billed charges,38.7
"L910235 OXALATE, URINE",83945,CPT,,,,,both,, ,660.98,660.98,Blue Cross and Blue Shield,Traditional,,255.8,38.7,38.7,660.98,25.78,337.1,percent of total billed charges,38.7
"L910235 OXALATE, URINE",83945,CPT,,,,,both,, ,660.98,660.98,Blue Cross and Blue Shield,Traditional,,255.8,38.7,38.7,660.98,25.78,337.1,percent of total billed charges,38.7
L15610 PTH INT ECLIA,83970,CPT,,,,,both,, ,420.49,420.49,Blue Cross and Blue Shield,Traditional,,162.73,38.7,38.7,420.49,16.4,214.45,percent of total billed charges,38.7
PARATHORMONE PTH,83970,CPT,,,,,both,, ,160.55,160.55,Blue Cross and Blue Shield,Traditional,,62.13,38.7,38.7,160.55,6.26,81.88,percent of total billed charges,38.7
PARATHORMONE PTH,83970,CPT,,,,,both,, ,1420.49,1420.49,Blue Cross and Blue Shield,Traditional,,549.73,38.7,38.7,1420.49,55.4,724.45,percent of total billed charges,38.7
"L910235 PH FLUID, NOS",83986,CPT,,,,,both,, ,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,38.7,240.26,9.37,122.53,percent of total billed charges,38.7
"PH FLUID,NOS",83986,CPT,,,,,both,, ,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,38.7,240.26,9.37,122.53,percent of total billed charges,38.7
"Q442 PH FLUID,NOS",83986,CPT,,,,,both,, ,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,38.7,240.26,9.37,122.53,percent of total billed charges,38.7
L790600 PCP MS,83992,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
CALPROTECTIN FECAL,83993,CPT,,,,,both,, ,395.75,395.75,Blue Cross and Blue Shield,Traditional,,153.16,38.7,38.7,395.75,15.43,201.83,percent of total billed charges,38.7
CALPROTECTIN FECAL,83993,CPT,,,,,both,, ,395.75,395.75,Blue Cross and Blue Shield,Traditional,,153.16,38.7,38.7,395.75,15.43,201.83,percent of total billed charges,38.7
NBS PHENYLALANINE BL,84030,CPT,,,,,both,, ,32.84,32.84,Blue Cross and Blue Shield,Traditional,,12.71,38.7,38.7,32.84,1.28,16.75,percent of total billed charges,38.7
NBS PHENYLALANINE BL,84030,CPT,,,,,both,, ,32.84,32.84,Blue Cross and Blue Shield,Traditional,,12.71,38.7,38.7,32.84,1.28,16.75,percent of total billed charges,38.7
"PHOSPHATASE, PROSTAT",84066,CPT,,,,,both,, ,540.85,540.85,Blue Cross and Blue Shield,Traditional,,209.31,38.7,38.7,540.85,21.09,275.83,percent of total billed charges,38.7
"PHOSPHATASE,ALKALINE",84075,CPT,,,,,both,, ,51.08,51.08,Blue Cross and Blue Shield,Traditional,,19.77,38.7,38.7,51.08,1.99,26.05,percent of total billed charges,38.7
"PHOSPHATASE,ALKALINE",84075,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
"PHOSPHATASE,ALKALINE",84075,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
"PHOSPHATASE,ALK ISO",84080,CPT,,,,,both,, ,637.41,637.41,Blue Cross and Blue Shield,Traditional,,246.68,38.7,38.7,637.41,24.86,325.08,percent of total billed charges,38.7
"PHOSPHATASE,ALK ISO",84080,CPT,,,,,both,, ,637.41,637.41,Blue Cross and Blue Shield,Traditional,,246.68,38.7,38.7,637.41,24.86,325.08,percent of total billed charges,38.7
PHOSPHATIDYLGLYCEROL,84081,CPT,,,,,both,, ,389.01,389.01,Blue Cross and Blue Shield,Traditional,,150.55,38.7,38.7,389.01,15.17,198.4,percent of total billed charges,38.7
"PHOSPHORUS, BLOOD",84100,CPT,,,,,both,, ,46.87,46.87,Blue Cross and Blue Shield,Traditional,,18.14,38.7,38.7,46.87,1.83,23.9,percent of total billed charges,38.7
"PHOSPHORUS, BLOOD",84100,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"L910235 PHOSPHORUS, URINE",84105,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"PHOSPHORUS, URINE",84105,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"Q442 PHOSPHORUS, URI",84105,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"PORPHOBILINOGEN,QUAN",84110,CPT,,,,,both,, ,630.96,630.96,Blue Cross and Blue Shield,Traditional,,244.18,38.7,38.7,630.96,24.61,321.79,percent of total billed charges,38.7
PAMG-1 QUALITATIVE,84112,CPT,,,,,both,, ,488.09,488.09,Blue Cross and Blue Shield,Traditional,,188.89,38.7,38.7,488.09,19.04,248.93,percent of total billed charges,38.7
L3194 PORPH QT U24,84120,CPT,,,,,both,, ,811.43,811.43,Blue Cross and Blue Shield,Traditional,,314.02,38.7,38.7,811.43,31.65,413.83,percent of total billed charges,38.7
"PORPHYRINS,UR,QUAN",84120,CPT,,,,,both,, ,811.42,811.42,Blue Cross and Blue Shield,Traditional,,314.02,38.7,38.7,811.42,31.65,413.82,percent of total billed charges,38.7
POTASSIUM SER PL WB,84132,CPT,,,,,both,, ,47.15,47.15,Blue Cross and Blue Shield,Traditional,,18.25,38.7,38.7,47.15,1.84,24.05,percent of total billed charges,38.7
POTASSIUM SER PL WB,84132,CPT,,,,,both,,,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,38.7,240.26,9.37,122.53,percent of total billed charges,38.7
POTASSIUM SER PL WB,84132,CPT,,,,,both,, ,240.26,240.26,Blue Cross and Blue Shield,Traditional,,92.98,38.7,38.7,240.26,9.37,122.53,percent of total billed charges,38.7
"L910235 POTASSIUM, URINE",84133,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"POTASSIUM, URINE",84133,CPT,,,,,both,,,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"POTASSIUM, URINE",84133,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"Q442 POTASSIUM, URIN",84133,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
PREALBUMIN,84134,CPT,,,,,both,, ,105.25,105.25,Blue Cross and Blue Shield,Traditional,,40.73,38.7,38.7,105.25,4.1,53.68,percent of total billed charges,38.7
PREALBUMIN,84134,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,38.7,1036.25,40.41,528.49,percent of total billed charges,38.7
PREGNENOLONE,84140,CPT,,,,,both,, ,164.75,164.75,Blue Cross and Blue Shield,Traditional,,63.76,38.7,38.7,164.75,6.43,84.02,percent of total billed charges,38.7
PREGNENOLONE,84140,CPT,,,,,both,, ,164.75,164.75,Blue Cross and Blue Shield,Traditional,,63.76,38.7,38.7,164.75,6.43,84.02,percent of total billed charges,38.7
"PREGNENOLONE,17-OH",84143,CPT,,,,,both,, ,387.89,387.89,Blue Cross and Blue Shield,Traditional,,150.11,38.7,38.7,387.89,15.13,197.82,percent of total billed charges,38.7
PROGESTERONE,84144,CPT,,,,,both,, ,62.58,62.58,Blue Cross and Blue Shield,Traditional,,24.22,38.7,38.7,62.58,2.44,31.92,percent of total billed charges,38.7
PROGESTERONE,84144,CPT,,,,,both,, ,1217.28,1217.28,Blue Cross and Blue Shield,Traditional,,471.09,38.7,38.7,1217.28,47.47,620.81,percent of total billed charges,38.7
PROGESTERONE,84144,CPT,,,,,both,, ,1217.28,1217.28,Blue Cross and Blue Shield,Traditional,,471.09,38.7,38.7,1217.28,47.47,620.81,percent of total billed charges,38.7
PROCALCITONIN PCT,84145,CPT,,,,,both,, ,232.11,232.11,Blue Cross and Blue Shield,Traditional,,89.83,38.7,38.7,232.11,9.05,118.38,percent of total billed charges,38.7
PROCALCITONIN PCT,84145,CPT,,,,,both,, ,232.11,232.11,Blue Cross and Blue Shield,Traditional,,89.83,38.7,38.7,232.11,9.05,118.38,percent of total billed charges,38.7
L4465 PROLACTI ECLIA,84146,CPT,,,,,both,, ,628.3,628.3,Blue Cross and Blue Shield,Traditional,,243.15,38.7,38.7,628.3,24.5,320.43,percent of total billed charges,38.7
PROLACTIN,84146,CPT,,,,,both,, ,143.14,143.14,Blue Cross and Blue Shield,Traditional,,55.4,38.7,38.7,143.14,5.58,73,percent of total billed charges,38.7
PROLACTIN,84146,CPT,,,,,both,, ,1077.5,1077.5,Blue Cross and Blue Shield,Traditional,,416.99,38.7,38.7,1077.5,42.02,549.53,percent of total billed charges,38.7
Q40049 PROLACTIN,84146,CPT,,,,,both,, ,959.75,959.75,Blue Cross and Blue Shield,Traditional,,371.42,38.7,38.7,959.75,37.43,489.47,percent of total billed charges,38.7
Q40049 PROLACTIN,84146,CPT,,,,,both,, ,959.75,959.75,Blue Cross and Blue Shield,Traditional,,371.42,38.7,38.7,959.75,37.43,489.47,percent of total billed charges,38.7
Q93958 23BPG UR,84150,CPT,,,,,both,, ,390.13,390.13,Blue Cross and Blue Shield,Traditional,,150.98,38.7,38.7,390.13,15.22,198.97,percent of total billed charges,38.7
PSA (prostate specific antigen),84153,CPT,,,,,both,,,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,38.7,1036.25,40.41,528.49,percent of total billed charges,38.7
"PSA, TOTAL",84153,CPT,,,,,both,, ,135.85,135.85,Blue Cross and Blue Shield,Traditional,,52.57,38.7,38.7,135.85,5.3,69.28,percent of total billed charges,38.7
"PSA, TOTAL",84153,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,38.7,1036.25,40.41,528.49,percent of total billed charges,38.7
"PSA, TOTAL",84153,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,38.7,1036.25,40.41,528.49,percent of total billed charges,38.7
PSA (prostate specific antigen),84154,CPT,,,,,both,,,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,38.7,1036.25,40.41,528.49,percent of total billed charges,38.7
"PSA, FREE",84154,CPT,,,,,both,, ,135.85,135.85,Blue Cross and Blue Shield,Traditional,,52.57,38.7,38.7,135.85,5.3,69.28,percent of total billed charges,38.7
"PSA, FREE",84154,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,38.7,1036.25,40.41,528.49,percent of total billed charges,38.7
"PSA, FREE",84154,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,38.7,1036.25,40.41,528.49,percent of total billed charges,38.7
PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,35.93,35.93,Blue Cross and Blue Shield,Traditional,,13.9,38.7,38.7,35.93,1.4,18.32,percent of total billed charges,38.7
Q10269 PROT TOT SER,84155,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
Q10269 PROT TOT SER,84155,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
Q10269 PROT TOT SER,84155,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
Q10269 PROT TOT SER,84155,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,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,,145.03,38.7,38.7,374.75,14.62,191.12,percent of total billed charges,38.7
PROT TOTL RANDOM URI,84156,CPT,,,,,both,,,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
PROT TOTL RANDOM URI,84156,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
PROT TOTL RANDOM URI,84156,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
PROTEIN TOT OTHR SRC,84157,CPT,,,,,both,, ,35.93,35.93,Blue Cross and Blue Shield,Traditional,,13.9,38.7,38.7,35.93,1.4,18.32,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,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
PROTEINELECTR FR-QNT,84165,CPT,,,,,both,, ,105.81,105.81,Blue Cross and Blue Shield,Traditional,,40.95,38.7,38.7,105.81,4.13,53.96,percent of total billed charges,38.7
Q10269 SPE FR QT,84165,CPT,,,,,both,, ,609.34,609.34,Blue Cross and Blue Shield,Traditional,,235.81,38.7,38.7,609.34,23.76,310.76,percent of total billed charges,38.7
Q10269 SPE FR QT,84165,CPT,,,,,both,, ,609.34,609.34,Blue Cross and Blue Shield,Traditional,,235.81,38.7,38.7,609.34,23.76,310.76,percent of total billed charges,38.7
Q10269 SPE FR QT,84165,CPT,,,,,both,, ,609.34,609.34,Blue Cross and Blue Shield,Traditional,,235.81,38.7,38.7,609.34,23.76,310.76,percent of total billed charges,38.7
Q10269 SPE FR QT,84165,CPT,,,,,both,, ,609.34,609.34,Blue Cross and Blue Shield,Traditional,,235.81,38.7,38.7,609.34,23.76,310.76,percent of total billed charges,38.7
Q38940 PROTEINELECTR FR QNT,84165,CPT,,,,,both,, ,542.75,542.75,Blue Cross and Blue Shield,Traditional,,210.04,38.7,38.7,542.75,21.17,276.8,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,,166.3,38.7,38.7,429.71,16.76,219.15,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,,166.3,38.7,38.7,429.71,16.76,219.15,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,,166.3,38.7,38.7,429.71,16.76,219.15,percent of total billed charges,38.7
Q94685 WEST BLOT PRB,84182,CPT,,,,,both,, ,136.4,136.4,Blue Cross and Blue Shield,Traditional,,52.79,38.7,38.7,136.4,5.32,69.56,percent of total billed charges,38.7
Q94685 WEST BLOT PRB,84182,CPT,,,,,both,, ,136.4,136.4,Blue Cross and Blue Shield,Traditional,,52.79,38.7,38.7,136.4,5.32,69.56,percent of total billed charges,38.7
"PROTOPORPH,RBC,QUAN",84202,CPT,,,,,both,, ,199.27,199.27,Blue Cross and Blue Shield,Traditional,,77.12,38.7,38.7,199.27,7.77,101.63,percent of total billed charges,38.7
"PROTOPORPH,RBC,QUAN",84202,CPT,,,,,both,, ,199.27,199.27,Blue Cross and Blue Shield,Traditional,,77.12,38.7,38.7,199.27,7.77,101.63,percent of total billed charges,38.7
Q22996 PROTOPORPH RBC QUAN,84202,CPT,,,,,both,, ,177.5,177.5,Blue Cross and Blue Shield,Traditional,,68.69,38.7,38.7,177.5,6.92,90.53,percent of total billed charges,38.7
PROINSULIN,84206,CPT,,,,,both,, ,266.91,266.91,Blue Cross and Blue Shield,Traditional,,103.29,38.7,38.7,266.91,10.41,136.12,percent of total billed charges,38.7
Q760 PROINSULIN IA,84206,CPT,,,,,both,, ,337.09,337.09,Blue Cross and Blue Shield,Traditional,,130.45,38.7,38.7,337.09,13.15,171.92,percent of total billed charges,38.7
VITAMIN B-6,84207,CPT,,,,,both,, ,738.17,738.17,Blue Cross and Blue Shield,Traditional,,285.67,38.7,38.7,738.17,28.79,376.47,percent of total billed charges,38.7
VITAMIN B-6,84207,CPT,,,,,both,, ,738.17,738.17,Blue Cross and Blue Shield,Traditional,,285.67,38.7,38.7,738.17,28.79,376.47,percent of total billed charges,38.7
PYRUVATE,84210,CPT,,,,,both,, ,1066.84,1066.84,Blue Cross and Blue Shield,Traditional,,412.87,38.7,38.7,1066.84,41.61,544.09,percent of total billed charges,38.7
"RECEPTOR, NON-ENDO",84238,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,38.7,326.71,12.74,166.62,percent of total billed charges,38.7
"RECEPTOR, NON-ENDO",84238,CPT,,,,,both,, ,326.71,326.71,Blue Cross and Blue Shield,Traditional,,126.44,38.7,38.7,326.71,12.74,166.62,percent of total billed charges,38.7
Q16846 PL REN LCMSMS,84244,CPT,,,,,both,, ,475.46,475.46,Blue Cross and Blue Shield,Traditional,,184,38.7,38.7,475.46,18.54,242.48,percent of total billed charges,38.7
Q16846 PL REN LCMSMS,84244,CPT,,,,,both,, ,475.46,475.46,Blue Cross and Blue Shield,Traditional,,184,38.7,38.7,475.46,18.54,242.48,percent of total billed charges,38.7
RENIN,84244,CPT,,,,,both,, ,1487.01,1487.01,Blue Cross and Blue Shield,Traditional,,575.47,38.7,38.7,1487.01,57.99,758.38,percent of total billed charges,38.7
VITAMIN B-2,84252,CPT,,,,,both,, ,180.75,180.75,Blue Cross and Blue Shield,Traditional,,69.95,38.7,38.7,180.75,7.05,92.18,percent of total billed charges,38.7
SELENIUM,84255,CPT,,,,,both,, ,409.5,409.5,Blue Cross and Blue Shield,Traditional,,158.48,38.7,38.7,409.5,15.97,208.85,percent of total billed charges,38.7
SELENIUM,84255,CPT,,,,,both,, ,409.5,409.5,Blue Cross and Blue Shield,Traditional,,158.48,38.7,38.7,409.5,15.97,208.85,percent of total billed charges,38.7
SEROTONIN,84260,CPT,,,,,both,, ,94.58,94.58,Blue Cross and Blue Shield,Traditional,,36.6,38.7,38.7,94.58,3.69,48.24,percent of total billed charges,38.7
Q14966 SEX HORM BIND,84270,CPT,,,,,both,, ,288.25,288.25,Blue Cross and Blue Shield,Traditional,,111.55,38.7,38.7,288.25,11.24,147.01,percent of total billed charges,38.7
Q30740 SHBG IA,84270,CPT,,,,,both,, ,288.25,288.25,Blue Cross and Blue Shield,Traditional,,111.55,38.7,38.7,288.25,11.24,147.01,percent of total billed charges,38.7
SEX HORM BIND GLOB,84270,CPT,,,,,both,, ,288.25,288.25,Blue Cross and Blue Shield,Traditional,,111.55,38.7,38.7,288.25,11.24,147.01,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,,18.36,38.7,38.7,47.43,1.85,24.19,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,,133.82,38.7,38.7,345.79,13.49,176.35,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,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"L910235 SODIUM, URINE",84300,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"Q442 SODIUM, URINE R",84300,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,, ,47.99,47.99,Blue Cross and Blue Shield,Traditional,,18.57,38.7,38.7,47.99,1.87,24.47,percent of total billed charges,38.7
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,,,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
SODIUM OTHER SOURCE,84302,CPT,,,,,both,, ,82.51,82.51,Blue Cross and Blue Shield,Traditional,,31.93,38.7,38.7,82.51,3.22,42.08,percent of total billed charges,38.7
SOMATOMEDIN,84305,CPT,,,,,both,, ,870.37,870.37,Blue Cross and Blue Shield,Traditional,,336.83,38.7,38.7,870.37,33.94,443.89,percent of total billed charges,38.7
SOMATOMEDIN,84305,CPT,,,,,both,, ,870.37,870.37,Blue Cross and Blue Shield,Traditional,,336.83,38.7,38.7,870.37,33.94,443.89,percent of total billed charges,38.7
ADENO DEAMNASE BFLD,84311,CPT,,,,,both,, ,93.74,93.74,Blue Cross and Blue Shield,Traditional,,36.28,38.7,38.7,93.74,3.66,47.81,percent of total billed charges,38.7
Q175858 CHOLEST PF C,84311,CPT,,,,,both,, ,93.74,93.74,Blue Cross and Blue Shield,Traditional,,36.28,38.7,38.7,93.74,3.66,47.81,percent of total billed charges,38.7
"SPECTROPHOTO, NOS",84311,CPT,,,,,both,, ,93.74,93.74,Blue Cross and Blue Shield,Traditional,,36.28,38.7,38.7,93.74,3.66,47.81,percent of total billed charges,38.7
SPECIFIC GRAVITY,84315,CPT,,,,,both,, ,210.5,210.5,Blue Cross and Blue Shield,Traditional,,81.46,38.7,38.7,210.5,8.21,107.36,percent of total billed charges,38.7
"SUGARS, SING, QUAL",84376,CPT,,,,,both,, ,93.74,93.74,Blue Cross and Blue Shield,Traditional,,36.28,38.7,38.7,93.74,3.66,47.81,percent of total billed charges,38.7
GLYCOMARK,84378,CPT,,,,,both,, ,224,224,Blue Cross and Blue Shield,Traditional,,86.69,38.7,38.7,224,8.74,114.24,percent of total billed charges,38.7
"L910235 SULFATE, URINE",84392,CPT,,,,,both,, ,31.71,31.71,Blue Cross and Blue Shield,Traditional,,12.27,38.7,38.7,31.71,1.24,16.17,percent of total billed charges,38.7
"L910235 SULFATE, URINE",84392,CPT,,,,,both,, ,31.71,31.71,Blue Cross and Blue Shield,Traditional,,12.27,38.7,38.7,31.71,1.24,16.17,percent of total billed charges,38.7
Q18944 TST FREE,84402,CPT,,,,,both,, ,1017.17,1017.17,Blue Cross and Blue Shield,Traditional,,393.64,38.7,38.7,1017.17,39.67,518.76,percent of total billed charges,38.7
Q36170 TESTOST FREE,84402,CPT,,,,,both,,,1017.17,1017.17,Blue Cross and Blue Shield,Traditional,,393.64,38.7,38.7,1017.17,39.67,518.76,percent of total billed charges,38.7
Q36170 TESTOST FREE,84402,CPT,,,,,both,, ,1017.17,1017.17,Blue Cross and Blue Shield,Traditional,,393.64,38.7,38.7,1017.17,39.67,518.76,percent of total billed charges,38.7
"TESTOSTERONE, FREE",84402,CPT,,,,,both,, ,1017.17,1017.17,Blue Cross and Blue Shield,Traditional,,393.64,38.7,38.7,1017.17,39.67,518.76,percent of total billed charges,38.7
Q14966 TESTOST TOTAL,84403,CPT,,,,,both,, ,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,percent of total billed charges,38.7
Q36170 TESTOST TOTAL,84403,CPT,,,,,both,,,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,percent of total billed charges,38.7
Q36170 TESTOST TOTAL,84403,CPT,,,,,both,, ,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,percent of total billed charges,38.7
"TESTOSTERONE, TOTAL",84403,CPT,,,,,both,, ,190.86,190.86,Blue Cross and Blue Shield,Traditional,,73.86,38.7,38.7,190.86,7.44,97.34,percent of total billed charges,38.7
"TESTOSTERONE, TOTAL",84403,CPT,,,,,both,, ,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,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,,81.72,38.7,38.7,211.15,8.23,107.69,percent of total billed charges,38.7
L121186VITB1 BL HPLC,84425,CPT,,,,,both,, ,1318.66,1318.66,Blue Cross and Blue Shield,Traditional,,510.32,38.7,38.7,1318.66,51.43,672.52,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,,104.16,38.7,38.7,269.16,10.5,137.27,percent of total billed charges,38.7
Q90353 VIT B1 LCMSMS,84425,CPT,,,,,both,, ,303.69,303.69,Blue Cross and Blue Shield,Traditional,,117.53,38.7,38.7,303.69,11.84,154.88,percent of total billed charges,38.7
VITAMIN B-1,84425,CPT,,,,,both,, ,156.89,156.89,Blue Cross and Blue Shield,Traditional,,60.72,38.7,38.7,156.89,6.12,80.01,percent of total billed charges,38.7
VITAMIN B-1,84425,CPT,,,,,both,, ,1437.33,1437.33,Blue Cross and Blue Shield,Traditional,,556.25,38.7,38.7,1437.33,56.06,733.04,percent of total billed charges,38.7
THIOCYANATE,84430,CPT,,,,,both,, ,174.57,174.57,Blue Cross and Blue Shield,Traditional,,67.56,38.7,38.7,174.57,6.81,89.03,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,,98.74,38.7,38.7,255.13,9.95,130.12,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,,98.74,38.7,38.7,255.13,9.95,130.12,percent of total billed charges,38.7
"THYROXINE T4,TOTAL",84436,CPT,,,,,both,, ,38.73,38.73,Blue Cross and Blue Shield,Traditional,,14.99,38.7,38.7,38.73,1.51,19.75,percent of total billed charges,38.7
"THYROXINE T4,TOTAL",84436,CPT,,,,,both,, ,405.57,405.57,Blue Cross and Blue Shield,Traditional,,156.96,38.7,38.7,405.57,15.82,206.84,percent of total billed charges,38.7
"THYROXINE T4, FREE",84439,CPT,,,,,both,, ,66.52,66.52,Blue Cross and Blue Shield,Traditional,,25.74,38.7,38.7,66.52,2.59,33.93,percent of total billed charges,38.7
"THYROXINE T4, FREE",84439,CPT,,,,,both,,,620.56,620.56,Blue Cross and Blue Shield,Traditional,,240.16,38.7,38.7,620.56,24.2,316.49,percent of total billed charges,38.7
"THYROXINE T4, FREE",84439,CPT,,,,,both,, ,620.56,620.56,Blue Cross and Blue Shield,Traditional,,240.16,38.7,38.7,620.56,24.2,316.49,percent of total billed charges,38.7
"THYROXINE T4, FREE",84439,CPT,,,,,both,, ,620.56,620.56,Blue Cross and Blue Shield,Traditional,,240.16,38.7,38.7,620.56,24.2,316.49,percent of total billed charges,38.7
L1735 TBG SER ICMA,84442,CPT,,,,,both,, ,195.7,195.7,Blue Cross and Blue Shield,Traditional,,75.74,38.7,38.7,195.7,7.63,99.81,percent of total billed charges,38.7
THYROXINE BIND GLOB,84442,CPT,,,,,both,, ,213.31,213.31,Blue Cross and Blue Shield,Traditional,,82.55,38.7,38.7,213.31,8.32,108.79,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,,285.46,38.7,38.7,737.61,28.77,376.18,percent of total billed charges,38.7
THYROID STIM TSH,84443,CPT,,,,,both,, ,124.05,124.05,Blue Cross and Blue Shield,Traditional,,48.01,38.7,38.7,124.05,4.84,63.27,percent of total billed charges,38.7
THYROID STIM TSH,84443,CPT,,,,,both,, ,737.61,737.61,Blue Cross and Blue Shield,Traditional,,285.46,38.7,38.7,737.61,28.77,376.18,percent of total billed charges,38.7
THYROID STIM TSH,84443,CPT,,,,,both,, ,737.61,737.61,Blue Cross and Blue Shield,Traditional,,285.46,38.7,38.7,737.61,28.77,376.18,percent of total billed charges,38.7
Q30551 TSI IA,84445,CPT,,,,,both,, ,733.12,733.12,Blue Cross and Blue Shield,Traditional,,283.72,38.7,38.7,733.12,28.59,373.89,percent of total billed charges,38.7
THYROID STIM IMMUNO,84445,CPT,,,,,both,, ,1178.27,1178.27,Blue Cross and Blue Shield,Traditional,,455.99,38.7,38.7,1178.27,45.95,600.92,percent of total billed charges,38.7
VITAMIN E,84446,CPT,,,,,both,, ,227.62,227.62,Blue Cross and Blue Shield,Traditional,,88.09,38.7,38.7,227.62,8.88,116.09,percent of total billed charges,38.7
VITAMIN E,84446,CPT,,,,,both,, ,227.62,227.62,Blue Cross and Blue Shield,Traditional,,88.09,38.7,38.7,227.62,8.88,116.09,percent of total billed charges,38.7
L500440 TRANSCORTIN,84449,CPT,,,,,both,, ,180,180,Blue Cross and Blue Shield,Traditional,,69.66,38.7,38.7,180,7.02,91.8,percent of total billed charges,38.7
TRANSFERASE AST,84450,CPT,,,,,both,, ,38.17,38.17,Blue Cross and Blue Shield,Traditional,,14.77,38.7,38.7,38.17,1.49,19.47,percent of total billed charges,38.7
TRANSFERASE AST,84450,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
TRANSFERASE ALT,84460,CPT,,,,,both,, ,39.29,39.29,Blue Cross and Blue Shield,Traditional,,15.21,38.7,38.7,39.29,1.53,20.04,percent of total billed charges,38.7
TRANSFERASE ALT,84460,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
TRANSFERRIN,84466,CPT,,,,,both,, ,94.31,94.31,Blue Cross and Blue Shield,Traditional,,36.5,38.7,38.7,94.31,3.68,48.1,percent of total billed charges,38.7
TRANSFERRIN,84466,CPT,,,,,both,, ,796.55,796.55,Blue Cross and Blue Shield,Traditional,,308.26,38.7,38.7,796.55,31.07,406.24,percent of total billed charges,38.7
TRANSFERRIN,84466,CPT,,,,,both,, ,796.55,796.55,Blue Cross and Blue Shield,Traditional,,308.26,38.7,38.7,796.55,31.07,406.24,percent of total billed charges,38.7
TRIGLYCERIDES,84478,CPT,,,,,both,, ,39.29,39.29,Blue Cross and Blue Shield,Traditional,,15.21,38.7,38.7,39.29,1.53,20.04,percent of total billed charges,38.7
TRIGLYCERIDES,84478,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
T3-T4 UPTAKE,84479,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,38.7,526.26,20.52,268.39,percent of total billed charges,38.7
"T3,TOTAL",84480,CPT,,,,,both,, ,1039.33,1039.33,Blue Cross and Blue Shield,Traditional,,402.22,38.7,38.7,1039.33,40.53,530.06,percent of total billed charges,38.7
"T3,FREE",84481,CPT,,,,,both,, ,858.3,858.3,Blue Cross and Blue Shield,Traditional,,332.16,38.7,38.7,858.3,33.47,437.73,percent of total billed charges,38.7
Q90963 T3 REV LCMSMS,84482,CPT,,,,,both,, ,858.3,858.3,Blue Cross and Blue Shield,Traditional,,332.16,38.7,38.7,858.3,33.47,437.73,percent of total billed charges,38.7
"T3,REVERSE",84482,CPT,,,,,both,, ,219.2,219.2,Blue Cross and Blue Shield,Traditional,,84.83,38.7,38.7,219.2,8.55,111.79,percent of total billed charges,38.7
"TROPONIN,QNT",84484,CPT,,,,,both,, ,133.88,133.88,Blue Cross and Blue Shield,Traditional,,51.81,38.7,38.7,133.88,5.22,68.28,percent of total billed charges,38.7
"TROPONIN,QNT",84484,CPT,,,,,both,,,713.19,713.19,Blue Cross and Blue Shield,Traditional,,276,38.7,38.7,713.19,27.81,363.73,percent of total billed charges,38.7
"TROPONIN,QNT",84484,CPT,,,,,both,, ,713.19,713.19,Blue Cross and Blue Shield,Traditional,,276,38.7,38.7,713.19,27.81,363.73,percent of total billed charges,38.7
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,, ,29.19,29.19,Blue Cross and Blue Shield,Traditional,,11.3,38.7,38.7,29.19,1.14,14.89,percent of total billed charges,38.7
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,,,277.59,277.59,Blue Cross and Blue Shield,Traditional,,107.43,38.7,38.7,277.59,10.83,141.57,percent of total billed charges,38.7
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,, ,277.59,277.59,Blue Cross and Blue Shield,Traditional,,107.43,38.7,38.7,277.59,10.83,141.57,percent of total billed charges,38.7
"UREA NITROGEN,URINE",84540,CPT,,,,,both,,,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"UREA NITROGEN,URINE",84540,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"UREA NITROGEN,URINE",84540,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"URIC ACID, BLOOD",84550,CPT,,,,,both,, ,44.34,44.34,Blue Cross and Blue Shield,Traditional,,17.16,38.7,38.7,44.34,1.73,22.61,percent of total billed charges,38.7
"URIC ACID, BLOOD",84550,CPT,,,,,both,,,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,38.7,285.17,11.12,145.44,percent of total billed charges,38.7
"URIC ACID, BLOOD",84550,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,38.7,285.17,11.12,145.44,percent of total billed charges,38.7
"L910235 URIC ACID, URINE",84560,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"Q442 URIC ACID,URINE",84560,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"URIC ACID,URINE RAND",84560,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
VANILLYLMANDELIC ACID (VMA) SERUM,84585,CPT,,,,,both,, ,116.7,116.7,Blue Cross and Blue Shield,Traditional,,45.16,38.7,38.7,116.7,4.55,59.52,percent of total billed charges,38.7
"VMA, URINE",84585,CPT,,,,,both,, ,355.05,355.05,Blue Cross and Blue Shield,Traditional,,137.4,38.7,38.7,355.05,13.85,181.08,percent of total billed charges,38.7
"VMA, URINE",84585,CPT,,,,,both,, ,355.05,355.05,Blue Cross and Blue Shield,Traditional,,137.4,38.7,38.7,355.05,13.85,181.08,percent of total billed charges,38.7
L10397 VIP PL RIA,84586,CPT,,,,,both,, ,338.36,338.36,Blue Cross and Blue Shield,Traditional,,130.95,38.7,38.7,338.36,13.2,172.56,percent of total billed charges,38.7
VASOINTESTINAL PEP,84586,CPT,,,,,both,, ,368.8,368.8,Blue Cross and Blue Shield,Traditional,,142.73,38.7,38.7,368.8,14.38,188.09,percent of total billed charges,38.7
VASOPRESSIN,84588,CPT,,,,,both,, ,295.83,295.83,Blue Cross and Blue Shield,Traditional,,114.49,38.7,38.7,295.83,11.54,150.87,percent of total billed charges,38.7
VASOPRESSIN,84588,CPT,,,,,both,, ,295.83,295.83,Blue Cross and Blue Shield,Traditional,,114.49,38.7,38.7,295.83,11.54,150.87,percent of total billed charges,38.7
VITAMIN A,84590,CPT,,,,,both,, ,186.08,186.08,Blue Cross and Blue Shield,Traditional,,72.01,38.7,38.7,186.08,7.26,94.9,percent of total billed charges,38.7
VITAMIN A,84590,CPT,,,,,both,, ,186.08,186.08,Blue Cross and Blue Shield,Traditional,,72.01,38.7,38.7,186.08,7.26,94.9,percent of total billed charges,38.7
"VITAMIN ASSAY, NOS",84591,CPT,,,,,both,, ,197.03,197.03,Blue Cross and Blue Shield,Traditional,,76.25,38.7,38.7,197.03,7.68,100.49,percent of total billed charges,38.7
VITAMIN K,84597,CPT,,,,,both,, ,188.89,188.89,Blue Cross and Blue Shield,Traditional,,73.1,38.7,38.7,188.89,7.37,96.33,percent of total billed charges,38.7
VITAMIN K,84597,CPT,,,,,both,, ,188.89,188.89,Blue Cross and Blue Shield,Traditional,,73.1,38.7,38.7,188.89,7.37,96.33,percent of total billed charges,38.7
VOLATILES,84600,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,38.7,728.07,28.39,371.32,percent of total billed charges,38.7
XYLOSE ABSORPTION,84620,CPT,,,,,both,, ,1111.47,1111.47,Blue Cross and Blue Shield,Traditional,,430.14,38.7,38.7,1111.47,43.35,566.85,percent of total billed charges,38.7
ZINC,84630,CPT,,,,,both,, ,1081.72,1081.72,Blue Cross and Blue Shield,Traditional,,418.63,38.7,38.7,1081.72,42.19,551.68,percent of total billed charges,38.7
ZINC,84630,CPT,,,,,both,, ,1081.72,1081.72,Blue Cross and Blue Shield,Traditional,,418.63,38.7,38.7,1081.72,42.19,551.68,percent of total billed charges,38.7
ZINC WHOLE BLOOD,84630,CPT,,,,,both,, ,80,80,Blue Cross and Blue Shield,Traditional,,30.96,38.7,38.7,80,3.12,40.8,percent of total billed charges,38.7
C-PEPTIDE,84681,CPT,,,,,both,, ,898.44,898.44,Blue Cross and Blue Shield,Traditional,,347.7,38.7,38.7,898.44,35.04,458.2,percent of total billed charges,38.7
C-PEPTIDE,84681,CPT,,,,,both,, ,898.44,898.44,Blue Cross and Blue Shield,Traditional,,347.7,38.7,38.7,898.44,35.04,458.2,percent of total billed charges,38.7
HCG QUANT,84702,CPT,,,,,both,, ,148.47,148.47,Blue Cross and Blue Shield,Traditional,,57.46,38.7,38.7,148.47,5.79,75.72,percent of total billed charges,38.7
HCG QUANT,84702,CPT,,,,,both,, ,758.66,758.66,Blue Cross and Blue Shield,Traditional,,293.6,38.7,38.7,758.66,29.59,386.92,percent of total billed charges,38.7
HCG QUANT,84702,CPT,,,,,both,, ,758.66,758.66,Blue Cross and Blue Shield,Traditional,,293.6,38.7,38.7,758.66,29.59,386.92,percent of total billed charges,38.7
"HCG, QUAL",84703,CPT,,,,,both,, ,74.1,74.1,Blue Cross and Blue Shield,Traditional,,28.68,38.7,38.7,74.1,2.89,37.79,percent of total billed charges,38.7
"HCG, QUAL",84703,CPT,,,,,both,,,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
"HCG, QUAL",84703,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
CLIN CHEM TEST NOS,84999,CPT,,,,,both,, ,274.5,274.5,Blue Cross and Blue Shield,Traditional,,106.23,38.7,38.7,274.5,10.71,140,percent of total billed charges,38.7
L123413 TMAO,84999,CPT,,,,,both,, ,225,225,Blue Cross and Blue Shield,Traditional,,87.08,38.7,38.7,225,8.78,114.75,percent of total billed charges,38.7
L123413 TMAO,84999,CPT,,,,,both,, ,225,225,Blue Cross and Blue Shield,Traditional,,87.08,38.7,38.7,225,8.78,114.75,percent of total billed charges,38.7
BLEEDING TIME,85002,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
AUTO DIFF WBC COUNT,85004,CPT,,,,,both,, ,47.99,47.99,Blue Cross and Blue Shield,Traditional,,18.57,38.7,38.7,47.99,1.87,24.47,percent of total billed charges,38.7
AUTO DIFF WBC COUNT,85004,CPT,,,,,both,, ,103,103,Blue Cross and Blue Shield,Traditional,,39.86,38.7,38.7,103,4.02,52.53,percent of total billed charges,38.7
"WBC DIFF, MAN",85007,CPT,,,,,both,, ,33.96,33.96,Blue Cross and Blue Shield,Traditional,,13.14,38.7,38.7,33.96,1.32,17.32,percent of total billed charges,38.7
"WBC DIFF, MAN",85007,CPT,,,,,both,, ,188.33,188.33,Blue Cross and Blue Shield,Traditional,,72.88,38.7,38.7,188.33,7.34,96.05,percent of total billed charges,38.7
BLOOD SMEAR SCAN,85008,CPT,,,,,both,, ,112.55,112.55,Blue Cross and Blue Shield,Traditional,,43.56,38.7,38.7,112.55,4.39,57.4,percent of total billed charges,38.7
"HEMATOCRIT, SPUN",85013,CPT,,,,,both,, ,32.84,32.84,Blue Cross and Blue Shield,Traditional,,12.71,38.7,38.7,32.84,1.28,16.75,percent of total billed charges,38.7
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,, ,13.18,13.18,Blue Cross and Blue Shield,Traditional,,5.1,38.7,38.7,13.18,0.51,6.72,percent of total billed charges,38.7
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,,,262.99,262.99,Blue Cross and Blue Shield,Traditional,,101.78,38.7,38.7,262.99,10.26,134.12,percent of total billed charges,38.7
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,, ,262.99,262.99,Blue Cross and Blue Shield,Traditional,,101.78,38.7,38.7,262.99,10.26,134.12,percent of total billed charges,38.7
HEMOGLOBIN,85018,CPT,,,,,both,, ,13.18,13.18,Blue Cross and Blue Shield,Traditional,,5.1,38.7,38.7,13.18,0.51,6.72,percent of total billed charges,38.7
HEMOGLOBIN,85018,CPT,,,,,both,,,262.99,262.99,Blue Cross and Blue Shield,Traditional,,101.78,38.7,38.7,262.99,10.26,134.12,percent of total billed charges,38.7
HEMOGLOBIN,85018,CPT,,,,,both,, ,262.99,262.99,Blue Cross and Blue Shield,Traditional,,101.78,38.7,38.7,262.99,10.26,134.12,percent of total billed charges,38.7
HEMOGLOBIN,85018,CPT,,,,,both,, ,262.99,262.99,Blue Cross and Blue Shield,Traditional,,101.78,38.7,38.7,262.99,10.26,134.12,percent of total billed charges,38.7
L121003 HEMOGLOBIN,85018,CPT,,,,,both,, ,10,10,Blue Cross and Blue Shield,Traditional,,3.87,38.7,38.7,10,0.39,5.1,percent of total billed charges,38.7
CBC W-PLT AUTO COMPD,85025,CPT,,,,,both,, ,28.9,28.9,Blue Cross and Blue Shield,Traditional,,11.18,38.7,38.7,28.9,1.13,14.74,percent of total billed charges,38.7
CBC W-PLT AUTO COMPD,85025,CPT,,,,,both,, ,428.3,428.3,Blue Cross and Blue Shield,Traditional,,165.75,38.7,38.7,428.3,16.7,218.43,percent of total billed charges,38.7
"Complete blood cell count, with differential white blood cells, automated",85025,CPT,,,,,both,,,428.3,428.3,Blue Cross and Blue Shield,Traditional,,165.75,38.7,38.7,428.3,16.7,218.43,percent of total billed charges,38.7
CBC W-PLT,85027,CPT,,,,,both,, ,24.13,24.13,Blue Cross and Blue Shield,Traditional,,9.34,38.7,38.7,24.13,0.94,12.31,percent of total billed charges,38.7
CBC W-PLT,85027,CPT,,,,,both,, ,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,38.7,412.87,16.1,210.56,percent of total billed charges,38.7
"Complete blood count, automated",85027,CPT,,,,,both,,,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,38.7,412.87,16.1,210.56,percent of total billed charges,38.7
MAN CELL CT ELP,85032,CPT,,,,,both,, ,466.48,466.48,Blue Cross and Blue Shield,Traditional,,180.53,38.7,38.7,466.48,18.19,237.9,percent of total billed charges,38.7
L1917 RBC COUNT,85041,CPT,,,,,both,, ,6.06,6.06,Blue Cross and Blue Shield,Traditional,,2.35,38.7,38.7,6.06,0.24,3.09,percent of total billed charges,38.7
"RETIC COUNT, MANUAL",85044,CPT,,,,,both,, ,489.78,489.78,Blue Cross and Blue Shield,Traditional,,189.54,38.7,38.7,489.78,19.1,249.79,percent of total billed charges,38.7
"RETIC COUNT, FLOW",85045,CPT,,,,,both,, ,39.29,39.29,Blue Cross and Blue Shield,Traditional,,15.21,38.7,38.7,39.29,1.53,20.04,percent of total billed charges,38.7
"RETIC COUNT, FLOW",85045,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
WBC COUNT,85048,CPT,,,,,both,, ,16.55,16.55,Blue Cross and Blue Shield,Traditional,,6.4,38.7,38.7,16.55,0.65,8.44,percent of total billed charges,38.7
WBC COUNT,85048,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,38.7,285.17,11.12,145.44,percent of total billed charges,38.7
CBC-PLT AUTORP CDM,85049,CPT,,,,,both,, ,16.55,16.55,Blue Cross and Blue Shield,Traditional,,6.4,38.7,38.7,16.55,0.65,8.44,percent of total billed charges,38.7
CBC-PLT AUTORP CDM,85049,CPT,,,,,both,, ,285.17,285.17,Blue Cross and Blue Shield,Traditional,,110.36,38.7,38.7,285.17,11.12,145.44,percent of total billed charges,38.7
BONE MARROW INTERPRE,85097,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,38.7,237.17,9.25,120.96,percent of total billed charges,38.7
APIXABAN ANTI-XA,85130,CPT,,,,,both,, ,250,250,Blue Cross and Blue Shield,Traditional,,96.75,38.7,38.7,250,9.75,127.5,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,,29,38.7,38.7,74.93,2.92,38.21,percent of total billed charges,38.7
FACTOR V ASSAY,85220,CPT,,,,,both,, ,121.53,121.53,Blue Cross and Blue Shield,Traditional,,47.03,38.7,38.7,121.53,4.74,61.98,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,,47.03,38.7,38.7,121.53,4.74,61.98,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,,47.03,38.7,38.7,121.53,4.74,61.98,percent of total billed charges,38.7
FACTOR VII ASSAY,85230,CPT,,,,,both,, ,335.69,335.69,Blue Cross and Blue Shield,Traditional,,129.91,38.7,38.7,335.69,13.09,171.2,percent of total billed charges,38.7
FACTOR VII ASSAY,85230,CPT,,,,,both,, ,335.69,335.69,Blue Cross and Blue Shield,Traditional,,129.91,38.7,38.7,335.69,13.09,171.2,percent of total billed charges,38.7
"FACTOR VIII, AHG",85240,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,38.7,728.07,28.39,371.32,percent of total billed charges,38.7
L503333 FAC8 AHG,85240,CPT,,,,,both,, ,706.86,706.86,Blue Cross and Blue Shield,Traditional,,273.55,38.7,38.7,706.86,27.57,360.5,percent of total billed charges,38.7
FACTOR VIII RISTOCET,85245,CPT,,,,,both,, ,1352.01,1352.01,Blue Cross and Blue Shield,Traditional,,523.23,38.7,38.7,1352.01,52.73,689.53,percent of total billed charges,38.7
L164509 VWF ACTIV PA,85245,CPT,,,,,both,, ,412,412,Blue Cross and Blue Shield,Traditional,,159.44,38.7,38.7,412,16.07,210.12,percent of total billed charges,38.7
FACTOR VIII VW AG,85246,CPT,,,,,both,, ,1164.52,1164.52,Blue Cross and Blue Shield,Traditional,,450.67,38.7,38.7,1164.52,45.42,593.91,percent of total billed charges,38.7
FACTOR VIII VW AG,85246,CPT,,,,,both,, ,1164.52,1164.52,Blue Cross and Blue Shield,Traditional,,450.67,38.7,38.7,1164.52,45.42,593.91,percent of total billed charges,38.7
"FACT VIII,VW,MULTIME",85247,CPT,,,,,both,, ,181.59,181.59,Blue Cross and Blue Shield,Traditional,,70.28,38.7,38.7,181.59,7.08,92.61,percent of total billed charges,38.7
FACTOR IX,85250,CPT,,,,,both,, ,151.56,151.56,Blue Cross and Blue Shield,Traditional,,58.65,38.7,38.7,151.56,5.91,77.3,percent of total billed charges,38.7
FACTOR X,85260,CPT,,,,,both,, ,142.58,142.58,Blue Cross and Blue Shield,Traditional,,55.18,38.7,38.7,142.58,5.56,72.72,percent of total billed charges,38.7
FACTOR XI,85270,CPT,,,,,both,, ,142.58,142.58,Blue Cross and Blue Shield,Traditional,,55.18,38.7,38.7,142.58,5.56,72.72,percent of total billed charges,38.7
ANTITHROMBIN IIIACTI,85300,CPT,,,,,both,, ,1930.76,1930.76,Blue Cross and Blue Shield,Traditional,,747.2,38.7,38.7,1930.76,75.3,984.69,percent of total billed charges,38.7
L015040 ANTITHROMBIN ACTIVITY,85300,CPT,,,,,both,, ,965.23,965.23,Blue Cross and Blue Shield,Traditional,,373.54,38.7,38.7,965.23,37.64,492.27,percent of total billed charges,38.7
Q5158 ATIII AG FRNEP,85301,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,38.7,72.13,2.81,36.79,percent of total billed charges,38.7
"PROTEIN C, AG",85302,CPT,,,,,both,, ,1907.47,1907.47,Blue Cross and Blue Shield,Traditional,,738.19,38.7,38.7,1907.47,74.39,972.81,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,,751.77,38.7,38.7,1942.55,75.76,990.7,percent of total billed charges,38.7
"PROTEIN C, ACTIVITY",85303,CPT,,,,,both,, ,1261.35,1261.35,Blue Cross and Blue Shield,Traditional,,488.14,38.7,38.7,1261.35,49.19,643.29,percent of total billed charges,38.7
"PROTEIN C, ACTIVITY",85303,CPT,,,,,both,, ,1261.35,1261.35,Blue Cross and Blue Shield,Traditional,,488.14,38.7,38.7,1261.35,49.19,643.29,percent of total billed charges,38.7
"Q7942 PROTEIN C, ACT",85303,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
L117754 PROT S TOT,85305,CPT,,,,,both,, ,116.1,116.1,Blue Cross and Blue Shield,Traditional,,44.93,38.7,38.7,116.1,4.53,59.21,percent of total billed charges,38.7
"PROTEIN S, TOTAL",85305,CPT,,,,,both,, ,1261.35,1261.35,Blue Cross and Blue Shield,Traditional,,488.14,38.7,38.7,1261.35,49.19,643.29,percent of total billed charges,38.7
"PROTEIN S, TOTAL",85305,CPT,,,,,both,, ,1261.35,1261.35,Blue Cross and Blue Shield,Traditional,,488.14,38.7,38.7,1261.35,49.19,643.29,percent of total billed charges,38.7
L117754 PROT S FREE,85306,CPT,,,,,both,, ,153.2,153.2,Blue Cross and Blue Shield,Traditional,,59.29,38.7,38.7,153.2,5.97,78.13,percent of total billed charges,38.7
"PROTEIN S, FREE",85306,CPT,,,,,both,, ,151,151,Blue Cross and Blue Shield,Traditional,,58.44,38.7,38.7,151,5.89,77.01,percent of total billed charges,38.7
"PROTEIN S, FREE",85306,CPT,,,,,both,, ,939.98,939.98,Blue Cross and Blue Shield,Traditional,,363.77,38.7,38.7,939.98,36.66,479.39,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,,363.77,38.7,38.7,939.98,36.66,479.39,percent of total billed charges,38.7
Q1779 PROT S ACT,85306,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
"Q7942 PROTEIN S, FRE",85306,CPT,,,,,both,, ,939.98,939.98,Blue Cross and Blue Shield,Traditional,,363.77,38.7,38.7,939.98,36.66,479.39,percent of total billed charges,38.7
PROTEIN C ACTIVATED,85307,CPT,,,,,both,, ,239.69,239.69,Blue Cross and Blue Shield,Traditional,,92.76,38.7,38.7,239.69,9.35,122.24,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,,230.82,38.7,38.7,596.43,23.26,304.18,percent of total billed charges,38.7
SOLUB LIV AG AB(RDL),85316,CPT,,,,,both,, ,567,567,Blue Cross and Blue Shield,Traditional,,219.43,38.7,38.7,567,22.11,289.17,percent of total billed charges,38.7
COAG TIME ACTIVATED,85347,CPT,,,,,both,, ,167.84,167.84,Blue Cross and Blue Shield,Traditional,,64.95,38.7,38.7,167.84,6.55,85.6,percent of total billed charges,38.7
FDP-FSP AGG SLIDE,85362,CPT,,,,,both,, ,691.58,691.58,Blue Cross and Blue Shield,Traditional,,267.64,38.7,38.7,691.58,26.97,352.71,percent of total billed charges,38.7
"D-DIMER, QUANT",85379,CPT,,,,,both,, ,100.48,100.48,Blue Cross and Blue Shield,Traditional,,38.89,38.7,38.7,100.48,3.92,51.24,percent of total billed charges,38.7
"D-DIMER, QUANT",85379,CPT,,,,,both,,,886.09,886.09,Blue Cross and Blue Shield,Traditional,,342.92,38.7,38.7,886.09,34.56,451.91,percent of total billed charges,38.7
"D-DIMER, QUANT",85379,CPT,,,,,both,, ,886.09,886.09,Blue Cross and Blue Shield,Traditional,,342.92,38.7,38.7,886.09,34.56,451.91,percent of total billed charges,38.7
FIBRINOGEN ACTIVITY,85384,CPT,,,,,both,, ,83.64,83.64,Blue Cross and Blue Shield,Traditional,,32.37,38.7,38.7,83.64,3.26,42.66,percent of total billed charges,38.7
FIBRINOGEN ACTIVITY,85384,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,38.7,1036.25,40.41,528.49,percent of total billed charges,38.7
Q14532 ADAMTS13 IA,85397,CPT,,,,,both,, ,188.05,188.05,Blue Cross and Blue Shield,Traditional,,72.78,38.7,38.7,188.05,7.33,95.91,percent of total billed charges,38.7
Q36555 PAI-1 IA,85415,CPT,,,,,both,, ,222.01,222.01,Blue Cross and Blue Shield,Traditional,,85.92,38.7,38.7,222.01,8.66,113.23,percent of total billed charges,38.7
FETAL HGB KLEIH-BETK,85460,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,38.7,526.26,20.52,268.39,percent of total billed charges,38.7
FETAL HGB KLEIH-BETK,85460,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,38.7,526.26,20.52,268.39,percent of total billed charges,38.7
"FETAL HGB, ROSETTE",85461,CPT,,,,,both,, ,349.72,349.72,Blue Cross and Blue Shield,Traditional,,135.34,38.7,38.7,349.72,13.64,178.36,percent of total billed charges,38.7
HEPARIN ASSAY,85520,CPT,,,,,both,, ,1274.26,1274.26,Blue Cross and Blue Shield,Traditional,,493.14,38.7,38.7,1274.26,49.7,649.87,percent of total billed charges,38.7
L117101 HEPARIN A-XA,85520,CPT,,,,,both,, ,139.05,139.05,Blue Cross and Blue Shield,Traditional,,53.81,38.7,38.7,139.05,5.42,70.92,percent of total billed charges,38.7
MURAMIDASE,85549,CPT,,,,,both,, ,261.02,261.02,Blue Cross and Blue Shield,Traditional,,101.01,38.7,38.7,261.02,10.18,133.12,percent of total billed charges,38.7
RBC OSMOTIC FRAGW-IN,85557,CPT,,,,,both,, ,450.48,450.48,Blue Cross and Blue Shield,Traditional,,174.34,38.7,38.7,450.48,17.57,229.74,percent of total billed charges,38.7
PLATELET AGGREGATION,85576,CPT,,,,,both,, ,344.67,344.67,Blue Cross and Blue Shield,Traditional,,133.39,38.7,38.7,344.67,13.44,175.78,percent of total billed charges,38.7
PLTT NEUTRALIZATION,85597,CPT,,,,,both,, ,160.55,160.55,Blue Cross and Blue Shield,Traditional,,62.13,38.7,38.7,160.55,6.26,81.88,percent of total billed charges,38.7
PLTT NEUTRALIZATION,85597,CPT,,,,,both,, ,160.55,160.55,Blue Cross and Blue Shield,Traditional,,62.13,38.7,38.7,160.55,6.26,81.88,percent of total billed charges,38.7
HEXAGONAL PHOSPHOLIP,85598,CPT,,,,,both,, ,153.52,153.52,Blue Cross and Blue Shield,Traditional,,59.41,38.7,38.7,153.52,5.99,78.3,percent of total billed charges,38.7
HEXAGONAL PHOSPHOLIP,85598,CPT,,,,,both,, ,153.52,153.52,Blue Cross and Blue Shield,Traditional,,59.41,38.7,38.7,153.52,5.99,78.3,percent of total billed charges,38.7
L117079 HEX PHOS,85598,CPT,,,,,both,, ,179.8,179.8,Blue Cross and Blue Shield,Traditional,,69.58,38.7,38.7,179.8,7.01,91.7,percent of total billed charges,38.7
"Blood test, clotting time",85610,CPT,,,,,both,,,430.27,430.27,Blue Cross and Blue Shield,Traditional,,166.51,38.7,38.7,430.27,16.78,219.44,percent of total billed charges,38.7
PROTHROMBIN TIME,85610,CPT,,,,,both,, ,14.6,14.6,Blue Cross and Blue Shield,Traditional,,5.65,38.7,38.7,14.6,0.57,7.45,percent of total billed charges,38.7
PROTHROMBIN TIME,85610,CPT,,,,,both,, ,430.27,430.27,Blue Cross and Blue Shield,Traditional,,166.51,38.7,38.7,430.27,16.78,219.44,percent of total billed charges,38.7
"PROTHROMBIN, SUBSTIT",85611,CPT,,,,,both,, ,728.07,728.07,Blue Cross and Blue Shield,Traditional,,281.76,38.7,38.7,728.07,28.39,371.32,percent of total billed charges,38.7
RUSSELL VIPER VEN DI,85613,CPT,,,,,both,, ,364.88,364.88,Blue Cross and Blue Shield,Traditional,,141.21,38.7,38.7,364.88,14.23,186.09,percent of total billed charges,38.7
RUSSELL VIPER VEN DI,85613,CPT,,,,,both,, ,364.88,364.88,Blue Cross and Blue Shield,Traditional,,141.21,38.7,38.7,364.88,14.23,186.09,percent of total billed charges,38.7
"SED RATE, AUTOMATED",85652,CPT,,,,,both,, ,26.66,26.66,Blue Cross and Blue Shield,Traditional,,10.32,38.7,38.7,26.66,1.04,13.6,percent of total billed charges,38.7
"SED RATE, AUTOMATED",85652,CPT,,,,,both,,,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"SED RATE, AUTOMATED",85652,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
O51226 SICKLE C  SCR,85660,CPT,,,,,both,, ,385.99,385.99,Blue Cross and Blue Shield,Traditional,,149.38,38.7,38.7,385.99,15.05,196.85,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,,145.03,38.7,38.7,374.75,14.62,191.12,percent of total billed charges,38.7
SICKLE CELL TEST RED,85660,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
SICKLE CELL TEST RED,85660,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
THROMBIN TIME,85670,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,38.7,526.26,20.52,268.39,percent of total billed charges,38.7
THROMBIN TIME,85670,CPT,,,,,both,, ,526.26,526.26,Blue Cross and Blue Shield,Traditional,,203.66,38.7,38.7,526.26,20.52,268.39,percent of total billed charges,38.7
Coagulation assessment blood test,85730,CPT,,,,,both,,,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,38.7,480.79,18.75,245.2,percent of total billed charges,38.7
THROMBOPLAST TIMEPTT,85730,CPT,,,,,both,, ,58.94,58.94,Blue Cross and Blue Shield,Traditional,,22.81,38.7,38.7,58.94,2.3,30.06,percent of total billed charges,38.7
THROMBOPLAST TIMEPTT,85730,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,38.7,480.79,18.75,245.2,percent of total billed charges,38.7
THROMBOPLAST TIMEPTT,85730,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,38.7,480.79,18.75,245.2,percent of total billed charges,38.7
PTT SUBSTITUT,85732,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,38.7,480.79,18.75,245.2,percent of total billed charges,38.7
PTT SUBSTITUT,85732,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,38.7,480.79,18.75,245.2,percent of total billed charges,38.7
VISCOSITY EXAM,85810,CPT,,,,,both,, ,80.27,80.27,Blue Cross and Blue Shield,Traditional,,31.06,38.7,38.7,80.27,3.13,40.94,percent of total billed charges,38.7
ALLERGEN IGG QT,86001,CPT,,,,,both,, ,66.24,66.24,Blue Cross and Blue Shield,Traditional,,25.63,38.7,38.7,66.24,2.58,33.78,percent of total billed charges,38.7
ALLERGEN IGG QT,86001,CPT,,,,,both,, ,66.24,66.24,Blue Cross and Blue Shield,Traditional,,25.63,38.7,38.7,66.24,2.58,33.78,percent of total billed charges,38.7
ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,51.36,51.36,Blue Cross and Blue Shield,Traditional,,19.88,38.7,38.7,51.36,2,26.19,percent of total billed charges,38.7
ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,38.7,148.75,5.8,75.86,percent of total billed charges,38.7
L602635 - ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,38.7,148.75,5.8,75.86,percent of total billed charges,38.7
Q10643 ALG IGE QT,86003,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,38.7,148.75,5.8,75.86,percent of total billed charges,38.7
Q10659 ALLERGEN IGE,86003,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,38.7,148.75,5.8,75.86,percent of total billed charges,38.7
Q10715 ALLERGEN IGE,86003,CPT,,,,,both,, ,148.75,148.75,Blue Cross and Blue Shield,Traditional,,57.57,38.7,38.7,148.75,5.8,75.86,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,,39.97,38.7,38.7,103.29,4.03,52.68,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,,39.97,38.7,38.7,103.29,4.03,52.68,percent of total billed charges,38.7
L6643 ASMA ELISA,86015,CPT,,,,,both,, ,702.72,702.72,Blue Cross and Blue Shield,Traditional,,271.95,38.7,38.7,702.72,27.41,358.39,percent of total billed charges,38.7
Q15043 ACTIN AB EA,86015,CPT,,,,,both,, ,514.48,514.48,Blue Cross and Blue Shield,Traditional,,199.1,38.7,38.7,514.48,20.06,262.38,percent of total billed charges,38.7
Q8796 MPO AB IA,86021,CPT,,,,,both,, ,500.72,500.72,Blue Cross and Blue Shield,Traditional,,193.78,38.7,38.7,500.72,19.53,255.37,percent of total billed charges,38.7
Q8796 MPO AB IA,86021,CPT,,,,,both,, ,500.72,500.72,Blue Cross and Blue Shield,Traditional,,193.78,38.7,38.7,500.72,19.53,255.37,percent of total billed charges,38.7
Q8796 MPO AB IA,86021,CPT,,,,,both,, ,500.72,500.72,Blue Cross and Blue Shield,Traditional,,193.78,38.7,38.7,500.72,19.53,255.37,percent of total billed charges,38.7
Q8796 MPO AB IA,86021,CPT,,,,,both,, ,500.72,500.72,Blue Cross and Blue Shield,Traditional,,193.78,38.7,38.7,500.72,19.53,255.37,percent of total billed charges,38.7
PLATELET AB,86022,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,38.7,871.22,33.98,444.32,percent of total billed charges,38.7
Q14627SRA UNF RB-14C,86022,CPT,,,,,both,, ,467.88,467.88,Blue Cross and Blue Shield,Traditional,,181.07,38.7,38.7,467.88,18.25,238.62,percent of total billed charges,38.7
Q14874 PLATELET AB,86022,CPT,,,,,both,, ,467.88,467.88,Blue Cross and Blue Shield,Traditional,,181.07,38.7,38.7,467.88,18.25,238.62,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,,181.07,38.7,38.7,467.88,18.25,238.62,percent of total billed charges,38.7
Q91740PLATELT IGG FC,86023,CPT,,,,,both,, ,83.08,83.08,Blue Cross and Blue Shield,Traditional,,32.15,38.7,38.7,83.08,3.24,42.37,percent of total billed charges,38.7
L162045 FLUORS AB SC,86036,CPT,,,,,both,, ,486.16,486.16,Blue Cross and Blue Shield,Traditional,,188.14,38.7,38.7,486.16,18.96,247.94,percent of total billed charges,38.7
Q70171 ANCA SCN IA,86036,CPT,,,,,both,, ,500.72,500.72,Blue Cross and Blue Shield,Traditional,,193.78,38.7,38.7,500.72,19.53,255.37,percent of total billed charges,38.7
L163061 ANCA TITER,86037,CPT,,,,,both,, ,120.5,120.5,Blue Cross and Blue Shield,Traditional,,46.63,38.7,38.7,120.5,4.7,61.46,percent of total billed charges,38.7
ANA,86038,CPT,,,,,both,, ,91.77,91.77,Blue Cross and Blue Shield,Traditional,,35.51,38.7,38.7,91.77,3.58,46.8,percent of total billed charges,38.7
ANA,86038,CPT,,,,,both,, ,898.44,898.44,Blue Cross and Blue Shield,Traditional,,347.7,38.7,38.7,898.44,35.04,458.2,percent of total billed charges,38.7
L164947 ANA IFA,86038,CPT,,,,,both,, ,824.26,824.26,Blue Cross and Blue Shield,Traditional,,318.99,38.7,38.7,824.26,32.15,420.37,percent of total billed charges,38.7
Q16814 ANA IFA REFIA,86038,CPT,,,,,both,,,898.44,898.44,Blue Cross and Blue Shield,Traditional,,347.7,38.7,38.7,898.44,35.04,458.2,percent of total billed charges,38.7
Q16814 ANA IFA REFIA,86038,CPT,,,,,both,, ,898.44,898.44,Blue Cross and Blue Shield,Traditional,,347.7,38.7,38.7,898.44,35.04,458.2,percent of total billed charges,38.7
Q249 ANA SCRN IFA,86038,CPT,,,,,both,, ,898.44,898.44,Blue Cross and Blue Shield,Traditional,,347.7,38.7,38.7,898.44,35.04,458.2,percent of total billed charges,38.7
"ANA,TITER",86039,CPT,,,,,both,, ,93.46,93.46,Blue Cross and Blue Shield,Traditional,,36.17,38.7,38.7,93.46,3.64,47.66,percent of total billed charges,38.7
"ANA,TITER",86039,CPT,,,,,both,, ,547.31,547.31,Blue Cross and Blue Shield,Traditional,,211.81,38.7,38.7,547.31,21.35,279.13,percent of total billed charges,38.7
"ANA,TITER",86039,CPT,,,,,both,, ,547.31,547.31,Blue Cross and Blue Shield,Traditional,,211.81,38.7,38.7,547.31,21.35,279.13,percent of total billed charges,38.7
ACETYLCH RCPT BND AB,86041,CPT,,,,,both,, ,55.2,55.2,Blue Cross and Blue Shield,Traditional,,21.36,38.7,38.7,55.2,2.15,28.15,percent of total billed charges,38.7
ACETYLC RCPT BLCK AB,86042,CPT,,,,,both,, ,55.2,55.2,Blue Cross and Blue Shield,Traditional,,21.36,38.7,38.7,55.2,2.15,28.15,percent of total billed charges,38.7
ACTYLC RCPT MODL AB,86043,CPT,,,,,both,, ,55.2,55.2,Blue Cross and Blue Shield,Traditional,,21.36,38.7,38.7,55.2,2.15,28.15,percent of total billed charges,38.7
Q38321 AQP4 NMOIGG,86052,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,38.7,529.91,20.67,270.25,percent of total billed charges,38.7
"ASO,TITER",86060,CPT,,,,,both,, ,71.85,71.85,Blue Cross and Blue Shield,Traditional,,27.81,38.7,38.7,71.85,2.8,36.64,percent of total billed charges,38.7
"ASO,TITER",86060,CPT,,,,,both,, ,539.45,539.45,Blue Cross and Blue Shield,Traditional,,208.77,38.7,38.7,539.45,21.04,275.12,percent of total billed charges,38.7
Q265 ASO AB ITA,86060,CPT,,,,,both,, ,189.17,189.17,Blue Cross and Blue Shield,Traditional,,73.21,38.7,38.7,189.17,7.38,96.48,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,,64.08,38.7,38.7,165.59,6.46,84.45,percent of total billed charges,38.7
C-REACTIVE PROTEIN,86140,CPT,,,,,both,, ,51.08,51.08,Blue Cross and Blue Shield,Traditional,,19.77,38.7,38.7,51.08,1.99,26.05,percent of total billed charges,38.7
C-REACTIVE PROTEIN,86140,CPT,,,,,both,, ,518.69,518.69,Blue Cross and Blue Shield,Traditional,,200.73,38.7,38.7,518.69,20.23,264.53,percent of total billed charges,38.7
Q10124 HS-CRP NEPHEL,86141,CPT,,,,,both,, ,999.76,999.76,Blue Cross and Blue Shield,Traditional,,386.91,38.7,38.7,999.76,38.99,509.88,percent of total billed charges,38.7
BETA-2 GLYCOPROT AB,86146,CPT,,,,,both,, ,252.04,252.04,Blue Cross and Blue Shield,Traditional,,97.54,38.7,38.7,252.04,9.83,128.54,percent of total billed charges,38.7
BETA-2 GLYCOPROT AB,86146,CPT,,,,,both,, ,252.04,252.04,Blue Cross and Blue Shield,Traditional,,97.54,38.7,38.7,252.04,9.83,128.54,percent of total billed charges,38.7
Q14890 BETA-2 GLYCOP,86146,CPT,,,,,both,, ,252.04,252.04,Blue Cross and Blue Shield,Traditional,,97.54,38.7,38.7,252.04,9.83,128.54,percent of total billed charges,38.7
Q14890 BETA-2 GLYCOP,86146,CPT,,,,,both,, ,252.04,252.04,Blue Cross and Blue Shield,Traditional,,97.54,38.7,38.7,252.04,9.83,128.54,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,,97.54,38.7,38.7,252.04,9.83,128.54,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,,97.54,38.7,38.7,252.04,9.83,128.54,percent of total billed charges,38.7
"CARDIOLIPIN AB,IGG",86147,CPT,,,,,both,, ,429.43,429.43,Blue Cross and Blue Shield,Traditional,,166.19,38.7,38.7,429.43,16.75,219.01,percent of total billed charges,38.7
"CARDIOLIPIN AB,IGG",86147,CPT,,,,,both,, ,429.43,429.43,Blue Cross and Blue Shield,Traditional,,166.19,38.7,38.7,429.43,16.75,219.01,percent of total billed charges,38.7
Q14890 CARDIOLIPIN A,86147,CPT,,,,,both,, ,429.43,429.43,Blue Cross and Blue Shield,Traditional,,166.19,38.7,38.7,429.43,16.75,219.01,percent of total billed charges,38.7
Q14890 CARDIOLIPIN A,86147,CPT,,,,,both,, ,429.43,429.43,Blue Cross and Blue Shield,Traditional,,166.19,38.7,38.7,429.43,16.75,219.01,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,,166.19,38.7,38.7,429.43,16.75,219.01,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,,166.19,38.7,38.7,429.43,16.75,219.01,percent of total billed charges,38.7
PHOSPHATIDYLSERIN AB,86148,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,38.7,141.46,5.52,72.14,percent of total billed charges,38.7
PHOSPHOLIPID AB,86148,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,38.7,141.46,5.52,72.14,percent of total billed charges,38.7
Q14890 PHOSPHOLIPID,86148,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,38.7,141.46,5.52,72.14,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,,27.91,38.7,38.7,72.13,2.81,36.79,percent of total billed charges,38.7
"COLD AGG, TITER",86157,CPT,,,,,both,, ,247.83,247.83,Blue Cross and Blue Shield,Traditional,,95.91,38.7,38.7,247.83,9.67,126.39,percent of total billed charges,38.7
L6353COLD HEMAGGL QT,86157,CPT,,,,,both,, ,40.7,40.7,Blue Cross and Blue Shield,Traditional,,15.75,38.7,38.7,40.7,1.59,20.76,percent of total billed charges,38.7
"COMPLEMENT AG, EA",86160,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
Q19882 COMP AG,86160,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
Q34888 COMPLE C7 RID,86160,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
Q34889 COMPLE C8 RID,86160,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
Q351 C3 COMPL ITA,86160,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
Q353 C4C COMP ITA,86160,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
Q354 COMPLEM C5 RID,86160,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,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,,267.53,38.7,38.7,691.29,26.96,352.56,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,,267.53,38.7,38.7,691.29,26.96,352.56,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,,30.96,38.7,38.7,79.99,3.12,40.79,percent of total billed charges,38.7
"COMP, TOTAL CH50",86162,CPT,,,,,both,, ,984.32,984.32,Blue Cross and Blue Shield,Traditional,,380.93,38.7,38.7,984.32,38.39,502,percent of total billed charges,38.7
"COMP, TOTAL CH50",86162,CPT,,,,,both,, ,984.32,984.32,Blue Cross and Blue Shield,Traditional,,380.93,38.7,38.7,984.32,38.39,502,percent of total billed charges,38.7
Q11173 CCP AB IGG IA,86200,CPT,,,,,both,, ,242.5,242.5,Blue Cross and Blue Shield,Traditional,,93.85,38.7,38.7,242.5,9.46,123.68,percent of total billed charges,38.7
DEOXYRIBONUCLEASE AB,86215,CPT,,,,,both,, ,198.72,198.72,Blue Cross and Blue Shield,Traditional,,76.9,38.7,38.7,198.72,7.75,101.35,percent of total billed charges,38.7
DEOXYRIBONUCLEASE AB,86215,CPT,,,,,both,, ,198.72,198.72,Blue Cross and Blue Shield,Traditional,,76.9,38.7,38.7,198.72,7.75,101.35,percent of total billed charges,38.7
"DNA AB,NATIVE-DOUBL",86225,CPT,,,,,both,, ,1077.5,1077.5,Blue Cross and Blue Shield,Traditional,,416.99,38.7,38.7,1077.5,42.02,549.53,percent of total billed charges,38.7
L165092 DNA DS AB,86225,CPT,,,,,both,, ,486.16,486.16,Blue Cross and Blue Shield,Traditional,,188.14,38.7,38.7,486.16,18.96,247.94,percent of total billed charges,38.7
L96346 DSDNA AB IA,86225,CPT,,,,,both,, ,219.1,219.1,Blue Cross and Blue Shield,Traditional,,84.79,38.7,38.7,219.1,8.54,111.74,percent of total billed charges,38.7
Q19882 DNA DS AB,86225,CPT,,,,,both,, ,1077.5,1077.5,Blue Cross and Blue Shield,Traditional,,416.99,38.7,38.7,1077.5,42.02,549.53,percent of total billed charges,38.7
Q255 DNA DS AB IA,86225,CPT,,,,,both,, ,1077.5,1077.5,Blue Cross and Blue Shield,Traditional,,416.99,38.7,38.7,1077.5,42.02,549.53,percent of total billed charges,38.7
DNA AB SINGLE STRAND,86226,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,38.7,1036.25,40.41,528.49,percent of total billed charges,38.7
DNA AB SINGLE STRAND,86226,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,38.7,1036.25,40.41,528.49,percent of total billed charges,38.7
Q14857 SSDNA ANTIBODY (IGG),86226,CPT,,,,,both,, ,923,923,Blue Cross and Blue Shield,Traditional,,357.2,38.7,38.7,923,36,470.73,percent of total billed charges,38.7
L165126 ENDMYS AB IG,86231,CPT,,,,,both,, ,60.05,60.05,Blue Cross and Blue Shield,Traditional,,23.24,38.7,38.7,60.05,2.34,30.63,percent of total billed charges,38.7
Q15064 ENDOMYS AB IG,86231,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,38.7,529.91,20.67,270.25,percent of total billed charges,38.7
Q19955 ENDOMYS AB IG,86231,CPT,,,,,both,, ,743.65,743.65,Blue Cross and Blue Shield,Traditional,,287.79,38.7,38.7,743.65,29,379.26,percent of total billed charges,38.7
ANTI-ENA,86235,CPT,,,,,both,, ,174.85,174.85,Blue Cross and Blue Shield,Traditional,,67.67,38.7,38.7,174.85,6.82,89.17,percent of total billed charges,38.7
ANTI-ENA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,38.7,274.22,10.69,139.85,percent of total billed charges,38.7
L165092 ANTI-ENA,86235,CPT,,,,,both,, ,251.58,251.58,Blue Cross and Blue Shield,Traditional,,97.36,38.7,38.7,251.58,9.81,128.31,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,,106.12,38.7,38.7,274.22,10.69,139.85,percent of total billed charges,38.7
Q171728MI-2 AAB RIPA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,38.7,274.22,10.69,139.85,percent of total billed charges,38.7
Q19882 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,38.7,274.22,10.69,139.85,percent of total billed charges,38.7
Q19887 RNP AB IA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,38.7,274.22,10.69,139.85,percent of total billed charges,38.7
Q34088 CHROMAT AB IA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,38.7,274.22,10.69,139.85,percent of total billed charges,38.7
Q37923 SM AB IA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,38.7,274.22,10.69,139.85,percent of total billed charges,38.7
Q38568 SS-A IA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,38.7,274.22,10.69,139.85,percent of total billed charges,38.7
Q38569 SS-B IA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,38.7,274.22,10.69,139.85,percent of total billed charges,38.7
Q4942 SCLEROD AB IA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,38.7,274.22,10.69,139.85,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,,106.12,38.7,38.7,274.22,10.69,139.85,percent of total billed charges,38.7
Q7448 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,38.7,274.22,10.69,139.85,percent of total billed charges,38.7
Q7832 ANTI-ENA,86235,CPT,,,,,both,, ,548.71,548.71,Blue Cross and Blue Shield,Traditional,,212.35,38.7,38.7,548.71,21.4,279.84,percent of total billed charges,38.7
Q7832 ANTI-ENA,86235,CPT,,,,,both,, ,548.71,548.71,Blue Cross and Blue Shield,Traditional,,212.35,38.7,38.7,548.71,21.4,279.84,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,,106.12,38.7,38.7,274.22,10.69,139.85,percent of total billed charges,38.7
Q94685 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,38.7,274.22,10.69,139.85,percent of total billed charges,38.7
Q94777 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,274.22,Blue Cross and Blue Shield,Traditional,,106.12,38.7,38.7,274.22,10.69,139.85,percent of total billed charges,38.7
L165620 STRIATIONAL ANTIBODIES,86255,CPT,,,,,both,, ,89.9,89.9,Blue Cross and Blue Shield,Traditional,,34.79,38.7,38.7,89.9,3.51,45.85,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,,100.87,38.7,38.7,260.64,10.16,132.93,percent of total billed charges,38.7
Q37097FLUORES AB SCN,86255,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,38.7,529.91,20.67,270.25,percent of total billed charges,38.7
Q37097FLUORES AB SCN,86255,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,38.7,529.91,20.67,270.25,percent of total billed charges,38.7
Q37097FLUORES AB SCN,86255,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,38.7,529.91,20.67,270.25,percent of total billed charges,38.7
Q37097FLUORES AB SCN,86255,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,38.7,529.91,20.67,270.25,percent of total billed charges,38.7
Q8292 ANTIADR AB IFA,86255,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,38.7,529.91,20.67,270.25,percent of total billed charges,38.7
Q8292 ANTIADR AB IFA,86255,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,38.7,529.91,20.67,270.25,percent of total billed charges,38.7
Q8292 ANTIADR AB IFA,86255,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,38.7,529.91,20.67,270.25,percent of total billed charges,38.7
Q8292 ANTIADR AB IFA,86255,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,38.7,529.91,20.67,270.25,percent of total billed charges,38.7
Q91985 ENDOMYSIAL(IGG)ANTIBODY SCRN TITR,86255,CPT,,,,,both,, ,472,472,Blue Cross and Blue Shield,Traditional,,182.66,38.7,38.7,472,18.41,240.72,percent of total billed charges,38.7
"FLUORESCENT AB,TITER",86256,CPT,,,,,both,, ,1217.28,1217.28,Blue Cross and Blue Shield,Traditional,,471.09,38.7,38.7,1217.28,47.47,620.81,percent of total billed charges,38.7
"Q261 FLUORES AB, TIT",86256,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,38.7,529.91,20.67,270.25,percent of total billed charges,38.7
"Q261 FLUORES AB, TIT",86256,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,38.7,529.91,20.67,270.25,percent of total billed charges,38.7
L165126 GLIA AB IGA,86258,CPT,,,,,both,, ,57.65,57.65,Blue Cross and Blue Shield,Traditional,,22.31,38.7,38.7,57.65,2.25,29.4,percent of total billed charges,38.7
Q11212GLIA AB IGG IA,86258,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,38.7,765.96,29.87,390.64,percent of total billed charges,38.7
Q11212GLIA AB IGG IA,86258,CPT,,,,,both,, ,765.96,765.96,Blue Cross and Blue Shield,Traditional,,296.43,38.7,38.7,765.96,29.87,390.64,percent of total billed charges,38.7
L143404 CA15-3 ECLIA,86300,CPT,,,,,both,, ,442.13,442.13,Blue Cross and Blue Shield,Traditional,,171.1,38.7,38.7,442.13,17.24,225.49,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,,186.5,38.7,38.7,481.92,18.79,245.78,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,,42.36,38.7,38.7,109.46,4.27,55.82,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,,277.38,38.7,38.7,716.75,27.95,365.54,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,,311.42,38.7,38.7,804.69,31.38,410.39,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,,311.42,38.7,38.7,804.69,31.38,410.39,percent of total billed charges,38.7
Q29256 CA 125 IA,86304,CPT,,,,,both,, ,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,38.7,804.69,31.38,410.39,percent of total billed charges,38.7
Q91155 TUMR AG CA125,86304,CPT,,,,,both,, ,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,38.7,804.69,31.38,410.39,percent of total billed charges,38.7
TUMOR AG CA 125,86304,CPT,,,,,both,, ,804.69,804.69,Blue Cross and Blue Shield,Traditional,,311.42,38.7,38.7,804.69,31.38,410.39,percent of total billed charges,38.7
Q91155 HE4,86305,CPT,,,,,both,, ,138.65,138.65,Blue Cross and Blue Shield,Traditional,,53.66,38.7,38.7,138.65,5.41,70.71,percent of total billed charges,38.7
HETEROPHILE AB SCREE,86308,CPT,,,,,both,, ,19.09,19.09,Blue Cross and Blue Shield,Traditional,,7.39,38.7,38.7,19.09,0.74,9.74,percent of total billed charges,38.7
HETEROPHILE AB SCREE,86308,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,38.7,480.79,18.75,245.2,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,,166.12,38.7,38.7,429.25,16.74,218.92,percent of total billed charges,38.7
"TUMOR AG, OTHER",86316,CPT,,,,,both,, ,481.92,481.92,Blue Cross and Blue Shield,Traditional,,186.5,38.7,38.7,481.92,18.79,245.78,percent of total billed charges,38.7
"TUMOR AG, OTHER",86316,CPT,,,,,both,, ,481.92,481.92,Blue Cross and Blue Shield,Traditional,,186.5,38.7,38.7,481.92,18.79,245.78,percent of total billed charges,38.7
INF AGENT IMMUNO QUA,86317,CPT,,,,,both,, ,217.52,217.52,Blue Cross and Blue Shield,Traditional,,84.18,38.7,38.7,217.52,8.48,110.94,percent of total billed charges,38.7
INF AGENT IMMUNO QUA,86317,CPT,,,,,both,, ,217.52,217.52,Blue Cross and Blue Shield,Traditional,,84.18,38.7,38.7,217.52,8.48,110.94,percent of total billed charges,38.7
TETANUS/DIPTHERIA AB,86317,CPT,,,,,both,, ,70,70,Blue Cross and Blue Shield,Traditional,,27.09,38.7,38.7,70,2.73,35.7,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,,31.39,38.7,38.7,81.11,3.16,41.37,percent of total billed charges,38.7
Q14978 IMMUNODI OUCN,86331,CPT,,,,,both,, ,69.04,69.04,Blue Cross and Blue Shield,Traditional,,26.72,38.7,38.7,69.04,2.69,35.21,percent of total billed charges,38.7
IMMUNOFIXATION ELECT,86334,CPT,,,,,both,, ,1021.37,1021.37,Blue Cross and Blue Shield,Traditional,,395.27,38.7,38.7,1021.37,39.83,520.9,percent of total billed charges,38.7
IMMUNOFIXATION ELECT,86334,CPT,,,,,both,, ,1021.37,1021.37,Blue Cross and Blue Shield,Traditional,,395.27,38.7,38.7,1021.37,39.83,520.9,percent of total billed charges,38.7
Q38940 IMMUNOFIXATION ELECT,86334,CPT,,,,,both,, ,909.75,909.75,Blue Cross and Blue Shield,Traditional,,352.07,38.7,38.7,909.75,35.48,463.97,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,,263.19,38.7,38.7,680.07,26.52,346.84,percent of total billed charges,38.7
Q10640 B2TF EL-IF,86335,CPT,,,,,both,, ,680.07,680.07,Blue Cross and Blue Shield,Traditional,,263.19,38.7,38.7,680.07,26.52,346.84,percent of total billed charges,38.7
Q213 IFE U,86335,CPT,,,,,both,, ,680.07,680.07,Blue Cross and Blue Shield,Traditional,,263.19,38.7,38.7,680.07,26.52,346.84,percent of total billed charges,38.7
INHIBIN A,86336,CPT,,,,,both,, ,145.66,145.66,Blue Cross and Blue Shield,Traditional,,56.37,38.7,38.7,145.66,5.68,74.29,percent of total billed charges,38.7
INSULIN AB,86337,CPT,,,,,both,, ,207.41,207.41,Blue Cross and Blue Shield,Traditional,,80.27,38.7,38.7,207.41,8.09,105.78,percent of total billed charges,38.7
INSULIN AB,86337,CPT,,,,,both,, ,207.41,207.41,Blue Cross and Blue Shield,Traditional,,80.27,38.7,38.7,207.41,8.09,105.78,percent of total billed charges,38.7
INTRINSIC FACTOR AB,86340,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
L10413 IFB AB ICMA,86340,CPT,,,,,both,, ,50,50,Blue Cross and Blue Shield,Traditional,,19.35,38.7,38.7,50,1.95,25.5,percent of total billed charges,38.7
ISLET CELL AB,86341,CPT,,,,,both,, ,296.67,296.67,Blue Cross and Blue Shield,Traditional,,114.81,38.7,38.7,296.67,11.57,151.3,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,,281.76,38.7,38.7,728.07,28.39,371.32,percent of total billed charges,38.7
Q36177 IA2 AB,86341,CPT,,,,,both,, ,296.67,296.67,Blue Cross and Blue Shield,Traditional,,114.81,38.7,38.7,296.67,11.57,151.3,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,,114.81,38.7,38.7,296.67,11.57,151.3,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,,102.26,38.7,38.7,264.25,10.31,134.77,percent of total billed charges,38.7
Q90123 LEUK HIST REL,86343,CPT,,,,,both,, ,55.95,55.95,Blue Cross and Blue Shield,Traditional,,21.65,38.7,38.7,55.95,2.18,28.53,percent of total billed charges,38.7
L820022 CHRN URTICAR,86352,CPT,,,,,both,, ,422.3,422.3,Blue Cross and Blue Shield,Traditional,,163.43,38.7,38.7,422.3,16.47,215.37,percent of total billed charges,38.7
"Q39588 B CELLS, TOTA",86355,CPT,,,,,both,, ,217.52,217.52,Blue Cross and Blue Shield,Traditional,,84.18,38.7,38.7,217.52,8.48,110.94,percent of total billed charges,38.7
MONONUC CELL AG QT,86356,CPT,,,,,both,, ,308.74,308.74,Blue Cross and Blue Shield,Traditional,,119.48,38.7,38.7,308.74,12.04,157.46,percent of total billed charges,38.7
MONONUC CELL AG QT,86356,CPT,,,,,both,, ,308.74,308.74,Blue Cross and Blue Shield,Traditional,,119.48,38.7,38.7,308.74,12.04,157.46,percent of total billed charges,38.7
Q37088 NK CELLS CF,86357,CPT,,,,,both,, ,217.52,217.52,Blue Cross and Blue Shield,Traditional,,84.18,38.7,38.7,217.52,8.48,110.94,percent of total billed charges,38.7
"Q39588 T CELLS, TOTA",86359,CPT,,,,,both,, ,217.52,217.52,Blue Cross and Blue Shield,Traditional,,84.18,38.7,38.7,217.52,8.48,110.94,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,,586.56,38.7,38.7,1515.65,59.11,772.98,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,,586.56,38.7,38.7,1515.65,59.11,772.98,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,,318.48,38.7,38.7,822.94,32.09,419.7,percent of total billed charges,38.7
"T CELL, ABSO CD4",86361,CPT,,,,,both,, ,878.79,878.79,Blue Cross and Blue Shield,Traditional,,340.09,38.7,38.7,878.79,34.27,448.18,percent of total billed charges,38.7
Q36952 MOG AB,86362,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,38.7,529.91,20.67,270.25,percent of total billed charges,38.7
L165126TTG AB IGG IA,86364,CPT,,,,,both,, ,57.65,57.65,Blue Cross and Blue Shield,Traditional,,22.31,38.7,38.7,57.65,2.25,29.4,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,,296.43,38.7,38.7,765.96,29.87,390.64,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,,296.43,38.7,38.7,765.96,29.87,390.64,percent of total billed charges,38.7
L504600 MSCLSPECKINAB,86366,CPT,,,,,both,, ,180.4,180.4,Blue Cross and Blue Shield,Traditional,,69.81,38.7,38.7,180.4,7.04,92,percent of total billed charges,38.7
Q5081 TPO AB IA,86376,CPT,,,,,both,, ,682.88,682.88,Blue Cross and Blue Shield,Traditional,,264.27,38.7,38.7,682.88,26.63,348.27,percent of total billed charges,38.7
Q5081 TPO AB IA,86376,CPT,,,,,both,, ,682.88,682.88,Blue Cross and Blue Shield,Traditional,,264.27,38.7,38.7,682.88,26.63,348.27,percent of total billed charges,38.7
Q5081 TPO AB IA,86376,CPT,,,,,both,, ,682.88,682.88,Blue Cross and Blue Shield,Traditional,,264.27,38.7,38.7,682.88,26.63,348.27,percent of total billed charges,38.7
Q5081 TPO AB IA,86376,CPT,,,,,both,, ,682.88,682.88,Blue Cross and Blue Shield,Traditional,,264.27,38.7,38.7,682.88,26.63,348.27,percent of total billed charges,38.7
Q259 MITO AB IA,86381,CPT,,,,,both,, ,529.91,529.91,Blue Cross and Blue Shield,Traditional,,205.08,38.7,38.7,529.91,20.67,270.25,percent of total billed charges,38.7
Q30321 MM2AB IGG EIA,86381,CPT,,,,,both,, ,414.83,414.83,Blue Cross and Blue Shield,Traditional,,160.54,38.7,38.7,414.83,16.18,211.56,percent of total billed charges,38.7
"NEUTRALIZ TEST,VIRAL",86382,CPT,,,,,both,, ,224.54,224.54,Blue Cross and Blue Shield,Traditional,,86.9,38.7,38.7,224.54,8.76,114.52,percent of total billed charges,38.7
"NEUTRALIZ TEST,VIRAL",86382,CPT,,,,,both,, ,224.54,224.54,Blue Cross and Blue Shield,Traditional,,86.9,38.7,38.7,224.54,8.76,114.52,percent of total billed charges,38.7
PART AGGLUT.SCREEN,86403,CPT,,,,,both,, ,547.31,547.31,Blue Cross and Blue Shield,Traditional,,211.81,38.7,38.7,547.31,21.35,279.13,percent of total billed charges,38.7
Q11196 CRYPTOC AG LA,86403,CPT,,,,,both,, ,172.9,172.9,Blue Cross and Blue Shield,Traditional,,66.91,38.7,38.7,172.9,6.74,88.18,percent of total billed charges,38.7
Q11196 CRYPTOC AG LA,86403,CPT,,,,,both,, ,172.9,172.9,Blue Cross and Blue Shield,Traditional,,66.91,38.7,38.7,172.9,6.74,88.18,percent of total billed charges,38.7
PART AGGLUT. TITER,86406,CPT,,,,,both,, ,147.91,147.91,Blue Cross and Blue Shield,Traditional,,57.24,38.7,38.7,147.91,5.77,75.43,percent of total billed charges,38.7
Q37521 RA FACT QT,86431,CPT,,,,,both,, ,401.19,401.19,Blue Cross and Blue Shield,Traditional,,155.26,38.7,38.7,401.19,15.65,204.61,percent of total billed charges,38.7
RHEUMATOID FACT QUAN,86431,CPT,,,,,both,, ,55.85,55.85,Blue Cross and Blue Shield,Traditional,,21.61,38.7,38.7,55.85,2.18,28.48,percent of total billed charges,38.7
RHEUMATOID FACT QUAN,86431,CPT,,,,,both,, ,437.29,437.29,Blue Cross and Blue Shield,Traditional,,169.23,38.7,38.7,437.29,17.05,223.02,percent of total billed charges,38.7
LRX182877 QTFERON TU,86480,CPT,,,,,both,, ,369.77,369.77,Blue Cross and Blue Shield,Traditional,,143.1,38.7,38.7,369.77,14.42,188.58,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,,155.98,38.7,38.7,403.05,15.72,205.56,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,,155.98,38.7,38.7,403.05,15.72,205.56,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,,155.98,38.7,38.7,403.05,15.72,205.56,percent of total billed charges,38.7
L006099 RFLX RPR,86592,CPT,,,,,both,, ,48.9,48.9,Blue Cross and Blue Shield,Traditional,,18.92,38.7,38.7,48.9,1.91,24.94,percent of total billed charges,38.7
"SYPHILIS TEST, QUAL",86592,CPT,,,,,both,, ,42.1,42.1,Blue Cross and Blue Shield,Traditional,,16.29,38.7,38.7,42.1,1.64,21.47,percent of total billed charges,38.7
"SYPHILIS TEST, QUAL",86592,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
"SYPHILIS TEST, QUAL",86592,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,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,,159.78,38.7,38.7,412.88,16.1,210.57,percent of total billed charges,38.7
"SYPHILIS TEST, QUANT",86593,CPT,,,,,both,, ,43.5,43.5,Blue Cross and Blue Shield,Traditional,,16.83,38.7,38.7,43.5,1.7,22.19,percent of total billed charges,38.7
"SYPHILIS TEST, QUANT",86593,CPT,,,,,both,, ,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,38.7,412.87,16.1,210.56,percent of total billed charges,38.7
VOLT-GTD CA CHNL AB,86596,CPT,,,,,both,, ,120.5,120.5,Blue Cross and Blue Shield,Traditional,,46.63,38.7,38.7,120.5,4.7,61.46,percent of total billed charges,38.7
ASPERGILLUS AB,86606,CPT,,,,,both,, ,145.95,145.95,Blue Cross and Blue Shield,Traditional,,56.48,38.7,38.7,145.95,5.69,74.43,percent of total billed charges,38.7
ASPERGILLUS AB,86606,CPT,,,,,both,, ,145.95,145.95,Blue Cross and Blue Shield,Traditional,,56.48,38.7,38.7,145.95,5.69,74.43,percent of total billed charges,38.7
"BACTERUIM AB, NOS",86609,CPT,,,,,both,, ,154.09,154.09,Blue Cross and Blue Shield,Traditional,,59.63,38.7,38.7,154.09,6.01,78.59,percent of total billed charges,38.7
"BACTERUIM AB, NOS",86609,CPT,,,,,both,, ,154.09,154.09,Blue Cross and Blue Shield,Traditional,,59.63,38.7,38.7,154.09,6.01,78.59,percent of total billed charges,38.7
Q34329 LISTERI AB CF,86609,CPT,,,,,both,, ,770.45,770.45,Blue Cross and Blue Shield,Traditional,,298.16,38.7,38.7,770.45,30.05,392.93,percent of total billed charges,38.7
BARTONELLA AB,86611,CPT,,,,,both,, ,348.32,348.32,Blue Cross and Blue Shield,Traditional,,134.8,38.7,38.7,348.32,13.58,177.64,percent of total billed charges,38.7
Q34251 BARTONELLA AB,86611,CPT,,,,,both,, ,264.11,264.11,Blue Cross and Blue Shield,Traditional,,102.21,38.7,38.7,264.11,10.3,134.7,percent of total billed charges,38.7
BLASTOMYCES AB,86612,CPT,,,,,both,, ,600.92,600.92,Blue Cross and Blue Shield,Traditional,,232.56,38.7,38.7,600.92,23.44,306.47,percent of total billed charges,38.7
BLASTOMYCES AB,86612,CPT,,,,,both,, ,600.92,600.92,Blue Cross and Blue Shield,Traditional,,232.56,38.7,38.7,600.92,23.44,306.47,percent of total billed charges,38.7
BORDETELLA AB,86615,CPT,,,,,both,, ,134.44,134.44,Blue Cross and Blue Shield,Traditional,,52.03,38.7,38.7,134.44,5.24,68.56,percent of total billed charges,38.7
BORDETELLA AB,86615,CPT,,,,,both,, ,134.44,134.44,Blue Cross and Blue Shield,Traditional,,52.03,38.7,38.7,134.44,5.24,68.56,percent of total billed charges,38.7
BORRELIA BURG.CONFIR,86617,CPT,,,,,both,, ,232.11,232.11,Blue Cross and Blue Shield,Traditional,,89.83,38.7,38.7,232.11,9.05,118.38,percent of total billed charges,38.7
BORRELIA BURG.CONFIR,86617,CPT,,,,,both,, ,232.11,232.11,Blue Cross and Blue Shield,Traditional,,89.83,38.7,38.7,232.11,9.05,118.38,percent of total billed charges,38.7
LYME DISEASE AB,86618,CPT,,,,,both,, ,167.84,167.84,Blue Cross and Blue Shield,Traditional,,64.95,38.7,38.7,167.84,6.55,85.6,percent of total billed charges,38.7
LYME DISEASE AB,86618,CPT,,,,,both,, ,573.13,573.13,Blue Cross and Blue Shield,Traditional,,221.8,38.7,38.7,573.13,22.35,292.3,percent of total billed charges,38.7
LYME DISEASE AB,86618,CPT,,,,,both,, ,573.13,573.13,Blue Cross and Blue Shield,Traditional,,221.8,38.7,38.7,573.13,22.35,292.3,percent of total billed charges,38.7
BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,405.29,Blue Cross and Blue Shield,Traditional,,156.85,38.7,38.7,405.29,15.81,206.7,percent of total billed charges,38.7
Q91068 BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,405.29,Blue Cross and Blue Shield,Traditional,,156.85,38.7,38.7,405.29,15.81,206.7,percent of total billed charges,38.7
Q91121 BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,405.29,Blue Cross and Blue Shield,Traditional,,156.85,38.7,38.7,405.29,15.81,206.7,percent of total billed charges,38.7
CANDIDA AB,86628,CPT,,,,,both,, ,157.18,157.18,Blue Cross and Blue Shield,Traditional,,60.83,38.7,38.7,157.18,6.13,80.16,percent of total billed charges,38.7
CHLAMYDIA AB,86631,CPT,,,,,both,, ,275.62,275.62,Blue Cross and Blue Shield,Traditional,,106.66,38.7,38.7,275.62,10.75,140.57,percent of total billed charges,38.7
CHLAMYDIA IGM AB,86632,CPT,,,,,both,, ,286.57,286.57,Blue Cross and Blue Shield,Traditional,,110.9,38.7,38.7,286.57,11.18,146.15,percent of total billed charges,38.7
CHLAMYDIA IGM AB,86632,CPT,,,,,both,, ,286.57,286.57,Blue Cross and Blue Shield,Traditional,,110.9,38.7,38.7,286.57,11.18,146.15,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,,287.74,38.7,38.7,743.51,29,379.19,percent of total billed charges,38.7
COCCIDIOIDES AB,86635,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
COCCIDIOIDES AB,86635,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
L806606 Q FEV,86638,CPT,,,,,both,, ,120,120,Blue Cross and Blue Shield,Traditional,,46.44,38.7,38.7,120,4.68,61.2,percent of total billed charges,38.7
Q37071 COXIELLA BRUN,86638,CPT,,,,,both,, ,69.89,69.89,Blue Cross and Blue Shield,Traditional,,27.05,38.7,38.7,69.89,2.73,35.64,percent of total billed charges,38.7
Q30430 CRYPTO AB IFA,86641,CPT,,,,,both,, ,74.65,74.65,Blue Cross and Blue Shield,Traditional,,28.89,38.7,38.7,74.65,2.91,38.07,percent of total billed charges,38.7
CMV AB,86644,CPT,,,,,both,, ,1113.43,1113.43,Blue Cross and Blue Shield,Traditional,,430.9,38.7,38.7,1113.43,43.42,567.85,percent of total billed charges,38.7
CMV AB,86644,CPT,,,,,both,, ,1113.43,1113.43,Blue Cross and Blue Shield,Traditional,,430.9,38.7,38.7,1113.43,43.42,567.85,percent of total billed charges,38.7
L6494 CMV IGG CLIA,86644,CPT,,,,,both,, ,1021.5,1021.5,Blue Cross and Blue Shield,Traditional,,395.32,38.7,38.7,1021.5,39.84,520.97,percent of total billed charges,38.7
"CMV AB, IGM",86645,CPT,,,,,both,, ,1277.07,1277.07,Blue Cross and Blue Shield,Traditional,,494.23,38.7,38.7,1277.07,49.81,651.31,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,,188.02,38.7,38.7,485.84,18.95,247.78,percent of total billed charges,38.7
Q37512 DIPTHTHER AB,86648,CPT,,,,,both,, ,101.32,101.32,Blue Cross and Blue Shield,Traditional,,39.21,38.7,38.7,101.32,3.95,51.67,percent of total billed charges,38.7
ENTEROVIRUS AB,86658,CPT,,,,,both,, ,375.82,375.82,Blue Cross and Blue Shield,Traditional,,145.44,38.7,38.7,375.82,14.66,191.67,percent of total billed charges,38.7
L830764 ENTEROVIR AB,86658,CPT,,,,,both,, ,212,212,Blue Cross and Blue Shield,Traditional,,82.04,38.7,38.7,212,8.27,108.12,percent of total billed charges,38.7
"EPSTEIN-BARR AB, EA",86663,CPT,,,,,both,, ,210.5,210.5,Blue Cross and Blue Shield,Traditional,,81.46,38.7,38.7,210.5,8.21,107.36,percent of total billed charges,38.7
"EPSTEIN-BARR AB, EA",86663,CPT,,,,,both,, ,210.5,210.5,Blue Cross and Blue Shield,Traditional,,81.46,38.7,38.7,210.5,8.21,107.36,percent of total billed charges,38.7
"EPSTEIN-BARR, EBNA",86664,CPT,,,,,both,, ,362.91,362.91,Blue Cross and Blue Shield,Traditional,,140.45,38.7,38.7,362.91,14.15,185.08,percent of total billed charges,38.7
"EPSTEIN-BARR, EBNA",86664,CPT,,,,,both,, ,362.91,362.91,Blue Cross and Blue Shield,Traditional,,140.45,38.7,38.7,362.91,14.15,185.08,percent of total billed charges,38.7
"EPSTEIN-BARR, VCA",86665,CPT,,,,,both,, ,362.91,362.91,Blue Cross and Blue Shield,Traditional,,140.45,38.7,38.7,362.91,14.15,185.08,percent of total billed charges,38.7
"EPSTEIN-BARR, VCA",86665,CPT,,,,,both,, ,362.91,362.91,Blue Cross and Blue Shield,Traditional,,140.45,38.7,38.7,362.91,14.15,185.08,percent of total billed charges,38.7
Q8426 EBV VCA IGM IA,86665,CPT,,,,,both,, ,210.5,210.5,Blue Cross and Blue Shield,Traditional,,81.46,38.7,38.7,210.5,8.21,107.36,percent of total billed charges,38.7
Q8426 EBV VCA IGM IA,86665,CPT,,,,,both,, ,210.5,210.5,Blue Cross and Blue Shield,Traditional,,81.46,38.7,38.7,210.5,8.21,107.36,percent of total billed charges,38.7
EHRLICHIA AB,86666,CPT,,,,,both,, ,255.98,255.98,Blue Cross and Blue Shield,Traditional,,99.06,38.7,38.7,255.98,9.98,130.55,percent of total billed charges,38.7
EHRLICHIA AB,86666,CPT,,,,,both,, ,255.98,255.98,Blue Cross and Blue Shield,Traditional,,99.06,38.7,38.7,255.98,9.98,130.55,percent of total billed charges,38.7
Q34271 EHRLICHIA AB,86666,CPT,,,,,both,, ,511.95,511.95,Blue Cross and Blue Shield,Traditional,,198.12,38.7,38.7,511.95,19.97,261.09,percent of total billed charges,38.7
FRANCISELLA TULARENS,86668,CPT,,,,,both,, ,1036.25,1036.25,Blue Cross and Blue Shield,Traditional,,401.03,38.7,38.7,1036.25,40.41,528.49,percent of total billed charges,38.7
"FUNGUS AB, NOS",86671,CPT,,,,,both,, ,284.32,284.32,Blue Cross and Blue Shield,Traditional,,110.03,38.7,38.7,284.32,11.09,145,percent of total billed charges,38.7
L162045 FUNG AB NOS,86671,CPT,,,,,both,, ,260.85,260.85,Blue Cross and Blue Shield,Traditional,,100.95,38.7,38.7,260.85,10.17,133.03,percent of total billed charges,38.7
Q10294 SCAB IGG IA,86671,CPT,,,,,both,, ,568.64,568.64,Blue Cross and Blue Shield,Traditional,,220.06,38.7,38.7,568.64,22.18,290.01,percent of total billed charges,38.7
Q10294 SCAB IGG IA,86671,CPT,,,,,both,, ,568.64,568.64,Blue Cross and Blue Shield,Traditional,,220.06,38.7,38.7,568.64,22.18,290.01,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,,21.94,38.7,38.7,56.69,2.21,28.91,percent of total billed charges,38.7
Q34168 FILAR IGG4 EL,86682,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29,38.7,38.7,74.93,2.92,38.21,percent of total billed charges,38.7
Q34168 FILAR IGG4 EL,86682,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29,38.7,38.7,74.93,2.92,38.21,percent of total billed charges,38.7
Q34168 FILAR IGG4 EL,86682,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29,38.7,38.7,74.93,2.92,38.21,percent of total billed charges,38.7
Q34168 FILAR IGG4 EL,86682,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29,38.7,38.7,74.93,2.92,38.21,percent of total billed charges,38.7
"HEPATITIS, DELTA AGE",86692,CPT,,,,,both,, ,1381.76,1381.76,Blue Cross and Blue Shield,Traditional,,534.74,38.7,38.7,1381.76,53.89,704.7,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,,280.89,38.7,38.7,725.82,28.31,370.17,percent of total billed charges,38.7
HERPES SIMP NON-SPEC,86694,CPT,,,,,both,, ,338.21,338.21,Blue Cross and Blue Shield,Traditional,,130.89,38.7,38.7,338.21,13.19,172.49,percent of total billed charges,38.7
L164806 HSV1/2 IGM,86694,CPT,,,,,both,, ,50.7,50.7,Blue Cross and Blue Shield,Traditional,,19.62,38.7,38.7,50.7,1.98,25.86,percent of total billed charges,38.7
HERPES SIMP TYPE 1,86695,CPT,,,,,both,, ,129.94,129.94,Blue Cross and Blue Shield,Traditional,,50.29,38.7,38.7,129.94,5.07,66.27,percent of total billed charges,38.7
Q6447 HERPES SMP TP1,86695,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
Q6447 HERPES SMP TP1,86695,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
Q6447 HERPES SMP TP1,86695,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
Q6447 HERPES SMP TP1,86695,CPT,,,,,both,, ,351.68,351.68,Blue Cross and Blue Shield,Traditional,,136.1,38.7,38.7,351.68,13.72,179.36,percent of total billed charges,38.7
HERPES SIMP TYPE 2,86696,CPT,,,,,both,, ,190.86,190.86,Blue Cross and Blue Shield,Traditional,,73.86,38.7,38.7,190.86,7.44,97.34,percent of total billed charges,38.7
L163006 HSV2 AB IG,86696,CPT,,,,,both,, ,300,300,Blue Cross and Blue Shield,Traditional,,116.1,38.7,38.7,300,11.7,153,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,,89.11,38.7,38.7,230.25,8.98,117.43,percent of total billed charges,38.7
Q6447 HERPES SMP TP2,86696,CPT,,,,,both,, ,258.5,258.5,Blue Cross and Blue Shield,Traditional,,100.04,38.7,38.7,258.5,10.08,131.84,percent of total billed charges,38.7
Q6447 HERPES SMP TP2,86696,CPT,,,,,both,, ,258.5,258.5,Blue Cross and Blue Shield,Traditional,,100.04,38.7,38.7,258.5,10.08,131.84,percent of total billed charges,38.7
Q6447 HERPES SMP TP2,86696,CPT,,,,,both,, ,258.5,258.5,Blue Cross and Blue Shield,Traditional,,100.04,38.7,38.7,258.5,10.08,131.84,percent of total billed charges,38.7
Q6447 HERPES SMP TP2,86696,CPT,,,,,both,, ,258.5,258.5,Blue Cross and Blue Shield,Traditional,,100.04,38.7,38.7,258.5,10.08,131.84,percent of total billed charges,38.7
HISTOPLASMA,86698,CPT,,,,,both,, ,450.48,450.48,Blue Cross and Blue Shield,Traditional,,174.34,38.7,38.7,450.48,17.57,229.74,percent of total billed charges,38.7
HISTOPLASMA,86698,CPT,,,,,both,, ,450.48,450.48,Blue Cross and Blue Shield,Traditional,,174.34,38.7,38.7,450.48,17.57,229.74,percent of total billed charges,38.7
HEP B CORE TOT,86704,CPT,,,,,both,, ,898.44,898.44,Blue Cross and Blue Shield,Traditional,,347.7,38.7,38.7,898.44,35.04,458.2,percent of total billed charges,38.7
HEP B CORE TOT,86704,CPT,,,,,both,, ,898.44,898.44,Blue Cross and Blue Shield,Traditional,,347.7,38.7,38.7,898.44,35.04,458.2,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,,405.26,38.7,38.7,1047.19,40.84,534.07,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,,405.26,38.7,38.7,1047.19,40.84,534.07,percent of total billed charges,38.7
L16881 HBC IGM ICMA,86705,CPT,,,,,both,, ,70.33,70.33,Blue Cross and Blue Shield,Traditional,,27.22,38.7,38.7,70.33,2.74,35.87,percent of total billed charges,38.7
HEP BE AB,86707,CPT,,,,,both,, ,999.76,999.76,Blue Cross and Blue Shield,Traditional,,386.91,38.7,38.7,999.76,38.99,509.88,percent of total billed charges,38.7
HEP BE AB,86707,CPT,,,,,both,, ,999.76,999.76,Blue Cross and Blue Shield,Traditional,,386.91,38.7,38.7,999.76,38.99,509.88,percent of total billed charges,38.7
"HEP A AB, TOTAL",86708,CPT,,,,,both,, ,547.88,547.88,Blue Cross and Blue Shield,Traditional,,212.03,38.7,38.7,547.88,21.37,279.42,percent of total billed charges,38.7
L6726HEPA AB TOT ICM,86708,CPT,,,,,both,, ,547.88,547.88,Blue Cross and Blue Shield,Traditional,,212.03,38.7,38.7,547.88,21.37,279.42,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,,212.03,38.7,38.7,547.88,21.37,279.42,percent of total billed charges,38.7
"HEP A AB, IGM",86709,CPT,,,,,both,,,725.82,725.82,Blue Cross and Blue Shield,Traditional,,280.89,38.7,38.7,725.82,28.31,370.17,percent of total billed charges,38.7
"HEP A AB, IGM",86709,CPT,,,,,both,, ,725.82,725.82,Blue Cross and Blue Shield,Traditional,,280.89,38.7,38.7,725.82,28.31,370.17,percent of total billed charges,38.7
L6734 HEP A IGM ICMA,86709,CPT,,,,,both,, ,70,70,Blue Cross and Blue Shield,Traditional,,27.09,38.7,38.7,70,2.73,35.7,percent of total billed charges,38.7
L6734 HEP A IGM ICMA,86709,CPT,,,,,both,, ,70,70,Blue Cross and Blue Shield,Traditional,,27.09,38.7,38.7,70,2.73,35.7,percent of total billed charges,38.7
INFLUENZA VIRUS AB,86710,CPT,,,,,both,, ,295.83,295.83,Blue Cross and Blue Shield,Traditional,,114.49,38.7,38.7,295.83,11.54,150.87,percent of total billed charges,38.7
INFLUENZA VIRUS AB,86710,CPT,,,,,both,, ,295.83,295.83,Blue Cross and Blue Shield,Traditional,,114.49,38.7,38.7,295.83,11.54,150.87,percent of total billed charges,38.7
Q91665 STRAT JCV AB,86711,CPT,,,,,both,, ,156.06,156.06,Blue Cross and Blue Shield,Traditional,,60.4,38.7,38.7,156.06,6.09,79.59,percent of total billed charges,38.7
L164616 LEGIONELL AB,86713,CPT,,,,,both,, ,781.12,781.12,Blue Cross and Blue Shield,Traditional,,302.29,38.7,38.7,781.12,30.46,398.37,percent of total billed charges,38.7
LEGIONELLA AB,86713,CPT,,,,,both,, ,781.11,781.11,Blue Cross and Blue Shield,Traditional,,302.29,38.7,38.7,781.11,30.46,398.37,percent of total billed charges,38.7
LEGIONELLA AB,86713,CPT,,,,,both,, ,781.11,781.11,Blue Cross and Blue Shield,Traditional,,302.29,38.7,38.7,781.11,30.46,398.37,percent of total billed charges,38.7
LEPTOSPIRA AB,86720,CPT,,,,,both,, ,329.51,329.51,Blue Cross and Blue Shield,Traditional,,127.52,38.7,38.7,329.51,12.85,168.05,percent of total billed charges,38.7
L96552MUMPS IGG CLIA,86735,CPT,,,,,both,, ,540.24,540.24,Blue Cross and Blue Shield,Traditional,,209.07,38.7,38.7,540.24,21.07,275.52,percent of total billed charges,38.7
MUMPS AB,86735,CPT,,,,,both,, ,96.55,96.55,Blue Cross and Blue Shield,Traditional,,37.36,38.7,38.7,96.55,3.77,49.24,percent of total billed charges,38.7
MUMPS AB,86735,CPT,,,,,both,, ,588.85,588.85,Blue Cross and Blue Shield,Traditional,,227.88,38.7,38.7,588.85,22.97,300.31,percent of total billed charges,38.7
Q36565 MUMPS IGM IFA,86735,CPT,,,,,both,, ,588.85,588.85,Blue Cross and Blue Shield,Traditional,,227.88,38.7,38.7,588.85,22.97,300.31,percent of total billed charges,38.7
Q8624 MUMPSAB IGG IA,86735,CPT,,,,,both,, ,588.85,588.85,Blue Cross and Blue Shield,Traditional,,227.88,38.7,38.7,588.85,22.97,300.31,percent of total billed charges,38.7
Q21130 MPAB IGM EIA,86738,CPT,,,,,both,, ,566.12,566.12,Blue Cross and Blue Shield,Traditional,,219.09,38.7,38.7,566.12,22.08,288.72,percent of total billed charges,38.7
Q21130 MPAB IGM EIA,86738,CPT,,,,,both,, ,566.12,566.12,Blue Cross and Blue Shield,Traditional,,219.09,38.7,38.7,566.12,22.08,288.72,percent of total billed charges,38.7
Q21130 MPAB IGM EIA,86738,CPT,,,,,both,, ,566.12,566.12,Blue Cross and Blue Shield,Traditional,,219.09,38.7,38.7,566.12,22.08,288.72,percent of total billed charges,38.7
Q21130 MPAB IGM EIA,86738,CPT,,,,,both,, ,566.12,566.12,Blue Cross and Blue Shield,Traditional,,219.09,38.7,38.7,566.12,22.08,288.72,percent of total billed charges,38.7
Q8948 PARVO IGM EIA,86747,CPT,,,,,both,, ,242.5,242.5,Blue Cross and Blue Shield,Traditional,,93.85,38.7,38.7,242.5,9.46,123.68,percent of total billed charges,38.7
Q8948 PARVO IGM EIA,86747,CPT,,,,,both,, ,242.5,242.5,Blue Cross and Blue Shield,Traditional,,93.85,38.7,38.7,242.5,9.46,123.68,percent of total billed charges,38.7
Q8948 PARVO IGM EIA,86747,CPT,,,,,both,, ,242.5,242.5,Blue Cross and Blue Shield,Traditional,,93.85,38.7,38.7,242.5,9.46,123.68,percent of total billed charges,38.7
Q8948 PARVO IGM EIA,86747,CPT,,,,,both,, ,242.5,242.5,Blue Cross and Blue Shield,Traditional,,93.85,38.7,38.7,242.5,9.46,123.68,percent of total billed charges,38.7
Q34278 ENTAB IGG ELI,86753,CPT,,,,,both,, ,64.27,64.27,Blue Cross and Blue Shield,Traditional,,24.87,38.7,38.7,64.27,2.51,32.78,percent of total billed charges,38.7
Q34300 PROTOZ AB NOS,86753,CPT,,,,,both,, ,64.27,64.27,Blue Cross and Blue Shield,Traditional,,24.87,38.7,38.7,64.27,2.51,32.78,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,,24.87,38.7,38.7,64.27,2.51,32.78,percent of total billed charges,38.7
L96131 RSV AB QT,86756,CPT,,,,,both,, ,95,95,Blue Cross and Blue Shield,Traditional,,36.77,38.7,38.7,95,3.71,48.45,percent of total billed charges,38.7
SPOTTED FEVER IGM,86757,CPT,,,,,both,, ,242.5,242.5,Blue Cross and Blue Shield,Traditional,,93.85,38.7,38.7,242.5,9.46,123.68,percent of total billed charges,38.7
SPOTTED FEVER IGM,86757,CPT,,,,,both,, ,242.5,242.5,Blue Cross and Blue Shield,Traditional,,93.85,38.7,38.7,242.5,9.46,123.68,percent of total billed charges,38.7
SPOTTED FEVER IGM,86757,CPT,,,,,both,, ,242.5,242.5,Blue Cross and Blue Shield,Traditional,,93.85,38.7,38.7,242.5,9.46,123.68,percent of total billed charges,38.7
SPOTTED FEVER IGM,86757,CPT,,,,,both,, ,242.5,242.5,Blue Cross and Blue Shield,Traditional,,93.85,38.7,38.7,242.5,9.46,123.68,percent of total billed charges,38.7
RUBELLA AB,86762,CPT,,,,,both,, ,88.69,88.69,Blue Cross and Blue Shield,Traditional,,34.32,38.7,38.7,88.69,3.46,45.23,percent of total billed charges,38.7
RUBELLA AB,86762,CPT,,,,,both,, ,906.3,906.3,Blue Cross and Blue Shield,Traditional,,350.74,38.7,38.7,906.3,35.35,462.21,percent of total billed charges,38.7
Q34256 MEASAB IGMIA,86765,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,38.7,871.22,33.98,444.32,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,,337.16,38.7,38.7,871.22,33.98,444.32,percent of total billed charges,38.7
RUBEOLA AB,86765,CPT,,,,,both,, ,111.15,111.15,Blue Cross and Blue Shield,Traditional,,43.02,38.7,38.7,111.15,4.33,56.69,percent of total billed charges,38.7
RUBEOLA AB,86765,CPT,,,,,both,, ,871.22,871.22,Blue Cross and Blue Shield,Traditional,,337.16,38.7,38.7,871.22,33.98,444.32,percent of total billed charges,38.7
SALMONELLA AB,86768,CPT,,,,,both,, ,127.7,127.7,Blue Cross and Blue Shield,Traditional,,49.42,38.7,38.7,127.7,4.98,65.13,percent of total billed charges,38.7
SALMONELLA AB,86768,CPT,,,,,both,, ,127.7,127.7,Blue Cross and Blue Shield,Traditional,,49.42,38.7,38.7,127.7,4.98,65.13,percent of total billed charges,38.7
COVID19 AB,86769,CPT,,,,,both,, ,224.54,224.54,Blue Cross and Blue Shield,Traditional,,86.9,38.7,38.7,224.54,8.76,114.52,percent of total billed charges,38.7
COVID19 AB,86769,CPT,,,,,both,, ,224.54,224.54,Blue Cross and Blue Shield,Traditional,,86.9,38.7,38.7,224.54,8.76,114.52,percent of total billed charges,38.7
L164055 COVID19ABIGG,86769,CPT,,,,,both,, ,206,206,Blue Cross and Blue Shield,Traditional,,79.72,38.7,38.7,206,8.03,105.06,percent of total billed charges,38.7
Q4862 TET ATOX ELISA,86774,CPT,,,,,both,, ,98.51,98.51,Blue Cross and Blue Shield,Traditional,,38.12,38.7,38.7,98.51,3.84,50.24,percent of total billed charges,38.7
Q3679 TOXOPLAS AB IA,86777,CPT,,,,,both,, ,247.83,247.83,Blue Cross and Blue Shield,Traditional,,95.91,38.7,38.7,247.83,9.67,126.39,percent of total billed charges,38.7
Q8636 TOXOPLASMA AB,86777,CPT,,,,,both,, ,247.83,247.83,Blue Cross and Blue Shield,Traditional,,95.91,38.7,38.7,247.83,9.67,126.39,percent of total billed charges,38.7
TOXOPLASMA AB,86777,CPT,,,,,both,, ,247.83,247.83,Blue Cross and Blue Shield,Traditional,,95.91,38.7,38.7,247.83,9.67,126.39,percent of total billed charges,38.7
"TOXOPLASMA AB, IGM",86778,CPT,,,,,both,, ,247.83,247.83,Blue Cross and Blue Shield,Traditional,,95.91,38.7,38.7,247.83,9.67,126.39,percent of total billed charges,38.7
"TOXOPLASMA AB, IGM",86778,CPT,,,,,both,, ,247.83,247.83,Blue Cross and Blue Shield,Traditional,,95.91,38.7,38.7,247.83,9.67,126.39,percent of total billed charges,38.7
L082370 TREP AB IA,86780,CPT,,,,,both,, ,132.4,132.4,Blue Cross and Blue Shield,Traditional,,51.24,38.7,38.7,132.4,5.16,67.52,percent of total billed charges,38.7
"TREP. PALLIDUM,CONFI",86780,CPT,,,,,both,, ,172.9,172.9,Blue Cross and Blue Shield,Traditional,,66.91,38.7,38.7,172.9,6.74,88.18,percent of total billed charges,38.7
"TREP. PALLIDUM,CONFI",86780,CPT,,,,,both,, ,172.9,172.9,Blue Cross and Blue Shield,Traditional,,66.91,38.7,38.7,172.9,6.74,88.18,percent of total billed charges,38.7
TREPONEMAL AB,86780,CPT,,,,,both,, ,48.9,48.9,Blue Cross and Blue Shield,Traditional,,18.92,38.7,38.7,48.9,1.91,24.94,percent of total billed charges,38.7
L96206 VZV IGG CLIA,86787,CPT,,,,,both,, ,831.47,831.47,Blue Cross and Blue Shield,Traditional,,321.78,38.7,38.7,831.47,32.43,424.05,percent of total billed charges,38.7
Q4439 VZV AB IGG IA,86787,CPT,,,,,both,, ,906.3,906.3,Blue Cross and Blue Shield,Traditional,,350.74,38.7,38.7,906.3,35.35,462.21,percent of total billed charges,38.7
Q8683 VZV AB IGM IA,86787,CPT,,,,,both,, ,906.3,906.3,Blue Cross and Blue Shield,Traditional,,350.74,38.7,38.7,906.3,35.35,462.21,percent of total billed charges,38.7
VARICELLA-ZOSTER AB,86787,CPT,,,,,both,, ,111.15,111.15,Blue Cross and Blue Shield,Traditional,,43.02,38.7,38.7,111.15,4.33,56.69,percent of total billed charges,38.7
VARICELLA-ZOSTER AB,86787,CPT,,,,,both,, ,906.3,906.3,Blue Cross and Blue Shield,Traditional,,350.74,38.7,38.7,906.3,35.35,462.21,percent of total billed charges,38.7
Q16012 WNVAB IGM EIA,86788,CPT,,,,,both,, ,252.61,252.61,Blue Cross and Blue Shield,Traditional,,97.76,38.7,38.7,252.61,9.85,128.83,percent of total billed charges,38.7
Q36596 WEST NILE VIR,86788,CPT,,,,,both,, ,252.61,252.61,Blue Cross and Blue Shield,Traditional,,97.76,38.7,38.7,252.61,9.85,128.83,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,,97.76,38.7,38.7,252.61,9.85,128.83,percent of total billed charges,38.7
Q36596 WEST NILE VIR,86789,CPT,,,,,both,, ,219.2,219.2,Blue Cross and Blue Shield,Traditional,,84.83,38.7,38.7,219.2,8.55,111.79,percent of total billed charges,38.7
WEST NILE VIR AB,86789,CPT,,,,,both,, ,215.84,215.84,Blue Cross and Blue Shield,Traditional,,83.53,38.7,38.7,215.84,8.42,110.08,percent of total billed charges,38.7
L878033 HHV-7 IGM IF,86790,CPT,,,,,both,, ,615,615,Blue Cross and Blue Shield,Traditional,,238.01,38.7,38.7,615,23.99,313.65,percent of total billed charges,38.7
Q36175HLTV I/II CL-I,86790,CPT,,,,,both,, ,124.9,124.9,Blue Cross and Blue Shield,Traditional,,48.34,38.7,38.7,124.9,4.87,63.7,percent of total billed charges,38.7
Q36175HLTV I/II CL-I,86790,CPT,,,,,both,, ,124.9,124.9,Blue Cross and Blue Shield,Traditional,,48.34,38.7,38.7,124.9,4.87,63.7,percent of total billed charges,38.7
Q94264 ZIKA AB IGM,86794,CPT,,,,,both,, ,97.11,97.11,Blue Cross and Blue Shield,Traditional,,37.58,38.7,38.7,97.11,3.79,49.53,percent of total billed charges,38.7
Q30278 THYROGLOB AB,86800,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,38.7,751.36,29.3,383.19,percent of total billed charges,38.7
Q30278 THYROGLOB AB,86800,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,38.7,751.36,29.3,383.19,percent of total billed charges,38.7
Q30278 THYROGLOB AB,86800,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,38.7,751.36,29.3,383.19,percent of total billed charges,38.7
Q30278 THYROGLOB AB,86800,CPT,,,,,both,, ,751.36,751.36,Blue Cross and Blue Shield,Traditional,,290.78,38.7,38.7,751.36,29.3,383.19,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,,259,38.7,38.7,669.25,26.1,341.32,percent of total billed charges,38.7
HEPATITIS C AB TEST,86803,CPT,,,,,both,, ,698.32,698.32,Blue Cross and Blue Shield,Traditional,,270.25,38.7,38.7,698.32,27.23,356.14,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,,138.71,38.7,38.7,358.42,13.98,182.79,percent of total billed charges,38.7
CYTOTOXIC REACTIVE AB SCREEN/STANDARD,86807,CPT,,,,,both,, ,87,87,Blue Cross and Blue Shield,Traditional,,33.67,38.7,38.7,87,3.39,44.37,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,,560.92,38.7,38.7,1449.41,56.53,739.2,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,,560.92,38.7,38.7,1449.41,56.53,739.2,percent of total billed charges,38.7
HLA SOLID PHASE/CALSS I&II AB QUAL,86828,CPT,,,,,both,, ,70,70,Blue Cross and Blue Shield,Traditional,,27.09,38.7,38.7,70,2.73,35.7,percent of total billed charges,38.7
HLA SOLID PHASE/CLASS 1 AB QUAL HIGHDEF,86832,CPT,,,,,both,, ,356,356,Blue Cross and Blue Shield,Traditional,,137.77,38.7,38.7,356,13.88,181.56,percent of total billed charges,38.7
L117065 PROTH AB IGG,86849,CPT,,,,,both,, ,157,157,Blue Cross and Blue Shield,Traditional,,60.76,38.7,38.7,157,6.12,80.07,percent of total billed charges,38.7
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,, ,61.75,61.75,Blue Cross and Blue Shield,Traditional,,23.9,38.7,38.7,61.75,2.41,31.49,percent of total billed charges,38.7
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,,,318,318,Blue Cross and Blue Shield,Traditional,,123.07,38.7,38.7,318,12.4,162.18,percent of total billed charges,38.7
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,, ,318,318,Blue Cross and Blue Shield,Traditional,,123.07,38.7,38.7,318,12.4,162.18,percent of total billed charges,38.7
O51200 AB SCRN,86850,CPT,,,,,both,, ,291.75,291.75,Blue Cross and Blue Shield,Traditional,,112.91,38.7,38.7,291.75,11.38,148.79,percent of total billed charges,38.7
"ANTIBODY ELUTION,RBC",86860,CPT,,,,,both,, ,174.3,174.3,Blue Cross and Blue Shield,Traditional,,67.45,38.7,38.7,174.3,6.8,88.89,percent of total billed charges,38.7
"ANTIBODY ELUTION,RBC",86860,CPT,,,,,both,, ,174.3,174.3,Blue Cross and Blue Shield,Traditional,,67.45,38.7,38.7,174.3,6.8,88.89,percent of total billed charges,38.7
"ANTIBODY ID,EA PANEL",86870,CPT,,,,,both,, ,488.65,488.65,Blue Cross and Blue Shield,Traditional,,189.11,38.7,38.7,488.65,19.06,249.21,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,,183.89,38.7,38.7,475.18,18.53,242.34,percent of total billed charges,38.7
DIRECT COOMBS TEST,86880,CPT,,,,,both,, ,250.64,250.64,Blue Cross and Blue Shield,Traditional,,97,38.7,38.7,250.64,9.77,127.83,percent of total billed charges,38.7
DIRECT COOMBS TEST,86880,CPT,,,,,both,, ,250.64,250.64,Blue Cross and Blue Shield,Traditional,,97,38.7,38.7,250.64,9.77,127.83,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,,15.31,38.7,38.7,39.57,1.54,20.18,percent of total billed charges,38.7
IDAT EACH AB TITER,86886,CPT,,,,,both,, ,326.14,326.14,Blue Cross and Blue Shield,Traditional,,126.22,38.7,38.7,326.14,12.72,166.33,percent of total billed charges,38.7
"AUTO COMPONENT,PROCS",86890,CPT,,,,,both,, ,756.41,756.41,Blue Cross and Blue Shield,Traditional,,292.73,38.7,38.7,756.41,29.5,385.77,percent of total billed charges,38.7
AUTOL BID OP SALV,86891,CPT,,,,,both,, ,3941.23,3941.23,Blue Cross and Blue Shield,Traditional,,1525.26,38.7,38.7,3941.23,153.71,2010.03,percent of total billed charges,38.7
BLOOD TYPING ABO,86900,CPT,,,,,both,, ,38.73,38.73,Blue Cross and Blue Shield,Traditional,,14.99,38.7,38.7,38.73,1.51,19.75,percent of total billed charges,38.7
BLOOD TYPING ABO,86900,CPT,,,,,both,,,97.39,97.39,Blue Cross and Blue Shield,Traditional,,37.69,38.7,38.7,97.39,3.8,49.67,percent of total billed charges,38.7
BLOOD TYPING ABO,86900,CPT,,,,,both,, ,97.39,97.39,Blue Cross and Blue Shield,Traditional,,37.69,38.7,38.7,97.39,3.8,49.67,percent of total billed charges,38.7
BLOOD TYPING ABO,86900,CPT,,,,,both,, ,97.39,97.39,Blue Cross and Blue Shield,Traditional,,37.69,38.7,38.7,97.39,3.8,49.67,percent of total billed charges,38.7
BLOOD TYPING RH D,86901,CPT,,,,,both,, ,38.73,38.73,Blue Cross and Blue Shield,Traditional,,14.99,38.7,38.7,38.73,1.51,19.75,percent of total billed charges,38.7
BLOOD TYPING RH D,86901,CPT,,,,,both,,,97.39,97.39,Blue Cross and Blue Shield,Traditional,,37.69,38.7,38.7,97.39,3.8,49.67,percent of total billed charges,38.7
BLOOD TYPING RH D,86901,CPT,,,,,both,, ,97.39,97.39,Blue Cross and Blue Shield,Traditional,,37.69,38.7,38.7,97.39,3.8,49.67,percent of total billed charges,38.7
BLOOD TYPING RH D,86901,CPT,,,,,both,, ,97.39,97.39,Blue Cross and Blue Shield,Traditional,,37.69,38.7,38.7,97.39,3.8,49.67,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,,107.53,38.7,38.7,277.86,10.84,141.71,percent of total billed charges,38.7
BLD TYPING OTHER AG,86905,CPT,,,,,both,,,217.52,217.52,Blue Cross and Blue Shield,Traditional,,84.18,38.7,38.7,217.52,8.48,110.94,percent of total billed charges,38.7
BLD TYPING OTHER AG,86905,CPT,,,,,both,, ,217.52,217.52,Blue Cross and Blue Shield,Traditional,,84.18,38.7,38.7,217.52,8.48,110.94,percent of total billed charges,38.7
BLD TYPING OTHER AG,86905,CPT,,,,,both,, ,217.52,217.52,Blue Cross and Blue Shield,Traditional,,84.18,38.7,38.7,217.52,8.48,110.94,percent of total billed charges,38.7
O51920 RH PHENO,86906,CPT,,,,,both,, ,224,224,Blue Cross and Blue Shield,Traditional,,86.69,38.7,38.7,224,8.74,114.24,percent of total billed charges,38.7
COMPATIB TEST IS,86920,CPT,,,,,both,,,275.62,275.62,Blue Cross and Blue Shield,Traditional,,106.66,38.7,38.7,275.62,10.75,140.57,percent of total billed charges,38.7
COMPATIB TEST IS,86920,CPT,,,,,both,, ,275.62,275.62,Blue Cross and Blue Shield,Traditional,,106.66,38.7,38.7,275.62,10.75,140.57,percent of total billed charges,38.7
COMPATIB TEST INCUB,86921,CPT,,,,,both,,,103,103,Blue Cross and Blue Shield,Traditional,,39.86,38.7,38.7,103,4.02,52.53,percent of total billed charges,38.7
COMPATIB TEST INCUB,86921,CPT,,,,,both,, ,103,103,Blue Cross and Blue Shield,Traditional,,39.86,38.7,38.7,103,4.02,52.53,percent of total billed charges,38.7
COMPATIB TEST AHG,86922,CPT,,,,,both,,,250.07,250.07,Blue Cross and Blue Shield,Traditional,,96.78,38.7,38.7,250.07,9.75,127.54,percent of total billed charges,38.7
COMPATIB TEST AHG,86922,CPT,,,,,both,, ,250.07,250.07,Blue Cross and Blue Shield,Traditional,,96.78,38.7,38.7,250.07,9.75,127.54,percent of total billed charges,38.7
FFP THAWING,86927,CPT,,,,,both,, ,233.8,233.8,Blue Cross and Blue Shield,Traditional,,90.48,38.7,38.7,233.8,9.12,119.24,percent of total billed charges,38.7
PLATELETS POOLING,86965,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,38.7,141.46,5.52,72.14,percent of total billed charges,38.7
O51010 CHEM TREATMNT,86970,CPT,,,,,both,, ,212.44,212.44,Blue Cross and Blue Shield,Traditional,,82.21,38.7,38.7,212.44,8.29,108.34,percent of total billed charges,38.7
RBC PRETREAT CHEM,86970,CPT,,,,,both,, ,231.55,231.55,Blue Cross and Blue Shield,Traditional,,89.61,38.7,38.7,231.55,9.03,118.09,percent of total billed charges,38.7
RBC PRETREAT ENZ,86971,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,38.7,141.46,5.52,72.14,percent of total billed charges,38.7
RBC PRETREAT ENZ,86971,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,38.7,141.46,5.52,72.14,percent of total billed charges,38.7
O51122 RBC CELL SEP,86972,CPT,,,,,both,, ,246.99,246.99,Blue Cross and Blue Shield,Traditional,,95.59,38.7,38.7,246.99,9.63,125.96,percent of total billed charges,38.7
"RBC PRETREAT,SER,INC",86975,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,38.7,141.46,5.52,72.14,percent of total billed charges,38.7
"RBC PRETREAT,SER DIL",86976,CPT,,,,,both,, ,61.8,61.8,Blue Cross and Blue Shield,Traditional,,23.92,38.7,38.7,61.8,2.41,31.52,percent of total billed charges,38.7
RBC PRETREAT W-INHIB,86977,CPT,,,,,both,, ,218.64,218.64,Blue Cross and Blue Shield,Traditional,,84.61,38.7,38.7,218.64,8.53,111.51,percent of total billed charges,38.7
O51234 ADSORPTION,86978,CPT,,,,,both,, ,149.35,149.35,Blue Cross and Blue Shield,Traditional,,57.8,38.7,38.7,149.35,5.82,76.17,percent of total billed charges,38.7
RBC PRETREAT DIFF EA,86978,CPT,,,,,both,, ,162.79,162.79,Blue Cross and Blue Shield,Traditional,,63,38.7,38.7,162.79,6.35,83.02,percent of total billed charges,38.7
SPLIT BLOOD OR PROD,86985,CPT,,,,,both,, ,546.75,546.75,Blue Cross and Blue Shield,Traditional,,211.59,38.7,38.7,546.75,21.32,278.84,percent of total billed charges,38.7
Q34286 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,177.39,Blue Cross and Blue Shield,Traditional,,68.65,38.7,38.7,177.39,6.92,90.47,percent of total billed charges,38.7
Q37213 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,177.39,Blue Cross and Blue Shield,Traditional,,68.65,38.7,38.7,177.39,6.92,90.47,percent of total billed charges,38.7
Q39480 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,177.39,Blue Cross and Blue Shield,Traditional,,68.65,38.7,38.7,177.39,6.92,90.47,percent of total billed charges,38.7
Q4554 SPECIMEN CONCE,87015,CPT,,,,,both,, ,177.39,177.39,Blue Cross and Blue Shield,Traditional,,68.65,38.7,38.7,177.39,6.92,90.47,percent of total billed charges,38.7
SPECIMEN CONCENTRATI,87015,CPT,,,,,both,, ,177.39,177.39,Blue Cross and Blue Shield,Traditional,,68.65,38.7,38.7,177.39,6.92,90.47,percent of total billed charges,38.7
CULTURE BLOOD BACTER,87040,CPT,,,,,both,,,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
CULTURE BLOOD BACTER,87040,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
CULT STL BACT W-ISOL,87045,CPT,,,,,both,, ,92.9,92.9,Blue Cross and Blue Shield,Traditional,,35.95,38.7,38.7,92.9,3.62,47.38,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,,116.77,38.7,38.7,301.72,11.77,153.88,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,,116.77,38.7,38.7,301.72,11.77,153.88,percent of total billed charges,38.7
CULT STL BACT EA ADD,87046,CPT,,,,,both,, ,92.9,92.9,Blue Cross and Blue Shield,Traditional,,35.95,38.7,38.7,92.9,3.62,47.38,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,,36.6,38.7,38.7,94.58,3.69,48.24,percent of total billed charges,38.7
CULTURE BACTERIA OTH,87070,CPT,,,,,both,, ,84.76,84.76,Blue Cross and Blue Shield,Traditional,,32.8,38.7,38.7,84.76,3.31,43.23,percent of total billed charges,38.7
CULTURE BACTERIA OTH,87070,CPT,,,,,both,,,998.91,998.91,Blue Cross and Blue Shield,Traditional,,386.58,38.7,38.7,998.91,38.96,509.44,percent of total billed charges,38.7
CULTURE BACTERIA OTH,87070,CPT,,,,,both,, ,998.91,998.91,Blue Cross and Blue Shield,Traditional,,386.58,38.7,38.7,998.91,38.96,509.44,percent of total billed charges,38.7
L188227 CULTURE BACT,87070,CPT,,,,,both,, ,86.2,86.2,Blue Cross and Blue Shield,Traditional,,33.36,38.7,38.7,86.2,3.36,43.96,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,,267.53,38.7,38.7,691.29,26.96,352.56,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,,241.25,38.7,38.7,623.38,24.31,317.92,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,,241.25,38.7,38.7,623.38,24.31,317.92,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,,241.25,38.7,38.7,623.38,24.31,317.92,percent of total billed charges,38.7
CULT ANAERO IDENT EA,87076,CPT,,,,,both,, ,412.87,412.87,Blue Cross and Blue Shield,Traditional,,159.78,38.7,38.7,412.87,16.1,210.56,percent of total billed charges,38.7
L182345 ORG ID ANAER,87076,CPT,,,,,both,, ,244.44,244.44,Blue Cross and Blue Shield,Traditional,,94.6,38.7,38.7,244.44,9.53,124.66,percent of total billed charges,38.7
CULT AEROBIC IDENTIF,87077,CPT,,,,,both,, ,389.01,389.01,Blue Cross and Blue Shield,Traditional,,150.55,38.7,38.7,389.01,15.17,198.4,percent of total billed charges,38.7
CULT AEROBIC IDENTIF,87077,CPT,,,,,both,, ,389.01,389.01,Blue Cross and Blue Shield,Traditional,,150.55,38.7,38.7,389.01,15.17,198.4,percent of total billed charges,38.7
CULTURE SCREEN ONLY,87081,CPT,,,,,both,, ,65.39,65.39,Blue Cross and Blue Shield,Traditional,,25.31,38.7,38.7,65.39,2.55,33.35,percent of total billed charges,38.7
CULTURE SCREEN ONLY,87081,CPT,,,,,both,,,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
CULTURE SCREEN ONLY,87081,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
CULT URINE-COLONY CT,87086,CPT,,,,,both,, ,59.78,59.78,Blue Cross and Blue Shield,Traditional,,23.13,38.7,38.7,59.78,2.33,30.49,percent of total billed charges,38.7
CULT URINE-COLONY CT,87086,CPT,,,,,both,,,495.95,495.95,Blue Cross and Blue Shield,Traditional,,191.93,38.7,38.7,495.95,19.34,252.93,percent of total billed charges,38.7
CULT URINE-COLONY CT,87086,CPT,,,,,both,, ,495.95,495.95,Blue Cross and Blue Shield,Traditional,,191.93,38.7,38.7,495.95,19.34,252.93,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,,16.4,38.7,38.7,42.37,1.65,21.61,percent of total billed charges,38.7
CULT SKIN FUNGI,87101,CPT,,,,,both,, ,349.99,349.99,Blue Cross and Blue Shield,Traditional,,135.45,38.7,38.7,349.99,13.65,178.49,percent of total billed charges,38.7
CULT SKIN FUNGI,87101,CPT,,,,,both,, ,349.99,349.99,Blue Cross and Blue Shield,Traditional,,135.45,38.7,38.7,349.99,13.65,178.49,percent of total billed charges,38.7
CULT FUNGUS ISOLATIO,87102,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
Q4553 CULT FUNGUS IS,87102,CPT,,,,,both,, ,525.7,525.7,Blue Cross and Blue Shield,Traditional,,203.45,38.7,38.7,525.7,20.5,268.11,percent of total billed charges,38.7
CULTURE FUNGUS BLOOD,87103,CPT,,,,,both,, ,518.69,518.69,Blue Cross and Blue Shield,Traditional,,200.73,38.7,38.7,518.69,20.23,264.53,percent of total billed charges,38.7
Q4606 FUNGUS CULT BL,87103,CPT,,,,,both,, ,478.95,478.95,Blue Cross and Blue Shield,Traditional,,185.35,38.7,38.7,478.95,18.68,244.26,percent of total billed charges,38.7
FUNGI IDENTIF YEAST,87106,CPT,,,,,both,, ,123.21,123.21,Blue Cross and Blue Shield,Traditional,,47.68,38.7,38.7,123.21,4.81,62.84,percent of total billed charges,38.7
FUNGI IDENTIF YEAST,87106,CPT,,,,,both,, ,123.21,123.21,Blue Cross and Blue Shield,Traditional,,47.68,38.7,38.7,123.21,4.81,62.84,percent of total billed charges,38.7
"FUNGI IDENTIF, MOLD",87107,CPT,,,,,both,, ,123.21,123.21,Blue Cross and Blue Shield,Traditional,,47.68,38.7,38.7,123.21,4.81,62.84,percent of total billed charges,38.7
"FUNGI IDENTIF, MOLD",87107,CPT,,,,,both,, ,123.21,123.21,Blue Cross and Blue Shield,Traditional,,47.68,38.7,38.7,123.21,4.81,62.84,percent of total billed charges,38.7
CULT MYCOPLASMA,87109,CPT,,,,,both,, ,1404.5,1404.5,Blue Cross and Blue Shield,Traditional,,543.54,38.7,38.7,1404.5,54.78,716.3,percent of total billed charges,38.7
UREA-MYCOPLS HOM CULT,87109,CPT,,,,,both,, ,153.9,153.9,Blue Cross and Blue Shield,Traditional,,59.56,38.7,38.7,153.9,6,78.49,percent of total billed charges,38.7
CULTURE CHLAMYDIA,87110,CPT,,,,,both,, ,1104.45,1104.45,Blue Cross and Blue Shield,Traditional,,427.42,38.7,38.7,1104.45,43.07,563.27,percent of total billed charges,38.7
CULTURE CHLAMYDIA,87110,CPT,,,,,both,, ,1104.45,1104.45,Blue Cross and Blue Shield,Traditional,,427.42,38.7,38.7,1104.45,43.07,563.27,percent of total billed charges,38.7
CULT MYCOBACTERIA,87116,CPT,,,,,both,,,827.43,827.43,Blue Cross and Blue Shield,Traditional,,320.22,38.7,38.7,827.43,32.27,421.99,percent of total billed charges,38.7
CULT MYCOBACTERIA,87116,CPT,,,,,both,, ,827.43,827.43,Blue Cross and Blue Shield,Traditional,,320.22,38.7,38.7,827.43,32.27,421.99,percent of total billed charges,38.7
Q10526MBAC BL CMBCS,87116,CPT,,,,,both,, ,827.43,827.43,Blue Cross and Blue Shield,Traditional,,320.22,38.7,38.7,827.43,32.27,421.99,percent of total billed charges,38.7
Q4554 CULT MYCOBACTE,87116,CPT,,,,,both,, ,827.43,827.43,Blue Cross and Blue Shield,Traditional,,320.22,38.7,38.7,827.43,32.27,421.99,percent of total billed charges,38.7
CULT TYPE IMMUNOFLUO,87140,CPT,,,,,both,, ,323.34,323.34,Blue Cross and Blue Shield,Traditional,,125.13,38.7,38.7,323.34,12.61,164.9,percent of total billed charges,38.7
CULT TYPE IMMUNOFLUO,87140,CPT,,,,,both,, ,323.34,323.34,Blue Cross and Blue Shield,Traditional,,125.13,38.7,38.7,323.34,12.61,164.9,percent of total billed charges,38.7
"CULT TYPE,IMMUNOLOGI",87147,CPT,,,,,both,, ,547.31,547.31,Blue Cross and Blue Shield,Traditional,,211.81,38.7,38.7,547.31,21.35,279.13,percent of total billed charges,38.7
"CULT TYPE,NUCLEIC AC",87149,CPT,,,,,both,, ,239.97,239.97,Blue Cross and Blue Shield,Traditional,,92.87,38.7,38.7,239.97,9.36,122.38,percent of total billed charges,38.7
LRX183755 AFB ID PB,87149,CPT,,,,,both,, ,239.99,239.99,Blue Cross and Blue Shield,Traditional,,92.88,38.7,38.7,239.99,9.36,122.39,percent of total billed charges,38.7
DNA-RNA AMPLI PROBE,87150,CPT,,,,,both,, ,339.33,339.33,Blue Cross and Blue Shield,Traditional,,131.32,38.7,38.7,339.33,13.23,173.06,percent of total billed charges,38.7
LRX183327 MOLD ID,87153,CPT,,,,,both,, ,239.99,239.99,Blue Cross and Blue Shield,Traditional,,92.88,38.7,38.7,239.99,9.36,122.39,percent of total billed charges,38.7
QRX9000010 AFB ID,87153,CPT,,,,,both,, ,388.45,388.45,Blue Cross and Blue Shield,Traditional,,150.33,38.7,38.7,388.45,15.15,198.11,percent of total billed charges,38.7
MACRO EXAM ARTHROPOD,87168,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,38.7,480.79,18.75,245.2,percent of total billed charges,38.7
MACRO EXAM PARASITE,87169,CPT,,,,,both,, ,207.7,207.7,Blue Cross and Blue Shield,Traditional,,80.38,38.7,38.7,207.7,8.1,105.93,percent of total billed charges,38.7
PINWORM EXAM,87172,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,38.7,480.79,18.75,245.2,percent of total billed charges,38.7
TISSUE HOMOGENIZ CUL,87176,CPT,,,,,both,, ,300.6,300.6,Blue Cross and Blue Shield,Traditional,,116.33,38.7,38.7,300.6,11.72,153.31,percent of total billed charges,38.7
OVA-PARASITES SMEARS,87177,CPT,,,,,both,, ,107.21,107.21,Blue Cross and Blue Shield,Traditional,,41.49,38.7,38.7,107.21,4.18,54.68,percent of total billed charges,38.7
OVA-PARASITES SMEARS,87177,CPT,,,,,both,, ,320.25,320.25,Blue Cross and Blue Shield,Traditional,,123.94,38.7,38.7,320.25,12.49,163.33,percent of total billed charges,38.7
OVA-PARASITES SMEARS,87177,CPT,,,,,both,, ,320.25,320.25,Blue Cross and Blue Shield,Traditional,,123.94,38.7,38.7,320.25,12.49,163.33,percent of total billed charges,38.7
MICROB SUSCEP DIFFUS,87181,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,38.7,141.46,5.52,72.14,percent of total billed charges,38.7
MICROBE SUSCEP DISK,87184,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,38.7,141.46,5.52,72.14,percent of total billed charges,38.7
MICROBE SUSCEP DISK,87184,CPT,,,,,both,, ,141.46,141.46,Blue Cross and Blue Shield,Traditional,,54.75,38.7,38.7,141.46,5.52,72.14,percent of total billed charges,38.7
MICROB SUSCEP ENZYME,87185,CPT,,,,,both,, ,180.19,180.19,Blue Cross and Blue Shield,Traditional,,69.73,38.7,38.7,180.19,7.03,91.9,percent of total billed charges,38.7
MICROBE SUSCEPT MIC,87186,CPT,,,,,both,, ,586.05,586.05,Blue Cross and Blue Shield,Traditional,,226.8,38.7,38.7,586.05,22.86,298.89,percent of total billed charges,38.7
MICROBE SUSCEPT MIC,87186,CPT,,,,,both,, ,586.05,586.05,Blue Cross and Blue Shield,Traditional,,226.8,38.7,38.7,586.05,22.86,298.89,percent of total billed charges,38.7
"SMEAR,GRAM STAIN",87205,CPT,,,,,both,, ,42.1,42.1,Blue Cross and Blue Shield,Traditional,,16.29,38.7,38.7,42.1,1.64,21.47,percent of total billed charges,38.7
"SMEAR,GRAM STAIN",87205,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
Q4554 SMEAR FLUORES-,87206,CPT,,,,,both,, ,507.74,507.74,Blue Cross and Blue Shield,Traditional,,196.5,38.7,38.7,507.74,19.8,258.95,percent of total billed charges,38.7
Q4554 SMEAR FLUORES-,87206,CPT,,,,,both,, ,507.74,507.74,Blue Cross and Blue Shield,Traditional,,196.5,38.7,38.7,507.74,19.8,258.95,percent of total billed charges,38.7
Q4554 SMEAR FLUORES-,87206,CPT,,,,,both,, ,507.74,507.74,Blue Cross and Blue Shield,Traditional,,196.5,38.7,38.7,507.74,19.8,258.95,percent of total billed charges,38.7
Q4554 SMEAR FLUORES-,87206,CPT,,,,,both,, ,507.74,507.74,Blue Cross and Blue Shield,Traditional,,196.5,38.7,38.7,507.74,19.8,258.95,percent of total billed charges,38.7
"SMEAR,SPECIAL STAIN",87207,CPT,,,,,both,, ,555.45,555.45,Blue Cross and Blue Shield,Traditional,,214.96,38.7,38.7,555.45,21.66,283.28,percent of total billed charges,38.7
SMEAR COMPLEX STN,87209,CPT,,,,,both,, ,190.86,190.86,Blue Cross and Blue Shield,Traditional,,73.86,38.7,38.7,190.86,7.44,97.34,percent of total billed charges,38.7
SMEAR COMPLEX STN,87209,CPT,,,,,both,, ,190.86,190.86,Blue Cross and Blue Shield,Traditional,,73.86,38.7,38.7,190.86,7.44,97.34,percent of total billed charges,38.7
SMEARWET MOUNT SAL-I,87210,CPT,,,,,both,, ,420.72,420.72,Blue Cross and Blue Shield,Traditional,,162.82,38.7,38.7,420.72,16.41,214.57,percent of total billed charges,38.7
TISSUE EX FOR FUNGI,87220,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,38.7,480.79,18.75,245.2,percent of total billed charges,38.7
TISSUE EX FOR FUNGI,87220,CPT,,,,,both,, ,480.79,480.79,Blue Cross and Blue Shield,Traditional,,186.07,38.7,38.7,480.79,18.75,245.2,percent of total billed charges,38.7
VIRUS INOCULAT TISSU,87252,CPT,,,,,both,, ,929.87,929.87,Blue Cross and Blue Shield,Traditional,,359.86,38.7,38.7,929.87,36.26,474.23,percent of total billed charges,38.7
VIRUS INOCULAT TISSU,87252,CPT,,,,,both,, ,929.87,929.87,Blue Cross and Blue Shield,Traditional,,359.86,38.7,38.7,929.87,36.26,474.23,percent of total billed charges,38.7
L186015 VIR INOC SHL,87254,CPT,,,,,both,, ,415.68,415.68,Blue Cross and Blue Shield,Traditional,,160.87,38.7,38.7,415.68,16.21,212,percent of total billed charges,38.7
Q17495VIRUS INOCU SH,87254,CPT,,,,,both,, ,415.68,415.68,Blue Cross and Blue Shield,Traditional,,160.87,38.7,38.7,415.68,16.21,212,percent of total billed charges,38.7
VIRUS INOCU SHELL VI,87254,CPT,,,,,both,, ,415.68,415.68,Blue Cross and Blue Shield,Traditional,,160.87,38.7,38.7,415.68,16.21,212,percent of total billed charges,38.7
Q2649 HSV CULT WREF,87255,CPT,,,,,both,, ,470.69,470.69,Blue Cross and Blue Shield,Traditional,,182.16,38.7,38.7,470.69,18.36,240.05,percent of total billed charges,38.7
Q841 HSV CULT HS,87255,CPT,,,,,both,, ,470.69,470.69,Blue Cross and Blue Shield,Traditional,,182.16,38.7,38.7,470.69,18.36,240.05,percent of total billed charges,38.7
VIRUS ISOLATION GEN,87255,CPT,,,,,both,, ,470.69,470.69,Blue Cross and Blue Shield,Traditional,,182.16,38.7,38.7,470.69,18.36,240.05,percent of total billed charges,38.7
"PERTUSSIS AG, IF",87265,CPT,,,,,both,, ,531.32,531.32,Blue Cross and Blue Shield,Traditional,,205.62,38.7,38.7,531.32,20.72,270.97,percent of total billed charges,38.7
"PERTUSSIS AG, IF",87265,CPT,,,,,both,, ,531.32,531.32,Blue Cross and Blue Shield,Traditional,,205.62,38.7,38.7,531.32,20.72,270.97,percent of total billed charges,38.7
INFAGT DT QLSQT CRYP,87272,CPT,,,,,both,, ,525.7,525.7,Blue Cross and Blue Shield,Traditional,,203.45,38.7,38.7,525.7,20.5,268.11,percent of total billed charges,38.7
Q37213 INFAGT DT QLS,87272,CPT,,,,,both,, ,525.7,525.7,Blue Cross and Blue Shield,Traditional,,203.45,38.7,38.7,525.7,20.5,268.11,percent of total billed charges,38.7
Q39480 INFAGT DT QLS,87272,CPT,,,,,both,, ,525.7,525.7,Blue Cross and Blue Shield,Traditional,,203.45,38.7,38.7,525.7,20.5,268.11,percent of total billed charges,38.7
L188227 LEGION PNEUM,87278,CPT,,,,,both,, ,156,156,Blue Cross and Blue Shield,Traditional,,60.37,38.7,38.7,156,6.08,79.56,percent of total billed charges,38.7
"LEGION PNEUMOPH AG,I",87278,CPT,,,,,both,, ,277.86,277.86,Blue Cross and Blue Shield,Traditional,,107.53,38.7,38.7,277.86,10.84,141.71,percent of total billed charges,38.7
"LEGION PNEUMOPH AG,I",87278,CPT,,,,,both,, ,277.86,277.86,Blue Cross and Blue Shield,Traditional,,107.53,38.7,38.7,277.86,10.84,141.71,percent of total billed charges,38.7
PNEUMOCYSTIS CAR AGI,87281,CPT,,,,,both,, ,371.89,371.89,Blue Cross and Blue Shield,Traditional,,143.92,38.7,38.7,371.89,14.5,189.66,percent of total billed charges,38.7
PNEUMOCYSTIS CAR AGI,87281,CPT,,,,,both,, ,371.89,371.89,Blue Cross and Blue Shield,Traditional,,143.92,38.7,38.7,371.89,14.5,189.66,percent of total billed charges,38.7
VARICELLA ZOSTER AGI,87290,CPT,,,,,both,, ,518.69,518.69,Blue Cross and Blue Shield,Traditional,,200.73,38.7,38.7,518.69,20.23,264.53,percent of total billed charges,38.7
"ANTIB DETECT NOS, IF",87299,CPT,,,,,both,, ,159.14,159.14,Blue Cross and Blue Shield,Traditional,,61.59,38.7,38.7,159.14,6.21,81.16,percent of total billed charges,38.7
AG DETECT POLYVAL IF,87300,CPT,,,,,both,, ,122.09,122.09,Blue Cross and Blue Shield,Traditional,,47.25,38.7,38.7,122.09,4.76,62.27,percent of total billed charges,38.7
L185041 ADV 40/41 IA,87301,CPT,,,,,both,, ,123.6,123.6,Blue Cross and Blue Shield,Traditional,,47.83,38.7,38.7,123.6,4.82,63.04,percent of total billed charges,38.7
Q14950ASPE AG EIA IA,87305,CPT,,,,,both,, ,111.7,111.7,Blue Cross and Blue Shield,Traditional,,43.23,38.7,38.7,111.7,4.36,56.97,percent of total billed charges,38.7
CLOSTRIDIUM DIF TOXN,87324,CPT,,,,,both,, ,118.16,118.16,Blue Cross and Blue Shield,Traditional,,45.73,38.7,38.7,118.16,4.61,60.26,percent of total billed charges,38.7
CLOSTRIDIUM DIF TOXN,87324,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
CRYPTOCOCCUS NEOF AG,87327,CPT,,,,,both,, ,1321.42,1321.42,Blue Cross and Blue Shield,Traditional,,511.39,38.7,38.7,1321.42,51.54,673.92,percent of total billed charges,38.7
"CRYPTOSPOR AG,EIA",87328,CPT,,,,,both,, ,64.55,64.55,Blue Cross and Blue Shield,Traditional,,24.98,38.7,38.7,64.55,2.52,32.92,percent of total billed charges,38.7
INFAGT DT QLSQT GIAR,87329,CPT,,,,,both,, ,200.12,200.12,Blue Cross and Blue Shield,Traditional,,77.45,38.7,38.7,200.12,7.8,102.06,percent of total billed charges,38.7
INFAGT DT QLSQT GIAR,87329,CPT,,,,,both,, ,200.12,200.12,Blue Cross and Blue Shield,Traditional,,77.45,38.7,38.7,200.12,7.8,102.06,percent of total billed charges,38.7
Q8625 GIARDAG EIA IA,87329,CPT,,,,,both,, ,192.49,192.49,Blue Cross and Blue Shield,Traditional,,74.49,38.7,38.7,192.49,7.51,98.17,percent of total billed charges,38.7
"HPYLORI,STOOL,EIA",87338,CPT,,,,,both,, ,183.56,183.56,Blue Cross and Blue Shield,Traditional,,71.04,38.7,38.7,183.56,7.16,93.62,percent of total billed charges,38.7
"HPYLORI,STOOL,EIA",87338,CPT,,,,,both,, ,183.56,183.56,Blue Cross and Blue Shield,Traditional,,71.04,38.7,38.7,183.56,7.16,93.62,percent of total billed charges,38.7
HBSAG,87340,CPT,,,,,both,,,570.04,570.04,Blue Cross and Blue Shield,Traditional,,220.61,38.7,38.7,570.04,22.23,290.72,percent of total billed charges,38.7
HBSAG,87340,CPT,,,,,both,, ,570.04,570.04,Blue Cross and Blue Shield,Traditional,,220.61,38.7,38.7,570.04,22.23,290.72,percent of total billed charges,38.7
HBEAG,87350,CPT,,,,,both,, ,1003.97,1003.97,Blue Cross and Blue Shield,Traditional,,388.54,38.7,38.7,1003.97,39.15,512.02,percent of total billed charges,38.7
HBEAG,87350,CPT,,,,,both,, ,1003.97,1003.97,Blue Cross and Blue Shield,Traditional,,388.54,38.7,38.7,1003.97,39.15,512.02,percent of total billed charges,38.7
HISTOPLASM CAPSU AGE,87385,CPT,,,,,both,, ,322.49,322.49,Blue Cross and Blue Shield,Traditional,,124.8,38.7,38.7,322.49,12.58,164.47,percent of total billed charges,38.7
HISTOPLASM CAPSU AGE,87385,CPT,,,,,both,, ,322.49,322.49,Blue Cross and Blue Shield,Traditional,,124.8,38.7,38.7,322.49,12.58,164.47,percent of total billed charges,38.7
"INFLUENZA A AG,EIA",87400,CPT,,,,,both,, ,118.16,118.16,Blue Cross and Blue Shield,Traditional,,45.73,38.7,38.7,118.16,4.61,60.26,percent of total billed charges,38.7
"INFLUENZA A AG,EIA",87400,CPT,,,,,both,, ,959.34,959.34,Blue Cross and Blue Shield,Traditional,,371.26,38.7,38.7,959.34,37.41,489.26,percent of total billed charges,38.7
L6866 ROTAVIRUS DDIA,87425,CPT,,,,,both,, ,123.6,123.6,Blue Cross and Blue Shield,Traditional,,47.83,38.7,38.7,123.6,4.82,63.04,percent of total billed charges,38.7
"ROTAVIRUS AG,EIA",87425,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
COVID19 AG EIA,87426,CPT,,,,,both,, ,84.2,84.2,Blue Cross and Blue Shield,Traditional,,32.59,38.7,38.7,84.2,3.28,42.94,percent of total billed charges,38.7
COVID19 AG EIA,87426,CPT,,,,,both,, ,88.35,88.35,Blue Cross and Blue Shield,Traditional,,34.19,38.7,38.7,88.35,3.45,45.06,percent of total billed charges,38.7
"SHIGA-LIKE TOX AG,EI",87427,CPT,,,,,both,, ,113.1,113.1,Blue Cross and Blue Shield,Traditional,,43.77,38.7,38.7,113.1,4.41,57.68,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,,60.5,38.7,38.7,156.33,6.1,79.73,percent of total billed charges,38.7
COVID19AG FLUAB SOF2,87428,CPT,,,,,both,, ,159,159,Blue Cross and Blue Shield,Traditional,,61.53,38.7,38.7,159,6.2,81.09,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,,342.92,38.7,38.7,886.09,34.56,451.91,percent of total billed charges,38.7
OXOID PBP2 MRSA SCRN,87449,CPT,,,,,both,, ,121.98,121.98,Blue Cross and Blue Shield,Traditional,,47.21,38.7,38.7,121.98,4.76,62.21,percent of total billed charges,38.7
OXOID PBP2 MRSA SCRN,87449,CPT,,,,,both,, ,121.98,121.98,Blue Cross and Blue Shield,Traditional,,47.21,38.7,38.7,121.98,4.76,62.21,percent of total billed charges,38.7
Q15544 NOROV EIA IA,87449,CPT,,,,,both,, ,886.09,886.09,Blue Cross and Blue Shield,Traditional,,342.92,38.7,38.7,886.09,34.56,451.91,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,,342.92,38.7,38.7,886.09,34.56,451.91,percent of total billed charges,38.7
CANDIDA DNA AMP PROB,87481,CPT,,,,,both,, ,281.8,281.8,Blue Cross and Blue Shield,Traditional,,109.06,38.7,38.7,281.8,10.99,143.72,percent of total billed charges,38.7
L183410 M ENCEPH CSF,87483,CPT,,,,,both,, ,1650,1650,Blue Cross and Blue Shield,Traditional,,638.55,38.7,38.7,1650,64.35,841.5,percent of total billed charges,38.7
L139650 CPNEU DNA,87486,CPT,,,,,both,, ,175,175,Blue Cross and Blue Shield,Traditional,,67.73,38.7,38.7,175,6.83,89.25,percent of total billed charges,38.7
Q37444 C PNEUMO PCR,87486,CPT,,,,,both,, ,105.27,105.27,Blue Cross and Blue Shield,Traditional,,40.74,38.7,38.7,105.27,4.11,53.69,percent of total billed charges,38.7
CHLMYD TRACH DNA AMP,87491,CPT,,,,,both,,,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,percent of total billed charges,38.7
L180021 CTRACH AMPPR,87491,CPT,,,,,both,, ,888.63,888.63,Blue Cross and Blue Shield,Traditional,,343.9,38.7,38.7,888.63,34.66,453.2,percent of total billed charges,38.7
Q11363 CHLMYD TRACH,87491,CPT,,,,,both,, ,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,percent of total billed charges,38.7
Q11363 CHLMYD TRACH,87491,CPT,,,,,both,, ,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,percent of total billed charges,38.7
Q11363 CHLMYD TRACH,87491,CPT,,,,,both,, ,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,percent of total billed charges,38.7
Q11363 CHLMYD TRACH,87491,CPT,,,,,both,, ,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,percent of total billed charges,38.7
C DIFF AMPLI PROBE,87493,CPT,,,,,both,, ,313.51,313.51,Blue Cross and Blue Shield,Traditional,,121.33,38.7,38.7,313.51,12.23,159.89,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,,407,38.7,38.7,1051.68,41.02,536.36,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,,344.33,38.7,38.7,889.73,34.7,453.76,percent of total billed charges,38.7
Q15082EVRNA QL RTPCR,87498,CPT,,,,,both,, ,437.85,437.85,Blue Cross and Blue Shield,Traditional,,169.45,38.7,38.7,437.85,17.08,223.3,percent of total billed charges,38.7
INFLU DNA AMP PROBE,87502,CPT,,,,,both,, ,215.11,215.11,Blue Cross and Blue Shield,Traditional,,83.25,38.7,38.7,215.11,8.39,109.71,percent of total billed charges,38.7
INFLU DNA AMP PROBE,87502,CPT,,,,,both,,,887.49,887.49,Blue Cross and Blue Shield,Traditional,,343.46,38.7,38.7,887.49,34.61,452.62,percent of total billed charges,38.7
INFLU DNA AMP PROBE,87502,CPT,,,,,both,, ,887.49,887.49,Blue Cross and Blue Shield,Traditional,,343.46,38.7,38.7,887.49,34.61,452.62,percent of total billed charges,38.7
L183480 GI PRO STOOL,87507,CPT,,,,,both,, ,1090.2,1090.2,Blue Cross and Blue Shield,Traditional,,421.91,38.7,38.7,1090.2,42.52,556,percent of total billed charges,38.7
GARDNER VAG DNA QUAN,87512,CPT,,,,,both,, ,335.12,335.12,Blue Cross and Blue Shield,Traditional,,129.69,38.7,38.7,335.12,13.07,170.91,percent of total billed charges,38.7
"HEPATITIS B,DNA QNT",87517,CPT,,,,,both,, ,1011.26,1011.26,Blue Cross and Blue Shield,Traditional,,391.36,38.7,38.7,1011.26,39.44,515.74,percent of total billed charges,38.7
"HEPATITIS B,DNA QNT",87517,CPT,,,,,both,, ,1011.26,1011.26,Blue Cross and Blue Shield,Traditional,,391.36,38.7,38.7,1011.26,39.44,515.74,percent of total billed charges,38.7
"HEPATITIS C,RNA,AMPP",87521,CPT,,,,,both,, ,728.91,728.91,Blue Cross and Blue Shield,Traditional,,282.09,38.7,38.7,728.91,28.43,371.74,percent of total billed charges,38.7
"HEPATITIS C,RNA,AMPP",87521,CPT,,,,,both,, ,728.91,728.91,Blue Cross and Blue Shield,Traditional,,282.09,38.7,38.7,728.91,28.43,371.74,percent of total billed charges,38.7
"HEPATITIS C,RNA,QUAN",87522,CPT,,,,,both,, ,2133.69,2133.69,Blue Cross and Blue Shield,Traditional,,825.74,38.7,38.7,2133.69,83.21,1088.18,percent of total billed charges,38.7
"HEPATITIS C,RNA,QUAN",87522,CPT,,,,,both,, ,2133.69,2133.69,Blue Cross and Blue Shield,Traditional,,825.74,38.7,38.7,2133.69,83.21,1088.18,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,,412.87,38.7,38.7,1066.84,41.61,544.09,percent of total billed charges,38.7
"HSV, DNA, AMP PROBE",87529,CPT,,,,,both,, ,3455.1,3455.1,Blue Cross and Blue Shield,Traditional,,1337.12,38.7,38.7,3455.1,134.75,1762.1,percent of total billed charges,38.7
"Q90570 HSV, DNA, AMP",87529,CPT,,,,,both,, ,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,percent of total billed charges,38.7
"Q90570 HSV, DNA, AMP",87529,CPT,,,,,both,, ,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,percent of total billed charges,38.7
"HSV, DNA, QUANT",87530,CPT,,,,,both,, ,512.23,512.23,Blue Cross and Blue Shield,Traditional,,198.23,38.7,38.7,512.23,19.98,261.24,percent of total billed charges,38.7
"HSV, DNA, QUANT",87530,CPT,,,,,both,, ,512.23,512.23,Blue Cross and Blue Shield,Traditional,,198.23,38.7,38.7,512.23,19.98,261.24,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,,665.19,38.7,38.7,1718.85,67.04,876.61,percent of total billed charges,38.7
"HIV-1, DNA, QUANT",87536,CPT,,,,,both,, ,1804.46,1804.46,Blue Cross and Blue Shield,Traditional,,698.33,38.7,38.7,1804.46,70.37,920.27,percent of total billed charges,38.7
"HIV-1, DNA, QUANT",87536,CPT,,,,,both,, ,1804.46,1804.46,Blue Cross and Blue Shield,Traditional,,698.33,38.7,38.7,1804.46,70.37,920.27,percent of total billed charges,38.7
"Q15062 LEGION PNEU,D",87541,CPT,,,,,both,, ,196.98,196.98,Blue Cross and Blue Shield,Traditional,,76.23,38.7,38.7,196.98,7.68,100.46,percent of total billed charges,38.7
"M.TUBERCULO,DNA,AMPP",87556,CPT,,,,,both,, ,815.91,815.91,Blue Cross and Blue Shield,Traditional,,315.76,38.7,38.7,815.91,31.82,416.11,percent of total billed charges,38.7
"M.TUBERCULO,DNA,AMPP",87556,CPT,,,,,both,, ,815.91,815.91,Blue Cross and Blue Shield,Traditional,,315.76,38.7,38.7,815.91,31.82,416.11,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,,144.14,38.7,38.7,372.45,14.53,189.95,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,,144.14,38.7,38.7,372.45,14.53,189.95,percent of total billed charges,38.7
L180076 M GENT NAA,87563,CPT,,,,,both,, ,180,180,Blue Cross and Blue Shield,Traditional,,69.66,38.7,38.7,180,7.02,91.8,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,,76.25,38.7,38.7,197.03,7.68,100.49,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,,76.25,38.7,38.7,197.03,7.68,100.49,percent of total billed charges,38.7
Q37444 MP QL RT-PCR,87581,CPT,,,,,both,, ,175.5,175.5,Blue Cross and Blue Shield,Traditional,,67.92,38.7,38.7,175.5,6.84,89.51,percent of total billed charges,38.7
L180021 NG AMP PRB,87591,CPT,,,,,both,, ,888.63,888.63,Blue Cross and Blue Shield,Traditional,,343.9,38.7,38.7,888.63,34.66,453.2,percent of total billed charges,38.7
"Q11363 N.GONORRHO,DN",87591,CPT,,,,,both,, ,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,percent of total billed charges,38.7
"Q11363 N.GONORRHO,DN",87591,CPT,,,,,both,, ,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,percent of total billed charges,38.7
"Q11363 N.GONORRHO,DN",87591,CPT,,,,,both,, ,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,percent of total billed charges,38.7
"Q11363 N.GONORRHO,DN",87591,CPT,,,,,both,, ,968.6,968.6,Blue Cross and Blue Shield,Traditional,,374.85,38.7,38.7,968.6,37.78,493.99,percent of total billed charges,38.7
L140230 ORTHOPOX VRS,87593,CPT,,,,,both,, ,308,308,Blue Cross and Blue Shield,Traditional,,119.2,38.7,38.7,308,12.01,157.08,percent of total billed charges,38.7
HPV HIGH RISK TYPES,87624,CPT,,,,,both,, ,241.38,241.38,Blue Cross and Blue Shield,Traditional,,93.41,38.7,38.7,241.38,9.41,123.1,percent of total billed charges,38.7
L199305 HPV HR,87624,CPT,,,,,both,, ,221.45,221.45,Blue Cross and Blue Shield,Traditional,,85.7,38.7,38.7,221.45,8.64,112.94,percent of total billed charges,38.7
Q92090 HPV HIGH RISK,87624,CPT,,,,,both,, ,215,215,Blue Cross and Blue Shield,Traditional,,83.21,38.7,38.7,215,8.39,109.65,percent of total billed charges,38.7
L507460 HPV GEN16 18,87625,CPT,,,,,both,, ,164.8,164.8,Blue Cross and Blue Shield,Traditional,,63.78,38.7,38.7,164.8,6.43,84.05,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,,220.79,38.7,38.7,570.52,22.25,290.97,percent of total billed charges,38.7
L139250 RVP PCR,87633,CPT,,,,,both,, ,175,175,Blue Cross and Blue Shield,Traditional,,67.73,38.7,38.7,175,6.83,89.25,percent of total billed charges,38.7
L139250 RVP PCR,87633,CPT,,,,,both,, ,175,175,Blue Cross and Blue Shield,Traditional,,67.73,38.7,38.7,175,6.83,89.25,percent of total billed charges,38.7
Q37444 RESP VIR PCR,87633,CPT,,,,,both,, ,1250.34,1250.34,Blue Cross and Blue Shield,Traditional,,483.88,38.7,38.7,1250.34,48.76,637.67,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,,61,38.7,38.7,157.62,6.15,80.39,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,,91.5,38.7,38.7,236.44,9.22,120.58,percent of total billed charges,38.7
COVID19 PRB,87635,CPT,,,,,both,, ,113.3,113.3,Blue Cross and Blue Shield,Traditional,,43.85,38.7,38.7,113.3,4.42,57.78,percent of total billed charges,38.7
COVID19 PRB,87635,CPT,,,,,both,, ,336.81,336.81,Blue Cross and Blue Shield,Traditional,,130.35,38.7,38.7,336.81,13.14,171.77,percent of total billed charges,38.7
"STAPH A,DNA,PROBE",87640,CPT,,,,,both,, ,118.16,118.16,Blue Cross and Blue Shield,Traditional,,45.73,38.7,38.7,118.16,4.61,60.26,percent of total billed charges,38.7
"MR-STAPH,DNA,PROBE",87641,CPT,,,,,both,, ,118.16,118.16,Blue Cross and Blue Shield,Traditional,,45.73,38.7,38.7,118.16,4.61,60.26,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,,30.49,38.7,38.7,78.78,3.07,40.18,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,,45.74,38.7,38.7,118.18,4.61,60.27,percent of total billed charges,38.7
Q90801T.VAGIN QL TMA,87661,CPT,,,,,both,, ,279.55,279.55,Blue Cross and Blue Shield,Traditional,,108.19,38.7,38.7,279.55,10.9,142.57,percent of total billed charges,38.7
Q90801T.VAGIN QL TMA,87661,CPT,,,,,both,, ,279.55,279.55,Blue Cross and Blue Shield,Traditional,,108.19,38.7,38.7,279.55,10.9,142.57,percent of total billed charges,38.7
Q90801T.VAGIN QL TMA,87661,CPT,,,,,both,, ,279.55,279.55,Blue Cross and Blue Shield,Traditional,,108.19,38.7,38.7,279.55,10.9,142.57,percent of total billed charges,38.7
Q90801T.VAGIN QL TMA,87661,CPT,,,,,both,, ,279.55,279.55,Blue Cross and Blue Shield,Traditional,,108.19,38.7,38.7,279.55,10.9,142.57,percent of total billed charges,38.7
T VAGINALIS AMP,87661,CPT,,,,,both,,,279.55,279.55,Blue Cross and Blue Shield,Traditional,,108.19,38.7,38.7,279.55,10.9,142.57,percent of total billed charges,38.7
Q93870 ZIKA RNA QL,87662,CPT,,,,,both,, ,295.83,295.83,Blue Cross and Blue Shield,Traditional,,114.49,38.7,38.7,295.83,11.54,150.87,percent of total billed charges,38.7
"DETECT AGNTNOS,DNAAM",87798,CPT,,,,,both,, ,2478.63,2478.63,Blue Cross and Blue Shield,Traditional,,959.23,38.7,38.7,2478.63,96.67,1264.1,percent of total billed charges,38.7
"DETECT AGNTNOS,DNAAM",87798,CPT,,,,,both,, ,2478.63,2478.63,Blue Cross and Blue Shield,Traditional,,959.23,38.7,38.7,2478.63,96.67,1264.1,percent of total billed charges,38.7
L139650 DET AGNT DNA,87798,CPT,,,,,both,, ,175,175,Blue Cross and Blue Shield,Traditional,,67.73,38.7,38.7,175,6.83,89.25,percent of total billed charges,38.7
L180021 DET AGT NOS,87798,CPT,,,,,both,, ,696.28,696.28,Blue Cross and Blue Shield,Traditional,,269.46,38.7,38.7,696.28,27.15,355.1,percent of total billed charges,38.7
L180021 DET AGT NOS,87798,CPT,,,,,both,, ,696.28,696.28,Blue Cross and Blue Shield,Traditional,,269.46,38.7,38.7,696.28,27.15,355.1,percent of total billed charges,38.7
L180040 DET AGT NOS,87798,CPT,,,,,both,, ,180,180,Blue Cross and Blue Shield,Traditional,,69.66,38.7,38.7,180,7.02,91.8,percent of total billed charges,38.7
Q10992 WNVRNA RT-PCR,87798,CPT,,,,,both,, ,1011.83,1011.83,Blue Cross and Blue Shield,Traditional,,391.58,38.7,38.7,1011.83,39.46,516.03,percent of total billed charges,38.7
Q10992 WNVRNA RT-PCR,87798,CPT,,,,,both,, ,1011.83,1011.83,Blue Cross and Blue Shield,Traditional,,391.58,38.7,38.7,1011.83,39.46,516.03,percent of total billed charges,38.7
Q11365DET AGNT DNAAM,87798,CPT,,,,,both,, ,758.95,758.95,Blue Cross and Blue Shield,Traditional,,293.71,38.7,38.7,758.95,29.6,387.06,percent of total billed charges,38.7
Q17220 JCPV QL RTPCR,87798,CPT,,,,,both,, ,1011.83,1011.83,Blue Cross and Blue Shield,Traditional,,391.58,38.7,38.7,1011.83,39.46,516.03,percent of total billed charges,38.7
Q17220 JCPV QL RTPCR,87798,CPT,,,,,both,, ,1011.83,1011.83,Blue Cross and Blue Shield,Traditional,,391.58,38.7,38.7,1011.83,39.46,516.03,percent of total billed charges,38.7
Q34296 PARVO B19 QL,87798,CPT,,,,,both,, ,1011.83,1011.83,Blue Cross and Blue Shield,Traditional,,391.58,38.7,38.7,1011.83,39.46,516.03,percent of total billed charges,38.7
Q34296 PARVO B19 QL,87798,CPT,,,,,both,, ,1011.83,1011.83,Blue Cross and Blue Shield,Traditional,,391.58,38.7,38.7,1011.83,39.46,516.03,percent of total billed charges,38.7
Q91475 SURESWAB MYCOPLASMA GENITALIUMPCR,87798,CPT,,,,,both,, ,901.25,901.25,Blue Cross and Blue Shield,Traditional,,348.78,38.7,38.7,901.25,35.15,459.64,percent of total billed charges,38.7
"DETECT AGNT NOS,DNAQ",87799,CPT,,,,,both,, ,454.41,454.41,Blue Cross and Blue Shield,Traditional,,175.86,38.7,38.7,454.41,17.72,231.75,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,,175.86,38.7,38.7,454.41,17.72,231.75,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,,175.86,38.7,38.7,454.41,17.72,231.75,percent of total billed charges,38.7
"DETECT AGT MULT,DNAA",87801,CPT,,,,,both,, ,715.16,715.16,Blue Cross and Blue Shield,Traditional,,276.77,38.7,38.7,715.16,27.89,364.73,percent of total billed charges,38.7
L180021 DET AGT MULT,87801,CPT,,,,,both,, ,656.11,656.11,Blue Cross and Blue Shield,Traditional,,253.91,38.7,38.7,656.11,25.59,334.62,percent of total billed charges,38.7
Q15564LYME RT-PCR SF,87801,CPT,,,,,both,, ,715.16,715.16,Blue Cross and Blue Shield,Traditional,,276.77,38.7,38.7,715.16,27.89,364.73,percent of total billed charges,38.7
Q15777LYM QL BL RTPC,87801,CPT,,,,,both,, ,715.16,715.16,Blue Cross and Blue Shield,Traditional,,276.77,38.7,38.7,715.16,27.89,364.73,percent of total billed charges,38.7
INFLUENZA ASSAY W-OP,87804,CPT,,,,,both,, ,30.87,30.87,Blue Cross and Blue Shield,Traditional,,11.95,38.7,38.7,30.87,1.2,15.74,percent of total billed charges,38.7
INFLUENZA ASSAY W-OP,87804,CPT,,,,,both,, ,104.12,104.12,Blue Cross and Blue Shield,Traditional,,40.29,38.7,38.7,104.12,4.06,53.1,percent of total billed charges,38.7
RSV ASSAY W-OPTIC,87807,CPT,,,,,both,, ,44.62,44.62,Blue Cross and Blue Shield,Traditional,,17.27,38.7,38.7,44.62,1.74,22.76,percent of total billed charges,38.7
RSV ASSAY W-OPTIC,87807,CPT,,,,,both,, ,277.86,277.86,Blue Cross and Blue Shield,Traditional,,107.53,38.7,38.7,277.86,10.84,141.71,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,,15.96,38.7,38.7,41.25,1.61,21.04,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,,110.36,38.7,38.7,285.17,11.12,145.44,percent of total billed charges,38.7
AGENT NOS ASSAY W-OP,87899,CPT,,,,,both,, ,172.9,172.9,Blue Cross and Blue Shield,Traditional,,66.91,38.7,38.7,172.9,6.74,88.18,percent of total billed charges,38.7
L183025 CRYPTO AG,87899,CPT,,,,,both,, ,158.62,158.62,Blue Cross and Blue Shield,Traditional,,61.39,38.7,38.7,158.62,6.19,80.9,percent of total billed charges,38.7
L183025 CRYPTO AG,87899,CPT,,,,,both,, ,158.62,158.62,Blue Cross and Blue Shield,Traditional,,61.39,38.7,38.7,158.62,6.19,80.9,percent of total billed charges,38.7
Q34949 PHENO INF DRG,87900,CPT,,,,,both,, ,773.54,773.54,Blue Cross and Blue Shield,Traditional,,299.36,38.7,38.7,773.54,30.17,394.51,percent of total billed charges,38.7
"GENOTYPE,DNA,HIV REV",87901,CPT,,,,,both,, ,1819.9,1819.9,Blue Cross and Blue Shield,Traditional,,704.3,38.7,38.7,1819.9,70.98,928.15,percent of total billed charges,38.7
"GENOTYPE,DNA,HIV REV",87901,CPT,,,,,both,, ,1819.9,1819.9,Blue Cross and Blue Shield,Traditional,,704.3,38.7,38.7,1819.9,70.98,928.15,percent of total billed charges,38.7
"GENOTYPE,DNA,HEPAT C",87902,CPT,,,,,both,, ,1611.91,1611.91,Blue Cross and Blue Shield,Traditional,,623.81,38.7,38.7,1611.91,62.86,822.07,percent of total billed charges,38.7
Q37811 HCVRNA GN MPR,87902,CPT,,,,,both,, ,1611.91,1611.91,Blue Cross and Blue Shield,Traditional,,623.81,38.7,38.7,1611.91,62.86,822.07,percent of total billed charges,38.7
Q92447 HCVG1 NS5A DR,87902,CPT,,,,,both,, ,1611.91,1611.91,Blue Cross and Blue Shield,Traditional,,623.81,38.7,38.7,1611.91,62.86,822.07,percent of total billed charges,38.7
L551690PHENO DNA HIV,87903,CPT,,,,,both,, ,1465,1465,Blue Cross and Blue Shield,Traditional,,566.96,38.7,38.7,1465,57.14,747.15,percent of total billed charges,38.7
L551690PHENO DNA HIV,87904,CPT,,,,,both,, ,104,104,Blue Cross and Blue Shield,Traditional,,40.25,38.7,38.7,104,4.06,53.04,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,,331.51,38.7,38.7,856.62,33.41,436.88,percent of total billed charges,38.7
AUTOPSY COMPL WO-CNS,88020,CPT,,,,,both,, ,3310.55,3310.55,Blue Cross and Blue Shield,Traditional,,1281.18,38.7,38.7,3310.55,129.11,1688.38,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,,42.47,38.7,38.7,109.74,4.28,55.97,percent of total billed charges,38.7
CYTOPATH FLD FTRW-IN,88106,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,38.7,109.74,4.28,55.97,percent of total billed charges,38.7
CYTOPATH CONCENT TEC,88108,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,38.7,109.74,4.28,55.97,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,,91.78,38.7,38.7,237.17,9.25,120.96,percent of total billed charges,38.7
CYTO UR 3-5PROB EA S,88120,CPT,,,,,both,, ,368.8,368.8,Blue Cross and Blue Shield,Traditional,,142.73,38.7,38.7,368.8,14.38,188.09,percent of total billed charges,38.7
CYTO UR 3-5 PROB CMP,88121,CPT,,,,,both,, ,368.8,368.8,Blue Cross and Blue Shield,Traditional,,142.73,38.7,38.7,368.8,14.38,188.09,percent of total billed charges,38.7
FORENSIC CYTOPATHOLO,88125,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,38.7,109.74,4.28,55.97,percent of total billed charges,38.7
SEX CHROMATIN ID BAR,88130,CPT,,,,,both,, ,144.83,144.83,Blue Cross and Blue Shield,Traditional,,56.05,38.7,38.7,144.83,5.65,73.86,percent of total billed charges,38.7
SEX CHROM ID POLYMOR,88140,CPT,,,,,both,, ,76.9,76.9,Blue Cross and Blue Shield,Traditional,,29.76,38.7,38.7,76.9,3,39.22,percent of total billed charges,38.7
L192555 PAP LB,88142,CPT,,,,,both,, ,234.07,234.07,Blue Cross and Blue Shield,Traditional,,90.59,38.7,38.7,234.07,9.13,119.38,percent of total billed charges,38.7
PAP THINLAY LIQ DIAG,88142,CPT,,,,,both,, ,189.74,189.74,Blue Cross and Blue Shield,Traditional,,73.43,38.7,38.7,189.74,7.4,96.77,percent of total billed charges,38.7
CYTOPATH C-V THNLYRE,88143,CPT,,,,,both,, ,189.74,189.74,Blue Cross and Blue Shield,Traditional,,73.43,38.7,38.7,189.74,7.4,96.77,percent of total billed charges,38.7
CYTOP C-V AUTOMATED,88147,CPT,,,,,both,, ,101.6,101.6,Blue Cross and Blue Shield,Traditional,,39.32,38.7,38.7,101.6,3.96,51.82,percent of total billed charges,38.7
CYTOP C-V AUTO RESCR,88148,CPT,,,,,both,, ,101.6,101.6,Blue Cross and Blue Shield,Traditional,,39.32,38.7,38.7,101.6,3.96,51.82,percent of total billed charges,38.7
CYTOPATH C-V MANUAL,88150,CPT,,,,,both,, ,101.6,101.6,Blue Cross and Blue Shield,Traditional,,39.32,38.7,38.7,101.6,3.96,51.82,percent of total billed charges,38.7
CYTOP C-V AUTO REDO,88152,CPT,,,,,both,, ,101.6,101.6,Blue Cross and Blue Shield,Traditional,,39.32,38.7,38.7,101.6,3.96,51.82,percent of total billed charges,38.7
CYTOPATH C-V REDO,88153,CPT,,,,,both,, ,101.6,101.6,Blue Cross and Blue Shield,Traditional,,39.32,38.7,38.7,101.6,3.96,51.82,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,,22.37,38.7,38.7,57.81,2.25,29.48,percent of total billed charges,38.7
CYTOP SMR OTHR SOURC,88160,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,38.7,109.74,4.28,55.97,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,,42.47,38.7,38.7,109.74,4.28,55.97,percent of total billed charges,38.7
CYTOP SMR OTH S5SLID,88162,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,38.7,237.17,9.25,120.96,percent of total billed charges,38.7
"CYTOP TBS,C-V,MANUAL",88164,CPT,,,,,both,, ,101.6,101.6,Blue Cross and Blue Shield,Traditional,,39.32,38.7,38.7,101.6,3.96,51.82,percent of total billed charges,38.7
"CYTOP TBS,C-V,REDO",88165,CPT,,,,,both,, ,101.6,101.6,Blue Cross and Blue Shield,Traditional,,39.32,38.7,38.7,101.6,3.96,51.82,percent of total billed charges,38.7
"CYTOP TBS,C-V AUTORE",88166,CPT,,,,,both,, ,101.6,101.6,Blue Cross and Blue Shield,Traditional,,39.32,38.7,38.7,101.6,3.96,51.82,percent of total billed charges,38.7
"CYTOP TBS,C-C,SELECT",88167,CPT,,,,,both,, ,101.6,101.6,Blue Cross and Blue Shield,Traditional,,39.32,38.7,38.7,101.6,3.96,51.82,percent of total billed charges,38.7
CYTOPATH EVAL OF FNA,88172,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,38.7,109.74,4.28,55.97,percent of total billed charges,38.7
"CYTOP EVAL,FNA,REPOR",88173,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,38.7,237.17,9.25,120.96,percent of total billed charges,38.7
CYTO-CERVICALRP CDM,88174,CPT,,,,,both,, ,205.45,205.45,Blue Cross and Blue Shield,Traditional,,79.51,38.7,38.7,205.45,8.01,104.78,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,,90.59,38.7,38.7,234.07,9.13,119.38,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,,98.74,38.7,38.7,255.13,9.95,130.12,percent of total billed charges,38.7
Q92090 PAP DIAG AUTO,88175,CPT,,,,,both,, ,227.25,227.25,Blue Cross and Blue Shield,Traditional,,87.95,38.7,38.7,227.25,8.86,115.9,percent of total billed charges,38.7
CYTO EVAL FNA ADD,88177,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,38.7,72.13,2.81,36.79,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,,27.05,38.7,38.7,69.89,2.73,35.64,percent of total billed charges,38.7
"FLOWCYTOMET-TC,1 MRK",88184,CPT,,,,,both,, ,203.21,203.21,Blue Cross and Blue Shield,Traditional,,78.64,38.7,38.7,203.21,7.93,103.64,percent of total billed charges,38.7
"FLOWCYTOMET-TC,1 MRK",88184,CPT,,,,,both,, ,203.21,203.21,Blue Cross and Blue Shield,Traditional,,78.64,38.7,38.7,203.21,7.93,103.64,percent of total billed charges,38.7
"FLOWCYTOMETRY-TC,ADD",88185,CPT,,,,,both,, ,195.35,195.35,Blue Cross and Blue Shield,Traditional,,75.6,38.7,38.7,195.35,7.62,99.63,percent of total billed charges,38.7
Q35080 FLOWCY-TC ADD,88185,CPT,,,,,both,, ,60,60,Blue Cross and Blue Shield,Traditional,,23.22,38.7,38.7,60,2.34,30.6,percent of total billed charges,38.7
A3001780 FLWCY 16MRK,88189,CPT,,,,,both,, ,360,360,Blue Cross and Blue Shield,Traditional,,139.32,38.7,38.7,360,14.04,183.6,percent of total billed charges,38.7
CYTOPATHOLOGY PROCED,88199,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,38.7,72.13,2.81,36.79,percent of total billed charges,38.7
TISSUE CULT LYMPHOCY,88230,CPT,,,,,both,, ,3469.98,3469.98,Blue Cross and Blue Shield,Traditional,,1342.88,38.7,38.7,3469.98,135.33,1769.69,percent of total billed charges,38.7
TISSUE CULT LYMPHOCY,88230,CPT,,,,,both,, ,3469.98,3469.98,Blue Cross and Blue Shield,Traditional,,1342.88,38.7,38.7,3469.98,135.33,1769.69,percent of total billed charges,38.7
TISSUE CULT SKIN/BIO,88233,CPT,,,,,both,, ,1353.98,1353.98,Blue Cross and Blue Shield,Traditional,,523.99,38.7,38.7,1353.98,52.81,690.53,percent of total billed charges,38.7
"TISSUE CULT, PLACENT",88235,CPT,,,,,both,, ,1416.56,1416.56,Blue Cross and Blue Shield,Traditional,,548.21,38.7,38.7,1416.56,55.25,722.45,percent of total billed charges,38.7
TISSUE CULT BONEMARR,88237,CPT,,,,,both,, ,849.04,849.04,Blue Cross and Blue Shield,Traditional,,328.58,38.7,38.7,849.04,33.11,433.01,percent of total billed charges,38.7
TISSUE CULT BONEMARR,88237,CPT,,,,,both,, ,849.04,849.04,Blue Cross and Blue Shield,Traditional,,328.58,38.7,38.7,849.04,33.11,433.01,percent of total billed charges,38.7
TISSUE CULTURE TUMOR,88239,CPT,,,,,both,, ,1419.09,1419.09,Blue Cross and Blue Shield,Traditional,,549.19,38.7,38.7,1419.09,55.34,723.74,percent of total billed charges,38.7
CELL CRYOPRESERV-STO,88240,CPT,,,,,both,, ,97.11,97.11,Blue Cross and Blue Shield,Traditional,,37.58,38.7,38.7,97.11,3.79,49.53,percent of total billed charges,38.7
FROZEN CELL PREPARAT,88241,CPT,,,,,both,, ,97.11,97.11,Blue Cross and Blue Shield,Traditional,,37.58,38.7,38.7,97.11,3.79,49.53,percent of total billed charges,38.7
CHROMOSOME ANAL20-25,88245,CPT,,,,,both,, ,1397.47,1397.47,Blue Cross and Blue Shield,Traditional,,540.82,38.7,38.7,1397.47,54.5,712.71,percent of total billed charges,38.7
CHROMOSOM ANAL50-100,88248,CPT,,,,,both,, ,1666.09,1666.09,Blue Cross and Blue Shield,Traditional,,644.78,38.7,38.7,1666.09,64.98,849.71,percent of total billed charges,38.7
CHROMOSOME ANALYS100,88249,CPT,,,,,both,, ,1666.09,1666.09,Blue Cross and Blue Shield,Traditional,,644.78,38.7,38.7,1666.09,64.98,849.71,percent of total billed charges,38.7
CHROMOSOME ANALYS  5,88261,CPT,,,,,both,, ,1700.32,1700.32,Blue Cross and Blue Shield,Traditional,,658.02,38.7,38.7,1700.32,66.31,867.16,percent of total billed charges,38.7
CHROMOSOME ANAL15-20,88262,CPT,,,,,both,, ,4292.64,4292.64,Blue Cross and Blue Shield,Traditional,,1661.25,38.7,38.7,4292.64,167.41,2189.25,percent of total billed charges,38.7
Q14596 CHR AN 15-20,88262,CPT,,,,,both,, ,1010,1010,Blue Cross and Blue Shield,Traditional,,390.87,38.7,38.7,1010,39.39,515.1,percent of total billed charges,38.7
CHROMOSOME ANALYS 45,88263,CPT,,,,,both,, ,1445.75,1445.75,Blue Cross and Blue Shield,Traditional,,559.51,38.7,38.7,1445.75,56.38,737.33,percent of total billed charges,38.7
CHROMOSOME ANAL20-25,88264,CPT,,,,,both,, ,2107.59,2107.59,Blue Cross and Blue Shield,Traditional,,815.64,38.7,38.7,2107.59,82.2,1074.87,percent of total billed charges,38.7
CHROMOSOME ANAL20-25,88264,CPT,,,,,both,, ,2107.59,2107.59,Blue Cross and Blue Shield,Traditional,,815.64,38.7,38.7,2107.59,82.2,1074.87,percent of total billed charges,38.7
CHROMOSOME ANAL-PLAC,88267,CPT,,,,,both,, ,1729.51,1729.51,Blue Cross and Blue Shield,Traditional,,669.32,38.7,38.7,1729.51,67.45,882.05,percent of total billed charges,38.7
CHROMOSOM ANAL AMNIO,88269,CPT,,,,,both,, ,1600.13,1600.13,Blue Cross and Blue Shield,Traditional,,619.25,38.7,38.7,1600.13,62.41,816.07,percent of total billed charges,38.7
CYTOGENETICS DNA-PRO,88271,CPT,,,,,both,, ,525.7,525.7,Blue Cross and Blue Shield,Traditional,,203.45,38.7,38.7,525.7,20.5,268.11,percent of total billed charges,38.7
CYTOGENETICS DNA-PRO,88271,CPT,,,,,both,, ,525.7,525.7,Blue Cross and Blue Shield,Traditional,,203.45,38.7,38.7,525.7,20.5,268.11,percent of total billed charges,38.7
CYTOGENETICS 3-5,88272,CPT,,,,,both,, ,243.63,243.63,Blue Cross and Blue Shield,Traditional,,94.28,38.7,38.7,243.63,9.5,124.25,percent of total billed charges,38.7
CYTOGENETICS 25-99,88274,CPT,,,,,both,, ,336.52,336.52,Blue Cross and Blue Shield,Traditional,,130.23,38.7,38.7,336.52,13.12,171.63,percent of total billed charges,38.7
CYTOGENETICS 100-300,88275,CPT,,,,,both,, ,1078.63,1078.63,Blue Cross and Blue Shield,Traditional,,417.43,38.7,38.7,1078.63,42.07,550.1,percent of total billed charges,38.7
CYTOGENETICS 100-300,88275,CPT,,,,,both,, ,1078.63,1078.63,Blue Cross and Blue Shield,Traditional,,417.43,38.7,38.7,1078.63,42.07,550.1,percent of total billed charges,38.7
CHROMOSOME KARYOT ST,88280,CPT,,,,,both,, ,962.71,962.71,Blue Cross and Blue Shield,Traditional,,372.57,38.7,38.7,962.71,37.55,490.98,percent of total billed charges,38.7
CHROMOSOM BANDINGSTU,88283,CPT,,,,,both,, ,375.26,375.26,Blue Cross and Blue Shield,Traditional,,145.23,38.7,38.7,375.26,14.64,191.38,percent of total billed charges,38.7
CHROMOSOME CT ADDITI,88285,CPT,,,,,both,, ,182.71,182.71,Blue Cross and Blue Shield,Traditional,,70.71,38.7,38.7,182.71,7.13,93.18,percent of total billed charges,38.7
CHROMOS STDY ADD HIG,88289,CPT,,,,,both,, ,284.04,284.04,Blue Cross and Blue Shield,Traditional,,109.92,38.7,38.7,284.04,11.08,144.86,percent of total billed charges,38.7
CYTOGENETIC STUDY,88299,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,38.7,72.13,2.81,36.79,percent of total billed charges,38.7
SURG PATH GROSS LVL1,88300,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,38.7,72.13,2.81,36.79,percent of total billed charges,38.7
SURG PATH GROSS LVL2,88302,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,38.7,109.74,4.28,55.97,percent of total billed charges,38.7
SURG PATH GROSS LVL3,88304,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,38.7,237.17,9.25,120.96,percent of total billed charges,38.7
SURG PATH GROSS LVL4,88305,CPT,,,,,both,, ,398.27,398.27,Blue Cross and Blue Shield,Traditional,,154.13,38.7,38.7,398.27,15.53,203.12,percent of total billed charges,38.7
SURG PATH GROSS LVL5,88307,CPT,,,,,both,, ,368.8,368.8,Blue Cross and Blue Shield,Traditional,,142.73,38.7,38.7,368.8,14.38,188.09,percent of total billed charges,38.7
SURG PATH GROSS LVL6,88309,CPT,,,,,both,, ,368.8,368.8,Blue Cross and Blue Shield,Traditional,,142.73,38.7,38.7,368.8,14.38,188.09,percent of total billed charges,38.7
DECALCIFY TISSUE,88311,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,38.7,72.13,2.81,36.79,percent of total billed charges,38.7
SPECIAL STAINS GRP 1,88312,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,38.7,109.74,4.28,55.97,percent of total billed charges,38.7
SPECIAL STAINS GRP 2,88313,CPT,,,,,both,, ,33.68,33.68,Blue Cross and Blue Shield,Traditional,,13.03,38.7,38.7,33.68,1.31,17.18,percent of total billed charges,38.7
SPECIAL STAINS GRP 2,88313,CPT,,,,,both,, ,241.94,241.94,Blue Cross and Blue Shield,Traditional,,93.63,38.7,38.7,241.94,9.44,123.39,percent of total billed charges,38.7
HISTOCHEMICAL STAIN,88314,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,38.7,109.74,4.28,55.97,percent of total billed charges,38.7
ENZYME HISTOCHEMISTR,88319,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,38.7,109.74,4.28,55.97,percent of total billed charges,38.7
MICROSLIDE-CONSULN-P,88321,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,38.7,109.74,4.28,55.97,percent of total billed charges,38.7
MICROSLID CONSUL-W-P,88323,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,38.7,237.17,9.25,120.96,percent of total billed charges,38.7
COMPRE REVIEW OFDATA,88325,CPT,,,,,both,, ,368.8,368.8,Blue Cross and Blue Shield,Traditional,,142.73,38.7,38.7,368.8,14.38,188.09,percent of total billed charges,38.7
PATH CONSULT INTROP,88329,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,38.7,109.74,4.28,55.97,percent of total billed charges,38.7
PATH CONSULT INT-1BL,88331,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,38.7,237.17,9.25,120.96,percent of total billed charges,38.7
PATH CONSULT-INTRADD,88332,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,38.7,72.13,2.81,36.79,percent of total billed charges,38.7
INOP CYTOPAT CNSLT 1,88333,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,38.7,109.74,4.28,55.97,percent of total billed charges,38.7
INOP CYTOPAT CNSLT 2,88334,CPT,,,,,both,, ,109.74,109.74,Blue Cross and Blue Shield,Traditional,,42.47,38.7,38.7,109.74,4.28,55.97,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,,92.11,38.7,38.7,238.01,9.28,121.39,percent of total billed charges,38.7
1ST SEP ID AB,88342,CPT,,,,,both,, ,238.01,238.01,Blue Cross and Blue Shield,Traditional,,92.11,38.7,38.7,238.01,9.28,121.39,percent of total billed charges,38.7
ICC MLTPX AB ST,88344,CPT,,,,,both,, ,221.17,221.17,Blue Cross and Blue Shield,Traditional,,85.59,38.7,38.7,221.17,8.63,112.8,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,,104.71,38.7,38.7,270.57,10.55,137.99,percent of total billed charges,38.7
ELECTRON MICROSCOPY,88348,CPT,,,,,both,, ,2028.15,2028.15,Blue Cross and Blue Shield,Traditional,,784.89,38.7,38.7,2028.15,79.1,1034.36,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,,104.71,38.7,38.7,270.57,10.55,137.99,percent of total billed charges,38.7
ANALYSIS SKELET MUSC,88355,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,38.7,237.17,9.25,120.96,percent of total billed charges,38.7
ANALYSIS NERVE,88356,CPT,,,,,both,, ,368.8,368.8,Blue Cross and Blue Shield,Traditional,,142.73,38.7,38.7,368.8,14.38,188.09,percent of total billed charges,38.7
ANALYSIS TUMOR,88358,CPT,,,,,both,, ,237.17,237.17,Blue Cross and Blue Shield,Traditional,,91.78,38.7,38.7,237.17,9.25,120.96,percent of total billed charges,38.7
TUMOR IHC QT MAN,88360,CPT,,,,,both,, ,1468.77,1468.77,Blue Cross and Blue Shield,Traditional,,568.41,38.7,38.7,1468.77,57.28,749.07,percent of total billed charges,38.7
TUMOR IHC QT UTO,88361,CPT,,,,,both,, ,1468.77,1468.77,Blue Cross and Blue Shield,Traditional,,568.41,38.7,38.7,1468.77,57.28,749.07,percent of total billed charges,38.7
NERVE TEASING PREPAR,88362,CPT,,,,,both,, ,368.8,368.8,Blue Cross and Blue Shield,Traditional,,142.73,38.7,38.7,368.8,14.38,188.09,percent of total billed charges,38.7
XM ARCHIVE TIS MOLEC,88363,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,38.7,72.13,2.81,36.79,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,,89.28,38.7,38.7,230.71,9,117.66,percent of total billed charges,38.7
TIS HYBRD SPEC INIT,88365,CPT,,,,,both,, ,304.81,304.81,Blue Cross and Blue Shield,Traditional,,117.96,38.7,38.7,304.81,11.89,155.45,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,,85.16,38.7,38.7,220.05,8.58,112.23,percent of total billed charges,38.7
INS HYBRD MAN SP INI,88368,CPT,,,,,both,, ,342.7,342.7,Blue Cross and Blue Shield,Traditional,,132.62,38.7,38.7,342.7,13.37,174.78,percent of total billed charges,38.7
INS HYBRD MAN SNG PR,88369,CPT,,,,,both,, ,342.7,342.7,Blue Cross and Blue Shield,Traditional,,132.62,38.7,38.7,342.7,13.37,174.78,percent of total billed charges,38.7
PROTEIN-WEST BLOTTIS,88371,CPT,,,,,both,, ,209.38,209.38,Blue Cross and Blue Shield,Traditional,,81.03,38.7,38.7,209.38,8.17,106.78,percent of total billed charges,38.7
PROTEIN ANALYSW/PROB,88372,CPT,,,,,both,, ,218.93,218.93,Blue Cross and Blue Shield,Traditional,,84.73,38.7,38.7,218.93,8.54,111.65,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,,85.16,38.7,38.7,220.05,8.58,112.23,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,,85.16,38.7,38.7,220.05,8.58,112.23,percent of total billed charges,38.7
INS HYBR MAN MUL PR,88377,CPT,,,,,both,, ,342.7,342.7,Blue Cross and Blue Shield,Traditional,,132.62,38.7,38.7,342.7,13.37,174.78,percent of total billed charges,38.7
MICRODISSECTION MANU,88381,CPT,,,,,both,, ,424.38,424.38,Blue Cross and Blue Shield,Traditional,,164.24,38.7,38.7,424.38,16.55,216.43,percent of total billed charges,38.7
SURGICAL PATH PROCED,88399,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,38.7,72.13,2.81,36.79,percent of total billed charges,38.7
BILIRUBIN TOT TRANS,88720,CPT,,,,,both,, ,75.22,75.22,Blue Cross and Blue Shield,Traditional,,29.11,38.7,38.7,75.22,2.93,38.36,percent of total billed charges,38.7
CELL CTW-DIF BODYFLU,89051,CPT,,,,,both,, ,54.17,54.17,Blue Cross and Blue Shield,Traditional,,20.96,38.7,38.7,54.17,2.11,27.63,percent of total billed charges,38.7
CELL CTW-DIF BODYFLU,89051,CPT,,,,,both,, ,691.29,691.29,Blue Cross and Blue Shield,Traditional,,267.53,38.7,38.7,691.29,26.96,352.56,percent of total billed charges,38.7
LEUKOCY ASSES FEC QL,89055,CPT,,,,,both,, ,109.46,109.46,Blue Cross and Blue Shield,Traditional,,42.36,38.7,38.7,109.46,4.27,55.82,percent of total billed charges,38.7
"CRYSTAL ID,TISSUE,FL",89060,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
"CRYSTAL ID,TISSUE,FL",89060,CPT,,,,,both,, ,345.79,345.79,Blue Cross and Blue Shield,Traditional,,133.82,38.7,38.7,345.79,13.49,176.35,percent of total billed charges,38.7
NASAL SMEAR-EOSINOPH,89190,CPT,,,,,both,, ,518.69,518.69,Blue Cross and Blue Shield,Traditional,,200.73,38.7,38.7,518.69,20.23,264.53,percent of total billed charges,38.7
UNL MISC PATH TEST,89240,CPT,,,,,both,, ,72.13,72.13,Blue Cross and Blue Shield,Traditional,,27.91,38.7,38.7,72.13,2.81,36.79,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,,203.66,38.7,38.7,526.26,20.52,268.39,percent of total billed charges,38.7
HEPATITIS B GLOB IM,90371,CPT,,,,,both,, ,679.03,679.03,Blue Cross and Blue Shield,Traditional,,262.78,38.7,38.7,679.03,26.48,346.31,percent of total billed charges,38.7
HEPATITIS B GLOB IM,90371,CPT,,,,,both,1,ML,953,953,Blue Cross and Blue Shield,Traditional,,368.81,38.7,38.7,953,37.17,486.03,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,,160.35,38.7,38.7,414.33,16.16,211.31,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,,536.03,38.7,38.7,1385.09,54.02,706.4,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,,552.77,38.7,38.7,1428.35,55.71,728.46,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,,722.58,38.7,38.7,1867.13,72.82,952.24,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,,791.34,38.7,38.7,2044.81,79.75,1042.85,percent of total billed charges,38.7
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,38.7,105.06,4.1,53.58,percent of total billed charges,38.7
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,38.7,105.06,4.1,53.58,percent of total billed charges,38.7
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,143.69,143.69,Blue Cross and Blue Shield,Traditional,,55.61,38.7,38.7,143.69,5.6,73.28,percent of total billed charges,38.7
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,230.72,230.72,Blue Cross and Blue Shield,Traditional,,89.29,38.7,38.7,230.72,9,117.67,percent of total billed charges,38.7
IMM ADM INJ SINGLE,90471,CPT,,,,,both,, ,162.25,162.25,Blue Cross and Blue Shield,Traditional,,62.79,38.7,38.7,162.25,6.33,82.75,percent of total billed charges,38.7
IMM ADM INJ SINGLE,90471,CPT,,,,,both,, ,162.25,162.25,Blue Cross and Blue Shield,Traditional,,62.79,38.7,38.7,162.25,6.33,82.75,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,,40.66,38.7,38.7,105.06,4.1,53.58,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,,40.66,38.7,38.7,105.06,4.1,53.58,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,,46.14,38.7,38.7,119.22,4.65,60.8,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,,46.14,38.7,38.7,119.22,4.65,60.8,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,,18.87,38.7,38.7,48.75,1.9,24.86,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,,18.87,38.7,38.7,48.75,1.9,24.86,percent of total billed charges,38.7
HAEMOPH B TETAN INJ,90648,CPT,,,,,both,, ,131.84,131.84,Blue Cross and Blue Shield,Traditional,,51.02,38.7,38.7,131.84,5.14,67.24,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,,168.21,38.7,38.7,434.66,16.95,221.68,percent of total billed charges,38.7
PNEUMOCOC 13-VAL IM,90670,CPT,,,,,both,0.5,ML,871.9,871.9,Blue Cross and Blue Shield,Traditional,,337.43,38.7,38.7,871.9,34,444.67,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,,80.52,38.7,38.7,208.06,8.11,106.11,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,,718.4,38.7,38.7,1856.32,72.4,946.72,percent of total billed charges,38.7
RABIES VAC IM,90675,CPT,,,,,both,, ,1941.04,1941.04,Blue Cross and Blue Shield,Traditional,,751.18,38.7,38.7,1941.04,75.7,989.93,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,,148.51,38.7,38.7,383.75,14.97,195.71,percent of total billed charges,38.7
FLU VACIIV4 PF .5ML,90686,CPT,,,,,both,, ,145.23,145.23,Blue Cross and Blue Shield,Traditional,,56.2,38.7,38.7,145.23,5.66,74.07,percent of total billed charges,38.7
FLU VAC IIV4 .25ML,90687,CPT,,,,,both,, ,135.45,135.45,Blue Cross and Blue Shield,Traditional,,52.42,38.7,38.7,135.45,5.28,69.08,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,,182.37,38.7,38.7,471.23,18.38,240.33,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,,81.32,38.7,38.7,210.12,8.19,107.16,percent of total billed charges,38.7
DIPH/TET/ACPERT .5ML,90715,CPT,,,,,both,0.5,ML,350.2,350.2,Blue Cross and Blue Shield,Traditional,,135.53,38.7,38.7,350.2,13.66,178.6,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,,143.4,38.7,38.7,370.54,14.45,188.98,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,,236.67,38.7,38.7,611.56,23.85,311.9,percent of total billed charges,38.7
PNEUMO-VAC 2YR-ADULT,90732,CPT,,,,,both,0.5,ML,544.1,544.1,Blue Cross and Blue Shield,Traditional,,210.57,38.7,38.7,544.1,21.22,277.49,percent of total billed charges,38.7
HEP B VAC PED,90744,CPT,,,,,both,, ,194.93,194.93,Blue Cross and Blue Shield,Traditional,,75.44,38.7,38.7,194.93,7.6,99.41,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,,79.32,38.7,38.7,204.97,7.99,104.53,percent of total billed charges,38.7
INTERACTIVE ADD-ON,90785,CPT,,,,,both,, ,310.8,310.8,Blue Cross and Blue Shield,Traditional,,120.28,38.7,38.7,310.8,12.12,158.51,percent of total billed charges,38.7
PSYCH DIAG EVAL,90791,CPT,,,,,both,, ,249.78,249.78,Blue Cross and Blue Shield,Traditional,,96.66,38.7,38.7,249.78,9.74,127.39,percent of total billed charges,38.7
PSYCH DIAG EVAL,90791,CPT,,,,,both,, ,757.82,757.82,Blue Cross and Blue Shield,Traditional,,293.28,38.7,38.7,757.82,29.55,386.49,percent of total billed charges,38.7
PSYCHOTHERAPY 30 MIN,90832,CPT,,,,,both,, ,238.96,238.96,Blue Cross and Blue Shield,Traditional,,92.48,38.7,38.7,238.96,9.32,121.87,percent of total billed charges,38.7
"Psychotherapy, 30 min",90832,CPT,,,,,both,,,238.96,238.96,Blue Cross and Blue Shield,Traditional,,92.48,38.7,38.7,238.96,9.32,121.87,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,,116.78,38.7,38.7,301.75,11.77,153.89,percent of total billed charges,38.7
PSYCHOTHERAPY 45 MIN,90834,CPT,,,,,both,, ,299.73,299.73,Blue Cross and Blue Shield,Traditional,,116,38.7,38.7,299.73,11.69,152.86,percent of total billed charges,38.7
"Psychotherapy, 45 min",90834,CPT,,,,,both,,,299.73,299.73,Blue Cross and Blue Shield,Traditional,,116,38.7,38.7,299.73,11.69,152.86,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,,120.84,38.7,38.7,312.25,12.18,159.25,percent of total billed charges,38.7
PSYCHOTHERAPY 60 MIN,90837,CPT,,,,,both,, ,359.73,359.73,Blue Cross and Blue Shield,Traditional,,139.22,38.7,38.7,359.73,14.03,183.46,percent of total billed charges,38.7
"Psychotherapy, 60 min",90837,CPT,,,,,both,,,359.73,359.73,Blue Cross and Blue Shield,Traditional,,139.22,38.7,38.7,359.73,14.03,183.46,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,,125.29,38.7,38.7,323.75,12.63,165.11,percent of total billed charges,38.7
FAM THERAPY W/PATIEN,90847,CPT,,,,,both,, ,842.03,842.03,Blue Cross and Blue Shield,Traditional,,325.87,38.7,38.7,842.03,32.84,429.44,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,,325.87,38.7,38.7,842.03,32.84,429.44,percent of total billed charges,38.7
MULTI-FAM GRP PSYCH,90849,CPT,,,,,both,, ,396.04,396.04,Blue Cross and Blue Shield,Traditional,,153.27,38.7,38.7,396.04,15.45,201.98,percent of total billed charges,38.7
Group psychotherapy,90853,CPT,,,,,both,,,220.94,220.94,Blue Cross and Blue Shield,Traditional,,85.5,38.7,38.7,220.94,8.62,112.68,percent of total billed charges,38.7
PSYCH GROUP THERAPY,90853,CPT,,,,,both,, ,220.94,220.94,Blue Cross and Blue Shield,Traditional,,85.5,38.7,38.7,220.94,8.62,112.68,percent of total billed charges,38.7
PSYCH GROUP THERAPY,90853,CPT,,,,,both,, ,689.33,689.33,Blue Cross and Blue Shield,Traditional,,266.77,38.7,38.7,689.33,26.88,351.56,percent of total billed charges,38.7
MEDICATION MGMT,90863,CPT,,,,,both,, ,294.25,294.25,Blue Cross and Blue Shield,Traditional,,113.87,38.7,38.7,294.25,11.48,150.07,percent of total billed charges,38.7
TMS INITIAL & 1ST TX,90867,CPT,,,,,both,, ,955.84,955.84,Blue Cross and Blue Shield,Traditional,,369.91,38.7,38.7,955.84,37.28,487.48,percent of total billed charges,38.7
TMS SUBSEQUENT TX,90868,CPT,,,,,both,, ,515.04,515.04,Blue Cross and Blue Shield,Traditional,,199.32,38.7,38.7,515.04,20.09,262.67,percent of total billed charges,38.7
TMS REMAPPING & TX,90869,CPT,,,,,both,, ,515.04,515.04,Blue Cross and Blue Shield,Traditional,,199.32,38.7,38.7,515.04,20.09,262.67,percent of total billed charges,38.7
HEMODIALY SING EVAL,90935,CPT,,,,,both,, ,9908.09,9908.09,Blue Cross and Blue Shield,Traditional,,3834.43,38.7,38.7,9908.09,386.42,5053.13,percent of total billed charges,38.7
OTH DIALY SING EVAL,90945,CPT,,,,,both,, ,4956.88,4956.88,Blue Cross and Blue Shield,Traditional,,1918.31,38.7,38.7,4956.88,193.32,2528.01,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,,70.53,38.7,38.7,182.25,7.11,92.95,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,,272.95,38.7,38.7,705.29,27.51,359.7,percent of total billed charges,38.7
SP-HEAR-GROUP-VISIT,92508,CPT,,,,,both,, ,324.19,324.19,Blue Cross and Blue Shield,Traditional,,125.46,38.7,38.7,324.19,12.64,165.34,percent of total billed charges,38.7
EV SP FLUENCY 15,92521,CPT,,,,,both,, ,135.5,135.5,Blue Cross and Blue Shield,Traditional,,52.44,38.7,38.7,135.5,5.28,69.11,percent of total billed charges,38.7
EVAL SPEECH FLUENCY,92521,CPT,,,,,both,, ,814.22,814.22,Blue Cross and Blue Shield,Traditional,,315.1,38.7,38.7,814.22,31.75,415.25,percent of total billed charges,38.7
EV SP PROD 15,92522,CPT,,,,,both,, ,182.25,182.25,Blue Cross and Blue Shield,Traditional,,70.53,38.7,38.7,182.25,7.11,92.95,percent of total billed charges,38.7
EVAL SPEECH SND PROD,92522,CPT,,,,,both,, ,814.22,814.22,Blue Cross and Blue Shield,Traditional,,315.1,38.7,38.7,814.22,31.75,415.25,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,,315.1,38.7,38.7,814.22,31.75,415.25,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,,70.53,38.7,38.7,182.25,7.11,92.95,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,,70.53,38.7,38.7,182.25,7.11,92.95,percent of total billed charges,38.7
BEHAV QL ANAL VOICE,92524,CPT,,,,,both,, ,814.22,814.22,Blue Cross and Blue Shield,Traditional,,315.1,38.7,38.7,814.22,31.75,415.25,percent of total billed charges,38.7
ORAL FUNC TX-VIS,92526,CPT,,,,,both,, ,705.29,705.29,Blue Cross and Blue Shield,Traditional,,272.95,38.7,38.7,705.29,27.51,359.7,percent of total billed charges,38.7
EVAL VOICE PROS DEV,92597,CPT,,,,,both,, ,390.11,390.11,Blue Cross and Blue Shield,Traditional,,150.97,38.7,38.7,390.11,15.21,198.96,percent of total billed charges,38.7
COCHLE IMP INTIL LT7,92601,CPT,,,,,both,, ,854.9,854.9,Blue Cross and Blue Shield,Traditional,,330.85,38.7,38.7,854.9,33.34,436,percent of total billed charges,38.7
SP-EVAL NSG DEV 1STH,92605,CPT,,,,,both,, ,813.7,813.7,Blue Cross and Blue Shield,Traditional,,314.9,38.7,38.7,813.7,31.73,414.99,percent of total billed charges,38.7
SP-EVAL SP DEV 1STHR,92607,CPT,,,,,both,, ,813.7,813.7,Blue Cross and Blue Shield,Traditional,,314.9,38.7,38.7,813.7,31.73,414.99,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,,295.37,38.7,38.7,763.23,29.77,389.25,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,,272.95,38.7,38.7,705.29,27.51,359.7,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,,293.38,38.7,38.7,758.08,29.57,386.62,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,,333.84,38.7,38.7,862.63,33.64,439.94,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,,219.73,38.7,38.7,567.79,22.14,289.57,percent of total billed charges,38.7
"IC-PTCA, SINGLE",92920,CPT,,,,,both,, ,65091.11,65091.11,Blue Cross and Blue Shield,Traditional,,25190.26,38.7,38.7,65091.11,2538.55,33196.47,percent of total billed charges,38.7
"IC-PTCA, ADDL",92921,CPT,,,,,both,, ,65091.11,65091.11,Blue Cross and Blue Shield,Traditional,,25190.26,38.7,38.7,65091.11,2538.55,33196.47,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,,34334.27,38.7,38.7,88719.05,3460.04,45246.72,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,,34334.27,38.7,38.7,88719.05,3460.04,45246.72,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,,34334.27,38.7,38.7,88719.05,3460.04,45246.72,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,,34334.27,38.7,38.7,88719.05,3460.04,45246.72,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,,34334.27,38.7,38.7,88719.05,3460.04,45246.72,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,,34334.27,38.7,38.7,88719.05,3460.04,45246.72,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,,34334.27,38.7,38.7,88719.05,3460.04,45246.72,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,,34334.27,38.7,38.7,88719.05,3460.04,45246.72,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,,34334.27,38.7,38.7,88719.05,3460.04,45246.72,percent of total billed charges,38.7
CPR,92950,CPT,,,,,both,, ,382.9,382.9,Blue Cross and Blue Shield,Traditional,,148.18,38.7,38.7,382.9,14.93,195.28,percent of total billed charges,38.7
CPR,92950,CPT,,,,,both,, ,382.9,382.9,Blue Cross and Blue Shield,Traditional,,148.18,38.7,38.7,382.9,14.93,195.28,percent of total billed charges,38.7
CPR,92950,CPT,,,,,both,, ,6031.42,6031.42,Blue Cross and Blue Shield,Traditional,,2334.16,38.7,38.7,6031.42,235.23,3076.02,percent of total billed charges,38.7
CPR ASSIST (NON ER),92950,CPT,,,,,both,, ,5533.42,5533.42,Blue Cross and Blue Shield,Traditional,,2141.43,38.7,38.7,5533.42,215.8,2822.04,percent of total billed charges,38.7
NI-TEMP EXT PACE,92953,CPT,,,,,both,, ,4462.48,4462.48,Blue Cross and Blue Shield,Traditional,,1726.98,38.7,38.7,4462.48,174.04,2275.86,percent of total billed charges,38.7
NI-TEMP EXT PACE,92953,CPT,,,,,both,, ,4864.09,4864.09,Blue Cross and Blue Shield,Traditional,,1882.4,38.7,38.7,4864.09,189.7,2480.69,percent of total billed charges,38.7
NI-CARDIOVERSION,92960,CPT,,,,,both,, ,4603.59,4603.59,Blue Cross and Blue Shield,Traditional,,1781.59,38.7,38.7,4603.59,179.54,2347.83,percent of total billed charges,38.7
NI-CARDIOVERSION,92960,CPT,,,,,both,, ,5017.9,5017.9,Blue Cross and Blue Shield,Traditional,,1941.93,38.7,38.7,5017.9,195.7,2559.13,percent of total billed charges,38.7
"EP-CARDIOVER,INTERN",92961,CPT,,,,,both,, ,2378.01,2378.01,Blue Cross and Blue Shield,Traditional,,920.29,38.7,38.7,2378.01,92.74,1212.79,percent of total billed charges,38.7
IC-COR THROMBECTOMY,92973,CPT,,,,,both,, ,29086.43,29086.43,Blue Cross and Blue Shield,Traditional,,11256.45,38.7,38.7,29086.43,1134.37,14834.08,percent of total billed charges,38.7
CC-INTRACOR THROMBO,92975,CPT,,,,,both,, ,18741.62,18741.62,Blue Cross and Blue Shield,Traditional,,7253.01,38.7,38.7,18741.62,730.92,9558.23,percent of total billed charges,38.7
CC-INTRACOR THROMBO,92975,CPT,,,,,both,, ,18741.62,18741.62,Blue Cross and Blue Shield,Traditional,,7253.01,38.7,38.7,18741.62,730.92,9558.23,percent of total billed charges,38.7
"THROMBOLY,CORONRY,IV",92977,CPT,,,,,both,, ,4033.02,4033.02,Blue Cross and Blue Shield,Traditional,,1560.78,38.7,38.7,4033.02,157.29,2056.84,percent of total billed charges,38.7
"IC-IVUS, INIT",92978,CPT,,,,,both,, ,537.92,537.92,Blue Cross and Blue Shield,Traditional,,208.18,38.7,38.7,537.92,20.98,274.34,percent of total billed charges,38.7
"IC-IVUS, ADDL",92979,CPT,,,,,both,, ,433.89,433.89,Blue Cross and Blue Shield,Traditional,,167.92,38.7,38.7,433.89,16.92,221.28,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,,592.44,38.7,38.7,1530.84,59.7,780.73,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,,25.21,38.7,38.7,65.15,2.54,33.23,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,,25.21,38.7,38.7,65.15,2.54,33.23,percent of total billed charges,38.7
"NI-EKG, 12 LEADS",93005,CPT,,,,,both,, ,714.82,714.82,Blue Cross and Blue Shield,Traditional,,276.64,38.7,38.7,714.82,27.88,364.56,percent of total billed charges,38.7
NI-STRESS TEST,93017,CPT,,,,,both,, ,5189.4,5189.4,Blue Cross and Blue Shield,Traditional,,2008.3,38.7,38.7,5189.4,202.39,2646.59,percent of total billed charges,38.7
EP-MICROVOLT T,93025,CPT,,,,,both,, ,1128.62,1128.62,Blue Cross and Blue Shield,Traditional,,436.78,38.7,38.7,1128.62,44.02,575.6,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,,773.8,38.7,38.7,1999.49,77.98,1019.74,percent of total billed charges,38.7
NI-HOLT RECRD TO48HR,93225,CPT,,,,,both,, ,9701.06,9701.06,Blue Cross and Blue Shield,Traditional,,3754.31,38.7,38.7,9701.06,378.34,4947.54,percent of total billed charges,38.7
NI-HOLT WSCAN TO48HR,93226,CPT,,,,,both,, ,1596.24,1596.24,Blue Cross and Blue Shield,Traditional,,617.74,38.7,38.7,1596.24,62.25,814.08,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,,4696.62,38.7,38.7,12135.98,473.3,6189.35,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,,3448.27,38.7,38.7,8910.27,347.5,4544.24,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,,1750.3,38.7,38.7,4522.73,176.39,2306.59,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,,3487.34,38.7,38.7,9011.21,351.44,4595.72,percent of total billed charges,38.7
US-ECHO DOPP COMP AD,93320,CPT,,,,,both,, ,1635.9,1635.9,Blue Cross and Blue Shield,Traditional,,633.09,38.7,38.7,1635.9,63.8,834.31,percent of total billed charges,38.7
NI-ECHO DOP LTD,93321,CPT,,,,,both,, ,541.78,541.78,Blue Cross and Blue Shield,Traditional,,209.67,38.7,38.7,541.78,21.13,276.31,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,,238.57,38.7,38.7,616.46,24.04,314.39,percent of total billed charges,38.7
US-TTE STRESS WO,93350,CPT,,,,,both,, ,6350.21,6350.21,Blue Cross and Blue Shield,Traditional,,2457.53,38.7,38.7,6350.21,247.66,3238.61,percent of total billed charges,38.7
CC-RHC,93451,CPT,,,,,both,, ,39597.32,39597.32,Blue Cross and Blue Shield,Traditional,,15324.16,38.7,38.7,39597.32,1544.3,20194.63,percent of total billed charges,38.7
CC-LHC VENT PUNC,93452,CPT,,,,,both,, ,43345.75,43345.75,Blue Cross and Blue Shield,Traditional,,16774.81,38.7,38.7,43345.75,1690.48,22106.33,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,,16774.81,38.7,38.7,43345.75,1690.48,22106.33,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,,16774.81,38.7,38.7,43345.75,1690.48,22106.33,percent of total billed charges,38.7
CC-ANGIO CORON ONLY,93454,CPT,,,,,both,, ,34667.23,34667.23,Blue Cross and Blue Shield,Traditional,,13416.22,38.7,38.7,34667.23,1352.02,17680.29,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,,13986.33,38.7,38.7,36140.38,1409.47,18431.59,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,,28740.28,38.7,38.7,74264.29,2896.31,37874.79,percent of total billed charges,38.7
CC-R HRT ART-GRF ANG,93457,CPT,,,,,both,, ,75737.7,75737.7,Blue Cross and Blue Shield,Traditional,,29310.49,38.7,38.7,75737.7,2953.77,38626.23,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,,19064.72,38.7,38.7,49262.84,1921.25,25124.05,percent of total billed charges,38.7
CC-L HRT ART-GRF ANG,93459,CPT,,,,,both,, ,50736,50736,Blue Cross and Blue Shield,Traditional,,19634.83,38.7,38.7,50736,1978.7,25875.36,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,,19064.72,38.7,38.7,49262.84,1921.25,25124.05,percent of total billed charges,38.7
CC-R-L HRT ART-ANGIO,93461,CPT,,,,,both,, ,50736,50736,Blue Cross and Blue Shield,Traditional,,19634.83,38.7,38.7,50736,1978.7,25875.36,percent of total billed charges,38.7
CC-DRUM ADM-HEMODYNC,93463,CPT,,,,,both,, ,451.91,451.91,Blue Cross and Blue Shield,Traditional,,174.89,38.7,38.7,451.91,17.62,230.47,percent of total billed charges,38.7
INSERTION FLOW CATH,93503,CPT,,,,,both,, ,13163.66,13163.66,Blue Cross and Blue Shield,Traditional,,5094.34,38.7,38.7,13163.66,513.38,6713.47,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,,1450.64,38.7,38.7,3748.43,146.19,1911.7,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,,1258.71,38.7,38.7,3252.48,126.85,1658.76,percent of total billed charges,38.7
CC-INJ SUPRV AORTOGR,93567,CPT,,,,,both,, ,5119.62,5119.62,Blue Cross and Blue Shield,Traditional,,1981.29,38.7,38.7,5119.62,199.67,2611.01,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,,1981.29,38.7,38.7,5119.62,199.67,2611.01,percent of total billed charges,38.7
HEART FLOW MEASURE,93571,CPT,,,,,both,, ,709.67,709.67,Blue Cross and Blue Shield,Traditional,,274.64,38.7,38.7,709.67,27.68,361.93,percent of total billed charges,38.7
HEART FLOW MEAS ADD,93572,CPT,,,,,both,, ,709.67,709.67,Blue Cross and Blue Shield,Traditional,,274.64,38.7,38.7,709.67,27.68,361.93,percent of total billed charges,38.7
CC-PDA CLOSE PERC,93582,CPT,,,,,both,, ,68501.18,68501.18,Blue Cross and Blue Shield,Traditional,,26509.96,38.7,38.7,68501.18,2671.55,34935.6,percent of total billed charges,38.7
EP-HIS BUNDLE REC,93600,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.5,38.7,38.7,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-INTRAATRIAL REC,93602,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.5,38.7,38.7,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-RV RECORD,93603,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.5,38.7,38.7,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-MAP TACHY,93609,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.5,38.7,38.7,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-INTRAATRIAL PAC,93610,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.5,38.7,38.7,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-INTRAVENT PAC,93612,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.5,38.7,38.7,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-MAP ADD,93613,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.5,38.7,38.7,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-ATRI RECORD ESO,93615,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.5,38.7,38.7,4670.54,182.15,2381.98,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,,1807.5,38.7,38.7,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-INDUC ARRY PAC,93618,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.5,38.7,38.7,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-COMP EP W-O ARRY,93619,CPT,,,,,both,, ,22625.5,22625.5,Blue Cross and Blue Shield,Traditional,,8756.07,38.7,38.7,22625.5,882.39,11539.01,percent of total billed charges,38.7
EP-COMP EP W- ARRY,93620,CPT,,,,,both,, ,22625.5,22625.5,Blue Cross and Blue Shield,Traditional,,8756.07,38.7,38.7,22625.5,882.39,11539.01,percent of total billed charges,38.7
"EP-LA PACING, ADD",93621,CPT,,,,,both,, ,22625.5,22625.5,Blue Cross and Blue Shield,Traditional,,8756.07,38.7,38.7,22625.5,882.39,11539.01,percent of total billed charges,38.7
"EP-LV PACING, ADD",93622,CPT,,,,,both,, ,22625.5,22625.5,Blue Cross and Blue Shield,Traditional,,8756.07,38.7,38.7,22625.5,882.39,11539.01,percent of total billed charges,38.7
EP-PROG STIM IV DRUG,93623,CPT,,,,,both,, ,22625.5,22625.5,Blue Cross and Blue Shield,Traditional,,8756.07,38.7,38.7,22625.5,882.39,11539.01,percent of total billed charges,38.7
EP-F-U EPW-ARRY IND,93624,CPT,,,,,both,, ,22625.5,22625.5,Blue Cross and Blue Shield,Traditional,,8756.07,38.7,38.7,22625.5,882.39,11539.01,percent of total billed charges,38.7
EP-INTRA OP MAPPNG,93631,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.5,38.7,38.7,4670.54,182.15,2381.98,percent of total billed charges,38.7
"EP-EVAL LEAD,INDUC",93640,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.5,38.7,38.7,4670.54,182.15,2381.98,percent of total billed charges,38.7
"EP-EVAL GEN, INDUC",93641,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.5,38.7,38.7,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-EVAL PREV DEVICE,93642,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.5,38.7,38.7,4670.54,182.15,2381.98,percent of total billed charges,38.7
EP-ABLATE AV NODE,93650,CPT,,,,,both,, ,22625.5,22625.5,Blue Cross and Blue Shield,Traditional,,8756.07,38.7,38.7,22625.5,882.39,11539.01,percent of total billed charges,38.7
EP-ABLATE SPRVNT ART,93653,CPT,,,,,both,, ,46220.99,46220.99,Blue Cross and Blue Shield,Traditional,,17887.52,38.7,38.7,46220.99,1802.62,23572.7,percent of total billed charges,38.7
EP-ABLATE VENT TACY,93654,CPT,,,,,both,, ,46220.99,46220.99,Blue Cross and Blue Shield,Traditional,,17887.52,38.7,38.7,46220.99,1802.62,23572.7,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,,17887.52,38.7,38.7,46220.99,1802.62,23572.7,percent of total billed charges,38.7
EP-INTCRD ECHO INTER,93662,CPT,,,,,both,, ,4670.54,4670.54,Blue Cross and Blue Shield,Traditional,,1807.5,38.7,38.7,4670.54,182.15,2381.98,percent of total billed charges,38.7
PAD REHB PER SESSION,93668,CPT,,,,,both,, ,169.18,169.18,Blue Cross and Blue Shield,Traditional,,65.47,38.7,38.7,169.18,6.6,86.28,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,,74.94,38.7,38.7,193.64,7.55,98.76,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,,114.7,38.7,38.7,296.38,11.56,151.15,percent of total billed charges,38.7
US-CAROTID DPLX SCAN,93880,CPT,,,,,both,, ,425.13,425.13,Blue Cross and Blue Shield,Traditional,,164.53,38.7,38.7,425.13,16.58,216.82,percent of total billed charges,38.7
US-CAROTID DPLX SCAN,93880,CPT,,,,,both,, ,457.58,457.58,Blue Cross and Blue Shield,Traditional,,177.08,38.7,38.7,457.58,17.85,233.37,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,,4920.44,38.7,38.7,12714.32,495.86,6484.3,percent of total billed charges,38.7
US-CAROTID DUP DOPLR,93882,CPT,,,,,both,, ,425.13,425.13,Blue Cross and Blue Shield,Traditional,,164.53,38.7,38.7,425.13,16.58,216.82,percent of total billed charges,38.7
US-CAROTID DUP DOPLR,93882,CPT,,,,,both,, ,457.58,457.58,Blue Cross and Blue Shield,Traditional,,177.08,38.7,38.7,457.58,17.85,233.37,percent of total billed charges,38.7
NI-EXT ARTERIAL LTD,93922,CPT,,,,,both,, ,2456.29,2456.29,Blue Cross and Blue Shield,Traditional,,950.58,38.7,38.7,2456.29,95.8,1252.71,percent of total billed charges,38.7
US-EXT ARTERIAL LTD,93922,CPT,,,,,both,, ,167.38,167.38,Blue Cross and Blue Shield,Traditional,,64.78,38.7,38.7,167.38,6.53,85.36,percent of total billed charges,38.7
NI-EXT ARTERIAL COMP,93923,CPT,,,,,both,, ,3819.24,3819.24,Blue Cross and Blue Shield,Traditional,,1478.05,38.7,38.7,3819.24,148.95,1947.81,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,,103.84,38.7,38.7,268.32,10.46,136.84,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,,2203.52,38.7,38.7,5693.84,222.06,2903.86,percent of total billed charges,38.7
NI-LW EXT DPX ART BI,93925,CPT,,,,,both,, ,5086.4,5086.4,Blue Cross and Blue Shield,Traditional,,1968.44,38.7,38.7,5086.4,198.37,2594.06,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,,983.57,38.7,38.7,2541.53,99.12,1296.18,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,,603.79,38.7,38.7,1560.19,60.85,795.7,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,,1967.14,38.7,38.7,5083.05,198.24,2592.36,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,,983.57,38.7,38.7,2541.53,99.12,1296.18,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,,784.07,38.7,38.7,2026.01,79.01,1033.27,percent of total billed charges,38.7
NI-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,5086.4,5086.4,Blue Cross and Blue Shield,Traditional,,1968.44,38.7,38.7,5086.4,198.37,2594.06,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,,164.53,38.7,38.7,425.13,16.58,216.82,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,,177.08,38.7,38.7,457.58,17.85,233.37,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,,116,38.7,38.7,299.73,11.69,152.86,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,,124.87,38.7,38.7,322.65,12.58,164.55,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,,983.57,38.7,38.7,2541.53,99.12,1296.18,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,,164.53,38.7,38.7,425.13,16.58,216.82,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,,177.08,38.7,38.7,457.58,17.85,233.37,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,,318.59,38.7,38.7,823.23,32.11,419.85,percent of total billed charges,38.7
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,425.13,425.13,Blue Cross and Blue Shield,Traditional,,164.53,38.7,38.7,425.13,16.58,216.82,percent of total billed charges,38.7
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,457.58,457.58,Blue Cross and Blue Shield,Traditional,,177.08,38.7,38.7,457.58,17.85,233.37,percent of total billed charges,38.7
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,828.89,828.89,Blue Cross and Blue Shield,Traditional,,320.78,38.7,38.7,828.89,32.33,422.73,percent of total billed charges,38.7
US-DPLXSCN GRFT ARTA,93978,CPT,,,,,both,, ,1665.51,1665.51,Blue Cross and Blue Shield,Traditional,,644.55,38.7,38.7,1665.51,64.95,849.41,percent of total billed charges,38.7
NI-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,1292.14,1292.14,Blue Cross and Blue Shield,Traditional,,500.06,38.7,38.7,1292.14,50.39,658.99,percent of total billed charges,38.7
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,425.13,425.13,Blue Cross and Blue Shield,Traditional,,164.53,38.7,38.7,425.13,16.58,216.82,percent of total billed charges,38.7
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,457.58,457.58,Blue Cross and Blue Shield,Traditional,,177.08,38.7,38.7,457.58,17.85,233.37,percent of total billed charges,38.7
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,841.51,841.51,Blue Cross and Blue Shield,Traditional,,325.66,38.7,38.7,841.51,32.82,429.17,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,,378.32,38.7,38.7,977.58,38.13,498.57,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,,378.32,38.7,38.7,977.58,38.13,498.57,percent of total billed charges,38.7
NI-DUPSCN HEMODIAL,93990,CPT,,,,,both,, ,4623.93,4623.93,Blue Cross and Blue Shield,Traditional,,1789.46,38.7,38.7,4623.93,180.33,2358.2,percent of total billed charges,38.7
MECH VENT INITIAL,94002,CPT,,,,,both,, ,4971.3,4971.3,Blue Cross and Blue Shield,Traditional,,1923.89,38.7,38.7,4971.3,193.88,2535.36,percent of total billed charges,38.7
MECH VENT DAILY SUBS,94003,CPT,,,,,both,, ,4971.3,4971.3,Blue Cross and Blue Shield,Traditional,,1923.89,38.7,38.7,4971.3,193.88,2535.36,percent of total billed charges,38.7
SPIROMETRY,94010,CPT,,,,,both,, ,530.45,530.45,Blue Cross and Blue Shield,Traditional,,205.28,38.7,38.7,530.45,20.69,270.53,percent of total billed charges,38.7
BRONCHO EVAL PRE/PST,94060,CPT,,,,,both,, ,2361.28,2361.28,Blue Cross and Blue Shield,Traditional,,913.82,38.7,38.7,2361.28,92.09,1204.25,percent of total billed charges,38.7
METHACHOLINE CHALLEN,94070,CPT,,,,,both,, ,961.51,961.51,Blue Cross and Blue Shield,Traditional,,372.1,38.7,38.7,961.51,37.5,490.37,percent of total billed charges,38.7
MAXIMUM VOLUNTARY VE,94200,CPT,,,,,both,, ,306.94,306.94,Blue Cross and Blue Shield,Traditional,,118.79,38.7,38.7,306.94,11.97,156.54,percent of total billed charges,38.7
HAST WITH 02 TITRATE,94453,CPT,,,,,both,, ,1089.74,1089.74,Blue Cross and Blue Shield,Traditional,,421.73,38.7,38.7,1089.74,42.5,555.77,percent of total billed charges,38.7
PULM STRESS SIMPLE,94618,CPT,,,,,both,, ,459.12,459.12,Blue Cross and Blue Shield,Traditional,,177.68,38.7,38.7,459.12,17.91,234.15,percent of total billed charges,38.7
PULM REHAB WO OXIMET,94625,CPT,,,,,both,, ,227.4,227.4,Blue Cross and Blue Shield,Traditional,,88,38.7,38.7,227.4,8.87,115.97,percent of total billed charges,38.7
PULM REHAB W OXIMET,94626,CPT,,,,,both,, ,227.4,227.4,Blue Cross and Blue Shield,Traditional,,88,38.7,38.7,227.4,8.87,115.97,percent of total billed charges,38.7
INHALATION TRTMT INI,94640,CPT,,,,,both,, ,569.5,569.5,Blue Cross and Blue Shield,Traditional,,220.4,38.7,38.7,569.5,22.21,290.45,percent of total billed charges,38.7
INHALATION TRTMT INI,94640,CPT,,,,,both,, ,586.59,586.59,Blue Cross and Blue Shield,Traditional,,227.01,38.7,38.7,586.59,22.88,299.16,percent of total billed charges,38.7
INHALATION TRTMT SUB,94640,CPT,,,,,both,, ,691.75,691.75,Blue Cross and Blue Shield,Traditional,,267.71,38.7,38.7,691.75,26.98,352.79,percent of total billed charges,38.7
INHALATION TRTMT SUB,94640,CPT,,,,,both,, ,712.5,712.5,Blue Cross and Blue Shield,Traditional,,275.74,38.7,38.7,712.5,27.79,363.38,percent of total billed charges,38.7
PENTAMIDINE ARSL INH,94642,CPT,,,,,both,, ,1061.67,1061.67,Blue Cross and Blue Shield,Traditional,,410.87,38.7,38.7,1061.67,41.41,541.45,percent of total billed charges,38.7
AEROSOL OBSTRUCT 1HR,94644,CPT,,,,,both,, ,719.71,719.71,Blue Cross and Blue Shield,Traditional,,278.53,38.7,38.7,719.71,28.07,367.05,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,,270.42,38.7,38.7,698.75,27.25,356.36,percent of total billed charges,38.7
AEROSOL OBSTR ADD HR,94645,CPT,,,,,both,, ,719.71,719.71,Blue Cross and Blue Shield,Traditional,,278.53,38.7,38.7,719.71,28.07,367.05,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,,270.42,38.7,38.7,698.75,27.25,356.36,percent of total billed charges,38.7
BIPAP/CPAP,94660,CPT,,,,,both,, ,2771.47,2771.47,Blue Cross and Blue Shield,Traditional,,1072.56,38.7,38.7,2771.47,108.09,1413.45,percent of total billed charges,38.7
EVAL-DEMO INHL DEVCE,94664,CPT,,,,,both,, ,342.73,342.73,Blue Cross and Blue Shield,Traditional,,132.64,38.7,38.7,342.73,13.37,174.79,percent of total billed charges,38.7
MANIP CHST WALL INIT,94667,CPT,,,,,both,, ,1191.45,1191.45,Blue Cross and Blue Shield,Traditional,,461.09,38.7,38.7,1191.45,46.47,607.64,percent of total billed charges,38.7
MANIP CHST WALL SBSQ,94668,CPT,,,,,both,, ,975.15,975.15,Blue Cross and Blue Shield,Traditional,,377.38,38.7,38.7,975.15,38.03,497.33,percent of total billed charges,38.7
MECHAN CHST WALL OSC,94669,CPT,,,,,both,, ,210.89,210.89,Blue Cross and Blue Shield,Traditional,,81.61,38.7,38.7,210.89,8.22,107.55,percent of total billed charges,38.7
PF TST PLETHYSMOGRA,94726,CPT,,,,,both,, ,548.73,548.73,Blue Cross and Blue Shield,Traditional,,212.36,38.7,38.7,548.73,21.4,279.85,percent of total billed charges,38.7
PF TEST BY GAS,94727,CPT,,,,,both,, ,548.73,548.73,Blue Cross and Blue Shield,Traditional,,212.36,38.7,38.7,548.73,21.4,279.85,percent of total billed charges,38.7
PF TEST OSCILLOMETRY,94728,CPT,,,,,both,, ,548.73,548.73,Blue Cross and Blue Shield,Traditional,,212.36,38.7,38.7,548.73,21.4,279.85,percent of total billed charges,38.7
CO2-MEMBANE DIFF CAP,94729,CPT,,,,,both,, ,2800.31,2800.31,Blue Cross and Blue Shield,Traditional,,1083.72,38.7,38.7,2800.31,109.21,1428.16,percent of total billed charges,38.7
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309,309,Blue Cross and Blue Shield,Traditional,,119.58,38.7,38.7,309,12.05,157.59,percent of total billed charges,38.7
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309,309,Blue Cross and Blue Shield,Traditional,,119.58,38.7,38.7,309,12.05,157.59,percent of total billed charges,38.7
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309,309,Blue Cross and Blue Shield,Traditional,,119.58,38.7,38.7,309,12.05,157.59,percent of total billed charges,38.7
PULSE OX MULTI/EXERC,94761,CPT,,,,,both,, ,797.48,797.48,Blue Cross and Blue Shield,Traditional,,308.62,38.7,38.7,797.48,31.1,406.71,percent of total billed charges,38.7
PULSE OX MULTI/EXERC,94761,CPT,,,,,both,, ,797.48,797.48,Blue Cross and Blue Shield,Traditional,,308.62,38.7,38.7,797.48,31.1,406.71,percent of total billed charges,38.7
PULSE OX CONTINUOS,94762,CPT,,,,,both,, ,388,388,Blue Cross and Blue Shield,Traditional,,150.16,38.7,38.7,388,15.13,197.88,percent of total billed charges,38.7
PULSE OX OVERNIGHT,94762,CPT,,,,,both,, ,468.91,468.91,Blue Cross and Blue Shield,Traditional,,181.47,38.7,38.7,468.91,18.29,239.14,percent of total billed charges,38.7
PULSE OX OVERNIGHT,94762,CPT,,,,,both,, ,468.91,468.91,Blue Cross and Blue Shield,Traditional,,181.47,38.7,38.7,468.91,18.29,239.14,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,,45.74,38.7,38.7,118.19,4.61,60.28,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,,22.82,38.7,38.7,58.97,2.3,30.07,percent of total billed charges,38.7
ALLERGY INJ SIM,95115,CPT,,,,,both,, ,70.56,70.56,Blue Cross and Blue Shield,Traditional,,27.31,38.7,38.7,70.56,2.75,35.99,percent of total billed charges,38.7
ALLERGY INJ SIM,95115,CPT,,,,,both,, ,70.81,70.81,Blue Cross and Blue Shield,Traditional,,27.4,38.7,38.7,70.81,2.76,36.11,percent of total billed charges,38.7
ALLERGY INJ MUL,95117,CPT,,,,,both,, ,70.56,70.56,Blue Cross and Blue Shield,Traditional,,27.31,38.7,38.7,70.56,2.75,35.99,percent of total billed charges,38.7
ALLERGY INJ MUL,95117,CPT,,,,,both,, ,70.81,70.81,Blue Cross and Blue Shield,Traditional,,27.4,38.7,38.7,70.81,2.76,36.11,percent of total billed charges,38.7
POLYSOMNO GT4 LT6YO,95782,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,38.7,2570.88,100.26,1311.15,percent of total billed charges,38.7
POLYSOMNO GT4 LT6YO,95782,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,38.7,2570.88,100.26,1311.15,percent of total billed charges,38.7
POLYS-CPAP GT4 LT6YO,95783,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,38.7,2570.88,100.26,1311.15,percent of total billed charges,38.7
POLYS-CPAP GT4 LT6YO,95783,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,38.7,2570.88,100.26,1311.15,percent of total billed charges,38.7
SLPSTDY UNATT AN-ST,95800,CPT,,,,,both,, ,428.48,428.48,Blue Cross and Blue Shield,Traditional,,165.82,38.7,38.7,428.48,16.71,218.52,percent of total billed charges,38.7
SLPSTDY UNATT AN-ST,95800,CPT,,,,,both,, ,625,625,Blue Cross and Blue Shield,Traditional,,241.88,38.7,38.7,625,24.38,318.75,percent of total billed charges,38.7
MULTI SLEEP LAT,95805,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,38.7,2570.88,100.26,1311.15,percent of total billed charges,38.7
MULTI SLEEP LAT,95805,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,38.7,2570.88,100.26,1311.15,percent of total billed charges,38.7
SLPSTDY UNATT RS EFF,95806,CPT,,,,,both,, ,428.48,428.48,Blue Cross and Blue Shield,Traditional,,165.82,38.7,38.7,428.48,16.71,218.52,percent of total billed charges,38.7
SLPSTDY UNATT RS EFF,95806,CPT,,,,,both,, ,625,625,Blue Cross and Blue Shield,Traditional,,241.88,38.7,38.7,625,24.38,318.75,percent of total billed charges,38.7
POLYSOMNO GT4 GE6YO,95810,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,38.7,2570.88,100.26,1311.15,percent of total billed charges,38.7
POLYSOMNO GT4 GE6YO,95810,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,38.7,2570.88,100.26,1311.15,percent of total billed charges,38.7
Sleep study,95810,CPT,,,,,both,,,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,38.7,2570.88,100.26,1311.15,percent of total billed charges,38.7
POLYS-CPAP GT4 GE6YO,95811,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,38.7,2570.88,100.26,1311.15,percent of total billed charges,38.7
POLYS-CPAP GT4 GE6YO,95811,CPT,,,,,both,, ,2570.88,2570.88,Blue Cross and Blue Shield,Traditional,,994.93,38.7,38.7,2570.88,100.26,1311.15,percent of total billed charges,38.7
EEG 41-60 MIN,95812,CPT,,,,,both,, ,1075.58,1075.58,Blue Cross and Blue Shield,Traditional,,416.25,38.7,38.7,1075.58,41.95,548.55,percent of total billed charges,38.7
EEG GT 1 HOUR,95813,CPT,,,,,both,, ,1044.25,1044.25,Blue Cross and Blue Shield,Traditional,,404.12,38.7,38.7,1044.25,40.73,532.57,percent of total billed charges,38.7
EEG AWAKE DROWSY,95816,CPT,,,,,both,, ,1075.58,1075.58,Blue Cross and Blue Shield,Traditional,,416.25,38.7,38.7,1075.58,41.95,548.55,percent of total billed charges,38.7
EEG AWAKE ASLEEP,95819,CPT,,,,,both,, ,3362.5,3362.5,Blue Cross and Blue Shield,Traditional,,1301.29,38.7,38.7,3362.5,131.14,1714.88,percent of total billed charges,38.7
EEG ASLEEP,95822,CPT,,,,,both,, ,4457.07,4457.07,Blue Cross and Blue Shield,Traditional,,1724.89,38.7,38.7,4457.07,173.83,2273.11,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,,8.17,38.7,38.7,21.12,0.82,10.77,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,,8.17,38.7,38.7,21.12,0.82,10.77,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,,8.17,38.7,38.7,21.12,0.82,10.77,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,,8.17,38.7,38.7,21.12,0.82,10.77,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,,188.24,38.7,38.7,486.42,0.82,248.07,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,,188.24,38.7,38.7,486.42,0.82,248.07,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,,173.6,38.7,38.7,448.57,0.82,228.77,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,,173.6,38.7,38.7,448.57,0.82,228.77,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,,162.1,38.7,38.7,418.86,0.82,213.62,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,,175.75,38.7,38.7,454.13,0.82,231.61,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,,162.1,38.7,38.7,418.86,0.82,213.62,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,,175.75,38.7,38.7,454.13,0.82,231.61,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,,6.28,38.7,38.7,16.22,0.82,8.27,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,,6.28,38.7,38.7,16.22,0.82,8.27,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,,6.28,38.7,38.7,16.22,0.82,8.27,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,,6.28,38.7,38.7,16.22,0.82,8.27,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,,188.24,38.7,38.7,486.42,0.82,248.07,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,,188.24,38.7,38.7,486.42,0.82,248.07,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,,173.6,38.7,38.7,448.57,0.82,228.77,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,,173.6,38.7,38.7,448.57,0.82,228.77,percent of total billed charges,38.7
"EMG, 1 EXTREM",95860,CPT,,,,,both,, ,3272.05,3272.05,Blue Cross and Blue Shield,Traditional,,1266.28,38.7,38.7,3272.05,0.82,1668.75,percent of total billed charges,38.7
"EMG, 2 EXTREM",95861,CPT,,,,,both,, ,5586.46,5586.46,Blue Cross and Blue Shield,Traditional,,2161.96,38.7,38.7,5586.46,0.82,2849.09,percent of total billed charges,38.7
"EMG, 3 EXTREM",95863,CPT,,,,,both,, ,7162.62,7162.62,Blue Cross and Blue Shield,Traditional,,2771.93,38.7,38.7,7162.62,0.82,3652.94,percent of total billed charges,38.7
"EMG, 4 EXTREM",95864,CPT,,,,,both,, ,8764.27,8764.27,Blue Cross and Blue Shield,Traditional,,3391.77,38.7,38.7,8764.27,0.82,4469.78,percent of total billed charges,38.7
"EMG, W-NERVE TEST",95885,CPT,,,,,both,, ,458.87,458.87,Blue Cross and Blue Shield,Traditional,,177.58,38.7,38.7,458.87,0.82,234.02,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,,177.58,38.7,38.7,458.87,0.82,234.02,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,,93.87,38.7,38.7,242.57,0.82,123.71,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,,317.89,38.7,38.7,821.43,0.82,418.93,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,,317.89,38.7,38.7,821.43,0.82,418.93,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,,317.89,38.7,38.7,821.43,0.82,418.93,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,,317.89,38.7,38.7,821.43,0.82,418.93,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,,317.89,38.7,38.7,821.43,0.82,418.93,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,,587.75,38.7,38.7,1518.74,0.82,774.56,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,,587.75,38.7,38.7,1518.74,0.82,774.56,percent of total billed charges,38.7
PARASYMP-SYMP HRT RT,95924,CPT,,,,,both,, ,461.44,461.44,Blue Cross and Blue Shield,Traditional,,178.58,38.7,38.7,461.44,0.82,235.33,percent of total billed charges,38.7
VISUAL EVOK POTENT,95930,CPT,,,,,both,, ,3397.2,3397.2,Blue Cross and Blue Shield,Traditional,,1314.72,38.7,38.7,3397.2,0.82,1732.57,percent of total billed charges,38.7
"REPETIT STIM, EA NE",95937,CPT,,,,,both,, ,3199.95,3199.95,Blue Cross and Blue Shield,Traditional,,1238.38,38.7,38.7,3199.95,0.82,1631.97,percent of total billed charges,38.7
CANALITH PER DAY,95992,CPT,,,,,both,, ,158.07,158.07,Blue Cross and Blue Shield,Traditional,,61.17,38.7,38.7,158.07,0.82,80.62,percent of total billed charges,38.7
CANALITH PER DAY PT,95992,CPT,,,,,both,, ,101.97,101.97,Blue Cross and Blue Shield,Traditional,,39.46,38.7,38.7,101.97,0.82,52,percent of total billed charges,38.7
CANALITH PER DAY PT,95992,CPT,,,,,both,, ,101.97,101.97,Blue Cross and Blue Shield,Traditional,,39.46,38.7,38.7,101.97,0.82,52,percent of total billed charges,38.7
CANALITH PER DAY PT,95992,CPT,,,,,both,, ,169.44,169.44,Blue Cross and Blue Shield,Traditional,,65.57,38.7,38.7,169.44,0.82,86.41,percent of total billed charges,38.7
CANALITH PER DAY PT,95992,CPT,,,,,both,, ,169.44,169.44,Blue Cross and Blue Shield,Traditional,,65.57,38.7,38.7,169.44,0.82,86.41,percent of total billed charges,38.7
APHASIA ASSESS 1HOUR,96105,CPT,,,,,both,, ,813.7,813.7,Blue Cross and Blue Shield,Traditional,,314.9,38.7,38.7,813.7,0.82,414.99,percent of total billed charges,38.7
DEV TEST 1ST HR,96112,CPT,,,,,both,, ,813.7,813.7,Blue Cross and Blue Shield,Traditional,,314.9,38.7,38.7,813.7,0.82,414.99,percent of total billed charges,38.7
DEV TEST ADD 30M,96113,CPT,,,,,both,, ,763.23,763.23,Blue Cross and Blue Shield,Traditional,,295.37,38.7,38.7,763.23,0.82,389.25,percent of total billed charges,38.7
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,253.9,253.9,Blue Cross and Blue Shield,Traditional,,98.26,38.7,38.7,253.9,0.82,129.49,percent of total billed charges,38.7
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,253.9,253.9,Blue Cross and Blue Shield,Traditional,,98.26,38.7,38.7,253.9,0.82,129.49,percent of total billed charges,38.7
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,487,487,Blue Cross and Blue Shield,Traditional,,188.47,38.7,38.7,487,0.82,248.37,percent of total billed charges,38.7
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,487,487,Blue Cross and Blue Shield,Traditional,,188.47,38.7,38.7,487,0.82,248.37,percent of total billed charges,38.7
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,501.61,501.61,Blue Cross and Blue Shield,Traditional,,194.12,38.7,38.7,501.61,0.82,255.82,percent of total billed charges,38.7
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,501.61,501.61,Blue Cross and Blue Shield,Traditional,,194.12,38.7,38.7,501.61,0.82,255.82,percent of total billed charges,38.7
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,1841.23,1841.23,Blue Cross and Blue Shield,Traditional,,712.56,38.7,38.7,1841.23,0.82,939.03,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,,27.4,38.7,38.7,70.81,0.82,36.11,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,,27.4,38.7,38.7,70.81,0.82,36.11,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,,52.54,38.7,38.7,135.75,0.82,69.23,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,,52.54,38.7,38.7,135.75,0.82,69.23,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,,54.11,38.7,38.7,139.82,0.82,71.31,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,,54.11,38.7,38.7,139.82,0.82,71.31,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,,712.56,38.7,38.7,1841.23,0.82,939.03,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,,159.74,38.7,38.7,412.77,0.82,210.51,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,,159.74,38.7,38.7,412.77,0.82,210.51,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,,359.21,38.7,38.7,928.18,0.82,473.37,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,,503.78,38.7,38.7,1301.75,0.82,663.89,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,,503.78,38.7,38.7,1301.75,0.82,663.89,percent of total billed charges,38.7
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1340.8,1340.8,Blue Cross and Blue Shield,Traditional,,518.89,38.7,38.7,1340.8,0.82,683.81,percent of total billed charges,38.7
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1340.8,1340.8,Blue Cross and Blue Shield,Traditional,,518.89,38.7,38.7,1340.8,0.82,683.81,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,,27.4,38.7,38.7,70.81,0.82,36.11,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,,27.4,38.7,38.7,70.81,0.82,36.11,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,,359.21,38.7,38.7,928.18,0.82,473.37,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,,503.78,38.7,38.7,1301.75,0.82,663.89,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,,503.78,38.7,38.7,1301.75,0.82,663.89,percent of total billed charges,38.7
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1340.8,1340.8,Blue Cross and Blue Shield,Traditional,,518.89,38.7,38.7,1340.8,0.82,683.81,percent of total billed charges,38.7
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1340.8,1340.8,Blue Cross and Blue Shield,Traditional,,518.89,38.7,38.7,1340.8,0.82,683.81,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,,40.66,38.7,38.7,105.06,0.82,53.58,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,,40.66,38.7,38.7,105.06,0.82,53.58,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,,77.88,38.7,38.7,201.25,0.82,102.64,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,,77.88,38.7,38.7,201.25,0.82,102.64,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,,80.22,38.7,38.7,207.29,0.82,105.72,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,,80.22,38.7,38.7,207.29,0.82,105.72,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,,359.21,38.7,38.7,928.18,0.82,473.37,percent of total billed charges,38.7
CONCURRENT IV THER,96368,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,38.7,105.06,0.82,53.58,percent of total billed charges,38.7
CONCURRENT IV THER,96368,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,38.7,105.06,0.82,53.58,percent of total billed charges,38.7
CONCURRENT IV THER,96368,CPT,,,,,both,, ,791.25,791.25,Blue Cross and Blue Shield,Traditional,,306.21,38.7,38.7,791.25,0.82,403.54,percent of total billed charges,38.7
CONCURRENT IV THER,96368,CPT,,,,,both,, ,791.25,791.25,Blue Cross and Blue Shield,Traditional,,306.21,38.7,38.7,791.25,0.82,403.54,percent of total billed charges,38.7
CONCURRENT IV THER,96368,CPT,,,,,both,, ,814.99,814.99,Blue Cross and Blue Shield,Traditional,,315.4,38.7,38.7,814.99,0.82,415.64,percent of total billed charges,38.7
CONCURRENT IV THER,96368,CPT,,,,,both,, ,814.99,814.99,Blue Cross and Blue Shield,Traditional,,315.4,38.7,38.7,814.99,0.82,415.64,percent of total billed charges,38.7
CONCURRENT IV THER,96368,CPT,,,,,both,, ,928.18,928.18,Blue Cross and Blue Shield,Traditional,,359.21,38.7,38.7,928.18,0.82,473.37,percent of total billed charges,38.7
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,38.7,105.06,0.82,53.58,percent of total billed charges,38.7
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,105.06,105.06,Blue Cross and Blue Shield,Traditional,,40.66,38.7,38.7,105.06,0.82,53.58,percent of total billed charges,38.7
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,201.25,201.25,Blue Cross and Blue Shield,Traditional,,77.88,38.7,38.7,201.25,0.82,102.64,percent of total billed charges,38.7
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,201.25,201.25,Blue Cross and Blue Shield,Traditional,,77.88,38.7,38.7,201.25,0.82,102.64,percent of total billed charges,38.7
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,207.29,207.29,Blue Cross and Blue Shield,Traditional,,80.22,38.7,38.7,207.29,0.82,105.72,percent of total billed charges,38.7
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,207.29,207.29,Blue Cross and Blue Shield,Traditional,,80.22,38.7,38.7,207.29,0.82,105.72,percent of total billed charges,38.7
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,301.16,301.16,Blue Cross and Blue Shield,Traditional,,116.55,38.7,38.7,301.16,0.82,153.59,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,,524.57,38.7,38.7,1355.48,0.82,691.29,percent of total billed charges,38.7
INJECTION IV PUSH,96374,CPT,,,,,both,, ,1477.47,1477.47,Blue Cross and Blue Shield,Traditional,,571.78,38.7,38.7,1477.47,0.82,753.51,percent of total billed charges,38.7
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,201.25,201.25,Blue Cross and Blue Shield,Traditional,,77.88,38.7,38.7,201.25,0.82,102.64,percent of total billed charges,38.7
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,201.25,201.25,Blue Cross and Blue Shield,Traditional,,77.88,38.7,38.7,201.25,0.82,102.64,percent of total billed charges,38.7
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,207.29,207.29,Blue Cross and Blue Shield,Traditional,,80.22,38.7,38.7,207.29,0.82,105.72,percent of total billed charges,38.7
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,253.9,253.9,Blue Cross and Blue Shield,Traditional,,98.26,38.7,38.7,253.9,0.82,129.49,percent of total billed charges,38.7
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,253.9,253.9,Blue Cross and Blue Shield,Traditional,,98.26,38.7,38.7,253.9,0.82,129.49,percent of total billed charges,38.7
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,501.61,501.61,Blue Cross and Blue Shield,Traditional,,194.12,38.7,38.7,501.61,0.82,255.82,percent of total billed charges,38.7
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,1355.48,1355.48,Blue Cross and Blue Shield,Traditional,,524.57,38.7,38.7,1355.48,0.82,691.29,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,,40.66,38.7,38.7,105.06,0.82,53.58,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,,40.66,38.7,38.7,105.06,0.82,53.58,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,,77.88,38.7,38.7,201.25,0.82,102.64,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,,77.88,38.7,38.7,201.25,0.82,102.64,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,,80.22,38.7,38.7,207.29,0.82,105.72,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,,80.22,38.7,38.7,207.29,0.82,105.72,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,,258.9,38.7,38.7,668.99,0.82,341.18,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,,282.2,38.7,38.7,729.19,0.82,371.89,percent of total billed charges,38.7
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,98.5,98.5,Blue Cross and Blue Shield,Traditional,,38.12,38.7,38.7,98.5,0.82,50.24,percent of total billed charges,38.7
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,98.5,98.5,Blue Cross and Blue Shield,Traditional,,38.12,38.7,38.7,98.5,0.82,50.24,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,,39.27,38.7,38.7,101.46,0.82,51.74,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,,39.27,38.7,38.7,101.46,0.82,51.74,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,,40.66,38.7,38.7,105.06,0.82,53.58,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,,40.66,38.7,38.7,105.06,0.82,53.58,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,,282.2,38.7,38.7,729.19,0.82,371.89,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,,184.46,38.7,38.7,476.63,0.82,243.08,percent of total billed charges,38.7
CHEMO HORMONAL IM SC,96402,CPT,,,,,both,, ,235.36,235.36,Blue Cross and Blue Shield,Traditional,,91.08,38.7,38.7,235.36,0.82,120.03,percent of total billed charges,38.7
CHEMO IV PUSH,96409,CPT,,,,,both,, ,382.65,382.65,Blue Cross and Blue Shield,Traditional,,148.09,38.7,38.7,382.65,0.82,195.15,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,,45.34,38.7,38.7,117.16,0.82,59.75,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,,532.94,38.7,38.7,1377.11,0.82,702.33,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,,90.78,38.7,38.7,234.58,0.82,119.64,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,,48.83,38.7,38.7,126.18,0.82,64.35,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,,148.28,38.7,38.7,383.16,0.82,195.41,percent of total billed charges,38.7
HOT-COLD PACKS,97010,CPT,,,,,both,, ,239.27,239.27,Blue Cross and Blue Shield,Traditional,,92.6,38.7,38.7,239.27,0.82,122.03,percent of total billed charges,38.7
HOT-COLD PACKS,97010,CPT,,,,,both,, ,259.41,259.41,Blue Cross and Blue Shield,Traditional,,100.39,38.7,38.7,259.41,0.82,132.3,percent of total billed charges,38.7
HOT-COLD PACKS OT,97010,CPT,,,,,both,, ,41.2,41.2,Blue Cross and Blue Shield,Traditional,,15.94,38.7,38.7,41.2,0.82,21.01,percent of total billed charges,38.7
HOT-COLD PACKS OT,97010,CPT,,,,,both,, ,41.2,41.2,Blue Cross and Blue Shield,Traditional,,15.94,38.7,38.7,41.2,0.82,21.01,percent of total billed charges,38.7
HOT-COLD PACKS OT,97010,CPT,,,,,both,, ,41.2,41.2,Blue Cross and Blue Shield,Traditional,,15.94,38.7,38.7,41.2,0.82,21.01,percent of total billed charges,38.7
HOT-COLD PACKS OT,97010,CPT,,,,,both,, ,41.2,41.2,Blue Cross and Blue Shield,Traditional,,15.94,38.7,38.7,41.2,0.82,21.01,percent of total billed charges,38.7
HOT-COLD PACKS OT,97010,CPT,,,,,both,, ,277.84,277.84,Blue Cross and Blue Shield,Traditional,,107.52,38.7,38.7,277.84,0.82,141.7,percent of total billed charges,38.7
HOT-COLD PACKS OT,97010,CPT,,,,,both,, ,277.84,277.84,Blue Cross and Blue Shield,Traditional,,107.52,38.7,38.7,277.84,0.82,141.7,percent of total billed charges,38.7
HOT-COLD PACKS PT,97010,CPT,,,,,both,, ,256.21,256.21,Blue Cross and Blue Shield,Traditional,,99.15,38.7,38.7,256.21,0.82,130.67,percent of total billed charges,38.7
HOT-COLD PACKS PT,97010,CPT,,,,,both,, ,256.21,256.21,Blue Cross and Blue Shield,Traditional,,99.15,38.7,38.7,256.21,0.82,130.67,percent of total billed charges,38.7
MECH TRACTION-VISIT,97012,CPT,,,,,both,, ,485.24,485.24,Blue Cross and Blue Shield,Traditional,,187.79,38.7,38.7,485.24,0.82,247.47,percent of total billed charges,38.7
MECH TRACTN-VST PT,97012,CPT,,,,,both,, ,39.4,39.4,Blue Cross and Blue Shield,Traditional,,15.25,38.7,38.7,39.4,0.82,20.09,percent of total billed charges,38.7
MECH TRACTN-VST PT,97012,CPT,,,,,both,, ,39.4,39.4,Blue Cross and Blue Shield,Traditional,,15.25,38.7,38.7,39.4,0.82,20.09,percent of total billed charges,38.7
MECH TRACTN-VST PT,97012,CPT,,,,,both,, ,519.89,519.89,Blue Cross and Blue Shield,Traditional,,201.2,38.7,38.7,519.89,0.82,265.14,percent of total billed charges,38.7
MECH TRACTN-VST PT,97012,CPT,,,,,both,, ,519.89,519.89,Blue Cross and Blue Shield,Traditional,,201.2,38.7,38.7,519.89,0.82,265.14,percent of total billed charges,38.7
PARAF BATH-VISIT OT,97018,CPT,,,,,both,, ,41.2,41.2,Blue Cross and Blue Shield,Traditional,,15.94,38.7,38.7,41.2,0.82,21.01,percent of total billed charges,38.7
PARAF BATH-VISIT OT,97018,CPT,,,,,both,, ,41.2,41.2,Blue Cross and Blue Shield,Traditional,,15.94,38.7,38.7,41.2,0.82,21.01,percent of total billed charges,38.7
PARAF BATH-VISIT OT,97018,CPT,,,,,both,, ,347.88,347.88,Blue Cross and Blue Shield,Traditional,,134.63,38.7,38.7,347.88,0.82,177.42,percent of total billed charges,38.7
PARAF BATH-VISIT OT,97018,CPT,,,,,both,, ,347.88,347.88,Blue Cross and Blue Shield,Traditional,,134.63,38.7,38.7,347.88,0.82,177.42,percent of total billed charges,38.7
PARAF BATH-VISIT PT,97018,CPT,,,,,both,, ,18.54,18.54,Blue Cross and Blue Shield,Traditional,,7.17,38.7,38.7,18.54,0.82,9.46,percent of total billed charges,38.7
PARAF BATH-VISIT PT,97018,CPT,,,,,both,, ,18.54,18.54,Blue Cross and Blue Shield,Traditional,,7.17,38.7,38.7,18.54,0.82,9.46,percent of total billed charges,38.7
PARAF BATH-VISIT PT,97018,CPT,,,,,both,, ,320.85,320.85,Blue Cross and Blue Shield,Traditional,,124.17,38.7,38.7,320.85,0.82,163.63,percent of total billed charges,38.7
PARAF BATH-VISIT PT,97018,CPT,,,,,both,, ,320.85,320.85,Blue Cross and Blue Shield,Traditional,,124.17,38.7,38.7,320.85,0.82,163.63,percent of total billed charges,38.7
PARAFFIN BATH-VISIT,97018,CPT,,,,,both,, ,299.53,299.53,Blue Cross and Blue Shield,Traditional,,115.92,38.7,38.7,299.53,0.82,152.76,percent of total billed charges,38.7
PARAFFIN BATH-VISIT,97018,CPT,,,,,both,, ,324.73,324.73,Blue Cross and Blue Shield,Traditional,,125.67,38.7,38.7,324.73,0.82,165.61,percent of total billed charges,38.7
WHIRLPOOL THRPY-VIST,97022,CPT,,,,,both,, ,652.7,652.7,Blue Cross and Blue Shield,Traditional,,252.59,38.7,38.7,652.7,0.82,332.88,percent of total billed charges,38.7
WHIRLPOOL THRPY-VIST,97022,CPT,,,,,both,, ,707.58,707.58,Blue Cross and Blue Shield,Traditional,,273.83,38.7,38.7,707.58,0.82,360.87,percent of total billed charges,38.7
WHRLPL THRPY-VST OT,97022,CPT,,,,,both,, ,46.87,46.87,Blue Cross and Blue Shield,Traditional,,18.14,38.7,38.7,46.87,0.82,23.9,percent of total billed charges,38.7
WHRLPL THRPY-VST OT,97022,CPT,,,,,both,, ,46.87,46.87,Blue Cross and Blue Shield,Traditional,,18.14,38.7,38.7,46.87,0.82,23.9,percent of total billed charges,38.7
WHRLPL THRPY-VST OT,97022,CPT,,,,,both,, ,46.87,46.87,Blue Cross and Blue Shield,Traditional,,18.14,38.7,38.7,46.87,0.82,23.9,percent of total billed charges,38.7
WHRLPL THRPY-VST OT,97022,CPT,,,,,both,, ,46.87,46.87,Blue Cross and Blue Shield,Traditional,,18.14,38.7,38.7,46.87,0.82,23.9,percent of total billed charges,38.7
WHRLPL THRPY-VST OT,97022,CPT,,,,,both,, ,758.08,758.08,Blue Cross and Blue Shield,Traditional,,293.38,38.7,38.7,758.08,0.82,386.62,percent of total billed charges,38.7
WHRLPL THRPY-VST OT,97022,CPT,,,,,both,, ,758.08,758.08,Blue Cross and Blue Shield,Traditional,,293.38,38.7,38.7,758.08,0.82,386.62,percent of total billed charges,38.7
WHRLPL THRPY-VST PT,97022,CPT,,,,,both,, ,699.11,699.11,Blue Cross and Blue Shield,Traditional,,270.56,38.7,38.7,699.11,0.82,356.55,percent of total billed charges,38.7
WHRLPL THRPY-VST PT,97022,CPT,,,,,both,, ,699.11,699.11,Blue Cross and Blue Shield,Traditional,,270.56,38.7,38.7,699.11,0.82,356.55,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,,180.47,38.7,38.7,466.32,0.82,237.82,percent of total billed charges,38.7
ELEC STIM-MAN-15 MIN,97032,CPT,,,,,both,, ,505.5,505.5,Blue Cross and Blue Shield,Traditional,,195.63,38.7,38.7,505.5,0.82,257.81,percent of total billed charges,38.7
ELEC STM-MN-15MN OT,97032,CPT,,,,,both,, ,39.4,39.4,Blue Cross and Blue Shield,Traditional,,15.25,38.7,38.7,39.4,0.82,20.09,percent of total billed charges,38.7
ELEC STM-MN-15MN OT,97032,CPT,,,,,both,, ,39.4,39.4,Blue Cross and Blue Shield,Traditional,,15.25,38.7,38.7,39.4,0.82,20.09,percent of total billed charges,38.7
ELEC STM-MN-15MN OT,97032,CPT,,,,,both,, ,39.4,39.4,Blue Cross and Blue Shield,Traditional,,15.25,38.7,38.7,39.4,0.82,20.09,percent of total billed charges,38.7
ELEC STM-MN-15MN OT,97032,CPT,,,,,both,, ,39.4,39.4,Blue Cross and Blue Shield,Traditional,,15.25,38.7,38.7,39.4,0.82,20.09,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,,209.57,38.7,38.7,541.52,0.82,276.18,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,,209.57,38.7,38.7,541.52,0.82,276.18,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,,193.33,38.7,38.7,499.55,0.82,254.77,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,,193.33,38.7,38.7,499.55,0.82,254.77,percent of total billed charges,38.7
IONTOPHOR-15 MIN OT,97033,CPT,,,,,both,, ,54.59,54.59,Blue Cross and Blue Shield,Traditional,,21.13,38.7,38.7,54.59,0.82,27.84,percent of total billed charges,38.7
IONTOPHOR-15 MIN OT,97033,CPT,,,,,both,, ,54.59,54.59,Blue Cross and Blue Shield,Traditional,,21.13,38.7,38.7,54.59,0.82,27.84,percent of total billed charges,38.7
IONTOPHOR-15 MIN OT,97033,CPT,,,,,both,, ,54.59,54.59,Blue Cross and Blue Shield,Traditional,,21.13,38.7,38.7,54.59,0.82,27.84,percent of total billed charges,38.7
IONTOPHOR-15 MIN OT,97033,CPT,,,,,both,, ,54.59,54.59,Blue Cross and Blue Shield,Traditional,,21.13,38.7,38.7,54.59,0.82,27.84,percent of total billed charges,38.7
IONTOPHOR-15 MIN OT,97033,CPT,,,,,both,, ,764.52,764.52,Blue Cross and Blue Shield,Traditional,,295.87,38.7,38.7,764.52,0.82,389.91,percent of total billed charges,38.7
IONTOPHOR-15 MIN OT,97033,CPT,,,,,both,, ,764.52,764.52,Blue Cross and Blue Shield,Traditional,,295.87,38.7,38.7,764.52,0.82,389.91,percent of total billed charges,38.7
IONTOPHOR-15 MIN PT,97033,CPT,,,,,both,, ,705.04,705.04,Blue Cross and Blue Shield,Traditional,,272.85,38.7,38.7,705.04,0.82,359.57,percent of total billed charges,38.7
IONTOPHOR-15 MIN PT,97033,CPT,,,,,both,, ,705.04,705.04,Blue Cross and Blue Shield,Traditional,,272.85,38.7,38.7,705.04,0.82,359.57,percent of total billed charges,38.7
IONTOPHORESIS-15 MIN,97033,CPT,,,,,both,, ,658.28,658.28,Blue Cross and Blue Shield,Traditional,,254.75,38.7,38.7,658.28,0.82,335.72,percent of total billed charges,38.7
IONTOPHORESIS-15 MIN,97033,CPT,,,,,both,, ,713.65,713.65,Blue Cross and Blue Shield,Traditional,,276.18,38.7,38.7,713.65,0.82,363.96,percent of total billed charges,38.7
CNTRST BTH-15MIN OT,97034,CPT,,,,,both,, ,40.17,40.17,Blue Cross and Blue Shield,Traditional,,15.55,38.7,38.7,40.17,0.82,20.49,percent of total billed charges,38.7
CNTRST BTH-15MIN OT,97034,CPT,,,,,both,, ,40.17,40.17,Blue Cross and Blue Shield,Traditional,,15.55,38.7,38.7,40.17,0.82,20.49,percent of total billed charges,38.7
CNTRST BTH-15MIN OT,97034,CPT,,,,,both,, ,40.17,40.17,Blue Cross and Blue Shield,Traditional,,15.55,38.7,38.7,40.17,0.82,20.49,percent of total billed charges,38.7
CNTRST BTH-15MIN OT,97034,CPT,,,,,both,, ,40.17,40.17,Blue Cross and Blue Shield,Traditional,,15.55,38.7,38.7,40.17,0.82,20.49,percent of total billed charges,38.7
CNTRST BTH-15MIN OT,97034,CPT,,,,,both,, ,514.74,514.74,Blue Cross and Blue Shield,Traditional,,199.2,38.7,38.7,514.74,0.82,262.52,percent of total billed charges,38.7
CNTRST BTH-15MIN OT,97034,CPT,,,,,both,, ,514.74,514.74,Blue Cross and Blue Shield,Traditional,,199.2,38.7,38.7,514.74,0.82,262.52,percent of total billed charges,38.7
CNTRST BTH-15MIN PT,97034,CPT,,,,,both,, ,474.83,474.83,Blue Cross and Blue Shield,Traditional,,183.76,38.7,38.7,474.83,0.82,242.16,percent of total billed charges,38.7
CNTRST BTH-15MIN PT,97034,CPT,,,,,both,, ,474.83,474.83,Blue Cross and Blue Shield,Traditional,,183.76,38.7,38.7,474.83,0.82,242.16,percent of total billed charges,38.7
CONTRAST BATH-15 MIN,97034,CPT,,,,,both,, ,443.25,443.25,Blue Cross and Blue Shield,Traditional,,171.54,38.7,38.7,443.25,0.82,226.06,percent of total billed charges,38.7
CONTRAST BATH-15 MIN,97034,CPT,,,,,both,, ,480.51,480.51,Blue Cross and Blue Shield,Traditional,,185.96,38.7,38.7,480.51,0.82,245.06,percent of total billed charges,38.7
ULTRASND-15 MIN OT,97035,CPT,,,,,both,, ,36.57,36.57,Blue Cross and Blue Shield,Traditional,,14.15,38.7,38.7,36.57,0.82,18.65,percent of total billed charges,38.7
ULTRASND-15 MIN OT,97035,CPT,,,,,both,, ,36.57,36.57,Blue Cross and Blue Shield,Traditional,,14.15,38.7,38.7,36.57,0.82,18.65,percent of total billed charges,38.7
ULTRASND-15 MIN OT,97035,CPT,,,,,both,, ,36.57,36.57,Blue Cross and Blue Shield,Traditional,,14.15,38.7,38.7,36.57,0.82,18.65,percent of total billed charges,38.7
ULTRASND-15 MIN OT,97035,CPT,,,,,both,, ,36.57,36.57,Blue Cross and Blue Shield,Traditional,,14.15,38.7,38.7,36.57,0.82,18.65,percent of total billed charges,38.7
ULTRASND-15 MIN OT,97035,CPT,,,,,both,, ,611.56,611.56,Blue Cross and Blue Shield,Traditional,,236.67,38.7,38.7,611.56,0.82,311.9,percent of total billed charges,38.7
ULTRASND-15 MIN OT,97035,CPT,,,,,both,, ,611.56,611.56,Blue Cross and Blue Shield,Traditional,,236.67,38.7,38.7,611.56,0.82,311.9,percent of total billed charges,38.7
ULTRASND-15 MIN PT,97035,CPT,,,,,both,, ,564.18,564.18,Blue Cross and Blue Shield,Traditional,,218.34,38.7,38.7,564.18,0.82,287.73,percent of total billed charges,38.7
ULTRASND-15 MIN PT,97035,CPT,,,,,both,, ,564.18,564.18,Blue Cross and Blue Shield,Traditional,,218.34,38.7,38.7,564.18,0.82,287.73,percent of total billed charges,38.7
ULTRASOUND-15 MIN,97035,CPT,,,,,both,, ,526.62,526.62,Blue Cross and Blue Shield,Traditional,,203.8,38.7,38.7,526.62,0.82,268.58,percent of total billed charges,38.7
ULTRASOUND-15 MIN,97035,CPT,,,,,both,, ,570.95,570.95,Blue Cross and Blue Shield,Traditional,,220.96,38.7,38.7,570.95,0.82,291.18,percent of total billed charges,38.7
"Physical therapy, therapeutic exercise .",97110,CPT,,,,,both,,,342.72,342.72,Blue Cross and Blue Shield,Traditional,,132.63,38.7,38.7,342.72,0.82,174.79,percent of total billed charges,38.7
THER EXRCS-15MIN OT,97110,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,38.7,81.37,0.82,41.5,percent of total billed charges,38.7
THER EXRCS-15MIN OT,97110,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,38.7,81.37,0.82,41.5,percent of total billed charges,38.7
THER EXRCS-15MIN OT,97110,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,38.7,81.37,0.82,41.5,percent of total billed charges,38.7
THER EXRCS-15MIN OT,97110,CPT,,,,,both,, ,81.37,81.37,Blue Cross and Blue Shield,Traditional,,31.49,38.7,38.7,81.37,0.82,41.5,percent of total billed charges,38.7
THER EXRCS-15MIN OT,97110,CPT,,,,,both,, ,398.1,398.1,Blue Cross and Blue Shield,Traditional,,154.06,38.7,38.7,398.1,0.82,203.03,percent of total billed charges,38.7
THER EXRCS-15MIN OT,97110,CPT,,,,,both,, ,398.1,398.1,Blue Cross and Blue Shield,Traditional,,154.06,38.7,38.7,398.1,0.82,203.03,percent of total billed charges,38.7
THER EXRCS-15MIN PT,97110,CPT,,,,,both,, ,367.2,367.2,Blue Cross and Blue Shield,Traditional,,142.11,38.7,38.7,367.2,0.82,187.27,percent of total billed charges,38.7
THER EXRCS-15MIN PT,97110,CPT,,,,,both,, ,367.2,367.2,Blue Cross and Blue Shield,Traditional,,142.11,38.7,38.7,367.2,0.82,187.27,percent of total billed charges,38.7
THERAP EXERCS-15 MIN,97110,CPT,,,,,both,, ,342.72,342.72,Blue Cross and Blue Shield,Traditional,,132.63,38.7,38.7,342.72,0.82,174.79,percent of total billed charges,38.7
THERAP EXERCS-15 MIN,97110,CPT,,,,,both,, ,371.55,371.55,Blue Cross and Blue Shield,Traditional,,143.79,38.7,38.7,371.55,0.82,189.49,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,,35.68,38.7,38.7,92.19,0.82,47.02,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,,35.68,38.7,38.7,92.19,0.82,47.02,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,,35.68,38.7,38.7,92.19,0.82,47.02,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,,35.68,38.7,38.7,92.19,0.82,47.02,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,,188.24,38.7,38.7,486.42,0.82,248.07,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,,188.24,38.7,38.7,486.42,0.82,248.07,percent of total billed charges,38.7
NEUR RE-ED-15MIN PT,97112,CPT,,,,,both,, ,367.2,367.2,Blue Cross and Blue Shield,Traditional,,142.11,38.7,38.7,367.2,0.82,187.27,percent of total billed charges,38.7
NEUR RE-ED-15MIN PT,97112,CPT,,,,,both,, ,367.2,367.2,Blue Cross and Blue Shield,Traditional,,142.11,38.7,38.7,367.2,0.82,187.27,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,,132.63,38.7,38.7,342.72,0.82,174.79,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,,175.75,38.7,38.7,454.13,0.82,231.61,percent of total billed charges,38.7
GAIT TRAINING-15 MIN,97116,CPT,,,,,both,, ,342.72,342.72,Blue Cross and Blue Shield,Traditional,,132.63,38.7,38.7,342.72,0.82,174.79,percent of total billed charges,38.7
GAIT TRAINING-15 MIN,97116,CPT,,,,,both,, ,454.13,454.13,Blue Cross and Blue Shield,Traditional,,175.75,38.7,38.7,454.13,0.82,231.61,percent of total billed charges,38.7
GAIT TRNNG-15MIN OT,97116,CPT,,,,,both,, ,80.34,80.34,Blue Cross and Blue Shield,Traditional,,31.09,38.7,38.7,80.34,0.82,40.97,percent of total billed charges,38.7
GAIT TRNNG-15MIN OT,97116,CPT,,,,,both,, ,80.34,80.34,Blue Cross and Blue Shield,Traditional,,31.09,38.7,38.7,80.34,0.82,40.97,percent of total billed charges,38.7
GAIT TRNNG-15MIN OT,97116,CPT,,,,,both,, ,80.34,80.34,Blue Cross and Blue Shield,Traditional,,31.09,38.7,38.7,80.34,0.82,40.97,percent of total billed charges,38.7
GAIT TRNNG-15MIN OT,97116,CPT,,,,,both,, ,80.34,80.34,Blue Cross and Blue Shield,Traditional,,31.09,38.7,38.7,80.34,0.82,40.97,percent of total billed charges,38.7
GAIT TRNNG-15MIN OT,97116,CPT,,,,,both,, ,486.42,486.42,Blue Cross and Blue Shield,Traditional,,188.24,38.7,38.7,486.42,0.82,248.07,percent of total billed charges,38.7
GAIT TRNNG-15MIN OT,97116,CPT,,,,,both,, ,486.42,486.42,Blue Cross and Blue Shield,Traditional,,188.24,38.7,38.7,486.42,0.82,248.07,percent of total billed charges,38.7
GAIT TRNNG-15MIN PT,97116,CPT,,,,,both,, ,367.2,367.2,Blue Cross and Blue Shield,Traditional,,142.11,38.7,38.7,367.2,0.82,187.27,percent of total billed charges,38.7
GAIT TRNNG-15MIN PT,97116,CPT,,,,,both,, ,367.2,367.2,Blue Cross and Blue Shield,Traditional,,142.11,38.7,38.7,367.2,0.82,187.27,percent of total billed charges,38.7
MASSAGE THRPY-15 MIN,97124,CPT,,,,,both,, ,294.09,294.09,Blue Cross and Blue Shield,Traditional,,113.81,38.7,38.7,294.09,0.82,149.99,percent of total billed charges,38.7
MASSAGE THRPY-15 MIN,97124,CPT,,,,,both,, ,318.84,318.84,Blue Cross and Blue Shield,Traditional,,123.39,38.7,38.7,318.84,0.82,162.61,percent of total billed charges,38.7
MASSG THRPY-15MN OT,97124,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29,38.7,38.7,74.93,0.82,38.21,percent of total billed charges,38.7
MASSG THRPY-15MN OT,97124,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29,38.7,38.7,74.93,0.82,38.21,percent of total billed charges,38.7
MASSG THRPY-15MN OT,97124,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29,38.7,38.7,74.93,0.82,38.21,percent of total billed charges,38.7
MASSG THRPY-15MN OT,97124,CPT,,,,,both,, ,74.93,74.93,Blue Cross and Blue Shield,Traditional,,29,38.7,38.7,74.93,0.82,38.21,percent of total billed charges,38.7
MASSG THRPY-15MN OT,97124,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,38.7,341.45,0.82,174.14,percent of total billed charges,38.7
MASSG THRPY-15MN OT,97124,CPT,,,,,both,, ,341.45,341.45,Blue Cross and Blue Shield,Traditional,,132.14,38.7,38.7,341.45,0.82,174.14,percent of total billed charges,38.7
MASSG THRPY-15MN PT,97124,CPT,,,,,both,, ,314.92,314.92,Blue Cross and Blue Shield,Traditional,,121.87,38.7,38.7,314.92,0.82,160.61,percent of total billed charges,38.7
MASSG THRPY-15MN PT,97124,CPT,,,,,both,, ,314.92,314.92,Blue Cross and Blue Shield,Traditional,,121.87,38.7,38.7,314.92,0.82,160.61,percent of total billed charges,38.7
COG SKL DV IN15 COTA,97129,CPT,,,,,both,, ,398.1,398.1,Blue Cross and Blue Shield,Traditional,,154.06,38.7,38.7,398.1,0.82,203.03,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,,32.69,38.7,38.7,84.46,0.82,43.07,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,,32.69,38.7,38.7,84.46,0.82,43.07,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,,32.69,38.7,38.7,84.46,0.82,43.07,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,,32.69,38.7,38.7,84.46,0.82,43.07,percent of total billed charges,38.7
COG SKL DV INI15 OT,97129,CPT,,,,,both,, ,398.1,398.1,Blue Cross and Blue Shield,Traditional,,154.06,38.7,38.7,398.1,0.82,203.03,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,,173.6,38.7,38.7,448.57,0.82,228.77,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,,173.6,38.7,38.7,448.57,0.82,228.77,percent of total billed charges,38.7
COG SKL DV INI15 SP,97129,CPT,,,,,both,, ,398.1,398.1,Blue Cross and Blue Shield,Traditional,,154.06,38.7,38.7,398.1,0.82,203.03,percent of total billed charges,38.7
COG SKL DV AD15 COTA,97130,CPT,,,,,both,, ,398.1,398.1,Blue Cross and Blue Shield,Traditional,,154.06,38.7,38.7,398.1,0.82,203.03,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,,32.69,38.7,38.7,84.46,0.82,43.07,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,,32.69,38.7,38.7,84.46,0.82,43.07,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,,32.69,38.7,38.7,84.46,0.82,43.07,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,,32.69,38.7,38.7,84.46,0.82,43.07,percent of total billed charges,38.7
COG SKL DV ADD15 OT,97130,CPT,,,,,both,, ,398.1,398.1,Blue Cross and Blue Shield,Traditional,,154.06,38.7,38.7,398.1,0.82,203.03,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,,173.6,38.7,38.7,448.57,0.82,228.77,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,,173.6,38.7,38.7,448.57,0.82,228.77,percent of total billed charges,38.7
COG SKL DV ADD15 SP,97130,CPT,,,,,both,, ,398.1,398.1,Blue Cross and Blue Shield,Traditional,,154.06,38.7,38.7,398.1,0.82,203.03,percent of total billed charges,38.7
MANUAL THRPY-15 MIN,97140,CPT,,,,,both,, ,342.72,342.72,Blue Cross and Blue Shield,Traditional,,132.63,38.7,38.7,342.72,0.82,174.79,percent of total billed charges,38.7
MANUAL THRPY-15 MIN,97140,CPT,,,,,both,, ,454.13,454.13,Blue Cross and Blue Shield,Traditional,,175.75,38.7,38.7,454.13,0.82,231.61,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,,28.5,38.7,38.7,73.65,0.82,37.56,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,,28.5,38.7,38.7,73.65,0.82,37.56,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,,28.5,38.7,38.7,73.65,0.82,37.56,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,,28.5,38.7,38.7,73.65,0.82,37.56,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,,188.24,38.7,38.7,486.42,0.82,248.07,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,,188.24,38.7,38.7,486.42,0.82,248.07,percent of total billed charges,38.7
MNL THRPY-15 MIN PT,97140,CPT,,,,,both,, ,367.2,367.2,Blue Cross and Blue Shield,Traditional,,142.11,38.7,38.7,367.2,0.82,187.27,percent of total billed charges,38.7
MNL THRPY-15 MIN PT,97140,CPT,,,,,both,, ,367.2,367.2,Blue Cross and Blue Shield,Traditional,,142.11,38.7,38.7,367.2,0.82,187.27,percent of total billed charges,38.7
GROUP THRP PROC-VIST,97150,CPT,,,,,both,, ,341.23,341.23,Blue Cross and Blue Shield,Traditional,,132.06,38.7,38.7,341.23,0.82,174.03,percent of total billed charges,38.7
GROUP THRP PROC-VIST,97150,CPT,,,,,both,, ,369.92,369.92,Blue Cross and Blue Shield,Traditional,,143.16,38.7,38.7,369.92,0.82,188.66,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,,18.84,38.7,38.7,48.67,0.82,24.82,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,,18.84,38.7,38.7,48.67,0.82,24.82,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,,18.84,38.7,38.7,48.67,0.82,24.82,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,,18.84,38.7,38.7,48.67,0.82,24.82,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,,153.36,38.7,38.7,396.29,0.82,202.11,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,,153.36,38.7,38.7,396.29,0.82,202.11,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,,141.51,38.7,38.7,365.65,0.82,186.48,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,,141.51,38.7,38.7,365.65,0.82,186.48,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,,86.6,38.7,38.7,223.77,0.82,114.12,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,,86.6,38.7,38.7,223.77,0.82,114.12,percent of total billed charges,38.7
PT EVAL- LOW CMP PT,97161,CPT,,,,,both,, ,721,721,Blue Cross and Blue Shield,Traditional,,279.03,38.7,38.7,721,0.82,367.71,percent of total billed charges,38.7
PT EVAL- LOW CMP PT,97161,CPT,,,,,both,, ,721,721,Blue Cross and Blue Shield,Traditional,,279.03,38.7,38.7,721,0.82,367.71,percent of total billed charges,38.7
PT EVAL- LOW COMP,97161,CPT,,,,,both,, ,673.18,673.18,Blue Cross and Blue Shield,Traditional,,260.52,38.7,38.7,673.18,0.82,343.32,percent of total billed charges,38.7
PT-EVAL LOW 15M MCD,97161,CPT,,,,,both,, ,700,700,Blue Cross and Blue Shield,Traditional,,270.9,38.7,38.7,700,0.82,357,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,,86.6,38.7,38.7,223.77,0.82,114.12,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,,86.6,38.7,38.7,223.77,0.82,114.12,percent of total billed charges,38.7
PT EVAL- MOD CMP PT,97162,CPT,,,,,both,, ,360.5,360.5,Blue Cross and Blue Shield,Traditional,,139.51,38.7,38.7,360.5,0.82,183.86,percent of total billed charges,38.7
PT EVAL- MOD CMP PT,97162,CPT,,,,,both,, ,360.5,360.5,Blue Cross and Blue Shield,Traditional,,139.51,38.7,38.7,360.5,0.82,183.86,percent of total billed charges,38.7
PT EVAL- MOD COMP,97162,CPT,,,,,both,, ,673.18,673.18,Blue Cross and Blue Shield,Traditional,,260.52,38.7,38.7,673.18,0.82,343.32,percent of total billed charges,38.7
PT-EVAL MOD 15M MCD,97162,CPT,,,,,both,, ,350,350,Blue Cross and Blue Shield,Traditional,,135.45,38.7,38.7,350,0.82,178.5,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,,86.7,38.7,38.7,224.03,0.82,114.26,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,,86.7,38.7,38.7,224.03,0.82,114.26,percent of total billed charges,38.7
PT EVAL- HGH CMP PT,97163,CPT,,,,,both,, ,721,721,Blue Cross and Blue Shield,Traditional,,279.03,38.7,38.7,721,0.82,367.71,percent of total billed charges,38.7
PT EVAL- HGH CMP PT,97163,CPT,,,,,both,, ,721,721,Blue Cross and Blue Shield,Traditional,,279.03,38.7,38.7,721,0.82,367.71,percent of total billed charges,38.7
PT EVAL- HGH COMP,97163,CPT,,,,,both,, ,673.18,673.18,Blue Cross and Blue Shield,Traditional,,260.52,38.7,38.7,673.18,0.82,343.32,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,,90.27,38.7,38.7,233.25,0.82,118.96,percent of total billed charges,38.7
PT RE-EVAL-VISIT,97164,CPT,,,,,both,, ,437.36,437.36,Blue Cross and Blue Shield,Traditional,,169.26,38.7,38.7,437.36,0.82,223.05,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,,58.6,38.7,38.7,151.41,0.82,77.22,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,,58.6,38.7,38.7,151.41,0.82,77.22,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,,181.27,38.7,38.7,468.39,0.82,238.88,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,,181.27,38.7,38.7,468.39,0.82,238.88,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,,86.6,38.7,38.7,223.77,0.82,114.12,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,,302.54,38.7,38.7,781.77,0.82,398.7,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,,302.54,38.7,38.7,781.77,0.82,398.7,percent of total billed charges,38.7
OT EVAL- LOW COMP,97165,CPT,,,,,both,, ,729.8,729.8,Blue Cross and Blue Shield,Traditional,,282.43,38.7,38.7,729.8,0.82,372.2,percent of total billed charges,38.7
OT-EVAL LOW 15M MCD,97165,CPT,,,,,both,, ,100,100,Blue Cross and Blue Shield,Traditional,,38.7,38.7,38.7,100,0.82,51,percent of total billed charges,38.7
OT-EVAL LOW 15M MCD,97165,CPT,,,,,both,, ,759,759,Blue Cross and Blue Shield,Traditional,,293.73,38.7,38.7,759,0.82,387.09,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,,86.6,38.7,38.7,223.77,0.82,114.12,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,,151.27,38.7,38.7,390.89,0.82,199.35,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,,151.27,38.7,38.7,390.89,0.82,199.35,percent of total billed charges,38.7
OT EVAL- MOD COMP,97166,CPT,,,,,both,, ,729.8,729.8,Blue Cross and Blue Shield,Traditional,,282.43,38.7,38.7,729.8,0.82,372.2,percent of total billed charges,38.7
OT-EVAL MOD 15M MCD,97166,CPT,,,,,both,, ,100,100,Blue Cross and Blue Shield,Traditional,,38.7,38.7,38.7,100,0.82,51,percent of total billed charges,38.7
OT-EVAL MOD 15M MCD,97166,CPT,,,,,both,, ,379.5,379.5,Blue Cross and Blue Shield,Traditional,,146.87,38.7,38.7,379.5,0.82,193.55,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,,86.6,38.7,38.7,223.77,0.82,114.12,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,,302.54,38.7,38.7,781.77,0.82,398.7,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,,302.54,38.7,38.7,781.77,0.82,398.7,percent of total billed charges,38.7
OT EVAL- HGH COMP,97167,CPT,,,,,both,, ,729.8,729.8,Blue Cross and Blue Shield,Traditional,,282.43,38.7,38.7,729.8,0.82,372.2,percent of total billed charges,38.7
OT-EVAL HGH 15M MCD,97167,CPT,,,,,both,, ,100,100,Blue Cross and Blue Shield,Traditional,,38.7,38.7,38.7,100,0.82,51,percent of total billed charges,38.7
OT-EVAL HGH 15M MCD,97167,CPT,,,,,both,, ,253,253,Blue Cross and Blue Shield,Traditional,,97.91,38.7,38.7,253,0.82,129.03,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,,58.6,38.7,38.7,151.41,0.82,77.22,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,,58.6,38.7,38.7,151.41,0.82,77.22,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,,196.51,38.7,38.7,507.79,0.82,258.97,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,,196.51,38.7,38.7,507.79,0.82,258.97,percent of total billed charges,38.7
OT RE-EVAL-VISIT,97168,CPT,,,,,both,, ,474.13,474.13,Blue Cross and Blue Shield,Traditional,,183.49,38.7,38.7,474.13,0.82,241.81,percent of total billed charges,38.7
THER ACTVT-15MIN OT,97530,CPT,,,,,both,, ,104.29,104.29,Blue Cross and Blue Shield,Traditional,,40.36,38.7,38.7,104.29,0.82,53.19,percent of total billed charges,38.7
THER ACTVT-15MIN OT,97530,CPT,,,,,both,, ,104.29,104.29,Blue Cross and Blue Shield,Traditional,,40.36,38.7,38.7,104.29,0.82,53.19,percent of total billed charges,38.7
THER ACTVT-15MIN OT,97530,CPT,,,,,both,, ,104.29,104.29,Blue Cross and Blue Shield,Traditional,,40.36,38.7,38.7,104.29,0.82,53.19,percent of total billed charges,38.7
THER ACTVT-15MIN OT,97530,CPT,,,,,both,, ,104.29,104.29,Blue Cross and Blue Shield,Traditional,,40.36,38.7,38.7,104.29,0.82,53.19,percent of total billed charges,38.7
THER ACTVT-15MIN OT,97530,CPT,,,,,both,, ,398.1,398.1,Blue Cross and Blue Shield,Traditional,,154.06,38.7,38.7,398.1,0.82,203.03,percent of total billed charges,38.7
THER ACTVT-15MIN OT,97530,CPT,,,,,both,, ,398.1,398.1,Blue Cross and Blue Shield,Traditional,,154.06,38.7,38.7,398.1,0.82,203.03,percent of total billed charges,38.7
THER ACTVT-15MIN PT,97530,CPT,,,,,both,, ,367.2,367.2,Blue Cross and Blue Shield,Traditional,,142.11,38.7,38.7,367.2,0.82,187.27,percent of total billed charges,38.7
THER ACTVT-15MIN PT,97530,CPT,,,,,both,, ,367.2,367.2,Blue Cross and Blue Shield,Traditional,,142.11,38.7,38.7,367.2,0.82,187.27,percent of total billed charges,38.7
THERAP ACTVTS-15 MIN,97530,CPT,,,,,both,, ,342.72,342.72,Blue Cross and Blue Shield,Traditional,,132.63,38.7,38.7,342.72,0.82,174.79,percent of total billed charges,38.7
THERAP ACTVTS-15 MIN,97530,CPT,,,,,both,, ,371.55,371.55,Blue Cross and Blue Shield,Traditional,,143.79,38.7,38.7,371.55,0.82,189.49,percent of total billed charges,38.7
SENS INTG-15 MIN,97533,CPT,,,,,both,, ,167.89,167.89,Blue Cross and Blue Shield,Traditional,,64.97,38.7,38.7,167.89,0.82,85.62,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,,34.88,38.7,38.7,90.13,0.82,45.97,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,,34.88,38.7,38.7,90.13,0.82,45.97,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,,265.97,38.7,38.7,687.27,0.82,350.51,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,,265.97,38.7,38.7,687.27,0.82,350.51,percent of total billed charges,38.7
SENSORY INTEG-15 MIN,97533,CPT,,,,,both,, ,641.59,641.59,Blue Cross and Blue Shield,Traditional,,248.3,38.7,38.7,641.59,0.82,327.21,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,,132.63,38.7,38.7,342.72,0.82,174.79,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,,143.79,38.7,38.7,371.55,0.82,189.49,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,,34.88,38.7,38.7,90.13,0.82,45.97,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,,34.88,38.7,38.7,90.13,0.82,45.97,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,,34.88,38.7,38.7,90.13,0.82,45.97,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,,34.88,38.7,38.7,90.13,0.82,45.97,percent of total billed charges,38.7
SLF CRE MGT-15MN OT,97535,CPT,,,,,both,, ,398.1,398.1,Blue Cross and Blue Shield,Traditional,,154.06,38.7,38.7,398.1,0.82,203.03,percent of total billed charges,38.7
SLF CRE MGT-15MN OT,97535,CPT,,,,,both,, ,398.1,398.1,Blue Cross and Blue Shield,Traditional,,154.06,38.7,38.7,398.1,0.82,203.03,percent of total billed charges,38.7
SLF CRE MGT-15MN PT,97535,CPT,,,,,both,, ,367.2,367.2,Blue Cross and Blue Shield,Traditional,,142.11,38.7,38.7,367.2,0.82,187.27,percent of total billed charges,38.7
SLF CRE MGT-15MN PT,97535,CPT,,,,,both,, ,367.2,367.2,Blue Cross and Blue Shield,Traditional,,142.11,38.7,38.7,367.2,0.82,187.27,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,,33.58,38.7,38.7,86.78,0.82,44.26,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,,33.58,38.7,38.7,86.78,0.82,44.26,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,,33.58,38.7,38.7,86.78,0.82,44.26,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,,33.58,38.7,38.7,86.78,0.82,44.26,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,,188.24,38.7,38.7,486.42,0.82,248.07,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,,188.24,38.7,38.7,486.42,0.82,248.07,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,,173.6,38.7,38.7,448.57,0.82,228.77,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,,173.6,38.7,38.7,448.57,0.82,228.77,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,,162.1,38.7,38.7,418.86,0.82,213.62,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,,175.75,38.7,38.7,454.13,0.82,231.61,percent of total billed charges,38.7
WHEELCHR MGT-15 MIN,97542,CPT,,,,,both,, ,418.86,418.86,Blue Cross and Blue Shield,Traditional,,162.1,38.7,38.7,418.86,0.82,213.62,percent of total billed charges,38.7
WHEELCHR MGT-15 MIN,97542,CPT,,,,,both,, ,454.13,454.13,Blue Cross and Blue Shield,Traditional,,175.75,38.7,38.7,454.13,0.82,231.61,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,,33.88,38.7,38.7,87.55,0.82,44.65,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,,33.88,38.7,38.7,87.55,0.82,44.65,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,,33.88,38.7,38.7,87.55,0.82,44.65,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,,33.88,38.7,38.7,87.55,0.82,44.65,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,,188.24,38.7,38.7,486.42,0.82,248.07,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,,188.24,38.7,38.7,486.42,0.82,248.07,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,,173.6,38.7,38.7,448.57,0.82,228.77,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,,173.6,38.7,38.7,448.57,0.82,228.77,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,,434.09,38.7,38.7,1121.67,0.82,572.05,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,,434.09,38.7,38.7,1121.67,0.82,572.05,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,,434.09,38.7,38.7,1121.67,0.82,572.05,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,,434.09,38.7,38.7,1121.67,0.82,572.05,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,,470.56,38.7,38.7,1215.92,0.82,620.12,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,,470.56,38.7,38.7,1215.92,0.82,620.12,percent of total billed charges,38.7
WK HR-CD 1ST 2HR PT,97545,CPT,,,,,both,, ,206,206,Blue Cross and Blue Shield,Traditional,,79.72,38.7,38.7,206,0.82,105.06,percent of total billed charges,38.7
WK HR-CD 1ST 2HR PT,97545,CPT,,,,,both,, ,206,206,Blue Cross and Blue Shield,Traditional,,79.72,38.7,38.7,206,0.82,105.06,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,,405.22,38.7,38.7,1047.07,0.82,534.01,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,,439.3,38.7,38.7,1135.14,0.82,578.92,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,,178.23,38.7,38.7,460.55,0.82,234.88,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,,219.65,38.7,38.7,567.57,0.82,289.46,percent of total billed charges,38.7
WRK HAR-CND-ADHR OT,97546,CPT,,,,,both,, ,103,103,Blue Cross and Blue Shield,Traditional,,39.86,38.7,38.7,103,0.82,52.53,percent of total billed charges,38.7
WRK HAR-CND-ADHR OT,97546,CPT,,,,,both,, ,103,103,Blue Cross and Blue Shield,Traditional,,39.86,38.7,38.7,103,0.82,52.53,percent of total billed charges,38.7
WRK HAR-CND-ADHR OT,97546,CPT,,,,,both,, ,103,103,Blue Cross and Blue Shield,Traditional,,39.86,38.7,38.7,103,0.82,52.53,percent of total billed charges,38.7
WRK HAR-CND-ADHR OT,97546,CPT,,,,,both,, ,103,103,Blue Cross and Blue Shield,Traditional,,39.86,38.7,38.7,103,0.82,52.53,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,,235.28,38.7,38.7,607.96,0.82,310.06,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,,235.28,38.7,38.7,607.96,0.82,310.06,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,,190.93,38.7,38.7,493.37,0.82,251.62,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,,190.93,38.7,38.7,493.37,0.82,251.62,percent of total billed charges,38.7
DEBRDE LE 20SQCM OT,97597,CPT,,,,,both,, ,447.54,447.54,Blue Cross and Blue Shield,Traditional,,173.2,38.7,38.7,447.54,0.82,228.25,percent of total billed charges,38.7
DEBRDE LE 20SQCM OT,97597,CPT,,,,,both,, ,447.54,447.54,Blue Cross and Blue Shield,Traditional,,173.2,38.7,38.7,447.54,0.82,228.25,percent of total billed charges,38.7
DEBRDE LE 20SQCM OT,97597,CPT,,,,,both,, ,447.54,447.54,Blue Cross and Blue Shield,Traditional,,173.2,38.7,38.7,447.54,0.82,228.25,percent of total billed charges,38.7
DEBRDE LE 20SQCM OT,97597,CPT,,,,,both,, ,447.54,447.54,Blue Cross and Blue Shield,Traditional,,173.2,38.7,38.7,447.54,0.82,228.25,percent of total billed charges,38.7
DEBRDE LE 20SQCM OT,97597,CPT,,,,,both,, ,731.82,731.82,Blue Cross and Blue Shield,Traditional,,283.21,38.7,38.7,731.82,0.82,373.23,percent of total billed charges,38.7
DEBRDE LE 20SQCM OT,97597,CPT,,,,,both,, ,731.82,731.82,Blue Cross and Blue Shield,Traditional,,283.21,38.7,38.7,731.82,0.82,373.23,percent of total billed charges,38.7
DEBRDE LE 20SQCM PT,97597,CPT,,,,,both,, ,675.17,675.17,Blue Cross and Blue Shield,Traditional,,261.29,38.7,38.7,675.17,0.82,344.34,percent of total billed charges,38.7
DEBRDE LE 20SQCM PT,97597,CPT,,,,,both,, ,675.17,675.17,Blue Cross and Blue Shield,Traditional,,261.29,38.7,38.7,675.17,0.82,344.34,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,,97.62,38.7,38.7,252.25,0.82,128.65,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,,97.62,38.7,38.7,252.25,0.82,128.65,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,,100.55,38.7,38.7,259.82,0.82,132.51,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,,100.55,38.7,38.7,259.82,0.82,132.51,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,,243.91,38.7,38.7,630.26,0.82,321.43,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,,264.43,38.7,38.7,683.29,0.82,348.48,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,,333.47,38.7,38.7,861.67,0.82,439.45,percent of total billed charges,38.7
SLCTV WND DEB =<20CM,97597,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,0.82,389.13,percent of total billed charges,38.7
DEBRDE EA AD20CM OT,97598,CPT,,,,,both,, ,450.63,450.63,Blue Cross and Blue Shield,Traditional,,174.39,38.7,38.7,450.63,0.82,229.82,percent of total billed charges,38.7
DEBRDE EA AD20CM OT,97598,CPT,,,,,both,, ,450.63,450.63,Blue Cross and Blue Shield,Traditional,,174.39,38.7,38.7,450.63,0.82,229.82,percent of total billed charges,38.7
DEBRDE EA AD20CM OT,97598,CPT,,,,,both,, ,488.48,488.48,Blue Cross and Blue Shield,Traditional,,189.04,38.7,38.7,488.48,0.82,249.12,percent of total billed charges,38.7
DEBRDE EA AD20CM OT,97598,CPT,,,,,both,, ,488.48,488.48,Blue Cross and Blue Shield,Traditional,,189.04,38.7,38.7,488.48,0.82,249.12,percent of total billed charges,38.7
DEBRDE EA AD20CM PT,97598,CPT,,,,,both,, ,450.63,450.63,Blue Cross and Blue Shield,Traditional,,174.39,38.7,38.7,450.63,0.82,229.82,percent of total billed charges,38.7
DEBRDE EA AD20CM PT,97598,CPT,,,,,both,, ,450.63,450.63,Blue Cross and Blue Shield,Traditional,,174.39,38.7,38.7,450.63,0.82,229.82,percent of total billed charges,38.7
DEBRDE EA AD20CM PT,97598,CPT,,,,,both,, ,450.63,450.63,Blue Cross and Blue Shield,Traditional,,174.39,38.7,38.7,450.63,0.82,229.82,percent of total billed charges,38.7
DEBRDE EA AD20CM PT,97598,CPT,,,,,both,, ,450.63,450.63,Blue Cross and Blue Shield,Traditional,,174.39,38.7,38.7,450.63,0.82,229.82,percent of total billed charges,38.7
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,252.25,252.25,Blue Cross and Blue Shield,Traditional,,97.62,38.7,38.7,252.25,0.82,128.65,percent of total billed charges,38.7
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,252.25,252.25,Blue Cross and Blue Shield,Traditional,,97.62,38.7,38.7,252.25,0.82,128.65,percent of total billed charges,38.7
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,259.82,259.82,Blue Cross and Blue Shield,Traditional,,100.55,38.7,38.7,259.82,0.82,132.51,percent of total billed charges,38.7
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,259.82,259.82,Blue Cross and Blue Shield,Traditional,,100.55,38.7,38.7,259.82,0.82,132.51,percent of total billed charges,38.7
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,420.57,420.57,Blue Cross and Blue Shield,Traditional,,162.76,38.7,38.7,420.57,0.82,214.49,percent of total billed charges,38.7
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,455.94,455.94,Blue Cross and Blue Shield,Traditional,,176.45,38.7,38.7,455.94,0.82,232.53,percent of total billed charges,38.7
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,575.1,575.1,Blue Cross and Blue Shield,Traditional,,222.56,38.7,38.7,575.1,0.82,293.3,percent of total billed charges,38.7
SLCTV WND DEB >20 CM,97598,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,0.82,389.13,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,,173.2,38.7,38.7,447.54,0.82,228.25,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,,173.2,38.7,38.7,447.54,0.82,228.25,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,,173.2,38.7,38.7,447.54,0.82,228.25,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,,173.2,38.7,38.7,447.54,0.82,228.25,percent of total billed charges,38.7
DBRD NON-SEL-VIS OT,97602,CPT,,,,,both,, ,521.7,521.7,Blue Cross and Blue Shield,Traditional,,201.9,38.7,38.7,521.7,0.82,266.07,percent of total billed charges,38.7
DBRD NON-SEL-VIS OT,97602,CPT,,,,,both,, ,521.7,521.7,Blue Cross and Blue Shield,Traditional,,201.9,38.7,38.7,521.7,0.82,266.07,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,,186.25,38.7,38.7,481.27,0.82,245.45,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,,186.25,38.7,38.7,481.27,0.82,245.45,percent of total billed charges,38.7
DEBRIDE NON-SELC-VIS,97602,CPT,,,,,both,, ,449.32,449.32,Blue Cross and Blue Shield,Traditional,,173.89,38.7,38.7,449.32,0.82,229.15,percent of total billed charges,38.7
DEBRIDE NON-SELC-VIS,97602,CPT,,,,,both,, ,487.13,487.13,Blue Cross and Blue Shield,Traditional,,188.52,38.7,38.7,487.13,0.82,248.44,percent of total billed charges,38.7
NON SELECTIVE DEBRID,97602,CPT,,,,,both,, ,158.11,158.11,Blue Cross and Blue Shield,Traditional,,61.19,38.7,38.7,158.11,0.82,80.64,percent of total billed charges,38.7
NON SELECTIVE DEBRID,97602,CPT,,,,,both,, ,158.11,158.11,Blue Cross and Blue Shield,Traditional,,61.19,38.7,38.7,158.11,0.82,80.64,percent of total billed charges,38.7
NSW DEB WO A/SESSION,97602,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,0.82,389.13,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,,56.8,38.7,38.7,146.78,0.82,74.86,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,,61.19,38.7,38.7,158.11,0.82,80.64,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,,61.19,38.7,38.7,158.11,0.82,80.64,percent of total billed charges,38.7
NEG PRESS WND TX <50,97605,CPT,,,,,both,, ,763,763,Blue Cross and Blue Shield,Traditional,,295.28,38.7,38.7,763,0.82,389.13,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,,93.38,38.7,38.7,241.28,0.82,123.05,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,,100.55,38.7,38.7,259.82,0.82,132.51,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,,100.55,38.7,38.7,259.82,0.82,132.51,percent of total billed charges,38.7
NEG PRESS WND TX >50,97606,CPT,,,,,both,, ,1520,1520,Blue Cross and Blue Shield,Traditional,,588.24,38.7,38.7,1520,0.82,775.2,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,,179.27,38.7,38.7,463.24,0.82,236.25,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,,179.27,38.7,38.7,463.24,0.82,236.25,percent of total billed charges,38.7
NEG PRES WND TX <=50,97607,CPT,,,,,both,, ,1520,1520,Blue Cross and Blue Shield,Traditional,,588.24,38.7,38.7,1520,0.82,775.2,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,,355.96,38.7,38.7,919.79,0.82,469.09,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,,35.58,38.7,38.7,91.93,0.82,46.88,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,,35.58,38.7,38.7,91.93,0.82,46.88,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,,35.58,38.7,38.7,91.93,0.82,46.88,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,,35.58,38.7,38.7,91.93,0.82,46.88,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,,392.63,38.7,38.7,1014.55,0.82,517.42,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,,392.63,38.7,38.7,1014.55,0.82,517.42,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,,362.24,38.7,38.7,936.01,0.82,477.37,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,,362.24,38.7,38.7,936.01,0.82,477.37,percent of total billed charges,38.7
PHYSICAL PERF-15 MIN,97750,CPT,,,,,both,, ,873.68,873.68,Blue Cross and Blue Shield,Traditional,,338.11,38.7,38.7,873.68,0.82,445.58,percent of total billed charges,38.7
PHYSICAL PERF-15 MIN,97750,CPT,,,,,both,, ,947.11,947.11,Blue Cross and Blue Shield,Traditional,,366.53,38.7,38.7,947.11,0.82,483.03,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,,132.63,38.7,38.7,342.72,0.82,174.79,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,,143.79,38.7,38.7,371.55,0.82,189.49,percent of total billed charges,38.7
ORTH TRN INI15MI OT,97760,CPT,,,,,both,, ,124.12,124.12,Blue Cross and Blue Shield,Traditional,,48.03,38.7,38.7,124.12,0.82,63.3,percent of total billed charges,38.7
ORTH TRN INI15MI OT,97760,CPT,,,,,both,, ,124.12,124.12,Blue Cross and Blue Shield,Traditional,,48.03,38.7,38.7,124.12,0.82,63.3,percent of total billed charges,38.7
ORTH TRN INI15MI OT,97760,CPT,,,,,both,, ,124.12,124.12,Blue Cross and Blue Shield,Traditional,,48.03,38.7,38.7,124.12,0.82,63.3,percent of total billed charges,38.7
ORTH TRN INI15MI OT,97760,CPT,,,,,both,, ,124.12,124.12,Blue Cross and Blue Shield,Traditional,,48.03,38.7,38.7,124.12,0.82,63.3,percent of total billed charges,38.7
ORTH TRN INI15MI OT,97760,CPT,,,,,both,, ,398.1,398.1,Blue Cross and Blue Shield,Traditional,,154.06,38.7,38.7,398.1,0.82,203.03,percent of total billed charges,38.7
ORTH TRN INI15MI OT,97760,CPT,,,,,both,, ,398.1,398.1,Blue Cross and Blue Shield,Traditional,,154.06,38.7,38.7,398.1,0.82,203.03,percent of total billed charges,38.7
ORTH TRN INI15MI PT,97760,CPT,,,,,both,, ,367.2,367.2,Blue Cross and Blue Shield,Traditional,,142.11,38.7,38.7,367.2,0.82,187.27,percent of total billed charges,38.7
ORTH TRN INI15MI PT,97760,CPT,,,,,both,, ,367.2,367.2,Blue Cross and Blue Shield,Traditional,,142.11,38.7,38.7,367.2,0.82,187.27,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,,132.63,38.7,38.7,342.72,0.82,174.79,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,,143.79,38.7,38.7,371.55,0.82,189.49,percent of total billed charges,38.7
PROS TRN INI15MI OT,97761,CPT,,,,,both,, ,107.38,107.38,Blue Cross and Blue Shield,Traditional,,41.56,38.7,38.7,107.38,0.82,54.76,percent of total billed charges,38.7
PROS TRN INI15MI OT,97761,CPT,,,,,both,, ,107.38,107.38,Blue Cross and Blue Shield,Traditional,,41.56,38.7,38.7,107.38,0.82,54.76,percent of total billed charges,38.7
PROS TRN INI15MI OT,97761,CPT,,,,,both,, ,107.38,107.38,Blue Cross and Blue Shield,Traditional,,41.56,38.7,38.7,107.38,0.82,54.76,percent of total billed charges,38.7
PROS TRN INI15MI OT,97761,CPT,,,,,both,, ,107.38,107.38,Blue Cross and Blue Shield,Traditional,,41.56,38.7,38.7,107.38,0.82,54.76,percent of total billed charges,38.7
PROS TRN INI15MI OT,97761,CPT,,,,,both,, ,398.1,398.1,Blue Cross and Blue Shield,Traditional,,154.06,38.7,38.7,398.1,0.82,203.03,percent of total billed charges,38.7
PROS TRN INI15MI OT,97761,CPT,,,,,both,, ,398.1,398.1,Blue Cross and Blue Shield,Traditional,,154.06,38.7,38.7,398.1,0.82,203.03,percent of total billed charges,38.7
PROS TRN INI15MI PT,97761,CPT,,,,,both,, ,367.2,367.2,Blue Cross and Blue Shield,Traditional,,142.11,38.7,38.7,367.2,0.82,187.27,percent of total billed charges,38.7
PROS TRN INI15MI PT,97761,CPT,,,,,both,, ,367.2,367.2,Blue Cross and Blue Shield,Traditional,,142.11,38.7,38.7,367.2,0.82,187.27,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,,123.18,38.7,38.7,318.29,0.82,162.33,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,,138.87,38.7,38.7,358.85,0.82,183.01,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,,50.72,38.7,38.7,131.07,0.82,66.85,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,,50.72,38.7,38.7,131.07,0.82,66.85,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,,50.72,38.7,38.7,131.07,0.82,66.85,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,,50.72,38.7,38.7,131.07,0.82,66.85,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,,131.94,38.7,38.7,340.93,0.82,173.87,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,,131.94,38.7,38.7,340.93,0.82,173.87,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,,148.78,38.7,38.7,384.45,0.82,196.07,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,,148.78,38.7,38.7,384.45,0.82,196.07,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,,75.24,38.7,38.7,194.41,0.82,99.15,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,,39.27,38.7,38.7,101.46,0.82,51.74,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,,86.4,38.7,38.7,223.25,0.82,113.86,percent of total billed charges,38.7
LAB COLLECTION,99000,CPT,,,,,both,, ,70,70,Blue Cross and Blue Shield,Traditional,,27.09,38.7,38.7,70,0.82,35.7,percent of total billed charges,38.7
SPEC CHAIN CUSTODY,99001,CPT,,,,,both,, ,21.33,21.33,Blue Cross and Blue Shield,Traditional,,8.25,38.7,38.7,21.33,0.82,10.88,percent of total billed charges,38.7
MSED SAMEGT5 1ST15,99152,CPT,,,,,both,, ,313.38,313.38,Blue Cross and Blue Shield,Traditional,,121.28,38.7,38.7,313.38,0.82,159.82,percent of total billed charges,38.7
MODSED SAME ADD15MIN,99153,CPT,,,,,both,, ,417.92,417.92,Blue Cross and Blue Shield,Traditional,,161.74,38.7,38.7,417.92,0.82,213.14,percent of total billed charges,38.7
HBO COMM PER SESSION,99183,CPT,,,,,both,, ,990.13,990.13,Blue Cross and Blue Shield,Traditional,,383.18,38.7,38.7,990.13,0.82,504.97,percent of total billed charges,38.7
PHLEBOTOMY THERAPEUT,99195,CPT,,,,,both,, ,266.77,266.77,Blue Cross and Blue Shield,Traditional,,103.24,38.7,38.7,266.77,0.82,136.05,percent of total billed charges,38.7
BRIEF ED VISIT,99281,CPT,,,,,Outpatient,, ,1098.28,12285.42,Blue Cross and Blue Shield,Traditional,,425.03,38.7,38.7,1098.28,0.82,560.12,percent of total billed charges,38.7
BRIEF ED VISIT,99281,CPT,,,,,Outpatient,, ,1098.28,4418.38,Blue Cross and Blue Shield,Traditional,,425.03,38.7,38.7,1098.28,0.82,560.12,percent of total billed charges,38.7
LIMITED ED VISIT,99282,CPT,,,,,Outpatient,, ,1925.14,127.46,Blue Cross and Blue Shield,Traditional,,745.03,38.7,38.7,1925.14,0.82,981.82,percent of total billed charges,38.7
INTERMEDIATE ED VIST,99283,CPT,,,,,Outpatient,, ,3494.12,127.46,Blue Cross and Blue Shield,Traditional,,1352.22,38.7,38.7,3494.12,0.82,1782,percent of total billed charges,38.7
EXTENDED ED VISIT,99284,CPT,,,,,Outpatient,, ,6509.13,2447.28,Blue Cross and Blue Shield,Traditional,,2519.03,38.7,38.7,6509.13,0.82,3319.66,percent of total billed charges,38.7
COMPREHENSIVE ED VST,99285,CPT,,,,,Outpatient,, ,8592.58,463.76,Blue Cross and Blue Shield,Traditional,,3325.33,38.7,38.7,8592.58,0.82,4382.22,percent of total billed charges,38.7
CRITICAL CARE LT 74M,99291,CPT,,,,,both,, ,12285.42,593,Blue Cross and Blue Shield,Traditional,,4754.46,38.7,38.7,12285.42,0.82,6265.56,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,,1709.91,38.7,38.7,4418.38,0.82,2253.37,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,,49.33,38.7,38.7,127.46,0.82,65,percent of total billed charges,38.7
BEHAV CHG SMOKE GR10,99407,CPT,,,,,both,, ,127.46,6.7,Blue Cross and Blue Shield,Traditional,,49.33,38.7,38.7,127.46,0.82,65,percent of total billed charges,38.7
NEWBORN RESUCITATION,99465,CPT,,,,,both,, ,2447.28,6.7,Blue Cross and Blue Shield,Traditional,,947.1,38.7,38.7,2447.28,0.82,1248.11,percent of total billed charges,38.7
RESPIRATORY PANEL PCR,0202U,HCPCS,,,,,both,, ,500,0.32,Blue Cross and Blue Shield,Traditional,,193.5,38.7,38.7,500,0.01,255,percent of total billed charges,38.7
COV19 FLUAB CEPHEID,0240U,CPT,,,,,both,, ,568,0.48,Blue Cross and Blue Shield,Traditional,,219.82,38.7,38.7,568,0.02,289.68,percent of total billed charges,38.7
COV19 FLUAB RSV CEPH,0241U,CPT,,,,,both,, ,570.52,8.76,Blue Cross and Blue Shield,Traditional,,220.79,38.7,38.7,570.52,0.34,290.97,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,,220.79,38.7,38.7,570.52,0.27,290.97,percent of total billed charges,38.7
INTRATUBAL OCCLU DEV,A4264,HCPCS,,,,,both,, ,8176.4,6.56,Blue Cross and Blue Shield,Traditional,,3164.27,38.7,38.7,8176.4,0.26,4169.96,percent of total billed charges,38.7
TISSUE MARKR IMPLT 1,A4648,HCPCS,,,,,both,, ,179.22,0.08,Blue Cross and Blue Shield,Traditional,,69.36,38.7,38.7,179.22,0.24,91.4,percent of total billed charges,38.7
TISSUE MARKR IMPLT 2,A4648,HCPCS,,,,,both,, ,1195.32,0.16,Blue Cross and Blue Shield,Traditional,,462.59,38.7,38.7,1195.32,0.01,609.61,percent of total billed charges,38.7
TISSUE MARKR IMPLT 3,A4648,HCPCS,,,,,both,, ,2390.63,6.88,Blue Cross and Blue Shield,Traditional,,925.17,38.7,38.7,2390.63,0.27,1219.22,percent of total billed charges,38.7
COLLAGEN WITH SILVER (PUROCOL),A6022,HCPCS,,,,,both,, ,28.28,6.28,Blue Cross and Blue Shield,Traditional,,10.94,38.7,38.7,28.28,0.24,14.42,percent of total billed charges,38.7
ENDOFORM ANTIMICROBIAL,A6022,HCPCS,,,,,both,, ,41.56,6.4,Blue Cross and Blue Shield,Traditional,,16.08,38.7,38.7,41.56,0.25,21.2,percent of total billed charges,38.7
COLLAGEN (PUROCOL),A6023,HCPCS,,,,,both,, ,19.8,1.64,Blue Cross and Blue Shield,Traditional,,7.66,38.7,38.7,19.8,0.06,10.1,percent of total billed charges,38.7
CONVAMAX PAD 4X4,A6196,HCPCS,,,,,both,, ,7.68,2.4,Blue Cross and Blue Shield,Traditional,,2.97,38.7,38.7,7.68,0.09,3.92,percent of total billed charges,38.7
CONVAMAX PAD 4X8,A6197,HCPCS,,,,,both,, ,8.88,8.44,Blue Cross and Blue Shield,Traditional,,3.44,38.7,38.7,8.88,0.33,4.53,percent of total billed charges,38.7
CONVAMAX PAD 6X8,A6197,HCPCS,,,,,both,, ,11.76,3547.64,Blue Cross and Blue Shield,Traditional,,4.55,38.7,38.7,11.76,138.36,6,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,,14.12,38.7,38.7,36.48,21.49,18.6,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,,12.01,38.7,38.7,31.04,13.54,15.83,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,,4.32,38.7,38.7,11.16,2.72,5.69,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,,5.46,38.7,38.7,14.12,3.73,7.2,percent of total billed charges,38.7
HYDROFERA BLUE TRANSFER 5X4,A6210,HCPCS,,,,,both,, ,24.12,81.89,Blue Cross and Blue Shield,Traditional,,9.33,38.7,38.7,24.12,3.19,12.3,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,,2.89,38.7,38.7,7.48,12.18,3.81,percent of total billed charges,38.7
"DRESSING,ALLEVYN,SACRUM,SMALL",A6212,HCPCS,,,,,both,, ,21.96,2305.66,Blue Cross and Blue Shield,Traditional,,8.5,38.7,38.7,21.96,89.92,11.2,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,,4.44,38.7,38.7,11.48,671.02,5.85,percent of total billed charges,38.7
"HEEL,LIFE,ALLEVYN",A6212,HCPCS,,,,,both,, ,29.16,170.47,Blue Cross and Blue Shield,Traditional,,11.28,38.7,38.7,29.16,6.65,14.87,percent of total billed charges,38.7
DRSG MED QUADRILOBE 5 1/16INX5,A6213,HCPCS,,,,,both,, ,9.8,235.61,Blue Cross and Blue Shield,Traditional,,3.79,38.7,38.7,9.8,9.19,5,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,,6.7,38.7,38.7,17.32,2.72,8.83,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,,3.14,38.7,38.7,8.12,2.45,4.14,percent of total billed charges,38.7
DUODERM THIN 4X2,A6237,HCPCS,,,,,both,, ,4.8,83.17,Blue Cross and Blue Shield,Traditional,,1.86,38.7,38.7,4.8,3.24,2.45,percent of total billed charges,38.7
DUODERM THIN 4X4,A6238,HCPCS,,,,,both,, ,4.12,529.68,Blue Cross and Blue Shield,Traditional,,1.59,38.7,38.7,4.12,20.66,2.1,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,,1.41,38.7,38.7,3.64,488.48,1.86,percent of total billed charges,38.7
HYDROGEL,A6248,HCPCS,,,,,both,, ,16.76,102.23,Blue Cross and Blue Shield,Traditional,,6.49,38.7,38.7,16.76,3.99,8.55,percent of total billed charges,38.7
NO-RINSE FOAM CLEANSER,A6250,HCPCS,,,,,both,, ,7.96,264.2,Blue Cross and Blue Shield,Traditional,,3.08,38.7,38.7,7.96,10.3,4.06,percent of total billed charges,38.7
ABD PADS 5X9,A6252,HCPCS,,,,,both,, ,0.32,69.78,Blue Cross and Blue Shield,Traditional,,0.12,38.7,38.7,0.32,2.72,0.16,percent of total billed charges,38.7
ABD PADS 8X10,A6253,HCPCS,,,,,both,, ,0.48,148.84,Blue Cross and Blue Shield,Traditional,,0.19,38.7,38.7,0.48,5.8,0.24,percent of total billed charges,38.7
IODOFORM PACKING 1 INCH,A6266,HCPCS,,,,,both,, ,8.76,938.33,Blue Cross and Blue Shield,Traditional,,3.39,38.7,38.7,8.76,36.59,4.47,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,,2.65,38.7,38.7,6.84,2.72,3.49,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,,2.54,38.7,38.7,6.56,575.34,3.35,percent of total billed charges,38.7
STERILE 2X2 GAUZE,A6402,HCPCS,,,,,both,, ,0.08,13.75,Blue Cross and Blue Shield,Traditional,,0.03,38.7,38.7,0.08,0.54,0.04,percent of total billed charges,38.7
STERILE 4X4 GAUZE,A6402,HCPCS,,,,,both,, ,0.16,13.75,Blue Cross and Blue Shield,Traditional,,0.06,38.7,38.7,0.16,0.54,0.08,percent of total billed charges,38.7
PLAIN PACKING 1 INCH,A6407,HCPCS,,,,,both,, ,6.88,14.16,Blue Cross and Blue Shield,Traditional,,2.66,38.7,38.7,6.88,0.55,3.51,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,,2.43,38.7,38.7,6.28,0.54,3.2,percent of total billed charges,38.7
PLAIN PACKING 1/4 INCH,A6407,HCPCS,,,,,both,, ,6.4,37.6,Blue Cross and Blue Shield,Traditional,,2.48,38.7,38.7,6.4,1.47,3.26,percent of total billed charges,38.7
ACE WRAP 4 INCH,A6449,HCPCS,,,,,both,, ,1.64,47.9,Blue Cross and Blue Shield,Traditional,,0.63,38.7,38.7,1.64,1.87,0.84,percent of total billed charges,38.7
ACE WRAP 6 INCH,A6450,HCPCS,,,,,both,, ,2.4,40.94,Blue Cross and Blue Shield,Traditional,,0.93,38.7,38.7,2.4,1.6,1.22,percent of total billed charges,38.7
ZINC PASTE TUBES,A6456,HCPCS,,,,,both,, ,8.44,129.01,Blue Cross and Blue Shield,Traditional,,3.27,38.7,38.7,8.44,5.03,4.3,percent of total billed charges,38.7
PICO DRESSING KIT,A9272,HCPCS,,,,,both,, ,3547.64,2873.7,Blue Cross and Blue Shield,Traditional,,1372.94,38.7,38.7,3547.64,112.07,1809.3,percent of total billed charges,38.7
TC-99M SESTA / DOSE,A9500,HCPCS,,,,,both,, ,551.05,4069.02,Blue Cross and Blue Shield,Traditional,,213.26,38.7,38.7,551.05,158.69,281.04,percent of total billed charges,38.7
TC-99M TETRO/UNITDOS,A9502,HCPCS,,,,,both,, ,347.11,4786.15,Blue Cross and Blue Shield,Traditional,,134.33,38.7,38.7,347.11,186.66,177.03,percent of total billed charges,38.7
TC99M MEDRO TO 30MCI,A9503,HCPCS,,,,,both,, ,69.78,6684.19,Blue Cross and Blue Shield,Traditional,,27,38.7,38.7,69.78,260.68,35.59,percent of total billed charges,38.7
"TL-201, PER MCI",A9505,HCPCS,,,,,both,, ,95.53,9567.67,Blue Cross and Blue Shield,Traditional,,36.97,38.7,38.7,95.53,373.14,48.72,percent of total billed charges,38.7
TC99M PERTECHNET/MCI,A9512,HCPCS,,,,,both,, ,81.89,14349.19,Blue Cross and Blue Shield,Traditional,,31.69,38.7,38.7,81.89,559.62,41.76,percent of total billed charges,38.7
"I123 CAP,DX /100UCI",A9516,HCPCS,,,,,both,, ,312.35,19130.71,Blue Cross and Blue Shield,Traditional,,120.88,38.7,38.7,312.35,746.1,159.3,percent of total billed charges,38.7
TC99 TILMAN DX .5MCI,A9520,HCPCS,,,,,both,, ,2305.66,23912.22,Blue Cross and Blue Shield,Traditional,,892.29,38.7,38.7,2305.66,932.58,1175.89,percent of total billed charges,38.7
TC99M EXAME / DOSE,A9521,HCPCS,,,,,both,, ,17205.64,31084.37,Blue Cross and Blue Shield,Traditional,,6658.58,38.7,38.7,17205.64,1212.29,8774.88,percent of total billed charges,38.7
TC99M MEBROF /15MCI,A9537,HCPCS,,,,,both,, ,170.47,38256.78,Blue Cross and Blue Shield,Traditional,,65.97,38.7,38.7,170.47,1492.01,86.94,percent of total billed charges,38.7
TC99M PYROPHOS/25MCI,A9538,HCPCS,,,,,both,, ,235.61,172.01,Blue Cross and Blue Shield,Traditional,,91.18,38.7,38.7,235.61,6.71,120.16,percent of total billed charges,38.7
TC99M PENTETAT/25MCI,A9539,HCPCS,,,,,both,, ,69.78,47814.92,Blue Cross and Blue Shield,Traditional,,27,38.7,38.7,69.78,1864.78,35.59,percent of total billed charges,38.7
TC99M MAA/10MCI,A9540,HCPCS,,,,,both,, ,62.83,57377.95,Blue Cross and Blue Shield,Traditional,,24.32,38.7,38.7,62.83,2237.74,32.04,percent of total billed charges,38.7
TC99M SULF COL/20MCI,A9541,HCPCS,,,,,both,, ,83.17,243.85,Blue Cross and Blue Shield,Traditional,,32.19,38.7,38.7,83.17,9.51,42.42,percent of total billed charges,38.7
TC99M SULFCOL2/20MCI,A9541,HCPCS,,,,,both,, ,529.68,411.23,Blue Cross and Blue Shield,Traditional,,204.99,38.7,38.7,529.68,16.04,270.14,percent of total billed charges,38.7
IN111 PENTETAT/.5MCI,A9548,HCPCS,,,,,both,, ,12525.06,602.55,Blue Cross and Blue Shield,Traditional,,4847.2,38.7,38.7,12525.06,23.5,6387.78,percent of total billed charges,38.7
GA67 GALLIUM/MCI,A9556,HCPCS,,,,,both,, ,102.23,841.51,Blue Cross and Blue Shield,Traditional,,39.56,38.7,38.7,102.23,32.82,52.14,percent of total billed charges,38.7
XE133 XENON 10MCI,A9558,HCPCS,,,,,both,, ,264.2,1200.21,Blue Cross and Blue Shield,Traditional,,102.25,38.7,38.7,264.2,46.81,134.74,percent of total billed charges,38.7
TC99M LABL RBC/30MCI,A9560,HCPCS,,,,,both,, ,69.78,1678.39,Blue Cross and Blue Shield,Traditional,,27,38.7,38.7,69.78,65.46,35.59,percent of total billed charges,38.7
TC99M OXIDRONA/30MCI,A9561,HCPCS,,,,,both,, ,148.84,2156.56,Blue Cross and Blue Shield,Traditional,,57.6,38.7,38.7,148.84,84.11,75.91,percent of total billed charges,38.7
TC99M MERTIATI/15MCI,A9562,HCPCS,,,,,both,, ,938.33,884.51,Blue Cross and Blue Shield,Traditional,,363.13,38.7,38.7,938.33,34.5,478.55,percent of total billed charges,38.7
TC99M AEROSOL 75 MCI,A9567,HCPCS,,,,,both,, ,69.78,2467.37,Blue Cross and Blue Shield,Traditional,,27,38.7,38.7,69.78,96.23,35.59,percent of total billed charges,38.7
IN-111 PENTETRE/6MCI,A9572,HCPCS,,,,,both,, ,14752.18,5379.18,Blue Cross and Blue Shield,Traditional,,5709.09,38.7,38.7,14752.18,209.79,7523.61,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,,5.32,38.7,38.7,13.75,327.26,7.01,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,,5.32,38.7,38.7,13.75,3659.64,7.01,percent of total billed charges,38.7
INJ MULTIHANCE /ML,A9577,HCPCS,,,,,both,, ,14.16,99999,Blue Cross and Blue Shield,Traditional,,5.48,38.7,38.7,14.16,3899.96,7.22,percent of total billed charges,38.7
INJ MULTIHANCE/ ML,A9577,HCPCS,,,,,both,, ,13.75,5379.18,Blue Cross and Blue Shield,Traditional,,5.32,38.7,38.7,13.75,209.79,7.01,percent of total billed charges,38.7
INJ GAD-MR1 CONTR ML,A9579,HCPCS,,,,,both,, ,37.6,16735.18,Blue Cross and Blue Shield,Traditional,,14.55,38.7,38.7,37.6,652.67,19.18,percent of total billed charges,38.7
INJ GAD-MR2 CONTR ML,A9579,HCPCS,,,,,both,, ,47.9,855.42,Blue Cross and Blue Shield,Traditional,,18.54,38.7,38.7,47.9,33.36,24.43,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,,15.84,38.7,38.7,40.94,67.43,20.88,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 1,C1713,HCPCS,,,,,both,, ,129.01,2726.15,Blue Cross and Blue Shield,Traditional,,49.93,38.7,38.7,129.01,106.32,65.8,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 10,C1713,HCPCS,,,,,both,, ,2873.7,4234.59,Blue Cross and Blue Shield,Traditional,,1112.12,38.7,38.7,2873.7,165.15,1465.59,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 11,C1713,HCPCS,,,,,both,, ,4069.02,6331.93,Blue Cross and Blue Shield,Traditional,,1574.71,38.7,38.7,4069.02,246.95,2075.2,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 12,C1713,HCPCS,,,,,both,, ,4786.15,1434.53,Blue Cross and Blue Shield,Traditional,,1852.24,38.7,38.7,4786.15,55.95,2440.94,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 13,C1713,HCPCS,,,,,both,, ,6684.19,2390.63,Blue Cross and Blue Shield,Traditional,,2586.78,38.7,38.7,6684.19,93.23,3408.94,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 14,C1713,HCPCS,,,,,both,, ,9567.67,717.14,Blue Cross and Blue Shield,Traditional,,3702.69,38.7,38.7,9567.67,27.97,4879.51,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 15,C1713,HCPCS,,,,,both,, ,14349.19,956.36,Blue Cross and Blue Shield,Traditional,,5553.14,38.7,38.7,14349.19,37.3,7318.09,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 16,C1713,HCPCS,,,,,both,, ,19130.71,11958.56,Blue Cross and Blue Shield,Traditional,,7403.58,38.7,38.7,19130.71,466.38,9756.66,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 17,C1713,HCPCS,,,,,both,, ,23912.22,84.2,Blue Cross and Blue Shield,Traditional,,9254.03,38.7,38.7,23912.22,3.28,12195.23,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 18,C1713,HCPCS,,,,,both,, ,31084.37,247.72,Blue Cross and Blue Shield,Traditional,,12029.65,38.7,38.7,31084.37,9.66,15853.03,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 19,C1713,HCPCS,,,,,both,, ,38256.78,727.18,Blue Cross and Blue Shield,Traditional,,14805.37,38.7,38.7,38256.78,28.36,19510.96,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 2,C1713,HCPCS,,,,,both,, ,172.01,1200.21,Blue Cross and Blue Shield,Traditional,,66.57,38.7,38.7,172.01,46.81,87.73,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 20,C1713,HCPCS,,,,,both,, ,47814.92,1917.35,Blue Cross and Blue Shield,Traditional,,18504.37,38.7,38.7,47814.92,74.78,24385.61,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 21,C1713,HCPCS,,,,,both,, ,57377.95,2634.48,Blue Cross and Blue Shield,Traditional,,22205.27,38.7,38.7,57377.95,102.74,29262.75,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 3,C1713,HCPCS,,,,,both,, ,243.85,3351.88,Blue Cross and Blue Shield,Traditional,,94.37,38.7,38.7,243.85,130.72,124.36,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 4,C1713,HCPCS,,,,,both,, ,411.23,4786.15,Blue Cross and Blue Shield,Traditional,,159.15,38.7,38.7,411.23,186.66,209.73,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 5,C1713,HCPCS,,,,,both,, ,602.55,7177.04,Blue Cross and Blue Shield,Traditional,,233.19,38.7,38.7,602.55,279.9,307.3,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 6,C1713,HCPCS,,,,,both,, ,841.51,9567.67,Blue Cross and Blue Shield,Traditional,,325.66,38.7,38.7,841.51,373.14,429.17,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 7,C1713,HCPCS,,,,,both,, ,1200.21,14344.55,Blue Cross and Blue Shield,Traditional,,464.48,38.7,38.7,1200.21,559.44,612.11,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 8,C1713,HCPCS,,,,,both,, ,1678.39,554.66,Blue Cross and Blue Shield,Traditional,,649.54,38.7,38.7,1678.39,21.63,855.98,percent of total billed charges,38.7
ANCHOR/SCRW LEVEL 9,C1713,HCPCS,,,,,both,, ,2156.56,1807.39,Blue Cross and Blue Shield,Traditional,,834.59,38.7,38.7,2156.56,70.49,1099.85,percent of total billed charges,38.7
BONE CEMENT 1,C1713,HCPCS,,,,,both,, ,884.51,6185.15,Blue Cross and Blue Shield,Traditional,,342.31,38.7,38.7,884.51,241.22,451.1,percent of total billed charges,38.7
BONE CEMENT 2,C1713,HCPCS,,,,,both,, ,2467.37,7172.15,Blue Cross and Blue Shield,Traditional,,954.87,38.7,38.7,2467.37,279.71,1258.36,percent of total billed charges,38.7
CATH TRNS ARTHR DIR1,C1714,HCPCS,,,,,both,, ,5379.18,15395.93,Blue Cross and Blue Shield,Traditional,,2081.74,38.7,38.7,5379.18,600.44,2743.38,percent of total billed charges,38.7
CATH TRNS ARTHR DIR2,C1714,HCPCS,,,,,both,, ,8391.41,1434.53,Blue Cross and Blue Shield,Traditional,,3247.48,38.7,38.7,8391.41,55.95,4279.62,percent of total billed charges,38.7
AICD DUAL CHAMBER L1,C1721,HCPCS,,,,,both,, ,93836.86,1912.71,Blue Cross and Blue Shield,Traditional,,36314.86,38.7,38.7,93836.86,74.6,47856.8,percent of total billed charges,38.7
AICD SINGLE CHAMBER1,C1722,HCPCS,,,,,both,, ,99999,89.61,Blue Cross and Blue Shield,Traditional,,38699.61,38.7,38.7,99999,3.49,50999.49,percent of total billed charges,38.7
CATH TRNS ARTHR ROT1,C1724,HCPCS,,,,,both,, ,5379.18,2395.52,Blue Cross and Blue Shield,Traditional,,2081.74,38.7,38.7,5379.18,93.43,2743.38,percent of total billed charges,38.7
CATH TRNS ARTHR ROT2,C1724,HCPCS,,,,,both,, ,16735.18,3351.88,Blue Cross and Blue Shield,Traditional,,6476.51,38.7,38.7,16735.18,130.72,8534.94,percent of total billed charges,38.7
CATH-ANGIO LEVEL 1,C1725,HCPCS,,,,,both,, ,855.42,4781.52,Blue Cross and Blue Shield,Traditional,,331.05,38.7,38.7,855.42,186.48,436.26,percent of total billed charges,38.7
CATH-ANGIO LEVEL 2,C1725,HCPCS,,,,,both,, ,1728.86,124.37,Blue Cross and Blue Shield,Traditional,,669.07,38.7,38.7,1728.86,4.85,881.72,percent of total billed charges,38.7
CATH-ANGIO LEVEL 3,C1725,HCPCS,,,,,both,, ,2726.15,243.85,Blue Cross and Blue Shield,Traditional,,1055.02,38.7,38.7,2726.15,9.51,1390.34,percent of total billed charges,38.7
CATH-ANGIO LEVEL 4,C1725,HCPCS,,,,,both,, ,4234.59,722.03,Blue Cross and Blue Shield,Traditional,,1638.79,38.7,38.7,4234.59,28.16,2159.64,percent of total billed charges,38.7
CATH-ANGIO LEVEL 5,C1725,HCPCS,,,,,both,, ,6331.93,960.99,Blue Cross and Blue Shield,Traditional,,2450.46,38.7,38.7,6331.93,37.48,3229.28,percent of total billed charges,38.7
CATH BAL DIL NONVAS1,C1726,HCPCS,,,,,both,, ,1434.53,960.99,Blue Cross and Blue Shield,Traditional,,555.16,38.7,38.7,1434.53,37.48,731.61,percent of total billed charges,38.7
CATH BAL DIL NONVAS2,C1726,HCPCS,,,,,both,, ,2390.63,1200.21,Blue Cross and Blue Shield,Traditional,,925.17,38.7,38.7,2390.63,46.81,1219.22,percent of total billed charges,38.7
CATH BRACHY SEED AD1,C1728,HCPCS,,,,,both,, ,717.14,1439.17,Blue Cross and Blue Shield,Traditional,,277.53,38.7,38.7,717.14,56.13,365.74,percent of total billed charges,38.7
CATH BRACHY SEED AD2,C1728,HCPCS,,,,,both,, ,956.36,1673.49,Blue Cross and Blue Shield,Traditional,,370.11,38.7,38.7,956.36,65.27,487.74,percent of total billed charges,38.7
CATH DRAINAG LEVEL11,C1729,HCPCS,,,,,both,, ,11958.56,358.7,Blue Cross and Blue Shield,Traditional,,4627.96,38.7,38.7,11958.56,13.99,6098.87,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 1,C1729,HCPCS,,,,,both,, ,84.2,478.18,Blue Cross and Blue Shield,Traditional,,32.59,38.7,38.7,84.2,18.65,42.94,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 2,C1729,HCPCS,,,,,both,, ,247.72,3586.2,Blue Cross and Blue Shield,Traditional,,95.87,38.7,38.7,247.72,139.86,126.34,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 3,C1729,HCPCS,,,,,both,, ,727.18,14344.55,Blue Cross and Blue Shield,Traditional,,281.42,38.7,38.7,727.18,559.44,370.86,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 4,C1729,HCPCS,,,,,both,, ,1200.21,5259.7,Blue Cross and Blue Shield,Traditional,,464.48,38.7,38.7,1200.21,205.13,612.11,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 5,C1729,HCPCS,,,,,both,, ,1917.35,238.96,Blue Cross and Blue Shield,Traditional,,742.01,38.7,38.7,1917.35,9.32,977.85,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 6,C1729,HCPCS,,,,,both,, ,2634.48,1792.97,Blue Cross and Blue Shield,Traditional,,1019.54,38.7,38.7,2634.48,69.93,1343.58,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 7,C1729,HCPCS,,,,,both,, ,3351.88,2395.52,Blue Cross and Blue Shield,Traditional,,1297.18,38.7,38.7,3351.88,93.43,1709.46,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 8,C1729,HCPCS,,,,,both,, ,4786.15,4781.52,Blue Cross and Blue Shield,Traditional,,1852.24,38.7,38.7,4786.15,186.48,2440.94,percent of total billed charges,38.7
CATH-DRAINAG LEVEL 9,C1729,HCPCS,,,,,both,, ,7177.04,478.18,Blue Cross and Blue Shield,Traditional,,2777.51,38.7,38.7,7177.04,18.65,3660.29,percent of total billed charges,38.7
CATH-DRAINAG LEVEL10,C1729,HCPCS,,,,,both,, ,9567.67,717.14,Blue Cross and Blue Shield,Traditional,,3702.69,38.7,38.7,9567.67,27.97,4879.51,percent of total billed charges,38.7
CATH-DRAINAG LEVEL12,C1729,HCPCS,,,,,both,, ,14344.55,956.36,Blue Cross and Blue Shield,Traditional,,5551.34,38.7,38.7,14344.55,37.3,7315.72,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,,214.65,38.7,38.7,554.66,279.71,282.88,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,,699.46,38.7,38.7,1807.39,372.96,921.77,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,,2393.65,38.7,38.7,6185.15,63.75,3154.43,percent of total billed charges,38.7
CATH EP DIG/ABL 3D 1,C1732,HCPCS,,,,,both,, ,7172.15,2504.7,Blue Cross and Blue Shield,Traditional,,2775.62,38.7,38.7,7172.15,97.68,3657.8,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,,5958.22,38.7,38.7,15395.93,56.09,7851.92,percent of total billed charges,38.7
CATH HEMODIAL LT 1,C1750,HCPCS,,,,,both,, ,1434.53,57377.95,Blue Cross and Blue Shield,Traditional,,555.16,38.7,38.7,1434.53,2237.74,731.61,percent of total billed charges,38.7
CATH HEMODIAL LT 2,C1750,HCPCS,,,,,both,, ,1912.71,1917.35,Blue Cross and Blue Shield,Traditional,,740.22,38.7,38.7,1912.71,74.78,975.48,percent of total billed charges,38.7
CATH-INFUS PERIF 1,C1751,HCPCS,,,,,both,, ,89.61,5742.51,Blue Cross and Blue Shield,Traditional,,34.68,38.7,38.7,89.61,223.96,45.7,percent of total billed charges,38.7
CATH-INFUS PERIF 10,C1751,HCPCS,,,,,both,, ,2395.52,9567.67,Blue Cross and Blue Shield,Traditional,,927.07,38.7,38.7,2395.52,373.14,1221.72,percent of total billed charges,38.7
CATH-INFUS PERIF 11,C1751,HCPCS,,,,,both,, ,3351.88,13393.09,Blue Cross and Blue Shield,Traditional,,1297.18,38.7,38.7,3351.88,522.33,1709.46,percent of total billed charges,38.7
CATH-INFUS PERIF 12,C1751,HCPCS,,,,,both,, ,4781.52,17218.25,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,38.7,4781.52,671.51,2438.58,percent of total billed charges,38.7
CATH-INFUS PERIF 2,C1751,HCPCS,,,,,both,, ,124.37,23907.59,Blue Cross and Blue Shield,Traditional,,48.13,38.7,38.7,124.37,932.4,63.43,percent of total billed charges,38.7
CATH-INFUS PERIF 3,C1751,HCPCS,,,,,both,, ,243.85,33475.26,Blue Cross and Blue Shield,Traditional,,94.37,38.7,38.7,243.85,1305.54,124.36,percent of total billed charges,38.7
CATH-INFUS PERIF 4,C1751,HCPCS,,,,,both,, ,722.03,43033.4,Blue Cross and Blue Shield,Traditional,,279.43,38.7,38.7,722.03,1678.3,368.24,percent of total billed charges,38.7
CATH-INFUS PERIF 5,C1751,HCPCS,,,,,both,, ,960.99,1796.58,Blue Cross and Blue Shield,Traditional,,371.9,38.7,38.7,960.99,70.07,490.1,percent of total billed charges,38.7
CATH-INFUS PERIF 5,C1751,HCPCS,,,,,both,, ,960.99,43033.4,Blue Cross and Blue Shield,Traditional,,371.9,38.7,38.7,960.99,1678.3,490.1,percent of total billed charges,38.7
CATH-INFUS PERIF 7,C1751,HCPCS,,,,,both,, ,1200.21,57377.95,Blue Cross and Blue Shield,Traditional,,464.48,38.7,38.7,1200.21,2237.74,612.11,percent of total billed charges,38.7
CATH-INFUS PERIF 8,C1751,HCPCS,,,,,both,, ,1439.17,2395.52,Blue Cross and Blue Shield,Traditional,,556.96,38.7,38.7,1439.17,93.43,733.98,percent of total billed charges,38.7
CATH-INFUS PERIF 9,C1751,HCPCS,,,,,both,, ,1673.49,4786.15,Blue Cross and Blue Shield,Traditional,,647.64,38.7,38.7,1673.49,186.66,853.48,percent of total billed charges,38.7
CATH HEMODIAL ST 1,C1752,HCPCS,,,,,both,, ,358.7,8611.57,Blue Cross and Blue Shield,Traditional,,138.82,38.7,38.7,358.7,335.85,182.94,percent of total billed charges,38.7
CATH HEMODIAL ST 2,C1752,HCPCS,,,,,both,, ,478.18,12436.74,Blue Cross and Blue Shield,Traditional,,185.06,38.7,38.7,478.18,485.03,243.87,percent of total billed charges,38.7
CATH INTRAVAS ULTRA1,C1753,HCPCS,,,,,both,, ,3586.2,15305.54,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,38.7,3586.2,596.92,1828.96,percent of total billed charges,38.7
CATH INTRAVAS ULTRA2,C1753,HCPCS,,,,,both,, ,14344.55,19130.71,Blue Cross and Blue Shield,Traditional,,5551.34,38.7,38.7,14344.55,746.1,7315.72,percent of total billed charges,38.7
CATHETER INTRASPINAL,C1755,HCPCS,,,,,both,, ,5259.7,23912.22,Blue Cross and Blue Shield,Traditional,,2035.5,38.7,38.7,5259.7,932.58,2682.45,percent of total billed charges,38.7
CATH THRMB/EMBOL 1,C1757,HCPCS,,,,,both,, ,238.96,33475.26,Blue Cross and Blue Shield,Traditional,,92.48,38.7,38.7,238.96,1305.54,121.87,percent of total billed charges,38.7
CATH THRMB/EMBOL 2,C1757,HCPCS,,,,,both,, ,1792.97,21590.35,Blue Cross and Blue Shield,Traditional,,693.88,38.7,38.7,1792.97,842.02,914.41,percent of total billed charges,38.7
CATH THRMB/EMBOL 3,C1757,HCPCS,,,,,both,, ,2395.52,717.14,Blue Cross and Blue Shield,Traditional,,927.07,38.7,38.7,2395.52,27.97,1221.72,percent of total billed charges,38.7
CATH THRMB/EMBOL 4,C1757,HCPCS,,,,,both,, ,4781.52,956.36,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,38.7,4781.52,37.3,2438.58,percent of total billed charges,38.7
CATH URETERAL 1,C1758,HCPCS,,,,,both,, ,478.18,8466.86,Blue Cross and Blue Shield,Traditional,,185.06,38.7,38.7,478.18,330.21,243.87,percent of total billed charges,38.7
CATH URETERAL 2,C1758,HCPCS,,,,,both,, ,717.14,4456.3,Blue Cross and Blue Shield,Traditional,,277.53,38.7,38.7,717.14,173.8,365.74,percent of total billed charges,38.7
CATH URETERAL 3,C1758,HCPCS,,,,,both,, ,956.36,35861.25,Blue Cross and Blue Shield,Traditional,,370.11,38.7,38.7,956.36,1398.59,487.74,percent of total billed charges,38.7
CATH INTRA ECHOCARD1,C1759,HCPCS,,,,,both,, ,7172.15,71722.51,Blue Cross and Blue Shield,Traditional,,2775.62,38.7,38.7,7172.15,2797.18,3657.8,percent of total billed charges,38.7
CATH INTRA ECHOCARD2,C1759,HCPCS,,,,,both,, ,9563.04,1796.58,Blue Cross and Blue Shield,Traditional,,3700.9,38.7,38.7,9563.04,70.07,4877.15,percent of total billed charges,38.7
CLOSURE DEVIC VASC 1,C1760,HCPCS,,,,,both,, ,1634.61,2395.52,Blue Cross and Blue Shield,Traditional,,632.59,38.7,38.7,1634.61,93.43,833.65,percent of total billed charges,38.7
CLOSURE DEVIC VASC 2,C1760,HCPCS,,,,,both,, ,2504.7,4786.15,Blue Cross and Blue Shield,Traditional,,969.32,38.7,38.7,2504.7,186.66,1277.4,percent of total billed charges,38.7
CONN TISSUE HUMAN 1,C1762,HCPCS,,,,,both,, ,1438.14,9567.67,Blue Cross and Blue Shield,Traditional,,556.56,38.7,38.7,1438.14,373.14,733.45,percent of total billed charges,38.7
CONN TISSUE HUMAN 10,C1762,HCPCS,,,,,both,, ,57377.95,14349.19,Blue Cross and Blue Shield,Traditional,,22205.27,38.7,38.7,57377.95,559.62,29262.75,percent of total billed charges,38.7
CONN TISSUE HUMAN 2,C1762,HCPCS,,,,,both,, ,1917.35,19130.71,Blue Cross and Blue Shield,Traditional,,742.01,38.7,38.7,1917.35,746.1,977.85,percent of total billed charges,38.7
CONN TISSUE HUMAN 3,C1762,HCPCS,,,,,both,, ,5742.51,23912.22,Blue Cross and Blue Shield,Traditional,,2222.35,38.7,38.7,5742.51,932.58,2928.68,percent of total billed charges,38.7
CONN TISSUE HUMAN 4,C1762,HCPCS,,,,,both,, ,9567.67,28688.85,Blue Cross and Blue Shield,Traditional,,3702.69,38.7,38.7,9567.67,1118.87,4879.51,percent of total billed charges,38.7
CONN TISSUE HUMAN 5,C1762,HCPCS,,,,,both,, ,13393.09,182.83,Blue Cross and Blue Shield,Traditional,,5183.13,38.7,38.7,13393.09,7.13,6830.48,percent of total billed charges,38.7
CONN TISSUE HUMAN 6,C1762,HCPCS,,,,,both,, ,17218.25,3830.06,Blue Cross and Blue Shield,Traditional,,6663.46,38.7,38.7,17218.25,149.37,8781.31,percent of total billed charges,38.7
CONN TISSUE HUMAN 7,C1762,HCPCS,,,,,both,, ,23907.59,4308.23,Blue Cross and Blue Shield,Traditional,,9252.24,38.7,38.7,23907.59,168.02,12192.87,percent of total billed charges,38.7
CONN TISSUE HUMAN 8,C1762,HCPCS,,,,,both,, ,33475.26,4786.15,Blue Cross and Blue Shield,Traditional,,12954.93,38.7,38.7,33475.26,186.66,17072.38,percent of total billed charges,38.7
CONN TISSUE HUMAN 9,C1762,HCPCS,,,,,both,, ,43033.4,7177.04,Blue Cross and Blue Shield,Traditional,,16653.93,38.7,38.7,43033.4,279.9,21947.03,percent of total billed charges,38.7
TISSUE NON-HUMAN 1,C1763,HCPCS,,,,,both,, ,1796.58,9567.67,Blue Cross and Blue Shield,Traditional,,695.28,38.7,38.7,1796.58,373.14,916.26,percent of total billed charges,38.7
TISSUE NON-HUMAN 10,C1763,HCPCS,,,,,both,, ,43033.4,14349.19,Blue Cross and Blue Shield,Traditional,,16653.93,38.7,38.7,43033.4,559.62,21947.03,percent of total billed charges,38.7
TISSUE NON-HUMAN 11,C1763,HCPCS,,,,,both,, ,57377.95,19130.71,Blue Cross and Blue Shield,Traditional,,22205.27,38.7,38.7,57377.95,746.1,29262.75,percent of total billed charges,38.7
TISSUE NON-HUMAN 2,C1763,HCPCS,,,,,both,, ,2395.52,23912.22,Blue Cross and Blue Shield,Traditional,,927.07,38.7,38.7,2395.52,932.58,1221.72,percent of total billed charges,38.7
TISSUE NON-HUMAN 3,C1763,HCPCS,,,,,both,, ,4786.15,31084.37,Blue Cross and Blue Shield,Traditional,,1852.24,38.7,38.7,4786.15,1212.29,2440.94,percent of total billed charges,38.7
TISSUE NON-HUMAN 4,C1763,HCPCS,,,,,both,, ,8611.57,38256.78,Blue Cross and Blue Shield,Traditional,,3332.68,38.7,38.7,8611.57,1492.01,4391.9,percent of total billed charges,38.7
TISSUE NON-HUMAN 5,C1763,HCPCS,,,,,both,, ,12436.74,243.85,Blue Cross and Blue Shield,Traditional,,4813.02,38.7,38.7,12436.74,9.51,6342.74,percent of total billed charges,38.7
TISSUE NON-HUMAN 6,C1763,HCPCS,,,,,both,, ,15305.54,47814.92,Blue Cross and Blue Shield,Traditional,,5923.24,38.7,38.7,15305.54,1864.78,7805.83,percent of total billed charges,38.7
TISSUE NON-HUMAN 7,C1763,HCPCS,,,,,both,, ,19130.71,482.81,Blue Cross and Blue Shield,Traditional,,7403.58,38.7,38.7,19130.71,18.83,9756.66,percent of total billed charges,38.7
TISSUE NON-HUMAN 8,C1763,HCPCS,,,,,both,, ,23912.22,960.99,Blue Cross and Blue Shield,Traditional,,9254.03,38.7,38.7,23912.22,37.48,12195.23,percent of total billed charges,38.7
TISSUE NON-HUMAN 9,C1763,HCPCS,,,,,both,, ,33475.26,1439.17,Blue Cross and Blue Shield,Traditional,,12954.93,38.7,38.7,33475.26,56.13,17072.38,percent of total billed charges,38.7
EVENT RECRDR CARDIAC,C1764,HCPCS,,,,,both,, ,21590.35,1917.35,Blue Cross and Blue Shield,Traditional,,8355.47,38.7,38.7,21590.35,74.78,11011.08,percent of total billed charges,38.7
ADHESION BARRIER1,C1765,HCPCS,,,,,both,, ,717.14,2395.52,Blue Cross and Blue Shield,Traditional,,277.53,38.7,38.7,717.14,93.43,365.74,percent of total billed charges,38.7
ADHESION BARRIER2,C1765,HCPCS,,,,,both,, ,956.36,3351.88,Blue Cross and Blue Shield,Traditional,,370.11,38.7,38.7,956.36,130.72,487.74,percent of total billed charges,38.7
ADHESION BARRIER3,C1765,HCPCS,,,,,both,, ,8466.86,3351.88,Blue Cross and Blue Shield,Traditional,,3276.67,38.7,38.7,8466.86,130.72,4318.1,percent of total billed charges,38.7
ADHESION BARRIER4,C1765,HCPCS,,,,,both,, ,4456.3,2868.81,Blue Cross and Blue Shield,Traditional,,1724.59,38.7,38.7,4456.3,111.88,2272.71,percent of total billed charges,38.7
GENRATR NEUROSTM 1,C1767,HCPCS,,,,,both,, ,35861.25,3825.16,Blue Cross and Blue Shield,Traditional,,13878.3,38.7,38.7,35861.25,149.18,18289.24,percent of total billed charges,38.7
GENRATR NEUROSTM 2,C1767,HCPCS,,,,,both,, ,71722.51,14344.55,Blue Cross and Blue Shield,Traditional,,27756.61,38.7,38.7,71722.51,559.44,36578.48,percent of total billed charges,38.7
GRAFT VASCULAR 1,C1768,HCPCS,,,,,both,, ,1796.58,2774.56,Blue Cross and Blue Shield,Traditional,,695.28,38.7,38.7,1796.58,108.21,916.26,percent of total billed charges,38.7
GRAFT VASCULAR 2,C1768,HCPCS,,,,,both,, ,2395.52,53552.79,Blue Cross and Blue Shield,Traditional,,927.07,38.7,38.7,2395.52,2088.56,1221.72,percent of total billed charges,38.7
GRAFT VASCULAR 3,C1768,HCPCS,,,,,both,, ,4786.15,1338.74,Blue Cross and Blue Shield,Traditional,,1852.24,38.7,38.7,4786.15,52.21,2440.94,percent of total billed charges,38.7
GRAFT VASCULAR 4,C1768,HCPCS,,,,,both,, ,9567.67,4781.52,Blue Cross and Blue Shield,Traditional,,3702.69,38.7,38.7,9567.67,186.48,4879.51,percent of total billed charges,38.7
GRAFT VASCULAR 5,C1768,HCPCS,,,,,both,, ,14349.19,3586.2,Blue Cross and Blue Shield,Traditional,,5553.14,38.7,38.7,14349.19,139.86,7318.09,percent of total billed charges,38.7
GRAFT VASCULAR 6,C1768,HCPCS,,,,,both,, ,19130.71,4781.52,Blue Cross and Blue Shield,Traditional,,7403.58,38.7,38.7,19130.71,186.48,9756.66,percent of total billed charges,38.7
GRAFT VASCULAR 7,C1768,HCPCS,,,,,both,, ,23912.22,9567.67,Blue Cross and Blue Shield,Traditional,,9254.03,38.7,38.7,23912.22,373.14,12195.23,percent of total billed charges,38.7
GRAFT VASCULAR 8,C1768,HCPCS,,,,,both,, ,28688.85,11958.56,Blue Cross and Blue Shield,Traditional,,11102.58,38.7,38.7,28688.85,466.38,14631.31,percent of total billed charges,38.7
GUIDEWIRE LEVEL 1,C1769,HCPCS,,,,,both,, ,182.83,19130.71,Blue Cross and Blue Shield,Traditional,,70.76,38.7,38.7,182.83,746.1,93.24,percent of total billed charges,38.7
GUIDEWIRE LEVEL 10,C1769,HCPCS,,,,,both,, ,3830.06,23912.22,Blue Cross and Blue Shield,Traditional,,1482.23,38.7,38.7,3830.06,932.58,1953.33,percent of total billed charges,38.7
GUIDEWIRE LEVEL 11,C1769,HCPCS,,,,,both,, ,4308.23,31084.37,Blue Cross and Blue Shield,Traditional,,1667.29,38.7,38.7,4308.23,1212.29,2197.2,percent of total billed charges,38.7
GUIDEWIRE LEVEL 12,C1769,HCPCS,,,,,both,, ,4786.15,38256.78,Blue Cross and Blue Shield,Traditional,,1852.24,38.7,38.7,4786.15,1492.01,2440.94,percent of total billed charges,38.7
GUIDEWIRE LEVEL 13,C1769,HCPCS,,,,,both,, ,7177.04,47819.81,Blue Cross and Blue Shield,Traditional,,2777.51,38.7,38.7,7177.04,1864.97,3660.29,percent of total billed charges,38.7
GUIDEWIRE LEVEL 14,C1769,HCPCS,,,,,both,, ,9567.67,71727.14,Blue Cross and Blue Shield,Traditional,,3702.69,38.7,38.7,9567.67,2797.36,4879.51,percent of total billed charges,38.7
GUIDEWIRE LEVEL 15,C1769,HCPCS,,,,,both,, ,14349.19,95629.84,Blue Cross and Blue Shield,Traditional,,5553.14,38.7,38.7,14349.19,3729.56,7318.09,percent of total billed charges,38.7
GUIDEWIRE LEVEL 16,C1769,HCPCS,,,,,both,, ,19130.71,99999,Blue Cross and Blue Shield,Traditional,,7403.58,38.7,38.7,19130.71,3899.96,9756.66,percent of total billed charges,38.7
GUIDEWIRE LEVEL 17,C1769,HCPCS,,,,,both,, ,23912.22,23599.62,Blue Cross and Blue Shield,Traditional,,9254.03,38.7,38.7,23912.22,920.39,12195.23,percent of total billed charges,38.7
GUIDEWIRE LEVEL 18,C1769,HCPCS,,,,,both,, ,31084.37,9563.04,Blue Cross and Blue Shield,Traditional,,12029.65,38.7,38.7,31084.37,372.96,15853.03,percent of total billed charges,38.7
GUIDEWIRE LEVEL 19,C1769,HCPCS,,,,,both,, ,38256.78,3586.2,Blue Cross and Blue Shield,Traditional,,14805.37,38.7,38.7,38256.78,139.86,19510.96,percent of total billed charges,38.7
GUIDEWIRE LEVEL 2,C1769,HCPCS,,,,,both,, ,243.85,14344.55,Blue Cross and Blue Shield,Traditional,,94.37,38.7,38.7,243.85,559.44,124.36,percent of total billed charges,38.7
GUIDEWIRE LEVEL 20,C1769,HCPCS,,,,,both,, ,47814.92,23907.59,Blue Cross and Blue Shield,Traditional,,18504.37,38.7,38.7,47814.92,932.4,24385.61,percent of total billed charges,38.7
GUIDEWIRE LEVEL 3,C1769,HCPCS,,,,,both,, ,482.81,9194.3,Blue Cross and Blue Shield,Traditional,,186.85,38.7,38.7,482.81,358.58,246.23,percent of total billed charges,38.7
GUIDEWIRE LEVEL 4,C1769,HCPCS,,,,,both,, ,960.99,717.14,Blue Cross and Blue Shield,Traditional,,371.9,38.7,38.7,960.99,27.97,490.1,percent of total billed charges,38.7
GUIDEWIRE LEVEL 5,C1769,HCPCS,,,,,both,, ,1439.17,11958.56,Blue Cross and Blue Shield,Traditional,,556.96,38.7,38.7,1439.17,466.38,733.98,percent of total billed charges,38.7
GUIDEWIRE LEVEL 6,C1769,HCPCS,,,,,both,, ,1917.35,14349.19,Blue Cross and Blue Shield,Traditional,,742.01,38.7,38.7,1917.35,559.62,977.85,percent of total billed charges,38.7
GUIDEWIRE LEVEL 7,C1769,HCPCS,,,,,both,, ,2395.52,19130.71,Blue Cross and Blue Shield,Traditional,,927.07,38.7,38.7,2395.52,746.1,1221.72,percent of total billed charges,38.7
GUIDEWIRE LEVEL 8,C1769,HCPCS,,,,,both,, ,3351.88,28693.74,Blue Cross and Blue Shield,Traditional,,1297.18,38.7,38.7,3351.88,1119.06,1709.46,percent of total billed charges,38.7
GUIDEWIRE LEVEL 8,C1769,HCPCS,,,,,both,, ,3351.88,43038.29,Blue Cross and Blue Shield,Traditional,,1297.18,38.7,38.7,3351.88,1678.49,1709.46,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,,1110.23,38.7,38.7,2868.81,37.48,1463.09,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,,1480.34,38.7,38.7,3825.16,74.78,1950.83,percent of total billed charges,38.7
REP DEV URINRY W/SL3,C1771,HCPCS,,,,,both,, ,14344.55,2873.7,Blue Cross and Blue Shield,Traditional,,5551.34,38.7,38.7,14344.55,112.07,7315.72,percent of total billed charges,38.7
INF PUMP PROGRAM LV1,C1772,HCPCS,,,,,both,, ,2774.56,3830.06,Blue Cross and Blue Shield,Traditional,,1073.75,38.7,38.7,2774.56,149.37,1415.03,percent of total billed charges,38.7
INF PUMP PROGRAM LV3,C1772,HCPCS,,,,,both,, ,53552.79,3830.06,Blue Cross and Blue Shield,Traditional,,20724.93,38.7,38.7,53552.79,149.37,27311.92,percent of total billed charges,38.7
CATH-RETRIEVAL 1,C1773,HCPCS,,,,,both,, ,1338.74,6220.69,Blue Cross and Blue Shield,Traditional,,518.09,38.7,38.7,1338.74,242.61,682.76,percent of total billed charges,38.7
CATH-RETRIEVAL 2,C1773,HCPCS,,,,,both,, ,4781.52,7655.22,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,38.7,4781.52,298.55,2438.58,percent of total billed charges,38.7
JOINT DEVICE IMPLT 1,C1776,HCPCS,,,,,both,, ,3586.2,9567.67,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,38.7,3586.2,373.14,1828.96,percent of total billed charges,38.7
JOINT DEVICE IMPLT 2,C1776,HCPCS,,,,,both,, ,4781.52,1792.97,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,38.7,4781.52,69.93,2438.58,percent of total billed charges,38.7
JOINT DEVICE IMPLT 3,C1776,HCPCS,,,,,both,, ,9567.67,4781.52,Blue Cross and Blue Shield,Traditional,,3702.69,38.7,38.7,9567.67,186.48,4879.51,percent of total billed charges,38.7
JOINT DEVICE IMPLT 4,C1776,HCPCS,,,,,both,, ,11958.56,9563.04,Blue Cross and Blue Shield,Traditional,,4627.96,38.7,38.7,11958.56,372.96,6098.87,percent of total billed charges,38.7
JOINT DEVICE IMPLT 5,C1776,HCPCS,,,,,both,, ,19130.71,15780.63,Blue Cross and Blue Shield,Traditional,,7403.58,38.7,38.7,19130.71,615.44,9756.66,percent of total billed charges,38.7
JOINT DEVICE IMPLT 6,C1776,HCPCS,,,,,both,, ,23912.22,84273.06,Blue Cross and Blue Shield,Traditional,,9254.03,38.7,38.7,23912.22,3286.65,12195.23,percent of total billed charges,38.7
JOINT DEVICE IMPLT 7,C1776,HCPCS,,,,,both,, ,31084.37,28809.36,Blue Cross and Blue Shield,Traditional,,12029.65,38.7,38.7,31084.37,1123.57,15853.03,percent of total billed charges,38.7
JOINT DEVICE IMPLT 8,C1776,HCPCS,,,,,both,, ,38256.78,62664.69,Blue Cross and Blue Shield,Traditional,,14805.37,38.7,38.7,38256.78,2443.92,19510.96,percent of total billed charges,38.7
JOINT DEVICE IMPLT 9,C1776,HCPCS,,,,,both,, ,47819.81,5302.96,Blue Cross and Blue Shield,Traditional,,18506.27,38.7,38.7,47819.81,206.82,24388.1,percent of total billed charges,38.7
JOINT DEVICE IMPLT10,C1776,HCPCS,,,,,both,, ,71727.14,720.74,Blue Cross and Blue Shield,Traditional,,27758.4,38.7,38.7,71727.14,28.11,36580.84,percent of total billed charges,38.7
JOINT DEVICE IMPLT11,C1776,HCPCS,,,,,both,, ,95629.84,960.99,Blue Cross and Blue Shield,Traditional,,37008.75,38.7,38.7,95629.84,37.48,48771.22,percent of total billed charges,38.7
JOINT DEVICE IMPLT12,C1776,HCPCS,,,,,both,, ,99999,1912.71,Blue Cross and Blue Shield,Traditional,,38699.61,38.7,38.7,99999,74.6,50999.49,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,,9133.05,38.7,38.7,23599.62,305.49,12035.81,percent of total billed charges,38.7
LEAD NEUROSTIMULAT 1,C1778,HCPCS,,,,,both,, ,9563.04,3586.2,Blue Cross and Blue Shield,Traditional,,3700.9,38.7,38.7,9563.04,139.86,4877.15,percent of total billed charges,38.7
LEAD NEUROSTIMULAT 2,C1778,HCPCS,,,,,both,, ,3586.2,4781.52,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,38.7,3586.2,186.48,1828.96,percent of total billed charges,38.7
LEAD NEUROSTIMULAT 3,C1778,HCPCS,,,,,both,, ,14344.55,14344.55,Blue Cross and Blue Shield,Traditional,,5551.34,38.7,38.7,14344.55,559.44,7315.72,percent of total billed charges,38.7
LEAD NEUROSTIMULAT 4,C1778,HCPCS,,,,,both,, ,23907.59,23907.59,Blue Cross and Blue Shield,Traditional,,9252.24,38.7,38.7,23907.59,932.4,12192.87,percent of total billed charges,38.7
LEAD PMKR TRNSV VDD1,C1779,HCPCS,,,,,both,, ,9194.3,1000,Blue Cross and Blue Shield,Traditional,,3558.19,38.7,38.7,9194.3,39,4689.09,percent of total billed charges,38.7
MESH IMPLANTABLE 1,C1781,HCPCS,,,,,both,, ,717.14,38545.95,Blue Cross and Blue Shield,Traditional,,277.53,38.7,38.7,717.14,1503.29,365.74,percent of total billed charges,38.7
MESH IMPLANTABLE 10,C1781,HCPCS,,,,,both,, ,11958.56,31193.29,Blue Cross and Blue Shield,Traditional,,4627.96,38.7,38.7,11958.56,1216.54,6098.87,percent of total billed charges,38.7
MESH IMPLANTABLE 11,C1781,HCPCS,,,,,both,, ,14349.19,44561.92,Blue Cross and Blue Shield,Traditional,,5553.14,38.7,38.7,14349.19,1737.91,7318.09,percent of total billed charges,38.7
MESH IMPLANTABLE 12,C1781,HCPCS,,,,,both,, ,19130.71,3586.2,Blue Cross and Blue Shield,Traditional,,7403.58,38.7,38.7,19130.71,139.86,9756.66,percent of total billed charges,38.7
MESH IMPLANTABLE 13,C1781,HCPCS,,,,,both,, ,28693.74,7172.15,Blue Cross and Blue Shield,Traditional,,11104.48,38.7,38.7,28693.74,279.71,14633.81,percent of total billed charges,38.7
MESH IMPLANTABLE 14,C1781,HCPCS,,,,,both,, ,43038.29,14344.55,Blue Cross and Blue Shield,Traditional,,16655.82,38.7,38.7,43038.29,559.44,21949.53,percent of total billed charges,38.7
MESH IMPLANTABLE 2,C1781,HCPCS,,,,,both,, ,960.99,23907.59,Blue Cross and Blue Shield,Traditional,,371.9,38.7,38.7,960.99,932.4,490.1,percent of total billed charges,38.7
MESH IMPLANTABLE 3,C1781,HCPCS,,,,,both,, ,1917.35,3589.81,Blue Cross and Blue Shield,Traditional,,742.01,38.7,38.7,1917.35,140,977.85,percent of total billed charges,38.7
MESH IMPLANTABLE 4,C1781,HCPCS,,,,,both,, ,2873.7,4786.15,Blue Cross and Blue Shield,Traditional,,1112.12,38.7,38.7,2873.7,186.66,1465.59,percent of total billed charges,38.7
MESH IMPLANTABLE 5,C1781,HCPCS,,,,,both,, ,3830.06,9567.67,Blue Cross and Blue Shield,Traditional,,1482.23,38.7,38.7,3830.06,373.14,1953.33,percent of total billed charges,38.7
MESH IMPLANTABLE 5,C1781,HCPCS,,,,,both,, ,3830.06,14344.55,Blue Cross and Blue Shield,Traditional,,1482.23,38.7,38.7,3830.06,559.44,1953.33,percent of total billed charges,38.7
MESH IMPLANTABLE 7,C1781,HCPCS,,,,,both,, ,6220.69,3586.2,Blue Cross and Blue Shield,Traditional,,2407.41,38.7,38.7,6220.69,139.86,3172.55,percent of total billed charges,38.7
MESH IMPLANTABLE 8,C1781,HCPCS,,,,,both,, ,7655.22,4781.52,Blue Cross and Blue Shield,Traditional,,2962.57,38.7,38.7,7655.22,186.48,3904.16,percent of total billed charges,38.7
MESH IMPLANTABLE 9,C1781,HCPCS,,,,,both,, ,9567.67,3586.2,Blue Cross and Blue Shield,Traditional,,3702.69,38.7,38.7,9567.67,139.86,4879.51,percent of total billed charges,38.7
MORCELLATOR 1,C1782,HCPCS,,,,,both,, ,1792.97,7172.15,Blue Cross and Blue Shield,Traditional,,693.88,38.7,38.7,1792.97,279.71,914.41,percent of total billed charges,38.7
MORCELLATOR 2,C1782,HCPCS,,,,,both,, ,4781.52,99999,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,38.7,4781.52,3899.96,2438.58,percent of total billed charges,38.7
MORCELLATOR 3,C1782,HCPCS,,,,,both,, ,9563.04,6144.21,Blue Cross and Blue Shield,Traditional,,3700.9,38.7,38.7,9563.04,239.62,4877.15,percent of total billed charges,38.7
OCLR DEV INTROP DTR1,C1784,HCPCS,,,,,both,, ,15780.63,7172.15,Blue Cross and Blue Shield,Traditional,,6107.1,38.7,38.7,15780.63,279.71,8048.12,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,,32613.67,38.7,38.7,84273.06,279.71,42979.26,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,,11149.22,38.7,38.7,28809.36,372.96,14692.77,percent of total billed charges,38.7
PMKR SINGL RATE-RSL1,C1786,HCPCS,,,,,both,, ,62664.69,358.7,Blue Cross and Blue Shield,Traditional,,24251.24,38.7,38.7,62664.69,13.99,31958.99,percent of total billed charges,38.7
PATIENT PROGR NEURO1,C1787,HCPCS,,,,,both,, ,5302.96,1195.32,Blue Cross and Blue Shield,Traditional,,2052.25,38.7,38.7,5302.96,46.62,2704.51,percent of total billed charges,38.7
PORT 1,C1788,HCPCS,,,,,both,, ,720.74,1912.71,Blue Cross and Blue Shield,Traditional,,278.93,38.7,38.7,720.74,74.6,367.58,percent of total billed charges,38.7
PORT 2,C1788,HCPCS,,,,,both,, ,960.99,896.62,Blue Cross and Blue Shield,Traditional,,371.9,38.7,38.7,960.99,34.97,490.1,percent of total billed charges,38.7
PORT 3,C1788,HCPCS,,,,,both,, ,1912.71,1195.32,Blue Cross and Blue Shield,Traditional,,740.22,38.7,38.7,1912.71,46.62,975.48,percent of total billed charges,38.7
BREAST IMPLANT 1,C1789,HCPCS,,,,,both,, ,7833.15,113.04,Blue Cross and Blue Shield,Traditional,,3031.43,38.7,38.7,7833.15,4.41,3994.91,percent of total billed charges,38.7
PRSTHS PENILE INFL 1,C1813,HCPCS,,,,,both,, ,3586.2,570.11,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,38.7,3586.2,22.23,1828.96,percent of total billed charges,38.7
PRSTHS PENILE INFL 2,C1813,HCPCS,,,,,both,, ,4781.52,10237.17,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,38.7,4781.52,399.25,2438.58,percent of total billed charges,38.7
PRSTHS PENILE INFL 3,C1813,HCPCS,,,,,both,, ,14344.55,179.22,Blue Cross and Blue Shield,Traditional,,5551.34,38.7,38.7,14344.55,6.99,7315.72,percent of total billed charges,38.7
PRSTHS PENILE INFL 4,C1813,HCPCS,,,,,both,, ,23907.59,478.18,Blue Cross and Blue Shield,Traditional,,9252.24,38.7,38.7,23907.59,18.65,12192.87,percent of total billed charges,38.7
TISSUE LOCALZ EXCISI,C1819,HCPCS,,,,,both,, ,1000,1434.53,Blue Cross and Blue Shield,Traditional,,387,38.7,38.7,1000,55.95,510,percent of total billed charges,38.7
GENRATE NEURO RECHR,C1820,HCPCS,,,,,both,, ,38545.95,611.31,Blue Cross and Blue Shield,Traditional,,14917.28,38.7,38.7,38545.95,23.84,19658.43,percent of total billed charges,38.7
INTERSPINOUS IMPL L1,C1821,HCPCS,,,,,both,, ,31193.29,3048.29,Blue Cross and Blue Shield,Traditional,,12071.8,38.7,38.7,31193.29,118.88,15908.58,percent of total billed charges,38.7
INTERSPINOUS IMPL L2,C1821,HCPCS,,,,,both,, ,44561.92,717.14,Blue Cross and Blue Shield,Traditional,,17245.46,38.7,38.7,44561.92,27.97,22726.58,percent of total billed charges,38.7
STNT COAT/COV W/DEL1,C1874,HCPCS,,,,,both,, ,3586.2,1434.53,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,38.7,3586.2,55.95,1828.96,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,,2775.62,38.7,38.7,7172.15,93.23,3657.8,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,,5551.34,38.7,38.7,14344.55,186.48,7315.72,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,,9252.24,38.7,38.7,23907.59,279.71,12192.87,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,,1389.26,38.7,38.7,3589.81,372.96,1830.8,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,,1852.24,38.7,38.7,4786.15,559.44,2440.94,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,,3702.69,38.7,38.7,9567.67,745.92,4879.51,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,,5551.34,38.7,38.7,14344.55,2974.84,7315.72,percent of total billed charges,38.7
STNT NO-COA/COV W/O1,C1877,HCPCS,,,,,both,, ,3586.2,16735.18,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,38.7,3586.2,652.67,1828.96,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,,1850.45,38.7,38.7,4781.52,632.06,2438.58,percent of total billed charges,38.7
VENA CAVA FILTER 1,C1880,HCPCS,,,,,both,, ,3586.2,3586.2,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,38.7,3586.2,139.86,1828.96,percent of total billed charges,38.7
VENA CAVA FILTER 2,C1880,HCPCS,,,,,both,, ,7172.15,6646.33,Blue Cross and Blue Shield,Traditional,,2775.62,38.7,38.7,7172.15,259.21,3657.8,percent of total billed charges,38.7
AICD OHR THN SGL/DU1,C1882,HCPCS,,,,,both,, ,99999,4781.52,Blue Cross and Blue Shield,Traditional,,38699.61,38.7,38.7,99999,186.48,50999.49,percent of total billed charges,38.7
EMBOLIZ PROTECT SYS1,C1884,HCPCS,,,,,both,, ,6144.21,41218.03,Blue Cross and Blue Shield,Traditional,,2377.81,38.7,38.7,6144.21,1607.5,3133.55,percent of total billed charges,38.7
EMBOLIZ PROTECT SYS2,C1884,HCPCS,,,,,both,, ,7172.15,20278.38,Blue Cross and Blue Shield,Traditional,,2775.62,38.7,38.7,7172.15,790.86,3657.8,percent of total billed charges,38.7
CATH TRNSLUM ANG LA1,C1885,HCPCS,,,,,both,, ,7172.15,5932.54,Blue Cross and Blue Shield,Traditional,,2775.62,38.7,38.7,7172.15,231.37,3657.8,percent of total billed charges,38.7
CATH TRNSLUM ANG LA2,C1885,HCPCS,,,,,both,, ,9563.04,2963.83,Blue Cross and Blue Shield,Traditional,,3700.9,38.7,38.7,9563.04,115.59,4877.15,percent of total billed charges,38.7
CATHETER GUIDING 1,C1887,HCPCS,,,,,both,, ,358.7,3586.2,Blue Cross and Blue Shield,Traditional,,138.82,38.7,38.7,358.7,139.86,182.94,percent of total billed charges,38.7
CATHETER GUIDING 2,C1887,HCPCS,,,,,both,, ,1195.32,4781.52,Blue Cross and Blue Shield,Traditional,,462.59,38.7,38.7,1195.32,186.48,609.61,percent of total billed charges,38.7
CATHETER GUIDING 3,C1887,HCPCS,,,,,both,, ,1912.71,9563.04,Blue Cross and Blue Shield,Traditional,,740.22,38.7,38.7,1912.71,372.96,975.48,percent of total billed charges,38.7
CATH ABLTN NOCRD ED1,C1888,HCPCS,,,,,both,, ,896.62,16735.18,Blue Cross and Blue Shield,Traditional,,346.99,38.7,38.7,896.62,652.67,457.28,percent of total billed charges,38.7
CATH ABLTN NOCRD ED2,C1888,HCPCS,,,,,both,, ,1195.32,73166.31,Blue Cross and Blue Shield,Traditional,,462.59,38.7,38.7,1195.32,2853.49,609.61,percent of total billed charges,38.7
EAR TUBES DRAINAGE 1,C1889,HCPCS,,,,,both,, ,113.04,45918.17,Blue Cross and Blue Shield,Traditional,,43.75,38.7,38.7,113.04,1790.81,57.65,percent of total billed charges,38.7
TISSUE EXP NONBREAST,C1889,HCPCS,,,,,both,, ,570.11,99999,Blue Cross and Blue Shield,Traditional,,220.63,38.7,38.7,570.11,3899.96,290.76,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,,3961.78,38.7,38.7,10237.17,1516.87,5220.96,percent of total billed charges,38.7
PEEL-AWAY SHEATH 1,C1892,HCPCS,,,,,both,, ,179.22,99999,Blue Cross and Blue Shield,Traditional,,69.36,38.7,38.7,179.22,3899.96,91.4,percent of total billed charges,38.7
PEEL-AWAY SHEATH 2,C1892,HCPCS,,,,,both,, ,478.18,541.52,Blue Cross and Blue Shield,Traditional,,185.06,38.7,38.7,478.18,21.12,243.87,percent of total billed charges,38.7
PEEL-AWAY SHEATH 3,C1892,HCPCS,,,,,both,, ,1434.53,722.03,Blue Cross and Blue Shield,Traditional,,555.16,38.7,38.7,1434.53,28.16,731.61,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,,236.58,38.7,38.7,611.31,147.73,311.77,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,,1179.69,38.7,38.7,3048.29,21.26,1554.63,percent of total billed charges,38.7
SHEATH NON-LASR 1,C1894,HCPCS,,,,,both,, ,717.14,172.01,Blue Cross and Blue Shield,Traditional,,277.53,38.7,38.7,717.14,6.71,365.74,percent of total billed charges,38.7
SHEATH NON-LASR 2,C1894,HCPCS,,,,,both,, ,1434.53,1075.84,Blue Cross and Blue Shield,Traditional,,555.16,38.7,38.7,1434.53,41.96,731.61,percent of total billed charges,38.7
SHEATH NON-LASR 3,C1894,HCPCS,,,,,both,, ,2390.63,717.14,Blue Cross and Blue Shield,Traditional,,925.17,38.7,38.7,2390.63,27.97,1219.22,percent of total billed charges,38.7
SHEATH NON-LASR 4,C1894,HCPCS,,,,,both,, ,4781.52,1434.53,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,38.7,4781.52,55.95,2438.58,percent of total billed charges,38.7
SHEATH NON-LASR 5,C1894,HCPCS,,,,,both,, ,7172.15,2390.63,Blue Cross and Blue Shield,Traditional,,2775.62,38.7,38.7,7172.15,93.23,3657.8,percent of total billed charges,38.7
SHEATH NON-LASR 6,C1894,HCPCS,,,,,both,, ,9563.04,5379.18,Blue Cross and Blue Shield,Traditional,,3700.9,38.7,38.7,9563.04,209.79,4877.15,percent of total billed charges,38.7
SHEATH NON-LASR 7,C1894,HCPCS,,,,,both,, ,14344.55,7172.15,Blue Cross and Blue Shield,Traditional,,5551.34,38.7,38.7,14344.55,279.71,7315.72,percent of total billed charges,38.7
SHEATH NON-LASR 8,C1894,HCPCS,,,,,both,, ,19126.07,8266.27,Blue Cross and Blue Shield,Traditional,,7401.79,38.7,38.7,19126.07,322.38,9754.3,percent of total billed charges,38.7
LEAD AICD END DUL L1,C1895,HCPCS,,,,,both,, ,76277.94,2393.6,Blue Cross and Blue Shield,Traditional,,29519.56,38.7,38.7,76277.94,93.35,38901.75,percent of total billed charges,38.7
LEAD AICD END DUL L2,C1895,HCPCS,,,,,both,, ,16735.18,2393.6,Blue Cross and Blue Shield,Traditional,,6476.51,38.7,38.7,16735.18,93.35,8534.94,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,,6271.93,38.7,38.7,16206.54,271.05,8265.34,percent of total billed charges,38.7
LEAD NEUROSTM TST K1,C1897,HCPCS,,,,,both,, ,3586.2,6950.12,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,38.7,3586.2,271.05,1828.96,percent of total billed charges,38.7
LEAD NEUROSTM TST K2,C1897,HCPCS,,,,,both,, ,6646.33,2393.6,Blue Cross and Blue Shield,Traditional,,2572.13,38.7,38.7,6646.33,93.35,3389.63,percent of total billed charges,38.7
LEAD PMKR NON-TRN L1,C1898,HCPCS,,,,,both,, ,4781.52,2393.6,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,38.7,4781.52,93.35,2438.58,percent of total billed charges,38.7
LEAD PMKR/AICD CMBL1,C1899,HCPCS,,,,,both,, ,41218.03,2393.6,Blue Cross and Blue Shield,Traditional,,15951.38,38.7,38.7,41218.03,93.35,21021.2,percent of total billed charges,38.7
LEAD LT VENT COR LV1,C1900,HCPCS,,,,,both,, ,20278.38,2393.6,Blue Cross and Blue Shield,Traditional,,7847.73,38.7,38.7,20278.38,93.35,10341.97,percent of total billed charges,38.7
SEALANT PULMNRY LIQD,C2615,HCPCS,,,,,both,, ,5932.54,1035.69,Blue Cross and Blue Shield,Traditional,,2295.89,38.7,38.7,5932.54,40.39,3025.6,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,,1147,38.7,38.7,2963.83,43.47,1511.55,percent of total billed charges,38.7
PROBE CRYOABLATION 1,C2618,HCPCS,,,,,both,, ,3586.2,715.99,Blue Cross and Blue Shield,Traditional,,1387.86,38.7,38.7,3586.2,27.92,1828.96,percent of total billed charges,38.7
PROBE CRYOABLATION 2,C2618,HCPCS,,,,,both,, ,4781.52,770.45,Blue Cross and Blue Shield,Traditional,,1850.45,38.7,38.7,4781.52,30.05,2438.58,percent of total billed charges,38.7
PROBE CRYOABLATION 3,C2618,HCPCS,,,,,both,, ,9563.04,1197.08,Blue Cross and Blue Shield,Traditional,,3700.9,38.7,38.7,9563.04,46.69,4877.15,percent of total billed charges,38.7
PROBE CRYOABLATION 4,C2618,HCPCS,,,,,both,, ,16735.18,1288.29,Blue Cross and Blue Shield,Traditional,,6476.51,38.7,38.7,16735.18,50.24,8534.94,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,,28315.36,38.7,38.7,73166.31,104.12,37314.82,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,,17770.33,38.7,38.7,45918.17,121.47,23418.27,percent of total billed charges,38.7
PMKR OTHR TH SNGL L1,C2621,HCPCS,,,,,both,, ,99999,3115.2,Blue Cross and Blue Shield,Traditional,,38699.61,38.7,38.7,99999,121.49,50999.49,percent of total billed charges,38.7
PRSTHS PENILE NNINF1,C2622,HCPCS,,,,,both,, ,38894.09,1197.08,Blue Cross and Blue Shield,Traditional,,15052.01,38.7,38.7,38894.09,46.69,19835.99,percent of total billed charges,38.7
WIRELESS PRESS SENS,C2624,HCPCS,,,,,both,, ,99999,1288.29,Blue Cross and Blue Shield,Traditional,,38699.61,38.7,38.7,99999,50.24,50999.49,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,,209.57,38.7,38.7,541.52,93.37,276.18,percent of total billed charges,38.7
STNT NON-COR TM DL 2,C2625,HCPCS,,,,,both,, ,722.03,2576.6,Blue Cross and Blue Shield,Traditional,,279.43,38.7,38.7,722.03,100.49,368.24,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,,1465.89,38.7,38.7,3787.83,1.97,1931.79,percent of total billed charges,38.7
INF PMP NON-PROG LV1,C2626,HCPCS,,,,,both,, ,545.13,8,Blue Cross and Blue Shield,Traditional,,210.97,38.7,38.7,545.13,0.31,278.02,percent of total billed charges,38.7
CATH SUPRPUBC-CYSTO1,C2627,HCPCS,,,,,both,, ,172.01,10077.78,Blue Cross and Blue Shield,Traditional,,66.57,38.7,38.7,172.01,393.03,87.73,percent of total billed charges,38.7
CATH SUPRPUBC-CYSTO2,C2627,HCPCS,,,,,both,, ,1075.84,2878.85,Blue Cross and Blue Shield,Traditional,,416.35,38.7,38.7,1075.84,112.28,548.68,percent of total billed charges,38.7
CATH OCCLUSION 1,C2628,HCPCS,,,,,both,, ,717.14,42411.02,Blue Cross and Blue Shield,Traditional,,277.53,38.7,38.7,717.14,1654.03,365.74,percent of total billed charges,38.7
CATH OCCLUSION 2,C2628,HCPCS,,,,,both,, ,1434.53,29428.39,Blue Cross and Blue Shield,Traditional,,555.16,38.7,38.7,1434.53,1147.71,731.61,percent of total billed charges,38.7
CATH OCCLUSION 3,C2628,HCPCS,,,,,both,, ,2390.63,106.25,Blue Cross and Blue Shield,Traditional,,925.17,38.7,38.7,2390.63,4.14,1219.22,percent of total billed charges,38.7
INTRO/SHEATH LASER 1,C2629,HCPCS,,,,,both,, ,5379.18,106.25,Blue Cross and Blue Shield,Traditional,,2081.74,38.7,38.7,5379.18,4.14,2743.38,percent of total billed charges,38.7
INTRO/SHEATH LASER 2,C2629,HCPCS,,,,,both,, ,7172.15,70.81,Blue Cross and Blue Shield,Traditional,,2775.62,38.7,38.7,7172.15,2.76,3657.8,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,,3199.05,38.7,38.7,8266.27,2.76,4215.8,percent of total billed charges,38.7
LC S SUB T/A/L 25S,C5271,HCPCS,,,,,both,, ,2393.6,109.18,Blue Cross and Blue Shield,Traditional,,926.32,38.7,38.7,2393.6,4.26,1220.74,percent of total billed charges,38.7
LC S SUB T/A/L ADL,C5272,HCPCS,,,,,both,, ,2393.6,143.69,Blue Cross and Blue Shield,Traditional,,926.32,38.7,38.7,2393.6,5.6,1220.74,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,,2689.7,38.7,38.7,6950.12,7.2,3544.56,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,,2689.7,38.7,38.7,6950.12,4.14,3544.56,percent of total billed charges,38.7
LC S SUB F/NK/HF/G,C5275,HCPCS,,,,,both,, ,2393.6,106.25,Blue Cross and Blue Shield,Traditional,,926.32,38.7,38.7,2393.6,4.14,1220.74,percent of total billed charges,38.7
LC S SUB F/NK/HF/G EA,C5276,HCPCS,,,,,both,, ,2393.6,105.06,Blue Cross and Blue Shield,Traditional,,926.32,38.7,38.7,2393.6,4.1,1220.74,percent of total billed charges,38.7
LC S SUB F/NK/HF/G 100SQ,C5277,HCPCS,,,,,both,, ,2393.6,105.06,Blue Cross and Blue Shield,Traditional,,926.32,38.7,38.7,2393.6,4.1,1220.74,percent of total billed charges,38.7
LC S SUB F/NK/HF/G EA,C5278,HCPCS,,,,,both,, ,2393.6,109.18,Blue Cross and Blue Shield,Traditional,,926.32,38.7,38.7,2393.6,4.26,1220.74,percent of total billed charges,38.7
MRA-ABDOMEN W,C8900,HCPCS,,,,,both,, ,1035.69,143.69,Blue Cross and Blue Shield,Traditional,,400.81,38.7,38.7,1035.69,5.6,528.2,percent of total billed charges,38.7
MRA-ABDOMEN W,C8900,HCPCS,,,,,both,, ,1114.55,184.63,Blue Cross and Blue Shield,Traditional,,431.33,38.7,38.7,1114.55,7.2,568.42,percent of total billed charges,38.7
MRA-ABDOMEN WO,C8901,HCPCS,,,,,both,, ,715.99,106.25,Blue Cross and Blue Shield,Traditional,,277.09,38.7,38.7,715.99,4.14,365.15,percent of total billed charges,38.7
MRA-ABDOMEN WO,C8901,HCPCS,,,,,both,, ,770.45,106.25,Blue Cross and Blue Shield,Traditional,,298.16,38.7,38.7,770.45,4.14,392.93,percent of total billed charges,38.7
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,1197.08,105.06,Blue Cross and Blue Shield,Traditional,,463.27,38.7,38.7,1197.08,4.1,610.51,percent of total billed charges,38.7
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,1288.29,105.06,Blue Cross and Blue Shield,Traditional,,498.57,38.7,38.7,1288.29,4.1,657.03,percent of total billed charges,38.7
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,2669.78,109.44,Blue Cross and Blue Shield,Traditional,,1033.2,38.7,38.7,2669.78,4.27,1361.59,percent of total billed charges,38.7
MR-BREAST UNI WWO,C8905,HCPCS,,,,,both,, ,3114.65,135.85,Blue Cross and Blue Shield,Traditional,,1205.37,38.7,38.7,3114.65,5.3,1588.47,percent of total billed charges,38.7
MR-BREAST BI WWO,C8908,HCPCS,,,,,both,, ,3115.2,1036.25,Blue Cross and Blue Shield,Traditional,,1205.58,38.7,38.7,3115.2,40.41,1588.75,percent of total billed charges,38.7
MRA-LW EXTR WWO,C8914,HCPCS,,,,,both,, ,1197.08,1036.25,Blue Cross and Blue Shield,Traditional,,463.27,38.7,38.7,1197.08,40.41,610.51,percent of total billed charges,38.7
MRA-LW EXTR WWO,C8914,HCPCS,,,,,both,, ,1288.29,1036.25,Blue Cross and Blue Shield,Traditional,,498.57,38.7,38.7,1288.29,40.41,657.03,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,,926.54,38.7,38.7,2394.15,10.2,1221.02,percent of total billed charges,38.7
MRA-LW EXTR WWO BI,C8914,CPT,,,,,both,, ,2576.6,195.06,Blue Cross and Blue Shield,Traditional,,997.14,38.7,38.7,2576.6,7.61,1314.07,percent of total billed charges,38.7
BR-CAD MRI LESION,C8937,HCPCS,,,,,both,, ,50.52,177.16,Blue Cross and Blue Shield,Traditional,,19.55,38.7,38.7,50.52,6.91,25.77,percent of total billed charges,38.7
COCAINE HCL NASL 1MG,C9046,HCPCS,,,,,both,4,ML,8,177.16,Blue Cross and Blue Shield,Traditional,,3.1,38.7,38.7,8,6.91,4.08,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,,3900.1,38.7,38.7,10077.78,6.91,5139.67,percent of total billed charges,38.7
REMDESIV 5MG/ML 20ML,C9399,HCPCS,,,,,both,, ,2878.85,9908.34,Blue Cross and Blue Shield,Traditional,,1114.11,38.7,38.7,2878.85,386.43,1468.21,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,,16413.06,38.7,38.7,42411.02,81.95,21629.62,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,,11388.79,38.7,38.7,29428.39,861.79,15008.48,percent of total billed charges,38.7
ADMIN FLU VACCINE,G0008,HCPCS,,,,,both,, ,106.25,265.23,Blue Cross and Blue Shield,Traditional,,41.12,38.7,38.7,106.25,10.34,54.19,percent of total billed charges,38.7
ADMIN FLU VACCINE,G0008,HCPCS,,,,,both,, ,106.25,160.68,Blue Cross and Blue Shield,Traditional,,41.12,38.7,38.7,106.25,6.27,54.19,percent of total billed charges,38.7
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,70.81,160.68,Blue Cross and Blue Shield,Traditional,,27.4,38.7,38.7,70.81,6.27,36.11,percent of total billed charges,38.7
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,70.81,133.9,Blue Cross and Blue Shield,Traditional,,27.4,38.7,38.7,70.81,5.22,36.11,percent of total billed charges,38.7
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,109.18,133.9,Blue Cross and Blue Shield,Traditional,,42.25,38.7,38.7,109.18,5.22,55.68,percent of total billed charges,38.7
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,143.69,443.37,Blue Cross and Blue Shield,Traditional,,55.61,38.7,38.7,143.69,17.29,73.28,percent of total billed charges,38.7
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,184.63,480.68,Blue Cross and Blue Shield,Traditional,,71.45,38.7,38.7,184.63,18.75,94.16,percent of total billed charges,38.7
ADMIN PNEU VACCINE,G0009,HCPCS,,,,,both,, ,106.25,37.08,Blue Cross and Blue Shield,Traditional,,41.12,38.7,38.7,106.25,1.45,54.19,percent of total billed charges,38.7
ADMIN PNEU VACCINE,G0009,HCPCS,,,,,both,, ,106.25,37.08,Blue Cross and Blue Shield,Traditional,,41.12,38.7,38.7,106.25,1.45,54.19,percent of total billed charges,38.7
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,105.06,37.08,Blue Cross and Blue Shield,Traditional,,40.66,38.7,38.7,105.06,1.45,53.58,percent of total billed charges,38.7
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,105.06,37.08,Blue Cross and Blue Shield,Traditional,,40.66,38.7,38.7,105.06,1.45,53.58,percent of total billed charges,38.7
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,109.18,515,Blue Cross and Blue Shield,Traditional,,42.25,38.7,38.7,109.18,20.09,55.68,percent of total billed charges,38.7
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,143.69,515,Blue Cross and Blue Shield,Traditional,,55.61,38.7,38.7,143.69,20.09,73.28,percent of total billed charges,38.7
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,184.63,474.83,Blue Cross and Blue Shield,Traditional,,71.45,38.7,38.7,184.63,18.52,94.16,percent of total billed charges,38.7
HEP B VACCINE ADMIN,G0010,HCPCS,,,,,both,, ,106.25,474.83,Blue Cross and Blue Shield,Traditional,,41.12,38.7,38.7,106.25,18.52,54.19,percent of total billed charges,38.7
HEP B VACCINE ADMIN,G0010,HCPCS,,,,,both,, ,106.25,159.42,Blue Cross and Blue Shield,Traditional,,41.12,38.7,38.7,106.25,6.22,54.19,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,,40.66,38.7,38.7,105.06,46.39,53.58,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,,40.66,38.7,38.7,105.06,46.39,53.58,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,,42.35,38.7,38.7,109.44,5.51,55.81,percent of total billed charges,38.7
"PSA, SCREENING",G0103,HCPCS,,,,,both,, ,135.85,151.15,Blue Cross and Blue Shield,Traditional,,52.57,38.7,38.7,135.85,5.89,69.28,percent of total billed charges,38.7
"PSA, SCREENING",G0103,HCPCS,,,,,both,,,1036.25,151.15,Blue Cross and Blue Shield,Traditional,,401.03,38.7,38.7,1036.25,5.89,528.49,percent of total billed charges,38.7
"PSA, SCREENING",G0103,CPT,,,,,both,, ,1036.25,610.15,Blue Cross and Blue Shield,Traditional,,401.03,38.7,38.7,1036.25,23.8,528.49,percent of total billed charges,38.7
"PSA, SCREENING",G0103,CPT,,,,,both,, ,1036.25,653.54,Blue Cross and Blue Shield,Traditional,,401.03,38.7,38.7,1036.25,25.49,528.49,percent of total billed charges,38.7
DSMT INDIVIDUAL 30M,G0108,HCPCS,,,,,both,, ,261.62,653.54,Blue Cross and Blue Shield,Traditional,,101.25,38.7,38.7,261.62,25.49,133.43,percent of total billed charges,38.7
PAP THINLAY LIQ SCRN,G0123,HCPCS,,,,,both,, ,195.06,428.48,Blue Cross and Blue Shield,Traditional,,75.49,38.7,38.7,195.06,16.71,99.48,percent of total billed charges,38.7
STRNGTH TRN SLG 15MI,G0237,HCPCS,,,,,both,, ,177.16,428.48,Blue Cross and Blue Shield,Traditional,,68.56,38.7,38.7,177.16,16.71,90.35,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,,68.56,38.7,38.7,177.16,41.32,90.35,percent of total billed charges,38.7
RESP FX TRAIN GROUP,G0239,HCPCS,,,,,both,, ,177.16,113.39,Blue Cross and Blue Shield,Traditional,,68.56,38.7,38.7,177.16,4.42,90.35,percent of total billed charges,38.7
DIALYSIS  EMERGENT,G0257,HCPCS,,,,,both,, ,9908.34,165.59,Blue Cross and Blue Shield,Traditional,,3834.53,38.7,38.7,9908.34,6.46,5053.25,percent of total billed charges,38.7
IR-ARTHROGRAM SI JTS,G0260,HCPCS,,,,,both,, ,2101.41,42.66,Blue Cross and Blue Shield,Traditional,,813.25,38.7,38.7,2101.41,1.66,1071.72,percent of total billed charges,38.7
CC-PLACE CLOS DEV,G0269,HCPCS,,,,,both,, ,22097.11,1036.25,Blue Cross and Blue Shield,Traditional,,8551.58,38.7,38.7,22097.11,40.41,11269.53,percent of total billed charges,38.7
HBO FB 30MN,G0277,HCPCS,,,,,both,, ,265.23,215.75,Blue Cross and Blue Shield,Traditional,,102.64,38.7,38.7,265.23,8.41,135.27,percent of total billed charges,38.7
BR-TOMO MAMMO BI,G0279,HCPCS,,,,,both,,,160.68,261,Blue Cross and Blue Shield,Traditional,,62.18,38.7,38.7,160.68,10.18,81.95,percent of total billed charges,38.7
BR-TOMO MAMMO BI,G0279,HCPCS,,,,,both,, ,160.68,520,Blue Cross and Blue Shield,Traditional,,62.18,38.7,38.7,160.68,20.28,81.95,percent of total billed charges,38.7
BR-TOMO MAMMO UNI,G0279,HCPCS,,,,,both,,,133.9,132.61,Blue Cross and Blue Shield,Traditional,,51.82,38.7,38.7,133.9,5.17,68.29,percent of total billed charges,38.7
BR-TOMO MAMMO UNI,G0279,HCPCS,,,,,both,, ,133.9,132.61,Blue Cross and Blue Shield,Traditional,,51.82,38.7,38.7,133.9,5.17,68.29,percent of total billed charges,38.7
ELEC STIM-UNATTND-VI,G0283,HCPCS,,,,,both,, ,443.37,249.52,Blue Cross and Blue Shield,Traditional,,171.58,38.7,38.7,443.37,9.73,226.12,percent of total billed charges,38.7
ELEC STIM-UNATTND-VI,G0283,HCPCS,,,,,both,, ,480.68,188.75,Blue Cross and Blue Shield,Traditional,,186.02,38.7,38.7,480.68,7.36,245.15,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,,14.35,38.7,38.7,37.08,7.36,18.91,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,,14.35,38.7,38.7,37.08,9.82,18.91,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,,14.35,38.7,38.7,37.08,9.82,18.91,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,,14.35,38.7,38.7,37.08,9.82,18.91,percent of total billed charges,38.7
ELEC STM-UNAT-VI OT,G0283,HCPCS,,,,,both,, ,515,251.84,Blue Cross and Blue Shield,Traditional,,199.31,38.7,38.7,515,9.82,262.65,percent of total billed charges,38.7
ELEC STM-UNAT-VI OT,G0283,HCPCS,,,,,both,, ,515,188.75,Blue Cross and Blue Shield,Traditional,,199.31,38.7,38.7,515,7.36,262.65,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,,183.76,38.7,38.7,474.83,12.64,242.16,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,,183.76,38.7,38.7,474.83,12.64,242.16,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,,61.7,38.7,38.7,159.42,16.61,81.3,percent of total billed charges,38.7
OBSERVATION 1ST HOUR,G0378,HCPCS,,,,,both,, ,1189.39,700.4,Blue Cross and Blue Shield,Traditional,,460.29,38.7,38.7,1189.39,27.32,606.59,percent of total billed charges,38.7
OBSERVATION 1ST HOUR,G0378,HCPCS,,,,,both,, ,1189.39,325.25,Blue Cross and Blue Shield,Traditional,,460.29,38.7,38.7,1189.39,12.68,606.59,percent of total billed charges,38.7
OBSRVATION ADDL HOUR,G0378,HCPCS,,,,,both,, ,141.21,379.5,Blue Cross and Blue Shield,Traditional,,54.65,38.7,38.7,141.21,14.8,72.02,percent of total billed charges,38.7
OBSRVATION ADDL HOUR,G0378,HCPCS,,,,,both,, ,151.15,433.5,Blue Cross and Blue Shield,Traditional,,58.5,38.7,38.7,151.15,16.91,77.09,percent of total billed charges,38.7
OBSRVATION ADDL HOUR,G0378,HCPCS,,,,,both,, ,151.15,487.5,Blue Cross and Blue Shield,Traditional,,58.5,38.7,38.7,151.15,19.01,77.09,percent of total billed charges,38.7
DIRECT ADMIT TO OBS,G0379,HCPCS,,,,,both,, ,610.15,55.62,Blue Cross and Blue Shield,Traditional,,236.13,38.7,38.7,610.15,2.17,311.18,percent of total billed charges,38.7
DIRECT ADMIT TO OBS,G0379,HCPCS,,,,,both,, ,653.54,55.62,Blue Cross and Blue Shield,Traditional,,252.92,38.7,38.7,653.54,2.17,333.31,percent of total billed charges,38.7
DIRECT ADMIT TO OBS,G0379,HCPCS,,,,,both,, ,653.54,66.95,Blue Cross and Blue Shield,Traditional,,252.92,38.7,38.7,653.54,2.61,333.31,percent of total billed charges,38.7
HOME SLEEP TYPE 3,G0399,HCPCS,,,,,both,, ,428.48,66.95,Blue Cross and Blue Shield,Traditional,,165.82,38.7,38.7,428.48,2.61,218.52,percent of total billed charges,38.7
HOME SLEEP TYPE 3,G0399,HCPCS,,,,,both,, ,428.48,294.25,Blue Cross and Blue Shield,Traditional,,165.82,38.7,38.7,428.48,11.48,218.52,percent of total billed charges,38.7
PROSTATE NDL BX ANY,G0416,HCPCS,,,,,both,, ,1059.54,60.5,Blue Cross and Blue Shield,Traditional,,410.04,38.7,38.7,1059.54,2.36,540.37,percent of total billed charges,38.7
HIV-1 AB EIA,G0432,HCPCS,,,,,both,, ,113.39,123.25,Blue Cross and Blue Shield,Traditional,,43.88,38.7,38.7,113.39,4.81,57.83,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,,64.08,38.7,38.7,165.59,4.81,84.45,percent of total billed charges,38.7
HIV1-HIV2 AB SNG RES,G0435,CPT,,,,,both,, ,42.66,213,Blue Cross and Blue Shield,Traditional,,16.51,38.7,38.7,42.66,8.31,21.76,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,,401.03,38.7,38.7,1036.25,8.18,528.49,percent of total billed charges,38.7
EVAL & MGMT LEVEL 3,G0463,HCPCS,,,,,both,, ,215.75,312.5,Blue Cross and Blue Shield,Traditional,,83.5,38.7,38.7,215.75,12.19,110.03,percent of total billed charges,38.7
EVAL & MGMT LEVEL 5,G0463,HCPCS,,,,,both,, ,261,309.25,Blue Cross and Blue Shield,Traditional,,101.01,38.7,38.7,261,12.06,133.11,percent of total billed charges,38.7
HOSPITAL OUTPT VISIT,G0463,HCPCS,,,,,both,, ,520,483.5,Blue Cross and Blue Shield,Traditional,,201.24,38.7,38.7,520,18.86,265.2,percent of total billed charges,38.7
LEVEL 1 EP,G0463,HCPCS,,,,,both,, ,132.61,414.25,Blue Cross and Blue Shield,Traditional,,51.32,38.7,38.7,132.61,16.16,67.63,percent of total billed charges,38.7
LEVEL 1 EP,G0463,HCPCS,,,,,both,, ,132.61,602.5,Blue Cross and Blue Shield,Traditional,,51.32,38.7,38.7,132.61,23.5,67.63,percent of total billed charges,38.7
LEVEL 1 EP,G0463,HCPCS,,,,,both,, ,249.52,239.73,Blue Cross and Blue Shield,Traditional,,96.56,38.7,38.7,249.52,9.35,127.26,percent of total billed charges,38.7
LEVEL 2 EP,G0463,HCPCS,,,,,both,, ,188.75,239.73,Blue Cross and Blue Shield,Traditional,,73.05,38.7,38.7,188.75,9.35,96.26,percent of total billed charges,38.7
LEVEL 2 NP,G0463,HCPCS,,,,,both,, ,188.75,239.73,Blue Cross and Blue Shield,Traditional,,73.05,38.7,38.7,188.75,9.35,96.26,percent of total billed charges,38.7
LEVEL 3 EP,G0463,HCPCS,,,,,both,, ,251.84,239.73,Blue Cross and Blue Shield,Traditional,,97.46,38.7,38.7,251.84,9.35,128.44,percent of total billed charges,38.7
LEVEL 3 EP,G0463,HCPCS,,,,,both,, ,251.84,234.07,Blue Cross and Blue Shield,Traditional,,97.46,38.7,38.7,251.84,9.13,128.44,percent of total billed charges,38.7
LEVEL 3 EP,G0463,HCPCS,,,,,both,, ,251.84,234.07,Blue Cross and Blue Shield,Traditional,,97.46,38.7,38.7,251.84,9.13,128.44,percent of total billed charges,38.7
LEVEL 3 EP,G0463,HCPCS,,,,,both,, ,251.84,281.71,Blue Cross and Blue Shield,Traditional,,97.46,38.7,38.7,251.84,10.99,128.44,percent of total billed charges,38.7
LEVEL 3 NP,G0463,HCPCS,,,,,both,, ,188.75,281.71,Blue Cross and Blue Shield,Traditional,,73.05,38.7,38.7,188.75,10.99,96.26,percent of total billed charges,38.7
LEVEL 4 EP,G0463,HCPCS,,,,,both,, ,324.19,261.88,Blue Cross and Blue Shield,Traditional,,125.46,38.7,38.7,324.19,10.21,165.34,percent of total billed charges,38.7
LEVEL 4 EP,G0463,HCPCS,,,,,both,, ,324.19,261.88,Blue Cross and Blue Shield,Traditional,,125.46,38.7,38.7,324.19,10.21,165.34,percent of total billed charges,38.7
LEVEL 5 EP,G0463,HCPCS,,,,,both,, ,425.91,311.83,Blue Cross and Blue Shield,Traditional,,164.83,38.7,38.7,425.91,12.16,217.21,percent of total billed charges,38.7
OB TRIAGE LVL 1 EP,G0463,HCPCS,,,,,both,, ,700.4,311.83,Blue Cross and Blue Shield,Traditional,,271.05,38.7,38.7,700.4,12.16,357.2,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,,125.87,38.7,38.7,325.25,11.3,165.88,percent of total billed charges,38.7
PAT EVAL/MGM LEVEL 3,G0463,HCPCS,,,,,both,, ,379.5,289.69,Blue Cross and Blue Shield,Traditional,,146.87,38.7,38.7,379.5,11.3,193.55,percent of total billed charges,38.7
PAT EVAL/MGM LEVEL 4,G0463,HCPCS,,,,,both,, ,433.5,317.5,Blue Cross and Blue Shield,Traditional,,167.76,38.7,38.7,433.5,12.38,221.09,percent of total billed charges,38.7
PAT EVAL/MGM LEVEL 5,G0463,HCPCS,,,,,both,, ,487.5,317.5,Blue Cross and Blue Shield,Traditional,,188.66,38.7,38.7,487.5,12.38,248.63,percent of total billed charges,38.7
PHYSICAL-EMPLOYMENT,G0463,HCPCS,,,,,both,, ,55.62,317.5,Blue Cross and Blue Shield,Traditional,,21.52,38.7,38.7,55.62,12.38,28.37,percent of total billed charges,38.7
PHYSICAL-EMPLOYMENT,G0463,HCPCS,,,,,both,, ,55.62,317.5,Blue Cross and Blue Shield,Traditional,,21.52,38.7,38.7,55.62,12.38,28.37,percent of total billed charges,38.7
PHYSICAL-SCHOOL,G0463,HCPCS,,,,,both,, ,66.95,166.16,Blue Cross and Blue Shield,Traditional,,25.91,38.7,38.7,66.95,6.48,34.14,percent of total billed charges,38.7
PHYSICAL-SCHOOL,G0463,HCPCS,,,,,both,, ,66.95,570.04,Blue Cross and Blue Shield,Traditional,,25.91,38.7,38.7,66.95,22.23,34.14,percent of total billed charges,38.7
PSYCH CLINIC TYPE A,G0463,HCPCS,,,,,both,, ,294.25,4719.72,Blue Cross and Blue Shield,Traditional,,113.87,38.7,38.7,294.25,184.07,150.07,percent of total billed charges,38.7
URG CARE L1 EP PROF,G0463,HCPCS,,,,,both,, ,60.5,3,Blue Cross and Blue Shield,Traditional,,23.41,38.7,38.7,60.5,0.12,30.86,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,,47.7,38.7,38.7,123.25,0.69,62.86,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,,47.7,38.7,38.7,123.25,0.01,62.86,percent of total billed charges,38.7
URG CARE L2 NP PROF,G0463,HCPCS,,,,,both,, ,213,1.03,Blue Cross and Blue Shield,Traditional,,82.43,38.7,38.7,213,0.04,108.63,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,,81.17,38.7,38.7,209.75,0.6,106.97,percent of total billed charges,38.7
URG CARE L3 NP PROF,G0463,HCPCS,,,,,both,, ,312.5,15.45,Blue Cross and Blue Shield,Traditional,,120.94,38.7,38.7,312.5,0.6,159.38,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,,119.68,38.7,38.7,309.25,0.1,157.72,percent of total billed charges,38.7
URG CARE L4 NP PROF,G0463,HCPCS,,,,,both,, ,483.5,8.65,Blue Cross and Blue Shield,Traditional,,187.11,38.7,38.7,483.5,0.34,246.59,percent of total billed charges,38.7
URG CARE L5 EP PROF,G0463,HCPCS,,,,,both,, ,414.25,4,Blue Cross and Blue Shield,Traditional,,160.31,38.7,38.7,414.25,0.16,211.27,percent of total billed charges,38.7
URG CARE L5 NP PROF,G0463,HCPCS,,,,,both,, ,602.5,28,Blue Cross and Blue Shield,Traditional,,233.17,38.7,38.7,602.5,1.09,307.28,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,,92.78,38.7,38.7,239.73,0.22,122.26,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,,92.78,38.7,38.7,239.73,2.3,122.26,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,,92.78,38.7,38.7,239.73,3.76,122.26,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,,92.78,38.7,38.7,239.73,0.2,122.26,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,,90.59,38.7,38.7,234.07,0.25,119.38,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,,90.59,38.7,38.7,234.07,12.53,119.38,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,,109.02,38.7,38.7,281.71,8.23,143.67,percent of total billed charges,38.7
URGENT CARE LVL 3 EP,G0463,HCPCS,,,,,both,, ,281.71,17,Blue Cross and Blue Shield,Traditional,,109.02,38.7,38.7,281.71,0.66,143.67,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,,101.35,38.7,38.7,261.88,1.04,133.56,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,,101.35,38.7,38.7,261.88,1.04,133.56,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,,120.68,38.7,38.7,311.83,2.26,159.03,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,,120.68,38.7,38.7,311.83,0.92,159.03,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,,112.11,38.7,38.7,289.69,2.46,147.74,percent of total billed charges,38.7
URGENT CARE LVL 4 NP,G0463,HCPCS,,,,,both,, ,289.69,13,Blue Cross and Blue Shield,Traditional,,112.11,38.7,38.7,289.69,0.51,147.74,percent of total billed charges,38.7
URGENT CARE LVL 5 EP,G0463,HCPCS,,,,,both,, ,317.5,20.34,Blue Cross and Blue Shield,Traditional,,122.87,38.7,38.7,317.5,0.79,161.93,percent of total billed charges,38.7
URGENT CARE LVL 5 EP,G0463,HCPCS,,,,,both,, ,317.5,101.71,Blue Cross and Blue Shield,Traditional,,122.87,38.7,38.7,317.5,3.97,161.93,percent of total billed charges,38.7
URGENT CARE LVL 5 EP,G0463,HCPCS,,,,,both,, ,317.5,40.69,Blue Cross and Blue Shield,Traditional,,122.87,38.7,38.7,317.5,1.59,161.93,percent of total billed charges,38.7
URGENT CARE LVL 5 EP,G0463,HCPCS,,,,,both,, ,317.5,2,Blue Cross and Blue Shield,Traditional,,122.87,38.7,38.7,317.5,0.08,161.93,percent of total billed charges,38.7
EVAL & MGMT LEVEL 4,G0463,HCPCS,,,,,Outpatient,, ,237.25,0.03,Blue Cross and Blue Shield,Traditional,,91.82,38.7,38.7,237.25,0.19,121,percent of total billed charges,38.7
"New patient office of other outpatient visit, typically 60 min",G0463,HCPCS,,,,,Outpatient,,,317.5,0.62,Blue Cross and Blue Shield,Traditional,,122.87,38.7,38.7,317.5,0.02,161.93,percent of total billed charges,38.7
"New patient office of other outpatient visit, typically 45 min",G0463,HCPCS,,,,,Outpatient,,,289.69,1.03,Blue Cross and Blue Shield,Traditional,,112.11,38.7,38.7,289.69,0.04,147.74,percent of total billed charges,38.7
"New patient office or other outpatient visit, typically 30 min",G0463,HCPCS,,,,,Outpatient,,,261.88,198.28,Blue Cross and Blue Shield,Traditional,,101.35,38.7,38.7,261.88,7.73,133.56,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,,64.3,38.7,38.7,166.16,11.99,84.74,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,,220.61,38.7,38.7,570.04,10.27,290.72,percent of total billed charges,38.7
ABCIXIMAB 10MG,J0130,HCPCS,,,,,both,, ,4719.72,34.25,Blue Cross and Blue Shield,Traditional,,1826.53,38.7,38.7,4719.72,1.34,2407.06,percent of total billed charges,38.7
ACETAMINO 10MG INJ,J0131,HCPCS,,,,,both,100,ML,3,35.54,Blue Cross and Blue Shield,Traditional,,1.16,38.7,38.7,3,1.39,1.53,percent of total billed charges,38.7
ACTYLCYSTN INJ 100MG,J0132,HCPCS,,,,,both,30,ML,17.77,43,Blue Cross and Blue Shield,Traditional,,6.88,38.7,38.7,17.77,1.68,9.06,percent of total billed charges,38.7
ACYCLOVIR 5MG INJ,J0133,HCPCS,,,,,both,, ,0.31,18.28,Blue Cross and Blue Shield,Traditional,,0.12,38.7,38.7,0.31,0.71,0.16,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,,0.4,38.7,38.7,1.03,1.31,0.53,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,,5.98,38.7,38.7,15.45,0.69,7.88,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,,5.98,38.7,38.7,15.45,0.24,7.88,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,,1.04,38.7,38.7,2.68,0.17,1.37,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,,3.35,38.7,38.7,8.65,3.29,4.41,percent of total billed charges,38.7
EPINEPHRINE INJ 30MG/30ML (1 MG/ML),J0171,HCPCS,,,,,both,30,ML,4,19.31,Blue Cross and Blue Shield,Traditional,,1.55,38.7,38.7,4,0.75,2.04,percent of total billed charges,38.7
REMDESIVIR 1MG INJ,J0248,HCPCS,,,,,both,1,EA,28,21.89,Blue Cross and Blue Shield,Traditional,,10.84,38.7,38.7,28,0.85,14.28,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,,2.15,38.7,38.7,5.56,0.5,2.84,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,,22.82,38.7,38.7,58.97,0.5,30.07,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,,37.27,38.7,38.7,96.31,0.58,49.12,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,,1.99,38.7,38.7,5.15,0.58,2.63,percent of total billed charges,38.7
AMIODARONE 30MG INJ,J0282,HCPCS,,,,,both,3,ML,6.39,22.4,Blue Cross and Blue Shield,Traditional,,2.47,38.7,38.7,6.39,0.87,3.26,percent of total billed charges,38.7
AMPHOTER B 50MG INJ,J0285,HCPCS,,,,,both,, ,321.36,9,Blue Cross and Blue Shield,Traditional,,124.37,38.7,38.7,321.36,0.35,163.89,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,,81.72,38.7,38.7,211.15,0.74,107.69,percent of total billed charges,38.7
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,17,24.72,Blue Cross and Blue Shield,Traditional,,6.58,38.7,38.7,17,0.96,8.67,percent of total billed charges,38.7
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,, ,26.78,53.82,Blue Cross and Blue Shield,Traditional,,10.36,38.7,38.7,26.78,2.1,13.66,percent of total billed charges,38.7
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,, ,26.78,28.84,Blue Cross and Blue Shield,Traditional,,10.36,38.7,38.7,26.78,1.12,13.66,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,,22.42,38.7,38.7,57.94,0.31,29.55,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,,9.17,38.7,38.7,23.69,0.45,12.08,percent of total billed charges,38.7
AMPICILLIN/SUB 1.5GM,J0295,HCPCS,,,,,both,, ,63.09,12.88,Blue Cross and Blue Shield,Traditional,,24.42,38.7,38.7,63.09,0.5,32.18,percent of total billed charges,38.7
SUCCINYLCHN 20MG INJ,J0330,HCPCS,,,,,both,10,ML,13,24.72,Blue Cross and Blue Shield,Traditional,,5.03,38.7,38.7,13,0.96,6.63,percent of total billed charges,38.7
SUCCINYLCHN 20MG INJ,J0330,HCPCS,,,,,both,, ,20.34,23.69,Blue Cross and Blue Shield,Traditional,,7.87,38.7,38.7,20.34,0.92,10.37,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,,39.36,38.7,38.7,101.71,1.76,51.87,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,,15.75,38.7,38.7,40.69,2.19,20.75,percent of total billed charges,38.7
ATROPINE 0.01 MG INJ,J0461,HCPCS,,,,,both,1,ML,2,16.48,Blue Cross and Blue Shield,Traditional,,0.77,38.7,38.7,2,0.64,1.02,percent of total billed charges,38.7
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,, ,0.03,24.72,Blue Cross and Blue Shield,Traditional,,0.01,38.7,38.7,0.03,0.96,0.02,percent of total billed charges,38.7
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,, ,0.62,236.64,Blue Cross and Blue Shield,Traditional,,0.24,38.7,38.7,0.62,9.23,0.32,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,,0.4,38.7,38.7,1.03,1.55,0.53,percent of total billed charges,38.7
DIMERCAPRO 100MG INJ,J0470,HCPCS,,,,,both,, ,198.28,687.78,Blue Cross and Blue Shield,Traditional,,76.73,38.7,38.7,198.28,26.82,101.12,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,,118.99,38.7,38.7,307.46,3.34,156.8,percent of total billed charges,38.7
BENZTROPN MES 1MGINJ,J0515,HCPCS,,,,,both,2,ML,263.42,3.5,Blue Cross and Blue Shield,Traditional,,101.94,38.7,38.7,263.42,0.14,134.34,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,,13.25,38.7,38.7,34.25,1.52,17.47,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,,13.75,38.7,38.7,35.54,1.52,18.13,percent of total billed charges,38.7
PEN G BENZ INJ 100K,J0561,HCPCS,,,,,both,2,ML,43,42.75,Blue Cross and Blue Shield,Traditional,,16.64,38.7,38.7,43,1.67,21.93,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,,7.07,38.7,38.7,18.28,1.67,9.32,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,,12.96,38.7,38.7,33.48,1.67,17.07,percent of total billed charges,38.7
BUTORPHANOL 1MG INJ,J0595,HCPCS,,,,,both,1,ML,17.77,18.8,Blue Cross and Blue Shield,Traditional,,6.88,38.7,38.7,17.77,0.73,9.06,percent of total billed charges,38.7
CINACALC 1MG PO ESRD,J0604,HCPCS,,,,,both,, ,6.18,111.5,Blue Cross and Blue Shield,Traditional,,2.39,38.7,38.7,6.18,4.35,3.15,percent of total billed charges,38.7
CALCITRIOL .1MCG INJ,J0636,HCPCS,,,,,both,, ,4.33,111.5,Blue Cross and Blue Shield,Traditional,,1.68,38.7,38.7,4.33,4.35,2.21,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,,32.69,38.7,38.7,84.46,4.85,43.07,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,,7.47,38.7,38.7,19.31,6.35,9.85,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,,8.47,38.7,38.7,21.89,6.35,11.16,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,,4.98,38.7,38.7,12.88,6.35,6.57,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,,4.98,38.7,38.7,12.88,2.59,6.57,percent of total billed charges,38.7
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,, ,14.94,132.87,Blue Cross and Blue Shield,Traditional,,5.78,38.7,38.7,14.94,5.18,7.62,percent of total billed charges,38.7
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,, ,14.94,96.31,Blue Cross and Blue Shield,Traditional,,5.78,38.7,38.7,14.94,3.76,7.62,percent of total billed charges,38.7
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,22.4,4.43,Blue Cross and Blue Shield,Traditional,,8.67,38.7,38.7,22.4,0.17,11.42,percent of total billed charges,38.7
CEFEPIME 500 MG INJ,J0692,CPT,,,,,both,1,EA,9,0.93,Blue Cross and Blue Shield,Traditional,,3.48,38.7,38.7,9,0.04,4.59,percent of total billed charges,38.7
CEFEPIME 500MG INJ,J0692,HCPCS,,,,,both,, ,19.06,593.28,Blue Cross and Blue Shield,Traditional,,7.38,38.7,38.7,19.06,23.14,9.72,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,,9.57,38.7,38.7,24.72,0.25,12.61,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,,20.83,38.7,38.7,53.82,12.03,27.45,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,,11.16,38.7,38.7,28.84,1.84,14.71,percent of total billed charges,38.7
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,8.03,6881.43,Blue Cross and Blue Shield,Traditional,,3.11,38.7,38.7,8.03,268.38,4.1,percent of total billed charges,38.7
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,11.59,5.36,Blue Cross and Blue Shield,Traditional,,4.49,38.7,38.7,11.59,0.21,5.91,percent of total billed charges,38.7
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,12.88,12.88,Blue Cross and Blue Shield,Traditional,,4.98,38.7,38.7,12.88,0.5,6.57,percent of total billed charges,38.7
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,24.72,1352.91,Blue Cross and Blue Shield,Traditional,,9.57,38.7,38.7,24.72,52.76,12.61,percent of total billed charges,38.7
CEFUROXIME 750MG INJ,J0697,HCPCS,,,,,both,, ,23.69,13.91,Blue Cross and Blue Shield,Traditional,,9.17,38.7,38.7,23.69,0.54,12.08,percent of total billed charges,38.7
CEFUROXIME 750MG INJ,J0697,HCPCS,,,,,both,, ,45.06,26.78,Blue Cross and Blue Shield,Traditional,,17.44,38.7,38.7,45.06,1.04,22.98,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,,21.73,38.7,38.7,56.14,1.12,28.63,percent of total billed charges,38.7
CEFTAROLIN 10MG INJ,J0712,HCPCS,,,,,both,, ,16.48,78.28,Blue Cross and Blue Shield,Traditional,,6.38,38.7,38.7,16.48,3.05,8.4,percent of total billed charges,38.7
CEFTAROLIN 10MG INJ,J0712,HCPCS,,,,,both,, ,24.72,8.55,Blue Cross and Blue Shield,Traditional,,9.57,38.7,38.7,24.72,0.33,12.61,percent of total billed charges,38.7
COLISTIME UP TO 150M,J0770,CPT,,,,,both,1,EA,236.64,164.8,Blue Cross and Blue Shield,Traditional,,91.58,38.7,38.7,236.64,6.43,120.69,percent of total billed charges,38.7
PROCHLORPE UPTO 10MG,J0780,HCPCS,,,,,both,, ,39.66,298.96,Blue Cross and Blue Shield,Traditional,,15.35,38.7,38.7,39.66,11.66,20.23,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,,266.17,38.7,38.7,687.78,7.68,350.77,percent of total billed charges,38.7
DALBAVANCIN 5MG INJ,J0875,HCPCS,,,,,both,, ,85.75,1016.61,Blue Cross and Blue Shield,Traditional,,33.19,38.7,38.7,85.75,39.65,43.73,percent of total billed charges,38.7
DAPTOMYCIN 1 MG INJ,J0878,HCPCS,,,,,both,1,EA,3.5,7,Blue Cross and Blue Shield,Traditional,,1.35,38.7,38.7,3.5,0.27,1.79,percent of total billed charges,38.7
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,38.88,4.53,Blue Cross and Blue Shield,Traditional,,15.05,38.7,38.7,38.88,0.18,19.83,percent of total billed charges,38.7
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,38.88,4.53,Blue Cross and Blue Shield,Traditional,,15.05,38.7,38.7,38.88,0.18,19.83,percent of total billed charges,38.7
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,32.19,Blue Cross and Blue Shield,Traditional,,16.54,38.7,38.7,42.75,1.26,21.8,percent of total billed charges,38.7
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,84.72,Blue Cross and Blue Shield,Traditional,,16.54,38.7,38.7,42.75,3.3,21.8,percent of total billed charges,38.7
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,144.72,Blue Cross and Blue Shield,Traditional,,16.54,38.7,38.7,42.75,5.64,21.8,percent of total billed charges,38.7
ARGATROBAN 1MG NESRD,J0883,HCPCS,,,,,both,2.5,ML,18.8,43.52,Blue Cross and Blue Shield,Traditional,,7.28,38.7,38.7,18.8,1.7,9.59,percent of total billed charges,38.7
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,111.5,10.82,Blue Cross and Blue Shield,Traditional,,43.15,38.7,38.7,111.5,0.42,56.87,percent of total billed charges,38.7
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,111.5,390.89,Blue Cross and Blue Shield,Traditional,,43.15,38.7,38.7,111.5,15.24,56.87,percent of total billed charges,38.7
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,124.37,390.89,Blue Cross and Blue Shield,Traditional,,48.13,38.7,38.7,124.37,15.24,63.43,percent of total billed charges,38.7
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,270.89,Blue Cross and Blue Shield,Traditional,,62.98,38.7,38.7,162.74,10.56,83,percent of total billed charges,38.7
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,270.89,Blue Cross and Blue Shield,Traditional,,62.98,38.7,38.7,162.74,10.56,83,percent of total billed charges,38.7
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,319.82,Blue Cross and Blue Shield,Traditional,,62.98,38.7,38.7,162.74,12.47,83,percent of total billed charges,38.7
DEFEROXAMIN 500MGINJ,J0895,HCPCS,,,,,both,1,EA,66.44,319.82,Blue Cross and Blue Shield,Traditional,,25.71,38.7,38.7,66.44,12.47,33.88,percent of total billed charges,38.7
DEFEROXAMIN 500MGINJ,J0895,HCPCS,,,,,both,, ,132.87,615.94,Blue Cross and Blue Shield,Traditional,,51.42,38.7,38.7,132.87,24.02,67.76,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,,37.27,38.7,38.7,96.31,10.02,49.12,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,,1.71,38.7,38.7,4.43,10.02,2.26,percent of total billed charges,38.7
TESTOSTER CYPION 1MG,J1071,HCPCS,,,,,both,, ,0.93,24.72,Blue Cross and Blue Shield,Traditional,,0.36,38.7,38.7,0.93,0.96,0.47,percent of total billed charges,38.7
TESTOSTER CYPION 1MG,J1071,HCPCS,,,,,both,, ,593.28,27.81,Blue Cross and Blue Shield,Traditional,,229.6,38.7,38.7,593.28,1.08,302.57,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,,2.47,38.7,38.7,6.39,1.12,3.26,percent of total billed charges,38.7
ACETAZOLAMI 500MGINJ,J1120,HCPCS,,,,,both,1,EA,308.49,710.19,Blue Cross and Blue Shield,Traditional,,119.39,38.7,38.7,308.49,27.7,157.33,percent of total billed charges,38.7
DIGOXIN 0.5MG INJ,J1160,HCPCS,,,,,both,2,ML,47.12,1505,Blue Cross and Blue Shield,Traditional,,18.24,38.7,38.7,47.12,58.7,24.03,percent of total billed charges,38.7
DIGOXIN IMMUNE FAB,J1162,HCPCS,,,,,both,1,EA,6881.43,68.5,Blue Cross and Blue Shield,Traditional,,2663.11,38.7,38.7,6881.43,2.67,3509.53,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,,2.07,38.7,38.7,5.36,7.14,2.73,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,,4.98,38.7,38.7,12.88,8.48,6.57,percent of total billed charges,38.7
DEXRAZOXANE 25OMG IJ,J1190,HCPCS,,,,,both,, ,1352.91,0.52,Blue Cross and Blue Shield,Traditional,,523.58,38.7,38.7,1352.91,0.02,689.98,percent of total billed charges,38.7
DIPHENHYDRAM 50MGINJ,J1200,HCPCS,,,,,both,1,ML,13.91,0.93,Blue Cross and Blue Shield,Traditional,,5.38,38.7,38.7,13.91,0.04,7.09,percent of total billed charges,38.7
DIPYRIDAMOLE 10MGINJ,J1245,HCPCS,,,,,both,, ,26.78,2.16,Blue Cross and Blue Shield,Traditional,,10.36,38.7,38.7,26.78,0.08,13.66,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,,11.16,38.7,38.7,28.84,0.22,14.71,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,,30.29,38.7,38.7,78.28,0.25,39.92,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,,3.31,38.7,38.7,8.55,0.76,4.36,percent of total billed charges,38.7
EPTIFABITIDE 5MG IJ,J1327,HCPCS,,,,,both,, ,164.8,27.81,Blue Cross and Blue Shield,Traditional,,63.78,38.7,38.7,164.8,1.08,84.05,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,,115.7,38.7,38.7,298.96,1.12,152.47,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,,76.24,38.7,38.7,196.99,1.63,100.46,percent of total billed charges,38.7
ESTROGEN CNJ 25MGINJ,J1410,HCPCS,,,,,both,, ,1016.61,76,Blue Cross and Blue Shield,Traditional,,393.43,38.7,38.7,1016.61,2.96,518.47,percent of total billed charges,38.7
FER CARBOXYM 1MG INJ,J1439,HCPCS,,,,,both,15,ML,7,57.17,Blue Cross and Blue Shield,Traditional,,2.71,38.7,38.7,7,2.23,3.57,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,,1.75,38.7,38.7,4.53,2.23,2.31,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,,1.75,38.7,38.7,4.53,2.23,2.31,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,,12.46,38.7,38.7,32.19,2.23,16.42,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,,32.79,38.7,38.7,84.72,2.23,43.21,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,,56.01,38.7,38.7,144.72,1.5,73.81,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,,16.84,38.7,38.7,43.52,2,22.2,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,,4.19,38.7,38.7,10.82,2.99,5.52,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,,151.27,38.7,38.7,390.89,3.33,199.35,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,,151.27,38.7,38.7,390.89,77.08,199.35,percent of total billed charges,38.7
IMMU GLOB LYO 500MG,J1566,HCPCS,,,,,both,, ,270.89,48.15,Blue Cross and Blue Shield,Traditional,,104.83,38.7,38.7,270.89,1.88,138.15,percent of total billed charges,38.7
IMMU GLOB LYO 500MG,J1566,HCPCS,,,,,both,, ,270.89,566,Blue Cross and Blue Shield,Traditional,,104.83,38.7,38.7,270.89,22.07,138.15,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,,123.77,38.7,38.7,319.82,62.88,163.11,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,,123.77,38.7,38.7,319.82,21.87,163.11,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,,238.37,38.7,38.7,615.94,5.18,314.13,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,,99.46,38.7,38.7,256.99,0.16,131.06,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,,99.46,38.7,38.7,256.99,1.08,131.06,percent of total billed charges,38.7
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,2,ML,24.72,1,Blue Cross and Blue Shield,Traditional,,9.57,38.7,38.7,24.72,0.04,12.61,percent of total billed charges,38.7
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,, ,27.81,6.39,Blue Cross and Blue Shield,Traditional,,10.76,38.7,38.7,27.81,0.25,14.18,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,,11.16,38.7,38.7,28.84,0.5,14.71,percent of total billed charges,38.7
GLUCAGON 1MG INJ,J1610,HCPCS,,,,,both,, ,710.19,25.75,Blue Cross and Blue Shield,Traditional,,274.84,38.7,38.7,710.19,1,362.2,percent of total billed charges,38.7
GLUCAGON 1MG INJ,J1610,HCPCS,,,,,both,1,EA,1505,5.67,Blue Cross and Blue Shield,Traditional,,582.44,38.7,38.7,1505,0.22,767.55,percent of total billed charges,38.7
HALOPERIDOL 5MG INJ,J1630,HCPCS,,,,,both,1,ML,68.5,12.88,Blue Cross and Blue Shield,Traditional,,26.51,38.7,38.7,68.5,0.5,34.94,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,,70.85,38.7,38.7,183.08,1,93.37,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,,84.11,38.7,38.7,217.33,235.17,110.84,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,,0.2,38.7,38.7,0.52,0.05,0.27,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,,0.36,38.7,38.7,0.93,2.28,0.47,percent of total billed charges,38.7
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,2.16,68.24,Blue Cross and Blue Shield,Traditional,,0.84,38.7,38.7,2.16,2.66,1.1,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,,2.19,38.7,38.7,5.67,3.05,2.89,percent of total billed charges,38.7
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,6.39,225.31,Blue Cross and Blue Shield,Traditional,,2.47,38.7,38.7,6.39,8.79,3.26,percent of total billed charges,38.7
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,19.57,258.79,Blue Cross and Blue Shield,Traditional,,7.57,38.7,38.7,19.57,10.09,9.98,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,,10.76,38.7,38.7,27.81,0.76,14.18,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,,11.16,38.7,38.7,28.84,0.59,14.71,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,,16.15,38.7,38.7,41.72,0.96,21.28,percent of total billed charges,38.7
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,250,ML,76,16.48,Blue Cross and Blue Shield,Traditional,,29.41,38.7,38.7,76,0.64,38.76,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,,22.12,38.7,38.7,57.17,0.71,29.16,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,,22.12,38.7,38.7,57.17,0.35,29.16,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,,22.12,38.7,38.7,57.17,0.35,29.16,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,,22.12,38.7,38.7,57.17,1.84,29.16,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,,22.12,38.7,38.7,57.17,0.17,29.16,percent of total billed charges,38.7
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,38.37,11.59,Blue Cross and Blue Shield,Traditional,,14.85,38.7,38.7,38.37,0.45,19.57,percent of total billed charges,38.7
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,51.24,1.03,Blue Cross and Blue Shield,Traditional,,19.83,38.7,38.7,51.24,0.04,26.13,percent of total billed charges,38.7
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,76.74,3.09,Blue Cross and Blue Shield,Traditional,,29.7,38.7,38.7,76.74,0.12,39.14,percent of total billed charges,38.7
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,85.49,7,Blue Cross and Blue Shield,Traditional,,33.08,38.7,38.7,85.49,0.27,43.6,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,,764.83,38.7,38.7,1976.31,0.33,1007.92,percent of total billed charges,38.7
HYDROCORTIS 100MGINJ,J1720,HCPCS,,,,,both,1,EA,48.15,3.25,Blue Cross and Blue Shield,Traditional,,18.63,38.7,38.7,48.15,0.13,24.56,percent of total billed charges,38.7
MELOXICAM 1MG INJ,J1738,HCPCS,,,,,both,1,ML,566,32.19,Blue Cross and Blue Shield,Traditional,,219.04,38.7,38.7,566,1.26,288.66,percent of total billed charges,38.7
IBUTILIDE 1MG INJ,J1742,HCPCS,,,,,both,, ,1612.21,1.03,Blue Cross and Blue Shield,Traditional,,623.93,38.7,38.7,1612.21,0.04,822.23,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,,217.05,38.7,38.7,560.84,0.2,286.03,percent of total billed charges,38.7
IRON DEX165 INJ 50MG,J1750,HCPCS,,,,,both,, ,132.87,14.94,Blue Cross and Blue Shield,Traditional,,51.42,38.7,38.7,132.87,0.58,67.76,percent of total billed charges,38.7
IRON SUCROSE 1MG INJ,J1756,HCPCS,,,,,both,, ,4.22,14.94,Blue Cross and Blue Shield,Traditional,,1.63,38.7,38.7,4.22,0.58,2.15,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,,10.76,38.7,38.7,27.81,0.58,14.18,percent of total billed charges,38.7
INSULIN 1 UNT INJ,J1815,CPT,,,,,both,10,ML,1,14.75,Blue Cross and Blue Shield,Traditional,,0.39,38.7,38.7,1,0.58,0.51,percent of total billed charges,38.7
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,, ,6.39,14.94,Blue Cross and Blue Shield,Traditional,,2.47,38.7,38.7,6.39,0.58,3.26,percent of total billed charges,38.7
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,1,ML,12.88,16,Blue Cross and Blue Shield,Traditional,,4.98,38.7,38.7,12.88,0.62,6.57,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,,9.97,38.7,38.7,25.75,3.38,13.13,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,,2.19,38.7,38.7,5.67,1,2.89,percent of total billed charges,38.7
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,4,ML,12.88,133.9,Blue Cross and Blue Shield,Traditional,,4.98,38.7,38.7,12.88,5.22,6.57,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,,9.97,38.7,38.7,25.75,5.43,13.13,percent of total billed charges,38.7
LUPR 3.75FEMALE/PEDS,J1950,HCPCS,,,,,both,1,EA,6029.88,133.9,Blue Cross and Blue Shield,Traditional,,2333.56,38.7,38.7,6029.88,5.22,3075.24,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,,0.46,38.7,38.7,1.18,0.83,0.6,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,,22.62,38.7,38.7,58.45,1.65,29.81,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,,26.41,38.7,38.7,68.24,10.93,34.8,percent of total billed charges,38.7
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,50,ML,78.28,156.3,Blue Cross and Blue Shield,Traditional,,30.29,38.7,38.7,78.28,6.1,39.92,percent of total billed charges,38.7
LINEZOLID 200 MG,J2020,HCPCS,,,,,both,300,ML,225.31,0.3,Blue Cross and Blue Shield,Traditional,,87.19,38.7,38.7,225.31,0.01,114.91,percent of total billed charges,38.7
LINEZOLID 200 MG,J2020,HCPCS,,,,,both,, ,258.79,42.23,Blue Cross and Blue Shield,Traditional,,100.15,38.7,38.7,258.79,1.65,131.98,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,,7.57,38.7,38.7,19.57,1.65,9.98,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,,5.86,38.7,38.7,15.14,2.3,7.72,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,,9.57,38.7,38.7,24.72,2.3,12.61,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,,6.38,38.7,38.7,16.48,2.3,8.4,percent of total billed charges,38.7
MEROPENEMBR 100MGINJ,J2184,HCPCS,,,,,both,, ,18.28,61.03,Blue Cross and Blue Shield,Traditional,,7.07,38.7,38.7,18.28,2.38,9.32,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,,3.47,38.7,38.7,8.96,7.55,4.57,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,,3.47,38.7,38.7,8.96,47.14,4.57,percent of total billed charges,38.7
METHYLERGONV .2MGINJ,J2210,HCPCS,,,,,both,1,ML,47.12,302.05,Blue Cross and Blue Shield,Traditional,,18.24,38.7,38.7,47.12,11.78,24.03,percent of total billed charges,38.7
METHYLNALTR .1MG INJ,J2212,HCPCS,,,,,both,, ,4.33,250.55,Blue Cross and Blue Shield,Traditional,,1.68,38.7,38.7,4.33,9.77,2.21,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,,4.49,38.7,38.7,11.59,1.63,5.91,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,,0.4,38.7,38.7,1.03,1,0.53,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,,1.2,38.7,38.7,3.09,0.44,1.58,percent of total billed charges,38.7
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,2,ML,7,11.59,Blue Cross and Blue Shield,Traditional,,2.71,38.7,38.7,7,0.45,3.57,percent of total billed charges,38.7
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,, ,8.34,41.97,Blue Cross and Blue Shield,Traditional,,3.23,38.7,38.7,8.34,1.64,4.25,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,,1.26,38.7,38.7,3.25,1.74,1.66,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,,12.46,38.7,38.7,32.19,1.88,16.42,percent of total billed charges,38.7
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,1.03,24.72,Blue Cross and Blue Shield,Traditional,,0.4,38.7,38.7,1.03,0.96,0.53,percent of total billed charges,38.7
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,5.15,167.89,Blue Cross and Blue Shield,Traditional,,1.99,38.7,38.7,5.15,6.55,2.63,percent of total billed charges,38.7
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,232.78,Blue Cross and Blue Shield,Traditional,,5.78,38.7,38.7,14.94,9.08,7.62,percent of total billed charges,38.7
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,27.81,Blue Cross and Blue Shield,Traditional,,5.78,38.7,38.7,14.94,1.08,7.62,percent of total billed charges,38.7
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,13.91,Blue Cross and Blue Shield,Traditional,,5.78,38.7,38.7,14.94,0.54,7.62,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,,5.71,38.7,38.7,14.75,5.42,7.52,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,,5.78,38.7,38.7,14.94,3.74,7.62,percent of total billed charges,38.7
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,16,1.44,Blue Cross and Blue Shield,Traditional,,6.19,38.7,38.7,16,0.06,8.16,percent of total billed charges,38.7
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,, ,86.78,2.68,Blue Cross and Blue Shield,Traditional,,33.58,38.7,38.7,86.78,0.1,44.26,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,,9.97,38.7,38.7,25.75,0.1,13.13,percent of total billed charges,38.7
NALOXONE HCL 1MG INJ,J2310,HCPCS,,,,,both,1,ML,133.9,13.91,Blue Cross and Blue Shield,Traditional,,51.82,38.7,38.7,133.9,0.54,68.29,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,,53.91,38.7,38.7,139.31,0.76,71.05,percent of total billed charges,38.7
OCRELIZUMAB 1MG INJ,J2350,HCPCS,,,,,both,10,ML,133.9,12.88,Blue Cross and Blue Shield,Traditional,,51.82,38.7,38.7,133.9,0.5,68.29,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,,8.27,38.7,38.7,21.37,37.77,10.9,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,,16.34,38.7,38.7,42.23,0.96,21.54,percent of total billed charges,38.7
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,, ,280.16,335.01,Blue Cross and Blue Shield,Traditional,,108.42,38.7,38.7,280.16,13.07,142.88,percent of total billed charges,38.7
ORPHENADR UP TO 60MG,J2360,HCPCS,,,,,both,2,ML,156.3,62.83,Blue Cross and Blue Shield,Traditional,,60.49,38.7,38.7,156.3,2.45,79.71,percent of total billed charges,38.7
CHLOROPR HCL INJ 1MG,J2401,HCPCS,,,,,both,20,ML,0.3,28.33,Blue Cross and Blue Shield,Traditional,,0.12,38.7,38.7,0.3,1.1,0.15,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,,16.34,38.7,38.7,42.23,1.34,21.54,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,,16.34,38.7,38.7,42.23,1.45,21.54,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,,22.82,38.7,38.7,58.97,0.04,30.07,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,,22.82,38.7,38.7,58.97,0.04,30.07,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,,22.82,38.7,38.7,58.97,0.04,30.07,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,,23.62,38.7,38.7,61.03,0.06,31.13,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,,74.94,38.7,38.7,193.64,0.08,98.76,percent of total billed charges,38.7
PAMIDRONATE 30MG IJ,J2430,HCPCS,,,,,both,, ,1208.71,2.16,Blue Cross and Blue Shield,Traditional,,467.77,38.7,38.7,1208.71,0.08,616.44,percent of total billed charges,38.7
PAPAVERINE UPTO 60MG,J2440,HCPCS,,,,,both,, ,302.05,670.53,Blue Cross and Blue Shield,Traditional,,116.89,38.7,38.7,302.05,26.15,154.05,percent of total billed charges,38.7
PALONOSETRON 25MCG,J2469,HCPCS,,,,,both,, ,250.55,53.56,Blue Cross and Blue Shield,Traditional,,96.96,38.7,38.7,250.55,2.09,127.78,percent of total billed charges,38.7
PANTOPRAZOLE SOD VL,J2470,HCPCS,,,,,both,1,EA,41.72,7366,Blue Cross and Blue Shield,Traditional,,16.15,38.7,38.7,41.72,287.27,21.28,percent of total billed charges,38.7
PARICALCITOL 1MCGINJ,J2501,HCPCS,,,,,both,1,ML,25.75,347.11,Blue Cross and Blue Shield,Traditional,,9.97,38.7,38.7,25.75,13.54,13.13,percent of total billed charges,38.7
PENICI G POT .6MUINJ,J2540,HCPCS,,,,,both,, ,11.33,353.55,Blue Cross and Blue Shield,Traditional,,4.38,38.7,38.7,11.33,13.79,5.78,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,,4.49,38.7,38.7,11.59,0.26,5.91,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,,16.24,38.7,38.7,41.97,0.56,21.4,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,,17.24,38.7,38.7,44.55,0.67,22.72,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,,18.63,38.7,38.7,48.15,0.79,24.56,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,,9.57,38.7,38.7,24.72,1.93,12.61,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,,64.97,38.7,38.7,167.89,24.64,85.62,percent of total billed charges,38.7
PHENOBARB 120MG INJ,J2560,HCPCS,,,,,both,, ,232.78,402.47,Blue Cross and Blue Shield,Traditional,,90.09,38.7,38.7,232.78,15.7,118.72,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,,10.76,38.7,38.7,27.81,1.12,14.18,percent of total billed charges,38.7
DESMOPRESSIN 1MCGINJ,J2597,HCPCS,,,,,both,1,ML,13.91,161.71,Blue Cross and Blue Shield,Traditional,,5.38,38.7,38.7,13.91,6.31,7.09,percent of total billed charges,38.7
FLUPHENZI UP TO 25MG,J2680,HCPCS,,,,,both,5,ML,139.05,185.4,Blue Cross and Blue Shield,Traditional,,53.81,38.7,38.7,139.05,7.23,70.92,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,,37.07,38.7,38.7,95.79,0.44,48.85,percent of total billed charges,38.7
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,20,ML,1.44,60,Blue Cross and Blue Shield,Traditional,,0.56,38.7,38.7,1.44,2.34,0.73,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,,1.04,38.7,38.7,2.68,2.95,1.37,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,,1.04,38.7,38.7,2.68,3.56,1.37,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,,5.38,38.7,38.7,13.91,1.04,7.09,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,,7.57,38.7,38.7,19.57,2.8,9.98,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,,4.98,38.7,38.7,12.88,1.11,6.57,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,,374.79,38.7,38.7,968.46,1.11,493.91,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,,9.57,38.7,38.7,24.72,1.11,12.61,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,,129.65,38.7,38.7,335.01,0.71,170.86,percent of total billed charges,38.7
RHOPHYLAC 100UNT,J2791,HCPCS,,,,,both,2,ML,62.83,18.28,Blue Cross and Blue Shield,Traditional,,24.32,38.7,38.7,62.83,0.71,32.04,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,,10.96,38.7,38.7,28.33,0.72,14.45,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,,13.25,38.7,38.7,34.25,3.94,17.47,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,,14.35,38.7,38.7,37.08,2.3,18.91,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,,0.4,38.7,38.7,1.03,2.3,0.53,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,,0.4,38.7,38.7,1.03,2.43,0.53,percent of total billed charges,38.7
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,20,ML,1.03,60,Blue Cross and Blue Shield,Traditional,,0.4,38.7,38.7,1.03,2.34,0.53,percent of total billed charges,38.7
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,, ,1.65,68,Blue Cross and Blue Shield,Traditional,,0.64,38.7,38.7,1.65,2.65,0.84,percent of total billed charges,38.7
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,100,ML,1.96,75,Blue Cross and Blue Shield,Traditional,,0.76,38.7,38.7,1.96,2.93,1,percent of total billed charges,38.7
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,10,ML,2.16,95,Blue Cross and Blue Shield,Traditional,,0.84,38.7,38.7,2.16,3.71,1.1,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,,259.5,38.7,38.7,670.53,3.76,341.97,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,,20.73,38.7,38.7,53.56,0.54,27.32,percent of total billed charges,38.7
RETEPLASE 18.1MG IJ,J2993,HCPCS,,,,,both,, ,7366,44.03,Blue Cross and Blue Shield,Traditional,,2850.64,38.7,38.7,7366,1.72,3756.66,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,,134.33,38.7,38.7,347.11,3.09,177.03,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,,136.82,38.7,38.7,353.55,3.3,180.31,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,,2.55,38.7,38.7,6.59,1.08,3.36,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,,5.58,38.7,38.7,14.42,1.25,7.35,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,,6.68,38.7,38.7,17.25,0.12,8.8,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,,7.84,38.7,38.7,20.25,0.04,10.33,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,,19.13,38.7,38.7,49.44,0.12,25.21,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,,244.55,38.7,38.7,631.91,0.5,322.27,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,,155.76,38.7,38.7,402.47,0.54,205.26,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,,11.16,38.7,38.7,28.84,0.58,14.71,percent of total billed charges,38.7
CHLORPROM UP TO 50MG,J3230,HCPCS,,,,,both,, ,161.71,1.03,Blue Cross and Blue Shield,Traditional,,62.58,38.7,38.7,161.71,0.04,82.47,percent of total billed charges,38.7
CHLORPROM UP TO 50MG,J3230,HCPCS,,,,,both,2,ML,185.4,1.03,Blue Cross and Blue Shield,Traditional,,71.75,38.7,38.7,185.4,0.04,94.55,percent of total billed charges,38.7
TIGECYCLINE 1 MG INJ,J3243,HCPCS,,,,,both,, ,11.33,2.68,Blue Cross and Blue Shield,Traditional,,4.38,38.7,38.7,11.33,0.1,5.78,percent of total billed charges,38.7
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,250,ML,60,12.36,Blue Cross and Blue Shield,Traditional,,23.22,38.7,38.7,60,0.48,30.6,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,,29.3,38.7,38.7,75.71,3.03,38.61,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,,35.28,38.7,38.7,91.16,12.97,46.49,percent of total billed charges,38.7
TRIMETHOBEN 200MGINJ,J3250,HCPCS,,,,,both,, ,26.78,1005.8,Blue Cross and Blue Shield,Traditional,,10.36,38.7,38.7,26.78,39.23,13.66,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,,27.8,38.7,38.7,71.84,6.74,36.64,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,,11.06,38.7,38.7,28.58,1,14.58,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,,11.06,38.7,38.7,28.58,1,14.58,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,,11.06,38.7,38.7,28.58,0.5,14.58,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,,7.07,38.7,38.7,18.28,1.04,9.32,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,,7.07,38.7,38.7,18.28,1,9.32,percent of total billed charges,38.7
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,, ,18.54,68.5,Blue Cross and Blue Shield,Traditional,,7.17,38.7,38.7,18.54,2.67,9.46,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,,39.06,38.7,38.7,100.94,1,51.48,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,,22.82,38.7,38.7,58.97,1,30.07,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,,22.82,38.7,38.7,58.97,1.63,30.07,percent of total billed charges,38.7
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,, ,62.32,24.72,Blue Cross and Blue Shield,Traditional,,24.12,38.7,38.7,62.32,0.96,31.78,percent of total billed charges,38.7
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,300,ML,60,25.75,Blue Cross and Blue Shield,Traditional,,23.22,38.7,38.7,60,1,30.6,percent of total billed charges,38.7
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,350,ML,68,25.75,Blue Cross and Blue Shield,Traditional,,26.32,38.7,38.7,68,1,34.68,percent of total billed charges,38.7
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,250,ML,75,24.72,Blue Cross and Blue Shield,Traditional,,29.03,38.7,38.7,75,0.96,38.25,percent of total billed charges,38.7
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,150,ML,95,25.75,Blue Cross and Blue Shield,Traditional,,36.77,38.7,38.7,95,1,48.45,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,,37.27,38.7,38.7,96.31,1.12,49.12,percent of total billed charges,38.7
HYDROXYZI UP TO 25MG,J3410,HCPCS,,,,,both,, ,13.91,25.75,Blue Cross and Blue Shield,Traditional,,5.38,38.7,38.7,13.91,1,7.09,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,,17.04,38.7,38.7,44.03,0.48,22.46,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,,30.69,38.7,38.7,79.31,0.49,40.45,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,,32.79,38.7,38.7,84.72,2.13,43.21,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,,10.76,38.7,38.7,27.81,0.79,14.18,percent of total billed charges,38.7
PHYTONADIONE 1MG INJ,J3430,HCPCS,,,,,both,1,ML,31.93,41.2,Blue Cross and Blue Shield,Traditional,,12.36,38.7,38.7,31.93,1.61,16.28,percent of total billed charges,38.7
HYALURONID RECOM 1UN,J3473,HCPCS,,,,,both,1,ML,3.19,27.3,Blue Cross and Blue Shield,Traditional,,1.23,38.7,38.7,3.19,1.06,1.63,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,,0.44,38.7,38.7,1.13,0.33,0.58,percent of total billed charges,38.7
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,20,ML,2.99,0.1,Blue Cross and Blue Shield,Traditional,,1.16,38.7,38.7,2.99,0.35,1.52,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,,4.98,38.7,38.7,12.88,0.01,6.57,percent of total billed charges,38.7
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,, ,13.91,0.72,Blue Cross and Blue Shield,Traditional,,5.38,38.7,38.7,13.91,0.03,7.09,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,,5.78,38.7,38.7,14.94,0.05,7.62,percent of total billed charges,38.7
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,20,ML,1.03,7,Blue Cross and Blue Shield,Traditional,,0.4,38.7,38.7,1.03,0.27,0.53,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,,0.4,38.7,38.7,1.03,4.19,0.53,percent of total billed charges,38.7
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,, ,2.68,19.31,Blue Cross and Blue Shield,Traditional,,1.04,38.7,38.7,2.68,0.75,1.37,percent of total billed charges,38.7
ZIDOVUDINE 10MG INJ,J3485,HCPCS,,,,,both,, ,12.36,191.84,Blue Cross and Blue Shield,Traditional,,4.78,38.7,38.7,12.36,7.48,6.3,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,,30.1,38.7,38.7,77.77,1.62,39.66,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,,128.75,38.7,38.7,332.69,0.19,169.67,percent of total billed charges,38.7
ZOLEDRONIC ACID 1MG,J3489,HCPCS,,,,,both,5,ML,1005.8,13.39,Blue Cross and Blue Shield,Traditional,,389.24,38.7,38.7,1005.8,0.52,512.96,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,,66.85,38.7,38.7,172.75,1.92,88.1,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,,9.97,38.7,38.7,25.75,2.09,13.13,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,,9.97,38.7,38.7,25.75,0.02,13.13,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,,4.98,38.7,38.7,12.88,0.05,6.57,percent of total billed charges,38.7
NORM SALINE 250ML IV,J7050,HCPCS,,,,,both,250,ML,26.78,3.5,Blue Cross and Blue Shield,Traditional,,10.36,38.7,38.7,26.78,0.14,13.66,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,,9.97,38.7,38.7,25.75,0.79,13.13,percent of total billed charges,38.7
SOD CHLOR .9% 100ML,J7050,HCPCS,,,,,both,100,ML,68.5,78.54,Blue Cross and Blue Shield,Traditional,,26.51,38.7,38.7,68.5,3.06,34.94,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,,9.97,38.7,38.7,25.75,5.76,13.13,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,,9.97,38.7,38.7,25.75,5.76,13.13,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,,16.15,38.7,38.7,41.72,10.36,21.28,percent of total billed charges,38.7
DEX 5%/WATER 500ML,J7060,HCPCS,,,,,both,, ,24.72,61.03,Blue Cross and Blue Shield,Traditional,,9.57,38.7,38.7,24.72,2.38,12.61,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,,9.97,38.7,38.7,25.75,0.21,13.13,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,,9.97,38.7,38.7,25.75,3.42,13.13,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,,9.57,38.7,38.7,24.72,1,12.61,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,,9.97,38.7,38.7,25.75,24.06,13.13,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,,11.16,38.7,38.7,28.84,26.94,14.71,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,,9.97,38.7,38.7,25.75,30.33,13.13,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,,4.74,38.7,38.7,12.25,0.25,6.25,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,,4.88,38.7,38.7,12.62,0.14,6.44,percent of total billed charges,38.7
MOMETA SIN IMP 10MCG,J7402,HCPCS,,,,,both,, ,54.59,61.03,Blue Cross and Blue Shield,Traditional,,21.13,38.7,38.7,54.59,2.38,27.84,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,,7.87,38.7,38.7,20.34,20.72,10.37,percent of total billed charges,38.7
CYCLOSPORNE 100MG PO,J7502,HCPCS,,,,,both,, ,41.2,12,Blue Cross and Blue Shield,Traditional,,15.94,38.7,38.7,41.2,0.47,21.01,percent of total billed charges,38.7
TACROLIMUS 1MG PO,J7507,HCPCS,,,,,both,100,EA,27.3,851.55,Blue Cross and Blue Shield,Traditional,,10.57,38.7,38.7,27.3,33.21,13.92,percent of total billed charges,38.7
METHYLPREDNIS 4MG PO,J7509,HCPCS,,,,,both,, ,8.55,1340.29,Blue Cross and Blue Shield,Traditional,,3.31,38.7,38.7,8.55,52.27,4.36,percent of total billed charges,38.7
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.1,1301.25,Blue Cross and Blue Shield,Traditional,,0.04,38.7,38.7,0.1,50.75,0.05,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,,0.12,38.7,38.7,0.31,50.75,0.16,percent of total billed charges,38.7
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.72,101.6,Blue Cross and Blue Shield,Traditional,,0.28,38.7,38.7,0.72,3.96,0.37,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,,0.52,38.7,38.7,1.34,11.06,0.68,percent of total billed charges,38.7
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,, ,7,884.69,Blue Cross and Blue Shield,Traditional,,2.71,38.7,38.7,7,34.5,3.57,percent of total billed charges,38.7
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,, ,107.38,638.53,Blue Cross and Blue Shield,Traditional,,41.56,38.7,38.7,107.38,24.9,54.76,percent of total billed charges,38.7
CYCLOSPORINE 25MG PO,J7515,HCPCS,,,,,both,, ,19.31,737.05,Blue Cross and Blue Shield,Traditional,,7.47,38.7,38.7,19.31,28.74,9.85,percent of total billed charges,38.7
CYCLOSPOR PAREN250MG,J7516,HCPCS,,,,,both,, ,191.84,2646.2,Blue Cross and Blue Shield,Traditional,,74.24,38.7,38.7,191.84,103.2,97.84,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,,16.05,38.7,38.7,41.46,109.06,21.14,percent of total billed charges,38.7
METHACHOL 1MGINH NEB,J7674,HCPCS,,,,,both,1,EA,4.84,1013.8,Blue Cross and Blue Shield,Traditional,,1.87,38.7,38.7,4.84,39.54,2.47,percent of total billed charges,38.7
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,, ,13.39,1025.03,Blue Cross and Blue Shield,Traditional,,5.18,38.7,38.7,13.39,39.98,6.83,percent of total billed charges,38.7
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,, ,49.18,614.12,Blue Cross and Blue Shield,Traditional,,19.03,38.7,38.7,49.18,23.95,25.08,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,,20.73,38.7,38.7,53.56,20.6,27.32,percent of total billed charges,38.7
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,, ,0.52,408.14,Blue Cross and Blue Shield,Traditional,,0.2,38.7,38.7,0.52,15.92,0.27,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,,0.52,38.7,38.7,1.34,24.33,0.68,percent of total billed charges,38.7
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,, ,3.5,1025.03,Blue Cross and Blue Shield,Traditional,,1.35,38.7,38.7,3.5,39.98,1.79,percent of total billed charges,38.7
METHOTREXATE 2.5MGPO,J8610,HCPCS,,,,,both,100,EA,20.34,634.6,Blue Cross and Blue Shield,Traditional,,7.87,38.7,38.7,20.34,24.75,10.37,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,,30.39,38.7,38.7,78.54,0.38,40.06,percent of total billed charges,38.7
BENDAMUSTINE 1MG INJ,J9033,HCPCS,,,,,both,, ,147.81,4.12,Blue Cross and Blue Shield,Traditional,,57.2,38.7,38.7,147.81,0.16,75.38,percent of total billed charges,38.7
BENDAMUSTINE 1MG INJ,J9033,HCPCS,,,,,both,, ,147.81,7.52,Blue Cross and Blue Shield,Traditional,,57.2,38.7,38.7,147.81,0.29,75.38,percent of total billed charges,38.7
BORTEZOMIB .1MG INJ,J9041,HCPCS,,,,,both,, ,265.74,33.73,Blue Cross and Blue Shield,Traditional,,102.84,38.7,38.7,265.74,1.32,135.53,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,,23.62,38.7,38.7,61.03,1.34,31.13,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,,2.07,38.7,38.7,5.36,3.25,2.73,percent of total billed charges,38.7
DOCETAXEL 1MG INJ,J9171,HCPCS,,,,,both,, ,87.81,456,Blue Cross and Blue Shield,Traditional,,33.98,38.7,38.7,87.81,17.78,44.78,percent of total billed charges,38.7
FLUOROURACIL 500MG,J9190,HCPCS,,,,,both,, ,25.75,469.68,Blue Cross and Blue Shield,Traditional,,9.97,38.7,38.7,25.75,18.32,13.13,percent of total billed charges,38.7
GEMCITABIN 200MG INJ,J9201,HCPCS,,,,,both,1,EA,616.97,307.8,Blue Cross and Blue Shield,Traditional,,238.77,38.7,38.7,616.97,12,314.65,percent of total billed charges,38.7
GEMCITABIN 200MG INJ,J9201,HCPCS,,,,,both,, ,690.87,323,Blue Cross and Blue Shield,Traditional,,267.37,38.7,38.7,690.87,12.6,352.34,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,,300.95,38.7,38.7,777.65,0.42,396.6,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,,2.47,38.7,38.7,6.39,23.39,3.26,percent of total billed charges,38.7
PACLITAXEL 1MG INJ,J9267,HCPCS,,,,,both,, ,3.71,4404,Blue Cross and Blue Shield,Traditional,,1.44,38.7,38.7,3.71,171.76,1.89,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,,23.62,38.7,38.7,61.03,6.51,31.13,percent of total billed charges,38.7
TRASTUZUMAB 10MG INJ,J9355,HCPCS,,,,,both,, ,531.22,31.93,Blue Cross and Blue Shield,Traditional,,205.58,38.7,38.7,531.22,1.25,270.92,percent of total billed charges,38.7
POST OP SHOES,L3260,HCPCS,,,,,both,, ,12,133.9,Blue Cross and Blue Shield,Traditional,,4.64,38.7,38.7,12,5.22,6.12,percent of total billed charges,38.7
ADM IV INF CASI IMDV,M0243,HCPCS,,,,,both,, ,851.55,2544,Blue Cross and Blue Shield,Traditional,,329.55,38.7,38.7,851.55,99.22,434.29,percent of total billed charges,38.7
ADM IV INF CASI IMDV,M0243,HCPCS,,,,,both,, ,1340.29,3469,Blue Cross and Blue Shield,Traditional,,518.69,38.7,38.7,1340.29,135.29,683.55,percent of total billed charges,38.7
ADM IV INF BAM ETES,M0245,HCPCS,,,,,both,, ,1301.25,3745,Blue Cross and Blue Shield,Traditional,,503.58,38.7,38.7,1301.25,146.06,663.64,percent of total billed charges,38.7
ADM IV INF SOTROVIM,M0247,HCPCS,,,,,both,, ,1301.25,3928,Blue Cross and Blue Shield,Traditional,,503.58,38.7,38.7,1301.25,153.19,663.64,percent of total billed charges,38.7
"PAP SMEAR, SCREEN",P3000,HCPCS,,,,,both,, ,101.6,347.63,Blue Cross and Blue Shield,Traditional,,39.32,38.7,38.7,101.6,13.56,51.82,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,,109.71,38.7,38.7,283.48,19.74,144.57,percent of total billed charges,38.7
S-H RBC LEUKO REDU,P9016,HCPCS,,,,,both,, ,884.69,6211,Blue Cross and Blue Shield,Traditional,,342.38,38.7,38.7,884.69,242.23,451.19,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,,247.11,38.7,38.7,638.53,22.23,325.65,percent of total billed charges,38.7
S-H RED BLD-UNIT,P9021,HCPCS,,,,,both,, ,737.05,5236,Blue Cross and Blue Shield,Traditional,,285.24,38.7,38.7,737.05,204.2,375.9,percent of total billed charges,38.7
S-H PLAT PHERE L-R,P9035,HCPCS,,,,,both,, ,2646.2,3534,Blue Cross and Blue Shield,Traditional,,1024.08,38.7,38.7,2646.2,137.83,1349.56,percent of total billed charges,38.7
S-H PLAT A-P L-R IRR,P9037,HCPCS,,,,,both,, ,2796.36,9540,Blue Cross and Blue Shield,Traditional,,1082.19,38.7,38.7,2796.36,372.06,1426.14,percent of total billed charges,38.7
S-H RBC IRRAD,P9038,HCPCS,,,,,both,, ,1013.8,545.13,Blue Cross and Blue Shield,Traditional,,392.34,38.7,38.7,1013.8,21.26,517.04,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,,396.69,38.7,38.7,1025.03,2.76,522.77,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,,237.66,38.7,38.7,614.12,3.64,313.2,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,,204.39,38.7,38.7,528.13,3.64,269.35,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,,157.95,38.7,38.7,408.14,3.64,208.15,percent of total billed charges,38.7
ALBUMIN 25% 50ML IV,P9047,HCPCS,,,,,both,50,ML,623.92,1184.5,Blue Cross and Blue Shield,Traditional,,241.46,38.7,38.7,623.92,46.2,318.2,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,,396.69,38.7,38.7,1025.03,0.06,522.77,percent of total billed charges,38.7
S-H FFP BTWN8-24HREA,P9059,HCPCS,,,,,both,, ,634.6,49.5,Blue Cross and Blue Shield,Traditional,,245.59,38.7,38.7,634.6,1.93,323.65,percent of total billed charges,38.7
FERUMOXYTOL1MG NESRD,Q0138,HCPCS,,,,,both,17,ML,9.68,1.65,Blue Cross and Blue Shield,Traditional,,3.75,38.7,38.7,9.68,0.06,4.94,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,,1.59,38.7,38.7,4.12,1.08,2.1,percent of total billed charges,38.7
CHLORPROMAZIN 5MG PO,Q0161,HCPCS,,,,,both,, ,7.52,36.82,Blue Cross and Blue Shield,Traditional,,2.91,38.7,38.7,7.52,1.44,3.84,percent of total billed charges,38.7
ONDANSETRON 1MG PO,Q0162,HCPCS,,,,,both,, ,33.73,36.82,Blue Cross and Blue Shield,Traditional,,13.05,38.7,38.7,33.73,1.44,17.2,percent of total billed charges,38.7
ONDANSETRON 1MG PO,Q0162,HCPCS,,,,,both,50,ML,34.25,6,Blue Cross and Blue Shield,Traditional,,13.25,38.7,38.7,34.25,0.23,17.47,percent of total billed charges,38.7
TELEHEALTH IP NEURO,Q3014,HCPCS,,,,,both,, ,83.25,6,Blue Cross and Blue Shield,Traditional,,32.22,38.7,38.7,83.25,0.23,42.46,percent of total billed charges,38.7
TOTAL CONTACT CAST 3 INCH,Q4038,HCPCS,,,,,both,, ,456,6,Blue Cross and Blue Shield,Traditional,,176.47,38.7,38.7,456,0.23,232.56,percent of total billed charges,38.7
TOTAL CONTACT CAST 4 INCH,Q4038,HCPCS,,,,,both,, ,469.68,4,Blue Cross and Blue Shield,Traditional,,181.77,38.7,38.7,469.68,0.16,239.54,percent of total billed charges,38.7
TOTAL CONTACT CAST BOOT LARGE,Q4038,HCPCS,,,,,both,, ,307.8,1337.97,Blue Cross and Blue Shield,Traditional,,119.12,38.7,38.7,307.8,52.18,156.98,percent of total billed charges,38.7
TOTAL CONTACT CAST BOOT X-LARGE,Q4038,HCPCS,,,,,both,, ,323,12.62,Blue Cross and Blue Shield,Traditional,,125,38.7,38.7,323,0.49,164.73,percent of total billed charges,38.7
OASIS WOUND MAT SQCM,Q4102,HCPCS,,,,,both,, ,10.82,1178.84,Blue Cross and Blue Shield,Traditional,,4.19,38.7,38.7,10.82,45.97,5.52,percent of total billed charges,38.7
INTEGRA BMWD SQ CM,Q4104,HCPCS,,,,,both,, ,599.72,0.6,Blue Cross and Blue Shield,Traditional,,232.09,38.7,38.7,599.72,0.02,305.86,percent of total billed charges,38.7
INTEGRA SKIN SUB 5X5CM,Q4108,HCPCS,,,,,both,, ,4404,0.6,Blue Cross and Blue Shield,Traditional,,1704.35,38.7,38.7,4404,0.02,2246.04,percent of total billed charges,38.7
DERMACELL SQ CM,Q4122,HCPCS,,,,,both,, ,166.86,7.4,Blue Cross and Blue Shield,Traditional,,64.57,38.7,38.7,166.86,0.29,85.1,percent of total billed charges,38.7
OASIS ULTRA TRI SQCM,Q4124,HCPCS,,,,,both,, ,31.93,7.4,Blue Cross and Blue Shield,Traditional,,12.36,38.7,38.7,31.93,0.29,16.28,percent of total billed charges,38.7
ACELL DERM MAT 1SQCM,Q4126,HCPCS,,,,,both,, ,133.9,7.4,Blue Cross and Blue Shield,Traditional,,51.82,38.7,38.7,133.9,0.29,68.29,percent of total billed charges,38.7
1AMNIOEXCEL SKIN 1.5X1.5CM,Q4137,HCPCS,,,,,both,, ,2544,7.4,Blue Cross and Blue Shield,Traditional,,984.53,38.7,38.7,2544,0.29,1297.44,percent of total billed charges,38.7
AMNIOEXCEL SKIN 2X3CM,Q4137,HCPCS,,,,,both,, ,3469,0.7,Blue Cross and Blue Shield,Traditional,,1342.5,38.7,38.7,3469,0.03,1769.19,percent of total billed charges,38.7
AMNIOEXCEL SKIN 3.5X3.5CM,Q4137,HCPCS,,,,,both,, ,3745,0.7,Blue Cross and Blue Shield,Traditional,,1449.32,38.7,38.7,3745,0.03,1909.95,percent of total billed charges,38.7
AMNIOEXCEL SKIN 4X4CM,Q4137,HCPCS,,,,,both,, ,3928,11.07,Blue Cross and Blue Shield,Traditional,,1520.14,38.7,38.7,3928,0.43,2003.28,percent of total billed charges,38.7
ALLOWRAP DS/DRY SQCM,Q4150,HCPCS,,,,,both,, ,347.63,11.07,Blue Cross and Blue Shield,Traditional,,134.53,38.7,38.7,347.63,0.43,177.29,percent of total billed charges,38.7
ALLOWRAP DS/DRY SQCM,Q4150,HCPCS,,,,,both,, ,506.25,11.07,Blue Cross and Blue Shield,Traditional,,195.92,38.7,38.7,506.25,0.43,258.19,percent of total billed charges,38.7
HELICOLL (PER SQ CM),Q4164,HCPCS,,,,,both,, ,6211,11.07,Blue Cross and Blue Shield,Traditional,,2403.66,38.7,38.7,6211,0.43,3167.61,percent of total billed charges,38.7
EPIFIX SQ CM,Q4186,HCPCS,,,,,both,, ,570.11,4,Blue Cross and Blue Shield,Traditional,,220.63,38.7,38.7,570.11,0.16,290.76,percent of total billed charges,38.7
MEMBRANE GRAFT/WRAP (PER SQ CM),Q4205,HCPCS,,,,,both,, ,5236,60.5,Blue Cross and Blue Shield,Traditional,,2026.33,38.7,38.7,5236,2.36,2670.36,percent of total billed charges,38.7
DERM-MAXX (PER SQ CM),Q4238,HCPCS,,,,,both,, ,3534,60.5,Blue Cross and Blue Shield,Traditional,,1367.66,38.7,38.7,3534,2.36,1802.34,percent of total billed charges,38.7
AMNIO-MAX (PER SQ CM),Q4239,HCPCS,,,,,both,, ,9540,115.88,Blue Cross and Blue Shield,Traditional,,3691.98,38.7,38.7,9540,4.52,4865.4,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,,210.97,38.7,38.7,545.13,0.1,278.02,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,,27.4,38.7,38.7,70.81,0.1,36.11,percent of total billed charges,38.7
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,, ,93.22,872.41,Blue Cross and Blue Shield,Traditional,,36.08,38.7,38.7,93.22,34.02,47.54,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,,36.08,38.7,38.7,93.22,4.72,47.54,percent of total billed charges,38.7
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,, ,93.22,172.81,Blue Cross and Blue Shield,Traditional,,36.08,38.7,38.7,93.22,6.74,47.54,percent of total billed charges,38.7
INJ PERFLUTRN LIP ML,Q9957,HCPCS,,,,,both,, ,1184.5,710.7,Blue Cross and Blue Shield,Traditional,,458.4,38.7,38.7,1184.5,604.1,604.1,percent of total billed charges,38.7
HOCM2 250-299MGML ML,Q9961,HCPCS,,,,,both,, ,1.65,0.99,Blue Cross and Blue Shield,Traditional,,0.64,38.7,38.7,1.65,0.84,0.84,percent of total billed charges,38.7
HOCM 350 MG ML 30ML,Q9963,HCPCS,,,,,both,30,ML,49.5,29.7,Blue Cross and Blue Shield,Traditional,,19.16,38.7,38.7,49.5,25.25,25.25,percent of total billed charges,38.7
HOCM 350-399MGML IOD,Q9963,HCPCS,,,,,both,, ,1.65,0.99,Blue Cross and Blue Shield,Traditional,,0.64,38.7,38.7,1.65,0.84,0.84,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,,10.76,38.7,38.7,27.81,14.18,14.18,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,,14.25,38.7,38.7,36.82,18.78,18.78,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,,14.25,38.7,38.7,36.82,18.78,18.78,percent of total billed charges,38.7
LOCM 240MG 100ML,Q9966,HCPCS,,,,,both,100,ML,6,3.6,Blue Cross and Blue Shield,Traditional,,2.32,38.7,38.7,6,3.06,3.06,percent of total billed charges,38.7
LOCM 240MG 50ML,Q9966,HCPCS,,,,,both,50,ML,6,3.6,Blue Cross and Blue Shield,Traditional,,2.32,38.7,38.7,6,3.06,3.06,percent of total billed charges,38.7
LOCM 270MG 150ML,Q9966,HCPCS,,,,,both,150,ML,6,3.6,Blue Cross and Blue Shield,Traditional,,2.32,38.7,38.7,6,3.06,3.06,percent of total billed charges,38.7
LOCM200MG/ML 41% 200,Q9966,HCPCS,,,,,both,200,ML,4,2.4,Blue Cross and Blue Shield,Traditional,,1.55,38.7,38.7,4,2.04,2.04,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,,517.79,38.7,38.7,1337.97,682.36,682.36,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,,4.88,38.7,38.7,12.62,6.44,6.44,percent of total billed charges,38.7
LOCM 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,1178.84,707.3,Blue Cross and Blue Shield,Traditional,,456.21,38.7,38.7,1178.84,601.21,601.21,percent of total billed charges,38.7
LOCM300MG/ML 61% 100,Q9967,HCPCS,,,,,both,, ,0.6,0.36,Blue Cross and Blue Shield,Traditional,,0.23,38.7,38.7,0.6,0.31,0.31,percent of total billed charges,38.7
LOCM300MG/ML 61% 100,Q9967,HCPCS,,,,,both,, ,0.6,0.36,Blue Cross and Blue Shield,Traditional,,0.23,38.7,38.7,0.6,0.31,0.31,percent of total billed charges,38.7
LOCM300MG/ML 61% 100,Q9967,HCPCS,,,,,both,100,ML,7.4,4.44,Blue Cross and Blue Shield,Traditional,,2.86,38.7,38.7,7.4,3.77,3.77,percent of total billed charges,38.7
LOCM300MG/ML 61% 100,Q9967,HCPCS,,,,,both,100,ML,7.4,4.44,Blue Cross and Blue Shield,Traditional,,2.86,38.7,38.7,7.4,3.77,3.77,percent of total billed charges,38.7
LOCM300MG/ML 61% 100,Q9967,HCPCS,,,,,both,100,ML,7.4,4.44,Blue Cross and Blue Shield,Traditional,,2.86,38.7,38.7,7.4,3.77,3.77,percent of total billed charges,38.7
LOCM300MG/ML 61% 100,Q9967,HCPCS,,,,,both,100,ML,7.4,4.44,Blue Cross and Blue Shield,Traditional,,2.86,38.7,38.7,7.4,3.77,3.77,percent of total billed charges,38.7
LOCM300MG/ML 76% 100,Q9967,HCPCS,,,,,both,, ,0.7,0.42,Blue Cross and Blue Shield,Traditional,,0.27,38.7,38.7,0.7,0.36,0.36,percent of total billed charges,38.7
LOCM300MG/ML 76% 100,Q9967,HCPCS,,,,,both,, ,0.7,0.42,Blue Cross and Blue Shield,Traditional,,0.27,38.7,38.7,0.7,0.36,0.36,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,,4.28,38.7,38.7,11.07,5.65,5.65,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,,4.28,38.7,38.7,11.07,5.65,5.65,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,,4.28,38.7,38.7,11.07,5.65,5.65,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,,4.28,38.7,38.7,11.07,5.65,5.65,percent of total billed charges,38.7
LOCM300MG/ML 76% 125,Q9967,HCPCS,,,,,both,125,ML,4,2.4,Blue Cross and Blue Shield,Traditional,,1.55,38.7,38.7,4,2.04,2.04,percent of total billed charges,38.7
LOCM300MG/ML M61% 15,Q9967,HCPCS,,,,,both,15,ML,60.5,36.3,Blue Cross and Blue Shield,Traditional,,23.41,38.7,38.7,60.5,30.86,30.86,percent of total billed charges,38.7
LOCM300MG/ML M61% 15,Q9967,HCPCS,,,,,both,15,ML,60.5,36.3,Blue Cross and Blue Shield,Traditional,,23.41,38.7,38.7,60.5,30.86,30.86,percent of total billed charges,38.7
LACTATION CONSULT,S9443,HCPCS,,,,,both,, ,115.88,69.52,Blue Cross and Blue Shield,Traditional,,44.85,38.7,38.7,115.88,59.1,59.1,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,,1,38.7,38.7,2.58,1.32,1.32,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,,1,38.7,38.7,2.58,1.32,1.32,percent of total billed charges,38.7
IOP PSYCH PER DIEM,S9480,HCPCS,,,,,both,, ,872.41,523.44,Blue Cross and Blue Shield,Traditional,,337.62,38.7,38.7,872.41,444.93,444.93,percent of total billed charges,38.7
CDC COVID19,U0001,HCPCS,,,,,both,, ,120.97,72.58,Blue Cross and Blue Shield,Traditional,,46.82,38.7,38.7,120.97,61.69,61.69,percent of total billed charges,38.7
STATE COVID19,U0002,HCPCS,,,,,both,, ,172.81,103.68,Blue Cross and Blue Shield,Traditional,,66.88,38.7,38.7,172.81,88.13,88.13,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,,,Fee Schedule,Medicaid Fee Schedule
CT-CATH FLUID DRAIN,10030,CPT,,,,,both,, ,1071.33,642.79,Medicaid,Illinois Medicaid,,,,,1071.33,,,,
I&D ABSCS SMPL/SGL,10060,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
I&D ABSCS COMP/MULTI,10061,CPT,,,,,both,, ,1519.68,911.8,Medicaid,Illinois Medicaid,,,,,1519.68,,,,
INC & REM FB SQ SMPL,10120,CPT,,,,,both,, ,1519.68,911.8,Medicaid,Illinois Medicaid,,,,,1519.68,,,,
INC & REM FB SQ COMP,10121,CPT,,,,,both,, ,6179,3707.4,Medicaid,Illinois Medicaid,,,,,6179,,,,
I&D HEMATOMA/FLUID,10140,CPT,,,,,both,, ,6179,3707.4,Medicaid,Illinois Medicaid,,,,,6179,,,,
PNXR ASP ABS HEM CYT,10160,CPT,,,,,both,, ,1519.68,911.8,Medicaid,Illinois Medicaid,,,,,1519.68,,,,
I&D CPLX PO WND INF,10180,CPT,,,,,both,, ,10829.4,6497.64,Medicaid,Illinois Medicaid,,,,,10829.4,,,,
DEBR EXZ/INF SKN <10%,11000,CPT,,,,,both,, ,2393.6,1436.16,Medicaid,Illinois Medicaid,,,,,2393.6,,,,
DEBR EXZ/INF SKN E A,11001,CPT,,,,,both,, ,2393.6,1436.16,Medicaid,Illinois Medicaid,,,,,2393.6,,,,
DEB SKN BONE FX SITE,11012,CPT,,,,,both,, ,10829.4,6497.64,Medicaid,Illinois Medicaid,,,,,10829.4,,,,
DEB SUB TIS 20 SQ CM<,11042,CPT,,,,,both,, ,1519.68,911.8,Medicaid,Illinois Medicaid,,,,,1519.68,,,,
DEB MUSC/FSCA <20 SQ,11043,CPT,,,,,both,, ,2393.6,1436.16,Medicaid,Illinois Medicaid,,,,,2393.6,,,,
DEB BONE 20 SQ CM/<,11044,CPT,,,,,both,, ,6179,3707.4,Medicaid,Illinois Medicaid,,,,,6179,,,,
DEB SUB TISS EA ADDL,11045,CPT,,,,,both,, ,6179,3707.4,Medicaid,Illinois Medicaid,,,,,6179,,,,
DEB MUSC/FSCA EA ADL,11046,CPT,,,,,both,, ,6179,3707.4,Medicaid,Illinois Medicaid,,,,,6179,,,,
DEB BONE EA ADDL,11047,CPT,,,,,both,, ,6179,3707.4,Medicaid,Illinois Medicaid,,,,,6179,,,,
PARG/CUTG B9 SGL LES,11055,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
TRIM SKIN LESION 2-4,11056,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
TRIM SKIN LESIONS >4,11057,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
TNGNTL BX SKN SGL LES,11102,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
TNGNTL BX SKN EA ADD,11103,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
PUNCH BX SKN SGL LES,11104,CPT,,,,,both,, ,1519.68,911.8,Medicaid,Illinois Medicaid,,,,,1519.68,,,,
PUNCH BX SKN EA ADDL,11105,CPT,,,,,both,, ,1519.68,911.8,Medicaid,Illinois Medicaid,,,,,1519.68,,,,
INCIS BX SKN SGL LES,11106,CPT,,,,,both,, ,2393.6,1436.16,Medicaid,Illinois Medicaid,,,,,2393.6,,,,
INCAL BX SKN EA ADDL,11107,CPT,,,,,both,, ,2393.6,1436.16,Medicaid,Illinois Medicaid,,,,,2393.6,,,,
RMV SKN TAGS<=15 LES,11200,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
RMV SKN TAGS EA ADDL,11201,CPT,,,,,both,, ,233.12,139.87,Medicaid,Illinois Medicaid,,,,,233.12,,,,
DEBRIDEMENT NAIL 1-5,11720,CPT,,,,,both,, ,233.12,139.87,Medicaid,Illinois Medicaid,,,,,233.12,,,,
DEBRIDEMENT NAIL >6,11721,CPT,,,,,both,, ,233.12,139.87,Medicaid,Illinois Medicaid,,,,,233.12,,,,
RMV NAIL PLATE SGL,11730,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
RMV NAIL PLATE E ADD,11732,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
EVAC SU HEMATOMA,11740,CPT,,,,,both,, ,486.84,292.1,Medicaid,Illinois Medicaid,,,,,486.84,,,,
TT F/C/M/N/A/G/H/F,14040,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
TT F/C/M/N/A/G/H/F AD,14041,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
WND PR T/A/L 100SQCM,15002,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
WND PR ADL 100 SQCM,15003,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
WND PREP F/N/HF/G,15004,CPT,,,,,both,, ,2393.6,1436.16,Medicaid,Illinois Medicaid,,,,,2393.6,,,,
WND PREP F/N/HF/G ADL,15005,CPT,,,,,both,, ,2393.6,1436.16,Medicaid,Illinois Medicaid,,,,,2393.6,,,,
PINCH GRFT UP TO 2CM,15050,CPT,,,,,both,, ,2393.6,1436.16,Medicaid,Illinois Medicaid,,,,,2393.6,,,,
SKIN SPLT GRFT T/A/L,15100,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
SKN SPLT GRF T/A/L EA,15101,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
EPIDRM AUTOGRFT T/A/L,15110,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
EPIDR AUTGF T/A/L EA,15111,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
EPIDR AGRFT F/N/H/G,15115,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
EPI AGRFT F/N/HF/G ADL,15116,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
SKN SPLT AGRFT F/N/H/G,15120,CPT,,,,,both,, ,13673.04,8203.82,Medicaid,Illinois Medicaid,,,,,13673.04,,,,
SKN SPLT AGRF F/N/H/G ADD,15121,CPT,,,,,both,, ,13673.04,8203.82,Medicaid,Illinois Medicaid,,,,,13673.04,,,,
DERM AUTOGRAF T/A/L,15130,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
DERM AGRAF T/A/L ADL,15131,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
DERM AGRF F/N/H/G,15135,CPT,,,,,both,, ,13673.04,8203.82,Medicaid,Illinois Medicaid,,,,,13673.04,,,,
DERM AGRF F/N/H/G ADD,15136,CPT,,,,,both,, ,13673.04,8203.82,Medicaid,Illinois Medicaid,,,,,13673.04,,,,
CULT SKN GRF T/A/L,15150,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
CUL SKN GRF T/A/L A,15151,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
CUL SKN GRF T/A/L +%,15152,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
CUL SKN GRF F/N/H/G,15155,CPT,,,,,both,, ,13673.04,8203.82,Medicaid,Illinois Medicaid,,,,,13673.04,,,,
CUL SKN GRF F/N/H/G ADD,15156,CPT,,,,,both,, ,13673.04,8203.82,Medicaid,Illinois Medicaid,,,,,13673.04,,,,
CUL EPIDR GRF F/N/HFG +%,15157,CPT,,,,,both,, ,13673.04,8203.82,Medicaid,Illinois Medicaid,,,,,13673.04,,,,
FTH GRF TRNK 20SQ/<,15200,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
FTH GRF FR TRNK EA AD,15201,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
FTH GF S/A/L 20 SQ/<,15220,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
FTH GF S/A/L 20 SQ E A,15221,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
FTH GR F/C/C/M/N/AX/G/H/F,15240,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
FTH GR F/C/C/M/N/AX/G/H/F EA,15241,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
FTH GR FR N/E/E/L 20SQ/<,15260,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
FTH GR FR N/E/E/L E A,15261,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
SKN SUB GRAFT T/A/L,15271,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
SKN SUB GRFT ADDL,15272,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
SKN S GRFT >100SQ,15273,CPT,,,,,both,, ,13673.04,8203.82,Medicaid,Illinois Medicaid,,,,,13673.04,,,,
SKN S GR ADD 100SQ,15274,CPT,,,,,both,, ,13673.04,8203.82,Medicaid,Illinois Medicaid,,,,,13673.04,,,,
SKN S GR F/NK/HF/G 25SQCM,15275,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
SKN S GR F/N/HF/G ADL,15276,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
SKN S GR F/N/HF/G CH,15277,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
SKN S GR F/N/HF/G CH ADD,15278,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
INIT TX 1ST DEG BURN,16000,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
DRS DEB PTHICK BRN S,16020,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
DRS DEB PTHICK BRN M,16025,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
DRS DEB PTHICK BRN L,16030,CPT,,,,,both,, ,1519.68,911.8,Medicaid,Illinois Medicaid,,,,,1519.68,,,,
DESTRCT PREMAL LES,17000,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
DESTRCT PREMAL 2-14,17003,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
DESTRCT PREMAL 15+,17004,CPT,,,,,both,, ,1519.68,911.8,Medicaid,Illinois Medicaid,,,,,1519.68,,,,
DESTR CV LES <=10 SQ,17106,CPT,,,,,both,, ,1519.68,911.8,Medicaid,Illinois Medicaid,,,,,1519.68,,,,
DESTR CV LES 10-50 SQ,17107,CPT,,,,,both,, ,2393.6,1436.16,Medicaid,Illinois Medicaid,,,,,2393.6,,,,
DESTR CV LES > 50 SQ,17108,CPT,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
DESTRUCT B9 LES 1-14,17110,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
CHEM CAUT GRANL TISS,17250,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
UNLISTD PROCEDURE,17999,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
S-BRST DUCTOGRM INJ,19030,CPT,,,,,both,, ,289.43,173.65,Medicaid,Illinois Medicaid,,,,,289.43,,,,
BX OF BREAST OPEN,19101,CPT,,,,,both,, ,14527.16,8716.29,Medicaid,Illinois Medicaid,,,,,14527.16,,,,
EXPL P WND EXTREM,20103,CPT,,,,,both,, ,6179,3707.4,Medicaid,Illinois Medicaid,,,,,6179,,,,
NJ TENDON SHEATH/LIG,20550,CPT,,,,,both,, ,1128.8,677.28,Medicaid,Illinois Medicaid,,,,,1128.8,,,,
S-JOINT ASP-INJ SM,20600,CPT,,,,,both,, ,487.45,292.47,Medicaid,Illinois Medicaid,,,,,487.45,,,,
US-DRN INJ SMAL JT W,20604,CPT,,,,,both,, ,726.15,435.69,Medicaid,Illinois Medicaid,,,,,726.15,,,,
S-JOINT ASP-INJ IM,20605,CPT,,,,,both,, ,700.66,420.39,Medicaid,Illinois Medicaid,,,,,700.66,,,,
US-DRN INJ INTM JT W,20606,CPT,,,,,both,, ,1594.18,956.5,Medicaid,Illinois Medicaid,,,,,1594.18,,,,
US-DRN INJ MAJR JT W,20611,CPT,,,,,both,, ,726.15,435.69,Medicaid,Illinois Medicaid,,,,,726.15,,,,
S-INJ TMJ ARTHROGRAM,21116,CPT,,,,,both,, ,289.43,173.65,Medicaid,Illinois Medicaid,,,,,289.43,,,,
S-INJ SHOULDER ARTH,23350,CPT,,,,,both,, ,289.43,173.65,Medicaid,Illinois Medicaid,,,,,289.43,,,,
S-INJ ELBOW ARTHRO,24220,CPT,,,,,both,, ,289.43,173.65,Medicaid,Illinois Medicaid,,,,,289.43,,,,
S-INJ WRIST ARTHRO,25246,CPT,,,,,both,, ,289.43,173.65,Medicaid,Illinois Medicaid,,,,,289.43,,,,
S-INJ HIP ARTHRO,27093,CPT,,,,,both,, ,289.43,173.65,Medicaid,Illinois Medicaid,,,,,289.43,,,,
S-INJ KNEE ARTHRO,27369,CPT,,,,,both,, ,289.43,173.65,Medicaid,Illinois Medicaid,,,,,289.43,,,,
S-INJ ANKLE ARTHRO,27648,CPT,,,,,both,, ,289.43,173.65,Medicaid,Illinois Medicaid,,,,,289.43,,,,
EXPLORE FOOT JOINT,28022,CPT,,,,,both,, ,12336.12,7401.67,Medicaid,Illinois Medicaid,,,,,12336.12,,,,
AMPUT TOE & METATRSL,28810,CPT,,,,,both,, ,12336.12,7401.67,Medicaid,Illinois Medicaid,,,,,12336.12,,,,
AMPUTATE TOE,28820,CPT,,,,,both,, ,12336.12,7401.67,Medicaid,Illinois Medicaid,,,,,12336.12,,,,
SPLNT LNG ARM SH PTA,29105,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
SPLNT LNG ARM SH PTA,29105,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
SPLNT LNG ARM SH PTA,29105,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
SPLNT LNG ARM SH PTA,29105,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
SPLNT LNG ARM SH PTA,29105,CPT,,,,,both,, ,1281.32,768.79,Medicaid,Illinois Medicaid,,,,,1281.32,,,,
SPLNT LNG ARM SH PTA,29105,CPT,,,,,both,, ,1281.32,768.79,Medicaid,Illinois Medicaid,,,,,1281.32,,,,
SPLNT LNGARM SH COTA,29105,CPT,,,,,both,, ,1388.96,833.37,Medicaid,Illinois Medicaid,,,,,1388.96,,,,
SPLNT LNGARM SH COTA,29105,CPT,,,,,both,, ,1388.96,833.37,Medicaid,Illinois Medicaid,,,,,1388.96,,,,
SPLNT LONG ARM S-H,29105,CPT,,,,,both,, ,1196.17,717.7,Medicaid,Illinois Medicaid,,,,,1196.17,,,,
SPLNT LONG ARM S-H,29105,CPT,,,,,both,, ,1296.73,778.03,Medicaid,Illinois Medicaid,,,,,1296.73,,,,
SPLNT SHRT ARM STATC,29125,CPT,,,,,both,, ,909.8,545.88,Medicaid,Illinois Medicaid,,,,,909.8,,,,
SPLNT SHRT ARM STATC,29125,CPT,,,,,both,, ,986.3,591.78,Medicaid,Illinois Medicaid,,,,,986.3,,,,
SPLT SHRT ARM ST PTA,29125,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,,,,270.12,,,,
SPLT SHRT ARM ST PTA,29125,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,,,,270.12,,,,
SPLT SHRT ARM ST PTA,29125,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,,,,270.12,,,,
SPLT SHRT ARM ST PTA,29125,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,,,,270.12,,,,
SPLT SHRT ARM ST PTA,29125,CPT,,,,,both,, ,974.64,584.78,Medicaid,Illinois Medicaid,,,,,974.64,,,,
SPLT SHRT ARM ST PTA,29125,CPT,,,,,both,, ,974.64,584.78,Medicaid,Illinois Medicaid,,,,,974.64,,,,
SPLT SHRTARM ST COTA,29125,CPT,,,,,both,, ,1056.52,633.91,Medicaid,Illinois Medicaid,,,,,1056.52,,,,
SPLT SHRTARM ST COTA,29125,CPT,,,,,both,, ,1056.52,633.91,Medicaid,Illinois Medicaid,,,,,1056.52,,,,
SPLN SHRT ARM DY PTA,29126,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,,,,270.12,,,,
SPLN SHRT ARM DY PTA,29126,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,,,,270.12,,,,
SPLN SHRT ARM DY PTA,29126,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,,,,270.12,,,,
SPLN SHRT ARM DY PTA,29126,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,,,,270.12,,,,
SPLN SHRT ARM DY PTA,29126,CPT,,,,,both,, ,1486.29,891.77,Medicaid,Illinois Medicaid,,,,,1486.29,,,,
SPLN SHRT ARM DY PTA,29126,CPT,,,,,both,, ,1486.29,891.77,Medicaid,Illinois Medicaid,,,,,1486.29,,,,
SPLNT SHRT ARM DYNAM,29126,CPT,,,,,both,, ,1387.43,832.45,Medicaid,Illinois Medicaid,,,,,1387.43,,,,
SPLNT SHRT ARM DYNAM,29126,CPT,,,,,both,, ,1504.12,902.47,Medicaid,Illinois Medicaid,,,,,1504.12,,,,
SPLT SHRTARM DY COTA,29126,CPT,,,,,both,, ,1611.18,966.7,Medicaid,Illinois Medicaid,,,,,1611.18,,,,
SPLT SHRTARM DY COTA,29126,CPT,,,,,both,, ,1611.18,966.7,Medicaid,Illinois Medicaid,,,,,1611.18,,,,
SPLNT FINGER STATIC,29130,CPT,,,,,both,, ,299.22,179.53,Medicaid,Illinois Medicaid,,,,,299.22,,,,
SPLNT FINGER STATIC,29130,CPT,,,,,both,, ,324.42,194.65,Medicaid,Illinois Medicaid,,,,,324.42,,,,
SPLNT FNGR STAT COTA,29130,CPT,,,,,both,, ,347.63,208.57,Medicaid,Illinois Medicaid,,,,,347.63,,,,
SPLNT FNGR STAT COTA,29130,CPT,,,,,both,, ,347.63,208.57,Medicaid,Illinois Medicaid,,,,,347.63,,,,
SPLNT FNGR STATC PTA,29130,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,,,,141.88,,,,
SPLNT FNGR STATC PTA,29130,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,,,,141.88,,,,
SPLNT FNGR STATC PTA,29130,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,,,,141.88,,,,
SPLNT FNGR STATC PTA,29130,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,,,,141.88,,,,
SPLNT FNGR STATC PTA,29130,CPT,,,,,both,, ,320.59,192.35,Medicaid,Illinois Medicaid,,,,,320.59,,,,
SPLNT FNGR STATC PTA,29130,CPT,,,,,both,, ,320.59,192.35,Medicaid,Illinois Medicaid,,,,,320.59,,,,
SPLNT FINGER DYNAM,29131,CPT,,,,,both,, ,453.68,272.2,Medicaid,Illinois Medicaid,,,,,453.68,,,,
SPLNT FINGER DYNAM,29131,CPT,,,,,both,, ,491.82,295.09,Medicaid,Illinois Medicaid,,,,,491.82,,,,
SPLNT FINGR DYNA PTA,29131,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,,,,141.88,,,,
SPLNT FINGR DYNA PTA,29131,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,,,,141.88,,,,
SPLNT FINGR DYNA PTA,29131,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,,,,141.88,,,,
SPLNT FINGR DYNA PTA,29131,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,,,,141.88,,,,
SPLNT FINGR DYNA PTA,29131,CPT,,,,,both,, ,485.9,291.54,Medicaid,Illinois Medicaid,,,,,485.9,,,,
SPLNT FINGR DYNA PTA,29131,CPT,,,,,both,, ,485.9,291.54,Medicaid,Illinois Medicaid,,,,,485.9,,,,
SPLNT FNGR DYNA COTA,29131,CPT,,,,,both,, ,526.85,316.11,Medicaid,Illinois Medicaid,,,,,526.85,,,,
SPLNT FNGR DYNA COTA,29131,CPT,,,,,both,, ,526.85,316.11,Medicaid,Illinois Medicaid,,,,,526.85,,,,
STRAPPING THORAX,29200,CPT,,,,,both,, ,377.17,226.3,Medicaid,Illinois Medicaid,,,,,377.17,,,,
STRAPPING THORAX PTA,29200,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
STRAPPING THORAX PTA,29200,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
STRAPPING THORAX PTA,29200,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
STRAPPING THORAX PTA,29200,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
STRAPPING THORAX PTA,29200,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,,,,404.02,,,,
STRAPPING THORAX PTA,29200,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,,,,404.02,,,,
STRAPPING SHOULD PTA,29240,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,,,,270.12,,,,
STRAPPING SHOULD PTA,29240,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,,,,270.12,,,,
STRAPPING SHOULD PTA,29240,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,,,,404.02,,,,
STRAPPING SHOULD PTA,29240,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,,,,404.02,,,,
STRAPPING SHOULDER,29240,CPT,,,,,both,, ,377.17,226.3,Medicaid,Illinois Medicaid,,,,,377.17,,,,
STRAPPING SHOULDER,29240,CPT,,,,,both,, ,408.86,245.31,Medicaid,Illinois Medicaid,,,,,408.86,,,,
STRAPPNG SHOULD COTA,29240,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,,,,81.37,,,,
STRAPPNG SHOULD COTA,29240,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,,,,81.37,,,,
STRAPPNG SHOULD COTA,29240,CPT,,,,,both,, ,438.01,262.8,Medicaid,Illinois Medicaid,,,,,438.01,,,,
STRAPPNG SHOULD COTA,29240,CPT,,,,,both,, ,438.01,262.8,Medicaid,Illinois Medicaid,,,,,438.01,,,,
STRAPPING ELBO-WRIST,29260,CPT,,,,,both,, ,377.17,226.3,Medicaid,Illinois Medicaid,,,,,377.17,,,,
STRAPPING ELBO-WRIST,29260,CPT,,,,,both,, ,408.86,245.31,Medicaid,Illinois Medicaid,,,,,408.86,,,,
STRPNG ELBO-WRST PTA,29260,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,,,,81.37,,,,
STRPNG ELBO-WRST PTA,29260,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,,,,81.37,,,,
STRPNG ELBO-WRST PTA,29260,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,,,,81.37,,,,
STRPNG ELBO-WRST PTA,29260,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,,,,81.37,,,,
STRPNG ELBO-WRST PTA,29260,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,,,,404.02,,,,
STRPNG ELBO-WRST PTA,29260,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,,,,404.02,,,,
STRPNG ELB-WRST COTA,29260,CPT,,,,,both,, ,438.01,262.8,Medicaid,Illinois Medicaid,,,,,438.01,,,,
STRPNG ELB-WRST COTA,29260,CPT,,,,,both,, ,438.01,262.8,Medicaid,Illinois Medicaid,,,,,438.01,,,,
STRAPPING HAND-FING,29280,CPT,,,,,both,, ,377.17,226.3,Medicaid,Illinois Medicaid,,,,,377.17,,,,
STRAPPING HAND-FING,29280,CPT,,,,,both,, ,408.86,245.31,Medicaid,Illinois Medicaid,,,,,408.86,,,,
STRPNG HND-FING COTA,29280,CPT,,,,,both,, ,438.01,262.8,Medicaid,Illinois Medicaid,,,,,438.01,,,,
STRPNG HND-FING COTA,29280,CPT,,,,,both,, ,438.01,262.8,Medicaid,Illinois Medicaid,,,,,438.01,,,,
STRPPNG HND-FING PTA,29280,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,,,,81.37,,,,
STRPPNG HND-FING PTA,29280,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,,,,81.37,,,,
STRPPNG HND-FING PTA,29280,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,,,,81.37,,,,
STRPPNG HND-FING PTA,29280,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,,,,81.37,,,,
STRPPNG HND-FING PTA,29280,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,,,,404.02,,,,
STRPPNG HND-FING PTA,29280,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,,,,404.02,,,,
APPLY RIGID LEG CAST,29445,CPT,,,,,both,, ,1023.52,614.11,Medicaid,Illinois Medicaid,,,,,1023.52,,,,
AP LNG LEG SPLNT PTA,29505,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
AP LNG LEG SPLNT PTA,29505,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
AP LNG LEG SPLNT PTA,29505,CPT,,,,,both,, ,1486.29,891.77,Medicaid,Illinois Medicaid,,,,,1486.29,,,,
AP LNG LEG SPLNT PTA,29505,CPT,,,,,both,, ,1486.29,891.77,Medicaid,Illinois Medicaid,,,,,1486.29,,,,
APP LNG LEG SPLINT,29505,CPT,,,,,both,, ,1387.43,832.45,Medicaid,Illinois Medicaid,,,,,1387.43,,,,
APPLY LNG LEG SPLNT,29505,CPT,,,,,both,, ,600.52,360.31,Medicaid,Illinois Medicaid,,,,,600.52,,,,
AP SHT LEG SPLNT PTA,29515,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
AP SHT LEG SPLNT PTA,29515,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
AP SHT LEG SPLNT PTA,29515,CPT,,,,,both,, ,974.64,584.78,Medicaid,Illinois Medicaid,,,,,974.64,,,,
AP SHT LEG SPLNT PTA,29515,CPT,,,,,both,, ,974.64,584.78,Medicaid,Illinois Medicaid,,,,,974.64,,,,
APP SHORT LEG SPLINT,29515,CPT,,,,,both,, ,909.8,545.88,Medicaid,Illinois Medicaid,,,,,909.8,,,,
APPLY SHRT LEG SPLNT,29515,CPT,,,,,both,, ,600.52,360.31,Medicaid,Illinois Medicaid,,,,,600.52,,,,
STRAPPING HIP,29520,CPT,,,,,both,, ,377.17,226.3,Medicaid,Illinois Medicaid,,,,,377.17,,,,
STRAPPING HIP PTA,29520,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,,,,141.88,,,,
STRAPPING HIP PTA,29520,CPT,,,,,both,, ,141.88,85.12,Medicaid,Illinois Medicaid,,,,,141.88,,,,
STRAPPING HIP PTA,29520,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,,,,404.02,,,,
STRAPPING HIP PTA,29520,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,,,,404.02,,,,
STRAPPING KNEE,29530,CPT,,,,,both,, ,377.17,226.3,Medicaid,Illinois Medicaid,,,,,377.17,,,,
STRAPPING KNEE PTA,29530,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,,,,270.12,,,,
STRAPPING KNEE PTA,29530,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,,,,270.12,,,,
STRAPPING KNEE PTA,29530,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,,,,404.02,,,,
STRAPPING KNEE PTA,29530,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,,,,404.02,,,,
STRAPPING ANKLE-FOOT,29540,CPT,,,,,both,, ,377.17,226.3,Medicaid,Illinois Medicaid,,,,,377.17,,,,
STRPPNG ANKLE-FT PTA,29540,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
STRPPNG ANKLE-FT PTA,29540,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
STRPPNG ANKLE-FT PTA,29540,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,,,,404.02,,,,
STRPPNG ANKLE-FT PTA,29540,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,,,,404.02,,,,
STRAPPING UNA BOOT,29580,CPT,,,,,both,, ,377.17,226.3,Medicaid,Illinois Medicaid,,,,,377.17,,,,
STRPPNG UNA BOOT PTA,29580,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
STRPPNG UNA BOOT PTA,29580,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
STRPPNG UNA BOOT PTA,29580,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,,,,404.02,,,,
STRPPNG UNA BOOT PTA,29580,CPT,,,,,both,, ,404.02,242.41,Medicaid,Illinois Medicaid,,,,,404.02,,,,
UNNA BOOT STRAPPING,29580,CPT,,,,,both,, ,600.52,360.31,Medicaid,Illinois Medicaid,,,,,600.52,,,,
UNNA WRAP,29580,CPT,,,,,both,, ,19.2,11.52,Medicaid,Illinois Medicaid,,,,,19.2,,,,
AP MULTLY COMP LR LEG,29581,CPT,,,,,both,, ,600.52,360.31,Medicaid,Illinois Medicaid,,,,,600.52,,,,
STRPPNG LOW BCK COTA,29799,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,,,,270.12,,,,
STRPPNG LOW BCK COTA,29799,CPT,,,,,both,, ,270.12,162.07,Medicaid,Illinois Medicaid,,,,,270.12,,,,
SUCTION PROC-NASOTRA,31720,CPT,,,,,both,, ,280.42,168.25,Medicaid,Illinois Medicaid,,,,,280.42,,,,
CT-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914,5948.4,Medicaid,Illinois Medicaid,,,,,9914,,,,
IR-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914,5948.4,Medicaid,Illinois Medicaid,,,,,9914,,,,
IR-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914,5948.4,Medicaid,Illinois Medicaid,,,,,9914,,,,
US-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,5184.63,3110.77,Medicaid,Illinois Medicaid,,,,,5184.63,,,,
CC-PERICARDIO W/IMG,33016,CPT,,,,,both,, ,3443.03,2065.81,Medicaid,Illinois Medicaid,,,,,3443.03,,,,
P-IMPLNT LOOP REC,33285,CPT,,,,,both,, ,27383.32,16429.99,Medicaid,Illinois Medicaid,,,,,27383.32,,,,
P-REMOV LOOP REC,33286,CPT,,,,,both,, ,5044.68,3026.8,Medicaid,Illinois Medicaid,,,,,5044.68,,,,
CC-IMP PRESS SEN ANG,33289,CPT,,,,,both,, ,11332.83,6799.69,Medicaid,Illinois Medicaid,,,,,11332.83,,,,
S-INTRO NDL CATH,36000,CPT,,,,,both,, ,168.75,101.25,Medicaid,Illinois Medicaid,,,,,168.75,,,,
S-INTRO NDL CATH VEI,36000,CPT,,,,,both,, ,173.81,104.28,Medicaid,Illinois Medicaid,,,,,173.81,,,,
S-INJ VENOGRAPHY,36005,CPT,,,,,both,, ,873.46,524.07,Medicaid,Illinois Medicaid,,,,,873.46,,,,
S-INTROCATH SEGPULM,36015,CPT,,,,,both,, ,839.21,503.52,Medicaid,Illinois Medicaid,,,,,839.21,,,,
S-CATH CAROTD VERT,36100,CPT,,,,,both,, ,1013.23,607.93,Medicaid,Illinois Medicaid,,,,,1013.23,,,,
S-CATH EXTREM ART,36140,CPT,,,,,both,, ,399.68,239.8,Medicaid,Illinois Medicaid,,,,,399.68,,,,
S-THORACIC 1ST ORDER,36215,CPT,,,,,both,, ,1839.26,1103.55,Medicaid,Illinois Medicaid,,,,,1839.26,,,,
IR-ANG EXT CRT NS,36221,CPT,,,,,both,, ,12592.76,7555.65,Medicaid,Illinois Medicaid,,,,,12592.76,,,,
IR-ANG CRT EXT CC BI,36222,CPT,,,,,both,, ,31881.02,19128.61,Medicaid,Illinois Medicaid,,,,,31881.02,,,,
IR-ANG CARTD IPS BI,36223,CPT,,,,,both,, ,45998.14,27598.88,Medicaid,Illinois Medicaid,,,,,45998.14,,,,
IR-ANG CARTD IPS UNI,36223,CPT,,,,,both,, ,31746.87,19048.12,Medicaid,Illinois Medicaid,,,,,31746.87,,,,
IR-ANG INT CAR IP BI,36224,CPT,,,,,both,, ,51895.68,31137.4,Medicaid,Illinois Medicaid,,,,,51895.68,,,,
IR-ANG INT CAR IP UN,36224,CPT,,,,,both,, ,32068.51,19241.1,Medicaid,Illinois Medicaid,,,,,32068.51,,,,
IR-ANG SUBCL IPS BI,36225,CPT,,,,,both,, ,24740.1,14844.06,Medicaid,Illinois Medicaid,,,,,24740.1,,,,
IR-ANG SUBCL IPS UNI,36225,CPT,,,,,both,, ,12369.34,7421.6,Medicaid,Illinois Medicaid,,,,,12369.34,,,,
CTH PLC EXT CD W-ANG,36227,CPT,,,,,both,, ,9411.59,5646.95,Medicaid,Illinois Medicaid,,,,,9411.59,,,,
CTH PLC EXT CD W-ANG,36227,CPT,,,,,both,, ,14117.39,8470.43,Medicaid,Illinois Medicaid,,,,,14117.39,,,,
S-ANG EXT CD IPS BI,36227,CPT,,,,,both,, ,8060.51,4836.3,Medicaid,Illinois Medicaid,,,,,8060.51,,,,
S-ANG EXT CD IPS BI,36227,CPT,,,,,both,, ,12090.77,7254.46,Medicaid,Illinois Medicaid,,,,,12090.77,,,,
S-ABDOMEN 1ST ORDER,36245,CPT,,,,,both,, ,1979.03,1187.41,Medicaid,Illinois Medicaid,,,,,1979.03,,,,
S-ABDOMEN 2ND ORDER,36246,CPT,,,,,both,, ,9539.09,5723.45,Medicaid,Illinois Medicaid,,,,,9539.09,,,,
S-ABDOMEN 3RD ORDER,36247,CPT,,,,,both,, ,16382.99,9829.79,Medicaid,Illinois Medicaid,,,,,16382.99,,,,
DNA SPECIMEN COLLECTION VENI,36415,CPT,,,,,both,, ,70,42,Medicaid,Illinois Medicaid,,,,,70,,,,
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,, ,8.19,4.91,Medicaid,Illinois Medicaid,,,,,8.19,,,,
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,,,90.37,90.37,Medicaid,Illinois Medicaid,,7.21,,,90.37,90.37,90.37,Fee Schedule,
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,, ,90.37,54.22,Medicaid,Illinois Medicaid,,,,,90.37,,,,
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,22.73,13.63,Medicaid,Illinois Medicaid,,,,,22.73,,,,
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,46.31,27.78,Medicaid,Illinois Medicaid,,,,,46.31,,,,
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,49.96,29.97,Medicaid,Illinois Medicaid,,,,,49.96,,,,
BLOOD TRANSF 0 2 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicaid,Illinois Medicaid,,,,,2260.55,,,,
BLOOD TRANSF 2 4 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicaid,Illinois Medicaid,,,,,2260.55,,,,
BLOOD TRANSF 4 6 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicaid,Illinois Medicaid,,,,,2260.55,,,,
BLOOD TRANSF 6 8 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicaid,Illinois Medicaid,,,,,2260.55,,,,
BLOOD TRANSF 8 10 HR,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicaid,Illinois Medicaid,,,,,2260.55,,,,
BLOOD TRANSFUSION,36430,CPT,,,,,both,, ,3283.64,1970.18,Medicaid,Illinois Medicaid,,,,,3283.64,,,,
BLOOD TRANSFUSION,36430,CPT,,,,,both,, ,3579.17,2147.5,Medicaid,Illinois Medicaid,,,,,3579.17,,,,
BLOOD PUSH TRAN U2YR,36440,CPT,,,,,both,, ,3579.17,2147.5,Medicaid,Illinois Medicaid,,,,,3579.17,,,,
THER APHERESIS WBC,36511,CPT,,,,,both,, ,5560.46,3336.27,Medicaid,Illinois Medicaid,,,,,5560.46,,,,
THER APHERESI PLASMA,36514,CPT,,,,,both,, ,5560.46,3336.27,Medicaid,Illinois Medicaid,,,,,5560.46,,,,
CC-INS NT CVC GT 5YR,36556,CPT,,,,,both,, ,4017.52,2410.51,Medicaid,Illinois Medicaid,,,,,4017.52,,,,
IR-RMV TUN CVC WO SQ,36589,CPT,,,,,both,, ,2370.55,1422.33,Medicaid,Illinois Medicaid,,,,,2370.55,,,,
BLD COLLECT VAD,36591,CPT,,,,,both,, ,445.15,267.09,Medicaid,Illinois Medicaid,,,,,445.15,,,,
BLD DRAW CENTRAL LN,36592,CPT,,,,,both,, ,388.45,233.07,Medicaid,Illinois Medicaid,,,,,388.45,,,,
IR-INJ W FLUR CV DEV,36598,CPT,,,,,both,, ,467.11,280.26,Medicaid,Illinois Medicaid,,,,,467.11,,,,
ARTERIAL PUNCTURE,36600,CPT,,,,,both,, ,327.26,196.35,Medicaid,Illinois Medicaid,,,,,327.26,,,,
S-INS ENDO VENA CAVA,37191,CPT,,,,,both,, ,29440.27,17664.16,Medicaid,Illinois Medicaid,,,,,29440.27,,,,
S-REDO ENDO VENA CAV,37192,CPT,,,,,both,, ,20313.85,12188.31,Medicaid,Illinois Medicaid,,,,,20313.85,,,,
S-REM ENDO VENA CAVA,37193,CPT,,,,,both,, ,20313.85,12188.31,Medicaid,Illinois Medicaid,,,,,20313.85,,,,
S-THROMBOLYSIS CEREB,37195,CPT,,,,,both,, ,860.31,516.18,Medicaid,Illinois Medicaid,,,,,860.31,,,,
S-ID SENTINEL NODE,38792,CPT,,,,,both,, ,1582.72,949.63,Medicaid,Illinois Medicaid,,,,,1582.72,,,,
S-BX NDL LIVER,47000,CPT,,,,,both,, ,1102.87,661.72,Medicaid,Illinois Medicaid,,,,,1102.87,,,,
CT-PERC CHOLECYSTOST,47490,CPT,,,,,both,, ,10295.62,6177.37,Medicaid,Illinois Medicaid,,,,,10295.62,,,,
IR-ABD PARACEN W IMG,49083,CPT,,,,,both,, ,3767.78,2260.66,Medicaid,Illinois Medicaid,,,,,3767.78,,,,
IR-PERITONEAL LAVAGE,49084,CPT,,,,,both,, ,3767.78,2260.66,Medicaid,Illinois Medicaid,,,,,3767.78,,,,
LITHOTRIPSY,50590,CPT,,,,,both,, ,54374.73,32624.83,Medicaid,Illinois Medicaid,,,,,54374.73,,,,
S-URETEROGRM INJ,50684,CPT,,,,,both,, ,323.94,194.36,Medicaid,Illinois Medicaid,,,,,323.94,,,,
S-INJ ILEAL CONDUIT,50690,CPT,,,,,both,, ,323.94,194.36,Medicaid,Illinois Medicaid,,,,,323.94,,,,
S-CORPCAVERNOSGR INJ,54230,CPT,,,,,both,, ,425.39,255.23,Medicaid,Illinois Medicaid,,,,,425.39,,,,
S-INJ CATH HYSTERSO,58340,CPT,,,,,both,, ,336.52,201.91,Medicaid,Illinois Medicaid,,,,,336.52,,,,
FETAL CONTRACTION ST,59020,CPT,,,,,both,, ,2089.1,1253.46,Medicaid,Illinois Medicaid,,,,,2089.1,,,,
FETAL NON STRESS TES,59025,CPT,,,,,both,, ,1169.57,701.74,Medicaid,Illinois Medicaid,,,,,1169.57,,,,
EXTERNAL CEPHALIC VE,59412,CPT,,,,,both,, ,5047.77,3028.66,Medicaid,Illinois Medicaid,,,,,5047.77,,,,
S-THYROID CORE BX,60100,CPT,,,,,both,, ,630.36,378.21,Medicaid,Illinois Medicaid,,,,,630.36,,,,
S-SPINAL TAP DIAGNST,62270,CPT,,,,,both,, ,1417.54,850.52,Medicaid,Illinois Medicaid,,,,,1417.54,,,,
S-INJ EPI BLD PATCH,62273,CPT,,,,,both,, ,1368.1,820.86,Medicaid,Illinois Medicaid,,,,,1368.1,,,,
S-MYELOGRAM INJ,62284,CPT,,,,,both,, ,629.07,377.44,Medicaid,Illinois Medicaid,,,,,629.07,,,,
IR-MYELO CERVICAL,62302,CPT,,,,,both,, ,2078.67,1247.2,Medicaid,Illinois Medicaid,,,,,2078.67,,,,
IR-MYELO THORACIC,62303,CPT,,,,,both,, ,1934.41,1160.64,Medicaid,Illinois Medicaid,,,,,1934.41,,,,
IR-MYELO LUMBAR,62304,CPT,,,,,both,, ,1964.44,1178.66,Medicaid,Illinois Medicaid,,,,,1964.44,,,,
IR-MYELO COMPLETE,62305,CPT,,,,,both,, ,4013.09,2407.85,Medicaid,Illinois Medicaid,,,,,4013.09,,,,
Injection of substance into spinal canal of lower back or sacrum using imaging guidance,62323,CPT,,,,,both,,,2450.37,2450.37,Medicaid,Illinois Medicaid,,67.44,,,2450.37,2450.37,2450.37,Fee Schedule,
IR-DI L-S INJ W IM,62323,CPT,,,,,both,, ,2450.37,1470.22,Medicaid,Illinois Medicaid,,,,,2450.37,,,,
IR-DI L-S INJ-IN WIM,62327,CPT,,,,,both,, ,2707.1,1624.26,Medicaid,Illinois Medicaid,,,,,2707.1,,,,
SPINAL TAP DIAG W-IM,62328,CPT,,,,,both,, ,1417.54,850.52,Medicaid,Illinois Medicaid,,,,,1417.54,,,,
IR-POSTERIOR FOSSA,70010,CPT,,,,,both,, ,2122.18,1273.3,Medicaid,Illinois Medicaid,,,,,2122.18,,,,
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,1239.46,743.67,Medicaid,Illinois Medicaid,,,,,1239.46,,,,
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,2479.48,1487.68,Medicaid,Illinois Medicaid,,,,,2479.48,,,,
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,,,883.84,883.84,Medicaid,Illinois Medicaid,,50.08,,,883.84,883.84,883.84,Fee Schedule,
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,883.84,530.3,Medicaid,Illinois Medicaid,,,,,883.84,,,,
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,,,,220.61,,,,
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,,,940.82,940.82,Medicaid,Illinois Medicaid,,62.6,,,940.82,940.82,940.82,Fee Schedule,
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,940.82,564.49,Medicaid,Illinois Medicaid,,,,,940.82,,,,
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,,,456.37,456.37,Medicaid,Illinois Medicaid,,39.89,,,456.37,456.37,456.37,Fee Schedule,
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,456.37,273.82,Medicaid,Illinois Medicaid,,,,,456.37,,,,
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,,,782.23,782.23,Medicaid,Illinois Medicaid,,57.4,,,782.23,782.23,782.23,Fee Schedule,
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,782.23,469.33,Medicaid,Illinois Medicaid,,,,,782.23,,,,
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,,,,220.61,,,,
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,,,1128.31,1128.31,Medicaid,Illinois Medicaid,,35.25,,,1128.31,1128.31,1128.31,Fee Schedule,
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,1128.31,676.98,Medicaid,Illinois Medicaid,,,,,1128.31,,,,
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-NASAL BONES CR,70160,CPT,,,,,both,,,782.23,782.23,Medicaid,Illinois Medicaid,,24.18,,,782.23,782.23,782.23,Fee Schedule,
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,782.23,469.33,Medicaid,Illinois Medicaid,,,,,782.23,,,,
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-ORBITS 4V CR,70200,CPT,,,,,both,,,918.37,918.37,Medicaid,Illinois Medicaid,,70.5,,,918.37,918.37,918.37,Fee Schedule,
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,918.37,551.02,Medicaid,Illinois Medicaid,,,,,918.37,,,,
HE-SINUSES LTD CR,70210,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-SINUSES LTD CR,70210,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,,,936.33,936.33,Medicaid,Illinois Medicaid,,28.7,,,936.33,936.33,936.33,Fee Schedule,
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,936.33,561.79,Medicaid,Illinois Medicaid,,,,,936.33,,,,
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-SKULL LIMITED CR,70250,CPT,,,,,both,,,1151.89,1151.89,Medicaid,Illinois Medicaid,,46.32,,,1151.89,1151.89,1151.89,Fee Schedule,
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,1151.89,691.13,Medicaid,Illinois Medicaid,,,,,1151.89,,,,
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,,,,220.61,,,,
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,,,1381.48,1381.48,Medicaid,Illinois Medicaid,,35.25,,,1381.48,1381.48,1381.48,Fee Schedule,
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,1381.48,828.88,Medicaid,Illinois Medicaid,,,,,1381.48,,,,
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,,,538.05,538.05,Medicaid,Illinois Medicaid,,28.7,,,538.05,538.05,538.05,Fee Schedule,
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,538.05,322.83,Medicaid,Illinois Medicaid,,,,,538.05,,,,
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,,,342.7,342.7,Medicaid,Illinois Medicaid,,33.94,,,342.7,342.7,342.7,Fee Schedule,
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,342.7,205.62,Medicaid,Illinois Medicaid,,,,,342.7,,,,
IR-ARTHGRM TMJ BI CR,70332,CPT,,,,,both,, ,2353.18,1411.9,Medicaid,Illinois Medicaid,,,,,2353.18,,,,
IR-ARTHROGRAM TMJ CR,70332,CPT,,,,,both,, ,1176.59,705.95,Medicaid,Illinois Medicaid,,,,,1176.59,,,,
HE-ORTHOPANTOGRAM CR,70355,CPT,,,,,both,, ,692.14,415.28,Medicaid,Illinois Medicaid,,,,,692.14,,,,
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,,,757.53,757.53,Medicaid,Illinois Medicaid,,40.46,,,757.53,757.53,757.53,Fee Schedule,
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,757.53,454.51,Medicaid,Illinois Medicaid,,,,,757.53,,,,
FL-PHX SP EV W CINE,70371,CPT,,,,,both,, ,808.06,484.83,Medicaid,Illinois Medicaid,,,,,808.06,,,,
IR-SIALOGRAM,70390,CPT,,,,,both,, ,1800.52,1080.31,Medicaid,Illinois Medicaid,,,,,1800.52,,,,
"CT scan, head or brain, without contrast",70450,CPT,,,,,both,,,1576.55,1576.55,Medicaid,Illinois Medicaid,,606.42,,,1576.55,1576.55,1576.55,Fee Schedule,
CT-HEAD WO,70450,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,,,,307.05,,,,
CT-HEAD WO,70450,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,,,,330.63,,,,
CT-HEAD WO,70450,CPT,,,,,both,, ,1576.55,945.93,Medicaid,Illinois Medicaid,,,,,1576.55,,,,
CT-HEAD W,70460,CPT,,,,,both,,,1765.72,1765.72,Medicaid,Illinois Medicaid,,140.51,,,1765.72,1765.72,1765.72,Fee Schedule,
CT-HEAD W,70460,CPT,,,,,both,, ,1765.72,1059.43,Medicaid,Illinois Medicaid,,,,,1765.72,,,,
CT-HEAD WWO,70470,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,,,,680.91,,,,
CT-HEAD WWO,70470,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,,,,732.83,,,,
CT-HEAD WWO,70470,CPT,,,,,both,,,3726.8,3726.8,Medicaid,Illinois Medicaid,,164.51,,,3726.8,3726.8,3726.8,Fee Schedule,
CT-HEAD WWO,70470,CPT,,,,,both,, ,3726.8,2236.08,Medicaid,Illinois Medicaid,,,,,3726.8,,,,
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,,,,307.05,,,,
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,,,,330.63,,,,
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,2847.17,1708.3,Medicaid,Illinois Medicaid,,,,,2847.17,,,,
CT-ORBIT EAR W,70481,CPT,,,,,both,, ,556.01,333.6,Medicaid,Illinois Medicaid,,,,,556.01,,,,
CT-ORBIT EAR W,70481,CPT,,,,,both,, ,1643.07,985.84,Medicaid,Illinois Medicaid,,,,,1643.07,,,,
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,,,,680.91,,,,
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,,,,732.83,,,,
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,4001.3,2400.78,Medicaid,Illinois Medicaid,,,,,4001.3,,,,
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,,,,307.05,,,,
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,,,,330.63,,,,
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,,,2847.17,2847.17,Medicaid,Illinois Medicaid,,84.62,,,2847.17,2847.17,2847.17,Fee Schedule,
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,2847.17,1708.3,Medicaid,Illinois Medicaid,,,,,2847.17,,,,
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,,,,604.85,,,,
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,,,,650.88,,,,
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,,,3178.64,3178.64,Medicaid,Illinois Medicaid,,100.97,,,3178.64,3178.64,3178.64,Fee Schedule,
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,3178.64,1907.18,Medicaid,Illinois Medicaid,,,,,3178.64,,,,
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,,,,680.91,,,,
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,,,,732.83,,,,
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,,,3726.8,3726.8,Medicaid,Illinois Medicaid,,122.05,,,3726.8,3726.8,3726.8,Fee Schedule,
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,3726.8,2236.08,Medicaid,Illinois Medicaid,,,,,3726.8,,,,
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,,,,307.05,,,,
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,,,,330.63,,,,
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,,,2737.98,2737.98,Medicaid,Illinois Medicaid,,99.81,,,2737.98,2737.98,2737.98,Fee Schedule,
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,2737.98,1642.78,Medicaid,Illinois Medicaid,,,,,2737.98,,,,
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,,,,604.85,,,,
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,,,,650.88,,,,
CT-NECK SOFT TIS W,70491,CPT,,,,,both,,,2743.59,2743.59,Medicaid,Illinois Medicaid,,122.28,,,2743.59,2743.59,2743.59,Fee Schedule,
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,2743.59,1646.15,Medicaid,Illinois Medicaid,,,,,2743.59,,,,
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,,,,680.91,,,,
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,,,,732.83,,,,
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,,,4317.62,4317.62,Medicaid,Illinois Medicaid,,146.49,,,4317.62,4317.62,4317.62,Fee Schedule,
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,4317.62,2590.57,Medicaid,Illinois Medicaid,,,,,4317.62,,,,
CTA-HEAD,70496,CPT,,,,,both,, ,893.1,535.86,Medicaid,Illinois Medicaid,,,,,893.1,,,,
CTA-HEAD,70496,CPT,,,,,both,,,2355.42,2355.42,Medicaid,Illinois Medicaid,,247.05,,,2355.42,2355.42,2355.42,Fee Schedule,
CTA-HEAD,70496,CPT,,,,,both,, ,2355.42,1413.25,Medicaid,Illinois Medicaid,,,,,2355.42,,,,
CTA-NECK,70498,CPT,,,,,both,, ,893.1,535.86,Medicaid,Illinois Medicaid,,,,,893.1,,,,
CTA-NECK,70498,CPT,,,,,both,,,2355.42,2355.42,Medicaid,Illinois Medicaid,,247.05,,,2355.42,2355.42,2355.42,Fee Schedule,
CTA-NECK,70498,CPT,,,,,both,, ,2355.42,1413.25,Medicaid,Illinois Medicaid,,,,,2355.42,,,,
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,,,,715.99,,,,
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,,,,770.45,,,,
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,4042.84,2425.7,Medicaid,Illinois Medicaid,,,,,4042.84,,,,
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,,,,1035.69,,,,
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,,,,1114.55,,,,
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,4293.48,2576.08,Medicaid,Illinois Medicaid,,,,,4293.48,,,,
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,,,,1197.08,,,,
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,,,,1288.29,,,,
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,5197.81,3118.68,Medicaid,Illinois Medicaid,,,,,5197.81,,,,
MRA-HEAD WO,70544,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,,,,715.99,,,,
MRA-HEAD WO,70544,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,,,,770.45,,,,
MRA-HEAD WO,70544,CPT,,,,,both,, ,1631.56,978.93,Medicaid,Illinois Medicaid,,,,,1631.56,,,,
MRA-HEAD W,70545,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,,,,1035.69,,,,
MRA-HEAD W,70545,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,,,,1114.55,,,,
MRA-HEAD W,70545,CPT,,,,,both,, ,1938.34,1163,Medicaid,Illinois Medicaid,,,,,1938.34,,,,
MRA-HEAD WWO,70546,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,,,,1197.08,,,,
MRA-HEAD WWO,70546,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,,,,1288.29,,,,
MRA-HEAD WWO,70546,CPT,,,,,both,, ,2669.78,1601.86,Medicaid,Illinois Medicaid,,,,,2669.78,,,,
MRA-NECK WO,70547,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,,,,715.99,,,,
MRA-NECK WO,70547,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,,,,770.45,,,,
MRA-NECK WO,70547,CPT,,,,,both,, ,1334.89,800.93,Medicaid,Illinois Medicaid,,,,,1334.89,,,,
MRA-NECK W,70548,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,,,,1035.69,,,,
MRA-NECK W,70548,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,,,,1114.55,,,,
MRA-NECK W,70548,CPT,,,,,both,, ,1938.34,1163,Medicaid,Illinois Medicaid,,,,,1938.34,,,,
MRA-NECK WWO,70549,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,,,,1197.08,,,,
MRA-NECK WWO,70549,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,,,,1288.29,,,,
MRA-NECK WWO,70549,CPT,,,,,both,, ,3263.12,1957.87,Medicaid,Illinois Medicaid,,,,,3263.12,,,,
MR-BRAIN WO,70551,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,,,,715.99,,,,
MR-BRAIN WO,70551,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,,,,770.45,,,,
MR-BRAIN WO,70551,CPT,,,,,both,,,4941.28,4941.28,Medicaid,Illinois Medicaid,,186.47,,,4941.28,4941.28,4941.28,Fee Schedule,
MR-BRAIN WO,70551,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,,,,4941.28,,,,
MR-BRAIN W,70552,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,,,,1035.69,,,,
MR-BRAIN W,70552,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,,,,1114.55,,,,
MR-BRAIN W,70552,CPT,,,,,both,,,2352.06,2352.06,Medicaid,Illinois Medicaid,,296.6,,,2352.06,2352.06,2352.06,Fee Schedule,
MR-BRAIN W,70552,CPT,,,,,both,, ,2352.06,1411.23,Medicaid,Illinois Medicaid,,,,,2352.06,,,,
MR-BRAIN WWO,70553,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,,,,1197.08,,,,
MR-BRAIN WWO,70553,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,,,,1288.29,,,,
MR-BRAIN WWO,70553,CPT,,,,,both,, ,6352.79,3811.67,Medicaid,Illinois Medicaid,,,,,6352.79,,,,
MRI scan of brain before and after contrast,70553,CPT,,,,,both,,,6352.79,6352.79,Medicaid,Illinois Medicaid,,976.42,,,6352.79,6352.79,6352.79,Fee Schedule,
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-CHEST 1V CR,71045,CPT,,,,,both,,,495.95,495.95,Medicaid,Illinois Medicaid,,100.02,,,495.95,495.95,495.95,Fee Schedule,
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,495.95,297.57,Medicaid,Illinois Medicaid,,,,,495.95,,,,
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-CHEST 2V CR,71046,CPT,,,,,both,,,750.52,750.52,Medicaid,Illinois Medicaid,,87.08,,,750.52,750.52,750.52,Fee Schedule,
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,750.52,450.31,Medicaid,Illinois Medicaid,,,,,750.52,,,,
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Medicaid,Illinois Medicaid,,,,,143.98,,,,
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Medicaid,Illinois Medicaid,,,,,143.98,,,,
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Medicaid,Illinois Medicaid,,,,,143.98,,,,
CH-CHEST 3V CR,71047,CPT,,,,,both,,,1091.82,1091.82,Medicaid,Illinois Medicaid,,87.08,,,1091.82,1091.82,1091.82,Fee Schedule,
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,1091.82,655.09,Medicaid,Illinois Medicaid,,,,,1091.82,,,,
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,143.98,86.38,Medicaid,Illinois Medicaid,,,,,143.98,,,,
CH-CHEST 4V CR,71048,CPT,,,,,both,,,1652.05,1652.05,Medicaid,Illinois Medicaid,,29.48,,,1652.05,1652.05,1652.05,Fee Schedule,
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,1652.05,991.23,Medicaid,Illinois Medicaid,,,,,1652.05,,,,
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-RIBS UNILAT CR,71100,CPT,,,,,both,,,876.83,876.83,Medicaid,Illinois Medicaid,,47.3,,,876.83,876.83,876.83,Fee Schedule,
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,876.83,526.09,Medicaid,Illinois Medicaid,,,,,876.83,,,,
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,,,,220.61,,,,
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,260.74,156.44,Medicaid,Illinois Medicaid,,,,,260.74,,,,
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,260.74,156.44,Medicaid,Illinois Medicaid,,,,,260.74,,,,
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,,,1152.17,1152.17,Medicaid,Illinois Medicaid,,54.62,,,1152.17,1152.17,1152.17,Fee Schedule,
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,1152.17,691.3,Medicaid,Illinois Medicaid,,,,,1152.17,,,,
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,,,,220.61,,,,
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,,,1381.48,1381.48,Medicaid,Illinois Medicaid,,28.39,,,1381.48,1381.48,1381.48,Fee Schedule,
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,1381.48,828.88,Medicaid,Illinois Medicaid,,,,,1381.48,,,,
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,,,,220.61,,,,
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,260.74,156.44,Medicaid,Illinois Medicaid,,,,,260.74,,,,
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,260.74,156.44,Medicaid,Illinois Medicaid,,,,,260.74,,,,
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,,,1877.99,1877.99,Medicaid,Illinois Medicaid,,34,,,1877.99,1877.99,1877.99,Fee Schedule,
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,1877.99,1126.79,Medicaid,Illinois Medicaid,,,,,1877.99,,,,
CH-STERNUM CR,71120,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-STERNUM CR,71120,CPT,,,,,both,,,947.27,947.27,Medicaid,Illinois Medicaid,,21.73,,,947.27,947.27,947.27,Fee Schedule,
CH-STERNUM CR,71120,CPT,,,,,both,, ,947.27,568.36,Medicaid,Illinois Medicaid,,,,,947.27,,,,
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,,,989.38,989.38,Medicaid,Illinois Medicaid,,28.7,,,989.38,989.38,989.38,Fee Schedule,
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,989.38,593.62,Medicaid,Illinois Medicaid,,,,,989.38,,,,
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,,,,307.05,,,,
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,,,,330.63,,,,
CT-CHEST DIAG WO,71250,CPT,,,,,both,,,3833.18,3833.18,Medicaid,Illinois Medicaid,,90.74,,,3833.18,3833.18,3833.18,Fee Schedule,
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,3833.18,2299.9,Medicaid,Illinois Medicaid,,,,,3833.18,,,,
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,,,,604.85,,,,
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,,,,650.88,,,,
CT-CHEST DIAG W,71260,CPT,,,,,both,,,4107.96,4107.96,Medicaid,Illinois Medicaid,,112.16,,,4107.96,4107.96,4107.96,Fee Schedule,
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,4107.96,2464.77,Medicaid,Illinois Medicaid,,,,,4107.96,,,,
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,,,,680.91,,,,
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,,,,732.83,,,,
CT-CHEST DIAG WWO,71270,CPT,,,,,both,,,3833.18,3833.18,Medicaid,Illinois Medicaid,,132.46,,,3833.18,3833.18,3833.18,Fee Schedule,
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,3833.18,2299.9,Medicaid,Illinois Medicaid,,,,,3833.18,,,,
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,, ,273.09,163.85,Medicaid,Illinois Medicaid,,,,,273.09,,,,
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,, ,273.09,163.85,Medicaid,Illinois Medicaid,,,,,273.09,,,,
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,,,568.92,568.92,Medicaid,Illinois Medicaid,,91.46,,,568.92,568.92,568.92,Fee Schedule,
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,, ,568.92,341.35,Medicaid,Illinois Medicaid,,,,,568.92,,,,
CTA-CHEST,71275,CPT,,,,,both,, ,708.98,425.38,Medicaid,Illinois Medicaid,,,,,708.98,,,,
CTA-CHEST,71275,CPT,,,,,both,, ,763.15,457.89,Medicaid,Illinois Medicaid,,,,,763.15,,,,
CTA-CHEST,71275,CPT,,,,,both,,,2355.14,2355.14,Medicaid,Illinois Medicaid,,265,,,2355.14,2355.14,2355.14,Fee Schedule,
CTA-CHEST,71275,CPT,,,,,both,, ,2355.14,1413.08,Medicaid,Illinois Medicaid,,,,,2355.14,,,,
MR-CHEST WO,71550,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,,,,715.99,,,,
MR-CHEST WO,71550,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,,,,770.45,,,,
MR-CHEST WO,71550,CPT,,,,,both,,,4042.84,4042.84,Medicaid,Illinois Medicaid,,296.6,,,4042.84,4042.84,4042.84,Fee Schedule,
MR-CHEST WO,71550,CPT,,,,,both,, ,4042.84,2425.7,Medicaid,Illinois Medicaid,,,,,4042.84,,,,
MR-CHEST W,71551,CPT,,,,,both,,,4293.48,4293.48,Medicaid,Illinois Medicaid,,296.6,,,4293.48,4293.48,4293.48,Fee Schedule,
MR-CHEST W,71551,CPT,,,,,both,, ,4293.48,2576.08,Medicaid,Illinois Medicaid,,,,,4293.48,,,,
MR-CHEST WWO,71552,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,,,,1197.08,,,,
MR-CHEST WWO,71552,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,,,,1288.29,,,,
MR-CHEST WWO,71552,CPT,,,,,both,,,5197.81,5197.81,Medicaid,Illinois Medicaid,,443.47,,,5197.81,5197.81,5197.81,Fee Schedule,
MR-CHEST WWO,71552,CPT,,,,,both,, ,5197.81,3118.68,Medicaid,Illinois Medicaid,,,,,5197.81,,,,
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,,,261.02,261.02,Medicaid,Illinois Medicaid,,90.25,,,261.02,261.02,261.02,Fee Schedule,
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,261.02,156.61,Medicaid,Illinois Medicaid,,,,,261.02,,,,
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,,,1085.36,1085.36,Medicaid,Illinois Medicaid,,76.62,,,1085.36,1085.36,1085.36,Fee Schedule,
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,1085.36,651.21,Medicaid,Illinois Medicaid,,,,,1085.36,,,,
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,,,,220.61,,,,
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,1112.87,667.72,Medicaid,Illinois Medicaid,,,,,1112.87,,,,
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,,,,220.61,,,,
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,1471.29,882.77,Medicaid,Illinois Medicaid,,,,,1471.29,,,,
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,,,1181.64,1181.64,Medicaid,Illinois Medicaid,,22.8,,,1181.64,1181.64,1181.64,Fee Schedule,
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,1181.64,708.98,Medicaid,Illinois Medicaid,,,,,1181.64,,,,
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,,,,220.61,,,,
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,,,1444.63,1444.63,Medicaid,Illinois Medicaid,,25.56,,,1444.63,1444.63,1444.63,Fee Schedule,
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,1444.63,866.77,Medicaid,Illinois Medicaid,,,,,1444.63,,,,
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,,,1444.63,1444.63,Medicaid,Illinois Medicaid,,25.4,,,1444.63,1444.63,1444.63,Fee Schedule,
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,1444.63,866.77,Medicaid,Illinois Medicaid,,,,,1444.63,,,,
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,139.77,83.86,Medicaid,Illinois Medicaid,,,,,139.77,,,,
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,149.32,89.59,Medicaid,Illinois Medicaid,,,,,149.32,,,,
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,1181.91,709.14,Medicaid,Illinois Medicaid,,,,,1181.91,,,,
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,139.77,83.86,Medicaid,Illinois Medicaid,,,,,139.77,,,,
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,149.32,89.59,Medicaid,Illinois Medicaid,,,,,149.32,,,,
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,230.71,138.42,Medicaid,Illinois Medicaid,,,,,230.71,,,,
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,1181.91,709.14,Medicaid,Illinois Medicaid,,,,,1181.91,,,,
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,230.71,138.42,Medicaid,Illinois Medicaid,,,,,230.71,,,,
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,279.26,167.55,Medicaid,Illinois Medicaid,,,,,279.26,,,,
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,298.64,179.18,Medicaid,Illinois Medicaid,,,,,298.64,,,,
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,2363.84,1418.3,Medicaid,Illinois Medicaid,,,,,2363.84,,,,
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,279.26,167.55,Medicaid,Illinois Medicaid,,,,,279.26,,,,
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,298.64,179.18,Medicaid,Illinois Medicaid,,,,,298.64,,,,
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,2363.84,1418.3,Medicaid,Illinois Medicaid,,,,,2363.84,,,,
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,,,1504.42,1504.42,Medicaid,Illinois Medicaid,,14.35,,,1504.42,1504.42,1504.42,Fee Schedule,
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,1504.42,902.65,Medicaid,Illinois Medicaid,,,,,1504.42,,,,
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,,,,220.61,,,,
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,1968.65,1181.19,Medicaid,Illinois Medicaid,,,,,1968.65,,,,
"X-Ray, lower back, minimum four views",72110,CPT,,,,,both,,,1968.65,1968.65,Medicaid,Illinois Medicaid, ,116.14,,,1968.65,1968.65,1968.65,Fee Schedule,
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,,,,220.61,,,,
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
SP-LS SPINE W BND CR,72114,CPT,,,,,both,,,2229.96,2229.96,Medicaid,Illinois Medicaid,,29.58,,,2229.96,2229.96,2229.96,Fee Schedule,
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,2229.96,1337.97,Medicaid,Illinois Medicaid,,,,,2229.96,,,,
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,,,,220.61,,,,
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
SP-LS SPINE BND CR,72120,CPT,,,,,both,,,1765.44,1765.44,Medicaid,Illinois Medicaid,,27.03,,,1765.44,1765.44,1765.44,Fee Schedule,
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,1765.44,1059.26,Medicaid,Illinois Medicaid,,,,,1765.44,,,,
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,,,,307.05,,,,
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,,,,330.63,,,,
CT-CERV SPINE WO,72125,CPT,,,,,both,,,3833.18,3833.18,Medicaid,Illinois Medicaid,,90.74,,,3833.18,3833.18,3833.18,Fee Schedule,
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,3833.18,2299.9,Medicaid,Illinois Medicaid,,,,,3833.18,,,,
CT-CERV SPINE W,72126,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,,,,604.85,,,,
CT-CERV SPINE W,72126,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,,,,650.88,,,,
CT-CERV SPINE W,72126,CPT,,,,,both,,,6031.42,6031.42,Medicaid,Illinois Medicaid,,111.81,,,6031.42,6031.42,6031.42,Fee Schedule,
CT-CERV SPINE W,72126,CPT,,,,,both,, ,6031.42,3618.85,Medicaid,Illinois Medicaid,,,,,6031.42,,,,
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,,,,680.91,,,,
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,,,,732.83,,,,
CT-CERV SPINE WWO,72127,CPT,,,,,both,,,6031.42,6031.42,Medicaid,Illinois Medicaid,,131.26,,,6031.42,6031.42,6031.42,Fee Schedule,
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,6031.42,3618.85,Medicaid,Illinois Medicaid,,,,,6031.42,,,,
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,,,,307.05,,,,
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,,,,330.63,,,,
CT-THOR SPINE WO,72128,CPT,,,,,both,,,3833.18,3833.18,Medicaid,Illinois Medicaid,,89.06,,,3833.18,3833.18,3833.18,Fee Schedule,
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,3833.18,2299.9,Medicaid,Illinois Medicaid,,,,,3833.18,,,,
CT-THOR SPINE W,72129,CPT,,,,,both,, ,534.96,320.97,Medicaid,Illinois Medicaid,,,,,534.96,,,,
CT-THOR SPINE W,72129,CPT,,,,,both,,,1786.22,1786.22,Medicaid,Illinois Medicaid,,112.76,,,1786.22,1786.22,1786.22,Fee Schedule,
CT-THOR SPINE W,72129,CPT,,,,,both,, ,1786.22,1071.73,Medicaid,Illinois Medicaid,,,,,1786.22,,,,
CT-THOR SPINE WWO,72130,CPT,,,,,both,,,2407.63,2407.63,Medicaid,Illinois Medicaid,,131.46,,,2407.63,2407.63,2407.63,Fee Schedule,
CT-THOR SPINE WWO,72130,CPT,,,,,both,, ,2407.63,1444.57,Medicaid,Illinois Medicaid,,,,,2407.63,,,,
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,,,,307.05,,,,
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,,,,330.63,,,,
CT-LUMB SPINE WO,72131,CPT,,,,,both,,,534.68,534.68,Medicaid,Illinois Medicaid,,88.66,,,534.68,534.68,534.68,Fee Schedule,
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,534.68,320.8,Medicaid,Illinois Medicaid,,,,,534.68,,,,
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,,,,604.85,,,,
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,,,,650.88,,,,
CT-LUMB SPINE W,72132,CPT,,,,,both,,,1653.45,1653.45,Medicaid,Illinois Medicaid,,112.02,,,1653.45,1653.45,1653.45,Fee Schedule,
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,1653.45,992.07,Medicaid,Illinois Medicaid,,,,,1653.45,,,,
CT-LUMB SPINE WWO,72133,CPT,,,,,both,, ,446.27,267.76,Medicaid,Illinois Medicaid,,,,,446.27,,,,
CT-LUMB SPINE WWO,72133,CPT,,,,,both,,,1126.62,1126.62,Medicaid,Illinois Medicaid,,130.84,,,1126.62,1126.62,1126.62,Fee Schedule,
CT-LUMB SPINE WWO,72133,CPT,,,,,both,, ,1126.62,675.97,Medicaid,Illinois Medicaid,,,,,1126.62,,,,
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,,,,715.99,,,,
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,,,,770.45,,,,
MR-CERV SPINE WO,72141,CPT,,,,,both,,,4941.28,4941.28,Medicaid,Illinois Medicaid,,181.39,,,4941.28,4941.28,4941.28,Fee Schedule,
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,,,,4941.28,,,,
MR-CERV SPINE W,72142,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,,,,1035.69,,,,
MR-CERV SPINE W,72142,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,,,,1114.55,,,,
MR-CERV SPINE W,72142,CPT,,,,,both,,,2352.06,2352.06,Medicaid,Illinois Medicaid,,260.96,,,2352.06,2352.06,2352.06,Fee Schedule,
MR-CERV SPINE W,72142,CPT,,,,,both,, ,2352.06,1411.23,Medicaid,Illinois Medicaid,,,,,2352.06,,,,
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,,,,715.99,,,,
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,,,,770.45,,,,
MR-THOR SPINE WO,72146,CPT,,,,,both,,,4941.28,4941.28,Medicaid,Illinois Medicaid,,181.09,,,4941.28,4941.28,4941.28,Fee Schedule,
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,,,,4941.28,,,,
MR-THOR SPINE W,72147,CPT,,,,,both,, ,1641.24,984.74,Medicaid,Illinois Medicaid,,,,,1641.24,,,,
MR-THOR SPINE W,72147,CPT,,,,,both,,,2351.49,2351.49,Medicaid,Illinois Medicaid,,258.42,,,2351.49,2351.49,2351.49,Fee Schedule,
MR-THOR SPINE W,72147,CPT,,,,,both,, ,2351.49,1410.89,Medicaid,Illinois Medicaid,,,,,2351.49,,,,
MRI scan of lower spinal canal,72148,CPT,,,,,both,,,4941.28,4941.28,Medicaid,Illinois Medicaid,,673.57,,,4941.28,4941.28,4941.28,Fee Schedule,
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,,,,715.99,,,,
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,,,,770.45,,,,
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,,,,4941.28,,,,
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,,,,1035.69,,,,
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,,,,1114.55,,,,
MR-LUMB SPINE W,72149,CPT,,,,,both,,,2352.06,2352.06,Medicaid,Illinois Medicaid,,256.48,,,2352.06,2352.06,2352.06,Fee Schedule,
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,2352.06,1411.23,Medicaid,Illinois Medicaid,,,,,2352.06,,,,
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,,,,1197.08,,,,
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,,,,1288.29,,,,
MR-CERV SPINE WWO,72156,CPT,,,,,both,,,6352.79,6352.79,Medicaid,Illinois Medicaid,,296.6,,,6352.79,6352.79,6352.79,Fee Schedule,
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,6352.79,3811.67,Medicaid,Illinois Medicaid,,,,,6352.79,,,,
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,,,,1197.08,,,,
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,,,,1288.29,,,,
MR-THOR SPINE WWO,72157,CPT,,,,,both,,,6352.79,6352.79,Medicaid,Illinois Medicaid,,296.6,,,6352.79,6352.79,6352.79,Fee Schedule,
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,6352.79,3811.67,Medicaid,Illinois Medicaid,,,,,6352.79,,,,
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,,,,1197.08,,,,
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,,,,1288.29,,,,
MR-LUMB SPINE WWO,72158,CPT,,,,,both,,,6352.79,6352.79,Medicaid,Illinois Medicaid,,296.6,,,6352.79,6352.79,6352.79,Fee Schedule,
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,6352.79,3811.67,Medicaid,Illinois Medicaid,,,,,6352.79,,,,
LE-PELVIS CR,72170,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-PELVIS CR,72170,CPT,,,,,both,,,936.33,936.33,Medicaid,Illinois Medicaid,,36.24,,,936.33,936.33,936.33,Fee Schedule,
LE-PELVIS CR,72170,CPT,,,,,both,, ,936.33,561.79,Medicaid,Illinois Medicaid,,,,,936.33,,,,
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,,,1774.99,1774.99,Medicaid,Illinois Medicaid,,35.25,,,1774.99,1774.99,1774.99,Fee Schedule,
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,1774.99,1064.99,Medicaid,Illinois Medicaid,,,,,1774.99,,,,
CT-PELVIS WO,72192,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,,,,307.05,,,,
CT-PELVIS WO,72192,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,,,,330.63,,,,
CT-PELVIS WO,72192,CPT,,,,,both,,,3285.58,3285.58,Medicaid,Illinois Medicaid,,88.45,,,3285.58,3285.58,3285.58,Fee Schedule,
CT-PELVIS WO,72192,CPT,,,,,both,, ,3285.58,1971.34,Medicaid,Illinois Medicaid,,,,,3285.58,,,,
"CT scan, pelvis, with contrast",72193,CPT,,,,,both,,,3726.8,3726.8,Medicaid,Illinois Medicaid,,823.46,,,3726.8,3726.8,3726.8,Fee Schedule,
CT-PELVIS W,72193,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,,,,604.85,,,,
CT-PELVIS W,72193,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,,,,650.88,,,,
CT-PELVIS W,72193,CPT,,,,,both,, ,3726.8,2236.08,Medicaid,Illinois Medicaid,,,,,3726.8,,,,
CT-PELVIS WWO,72194,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,,,,680.91,,,,
CT-PELVIS WWO,72194,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,,,,732.83,,,,
CT-PELVIS WWO,72194,CPT,,,,,both,,,4047.33,4047.33,Medicaid,Illinois Medicaid,,165.96,,,4047.33,4047.33,4047.33,Fee Schedule,
CT-PELVIS WWO,72194,CPT,,,,,both,, ,4047.33,2428.39,Medicaid,Illinois Medicaid,,,,,4047.33,,,,
MR-PELVIS WO,72195,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,,,,715.99,,,,
MR-PELVIS WO,72195,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,,,,770.45,,,,
MR-PELVIS WO,72195,CPT,,,,,both,,,4042.84,4042.84,Medicaid,Illinois Medicaid,,216.87,,,4042.84,4042.84,4042.84,Fee Schedule,
MR-PELVIS WO,72195,CPT,,,,,both,, ,4042.84,2425.7,Medicaid,Illinois Medicaid,,,,,4042.84,,,,
MR-PELVIS W,72196,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,,,,1035.69,,,,
MR-PELVIS W,72196,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,,,,1114.55,,,,
MR-PELVIS W,72196,CPT,,,,,both,,,2940.06,2940.06,Medicaid,Illinois Medicaid,,254.09,,,2940.06,2940.06,2940.06,Fee Schedule,
MR-PELVIS W,72196,CPT,,,,,both,, ,2940.06,1764.03,Medicaid,Illinois Medicaid,,,,,2940.06,,,,
MR-PELVIS WWO,72197,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,,,,1197.08,,,,
MR-PELVIS WWO,72197,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,,,,1288.29,,,,
MR-PELVIS WWO,72197,CPT,,,,,both,,,5197.81,5197.81,Medicaid,Illinois Medicaid,,318.76,,,5197.81,5197.81,5197.81,Fee Schedule,
MR-PELVIS WWO,72197,CPT,,,,,both,, ,5197.81,3118.68,Medicaid,Illinois Medicaid,,,,,5197.81,,,,
SP-SI JOINTS 2V CR,72200,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-SI JOINTS 2V CR,72200,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,,,757.53,757.53,Medicaid,Illinois Medicaid,,25.35,,,757.53,757.53,757.53,Fee Schedule,
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,757.53,454.51,Medicaid,Illinois Medicaid,,,,,757.53,,,,
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,,,989.38,989.38,Medicaid,Illinois Medicaid,,21.5,,,989.38,989.38,989.38,Fee Schedule,
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,989.38,593.62,Medicaid,Illinois Medicaid,,,,,989.38,,,,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,,,721.61,721.61,Medicaid,Illinois Medicaid,,42.04,,,721.61,721.61,721.61,Fee Schedule,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,721.61,432.96,Medicaid,Illinois Medicaid,,,,,721.61,,,,
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-CLAVICLE CR,73000,CPT,,,,,both,,,353.93,353.93,Medicaid,Illinois Medicaid,,42.04,,,353.93,353.93,353.93,Fee Schedule,
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,353.93,212.35,Medicaid,Illinois Medicaid,,,,,353.93,,,,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,273.37,164.02,Medicaid,Illinois Medicaid,,,,,273.37,,,,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,273.37,164.02,Medicaid,Illinois Medicaid,,,,,273.37,,,,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,,,804.69,804.69,Medicaid,Illinois Medicaid,,21.5,,,804.69,804.69,804.69,Fee Schedule,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,,,,804.69,,,,
UE-SCAPULA CR,73010,CPT,,,,,both,, ,136.68,82,Medicaid,Illinois Medicaid,,,,,136.68,,,,
UE-SCAPULA CR,73010,CPT,,,,,both,, ,136.68,82,Medicaid,Illinois Medicaid,,,,,136.68,,,,
UE-SCAPULA CR,73010,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-SCAPULA CR,73010,CPT,,,,,both,,,402.2,402.2,Medicaid,Illinois Medicaid,,21.5,,,402.2,402.2,402.2,Fee Schedule,
UE-SCAPULA CR,73010,CPT,,,,,both,, ,402.2,241.32,Medicaid,Illinois Medicaid,,,,,402.2,,,,
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,,,978.43,978.43,Medicaid,Illinois Medicaid,,40.3,,,978.43,978.43,978.43,Fee Schedule,
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,978.43,587.05,Medicaid,Illinois Medicaid,,,,,978.43,,,,
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-SHOULDER 1V CR,73020,CPT,,,,,both,,,489.5,489.5,Medicaid,Illinois Medicaid,,40.3,,,489.5,489.5,489.5,Fee Schedule,
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,489.5,293.7,Medicaid,Illinois Medicaid,,,,,489.5,,,,
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,,,863.36,863.36,Medicaid,Illinois Medicaid,,22.53,,,863.36,863.36,863.36,Fee Schedule,
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,863.36,518.01,Medicaid,Illinois Medicaid,,,,,863.36,,,,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,,,1726.71,1726.71,Medicaid,Illinois Medicaid,,22.53,,,1726.71,1726.71,1726.71,Fee Schedule,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,1726.71,1036.02,Medicaid,Illinois Medicaid,,,,,1726.71,,,,
IR-ARTHROGM SHLDR CR,73040,CPT,,,,,both,, ,3748.7,2249.22,Medicaid,Illinois Medicaid,,,,,3748.7,,,,
IR-ATHGRM SHLD BI CR,73040,CPT,,,,,both,, ,7497.39,4498.43,Medicaid,Illinois Medicaid,,,,,7497.39,,,,
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-AC JTS BILAT CR,73050,CPT,,,,,both,,,918.37,918.37,Medicaid,Illinois Medicaid,,20.5,,,918.37,918.37,918.37,Fee Schedule,
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,918.37,551.02,Medicaid,Illinois Medicaid,,,,,918.37,,,,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,,,721.61,721.61,Medicaid,Illinois Medicaid,,42.04,,,721.61,721.61,721.61,Fee Schedule,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,721.61,432.96,Medicaid,Illinois Medicaid,,,,,721.61,,,,
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-HUMERUS CR,73060,CPT,,,,,both,,,1442.95,1442.95,Medicaid,Illinois Medicaid,,42.04,,,1442.95,1442.95,1442.95,Fee Schedule,
UE-HUMERUS CR,73060,CPT,,,,,both,, ,1442.95,865.77,Medicaid,Illinois Medicaid,,,,,1442.95,,,,
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-ELBOW 2V CR,73070,CPT,,,,,both,,,662.39,662.39,Medicaid,Illinois Medicaid,,19.6,,,662.39,662.39,662.39,Fee Schedule,
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,662.39,397.43,Medicaid,Illinois Medicaid,,,,,662.39,,,,
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,,,1325.06,1325.06,Medicaid,Illinois Medicaid,,19.6,,,1325.06,1325.06,1325.06,Fee Schedule,
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,1325.06,795.03,Medicaid,Illinois Medicaid,,,,,1325.06,,,,
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-ELBOW 3V CR,73080,CPT,,,,,both,,,804.69,804.69,Medicaid,Illinois Medicaid,,21.5,,,804.69,804.69,804.69,Fee Schedule,
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,,,,804.69,,,,
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,,,1609.11,1609.11,Medicaid,Illinois Medicaid,,21.5,,,1609.11,1609.11,1609.11,Fee Schedule,
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,1609.11,965.46,Medicaid,Illinois Medicaid,,,,,1609.11,,,,
IR-ARTHRGRM ELBOW BI,73085,CPT,,,,,both,, ,3748.7,2249.22,Medicaid,Illinois Medicaid,,,,,3748.7,,,,
IR-ARTHRGRM ELBOW BI,73085,CPT,,,,,both,, ,3748.7,2249.22,Medicaid,Illinois Medicaid,,,,,3748.7,,,,
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-FOREARM 2V CR,73090,CPT,,,,,both,,,662.39,662.39,Medicaid,Illinois Medicaid,,37.88,,,662.39,662.39,662.39,Fee Schedule,
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,662.39,397.43,Medicaid,Illinois Medicaid,,,,,662.39,,,,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,,,1325.06,1325.06,Medicaid,Illinois Medicaid,,37.88,,,1325.06,1325.06,1325.06,Fee Schedule,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,1325.06,795.03,Medicaid,Illinois Medicaid,,,,,1325.06,,,,
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,,,,220.61,,,,
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
UE-UP EXT INFANT CR,73092,CPT,,,,,both,,,721.61,721.61,Medicaid,Illinois Medicaid,,40.8,,,721.61,721.61,721.61,Fee Schedule,
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,721.61,432.96,Medicaid,Illinois Medicaid,,,,,721.61,,,,
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,441.5,264.9,Medicaid,Illinois Medicaid,,,,,441.5,,,,
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,475.18,285.1,Medicaid,Illinois Medicaid,,,,,475.18,,,,
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,,,1444.91,1444.91,Medicaid,Illinois Medicaid,,40.8,,,1444.91,1444.91,1444.91,Fee Schedule,
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,1444.91,866.94,Medicaid,Illinois Medicaid,,,,,1444.91,,,,
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-WRIST 2V CR,73100,CPT,,,,,both,,,607.94,607.94,Medicaid,Illinois Medicaid,,43.74,,,607.94,607.94,607.94,Fee Schedule,
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,607.94,364.76,Medicaid,Illinois Medicaid,,,,,607.94,,,,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,,,1216.16,1216.16,Medicaid,Illinois Medicaid,,43.72,,,1216.16,1216.16,1216.16,Fee Schedule,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,1216.16,729.69,Medicaid,Illinois Medicaid,,,,,1216.16,,,,
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,,,662.39,662.39,Medicaid,Illinois Medicaid,,26.48,,,662.39,662.39,662.39,Fee Schedule,
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,662.39,397.43,Medicaid,Illinois Medicaid,,,,,662.39,,,,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,,,1325.06,1325.06,Medicaid,Illinois Medicaid,,26.48,,,1325.06,1325.06,1325.06,Fee Schedule,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,1325.06,795.03,Medicaid,Illinois Medicaid,,,,,1325.06,,,,
IR-ARTHRGRM WRIST BI,73115,CPT,,,,,both,, ,3748.7,2249.22,Medicaid,Illinois Medicaid,,,,,3748.7,,,,
IR-ARTHRGRM WRIST BI,73115,CPT,,,,,both,, ,3748.7,2249.22,Medicaid,Illinois Medicaid,,,,,3748.7,,,,
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-HAND 2V CR,73120,CPT,,,,,both,,,662.39,662.39,Medicaid,Illinois Medicaid,,20.4,,,662.39,662.39,662.39,Fee Schedule,
UE-HAND 2V CR,73120,CPT,,,,,both,, ,662.39,397.43,Medicaid,Illinois Medicaid,,,,,662.39,,,,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,,,1325.06,1325.06,Medicaid,Illinois Medicaid,,20.4,,,1325.06,1325.06,1325.06,Fee Schedule,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,1325.06,795.03,Medicaid,Illinois Medicaid,,,,,1325.06,,,,
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-HAND 3V CR,73130,CPT,,,,,both,,,804.69,804.69,Medicaid,Illinois Medicaid,,71.91,,,804.69,804.69,804.69,Fee Schedule,
UE-HAND 3V CR,73130,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,,,,804.69,,,,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,,,1609.11,1609.11,Medicaid,Illinois Medicaid,,71.91,,,1609.11,1609.11,1609.11,Fee Schedule,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,1609.11,965.46,Medicaid,Illinois Medicaid,,,,,1609.11,,,,
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,,,1137.3,1137.3,Medicaid,Illinois Medicaid,,24.51,,,1137.3,1137.3,1137.3,Fee Schedule,
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,1137.3,682.38,Medicaid,Illinois Medicaid,,,,,1137.3,,,,
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,,,568.64,568.64,Medicaid,Illinois Medicaid,,24.51,,,568.64,568.64,568.64,Fee Schedule,
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,568.64,341.18,Medicaid,Illinois Medicaid,,,,,568.64,,,,
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,,,,307.05,,,,
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,,,,330.63,,,,
CT-UPPER EXT WO,73200,CPT,,,,,both,,,3015.85,3015.85,Medicaid,Illinois Medicaid,,106.34,,,3015.85,3015.85,3015.85,Fee Schedule,
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,3015.85,1809.51,Medicaid,Illinois Medicaid,,,,,3015.85,,,,
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,614.4,368.64,Medicaid,Illinois Medicaid,,,,,614.4,,,,
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,660.98,396.58,Medicaid,Illinois Medicaid,,,,,660.98,,,,
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,6031.42,3618.85,Medicaid,Illinois Medicaid,,,,,6031.42,,,,
CT-UPPER EXT W,73201,CPT,,,,,both,, ,556.01,333.6,Medicaid,Illinois Medicaid,,,,,556.01,,,,
CT-UPPER EXT W,73201,CPT,,,,,both,,,3350.14,3350.14,Medicaid,Illinois Medicaid,,132.38,,,3350.14,3350.14,3350.14,Fee Schedule,
CT-UPPER EXT W,73201,CPT,,,,,both,, ,3350.14,2010.08,Medicaid,Illinois Medicaid,,,,,3350.14,,,,
CTA-UPPER EXT,73206,CPT,,,,,both,,,1947.6,1947.6,Medicaid,Illinois Medicaid,,231.1,,,1947.6,1947.6,1947.6,Fee Schedule,
CTA-UPPER EXT,73206,CPT,,,,,both,, ,1947.6,1168.56,Medicaid,Illinois Medicaid,,,,,1947.6,,,,
CTA-UPPER EXT BI,73206,CPT,,,,,both,, ,3895.2,2337.12,Medicaid,Illinois Medicaid,,,,,3895.2,,,,
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,1431.72,859.03,Medicaid,Illinois Medicaid,,,,,1431.72,,,,
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,1540.9,924.54,Medicaid,Illinois Medicaid,,,,,1540.9,,,,
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,4042.84,2425.7,Medicaid,Illinois Medicaid,,,,,4042.84,,,,
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,,,,715.99,,,,
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,,,,770.45,,,,
MR-UPPER EXT WO,73218,CPT,,,,,both,,,2470.5,2470.5,Medicaid,Illinois Medicaid,,285.24,,,2470.5,2470.5,2470.5,Fee Schedule,
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,2470.5,1482.3,Medicaid,Illinois Medicaid,,,,,2470.5,,,,
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,2394.15,1436.49,Medicaid,Illinois Medicaid,,,,,2394.15,,,,
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,2576.6,1545.96,Medicaid,Illinois Medicaid,,,,,2576.6,,,,
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,5197.81,3118.68,Medicaid,Illinois Medicaid,,,,,5197.81,,,,
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,,,,1197.08,,,,
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,,,,1288.29,,,,
MR-UPPER EXT WWO,73220,CPT,,,,,both,,,2598.76,2598.76,Medicaid,Illinois Medicaid,,296.6,,,2598.76,2598.76,2598.76,Fee Schedule,
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,2598.76,1559.25,Medicaid,Illinois Medicaid,,,,,2598.76,,,,
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,,,,715.99,,,,
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,,,,770.45,,,,
MR-UPPER JOINT WO,73221,CPT,,,,,both,,,2523.26,2523.26,Medicaid,Illinois Medicaid,,192.21,,,2523.26,2523.26,2523.26,Fee Schedule,
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,2523.26,1513.95,Medicaid,Illinois Medicaid,,,,,2523.26,,,,
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,,,,1035.69,,,,
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,,,,1114.55,,,,
MR-UPPER JOINT W,73222,CPT,,,,,both,,,4293.48,4293.48,Medicaid,Illinois Medicaid,,295.13,,,4293.48,4293.48,4293.48,Fee Schedule,
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,4293.48,2576.08,Medicaid,Illinois Medicaid,,,,,4293.48,,,,
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,,,,1197.08,,,,
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,,,,1288.29,,,,
MR-UPPER JOINT WWO,73223,CPT,,,,,both,,,4941.28,4941.28,Medicaid,Illinois Medicaid,,296.6,,,4941.28,4941.28,4941.28,Fee Schedule,
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,,,,4941.28,,,,
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,,,333.44,333.44,Medicaid,Illinois Medicaid,,21.27,,,333.44,333.44,333.44,Fee Schedule,
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,333.44,200.06,Medicaid,Illinois Medicaid,,,,,333.44,,,,
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,139.77,83.86,Medicaid,Illinois Medicaid,,,,,139.77,,,,
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Medicaid,Illinois Medicaid,,,,,149.32,,,,
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Medicaid,Illinois Medicaid,,,,,149.32,,,,
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Medicaid,Illinois Medicaid,,,,,149.32,,,,
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,887.49,532.49,Medicaid,Illinois Medicaid,,,,,887.49,,,,
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,209.94,125.96,Medicaid,Illinois Medicaid,,,,,209.94,,,,
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Medicaid,Illinois Medicaid,,,,,224.54,,,,
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Medicaid,Illinois Medicaid,,,,,224.54,,,,
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Medicaid,Illinois Medicaid,,,,,224.54,,,,
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,1330.96,798.57,Medicaid,Illinois Medicaid,,,,,1330.96,,,,
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,,,,220.88,,,,
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.8,Medicaid,Illinois Medicaid,,,,,238.01,,,,
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.8,Medicaid,Illinois Medicaid,,,,,238.01,,,,
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.8,Medicaid,Illinois Medicaid,,,,,238.01,,,,
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,,,1774.7,1774.7,Medicaid,Illinois Medicaid,,26.58,,,1774.7,1774.7,1774.7,Fee Schedule,
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,1774.7,1064.82,Medicaid,Illinois Medicaid,,,,,1774.7,,,,
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,,,,220.88,,,,
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.8,Medicaid,Illinois Medicaid,,,,,238.01,,,,
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.8,Medicaid,Illinois Medicaid,,,,,238.01,,,,
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.8,Medicaid,Illinois Medicaid,,,,,238.01,,,,
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,,,1774.7,1774.7,Medicaid,Illinois Medicaid,,34.66,,,1774.7,1774.7,1774.7,Fee Schedule,
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,1774.7,1064.82,Medicaid,Illinois Medicaid,,,,,1774.7,,,,
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,442.06,265.23,Medicaid,Illinois Medicaid,,,,,442.06,,,,
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Medicaid,Illinois Medicaid,,,,,476.02,,,,
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Medicaid,Illinois Medicaid,,,,,476.02,,,,
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Medicaid,Illinois Medicaid,,,,,476.02,,,,
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,,,3549.69,3549.69,Medicaid,Illinois Medicaid,,82.64,,,3549.69,3549.69,3549.69,Fee Schedule,
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,3549.69,2129.81,Medicaid,Illinois Medicaid,,,,,3549.69,,,,
IR-ARTHGRM BI HIP CR,73525,CPT,,,,,both,, ,3760.2,2256.12,Medicaid,Illinois Medicaid,,,,,3760.2,,,,
IR-ARTHGRM BI HIP CR,73525,CPT,,,,,both,, ,3760.2,2256.12,Medicaid,Illinois Medicaid,,,,,3760.2,,,,
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.2,88.92,Medicaid,Illinois Medicaid,,,,,148.2,,,,
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.2,88.92,Medicaid,Illinois Medicaid,,,,,148.2,,,,
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.2,88.92,Medicaid,Illinois Medicaid,,,,,148.2,,,,
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.2,88.92,Medicaid,Illinois Medicaid,,,,,148.2,,,,
LE-FEMUR 1V CR,73551,CPT,,,,,both,,,307.05,307.05,Medicaid,Illinois Medicaid,,18.94,,,307.05,307.05,307.05,Fee Schedule,
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,,,,307.05,,,,
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-FEMUR 2V CR,73552,CPT,,,,,both,,,782.23,782.23,Medicaid,Illinois Medicaid,,34.66,,,782.23,782.23,782.23,Fee Schedule,
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,782.23,469.33,Medicaid,Illinois Medicaid,,,,,782.23,,,,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,,,1564.76,1564.76,Medicaid,Illinois Medicaid,,25.19,,,1564.76,1564.76,1564.76,Fee Schedule,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,1564.76,938.85,Medicaid,Illinois Medicaid,,,,,1564.76,,,,
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,,,721.61,721.61,Medicaid,Illinois Medicaid,,388.28,,,721.61,721.61,721.61,Fee Schedule,
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,721.61,432.96,Medicaid,Illinois Medicaid,,,,,721.61,,,,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,,,1442.95,1442.95,Medicaid,Illinois Medicaid,,88.28,,,1442.95,1442.95,1442.95,Fee Schedule,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,1442.95,865.77,Medicaid,Illinois Medicaid,,,,,1442.95,,,,
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-KNEE 3V CR,73562,CPT,,,,,both,,,981.24,981.24,Medicaid,Illinois Medicaid,,26.29,,,981.24,981.24,981.24,Fee Schedule,
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,981.24,588.74,Medicaid,Illinois Medicaid,,,,,981.24,,,,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,,,1962.48,1962.48,Medicaid,Illinois Medicaid,,26.29,,,1962.48,1962.48,1962.48,Fee Schedule,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,1962.48,1177.48,Medicaid,Illinois Medicaid,,,,,1962.48,,,,
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,,,1070.49,1070.49,Medicaid,Illinois Medicaid,,121.4,,,1070.49,1070.49,1070.49,Fee Schedule,
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,1070.49,642.29,Medicaid,Illinois Medicaid,,,,,1070.49,,,,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,,,2141.27,2141.27,Medicaid,Illinois Medicaid,,121.4,,,2141.27,2141.27,2141.27,Fee Schedule,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,2141.27,1284.76,Medicaid,Illinois Medicaid,,,,,2141.27,,,,
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,,,721.61,721.61,Medicaid,Illinois Medicaid,,33.4,,,721.61,721.61,721.61,Fee Schedule,
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,721.61,432.96,Medicaid,Illinois Medicaid,,,,,721.61,,,,
IR-ARTHRGRM KNEE BI,73580,CPT,,,,,both,, ,7520.68,4512.4,Medicaid,Illinois Medicaid,,,,,7520.68,,,,
IR-ARTHROGRAM KNEE,73580,CPT,,,,,both,, ,3760.2,2256.12,Medicaid,Illinois Medicaid,,,,,3760.2,,,,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,,,1442.95,1442.95,Medicaid,Illinois Medicaid,,64.5,,,1442.95,1442.95,1442.95,Fee Schedule,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,1442.95,865.77,Medicaid,Illinois Medicaid,,,,,1442.95,,,,
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-TIB FIB 2V CR,73590,CPT,,,,,both,,,721.61,721.61,Medicaid,Illinois Medicaid,,64.5,,,721.61,721.61,721.61,Fee Schedule,
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,721.61,432.96,Medicaid,Illinois Medicaid,,,,,721.61,,,,
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,,,1442.95,1442.95,Medicaid,Illinois Medicaid,,21,,,1442.95,1442.95,1442.95,Fee Schedule,
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,1442.95,865.77,Medicaid,Illinois Medicaid,,,,,1442.95,,,,
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,,,721.61,721.61,Medicaid,Illinois Medicaid,,21.5,,,721.61,721.61,721.61,Fee Schedule,
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,721.61,432.96,Medicaid,Illinois Medicaid,,,,,721.61,,,,
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-ANKLE 2V CR,73600,CPT,,,,,both,,,720.49,720.49,Medicaid,Illinois Medicaid,,43,,,720.49,720.49,720.49,Fee Schedule,
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,720.49,432.29,Medicaid,Illinois Medicaid,,,,,720.49,,,,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,,,1107.82,1107.82,Medicaid,Illinois Medicaid,,43,,,1107.82,1107.82,1107.82,Fee Schedule,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,1107.82,664.69,Medicaid,Illinois Medicaid,,,,,1107.82,,,,
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,,,804.69,804.69,Medicaid,Illinois Medicaid,,86.1,,,804.69,804.69,804.69,Fee Schedule,
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,,,,804.69,,,,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,,,1609.11,1609.11,Medicaid,Illinois Medicaid,,81.79,,,1609.11,1609.11,1609.11,Fee Schedule,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,1609.11,965.46,Medicaid,Illinois Medicaid,,,,,1609.11,,,,
IR-ARTHRGRM ANKLE BI,73615,CPT,,,,,both,, ,3760.2,2256.12,Medicaid,Illinois Medicaid,,,,,3760.2,,,,
IR-ARTHRGRM ANKLE BI,73615,CPT,,,,,both,, ,3760.2,2256.12,Medicaid,Illinois Medicaid,,,,,3760.2,,,,
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-FOOT 2V CR,73620,CPT,,,,,both,,,553.77,553.77,Medicaid,Illinois Medicaid,,37.04,,,553.77,553.77,553.77,Fee Schedule,
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,553.77,332.26,Medicaid,Illinois Medicaid,,,,,553.77,,,,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,,,1107.82,1107.82,Medicaid,Illinois Medicaid,,37.04,,,1107.82,1107.82,1107.82,Fee Schedule,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,1107.82,664.69,Medicaid,Illinois Medicaid,,,,,1107.82,,,,
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,,,662.39,662.39,Medicaid,Illinois Medicaid,,22.09,,,662.39,662.39,662.39,Fee Schedule,
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,662.39,397.43,Medicaid,Illinois Medicaid,,,,,662.39,,,,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,,,1250.97,1250.97,Medicaid,Illinois Medicaid,,22.09,,,1250.97,1250.97,1250.97,Fee Schedule,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,1250.97,750.58,Medicaid,Illinois Medicaid,,,,,1250.97,,,,
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,,,353.93,353.93,Medicaid,Illinois Medicaid,,37.04,,,353.93,353.93,353.93,Fee Schedule,
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,353.93,212.35,Medicaid,Illinois Medicaid,,,,,353.93,,,,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,,,662.39,662.39,Medicaid,Illinois Medicaid,,37.04,,,662.39,662.39,662.39,Fee Schedule,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,662.39,397.43,Medicaid,Illinois Medicaid,,,,,662.39,,,,
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,,,568.64,568.64,Medicaid,Illinois Medicaid,,18.87,,,568.64,568.64,568.64,Fee Schedule,
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,568.64,341.18,Medicaid,Illinois Medicaid,,,,,568.64,,,,
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,278.43,167.05,Medicaid,Illinois Medicaid,,,,,278.43,,,,
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,299.76,179.85,Medicaid,Illinois Medicaid,,,,,299.76,,,,
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,,,1137.3,1137.3,Medicaid,Illinois Medicaid,,18.87,,,1137.3,1137.3,1137.3,Fee Schedule,
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,1137.3,682.38,Medicaid,Illinois Medicaid,,,,,1137.3,,,,
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,,,,307.05,,,,
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,,,,330.63,,,,
CT-LOWER EXT WO,73700,CPT,,,,,both,,,3013.04,3013.04,Medicaid,Illinois Medicaid,,8.66,,,3013.04,3013.04,3013.04,Fee Schedule,
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,3013.04,1807.82,Medicaid,Illinois Medicaid,,,,,3013.04,,,,
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,614.4,368.64,Medicaid,Illinois Medicaid,,,,,614.4,,,,
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,660.98,396.58,Medicaid,Illinois Medicaid,,,,,660.98,,,,
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,,,,4941.28,,,,
CT-LOWER EXT W,73701,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,,,,604.85,,,,
CT-LOWER EXT W,73701,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,,,,604.85,,,,
CT-LOWER EXT W,73701,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,,,,650.88,,,,
CT-LOWER EXT W,73701,CPT,,,,,both,,,3013.04,3013.04,Medicaid,Illinois Medicaid,,110.57,,,3013.04,3013.04,3013.04,Fee Schedule,
CT-LOWER EXT W,73701,CPT,,,,,both,, ,3013.04,1807.82,Medicaid,Illinois Medicaid,,,,,3013.04,,,,
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,,,,680.91,,,,
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,,,,732.83,,,,
CT-LOWER EXT WWO,73702,CPT,,,,,both,,,3013.04,3013.04,Medicaid,Illinois Medicaid,,132.76,,,3013.04,3013.04,3013.04,Fee Schedule,
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,3013.04,1807.82,Medicaid,Illinois Medicaid,,,,,3013.04,,,,
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,1361.84,817.1,Medicaid,Illinois Medicaid,,,,,1361.84,,,,
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,1465.68,879.4,Medicaid,Illinois Medicaid,,,,,1465.68,,,,
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,,,,4941.28,,,,
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,1540.9,924.54,Medicaid,Illinois Medicaid,,,,,1540.9,,,,
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,,,,4941.28,,,,
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,,,,715.99,,,,
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,,,,715.99,,,,
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,,,,770.45,,,,
MR-LOWER EXTR WO,73718,CPT,,,,,both,,,2470.5,2470.5,Medicaid,Illinois Medicaid,,422.06,,,2470.5,2470.5,2470.5,Fee Schedule,
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,2470.5,1482.3,Medicaid,Illinois Medicaid,,,,,2470.5,,,,
MR-LOWER EXTR W,73719,CPT,,,,,both,,,832.76,832.76,Medicaid,Illinois Medicaid,,497.68,,,832.76,832.76,832.76,Fee Schedule,
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,832.76,499.65,Medicaid,Illinois Medicaid,,,,,832.76,,,,
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,,,,1035.69,,,,
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,,,,1114.55,,,,
MR-LOWER EXTR BI WWO,73720,CPT,,,,,both,, ,2394.15,1436.49,Medicaid,Illinois Medicaid,,,,,2394.15,,,,
MR-LOWER EXTR BI WWO,73720,CPT,,,,,both,, ,2576.6,1545.96,Medicaid,Illinois Medicaid,,,,,2576.6,,,,
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,,,,1197.08,,,,
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,,,,1288.29,,,,
MR-LOWER EXTR WWO,73720,CPT,,,,,both,,,3084.06,3084.06,Medicaid,Illinois Medicaid,,593.2,,,3084.06,3084.06,3084.06,Fee Schedule,
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,3084.06,1850.43,Medicaid,Illinois Medicaid,,,,,3084.06,,,,
MRI scan of leg joint,73721,CPT,,,,,both,,,4941.28,4941.28,Medicaid,Illinois Medicaid,,673.58,,,4941.28,4941.28,4941.28,Fee Schedule,
MR-LW JOINT WO,73721,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,,,,715.99,,,,
MR-LW JOINT WO,73721,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,,,,770.45,,,,
MR-LW JOINT WO,73721,CPT,,,,,both,, ,4941.28,2964.76,Medicaid,Illinois Medicaid,,,,,4941.28,,,,
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,1431.72,859.03,Medicaid,Illinois Medicaid,,,,,1431.72,,,,
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,1540.9,924.54,Medicaid,Illinois Medicaid,,,,,1540.9,,,,
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,9881.44,5928.86,Medicaid,Illinois Medicaid,,,,,9881.44,,,,
MR-LW JOINT W,73722,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,,,,1035.69,,,,
MR-LW JOINT W,73722,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,,,,1114.55,,,,
MR-LW JOINT W,73722,CPT,,,,,both,,,4293.48,4293.48,Medicaid,Illinois Medicaid,,593.2,,,4293.48,4293.48,4293.48,Fee Schedule,
MR-LW JOINT W,73722,CPT,,,,,both,, ,4293.48,2576.08,Medicaid,Illinois Medicaid,,,,,4293.48,,,,
MR-LW JOINT W BI,73722,CPT,,,,,both,, ,7641.1,4584.66,Medicaid,Illinois Medicaid,,,,,7641.1,,,,
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,,,,1197.08,,,,
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,,,,1288.29,,,,
MR-LW JOINT WWO,73723,CPT,,,,,both,,,5197.81,5197.81,Medicaid,Illinois Medicaid,,727.42,,,5197.81,5197.81,5197.81,Fee Schedule,
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,5197.81,3118.68,Medicaid,Illinois Medicaid,,,,,5197.81,,,,
MR-LW JOINT WWO BI,73723,CPT,,,,,both,, ,10395.64,6237.38,Medicaid,Illinois Medicaid,,,,,10395.64,,,,
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,,,694.38,694.38,Medicaid,Illinois Medicaid,,57.21,,,694.38,694.38,694.38,Fee Schedule,
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,694.38,416.62,Medicaid,Illinois Medicaid,,,,,694.38,,,,
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,,,1144.03,1144.03,Medicaid,Illinois Medicaid,,46.06,,,1144.03,1144.03,1144.03,Fee Schedule,
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,1144.03,686.41,Medicaid,Illinois Medicaid,,,,,1144.03,,,,
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,,,868.4,868.4,Medicaid,Illinois Medicaid,,53.96,,,868.4,868.4,868.4,Fee Schedule,
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,868.4,521.04,Medicaid,Illinois Medicaid,,,,,868.4,,,,
CH-ABD SER PA CXR CR,74022,CPT,,,,,both,,,970.85,970.85,Medicaid,Illinois Medicaid,,40.77,,,970.85,970.85,970.85,Fee Schedule,
CH-ABD SER PA CXR CR,74022,CPT,,,,,both,, ,970.85,582.51,Medicaid,Illinois Medicaid,,,,,970.85,,,,
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,307.05,184.23,Medicaid,Illinois Medicaid,,,,,307.05,,,,
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,330.63,198.37,Medicaid,Illinois Medicaid,,,,,330.63,,,,
CT-ABDOMEN WO,74150,CPT,,,,,both,,,3285.58,3285.58,Medicaid,Illinois Medicaid,,90.95,,,3285.58,3285.58,3285.58,Fee Schedule,
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,3285.58,1971.34,Medicaid,Illinois Medicaid,,,,,3285.58,,,,
CT-ABDOMEN W,74160,CPT,,,,,both,, ,604.85,362.91,Medicaid,Illinois Medicaid,,,,,604.85,,,,
CT-ABDOMEN W,74160,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,,,,650.88,,,,
CT-ABDOMEN W,74160,CPT,,,,,both,,,3726.8,3726.8,Medicaid,Illinois Medicaid,,153.62,,,3726.8,3726.8,3726.8,Fee Schedule,
CT-ABDOMEN W,74160,CPT,,,,,both,, ,3726.8,2236.08,Medicaid,Illinois Medicaid,,,,,3726.8,,,,
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,680.91,408.54,Medicaid,Illinois Medicaid,,,,,680.91,,,,
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,732.83,439.69,Medicaid,Illinois Medicaid,,,,,732.83,,,,
CT-ABDOMEN WWO,74170,CPT,,,,,both,,,4317.62,4317.62,Medicaid,Illinois Medicaid,,172.49,,,4317.62,4317.62,4317.62,Fee Schedule,
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,4317.62,2590.57,Medicaid,Illinois Medicaid,,,,,4317.62,,,,
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,893.1,535.86,Medicaid,Illinois Medicaid,,,,,893.1,,,,
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,893.1,535.86,Medicaid,Illinois Medicaid,,,,,893.1,,,,
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,,,1894.27,1894.27,Medicaid,Illinois Medicaid,,312.08,,,1894.27,1894.27,1894.27,Fee Schedule,
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,1894.27,1136.56,Medicaid,Illinois Medicaid,,,,,1894.27,,,,
CTA-ABDOMEN,74175,CPT,,,,,both,, ,893.1,535.86,Medicaid,Illinois Medicaid,,,,,893.1,,,,
CTA-ABDOMEN,74175,CPT,,,,,both,,,1894.27,1894.27,Medicaid,Illinois Medicaid,,256.65,,,1894.27,1894.27,1894.27,Fee Schedule,
CTA-ABDOMEN,74175,CPT,,,,,both,, ,1894.27,1136.56,Medicaid,Illinois Medicaid,,,,,1894.27,,,,
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,587.17,352.3,Medicaid,Illinois Medicaid,,,,,587.17,,,,
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,632.08,379.24,Medicaid,Illinois Medicaid,,,,,632.08,,,,
CT-ABD PELVIS WO,74176,CPT,,,,,both,,,6571.44,6571.44,Medicaid,Illinois Medicaid,,125.04,,,6571.44,6571.44,6571.44,Fee Schedule,
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,6571.44,3942.86,Medicaid,Illinois Medicaid,,,,,6571.44,,,,
CT scan of abdomen and pelvis with contrast,74177,CPT,,,,,both,,,7453.61,7453.61,Medicaid,Illinois Medicaid,,1646.92,,,7453.61,7453.61,7453.61,Fee Schedule,
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,947.56,568.53,Medicaid,Illinois Medicaid,,,,,947.56,,,,
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,1019.69,611.81,Medicaid,Illinois Medicaid,,,,,1019.69,,,,
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,7453.61,4472.16,Medicaid,Illinois Medicaid,,,,,7453.61,,,,
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,947.56,568.53,Medicaid,Illinois Medicaid,,,,,947.56,,,,
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,1019.69,611.81,Medicaid,Illinois Medicaid,,,,,1019.69,,,,
CT-ABD PELVIS WWO,74178,CPT,,,,,both,,,8364.95,8364.95,Medicaid,Illinois Medicaid,,246.35,,,8364.95,8364.95,8364.95,Fee Schedule,
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,8364.95,5018.97,Medicaid,Illinois Medicaid,,,,,8364.95,,,,
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,,,,715.99,,,,
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,,,,770.45,,,,
MR-ABDOMEN WO,74181,CPT,,,,,both,,,4042.84,4042.84,Medicaid,Illinois Medicaid,,186.11,,,4042.84,4042.84,4042.84,Fee Schedule,
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,4042.84,2425.7,Medicaid,Illinois Medicaid,,,,,4042.84,,,,
MR-ABDOMEN W,74182,CPT,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,,,,1035.69,,,,
MR-ABDOMEN W,74182,CPT,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,,,,1114.55,,,,
MR-ABDOMEN W,74182,CPT,,,,,both,,,4293.48,4293.48,Medicaid,Illinois Medicaid,,285.45,,,4293.48,4293.48,4293.48,Fee Schedule,
MR-ABDOMEN W,74182,CPT,,,,,both,, ,4293.48,2576.08,Medicaid,Illinois Medicaid,,,,,4293.48,,,,
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,,,,1197.08,,,,
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,,,,1288.29,,,,
MR-ABDOMEN WWO,74183,CPT,,,,,both,,,5197.81,5197.81,Medicaid,Illinois Medicaid,,319.96,,,5197.81,5197.81,5197.81,Fee Schedule,
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,5197.81,3118.68,Medicaid,Illinois Medicaid,,,,,5197.81,,,,
FL-ESOPHAGUS,74220,CPT,,,,,both,, ,1227.11,736.26,Medicaid,Illinois Medicaid,,,,,1227.11,,,,
FL-MOD BA SWALLOW,74230,CPT,,,,,both,, ,391.26,234.75,Medicaid,Illinois Medicaid,,,,,391.26,,,,
FL-GI SERIES,74240,CPT,,,,,both,, ,1557.58,934.54,Medicaid,Illinois Medicaid,,,,,1557.58,,,,
FL-UPPER GI SINGLE,74240,CPT,,,,,both,, ,1818.77,1091.26,Medicaid,Illinois Medicaid,,,,,1818.77,,,,
FL-GI SERIES AIR,74246,CPT,,,,,both,, ,1500.93,900.55,Medicaid,Illinois Medicaid,,,,,1500.93,,,,
FL-UPPER GI DOUBLE,74246,CPT,,,,,both,, ,1752.53,1051.51,Medicaid,Illinois Medicaid,,,,,1752.53,,,,
FL-LOWER GI FOLLOW,74248,CPT,,,,,both,, ,3343.68,2006.2,Medicaid,Illinois Medicaid,,,,,3343.68,,,,
FL-SMALL BOWEL CR,74250,CPT,,,,,both,, ,2123.58,1274.14,Medicaid,Illinois Medicaid,,,,,2123.58,,,,
FL-SM BWL ENT TBE CR,74251,CPT,,,,,both,, ,2123.58,1274.14,Medicaid,Illinois Medicaid,,,,,2123.58,,,,
FL-BARIUM ENEMA,74270,CPT,,,,,both,, ,1890.9,1134.54,Medicaid,Illinois Medicaid,,,,,1890.9,,,,
FL-BARIUM ENEMA AIR,74280,CPT,,,,,both,, ,2333.25,1399.95,Medicaid,Illinois Medicaid,,,,,2333.25,,,,
SU-CHOLE W GRAMS DR,74300,CPT,,,,,both,, ,1968.65,1181.19,Medicaid,Illinois Medicaid,,,,,1968.65,,,,
FL-ENDO BILIARY,74328,CPT,,,,,both,, ,3722.58,2233.54,Medicaid,Illinois Medicaid,,,,,3722.58,,,,
FL-ENDO PANCREATIC,74329,CPT,,,,,both,, ,1034.01,620.4,Medicaid,Illinois Medicaid,,,,,1034.01,,,,
FL-ENDO BIL PANC,74330,CPT,,,,,both,, ,1304.29,782.57,Medicaid,Illinois Medicaid,,,,,1304.29,,,,
FL-LONG GI TUBE PLC,74340,CPT,,,,,both,, ,1359.02,815.41,Medicaid,Illinois Medicaid,,,,,1359.02,,,,
FL-ENTEROCLYSIS PLAC,74355,CPT,,,,,both,, ,932.4,559.44,Medicaid,Illinois Medicaid,,,,,932.4,,,,
FL-IVP CR,74400,CPT,,,,,both,, ,1836.17,1101.7,Medicaid,Illinois Medicaid,,,,,1836.17,,,,
FL-UROGRAPH RETRO CR,74420,CPT,,,,,both,, ,2105.34,1263.2,Medicaid,Illinois Medicaid,,,,,2105.34,,,,
FL-UROGRAPHY ANTE CR,74425,CPT,,,,,both,, ,2165.12,1299.07,Medicaid,Illinois Medicaid,,,,,2165.12,,,,
FL-CYSTOGRM 3VPLS CR,74430,CPT,,,,,both,, ,1407.87,844.72,Medicaid,Illinois Medicaid,,,,,1407.87,,,,
FL-CAVERNOSOGRAPH CR,74445,CPT,,,,,both,, ,698.32,418.99,Medicaid,Illinois Medicaid,,,,,698.32,,,,
FL-UCG RETRO CR,74450,CPT,,,,,both,, ,1357.62,814.57,Medicaid,Illinois Medicaid,,,,,1357.62,,,,
FL-UCG VOIDING,74455,CPT,,,,,both,, ,1357.62,814.57,Medicaid,Illinois Medicaid,,,,,1357.62,,,,
FL-UCG VOIDING CR,74455,CPT,,,,,both,, ,1162.77,697.66,Medicaid,Illinois Medicaid,,,,,1162.77,,,,
IR-DILATION GU,74485,CPT,,,,,both,, ,976.75,586.05,Medicaid,Illinois Medicaid,,,,,976.75,,,,
IR-HYSTERSALPINGO CR,74740,CPT,,,,,both,,,1704.21,1704.21,Medicaid,Illinois Medicaid,,59.83,,,1704.21,1704.21,1704.21,Fee Schedule,
IR-HYSTERSALPINGO CR,74740,CPT,,,,,both,, ,1704.21,1022.52,Medicaid,Illinois Medicaid,,,,,1704.21,,,,
IR-HYSTERSALPINGOGRM,74740,CPT,,,,,both,,,1989.98,1989.98,Medicaid,Illinois Medicaid,,59.83,,,1989.98,1989.98,1989.98,Fee Schedule,
IR-HYSTERSALPINGOGRM,74740,CPT,,,,,both,, ,1989.98,1193.98,Medicaid,Illinois Medicaid,,,,,1989.98,,,,
IR-PERINEOGRAM CR,74775,CPT,,,,,both,, ,1991.67,1195,Medicaid,Illinois Medicaid,,,,,1991.67,,,,
CT-HT ACC LV RV W,75573,CPT,,,,,both,, ,580.15,348.09,Medicaid,Illinois Medicaid,,,,,580.15,,,,
CT-HT ACC LV RV W,75573,CPT,,,,,both,, ,1696.4,1017.84,Medicaid,Illinois Medicaid,,,,,1696.4,,,,
CT-HT CARD FUNC W,75574,CPT,,,,,both,, ,580.15,348.09,Medicaid,Illinois Medicaid,,,,,580.15,,,,
CT-HT CARD FUNC W,75574,CPT,,,,,both,, ,1696.4,1017.84,Medicaid,Illinois Medicaid,,,,,1696.4,,,,
CATH-ABD AORTA SERIAL,75625,CPT,,,,,both,, ,8483,5089.8,Medicaid,Illinois Medicaid,,,,,8483,,,,
IR-ABD AORTA SERIAL,75625,CPT,,,,,both,, ,9523.86,5714.31,Medicaid,Illinois Medicaid,,,,,9523.86,,,,
CATH-AABF SERIAL     ,75630,CPT,,,,,both,, ,11199.75,6719.85,Medicaid,Illinois Medicaid,,,,,11199.75,,,,
IR-AABF SERIAL,75630,CPT,,,,,both,, ,12573.95,7544.37,Medicaid,Illinois Medicaid,,,,,12573.95,,,,
CTA-ABD ART W RUNOFF,75635,CPT,,,,,both,, ,650.88,390.52,Medicaid,Illinois Medicaid,,,,,650.88,,,,
CTA-ABD ART W RUNOFF,75635,CPT,,,,,both,, ,2355.42,1413.25,Medicaid,Illinois Medicaid,,,,,2355.42,,,,
CATH-ANGIO EXTREM UNI,75710,CPT,,,,,both,, ,7520.75,4512.45,Medicaid,Illinois Medicaid,,,,,7520.75,,,,
IR-ANGIO EXTREM UNI,75710,CPT,,,,,both,, ,8443.54,5066.12,Medicaid,Illinois Medicaid,,,,,8443.54,,,,
CATH-ANGIO EXTREM BI ,75716,CPT,,,,,both,, ,7520.75,4512.45,Medicaid,Illinois Medicaid,,,,,7520.75,,,,
IR-ANGIO EXTREM BI,75716,CPT,,,,,both,, ,8423.33,5053.99,Medicaid,Illinois Medicaid,,,,,8423.33,,,,
IR-ANGIO VISCERAL SE,75726,CPT,,,,,both,, ,13364.62,8018.77,Medicaid,Illinois Medicaid,,,,,13364.62,,,,
IR-ANG PULMONARY UNI,75741,CPT,,,,,both,, ,4237.35,2542.41,Medicaid,Illinois Medicaid,,,,,4237.35,,,,
IR-ANG PULMONARY BI,75743,CPT,,,,,both,, ,12357.84,7414.7,Medicaid,Illinois Medicaid,,,,,12357.84,,,,
IR-SHUNTOGRAM,75809,CPT,,,,,both,, ,386.21,231.72,Medicaid,Illinois Medicaid,,,,,386.21,,,,
CATH-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,7641.75,4585.05,Medicaid,Illinois Medicaid,,,,,7641.75,,,,
IR-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,8579.39,5147.63,Medicaid,Illinois Medicaid,,,,,8579.39,,,,
IR-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,8579.39,5147.63,Medicaid,Illinois Medicaid,,,,,8579.39,,,,
CATH-VENOGRAM EXT BI ,75822,CPT,,,,,both,, ,3510,2106,Medicaid,Illinois Medicaid,,,,,3510,,,,
IR-VENOGRAM EXT BI,75822,CPT,,,,,both,, ,3940.68,2364.4,Medicaid,Illinois Medicaid,,,,,3940.68,,,,
IR-VENACAVAGRAM INF,75825,CPT,,,,,both,, ,8923.22,5353.93,Medicaid,Illinois Medicaid,,,,,8923.22,,,,
IR-VENOUS SAMPL CATH,75893,CPT,,,,,both,, ,3915.41,2349.24,Medicaid,Illinois Medicaid,,,,,3915.41,,,,
IR-ANGIO EXIST CATH,75898,CPT,,,,,both,, ,513.35,308.01,Medicaid,Illinois Medicaid,,,,,513.35,,,,
IR-DRAIN TUBE CHANGE,75984,CPT,,,,,both,, ,2098.33,1258.99,Medicaid,Illinois Medicaid,,,,,2098.33,,,,
CT-ABSC DRN CATH PLA,75989,CPT,,,,,both,, ,2649.01,1589.4,Medicaid,Illinois Medicaid,,,,,2649.01,,,,
US-ABSC DRN CATH PLA,75989,CPT,,,,,both,, ,1120.45,672.27,Medicaid,Illinois Medicaid,,,,,1120.45,,,,
FL-FLUORO 1 HOUR,76000,CPT,,,,,both,, ,553.77,332.26,Medicaid,Illinois Medicaid,,,,,553.77,,,,
FL-FLUORO 1 HOUR CR,76000,CPT,,,,,both,, ,474.31,284.58,Medicaid,Illinois Medicaid,,,,,474.31,,,,
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,756.41,453.84,Medicaid,Illinois Medicaid,,,,,756.41,,,,
IR-FISTULOGRAM CR,76080,CPT,,,,,both,, ,758.66,455.19,Medicaid,Illinois Medicaid,,,,,758.66,,,,
EXAM SURG SPECMN CR,76098,CPT,,,,,both,, ,1190.34,714.2,Medicaid,Illinois Medicaid,,,,,1190.34,,,,
TOMOGRAM ONE PLNE CR,76100,CPT,,,,,both,, ,2030.12,1218.07,Medicaid,Illinois Medicaid,,,,,2030.12,,,,
CT-3D W POSTPROCESS,76377,CPT,,,,,both,, ,528.5,317.1,Medicaid,Illinois Medicaid,,,,,528.5,,,,
CT-3D W POSTPROCESS,76377,CPT,,,,,both,, ,536.93,322.15,Medicaid,Illinois Medicaid,,,,,536.93,,,,
MR-3D W POSTPROCESS,76377,CPT,,,,,both,, ,491.18,294.7,Medicaid,Illinois Medicaid,,,,,491.18,,,,
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,193.1,115.86,Medicaid,Illinois Medicaid,,,,,193.1,,,,
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,207.98,124.78,Medicaid,Illinois Medicaid,,,,,207.98,,,,
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,724.14,434.48,Medicaid,Illinois Medicaid,,,,,724.14,,,,
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,,,2030.68,2030.68,Medicaid,Illinois Medicaid,,70.75,,,2030.68,2030.68,2030.68,Fee Schedule,
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,2030.68,1218.4,Medicaid,Illinois Medicaid,,,,,2030.68,,,,
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,1602.93,961.75,Medicaid,Illinois Medicaid,,,,,1602.93,,,,
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,218.64,131.18,Medicaid,Illinois Medicaid,,,,,218.64,,,,
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,218.64,131.18,Medicaid,Illinois Medicaid,,,,,218.64,,,,
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,1680.12,1008.07,Medicaid,Illinois Medicaid,,,,,1680.12,,,,
US-BREAST LIMITED,76642,CPT,,,,,both,, ,218.64,131.18,Medicaid,Illinois Medicaid,,,,,218.64,,,,
US-BREAST LIMITED,76642,CPT,,,,,both,, ,218.64,131.18,Medicaid,Illinois Medicaid,,,,,218.64,,,,
US-BREAST LIMITED,76642,CPT,,,,,both,,,1680.12,1680.12,Medicaid,Illinois Medicaid,,55.22,,,1680.12,1680.12,1680.12,Fee Schedule,
US-BREAST LIMITED,76642,CPT,,,,,both,, ,1680.12,1008.07,Medicaid,Illinois Medicaid,,,,,1680.12,,,,
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,437.29,262.37,Medicaid,Illinois Medicaid,,,,,437.29,,,,
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,437.29,262.37,Medicaid,Illinois Medicaid,,,,,437.29,,,,
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,3359.95,2015.97,Medicaid,Illinois Medicaid,,,,,3359.95,,,,
Ultrasound of abdomen,76700,CPT,,,,,both,,,2330.73,2330.73,Medicaid,Illinois Medicaid,,217.61,,,2330.73,2330.73,2330.73,Fee Schedule,
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,2330.73,1398.43,Medicaid,Illinois Medicaid,,,,,2330.73,,,,
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-ABDOMEN LTD WO,76705,CPT,,,,,both,,,1908.87,1908.87,Medicaid,Illinois Medicaid,,125.4,,,1908.87,1908.87,1908.87,Fee Schedule,
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,1908.87,1145.32,Medicaid,Illinois Medicaid,,,,,1908.87,,,,
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-ABDOMEN RETROPER,76770,CPT,,,,,both,,,2030.68,2030.68,Medicaid,Illinois Medicaid,,75.9,,,2030.68,2030.68,2030.68,Fee Schedule,
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,2030.68,1218.4,Medicaid,Illinois Medicaid,,,,,2030.68,,,,
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,,,1965,1965,Medicaid,Illinois Medicaid,,55.74,,,1965,1965,1965,Fee Schedule,
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,1965,1179,Medicaid,Illinois Medicaid,,,,,1965,,,,
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-PELV PREG 14 WKS,76801,CPT,,,,,both,,,813.67,813.67,Medicaid,Illinois Medicaid,,76.12,,,813.67,813.67,813.67,Fee Schedule,
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,813.67,488.2,Medicaid,Illinois Medicaid,,,,,813.67,,,,
US-PLV PRG 14 WKS AD,76802,CPT,,,,,both,, ,329.51,197.7,Medicaid,Illinois Medicaid,,,,,329.51,,,,
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,76805,CPT,,,,,both,,,1931.6,1931.6,Medicaid,Illinois Medicaid,,212.35,,,1931.6,1931.6,1931.6,Fee Schedule,
US-PELVIS PREG,76805,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
US-PELVIS PREG,76805,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-PELVIS PREG,76805,CPT,,,,,both,, ,1931.6,1158.96,Medicaid,Illinois Medicaid,,,,,1931.6,,,,
US-PELVS PREG GESADD,76810,CPT,,,,,both,, ,329.51,197.7,Medicaid,Illinois Medicaid,,,,,329.51,,,,
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,577,346.2,Medicaid,Illinois Medicaid,,,,,577,,,,
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,647.8,388.68,Medicaid,Illinois Medicaid,,,,,647.8,,,,
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,218.64,131.18,Medicaid,Illinois Medicaid,,,,,218.64,,,,
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,235.48,141.28,Medicaid,Illinois Medicaid,,,,,235.48,,,,
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,647.8,388.68,Medicaid,Illinois Medicaid,,,,,647.8,,,,
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-PLV PRG TRNSV,76817,CPT,,,,,both,,,655.09,655.09,Medicaid,Illinois Medicaid,,77.07,,,655.09,655.09,655.09,Fee Schedule,
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,655.09,393.05,Medicaid,Illinois Medicaid,,,,,655.09,,,,
US-FETAL BIO W NST,76818,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-FETAL BIO W NST,76818,CPT,,,,,both,, ,1198.2,718.92,Medicaid,Illinois Medicaid,,,,,1198.2,,,,
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,793.18,475.9,Medicaid,Illinois Medicaid,,,,,793.18,,,,
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,218.64,131.18,Medicaid,Illinois Medicaid,,,,,218.64,,,,
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,235.48,141.28,Medicaid,Illinois Medicaid,,,,,235.48,,,,
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,780.55,468.33,Medicaid,Illinois Medicaid,,,,,780.55,,,,
Ultrasound pelvis through vagina,76830,CPT,,,,,both,,,689.62,689.62,Medicaid,Illinois Medicaid,,212.35,,,689.62,689.62,689.62,Fee Schedule,
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,689.62,413.77,Medicaid,Illinois Medicaid,,,,,689.62,,,,
US-PELVIS NON OB,76856,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
US-PELVIS NON OB,76856,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-PELVIS NON OB,76856,CPT,,,,,both,,,1931.6,1931.6,Medicaid,Illinois Medicaid,,71.9,,,1931.6,1931.6,1931.6,Fee Schedule,
US-PELVIS NON OB,76856,CPT,,,,,both,, ,1931.6,1158.96,Medicaid,Illinois Medicaid,,,,,1931.6,,,,
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,209.94,125.96,Medicaid,Illinois Medicaid,,,,,209.94,,,,
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,209.94,125.96,Medicaid,Illinois Medicaid,,,,,209.94,,,,
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,437.29,262.37,Medicaid,Illinois Medicaid,,,,,437.29,,,,
US-SCROTUM,76870,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
US-SCROTUM,76870,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-SCROTUM,76870,CPT,,,,,both,,,2005.7,2005.7,Medicaid,Illinois Medicaid,,64.44,,,2005.7,2005.7,2005.7,Fee Schedule,
US-SCROTUM,76870,CPT,,,,,both,, ,2005.7,1203.42,Medicaid,Illinois Medicaid,,,,,2005.7,,,,
US-TRANSRECTAL,76872,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
US-TRANSRECTAL,76872,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-TRANSRECTAL,76872,CPT,,,,,both,, ,1300.09,780.05,Medicaid,Illinois Medicaid,,,,,1300.09,,,,
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,378.35,227.01,Medicaid,Illinois Medicaid,,,,,378.35,,,,
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,189.17,113.5,Medicaid,Illinois Medicaid,,,,,189.17,,,,
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,218.64,131.18,Medicaid,Illinois Medicaid,,,,,218.64,,,,
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,235.48,141.28,Medicaid,Illinois Medicaid,,,,,235.48,,,,
NI-VAS ACCSS SITES,76937,CPT,,,,,both,, ,797.67,478.6,Medicaid,Illinois Medicaid,,,,,797.67,,,,
NI-VAS ACCSS SITES ,76937,CPT,,,,,both,, ,710.5,426.3,Medicaid,Illinois Medicaid,,,,,710.5,,,,
US-GUIDE NEEDLE PLAC,76942,CPT,,,,,both,, ,2221.26,1332.75,Medicaid,Illinois Medicaid,,,,,2221.26,,,,
US-GUIDE AMNIOCENT,76946,CPT,,,,,both,, ,2221.26,1332.75,Medicaid,Illinois Medicaid,,,,,2221.26,,,,
US-GUIDE INTRAOPERAT,76998,CPT,,,,,both,, ,604.57,362.74,Medicaid,Illinois Medicaid,,,,,604.57,,,,
FL-FLUORO CVAD ANY,77001,CPT,,,,,both,, ,1968.65,1181.19,Medicaid,Illinois Medicaid,,,,,1968.65,,,,
FL-NEDL GUIDE FLUORO,77002,CPT,,,,,both,, ,521.21,312.72,Medicaid,Illinois Medicaid,,,,,521.21,,,,
FL-FLUORO GUIDE SPIN,77003,CPT,,,,,both,, ,553.77,332.26,Medicaid,Illinois Medicaid,,,,,553.77,,,,
CT-GUIDE NEEDLE BX,77012,CPT,,,,,both,, ,2649.01,1589.4,Medicaid,Illinois Medicaid,,,,,2649.01,,,,
CT-GUIDE TISSUE ABLA,77013,CPT,,,,,both,, ,3157.31,1894.38,Medicaid,Illinois Medicaid,,,,,3157.31,,,,
MR-BREAST UNI WO,77046,CPT,,,,,both,, ,674.73,404.83,Medicaid,Illinois Medicaid,,,,,674.73,,,,
MR-BREAST BIL WO,77047,CPT,,,,,both,, ,674.73,404.83,Medicaid,Illinois Medicaid,,,,,674.73,,,,
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,772.13,463.27,Medicaid,Illinois Medicaid,,,,,772.13,,,,
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,830.8,498.48,Medicaid,Illinois Medicaid,,,,,830.8,,,,
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,1469.05,881.43,Medicaid,Illinois Medicaid,,,,,1469.05,,,,
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,772.13,463.27,Medicaid,Illinois Medicaid,,,,,772.13,,,,
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,830.8,498.48,Medicaid,Illinois Medicaid,,,,,830.8,,,,
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,1889.78,1133.86,Medicaid,Illinois Medicaid,,,,,1889.78,,,,
BR-TOMO MAMM SCR BI,77063,CPT,,,,,both,,,107.12,107.12,Medicaid,Illinois Medicaid,,34.15,,,107.12,107.12,107.12,Fee Schedule,
BR-TOMO MAMM SCR BI,77063,CPT,,,,,both,, ,107.12,64.27,Medicaid,Illinois Medicaid,,,,,107.12,,,,
BR-TOMO MAMM SCR UNI,77063,CPT,,,,,both,, ,80.34,48.2,Medicaid,Illinois Medicaid,,,,,80.34,,,,
BR-TOMOSYN SCR AD BI,77063,CPT,,,,,both,, ,100,60,Medicaid,Illinois Medicaid,,,,,100,,,,
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,411.49,246.89,Medicaid,Illinois Medicaid,,,,,411.49,,,,
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,411.49,246.89,Medicaid,Illinois Medicaid,,,,,411.49,,,,
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,439.55,263.73,Medicaid,Illinois Medicaid,,,,,439.55,,,,
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,448.82,269.29,Medicaid,Illinois Medicaid,,,,,448.82,,,,
Mammography of one breast,77065,CPT,,,,,both,,,448.82,448.82,Medicaid,Illinois Medicaid,,99.75,,,448.82,448.82,448.82,Fee Schedule,
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,411.49,246.89,Medicaid,Illinois Medicaid,,,,,411.49,,,,
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,411.49,246.89,Medicaid,Illinois Medicaid,,,,,411.49,,,,
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,439.55,263.73,Medicaid,Illinois Medicaid,,,,,439.55,,,,
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,556.97,334.18,Medicaid,Illinois Medicaid,,,,,556.97,,,,
Mammography of both breasts,77066,CPT,,,,,both,,,556.97,556.97,Medicaid,Illinois Medicaid,,117.06,,,556.97,556.97,556.97,Fee Schedule,
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,345.31,207.18,Medicaid,Illinois Medicaid,,,,,345.31,,,,
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,345.31,207.18,Medicaid,Illinois Medicaid,,,,,345.31,,,,
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,368.23,220.93,Medicaid,Illinois Medicaid,,,,,368.23,,,,
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,488.99,293.39,Medicaid,Illinois Medicaid,,,,,488.99,,,,
BR-DIG MAMMO SCRN UN,77067,CPT,,,,,both,, ,366.68,220,Medicaid,Illinois Medicaid,,,,,366.68,,,,
"Mammography, screening, bilateral",77067,CPT,,,,,both,,,488.99,488.99,Medicaid,Illinois Medicaid,,107.46,,,488.99,488.99,488.99,Fee Schedule,
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
BONE AGE STUDY CR,77072,CPT,,,,,both,,,721.61,721.61,Medicaid,Illinois Medicaid,,21.5,,,721.61,721.61,721.61,Fee Schedule,
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,721.61,432.96,Medicaid,Illinois Medicaid,,,,,721.61,,,,
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
BONE LENGTH STUDY CR,77073,CPT,,,,,both,,,1904.1,1904.1,Medicaid,Illinois Medicaid,,29.27,,,1904.1,1904.1,1904.1,Fee Schedule,
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,1904.1,1142.46,Medicaid,Illinois Medicaid,,,,,1904.1,,,,
BNE SRVY LTD METS CR,77074,CPT,,,,,both,,,523.46,523.46,Medicaid,Illinois Medicaid,,57.5,,,523.46,523.46,523.46,Fee Schedule,
BNE SRVY LTD METS CR,77074,CPT,,,,,both,, ,523.46,314.07,Medicaid,Illinois Medicaid,,,,,523.46,,,,
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,,,,220.61,,,,
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
BNE SRVY CMP METS CR,77075,CPT,,,,,both,,,418.2,418.2,Medicaid,Illinois Medicaid,,91.64,,,418.2,418.2,418.2,Fee Schedule,
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,418.2,250.92,Medicaid,Illinois Medicaid,,,,,418.2,,,,
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,220.61,132.36,Medicaid,Illinois Medicaid,,,,,220.61,,,,
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Medicaid,Illinois Medicaid,,,,,237.45,,,,
BONE SRVY INFANT CR,77076,CPT,,,,,both,,,833.32,833.32,Medicaid,Illinois Medicaid,,69.37,,,833.32,833.32,833.32,Fee Schedule,
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,833.32,499.99,Medicaid,Illinois Medicaid,,,,,833.32,,,,
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
JOINT SURVEY 1V CR,77077,CPT,,,,,both,,,1387.37,1387.37,Medicaid,Illinois Medicaid,,41.9,,,1387.37,1387.37,1387.37,Fee Schedule,
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,1387.37,832.42,Medicaid,Illinois Medicaid,,,,,1387.37,,,,
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,218.93,131.35,Medicaid,Illinois Medicaid,,,,,218.93,,,,
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,235.77,141.46,Medicaid,Illinois Medicaid,,,,,235.77,,,,
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,613.55,368.13,Medicaid,Illinois Medicaid,,,,,613.55,,,,
DEXA AXIAL,77080,CPT,,,,,both,, ,218.93,131.35,Medicaid,Illinois Medicaid,,,,,218.93,,,,
DEXA AXIAL,77080,CPT,,,,,both,, ,235.77,141.46,Medicaid,Illinois Medicaid,,,,,235.77,,,,
DEXA AXIAL,77080,CPT,,,,,both,,,430.83,430.83,Medicaid,Illinois Medicaid,,35.82,,,430.83,430.83,430.83,Fee Schedule,
DEXA AXIAL,77080,CPT,,,,,both,, ,430.83,258.49,Medicaid,Illinois Medicaid,,,,,430.83,,,,
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,139.21,83.52,Medicaid,Illinois Medicaid,,,,,139.21,,,,
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,149.88,89.92,Medicaid,Illinois Medicaid,,,,,149.88,,,,
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,266.91,160.14,Medicaid,Illinois Medicaid,,,,,266.91,,,,
NM-THYR UPT S-M-SUPP,78012,CPT,,,,,both,, ,1025.37,615.22,Medicaid,Illinois Medicaid,,,,,1025.37,,,,
NM-THYROID IMG W-BF,78013,CPT,,,,,both,, ,1365.27,819.16,Medicaid,Illinois Medicaid,,,,,1365.27,,,,
NM-THY UPT IMG W-BF,78014,CPT,,,,,both,, ,1719.59,1031.75,Medicaid,Illinois Medicaid,,,,,1719.59,,,,
NM-PAR PLAN THY IMG,78070,CPT,,,,,both,, ,1365.27,819.16,Medicaid,Illinois Medicaid,,,,,1365.27,,,,
NM-PARA PLN IMG SPEC,78071,CPT,,,,,both,, ,1884.64,1130.78,Medicaid,Illinois Medicaid,,,,,1884.64,,,,
NM-PAR PL IMG SPE CT,78072,CPT,,,,,both,, ,1884.64,1130.78,Medicaid,Illinois Medicaid,,,,,1884.64,,,,
NM-ADRENAL IMAGING,78075,CPT,,,,,both,, ,5329.74,3197.84,Medicaid,Illinois Medicaid,,,,,5329.74,,,,
NM-BONE MARROW LMTD,78102,CPT,,,,,both,, ,1409.3,845.58,Medicaid,Illinois Medicaid,,,,,1409.3,,,,
NM-BONE MARROW MULT,78103,CPT,,,,,both,, ,1409.3,845.58,Medicaid,Illinois Medicaid,,,,,1409.3,,,,
NM-BONE MARROW BODY,78104,CPT,,,,,both,, ,1409.3,845.58,Medicaid,Illinois Medicaid,,,,,1409.3,,,,
NM-LYMPHATICS NODES,78195,CPT,,,,,both,, ,4917.74,2950.64,Medicaid,Illinois Medicaid,,,,,4917.74,,,,
NM-LIVER,78201,CPT,,,,,both,, ,3830.06,2298.03,Medicaid,Illinois Medicaid,,,,,3830.06,,,,
NM-LIVER AND SPLEEN,78215,CPT,,,,,both,, ,3830.06,2298.03,Medicaid,Illinois Medicaid,,,,,3830.06,,,,
NM-HEPATOBILIARY SYS,78226,CPT,,,,,both,, ,4088.59,2453.15,Medicaid,Illinois Medicaid,,,,,4088.59,,,,
NM-HEPATOBIL W PHARM,78227,CPT,,,,,both,,,4088.59,4088.59,Medicaid,Illinois Medicaid,,246.76,,,4088.59,4088.59,4088.59,Fee Schedule,
NM-HEPATOBIL W PHARM,78227,CPT,,,,,both,, ,4088.59,2453.15,Medicaid,Illinois Medicaid,,,,,4088.59,,,,
NM-GI REFLUX,78262,CPT,,,,,both,, ,3415.74,2049.44,Medicaid,Illinois Medicaid,,,,,3415.74,,,,
NM-GASTRIC EMPTYING,78264,CPT,,,,,both,,,3415.74,3415.74,Medicaid,Illinois Medicaid,,186.87,,,3415.74,3415.74,3415.74,Fee Schedule,
NM-GASTRIC EMPTYING,78264,CPT,,,,,both,, ,3415.74,2049.44,Medicaid,Illinois Medicaid,,,,,3415.74,,,,
NM-GAST EMPT SM BWL,78265,CPT,,,,,both,, ,1543.71,926.22,Medicaid,Illinois Medicaid,,,,,1543.71,,,,
NM-GE SM BWL CLN MUL,78266,CPT,,,,,both,, ,2046.87,1228.12,Medicaid,Illinois Medicaid,,,,,2046.87,,,,
NM-GI BLOOD LOSS,78278,CPT,,,,,both,, ,3415.74,2049.44,Medicaid,Illinois Medicaid,,,,,3415.74,,,,
NM-MECKELS SCAN,78290,CPT,,,,,both,, ,3576.68,2146,Medicaid,Illinois Medicaid,,,,,3576.68,,,,
NM-BONE SCAN LMTD,78300,CPT,,,,,both,, ,2526.59,1515.95,Medicaid,Illinois Medicaid,,,,,2526.59,,,,
NM-BONE SCAN MULTI,78305,CPT,,,,,both,, ,2526.59,1515.95,Medicaid,Illinois Medicaid,,,,,2526.59,,,,
NM-BONE SCAN BODY,78306,CPT,,,,,both,,,3512.04,3512.04,Medicaid,Illinois Medicaid,,168.47,,,3512.04,3512.04,3512.04,Fee Schedule,
NM-BONE SCAN BODY,78306,CPT,,,,,both,, ,3512.04,2107.22,Medicaid,Illinois Medicaid,,,,,3512.04,,,,
NM-BONE SCAN 3 PHASE,78315,CPT,,,,,both,,,2911.81,2911.81,Medicaid,Illinois Medicaid,,196.37,,,2911.81,2911.81,2911.81,Fee Schedule,
NM-BONE SCAN 3 PHASE,78315,CPT,,,,,both,, ,2911.81,1747.08,Medicaid,Illinois Medicaid,,,,,2911.81,,,,
NM-VASCULAR FLOW,78445,CPT,,,,,both,, ,1719.84,1031.9,Medicaid,Illinois Medicaid,,,,,1719.84,,,,
NM-MYOCRD SPECT SNGL,78451,CPT,,,,,both,, ,3741.73,2245.03,Medicaid,Illinois Medicaid,,,,,3741.73,,,,
NM-MYOCRD SPECT MULT,78452,CPT,,,,,both,,,7071.47,7071.47,Medicaid,Illinois Medicaid,,225.79,,,7071.47,7071.47,7071.47,Fee Schedule,
NM-MYOCRD SPECT MULT,78452,CPT,,,,,both,, ,7071.47,4242.88,Medicaid,Illinois Medicaid,,,,,7071.47,,,,
NM-MYOCARD SINGLE,78453,CPT,,,,,both,, ,4803.15,2881.89,Medicaid,Illinois Medicaid,,,,,4803.15,,,,
NM-MYOCARD INFARCT,78466,CPT,,,,,both,, ,3415.74,2049.44,Medicaid,Illinois Medicaid,,,,,3415.74,,,,
NM-MYOCARD INF SPECT,78469,CPT,,,,,both,, ,3184.5,1910.7,Medicaid,Illinois Medicaid,,,,,3184.5,,,,
NM-GATED BLD POOL SN,78472,CPT,,,,,both,, ,3415.74,2049.44,Medicaid,Illinois Medicaid,,,,,3415.74,,,,
NM-LUNG VENT IMAGING,78579,CPT,,,,,both,,,4088.59,4088.59,Medicaid,Illinois Medicaid,,109.6,,,4088.59,4088.59,4088.59,Fee Schedule,
NM-LUNG VENT IMAGING,78579,CPT,,,,,both,, ,4088.59,2453.15,Medicaid,Illinois Medicaid,,,,,4088.59,,,,
NM-LUNG PERF PARTICU,78580,CPT,,,,,both,, ,3590.32,2154.19,Medicaid,Illinois Medicaid,,,,,3590.32,,,,
NM-LUNG VENT PERFUS,78582,CPT,,,,,both,,,6243.6,6243.6,Medicaid,Illinois Medicaid,,193.46,,,6243.6,6243.6,6243.6,Fee Schedule,
NM-LUNG VENT PERFUS,78582,CPT,,,,,both,, ,6243.6,3746.16,Medicaid,Illinois Medicaid,,,,,6243.6,,,,
NM-LUNG PERFVENT DIF,78598,CPT,,,,,both,, ,8897.66,5338.59,Medicaid,Illinois Medicaid,,,,,8897.66,,,,
NM-BRAIN CSF CISTERN,78630,CPT,,,,,both,, ,1616.07,969.64,Medicaid,Illinois Medicaid,,,,,1616.07,,,,
NM-KIDNEY STATIC,78700,CPT,,,,,both,, ,3590.32,2154.19,Medicaid,Illinois Medicaid,,,,,3590.32,,,,
NM-KIDNEY STATIC FLO,78701,CPT,,,,,both,, ,4802.63,2881.57,Medicaid,Illinois Medicaid,,,,,4802.63,,,,
NM-KIDNEY VF NO PHRM,78707,CPT,,,,,both,, ,4802.63,2881.57,Medicaid,Illinois Medicaid,,,,,4802.63,,,,
NM-KID VF PHRM SNGL,78708,CPT,,,,,both,, ,4802.63,2881.57,Medicaid,Illinois Medicaid,,,,,4802.63,,,,
NM-KIDNEY FUNCTION,78725,CPT,,,,,both,, ,617.74,370.64,Medicaid,Illinois Medicaid,,,,,617.74,,,,
NM-URIN BLDDR REFLUX,78740,CPT,,,,,both,, ,3590.32,2154.19,Medicaid,Illinois Medicaid,,,,,3590.32,,,,
NM-TUMOR LOC LMTD,78800,CPT,,,,,both,, ,4590.83,2754.49,Medicaid,Illinois Medicaid,,,,,4590.83,,,,
NM-TUMOR LOC LMTD 1D,78800,CPT,,,,,both,, ,4917.74,2950.64,Medicaid,Illinois Medicaid,,,,,4917.74,,,,
NM-TUMOR LOC MULTI,78801,CPT,,,,,both,, ,4917.74,2950.64,Medicaid,Illinois Medicaid,,,,,4917.74,,,,
NM-TUMOR LOC BDY 1D,78802,CPT,,,,,both,, ,6129.79,3677.87,Medicaid,Illinois Medicaid,,,,,6129.79,,,,
NM-TUMOR LOC BODY,78802,CPT,,,,,both,, ,4590.83,2754.49,Medicaid,Illinois Medicaid,,,,,4590.83,,,,
NM-TUMR LOC SPECT 1D,78803,CPT,,,,,both,, ,5042.88,3025.72,Medicaid,Illinois Medicaid,,,,,5042.88,,,,
NM-TUMR LOC BDY >1D,78804,CPT,,,,,both,, ,5251.46,3150.87,Medicaid,Illinois Medicaid,,,,,5251.46,,,,
NM-UNLISTED MISC,78999,CPT,,,,,both,, ,593.54,356.12,Medicaid,Illinois Medicaid,,,,,593.54,,,,
NUCLEAR RX IV ADMIN,79101,CPT,,,,,both,, ,1716.5,1029.9,Medicaid,Illinois Medicaid,,,,,1716.5,,,,
BASIC META W-ION CA,80047,CPT,,,,,both,, ,29.19,17.51,Medicaid,Illinois Medicaid,,,,,29.19,,,,
BASIC META W-ION CA,80047,CPT,,,,,both,, ,163.63,98.17,Medicaid,Illinois Medicaid,,,,,163.63,,,,
BASIC METABO CA TOTA,80048,CPT,,,,,both,, ,89.53,53.71,Medicaid,Illinois Medicaid,,,,,89.53,,,,
BASIC METABO CA TOTA,80048,CPT,,,,,both,, ,510.83,306.49,Medicaid,Illinois Medicaid,,,,,510.83,,,,
Basic metabolic panel,80048,CPT,,,,,both,,,510.83,510.83,Medicaid,Illinois Medicaid,,8.46, ,,510.83,510.83,510.83,Fee Schedule,
GENERAL HEALTH PANEL,80050,CPT,,,,,both,,,1796.88,1796.88,Medicaid,Illinois Medicaid,,,,,1796.88,1796.88,1796.88,Fee Schedule,
GENERAL HEALTH PANEL,80050,CPT,,,,,both,, ,1796.88,1078.12,Medicaid,Illinois Medicaid,,,,,1796.88,,,,
ELECTROLYTE PANEL,80051,CPT,,,,,both,, ,74.1,44.46,Medicaid,Illinois Medicaid,,,,,74.1,,,,
ELECTROLYTE PANEL,80051,CPT,,,,,both,, ,390.41,234.24,Medicaid,Illinois Medicaid,,,,,390.41,,,,
"Blood test, comprehensive group of blood chemicals",80053,CPT,,,,,both,,,630.96,630.96,Medicaid,Illinois Medicaid,,10.46,,,630.96,630.96,630.96,Fee Schedule,
COMP METAB PANEL,80053,CPT,,,,,both,, ,111.7,67.02,Medicaid,Illinois Medicaid,,,,,111.7,,,,
COMP METAB PANEL,80053,CPT,,,,,both,, ,630.96,378.57,Medicaid,Illinois Medicaid,,,,,630.96,,,,
Obstetric blood test panel,80055,CPT,,,,,both,,,1727.55,1727.55,Medicaid,Illinois Medicaid,,1036.53,,,1727.55,1727.55,1727.55,Fee Schedule,
OBSTETRIC PANEL,80055,CPT,,,,,both,, ,350.84,210.5,Medicaid,Illinois Medicaid,,,,,350.84,,,,
OBSTETRIC PANEL,80055,CPT,,,,,both,, ,1727.55,1036.53,Medicaid,Illinois Medicaid,,,,,1727.55,,,,
"Blood test, lipids (cholesterol and triglycerides)",80061,CPT,,,,,both,,,565.84,565.84,Medicaid,Illinois Medicaid,,9.37,,,565.84,565.84,565.84,Fee Schedule,
LIPID PANEL,80061,CPT,,,,,both,, ,86.73,52.03,Medicaid,Illinois Medicaid,,,,,86.73,,,,
Q92145 LIPID PANEL,80061,CPT,,,,,both,, ,565.84,339.5,Medicaid,Illinois Medicaid,,,,,565.84,,,,
Q92145 LIPID PANEL,80061,CPT,,,,,both,, ,565.84,339.5,Medicaid,Illinois Medicaid,,,,,565.84,,,,
Kidney function panel test,80069,CPT,,,,,both,,,570.89,570.89,Medicaid,Illinois Medicaid,,8.52,,,570.89,570.89,570.89,Fee Schedule,
RENAL FUNCTION PANEL,80069,CPT,,,,,both,, ,91.77,55.06,Medicaid,Illinois Medicaid,,,,,91.77,,,,
RENAL FUNCTION PANEL,80069,CPT,,,,,both,, ,570.89,342.53,Medicaid,Illinois Medicaid,,,,,570.89,,,,
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,, ,282.08,169.24,Medicaid,Illinois Medicaid,,,,,282.08,,,,
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,,,3484.29,3484.29,Medicaid,Illinois Medicaid,,19.24,,,3484.29,3484.29,3484.29,Fee Schedule,
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,, ,3484.29,2090.57,Medicaid,Illinois Medicaid,,,,,3484.29,,,,
HEPATIC FUNCTION PAN,80076,CPT,,,,,both,, ,86.45,51.87,Medicaid,Illinois Medicaid,,,,,86.45,,,,
HEPATIC FUNCTION PAN,80076,CPT,,,,,both,, ,450.48,270.28,Medicaid,Illinois Medicaid,,,,,450.48,,,,
Liver function blood test panel,80076,CPT,,,,,both,,,450.48,450.48,Medicaid,Illinois Medicaid,,7.98,,,450.48,450.48,450.48,Fee Schedule,
OBSTETRIC PNL W HIV,80081,CPT,,,,,both,, ,1883.6,1130.16,Medicaid,Illinois Medicaid,,,,,1883.6,,,,
ACETAMINOPHEN QT,80143,CPT,,,,,both,, ,186.06,111.63,Medicaid,Illinois Medicaid,,,,,186.06,,,,
Q36298 ADM LEV IBD,80145,CPT,,,,,both,, ,174.02,104.41,Medicaid,Illinois Medicaid,,,,,174.02,,,,
AMIKACIN,80150,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q36721 AMIOD HPLC/LC,80151,CPT,,,,,both,, ,546.19,327.71,Medicaid,Illinois Medicaid,,,,,546.19,,,,
CARBAMAZEPINE TOTAL,80156,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
Q18948 CBZ FREE LCMS,80157,CPT,,,,,both,, ,88.4,53.04,Medicaid,Illinois Medicaid,,,,,88.4,,,,
CYCLOSPORINE,80158,CPT,,,,,both,, ,91.49,54.89,Medicaid,Illinois Medicaid,,,,,91.49,,,,
CYCLOSPORINE,80158,CPT,,,,,both,, ,1555.5,933.3,Medicaid,Illinois Medicaid,,,,,1555.5,,,,
Q15220CYC A BL LCMSM,80158,CPT,,,,,both,, ,1555.5,933.3,Medicaid,Illinois Medicaid,,,,,1555.5,,,,
Q8812 CYA TRGH BL IA,80158,CPT,,,,,both,, ,1555.5,933.3,Medicaid,Illinois Medicaid,,,,,1555.5,,,,
Q1769 CLOZAP LCMSMS,80159,CPT,,,,,both,, ,95.43,57.25,Medicaid,Illinois Medicaid,,,,,95.43,,,,
Q1769 CLOZAP LCMSMS,80159,CPT,,,,,both,, ,95.43,57.25,Medicaid,Illinois Medicaid,,,,,95.43,,,,
DIGOXIN TOTAL,80162,CPT,,,,,both,, ,130.23,78.13,Medicaid,Illinois Medicaid,,,,,130.23,,,,
DIGOXIN TOTAL,80162,CPT,,,,,both,, ,787.57,472.54,Medicaid,Illinois Medicaid,,,,,787.57,,,,
DIGOXIN FREE,80163,CPT,,,,,both,, ,130.23,78.13,Medicaid,Illinois Medicaid,,,,,130.23,,,,
Q6651 VALP ACID TOT,80164,CPT,,,,,both,, ,691.06,414.63,Medicaid,Illinois Medicaid,,,,,691.06,,,,
VALPROIC ACID TOTAL,80164,CPT,,,,,both,, ,132.76,79.65,Medicaid,Illinois Medicaid,,,,,132.76,,,,
VALPROIC ACID TOTAL,80164,CPT,,,,,both,,,711.79,711.79,Medicaid,Illinois Medicaid,,52.6,,,711.79,711.79,711.79,Fee Schedule,
VALPROIC ACID TOTAL,80164,CPT,,,,,both,, ,711.79,427.07,Medicaid,Illinois Medicaid,,,,,711.79,,,,
Q6651 VALP ACID FREE,80165,CPT,,,,,both,, ,691.06,414.63,Medicaid,Illinois Medicaid,,,,,691.06,,,,
VALPROIC ACID FREE,80165,CPT,,,,,both,, ,132.76,79.65,Medicaid,Illinois Medicaid,,,,,132.76,,,,
VALPROIC ACID FREE,80165,CPT,,,,,both,, ,711.79,427.07,Medicaid,Illinois Medicaid,,,,,711.79,,,,
Q3081 FELBAMATE MS,80167,CPT,,,,,both,, ,191.99,115.19,Medicaid,Illinois Medicaid,,,,,191.99,,,,
ETHOSUXIMIDE,80168,CPT,,,,,both,, ,864.19,518.51,Medicaid,Illinois Medicaid,,,,,864.19,,,,
Q18883 EVEROLI LM/MS,80169,CPT,,,,,both,, ,106.93,64.15,Medicaid,Illinois Medicaid,,,,,106.93,,,,
GENTAMICIN,80170,CPT,,,,,both,, ,900.96,540.57,Medicaid,Illinois Medicaid,,,,,900.96,,,,
GABAPENTIN QT,80171,CPT,,,,,both,, ,105.53,63.31,Medicaid,Illinois Medicaid,,,,,105.53,,,,
L716811 GABAP LCMSMS,80171,CPT,,,,,both,, ,102.46,61.47,Medicaid,Illinois Medicaid,,,,,102.46,,,,
HALOPERIDOL,80173,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,,,,871.22,,,,
Q22060 LAMOTR LCMSMS,80175,CPT,,,,,both,, ,105.53,63.31,Medicaid,Illinois Medicaid,,,,,105.53,,,,
Q22060 LAMOTR LCMSMS,80175,CPT,,,,,both,, ,105.53,63.31,Medicaid,Illinois Medicaid,,,,,105.53,,,,
Q605 LIDOCAINE IA,80176,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,,,,871.22,,,,
Q605 LIDOCAINE IA,80176,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,,,,871.22,,,,
Q15142 LEVE LC/MS/MS,80177,CPT,,,,,both,, ,105.53,63.31,Medicaid,Illinois Medicaid,,,,,105.53,,,,
Lithium,80178,CPT,,,,,both,,,420.72,420.72,Medicaid,Illinois Medicaid,,6.46,,,420.72,420.72,420.72,Fee Schedule,
LITHIUM,80178,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
SALICYLATE QT,80179,CPT,,,,,both,, ,191.99,115.19,Medicaid,Illinois Medicaid,,,,,191.99,,,,
Q10662 MPA LC/MS/MS,80180,CPT,,,,,both,, ,143.71,86.22,Medicaid,Illinois Medicaid,,,,,143.71,,,,
Q36637 OCBZ LC/MS/MS,80183,CPT,,,,,both,, ,122.37,73.42,Medicaid,Illinois Medicaid,,,,,122.37,,,,
Q36637 OCBZ LC/MS/MS,80183,CPT,,,,,both,, ,122.37,73.42,Medicaid,Illinois Medicaid,,,,,122.37,,,,
PHENOBARBITAL,80184,CPT,,,,,both,, ,120.96,72.57,Medicaid,Illinois Medicaid,,,,,120.96,,,,
Q751 PHENOBARBITAL,80184,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,,,,871.22,,,,
Q751 PHENOBARBITAL,80184,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,,,,871.22,,,,
L70706 PHENYTOIN TOT,80185,CPT,,,,,both,, ,847.64,508.58,Medicaid,Illinois Medicaid,,,,,847.64,,,,
L70706 PHENYTOIN TOT,80185,CPT,,,,,both,, ,847.64,508.58,Medicaid,Illinois Medicaid,,,,,847.64,,,,
PHENYTOIN TOTAL,80185,CPT,,,,,both,, ,140.05,84.03,Medicaid,Illinois Medicaid,,,,,140.05,,,,
L70706PHENYTOIN FREE,80186,CPT,,,,,both,, ,91.77,55.06,Medicaid,Illinois Medicaid,,,,,91.77,,,,
L70706PHENYTOIN FREE,80186,CPT,,,,,both,, ,91.77,55.06,Medicaid,Illinois Medicaid,,,,,91.77,,,,
PRIMIDONE,80188,CPT,,,,,both,, ,1757.58,1054.54,Medicaid,Illinois Medicaid,,,,,1757.58,,,,
Q751 PRIMIDONE,80188,CPT,,,,,both,, ,878.79,527.27,Medicaid,Illinois Medicaid,,,,,878.79,,,,
PROCAINAMIDE+NAPA,80192,CPT,,,,,both,, ,900.96,540.57,Medicaid,Illinois Medicaid,,,,,900.96,,,,
QUINIDINE,80194,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,,,,765.96,,,,
SIROLIMUS,80195,CPT,,,,,both,, ,257.1,154.26,Medicaid,Illinois Medicaid,,,,,257.1,,,,
SIROLIMUS,80195,CPT,,,,,both,, ,257.1,154.26,Medicaid,Illinois Medicaid,,,,,257.1,,,,
Q70007 TAC HS LCMSMS,80197,CPT,,,,,both,, ,822.37,493.42,Medicaid,Illinois Medicaid,,,,,822.37,,,,
Q70007 TAC HS LCMSMS,80197,CPT,,,,,both,, ,822.37,493.42,Medicaid,Illinois Medicaid,,,,,822.37,,,,
THEOPHYLLINE,80198,CPT,,,,,both,, ,781.11,468.66,Medicaid,Illinois Medicaid,,,,,781.11,,,,
"THEOPHYLLINE, SERUM",80198,CPT,,,,,both,, ,149.6,89.76,Medicaid,Illinois Medicaid,,,,,149.6,,,,
"THEOPHYLLINE, SERUM",80198,CPT,,,,,both,, ,149.6,89.76,Medicaid,Illinois Medicaid,,,,,149.6,,,,
TIAGABINE QT,80199,CPT,,,,,both,, ,143.71,86.22,Medicaid,Illinois Medicaid,,,,,143.71,,,,
TOBRAMYCIN,80200,CPT,,,,,both,, ,75.5,45.3,Medicaid,Illinois Medicaid,,,,,75.5,,,,
TOPIRAMATE,80201,CPT,,,,,both,, ,445.71,267.42,Medicaid,Illinois Medicaid,,,,,445.71,,,,
VANCOMYCIN,80202,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,,,,765.96,,,,
ZONISAMIDE,80203,CPT,,,,,both,, ,105.53,63.31,Medicaid,Illinois Medicaid,,,,,105.53,,,,
ZONISAMIDE,80203,CPT,,,,,both,, ,105.53,63.31,Medicaid,Illinois Medicaid,,,,,105.53,,,,
Q648 METHOTREXATE IA,80204,CPT,,,,,both,, ,501.1,300.66,Medicaid,Illinois Medicaid,,,,,501.1,,,,
L503870 INFLIXIMAB,80230,CPT,,,,,both,, ,159.65,95.79,Medicaid,Illinois Medicaid,,,,,159.65,,,,
L504567 VEDOLIZUMAB,80280,CPT,,,,,both,, ,198.79,119.27,Medicaid,Illinois Medicaid,,,,,198.79,,,,
DRUG UNSPEC QUANT,80299,CPT,,,,,both,, ,873.46,524.07,Medicaid,Illinois Medicaid,,,,,873.46,,,,
L7609 DOXEPIN LCMSMS,80299,CPT,,,,,both,, ,148.4,89.04,Medicaid,Illinois Medicaid,,,,,148.4,,,,
Q2548 DRUG UNSPEC QT,80299,CPT,,,,,both,, ,546.19,327.71,Medicaid,Illinois Medicaid,,,,,546.19,,,,
Q2548 DRUG UNSPEC QT,80299,CPT,,,,,both,, ,546.19,327.71,Medicaid,Illinois Medicaid,,,,,546.19,,,,
Q29391DEXAMET LCMSMS,80299,CPT,,,,,both,, ,342,205.2,Medicaid,Illinois Medicaid,,,,,342,,,,
Q8389 FLUOXET LCMSMS,80299,CPT,,,,,both,, ,811.42,486.85,Medicaid,Illinois Medicaid,,,,,811.42,,,,
PRS DRG IA VIS,80305,CPT,,,,,both,, ,137.8,82.68,Medicaid,Illinois Medicaid,,,,,137.8,,,,
PRS DRG IA MET,80306,CPT,,,,,both,, ,137.8,82.68,Medicaid,Illinois Medicaid,,,,,137.8,,,,
733726 URINE DRUG PROFILE 14/MEDWATCH,80307,CPT,,,,,both,, ,360,216,Medicaid,Illinois Medicaid,,,,,360,,,,
DRUGPROF ORAL FLD,80307,CPT,,,,,both,, ,116,69.6,Medicaid,Illinois Medicaid,,,,,116,,,,
L074401 AMPH UR SCRN,80307,CPT,,,,,both,, ,60,36,Medicaid,Illinois Medicaid,,,,,60,,,,
L074401 AMPH UR SCRN,80307,CPT,,,,,both,, ,60,36,Medicaid,Illinois Medicaid,,,,,60,,,,
L733740 ULTRM SCR UR,80307,CPT,,,,,both,, ,200,120,Medicaid,Illinois Medicaid,,,,,200,,,,
L790600 DAB SCN PRES,80307,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
L790600 DAB SCN PRES,80307,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
PRS DRG IA ANAZ,80307,CPT,,,,,both,,,1174.34,1174.34,Medicaid,Illinois Medicaid,,47.89,,,1174.34,1174.34,1174.34,Fee Schedule,
Q19027 CONF DRUG 1 U,80307,CPT,,,,,both,, ,1174.34,704.6,Medicaid,Illinois Medicaid,,,,,1174.34,,,,
Q19027 CONF DRUG 1 U,80307,CPT,,,,,both,, ,1174.34,704.6,Medicaid,Illinois Medicaid,,,,,1174.34,,,,
Q643 METHYL ALC BL C,80320,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,,,,728.07,,,,
ALKALOIDS NOS MS,80323,CPT,,,,,both,, ,713.47,428.08,Medicaid,Illinois Medicaid,,,,,713.47,,,,
Q90642NIC&COT S LCMS,80323,CPT,,,,,both,, ,713.47,428.08,Medicaid,Illinois Medicaid,,,,,713.47,,,,
Q90646NIC&COT U LCMS,80323,CPT,,,,,both,, ,713.47,428.08,Medicaid,Illinois Medicaid,,,,,713.47,,,,
Q241Z AMPHET U GC/MS,80324,CPT,,,,,both,, ,184.68,110.8,Medicaid,Illinois Medicaid,,,,,184.68,,,,
Q241Z AMPHET U GC/MS,80324,CPT,,,,,both,, ,184.68,110.8,Medicaid,Illinois Medicaid,,,,,184.68,,,,
L790600 AMPH MS 5P,80326,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
ANABOLC STRD MS 1-2,80327,CPT,,,,,both,, ,269.16,161.49,Medicaid,Illinois Medicaid,,,,,269.16,,,,
L790600 ANLGNO MS 6P,80331,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
ANTIDPRS SERO MS 3-5,80333,CPT,,,,,both,, ,771.01,462.6,Medicaid,Illinois Medicaid,,,,,771.01,,,,
L790600 AD MS 6PL,80334,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
Q272 NORTRI LC/MS/MS,80335,CPT,,,,,both,, ,826.59,495.95,Medicaid,Illinois Medicaid,,,,,826.59,,,,
Q272 NORTRI LC/MS/MS,80335,CPT,,,,,both,, ,826.59,495.95,Medicaid,Illinois Medicaid,,,,,826.59,,,,
Q412 DESIPRAM LCMSMS,80335,CPT,,,,,both,, ,826.59,495.95,Medicaid,Illinois Medicaid,,,,,826.59,,,,
Q412 DESIPRAM LCMSMS,80335,CPT,,,,,both,, ,826.59,495.95,Medicaid,Illinois Medicaid,,,,,826.59,,,,
Q887 IMIPRAM LCMSMS,80335,CPT,,,,,both,, ,826.59,495.95,Medicaid,Illinois Medicaid,,,,,826.59,,,,
Q887 IMIPRAM LCMSMS,80335,CPT,,,,,both,, ,826.59,495.95,Medicaid,Illinois Medicaid,,,,,826.59,,,,
ANTIDPRS TRIC MS 3-5,80336,CPT,,,,,both,, ,571.45,342.87,Medicaid,Illinois Medicaid,,,,,571.45,,,,
L790600 ADEP TRI 6PL,80337,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
ANTIDPRS NOS MS,80338,CPT,,,,,both,, ,928.18,556.9,Medicaid,Illinois Medicaid,,,,,928.18,,,,
L790600 AD NOS MS,80338,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
L790600 AED MS 7P,80341,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
ANTIPSYCH NOS MS 1-3,80342,CPT,,,,,both,, ,811.42,486.85,Medicaid,Illinois Medicaid,,,,,811.42,,,,
L790600 APD MS 7P,80344,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
L809630 FLTZP MS,80346,CPT,,,,,both,, ,600,360,Medicaid,Illinois Medicaid,,,,,600,,,,
Q340 CLONAZEP LCMSMS,80346,CPT,,,,,both,, ,814.24,488.54,Medicaid,Illinois Medicaid,,,,,814.24,,,,
Q340 CLONAZEP LCMSMS,80346,CPT,,,,,both,, ,814.24,488.54,Medicaid,Illinois Medicaid,,,,,814.24,,,,
L790600 BZD MS 13P,80347,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
L790600 BUP MS,80348,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
L790600 BUP MS,80348,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
Q93031 BUPRENOPHINE & METABOLITIES LC/MS,80348,CPT,,,,,both,, ,119.25,71.55,Medicaid,Illinois Medicaid,,,,,119.25,,,,
CANNABINDS NATUR MS,80349,CPT,,,,,both,, ,147.91,88.74,Medicaid,Illinois Medicaid,,,,,147.91,,,,
L790697 SYNCBD WB MS,80352,CPT,,,,,both,, ,300,180,Medicaid,Illinois Medicaid,,,,,300,,,,
L790600 COCAINE MS,80353,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
FENTANYL MS,80354,CPT,,,,,both,, ,534.41,320.64,Medicaid,Illinois Medicaid,,,,,534.41,,,,
L790600 FENT MET MS,80354,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
GABAPENTIN NONBLD MS,80355,CPT,,,,,both,, ,534.41,320.64,Medicaid,Illinois Medicaid,,,,,534.41,,,,
L790600 GPT NBLD MS,80355,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
HEROIN METABOLITE MS,80356,CPT,,,,,both,, ,227.91,136.74,Medicaid,Illinois Medicaid,,,,,227.91,,,,
L790600 KET NKET MS,80357,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
L790600 MTD MS,80358,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
METHADONE MS,80358,CPT,,,,,both,, ,327.54,196.52,Medicaid,Illinois Medicaid,,,,,327.54,,,,
L791194 MDMA MS,80359,CPT,,,,,both,, ,133.38,80.02,Medicaid,Illinois Medicaid,,,,,133.38,,,,
Q84578 MDMA MS,80359,CPT,,,,,both,, ,404.17,242.5,Medicaid,Illinois Medicaid,,,,,404.17,,,,
Q84578 MDMA MS,80359,CPT,,,,,both,, ,404.17,242.5,Medicaid,Illinois Medicaid,,,,,404.17,,,,
L790600 MPH MS,80360,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
L790600 OPI MS 1P,80361,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
OPIATES MS 1 PL,80361,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
Q20907 OPI MS,80361,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
L790600 OPD OPI MS5P,80364,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
L790600 OXY MS,80365,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
Q20907 OXY MS,80365,CPT,,,,,both,, ,428.58,257.14,Medicaid,Illinois Medicaid,,,,,428.58,,,,
Q20907 OXY MS,80365,CPT,,,,,both,, ,428.58,257.14,Medicaid,Illinois Medicaid,,,,,428.58,,,,
L790600 PGB MS,80366,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
PREGABALIN MS,80366,CPT,,,,,both,, ,811.42,486.85,Medicaid,Illinois Medicaid,,,,,811.42,,,,
L790600 PPX MS,80367,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
L790600 SED HYP MS,80368,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
L790600 SM RLX MS3PL,80370,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
L790600 STIM SYN MS,80371,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
L790600 TAPENTADL MS,80372,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
L761019TRAMADOL CONF,80373,CPT,,,,,both,, ,412,247.2,Medicaid,Illinois Medicaid,,,,,412,,,,
L790600 TRA MS,80373,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
DEF DRUG NOS MS 1-3,80375,CPT,,,,,both,, ,546.19,327.71,Medicaid,Illinois Medicaid,,,,,546.19,,,,
DEF DRUG NOS MS 7PL,80377,CPT,,,,,both,, ,571.45,342.87,Medicaid,Illinois Medicaid,,,,,571.45,,,,
L790600 DRGNOS MS 7P,80377,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
Manual urinalysis test with examination using microscope,81001,CPT,,,,,both,,,240.26,240.26,Medicaid,Illinois Medicaid,,12.3,,,240.26,240.26,240.26,Fee Schedule,
"UA, AUTO W-SCOPE",81001,CPT,,,,,both,, ,33.39,20.03,Medicaid,Illinois Medicaid,,,,,33.39,,,,
"UA, AUTO W-SCOPE",81001,CPT,,,,,both,, ,240.26,144.15,Medicaid,Illinois Medicaid,,,,,240.26,,,,
Automated urinalysis test,81003,CPT,,,,,both,,,210.5,210.5,Medicaid,Illinois Medicaid,,8.77,,,210.5,210.5,210.5,Fee Schedule,
"UA, AUTO, W-O SCOPE",81003,CPT,,,,,both,, ,23.85,14.31,Medicaid,Illinois Medicaid,,,,,23.85,,,,
"UA, AUTO, W-O SCOPE",81003,CPT,,,,,both,, ,210.5,126.3,Medicaid,Illinois Medicaid,,,,,210.5,,,,
URINALYSIS,81005,CPT,,,,,both,, ,180.19,108.11,Medicaid,Illinois Medicaid,,,,,180.19,,,,
MICROSCOPIC EX OF UR,81015,CPT,,,,,both,, ,10.55,6.33,Medicaid,Illinois Medicaid,,,,,10.55,,,,
MICROSCOPIC EX OF UR,81015,CPT,,,,,both,, ,180.19,108.11,Medicaid,Illinois Medicaid,,,,,180.19,,,,
URINE PREG TEST QL,81025,CPT,,,,,both,, ,23.58,14.14,Medicaid,Illinois Medicaid,,,,,23.58,,,,
URINE PREG TEST QL,81025,CPT,,,,,both,,,420.72,420.72,Medicaid,Illinois Medicaid,,3.96,,,420.72,420.72,420.72,Fee Schedule,
URINE PREG TEST QL,81025,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
"L910235 URINE VOLUME, TIMED",81050,CPT,,,,,both,, ,30.64,18.38,Medicaid,Illinois Medicaid,,,,,30.64,,,,
Q91863 BRCADVAN COMP,81162,CPT,,,,,both,, ,5261.25,3156.75,Medicaid,Illinois Medicaid,,,,,5261.25,,,,
L480510 BCRABL1 KDMA,81170,CPT,,,,,both,, ,1792,1075.2,Medicaid,Illinois Medicaid,,,,,1792,,,,
Q91065 P210 BCRABL1,81206,CPT,,,,,both,, ,552.22,331.33,Medicaid,Illinois Medicaid,,,,,552.22,,,,
Q91065 P190 BCRABL1,81207,CPT,,,,,both,, ,487.83,292.69,Medicaid,Illinois Medicaid,,,,,487.83,,,,
BRAF GENE ANALY V600,81210,CPT,,,,,both,, ,393.84,236.3,Medicaid,Illinois Medicaid,,,,,393.84,,,,
L489450 CALR MA,81219,CPT,,,,,both,, ,675,405,Medicaid,Illinois Medicaid,,,,,675,,,,
Q10458 CFSCN OLA-PCR,81220,CPT,,,,,both,, ,1100,660,Medicaid,Illinois Medicaid,,,,,1100,,,,
L252900 CF CFTR DD,81222,CPT,,,,,both,, ,930,558,Medicaid,Illinois Medicaid,,,,,930,,,,
L511230 CYT P450 2D6,81226,CPT,,,,,both,, ,600,360,Medicaid,Illinois Medicaid,,,,,600,,,,
Q161608 CYP2C9 GN AN,81227,CPT,,,,,both,, ,610,366,Medicaid,Illinois Medicaid,,,,,610,,,,
EGFR GENE COM VAR,81235,CPT,,,,,both,, ,963.55,578.13,Medicaid,Illinois Medicaid,,,,,963.55,,,,
F2 GEN ANALY 20210GA,81240,CPT,,,,,both,, ,2183.65,1310.19,Medicaid,Illinois Medicaid,,,,,2183.65,,,,
Q17909 PGM HYBEACONS,81240,CPT,,,,,both,, ,1091.82,655.09,Medicaid,Illinois Medicaid,,,,,1091.82,,,,
Q17900 FVLM HYBEACON,81241,CPT,,,,,both,, ,2183.65,1310.19,Medicaid,Illinois Medicaid,,,,,2183.65,,,,
Q17900 FVLM HYBEACON,81241,CPT,,,,,both,, ,2183.65,1310.19,Medicaid,Illinois Medicaid,,,,,2183.65,,,,
FMR1 GENE ANALY AB,81243,CPT,,,,,both,, ,1863.12,1117.87,Medicaid,Illinois Medicaid,,,,,1863.12,,,,
Q35079 HHC FRFLP-PCR,81256,CPT,,,,,both,, ,3396.72,2038.03,Medicaid,Illinois Medicaid,,,,,3396.72,,,,
Q35079 HHC FRFLP-PCR,81256,CPT,,,,,both,, ,3396.72,2038.03,Medicaid,Illinois Medicaid,,,,,3396.72,,,,
Q11175AGLOB MUT PCR,81257,CPT,,,,,both,, ,477.7,286.62,Medicaid,Illinois Medicaid,,,,,477.7,,,,
L489421 JAK2V617F QL,81270,CPT,,,,,both,, ,1306.56,783.93,Medicaid,Illinois Medicaid,,,,,1306.56,,,,
Q16539 JAK2 V617F QL,81270,CPT,,,,,both,, ,1424.14,854.48,Medicaid,Illinois Medicaid,,,,,1424.14,,,,
Q16539 JAK2 V617F QL,81270,CPT,,,,,both,, ,1424.14,854.48,Medicaid,Illinois Medicaid,,,,,1424.14,,,,
L511040 CHRO ANA CMA,81277,CPT,,,,,both,, ,2260,1356,Medicaid,Illinois Medicaid,,,,,2260,,,,
L115101 JAK2 EX12-15,81279,CPT,,,,,both,, ,865.04,519.02,Medicaid,Illinois Medicaid,,,,,865.04,,,,
Q90251 IL28B RT-PCR,81283,CPT,,,,,both,, ,352.24,211.34,Medicaid,Illinois Medicaid,,,,,352.24,,,,
Q17911 MTHFR DNA HYB,81291,CPT,,,,,both,, ,3892.4,2335.44,Medicaid,Illinois Medicaid,,,,,3892.4,,,,
Q17911 MTHFR DNA HYB,81291,CPT,,,,,both,, ,3892.4,2335.44,Medicaid,Illinois Medicaid,,,,,3892.4,,,,
MICROSAT INSTAB VAR,81301,CPT,,,,,both,, ,960.19,576.11,Medicaid,Illinois Medicaid,,,,,960.19,,,,
PCA3 KLK3 RATIO,81313,CPT,,,,,both,, ,636.57,381.94,Medicaid,Illinois Medicaid,,,,,636.57,,,,
Q18041 SMA CAR SCN,81329,CPT,,,,,both,, ,685,411,Medicaid,Illinois Medicaid,,,,,685,,,,
Q15340 ALPHA-1 ANTITRYPSIN (AAT) MUTATIO,81332,CPT,,,,,both,, ,3025.5,1815.3,Medicaid,Illinois Medicaid,,,,,3025.5,,,,
SERPINA1 GENE ANA CV,81332,CPT,,,,,both,, ,3396.72,2038.03,Medicaid,Illinois Medicaid,,,,,3396.72,,,,
L489150 MPL MUT AN,81338,CPT,,,,,both,, ,675,405,Medicaid,Illinois Medicaid,,,,,675,,,,
Q92476 MPL MA QL,81339,CPT,,,,,both,, ,701.97,421.18,Medicaid,Illinois Medicaid,,,,,701.97,,,,
CSI153 UGTIA1 GEN AN,81350,CPT,,,,,both,, ,819.57,491.74,Medicaid,Illinois Medicaid,,,,,819.57,,,,
Q15584 HLA-B27 DETER,81374,CPT,,,,,both,, ,250.36,150.21,Medicaid,Illinois Medicaid,,,,,250.36,,,,
Q17135 HLA2 TYP LR 1,81376,CPT,,,,,both,, ,610.75,366.45,Medicaid,Illinois Medicaid,,,,,610.75,,,,
L167082 HLA2 LR1 AG,81377,CPT,,,,,both,, ,235.1,141.06,Medicaid,Illinois Medicaid,,,,,235.1,,,,
HLA1 TYP HR 1 AL EA,81381,CPT,,,,,both,, ,724.42,434.65,Medicaid,Illinois Medicaid,,,,,724.42,,,,
Q17135 HLA2 TYP HR 1,81382,CPT,,,,,both,, ,618.04,370.82,Medicaid,Illinois Medicaid,,,,,618.04,,,,
L167082 HLA2 HR1 AL,81383,CPT,,,,,both,, ,334.75,200.85,Medicaid,Illinois Medicaid,,,,,334.75,,,,
Q90808 MP L2,81401,CPT,,,,,both,, ,1062.07,637.24,Medicaid,Illinois Medicaid,,,,,1062.07,,,,
Q90808 MP L2,81401,CPT,,,,,both,, ,1062.07,637.24,Medicaid,Illinois Medicaid,,,,,1062.07,,,,
O51115 RHD GENOTYPE,81403,CPT,,,,,both,, ,865.04,519.02,Medicaid,Illinois Medicaid,,,,,865.04,,,,
O51115 RHD GENOTYPE,81403,CPT,,,,,both,, ,865.04,519.02,Medicaid,Illinois Medicaid,,,,,865.04,,,,
L630540 THRB,81405,CPT,,,,,both,, ,4320,2592,Medicaid,Illinois Medicaid,,,,,4320,,,,
B5306-6 ACGH MOL KAR,81406,CPT,,,,,both,, ,2000,1200,Medicaid,Illinois Medicaid,,,,,2000,,,,
BB893-9 UNL MOL PTH,81479,CPT,,,,,both,, ,618,370.8,Medicaid,Illinois Medicaid,,,,,618,,,,
NBS SCID,81479,CPT,,,,,both,, ,109.46,65.67,Medicaid,Illinois Medicaid,,,,,109.46,,,,
UNLIST MOLEC PATH,81479,CPT,,,,,both,, ,1145.43,687.25,Medicaid,Illinois Medicaid,,,,,1145.43,,,,
L140045 OVARIAN MALIGNANCY RISK - ROMA,81500,CPT,,,,,both,, ,600,360,Medicaid,Illinois Medicaid,,,,,600,,,,
FTL CGEN ABN 4 ANAL,81511,CPT,,,,,both,, ,466.48,279.88,Medicaid,Illinois Medicaid,,,,,466.48,,,,
Q30294 QUAD SCREEN,81511,CPT,,,,,both,, ,415.5,249.3,Medicaid,Illinois Medicaid,,,,,415.5,,,,
FTL CGEN ABN 5 ANAL,81512,CPT,,,,,both,, ,791.78,475.06,Medicaid,Illinois Medicaid,,,,,791.78,,,,
L550659 LIVR BIOMRKR,81517,CPT,,,,,both,, ,1143,685.8,Medicaid,Illinois Medicaid,,,,,1143,,,,
Q92688 LIVER FIBROS,81596,CPT,,,,,both,, ,337.09,202.25,Medicaid,Illinois Medicaid,,,,,337.09,,,,
ACETON-KETON SERM QL,82009,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
ACETON-KETON SERM QT,82010,CPT,,,,,both,, ,80.55,48.33,Medicaid,Illinois Medicaid,,,,,80.55,,,,
ACETON-KETON SERM QT,82010,CPT,,,,,both,, ,341.3,204.78,Medicaid,Illinois Medicaid,,,,,341.3,,,,
NBS ACYLCARNITINE QL,82016,CPT,,,,,both,, ,82.79,49.67,Medicaid,Illinois Medicaid,,,,,82.79,,,,
ADRENOCORT ACTH,82024,CPT,,,,,both,, ,2343.07,1405.84,Medicaid,Illinois Medicaid,,,,,2343.07,,,,
Q211 ACTH PL IA,82024,CPT,,,,,both,, ,334,200.4,Medicaid,Illinois Medicaid,,,,,334,,,,
ALBUMIN SERUM,82040,CPT,,,,,both,, ,35.08,21.04,Medicaid,Illinois Medicaid,,,,,35.08,,,,
ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
Q14966 ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
Q70858 ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
Q70858 ALBUMIN FLUID,82042,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
Q70858 ALBUMIN FLUID,82042,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
MICROALB QNT,82043,CPT,,,,,both,, ,77.74,46.64,Medicaid,Illinois Medicaid,,,,,77.74,,,,
MICROALB QNT,82043,CPT,,,,,both,,,660.98,660.98,Medicaid,Illinois Medicaid,,18.81,,,660.98,660.98,660.98,Fee Schedule,
MICROALB QNT,82043,CPT,,,,,both,, ,660.98,396.58,Medicaid,Illinois Medicaid,,,,,660.98,,,,
ETHANOL IA,82077,CPT,,,,,both,, ,177.88,106.72,Medicaid,Illinois Medicaid,,,,,177.88,,,,
Q227 ALDOLASE ENZEMA,82085,CPT,,,,,both,, ,648.35,389.01,Medicaid,Illinois Medicaid,,,,,648.35,,,,
Q227 ALDOLASE ENZEMA,82085,CPT,,,,,both,, ,648.35,389.01,Medicaid,Illinois Medicaid,,,,,648.35,,,,
ALDOSTERONE,82088,CPT,,,,,both,, ,2366.36,1419.81,Medicaid,Illinois Medicaid,,,,,2366.36,,,,
Q16845 ALDOSTERONE,82088,CPT,,,,,both,, ,587.45,352.47,Medicaid,Illinois Medicaid,,,,,587.45,,,,
Q17181 ALDOST LCMSMS,82088,CPT,,,,,both,, ,587.45,352.47,Medicaid,Illinois Medicaid,,,,,587.45,,,,
Q229 ALDOSTERONE U24,82088,CPT,,,,,both,, ,587.45,352.47,Medicaid,Illinois Medicaid,,,,,587.45,,,,
Q235 A1A QT NEPH,82103,CPT,,,,,both,, ,969.17,581.5,Medicaid,Illinois Medicaid,,,,,969.17,,,,
Q235 A1A QT NEPH,82103,CPT,,,,,both,, ,969.17,581.5,Medicaid,Illinois Medicaid,,,,,969.17,,,,
Q853 A1AT PHENO IEF,82104,CPT,,,,,both,, ,1051.68,631,Medicaid,Illinois Medicaid,,,,,1051.68,,,,
Q853 A1AT PHENO IEF,82104,CPT,,,,,both,, ,1051.68,631,Medicaid,Illinois Medicaid,,,,,1051.68,,,,
AFP SERUM,82105,CPT,,,,,both,, ,1142.06,685.23,Medicaid,Illinois Medicaid,,,,,1142.06,,,,
Q237 AFP TUMR MRK IA,82105,CPT,,,,,both,, ,1142.06,685.23,Medicaid,Illinois Medicaid,,,,,1142.06,,,,
Q5059 MAT SER AFP IA,82105,CPT,,,,,both,, ,1142.06,685.23,Medicaid,Illinois Medicaid,,,,,1142.06,,,,
AFP AMNIOTIC FLD,82106,CPT,,,,,both,, ,705.89,423.53,Medicaid,Illinois Medicaid,,,,,705.89,,,,
Q19529 AFP/L3 LIBASY,82107,CPT,,,,,both,, ,530.47,318.28,Medicaid,Illinois Medicaid,,,,,530.47,,,,
Q19529 AFP/L3 LIBASY,82107,CPT,,,,,both,, ,530.47,318.28,Medicaid,Illinois Medicaid,,,,,530.47,,,,
ALUMINUM,82108,CPT,,,,,both,, ,265.51,159.3,Medicaid,Illinois Medicaid,,,,,265.51,,,,
NBS AMINO ACD MUL QL,82128,CPT,,,,,both,, ,82.79,49.67,Medicaid,Illinois Medicaid,,,,,82.79,,,,
Q10947CYSTN U24 LCMS,82131,CPT,,,,,both,, ,175.98,105.58,Medicaid,Illinois Medicaid,,,,,175.98,,,,
AMINO ACID QUAN 6+,82139,CPT,,,,,both,, ,873.74,524.24,Medicaid,Illinois Medicaid,,,,,873.74,,,,
AMMONIA,82140,CPT,,,,,both,, ,154.09,92.45,Medicaid,Illinois Medicaid,,,,,154.09,,,,
AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
L910235 AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q442 AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
AMYLASE,82150,CPT,,,,,both,, ,68.48,41.08,Medicaid,Illinois Medicaid,,,,,68.48,,,,
Q845 AMYLASE,82150,CPT,,,,,both,, ,518.69,311.21,Medicaid,Illinois Medicaid,,,,,518.69,,,,
Q845 AMYLASE,82150,CPT,,,,,both,, ,518.69,311.21,Medicaid,Illinois Medicaid,,,,,518.69,,,,
"ANDROSTENEDIONE, LCMS",82157,CPT,,,,,both,, ,769.33,461.59,Medicaid,Illinois Medicaid,,,,,769.33,,,,
"ANDROSTENEDIONE, LCMS",82157,CPT,,,,,both,, ,769.33,461.59,Medicaid,Illinois Medicaid,,,,,769.33,,,,
ANGIOTENSIN CONV ENZ,82164,CPT,,,,,both,, ,143.71,86.22,Medicaid,Illinois Medicaid,,,,,143.71,,,,
ANGIOTENSIN CONV ENZ,82164,CPT,,,,,both,, ,1081.72,649.03,Medicaid,Illinois Medicaid,,,,,1081.72,,,,
Q34692 ACE CSF KINET,82164,CPT,,,,,both,, ,1081.72,649.03,Medicaid,Illinois Medicaid,,,,,1081.72,,,,
Q683 ACE SP,82164,CPT,,,,,both,, ,1081.72,649.03,Medicaid,Illinois Medicaid,,,,,1081.72,,,,
ANTI-MULLERIAN HORM,82166,CPT,,,,,both,, ,116,69.6,Medicaid,Illinois Medicaid,,,,,116,,,,
Q92145 APOLIPOPROTEI,82172,CPT,,,,,both,, ,467.04,280.22,Medicaid,Illinois Medicaid,,,,,467.04,,,,
Q92145 APOLIPOPROTEI,82172,CPT,,,,,both,, ,467.04,280.22,Medicaid,Illinois Medicaid,,,,,467.04,,,,
ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,,,,751.36,,,,
Q269 AS BL ICP/MS,82175,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,,,,751.36,,,,
Q36438 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,,,,751.36,,,,
Q7507 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,,,,751.36,,,,
Q7655 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,,,,751.36,,,,
Q929 VIT C LC/MS/MS,82180,CPT,,,,,both,, ,67.92,40.75,Medicaid,Illinois Medicaid,,,,,67.92,,,,
Q852 B2M SERUM NEPH,82232,CPT,,,,,both,, ,936.89,562.13,Medicaid,Illinois Medicaid,,,,,936.89,,,,
Q852 B2M SERUM NEPH,82232,CPT,,,,,both,, ,936.89,562.13,Medicaid,Illinois Medicaid,,,,,936.89,,,,
Q14801 BILE AC ENZ,82239,CPT,,,,,both,, ,274.77,164.86,Medicaid,Illinois Medicaid,,,,,274.77,,,,
BILIRUBIN TOTAL,82247,CPT,,,,,both,, ,53.05,31.83,Medicaid,Illinois Medicaid,,,,,53.05,,,,
BILIRUBIN TOTAL,82247,CPT,,,,,both,, ,282.92,169.75,Medicaid,Illinois Medicaid,,,,,282.92,,,,
BILIRUBIN DIRECT,82248,CPT,,,,,both,, ,53.05,31.83,Medicaid,Illinois Medicaid,,,,,53.05,,,,
BILIRUBIN DIRECT,82248,CPT,,,,,both,, ,282.92,169.75,Medicaid,Illinois Medicaid,,,,,282.92,,,,
NBS BIOTINIDASE,82261,CPT,,,,,both,, ,100.75,60.45,Medicaid,Illinois Medicaid,,,,,100.75,,,,
BLD OCCULT FECES 1-3,82270,CPT,,,,,both,, ,31.99,19.19,Medicaid,Illinois Medicaid,,,,,31.99,,,,
BLD OCCULT FECES 1-3,82270,CPT,,,,,both,, ,210.5,126.3,Medicaid,Illinois Medicaid,,,,,210.5,,,,
BLD OCCULT OTHER SRC,82271,CPT,,,,,both,, ,277.59,166.55,Medicaid,Illinois Medicaid,,,,,277.59,,,,
BLD OCC NON CA SCREE,82272,CPT,,,,,both,, ,210.5,126.3,Medicaid,Illinois Medicaid,,,,,210.5,,,,
BLD OCCULT FECES EIA,82274,CPT,,,,,both,, ,165.87,99.52,Medicaid,Illinois Medicaid,,,,,165.87,,,,
Q299CADMIUM BL ICPMS,82300,CPT,,,,,both,, ,536.08,321.64,Medicaid,Illinois Medicaid,,,,,536.08,,,,
Q299CADMIUM BL ICPMS,82300,CPT,,,,,both,, ,536.08,321.64,Medicaid,Illinois Medicaid,,,,,536.08,,,,
Q672 CADMIUM,82300,CPT,,,,,both,, ,125,75,Medicaid,Illinois Medicaid,,,,,125,,,,
L504115VITD 25-OH LC,82306,CPT,,,,,both,, ,651.73,391.03,Medicaid,Illinois Medicaid,,,,,651.73,,,,
VITAMIN D 25OH,82306,CPT,,,,,both,, ,279.26,167.55,Medicaid,Illinois Medicaid,,,,,279.26,,,,
VITAMIN D 25OH,82306,CPT,,,,,both,,,710.38,710.38,Medicaid,Illinois Medicaid,,15.81,,,710.38,710.38,710.38,Fee Schedule,
VITAMIN D 25OH,82306,CPT,,,,,both,, ,710.38,426.22,Medicaid,Illinois Medicaid,,,,,710.38,,,,
CALCITONIN,82308,CPT,,,,,both,, ,297.79,178.67,Medicaid,Illinois Medicaid,,,,,297.79,,,,
Q30742 CALCITONIN IA,82308,CPT,,,,,both,, ,796.27,477.76,Medicaid,Illinois Medicaid,,,,,796.27,,,,
CALCIUM TOTAL,82310,CPT,,,,,both,, ,54.45,32.67,Medicaid,Illinois Medicaid,,,,,54.45,,,,
L54601 CALCIUM TOTAL,82310,CPT,,,,,both,, ,315.48,189.28,Medicaid,Illinois Medicaid,,,,,315.48,,,,
L54601 CALCIUM TOTAL,82310,CPT,,,,,both,, ,315.48,189.28,Medicaid,Illinois Medicaid,,,,,315.48,,,,
CALCIUM IONIZED,82330,CPT,,,,,both,, ,35.36,21.21,Medicaid,Illinois Medicaid,,,,,35.36,,,,
CALCIUM IONIZED,82330,CPT,,,,,both,,,796.27,796.27,Medicaid,Illinois Medicaid,,26.72,,,796.27,796.27,796.27,Fee Schedule,
Q306 ICA ISE,82330,CPT,,,,,both,, ,796.27,477.76,Medicaid,Illinois Medicaid,,,,,796.27,,,,
Q306 ICA ISE,82330,CPT,,,,,both,, ,796.27,477.76,Medicaid,Illinois Medicaid,,,,,796.27,,,,
CALCIUM URI QN TIMED,82340,CPT,,,,,both,,,412.87,412.87,Medicaid,Illinois Medicaid,,5.4,,,412.87,412.87,412.87,Fee Schedule,
CALCIUM URI QN TIMED,82340,CPT,,,,,both,, ,412.87,247.72,Medicaid,Illinois Medicaid,,,,,412.87,,,,
"L910235 CALCIUM, URINE",82340,CPT,,,,,both,, ,412.87,247.72,Medicaid,Illinois Medicaid,,,,,412.87,,,,
Q442 CALCIUM URI QN,82340,CPT,,,,,both,, ,412.87,247.72,Medicaid,Illinois Medicaid,,,,,412.87,,,,
Q30260 STN ANAL NID,82365,CPT,,,,,both,, ,1187.82,712.69,Medicaid,Illinois Medicaid,,,,,1187.82,,,,
Q30260 STN ANAL NID,82365,CPT,,,,,both,, ,1187.82,712.69,Medicaid,Illinois Medicaid,,,,,1187.82,,,,
CARBON DIOXIDE CO2,82374,CPT,,,,,both,, ,47.99,28.79,Medicaid,Illinois Medicaid,,,,,47.99,,,,
CARBON DIOXIDE CO2,82374,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
CARBON MONOXIDE QUAN,82375,CPT,,,,,both,, ,203.49,122.09,Medicaid,Illinois Medicaid,,,,,203.49,,,,
CARBON MONOXIDE QUAN,82375,CPT,,,,,both,, ,203.49,122.09,Medicaid,Illinois Medicaid,,,,,203.49,,,,
CARCINOEMBRYONIC AG,82378,CPT,,,,,both,, ,121.53,72.91,Medicaid,Illinois Medicaid,,,,,121.53,,,,
L480095 CEA SM,82378,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,,,,526.26,,,,
L480095 CEA SM,82378,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,,,,526.26,,,,
CAROTENE,82380,CPT,,,,,both,, ,1171.81,703.08,Medicaid,Illinois Medicaid,,,,,1171.81,,,,
L1529 CAROTENE HPLC,82380,CPT,,,,,both,, ,75.2,45.12,Medicaid,Illinois Medicaid,,,,,75.2,,,,
Q318CATEC FR U24 HPL,82384,CPT,,,,,both,, ,263.27,157.96,Medicaid,Illinois Medicaid,,,,,263.27,,,,
Q318CATEC FR U24 HPL,82384,CPT,,,,,both,, ,263.27,157.96,Medicaid,Illinois Medicaid,,,,,263.27,,,,
Q318CATEC FR U24 HPL,82384,CPT,,,,,both,, ,263.27,157.96,Medicaid,Illinois Medicaid,,,,,263.27,,,,
Q318CATEC FR U24 HPL,82384,CPT,,,,,both,, ,263.27,157.96,Medicaid,Illinois Medicaid,,,,,263.27,,,,
Q326 CERULOP NEPHELO,82390,CPT,,,,,both,, ,859.7,515.82,Medicaid,Illinois Medicaid,,,,,859.7,,,,
Q326 CERULOP NEPHELO,82390,CPT,,,,,both,, ,859.7,515.82,Medicaid,Illinois Medicaid,,,,,859.7,,,,
CHEMILUM ASSAY NOS,82397,CPT,,,,,both,, ,444.59,266.75,Medicaid,Illinois Medicaid,,,,,444.59,,,,
L503870 CHEM ASY NOS,82397,CPT,,,,,both,, ,444.59,266.75,Medicaid,Illinois Medicaid,,,,,444.59,,,,
L504567 CHEM ASY NOS,82397,CPT,,,,,both,, ,407.88,244.72,Medicaid,Illinois Medicaid,,,,,407.88,,,,
Q34445 INHIBIN B CL,82397,CPT,,,,,both,, ,444.59,266.75,Medicaid,Illinois Medicaid,,,,,444.59,,,,
Q37227 ANTI-MULLERIAN HORMONE(AMH)FEMALE,82397,CPT,,,,,both,, ,396,237.6,Medicaid,Illinois Medicaid,,,,,396,,,,
Q37227 ANTI-MULLERIAN HORMONE(AMH)FEMALE,82397,CPT,,,,,both,, ,396,237.6,Medicaid,Illinois Medicaid,,,,,396,,,,
CHLORIDE BLOOD,82435,CPT,,,,,both,, ,38.73,23.23,Medicaid,Illinois Medicaid,,,,,38.73,,,,
CHLORIDE BLOOD,82435,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
"L910235 CHLORIDE, URINE",82436,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
"L910235 CHLORIDE, URINE",82436,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
CHLORIDES OTHER FLD,82438,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
CHOLESTEROL TOTAL,82465,CPT,,,,,both,, ,49.68,29.8,Medicaid,Illinois Medicaid,,,,,49.68,,,,
CHOLESTEROL TOTAL,82465,CPT,,,,,both,, ,315.48,189.28,Medicaid,Illinois Medicaid,,,,,315.48,,,,
CHOLINESTERASE SERUM,82480,CPT,,,,,both,, ,563.6,338.16,Medicaid,Illinois Medicaid,,,,,563.6,,,,
Q338 CHOLINEST SER,82480,CPT,,,,,both,, ,563.6,338.16,Medicaid,Illinois Medicaid,,,,,563.6,,,,
Q7961 CHOLINEST SER,82480,CPT,,,,,both,, ,563.6,338.16,Medicaid,Illinois Medicaid,,,,,563.6,,,,
Q338 CHOLINEST RBC,82482,CPT,,,,,both,, ,676.14,405.68,Medicaid,Illinois Medicaid,,,,,676.14,,,,
Q338 CHOLINEST RBC,82482,CPT,,,,,both,, ,676.14,405.68,Medicaid,Illinois Medicaid,,,,,676.14,,,,
CHROMIUM,82495,CPT,,,,,both,, ,242.5,145.5,Medicaid,Illinois Medicaid,,,,,242.5,,,,
CHROMIUM U,82495,CPT,,,,,both,, ,202.8,121.68,Medicaid,Illinois Medicaid,,,,,202.8,,,,
"L910235 CITRATE, URINE",82507,CPT,,,,,both,, ,242.5,145.5,Medicaid,Illinois Medicaid,,,,,242.5,,,,
Q11315 CIT AC U24 SP,82507,CPT,,,,,both,, ,242.5,145.5,Medicaid,Illinois Medicaid,,,,,242.5,,,,
Q442 CITRATE,82507,CPT,,,,,both,, ,242.5,145.5,Medicaid,Illinois Medicaid,,,,,242.5,,,,
COLLAGEN CROSSLINKS,82523,CPT,,,,,both,, ,280.11,168.06,Medicaid,Illinois Medicaid,,,,,280.11,,,,
L500089 C-TELO ELISA,82523,CPT,,,,,both,, ,529.2,317.52,Medicaid,Illinois Medicaid,,,,,529.2,,,,
"N-TELOPEP (NTX), UR",82523,CPT,,,,,both,, ,186.8,112.08,Medicaid,Illinois Medicaid,,,,,186.8,,,,
Q363 CU ICP/MS AS,82525,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
Q363 CU ICP/MS AS,82525,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
Q363 CU ICP/MS AS,82525,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
Q363 CU ICP/MS AS,82525,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
Q198978CORTIS LCMSMS,82530,CPT,,,,,both,, ,938.86,563.31,Medicaid,Illinois Medicaid,,,,,938.86,,,,
Q198978CORTIS LCMSMS,82530,CPT,,,,,both,, ,938.86,563.31,Medicaid,Illinois Medicaid,,,,,938.86,,,,
Q36423 CORT FR LCMSM,82530,CPT,,,,,both,, ,939.13,563.47,Medicaid,Illinois Medicaid,,,,,939.13,,,,
CORTISOL TOTAL,82533,CPT,,,,,both,, ,132.19,79.31,Medicaid,Illinois Medicaid,,,,,132.19,,,,
CORTISOL TOTAL,82533,CPT,,,,,both,,,1343.58,1343.58,Medicaid,Illinois Medicaid,,56.56,,,1343.58,1343.58,1343.58,Fee Schedule,
CORTISOL TOTAL,82533,CPT,,,,,both,, ,1343.58,806.14,Medicaid,Illinois Medicaid,,,,,1343.58,,,,
L500179SALIV CORT MS,82533,CPT,,,,,both,, ,335.78,201.46,Medicaid,Illinois Medicaid,,,,,335.78,,,,
L500440 CORTISOL TOT,82533,CPT,,,,,both,, ,163,97.8,Medicaid,Illinois Medicaid,,,,,163,,,,
CREATINE,82540,CPT,,,,,both,, ,38.73,23.23,Medicaid,Illinois Medicaid,,,,,38.73,,,,
L823430 OMEGACHECK (EPA+DPA+DHA),82542,CPT,,,,,both,, ,430,258,Medicaid,Illinois Medicaid,,,,,430,,,,
N-METHLHIST 24H UR,82542,CPT,,,,,both,, ,600,360,Medicaid,Illinois Medicaid,,,,,600,,,,
Q16602 IODINE U24,82542,CPT,,,,,both,, ,320.53,192.31,Medicaid,Illinois Medicaid,,,,,320.53,,,,
Q16602 IODINE U24,82542,CPT,,,,,both,, ,320.53,192.31,Medicaid,Illinois Medicaid,,,,,320.53,,,,
Q16602 IODINE U24,82542,CPT,,,,,both,, ,320.53,192.31,Medicaid,Illinois Medicaid,,,,,320.53,,,,
Q16602 IODINE U24,82542,CPT,,,,,both,, ,320.53,192.31,Medicaid,Illinois Medicaid,,,,,320.53,,,,
CPK TOTAL,82550,CPT,,,,,both,, ,64.27,38.56,Medicaid,Illinois Medicaid,,,,,64.27,,,,
CPK TOTAL,82550,CPT,,,,,both,,,282.92,282.92,Medicaid,Illinois Medicaid,,25.31,,,282.92,282.92,282.92,Fee Schedule,
Q6422 CPK TOTAL,82550,CPT,,,,,both,, ,282.92,169.75,Medicaid,Illinois Medicaid,,,,,282.92,,,,
Q6422 CPK TOTAL,82550,CPT,,,,,both,, ,282.92,169.75,Medicaid,Illinois Medicaid,,,,,282.92,,,,
Q6422 CPK ISOENZYMES,82552,CPT,,,,,both,, ,626.18,375.7,Medicaid,Illinois Medicaid,,,,,626.18,,,,
Q6422 CPK ISOENZYMES,82552,CPT,,,,,both,, ,626.18,375.7,Medicaid,Illinois Medicaid,,,,,626.18,,,,
CPK MB FRACTION,82553,CPT,,,,,both,, ,113.67,68.2,Medicaid,Illinois Medicaid,,,,,113.67,,,,
CPK MB FRACTION,82553,CPT,,,,,both,, ,620.56,372.33,Medicaid,Illinois Medicaid,,,,,620.56,,,,
CREATININE BLOOD,82565,CPT,,,,,both,, ,19.09,11.45,Medicaid,Illinois Medicaid,,,,,19.09,,,,
CREATININE BLOOD,82565,CPT,,,,,both,,,285.17,285.17,Medicaid,Illinois Medicaid,,19.94,,,285.17,285.17,285.17,Fee Schedule,
CREATININE BLOOD,82565,CPT,,,,,both,, ,285.17,171.1,Medicaid,Illinois Medicaid,,,,,285.17,,,,
CREATININE UR-OTHER,82570,CPT,,,,,both,, ,32.84,19.7,Medicaid,Illinois Medicaid,,,,,32.84,,,,
CREATININE UR-OTHER,82570,CPT,,,,,both,,,285.17,285.17,Medicaid,Illinois Medicaid,,20.22,,,285.17,285.17,285.17,Fee Schedule,
CREATININE UR-OTHER,82570,CPT,,,,,both,, ,285.17,171.1,Medicaid,Illinois Medicaid,,,,,285.17,,,,
Q1648 CREATININE UR-,82570,CPT,,,,,both,, ,285.17,171.1,Medicaid,Illinois Medicaid,,,,,285.17,,,,
Q17422 CREATIN PTF C,82570,CPT,,,,,both,, ,285.17,171.1,Medicaid,Illinois Medicaid,,,,,285.17,,,,
Q442 CREATININE UR-O,82570,CPT,,,,,both,, ,285.17,171.1,Medicaid,Illinois Medicaid,,,,,285.17,,,,
Q5244 CREAT UR,82570,CPT,,,,,both,, ,261.87,157.12,Medicaid,Illinois Medicaid,,,,,261.87,,,,
Q5244 CREAT UR,82570,CPT,,,,,both,, ,261.87,157.12,Medicaid,Illinois Medicaid,,,,,261.87,,,,
Q682 CREATININE UR-O,82570,CPT,,,,,both,, ,285.17,171.1,Medicaid,Illinois Medicaid,,,,,285.17,,,,
Q7507 CREATIN UR-OTH,82570,CPT,,,,,both,, ,285.17,171.1,Medicaid,Illinois Medicaid,,,,,285.17,,,,
Q8525 CREATININE UR-,82570,CPT,,,,,both,, ,285.17,171.1,Medicaid,Illinois Medicaid,,,,,285.17,,,,
CREATININE CLEARANCE,82575,CPT,,,,,both,,,555.45,555.45,Medicaid,Illinois Medicaid,,36.9,,,555.45,555.45,555.45,Fee Schedule,
CREATININE CLEARANCE,82575,CPT,,,,,both,, ,555.45,333.27,Medicaid,Illinois Medicaid,,,,,555.45,,,,
Q36562 C-GLOB SER VI,82595,CPT,,,,,both,, ,968.6,581.16,Medicaid,Illinois Medicaid,,,,,968.6,,,,
Q36562 C-GLOB SER VI,82595,CPT,,,,,both,, ,968.6,581.16,Medicaid,Illinois Medicaid,,,,,968.6,,,,
VITAMIN B-12,82607,CPT,,,,,both,, ,111.43,66.85,Medicaid,Illinois Medicaid,,,,,111.43,,,,
VITAMIN B-12,82607,CPT,,,,,both,,,641.06,641.06,Medicaid,Illinois Medicaid,,26.72,,,641.06,641.06,641.06,Fee Schedule,
VITAMIN B-12,82607,CPT,,,,,both,, ,641.06,384.63,Medicaid,Illinois Medicaid,,,,,641.06,,,,
VITAMIN B-12 BINDING,82608,CPT,,,,,both,, ,183.56,110.13,Medicaid,Illinois Medicaid,,,,,183.56,,,,
Q10570 CYSTAT C NEPH,82610,CPT,,,,,both,, ,121.25,72.75,Medicaid,Illinois Medicaid,,,,,121.25,,,,
"L910235 CREATININE, URINE",82615,CPT,,,,,both,, ,285.17,171.1,Medicaid,Illinois Medicaid,,,,,285.17,,,,
L910235 CYSTINE/HOMOCYSTINE UR,82615,CPT,,,,,both,, ,50,30,Medicaid,Illinois Medicaid,,,,,50,,,,
Q19894DHEA UN LCMSMS,82626,CPT,,,,,both,, ,263.55,158.13,Medicaid,Illinois Medicaid,,,,,263.55,,,,
Q19894DHEA UN LCMSMS,82626,CPT,,,,,both,, ,263.55,158.13,Medicaid,Illinois Medicaid,,,,,263.55,,,,
Q402 DHEA SULFATE IA,82627,CPT,,,,,both,, ,664.35,398.61,Medicaid,Illinois Medicaid,,,,,664.35,,,,
Q402 DHEA SULFATE IA,82627,CPT,,,,,both,, ,664.35,398.61,Medicaid,Illinois Medicaid,,,,,664.35,,,,
DEOXYCORTISOL,82634,CPT,,,,,both,, ,177.39,106.43,Medicaid,Illinois Medicaid,,,,,177.39,,,,
Q7961 DIBUCAINE NUMB,82638,CPT,,,,,both,, ,270.28,162.16,Medicaid,Illinois Medicaid,,,,,270.28,,,,
Q7961 DIBUCAINE NUMB,82638,CPT,,,,,both,, ,270.28,162.16,Medicaid,Illinois Medicaid,,,,,270.28,,,,
DIHYDROTESTOST (DHT),82642,CPT,,,,,both,, ,151.84,91.1,Medicaid,Illinois Medicaid,,,,,151.84,,,,
DIHYDROXY VITAMIN D,82652,CPT,,,,,both,, ,379.18,227.5,Medicaid,Illinois Medicaid,,,,,379.18,,,,
DIHYDROXY VITAMIN D,82652,CPT,,,,,both,, ,1307.38,784.42,Medicaid,Illinois Medicaid,,,,,1307.38,,,,
Q16558 VITD LCMSMS,82652,CPT,,,,,both,, ,554.89,332.93,Medicaid,Illinois Medicaid,,,,,554.89,,,,
L123234 PE FEC ELISA,82653,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,,,,414.83,,,,
L123234 PE FEC ELISA,82653,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,,,,414.83,,,,
Q14693 PE-1 IA,82656,CPT,,,,,both,, ,228.97,137.38,Medicaid,Illinois Medicaid,,,,,228.97,,,,
Q146938 PE-1 FEC,82656,CPT,,,,,both,, ,267.48,160.48,Medicaid,Illinois Medicaid,,,,,267.48,,,,
Q146938 PE-1 FEC,82656,CPT,,,,,both,, ,267.48,160.48,Medicaid,Illinois Medicaid,,,,,267.48,,,,
Q427 ERYTHROPOIET IA,82668,CPT,,,,,both,, ,1449.41,869.64,Medicaid,Illinois Medicaid,,,,,1449.41,,,,
Q427 ERYTHROPOIET IA,82668,CPT,,,,,both,, ,1449.41,869.64,Medicaid,Illinois Medicaid,,,,,1449.41,,,,
ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Medicaid,Illinois Medicaid,,,,,976.46,,,,
L500649 ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Medicaid,Illinois Medicaid,,,,,976.46,,,,
Q30289 ESTRADIOL US,82670,CPT,,,,,both,, ,976.46,585.87,Medicaid,Illinois Medicaid,,,,,976.46,,,,
Q36169 ESTRA FR DIR,82670,CPT,,,,,both,, ,895.84,537.5,Medicaid,Illinois Medicaid,,,,,895.84,,,,
Q36169 ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Medicaid,Illinois Medicaid,,,,,976.46,,,,
Q4021 ESTRADIOL IA,82670,CPT,,,,,both,, ,976.46,585.87,Medicaid,Illinois Medicaid,,,,,976.46,,,,
Q36742 EST FR LCMSMS,82671,CPT,,,,,both,, ,170.36,102.21,Medicaid,Illinois Medicaid,,,,,170.36,,,,
ESTROGEN TOTAL,82672,CPT,,,,,both,, ,1727.55,1036.53,Medicaid,Illinois Medicaid,,,,,1727.55,,,,
Q439 ESTROG TOT RIA,82672,CPT,,,,,both,, ,304.53,182.71,Medicaid,Illinois Medicaid,,,,,304.53,,,,
Q34883 ESTRIO LCMSMS,82677,CPT,,,,,both,, ,317.44,190.46,Medicaid,Illinois Medicaid,,,,,317.44,,,,
Q34883 ESTRIO LCMSMS,82677,CPT,,,,,both,, ,317.44,190.46,Medicaid,Illinois Medicaid,,,,,317.44,,,,
Q23244 ESTRON LCMSMS,82679,CPT,,,,,both,, ,116.47,69.88,Medicaid,Illinois Medicaid,,,,,116.47,,,,
Q23244 ESTRON LCMSMS,82679,CPT,,,,,both,, ,116.47,69.88,Medicaid,Illinois Medicaid,,,,,116.47,,,,
L500649 ESTRA FR DIR,82681,CPT,,,,,both,, ,251.84,151.1,Medicaid,Illinois Medicaid,,,,,251.84,,,,
ETHYLENE GLYCOL,82693,CPT,,,,,both,,,1577.11,1577.11,Medicaid,Illinois Medicaid,,35.07,,,1577.11,1577.11,1577.11,Fee Schedule,
ETHYLENE GLYCOL,82693,CPT,,,,,both,, ,1577.11,946.26,Medicaid,Illinois Medicaid,,,,,1577.11,,,,
Q801 ETHYL GLY CHRMT,82693,CPT,,,,,both,, ,935.21,561.12,Medicaid,Illinois Medicaid,,,,,935.21,,,,
Q3967 FEC FT QL MIC,82705,CPT,,,,,both,, ,600.92,360.55,Medicaid,Illinois Medicaid,,,,,600.92,,,,
Q3967 FEC FT QL MIC,82705,CPT,,,,,both,, ,600.92,360.55,Medicaid,Illinois Medicaid,,,,,600.92,,,,
FECAL FAT QUANT 72HR,82710,CPT,,,,,both,, ,122.2,73.32,Medicaid,Illinois Medicaid,,,,,122.2,,,,
Q455 FEC FT QT NMR,82710,CPT,,,,,both,, ,768.2,460.92,Medicaid,Illinois Medicaid,,,,,768.2,,,,
Q455 FEC FT QT NMR,82710,CPT,,,,,both,, ,768.2,460.92,Medicaid,Illinois Medicaid,,,,,768.2,,,,
Q90559 VLCFA,82726,CPT,,,,,both,, ,88.69,53.21,Medicaid,Illinois Medicaid,,,,,88.69,,,,
FERRITIN,82728,CPT,,,,,both,, ,100.75,60.45,Medicaid,Illinois Medicaid,,,,,100.75,,,,
FERRITIN,82728,CPT,,,,,both,,,864.19,864.19,Medicaid,Illinois Medicaid,,9.54,,,864.19,864.19,864.19,Fee Schedule,
FERRITIN,82728,CPT,,,,,both,, ,864.19,518.51,Medicaid,Illinois Medicaid,,,,,864.19,,,,
FETAL FIBRONECTIN,82731,CPT,,,,,both,, ,701.69,421.01,Medicaid,Illinois Medicaid,,,,,701.69,,,,
FOLIC ACID SERUM,82746,CPT,,,,,both,, ,108.61,65.16,Medicaid,Illinois Medicaid,,,,,108.61,,,,
FOLIC ACID SERUM,82746,CPT,,,,,both,,,735.65,735.65,Medicaid,Illinois Medicaid,,57.27,,,735.65,735.65,735.65,Fee Schedule,
FOLIC ACID SERUM,82746,CPT,,,,,both,, ,735.65,441.39,Medicaid,Illinois Medicaid,,,,,735.65,,,,
Q467 FOLATE RBC IA,82747,CPT,,,,,both,, ,627.3,376.38,Medicaid,Illinois Medicaid,,,,,627.3,,,,
Q467 FOLATE RBC IA,82747,CPT,,,,,both,, ,627.3,376.38,Medicaid,Illinois Medicaid,,,,,627.3,,,,
NBS GALACTOSE,82760,CPT,,,,,both,, ,66.8,40.08,Medicaid,Illinois Medicaid,,,,,66.8,,,,
NBS GALACTOSE TRANS,82776,CPT,,,,,both,, ,49.96,29.97,Medicaid,Illinois Medicaid,,,,,49.96,,,,
Q19955GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,,,,220.88,,,,
Q19955GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,,,,220.88,,,,
Q19955GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,,,,220.88,,,,
Q19955GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,,,,220.88,,,,
Q36336 GAMMGLB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,,,,220.88,,,,
Q36336 GAMMGLB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,,,,220.88,,,,
Q36336 GAMMGLB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,,,,220.88,,,,
Q36336 GAMMGLB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,,,,220.88,,,,
Q38940 GAMMAGLOB M G A D,82784,CPT,,,,,both,, ,196.75,118.05,Medicaid,Illinois Medicaid,,,,,196.75,,,,
Q539 IGA IMMUNOTURB,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,,,,220.88,,,,
Q539 IGA IMMUNOTURB,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,,,,220.88,,,,
Q539 IGA IMMUNOTURB,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,,,,220.88,,,,
Q539 IGA IMMUNOTURB,82784,CPT,,,,,both,, ,220.88,132.52,Medicaid,Illinois Medicaid,,,,,220.88,,,,
GAMMAGLOBULIN IGE,82785,CPT,,,,,both,, ,127.14,76.28,Medicaid,Illinois Medicaid,,,,,127.14,,,,
GAMMAGLOBULIN IGE,82785,CPT,,,,,both,, ,906.3,543.78,Medicaid,Illinois Medicaid,,,,,906.3,,,,
Q10659 GAMMAGLOB IGE,82785,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,,,,148.75,,,,
Q10659 GAMMAGLOB IGE,82785,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,,,,148.75,,,,
Q10659 GAMMAGLOB IGE,82785,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,,,,148.75,,,,
Q10659 GAMMAGLOB IGE,82785,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,,,,148.75,,,,
"IGG SUB 1,2,3 OR 4",82787,CPT,,,,,both,, ,389.01,233.4,Medicaid,Illinois Medicaid,,,,,389.01,,,,
Q143422 IGG SUB4 NEP,82787,CPT,,,,,both,, ,389.01,233.4,Medicaid,Illinois Medicaid,,,,,389.01,,,,
"Q7903IGG SUB 1,2,3,4",82787,CPT,,,,,both,, ,389.01,233.4,Medicaid,Illinois Medicaid,,,,,389.01,,,,
BLOOD PH,82800,CPT,,,,,both,, ,618.04,370.82,Medicaid,Illinois Medicaid,,,,,618.04,,,,
BLD GAS W-O2 SAT DIR,82805,CPT,,,,,both,, ,1760.39,1056.23,Medicaid,Illinois Medicaid,,,,,1760.39,,,,
BLD GAS POC/O2 SAT,82810,CPT,,,,,both,, ,100.63,60.37,Medicaid,Illinois Medicaid,,,,,100.63,,,,
BLD GAS POC/O2 SAT,82810,CPT,,,,,both,, ,100.63,60.37,Medicaid,Illinois Medicaid,,,,,100.63,,,,
Q478 GASTRIN IA,82941,CPT,,,,,both,, ,863.91,518.34,Medicaid,Illinois Medicaid,,,,,863.91,,,,
Q478 GASTRIN IA,82941,CPT,,,,,both,, ,863.91,518.34,Medicaid,Illinois Medicaid,,,,,863.91,,,,
Q519 GLUCAG EXT-RIA,82943,CPT,,,,,both,, ,82.51,49.5,Medicaid,Illinois Medicaid,,,,,82.51,,,,
GLUCOSE BODY FLUID,82945,CPT,,,,,both,, ,412.87,247.72,Medicaid,Illinois Medicaid,,,,,412.87,,,,
"GLUCOSE, QUANT",82947,CPT,,,,,both,, ,21.89,13.13,Medicaid,Illinois Medicaid,,,,,21.89,,,,
"GLUCOSE, QUANT",82947,CPT,,,,,both,,,240.26,240.26,Medicaid,Illinois Medicaid,,15.13,,,240.26,240.26,240.26,Fee Schedule,
"GLUCOSE, QUANT",82947,CPT,,,,,both,, ,240.26,144.15,Medicaid,Illinois Medicaid,,,,,240.26,,,,
"GLUCOSE, POST DOSE",82950,CPT,,,,,both,,,450.48,450.48,Medicaid,Illinois Medicaid,,4.66,,,450.48,450.48,450.48,Fee Schedule,
"GLUCOSE, POST DOSE",82950,CPT,,,,,both,, ,450.48,270.28,Medicaid,Illinois Medicaid,,,,,450.48,,,,
GTT 3 SPEC,82951,CPT,,,,,both,, ,758.95,455.37,Medicaid,Illinois Medicaid,,,,,758.95,,,,
GTT ADD SP,82952,CPT,,,,,both,, ,188.05,112.83,Medicaid,Illinois Medicaid,,,,,188.05,,,,
"G6PD, QUANT",82955,CPT,,,,,both,, ,1026.43,615.85,Medicaid,Illinois Medicaid,,,,,1026.43,,,,
"L121003 G6PD, QUANT",82955,CPT,,,,,both,, ,60,36,Medicaid,Illinois Medicaid,,,,,60,,,,
"GLU,HOME USE DIAGNOS",82962,CPT,,,,,both,, ,8.76,5.25,Medicaid,Illinois Medicaid,,,,,8.76,,,,
"GLU,HOME USE DIAGNOS",82962,CPT,,,,,both,, ,99.35,59.61,Medicaid,Illinois Medicaid,,,,,99.35,,,,
GGT,82977,CPT,,,,,both,, ,71.01,42.6,Medicaid,Illinois Medicaid,,,,,71.01,,,,
GGT,82977,CPT,,,,,both,, ,412.87,247.72,Medicaid,Illinois Medicaid,,,,,412.87,,,,
L7700 GSH TOT,82978,CPT,,,,,both,, ,61,36.6,Medicaid,Illinois Medicaid,,,,,61,,,,
GLYCATED PROTEIN,82985,CPT,,,,,both,, ,263.83,158.29,Medicaid,Illinois Medicaid,,,,,263.83,,,,
Q8340 FRUCTOSAMINE C,82985,CPT,,,,,both,, ,298.92,179.35,Medicaid,Illinois Medicaid,,,,,298.92,,,,
FOLLICLE STIM HORM,83001,CPT,,,,,both,, ,137.25,82.35,Medicaid,Illinois Medicaid,,,,,137.25,,,,
L4309 FSH ECLIA,83001,CPT,,,,,both,, ,812.55,487.53,Medicaid,Illinois Medicaid,,,,,812.55,,,,
L4309 FSH ECLIA,83001,CPT,,,,,both,, ,812.55,487.53,Medicaid,Illinois Medicaid,,,,,812.55,,,,
L4283 LH ECLIA,83002,CPT,,,,,both,, ,812.55,487.53,Medicaid,Illinois Medicaid,,,,,812.55,,,,
L4283 LH ECLIA,83002,CPT,,,,,both,, ,812.55,487.53,Medicaid,Illinois Medicaid,,,,,812.55,,,,
LEUTEINIZING HORMONE,83002,CPT,,,,,both,, ,136.97,82.18,Medicaid,Illinois Medicaid,,,,,136.97,,,,
GROWTH HORMONE,83003,CPT,,,,,both,, ,1201.85,721.11,Medicaid,Illinois Medicaid,,,,,1201.85,,,,
Q521 GH IA,83003,CPT,,,,,both,, ,74.86,44.91,Medicaid,Illinois Medicaid,,,,,74.86,,,,
Q91823 GRTH STM GN 2,83006,CPT,,,,,both,, ,189,113.4,Medicaid,Illinois Medicaid,,,,,189,,,,
L1628 HAPTOGLOB IMM,83010,CPT,,,,,both,, ,1109.23,665.53,Medicaid,Illinois Medicaid,,,,,1109.23,,,,
L1628 HAPTOGLOB IMM,83010,CPT,,,,,both,, ,1109.23,665.53,Medicaid,Illinois Medicaid,,,,,1109.23,,,,
Q14839H.PYLO UREA IR,83013,CPT,,,,,both,, ,623.38,374.02,Medicaid,Illinois Medicaid,,,,,623.38,,,,
"HEAVY METALS, QUANT",83018,CPT,,,,,both,, ,175.14,105.08,Medicaid,Illinois Medicaid,,,,,175.14,,,,
L121690 - HEMOGLOBIN ELECTRO,83020,CPT,,,,,both,, ,108.15,64.89,Medicaid,Illinois Medicaid,,,,,108.15,,,,
NBS HGB ELECTRO,83020,CPT,,,,,both,, ,76.9,46.14,Medicaid,Illinois Medicaid,,,,,76.9,,,,
Q35489 HEMOGLO CHROM,83021,CPT,,,,,both,, ,180.6,108.36,Medicaid,Illinois Medicaid,,,,,180.6,,,,
Q35489 HEMOGLO CHROM,83021,CPT,,,,,both,, ,180.6,108.36,Medicaid,Illinois Medicaid,,,,,180.6,,,,
"HEMOGLOB,FETGAL,QUAL",83033,CPT,,,,,both,, ,354.77,212.86,Medicaid,Illinois Medicaid,,,,,354.77,,,,
HEMOGLOBIN A1C,83036,CPT,,,,,both,, ,95.71,57.42,Medicaid,Illinois Medicaid,,,,,95.71,,,,
HEMOGLOBIN A1C,83036,CPT,,,,,both,,,454.97,454.97,Medicaid,Illinois Medicaid,,18.52,,,454.97,454.97,454.97,Fee Schedule,
Q496 HEMOGLO A1C ITA,83036,CPT,,,,,both,, ,454.97,272.98,Medicaid,Illinois Medicaid,,,,,454.97,,,,
Q496 HEMOGLO A1C ITA,83036,CPT,,,,,both,, ,454.97,272.98,Medicaid,Illinois Medicaid,,,,,454.97,,,,
"METHEMOGLOBIN,QUAN",83050,CPT,,,,,both,, ,122.09,73.25,Medicaid,Illinois Medicaid,,,,,122.09,,,,
"HEMOGLOBIN, PLASMA",83051,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
"HEMOSIDERIN, QUAL",83070,CPT,,,,,both,, ,373.57,224.14,Medicaid,Illinois Medicaid,,,,,373.57,,,,
HISTAMINE,83088,CPT,,,,,both,, ,385.09,231.05,Medicaid,Illinois Medicaid,,,,,385.09,,,,
Q36586 HISTAM PL RIA,83088,CPT,,,,,both,, ,385.09,231.05,Medicaid,Illinois Medicaid,,,,,385.09,,,,
Q4946 HISTAM U24 IA,83088,CPT,,,,,both,, ,385.09,231.05,Medicaid,Illinois Medicaid,,,,,385.09,,,,
Q31789 HCYSTEINE ENZ,83090,CPT,,,,,both,, ,227.91,136.74,Medicaid,Illinois Medicaid,,,,,227.91,,,,
Q31789 HCYSTEINE ENZ,83090,CPT,,,,,both,, ,227.91,136.74,Medicaid,Illinois Medicaid,,,,,227.91,,,,
CORTICOSTEROIDS,83491,CPT,,,,,both,, ,1217.28,730.36,Medicaid,Illinois Medicaid,,,,,1217.28,,,,
5-HIAA,83497,CPT,,,,,both,, ,976.46,585.87,Medicaid,Illinois Medicaid,,,,,976.46,,,,
Q1648 5-HIAA,83497,CPT,,,,,both,, ,976.46,585.87,Medicaid,Illinois Medicaid,,,,,976.46,,,,
Q523 5-HIAA U24 HPLC,83497,CPT,,,,,both,, ,976.46,585.87,Medicaid,Illinois Medicaid,,,,,976.46,,,,
HYDROXYPROGES 17-D,83498,CPT,,,,,both,, ,600.92,360.55,Medicaid,Illinois Medicaid,,,,,600.92,,,,
NBS HYDROXYPROG 17-D,83498,CPT,,,,,both,, ,162.23,97.33,Medicaid,Illinois Medicaid,,,,,162.23,,,,
Q17180 17-OHP LCMSMS,83498,CPT,,,,,both,, ,601.2,360.72,Medicaid,Illinois Medicaid,,,,,601.2,,,,
"IMMUNOASSAY, OTHER",83516,CPT,,,,,both,,,765.96,765.96,Medicaid,Illinois Medicaid,,16.56,,,765.96,765.96,765.96,Fee Schedule,
"IMMUNOASSAY, OTHER",83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,,,,765.96,,,,
L162045 IA OTH,83516,CPT,,,,,both,, ,702.72,421.63,Medicaid,Illinois Medicaid,,,,,702.72,,,,
L163061 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,,,,765.96,,,,
L165126 IA OTH,83516,CPT,,,,,both,, ,702.72,421.63,Medicaid,Illinois Medicaid,,,,,702.72,,,,
L341142 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,,,,765.96,,,,
L520057 ANTI-HMGCR,83516,CPT,,,,,both,, ,630,378,Medicaid,Illinois Medicaid,,,,,630,,,,
L520085 IA OTHER,83516,CPT,,,,,both,, ,702.72,421.63,Medicaid,Illinois Medicaid,,,,,702.72,,,,
L520139 ANTI-GP210AB,83516,CPT,,,,,both,, ,300,180,Medicaid,Illinois Medicaid,,,,,300,,,,
L520311 CARP AB,83516,CPT,,,,,both,, ,520,312,Medicaid,Illinois Medicaid,,,,,520,,,,
L6486PARIET AB ELISA,83516,CPT,,,,,both,, ,81.5,48.9,Medicaid,Illinois Medicaid,,,,,81.5,,,,
Q15114PARCL AB ELISA,83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,,,,765.96,,,,
Q18855 KU AUTOANTIBODIES,83516,CPT,,,,,both,, ,682.25,409.35,Medicaid,Illinois Medicaid,,,,,682.25,,,,
Q19899RNA P-III ELIS,83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,,,,765.96,,,,
Q34283 RIBO P AB IA,83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,,,,765.96,,,,
Q36336 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,,,,765.96,,,,
Q37056 HISTON AB EIA,83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,,,,765.96,,,,
Q39226  21OH AB,83516,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,,,,765.96,,,,
L10421 MSH,83519,CPT,,,,,both,, ,184,110.4,Medicaid,Illinois Medicaid,,,,,184,,,,
L504600 MUSCLE SPECIFIC KINASE,83519,CPT,,,,,both,, ,1200,720,Medicaid,Illinois Medicaid,,,,,1200,,,,
Q206 ACHR AB RIA,83519,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,,,,728.07,,,,
Q206 ACHR AB RIA,83519,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,,,,728.07,,,,
Q206 ACHR AB RIA,83519,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,,,,728.07,,,,
Q206 ACHR AB RIA,83519,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,,,,728.07,,,,
Q36590 IGFBP-1 RIA,83519,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,,,,728.07,,,,
Q36590 IGFBP-1 RIA,83519,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,,,,728.07,,,,
Q36590 IGFBP-1 RIA,83519,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,,,,728.07,,,,
Q36590 IGFBP-1 RIA,83519,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,,,,728.07,,,,
L117021 VEGF SER,83520,CPT,,,,,both,, ,175,105,Medicaid,Illinois Medicaid,,,,,175,,,,
L146712 LEPTIN S EIA,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,,,,414.83,,,,
L146712 LEPTIN S EIA,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,,,,414.83,,,,
L146795INHIBIN B EIA,83520,CPT,,,,,both,, ,380.59,228.35,Medicaid,Illinois Medicaid,,,,,380.59,,,,
L500016PROTHR FR 1+2,83520,CPT,,,,,both,, ,172.7,103.62,Medicaid,Illinois Medicaid,,,,,172.7,,,,
L500124 MMP9,83520,CPT,,,,,both,, ,170,102,Medicaid,Illinois Medicaid,,,,,170,,,,
NBS IMMUNOASSAY NOS,83520,CPT,,,,,both,, ,77.47,46.48,Medicaid,Illinois Medicaid,,,,,77.47,,,,
Q16034 BULLOUS PEMPHIGOID (BP180) ANTIBO,83520,CPT,,,,,both,, ,369.5,221.7,Medicaid,Illinois Medicaid,,,,,369.5,,,,
Q16034 BULLOUS PEMPHIGOID (BP180) ANTIBO,83520,CPT,,,,,both,, ,369.5,221.7,Medicaid,Illinois Medicaid,,,,,369.5,,,,
Q16034 BULLOUS PEMPHIGOID (BP180) ANTIBO,83520,CPT,,,,,both,, ,369.5,221.7,Medicaid,Illinois Medicaid,,,,,369.5,,,,
Q16034 BULLOUS PEMPHIGOID (BP180) ANTIBO,83520,CPT,,,,,both,, ,369.5,221.7,Medicaid,Illinois Medicaid,,,,,369.5,,,,
Q16039 MBL ELISA,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,,,,414.83,,,,
Q16039 MBL ELISA,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,,,,414.83,,,,
Q257 GBM AB IGG IA,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,,,,414.83,,,,
Q257 GBM AB IGG IA,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,,,,414.83,,,,
Q8658 ALPH SUB ECLIA,83520,CPT,,,,,both,, ,444.59,266.75,Medicaid,Illinois Medicaid,,,,,444.59,,,,
Q8658 ALPH SUB ECLIA,83520,CPT,,,,,both,, ,444.59,266.75,Medicaid,Illinois Medicaid,,,,,444.59,,,,
Q90123 IA NOS,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,,,,414.83,,,,
Q90123 IA NOS,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,,,,414.83,,,,
Q91455 14-3-3 ETA PR,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,,,,414.83,,,,
Q91455 14-3-3 ETA PR,83520,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,,,,414.83,,,,
L121137 LTCHN KAPLAM,83521,CPT,,,,,both,, ,103.62,62.17,Medicaid,Illinois Medicaid,,,,,103.62,,,,
L121137 LTCHN KAPLAM,83521,CPT,,,,,both,, ,103.62,62.17,Medicaid,Illinois Medicaid,,,,,103.62,,,,
Q11233 LTCHN KAP LAM,83521,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
Q11233 LTCHN KAP LAM,83521,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
"INSULIN, TOTAL",83525,CPT,,,,,both,, ,53.89,32.33,Medicaid,Illinois Medicaid,,,,,53.89,,,,
"INSULIN, TOTAL",83525,CPT,,,,,both,, ,600.92,360.55,Medicaid,Illinois Medicaid,,,,,600.92,,,,
Q561 INSULIN IA,83525,CPT,,,,,both,, ,632.36,379.41,Medicaid,Illinois Medicaid,,,,,632.36,,,,
"INSULIN, FREE",83527,CPT,,,,,both,, ,193.94,116.36,Medicaid,Illinois Medicaid,,,,,193.94,,,,
L501561 INSULIN FREE,83527,CPT,,,,,both,, ,193.94,116.36,Medicaid,Illinois Medicaid,,,,,193.94,,,,
Q36700 INSULIN FR IA,83527,CPT,,,,,both,, ,193.94,116.36,Medicaid,Illinois Medicaid,,,,,193.94,,,,
IRON,83540,CPT,,,,,both,, ,63.99,38.39,Medicaid,Illinois Medicaid,,,,,63.99,,,,
IRON,83540,CPT,,,,,both,,,345.79,345.79,Medicaid,Illinois Medicaid,,12.76,,,345.79,345.79,345.79,Fee Schedule,
IRON,83540,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
IRON BINDING CAPACIT,83550,CPT,,,,,both,, ,86.16,51.69,Medicaid,Illinois Medicaid,,,,,86.16,,,,
IRON BINDING CAPACIT,83550,CPT,,,,,both,,,526.26,526.26,Medicaid,Illinois Medicaid,,33.94,,,526.26,526.26,526.26,Fee Schedule,
IRON BINDING CAPACIT,83550,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,,,,526.26,,,,
"17-KETOSTEROIDS, TOT",83586,CPT,,,,,both,, ,164.19,98.51,Medicaid,Illinois Medicaid,,,,,164.19,,,,
LACTIC ACID,83605,CPT,,,,,both,, ,105.25,63.15,Medicaid,Illinois Medicaid,,,,,105.25,,,,
LACTIC ACID,83605,CPT,,,,,both,,,691.29,691.29,Medicaid,Illinois Medicaid,,41.57,,,691.29,691.29,691.29,Fee Schedule,
LACTIC ACID,83605,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
LACTATE DEHYDROGENASE LDH FLUID,83615,CPT,,,,,both,, ,600.92,360.55,Medicaid,Illinois Medicaid,,,,,600.92,,,,
LACTATE DEHYDROGENASE LDH FLUID,83615,CPT,,,,,both,, ,600.92,360.55,Medicaid,Illinois Medicaid,,,,,600.92,,,,
LACTATE DEHYDROLDH,83615,CPT,,,,,both,, ,59.5,35.7,Medicaid,Illinois Medicaid,,,,,59.5,,,,
LDH ISOENZYMES,83625,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q10156 LACTOFER IA,83630,CPT,,,,,both,, ,267.48,160.48,Medicaid,Illinois Medicaid,,,,,267.48,,,,
LEAD,83655,CPT,,,,,both,, ,56.97,34.18,Medicaid,Illinois Medicaid,,,,,56.97,,,,
LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
"Q3058 LEAD, BLOOD (OSHA)",83655,CPT,,,,,both,, ,615.75,369.45,Medicaid,Illinois Medicaid,,,,,615.75,,,,
"Q3058 LEAD, BLOOD (OSHA)",83655,CPT,,,,,both,, ,615.75,369.45,Medicaid,Illinois Medicaid,,,,,615.75,,,,
Q36438 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q36440LEAD U24 ICPMS,83655,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q599 PB BL ICP/MS,83655,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q601 PB U ICP/MS,83655,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q7507 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q7655 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
"FETAL LUNG,L-S RATIO",83661,CPT,,,,,both,, ,175.14,105.08,Medicaid,Illinois Medicaid,,,,,175.14,,,,
"FETAL LUNG, FPIA",83663,CPT,,,,,both,, ,863.91,518.34,Medicaid,Illinois Medicaid,,,,,863.91,,,,
LIPASE,83690,CPT,,,,,both,, ,67.92,40.75,Medicaid,Illinois Medicaid,,,,,67.92,,,,
LIPASE,83690,CPT,,,,,both,,,420.72,420.72,Medicaid,Illinois Medicaid,,25.45,,,420.72,420.72,420.72,Fee Schedule,
LIPASE,83690,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
Q34604 LIPOPRT A ITA,83695,CPT,,,,,both,, ,467.04,280.22,Medicaid,Illinois Medicaid,,,,,467.04,,,,
Q92145 LIPOPROTEIN,83695,CPT,,,,,both,, ,112.27,67.36,Medicaid,Illinois Medicaid,,,,,112.27,,,,
Q92145 LIPOPROTEIN,83695,CPT,,,,,both,, ,112.27,67.36,Medicaid,Illinois Medicaid,,,,,112.27,,,,
Q94220 LP-PLA2,83698,CPT,,,,,both,, ,216.39,129.83,Medicaid,Illinois Medicaid,,,,,216.39,,,,
Q92145 LIPOPROT BLD,83704,CPT,,,,,both,, ,374.69,224.81,Medicaid,Illinois Medicaid,,,,,374.69,,,,
Q92145 LIPOPROT BLD,83704,CPT,,,,,both,, ,374.69,224.81,Medicaid,Illinois Medicaid,,,,,374.69,,,,
"LIPOPROTEIN, HDL",83718,CPT,,,,,both,, ,60.63,36.37,Medicaid,Illinois Medicaid,,,,,60.63,,,,
"LIPOPROTEIN, HDL",83718,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,,,,480.79,,,,
"LIPOPROTEIN, LDL",83721,CPT,,,,,both,, ,570.89,342.53,Medicaid,Illinois Medicaid,,,,,570.89,,,,
L80283 MG RBC AAS-IC,83735,CPT,,,,,both,, ,67,40.2,Medicaid,Illinois Medicaid,,,,,67,,,,
L80283 MG RBC AAS-IC,83735,CPT,,,,,both,, ,67,40.2,Medicaid,Illinois Medicaid,,,,,67,,,,
MAGNESIUM,83735,CPT,,,,,both,, ,49.68,29.8,Medicaid,Illinois Medicaid,,,,,49.68,,,,
MAGNESIUM,83735,CPT,,,,,both,,,344.1,344.1,Medicaid,Illinois Medicaid,,26.16,,,344.1,344.1,344.1,Fee Schedule,
Q442 MAGNESIUM,83735,CPT,,,,,both,, ,344.1,206.46,Medicaid,Illinois Medicaid,,,,,344.1,,,,
Q442 MAGNESIUM,83735,CPT,,,,,both,, ,344.1,206.46,Medicaid,Illinois Medicaid,,,,,344.1,,,,
MANGANESE WHOLE BLOOD,83785,CPT,,,,,both,, ,133,79.8,Medicaid,Illinois Medicaid,,,,,133,,,,
L70034 I S/P ICP/MS,83789,CPT,,,,,both,, ,315,189,Medicaid,Illinois Medicaid,,,,,315,,,,
L70222 I U ICP/MS,83789,CPT,,,,,both,, ,390.49,234.29,Medicaid,Illinois Medicaid,,,,,390.49,,,,
Q91745THIOPUR LCMSMS,83789,CPT,,,,,both,, ,402.2,241.32,Medicaid,Illinois Medicaid,,,,,402.2,,,,
Q91745THIOPUR LCMSMS,83789,CPT,,,,,both,, ,402.2,241.32,Medicaid,Illinois Medicaid,,,,,402.2,,,,
MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,,,,751.36,,,,
Q36438 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,,,,751.36,,,,
Q636 HG BL ICP/MS,83825,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,,,,751.36,,,,
Q7507 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,,,,751.36,,,,
Q7655 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,,,,751.36,,,,
METANEPHRINES,83835,CPT,,,,,both,, ,2599.05,1559.43,Medicaid,Illinois Medicaid,,,,,2599.05,,,,
Q14961 METANEPHRINES,83835,CPT,,,,,both,, ,488.65,293.19,Medicaid,Illinois Medicaid,,,,,488.65,,,,
Q14962MNFR U24 LCMSM,83835,CPT,,,,,both,, ,488.65,293.19,Medicaid,Illinois Medicaid,,,,,488.65,,,,
Q19548 MN FRC LCMSMS,83835,CPT,,,,,both,, ,488.65,293.19,Medicaid,Illinois Medicaid,,,,,488.65,,,,
Q70858 MYELIN BASIC,83873,CPT,,,,,both,, ,509.14,305.48,Medicaid,Illinois Medicaid,,,,,509.14,,,,
Q70858 MYELIN BASIC,83873,CPT,,,,,both,, ,509.14,305.48,Medicaid,Illinois Medicaid,,,,,509.14,,,,
L3079MYOGL QT U ICMA,83874,CPT,,,,,both,, ,627.3,376.38,Medicaid,Illinois Medicaid,,,,,627.3,,,,
L3079MYOGL QT U ICMA,83874,CPT,,,,,both,, ,627.3,376.38,Medicaid,Illinois Medicaid,,,,,627.3,,,,
L143000 NT-PROBNP,83880,CPT,,,,,both,, ,450,270,Medicaid,Illinois Medicaid,,,,,450,,,,
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,, ,279.55,167.73,Medicaid,Illinois Medicaid,,,,,279.55,,,,
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,,,1229.07,1229.07,Medicaid,Illinois Medicaid,,86.92,,,1229.07,1229.07,1229.07,Fee Schedule,
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,, ,1229.07,737.44,Medicaid,Illinois Medicaid,,,,,1229.07,,,,
Q37863 NEPHELOM NOS,83883,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
Q37863 NEPHELOM NOS,83883,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
Q38940 NEPHELOMETRY NOS,83883,CPT,,,,,both,, ,374.75,224.85,Medicaid,Illinois Medicaid,,,,,374.75,,,,
NICKEL,83885,CPT,,,,,both,, ,934.09,560.45,Medicaid,Illinois Medicaid,,,,,934.09,,,,
Q14624 5'NUCLEO C-KN,83915,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,,,,871.22,,,,
Q14624 5'NUCLEO C-KN,83915,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,,,,871.22,,,,
Q70858 OLIGOCLONAL B,83916,CPT,,,,,both,, ,530.75,318.45,Medicaid,Illinois Medicaid,,,,,530.75,,,,
Q70858 OLIGOCLONAL B,83916,CPT,,,,,both,, ,530.75,318.45,Medicaid,Illinois Medicaid,,,,,530.75,,,,
Q34879 MMA MS/MS,83921,CPT,,,,,both,, ,396.02,237.61,Medicaid,Illinois Medicaid,,,,,396.02,,,,
Q34879 MMA MS/MS,83921,CPT,,,,,both,, ,396.02,237.61,Medicaid,Illinois Medicaid,,,,,396.02,,,,
L2071 OSMALALITY FPD,83930,CPT,,,,,both,, ,40.89,24.53,Medicaid,Illinois Medicaid,,,,,40.89,,,,
"OSMOLALITY, BLOOD",83930,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
L3442 OSMOLALI U FPD,83935,CPT,,,,,both,, ,50.9,30.54,Medicaid,Illinois Medicaid,,,,,50.9,,,,
"OSMOLALITY,URINE",83935,CPT,,,,,both,, ,67.07,40.24,Medicaid,Illinois Medicaid,,,,,67.07,,,,
"OSMOLALITY,URINE",83935,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
L10249 OSTREOC ELISA,83937,CPT,,,,,both,, ,203.6,122.16,Medicaid,Illinois Medicaid,,,,,203.6,,,,
OSTEOCALCIN,83937,CPT,,,,,both,, ,447.39,268.43,Medicaid,Illinois Medicaid,,,,,447.39,,,,
Q682 OXALATE,83945,CPT,,,,,both,, ,660.98,396.58,Medicaid,Illinois Medicaid,,,,,660.98,,,,
Q682 OXALATE,83945,CPT,,,,,both,, ,660.98,396.58,Medicaid,Illinois Medicaid,,,,,660.98,,,,
Q682 OXALATE,83945,CPT,,,,,both,, ,660.98,396.58,Medicaid,Illinois Medicaid,,,,,660.98,,,,
Q682 OXALATE,83945,CPT,,,,,both,, ,660.98,396.58,Medicaid,Illinois Medicaid,,,,,660.98,,,,
L15610 PTH INT ECLIA,83970,CPT,,,,,both,, ,420.49,252.29,Medicaid,Illinois Medicaid,,,,,420.49,,,,
PARATHORMONE PTH,83970,CPT,,,,,both,, ,160.55,96.33,Medicaid,Illinois Medicaid,,,,,160.55,,,,
PARATHORMONE PTH,83970,CPT,,,,,both,, ,1420.49,852.29,Medicaid,Illinois Medicaid,,,,,1420.49,,,,
"L910235 PH FLUID, NOS",83986,CPT,,,,,both,, ,240.26,144.15,Medicaid,Illinois Medicaid,,,,,240.26,,,,
"PH FLUID,NOS",83986,CPT,,,,,both,, ,240.26,144.15,Medicaid,Illinois Medicaid,,,,,240.26,,,,
"Q442 PH FLUID,NOS",83986,CPT,,,,,both,, ,240.26,144.15,Medicaid,Illinois Medicaid,,,,,240.26,,,,
L790600 PCP MS,83992,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
Q16796 CALPRO STL IA,83993,CPT,,,,,both,, ,395.75,237.45,Medicaid,Illinois Medicaid,,,,,395.75,,,,
Q16796 CALPRO STL IA,83993,CPT,,,,,both,, ,395.75,237.45,Medicaid,Illinois Medicaid,,,,,395.75,,,,
Q37356 PNENYLAL HPLC,84030,CPT,,,,,both,, ,32.84,19.7,Medicaid,Illinois Medicaid,,,,,32.84,,,,
Q37356 PNENYLAL HPLC,84030,CPT,,,,,both,, ,32.84,19.7,Medicaid,Illinois Medicaid,,,,,32.84,,,,
"PHOSPHATASE, PROSTAT",84066,CPT,,,,,both,, ,540.85,324.51,Medicaid,Illinois Medicaid,,,,,540.85,,,,
"PHOSPHATASE,ALKALINE",84075,CPT,,,,,both,, ,51.08,30.64,Medicaid,Illinois Medicaid,,,,,51.08,,,,
Q6432 PHOSPHATAS ALK,84075,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
Q6432 PHOSPHATAS ALK,84075,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
Q6432 PHOSPH ALK ISO,84080,CPT,,,,,both,, ,637.41,382.44,Medicaid,Illinois Medicaid,,,,,637.41,,,,
Q6432 PHOSPH ALK ISO,84080,CPT,,,,,both,, ,637.41,382.44,Medicaid,Illinois Medicaid,,,,,637.41,,,,
PHOSPHATIDYLGLYCEROL,84081,CPT,,,,,both,, ,389.01,233.4,Medicaid,Illinois Medicaid,,,,,389.01,,,,
"PHOSPHORUS, BLOOD",84100,CPT,,,,,both,, ,46.87,28.12,Medicaid,Illinois Medicaid,,,,,46.87,,,,
"PHOSPHORUS, BLOOD",84100,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
"L910235 PHOSPHORUS, URINE",84105,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
"PHOSPHORUS, URINE",84105,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
"Q442 PHOSPHORUS, URI",84105,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
"PORPHOBILINOGEN,QUAN",84110,CPT,,,,,both,, ,630.96,378.57,Medicaid,Illinois Medicaid,,,,,630.96,,,,
PAMG-1 QUALITATIVE,84112,CPT,,,,,both,, ,488.09,292.85,Medicaid,Illinois Medicaid,,,,,488.09,,,,
L3194 PORPH QT U24,84120,CPT,,,,,both,, ,811.43,486.85,Medicaid,Illinois Medicaid,,,,,811.43,,,,
"PORPHYRINS,UR,QUAN",84120,CPT,,,,,both,, ,811.42,486.85,Medicaid,Illinois Medicaid,,,,,811.42,,,,
POTASSIUM SER PL WB,84132,CPT,,,,,both,, ,47.15,28.29,Medicaid,Illinois Medicaid,,,,,47.15,,,,
POTASSIUM SER PL WB,84132,CPT,,,,,both,,,240.26,240.26,Medicaid,Illinois Medicaid,,17.96,,,240.26,240.26,240.26,Fee Schedule,
POTASSIUM SER PL WB,84132,CPT,,,,,both,, ,240.26,144.15,Medicaid,Illinois Medicaid,,,,,240.26,,,,
"L910235 POTASSIUM, URINE",84133,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
"POTASSIUM, URINE",84133,CPT,,,,,both,,,345.79,345.79,Medicaid,Illinois Medicaid,,16.83,,,345.79,345.79,345.79,Fee Schedule,
"POTASSIUM, URINE",84133,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
"Q442 POTASSIUM, URIN",84133,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
PREALBUMIN,84134,CPT,,,,,both,, ,105.25,63.15,Medicaid,Illinois Medicaid,,,,,105.25,,,,
PREALBUMIN,84134,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
PREGNENOLONE MS,84140,CPT,,,,,both,, ,164.75,98.85,Medicaid,Illinois Medicaid,,,,,164.75,,,,
PREGNENOLONE MS,84140,CPT,,,,,both,, ,164.75,98.85,Medicaid,Illinois Medicaid,,,,,164.75,,,,
"PREGNENOLONE,17-OH",84143,CPT,,,,,both,, ,387.89,232.73,Medicaid,Illinois Medicaid,,,,,387.89,,,,
L4317 PROGESTE ECLIA,84144,CPT,,,,,both,, ,1217.28,730.36,Medicaid,Illinois Medicaid,,,,,1217.28,,,,
L4317 PROGESTE ECLIA,84144,CPT,,,,,both,, ,1217.28,730.36,Medicaid,Illinois Medicaid,,,,,1217.28,,,,
PROGESTERONE,84144,CPT,,,,,both,, ,62.58,37.54,Medicaid,Illinois Medicaid,,,,,62.58,,,,
Q16265 PROCALCIT IFA,84145,CPT,,,,,both,, ,232.11,139.26,Medicaid,Illinois Medicaid,,,,,232.11,,,,
Q16265 PROCALCIT IFA,84145,CPT,,,,,both,, ,232.11,139.26,Medicaid,Illinois Medicaid,,,,,232.11,,,,
L4465 PROLACTI ECLIA,84146,CPT,,,,,both,, ,628.3,376.98,Medicaid,Illinois Medicaid,,,,,628.3,,,,
PROLACTIN,84146,CPT,,,,,both,, ,143.14,85.88,Medicaid,Illinois Medicaid,,,,,143.14,,,,
PROLACTIN,84146,CPT,,,,,both,, ,1077.5,646.5,Medicaid,Illinois Medicaid,,,,,1077.5,,,,
Q16122 PROLACTIN,84146,CPT,,,,,both,, ,959.75,575.85,Medicaid,Illinois Medicaid,,,,,959.75,,,,
Q16122 PROLACTIN,84146,CPT,,,,,both,, ,959.75,575.85,Medicaid,Illinois Medicaid,,,,,959.75,,,,
Q93958 23BPG UR,84150,CPT,,,,,both,, ,390.13,234.07,Medicaid,Illinois Medicaid,,,,,390.13,,,,
PSA (prostate specific antigen),84153,CPT,,,,,both,,,1036.25,1036.25,Medicaid,Illinois Medicaid,,35.49,,,1036.25,1036.25,1036.25,Fee Schedule,
"PSA, TOTAL",84153,CPT,,,,,both,, ,135.85,81.51,Medicaid,Illinois Medicaid,,,,,135.85,,,,
"Q31348 PSA, TOTAL",84153,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
"Q31348 PSA, TOTAL",84153,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
PSA (prostate specific antigen),84154,CPT,,,,,both,,,1036.25,1036.25,Medicaid,Illinois Medicaid,,38.46,,,1036.25,1036.25,1036.25,Fee Schedule,
"PSA, FREE",84154,CPT,,,,,both,, ,135.85,81.51,Medicaid,Illinois Medicaid,,,,,135.85,,,,
"Q31348 PSA, FREE",84154,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
"Q31348 PSA, FREE",84154,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,35.93,21.55,Medicaid,Illinois Medicaid,,,,,35.93,,,,
Q38940 PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,374.75,224.85,Medicaid,Illinois Medicaid,,,,,374.75,,,,
Q747 PROTEIN TOT SER,84155,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
Q747 PROTEIN TOT SER,84155,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
Q747 PROTEIN TOT SER,84155,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
Q747 PROTEIN TOT SER,84155,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
PROT TOTL RANDOM URI,84156,CPT,,,,,both,,,420.72,420.72,Medicaid,Illinois Medicaid,,12.73,,,420.72,420.72,420.72,Fee Schedule,
Q8525 PROT TOTL RAND,84156,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
Q8525 PROT TOTL RAND,84156,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
PROTEIN TOT OTHR SRC,84157,CPT,,,,,both,, ,35.93,21.55,Medicaid,Illinois Medicaid,,,,,35.93,,,,
Q749 PROT TOT OTH SR,84157,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
PROTEINELECTR FR-QNT,84165,CPT,,,,,both,, ,105.81,63.48,Medicaid,Illinois Medicaid,,,,,105.81,,,,
Q38940 PROTEINELECTR FR QNT,84165,CPT,,,,,both,, ,542.75,325.65,Medicaid,Illinois Medicaid,,,,,542.75,,,,
Q747 PROTEINELECTR F,84165,CPT,,,,,both,, ,609.34,365.6,Medicaid,Illinois Medicaid,,,,,609.34,,,,
Q747 PROTEINELECTR F,84165,CPT,,,,,both,, ,609.34,365.6,Medicaid,Illinois Medicaid,,,,,609.34,,,,
Q747 PROTEINELECTR F,84165,CPT,,,,,both,, ,609.34,365.6,Medicaid,Illinois Medicaid,,,,,609.34,,,,
Q747 PROTEINELECTR F,84165,CPT,,,,,both,, ,609.34,365.6,Medicaid,Illinois Medicaid,,,,,609.34,,,,
PROT E-PHOR-URIN-CSF,84166,CPT,,,,,both,, ,429.71,257.82,Medicaid,Illinois Medicaid,,,,,429.71,,,,
Q749 PROT E-PHOR-URI,84166,CPT,,,,,both,, ,429.71,257.82,Medicaid,Illinois Medicaid,,,,,429.71,,,,
Q8525 PROT E-PHOR-UR,84166,CPT,,,,,both,, ,429.71,257.82,Medicaid,Illinois Medicaid,,,,,429.71,,,,
Q94777 WEST BLOT PRB,84182,CPT,,,,,both,, ,136.4,81.84,Medicaid,Illinois Medicaid,,,,,136.4,,,,
Q94777 WEST BLOT PRB,84182,CPT,,,,,both,, ,136.4,81.84,Medicaid,Illinois Medicaid,,,,,136.4,,,,
Q22996 PROTOPORPH RBC QUAN,84202,CPT,,,,,both,, ,177.5,106.5,Medicaid,Illinois Medicaid,,,,,177.5,,,,
Q948 ZPP HEMATOFLUOR,84202,CPT,,,,,both,, ,199.27,119.56,Medicaid,Illinois Medicaid,,,,,199.27,,,,
Q948 ZPP HEMATOFLUOR,84202,CPT,,,,,both,, ,199.27,119.56,Medicaid,Illinois Medicaid,,,,,199.27,,,,
PROINSULIN,84206,CPT,,,,,both,, ,266.91,160.14,Medicaid,Illinois Medicaid,,,,,266.91,,,,
Q760 PROINSULIN IA,84206,CPT,,,,,both,, ,337.09,202.25,Medicaid,Illinois Medicaid,,,,,337.09,,,,
Q926 B6 PL LC/MS/MS,84207,CPT,,,,,both,, ,738.17,442.9,Medicaid,Illinois Medicaid,,,,,738.17,,,,
Q926 B6 PL LC/MS/MS,84207,CPT,,,,,both,, ,738.17,442.9,Medicaid,Illinois Medicaid,,,,,738.17,,,,
PYRUVATE,84210,CPT,,,,,both,, ,1066.84,640.1,Medicaid,Illinois Medicaid,,,,,1066.84,,,,
Q91031 STFR NEPHELOM,84238,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
Q91031 STFR NEPHELOM,84238,CPT,,,,,both,, ,326.71,196.02,Medicaid,Illinois Medicaid,,,,,326.71,,,,
Q16845 RENIN,84244,CPT,,,,,both,, ,475.46,285.27,Medicaid,Illinois Medicaid,,,,,475.46,,,,
Q16845 RENIN,84244,CPT,,,,,both,, ,475.46,285.27,Medicaid,Illinois Medicaid,,,,,475.46,,,,
RENIN,84244,CPT,,,,,both,, ,1487.01,892.2,Medicaid,Illinois Medicaid,,,,,1487.01,,,,
VITAMIN B-2,84252,CPT,,,,,both,, ,180.75,108.45,Medicaid,Illinois Medicaid,,,,,180.75,,,,
Q5507 SELENIUM AS,84255,CPT,,,,,both,, ,409.5,245.7,Medicaid,Illinois Medicaid,,,,,409.5,,,,
Q5507 SELENIUM AS,84255,CPT,,,,,both,, ,409.5,245.7,Medicaid,Illinois Medicaid,,,,,409.5,,,,
SEROTONIN,84260,CPT,,,,,both,, ,94.58,56.74,Medicaid,Illinois Medicaid,,,,,94.58,,,,
Q14966 SEX HORM BIND,84270,CPT,,,,,both,, ,288.25,172.95,Medicaid,Illinois Medicaid,,,,,288.25,,,,
Q30740 SHBG IA,84270,CPT,,,,,both,, ,288.25,172.95,Medicaid,Illinois Medicaid,,,,,288.25,,,,
SEX HORM BIND GLOB,84270,CPT,,,,,both,, ,288.25,172.95,Medicaid,Illinois Medicaid,,,,,288.25,,,,
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,, ,47.43,28.45,Medicaid,Illinois Medicaid,,,,,47.43,,,,
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,,,345.79,345.79,Medicaid,Illinois Medicaid,,18.81,,,345.79,345.79,345.79,Fee Schedule,
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
"L910235 SODIUM, URINE",84300,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
"Q442 SODIUM, URINE R",84300,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,, ,47.99,28.79,Medicaid,Illinois Medicaid,,,,,47.99,,,,
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,,,345.79,345.79,Medicaid,Illinois Medicaid,,18.81,,,345.79,345.79,345.79,Fee Schedule,
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
SODIUM OTHER SOURCE,84302,CPT,,,,,both,, ,82.51,49.5,Medicaid,Illinois Medicaid,,,,,82.51,,,,
Q16293 IGF-I LC/MS,84305,CPT,,,,,both,, ,870.37,522.22,Medicaid,Illinois Medicaid,,,,,870.37,,,,
Q16293 IGF-I LC/MS,84305,CPT,,,,,both,, ,870.37,522.22,Medicaid,Illinois Medicaid,,,,,870.37,,,,
ADENO DEAMNASE BFLD,84311,CPT,,,,,both,, ,93.74,56.24,Medicaid,Illinois Medicaid,,,,,93.74,,,,
Q175858 CHOLEST PF C,84311,CPT,,,,,both,, ,93.74,56.24,Medicaid,Illinois Medicaid,,,,,93.74,,,,
"SPECTROPHOTO, NOS",84311,CPT,,,,,both,, ,93.74,56.24,Medicaid,Illinois Medicaid,,,,,93.74,,,,
SPECIFIC GRAVITY,84315,CPT,,,,,both,, ,210.5,126.3,Medicaid,Illinois Medicaid,,,,,210.5,,,,
"SUGARS, SING, QUAL",84376,CPT,,,,,both,, ,93.74,56.24,Medicaid,Illinois Medicaid,,,,,93.74,,,,
GLYCOMARK,84378,CPT,,,,,both,, ,224,134.4,Medicaid,Illinois Medicaid,,,,,224,,,,
"Q442 SULFATE, URINE",84392,CPT,,,,,both,, ,31.71,19.02,Medicaid,Illinois Medicaid,,,,,31.71,,,,
"Q442 SULFATE, URINE",84392,CPT,,,,,both,, ,31.71,19.02,Medicaid,Illinois Medicaid,,,,,31.71,,,,
Q18944 TST FREE,84402,CPT,,,,,both,, ,1017.17,610.3,Medicaid,Illinois Medicaid,,,,,1017.17,,,,
Q36170 TESTOST FREE,84402,CPT,,,,,both,,,1017.17,1017.17,Medicaid,Illinois Medicaid,,18.34,,,1017.17,1017.17,1017.17,Fee Schedule,
Q36170 TESTOST FREE,84402,CPT,,,,,both,, ,1017.17,610.3,Medicaid,Illinois Medicaid,,,,,1017.17,,,,
"TESTOSTERONE, FREE",84402,CPT,,,,,both,, ,1017.17,610.3,Medicaid,Illinois Medicaid,,,,,1017.17,,,,
Q14966 TESTOST TOTAL,84403,CPT,,,,,both,, ,968.6,581.16,Medicaid,Illinois Medicaid,,,,,968.6,,,,
Q36170 TESTOST TOTAL,84403,CPT,,,,,both,,,968.6,968.6,Medicaid,Illinois Medicaid,,8.14,,,968.6,968.6,968.6,Fee Schedule,
Q36170 TESTOST TOTAL,84403,CPT,,,,,both,, ,968.6,581.16,Medicaid,Illinois Medicaid,,,,,968.6,,,,
"TESTOSTERONE, TOTAL",84403,CPT,,,,,both,, ,190.86,114.51,Medicaid,Illinois Medicaid,,,,,190.86,,,,
"TESTOSTERONE, TOTAL",84403,CPT,,,,,both,, ,968.6,581.16,Medicaid,Illinois Medicaid,,,,,968.6,,,,
L70282 TEST FR WB T,84410,CPT,,,,,both,, ,211.15,126.69,Medicaid,Illinois Medicaid,,,,,211.15,,,,
L121186VITB1 BL HPLC,84425,CPT,,,,,both,, ,1318.66,791.19,Medicaid,Illinois Medicaid,,,,,1318.66,,,,
Q5042 B1 BL LC/MS/MS,84425,CPT,,,,,both,, ,269.16,161.49,Medicaid,Illinois Medicaid,,,,,269.16,,,,
Q90353 VIT B1 LCMSMS,84425,CPT,,,,,both,, ,303.69,182.21,Medicaid,Illinois Medicaid,,,,,303.69,,,,
VITAMIN B-1,84425,CPT,,,,,both,, ,156.89,94.13,Medicaid,Illinois Medicaid,,,,,156.89,,,,
VITAMIN B-1,84425,CPT,,,,,both,, ,1437.33,862.39,Medicaid,Illinois Medicaid,,,,,1437.33,,,,
THIOCYANATE,84430,CPT,,,,,both,, ,174.57,104.74,Medicaid,Illinois Medicaid,,,,,174.57,,,,
Q30278 THYROGLOBULIN,84432,CPT,,,,,both,, ,255.13,153.07,Medicaid,Illinois Medicaid,,,,,255.13,,,,
Q30278 THYROGLOBULIN,84432,CPT,,,,,both,, ,255.13,153.07,Medicaid,Illinois Medicaid,,,,,255.13,,,,
"THYROXINE T4,TOTAL",84436,CPT,,,,,both,, ,38.73,23.23,Medicaid,Illinois Medicaid,,,,,38.73,,,,
"THYROXINE T4,TOTAL",84436,CPT,,,,,both,, ,405.57,243.34,Medicaid,Illinois Medicaid,,,,,405.57,,,,
Q35167 T4FREE DED-IA,84439,CPT,,,,,both,, ,620.56,372.33,Medicaid,Illinois Medicaid,,,,,620.56,,,,
Q35167 T4FREE DED-IA,84439,CPT,,,,,both,, ,620.56,372.33,Medicaid,Illinois Medicaid,,,,,620.56,,,,
"THYROXINE T4, FREE",84439,CPT,,,,,both,, ,66.52,39.91,Medicaid,Illinois Medicaid,,,,,66.52,,,,
"THYROXINE T4, FREE",84439,CPT,,,,,both,,,620.56,620.56,Medicaid,Illinois Medicaid,,35.07,,,620.56,620.56,620.56,Fee Schedule,
L1735 TBG SER ICMA,84442,CPT,,,,,both,, ,195.7,117.42,Medicaid,Illinois Medicaid,,,,,195.7,,,,
THYROXINE BIND GLOB,84442,CPT,,,,,both,, ,213.31,127.98,Medicaid,Illinois Medicaid,,,,,213.31,,,,
"Blood test, thyroid stimulating hormone (TSH)",84443,CPT,,,,,both,,,737.61,737.61,Medicaid,Illinois Medicaid,,7.35,,,737.61,737.61,737.61,Fee Schedule,
Q90123 TSH,84443,CPT,,,,,both,, ,737.61,442.56,Medicaid,Illinois Medicaid,,,,,737.61,,,,
Q90123 TSH,84443,CPT,,,,,both,, ,737.61,442.56,Medicaid,Illinois Medicaid,,,,,737.61,,,,
THYROID STIM TSH,84443,CPT,,,,,both,, ,124.05,74.43,Medicaid,Illinois Medicaid,,,,,124.05,,,,
Q30551 TSI IA,84445,CPT,,,,,both,, ,733.12,439.87,Medicaid,Illinois Medicaid,,,,,733.12,,,,
THYROID STIM IMMUNO,84445,CPT,,,,,both,, ,1178.27,706.96,Medicaid,Illinois Medicaid,,,,,1178.27,,,,
Q931 VIT E HPLC,84446,CPT,,,,,both,, ,227.62,136.57,Medicaid,Illinois Medicaid,,,,,227.62,,,,
Q931 VIT E HPLC,84446,CPT,,,,,both,, ,227.62,136.57,Medicaid,Illinois Medicaid,,,,,227.62,,,,
L500440 TRANSCORTIN,84449,CPT,,,,,both,, ,180,108,Medicaid,Illinois Medicaid,,,,,180,,,,
TRANSFERASE AST,84450,CPT,,,,,both,, ,38.17,22.9,Medicaid,Illinois Medicaid,,,,,38.17,,,,
TRANSFERASE AST,84450,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
TRANSFERASE ALT,84460,CPT,,,,,both,, ,39.29,23.57,Medicaid,Illinois Medicaid,,,,,39.29,,,,
TRANSFERASE ALT,84460,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
Q891 TRANSFERRI NEPH,84466,CPT,,,,,both,, ,796.55,477.93,Medicaid,Illinois Medicaid,,,,,796.55,,,,
Q891 TRANSFERRI NEPH,84466,CPT,,,,,both,, ,796.55,477.93,Medicaid,Illinois Medicaid,,,,,796.55,,,,
TRANSFERRIN,84466,CPT,,,,,both,, ,94.31,56.58,Medicaid,Illinois Medicaid,,,,,94.31,,,,
TRIGLYCERIDES,84478,CPT,,,,,both,, ,39.29,23.57,Medicaid,Illinois Medicaid,,,,,39.29,,,,
TRIGLYCERIDES,84478,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
T3-T4 UPTAKE,84479,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,,,,526.26,,,,
"T3,TOTAL",84480,CPT,,,,,both,, ,1039.33,623.59,Medicaid,Illinois Medicaid,,,,,1039.33,,,,
"T3,FREE",84481,CPT,,,,,both,, ,858.3,514.98,Medicaid,Illinois Medicaid,,,,,858.3,,,,
Q90963 T3 REV LCMSMS,84482,CPT,,,,,both,, ,858.3,514.98,Medicaid,Illinois Medicaid,,,,,858.3,,,,
"T3,REVERSE",84482,CPT,,,,,both,, ,219.2,131.52,Medicaid,Illinois Medicaid,,,,,219.2,,,,
"TROPONIN,QNT",84484,CPT,,,,,both,, ,133.88,80.32,Medicaid,Illinois Medicaid,,,,,133.88,,,,
"TROPONIN,QNT",84484,CPT,,,,,both,,,713.19,713.19,Medicaid,Illinois Medicaid,,17.46,,,713.19,713.19,713.19,Fee Schedule,
"TROPONIN,QNT",84484,CPT,,,,,both,, ,713.19,427.91,Medicaid,Illinois Medicaid,,,,,713.19,,,,
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,, ,29.19,17.51,Medicaid,Illinois Medicaid,,,,,29.19,,,,
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,,,277.59,277.59,Medicaid,Illinois Medicaid,,18.38,,,277.59,277.59,277.59,Fee Schedule,
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,, ,277.59,166.55,Medicaid,Illinois Medicaid,,,,,277.59,,,,
"L910235 UREA NITROGEN, URINE",84540,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
"L910235 UREA NITROGEN, URINE",84540,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
"UREA NITROGEN,URINE",84540,CPT,,,,,both,,,345.79,345.79,Medicaid,Illinois Medicaid,,18.38,,,345.79,345.79,345.79,Fee Schedule,
"URIC ACID, BLOOD",84550,CPT,,,,,both,, ,44.34,26.6,Medicaid,Illinois Medicaid,,,,,44.34,,,,
"URIC ACID, BLOOD",84550,CPT,,,,,both,,,285.17,285.17,Medicaid,Illinois Medicaid,,17.53,,,285.17,285.17,285.17,Fee Schedule,
"URIC ACID, BLOOD",84550,CPT,,,,,both,, ,285.17,171.1,Medicaid,Illinois Medicaid,,,,,285.17,,,,
"L910235 URIC ACID, URINE",84560,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
"Q442 URIC ACID,URINE",84560,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
"URIC ACID,URINE RAND",84560,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
L4143 VMA U24 LCMSMS,84585,CPT,,,,,both,, ,355.05,213.03,Medicaid,Illinois Medicaid,,,,,355.05,,,,
L4143 VMA U24 LCMSMS,84585,CPT,,,,,both,, ,355.05,213.03,Medicaid,Illinois Medicaid,,,,,355.05,,,,
VANILLYLMANDELIC ACID (VMA) SERUM,84585,CPT,,,,,both,, ,116.7,70.02,Medicaid,Illinois Medicaid,,,,,116.7,,,,
L10397 VIP PL RIA,84586,CPT,,,,,both,, ,338.36,203.01,Medicaid,Illinois Medicaid,,,,,338.36,,,,
VASOINTESTINAL PEP,84586,CPT,,,,,both,, ,368.8,221.28,Medicaid,Illinois Medicaid,,,,,368.8,,,,
Q252 AVP ADH EXT-RIA,84588,CPT,,,,,both,, ,295.83,177.49,Medicaid,Illinois Medicaid,,,,,295.83,,,,
Q252 AVP ADH EXT-RIA,84588,CPT,,,,,both,, ,295.83,177.49,Medicaid,Illinois Medicaid,,,,,295.83,,,,
Q921 VIT A HPLC,84590,CPT,,,,,both,, ,186.08,111.64,Medicaid,Illinois Medicaid,,,,,186.08,,,,
Q921 VIT A HPLC,84590,CPT,,,,,both,, ,186.08,111.64,Medicaid,Illinois Medicaid,,,,,186.08,,,,
"VITAMIN ASSAY, NOS",84591,CPT,,,,,both,, ,197.03,118.21,Medicaid,Illinois Medicaid,,,,,197.03,,,,
Q36585 VITAM K HPLC,84597,CPT,,,,,both,, ,188.89,113.33,Medicaid,Illinois Medicaid,,,,,188.89,,,,
Q36585 VITAM K HPLC,84597,CPT,,,,,both,, ,188.89,113.33,Medicaid,Illinois Medicaid,,,,,188.89,,,,
VOLATILES,84600,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,,,,728.07,,,,
XYLOSE ABSORPTION,84620,CPT,,,,,both,, ,1111.47,666.88,Medicaid,Illinois Medicaid,,,,,1111.47,,,,
Q945 ZN ICP/MS AS,84630,CPT,,,,,both,, ,1081.72,649.03,Medicaid,Illinois Medicaid,,,,,1081.72,,,,
Q945 ZN ICP/MS AS,84630,CPT,,,,,both,, ,1081.72,649.03,Medicaid,Illinois Medicaid,,,,,1081.72,,,,
ZINC WHOLE BLOOD,84630,CPT,,,,,both,, ,80,48,Medicaid,Illinois Medicaid,,,,,80,,,,
Q372 C-PEPTIDE IA,84681,CPT,,,,,both,, ,898.44,539.06,Medicaid,Illinois Medicaid,,,,,898.44,,,,
Q372 C-PEPTIDE IA,84681,CPT,,,,,both,, ,898.44,539.06,Medicaid,Illinois Medicaid,,,,,898.44,,,,
HCG QUANT,84702,CPT,,,,,both,, ,148.47,89.08,Medicaid,Illinois Medicaid,,,,,148.47,,,,
L140450 HCG TUMOR MK,84702,CPT,,,,,both,, ,758.66,455.19,Medicaid,Illinois Medicaid,,,,,758.66,,,,
L140450 HCG TUMOR MK,84702,CPT,,,,,both,, ,758.66,455.19,Medicaid,Illinois Medicaid,,,,,758.66,,,,
"HCG, QUAL",84703,CPT,,,,,both,, ,74.1,44.46,Medicaid,Illinois Medicaid,,,,,74.1,,,,
"HCG, QUAL",84703,CPT,,,,,both,,,420.72,420.72,Medicaid,Illinois Medicaid,,29.13,,,420.72,420.72,420.72,Fee Schedule,
"HCG, QUAL",84703,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
CLIN CHEM TEST NOS,84999,CPT,,,,,both,, ,274.5,164.7,Medicaid,Illinois Medicaid,,,,,274.5,,,,
L820610Z K FEC,84999,CPT,,,,,both,, ,225,135,Medicaid,Illinois Medicaid,,,,,225,,,,
L820610Z K FEC,84999,CPT,,,,,both,, ,225,135,Medicaid,Illinois Medicaid,,,,,225,,,,
BLEEDING TIME,85002,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
AUTO DIFF WBC COUNT,85004,CPT,,,,,both,, ,47.99,28.79,Medicaid,Illinois Medicaid,,,,,47.99,,,,
AUTO DIFF WBC COUNT,85004,CPT,,,,,both,, ,103,61.8,Medicaid,Illinois Medicaid,,,,,103,,,,
"WBC DIFF, MAN",85007,CPT,,,,,both,, ,33.96,20.37,Medicaid,Illinois Medicaid,,,,,33.96,,,,
"WBC DIFF, MAN",85007,CPT,,,,,both,, ,188.33,112.99,Medicaid,Illinois Medicaid,,,,,188.33,,,,
BLOOD SMEAR SCAN,85008,CPT,,,,,both,, ,112.55,67.53,Medicaid,Illinois Medicaid,,,,,112.55,,,,
"HEMATOCRIT, SPUN",85013,CPT,,,,,both,, ,32.84,19.7,Medicaid,Illinois Medicaid,,,,,32.84,,,,
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,, ,13.18,7.9,Medicaid,Illinois Medicaid,,,,,13.18,,,,
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,,,262.99,262.99,Medicaid,Illinois Medicaid,,9.33,,,262.99,262.99,262.99,Fee Schedule,
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,, ,262.99,157.79,Medicaid,Illinois Medicaid,,,,,262.99,,,,
HEMOGLOBIN,85018,CPT,,,,,both,, ,13.18,7.9,Medicaid,Illinois Medicaid,,,,,13.18,,,,
HEMOGLOBIN,85018,CPT,,,,,both,,,262.99,262.99,Medicaid,Illinois Medicaid,,9.33,,,262.99,262.99,262.99,Fee Schedule,
HEMOGLOBIN,85018,CPT,,,,,both,, ,262.99,157.79,Medicaid,Illinois Medicaid,,,,,262.99,,,,
HEMOGLOBIN,85018,CPT,,,,,both,, ,262.99,157.79,Medicaid,Illinois Medicaid,,,,,262.99,,,,
L121003 HEMOGLOBIN,85018,CPT,,,,,both,, ,10,6,Medicaid,Illinois Medicaid,,,,,10,,,,
CBC W-PLT AUTO COMPD,85025,CPT,,,,,both,, ,28.9,17.34,Medicaid,Illinois Medicaid,,,,,28.9,,,,
CBC W-PLT AUTO COMPD,85025,CPT,,,,,both,, ,428.3,256.98,Medicaid,Illinois Medicaid,,,,,428.3,,,,
"Complete blood cell count, with differential white blood cells, automated",85025,CPT,,,,,both,,,428.3,428.3,Medicaid,Illinois Medicaid,,30.26,,,428.3,428.3,428.3,Fee Schedule,
CBC W-PLT,85027,CPT,,,,,both,, ,24.13,14.47,Medicaid,Illinois Medicaid,,,,,24.13,,,,
CBC W-PLT,85027,CPT,,,,,both,, ,412.87,247.72,Medicaid,Illinois Medicaid,,,,,412.87,,,,
"Complete blood count, automated",85027,CPT,,,,,both,,,412.87,412.87,Medicaid,Illinois Medicaid,,25.17,,,412.87,412.87,412.87,Fee Schedule,
MAN CELL CT ELP,85032,CPT,,,,,both,, ,466.48,279.88,Medicaid,Illinois Medicaid,,,,,466.48,,,,
L1917 RBC COUNT,85041,CPT,,,,,both,, ,6.06,3.63,Medicaid,Illinois Medicaid,,,,,6.06,,,,
"RETIC COUNT, MANUAL",85044,CPT,,,,,both,, ,489.78,293.86,Medicaid,Illinois Medicaid,,,,,489.78,,,,
"RETIC COUNT, FLOW",85045,CPT,,,,,both,, ,39.29,23.57,Medicaid,Illinois Medicaid,,,,,39.29,,,,
"RETIC COUNT, FLOW",85045,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
WBC COUNT,85048,CPT,,,,,both,, ,16.55,9.93,Medicaid,Illinois Medicaid,,,,,16.55,,,,
WBC COUNT,85048,CPT,,,,,both,, ,285.17,171.1,Medicaid,Illinois Medicaid,,,,,285.17,,,,
CBC-PLT AUTORP CDM,85049,CPT,,,,,both,, ,16.55,9.93,Medicaid,Illinois Medicaid,,,,,16.55,,,,
CBC-PLT AUTORP CDM,85049,CPT,,,,,both,, ,285.17,171.1,Medicaid,Illinois Medicaid,,,,,285.17,,,,
BONE MARROW INTERPRE,85097,CPT,,,,,both,, ,237.17,142.3,Medicaid,Illinois Medicaid,,,,,237.17,,,,
APIXABAN ANTI-XA,85130,CPT,,,,,both,, ,250,150,Medicaid,Illinois Medicaid,,,,,250,,,,
Q331 FACT II ACT PCD,85210,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,,,,74.93,,,,
FACTOR V ASSAY,85220,CPT,,,,,both,, ,121.53,72.91,Medicaid,Illinois Medicaid,,,,,121.53,,,,
L86249 FACT V ACT CD,85220,CPT,,,,,both,, ,121.53,72.91,Medicaid,Illinois Medicaid,,,,,121.53,,,,
Q344 FACT V CLOT PCD,85220,CPT,,,,,both,, ,121.53,72.91,Medicaid,Illinois Medicaid,,,,,121.53,,,,
L800599FACTVII ACT C,85230,CPT,,,,,both,, ,335.69,201.41,Medicaid,Illinois Medicaid,,,,,335.69,,,,
L800599FACTVII ACT C,85230,CPT,,,,,both,, ,335.69,201.41,Medicaid,Illinois Medicaid,,,,,335.69,,,,
"FACTOR VIII, AHG",85240,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,,,,728.07,,,,
L503333 FAC8 AHG,85240,CPT,,,,,both,, ,706.86,424.11,Medicaid,Illinois Medicaid,,,,,706.86,,,,
FACTOR VIII RISTOCET,85245,CPT,,,,,both,, ,1352.01,811.2,Medicaid,Illinois Medicaid,,,,,1352.01,,,,
L164509 VWF ACTIV PA,85245,CPT,,,,,both,, ,412,247.2,Medicaid,Illinois Medicaid,,,,,412,,,,
Q4919 VWF AG ITA,85246,CPT,,,,,both,, ,1164.52,698.71,Medicaid,Illinois Medicaid,,,,,1164.52,,,,
Q4919 VWF AG ITA,85246,CPT,,,,,both,, ,1164.52,698.71,Medicaid,Illinois Medicaid,,,,,1164.52,,,,
"FACT VIII,VW,MULTIME",85247,CPT,,,,,both,, ,181.59,108.95,Medicaid,Illinois Medicaid,,,,,181.59,,,,
FACTOR IX,85250,CPT,,,,,both,, ,151.56,90.93,Medicaid,Illinois Medicaid,,,,,151.56,,,,
FACTOR X,85260,CPT,,,,,both,, ,142.58,85.54,Medicaid,Illinois Medicaid,,,,,142.58,,,,
FACTOR XI,85270,CPT,,,,,both,, ,142.58,85.54,Medicaid,Illinois Medicaid,,,,,142.58,,,,
ANTITHROMBIN IIIACTI,85300,CPT,,,,,both,, ,1930.76,1158.45,Medicaid,Illinois Medicaid,,,,,1930.76,,,,
L015040 ANTITHROMBIN ACTIVITY,85300,CPT,,,,,both,, ,965.23,579.13,Medicaid,Illinois Medicaid,,,,,965.23,,,,
Q5158 ATIII AG FRNEP,85301,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,,,,72.13,,,,
"PROTEIN C, AG",85302,CPT,,,,,both,, ,1907.47,1144.48,Medicaid,Illinois Medicaid,,,,,1907.47,,,,
Q4948 PROT C AG IA,85302,CPT,,,,,both,, ,1942.55,1165.53,Medicaid,Illinois Medicaid,,,,,1942.55,,,,
Q1777 PROT C ACT,85303,CPT,,,,,both,, ,1261.35,756.81,Medicaid,Illinois Medicaid,,,,,1261.35,,,,
Q1777 PROT C ACT,85303,CPT,,,,,both,, ,1261.35,756.81,Medicaid,Illinois Medicaid,,,,,1261.35,,,,
"Q7942 PROTEIN C, ACT",85303,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
L117754 PROT S TOT,85305,CPT,,,,,both,, ,116.1,69.66,Medicaid,Illinois Medicaid,,,,,116.1,,,,
Q5165 PROT S AG ITA,85305,CPT,,,,,both,, ,1261.35,756.81,Medicaid,Illinois Medicaid,,,,,1261.35,,,,
Q5165 PROT S AG ITA,85305,CPT,,,,,both,, ,1261.35,756.81,Medicaid,Illinois Medicaid,,,,,1261.35,,,,
L117754 PROT S FREE,85306,CPT,,,,,both,, ,153.2,91.92,Medicaid,Illinois Medicaid,,,,,153.2,,,,
"PROTEIN S, FREE",85306,CPT,,,,,both,, ,151,90.6,Medicaid,Illinois Medicaid,,,,,151,,,,
"PROTEIN S, FREE",85306,CPT,,,,,both,, ,939.98,563.98,Medicaid,Illinois Medicaid,,,,,939.98,,,,
Q10170 PROT S AG ITA,85306,CPT,,,,,both,, ,939.98,563.98,Medicaid,Illinois Medicaid,,,,,939.98,,,,
Q1779 PROT S ACT,85306,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
"Q7942 PROTEIN S, FRE",85306,CPT,,,,,both,, ,939.98,563.98,Medicaid,Illinois Medicaid,,,,,939.98,,,,
PROTEIN C ACTIVATED,85307,CPT,,,,,both,, ,239.69,143.81,Medicaid,Illinois Medicaid,,,,,239.69,,,,
Q22 APCR RVVT-BSE AS,85307,CPT,,,,,both,, ,596.43,357.85,Medicaid,Illinois Medicaid,,,,,596.43,,,,
SOLUB LIV AG AB(RDL),85316,CPT,,,,,both,, ,567,340.2,Medicaid,Illinois Medicaid,,,,,567,,,,
COAG TIME ACTIVATED,85347,CPT,,,,,both,, ,167.84,100.7,Medicaid,Illinois Medicaid,,,,,167.84,,,,
FDP-FSP AGG SLIDE,85362,CPT,,,,,both,, ,691.58,414.94,Medicaid,Illinois Medicaid,,,,,691.58,,,,
"D-DIMER, QUANT",85379,CPT,,,,,both,, ,100.48,60.28,Medicaid,Illinois Medicaid,,,,,100.48,,,,
"D-DIMER, QUANT",85379,CPT,,,,,both,,,886.09,886.09,Medicaid,Illinois Medicaid,,33.09,,,886.09,886.09,886.09,Fee Schedule,
"D-DIMER, QUANT",85379,CPT,,,,,both,, ,886.09,531.65,Medicaid,Illinois Medicaid,,,,,886.09,,,,
FIBRINOGEN ACTIVITY,85384,CPT,,,,,both,, ,83.64,50.18,Medicaid,Illinois Medicaid,,,,,83.64,,,,
FIBRINOGEN ACTIVITY,85384,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
Q14532 ADAMTS13 IA,85397,CPT,,,,,both,, ,188.05,112.83,Medicaid,Illinois Medicaid,,,,,188.05,,,,
Q36555 PAI-1 IA,85415,CPT,,,,,both,, ,222.01,133.2,Medicaid,Illinois Medicaid,,,,,222.01,,,,
LSKBFHS FET HGB ST,85460,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,,,,526.26,,,,
LSKBFHS FET HGB ST,85460,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,,,,526.26,,,,
"FETAL HGB, ROSETTE",85461,CPT,,,,,both,, ,349.72,209.83,Medicaid,Illinois Medicaid,,,,,349.72,,,,
HEPARIN ASSAY,85520,CPT,,,,,both,, ,1274.26,764.55,Medicaid,Illinois Medicaid,,,,,1274.26,,,,
L117101 HEPARIN A-XA,85520,CPT,,,,,both,, ,139.05,83.43,Medicaid,Illinois Medicaid,,,,,139.05,,,,
MURAMIDASE,85549,CPT,,,,,both,, ,261.02,156.61,Medicaid,Illinois Medicaid,,,,,261.02,,,,
RBC OSMOTIC FRAGW-IN,85557,CPT,,,,,both,, ,450.48,270.28,Medicaid,Illinois Medicaid,,,,,450.48,,,,
PLATELET AGGREGATION,85576,CPT,,,,,both,, ,344.67,206.8,Medicaid,Illinois Medicaid,,,,,344.67,,,,
QRX143590 DRVVT CONF,85597,CPT,,,,,both,, ,160.55,96.33,Medicaid,Illinois Medicaid,,,,,160.55,,,,
QRX143590 DRVVT CONF,85597,CPT,,,,,both,, ,160.55,96.33,Medicaid,Illinois Medicaid,,,,,160.55,,,,
L117079 HEX PHOS,85598,CPT,,,,,both,, ,179.8,107.88,Medicaid,Illinois Medicaid,,,,,179.8,,,,
Q143583HEXA PHSE CD,85598,CPT,,,,,both,, ,153.52,92.11,Medicaid,Illinois Medicaid,,,,,153.52,,,,
Q143583HEXA PHSE CD,85598,CPT,,,,,both,, ,153.52,92.11,Medicaid,Illinois Medicaid,,,,,153.52,,,,
"Blood test, clotting time",85610,CPT,,,,,both,,,430.27,430.27,Medicaid,Illinois Medicaid,,15.27,,,430.27,430.27,430.27,Fee Schedule,
PROTHROMBIN TIME,85610,CPT,,,,,both,, ,14.6,8.76,Medicaid,Illinois Medicaid,,,,,14.6,,,,
PROTHROMBIN TIME,85610,CPT,,,,,both,, ,430.27,258.16,Medicaid,Illinois Medicaid,,,,,430.27,,,,
"PROTHROMBIN, SUBSTIT",85611,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,,,,728.07,,,,
Q7079 RUSSELL VIPER,85613,CPT,,,,,both,, ,364.88,218.92,Medicaid,Illinois Medicaid,,,,,364.88,,,,
Q7079 RUSSELL VIPER,85613,CPT,,,,,both,, ,364.88,218.92,Medicaid,Illinois Medicaid,,,,,364.88,,,,
"SED RATE, AUTOMATED",85652,CPT,,,,,both,, ,26.66,15.99,Medicaid,Illinois Medicaid,,,,,26.66,,,,
"SED RATE, AUTOMATED",85652,CPT,,,,,both,,,345.79,345.79,Medicaid,Illinois Medicaid,,11.45,,,345.79,345.79,345.79,Fee Schedule,
"SED RATE, AUTOMATED",85652,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
O51226 SICKLE C  SCR,85660,CPT,,,,,both,, ,385.99,231.59,Medicaid,Illinois Medicaid,,,,,385.99,,,,
Q37679 SICKLE CELL SCRN WITH REFLEX HEMO,85660,CPT,,,,,both,, ,374.75,224.85,Medicaid,Illinois Medicaid,,,,,374.75,,,,
Q825 SICKL CL HS SOL,85660,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
Q825 SICKL CL HS SOL,85660,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
Q883 THROMB CLT BCS,85670,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,,,,526.26,,,,
Q883 THROMB CLT BCS,85670,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,,,,526.26,,,,
Coagulation assessment blood test,85730,CPT,,,,,both,,,480.79,480.79,Medicaid,Illinois Medicaid,,6.8,,,480.79,480.79,480.79,Fee Schedule,
Q7079 THROMBOPLAST T,85730,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,,,,480.79,,,,
Q7079 THROMBOPLAST T,85730,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,,,,480.79,,,,
THROMBOPLAST TIMEPTT,85730,CPT,,,,,both,, ,58.94,35.36,Medicaid,Illinois Medicaid,,,,,58.94,,,,
PTT-LA MIX,85732,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,,,,480.79,,,,
PTT-LA MIX,85732,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,,,,480.79,,,,
VISCOSITY EXAM,85810,CPT,,,,,both,, ,80.27,48.16,Medicaid,Illinois Medicaid,,,,,80.27,,,,
Q94609 ALG IGG QT,86001,CPT,,,,,both,, ,66.24,39.74,Medicaid,Illinois Medicaid,,,,,66.24,,,,
Q94609 ALG IGG QT,86001,CPT,,,,,both,, ,66.24,39.74,Medicaid,Illinois Medicaid,,,,,66.24,,,,
ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,51.36,30.81,Medicaid,Illinois Medicaid,,,,,51.36,,,,
ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,,,,148.75,,,,
L602635 - ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,,,,148.75,,,,
Q10643 ALG IGE QT,86003,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,,,,148.75,,,,
Q10659 ALLERGEN IGE,86003,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,,,,148.75,,,,
Q10715 ALLERGEN IGE,86003,CPT,,,,,both,, ,148.75,89.25,Medicaid,Illinois Medicaid,,,,,148.75,,,,
Q91681 ALLERGEN IGE,86008,CPT,,,,,both,, ,103.29,61.97,Medicaid,Illinois Medicaid,,,,,103.29,,,,
Q91681 ALLERGEN IGE,86008,CPT,,,,,both,, ,103.29,61.97,Medicaid,Illinois Medicaid,,,,,103.29,,,,
L6643 ASMA ELISA,86015,CPT,,,,,both,, ,702.72,421.63,Medicaid,Illinois Medicaid,,,,,702.72,,,,
Q15043 ACTIN AB EA,86015,CPT,,,,,both,, ,514.48,308.68,Medicaid,Illinois Medicaid,,,,,514.48,,,,
Q34151 PR-3 AB IA,86021,CPT,,,,,both,, ,500.72,300.43,Medicaid,Illinois Medicaid,,,,,500.72,,,,
Q34151 PR-3 AB IA,86021,CPT,,,,,both,, ,500.72,300.43,Medicaid,Illinois Medicaid,,,,,500.72,,,,
Q34151 PR-3 AB IA,86021,CPT,,,,,both,, ,500.72,300.43,Medicaid,Illinois Medicaid,,,,,500.72,,,,
Q34151 PR-3 AB IA,86021,CPT,,,,,both,, ,500.72,300.43,Medicaid,Illinois Medicaid,,,,,500.72,,,,
PLATELET AB,86022,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,,,,871.22,,,,
Q14627SRA UNF RB-14C,86022,CPT,,,,,both,, ,467.88,280.72,Medicaid,Illinois Medicaid,,,,,467.88,,,,
Q14874 PLATELET AB,86022,CPT,,,,,both,, ,467.88,280.72,Medicaid,Illinois Medicaid,,,,,467.88,,,,
Q414 HEP-IND PLAT AB,86022,CPT,,,,,both,, ,467.88,280.72,Medicaid,Illinois Medicaid,,,,,467.88,,,,
Q91740PLATELT IGG FC,86023,CPT,,,,,both,, ,83.08,49.84,Medicaid,Illinois Medicaid,,,,,83.08,,,,
L162045 FLUORS AB SC,86036,CPT,,,,,both,, ,486.16,291.69,Medicaid,Illinois Medicaid,,,,,486.16,,,,
Q70171 ANCA SCN IA,86036,CPT,,,,,both,, ,500.72,300.43,Medicaid,Illinois Medicaid,,,,,500.72,,,,
L163061 ANCA TITER,86037,CPT,,,,,both,, ,120.5,72.3,Medicaid,Illinois Medicaid,,,,,120.5,,,,
ANA,86038,CPT,,,,,both,, ,91.77,55.06,Medicaid,Illinois Medicaid,,,,,91.77,,,,
ANA,86038,CPT,,,,,both,, ,898.44,539.06,Medicaid,Illinois Medicaid,,,,,898.44,,,,
L164947 ANA IFA,86038,CPT,,,,,both,, ,824.26,494.55,Medicaid,Illinois Medicaid,,,,,824.26,,,,
Q16814 ANA IFA REFIA,86038,CPT,,,,,both,,,898.44,898.44,Medicaid,Illinois Medicaid,,12.09,,,898.44,898.44,898.44,Fee Schedule,
Q16814 ANA IFA REFIA,86038,CPT,,,,,both,, ,898.44,539.06,Medicaid,Illinois Medicaid,,,,,898.44,,,,
Q249 ANA SCRN IFA,86038,CPT,,,,,both,, ,898.44,539.06,Medicaid,Illinois Medicaid,,,,,898.44,,,,
"ANA,TITER",86039,CPT,,,,,both,, ,93.46,56.07,Medicaid,Illinois Medicaid,,,,,93.46,,,,
QRX ANA TITER PATTRN,86039,CPT,,,,,both,, ,547.31,328.38,Medicaid,Illinois Medicaid,,,,,547.31,,,,
QRX ANA TITER PATTRN,86039,CPT,,,,,both,, ,547.31,328.38,Medicaid,Illinois Medicaid,,,,,547.31,,,,
ACETYLCH RCPT BND AB,86041,CPT,,,,,both,, ,55.2,33.12,Medicaid,Illinois Medicaid,,,,,55.2,,,,
ACETYLC RCPT BLCK AB,86042,CPT,,,,,both,, ,55.2,33.12,Medicaid,Illinois Medicaid,,,,,55.2,,,,
ACTYLC RCPT MODL AB,86043,CPT,,,,,both,, ,55.2,33.12,Medicaid,Illinois Medicaid,,,,,55.2,,,,
Q38321 AQP4 NMOIGG,86052,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,,,,529.91,,,,
"ASO,TITER",86060,CPT,,,,,both,, ,71.85,43.11,Medicaid,Illinois Medicaid,,,,,71.85,,,,
"ASO,TITER",86060,CPT,,,,,both,, ,539.45,323.67,Medicaid,Illinois Medicaid,,,,,539.45,,,,
Q265 ASO AB ITA,86060,CPT,,,,,both,, ,189.17,113.5,Medicaid,Illinois Medicaid,,,,,189.17,,,,
PHYS BB SERV TRAN RE,86078,CPT,,,,,both,, ,165.59,99.35,Medicaid,Illinois Medicaid,,,,,165.59,,,,
C-REACTIVE PROTEIN,86140,CPT,,,,,both,, ,51.08,30.64,Medicaid,Illinois Medicaid,,,,,51.08,,,,
C-REACTIVE PROTEIN,86140,CPT,,,,,both,, ,518.69,311.21,Medicaid,Illinois Medicaid,,,,,518.69,,,,
Q10124 HS-CRP NEPHEL,86141,CPT,,,,,both,, ,999.76,599.85,Medicaid,Illinois Medicaid,,,,,999.76,,,,
Q30340 BETA-2 GLYCOP,86146,CPT,,,,,both,, ,252.04,151.22,Medicaid,Illinois Medicaid,,,,,252.04,,,,
Q30340 BETA-2 GLYCOP,86146,CPT,,,,,both,, ,252.04,151.22,Medicaid,Illinois Medicaid,,,,,252.04,,,,
Q36552 B2-GPIAB IGA,86146,CPT,,,,,both,, ,252.04,151.22,Medicaid,Illinois Medicaid,,,,,252.04,,,,
Q36552 B2-GPIAB IGA,86146,CPT,,,,,both,, ,252.04,151.22,Medicaid,Illinois Medicaid,,,,,252.04,,,,
Q36554B-2-GP1 IGG IA,86146,CPT,,,,,both,, ,252.04,151.22,Medicaid,Illinois Medicaid,,,,,252.04,,,,
Q36554B-2-GP1 IGG IA,86146,CPT,,,,,both,, ,252.04,151.22,Medicaid,Illinois Medicaid,,,,,252.04,,,,
L161950CARDIOLIPIN A,86147,CPT,,,,,both,, ,429.43,257.65,Medicaid,Illinois Medicaid,,,,,429.43,,,,
L161950CARDIOLIPIN A,86147,CPT,,,,,both,, ,429.43,257.65,Medicaid,Illinois Medicaid,,,,,429.43,,,,
Q4661 C-LIPIN AB IGA,86147,CPT,,,,,both,, ,429.43,257.65,Medicaid,Illinois Medicaid,,,,,429.43,,,,
Q4661 C-LIPIN AB IGA,86147,CPT,,,,,both,, ,429.43,257.65,Medicaid,Illinois Medicaid,,,,,429.43,,,,
Q4663 C-LIPIN AB IGM,86147,CPT,,,,,both,, ,429.43,257.65,Medicaid,Illinois Medicaid,,,,,429.43,,,,
Q4663 C-LIPIN AB IGM,86147,CPT,,,,,both,, ,429.43,257.65,Medicaid,Illinois Medicaid,,,,,429.43,,,,
PHOSPHATIDYLSERIN AB,86148,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,,,,141.46,,,,
PHOSPHOLIPID AB,86148,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,,,,141.46,,,,
Q14890 PHOSPHOLIPID,86148,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,,,,141.46,,,,
CELL ENUM IS AND ID,86152,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,,,,72.13,,,,
"COLD AGG, TITER",86157,CPT,,,,,both,, ,247.83,148.69,Medicaid,Illinois Medicaid,,,,,247.83,,,,
L6353COLD HEMAGGL QT,86157,CPT,,,,,both,, ,40.7,24.42,Medicaid,Illinois Medicaid,,,,,40.7,,,,
"COMPLEMENT AG, EA",86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q19882 COMP AG,86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q34888 COMPLE C7 RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q34889 COMPLE C8 RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q351 C3 COMPL ITA,86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q353 C4C COMP ITA,86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q354 COMPLEM C5 RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q433 COMPL CP C2 RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q981 COMPL C C1Q RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q297 C1 INH FUNC IA,86161,CPT,,,,,both,, ,79.99,47.99,Medicaid,Illinois Medicaid,,,,,79.99,,,,
Q618 COMPL CH50 LIPO,86162,CPT,,,,,both,, ,984.32,590.59,Medicaid,Illinois Medicaid,,,,,984.32,,,,
Q618 COMPL CH50 LIPO,86162,CPT,,,,,both,, ,984.32,590.59,Medicaid,Illinois Medicaid,,,,,984.32,,,,
Q11173 CCP AB IGG IA,86200,CPT,,,,,both,, ,242.5,145.5,Medicaid,Illinois Medicaid,,,,,242.5,,,,
L96286 ADNASE-B NEPH,86215,CPT,,,,,both,, ,198.72,119.23,Medicaid,Illinois Medicaid,,,,,198.72,,,,
L96286 ADNASE-B NEPH,86215,CPT,,,,,both,, ,198.72,119.23,Medicaid,Illinois Medicaid,,,,,198.72,,,,
"DNA AB,NATIVE-DOUBL",86225,CPT,,,,,both,, ,1077.5,646.5,Medicaid,Illinois Medicaid,,,,,1077.5,,,,
L165092 DNA DS AB,86225,CPT,,,,,both,, ,486.16,291.69,Medicaid,Illinois Medicaid,,,,,486.16,,,,
L96346 DSDNA AB IA,86225,CPT,,,,,both,, ,219.1,131.46,Medicaid,Illinois Medicaid,,,,,219.1,,,,
Q19882 DNA DS AB,86225,CPT,,,,,both,, ,1077.5,646.5,Medicaid,Illinois Medicaid,,,,,1077.5,,,,
Q255 DNA DS AB IA,86225,CPT,,,,,both,, ,1077.5,646.5,Medicaid,Illinois Medicaid,,,,,1077.5,,,,
Q14857 SSDNA ANTIBODY (IGG),86226,CPT,,,,,both,, ,923,553.8,Medicaid,Illinois Medicaid,,,,,923,,,,
Q45972 SSDNA IGG EIA,86226,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
Q45972 SSDNA IGG EIA,86226,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
L165126 ENDMYS AB IG,86231,CPT,,,,,both,, ,60.05,36.03,Medicaid,Illinois Medicaid,,,,,60.05,,,,
Q15064 ENDOMYS AB IG,86231,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,,,,529.91,,,,
Q19955 ENDOMYS AB IG,86231,CPT,,,,,both,, ,743.65,446.19,Medicaid,Illinois Medicaid,,,,,743.65,,,,
ANTI-ENA,86235,CPT,,,,,both,, ,174.85,104.91,Medicaid,Illinois Medicaid,,,,,174.85,,,,
ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,,,,274.22,,,,
L165092 ANTI-ENA,86235,CPT,,,,,both,, ,251.58,150.94,Medicaid,Illinois Medicaid,,,,,251.58,,,,
L520085 ANTI-ENS,86235,CPT,,,,,both,, ,548.71,329.22,Medicaid,Illinois Medicaid,,,,,548.71,,,,
L520085 ANTI-ENS,86235,CPT,,,,,both,, ,548.71,329.22,Medicaid,Illinois Medicaid,,,,,548.71,,,,
Q16088 CENTR B AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,,,,274.22,,,,
Q171728MI-2 AAB RIPA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,,,,274.22,,,,
Q19882 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,,,,274.22,,,,
Q19887 RNP AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,,,,274.22,,,,
Q34088 CHROMAT AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,,,,274.22,,,,
Q37923 SM AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,,,,274.22,,,,
Q38568 SS-A IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,,,,274.22,,,,
Q38569 SS-B IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,,,,274.22,,,,
Q4942 SCLEROD AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,,,,274.22,,,,
Q5810 JO-1 AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,,,,274.22,,,,
Q7448 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,,,,274.22,,,,
Q94025 PM-SCL AB EIA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,,,,274.22,,,,
Q94685 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,,,,274.22,,,,
Q94777 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicaid,Illinois Medicaid,,,,,274.22,,,,
L165620 STRIATIONAL ANTIBODIES,86255,CPT,,,,,both,, ,89.9,53.94,Medicaid,Illinois Medicaid,,,,,89.9,,,,
LC505225 ACETYLCHOLINE RECEPT-MODULAT AB,86255,CPT,,,,,both,, ,260.64,156.38,Medicaid,Illinois Medicaid,,,,,260.64,,,,
Q261 FLUORES AB SCN,86255,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,,,,529.91,,,,
Q261 FLUORES AB SCN,86255,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,,,,529.91,,,,
Q261 FLUORES AB SCN,86255,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,,,,529.91,,,,
Q261 FLUORES AB SCN,86255,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,,,,529.91,,,,
Q263 SMTH MUS AB WRE,86255,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,,,,529.91,,,,
Q263 SMTH MUS AB WRE,86255,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,,,,529.91,,,,
Q263 SMTH MUS AB WRE,86255,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,,,,529.91,,,,
Q263 SMTH MUS AB WRE,86255,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,,,,529.91,,,,
Q91985 ENDOMYSIAL(IGG)ANTIBODY SCRN TITR,86255,CPT,,,,,both,, ,472,283.2,Medicaid,Illinois Medicaid,,,,,472,,,,
"FLUORESCENT AB,TITER",86256,CPT,,,,,both,, ,1217.28,730.36,Medicaid,Illinois Medicaid,,,,,1217.28,,,,
L831723 FLUOR AB TIT,86256,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,,,,529.91,,,,
L831723 FLUOR AB TIT,86256,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,,,,529.91,,,,
L165126 GLIA AB IGA,86258,CPT,,,,,both,, ,57.65,34.59,Medicaid,Illinois Medicaid,,,,,57.65,,,,
Q8889 GLIA AB IGG IA,86258,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,,,,765.96,,,,
Q8889 GLIA AB IGG IA,86258,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,,,,765.96,,,,
L143404 CA15-3 ECLIA,86300,CPT,,,,,both,, ,442.13,265.27,Medicaid,Illinois Medicaid,,,,,442.13,,,,
Q29493 CA 27.29 IA,86300,CPT,,,,,both,, ,481.92,289.15,Medicaid,Illinois Medicaid,,,,,481.92,,,,
TUMR AG CA15-3 27-29,86300,CPT,,,,,both,, ,109.46,65.67,Medicaid,Illinois Medicaid,,,,,109.46,,,,
Q17638 CA 19-9 PERITONEAL FLUID,86301,CPT,,,,,both,, ,716.75,430.05,Medicaid,Illinois Medicaid,,,,,716.75,,,,
Q4698 CA 19-9 IA,86301,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,,,,804.69,,,,
Q4698 CA 19-9 IA,86301,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,,,,804.69,,,,
Q29256 CA 125 IA,86304,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,,,,804.69,,,,
Q91155 TUMR AG CA125,86304,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,,,,804.69,,,,
TUMOR AG CA 125,86304,CPT,,,,,both,, ,804.69,482.81,Medicaid,Illinois Medicaid,,,,,804.69,,,,
Q91155 HE4,86305,CPT,,,,,both,, ,138.65,83.19,Medicaid,Illinois Medicaid,,,,,138.65,,,,
HETEROPHILE AB SCREE,86308,CPT,,,,,both,, ,19.09,11.45,Medicaid,Illinois Medicaid,,,,,19.09,,,,
HETEROPHILE AB SCREE,86308,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,,,,480.79,,,,
Q16379 CGA ECLIA,86316,CPT,,,,,both,, ,481.92,289.15,Medicaid,Illinois Medicaid,,,,,481.92,,,,
Q16379 CGA ECLIA,86316,CPT,,,,,both,, ,481.92,289.15,Medicaid,Illinois Medicaid,,,,,481.92,,,,
Q17410 ALPHA-FETOPROTEIN PERITONEAL FLUI,86316,CPT,,,,,both,, ,429.25,257.55,Medicaid,Illinois Medicaid,,,,,429.25,,,,
Q16963 INF AGENT IMM,86317,CPT,,,,,both,, ,217.52,130.51,Medicaid,Illinois Medicaid,,,,,217.52,,,,
Q16963 INF AGENT IMM,86317,CPT,,,,,both,, ,217.52,130.51,Medicaid,Illinois Medicaid,,,,,217.52,,,,
TETANUS/DIPTHERIA AB,86317,CPT,,,,,both,, ,70,42,Medicaid,Illinois Medicaid,,,,,70,,,,
Q15914 C4 BND PL RID,86329,CPT,,,,,both,, ,81.11,48.66,Medicaid,Illinois Medicaid,,,,,81.11,,,,
Q14978 IMMUNODI OUCN,86331,CPT,,,,,both,, ,69.04,41.42,Medicaid,Illinois Medicaid,,,,,69.04,,,,
Q38940 IMMUNOFIXATION ELECT,86334,CPT,,,,,both,, ,909.75,545.85,Medicaid,Illinois Medicaid,,,,,909.75,,,,
Q549 IFE SERUM,86334,CPT,,,,,both,, ,1021.37,612.82,Medicaid,Illinois Medicaid,,,,,1021.37,,,,
Q549 IFE SERUM,86334,CPT,,,,,both,, ,1021.37,612.82,Medicaid,Illinois Medicaid,,,,,1021.37,,,,
IMM E-PHORS-URIN-CSF,86335,CPT,,,,,both,, ,680.07,408.04,Medicaid,Illinois Medicaid,,,,,680.07,,,,
Q10640 B2TF EL-IF,86335,CPT,,,,,both,, ,680.07,408.04,Medicaid,Illinois Medicaid,,,,,680.07,,,,
Q213 IFE U,86335,CPT,,,,,both,, ,680.07,408.04,Medicaid,Illinois Medicaid,,,,,680.07,,,,
INHIBIN A,86336,CPT,,,,,both,, ,145.66,87.39,Medicaid,Illinois Medicaid,,,,,145.66,,,,
Q36178 INSUL AAB RBA,86337,CPT,,,,,both,, ,207.41,124.44,Medicaid,Illinois Medicaid,,,,,207.41,,,,
Q36178 INSUL AAB RBA,86337,CPT,,,,,both,, ,207.41,124.44,Medicaid,Illinois Medicaid,,,,,207.41,,,,
INTRINSIC FACTOR AB,86340,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
L10413 IFB AB ICMA,86340,CPT,,,,,both,, ,50,30,Medicaid,Illinois Medicaid,,,,,50,,,,
ISLET CELL AB,86341,CPT,,,,,both,, ,296.67,178,Medicaid,Illinois Medicaid,,,,,296.67,,,,
Q34878 GAD-65 AB RBA,86341,CPT,,,,,both,, ,728.07,436.84,Medicaid,Illinois Medicaid,,,,,728.07,,,,
Q36177 IA2 AB,86341,CPT,,,,,both,, ,296.67,178,Medicaid,Illinois Medicaid,,,,,296.67,,,,
Q36741 ISL CL AB IFA,86341,CPT,,,,,both,, ,296.67,178,Medicaid,Illinois Medicaid,,,,,296.67,,,,
Q93022 ZINC TRANSPORTER 8 (ZNT8)ANTIBODY,86341,CPT,,,,,both,, ,264.25,158.55,Medicaid,Illinois Medicaid,,,,,264.25,,,,
Q90123 LEUK HIST REL,86343,CPT,,,,,both,, ,55.95,33.57,Medicaid,Illinois Medicaid,,,,,55.95,,,,
L820022 CHRN URTICAR,86352,CPT,,,,,both,, ,422.3,253.38,Medicaid,Illinois Medicaid,,,,,422.3,,,,
"Q39588 B CELLS, TOTA",86355,CPT,,,,,both,, ,217.52,130.51,Medicaid,Illinois Medicaid,,,,,217.52,,,,
Q10981 RITXN SN CD20,86356,CPT,,,,,both,, ,308.74,185.24,Medicaid,Illinois Medicaid,,,,,308.74,,,,
Q10981 RITXN SN CD20,86356,CPT,,,,,both,, ,308.74,185.24,Medicaid,Illinois Medicaid,,,,,308.74,,,,
Q37088 NK CELLS CF,86357,CPT,,,,,both,, ,217.52,130.51,Medicaid,Illinois Medicaid,,,,,217.52,,,,
"Q39588 T CELLS, TOTA",86359,CPT,,,,,both,, ,217.52,130.51,Medicaid,Illinois Medicaid,,,,,217.52,,,,
Q7924 LYMPH SUBP4 FC,86360,CPT,,,,,both,, ,1515.65,909.39,Medicaid,Illinois Medicaid,,,,,1515.65,,,,
Q7924 LYMPH SUBP4 FC,86360,CPT,,,,,both,, ,1515.65,909.39,Medicaid,Illinois Medicaid,,,,,1515.65,,,,
Q8360 LYMP SUB P5 FC,86361,CPT,,,,,both,, ,822.94,493.76,Medicaid,Illinois Medicaid,,,,,822.94,,,,
"T CELL, ABSO CD4",86361,CPT,,,,,both,, ,878.79,527.27,Medicaid,Illinois Medicaid,,,,,878.79,,,,
Q36952 MOG AB,86362,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,,,,529.91,,,,
L165126TTG AB IGG IA,86364,CPT,,,,,both,, ,57.65,34.59,Medicaid,Illinois Medicaid,,,,,57.65,,,,
Q11070 TTG AB IGG IA,86364,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,,,,765.96,,,,
Q11070 TTG AB IGG IA,86364,CPT,,,,,both,, ,765.96,459.57,Medicaid,Illinois Medicaid,,,,,765.96,,,,
L504600 MSCLSPECKINAB,86366,CPT,,,,,both,, ,180.4,108.24,Medicaid,Illinois Medicaid,,,,,180.4,,,,
Q15038LKM1 AB IGG IA,86376,CPT,,,,,both,, ,682.88,409.72,Medicaid,Illinois Medicaid,,,,,682.88,,,,
Q15038LKM1 AB IGG IA,86376,CPT,,,,,both,, ,682.88,409.72,Medicaid,Illinois Medicaid,,,,,682.88,,,,
Q15038LKM1 AB IGG IA,86376,CPT,,,,,both,, ,682.88,409.72,Medicaid,Illinois Medicaid,,,,,682.88,,,,
Q15038LKM1 AB IGG IA,86376,CPT,,,,,both,, ,682.88,409.72,Medicaid,Illinois Medicaid,,,,,682.88,,,,
Q259 MITO AB IA,86381,CPT,,,,,both,, ,529.91,317.94,Medicaid,Illinois Medicaid,,,,,529.91,,,,
Q30321 MM2AB IGG EIA,86381,CPT,,,,,both,, ,414.83,248.89,Medicaid,Illinois Medicaid,,,,,414.83,,,,
Q94106 NEUT TST VIR,86382,CPT,,,,,both,, ,224.54,134.72,Medicaid,Illinois Medicaid,,,,,224.54,,,,
Q94106 NEUT TST VIR,86382,CPT,,,,,both,, ,224.54,134.72,Medicaid,Illinois Medicaid,,,,,224.54,,,,
PART AGGLUT.SCREEN,86403,CPT,,,,,both,, ,547.31,328.38,Medicaid,Illinois Medicaid,,,,,547.31,,,,
Q16786 S.PN AG U LA,86403,CPT,,,,,both,, ,172.9,103.74,Medicaid,Illinois Medicaid,,,,,172.9,,,,
Q16786 S.PN AG U LA,86403,CPT,,,,,both,, ,172.9,103.74,Medicaid,Illinois Medicaid,,,,,172.9,,,,
PART AGGLUT. TITER,86406,CPT,,,,,both,, ,147.91,88.74,Medicaid,Illinois Medicaid,,,,,147.91,,,,
Q37521 RA FACT QT,86431,CPT,,,,,both,, ,401.19,240.71,Medicaid,Illinois Medicaid,,,,,401.19,,,,
RHEUMATOID FACT QUAN,86431,CPT,,,,,both,, ,55.85,33.51,Medicaid,Illinois Medicaid,,,,,55.85,,,,
RHEUMATOID FACT QUAN,86431,CPT,,,,,both,, ,437.29,262.37,Medicaid,Illinois Medicaid,,,,,437.29,,,,
LRX182877 QTFERON TU,86480,CPT,,,,,both,, ,369.77,221.86,Medicaid,Illinois Medicaid,,,,,369.77,,,,
Q19453 TB GOLD BIO A,86480,CPT,,,,,both,,,403.05,403.05,Medicaid,Illinois Medicaid,,51.95,,,403.05,403.05,403.05,Fee Schedule,
Q19453 TB GOLD BIO A,86480,CPT,,,,,both,, ,403.05,241.83,Medicaid,Illinois Medicaid,,,,,403.05,,,,
Q19453 TB GOLD BIO A,86480,CPT,,,,,both,, ,403.05,241.83,Medicaid,Illinois Medicaid,,,,,403.05,,,,
L006099 RFLX RPR,86592,CPT,,,,,both,, ,48.9,29.34,Medicaid,Illinois Medicaid,,,,,48.9,,,,
L12005 RPR CHAR FLOC,86592,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
L12005 RPR CHAR FLOC,86592,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
"SYPHILIS TEST, QUAL",86592,CPT,,,,,both,, ,42.1,25.26,Medicaid,Illinois Medicaid,,,,,42.1,,,,
L6460 RPR QT CHAR FL,86593,CPT,,,,,both,, ,412.88,247.72,Medicaid,Illinois Medicaid,,,,,412.88,,,,
"SYPHILIS TEST, QUANT",86593,CPT,,,,,both,, ,43.5,26.1,Medicaid,Illinois Medicaid,,,,,43.5,,,,
"SYPHILIS TEST, QUANT",86593,CPT,,,,,both,, ,412.87,247.72,Medicaid,Illinois Medicaid,,,,,412.87,,,,
VOLT-GTD CA CHNL AB,86596,CPT,,,,,both,, ,120.5,72.3,Medicaid,Illinois Medicaid,,,,,120.5,,,,
Q94609 ASP AB,86606,CPT,,,,,both,, ,145.95,87.57,Medicaid,Illinois Medicaid,,,,,145.95,,,,
Q94609 ASP AB,86606,CPT,,,,,both,, ,145.95,87.57,Medicaid,Illinois Medicaid,,,,,145.95,,,,
Q34329 LISTERI AB CF,86609,CPT,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,,,,770.45,,,,
Q94609 BACTERUIM AB,86609,CPT,,,,,both,, ,154.09,92.45,Medicaid,Illinois Medicaid,,,,,154.09,,,,
Q94609 BACTERUIM AB,86609,CPT,,,,,both,, ,154.09,92.45,Medicaid,Illinois Medicaid,,,,,154.09,,,,
BARTONELLA AB,86611,CPT,,,,,both,, ,348.32,208.99,Medicaid,Illinois Medicaid,,,,,348.32,,,,
Q34251 BARTONELLA AB,86611,CPT,,,,,both,, ,264.11,158.46,Medicaid,Illinois Medicaid,,,,,264.11,,,,
Q932 BLASTOM AB ID S,86612,CPT,,,,,both,, ,600.92,360.55,Medicaid,Illinois Medicaid,,,,,600.92,,,,
Q932 BLASTOM AB ID S,86612,CPT,,,,,both,, ,600.92,360.55,Medicaid,Illinois Medicaid,,,,,600.92,,,,
Q37294 B PERTUS AB,86615,CPT,,,,,both,, ,134.44,80.66,Medicaid,Illinois Medicaid,,,,,134.44,,,,
Q37294 B PERTUS AB,86615,CPT,,,,,both,, ,134.44,80.66,Medicaid,Illinois Medicaid,,,,,134.44,,,,
Q8593 BORRELIA BURG.,86617,CPT,,,,,both,, ,232.11,139.26,Medicaid,Illinois Medicaid,,,,,232.11,,,,
Q8593 BORRELIA BURG.,86617,CPT,,,,,both,, ,232.11,139.26,Medicaid,Illinois Medicaid,,,,,232.11,,,,
LYME DISEASE AB,86618,CPT,,,,,both,, ,167.84,100.7,Medicaid,Illinois Medicaid,,,,,167.84,,,,
Q6646 LYM AB IGG/IGM,86618,CPT,,,,,both,, ,573.13,343.87,Medicaid,Illinois Medicaid,,,,,573.13,,,,
Q6646 LYM AB IGG/IGM,86618,CPT,,,,,both,, ,573.13,343.87,Medicaid,Illinois Medicaid,,,,,573.13,,,,
BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Medicaid,Illinois Medicaid,,,,,405.29,,,,
Q91068 BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Medicaid,Illinois Medicaid,,,,,405.29,,,,
Q91121 BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Medicaid,Illinois Medicaid,,,,,405.29,,,,
CANDIDA AB,86628,CPT,,,,,both,, ,157.18,94.3,Medicaid,Illinois Medicaid,,,,,157.18,,,,
CHLAMYDIA AB,86631,CPT,,,,,both,, ,275.62,165.37,Medicaid,Illinois Medicaid,,,,,275.62,,,,
Q38481 C.PNEU AB IGM,86632,CPT,,,,,both,, ,743.51,446.1,Medicaid,Illinois Medicaid,,,,,743.51,,,,
Q5157 C.TRACH AB IGM,86632,CPT,,,,,both,, ,286.57,171.94,Medicaid,Illinois Medicaid,,,,,286.57,,,,
Q5157 C.TRACH AB IGM,86632,CPT,,,,,both,, ,286.57,171.94,Medicaid,Illinois Medicaid,,,,,286.57,,,,
Q906 COCCIDIO AB CF,86635,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
Q906 COCCIDIO AB CF,86635,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
L806606 Q FEV,86638,CPT,,,,,both,, ,120,72,Medicaid,Illinois Medicaid,,,,,120,,,,
Q37071 COXIELLA BRUN,86638,CPT,,,,,both,, ,69.89,41.93,Medicaid,Illinois Medicaid,,,,,69.89,,,,
Q30430 CRYPTO AB IFA,86641,CPT,,,,,both,, ,74.65,44.79,Medicaid,Illinois Medicaid,,,,,74.65,,,,
L6494 CMV IGG CLIA,86644,CPT,,,,,both,, ,1021.5,612.9,Medicaid,Illinois Medicaid,,,,,1021.5,,,,
Q403 CMV AB IGG IA,86644,CPT,,,,,both,, ,1113.43,668.05,Medicaid,Illinois Medicaid,,,,,1113.43,,,,
Q403 CMV AB IGG IA,86644,CPT,,,,,both,, ,1113.43,668.05,Medicaid,Illinois Medicaid,,,,,1113.43,,,,
"CMV AB, IGM",86645,CPT,,,,,both,, ,1277.07,766.24,Medicaid,Illinois Medicaid,,,,,1277.07,,,,
Q8503 CMV AB IGM IA,86645,CPT,,,,,both,, ,485.84,291.5,Medicaid,Illinois Medicaid,,,,,485.84,,,,
Q37512 DIPTHTHER AB,86648,CPT,,,,,both,, ,101.32,60.79,Medicaid,Illinois Medicaid,,,,,101.32,,,,
ENTEROVIRUS AB,86658,CPT,,,,,both,, ,375.82,225.49,Medicaid,Illinois Medicaid,,,,,375.82,,,,
L830764 ENTEROVIR AB,86658,CPT,,,,,both,, ,212,127.2,Medicaid,Illinois Medicaid,,,,,212,,,,
EBV IGG TO EAD,86663,CPT,,,,,both,, ,210.5,126.3,Medicaid,Illinois Medicaid,,,,,210.5,,,,
EBV IGG TO EAD,86663,CPT,,,,,both,, ,210.5,126.3,Medicaid,Illinois Medicaid,,,,,210.5,,,,
"Q6421EPST-BARR, EBNA",86664,CPT,,,,,both,, ,362.91,217.74,Medicaid,Illinois Medicaid,,,,,362.91,,,,
"Q6421EPST-BARR, EBNA",86664,CPT,,,,,both,, ,362.91,217.74,Medicaid,Illinois Medicaid,,,,,362.91,,,,
"Q6421EPSTE-BARR, VCA",86665,CPT,,,,,both,, ,362.91,217.74,Medicaid,Illinois Medicaid,,,,,362.91,,,,
"Q6421EPSTE-BARR, VCA",86665,CPT,,,,,both,, ,362.91,217.74,Medicaid,Illinois Medicaid,,,,,362.91,,,,
Q8474 EBV VCA IGG IA,86665,CPT,,,,,both,, ,210.5,126.3,Medicaid,Illinois Medicaid,,,,,210.5,,,,
Q8474 EBV VCA IGG IA,86665,CPT,,,,,both,, ,210.5,126.3,Medicaid,Illinois Medicaid,,,,,210.5,,,,
Q34271 EHRLICHIA AB,86666,CPT,,,,,both,, ,511.95,307.17,Medicaid,Illinois Medicaid,,,,,511.95,,,,
Q34464 EHRLICHIA AB,86666,CPT,,,,,both,, ,255.98,153.58,Medicaid,Illinois Medicaid,,,,,255.98,,,,
Q34464 EHRLICHIA AB,86666,CPT,,,,,both,, ,255.98,153.58,Medicaid,Illinois Medicaid,,,,,255.98,,,,
FRANCISELLA TULARENS,86668,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
"FUNGUS AB, NOS",86671,CPT,,,,,both,, ,284.32,170.59,Medicaid,Illinois Medicaid,,,,,284.32,,,,
L162045 FUNG AB NOS,86671,CPT,,,,,both,, ,260.85,156.51,Medicaid,Illinois Medicaid,,,,,260.85,,,,
Q10295 SCAB IGA IA,86671,CPT,,,,,both,, ,568.64,341.18,Medicaid,Illinois Medicaid,,,,,568.64,,,,
Q10295 SCAB IGA IA,86671,CPT,,,,,both,, ,568.64,341.18,Medicaid,Illinois Medicaid,,,,,568.64,,,,
Q37695 H PYLORI AB Q,86677,CPT,,,,,both,, ,56.69,34.01,Medicaid,Illinois Medicaid,,,,,56.69,,,,
Q34309STRONGY AB IGG,86682,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,,,,74.93,,,,
Q34309STRONGY AB IGG,86682,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,,,,74.93,,,,
Q34309STRONGY AB IGG,86682,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,,,,74.93,,,,
Q34309STRONGY AB IGG,86682,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,,,,74.93,,,,
"HEPATITIS, DELTA AGE",86692,CPT,,,,,both,, ,1381.76,829.05,Medicaid,Illinois Medicaid,,,,,1381.76,,,,
Q4990 HEP D AB TOTAL,86692,CPT,,,,,both,, ,725.82,435.49,Medicaid,Illinois Medicaid,,,,,725.82,,,,
HERPES SIMP NON-SPEC,86694,CPT,,,,,both,, ,338.21,202.92,Medicaid,Illinois Medicaid,,,,,338.21,,,,
L164806 HSV1/2 IGM,86694,CPT,,,,,both,, ,50.7,30.42,Medicaid,Illinois Medicaid,,,,,50.7,,,,
HERPES SIMP TYPE 1,86695,CPT,,,,,both,, ,129.94,77.96,Medicaid,Illinois Medicaid,,,,,129.94,,,,
Q3636 HSV1 IGG IA,86695,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
Q3636 HSV1 IGG IA,86695,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
Q3636 HSV1 IGG IA,86695,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
Q3636 HSV1 IGG IA,86695,CPT,,,,,both,, ,351.68,211,Medicaid,Illinois Medicaid,,,,,351.68,,,,
HERPES SIMP TYPE 2,86696,CPT,,,,,both,, ,190.86,114.51,Medicaid,Illinois Medicaid,,,,,190.86,,,,
L163006 HSV2 AB IG,86696,CPT,,,,,both,, ,300,180,Medicaid,Illinois Medicaid,,,,,300,,,,
Q17170 HERPES SIMPLEX VIRUS 2 (IGG),86696,CPT,,,,,both,, ,230.25,138.15,Medicaid,Illinois Medicaid,,,,,230.25,,,,
Q3640 HSV 2 SPEC AB,86696,CPT,,,,,both,, ,258.5,155.1,Medicaid,Illinois Medicaid,,,,,258.5,,,,
Q3640 HSV 2 SPEC AB,86696,CPT,,,,,both,, ,258.5,155.1,Medicaid,Illinois Medicaid,,,,,258.5,,,,
Q3640 HSV 2 SPEC AB,86696,CPT,,,,,both,, ,258.5,155.1,Medicaid,Illinois Medicaid,,,,,258.5,,,,
Q3640 HSV 2 SPEC AB,86696,CPT,,,,,both,, ,258.5,155.1,Medicaid,Illinois Medicaid,,,,,258.5,,,,
Q938 HISTOPLASMA,86698,CPT,,,,,both,, ,450.48,270.28,Medicaid,Illinois Medicaid,,,,,450.48,,,,
Q938 HISTOPLASMA,86698,CPT,,,,,both,, ,450.48,270.28,Medicaid,Illinois Medicaid,,,,,450.48,,,,
Q501 HBC AB TOT IA,86704,CPT,,,,,both,, ,898.44,539.06,Medicaid,Illinois Medicaid,,,,,898.44,,,,
Q501 HBC AB TOT IA,86704,CPT,,,,,both,, ,898.44,539.06,Medicaid,Illinois Medicaid,,,,,898.44,,,,
"HEP B CORE AB, IGM",86705,CPT,,,,,both,,,1047.19,1047.19,Medicaid,Illinois Medicaid,,35.07,,,1047.19,1047.19,1047.19,Fee Schedule,
"HEP B CORE AB, IGM",86705,CPT,,,,,both,, ,1047.19,628.31,Medicaid,Illinois Medicaid,,,,,1047.19,,,,
L16881 HBC IGM ICMA,86705,CPT,,,,,both,, ,70.33,42.19,Medicaid,Illinois Medicaid,,,,,70.33,,,,
Q556 HBEAB IA,86707,CPT,,,,,both,, ,999.76,599.85,Medicaid,Illinois Medicaid,,,,,999.76,,,,
Q556 HBEAB IA,86707,CPT,,,,,both,, ,999.76,599.85,Medicaid,Illinois Medicaid,,,,,999.76,,,,
"HEP A AB, TOTAL",86708,CPT,,,,,both,, ,547.88,328.72,Medicaid,Illinois Medicaid,,,,,547.88,,,,
L6726HEPA AB TOT ICM,86708,CPT,,,,,both,, ,547.88,328.72,Medicaid,Illinois Medicaid,,,,,547.88,,,,
Q36504 HEPA AB IGM I,86708,CPT,,,,,both,, ,547.88,328.72,Medicaid,Illinois Medicaid,,,,,547.88,,,,
"HEP A AB, IGM",86709,CPT,,,,,both,,,725.82,725.82,Medicaid,Illinois Medicaid,,33.51,,,725.82,725.82,725.82,Fee Schedule,
"HEP A AB, IGM",86709,CPT,,,,,both,, ,725.82,435.49,Medicaid,Illinois Medicaid,,,,,725.82,,,,
L28928 HEP A AB IGM,86709,CPT,,,,,both,, ,70,42,Medicaid,Illinois Medicaid,,,,,70,,,,
L28928 HEP A AB IGM,86709,CPT,,,,,both,, ,70,42,Medicaid,Illinois Medicaid,,,,,70,,,,
Q7250 INFLUENZA VIRU,86710,CPT,,,,,both,, ,295.83,177.49,Medicaid,Illinois Medicaid,,,,,295.83,,,,
Q7250 INFLUENZA VIRU,86710,CPT,,,,,both,, ,295.83,177.49,Medicaid,Illinois Medicaid,,,,,295.83,,,,
Q91665 STRAT JCV AB,86711,CPT,,,,,both,, ,156.06,93.63,Medicaid,Illinois Medicaid,,,,,156.06,,,,
L164616 LEGIONELL AB,86713,CPT,,,,,both,, ,781.12,468.67,Medicaid,Illinois Medicaid,,,,,781.12,,,,
L819877 LEGIONELL AB,86713,CPT,,,,,both,, ,781.11,468.66,Medicaid,Illinois Medicaid,,,,,781.11,,,,
L819877 LEGIONELL AB,86713,CPT,,,,,both,, ,781.11,468.66,Medicaid,Illinois Medicaid,,,,,781.11,,,,
LEPTOSPIRA AB,86720,CPT,,,,,both,, ,329.51,197.7,Medicaid,Illinois Medicaid,,,,,329.51,,,,
L96552MUMPS IGG CLIA,86735,CPT,,,,,both,, ,540.24,324.14,Medicaid,Illinois Medicaid,,,,,540.24,,,,
MUMPS AB,86735,CPT,,,,,both,, ,96.55,57.93,Medicaid,Illinois Medicaid,,,,,96.55,,,,
MUMPS AB,86735,CPT,,,,,both,, ,588.85,353.31,Medicaid,Illinois Medicaid,,,,,588.85,,,,
Q36565 MUMPS IGM IFA,86735,CPT,,,,,both,, ,588.85,353.31,Medicaid,Illinois Medicaid,,,,,588.85,,,,
Q8624 MUMPSAB IGG IA,86735,CPT,,,,,both,, ,588.85,353.31,Medicaid,Illinois Medicaid,,,,,588.85,,,,
Q659 MP AB IGG EIA,86738,CPT,,,,,both,, ,566.12,339.67,Medicaid,Illinois Medicaid,,,,,566.12,,,,
Q659 MP AB IGG EIA,86738,CPT,,,,,both,, ,566.12,339.67,Medicaid,Illinois Medicaid,,,,,566.12,,,,
Q659 MP AB IGG EIA,86738,CPT,,,,,both,, ,566.12,339.67,Medicaid,Illinois Medicaid,,,,,566.12,,,,
Q659 MP AB IGG EIA,86738,CPT,,,,,both,, ,566.12,339.67,Medicaid,Illinois Medicaid,,,,,566.12,,,,
Q8945 PARVO IGG EIA,86747,CPT,,,,,both,, ,242.5,145.5,Medicaid,Illinois Medicaid,,,,,242.5,,,,
Q8945 PARVO IGG EIA,86747,CPT,,,,,both,, ,242.5,145.5,Medicaid,Illinois Medicaid,,,,,242.5,,,,
Q8945 PARVO IGG EIA,86747,CPT,,,,,both,, ,242.5,145.5,Medicaid,Illinois Medicaid,,,,,242.5,,,,
Q8945 PARVO IGG EIA,86747,CPT,,,,,both,, ,242.5,145.5,Medicaid,Illinois Medicaid,,,,,242.5,,,,
Q34278 ENTAB IGG ELI,86753,CPT,,,,,both,, ,64.27,38.56,Medicaid,Illinois Medicaid,,,,,64.27,,,,
Q34300 PROTOZ AB NOS,86753,CPT,,,,,both,, ,64.27,38.56,Medicaid,Illinois Medicaid,,,,,64.27,,,,
Q90827 T CRUZI AB IA,86753,CPT,,,,,both,, ,64.27,38.56,Medicaid,Illinois Medicaid,,,,,64.27,,,,
L96131 RSV AB QT,86756,CPT,,,,,both,, ,95,57,Medicaid,Illinois Medicaid,,,,,95,,,,
SPOTTED FEVER IGG,86757,CPT,,,,,both,, ,242.5,145.5,Medicaid,Illinois Medicaid,,,,,242.5,,,,
SPOTTED FEVER IGG,86757,CPT,,,,,both,, ,242.5,145.5,Medicaid,Illinois Medicaid,,,,,242.5,,,,
SPOTTED FEVER IGG,86757,CPT,,,,,both,, ,242.5,145.5,Medicaid,Illinois Medicaid,,,,,242.5,,,,
SPOTTED FEVER IGG,86757,CPT,,,,,both,, ,242.5,145.5,Medicaid,Illinois Medicaid,,,,,242.5,,,,
RUBELLA AB,86762,CPT,,,,,both,, ,88.69,53.21,Medicaid,Illinois Medicaid,,,,,88.69,,,,
RUBELLA AB,86762,CPT,,,,,both,, ,906.3,543.78,Medicaid,Illinois Medicaid,,,,,906.3,,,,
Q34256 MEASAB IGMIA,86765,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,,,,871.22,,,,
Q964 MEAS AB IGG IA,86765,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,,,,871.22,,,,
RUBEOLA AB,86765,CPT,,,,,both,, ,111.15,66.69,Medicaid,Illinois Medicaid,,,,,111.15,,,,
RUBEOLA AB,86765,CPT,,,,,both,, ,871.22,522.73,Medicaid,Illinois Medicaid,,,,,871.22,,,,
Q91121 SALMONELLA AB,86768,CPT,,,,,both,, ,127.7,76.62,Medicaid,Illinois Medicaid,,,,,127.7,,,,
Q91121 SALMONELLA AB,86768,CPT,,,,,both,, ,127.7,76.62,Medicaid,Illinois Medicaid,,,,,127.7,,,,
L164055 COVID19ABIGG,86769,CPT,,,,,both,, ,206,123.6,Medicaid,Illinois Medicaid,,,,,206,,,,
Q39504 COVID19 ABIGG,86769,CPT,,,,,both,, ,224.54,134.72,Medicaid,Illinois Medicaid,,,,,224.54,,,,
Q39504 COVID19 ABIGG,86769,CPT,,,,,both,, ,224.54,134.72,Medicaid,Illinois Medicaid,,,,,224.54,,,,
Q4862 TET ATOX ELISA,86774,CPT,,,,,both,, ,98.51,59.1,Medicaid,Illinois Medicaid,,,,,98.51,,,,
Q3679 TOXOPLAS AB IA,86777,CPT,,,,,both,, ,247.83,148.69,Medicaid,Illinois Medicaid,,,,,247.83,,,,
Q8636 TOXOPLASMA AB,86777,CPT,,,,,both,, ,247.83,148.69,Medicaid,Illinois Medicaid,,,,,247.83,,,,
TOXOPLASMA AB,86777,CPT,,,,,both,, ,247.83,148.69,Medicaid,Illinois Medicaid,,,,,247.83,,,,
Q8636 TOXOPL AB IGM,86778,CPT,,,,,both,, ,247.83,148.69,Medicaid,Illinois Medicaid,,,,,247.83,,,,
Q8636 TOXOPL AB IGM,86778,CPT,,,,,both,, ,247.83,148.69,Medicaid,Illinois Medicaid,,,,,247.83,,,,
L082370 TREP AB IA,86780,CPT,,,,,both,, ,132.4,79.44,Medicaid,Illinois Medicaid,,,,,132.4,,,,
Q4112 FTA-ABS IFA,86780,CPT,,,,,both,, ,172.9,103.74,Medicaid,Illinois Medicaid,,,,,172.9,,,,
Q4112 FTA-ABS IFA,86780,CPT,,,,,both,, ,172.9,103.74,Medicaid,Illinois Medicaid,,,,,172.9,,,,
TREPONEMAL AB,86780,CPT,,,,,both,, ,48.9,29.34,Medicaid,Illinois Medicaid,,,,,48.9,,,,
L96206 VZV IGG CLIA,86787,CPT,,,,,both,, ,831.47,498.88,Medicaid,Illinois Medicaid,,,,,831.47,,,,
Q4439 VZV AB IGG IA,86787,CPT,,,,,both,, ,906.3,543.78,Medicaid,Illinois Medicaid,,,,,906.3,,,,
Q8683 VZV AB IGM IA,86787,CPT,,,,,both,, ,906.3,543.78,Medicaid,Illinois Medicaid,,,,,906.3,,,,
VARICELLA-ZOSTER AB,86787,CPT,,,,,both,, ,111.15,66.69,Medicaid,Illinois Medicaid,,,,,111.15,,,,
VARICELLA-ZOSTER AB,86787,CPT,,,,,both,, ,906.3,543.78,Medicaid,Illinois Medicaid,,,,,906.3,,,,
Q16012 WNVAB IGM EIA,86788,CPT,,,,,both,, ,252.61,151.56,Medicaid,Illinois Medicaid,,,,,252.61,,,,
Q36596 WEST NILE VIR,86788,CPT,,,,,both,, ,252.61,151.56,Medicaid,Illinois Medicaid,,,,,252.61,,,,
WEST NILE VIR AB IGM,86788,CPT,,,,,both,, ,252.61,151.56,Medicaid,Illinois Medicaid,,,,,252.61,,,,
Q36596 WEST NILE VIR,86789,CPT,,,,,both,, ,219.2,131.52,Medicaid,Illinois Medicaid,,,,,219.2,,,,
WEST NILE VIR AB,86789,CPT,,,,,both,, ,215.84,129.5,Medicaid,Illinois Medicaid,,,,,215.84,,,,
L878033 HHV-7 IGM IF,86790,CPT,,,,,both,, ,615,369,Medicaid,Illinois Medicaid,,,,,615,,,,
"Q15085 VIRUS AB, NOS",86790,CPT,,,,,both,, ,124.9,74.94,Medicaid,Illinois Medicaid,,,,,124.9,,,,
"Q15085 VIRUS AB, NOS",86790,CPT,,,,,both,, ,124.9,74.94,Medicaid,Illinois Medicaid,,,,,124.9,,,,
Q94264 ZIKA AB IGM,86794,CPT,,,,,both,, ,97.11,58.26,Medicaid,Illinois Medicaid,,,,,97.11,,,,
Q267 TG AB IA,86800,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,,,,751.36,,,,
Q267 TG AB IA,86800,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,,,,751.36,,,,
Q267 TG AB IA,86800,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,,,,751.36,,,,
Q267 TG AB IA,86800,CPT,,,,,both,, ,751.36,450.81,Medicaid,Illinois Medicaid,,,,,751.36,,,,
Q90814 THYROID CANCER (THYROGLOBULIN)MON,86800,CPT,,,,,both,, ,669.25,401.55,Medicaid,Illinois Medicaid,,,,,669.25,,,,
HEPATITIS C AB TEST,86803,CPT,,,,,both,, ,698.32,418.99,Medicaid,Illinois Medicaid,,,,,698.32,,,,
"HEP C AB TEST,CONFIR",86804,CPT,,,,,both,, ,358.42,215.05,Medicaid,Illinois Medicaid,,,,,358.42,,,,
CYTOTOXIC REACTIVE AB SCREEN/STANDARD,86807,CPT,,,,,both,, ,87,52.2,Medicaid,Illinois Medicaid,,,,,87,,,,
Q528 HLA-B27 AG FC,86812,CPT,,,,,both,, ,1449.41,869.64,Medicaid,Illinois Medicaid,,,,,1449.41,,,,
Q528 HLA-B27 AG FC,86812,CPT,,,,,both,, ,1449.41,869.64,Medicaid,Illinois Medicaid,,,,,1449.41,,,,
HLA SOLID PHASE/CALSS I&II AB QUAL,86828,CPT,,,,,both,, ,70,42,Medicaid,Illinois Medicaid,,,,,70,,,,
HLA SOLID PHASE/CLASS 1 AB QUAL HIGHDEF,86832,CPT,,,,,both,, ,356,213.6,Medicaid,Illinois Medicaid,,,,,356,,,,
L117065 PROTH AB IGG,86849,CPT,,,,,both,, ,157,94.2,Medicaid,Illinois Medicaid,,,,,157,,,,
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,, ,61.75,37.05,Medicaid,Illinois Medicaid,,,,,61.75,,,,
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,,,318,318,Medicaid,Illinois Medicaid,,35.49,,,318,318,318,Fee Schedule,
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,, ,318,190.8,Medicaid,Illinois Medicaid,,,,,318,,,,
O51200 AB SCRN,86850,CPT,,,,,both,, ,291.75,175.05,Medicaid,Illinois Medicaid,,,,,291.75,,,,
O51128 AB ELUTION,86860,CPT,,,,,both,, ,174.3,104.58,Medicaid,Illinois Medicaid,,,,,174.3,,,,
O51128 AB ELUTION,86860,CPT,,,,,both,, ,174.3,104.58,Medicaid,Illinois Medicaid,,,,,174.3,,,,
"ANTIBODY ID,EA PANEL",86870,CPT,,,,,both,, ,488.65,293.19,Medicaid,Illinois Medicaid,,,,,488.65,,,,
O51108 AB ID EA PNL,86870,CPT,,,,,both,, ,475.18,285.1,Medicaid,Illinois Medicaid,,,,,475.18,,,,
O51612 DAT,86880,CPT,,,,,both,, ,250.64,150.38,Medicaid,Illinois Medicaid,,,,,250.64,,,,
O51612 DAT,86880,CPT,,,,,both,, ,250.64,150.38,Medicaid,Illinois Medicaid,,,,,250.64,,,,
IDAT QUAL EA RGT RBC,86885,CPT,,,,,both,, ,39.57,23.74,Medicaid,Illinois Medicaid,,,,,39.57,,,,
IDAT EACH AB TITER,86886,CPT,,,,,both,, ,326.14,195.68,Medicaid,Illinois Medicaid,,,,,326.14,,,,
"AUTO COMPONENT,PROCS",86890,CPT,,,,,both,, ,756.41,453.84,Medicaid,Illinois Medicaid,,,,,756.41,,,,
AUTOL BID OP SALV,86891,CPT,,,,,both,, ,3941.23,2364.73,Medicaid,Illinois Medicaid,,,,,3941.23,,,,
BLOOD TYPING ABO,86900,CPT,,,,,both,, ,38.73,23.23,Medicaid,Illinois Medicaid,,,,,38.73,,,,
BLOOD TYPING ABO,86900,CPT,,,,,both,,,97.39,97.39,Medicaid,Illinois Medicaid,,2.99,,,97.39,97.39,97.39,Fee Schedule,
REF  BLD TYPING ABO,86900,CPT,,,,,both,, ,97.39,58.43,Medicaid,Illinois Medicaid,,,,,97.39,,,,
REF  BLD TYPING ABO,86900,CPT,,,,,both,, ,97.39,58.43,Medicaid,Illinois Medicaid,,,,,97.39,,,,
BLOOD TYPING RH D,86901,CPT,,,,,both,, ,38.73,23.23,Medicaid,Illinois Medicaid,,,,,38.73,,,,
BLOOD TYPING RH D,86901,CPT,,,,,both,,,97.39,97.39,Medicaid,Illinois Medicaid,,2.99,,,97.39,97.39,97.39,Fee Schedule,
REF  BLD TYPING RH D,86901,CPT,,,,,both,, ,97.39,58.43,Medicaid,Illinois Medicaid,,,,,97.39,,,,
REF  BLD TYPING RH D,86901,CPT,,,,,both,, ,97.39,58.43,Medicaid,Illinois Medicaid,,,,,97.39,,,,
BLD TYPE DONOR EA AG,86902,CPT,,,,,both,, ,277.86,166.71,Medicaid,Illinois Medicaid,,,,,277.86,,,,
BLD TYPING OTHER AG,86905,CPT,,,,,both,,,217.52,217.52,Medicaid,Illinois Medicaid,,36.64,,,217.52,217.52,217.52,Fee Schedule,
O51232 RBC AG TYP,86905,CPT,,,,,both,, ,217.52,130.51,Medicaid,Illinois Medicaid,,,,,217.52,,,,
O51232 RBC AG TYP,86905,CPT,,,,,both,, ,217.52,130.51,Medicaid,Illinois Medicaid,,,,,217.52,,,,
O51920 RH PHENO,86906,CPT,,,,,both,, ,224,134.4,Medicaid,Illinois Medicaid,,,,,224,,,,
COMPATIB TEST IS,86920,CPT,,,,,both,,,275.62,275.62,Medicaid,Illinois Medicaid,,4.7,,,275.62,275.62,275.62,Fee Schedule,
COMPATIB TEST IS,86920,CPT,,,,,both,, ,275.62,165.37,Medicaid,Illinois Medicaid,,,,,275.62,,,,
COMPATIB TEST INCUB,86921,CPT,,,,,both,,,103,103,Medicaid,Illinois Medicaid,,18.8,,,103,103,103,Fee Schedule,
COMPATIB TEST INCUB,86921,CPT,,,,,both,, ,103,61.8,Medicaid,Illinois Medicaid,,,,,103,,,,
COMPATIB TEST AHG,86922,CPT,,,,,both,,,250.07,250.07,Medicaid,Illinois Medicaid,,9.4,,,250.07,250.07,250.07,Fee Schedule,
COMPATIB TEST AHG,86922,CPT,,,,,both,, ,250.07,150.04,Medicaid,Illinois Medicaid,,,,,250.07,,,,
FFP THAWING,86927,CPT,,,,,both,, ,233.8,140.28,Medicaid,Illinois Medicaid,,,,,233.8,,,,
PLATELETS POOLING,86965,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,,,,141.46,,,,
O51010 CHEM TREATMNT,86970,CPT,,,,,both,, ,212.44,127.46,Medicaid,Illinois Medicaid,,,,,212.44,,,,
RBC PRETREAT CHEM,86970,CPT,,,,,both,, ,231.55,138.93,Medicaid,Illinois Medicaid,,,,,231.55,,,,
O51701 ENZYME TREAT,86971,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,,,,141.46,,,,
O51701 ENZYME TREAT,86971,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,,,,141.46,,,,
O51122 RBC CELL SEP,86972,CPT,,,,,both,, ,246.99,148.19,Medicaid,Illinois Medicaid,,,,,246.99,,,,
"RBC PRETREAT,SER,INC",86975,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,,,,141.46,,,,
"RBC PRETREAT,SER DIL",86976,CPT,,,,,both,, ,61.8,37.08,Medicaid,Illinois Medicaid,,,,,61.8,,,,
RBC PRETREAT W-INHIB,86977,CPT,,,,,both,, ,218.64,131.18,Medicaid,Illinois Medicaid,,,,,218.64,,,,
O51234 ADSORPTION,86978,CPT,,,,,both,, ,149.35,89.61,Medicaid,Illinois Medicaid,,,,,149.35,,,,
RBC PRETREAT DIFF EA,86978,CPT,,,,,both,, ,162.79,97.67,Medicaid,Illinois Medicaid,,,,,162.79,,,,
SPLIT BLOOD OR PROD,86985,CPT,,,,,both,, ,546.75,328.05,Medicaid,Illinois Medicaid,,,,,546.75,,,,
Q34286 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Medicaid,Illinois Medicaid,,,,,177.39,,,,
Q37213 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Medicaid,Illinois Medicaid,,,,,177.39,,,,
Q39480 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Medicaid,Illinois Medicaid,,,,,177.39,,,,
Q4554 SPECIMEN CONCE,87015,CPT,,,,,both,, ,177.39,106.43,Medicaid,Illinois Medicaid,,,,,177.39,,,,
SPECIMEN CONCENTRATI,87015,CPT,,,,,both,, ,177.39,106.43,Medicaid,Illinois Medicaid,,,,,177.39,,,,
CULTURE BLOOD BACTER,87040,CPT,,,,,both,,,691.29,691.29,Medicaid,Illinois Medicaid,,40.16,,,691.29,691.29,691.29,Fee Schedule,
CULTURE BLOOD BACTER,87040,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
CULT STL BACT W-ISOL,87045,CPT,,,,,both,, ,92.9,55.74,Medicaid,Illinois Medicaid,,,,,92.9,,,,
CULT STL BACT W-ISOL,87045,CPT,,,,,both,,,301.72,301.72,Medicaid,Illinois Medicaid,,36.62,,,301.72,301.72,301.72,Fee Schedule,
CULT STL BACT W-ISOL,87045,CPT,,,,,both,, ,301.72,181.03,Medicaid,Illinois Medicaid,,,,,301.72,,,,
CULT STL BACT EA ADD,87046,CPT,,,,,both,, ,92.9,55.74,Medicaid,Illinois Medicaid,,,,,92.9,,,,
CULT STL BACT EA ADD,87046,CPT,,,,,both,, ,94.58,56.74,Medicaid,Illinois Medicaid,,,,,94.58,,,,
CULTURE BACTERIA OTH,87070,CPT,,,,,both,, ,84.76,50.85,Medicaid,Illinois Medicaid,,,,,84.76,,,,
CULTURE BACTERIA OTH,87070,CPT,,,,,both,,,998.91,998.91,Medicaid,Illinois Medicaid,,6.08,,,998.91,998.91,998.91,Fee Schedule,
CULTURE BACTERIA OTH,87070,CPT,,,,,both,, ,998.91,599.34,Medicaid,Illinois Medicaid,,,,,998.91,,,,
L188227 CULTURE BACT,87070,CPT,,,,,both,, ,86.2,51.72,Medicaid,Illinois Medicaid,,,,,86.2,,,,
CULT BAC AEROB OT QT,87071,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
CULT BACT ANA ANY SO,87075,CPT,,,,,both,,,623.38,623.38,Medicaid,Illinois Medicaid,,36.9,,,623.38,623.38,623.38,Fee Schedule,
L8904 ANAEROBIC CULT,87075,CPT,,,,,both,, ,623.38,374.02,Medicaid,Illinois Medicaid,,,,,623.38,,,,
L8904 ANAEROBIC CULT,87075,CPT,,,,,both,, ,623.38,374.02,Medicaid,Illinois Medicaid,,,,,623.38,,,,
CULT ANAERO IDENT EA,87076,CPT,,,,,both,, ,412.87,247.72,Medicaid,Illinois Medicaid,,,,,412.87,,,,
L182345 ORG ID ANAER,87076,CPT,,,,,both,, ,244.44,146.66,Medicaid,Illinois Medicaid,,,,,244.44,,,,
CULT AEROBIC ID REF,87077,CPT,,,,,both,, ,389.01,233.4,Medicaid,Illinois Medicaid,,,,,389.01,,,,
CULT AEROBIC ID REF,87077,CPT,,,,,both,, ,389.01,233.4,Medicaid,Illinois Medicaid,,,,,389.01,,,,
CULTURE SCREEN ONLY,87081,CPT,,,,,both,, ,65.39,39.23,Medicaid,Illinois Medicaid,,,,,65.39,,,,
CULTURE SCREEN ONLY,87081,CPT,,,,,both,,,420.72,420.72,Medicaid,Illinois Medicaid,,31.53,,,420.72,420.72,420.72,Fee Schedule,
CULTURE SCREEN ONLY,87081,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
CULT URINE-COLONY CT,87086,CPT,,,,,both,, ,59.78,35.86,Medicaid,Illinois Medicaid,,,,,59.78,,,,
CULT URINE-COLONY CT,87086,CPT,,,,,both,,,495.95,495.95,Medicaid,Illinois Medicaid,,31.53,,,495.95,495.95,495.95,Fee Schedule,
CULT URINE-COLONY CT,87086,CPT,,,,,both,, ,495.95,297.57,Medicaid,Illinois Medicaid,,,,,495.95,,,,
CULT URINE W-P ID,87088,CPT,,,,,both,, ,42.37,25.42,Medicaid,Illinois Medicaid,,,,,42.37,,,,
L188243CUL SKIN FUNG,87101,CPT,,,,,both,, ,349.99,209.99,Medicaid,Illinois Medicaid,,,,,349.99,,,,
L188243CUL SKIN FUNG,87101,CPT,,,,,both,, ,349.99,209.99,Medicaid,Illinois Medicaid,,,,,349.99,,,,
CULT FUNGUS ISOLATIO,87102,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
Q4553 CULT FUNGUS IS,87102,CPT,,,,,both,, ,525.7,315.42,Medicaid,Illinois Medicaid,,,,,525.7,,,,
CULTURE FUNGUS BLOOD,87103,CPT,,,,,both,, ,518.69,311.21,Medicaid,Illinois Medicaid,,,,,518.69,,,,
Q4606 FUNGUS CULT BL,87103,CPT,,,,,both,, ,478.95,287.37,Medicaid,Illinois Medicaid,,,,,478.95,,,,
Q575 FUNGAL ID EXAM,87106,CPT,,,,,both,, ,123.21,73.92,Medicaid,Illinois Medicaid,,,,,123.21,,,,
Q575 FUNGAL ID EXAM,87106,CPT,,,,,both,, ,123.21,73.92,Medicaid,Illinois Medicaid,,,,,123.21,,,,
L8474 MOLD IDENTIF,87107,CPT,,,,,both,, ,123.21,73.92,Medicaid,Illinois Medicaid,,,,,123.21,,,,
L8474 MOLD IDENTIF,87107,CPT,,,,,both,, ,123.21,73.92,Medicaid,Illinois Medicaid,,,,,123.21,,,,
CULT MYCOPLASMA,87109,CPT,,,,,both,, ,1404.5,842.7,Medicaid,Illinois Medicaid,,,,,1404.5,,,,
UREA-MYCOPLS HOM CULT,87109,CPT,,,,,both,, ,153.9,92.34,Medicaid,Illinois Medicaid,,,,,153.9,,,,
Q690 CULTURE CHLAMYD,87110,CPT,,,,,both,, ,1104.45,662.67,Medicaid,Illinois Medicaid,,,,,1104.45,,,,
Q690 CULTURE CHLAMYD,87110,CPT,,,,,both,, ,1104.45,662.67,Medicaid,Illinois Medicaid,,,,,1104.45,,,,
CULT MYCOBACTERIA,87116,CPT,,,,,both,,,827.43,827.43,Medicaid,Illinois Medicaid,,42.14,,,827.43,827.43,827.43,Fee Schedule,
CULT MYCOBACTERIA,87116,CPT,,,,,both,, ,827.43,496.45,Medicaid,Illinois Medicaid,,,,,827.43,,,,
Q10526MBAC BL CMBCS,87116,CPT,,,,,both,, ,827.43,496.45,Medicaid,Illinois Medicaid,,,,,827.43,,,,
Q4554 CULT MYCOBACTE,87116,CPT,,,,,both,, ,827.43,496.45,Medicaid,Illinois Medicaid,,,,,827.43,,,,
Q690 CULT TYPE IMMUN,87140,CPT,,,,,both,, ,323.34,194,Medicaid,Illinois Medicaid,,,,,323.34,,,,
Q690 CULT TYPE IMMUN,87140,CPT,,,,,both,, ,323.34,194,Medicaid,Illinois Medicaid,,,,,323.34,,,,
"CULT TYPE,IMMUNOLOGI",87147,CPT,,,,,both,, ,547.31,328.38,Medicaid,Illinois Medicaid,,,,,547.31,,,,
"CULT TYPE,NUCLEIC AC",87149,CPT,,,,,both,, ,239.97,143.98,Medicaid,Illinois Medicaid,,,,,239.97,,,,
LRX183755 AFB ID PB,87149,CPT,,,,,both,, ,239.99,143.99,Medicaid,Illinois Medicaid,,,,,239.99,,,,
DNA-RNA AMPLI PROBE,87150,CPT,,,,,both,, ,339.33,203.59,Medicaid,Illinois Medicaid,,,,,339.33,,,,
LRX183327 MOLD ID,87153,CPT,,,,,both,, ,239.99,143.99,Medicaid,Illinois Medicaid,,,,,239.99,,,,
QRX9000010 AFB ID,87153,CPT,,,,,both,, ,388.45,233.07,Medicaid,Illinois Medicaid,,,,,388.45,,,,
MACRO EXAM ARTHROPOD,87168,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,,,,480.79,,,,
MACRO EXAM PARASITE,87169,CPT,,,,,both,, ,207.7,124.62,Medicaid,Illinois Medicaid,,,,,207.7,,,,
PINWORM EXAM,87172,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,,,,480.79,,,,
TISSUE HOMOGENIZ CUL,87176,CPT,,,,,both,, ,300.6,180.36,Medicaid,Illinois Medicaid,,,,,300.6,,,,
OVA-PARASITES SMEARS,87177,CPT,,,,,both,, ,107.21,64.32,Medicaid,Illinois Medicaid,,,,,107.21,,,,
Q681 OVA-PARASITES S,87177,CPT,,,,,both,, ,320.25,192.15,Medicaid,Illinois Medicaid,,,,,320.25,,,,
Q681 OVA-PARASITES S,87177,CPT,,,,,both,, ,320.25,192.15,Medicaid,Illinois Medicaid,,,,,320.25,,,,
MICROB SUSCEP DIFFUS,87181,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,,,,141.46,,,,
Q18869 MOD HODGE DD,87184,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,,,,141.46,,,,
Q18869 MOD HODGE DD,87184,CPT,,,,,both,, ,141.46,84.87,Medicaid,Illinois Medicaid,,,,,141.46,,,,
MICROB SUSCEP ENZYME,87185,CPT,,,,,both,, ,180.19,108.11,Medicaid,Illinois Medicaid,,,,,180.19,,,,
MICROBE SUSCEPT REF,87186,CPT,,,,,both,, ,586.05,351.63,Medicaid,Illinois Medicaid,,,,,586.05,,,,
MICROBE SUSCEPT REF,87186,CPT,,,,,both,, ,586.05,351.63,Medicaid,Illinois Medicaid,,,,,586.05,,,,
"SMEAR,GRAM STAIN",87205,CPT,,,,,both,, ,42.1,25.26,Medicaid,Illinois Medicaid,,,,,42.1,,,,
"SMEAR,GRAM STAIN",87205,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
Q4503AC-FST BACI STN,87206,CPT,,,,,both,, ,507.74,304.64,Medicaid,Illinois Medicaid,,,,,507.74,,,,
Q4503AC-FST BACI STN,87206,CPT,,,,,both,, ,507.74,304.64,Medicaid,Illinois Medicaid,,,,,507.74,,,,
Q4503AC-FST BACI STN,87206,CPT,,,,,both,, ,507.74,304.64,Medicaid,Illinois Medicaid,,,,,507.74,,,,
Q4503AC-FST BACI STN,87206,CPT,,,,,both,, ,507.74,304.64,Medicaid,Illinois Medicaid,,,,,507.74,,,,
"SMEAR,SPECIAL STAIN",87207,CPT,,,,,both,, ,555.45,333.27,Medicaid,Illinois Medicaid,,,,,555.45,,,,
Q681 SMEAR COMPLEX S,87209,CPT,,,,,both,, ,190.86,114.51,Medicaid,Illinois Medicaid,,,,,190.86,,,,
Q681 SMEAR COMPLEX S,87209,CPT,,,,,both,, ,190.86,114.51,Medicaid,Illinois Medicaid,,,,,190.86,,,,
SMEARWET MOUNT SAL-I,87210,CPT,,,,,both,, ,420.72,252.43,Medicaid,Illinois Medicaid,,,,,420.72,,,,
Q8628 SCABIES MIC EX,87220,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,,,,480.79,,,,
Q8628 SCABIES MIC EX,87220,CPT,,,,,both,, ,480.79,288.47,Medicaid,Illinois Medicaid,,,,,480.79,,,,
Q689 VIR CULT IFA-TC,87252,CPT,,,,,both,, ,929.87,557.92,Medicaid,Illinois Medicaid,,,,,929.87,,,,
Q689 VIR CULT IFA-TC,87252,CPT,,,,,both,, ,929.87,557.92,Medicaid,Illinois Medicaid,,,,,929.87,,,,
L186015 VIR INOC SHL,87254,CPT,,,,,both,, ,415.68,249.4,Medicaid,Illinois Medicaid,,,,,415.68,,,,
Q17495VIRUS INOCU SH,87254,CPT,,,,,both,, ,415.68,249.4,Medicaid,Illinois Medicaid,,,,,415.68,,,,
VIRUS INOCU SHELL VI,87254,CPT,,,,,both,, ,415.68,249.4,Medicaid,Illinois Medicaid,,,,,415.68,,,,
Q2649 HSV CULT WREF,87255,CPT,,,,,both,, ,470.69,282.41,Medicaid,Illinois Medicaid,,,,,470.69,,,,
Q841 HSV CULT HS,87255,CPT,,,,,both,, ,470.69,282.41,Medicaid,Illinois Medicaid,,,,,470.69,,,,
VIRUS ISOLATION GEN,87255,CPT,,,,,both,, ,470.69,282.41,Medicaid,Illinois Medicaid,,,,,470.69,,,,
"Q34966 PERTUSSIS AG,",87265,CPT,,,,,both,, ,531.32,318.79,Medicaid,Illinois Medicaid,,,,,531.32,,,,
"Q34966 PERTUSSIS AG,",87265,CPT,,,,,both,, ,531.32,318.79,Medicaid,Illinois Medicaid,,,,,531.32,,,,
INFAGT DT QLSQT CRYP,87272,CPT,,,,,both,, ,525.7,315.42,Medicaid,Illinois Medicaid,,,,,525.7,,,,
Q37213 INFAGT DT QLS,87272,CPT,,,,,both,, ,525.7,315.42,Medicaid,Illinois Medicaid,,,,,525.7,,,,
Q39480 INFAGT DT QLS,87272,CPT,,,,,both,, ,525.7,315.42,Medicaid,Illinois Medicaid,,,,,525.7,,,,
L188227 LEGION PNEUM,87278,CPT,,,,,both,, ,156,93.6,Medicaid,Illinois Medicaid,,,,,156,,,,
Q34475 LEGPNE AG DFA,87278,CPT,,,,,both,, ,277.86,166.71,Medicaid,Illinois Medicaid,,,,,277.86,,,,
Q34475 LEGPNE AG DFA,87278,CPT,,,,,both,, ,277.86,166.71,Medicaid,Illinois Medicaid,,,,,277.86,,,,
Q34286 PNEUMOCYSTIS,87281,CPT,,,,,both,, ,371.89,223.13,Medicaid,Illinois Medicaid,,,,,371.89,,,,
Q34286 PNEUMOCYSTIS,87281,CPT,,,,,both,, ,371.89,223.13,Medicaid,Illinois Medicaid,,,,,371.89,,,,
VARICELLA ZOSTER AGI,87290,CPT,,,,,both,, ,518.69,311.21,Medicaid,Illinois Medicaid,,,,,518.69,,,,
"ANTIB DETECT NOS, IF",87299,CPT,,,,,both,, ,159.14,95.48,Medicaid,Illinois Medicaid,,,,,159.14,,,,
AG DETECT POLYVAL IF,87300,CPT,,,,,both,, ,122.09,73.25,Medicaid,Illinois Medicaid,,,,,122.09,,,,
L185041 ADV 40/41 IA,87301,CPT,,,,,both,, ,123.6,74.16,Medicaid,Illinois Medicaid,,,,,123.6,,,,
Q14950ASPE AG EIA IA,87305,CPT,,,,,both,, ,111.7,67.02,Medicaid,Illinois Medicaid,,,,,111.7,,,,
CLOSTRIDIUM DIF TOXN,87324,CPT,,,,,both,, ,118.16,70.89,Medicaid,Illinois Medicaid,,,,,118.16,,,,
CLOSTRIDIUM DIF TOXN,87324,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
CRYPTOCOCCUS NEOF AG,87327,CPT,,,,,both,, ,1321.42,792.85,Medicaid,Illinois Medicaid,,,,,1321.42,,,,
"CRYPTOSPOR AG,EIA",87328,CPT,,,,,both,, ,64.55,38.73,Medicaid,Illinois Medicaid,,,,,64.55,,,,
Q39480 INFAGT DT QLS,87329,CPT,,,,,both,, ,200.12,120.07,Medicaid,Illinois Medicaid,,,,,200.12,,,,
Q39480 INFAGT DT QLS,87329,CPT,,,,,both,, ,200.12,120.07,Medicaid,Illinois Medicaid,,,,,200.12,,,,
Q8625 GIARDAG EIA IA,87329,CPT,,,,,both,, ,192.49,115.49,Medicaid,Illinois Medicaid,,,,,192.49,,,,
Q34838 HPYLAG EIA IA,87338,CPT,,,,,both,, ,183.56,110.13,Medicaid,Illinois Medicaid,,,,,183.56,,,,
Q34838 HPYLAG EIA IA,87338,CPT,,,,,both,, ,183.56,110.13,Medicaid,Illinois Medicaid,,,,,183.56,,,,
HBSAG,87340,CPT,,,,,both,,,570.04,570.04,Medicaid,Illinois Medicaid,,40.16,,,570.04,570.04,570.04,Fee Schedule,
HBSAG,87340,CPT,,,,,both,, ,570.04,342.02,Medicaid,Illinois Medicaid,,,,,570.04,,,,
Q555 HBEAG IA,87350,CPT,,,,,both,, ,1003.97,602.38,Medicaid,Illinois Medicaid,,,,,1003.97,,,,
Q555 HBEAG IA,87350,CPT,,,,,both,, ,1003.97,602.38,Medicaid,Illinois Medicaid,,,,,1003.97,,,,
Q91212H.GALA AG U IA,87385,CPT,,,,,both,, ,322.49,193.49,Medicaid,Illinois Medicaid,,,,,322.49,,,,
Q91212H.GALA AG U IA,87385,CPT,,,,,both,, ,322.49,193.49,Medicaid,Illinois Medicaid,,,,,322.49,,,,
"INFLUENZA A AG,EIA",87400,CPT,,,,,both,, ,118.16,70.89,Medicaid,Illinois Medicaid,,,,,118.16,,,,
"INFLUENZA A AG,EIA",87400,CPT,,,,,both,, ,959.34,575.6,Medicaid,Illinois Medicaid,,,,,959.34,,,,
L6866 ROTAVIRUS DDIA,87425,CPT,,,,,both,, ,123.6,74.16,Medicaid,Illinois Medicaid,,,,,123.6,,,,
"ROTAVIRUS AG,EIA",87425,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
COVID19 AG EIA,87426,CPT,,,,,both,, ,84.2,50.52,Medicaid,Illinois Medicaid,,,,,84.2,,,,
COVID19 AG EIA,87426,CPT,,,,,both,, ,88.35,53.01,Medicaid,Illinois Medicaid,,,,,88.35,,,,
"SHIGA-LIKE TOX AG,EI",87427,CPT,,,,,both,, ,113.1,67.86,Medicaid,Illinois Medicaid,,,,,113.1,,,,
"SHIGA-LIKE TOX AG,EI",87427,CPT,,,,,both,, ,156.33,93.79,Medicaid,Illinois Medicaid,,,,,156.33,,,,
COVID19AG FLUAB SOF2,87428,CPT,,,,,both,, ,159,95.4,Medicaid,Illinois Medicaid,,,,,159,,,,
"AG DETEC NOS,EIA MUL",87449,CPT,,,,,both,, ,886.09,531.65,Medicaid,Illinois Medicaid,,,,,886.09,,,,
FUNGITELL SERUM,87449,CPT,,,,,both,, ,121.98,73.18,Medicaid,Illinois Medicaid,,,,,121.98,,,,
FUNGITELL SERUM,87449,CPT,,,,,both,, ,121.98,73.18,Medicaid,Illinois Medicaid,,,,,121.98,,,,
Q15544 NOROV EIA IA,87449,CPT,,,,,both,, ,886.09,531.65,Medicaid,Illinois Medicaid,,,,,886.09,,,,
Q8856 LEGIO AG U IA,87449,CPT,,,,,both,, ,886.09,531.65,Medicaid,Illinois Medicaid,,,,,886.09,,,,
CANDIDA DNA AMP PROB,87481,CPT,,,,,both,, ,281.8,169.08,Medicaid,Illinois Medicaid,,,,,281.8,,,,
L183410 M ENCEPH CSF,87483,CPT,,,,,both,, ,1650,990,Medicaid,Illinois Medicaid,,,,,1650,,,,
L139650 CPNEU DNA,87486,CPT,,,,,both,, ,175,105,Medicaid,Illinois Medicaid,,,,,175,,,,
Q37444 C PNEUMO PCR,87486,CPT,,,,,both,, ,105.27,63.16,Medicaid,Illinois Medicaid,,,,,105.27,,,,
CHLMYD TRACH DNA AMP,87491,CPT,,,,,both,,,968.6,968.6,Medicaid,Illinois Medicaid,,14.7,,,968.6,968.6,968.6,Fee Schedule,
L180021 CTRACH AMPPR,87491,CPT,,,,,both,, ,888.63,533.17,Medicaid,Illinois Medicaid,,,,,888.63,,,,
Q11361 C.TRA RNA TMA,87491,CPT,,,,,both,, ,968.6,581.16,Medicaid,Illinois Medicaid,,,,,968.6,,,,
Q11361 C.TRA RNA TMA,87491,CPT,,,,,both,, ,968.6,581.16,Medicaid,Illinois Medicaid,,,,,968.6,,,,
Q11361 C.TRA RNA TMA,87491,CPT,,,,,both,, ,968.6,581.16,Medicaid,Illinois Medicaid,,,,,968.6,,,,
Q11361 C.TRA RNA TMA,87491,CPT,,,,,both,, ,968.6,581.16,Medicaid,Illinois Medicaid,,,,,968.6,,,,
C DIFF AMPLI PROBE,87493,CPT,,,,,both,, ,313.51,188.1,Medicaid,Illinois Medicaid,,,,,313.51,,,,
Q10601 CMV QL RT-PCR,87496,CPT,,,,,both,, ,1051.68,631,Medicaid,Illinois Medicaid,,,,,1051.68,,,,
Q10600 CMV QT RT-PCR,87497,CPT,,,,,both,, ,889.73,533.83,Medicaid,Illinois Medicaid,,,,,889.73,,,,
Q15082EVRNA QL RTPCR,87498,CPT,,,,,both,, ,437.85,262.71,Medicaid,Illinois Medicaid,,,,,437.85,,,,
INFLU DNA AMP PROBE,87502,CPT,,,,,both,, ,215.11,129.06,Medicaid,Illinois Medicaid,,,,,215.11,,,,
INFLU DNA AMP PROBE,87502,CPT,,,,,both,,,887.49,887.49,Medicaid,Illinois Medicaid,,18.52,,,887.49,887.49,887.49,Fee Schedule,
INFLU DNA AMP PROBE,87502,CPT,,,,,both,, ,887.49,532.49,Medicaid,Illinois Medicaid,,,,,887.49,,,,
L183480 GI PRO STOOL,87507,CPT,,,,,both,, ,1090.2,654.12,Medicaid,Illinois Medicaid,,,,,1090.2,,,,
GARDNER VAG DNA QUAN,87512,CPT,,,,,both,, ,335.12,201.07,Medicaid,Illinois Medicaid,,,,,335.12,,,,
Q8369 HBV QT RT-PCR,87517,CPT,,,,,both,, ,1011.26,606.75,Medicaid,Illinois Medicaid,,,,,1011.26,,,,
Q8369 HBV QT RT-PCR,87517,CPT,,,,,both,, ,1011.26,606.75,Medicaid,Illinois Medicaid,,,,,1011.26,,,,
Q37273 HCVRNA QL TMA,87521,CPT,,,,,both,, ,728.91,437.34,Medicaid,Illinois Medicaid,,,,,728.91,,,,
Q37273 HCVRNA QL TMA,87521,CPT,,,,,both,, ,728.91,437.34,Medicaid,Illinois Medicaid,,,,,728.91,,,,
Q11348 HCV QT RT-PCR,87522,CPT,,,,,both,, ,1066.84,640.1,Medicaid,Illinois Medicaid,,,,,1066.84,,,,
Q35645 HCV RNAQT RT-,87522,CPT,,,,,both,, ,2133.69,1280.21,Medicaid,Illinois Medicaid,,,,,2133.69,,,,
Q35645 HCV RNAQT RT-,87522,CPT,,,,,both,, ,2133.69,1280.21,Medicaid,Illinois Medicaid,,,,,2133.69,,,,
"HSV, DNA, AMP PROBE",87529,CPT,,,,,both,, ,3455.1,2073.06,Medicaid,Illinois Medicaid,,,,,3455.1,,,,
"Q34257 HSV, DNA, AMP",87529,CPT,,,,,both,, ,968.6,581.16,Medicaid,Illinois Medicaid,,,,,968.6,,,,
"Q34257 HSV, DNA, AMP",87529,CPT,,,,,both,, ,968.6,581.16,Medicaid,Illinois Medicaid,,,,,968.6,,,,
"Q19502 HSV, DNA, QUA",87530,CPT,,,,,both,, ,512.23,307.33,Medicaid,Illinois Medicaid,,,,,512.23,,,,
"Q19502 HSV, DNA, QUA",87530,CPT,,,,,both,, ,512.23,307.33,Medicaid,Illinois Medicaid,,,,,512.23,,,,
"HIV-1, DNA,AMP PROBE",87535,CPT,,,,,both,, ,1718.85,1031.31,Medicaid,Illinois Medicaid,,,,,1718.85,,,,
Q40085 HIV1RNA RTPCR,87536,CPT,,,,,both,, ,1804.46,1082.67,Medicaid,Illinois Medicaid,,,,,1804.46,,,,
Q40085 HIV1RNA RTPCR,87536,CPT,,,,,both,, ,1804.46,1082.67,Medicaid,Illinois Medicaid,,,,,1804.46,,,,
"Q15062 LEGION PNEU,D",87541,CPT,,,,,both,, ,196.98,118.18,Medicaid,Illinois Medicaid,,,,,196.98,,,,
Q30298MTB COMP RTPCR,87556,CPT,,,,,both,, ,815.91,489.54,Medicaid,Illinois Medicaid,,,,,815.91,,,,
Q30298MTB COMP RTPCR,87556,CPT,,,,,both,, ,815.91,489.54,Medicaid,Illinois Medicaid,,,,,815.91,,,,
"Q16064 M.AVIUM-INTR,",87561,CPT,,,,,both,, ,372.45,223.47,Medicaid,Illinois Medicaid,,,,,372.45,,,,
"Q16064 M.AVIUM-INTR,",87561,CPT,,,,,both,, ,372.45,223.47,Medicaid,Illinois Medicaid,,,,,372.45,,,,
L180076 M GENT NAA,87563,CPT,,,,,both,, ,180,108,Medicaid,Illinois Medicaid,,,,,180,,,,
L139650 MPNEU DNA,87581,CPT,,,,,both,, ,197.03,118.21,Medicaid,Illinois Medicaid,,,,,197.03,,,,
L139650 MPNEU DNA,87581,CPT,,,,,both,, ,197.03,118.21,Medicaid,Illinois Medicaid,,,,,197.03,,,,
Q37444 MP QL RT-PCR,87581,CPT,,,,,both,, ,175.5,105.3,Medicaid,Illinois Medicaid,,,,,175.5,,,,
L180021 NG AMP PRB,87591,CPT,,,,,both,, ,888.63,533.17,Medicaid,Illinois Medicaid,,,,,888.63,,,,
Q11362 N.GON RNA TMA,87591,CPT,,,,,both,, ,968.6,581.16,Medicaid,Illinois Medicaid,,,,,968.6,,,,
Q11362 N.GON RNA TMA,87591,CPT,,,,,both,, ,968.6,581.16,Medicaid,Illinois Medicaid,,,,,968.6,,,,
Q11362 N.GON RNA TMA,87591,CPT,,,,,both,, ,968.6,581.16,Medicaid,Illinois Medicaid,,,,,968.6,,,,
Q11362 N.GON RNA TMA,87591,CPT,,,,,both,, ,968.6,581.16,Medicaid,Illinois Medicaid,,,,,968.6,,,,
L140230 ORTHOPOX VRS,87593,CPT,,,,,both,, ,308,184.8,Medicaid,Illinois Medicaid,,,,,308,,,,
HPV HIGH RISK TYPES,87624,CPT,,,,,both,, ,241.38,144.82,Medicaid,Illinois Medicaid,,,,,241.38,,,,
L199305 HPV HR,87624,CPT,,,,,both,, ,221.45,132.87,Medicaid,Illinois Medicaid,,,,,221.45,,,,
Q92090 HPV HIGH RISK,87624,CPT,,,,,both,, ,215,129,Medicaid,Illinois Medicaid,,,,,215,,,,
L507460 HPV GEN16 18,87625,CPT,,,,,both,, ,164.8,98.88,Medicaid,Illinois Medicaid,,,,,164.8,,,,
RESP VIRUS 3-5 TARG,87631,CPT,,,,,both,, ,570.52,342.31,Medicaid,Illinois Medicaid,,,,,570.52,,,,
L139650 RES V 12-25,87633,CPT,,,,,both,, ,175,105,Medicaid,Illinois Medicaid,,,,,175,,,,
L139650 RES V 12-25,87633,CPT,,,,,both,, ,175,105,Medicaid,Illinois Medicaid,,,,,175,,,,
Q37444 RESP VIR PCR,87633,CPT,,,,,both,, ,1250.34,750.2,Medicaid,Illinois Medicaid,,,,,1250.34,,,,
RSV DNA/ MA AMP PROB,87634,CPT,,,,,both,, ,157.62,94.57,Medicaid,Illinois Medicaid,,,,,157.62,,,,
RSV DNA/ MA AMP PROB,87634,CPT,,,,,both,, ,236.44,141.86,Medicaid,Illinois Medicaid,,,,,236.44,,,,
COVID19 PRB,87635,CPT,,,,,both,, ,113.3,67.98,Medicaid,Illinois Medicaid,,,,,113.3,,,,
COVID19 PRB,87635,CPT,,,,,both,, ,336.81,202.08,Medicaid,Illinois Medicaid,,,,,336.81,,,,
"STAPH A,DNA,PROBE",87640,CPT,,,,,both,, ,118.16,70.89,Medicaid,Illinois Medicaid,,,,,118.16,,,,
"MR-STAPH,DNA,PROBE",87641,CPT,,,,,both,, ,118.16,70.89,Medicaid,Illinois Medicaid,,,,,118.16,,,,
"STREP A,DNA,AMP PROB",87651,CPT,,,,,both,, ,78.78,47.26,Medicaid,Illinois Medicaid,,,,,78.78,,,,
"STREP A,DNA,AMP PROB",87651,CPT,,,,,both,, ,118.18,70.9,Medicaid,Illinois Medicaid,,,,,118.18,,,,
Q19550T.VAGIN QL TMA,87661,CPT,,,,,both,, ,279.55,167.73,Medicaid,Illinois Medicaid,,,,,279.55,,,,
Q19550T.VAGIN QL TMA,87661,CPT,,,,,both,, ,279.55,167.73,Medicaid,Illinois Medicaid,,,,,279.55,,,,
Q19550T.VAGIN QL TMA,87661,CPT,,,,,both,, ,279.55,167.73,Medicaid,Illinois Medicaid,,,,,279.55,,,,
Q19550T.VAGIN QL TMA,87661,CPT,,,,,both,, ,279.55,167.73,Medicaid,Illinois Medicaid,,,,,279.55,,,,
T VAGINALIS AMP,87661,CPT,,,,,both,,,279.55,279.55,Medicaid,Illinois Medicaid,,7.78,,,279.55,279.55,279.55,Fee Schedule,
Q93870 ZIKA RNA QL,87662,CPT,,,,,both,, ,295.83,177.49,Medicaid,Illinois Medicaid,,,,,295.83,,,,
L139650 DET AGNT DNA,87798,CPT,,,,,both,, ,175,105,Medicaid,Illinois Medicaid,,,,,175,,,,
L180040 DET AGT NOS,87798,CPT,,,,,both,, ,180,108,Medicaid,Illinois Medicaid,,,,,180,,,,
L180060 DET AGT NOS,87798,CPT,,,,,both,, ,696.28,417.76,Medicaid,Illinois Medicaid,,,,,696.28,,,,
L180060 DET AGT NOS,87798,CPT,,,,,both,, ,696.28,417.76,Medicaid,Illinois Medicaid,,,,,696.28,,,,
Q11068DET AGNT DNAAM,87798,CPT,,,,,both,, ,2478.63,1487.17,Medicaid,Illinois Medicaid,,,,,2478.63,,,,
Q11068DET AGNT DNAAM,87798,CPT,,,,,both,, ,2478.63,1487.17,Medicaid,Illinois Medicaid,,,,,2478.63,,,,
Q11190 WNVR CSF RT-P,87798,CPT,,,,,both,, ,1011.83,607.09,Medicaid,Illinois Medicaid,,,,,1011.83,,,,
Q11190 WNVR CSF RT-P,87798,CPT,,,,,both,, ,1011.83,607.09,Medicaid,Illinois Medicaid,,,,,1011.83,,,,
Q11365DET AGNT DNAAM,87798,CPT,,,,,both,, ,758.95,455.37,Medicaid,Illinois Medicaid,,,,,758.95,,,,
Q15062DET AGNT DNAAM,87798,CPT,,,,,both,, ,1011.83,607.09,Medicaid,Illinois Medicaid,,,,,1011.83,,,,
Q15062DET AGNT DNAAM,87798,CPT,,,,,both,, ,1011.83,607.09,Medicaid,Illinois Medicaid,,,,,1011.83,,,,
Q18835 P.JIRO QL PCR,87798,CPT,,,,,both,, ,1011.83,607.09,Medicaid,Illinois Medicaid,,,,,1011.83,,,,
Q18835 P.JIRO QL PCR,87798,CPT,,,,,both,, ,1011.83,607.09,Medicaid,Illinois Medicaid,,,,,1011.83,,,,
Q91475 SURESWAB MYCOPLASMA GENITALIUMPCR,87798,CPT,,,,,both,, ,901.25,540.75,Medicaid,Illinois Medicaid,,,,,901.25,,,,
"DETECT AGNT NOS,DNAQ",87799,CPT,,,,,both,, ,454.41,272.64,Medicaid,Illinois Medicaid,,,,,454.41,,,,
Q10186 EBV QT RT-PCR,87799,CPT,,,,,both,, ,454.41,272.64,Medicaid,Illinois Medicaid,,,,,454.41,,,,
Q11274 BKV QT RT-PCR,87799,CPT,,,,,both,, ,454.41,272.64,Medicaid,Illinois Medicaid,,,,,454.41,,,,
"DETECT AGT MULT,DNAA",87801,CPT,,,,,both,, ,715.16,429.09,Medicaid,Illinois Medicaid,,,,,715.16,,,,
L180021 DET AGT MULT,87801,CPT,,,,,both,, ,656.11,393.66,Medicaid,Illinois Medicaid,,,,,656.11,,,,
Q15564LYME RT-PCR SF,87801,CPT,,,,,both,, ,715.16,429.09,Medicaid,Illinois Medicaid,,,,,715.16,,,,
Q15777LYM QL BL RTPC,87801,CPT,,,,,both,, ,715.16,429.09,Medicaid,Illinois Medicaid,,,,,715.16,,,,
INFLUENZA ASSAY W-OP,87804,CPT,,,,,both,, ,30.87,18.52,Medicaid,Illinois Medicaid,,,,,30.87,,,,
INFLUENZA ASSAY W-OP,87804,CPT,,,,,both,, ,104.12,62.47,Medicaid,Illinois Medicaid,,,,,104.12,,,,
RSV ASSAY W-OPTIC,87807,CPT,,,,,both,, ,44.62,26.77,Medicaid,Illinois Medicaid,,,,,44.62,,,,
RSV ASSAY W-OPTIC,87807,CPT,,,,,both,, ,277.86,166.71,Medicaid,Illinois Medicaid,,,,,277.86,,,,
STREP A ASSAY W-OPTI,87880,CPT,,,,,both,, ,41.25,24.75,Medicaid,Illinois Medicaid,,,,,41.25,,,,
STREP A ASSAY W-OPTI,87880,CPT,,,,,both,, ,285.17,171.1,Medicaid,Illinois Medicaid,,,,,285.17,,,,
AGENT NOS ASSAY W-OP,87899,CPT,,,,,both,, ,172.9,103.74,Medicaid,Illinois Medicaid,,,,,172.9,,,,
L183009 SPNEU AG U C,87899,CPT,,,,,both,, ,158.62,95.17,Medicaid,Illinois Medicaid,,,,,158.62,,,,
L183009 SPNEU AG U C,87899,CPT,,,,,both,, ,158.62,95.17,Medicaid,Illinois Medicaid,,,,,158.62,,,,
Q34949 PHENO INF DRG,87900,CPT,,,,,both,, ,773.54,464.12,Medicaid,Illinois Medicaid,,,,,773.54,,,,
Q34949 GENO DNA HIV,87901,CPT,,,,,both,, ,1819.9,1091.94,Medicaid,Illinois Medicaid,,,,,1819.9,,,,
Q34949 GENO DNA HIV,87901,CPT,,,,,both,, ,1819.9,1091.94,Medicaid,Illinois Medicaid,,,,,1819.9,,,,
"GENOTYPE,DNA,HEPAT C",87902,CPT,,,,,both,, ,1611.91,967.14,Medicaid,Illinois Medicaid,,,,,1611.91,,,,
Q37811 HCVRNA GN MPR,87902,CPT,,,,,both,, ,1611.91,967.14,Medicaid,Illinois Medicaid,,,,,1611.91,,,,
Q92447 HCVG1 NS5A DR,87902,CPT,,,,,both,, ,1611.91,967.14,Medicaid,Illinois Medicaid,,,,,1611.91,,,,
L551690PHENO DNA HIV,87903,CPT,,,,,both,, ,1465,879,Medicaid,Illinois Medicaid,,,,,1465,,,,
L551690PHENO DNA HIV,87904,CPT,,,,,both,, ,104,62.4,Medicaid,Illinois Medicaid,,,,,104,,,,
HIV GEN DNA REV OTH,87906,CPT,,,,,both,, ,856.62,513.97,Medicaid,Illinois Medicaid,,,,,856.62,,,,
AUTOPSY COMPL WO-CNS,88020,CPT,,,,,both,, ,3310.55,1986.33,Medicaid,Illinois Medicaid,,,,,3310.55,,,,
CYTOPATH FLD NOT V-C,88104,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,,,,109.74,,,,
CYTOPATH FLD FTRW-IN,88106,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,,,,109.74,,,,
CYTOPATH CONCENT TEC,88108,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,,,,109.74,,,,
CYTOCELL ENH X CR-VG,88112,CPT,,,,,both,, ,237.17,142.3,Medicaid,Illinois Medicaid,,,,,237.17,,,,
CYTO UR 3-5PROB EA S,88120,CPT,,,,,both,, ,368.8,221.28,Medicaid,Illinois Medicaid,,,,,368.8,,,,
CYTO UR 3-5 PROB CMP,88121,CPT,,,,,both,, ,368.8,221.28,Medicaid,Illinois Medicaid,,,,,368.8,,,,
FORENSIC CYTOPATHOLO,88125,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,,,,109.74,,,,
SEX CHROMATIN ID BAR,88130,CPT,,,,,both,, ,144.83,86.89,Medicaid,Illinois Medicaid,,,,,144.83,,,,
SEX CHROM ID POLYMOR,88140,CPT,,,,,both,, ,76.9,46.14,Medicaid,Illinois Medicaid,,,,,76.9,,,,
L192555 PAP LB,88142,CPT,,,,,both,, ,234.07,140.44,Medicaid,Illinois Medicaid,,,,,234.07,,,,
PAP THINLAY LIQ DIAG,88142,CPT,,,,,both,, ,189.74,113.84,Medicaid,Illinois Medicaid,,,,,189.74,,,,
CYTOPATH C-V THNLYRE,88143,CPT,,,,,both,, ,189.74,113.84,Medicaid,Illinois Medicaid,,,,,189.74,,,,
CYTOP C-V AUTOMATED,88147,CPT,,,,,both,, ,101.6,60.96,Medicaid,Illinois Medicaid,,,,,101.6,,,,
CYTOP C-V AUTO RESCR,88148,CPT,,,,,both,, ,101.6,60.96,Medicaid,Illinois Medicaid,,,,,101.6,,,,
CYTOPATH C-V MANUAL,88150,CPT,,,,,both,, ,101.6,60.96,Medicaid,Illinois Medicaid,,,,,101.6,,,,
CYTOP C-V AUTO REDO,88152,CPT,,,,,both,, ,101.6,60.96,Medicaid,Illinois Medicaid,,,,,101.6,,,,
CYTOPATH C-V REDO,88153,CPT,,,,,both,, ,101.6,60.96,Medicaid,Illinois Medicaid,,,,,101.6,,,,
CYTOP C-V INDX ADDON,88155,CPT,,,,,both,, ,57.81,34.68,Medicaid,Illinois Medicaid,,,,,57.81,,,,
CYTOP SMR OTHR SOURC,88160,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,,,,109.74,,,,
CYTOP SMR OTH PRE-SC,88161,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,,,,109.74,,,,
CYTOP SMR OTH S5SLID,88162,CPT,,,,,both,, ,237.17,142.3,Medicaid,Illinois Medicaid,,,,,237.17,,,,
"CYTOP TBS,C-V,MANUAL",88164,CPT,,,,,both,, ,101.6,60.96,Medicaid,Illinois Medicaid,,,,,101.6,,,,
"CYTOP TBS,C-V,REDO",88165,CPT,,,,,both,, ,101.6,60.96,Medicaid,Illinois Medicaid,,,,,101.6,,,,
"CYTOP TBS,C-V AUTORE",88166,CPT,,,,,both,, ,101.6,60.96,Medicaid,Illinois Medicaid,,,,,101.6,,,,
"CYTOP TBS,C-C,SELECT",88167,CPT,,,,,both,, ,101.6,60.96,Medicaid,Illinois Medicaid,,,,,101.6,,,,
CYTOPATH EVAL OF FNA,88172,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,,,,109.74,,,,
"CYTOP EVAL,FNA,REPOR",88173,CPT,,,,,both,, ,237.17,142.3,Medicaid,Illinois Medicaid,,,,,237.17,,,,
CYTO-CERVICALRP CDM,88174,CPT,,,,,both,, ,205.45,123.27,Medicaid,Illinois Medicaid,,,,,205.45,,,,
L199305 PAP AU MN RS,88175,CPT,,,,,both,, ,234.07,140.44,Medicaid,Illinois Medicaid,,,,,234.07,,,,
PAP DIAG AUTO MAN RS,88175,CPT,,,,,both,, ,255.13,153.07,Medicaid,Illinois Medicaid,,,,,255.13,,,,
Q92090 PAP DIAG AUTO,88175,CPT,,,,,both,, ,227.25,136.35,Medicaid,Illinois Medicaid,,,,,227.25,,,,
CYTO EVAL FNA ADD,88177,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,,,,72.13,,,,
CELL MRK STDY CY-DNA,88182,CPT,,,,,both,, ,69.89,41.93,Medicaid,Illinois Medicaid,,,,,69.89,,,,
Q35080FLOWCY-TC 1MRK,88184,CPT,,,,,both,, ,203.21,121.92,Medicaid,Illinois Medicaid,,,,,203.21,,,,
Q35080FLOWCY-TC 1MRK,88184,CPT,,,,,both,, ,203.21,121.92,Medicaid,Illinois Medicaid,,,,,203.21,,,,
"FLOWCYTOMETRY-TC,ADD",88185,CPT,,,,,both,, ,195.35,117.21,Medicaid,Illinois Medicaid,,,,,195.35,,,,
Q35080 FLOWCY-TC ADD,88185,CPT,,,,,both,, ,60,36,Medicaid,Illinois Medicaid,,,,,60,,,,
A3001780 FLWCY 16MRK,88189,CPT,,,,,both,, ,360,216,Medicaid,Illinois Medicaid,,,,,360,,,,
CYTOPATHOLOGY PROCED,88199,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,,,,72.13,,,,
Q14596 TISSUE CULT L,88230,CPT,,,,,both,, ,3469.98,2081.98,Medicaid,Illinois Medicaid,,,,,3469.98,,,,
Q14596 TISSUE CULT L,88230,CPT,,,,,both,, ,3469.98,2081.98,Medicaid,Illinois Medicaid,,,,,3469.98,,,,
TISSUE CULT SKIN/BIO,88233,CPT,,,,,both,, ,1353.98,812.38,Medicaid,Illinois Medicaid,,,,,1353.98,,,,
"TISSUE CULT, PLACENT",88235,CPT,,,,,both,, ,1416.56,849.93,Medicaid,Illinois Medicaid,,,,,1416.56,,,,
Q14600 TIS CUL BM,88237,CPT,,,,,both,, ,849.04,509.42,Medicaid,Illinois Medicaid,,,,,849.04,,,,
Q14600 TIS CUL BM,88237,CPT,,,,,both,, ,849.04,509.42,Medicaid,Illinois Medicaid,,,,,849.04,,,,
TISSUE CULTURE TUMOR,88239,CPT,,,,,both,, ,1419.09,851.45,Medicaid,Illinois Medicaid,,,,,1419.09,,,,
CELL CRYOPRESERV-STO,88240,CPT,,,,,both,, ,97.11,58.26,Medicaid,Illinois Medicaid,,,,,97.11,,,,
FROZEN CELL PREPARAT,88241,CPT,,,,,both,, ,97.11,58.26,Medicaid,Illinois Medicaid,,,,,97.11,,,,
CHROMOSOME ANAL20-25,88245,CPT,,,,,both,, ,1397.47,838.48,Medicaid,Illinois Medicaid,,,,,1397.47,,,,
CHROMOSOM ANAL50-100,88248,CPT,,,,,both,, ,1666.09,999.65,Medicaid,Illinois Medicaid,,,,,1666.09,,,,
CHROMOSOME ANALYS100,88249,CPT,,,,,both,, ,1666.09,999.65,Medicaid,Illinois Medicaid,,,,,1666.09,,,,
CHROMOSOME ANALYS  5,88261,CPT,,,,,both,, ,1700.32,1020.19,Medicaid,Illinois Medicaid,,,,,1700.32,,,,
CHROMOSOME ANAL15-20,88262,CPT,,,,,both,, ,4292.64,2575.58,Medicaid,Illinois Medicaid,,,,,4292.64,,,,
Q14596 CHR AN 15-20,88262,CPT,,,,,both,, ,1010,606,Medicaid,Illinois Medicaid,,,,,1010,,,,
CHROMOSOME ANALYS 45,88263,CPT,,,,,both,, ,1445.75,867.45,Medicaid,Illinois Medicaid,,,,,1445.75,,,,
Q14600 CHRM AN 20-25,88264,CPT,,,,,both,, ,2107.59,1264.55,Medicaid,Illinois Medicaid,,,,,2107.59,,,,
Q14600 CHRM AN 20-25,88264,CPT,,,,,both,, ,2107.59,1264.55,Medicaid,Illinois Medicaid,,,,,2107.59,,,,
CHROMOSOME ANAL-PLAC,88267,CPT,,,,,both,, ,1729.51,1037.7,Medicaid,Illinois Medicaid,,,,,1729.51,,,,
CHROMOSOM ANAL AMNIO,88269,CPT,,,,,both,, ,1600.13,960.07,Medicaid,Illinois Medicaid,,,,,1600.13,,,,
Q12070 CYTOGEN PRO,88271,CPT,,,,,both,, ,525.7,315.42,Medicaid,Illinois Medicaid,,,,,525.7,,,,
Q12070 CYTOGEN PRO,88271,CPT,,,,,both,, ,525.7,315.42,Medicaid,Illinois Medicaid,,,,,525.7,,,,
CYTOGENETICS 3-5,88272,CPT,,,,,both,, ,243.63,146.17,Medicaid,Illinois Medicaid,,,,,243.63,,,,
CYTOGENETICS 25-99,88274,CPT,,,,,both,, ,336.52,201.91,Medicaid,Illinois Medicaid,,,,,336.52,,,,
Q12070CYTOGN 100-300,88275,CPT,,,,,both,, ,1078.63,647.17,Medicaid,Illinois Medicaid,,,,,1078.63,,,,
Q12070CYTOGN 100-300,88275,CPT,,,,,both,, ,1078.63,647.17,Medicaid,Illinois Medicaid,,,,,1078.63,,,,
CHROMOSOME KARYOT ST,88280,CPT,,,,,both,, ,962.71,577.62,Medicaid,Illinois Medicaid,,,,,962.71,,,,
CHROMOSOM BANDINGSTU,88283,CPT,,,,,both,, ,375.26,225.15,Medicaid,Illinois Medicaid,,,,,375.26,,,,
CHROMOSOME CT ADDITI,88285,CPT,,,,,both,, ,182.71,109.62,Medicaid,Illinois Medicaid,,,,,182.71,,,,
CHROMOS STDY ADD HIG,88289,CPT,,,,,both,, ,284.04,170.42,Medicaid,Illinois Medicaid,,,,,284.04,,,,
CYTOGENETIC STUDY,88299,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,,,,72.13,,,,
SURG PATH GROSS LVL1,88300,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,,,,72.13,,,,
SURG PATH GROSS LVL2,88302,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,,,,109.74,,,,
SURG PATH GROSS LVL3,88304,CPT,,,,,both,, ,237.17,142.3,Medicaid,Illinois Medicaid,,,,,237.17,,,,
SURG PATH GROSS LVL4,88305,CPT,,,,,both,, ,398.27,238.96,Medicaid,Illinois Medicaid,,,,,398.27,,,,
SURG PATH GROSS LVL5,88307,CPT,,,,,both,, ,368.8,221.28,Medicaid,Illinois Medicaid,,,,,368.8,,,,
SURG PATH GROSS LVL6,88309,CPT,,,,,both,, ,368.8,221.28,Medicaid,Illinois Medicaid,,,,,368.8,,,,
DECALCIFY TISSUE,88311,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,,,,72.13,,,,
SPECIAL STAINS GRP 1,88312,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,,,,109.74,,,,
SPECIAL STAINS GRP 2,88313,CPT,,,,,both,, ,33.68,20.2,Medicaid,Illinois Medicaid,,,,,33.68,,,,
SPECIAL STAINS GRP 2,88313,CPT,,,,,both,, ,241.94,145.16,Medicaid,Illinois Medicaid,,,,,241.94,,,,
HISTOCHEMICAL STAIN,88314,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,,,,109.74,,,,
ENZYME HISTOCHEMISTR,88319,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,,,,109.74,,,,
MICROSLIDE-CONSULN-P,88321,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,,,,109.74,,,,
MICROSLID CONSUL-W-P,88323,CPT,,,,,both,, ,237.17,142.3,Medicaid,Illinois Medicaid,,,,,237.17,,,,
COMPRE REVIEW OFDATA,88325,CPT,,,,,both,, ,368.8,221.28,Medicaid,Illinois Medicaid,,,,,368.8,,,,
PATH CONSULT INTROP,88329,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,,,,109.74,,,,
PATH CONSULT INT-1BL,88331,CPT,,,,,both,, ,237.17,142.3,Medicaid,Illinois Medicaid,,,,,237.17,,,,
PATH CONSULT-INTRADD,88332,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,,,,72.13,,,,
INOP CYTOPAT CNSLT 1,88333,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,,,,109.74,,,,
INOP CYTOPAT CNSLT 2,88334,CPT,,,,,both,, ,109.74,65.84,Medicaid,Illinois Medicaid,,,,,109.74,,,,
ICC ADD AB PER SLIDE,88341,CPT,,,,,both,, ,238.01,142.8,Medicaid,Illinois Medicaid,,,,,238.01,,,,
1ST SEP ID AB,88342,CPT,,,,,both,, ,238.01,142.8,Medicaid,Illinois Medicaid,,,,,238.01,,,,
ICC MLTPX AB ST,88344,CPT,,,,,both,, ,221.17,132.7,Medicaid,Illinois Medicaid,,,,,221.17,,,,
IMF SPEC 1ST AB ST,88346,CPT,,,,,both,, ,270.57,162.34,Medicaid,Illinois Medicaid,,,,,270.57,,,,
ELECTRON MICROSCOPY,88348,CPT,,,,,both,, ,2028.15,1216.89,Medicaid,Illinois Medicaid,,,,,2028.15,,,,
IMF/SPEC ADD AB ST,88350,CPT,,,,,both,, ,270.57,162.34,Medicaid,Illinois Medicaid,,,,,270.57,,,,
ANALYSIS SKELET MUSC,88355,CPT,,,,,both,, ,237.17,142.3,Medicaid,Illinois Medicaid,,,,,237.17,,,,
ANALYSIS NERVE,88356,CPT,,,,,both,, ,368.8,221.28,Medicaid,Illinois Medicaid,,,,,368.8,,,,
ANALYSIS TUMOR,88358,CPT,,,,,both,, ,237.17,142.3,Medicaid,Illinois Medicaid,,,,,237.17,,,,
TUMOR IHC QT MAN,88360,CPT,,,,,both,, ,1468.77,881.26,Medicaid,Illinois Medicaid,,,,,1468.77,,,,
TUMOR IHC QT UTO,88361,CPT,,,,,both,, ,1468.77,881.26,Medicaid,Illinois Medicaid,,,,,1468.77,,,,
NERVE TEASING PREPAR,88362,CPT,,,,,both,, ,368.8,221.28,Medicaid,Illinois Medicaid,,,,,368.8,,,,
XM ARCHIVE TIS MOLEC,88363,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,,,,72.13,,,,
TIS HYBRD AD SNG PRB,88364,CPT,,,,,both,, ,230.71,138.42,Medicaid,Illinois Medicaid,,,,,230.71,,,,
TIS HYBRD SPEC INIT,88365,CPT,,,,,both,, ,304.81,182.88,Medicaid,Illinois Medicaid,,,,,304.81,,,,
INS HYBR AUT SP INIT,88367,CPT,,,,,both,, ,220.05,132.03,Medicaid,Illinois Medicaid,,,,,220.05,,,,
INS HYBRD MAN SP INI,88368,CPT,,,,,both,, ,342.7,205.62,Medicaid,Illinois Medicaid,,,,,342.7,,,,
INS HYBRD MAN SNG PR,88369,CPT,,,,,both,, ,342.7,205.62,Medicaid,Illinois Medicaid,,,,,342.7,,,,
PROTEIN-WEST BLOTTIS,88371,CPT,,,,,both,, ,209.38,125.62,Medicaid,Illinois Medicaid,,,,,209.38,,,,
PROTEIN ANALYSW/PROB,88372,CPT,,,,,both,, ,218.93,131.35,Medicaid,Illinois Medicaid,,,,,218.93,,,,
INS HYBR AUT SNG PR,88373,CPT,,,,,both,, ,220.05,132.03,Medicaid,Illinois Medicaid,,,,,220.05,,,,
INS HYBR AUT MUL PR,88374,CPT,,,,,both,, ,220.05,132.03,Medicaid,Illinois Medicaid,,,,,220.05,,,,
INS HYBR MAN MUL PR,88377,CPT,,,,,both,, ,342.7,205.62,Medicaid,Illinois Medicaid,,,,,342.7,,,,
MICRODISSECTION MANU,88381,CPT,,,,,both,, ,424.38,254.62,Medicaid,Illinois Medicaid,,,,,424.38,,,,
SURGICAL PATH PROCED,88399,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,,,,72.13,,,,
BILIRUBIN TOT TRANS,88720,CPT,,,,,both,, ,75.22,45.13,Medicaid,Illinois Medicaid,,,,,75.22,,,,
CELL CTW-DIF BODYFLU,89051,CPT,,,,,both,, ,54.17,32.5,Medicaid,Illinois Medicaid,,,,,54.17,,,,
CELL CTW-DIF BODYFLU,89051,CPT,,,,,both,, ,691.29,414.77,Medicaid,Illinois Medicaid,,,,,691.29,,,,
LEUKOCY ASSES FEC QL,89055,CPT,,,,,both,, ,109.46,65.67,Medicaid,Illinois Medicaid,,,,,109.46,,,,
CRYSTALS SYNOVIAL FLD,89060,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
CRYSTALS SYNOVIAL FLD,89060,CPT,,,,,both,, ,345.79,207.47,Medicaid,Illinois Medicaid,,,,,345.79,,,,
NASAL SMEAR-EOSINOPH,89190,CPT,,,,,both,, ,518.69,311.21,Medicaid,Illinois Medicaid,,,,,518.69,,,,
UNL MISC PATH TEST,89240,CPT,,,,,both,, ,72.13,43.27,Medicaid,Illinois Medicaid,,,,,72.13,,,,
SEMEN ANYL PRES-M-S,89321,CPT,,,,,both,, ,526.26,315.75,Medicaid,Illinois Medicaid,,,,,526.26,,,,
HEPATITIS B GLOB IM,90371,CPT,,,,,both,, ,679.03,407.41,Medicaid,Illinois Medicaid,,,,,679.03,,,,
HEPATITIS B GLOB IM,90371,CPT,,,,,both,1,ML,953,571.8,Medicaid,Illinois Medicaid,,,,,953,,,,
RABIES IG IM/SC 150U,90375,CPT,,,,,both,3,ML,414.33,248.59,Medicaid,Illinois Medicaid,,,,,414.33,,,,
RABIES IG IM/SC 150U,90375,CPT,,,,,both,, ,1385.09,831.05,Medicaid,Illinois Medicaid,,,,,1385.09,,,,
RABIES IG IM/SC 150U,90375,CPT,,,,,both,, ,1428.35,857.01,Medicaid,Illinois Medicaid,,,,,1428.35,,,,
RABIES IG IM/SC 150U,90375,HCPCS,,,,,both,5,ML,1867.13,1120.27,Medicaid,Illinois Medicaid,,,,,1867.13,,,,
RABIES IG IM/SC 150U,90375,HCPCS,,,,,both,1,ML,2044.81,1226.88,Medicaid,Illinois Medicaid,,,,,2044.81,,,,
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,143.69,86.21,Medicaid,Illinois Medicaid,,,,,143.69,,,,
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,230.72,138.43,Medicaid,Illinois Medicaid,,,,,230.72,,,,
IMM ADM INJ SINGLE,90471,CPT,,,,,both,, ,162.25,97.35,Medicaid,Illinois Medicaid,,,,,162.25,,,,
IMM ADM INJ SINGLE,90471,CPT,,,,,both,, ,162.25,97.35,Medicaid,Illinois Medicaid,,,,,162.25,,,,
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,119.22,71.53,Medicaid,Illinois Medicaid,,,,,119.22,,,,
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,119.22,71.53,Medicaid,Illinois Medicaid,,,,,119.22,,,,
IMM ADM INJ EA ADD,90472,CPT,,,,,both,, ,48.75,29.25,Medicaid,Illinois Medicaid,,,,,48.75,,,,
IMM ADM INJ EA ADD,90472,CPT,,,,,both,, ,48.75,29.25,Medicaid,Illinois Medicaid,,,,,48.75,,,,
HAEMOPH B TETAN INJ,90648,CPT,,,,,both,, ,131.84,79.1,Medicaid,Illinois Medicaid,,,,,131.84,,,,
FLU VAC NOPRSV ANTIG,90662,CPT,,,,,both,0.7,ML,434.66,260.79,Medicaid,Illinois Medicaid,,,,,434.66,,,,
PNEUMOCOC 13-VAL IM,90670,CPT,,,,,both,0.5,ML,871.9,523.14,Medicaid,Illinois Medicaid,,,,,871.9,,,,
FLU VAC CCIIV4 PF&AB,90674,CPT,,,,,both,0.5,ML,208.06,124.83,Medicaid,Illinois Medicaid,,,,,208.06,,,,
RABIES VAC IM,90675,CPT,,,,,both,1,EA,1856.32,1113.79,Medicaid,Illinois Medicaid,,,,,1856.32,,,,
RABIES VAC IM,90675,CPT,,,,,both,, ,1941.04,1164.62,Medicaid,Illinois Medicaid,,,,,1941.04,,,,
FLU VAC QUAD DNA HA,90682,CPT,,,,,both,, ,383.75,230.25,Medicaid,Illinois Medicaid,,,,,383.75,,,,
FLU VACIIV4 PF .5ML,90686,CPT,,,,,both,, ,145.23,87.13,Medicaid,Illinois Medicaid,,,,,145.23,,,,
FLU VAC IIV4 .25ML,90687,CPT,,,,,both,, ,135.45,81.27,Medicaid,Illinois Medicaid,,,,,135.45,,,,
M-M-R II INJ,90707,CPT,,,,,both,1,EA,471.23,282.73,Medicaid,Illinois Medicaid,,,,,471.23,,,,
TD IM NO PRSRV GE 7Y,90714,CPT,,,,,both,0.5,ML,210.12,126.07,Medicaid,Illinois Medicaid,,,,,210.12,,,,
DIPH/TET/ACPERT .5ML,90715,CPT,,,,,both,0.5,ML,350.2,210.12,Medicaid,Illinois Medicaid,,,,,350.2,,,,
DIPH/TET/ACPERT .5ML,90715,CPT,,,,,both,0.5,ML,370.54,222.32,Medicaid,Illinois Medicaid,,,,,370.54,,,,
VARICELLA VIR VAC SC,90716,CPT,,,,,both,1,EA,611.56,366.93,Medicaid,Illinois Medicaid,,,,,611.56,,,,
PNEUMO-VAC 2YR-ADULT,90732,CPT,,,,,both,0.5,ML,544.1,326.46,Medicaid,Illinois Medicaid,,,,,544.1,,,,
HEP B VAC PED,90744,CPT,,,,,both,, ,194.93,116.95,Medicaid,Illinois Medicaid,,,,,194.93,,,,
HEP B VAC PED,90744,CPT,,,,,both,0.5,ML,204.97,122.98,Medicaid,Illinois Medicaid,,,,,204.97,,,,
INTERACTIVE ADD-ON,90785,CPT,,,,,both,, ,310.8,186.48,Medicaid,Illinois Medicaid,,,,,310.8,,,,
PSYCH DIAG EVAL,90791,CPT,,,,,both,, ,249.78,149.86,Medicaid,Illinois Medicaid,,,,,249.78,,,,
PSYCH DIAG EVAL,90791,CPT,,,,,both,, ,757.82,454.69,Medicaid,Illinois Medicaid,,,,,757.82,,,,
PSYCHOTHERAPY 30 MIN,90832,CPT,,,,,both,, ,238.96,143.37,Medicaid,Illinois Medicaid,,,,,238.96,,,,
"Psychotherapy, 30 min",90832,CPT,,,,,both,,,238.96,238.96,Medicaid,Illinois Medicaid,,46.08,,,238.96,238.96,238.96,Fee Schedule,
PSYCHOTHER 30M W/E&M,90833,CPT,,,,,both,, ,301.75,181.05,Medicaid,Illinois Medicaid,,,,,301.75,,,,
PSYCHOTHERAPY 45 MIN,90834,CPT,,,,,both,, ,299.73,179.83,Medicaid,Illinois Medicaid,,,,,299.73,,,,
"Psychotherapy, 45 min",90834,CPT,,,,,both,,,299.73,299.73,Medicaid,Illinois Medicaid,,124.06,,,299.73,299.73,299.73,Fee Schedule,
PSYCHOTHER 45M W/E&M,90836,CPT,,,,,both,, ,312.25,187.35,Medicaid,Illinois Medicaid,,,,,312.25,,,,
PSYCHOTHERAPY 60 MIN,90837,CPT,,,,,both,, ,359.73,215.83,Medicaid,Illinois Medicaid,,,,,359.73,,,,
"Psychotherapy, 60 min",90837,CPT,,,,,both,,,359.73,359.73,Medicaid,Illinois Medicaid,,183.16,,,359.73,359.73,359.73,Fee Schedule,
PSYCHOTHER 60M W/E&M,90838,CPT,,,,,both,, ,323.75,194.25,Medicaid,Illinois Medicaid,,,,,323.75,,,,
FAM THERAPY W/PATIEN,90847,CPT,,,,,both,, ,842.03,505.21,Medicaid,Illinois Medicaid,,,,,842.03,,,,
"Family psychotherapy, including patient, 50 min",90847,CPT,,,,,both,,,842.03,842.03,Medicaid,Illinois Medicaid,,69.8,,,842.03,842.03,842.03,Fee Schedule,
MULTI-FAM GRP PSYCH,90849,CPT,,,,,both,, ,396.04,237.62,Medicaid,Illinois Medicaid,,,,,396.04,,,,
Group psychotherapy,90853,CPT,,,,,both,,,220.94,220.94,Medicaid,Illinois Medicaid,,33.7,,,220.94,220.94,220.94,Fee Schedule,
PSYCH GROUP THERAPY,90853,CPT,,,,,both,, ,220.94,132.56,Medicaid,Illinois Medicaid,,,,,220.94,,,,
PSYCH GROUP THERAPY,90853,CPT,,,,,both,, ,689.33,413.59,Medicaid,Illinois Medicaid,,,,,689.33,,,,
MEDICATION MGMT,90863,CPT,,,,,both,, ,294.25,176.55,Medicaid,Illinois Medicaid,,,,,294.25,,,,
TMS INITIAL & 1ST TX,90867,CPT,,,,,both,, ,955.84,573.5,Medicaid,Illinois Medicaid,,,,,955.84,,,,
TMS SUBSEQUENT TX,90868,CPT,,,,,both,, ,515.04,309.02,Medicaid,Illinois Medicaid,,,,,515.04,,,,
TMS REMAPPING & TX,90869,CPT,,,,,both,, ,515.04,309.02,Medicaid,Illinois Medicaid,,,,,515.04,,,,
HEMODIALY SING EVAL,90935,CPT,,,,,both,, ,9908.09,5944.85,Medicaid,Illinois Medicaid,,,,,9908.09,,,,
OTH DIALY SING EVAL,90945,CPT,,,,,both,, ,4956.88,2974.12,Medicaid,Illinois Medicaid,,,,,4956.88,,,,
SP AR MCD TRMT 15MIN,92507,CPT,,,,,both,, ,182.25,109.35,Medicaid,Illinois Medicaid,,,,,182.25,,,,
SP-HEAR-TX-INDI VIST,92507,CPT,,,,,both,, ,705.29,423.17,Medicaid,Illinois Medicaid,,,,,705.29,,,,
SP-HEAR-GROUP-VISIT,92508,CPT,,,,,both,, ,324.19,194.51,Medicaid,Illinois Medicaid,,,,,324.19,,,,
EV SP FLUENCY 15,92521,CPT,,,,,both,, ,135.5,81.3,Medicaid,Illinois Medicaid,,,,,135.5,,,,
EVAL SPEECH FLUENCY,92521,CPT,,,,,both,, ,814.22,488.53,Medicaid,Illinois Medicaid,,,,,814.22,,,,
EV SP PROD 15,92522,CPT,,,,,both,, ,182.25,109.35,Medicaid,Illinois Medicaid,,,,,182.25,,,,
EVAL SPEECH SND PROD,92522,CPT,,,,,both,, ,814.22,488.53,Medicaid,Illinois Medicaid,,,,,814.22,,,,
EVAL SP SND PROD CMP,92523,CPT,,,,,both,, ,814.22,488.53,Medicaid,Illinois Medicaid,,,,,814.22,,,,
SP SOUND LANG CMP 15,92523,CPT,,,,,both,, ,182.25,109.35,Medicaid,Illinois Medicaid,,,,,182.25,,,,
BEH QL ANAL VOICE 15,92524,CPT,,,,,both,, ,182.25,109.35,Medicaid,Illinois Medicaid,,,,,182.25,,,,
BEHAV QL ANAL VOICE,92524,CPT,,,,,both,, ,814.22,488.53,Medicaid,Illinois Medicaid,,,,,814.22,,,,
ORAL FUNC TX-VIS,92526,CPT,,,,,both,, ,705.29,423.17,Medicaid,Illinois Medicaid,,,,,705.29,,,,
EVAL VOICE PROS DEV,92597,CPT,,,,,both,, ,390.11,234.06,Medicaid,Illinois Medicaid,,,,,390.11,,,,
COCHLE IMP INTIL LT7,92601,CPT,,,,,both,, ,854.9,512.94,Medicaid,Illinois Medicaid,,,,,854.9,,,,
SP-EVAL NSG DEV 1STH,92605,CPT,,,,,both,, ,813.7,488.22,Medicaid,Illinois Medicaid,,,,,813.7,,,,
SP-EVAL SP DEV 1STHR,92607,CPT,,,,,both,, ,813.7,488.22,Medicaid,Illinois Medicaid,,,,,813.7,,,,
SP-EVAL SP DEV AD30M,92608,CPT,,,,,both,, ,763.23,457.93,Medicaid,Illinois Medicaid,,,,,763.23,,,,
SP-THER SVC SPCH DEV,92609,CPT,,,,,both,, ,705.29,423.17,Medicaid,Illinois Medicaid,,,,,705.29,,,,
SP-EVAL SWL WO RADOP,92610,CPT,,,,,both,, ,758.08,454.84,Medicaid,Illinois Medicaid,,,,,758.08,,,,
SP-EVAL SWL W-RADOPQ,92611,CPT,,,,,both,, ,862.63,517.57,Medicaid,Illinois Medicaid,,,,,862.63,,,,
AUD EVOKE HR BRD STM,92651,CPT,,,,,both,, ,567.79,340.67,Medicaid,Illinois Medicaid,,,,,567.79,,,,
"IC-PTCA, SINGLE",92920,CPT,,,,,both,, ,65091.11,39054.66,Medicaid,Illinois Medicaid,,,,,65091.11,,,,
"IC-PTCA, ADDL",92921,CPT,,,,,both,, ,65091.11,39054.66,Medicaid,Illinois Medicaid,,,,,65091.11,,,,
IC-PRQ CRD STN W-ANG,92928,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,,,,88719.05,,,,
IC-PRQ STNT W-ANG EA,92929,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,,,,88719.05,,,,
IC-PRQ CRD ST-AT-ANG,92933,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,,,,88719.05,,,,
IC-PRQ ST-AT-ANG EA,92934,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,,,,88719.05,,,,
IC-PRQ RV BYP GRF IN,92937,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,,,,88719.05,,,,
IC-PRQ RV BYP GRF AD,92938,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,,,,88719.05,,,,
IC-PRQ CARD REV 1 VS,92941,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,,,,88719.05,,,,
IC-PRQ REVSC CHR 1VS,92943,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,,,,88719.05,,,,
IC-PRQ REVSC CHR ADD,92944,CPT,,,,,both,, ,88719.05,53231.43,Medicaid,Illinois Medicaid,,,,,88719.05,,,,
CPR,92950,CPT,,,,,both,, ,382.9,229.74,Medicaid,Illinois Medicaid,,,,,382.9,,,,
CPR,92950,CPT,,,,,both,, ,382.9,229.74,Medicaid,Illinois Medicaid,,,,,382.9,,,,
CPR,92950,CPT,,,,,both,, ,6031.42,3618.85,Medicaid,Illinois Medicaid,,,,,6031.42,,,,
CPR ASSIST (NON ER),92950,CPT,,,,,both,, ,5533.42,3320.05,Medicaid,Illinois Medicaid,,,,,5533.42,,,,
NI-TEMP EXT PACE,92953,CPT,,,,,both,, ,4462.48,2677.48,Medicaid,Illinois Medicaid,,,,,4462.48,,,,
NI-TEMP EXT PACE,92953,CPT,,,,,both,, ,4864.09,2918.45,Medicaid,Illinois Medicaid,,,,,4864.09,,,,
NI-CARDIOVERSION,92960,CPT,,,,,both,, ,4603.59,2762.15,Medicaid,Illinois Medicaid,,,,,4603.59,,,,
NI-CARDIOVERSION,92960,CPT,,,,,both,, ,5017.9,3010.74,Medicaid,Illinois Medicaid,,,,,5017.9,,,,
"EP-CARDIOVER,INTERN",92961,CPT,,,,,both,, ,2378.01,1426.8,Medicaid,Illinois Medicaid,,,,,2378.01,,,,
IC-COR THROMBECTOMY,92973,CPT,,,,,both,, ,29086.43,17451.85,Medicaid,Illinois Medicaid,,,,,29086.43,,,,
IC-INTRCOR THROMBOL,92975,CPT,,,,,both,, ,18741.62,11244.97,Medicaid,Illinois Medicaid,,,,,18741.62,,,,
IC-INTRCOR THROMBOL,92975,CPT,,,,,both,, ,18741.62,11244.97,Medicaid,Illinois Medicaid,,,,,18741.62,,,,
"THROMBOLY,CORONRY,IV",92977,CPT,,,,,both,, ,4033.02,2419.81,Medicaid,Illinois Medicaid,,,,,4033.02,,,,
"IC-IVUS, INIT",92978,CPT,,,,,both,, ,537.92,322.75,Medicaid,Illinois Medicaid,,,,,537.92,,,,
"IC-IVUS, ADDL",92979,CPT,,,,,both,, ,433.89,260.33,Medicaid,Illinois Medicaid,,,,,433.89,,,,
EKG 12 LEAD ED STAFF,93005,CPT,,,,,both,, ,1530.84,918.5,Medicaid,Illinois Medicaid,,,,,1530.84,,,,
EKG 12 LEAD UC STAFF,93005,CPT,,,,,both,, ,65.15,39.09,Medicaid,Illinois Medicaid,,,,,65.15,,,,
EKG 12 LEAD UC STAFF,93005,CPT,,,,,both,, ,65.15,39.09,Medicaid,Illinois Medicaid,,,,,65.15,,,,
"NI-EKG, 12 LEADS",93005,CPT,,,,,both,, ,714.82,428.89,Medicaid,Illinois Medicaid,,,,,714.82,,,,
NI-STRESS TEST,93017,CPT,,,,,both,, ,5189.4,3113.64,Medicaid,Illinois Medicaid,,,,,5189.4,,,,
EP-MICROVOLT T,93025,CPT,,,,,both,, ,1128.62,677.17,Medicaid,Illinois Medicaid,,,,,1128.62,,,,
"NI-EKG, 1-3 LEADS",93041,CPT,,,,,both,, ,1999.49,1199.69,Medicaid,Illinois Medicaid,,,,,1999.49,,,,
NI-HOLT RECRD TO48HR,93225,CPT,,,,,both,, ,9701.06,5820.63,Medicaid,Illinois Medicaid,,,,,9701.06,,,,
NI-HOLT WSCAN TO48HR,93226,CPT,,,,,both,, ,1596.24,957.74,Medicaid,Illinois Medicaid,,,,,1596.24,,,,
NI-TTE 2D W DOPP,93306,CPT,,,,,both,, ,12135.98,7281.58,Medicaid,Illinois Medicaid,,,,,12135.98,,,,
NI-TTE 2D MM COMP WO,93307,CPT,,,,,both,, ,8910.27,5346.16,Medicaid,Illinois Medicaid,,,,,8910.27,,,,
NI-TTE 2D MM LTD WO,93308,CPT,,,,,both,, ,4522.73,2713.63,Medicaid,Illinois Medicaid,,,,,4522.73,,,,
NI-TEE COMP 2D MM WO,93312,CPT,,,,,both,, ,9011.21,5406.72,Medicaid,Illinois Medicaid,,,,,9011.21,,,,
US-ECHO DOPP COMP AD,93320,CPT,,,,,both,, ,1635.9,981.54,Medicaid,Illinois Medicaid,,,,,1635.9,,,,
NI-ECHO DOP LTD,93321,CPT,,,,,both,, ,541.78,325.06,Medicaid,Illinois Medicaid,,,,,541.78,,,,
US-ECHO DOP CO FL AD,93325,CPT,,,,,both,, ,616.46,369.87,Medicaid,Illinois Medicaid,,,,,616.46,,,,
US-TTE STRESS WO,93350,CPT,,,,,both,, ,6350.21,3810.12,Medicaid,Illinois Medicaid,,,,,6350.21,,,,
CC-RHC,93451,CPT,,,,,both,, ,39597.32,23758.39,Medicaid,Illinois Medicaid,,,,,39597.32,,,,
CC-LHC VENT PUNC,93452,CPT,,,,,both,, ,43345.75,26007.45,Medicaid,Illinois Medicaid,,,,,43345.75,,,,
Insertion of catheter into left heart for diagnosis,93452,CPT,,,,,both,,,43345.75,43345.75,Medicaid,Illinois Medicaid,,3573.52,,,43345.75,43345.75,43345.75,Fee Schedule,
CC-R-L CATH LV PUNC,93453,CPT,,,,,both,, ,43345.75,26007.45,Medicaid,Illinois Medicaid,,,,,43345.75,,,,
CC-ANGIO CORON ONLY,93454,CPT,,,,,both,, ,34667.23,20800.33,Medicaid,Illinois Medicaid,,,,,34667.23,,,,
CC-S-I VNT ATR ANGIO,93455,CPT,,,,,both,, ,36140.38,21684.22,Medicaid,Illinois Medicaid,,,,,36140.38,,,,
CC-R HRT CORONRY ART,93456,CPT,,,,,both,, ,74264.29,44558.57,Medicaid,Illinois Medicaid,,,,,74264.29,,,,
CC-R HRT ART-GRF ANG,93457,CPT,,,,,both,, ,75737.7,45442.62,Medicaid,Illinois Medicaid,,,,,75737.7,,,,
CC-L HRT ARTERY-VENT,93458,CPT,,,,,both,, ,49262.84,29557.7,Medicaid,Illinois Medicaid,,,,,49262.84,,,,
CC-L HRT ART-GRF ANG,93459,CPT,,,,,both,, ,50736,30441.6,Medicaid,Illinois Medicaid,,,,,50736,,,,
CC-R-L HRT ART-VENT,93460,CPT,,,,,both,, ,49262.84,29557.7,Medicaid,Illinois Medicaid,,,,,49262.84,,,,
CC-R-L HRT ART-ANGIO,93461,CPT,,,,,both,, ,50736,30441.6,Medicaid,Illinois Medicaid,,,,,50736,,,,
CC-DRUM ADM-HEMODYNC,93463,CPT,,,,,both,, ,451.91,271.14,Medicaid,Illinois Medicaid,,,,,451.91,,,,
INSERTION FLOW CATH,93503,CPT,,,,,both,, ,13163.66,7898.19,Medicaid,Illinois Medicaid,,,,,13163.66,,,,
CC-INJ L VENT-ATRIAL,93565,CPT,,,,,both,, ,3748.43,2249.05,Medicaid,Illinois Medicaid,,,,,3748.43,,,,
CC-INJ R VENT-ATRIAL,93566,CPT,,,,,both,, ,3252.48,1951.48,Medicaid,Illinois Medicaid,,,,,3252.48,,,,
CC-INJ SUPRV AORTOGR,93567,CPT,,,,,both,, ,5119.62,3071.77,Medicaid,Illinois Medicaid,,,,,5119.62,,,,
CC-INJ PULM ART HRTC,93568,CPT,,,,,both,, ,5119.62,3071.77,Medicaid,Illinois Medicaid,,,,,5119.62,,,,
HEART FLOW MEASURE,93571,CPT,,,,,both,, ,709.67,425.8,Medicaid,Illinois Medicaid,,,,,709.67,,,,
HEART FLOW MEAS ADD,93572,CPT,,,,,both,, ,709.67,425.8,Medicaid,Illinois Medicaid,,,,,709.67,,,,
CC-PDA CLOSE PERC,93582,CPT,,,,,both,, ,68501.18,41100.7,Medicaid,Illinois Medicaid,,,,,68501.18,,,,
EP-HIS BUNDLE REC,93600,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,,,,4670.54,,,,
EP-INTRAATRIAL REC,93602,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,,,,4670.54,,,,
EP-RV RECORD,93603,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,,,,4670.54,,,,
EP-MAP TACHY,93609,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,,,,4670.54,,,,
EP-INTRAATRIAL PAC,93610,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,,,,4670.54,,,,
EP-INTRAVENT PAC,93612,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,,,,4670.54,,,,
EP-MAP ADD,93613,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,,,,4670.54,,,,
EP-ATRI RECORD ESO,93615,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,,,,4670.54,,,,
EP-ATRI REC-PAC ESO,93616,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,,,,4670.54,,,,
EP-INDUC ARRY PAC,93618,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,,,,4670.54,,,,
EP-COMP EP W-O ARRY,93619,CPT,,,,,both,, ,22625.5,13575.3,Medicaid,Illinois Medicaid,,,,,22625.5,,,,
EP-COMP EP W- ARRY,93620,CPT,,,,,both,, ,22625.5,13575.3,Medicaid,Illinois Medicaid,,,,,22625.5,,,,
"EP-LA PACING, ADD",93621,CPT,,,,,both,, ,22625.5,13575.3,Medicaid,Illinois Medicaid,,,,,22625.5,,,,
"EP-LV PACING, ADD",93622,CPT,,,,,both,, ,22625.5,13575.3,Medicaid,Illinois Medicaid,,,,,22625.5,,,,
EP-PROG STIM IV DRUG,93623,CPT,,,,,both,, ,22625.5,13575.3,Medicaid,Illinois Medicaid,,,,,22625.5,,,,
EP-F-U EPW-ARRY IND,93624,CPT,,,,,both,, ,22625.5,13575.3,Medicaid,Illinois Medicaid,,,,,22625.5,,,,
EP-INTRA OP MAPPNG,93631,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,,,,4670.54,,,,
"EP-EVAL LEAD,INDUC",93640,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,,,,4670.54,,,,
"EP-EVAL GEN, INDUC",93641,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,,,,4670.54,,,,
EP-EVAL PREV DEVICE,93642,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,,,,4670.54,,,,
EP-ABLATE AV NODE,93650,CPT,,,,,both,, ,22625.5,13575.3,Medicaid,Illinois Medicaid,,,,,22625.5,,,,
EP-ABLATE SPRVNT ART,93653,CPT,,,,,both,, ,46220.99,27732.59,Medicaid,Illinois Medicaid,,,,,46220.99,,,,
EP-ABLATE VENT TACY,93654,CPT,,,,,both,, ,46220.99,27732.59,Medicaid,Illinois Medicaid,,,,,46220.99,,,,
EP-ATR FIB PULM VN I,93656,CPT,,,,,both,, ,46220.99,27732.59,Medicaid,Illinois Medicaid,,,,,46220.99,,,,
EP-INTCRD ECHO INTER,93662,CPT,,,,,both,, ,4670.54,2802.32,Medicaid,Illinois Medicaid,,,,,4670.54,,,,
PAD REHB PER SESSION,93668,CPT,,,,,both,, ,169.18,101.5,Medicaid,Illinois Medicaid,,,,,169.18,,,,
NI-CARD REHAB W-O MO,93797,CPT,,,,,both,, ,193.64,116.18,Medicaid,Illinois Medicaid,,,,,193.64,,,,
NI-CARDI REHAB W- MO,93798,CPT,,,,,both,, ,296.38,177.82,Medicaid,Illinois Medicaid,,,,,296.38,,,,
US-CAROTID DPLX SCAN,93880,CPT,,,,,both,, ,425.13,255.07,Medicaid,Illinois Medicaid,,,,,425.13,,,,
US-CAROTID DPLX SCAN,93880,CPT,,,,,both,, ,457.58,274.54,Medicaid,Illinois Medicaid,,,,,457.58,,,,
US-CRAN DPLX SCN BIL,93880,CPT,,,,,both,, ,12714.32,7628.59,Medicaid,Illinois Medicaid,,,,,12714.32,,,,
US-CAROTID DUP DOPLR,93882,CPT,,,,,both,, ,425.13,255.07,Medicaid,Illinois Medicaid,,,,,425.13,,,,
US-CAROTID DUP DOPLR,93882,CPT,,,,,both,, ,457.58,274.54,Medicaid,Illinois Medicaid,,,,,457.58,,,,
NI-EXT ARTERIAL LTD,93922,CPT,,,,,both,, ,2456.29,1473.77,Medicaid,Illinois Medicaid,,,,,2456.29,,,,
US-EXT ARTERIAL LTD,93922,CPT,,,,,both,, ,167.38,100.42,Medicaid,Illinois Medicaid,,,,,167.38,,,,
NI-EXT ARTERIAL COMP,93923,CPT,,,,,both,, ,3819.24,2291.54,Medicaid,Illinois Medicaid,,,,,3819.24,,,,
US-NON INV ARTER EXT,93923,CPT,,,,,both,, ,268.32,160.99,Medicaid,Illinois Medicaid,,,,,268.32,,,,
NI-STD LE STRS REST,93924,CPT,,,,,both,, ,5693.84,3416.3,Medicaid,Illinois Medicaid,,,,,5693.84,,,,
NI-LW EXT DPX ART BI,93925,CPT,,,,,both,, ,5086.4,3051.84,Medicaid,Illinois Medicaid,,,,,5086.4,,,,
NI-LW EXT DPX ART UN,93926,CPT,,,,,both,, ,2541.53,1524.91,Medicaid,Illinois Medicaid,,,,,2541.53,,,,
US-LW EXT DPX ART UN,93926,CPT,,,,,both,, ,1560.19,936.11,Medicaid,Illinois Medicaid,,,,,1560.19,,,,
NI-UP EXT DPX ART BI,93930,CPT,,,,,both,, ,5083.05,3049.83,Medicaid,Illinois Medicaid,,,,,5083.05,,,,
NI-UP EXT DPX ART UN,93931,CPT,,,,,both,, ,2541.53,1524.91,Medicaid,Illinois Medicaid,,,,,2541.53,,,,
US-UP EXT DPX ART UN,93931,CPT,,,,,both,, ,2026.01,1215.6,Medicaid,Illinois Medicaid,,,,,2026.01,,,,
NI-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,5086.4,3051.84,Medicaid,Illinois Medicaid,,,,,5086.4,,,,
US-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,425.13,255.07,Medicaid,Illinois Medicaid,,,,,425.13,,,,
US-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,457.58,274.54,Medicaid,Illinois Medicaid,,,,,457.58,,,,
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,299.73,179.83,Medicaid,Illinois Medicaid,,,,,299.73,,,,
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,322.65,193.59,Medicaid,Illinois Medicaid,,,,,322.65,,,,
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,2541.53,1524.91,Medicaid,Illinois Medicaid,,,,,2541.53,,,,
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,425.13,255.07,Medicaid,Illinois Medicaid,,,,,425.13,,,,
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,457.58,274.54,Medicaid,Illinois Medicaid,,,,,457.58,,,,
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,823.23,493.93,Medicaid,Illinois Medicaid,,,,,823.23,,,,
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,425.13,255.07,Medicaid,Illinois Medicaid,,,,,425.13,,,,
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,457.58,274.54,Medicaid,Illinois Medicaid,,,,,457.58,,,,
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,828.89,497.33,Medicaid,Illinois Medicaid,,,,,828.89,,,,
US-DPLXSCN GRFT ARTA,93978,CPT,,,,,both,, ,1665.51,999.3,Medicaid,Illinois Medicaid,,,,,1665.51,,,,
NI-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,1292.14,775.28,Medicaid,Illinois Medicaid,,,,,1292.14,,,,
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,425.13,255.07,Medicaid,Illinois Medicaid,,,,,425.13,,,,
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,457.58,274.54,Medicaid,Illinois Medicaid,,,,,457.58,,,,
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,841.51,504.9,Medicaid,Illinois Medicaid,,,,,841.51,,,,
VESS MAP HEMO ACC BI,93985,CPT,,,,,both,, ,977.58,586.54,Medicaid,Illinois Medicaid,,,,,977.58,,,,
VESS MAP HEMO ACC UN,93986,CPT,,,,,both,, ,977.58,586.54,Medicaid,Illinois Medicaid,,,,,977.58,,,,
NI-DUPSCN HEMODIAL,93990,CPT,,,,,both,, ,4623.93,2774.35,Medicaid,Illinois Medicaid,,,,,4623.93,,,,
MECH VENT INITIAL,94002,CPT,,,,,both,, ,4971.3,2982.78,Medicaid,Illinois Medicaid,,,,,4971.3,,,,
MECH VENT DAILY SUBS,94003,CPT,,,,,both,, ,4971.3,2982.78,Medicaid,Illinois Medicaid,,,,,4971.3,,,,
SPIROMETRY,94010,CPT,,,,,both,, ,530.45,318.27,Medicaid,Illinois Medicaid,,,,,530.45,,,,
BRONCHO EVAL PRE/PST,94060,CPT,,,,,both,, ,2361.28,1416.76,Medicaid,Illinois Medicaid,,,,,2361.28,,,,
METHACHOLINE CHALLEN,94070,CPT,,,,,both,, ,961.51,576.9,Medicaid,Illinois Medicaid,,,,,961.51,,,,
MAXIMUM VOLUNTARY VE,94200,CPT,,,,,both,, ,306.94,184.16,Medicaid,Illinois Medicaid,,,,,306.94,,,,
HAST WITH 02 TITRATE,94453,CPT,,,,,both,, ,1089.74,653.84,Medicaid,Illinois Medicaid,,,,,1089.74,,,,
PULM STRESS SIMPLE,94618,CPT,,,,,both,, ,459.12,275.47,Medicaid,Illinois Medicaid,,,,,459.12,,,,
PULM REHAB WO OXIMET,94625,CPT,,,,,both,, ,227.4,136.44,Medicaid,Illinois Medicaid,,,,,227.4,,,,
PULM REHAB W OXIMET,94626,CPT,,,,,both,, ,227.4,136.44,Medicaid,Illinois Medicaid,,,,,227.4,,,,
INHALATION TRTMT INI,94640,CPT,,,,,both,, ,569.5,341.7,Medicaid,Illinois Medicaid,,,,,569.5,,,,
INHALATION TRTMT INI,94640,CPT,,,,,both,, ,586.59,351.95,Medicaid,Illinois Medicaid,,,,,586.59,,,,
INHALATION TRTMT SUB,94640,CPT,,,,,both,, ,691.75,415.05,Medicaid,Illinois Medicaid,,,,,691.75,,,,
INHALATION TRTMT SUB,94640,CPT,,,,,both,, ,712.5,427.5,Medicaid,Illinois Medicaid,,,,,712.5,,,,
PENTAMIDINE ARSL INH,94642,CPT,,,,,both,, ,1061.67,637,Medicaid,Illinois Medicaid,,,,,1061.67,,,,
AEROSOL OBSTRUCT 1HR,94644,CPT,,,,,both,, ,719.71,431.82,Medicaid,Illinois Medicaid,,,,,719.71,,,,
CONT INH TX ED 1HR,94644,CPT,,,,,both,, ,698.75,419.25,Medicaid,Illinois Medicaid,,,,,698.75,,,,
AEROSOL OBSTR ADD HR,94645,CPT,,,,,both,, ,719.71,431.82,Medicaid,Illinois Medicaid,,,,,719.71,,,,
CONT INH TX ED AD HR,94645,CPT,,,,,both,, ,698.75,419.25,Medicaid,Illinois Medicaid,,,,,698.75,,,,
BIPAP/CPAP,94660,CPT,,,,,both,, ,2771.47,1662.88,Medicaid,Illinois Medicaid,,,,,2771.47,,,,
EVAL-DEMO INHL DEVCE,94664,CPT,,,,,both,, ,342.73,205.63,Medicaid,Illinois Medicaid,,,,,342.73,,,,
MANIP CHST WALL INIT,94667,CPT,,,,,both,, ,1191.45,714.87,Medicaid,Illinois Medicaid,,,,,1191.45,,,,
MANIP CHST WALL SBSQ,94668,CPT,,,,,both,, ,975.15,585.09,Medicaid,Illinois Medicaid,,,,,975.15,,,,
MECHAN CHST WALL OSC,94669,CPT,,,,,both,, ,210.89,126.53,Medicaid,Illinois Medicaid,,,,,210.89,,,,
PF TST PLETHYSMOGRA,94726,CPT,,,,,both,, ,548.73,329.23,Medicaid,Illinois Medicaid,,,,,548.73,,,,
PF TEST BY GAS,94727,CPT,,,,,both,, ,548.73,329.23,Medicaid,Illinois Medicaid,,,,,548.73,,,,
PF TEST OSCILLOMETRY,94728,CPT,,,,,both,, ,548.73,329.23,Medicaid,Illinois Medicaid,,,,,548.73,,,,
CO2-MEMBANE DIFF CAP,94729,CPT,,,,,both,, ,2800.31,1680.18,Medicaid,Illinois Medicaid,,,,,2800.31,,,,
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309,185.4,Medicaid,Illinois Medicaid,,,,,309,,,,
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309,185.4,Medicaid,Illinois Medicaid,,,,,309,,,,
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309,185.4,Medicaid,Illinois Medicaid,,,,,309,,,,
PULSE OX NWBRN MULTI,94761,CPT,,,,,both,, ,797.48,478.48,Medicaid,Illinois Medicaid,,,,,797.48,,,,
PULSE OX NWBRN MULTI,94761,CPT,,,,,both,, ,797.48,478.48,Medicaid,Illinois Medicaid,,,,,797.48,,,,
PULSE OX CONTINUOS,94762,CPT,,,,,both,, ,388,232.8,Medicaid,Illinois Medicaid,,,,,388,,,,
PULSE OX CONTINUOS,94762,CPT,,,,,both,, ,468.91,281.34,Medicaid,Illinois Medicaid,,,,,468.91,,,,
PULSE OX CONTINUOS,94762,CPT,,,,,both,, ,468.91,281.34,Medicaid,Illinois Medicaid,,,,,468.91,,,,
CAR SEAT BED TST 60M,94780,CPT,,,,,both,, ,118.19,70.91,Medicaid,Illinois Medicaid,,,,,118.19,,,,
CAR SE-BED TST AD 30,94781,CPT,,,,,both,, ,58.97,35.38,Medicaid,Illinois Medicaid,,,,,58.97,,,,
ALLERGY INJ SIM,95115,CPT,,,,,both,, ,70.56,42.33,Medicaid,Illinois Medicaid,,,,,70.56,,,,
ALLERGY INJ SIM,95115,CPT,,,,,both,, ,70.81,42.48,Medicaid,Illinois Medicaid,,,,,70.81,,,,
ALLERGY INJ MUL,95117,CPT,,,,,both,, ,70.56,42.33,Medicaid,Illinois Medicaid,,,,,70.56,,,,
ALLERGY INJ MUL,95117,CPT,,,,,both,, ,70.81,42.48,Medicaid,Illinois Medicaid,,,,,70.81,,,,
POLYSOMNO GT4 LT6YO,95782,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,,,,2570.88,,,,
POLYSOMNO GT4 LT6YO,95782,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,,,,2570.88,,,,
POLYS-CPAP GT4 LT6YO,95783,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,,,,2570.88,,,,
POLYS-CPAP GT4 LT6YO,95783,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,,,,2570.88,,,,
SLPSTDY UNATT AN-ST,95800,CPT,,,,,both,, ,428.48,257.08,Medicaid,Illinois Medicaid,,,,,428.48,,,,
SLPSTDY UNATT AN-ST,95800,CPT,,,,,both,, ,625,375,Medicaid,Illinois Medicaid,,,,,625,,,,
MULTI SLEEP LAT,95805,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,,,,2570.88,,,,
MULTI SLEEP LAT,95805,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,,,,2570.88,,,,
SLPSTDY UNATT RS EFF,95806,CPT,,,,,both,, ,428.48,257.08,Medicaid,Illinois Medicaid,,,,,428.48,,,,
SLPSTDY UNATT RS EFF,95806,CPT,,,,,both,, ,625,375,Medicaid,Illinois Medicaid,,,,,625,,,,
POLYSOMNO GT4 GE6YO,95810,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,,,,2570.88,,,,
POLYSOMNO GT4 GE6YO,95810,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,,,,2570.88,,,,
Sleep study,95810,CPT,,,,,both,,,2570.88,2570.88,Medicaid,Illinois Medicaid,,1100.85,,,2570.88,2570.88,2570.88,Fee Schedule,
POLYS-CPAP GT4 GE6YO,95811,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,,,,2570.88,,,,
POLYS-CPAP GT4 GE6YO,95811,CPT,,,,,both,, ,2570.88,1542.52,Medicaid,Illinois Medicaid,,,,,2570.88,,,,
EEG 41-60 MIN,95812,CPT,,,,,both,, ,1075.58,645.34,Medicaid,Illinois Medicaid,,,,,1075.58,,,,
EEG GT 1 HOUR,95813,CPT,,,,,both,, ,1044.25,626.55,Medicaid,Illinois Medicaid,,,,,1044.25,,,,
EEG AWAKE DROWSY,95816,CPT,,,,,both,, ,1075.58,645.34,Medicaid,Illinois Medicaid,,,,,1075.58,,,,
EEG AWAKE ASLEEP,95819,CPT,,,,,both,, ,3362.5,2017.5,Medicaid,Illinois Medicaid,,,,,3362.5,,,,
EEG ASLEEP,95822,CPT,,,,,both,, ,4457.07,2674.24,Medicaid,Illinois Medicaid,,,,,4457.07,,,,
ROM WR EA EXTRK COTA,95851,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,,,,486.42,,,,
ROM WR EA EXTRK COTA,95851,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,,,,486.42,,,,
ROM WR EA EXTRNK PTA,95851,CPT,,,,,both,, ,21.12,12.67,Medicaid,Illinois Medicaid,,,,,21.12,,,,
ROM WR EA EXTRNK PTA,95851,CPT,,,,,both,, ,21.12,12.67,Medicaid,Illinois Medicaid,,,,,21.12,,,,
ROM WR EA EXTRNK PTA,95851,CPT,,,,,both,, ,21.12,12.67,Medicaid,Illinois Medicaid,,,,,21.12,,,,
ROM WR EA EXTRNK PTA,95851,CPT,,,,,both,, ,21.12,12.67,Medicaid,Illinois Medicaid,,,,,21.12,,,,
ROM WR EA EXTRNK PTA,95851,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,,,,448.57,,,,
ROM WR EA EXTRNK PTA,95851,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,,,,448.57,,,,
ROM W-R EA EXT-TRNK,95851,CPT,,,,,both,, ,418.86,251.31,Medicaid,Illinois Medicaid,,,,,418.86,,,,
ROM W-R EA EXT-TRNK,95851,CPT,,,,,both,, ,454.13,272.47,Medicaid,Illinois Medicaid,,,,,454.13,,,,
ROM W-R HND W-WO COM,95852,CPT,,,,,both,, ,418.86,251.31,Medicaid,Illinois Medicaid,,,,,418.86,,,,
ROM W-R HND W-WO COM,95852,CPT,,,,,both,, ,454.13,272.47,Medicaid,Illinois Medicaid,,,,,454.13,,,,
ROM WR HND W-WO COTA,95852,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,,,,486.42,,,,
ROM WR HND W-WO COTA,95852,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,,,,486.42,,,,
ROM W-R HND W-WO PTA,95852,CPT,,,,,both,, ,16.22,9.73,Medicaid,Illinois Medicaid,,,,,16.22,,,,
ROM W-R HND W-WO PTA,95852,CPT,,,,,both,, ,16.22,9.73,Medicaid,Illinois Medicaid,,,,,16.22,,,,
ROM W-R HND W-WO PTA,95852,CPT,,,,,both,, ,16.22,9.73,Medicaid,Illinois Medicaid,,,,,16.22,,,,
ROM W-R HND W-WO PTA,95852,CPT,,,,,both,, ,16.22,9.73,Medicaid,Illinois Medicaid,,,,,16.22,,,,
ROM W-R HND W-WO PTA,95852,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,,,,448.57,,,,
ROM W-R HND W-WO PTA,95852,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,,,,448.57,,,,
"EMG, 1 EXTREM",95860,CPT,,,,,both,, ,3272.05,1963.23,Medicaid,Illinois Medicaid,,,,,3272.05,,,,
"EMG, 2 EXTREM",95861,CPT,,,,,both,, ,5586.46,3351.87,Medicaid,Illinois Medicaid,,,,,5586.46,,,,
"EMG, 3 EXTREM",95863,CPT,,,,,both,, ,7162.62,4297.57,Medicaid,Illinois Medicaid,,,,,7162.62,,,,
"EMG, 4 EXTREM",95864,CPT,,,,,both,, ,8764.27,5258.56,Medicaid,Illinois Medicaid,,,,,8764.27,,,,
"EMG, W-NERVE TEST",95885,CPT,,,,,both,, ,458.87,275.32,Medicaid,Illinois Medicaid,,,,,458.87,,,,
EMG W-NRV TST COM,95886,CPT,,,,,both,, ,458.87,275.32,Medicaid,Illinois Medicaid,,,,,458.87,,,,
EMG W-NRV TST NON,95887,CPT,,,,,both,, ,242.57,145.54,Medicaid,Illinois Medicaid,,,,,242.57,,,,
MTR-SENS 1-2 NRV TST,95907,CPT,,,,,both,, ,821.43,492.85,Medicaid,Illinois Medicaid,,,,,821.43,,,,
MTR-SENS 3-4 NRV TST,95908,CPT,,,,,both,, ,821.43,492.85,Medicaid,Illinois Medicaid,,,,,821.43,,,,
MTR-SENS 5-6 NRV TST,95909,CPT,,,,,both,, ,821.43,492.85,Medicaid,Illinois Medicaid,,,,,821.43,,,,
MTR-SENS 7-8 NRV TST,95910,CPT,,,,,both,, ,821.43,492.85,Medicaid,Illinois Medicaid,,,,,821.43,,,,
MTR-SES 9-10 NRV TST,95911,CPT,,,,,both,, ,821.43,492.85,Medicaid,Illinois Medicaid,,,,,821.43,,,,
MTR-SES 11-12 NRV TS,95912,CPT,,,,,both,, ,1518.74,911.24,Medicaid,Illinois Medicaid,,,,,1518.74,,,,
MTR-SNS 13 OR MORE,95913,CPT,,,,,both,, ,1518.74,911.24,Medicaid,Illinois Medicaid,,,,,1518.74,,,,
PARASYMP-SYMP HRT RT,95924,CPT,,,,,both,, ,461.44,276.86,Medicaid,Illinois Medicaid,,,,,461.44,,,,
VISUAL EVOK POTENT,95930,CPT,,,,,both,, ,3397.2,2038.32,Medicaid,Illinois Medicaid,,,,,3397.2,,,,
"REPETIT STIM, EA NE",95937,CPT,,,,,both,, ,3199.95,1919.97,Medicaid,Illinois Medicaid,,,,,3199.95,,,,
CANALITH PER DAY,95992,CPT,,,,,both,, ,158.07,94.84,Medicaid,Illinois Medicaid,,,,,158.07,,,,
CANALITH PER DAY PTA,95992,CPT,,,,,both,, ,101.97,61.18,Medicaid,Illinois Medicaid,,,,,101.97,,,,
CANALITH PER DAY PTA,95992,CPT,,,,,both,, ,101.97,61.18,Medicaid,Illinois Medicaid,,,,,101.97,,,,
CANALITH PER DAY PTA,95992,CPT,,,,,both,, ,169.44,101.66,Medicaid,Illinois Medicaid,,,,,169.44,,,,
CANALITH PER DAY PTA,95992,CPT,,,,,both,, ,169.44,101.66,Medicaid,Illinois Medicaid,,,,,169.44,,,,
APHASIA ASSESS 1HOUR,96105,CPT,,,,,both,, ,813.7,488.22,Medicaid,Illinois Medicaid,,,,,813.7,,,,
DEV TEST 1ST HR,96112,CPT,,,,,both,, ,813.7,488.22,Medicaid,Illinois Medicaid,,,,,813.7,,,,
DEV TEST ADD 30M,96113,CPT,,,,,both,, ,763.23,457.93,Medicaid,Illinois Medicaid,,,,,763.23,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,253.9,152.34,Medicaid,Illinois Medicaid,,,,,253.9,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,253.9,152.34,Medicaid,Illinois Medicaid,,,,,253.9,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,487,292.2,Medicaid,Illinois Medicaid,,,,,487,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,487,292.2,Medicaid,Illinois Medicaid,,,,,487,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,501.61,300.96,Medicaid,Illinois Medicaid,,,,,501.61,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,501.61,300.96,Medicaid,Illinois Medicaid,,,,,501.61,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,1841.23,1104.73,Medicaid,Illinois Medicaid,,,,,1841.23,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,70.81,42.48,Medicaid,Illinois Medicaid,,,,,70.81,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,70.81,42.48,Medicaid,Illinois Medicaid,,,,,70.81,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,135.75,81.45,Medicaid,Illinois Medicaid,,,,,135.75,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,135.75,81.45,Medicaid,Illinois Medicaid,,,,,135.75,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,139.82,83.89,Medicaid,Illinois Medicaid,,,,,139.82,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,139.82,83.89,Medicaid,Illinois Medicaid,,,,,139.82,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,1841.23,1104.73,Medicaid,Illinois Medicaid,,,,,1841.23,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,412.77,247.66,Medicaid,Illinois Medicaid,,,,,412.77,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,412.77,247.66,Medicaid,Illinois Medicaid,,,,,412.77,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,928.18,556.9,Medicaid,Illinois Medicaid,,,,,928.18,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1301.75,781.05,Medicaid,Illinois Medicaid,,,,,1301.75,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1301.75,781.05,Medicaid,Illinois Medicaid,,,,,1301.75,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1340.8,804.48,Medicaid,Illinois Medicaid,,,,,1340.8,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1340.8,804.48,Medicaid,Illinois Medicaid,,,,,1340.8,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,70.81,42.48,Medicaid,Illinois Medicaid,,,,,70.81,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,70.81,42.48,Medicaid,Illinois Medicaid,,,,,70.81,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,928.18,556.9,Medicaid,Illinois Medicaid,,,,,928.18,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1301.75,781.05,Medicaid,Illinois Medicaid,,,,,1301.75,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1301.75,781.05,Medicaid,Illinois Medicaid,,,,,1301.75,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1340.8,804.48,Medicaid,Illinois Medicaid,,,,,1340.8,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1340.8,804.48,Medicaid,Illinois Medicaid,,,,,1340.8,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,201.25,120.75,Medicaid,Illinois Medicaid,,,,,201.25,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,201.25,120.75,Medicaid,Illinois Medicaid,,,,,201.25,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,207.29,124.37,Medicaid,Illinois Medicaid,,,,,207.29,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,207.29,124.37,Medicaid,Illinois Medicaid,,,,,207.29,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,928.18,556.9,Medicaid,Illinois Medicaid,,,,,928.18,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,791.25,474.75,Medicaid,Illinois Medicaid,,,,,791.25,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,791.25,474.75,Medicaid,Illinois Medicaid,,,,,791.25,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,814.99,488.99,Medicaid,Illinois Medicaid,,,,,814.99,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,814.99,488.99,Medicaid,Illinois Medicaid,,,,,814.99,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,928.18,556.9,Medicaid,Illinois Medicaid,,,,,928.18,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,201.25,120.75,Medicaid,Illinois Medicaid,,,,,201.25,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,201.25,120.75,Medicaid,Illinois Medicaid,,,,,201.25,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,207.29,124.37,Medicaid,Illinois Medicaid,,,,,207.29,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,207.29,124.37,Medicaid,Illinois Medicaid,,,,,207.29,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,301.16,180.69,Medicaid,Illinois Medicaid,,,,,301.16,,,,
S-INJ NON CHEMO IA,96373,CPT,,,,,both,, ,1355.48,813.28,Medicaid,Illinois Medicaid,,,,,1355.48,,,,
INJECTION IV PUSH,96374,CPT,,,,,both,, ,1477.47,886.48,Medicaid,Illinois Medicaid,,,,,1477.47,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,201.25,120.75,Medicaid,Illinois Medicaid,,,,,201.25,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,201.25,120.75,Medicaid,Illinois Medicaid,,,,,201.25,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,207.29,124.37,Medicaid,Illinois Medicaid,,,,,207.29,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,253.9,152.34,Medicaid,Illinois Medicaid,,,,,253.9,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,253.9,152.34,Medicaid,Illinois Medicaid,,,,,253.9,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,501.61,300.96,Medicaid,Illinois Medicaid,,,,,501.61,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,1355.48,813.28,Medicaid,Illinois Medicaid,,,,,1355.48,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,201.25,120.75,Medicaid,Illinois Medicaid,,,,,201.25,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,201.25,120.75,Medicaid,Illinois Medicaid,,,,,201.25,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,207.29,124.37,Medicaid,Illinois Medicaid,,,,,207.29,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,207.29,124.37,Medicaid,Illinois Medicaid,,,,,207.29,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,668.99,401.39,Medicaid,Illinois Medicaid,,,,,668.99,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,729.19,437.51,Medicaid,Illinois Medicaid,,,,,729.19,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,98.5,59.1,Medicaid,Illinois Medicaid,,,,,98.5,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,98.5,59.1,Medicaid,Illinois Medicaid,,,,,98.5,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,101.46,60.87,Medicaid,Illinois Medicaid,,,,,101.46,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,101.46,60.87,Medicaid,Illinois Medicaid,,,,,101.46,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,729.19,437.51,Medicaid,Illinois Medicaid,,,,,729.19,,,,
CHEMO NON HORM IM SC,96401,CPT,,,,,both,, ,476.63,285.97,Medicaid,Illinois Medicaid,,,,,476.63,,,,
CHEMO HORMONAL IM SC,96402,CPT,,,,,both,, ,235.36,141.21,Medicaid,Illinois Medicaid,,,,,235.36,,,,
CHEMO IV PUSH,96409,CPT,,,,,both,, ,382.65,229.59,Medicaid,Illinois Medicaid,,,,,382.65,,,,
CHEMO EA AD IV PUSH,96411,CPT,,,,,both,, ,117.16,70.29,Medicaid,Illinois Medicaid,,,,,117.16,,,,
CHEMO IV INFU 1ST HR,96413,CPT,,,,,both,, ,1377.11,826.26,Medicaid,Illinois Medicaid,,,,,1377.11,,,,
CHEMO IV IN EA AD HR,96415,CPT,,,,,both,, ,234.58,140.74,Medicaid,Illinois Medicaid,,,,,234.58,,,,
CHEMO IV EA SEQ INF,96417,CPT,,,,,both,, ,126.18,75.7,Medicaid,Illinois Medicaid,,,,,126.18,,,,
IR-IRR PORT DRUG DEL,96523,CPT,,,,,both,, ,383.16,229.89,Medicaid,Illinois Medicaid,,,,,383.16,,,,
HOT-COLD PACKS,97010,CPT,,,,,both,, ,239.27,143.56,Medicaid,Illinois Medicaid,,,,,239.27,,,,
HOT-COLD PACKS,97010,CPT,,,,,both,, ,259.41,155.64,Medicaid,Illinois Medicaid,,,,,259.41,,,,
HOT-COLD PACKS COTA,97010,CPT,,,,,both,, ,277.84,166.7,Medicaid,Illinois Medicaid,,,,,277.84,,,,
HOT-COLD PACKS COTA,97010,CPT,,,,,both,, ,277.84,166.7,Medicaid,Illinois Medicaid,,,,,277.84,,,,
HOT-COLD PACKS PTA,97010,CPT,,,,,both,, ,41.2,24.72,Medicaid,Illinois Medicaid,,,,,41.2,,,,
HOT-COLD PACKS PTA,97010,CPT,,,,,both,, ,41.2,24.72,Medicaid,Illinois Medicaid,,,,,41.2,,,,
HOT-COLD PACKS PTA,97010,CPT,,,,,both,, ,41.2,24.72,Medicaid,Illinois Medicaid,,,,,41.2,,,,
HOT-COLD PACKS PTA,97010,CPT,,,,,both,, ,41.2,24.72,Medicaid,Illinois Medicaid,,,,,41.2,,,,
HOT-COLD PACKS PTA,97010,CPT,,,,,both,, ,256.21,153.72,Medicaid,Illinois Medicaid,,,,,256.21,,,,
HOT-COLD PACKS PTA,97010,CPT,,,,,both,, ,256.21,153.72,Medicaid,Illinois Medicaid,,,,,256.21,,,,
MECH TRACTION-VISIT,97012,CPT,,,,,both,, ,485.24,291.14,Medicaid,Illinois Medicaid,,,,,485.24,,,,
MECH TRACTN-VST PTA,97012,CPT,,,,,both,, ,39.4,23.64,Medicaid,Illinois Medicaid,,,,,39.4,,,,
MECH TRACTN-VST PTA,97012,CPT,,,,,both,, ,39.4,23.64,Medicaid,Illinois Medicaid,,,,,39.4,,,,
MECH TRACTN-VST PTA,97012,CPT,,,,,both,, ,519.89,311.93,Medicaid,Illinois Medicaid,,,,,519.89,,,,
MECH TRACTN-VST PTA,97012,CPT,,,,,both,, ,519.89,311.93,Medicaid,Illinois Medicaid,,,,,519.89,,,,
PARAF BATH-VISIT PTA,97018,CPT,,,,,both,, ,18.54,11.12,Medicaid,Illinois Medicaid,,,,,18.54,,,,
PARAF BATH-VISIT PTA,97018,CPT,,,,,both,, ,18.54,11.12,Medicaid,Illinois Medicaid,,,,,18.54,,,,
PARAF BATH-VISIT PTA,97018,CPT,,,,,both,, ,320.85,192.51,Medicaid,Illinois Medicaid,,,,,320.85,,,,
PARAF BATH-VISIT PTA,97018,CPT,,,,,both,, ,320.85,192.51,Medicaid,Illinois Medicaid,,,,,320.85,,,,
PARAF BTH-VISIT COTA,97018,CPT,,,,,both,, ,41.2,24.72,Medicaid,Illinois Medicaid,,,,,41.2,,,,
PARAF BTH-VISIT COTA,97018,CPT,,,,,both,, ,41.2,24.72,Medicaid,Illinois Medicaid,,,,,41.2,,,,
PARAF BTH-VISIT COTA,97018,CPT,,,,,both,, ,347.88,208.72,Medicaid,Illinois Medicaid,,,,,347.88,,,,
PARAF BTH-VISIT COTA,97018,CPT,,,,,both,, ,347.88,208.72,Medicaid,Illinois Medicaid,,,,,347.88,,,,
PARAFFIN BATH-VISIT,97018,CPT,,,,,both,, ,299.53,179.71,Medicaid,Illinois Medicaid,,,,,299.53,,,,
PARAFFIN BATH-VISIT,97018,CPT,,,,,both,, ,324.73,194.83,Medicaid,Illinois Medicaid,,,,,324.73,,,,
WHIRLPOOL THRPY-VIST,97022,CPT,,,,,both,, ,652.7,391.62,Medicaid,Illinois Medicaid,,,,,652.7,,,,
WHIRLPOOL THRPY-VIST,97022,CPT,,,,,both,, ,707.58,424.54,Medicaid,Illinois Medicaid,,,,,707.58,,,,
WHRLPL THPY-VST COTA,97022,CPT,,,,,both,, ,758.08,454.84,Medicaid,Illinois Medicaid,,,,,758.08,,,,
WHRLPL THPY-VST COTA,97022,CPT,,,,,both,, ,758.08,454.84,Medicaid,Illinois Medicaid,,,,,758.08,,,,
WHRLPL THRPY-VST PTA,97022,CPT,,,,,both,, ,46.87,28.12,Medicaid,Illinois Medicaid,,,,,46.87,,,,
WHRLPL THRPY-VST PTA,97022,CPT,,,,,both,, ,46.87,28.12,Medicaid,Illinois Medicaid,,,,,46.87,,,,
WHRLPL THRPY-VST PTA,97022,CPT,,,,,both,, ,46.87,28.12,Medicaid,Illinois Medicaid,,,,,46.87,,,,
WHRLPL THRPY-VST PTA,97022,CPT,,,,,both,, ,46.87,28.12,Medicaid,Illinois Medicaid,,,,,46.87,,,,
WHRLPL THRPY-VST PTA,97022,CPT,,,,,both,, ,699.11,419.46,Medicaid,Illinois Medicaid,,,,,699.11,,,,
WHRLPL THRPY-VST PTA,97022,CPT,,,,,both,, ,699.11,419.46,Medicaid,Illinois Medicaid,,,,,699.11,,,,
ELE STM-MN-15MN COTA,97032,CPT,,,,,both,, ,541.52,324.91,Medicaid,Illinois Medicaid,,,,,541.52,,,,
ELE STM-MN-15MN COTA,97032,CPT,,,,,both,, ,541.52,324.91,Medicaid,Illinois Medicaid,,,,,541.52,,,,
ELEC STIM-MAN-15 MIN,97032,CPT,,,,,both,, ,466.32,279.79,Medicaid,Illinois Medicaid,,,,,466.32,,,,
ELEC STIM-MAN-15 MIN,97032,CPT,,,,,both,, ,505.5,303.3,Medicaid,Illinois Medicaid,,,,,505.5,,,,
ELEC STM-MN-15MN PTA,97032,CPT,,,,,both,, ,39.4,23.64,Medicaid,Illinois Medicaid,,,,,39.4,,,,
ELEC STM-MN-15MN PTA,97032,CPT,,,,,both,, ,39.4,23.64,Medicaid,Illinois Medicaid,,,,,39.4,,,,
ELEC STM-MN-15MN PTA,97032,CPT,,,,,both,, ,39.4,23.64,Medicaid,Illinois Medicaid,,,,,39.4,,,,
ELEC STM-MN-15MN PTA,97032,CPT,,,,,both,, ,39.4,23.64,Medicaid,Illinois Medicaid,,,,,39.4,,,,
ELEC STM-MN-15MN PTA,97032,CPT,,,,,both,, ,499.55,299.73,Medicaid,Illinois Medicaid,,,,,499.55,,,,
ELEC STM-MN-15MN PTA,97032,CPT,,,,,both,, ,499.55,299.73,Medicaid,Illinois Medicaid,,,,,499.55,,,,
IONTOPHO-15 MIN COTA,97033,CPT,,,,,both,, ,764.52,458.71,Medicaid,Illinois Medicaid,,,,,764.52,,,,
IONTOPHO-15 MIN COTA,97033,CPT,,,,,both,, ,764.52,458.71,Medicaid,Illinois Medicaid,,,,,764.52,,,,
IONTOPHOR-15 MIN PTA,97033,CPT,,,,,both,, ,54.59,32.75,Medicaid,Illinois Medicaid,,,,,54.59,,,,
IONTOPHOR-15 MIN PTA,97033,CPT,,,,,both,, ,54.59,32.75,Medicaid,Illinois Medicaid,,,,,54.59,,,,
IONTOPHOR-15 MIN PTA,97033,CPT,,,,,both,, ,54.59,32.75,Medicaid,Illinois Medicaid,,,,,54.59,,,,
IONTOPHOR-15 MIN PTA,97033,CPT,,,,,both,, ,54.59,32.75,Medicaid,Illinois Medicaid,,,,,54.59,,,,
IONTOPHOR-15 MIN PTA,97033,CPT,,,,,both,, ,705.04,423.02,Medicaid,Illinois Medicaid,,,,,705.04,,,,
IONTOPHOR-15 MIN PTA,97033,CPT,,,,,both,, ,705.04,423.02,Medicaid,Illinois Medicaid,,,,,705.04,,,,
IONTOPHORESIS-15 MIN,97033,CPT,,,,,both,, ,658.28,394.96,Medicaid,Illinois Medicaid,,,,,658.28,,,,
IONTOPHORESIS-15 MIN,97033,CPT,,,,,both,, ,713.65,428.19,Medicaid,Illinois Medicaid,,,,,713.65,,,,
CNTRST BTH-15MIN PTA,97034,CPT,,,,,both,, ,40.17,24.1,Medicaid,Illinois Medicaid,,,,,40.17,,,,
CNTRST BTH-15MIN PTA,97034,CPT,,,,,both,, ,40.17,24.1,Medicaid,Illinois Medicaid,,,,,40.17,,,,
CNTRST BTH-15MIN PTA,97034,CPT,,,,,both,, ,40.17,24.1,Medicaid,Illinois Medicaid,,,,,40.17,,,,
CNTRST BTH-15MIN PTA,97034,CPT,,,,,both,, ,40.17,24.1,Medicaid,Illinois Medicaid,,,,,40.17,,,,
CNTRST BTH-15MIN PTA,97034,CPT,,,,,both,, ,474.83,284.89,Medicaid,Illinois Medicaid,,,,,474.83,,,,
CNTRST BTH-15MIN PTA,97034,CPT,,,,,both,, ,474.83,284.89,Medicaid,Illinois Medicaid,,,,,474.83,,,,
CNTRST BTH-15MN COTA,97034,CPT,,,,,both,, ,514.74,308.84,Medicaid,Illinois Medicaid,,,,,514.74,,,,
CNTRST BTH-15MN COTA,97034,CPT,,,,,both,, ,514.74,308.84,Medicaid,Illinois Medicaid,,,,,514.74,,,,
CONTRAST BATH-15 MIN,97034,CPT,,,,,both,, ,443.25,265.95,Medicaid,Illinois Medicaid,,,,,443.25,,,,
CONTRAST BATH-15 MIN,97034,CPT,,,,,both,, ,480.51,288.3,Medicaid,Illinois Medicaid,,,,,480.51,,,,
ULTRASND-15 MIN COTA,97035,CPT,,,,,both,, ,611.56,366.93,Medicaid,Illinois Medicaid,,,,,611.56,,,,
ULTRASND-15 MIN COTA,97035,CPT,,,,,both,, ,611.56,366.93,Medicaid,Illinois Medicaid,,,,,611.56,,,,
ULTRASND-15 MIN PTA,97035,CPT,,,,,both,, ,36.57,21.94,Medicaid,Illinois Medicaid,,,,,36.57,,,,
ULTRASND-15 MIN PTA,97035,CPT,,,,,both,, ,36.57,21.94,Medicaid,Illinois Medicaid,,,,,36.57,,,,
ULTRASND-15 MIN PTA,97035,CPT,,,,,both,, ,36.57,21.94,Medicaid,Illinois Medicaid,,,,,36.57,,,,
ULTRASND-15 MIN PTA,97035,CPT,,,,,both,, ,36.57,21.94,Medicaid,Illinois Medicaid,,,,,36.57,,,,
ULTRASND-15 MIN PTA,97035,CPT,,,,,both,, ,564.18,338.5,Medicaid,Illinois Medicaid,,,,,564.18,,,,
ULTRASND-15 MIN PTA,97035,CPT,,,,,both,, ,564.18,338.5,Medicaid,Illinois Medicaid,,,,,564.18,,,,
ULTRASOUND-15 MIN,97035,CPT,,,,,both,, ,526.62,315.97,Medicaid,Illinois Medicaid,,,,,526.62,,,,
ULTRASOUND-15 MIN,97035,CPT,,,,,both,, ,570.95,342.57,Medicaid,Illinois Medicaid,,,,,570.95,,,,
"Physical therapy, therapeutic exercise .",97110,CPT,,,,,both,,,342.72,342.72,Medicaid,Illinois Medicaid,,19.41,,,342.72,342.72,342.72,Fee Schedule,
THER EXRCS-15MIN PTA,97110,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,,,,81.37,,,,
THER EXRCS-15MIN PTA,97110,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,,,,81.37,,,,
THER EXRCS-15MIN PTA,97110,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,,,,81.37,,,,
THER EXRCS-15MIN PTA,97110,CPT,,,,,both,, ,81.37,48.82,Medicaid,Illinois Medicaid,,,,,81.37,,,,
THER EXRCS-15MIN PTA,97110,CPT,,,,,both,, ,367.2,220.32,Medicaid,Illinois Medicaid,,,,,367.2,,,,
THER EXRCS-15MIN PTA,97110,CPT,,,,,both,, ,367.2,220.32,Medicaid,Illinois Medicaid,,,,,367.2,,,,
THER EXRCS-15MN COTA,97110,CPT,,,,,both,, ,398.1,238.86,Medicaid,Illinois Medicaid,,,,,398.1,,,,
THER EXRCS-15MN COTA,97110,CPT,,,,,both,, ,398.1,238.86,Medicaid,Illinois Medicaid,,,,,398.1,,,,
THERAP EXERCS-15 MIN,97110,CPT,,,,,both,, ,342.72,205.63,Medicaid,Illinois Medicaid,,,,,342.72,,,,
THERAP EXERCS-15 MIN,97110,CPT,,,,,both,, ,371.55,222.93,Medicaid,Illinois Medicaid,,,,,371.55,,,,
NEUR RE-ED-15MIN PTA,97112,CPT,,,,,both,, ,92.19,55.31,Medicaid,Illinois Medicaid,,,,,92.19,,,,
NEUR RE-ED-15MIN PTA,97112,CPT,,,,,both,, ,92.19,55.31,Medicaid,Illinois Medicaid,,,,,92.19,,,,
NEUR RE-ED-15MIN PTA,97112,CPT,,,,,both,, ,92.19,55.31,Medicaid,Illinois Medicaid,,,,,92.19,,,,
NEUR RE-ED-15MIN PTA,97112,CPT,,,,,both,, ,92.19,55.31,Medicaid,Illinois Medicaid,,,,,92.19,,,,
NEUR RE-ED-15MIN PTA,97112,CPT,,,,,both,, ,367.2,220.32,Medicaid,Illinois Medicaid,,,,,367.2,,,,
NEUR RE-ED-15MIN PTA,97112,CPT,,,,,both,, ,367.2,220.32,Medicaid,Illinois Medicaid,,,,,367.2,,,,
NEUR RE-ED-15MN COTA,97112,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,,,,486.42,,,,
NEUR RE-ED-15MN COTA,97112,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,,,,486.42,,,,
NEURO RE-ED-15 MIN,97112,CPT,,,,,both,, ,342.72,205.63,Medicaid,Illinois Medicaid,,,,,342.72,,,,
NEURO RE-ED-15 MIN,97112,CPT,,,,,both,, ,454.13,272.47,Medicaid,Illinois Medicaid,,,,,454.13,,,,
GAIT TRAINING-15 MIN,97116,CPT,,,,,both,, ,342.72,205.63,Medicaid,Illinois Medicaid,,,,,342.72,,,,
GAIT TRAINING-15 MIN,97116,CPT,,,,,both,, ,454.13,272.47,Medicaid,Illinois Medicaid,,,,,454.13,,,,
GAIT TRNG-15MIN COTA,97116,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,,,,486.42,,,,
GAIT TRNG-15MIN COTA,97116,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,,,,486.42,,,,
GAIT TRNNG-15MIN PTA,97116,CPT,,,,,both,, ,80.34,48.2,Medicaid,Illinois Medicaid,,,,,80.34,,,,
GAIT TRNNG-15MIN PTA,97116,CPT,,,,,both,, ,80.34,48.2,Medicaid,Illinois Medicaid,,,,,80.34,,,,
GAIT TRNNG-15MIN PTA,97116,CPT,,,,,both,, ,80.34,48.2,Medicaid,Illinois Medicaid,,,,,80.34,,,,
GAIT TRNNG-15MIN PTA,97116,CPT,,,,,both,, ,80.34,48.2,Medicaid,Illinois Medicaid,,,,,80.34,,,,
GAIT TRNNG-15MIN PTA,97116,CPT,,,,,both,, ,367.2,220.32,Medicaid,Illinois Medicaid,,,,,367.2,,,,
GAIT TRNNG-15MIN PTA,97116,CPT,,,,,both,, ,367.2,220.32,Medicaid,Illinois Medicaid,,,,,367.2,,,,
MASSAGE THRPY-15 MIN,97124,CPT,,,,,both,, ,294.09,176.45,Medicaid,Illinois Medicaid,,,,,294.09,,,,
MASSAGE THRPY-15 MIN,97124,CPT,,,,,both,, ,318.84,191.3,Medicaid,Illinois Medicaid,,,,,318.84,,,,
MASSG THRP-15MN COTA,97124,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
MASSG THRP-15MN COTA,97124,CPT,,,,,both,, ,341.45,204.87,Medicaid,Illinois Medicaid,,,,,341.45,,,,
MASSG THRPY-15MN PTA,97124,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,,,,74.93,,,,
MASSG THRPY-15MN PTA,97124,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,,,,74.93,,,,
MASSG THRPY-15MN PTA,97124,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,,,,74.93,,,,
MASSG THRPY-15MN PTA,97124,CPT,,,,,both,, ,74.93,44.95,Medicaid,Illinois Medicaid,,,,,74.93,,,,
MASSG THRPY-15MN PTA,97124,CPT,,,,,both,, ,314.92,188.95,Medicaid,Illinois Medicaid,,,,,314.92,,,,
MASSG THRPY-15MN PTA,97124,CPT,,,,,both,, ,314.92,188.95,Medicaid,Illinois Medicaid,,,,,314.92,,,,
COG SKL DV IN15 COTA,97129,CPT,,,,,both,, ,398.1,238.86,Medicaid,Illinois Medicaid,,,,,398.1,,,,
COG SKL DV INI15 OT,97129,CPT,,,,,both,, ,398.1,238.86,Medicaid,Illinois Medicaid,,,,,398.1,,,,
COG SKL DV INI15 PTA,97129,CPT,,,,,both,, ,84.46,50.67,Medicaid,Illinois Medicaid,,,,,84.46,,,,
COG SKL DV INI15 PTA,97129,CPT,,,,,both,, ,84.46,50.67,Medicaid,Illinois Medicaid,,,,,84.46,,,,
COG SKL DV INI15 PTA,97129,CPT,,,,,both,, ,84.46,50.67,Medicaid,Illinois Medicaid,,,,,84.46,,,,
COG SKL DV INI15 PTA,97129,CPT,,,,,both,, ,84.46,50.67,Medicaid,Illinois Medicaid,,,,,84.46,,,,
COG SKL DV INI15 PTA,97129,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,,,,448.57,,,,
COG SKL DV INI15 PTA,97129,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,,,,448.57,,,,
COG SKL DV INI15 SP,97129,CPT,,,,,both,, ,398.1,238.86,Medicaid,Illinois Medicaid,,,,,398.1,,,,
COG SKL DV AD15 COTA,97130,CPT,,,,,both,, ,398.1,238.86,Medicaid,Illinois Medicaid,,,,,398.1,,,,
COG SKL DV ADD15 OT,97130,CPT,,,,,both,, ,398.1,238.86,Medicaid,Illinois Medicaid,,,,,398.1,,,,
COG SKL DV ADD15 PTA,97130,CPT,,,,,both,, ,84.46,50.67,Medicaid,Illinois Medicaid,,,,,84.46,,,,
COG SKL DV ADD15 PTA,97130,CPT,,,,,both,, ,84.46,50.67,Medicaid,Illinois Medicaid,,,,,84.46,,,,
COG SKL DV ADD15 PTA,97130,CPT,,,,,both,, ,84.46,50.67,Medicaid,Illinois Medicaid,,,,,84.46,,,,
COG SKL DV ADD15 PTA,97130,CPT,,,,,both,, ,84.46,50.67,Medicaid,Illinois Medicaid,,,,,84.46,,,,
COG SKL DV ADD15 PTA,97130,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,,,,448.57,,,,
COG SKL DV ADD15 PTA,97130,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,,,,448.57,,,,
COG SKL DV ADD15 SP,97130,CPT,,,,,both,, ,398.1,238.86,Medicaid,Illinois Medicaid,,,,,398.1,,,,
MANUAL THRPY-15 MIN,97140,CPT,,,,,both,, ,342.72,205.63,Medicaid,Illinois Medicaid,,,,,342.72,,,,
MANUAL THRPY-15 MIN,97140,CPT,,,,,both,, ,454.13,272.47,Medicaid,Illinois Medicaid,,,,,454.13,,,,
MNL THRPY-15 MIN PTA,97140,CPT,,,,,both,, ,73.65,44.19,Medicaid,Illinois Medicaid,,,,,73.65,,,,
MNL THRPY-15 MIN PTA,97140,CPT,,,,,both,, ,73.65,44.19,Medicaid,Illinois Medicaid,,,,,73.65,,,,
MNL THRPY-15 MIN PTA,97140,CPT,,,,,both,, ,73.65,44.19,Medicaid,Illinois Medicaid,,,,,73.65,,,,
MNL THRPY-15 MIN PTA,97140,CPT,,,,,both,, ,73.65,44.19,Medicaid,Illinois Medicaid,,,,,73.65,,,,
MNL THRPY-15 MIN PTA,97140,CPT,,,,,both,, ,367.2,220.32,Medicaid,Illinois Medicaid,,,,,367.2,,,,
MNL THRPY-15 MIN PTA,97140,CPT,,,,,both,, ,367.2,220.32,Medicaid,Illinois Medicaid,,,,,367.2,,,,
MNL THRPY-15MIN COTA,97140,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,,,,486.42,,,,
MNL THRPY-15MIN COTA,97140,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,,,,486.42,,,,
GROUP THRP PROC-VIST,97150,CPT,,,,,both,, ,341.23,204.73,Medicaid,Illinois Medicaid,,,,,341.23,,,,
GROUP THRP PROC-VIST,97150,CPT,,,,,both,, ,369.92,221.95,Medicaid,Illinois Medicaid,,,,,369.92,,,,
GRP THR PRC-VST COTA,97150,CPT,,,,,both,, ,396.29,237.77,Medicaid,Illinois Medicaid,,,,,396.29,,,,
GRP THR PRC-VST COTA,97150,CPT,,,,,both,, ,396.29,237.77,Medicaid,Illinois Medicaid,,,,,396.29,,,,
GRP THRP PRC-VST PTA,97150,CPT,,,,,both,, ,48.67,29.2,Medicaid,Illinois Medicaid,,,,,48.67,,,,
GRP THRP PRC-VST PTA,97150,CPT,,,,,both,, ,48.67,29.2,Medicaid,Illinois Medicaid,,,,,48.67,,,,
GRP THRP PRC-VST PTA,97150,CPT,,,,,both,, ,48.67,29.2,Medicaid,Illinois Medicaid,,,,,48.67,,,,
GRP THRP PRC-VST PTA,97150,CPT,,,,,both,, ,48.67,29.2,Medicaid,Illinois Medicaid,,,,,48.67,,,,
GRP THRP PRC-VST PTA,97150,CPT,,,,,both,, ,365.65,219.39,Medicaid,Illinois Medicaid,,,,,365.65,,,,
GRP THRP PRC-VST PTA,97150,CPT,,,,,both,, ,365.65,219.39,Medicaid,Illinois Medicaid,,,,,365.65,,,,
PT EVAL- LOW CMP PTA,97161,CPT,,,,,both,, ,223.77,134.26,Medicaid,Illinois Medicaid,,,,,223.77,,,,
PT EVAL- LOW CMP PTA,97161,CPT,,,,,both,, ,223.77,134.26,Medicaid,Illinois Medicaid,,,,,223.77,,,,
PT EVAL- LOW CMP PTA,97161,CPT,,,,,both,, ,721,432.6,Medicaid,Illinois Medicaid,,,,,721,,,,
PT EVAL- LOW CMP PTA,97161,CPT,,,,,both,, ,721,432.6,Medicaid,Illinois Medicaid,,,,,721,,,,
PT EVAL- LOW COMP,97161,CPT,,,,,both,, ,673.18,403.9,Medicaid,Illinois Medicaid,,,,,673.18,,,,
PT-EVAL LOW 15M MCD,97161,CPT,,,,,both,, ,700,420,Medicaid,Illinois Medicaid,,,,,700,,,,
PT EVAL- MOD CMP PTA,97162,CPT,,,,,both,, ,223.77,134.26,Medicaid,Illinois Medicaid,,,,,223.77,,,,
PT EVAL- MOD CMP PTA,97162,CPT,,,,,both,, ,223.77,134.26,Medicaid,Illinois Medicaid,,,,,223.77,,,,
PT EVAL- MOD CMP PTA,97162,CPT,,,,,both,, ,360.5,216.3,Medicaid,Illinois Medicaid,,,,,360.5,,,,
PT EVAL- MOD CMP PTA,97162,CPT,,,,,both,, ,360.5,216.3,Medicaid,Illinois Medicaid,,,,,360.5,,,,
PT EVAL- MOD COMP,97162,CPT,,,,,both,, ,673.18,403.9,Medicaid,Illinois Medicaid,,,,,673.18,,,,
PT-EVAL MOD 15M MCD,97162,CPT,,,,,both,, ,350,210,Medicaid,Illinois Medicaid,,,,,350,,,,
PT EVAL- HGH CMP PTA,97163,CPT,,,,,both,, ,224.03,134.41,Medicaid,Illinois Medicaid,,,,,224.03,,,,
PT EVAL- HGH CMP PTA,97163,CPT,,,,,both,, ,224.03,134.41,Medicaid,Illinois Medicaid,,,,,224.03,,,,
PT EVAL- HGH CMP PTA,97163,CPT,,,,,both,, ,721,432.6,Medicaid,Illinois Medicaid,,,,,721,,,,
PT EVAL- HGH CMP PTA,97163,CPT,,,,,both,, ,721,432.6,Medicaid,Illinois Medicaid,,,,,721,,,,
PT EVAL- HGH COMP,97163,CPT,,,,,both,, ,673.18,403.9,Medicaid,Illinois Medicaid,,,,,673.18,,,,
PT-EVAL HGH 15M MCD,97163,CPT,,,,,both,, ,233.25,139.95,Medicaid,Illinois Medicaid,,,,,233.25,,,,
PT RE-EVAL-VISIT,97164,CPT,,,,,both,, ,437.36,262.41,Medicaid,Illinois Medicaid,,,,,437.36,,,,
PT RE-EVAL-VISIT PTA,97164,CPT,,,,,both,, ,151.41,90.84,Medicaid,Illinois Medicaid,,,,,151.41,,,,
PT RE-EVAL-VISIT PTA,97164,CPT,,,,,both,, ,151.41,90.84,Medicaid,Illinois Medicaid,,,,,151.41,,,,
PT RE-EVAL-VISIT PTA,97164,CPT,,,,,both,, ,468.39,281.03,Medicaid,Illinois Medicaid,,,,,468.39,,,,
PT RE-EVAL-VISIT PTA,97164,CPT,,,,,both,, ,468.39,281.03,Medicaid,Illinois Medicaid,,,,,468.39,,,,
OT EVAL- LOW CMP OT,97165,CPT,,,,,both,, ,223.77,134.26,Medicaid,Illinois Medicaid,,,,,223.77,,,,
OT EVAL- LOW COMP,97165,CPT,,,,,both,, ,729.8,437.88,Medicaid,Illinois Medicaid,,,,,729.8,,,,
OT EVAL-LOW CMP COTA,97165,CPT,,,,,both,, ,781.77,469.06,Medicaid,Illinois Medicaid,,,,,781.77,,,,
OT EVAL-LOW CMP COTA,97165,CPT,,,,,both,, ,781.77,469.06,Medicaid,Illinois Medicaid,,,,,781.77,,,,
OT-EVAL LOW 15M MCD,97165,CPT,,,,,both,, ,100,60,Medicaid,Illinois Medicaid,,,,,100,,,,
OT-EVAL LOW 15M MCD,97165,CPT,,,,,both,, ,759,455.4,Medicaid,Illinois Medicaid,,,,,759,,,,
OT EVAL- MOD CMP OT,97166,CPT,,,,,both,, ,223.77,134.26,Medicaid,Illinois Medicaid,,,,,223.77,,,,
OT EVAL- MOD COMP,97166,CPT,,,,,both,, ,729.8,437.88,Medicaid,Illinois Medicaid,,,,,729.8,,,,
OT EVAL-MOD CMP COTA,97166,CPT,,,,,both,, ,390.89,234.53,Medicaid,Illinois Medicaid,,,,,390.89,,,,
OT EVAL-MOD CMP COTA,97166,CPT,,,,,both,, ,390.89,234.53,Medicaid,Illinois Medicaid,,,,,390.89,,,,
OT-EVAL MOD 15M MCD,97166,CPT,,,,,both,, ,100,60,Medicaid,Illinois Medicaid,,,,,100,,,,
OT-EVAL MOD 15M MCD,97166,CPT,,,,,both,, ,379.5,227.7,Medicaid,Illinois Medicaid,,,,,379.5,,,,
OT EVAL- HGH CMP OT,97167,CPT,,,,,both,, ,223.77,134.26,Medicaid,Illinois Medicaid,,,,,223.77,,,,
OT EVAL- HGH COMP,97167,CPT,,,,,both,, ,729.8,437.88,Medicaid,Illinois Medicaid,,,,,729.8,,,,
OT EVAL-HGH CMP COTA,97167,CPT,,,,,both,, ,781.77,469.06,Medicaid,Illinois Medicaid,,,,,781.77,,,,
OT EVAL-HGH CMP COTA,97167,CPT,,,,,both,, ,781.77,469.06,Medicaid,Illinois Medicaid,,,,,781.77,,,,
OT-EVAL HGH 15M MCD,97167,CPT,,,,,both,, ,100,60,Medicaid,Illinois Medicaid,,,,,100,,,,
OT-EVAL HGH 15M MCD,97167,CPT,,,,,both,, ,253,151.8,Medicaid,Illinois Medicaid,,,,,253,,,,
OT RE-EVAL VIST COTA,97168,CPT,,,,,both,, ,151.41,90.84,Medicaid,Illinois Medicaid,,,,,151.41,,,,
OT RE-EVAL VIST COTA,97168,CPT,,,,,both,, ,151.41,90.84,Medicaid,Illinois Medicaid,,,,,151.41,,,,
OT RE-EVAL VIST COTA,97168,CPT,,,,,both,, ,507.79,304.67,Medicaid,Illinois Medicaid,,,,,507.79,,,,
OT RE-EVAL VIST COTA,97168,CPT,,,,,both,, ,507.79,304.67,Medicaid,Illinois Medicaid,,,,,507.79,,,,
OT RE-EVAL-VISIT,97168,CPT,,,,,both,, ,474.13,284.47,Medicaid,Illinois Medicaid,,,,,474.13,,,,
THER ACTV-15MIN COTA,97530,CPT,,,,,both,, ,398.1,238.86,Medicaid,Illinois Medicaid,,,,,398.1,,,,
THER ACTV-15MIN COTA,97530,CPT,,,,,both,, ,398.1,238.86,Medicaid,Illinois Medicaid,,,,,398.1,,,,
THER ACTVT-15MIN PTA,97530,CPT,,,,,both,, ,104.29,62.57,Medicaid,Illinois Medicaid,,,,,104.29,,,,
THER ACTVT-15MIN PTA,97530,CPT,,,,,both,, ,104.29,62.57,Medicaid,Illinois Medicaid,,,,,104.29,,,,
THER ACTVT-15MIN PTA,97530,CPT,,,,,both,, ,104.29,62.57,Medicaid,Illinois Medicaid,,,,,104.29,,,,
THER ACTVT-15MIN PTA,97530,CPT,,,,,both,, ,104.29,62.57,Medicaid,Illinois Medicaid,,,,,104.29,,,,
THER ACTVT-15MIN PTA,97530,CPT,,,,,both,, ,367.2,220.32,Medicaid,Illinois Medicaid,,,,,367.2,,,,
THER ACTVT-15MIN PTA,97530,CPT,,,,,both,, ,367.2,220.32,Medicaid,Illinois Medicaid,,,,,367.2,,,,
THERAP ACTVTS-15 MIN,97530,CPT,,,,,both,, ,342.72,205.63,Medicaid,Illinois Medicaid,,,,,342.72,,,,
THERAP ACTVTS-15 MIN,97530,CPT,,,,,both,, ,371.55,222.93,Medicaid,Illinois Medicaid,,,,,371.55,,,,
SENS INTG-15 MIN,97533,CPT,,,,,both,, ,167.89,100.73,Medicaid,Illinois Medicaid,,,,,167.89,,,,
SENS INTG-15MIN COTA,97533,CPT,,,,,both,, ,90.13,54.07,Medicaid,Illinois Medicaid,,,,,90.13,,,,
SENS INTG-15MIN COTA,97533,CPT,,,,,both,, ,90.13,54.07,Medicaid,Illinois Medicaid,,,,,90.13,,,,
SENS INTG-15MIN COTA,97533,CPT,,,,,both,, ,687.27,412.36,Medicaid,Illinois Medicaid,,,,,687.27,,,,
SENS INTG-15MIN COTA,97533,CPT,,,,,both,, ,687.27,412.36,Medicaid,Illinois Medicaid,,,,,687.27,,,,
SENSORY INTEG-15 MIN,97533,CPT,,,,,both,, ,641.59,384.95,Medicaid,Illinois Medicaid,,,,,641.59,,,,
SELF CARE MGT-15 MIN,97535,CPT,,,,,both,, ,342.72,205.63,Medicaid,Illinois Medicaid,,,,,342.72,,,,
SELF CARE MGT-15 MIN,97535,CPT,,,,,both,, ,371.55,222.93,Medicaid,Illinois Medicaid,,,,,371.55,,,,
SLF CR MGT-15MN COTA,97535,CPT,,,,,both,, ,398.1,238.86,Medicaid,Illinois Medicaid,,,,,398.1,,,,
SLF CR MGT-15MN COTA,97535,CPT,,,,,both,, ,398.1,238.86,Medicaid,Illinois Medicaid,,,,,398.1,,,,
SLF CRE MGT-15MN PTA,97535,CPT,,,,,both,, ,90.13,54.07,Medicaid,Illinois Medicaid,,,,,90.13,,,,
SLF CRE MGT-15MN PTA,97535,CPT,,,,,both,, ,90.13,54.07,Medicaid,Illinois Medicaid,,,,,90.13,,,,
SLF CRE MGT-15MN PTA,97535,CPT,,,,,both,, ,90.13,54.07,Medicaid,Illinois Medicaid,,,,,90.13,,,,
SLF CRE MGT-15MN PTA,97535,CPT,,,,,both,, ,90.13,54.07,Medicaid,Illinois Medicaid,,,,,90.13,,,,
SLF CRE MGT-15MN PTA,97535,CPT,,,,,both,, ,367.2,220.32,Medicaid,Illinois Medicaid,,,,,367.2,,,,
SLF CRE MGT-15MN PTA,97535,CPT,,,,,both,, ,367.2,220.32,Medicaid,Illinois Medicaid,,,,,367.2,,,,
CM-WK REIN-15MN COTA,97537,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,,,,486.42,,,,
CM-WK REIN-15MN COTA,97537,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,,,,486.42,,,,
COM-WK REIN-15MN PTA,97537,CPT,,,,,both,, ,86.78,52.06,Medicaid,Illinois Medicaid,,,,,86.78,,,,
COM-WK REIN-15MN PTA,97537,CPT,,,,,both,, ,86.78,52.06,Medicaid,Illinois Medicaid,,,,,86.78,,,,
COM-WK REIN-15MN PTA,97537,CPT,,,,,both,, ,86.78,52.06,Medicaid,Illinois Medicaid,,,,,86.78,,,,
COM-WK REIN-15MN PTA,97537,CPT,,,,,both,, ,86.78,52.06,Medicaid,Illinois Medicaid,,,,,86.78,,,,
COM-WK REIN-15MN PTA,97537,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,,,,448.57,,,,
COM-WK REIN-15MN PTA,97537,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,,,,448.57,,,,
COM-WRK REINT-15 MIN,97537,CPT,,,,,both,, ,418.86,251.31,Medicaid,Illinois Medicaid,,,,,418.86,,,,
COM-WRK REINT-15 MIN,97537,CPT,,,,,both,, ,454.13,272.47,Medicaid,Illinois Medicaid,,,,,454.13,,,,
WHEELCHR MGT-15 MIN,97542,CPT,,,,,both,, ,418.86,251.31,Medicaid,Illinois Medicaid,,,,,418.86,,,,
WHEELCHR MGT-15 MIN,97542,CPT,,,,,both,, ,454.13,272.47,Medicaid,Illinois Medicaid,,,,,454.13,,,,
WHLCHR MGT-15MIN PTA,97542,CPT,,,,,both,, ,87.55,52.53,Medicaid,Illinois Medicaid,,,,,87.55,,,,
WHLCHR MGT-15MIN PTA,97542,CPT,,,,,both,, ,87.55,52.53,Medicaid,Illinois Medicaid,,,,,87.55,,,,
WHLCHR MGT-15MIN PTA,97542,CPT,,,,,both,, ,87.55,52.53,Medicaid,Illinois Medicaid,,,,,87.55,,,,
WHLCHR MGT-15MIN PTA,97542,CPT,,,,,both,, ,87.55,52.53,Medicaid,Illinois Medicaid,,,,,87.55,,,,
WHLCHR MGT-15MIN PTA,97542,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,,,,448.57,,,,
WHLCHR MGT-15MIN PTA,97542,CPT,,,,,both,, ,448.57,269.14,Medicaid,Illinois Medicaid,,,,,448.57,,,,
WHLCHR MGT-15MN COTA,97542,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,,,,486.42,,,,
WHLCHR MGT-15MN COTA,97542,CPT,,,,,both,, ,486.42,291.85,Medicaid,Illinois Medicaid,,,,,486.42,,,,
WK HR-CD 1ST 2HR PTA,97545,CPT,,,,,both,, ,206,123.6,Medicaid,Illinois Medicaid,,,,,206,,,,
WK HR-CD 1ST 2HR PTA,97545,CPT,,,,,both,, ,206,123.6,Medicaid,Illinois Medicaid,,,,,206,,,,
WK HR-CD 1ST 2HR PTA,97545,CPT,,,,,both,, ,1121.67,673,Medicaid,Illinois Medicaid,,,,,1121.67,,,,
WK HR-CD 1ST 2HR PTA,97545,CPT,,,,,both,, ,1121.67,673,Medicaid,Illinois Medicaid,,,,,1121.67,,,,
WK HR-CD 1ST 2HR PTA,97545,CPT,,,,,both,, ,1121.67,673,Medicaid,Illinois Medicaid,,,,,1121.67,,,,
WK HR-CD 1ST 2HR PTA,97545,CPT,,,,,both,, ,1121.67,673,Medicaid,Illinois Medicaid,,,,,1121.67,,,,
WK HR-CD IN 2HR COTA,97545,CPT,,,,,both,, ,1215.92,729.55,Medicaid,Illinois Medicaid,,,,,1215.92,,,,
WK HR-CD IN 2HR COTA,97545,CPT,,,,,both,, ,1215.92,729.55,Medicaid,Illinois Medicaid,,,,,1215.92,,,,
WRK HAR-CND 1ST 2HRS,97545,CPT,,,,,both,, ,1047.07,628.24,Medicaid,Illinois Medicaid,,,,,1047.07,,,,
WRK HAR-CND 1ST 2HRS,97545,CPT,,,,,both,, ,1135.14,681.08,Medicaid,Illinois Medicaid,,,,,1135.14,,,,
WK HAR-CND-ADHR COTA,97546,CPT,,,,,both,, ,607.96,364.77,Medicaid,Illinois Medicaid,,,,,607.96,,,,
WK HAR-CND-ADHR COTA,97546,CPT,,,,,both,, ,607.96,364.77,Medicaid,Illinois Medicaid,,,,,607.96,,,,
WRK HAR-CND-ADD HR,97546,CPT,,,,,both,, ,460.55,276.33,Medicaid,Illinois Medicaid,,,,,460.55,,,,
WRK HAR-CND-ADD HR,97546,CPT,,,,,both,, ,567.57,340.54,Medicaid,Illinois Medicaid,,,,,567.57,,,,
WRK HAR-CND-ADHR PTA,97546,CPT,,,,,both,, ,103,61.8,Medicaid,Illinois Medicaid,,,,,103,,,,
WRK HAR-CND-ADHR PTA,97546,CPT,,,,,both,, ,103,61.8,Medicaid,Illinois Medicaid,,,,,103,,,,
WRK HAR-CND-ADHR PTA,97546,CPT,,,,,both,, ,103,61.8,Medicaid,Illinois Medicaid,,,,,103,,,,
WRK HAR-CND-ADHR PTA,97546,CPT,,,,,both,, ,103,61.8,Medicaid,Illinois Medicaid,,,,,103,,,,
WRK HAR-CND-ADHR PTA,97546,CPT,,,,,both,, ,493.37,296.02,Medicaid,Illinois Medicaid,,,,,493.37,,,,
WRK HAR-CND-ADHR PTA,97546,CPT,,,,,both,, ,493.37,296.02,Medicaid,Illinois Medicaid,,,,,493.37,,,,
DEBRD LE 20SQCM COTA,97597,CPT,,,,,both,, ,731.82,439.09,Medicaid,Illinois Medicaid,,,,,731.82,,,,
DEBRD LE 20SQCM COTA,97597,CPT,,,,,both,, ,731.82,439.09,Medicaid,Illinois Medicaid,,,,,731.82,,,,
DEBRDE LE 20SQCM PTA,97597,CPT,,,,,both,, ,447.54,268.52,Medicaid,Illinois Medicaid,,,,,447.54,,,,
DEBRDE LE 20SQCM PTA,97597,CPT,,,,,both,, ,447.54,268.52,Medicaid,Illinois Medicaid,,,,,447.54,,,,
DEBRDE LE 20SQCM PTA,97597,CPT,,,,,both,, ,447.54,268.52,Medicaid,Illinois Medicaid,,,,,447.54,,,,
DEBRDE LE 20SQCM PTA,97597,CPT,,,,,both,, ,447.54,268.52,Medicaid,Illinois Medicaid,,,,,447.54,,,,
DEBRDE LE 20SQCM PTA,97597,CPT,,,,,both,, ,675.17,405.1,Medicaid,Illinois Medicaid,,,,,675.17,,,,
DEBRDE LE 20SQCM PTA,97597,CPT,,,,,both,, ,675.17,405.1,Medicaid,Illinois Medicaid,,,,,675.17,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,252.25,151.35,Medicaid,Illinois Medicaid,,,,,252.25,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,252.25,151.35,Medicaid,Illinois Medicaid,,,,,252.25,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,259.82,155.89,Medicaid,Illinois Medicaid,,,,,259.82,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,259.82,155.89,Medicaid,Illinois Medicaid,,,,,259.82,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,630.26,378.15,Medicaid,Illinois Medicaid,,,,,630.26,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,683.29,409.97,Medicaid,Illinois Medicaid,,,,,683.29,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,861.67,517,Medicaid,Illinois Medicaid,,,,,861.67,,,,
SLCTV WND DEB =<20CM,97597,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
DEBRD EA AD20CM COTA,97598,CPT,,,,,both,, ,450.63,270.37,Medicaid,Illinois Medicaid,,,,,450.63,,,,
DEBRD EA AD20CM COTA,97598,CPT,,,,,both,, ,450.63,270.37,Medicaid,Illinois Medicaid,,,,,450.63,,,,
DEBRD EA AD20CM COTA,97598,CPT,,,,,both,, ,488.48,293.08,Medicaid,Illinois Medicaid,,,,,488.48,,,,
DEBRD EA AD20CM COTA,97598,CPT,,,,,both,, ,488.48,293.08,Medicaid,Illinois Medicaid,,,,,488.48,,,,
DEBRDE EA AD20CM PTA,97598,CPT,,,,,both,, ,450.63,270.37,Medicaid,Illinois Medicaid,,,,,450.63,,,,
DEBRDE EA AD20CM PTA,97598,CPT,,,,,both,, ,450.63,270.37,Medicaid,Illinois Medicaid,,,,,450.63,,,,
DEBRDE EA AD20CM PTA,97598,CPT,,,,,both,, ,450.63,270.37,Medicaid,Illinois Medicaid,,,,,450.63,,,,
DEBRDE EA AD20CM PTA,97598,CPT,,,,,both,, ,450.63,270.37,Medicaid,Illinois Medicaid,,,,,450.63,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,252.25,151.35,Medicaid,Illinois Medicaid,,,,,252.25,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,252.25,151.35,Medicaid,Illinois Medicaid,,,,,252.25,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,259.82,155.89,Medicaid,Illinois Medicaid,,,,,259.82,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,259.82,155.89,Medicaid,Illinois Medicaid,,,,,259.82,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,420.57,252.34,Medicaid,Illinois Medicaid,,,,,420.57,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,455.94,273.56,Medicaid,Illinois Medicaid,,,,,455.94,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,575.1,345.06,Medicaid,Illinois Medicaid,,,,,575.1,,,,
SLCTV WND DEB >20 CM,97598,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
DBRD NONSEL-VIS COTA,97602,CPT,,,,,both,, ,521.7,313.02,Medicaid,Illinois Medicaid,,,,,521.7,,,,
DBRD NONSEL-VIS COTA,97602,CPT,,,,,both,, ,521.7,313.02,Medicaid,Illinois Medicaid,,,,,521.7,,,,
DBRD NON-SEL-VIS PTA,97602,CPT,,,,,both,, ,447.54,268.52,Medicaid,Illinois Medicaid,,,,,447.54,,,,
DBRD NON-SEL-VIS PTA,97602,CPT,,,,,both,, ,447.54,268.52,Medicaid,Illinois Medicaid,,,,,447.54,,,,
DBRD NON-SEL-VIS PTA,97602,CPT,,,,,both,, ,447.54,268.52,Medicaid,Illinois Medicaid,,,,,447.54,,,,
DBRD NON-SEL-VIS PTA,97602,CPT,,,,,both,, ,447.54,268.52,Medicaid,Illinois Medicaid,,,,,447.54,,,,
DBRD NON-SEL-VIS PTA,97602,CPT,,,,,both,, ,481.27,288.76,Medicaid,Illinois Medicaid,,,,,481.27,,,,
DBRD NON-SEL-VIS PTA,97602,CPT,,,,,both,, ,481.27,288.76,Medicaid,Illinois Medicaid,,,,,481.27,,,,
DEBRIDE NON-SELC-VIS,97602,CPT,,,,,both,, ,449.32,269.59,Medicaid,Illinois Medicaid,,,,,449.32,,,,
DEBRIDE NON-SELC-VIS,97602,CPT,,,,,both,, ,487.13,292.27,Medicaid,Illinois Medicaid,,,,,487.13,,,,
NON SELECTIVE DEBRID,97602,CPT,,,,,both,, ,158.11,94.86,Medicaid,Illinois Medicaid,,,,,158.11,,,,
NON SELECTIVE DEBRID,97602,CPT,,,,,both,, ,158.11,94.86,Medicaid,Illinois Medicaid,,,,,158.11,,,,
NSW DEB WO A/SESSION,97602,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,146.78,88.06,Medicaid,Illinois Medicaid,,,,,146.78,,,,
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,158.11,94.86,Medicaid,Illinois Medicaid,,,,,158.11,,,,
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,158.11,94.86,Medicaid,Illinois Medicaid,,,,,158.11,,,,
NEG PRESS WND TX <50,97605,CPT,,,,,both,, ,763,457.8,Medicaid,Illinois Medicaid,,,,,763,,,,
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,241.28,144.76,Medicaid,Illinois Medicaid,,,,,241.28,,,,
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,259.82,155.89,Medicaid,Illinois Medicaid,,,,,259.82,,,,
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,259.82,155.89,Medicaid,Illinois Medicaid,,,,,259.82,,,,
NEG PRESS WND TX >50,97606,CPT,,,,,both,, ,1520,912,Medicaid,Illinois Medicaid,,,,,1520,,,,
NEG PR WN MD LT 50CM,97607,CPT,,,,,both,, ,463.24,277.94,Medicaid,Illinois Medicaid,,,,,463.24,,,,
NEG PR WN MD LT 50CM,97607,CPT,,,,,both,, ,463.24,277.94,Medicaid,Illinois Medicaid,,,,,463.24,,,,
NEG PRES WND TX <=50,97607,CPT,,,,,both,, ,1520,912,Medicaid,Illinois Medicaid,,,,,1520,,,,
NEG PR WN MD GT 50CM,97608,CPT,,,,,both,, ,919.79,551.87,Medicaid,Illinois Medicaid,,,,,919.79,,,,
PHYS PERF-15 MIN PTA,97750,CPT,,,,,both,, ,91.93,55.15,Medicaid,Illinois Medicaid,,,,,91.93,,,,
PHYS PERF-15 MIN PTA,97750,CPT,,,,,both,, ,91.93,55.15,Medicaid,Illinois Medicaid,,,,,91.93,,,,
PHYS PERF-15 MIN PTA,97750,CPT,,,,,both,, ,91.93,55.15,Medicaid,Illinois Medicaid,,,,,91.93,,,,
PHYS PERF-15 MIN PTA,97750,CPT,,,,,both,, ,91.93,55.15,Medicaid,Illinois Medicaid,,,,,91.93,,,,
PHYS PERF-15 MIN PTA,97750,CPT,,,,,both,, ,936.01,561.6,Medicaid,Illinois Medicaid,,,,,936.01,,,,
PHYS PERF-15 MIN PTA,97750,CPT,,,,,both,, ,936.01,561.6,Medicaid,Illinois Medicaid,,,,,936.01,,,,
PHYS PERF-15MIN COTA,97750,CPT,,,,,both,, ,1014.55,608.73,Medicaid,Illinois Medicaid,,,,,1014.55,,,,
PHYS PERF-15MIN COTA,97750,CPT,,,,,both,, ,1014.55,608.73,Medicaid,Illinois Medicaid,,,,,1014.55,,,,
PHYSICAL PERF-15 MIN,97750,CPT,,,,,both,, ,873.68,524.2,Medicaid,Illinois Medicaid,,,,,873.68,,,,
PHYSICAL PERF-15 MIN,97750,CPT,,,,,both,, ,947.11,568.26,Medicaid,Illinois Medicaid,,,,,947.11,,,,
ORTH TRAIN INI-15 MI,97760,CPT,,,,,both,, ,342.72,205.63,Medicaid,Illinois Medicaid,,,,,342.72,,,,
ORTH TRAIN INI-15 MI,97760,CPT,,,,,both,, ,371.55,222.93,Medicaid,Illinois Medicaid,,,,,371.55,,,,
ORTH TRN IN15MI COTA,97760,CPT,,,,,both,, ,398.1,238.86,Medicaid,Illinois Medicaid,,,,,398.1,,,,
ORTH TRN IN15MI COTA,97760,CPT,,,,,both,, ,398.1,238.86,Medicaid,Illinois Medicaid,,,,,398.1,,,,
ORTH TRN INI15MI PTA,97760,CPT,,,,,both,, ,124.12,74.47,Medicaid,Illinois Medicaid,,,,,124.12,,,,
ORTH TRN INI15MI PTA,97760,CPT,,,,,both,, ,124.12,74.47,Medicaid,Illinois Medicaid,,,,,124.12,,,,
ORTH TRN INI15MI PTA,97760,CPT,,,,,both,, ,124.12,74.47,Medicaid,Illinois Medicaid,,,,,124.12,,,,
ORTH TRN INI15MI PTA,97760,CPT,,,,,both,, ,124.12,74.47,Medicaid,Illinois Medicaid,,,,,124.12,,,,
ORTH TRN INI15MI PTA,97760,CPT,,,,,both,, ,367.2,220.32,Medicaid,Illinois Medicaid,,,,,367.2,,,,
ORTH TRN INI15MI PTA,97760,CPT,,,,,both,, ,367.2,220.32,Medicaid,Illinois Medicaid,,,,,367.2,,,,
PROS TRAIN INI-15 MI,97761,CPT,,,,,both,, ,342.72,205.63,Medicaid,Illinois Medicaid,,,,,342.72,,,,
PROS TRAIN INI-15 MI,97761,CPT,,,,,both,, ,371.55,222.93,Medicaid,Illinois Medicaid,,,,,371.55,,,,
PROS TRN IN15MI COTA,97761,CPT,,,,,both,, ,398.1,238.86,Medicaid,Illinois Medicaid,,,,,398.1,,,,
PROS TRN IN15MI COTA,97761,CPT,,,,,both,, ,398.1,238.86,Medicaid,Illinois Medicaid,,,,,398.1,,,,
PROS TRN INI15MI PTA,97761,CPT,,,,,both,, ,107.38,64.42,Medicaid,Illinois Medicaid,,,,,107.38,,,,
PROS TRN INI15MI PTA,97761,CPT,,,,,both,, ,107.38,64.42,Medicaid,Illinois Medicaid,,,,,107.38,,,,
PROS TRN INI15MI PTA,97761,CPT,,,,,both,, ,107.38,64.42,Medicaid,Illinois Medicaid,,,,,107.38,,,,
PROS TRN INI15MI PTA,97761,CPT,,,,,both,, ,107.38,64.42,Medicaid,Illinois Medicaid,,,,,107.38,,,,
PROS TRN INI15MI PTA,97761,CPT,,,,,both,, ,367.2,220.32,Medicaid,Illinois Medicaid,,,,,367.2,,,,
PROS TRN INI15MI PTA,97761,CPT,,,,,both,, ,367.2,220.32,Medicaid,Illinois Medicaid,,,,,367.2,,,,
PROS-ORTH SUB-15 MIN,97763,CPT,,,,,both,, ,318.29,190.97,Medicaid,Illinois Medicaid,,,,,318.29,,,,
PROS-ORTH SUB-15 MIN,97763,CPT,,,,,both,, ,358.85,215.31,Medicaid,Illinois Medicaid,,,,,358.85,,,,
PRS-ORT SUB15MN COTA,97763,CPT,,,,,both,, ,340.93,204.55,Medicaid,Illinois Medicaid,,,,,340.93,,,,
PRS-ORT SUB15MN COTA,97763,CPT,,,,,both,, ,340.93,204.55,Medicaid,Illinois Medicaid,,,,,340.93,,,,
PRS-ORT SUB-15MN PTA,97763,CPT,,,,,both,, ,131.07,78.64,Medicaid,Illinois Medicaid,,,,,131.07,,,,
PRS-ORT SUB-15MN PTA,97763,CPT,,,,,both,, ,131.07,78.64,Medicaid,Illinois Medicaid,,,,,131.07,,,,
PRS-ORT SUB-15MN PTA,97763,CPT,,,,,both,, ,131.07,78.64,Medicaid,Illinois Medicaid,,,,,131.07,,,,
PRS-ORT SUB-15MN PTA,97763,CPT,,,,,both,, ,131.07,78.64,Medicaid,Illinois Medicaid,,,,,131.07,,,,
PRS-ORT SUB-15MN PTA,97763,CPT,,,,,both,, ,384.45,230.67,Medicaid,Illinois Medicaid,,,,,384.45,,,,
PRS-ORT SUB-15MN PTA,97763,CPT,,,,,both,, ,384.45,230.67,Medicaid,Illinois Medicaid,,,,,384.45,,,,
MNT INITIAL EA 15 MN,97802,CPT,,,,,both,, ,194.41,116.64,Medicaid,Illinois Medicaid,,,,,194.41,,,,
MNT REASSES EA 15 MN,97803,CPT,,,,,both,, ,101.46,60.87,Medicaid,Illinois Medicaid,,,,,101.46,,,,
MNT GROUP EA 30 MIN,97804,CPT,,,,,both,, ,223.25,133.95,Medicaid,Illinois Medicaid,,,,,223.25,,,,
LAB COLLECTION,99000,CPT,,,,,both,, ,70,42,Medicaid,Illinois Medicaid,,,,,70,,,,
SPEC CHAIN CUSTODY,99001,CPT,,,,,both,, ,21.33,12.79,Medicaid,Illinois Medicaid,,,,,21.33,,,,
MSED SAMEGT5 1ST15,99152,CPT,,,,,both,, ,313.38,188.02,Medicaid,Illinois Medicaid,,,,,313.38,,,,
MODSED SAME ADD15MIN,99153,CPT,,,,,both,, ,417.92,250.75,Medicaid,Illinois Medicaid,,,,,417.92,,,,
HBO COMM PER SESSION,99183,CPT,,,,,both,, ,990.13,594.07,Medicaid,Illinois Medicaid,,,,,990.13,,,,
PHLEBOTOMY THERAPEUT,99195,CPT,,,,,both,, ,266.77,160.06,Medicaid,Illinois Medicaid,,,,,266.77,,,,
SUTURE REMOVAL/RECHE,99281,CPT,,,,,Outpatient,, ,1098.28,658.96,Medicaid,Illinois Medicaid,,,,,1098.28,,,,
SUTURE REMOVAL/RECHE,99281,CPT,,,,,Outpatient,, ,1098.28,658.96,Medicaid,Illinois Medicaid,,,,,1098.28,,,,
LIMITED ED VISIT,99282,CPT,,,,,Outpatient,, ,1925.14,1155.08,Medicaid,Illinois Medicaid,,,,,1925.14,,,,
INTERMEDIATE ED VIST,99283,CPT,,,,,Outpatient,, ,3494.12,2096.47,Medicaid,Illinois Medicaid,,,,,3494.12,,,,
EXTENDED ED VISIT,99284,CPT,,,,,Outpatient,, ,6509.13,3905.47,Medicaid,Illinois Medicaid,,,,,6509.13,,,,
COMPREHENSIVE ED VST,99285,CPT,,,,,Outpatient,, ,8592.58,5155.54,Medicaid,Illinois Medicaid,,,,,8592.58,,,,
CRITICAL CARE LT 74M,99291,CPT,,,,,both,, ,12285.42,7371.25,Medicaid,Illinois Medicaid,,,,,12285.42,,,,
CRIT CARE EA 30 MIN,99292,CPT,,,,,both,, ,4418.38,2651.02,Medicaid,Illinois Medicaid,,,,,4418.38,,,,
BEHAV CHG SMOKE U 10,99406,CPT,,,,,both,, ,127.46,76.47,Medicaid,Illinois Medicaid,,,,,127.46,,,,
BEHAV CHG SMOKE GR10,99407,CPT,,,,,both,, ,127.46,76.47,Medicaid,Illinois Medicaid,,,,,127.46,,,,
NEWBORN RESUCITATION,99465,CPT,,,,,both,, ,2447.28,1468.36,Medicaid,Illinois Medicaid,,,,,2447.28,,,,
RESPIRATORY PANEL PCR,0202U,HCPCS,,,,,both,, ,500,300,Medicaid,Illinois Medicaid,,,,,500,,,,
COV19 FLUAB CEPHEID,0240U,CPT,,,,,both,, ,568,340.8,Medicaid,Illinois Medicaid,,,,,568,,,,
COV19 FLUAB RSV CEPH,0241U,CPT,,,,,both,, ,570.52,342.31,Medicaid,Illinois Medicaid,,,,,570.52,,,,
MVP MULTIPLEX VAGINAL DNA PROBE,0352U,HCPCS,,,,,both,, ,570.52,342.31,Medicaid,Illinois Medicaid,,,,,570.52,,,,
INTRATUBAL OCCLU DEV,A4264,HCPCS,,,,,both,, ,8176.4,4905.84,Medicaid,Illinois Medicaid,,,,,8176.4,,,,
TISSUE MARKR IMPLT 1,A4648,HCPCS,,,,,both,, ,179.22,107.53,Medicaid,Illinois Medicaid,,,,,179.22,,,,
TISSUE MARKR IMPLT 2,A4648,HCPCS,,,,,both,, ,1195.32,717.19,Medicaid,Illinois Medicaid,,,,,1195.32,,,,
TISSUE MARKR IMPLT 3,A4648,HCPCS,,,,,both,, ,2390.63,1434.37,Medicaid,Illinois Medicaid,,,,,2390.63,,,,
COLLAGEN WITH SILVER (PUROCOL),A6022,HCPCS,,,,,both,, ,28.28,16.96,Medicaid,Illinois Medicaid,,,,,28.28,,,,
ENDOFORM ANTIMICROBIAL,A6022,HCPCS,,,,,both,, ,41.56,24.93,Medicaid,Illinois Medicaid,,,,,41.56,,,,
COLLAGEN (PUROCOL),A6023,HCPCS,,,,,both,, ,19.8,11.88,Medicaid,Illinois Medicaid,,,,,19.8,,,,
CONVAMAX PAD 4X4,A6196,HCPCS,,,,,both,, ,7.68,4.6,Medicaid,Illinois Medicaid,,,,,7.68,,,,
CONVAMAX PAD 4X8,A6197,HCPCS,,,,,both,, ,8.88,5.32,Medicaid,Illinois Medicaid,,,,,8.88,,,,
CONVAMAX PAD 6X8,A6197,HCPCS,,,,,both,, ,11.76,7.05,Medicaid,Illinois Medicaid,,,,,11.76,,,,
DRSG GRMCDL 45X2CM AQCL AG MIC,A6197,HCPCS,,,,,both,, ,36.48,21.88,Medicaid,Illinois Medicaid,,,,,36.48,,,,
DRSG GRMCDL 4X5IN AQCL AG,A6197,HCPCS,,,,,both,, ,31.04,18.62,Medicaid,Illinois Medicaid,,,,,31.04,,,,
DRSG WND 5X4IN SQ AQCL X HDRFB,A6198,HCPCS,,,,,both,, ,11.16,6.69,Medicaid,Illinois Medicaid,,,,,11.16,,,,
DRSG ALG 18X.75IN AQCL HDRFB,A6199,HCPCS,,,,,both,, ,14.12,8.47,Medicaid,Illinois Medicaid,,,,,14.12,,,,
HYDROFERA BLUE TRANSFER 5X4,A6210,HCPCS,,,,,both,, ,24.12,14.47,Medicaid,Illinois Medicaid,,,,,24.12,,,,
4X4 AQUACEL FOAM NO ADHESIVE,A6211,HCPCS,,,,,both,, ,7.48,4.48,Medicaid,Illinois Medicaid,,,,,7.48,,,,
"DRESSING,ALLEVYN,SACRUM,SMALL",A6212,HCPCS,,,,,both,, ,21.96,13.17,Medicaid,Illinois Medicaid,,,,,21.96,,,,
DRSG LG QUADRILOBE 6 1/16INX6,A6212,HCPCS,,,,,both,, ,11.48,6.88,Medicaid,Illinois Medicaid,,,,,11.48,,,,
"HEEL,LIFE,ALLEVYN",A6212,HCPCS,,,,,both,, ,29.16,17.49,Medicaid,Illinois Medicaid,,,,,29.16,,,,
DRSG MED QUADRILOBE 5 1/16INX5,A6213,HCPCS,,,,,both,, ,9.8,5.88,Medicaid,Illinois Medicaid,,,,,9.8,,,,
SACRAL AQUACEL FOAM WITH ADHESIVE,A6213,HCPCS,,,,,both,, ,17.32,10.39,Medicaid,Illinois Medicaid,,,,,17.32,,,,
4X4 AQUACEL FOAM WITH ADHESIVE,A6214,HCPCS,,,,,both,, ,8.12,4.87,Medicaid,Illinois Medicaid,,,,,8.12,,,,
DUODERM THIN 4X2,A6237,HCPCS,,,,,both,, ,4.8,2.88,Medicaid,Illinois Medicaid,,,,,4.8,,,,
DUODERM THIN 4X4,A6238,HCPCS,,,,,both,, ,4.12,2.47,Medicaid,Illinois Medicaid,,,,,4.12,,,,
TRIAD CREAM 2.5 OUNCES,A6240,HCPCS,,,,,both,, ,3.64,2.18,Medicaid,Illinois Medicaid,,,,,3.64,,,,
HYDROGEL,A6248,HCPCS,,,,,both,, ,16.76,10.05,Medicaid,Illinois Medicaid,,,,,16.76,,,,
NO-RINSE FOAM CLEANSER,A6250,HCPCS,,,,,both,, ,7.96,4.77,Medicaid,Illinois Medicaid,,,,,7.96,,,,
ABD PADS 5X9,A6252,HCPCS,,,,,both,, ,0.32,0.19,Medicaid,Illinois Medicaid,,,,,0.32,,,,
ABD PADS 8X10,A6253,HCPCS,,,,,both,, ,0.48,0.28,Medicaid,Illinois Medicaid,,,,,0.48,,,,
IODOFORM PACKING 1 INCH,A6266,HCPCS,,,,,both,, ,8.76,5.25,Medicaid,Illinois Medicaid,,,,,8.76,,,,
IODOFORM PACKING 1/2 INCH,A6266,HCPCS,,,,,both,, ,6.84,4.1,Medicaid,Illinois Medicaid,,,,,6.84,,,,
IODOFORM PACKING 1/4 INCH,A6266,HCPCS,,,,,both,, ,6.56,3.93,Medicaid,Illinois Medicaid,,,,,6.56,,,,
STERILE 2X2 GAUZE,A6402,HCPCS,,,,,both,, ,0.08,0.04,Medicaid,Illinois Medicaid,,,,,0.08,,,,
STERILE 4X4 GAUZE,A6402,HCPCS,,,,,both,, ,0.16,0.09,Medicaid,Illinois Medicaid,,,,,0.16,,,,
PLAIN PACKING 1 INCH,A6407,HCPCS,,,,,both,, ,6.88,4.12,Medicaid,Illinois Medicaid,,,,,6.88,,,,
PLAIN PACKING 1/2 INCH,A6407,HCPCS,,,,,both,, ,6.28,3.76,Medicaid,Illinois Medicaid,,,,,6.28,,,,
PLAIN PACKING 1/4 INCH,A6407,HCPCS,,,,,both,, ,6.4,3.84,Medicaid,Illinois Medicaid,,,,,6.4,,,,
ACE WRAP 4 INCH,A6449,HCPCS,,,,,both,, ,1.64,0.98,Medicaid,Illinois Medicaid,,,,,1.64,,,,
ACE WRAP 6 INCH,A6450,HCPCS,,,,,both,, ,2.4,1.44,Medicaid,Illinois Medicaid,,,,,2.4,,,,
ZINC PASTE TUBES,A6456,HCPCS,,,,,both,, ,8.44,5.06,Medicaid,Illinois Medicaid,,,,,8.44,,,,
PICO DRESSING KIT,A9272,HCPCS,,,,,both,, ,3547.64,2128.58,Medicaid,Illinois Medicaid,,,,,3547.64,,,,
TC-99M SESTA / DOSE,A9500,HCPCS,,,,,both,, ,551.05,330.63,Medicaid,Illinois Medicaid,,,,,551.05,,,,
TC-99M TETRO/UNITDOS,A9502,HCPCS,,,,,both,, ,347.11,208.26,Medicaid,Illinois Medicaid,,,,,347.11,,,,
TC99M MEDRO TO 30MCI,A9503,HCPCS,,,,,both,, ,69.78,41.86,Medicaid,Illinois Medicaid,,,,,69.78,,,,
"TL-201, PER MCI",A9505,HCPCS,,,,,both,, ,95.53,57.31,Medicaid,Illinois Medicaid,,,,,95.53,,,,
TC99M PERTECHNET/MCI,A9512,HCPCS,,,,,both,, ,81.89,49.13,Medicaid,Illinois Medicaid,,,,,81.89,,,,
"I123 CAP,DX /100UCI",A9516,HCPCS,,,,,both,, ,312.35,187.41,Medicaid,Illinois Medicaid,,,,,312.35,,,,
TC99 TILMAN DX .5MCI,A9520,HCPCS,,,,,both,, ,2305.66,1383.39,Medicaid,Illinois Medicaid,,,,,2305.66,,,,
TC99M EXAME / DOSE,A9521,HCPCS,,,,,both,, ,17205.64,10323.38,Medicaid,Illinois Medicaid,,,,,17205.64,,,,
TC99M MEBROF /15MCI,A9537,HCPCS,,,,,both,, ,170.47,102.28,Medicaid,Illinois Medicaid,,,,,170.47,,,,
TC99M PYROPHOS/25MCI,A9538,HCPCS,,,,,both,, ,235.61,141.36,Medicaid,Illinois Medicaid,,,,,235.61,,,,
TC99M PENTETAT/25MCI,A9539,HCPCS,,,,,both,, ,69.78,41.86,Medicaid,Illinois Medicaid,,,,,69.78,,,,
TC99M MAA/10MCI,A9540,HCPCS,,,,,both,, ,62.83,37.69,Medicaid,Illinois Medicaid,,,,,62.83,,,,
TC99M SULF COL/20MCI,A9541,HCPCS,,,,,both,, ,83.17,49.9,Medicaid,Illinois Medicaid,,,,,83.17,,,,
TC99M SULFCOL2/20MCI,A9541,HCPCS,,,,,both,, ,529.68,317.8,Medicaid,Illinois Medicaid,,,,,529.68,,,,
IN111 PENTETAT/.5MCI,A9548,HCPCS,,,,,both,, ,12525.06,7515.03,Medicaid,Illinois Medicaid,,,,,12525.06,,,,
GA67 GALLIUM/MCI,A9556,HCPCS,,,,,both,, ,102.23,61.33,Medicaid,Illinois Medicaid,,,,,102.23,,,,
XE133 XENON 10MCI,A9558,HCPCS,,,,,both,, ,264.2,158.52,Medicaid,Illinois Medicaid,,,,,264.2,,,,
TC99M LABL RBC/30MCI,A9560,HCPCS,,,,,both,, ,69.78,41.86,Medicaid,Illinois Medicaid,,,,,69.78,,,,
TC99M OXIDRONA/30MCI,A9561,HCPCS,,,,,both,, ,148.84,89.3,Medicaid,Illinois Medicaid,,,,,148.84,,,,
TC99M MERTIATI/15MCI,A9562,HCPCS,,,,,both,, ,938.33,562.99,Medicaid,Illinois Medicaid,,,,,938.33,,,,
TC99M AEROSOL 75 MCI,A9567,HCPCS,,,,,both,, ,69.78,41.86,Medicaid,Illinois Medicaid,,,,,69.78,,,,
IN-111 PENTETRE/6MCI,A9572,HCPCS,,,,,both,, ,14752.18,8851.3,Medicaid,Illinois Medicaid,,,,,14752.18,,,,
INJ GADO DIMEG ML 15,A9577,HCPCS,,,,,both,15,ML,13.75,8.25,Medicaid,Illinois Medicaid,,,,,13.75,,,,
INJ GADO DIMEG ML 20,A9577,HCPCS,,,,,both,20,ML,13.75,8.25,Medicaid,Illinois Medicaid,,,,,13.75,,,,
INJ MULTIHANCE /ML,A9577,HCPCS,,,,,both,, ,14.16,8.49,Medicaid,Illinois Medicaid,,,,,14.16,,,,
INJ MULTIHANCE/ ML,A9577,HCPCS,,,,,both,, ,13.75,8.25,Medicaid,Illinois Medicaid,,,,,13.75,,,,
INJ GAD-MR1 CONTR ML,A9579,HCPCS,,,,,both,, ,37.6,22.56,Medicaid,Illinois Medicaid,,,,,37.6,,,,
INJ GAD-MR2 CONTR ML,A9579,HCPCS,,,,,both,, ,47.9,28.74,Medicaid,Illinois Medicaid,,,,,47.9,,,,
INJ GAD-MR3 CONTR ML,A9579,HCPCS,,,,,both,, ,40.94,24.56,Medicaid,Illinois Medicaid,,,,,40.94,,,,
ANCHOR/SCRW LEVEL 1,C1713,HCPCS,,,,,both,, ,129.01,77.4,Medicaid,Illinois Medicaid,,,,,129.01,,,,
ANCHOR/SCRW LEVEL 10,C1713,HCPCS,,,,,both,, ,2873.7,1724.22,Medicaid,Illinois Medicaid,,,,,2873.7,,,,
ANCHOR/SCRW LEVEL 11,C1713,HCPCS,,,,,both,, ,4069.02,2441.41,Medicaid,Illinois Medicaid,,,,,4069.02,,,,
ANCHOR/SCRW LEVEL 12,C1713,HCPCS,,,,,both,, ,4786.15,2871.69,Medicaid,Illinois Medicaid,,,,,4786.15,,,,
ANCHOR/SCRW LEVEL 13,C1713,HCPCS,,,,,both,, ,6684.19,4010.51,Medicaid,Illinois Medicaid,,,,,6684.19,,,,
ANCHOR/SCRW LEVEL 14,C1713,HCPCS,,,,,both,, ,9567.67,5740.6,Medicaid,Illinois Medicaid,,,,,9567.67,,,,
ANCHOR/SCRW LEVEL 15,C1713,HCPCS,,,,,both,, ,14349.19,8609.51,Medicaid,Illinois Medicaid,,,,,14349.19,,,,
ANCHOR/SCRW LEVEL 16,C1713,HCPCS,,,,,both,, ,19130.71,11478.42,Medicaid,Illinois Medicaid,,,,,19130.71,,,,
ANCHOR/SCRW LEVEL 17,C1713,HCPCS,,,,,both,, ,23912.22,14347.33,Medicaid,Illinois Medicaid,,,,,23912.22,,,,
ANCHOR/SCRW LEVEL 18,C1713,HCPCS,,,,,both,, ,31084.37,18650.62,Medicaid,Illinois Medicaid,,,,,31084.37,,,,
ANCHOR/SCRW LEVEL 19,C1713,HCPCS,,,,,both,, ,38256.78,22954.06,Medicaid,Illinois Medicaid,,,,,38256.78,,,,
ANCHOR/SCRW LEVEL 2,C1713,HCPCS,,,,,both,, ,172.01,103.2,Medicaid,Illinois Medicaid,,,,,172.01,,,,
ANCHOR/SCRW LEVEL 20,C1713,HCPCS,,,,,both,, ,47814.92,28688.95,Medicaid,Illinois Medicaid,,,,,47814.92,,,,
ANCHOR/SCRW LEVEL 21,C1713,HCPCS,,,,,both,, ,57377.95,34426.77,Medicaid,Illinois Medicaid,,,,,57377.95,,,,
ANCHOR/SCRW LEVEL 3,C1713,HCPCS,,,,,both,, ,243.85,146.31,Medicaid,Illinois Medicaid,,,,,243.85,,,,
ANCHOR/SCRW LEVEL 4,C1713,HCPCS,,,,,both,, ,411.23,246.73,Medicaid,Illinois Medicaid,,,,,411.23,,,,
ANCHOR/SCRW LEVEL 5,C1713,HCPCS,,,,,both,, ,602.55,361.53,Medicaid,Illinois Medicaid,,,,,602.55,,,,
ANCHOR/SCRW LEVEL 6,C1713,HCPCS,,,,,both,, ,841.51,504.9,Medicaid,Illinois Medicaid,,,,,841.51,,,,
ANCHOR/SCRW LEVEL 7,C1713,HCPCS,,,,,both,, ,1200.21,720.12,Medicaid,Illinois Medicaid,,,,,1200.21,,,,
ANCHOR/SCRW LEVEL 8,C1713,HCPCS,,,,,both,, ,1678.39,1007.03,Medicaid,Illinois Medicaid,,,,,1678.39,,,,
ANCHOR/SCRW LEVEL 9,C1713,HCPCS,,,,,both,, ,2156.56,1293.93,Medicaid,Illinois Medicaid,,,,,2156.56,,,,
BONE CEMENT 1,C1713,HCPCS,,,,,both,, ,884.51,530.7,Medicaid,Illinois Medicaid,,,,,884.51,,,,
BONE CEMENT 2,C1713,HCPCS,,,,,both,, ,2467.37,1480.42,Medicaid,Illinois Medicaid,,,,,2467.37,,,,
CATH TRNS ARTHR DIR1,C1714,HCPCS,,,,,both,, ,5379.18,3227.5,Medicaid,Illinois Medicaid,,,,,5379.18,,,,
CATH TRNS ARTHR DIR2,C1714,HCPCS,,,,,both,, ,8391.41,5034.84,Medicaid,Illinois Medicaid,,,,,8391.41,,,,
AICD DUAL CHAMBER L1,C1721,HCPCS,,,,,both,, ,93836.86,56302.11,Medicaid,Illinois Medicaid,,,,,93836.86,,,,
AICD SINGLE CHAMBER1,C1722,HCPCS,,,,,both,, ,99999,59999.4,Medicaid,Illinois Medicaid,,,,,99999,,,,
CATH TRNS ARTHR ROT1,C1724,HCPCS,,,,,both,, ,5379.18,3227.5,Medicaid,Illinois Medicaid,,,,,5379.18,,,,
CATH TRNS ARTHR ROT2,C1724,HCPCS,,,,,both,, ,16735.18,10041.1,Medicaid,Illinois Medicaid,,,,,16735.18,,,,
CATH-ANGIO LEVEL 1,C1725,HCPCS,,,,,both,, ,855.42,513.25,Medicaid,Illinois Medicaid,,,,,855.42,,,,
CATH-ANGIO LEVEL 2,C1725,HCPCS,,,,,both,, ,1728.86,1037.31,Medicaid,Illinois Medicaid,,,,,1728.86,,,,
CATH-ANGIO LEVEL 3,C1725,HCPCS,,,,,both,, ,2726.15,1635.69,Medicaid,Illinois Medicaid,,,,,2726.15,,,,
CATH-ANGIO LEVEL 4,C1725,HCPCS,,,,,both,, ,4234.59,2540.75,Medicaid,Illinois Medicaid,,,,,4234.59,,,,
CATH-ANGIO LEVEL 5,C1725,HCPCS,,,,,both,, ,6331.93,3799.15,Medicaid,Illinois Medicaid,,,,,6331.93,,,,
CATH BAL DIL NONVAS1,C1726,HCPCS,,,,,both,, ,1434.53,860.71,Medicaid,Illinois Medicaid,,,,,1434.53,,,,
CATH BAL DIL NONVAS2,C1726,HCPCS,,,,,both,, ,2390.63,1434.37,Medicaid,Illinois Medicaid,,,,,2390.63,,,,
CATH BRACHY SEED AD1,C1728,HCPCS,,,,,both,, ,717.14,430.28,Medicaid,Illinois Medicaid,,,,,717.14,,,,
CATH BRACHY SEED AD2,C1728,HCPCS,,,,,both,, ,956.36,573.81,Medicaid,Illinois Medicaid,,,,,956.36,,,,
CATH DRAINAG LEVEL11,C1729,HCPCS,,,,,both,, ,11958.56,7175.13,Medicaid,Illinois Medicaid,,,,,11958.56,,,,
CATH-DRAINAG LEVEL 1,C1729,HCPCS,,,,,both,, ,84.2,50.52,Medicaid,Illinois Medicaid,,,,,84.2,,,,
CATH-DRAINAG LEVEL 2,C1729,HCPCS,,,,,both,, ,247.72,148.63,Medicaid,Illinois Medicaid,,,,,247.72,,,,
CATH-DRAINAG LEVEL 3,C1729,HCPCS,,,,,both,, ,727.18,436.3,Medicaid,Illinois Medicaid,,,,,727.18,,,,
CATH-DRAINAG LEVEL 4,C1729,HCPCS,,,,,both,, ,1200.21,720.12,Medicaid,Illinois Medicaid,,,,,1200.21,,,,
CATH-DRAINAG LEVEL 5,C1729,HCPCS,,,,,both,, ,1917.35,1150.41,Medicaid,Illinois Medicaid,,,,,1917.35,,,,
CATH-DRAINAG LEVEL 6,C1729,HCPCS,,,,,both,, ,2634.48,1580.68,Medicaid,Illinois Medicaid,,,,,2634.48,,,,
CATH-DRAINAG LEVEL 7,C1729,HCPCS,,,,,both,, ,3351.88,2011.12,Medicaid,Illinois Medicaid,,,,,3351.88,,,,
CATH-DRAINAG LEVEL 8,C1729,HCPCS,,,,,both,, ,4786.15,2871.69,Medicaid,Illinois Medicaid,,,,,4786.15,,,,
CATH-DRAINAG LEVEL 9,C1729,HCPCS,,,,,both,, ,7177.04,4306.22,Medicaid,Illinois Medicaid,,,,,7177.04,,,,
CATH-DRAINAG LEVEL10,C1729,HCPCS,,,,,both,, ,9567.67,5740.6,Medicaid,Illinois Medicaid,,,,,9567.67,,,,
CATH-DRAINAG LEVEL12,C1729,HCPCS,,,,,both,, ,14344.55,8606.73,Medicaid,Illinois Medicaid,,,,,14344.55,,,,
CATH EP 19 OR FEW 1,C1730,HCPCS,,,,,both,, ,554.66,332.79,Medicaid,Illinois Medicaid,,,,,554.66,,,,
CATH EP 19 OR FEW 2,C1730,HCPCS,,,,,both,, ,1807.39,1084.43,Medicaid,Illinois Medicaid,,,,,1807.39,,,,
CATH EP 20 OR MORE 1,C1731,HCPCS,,,,,both,, ,6185.15,3711.09,Medicaid,Illinois Medicaid,,,,,6185.15,,,,
CATH EP DIG/ABL 3D 1,C1732,HCPCS,,,,,both,, ,7172.15,4303.29,Medicaid,Illinois Medicaid,,,,,7172.15,,,,
CATH EP DIG/ABL 3D 2,C1732,HCPCS,,,,,both,, ,15395.93,9237.55,Medicaid,Illinois Medicaid,,,,,15395.93,,,,
CATH HEMODIAL LT 1,C1750,HCPCS,,,,,both,, ,1434.53,860.71,Medicaid,Illinois Medicaid,,,,,1434.53,,,,
CATH HEMODIAL LT 2,C1750,HCPCS,,,,,both,, ,1912.71,1147.62,Medicaid,Illinois Medicaid,,,,,1912.71,,,,
CATH-INFUS PERIF 1,C1751,HCPCS,,,,,both,, ,89.61,53.76,Medicaid,Illinois Medicaid,,,,,89.61,,,,
CATH-INFUS PERIF 10,C1751,HCPCS,,,,,both,, ,2395.52,1437.31,Medicaid,Illinois Medicaid,,,,,2395.52,,,,
CATH-INFUS PERIF 11,C1751,HCPCS,,,,,both,, ,3351.88,2011.12,Medicaid,Illinois Medicaid,,,,,3351.88,,,,
CATH-INFUS PERIF 12,C1751,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,,,,4781.52,,,,
CATH-INFUS PERIF 2,C1751,HCPCS,,,,,both,, ,124.37,74.62,Medicaid,Illinois Medicaid,,,,,124.37,,,,
CATH-INFUS PERIF 3,C1751,HCPCS,,,,,both,, ,243.85,146.31,Medicaid,Illinois Medicaid,,,,,243.85,,,,
CATH-INFUS PERIF 4,C1751,HCPCS,,,,,both,, ,722.03,433.21,Medicaid,Illinois Medicaid,,,,,722.03,,,,
CATH-INFUS PERIF 6,C1751,HCPCS,,,,,both,, ,960.99,576.59,Medicaid,Illinois Medicaid,,,,,960.99,,,,
CATH-INFUS PERIF 6,C1751,HCPCS,,,,,both,, ,960.99,576.59,Medicaid,Illinois Medicaid,,,,,960.99,,,,
CATH-INFUS PERIF 7,C1751,HCPCS,,,,,both,, ,1200.21,720.12,Medicaid,Illinois Medicaid,,,,,1200.21,,,,
CATH-INFUS PERIF 8,C1751,HCPCS,,,,,both,, ,1439.17,863.5,Medicaid,Illinois Medicaid,,,,,1439.17,,,,
CATH-INFUS PERIF 9,C1751,HCPCS,,,,,both,, ,1673.49,1004.09,Medicaid,Illinois Medicaid,,,,,1673.49,,,,
CATH HEMODIAL ST 1,C1752,HCPCS,,,,,both,, ,358.7,215.22,Medicaid,Illinois Medicaid,,,,,358.7,,,,
CATH HEMODIAL ST 2,C1752,HCPCS,,,,,both,, ,478.18,286.9,Medicaid,Illinois Medicaid,,,,,478.18,,,,
CATH INTRAVAS ULTRA1,C1753,HCPCS,,,,,both,, ,3586.2,2151.72,Medicaid,Illinois Medicaid,,,,,3586.2,,,,
CATH INTRAVAS ULTRA2,C1753,HCPCS,,,,,both,, ,14344.55,8606.73,Medicaid,Illinois Medicaid,,,,,14344.55,,,,
CATHETER INTRASPINAL,C1755,HCPCS,,,,,both,, ,5259.7,3155.82,Medicaid,Illinois Medicaid,,,,,5259.7,,,,
CATH THRMB/EMBOL 1,C1757,HCPCS,,,,,both,, ,238.96,143.37,Medicaid,Illinois Medicaid,,,,,238.96,,,,
CATH THRMB/EMBOL 2,C1757,HCPCS,,,,,both,, ,1792.97,1075.78,Medicaid,Illinois Medicaid,,,,,1792.97,,,,
CATH THRMB/EMBOL 3,C1757,HCPCS,,,,,both,, ,2395.52,1437.31,Medicaid,Illinois Medicaid,,,,,2395.52,,,,
CATH THRMB/EMBOL 4,C1757,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,,,,4781.52,,,,
CATH URETERAL 1,C1758,HCPCS,,,,,both,, ,478.18,286.9,Medicaid,Illinois Medicaid,,,,,478.18,,,,
CATH URETERAL 2,C1758,HCPCS,,,,,both,, ,717.14,430.28,Medicaid,Illinois Medicaid,,,,,717.14,,,,
CATH URETERAL 3,C1758,HCPCS,,,,,both,, ,956.36,573.81,Medicaid,Illinois Medicaid,,,,,956.36,,,,
CATH INTRA ECHOCARD1,C1759,HCPCS,,,,,both,, ,7172.15,4303.29,Medicaid,Illinois Medicaid,,,,,7172.15,,,,
CATH INTRA ECHOCARD2,C1759,HCPCS,,,,,both,, ,9563.04,5737.82,Medicaid,Illinois Medicaid,,,,,9563.04,,,,
CLOSURE DEVIC VASC 1,C1760,HCPCS,,,,,both,, ,1634.61,980.76,Medicaid,Illinois Medicaid,,,,,1634.61,,,,
CLOSURE DEVIC VASC 2,C1760,HCPCS,,,,,both,, ,2504.7,1502.82,Medicaid,Illinois Medicaid,,,,,2504.7,,,,
CONN TISSUE HUMAN 1,C1762,HCPCS,,,,,both,, ,1438.14,862.88,Medicaid,Illinois Medicaid,,,,,1438.14,,,,
CONN TISSUE HUMAN 10,C1762,HCPCS,,,,,both,, ,57377.95,34426.77,Medicaid,Illinois Medicaid,,,,,57377.95,,,,
CONN TISSUE HUMAN 2,C1762,HCPCS,,,,,both,, ,1917.35,1150.41,Medicaid,Illinois Medicaid,,,,,1917.35,,,,
CONN TISSUE HUMAN 3,C1762,HCPCS,,,,,both,, ,5742.51,3445.5,Medicaid,Illinois Medicaid,,,,,5742.51,,,,
CONN TISSUE HUMAN 4,C1762,HCPCS,,,,,both,, ,9567.67,5740.6,Medicaid,Illinois Medicaid,,,,,9567.67,,,,
CONN TISSUE HUMAN 5,C1762,HCPCS,,,,,both,, ,13393.09,8035.85,Medicaid,Illinois Medicaid,,,,,13393.09,,,,
CONN TISSUE HUMAN 6,C1762,HCPCS,,,,,both,, ,17218.25,10330.95,Medicaid,Illinois Medicaid,,,,,17218.25,,,,
CONN TISSUE HUMAN 7,C1762,HCPCS,,,,,both,, ,23907.59,14344.55,Medicaid,Illinois Medicaid,,,,,23907.59,,,,
CONN TISSUE HUMAN 8,C1762,HCPCS,,,,,both,, ,33475.26,20085.15,Medicaid,Illinois Medicaid,,,,,33475.26,,,,
CONN TISSUE HUMAN 9,C1762,HCPCS,,,,,both,, ,43033.4,25820.04,Medicaid,Illinois Medicaid,,,,,43033.4,,,,
TISSUE NON-HUMAN 1,C1763,HCPCS,,,,,both,, ,1796.58,1077.94,Medicaid,Illinois Medicaid,,,,,1796.58,,,,
TISSUE NON-HUMAN 10,C1763,HCPCS,,,,,both,, ,43033.4,25820.04,Medicaid,Illinois Medicaid,,,,,43033.4,,,,
TISSUE NON-HUMAN 11,C1763,HCPCS,,,,,both,, ,57377.95,34426.77,Medicaid,Illinois Medicaid,,,,,57377.95,,,,
TISSUE NON-HUMAN 2,C1763,HCPCS,,,,,both,, ,2395.52,1437.31,Medicaid,Illinois Medicaid,,,,,2395.52,,,,
TISSUE NON-HUMAN 3,C1763,HCPCS,,,,,both,, ,4786.15,2871.69,Medicaid,Illinois Medicaid,,,,,4786.15,,,,
TISSUE NON-HUMAN 4,C1763,HCPCS,,,,,both,, ,8611.57,5166.94,Medicaid,Illinois Medicaid,,,,,8611.57,,,,
TISSUE NON-HUMAN 5,C1763,HCPCS,,,,,both,, ,12436.74,7462.04,Medicaid,Illinois Medicaid,,,,,12436.74,,,,
TISSUE NON-HUMAN 6,C1763,HCPCS,,,,,both,, ,15305.54,9183.32,Medicaid,Illinois Medicaid,,,,,15305.54,,,,
TISSUE NON-HUMAN 7,C1763,HCPCS,,,,,both,, ,19130.71,11478.42,Medicaid,Illinois Medicaid,,,,,19130.71,,,,
TISSUE NON-HUMAN 8,C1763,HCPCS,,,,,both,, ,23912.22,14347.33,Medicaid,Illinois Medicaid,,,,,23912.22,,,,
TISSUE NON-HUMAN 9,C1763,HCPCS,,,,,both,, ,33475.26,20085.15,Medicaid,Illinois Medicaid,,,,,33475.26,,,,
EVENT RECRDR CARDIAC,C1764,HCPCS,,,,,both,, ,21590.35,12954.21,Medicaid,Illinois Medicaid,,,,,21590.35,,,,
ADHESION BARRIER1,C1765,HCPCS,,,,,both,, ,717.14,430.28,Medicaid,Illinois Medicaid,,,,,717.14,,,,
ADHESION BARRIER2,C1765,HCPCS,,,,,both,, ,956.36,573.81,Medicaid,Illinois Medicaid,,,,,956.36,,,,
ADHESION BARRIER3,C1765,HCPCS,,,,,both,, ,8466.86,5080.11,Medicaid,Illinois Medicaid,,,,,8466.86,,,,
ADHESION BARRIER4,C1765,HCPCS,,,,,both,, ,4456.3,2673.78,Medicaid,Illinois Medicaid,,,,,4456.3,,,,
GENRATR NEUROSTM 1,C1767,HCPCS,,,,,both,, ,35861.25,21516.75,Medicaid,Illinois Medicaid,,,,,35861.25,,,,
GENRATR NEUROSTM 2,C1767,HCPCS,,,,,both,, ,71722.51,43033.5,Medicaid,Illinois Medicaid,,,,,71722.51,,,,
GRAFT VASCULAR 1,C1768,HCPCS,,,,,both,, ,1796.58,1077.94,Medicaid,Illinois Medicaid,,,,,1796.58,,,,
GRAFT VASCULAR 2,C1768,HCPCS,,,,,both,, ,2395.52,1437.31,Medicaid,Illinois Medicaid,,,,,2395.52,,,,
GRAFT VASCULAR 3,C1768,HCPCS,,,,,both,, ,4786.15,2871.69,Medicaid,Illinois Medicaid,,,,,4786.15,,,,
GRAFT VASCULAR 4,C1768,HCPCS,,,,,both,, ,9567.67,5740.6,Medicaid,Illinois Medicaid,,,,,9567.67,,,,
GRAFT VASCULAR 5,C1768,HCPCS,,,,,both,, ,14349.19,8609.51,Medicaid,Illinois Medicaid,,,,,14349.19,,,,
GRAFT VASCULAR 6,C1768,HCPCS,,,,,both,, ,19130.71,11478.42,Medicaid,Illinois Medicaid,,,,,19130.71,,,,
GRAFT VASCULAR 7,C1768,HCPCS,,,,,both,, ,23912.22,14347.33,Medicaid,Illinois Medicaid,,,,,23912.22,,,,
GRAFT VASCULAR 8,C1768,HCPCS,,,,,both,, ,28688.85,17213.31,Medicaid,Illinois Medicaid,,,,,28688.85,,,,
GUIDEWIRE LEVEL 1,C1769,HCPCS,,,,,both,, ,182.83,109.69,Medicaid,Illinois Medicaid,,,,,182.83,,,,
GUIDEWIRE LEVEL 10,C1769,HCPCS,,,,,both,, ,3830.06,2298.03,Medicaid,Illinois Medicaid,,,,,3830.06,,,,
GUIDEWIRE LEVEL 11,C1769,HCPCS,,,,,both,, ,4308.23,2584.93,Medicaid,Illinois Medicaid,,,,,4308.23,,,,
GUIDEWIRE LEVEL 12,C1769,HCPCS,,,,,both,, ,4786.15,2871.69,Medicaid,Illinois Medicaid,,,,,4786.15,,,,
GUIDEWIRE LEVEL 13,C1769,HCPCS,,,,,both,, ,7177.04,4306.22,Medicaid,Illinois Medicaid,,,,,7177.04,,,,
GUIDEWIRE LEVEL 14,C1769,HCPCS,,,,,both,, ,9567.67,5740.6,Medicaid,Illinois Medicaid,,,,,9567.67,,,,
GUIDEWIRE LEVEL 15,C1769,HCPCS,,,,,both,, ,14349.19,8609.51,Medicaid,Illinois Medicaid,,,,,14349.19,,,,
GUIDEWIRE LEVEL 16,C1769,HCPCS,,,,,both,, ,19130.71,11478.42,Medicaid,Illinois Medicaid,,,,,19130.71,,,,
GUIDEWIRE LEVEL 17,C1769,HCPCS,,,,,both,, ,23912.22,14347.33,Medicaid,Illinois Medicaid,,,,,23912.22,,,,
GUIDEWIRE LEVEL 18,C1769,HCPCS,,,,,both,, ,31084.37,18650.62,Medicaid,Illinois Medicaid,,,,,31084.37,,,,
GUIDEWIRE LEVEL 19,C1769,HCPCS,,,,,both,, ,38256.78,22954.06,Medicaid,Illinois Medicaid,,,,,38256.78,,,,
GUIDEWIRE LEVEL 2,C1769,HCPCS,,,,,both,, ,243.85,146.31,Medicaid,Illinois Medicaid,,,,,243.85,,,,
GUIDEWIRE LEVEL 20,C1769,HCPCS,,,,,both,, ,47814.92,28688.95,Medicaid,Illinois Medicaid,,,,,47814.92,,,,
GUIDEWIRE LEVEL 3,C1769,HCPCS,,,,,both,, ,482.81,289.68,Medicaid,Illinois Medicaid,,,,,482.81,,,,
GUIDEWIRE LEVEL 4,C1769,HCPCS,,,,,both,, ,960.99,576.59,Medicaid,Illinois Medicaid,,,,,960.99,,,,
GUIDEWIRE LEVEL 5,C1769,HCPCS,,,,,both,, ,1439.17,863.5,Medicaid,Illinois Medicaid,,,,,1439.17,,,,
GUIDEWIRE LEVEL 6,C1769,HCPCS,,,,,both,, ,1917.35,1150.41,Medicaid,Illinois Medicaid,,,,,1917.35,,,,
GUIDEWIRE LEVEL 7,C1769,HCPCS,,,,,both,, ,2395.52,1437.31,Medicaid,Illinois Medicaid,,,,,2395.52,,,,
GUIDEWIRE LEVEL 9,C1769,HCPCS,,,,,both,, ,3351.88,2011.12,Medicaid,Illinois Medicaid,,,,,3351.88,,,,
GUIDEWIRE LEVEL 9,C1769,HCPCS,,,,,both,, ,3351.88,2011.12,Medicaid,Illinois Medicaid,,,,,3351.88,,,,
REP DEV URINRY W/SL1,C1771,HCPCS,,,,,both,, ,2868.81,1721.28,Medicaid,Illinois Medicaid,,,,,2868.81,,,,
REP DEV URINRY W/SL2,C1771,HCPCS,,,,,both,, ,3825.16,2295.09,Medicaid,Illinois Medicaid,,,,,3825.16,,,,
REP DEV URINRY W/SL3,C1771,HCPCS,,,,,both,, ,14344.55,8606.73,Medicaid,Illinois Medicaid,,,,,14344.55,,,,
INF PUMP PROGRAM LV1,C1772,HCPCS,,,,,both,, ,2774.56,1664.73,Medicaid,Illinois Medicaid,,,,,2774.56,,,,
INF PUMP PROGRAM LV3,C1772,HCPCS,,,,,both,, ,53552.79,32131.67,Medicaid,Illinois Medicaid,,,,,53552.79,,,,
CATH-RETRIEVAL 1,C1773,HCPCS,,,,,both,, ,1338.74,803.24,Medicaid,Illinois Medicaid,,,,,1338.74,,,,
CATH-RETRIEVAL 2,C1773,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,,,,4781.52,,,,
JOINT DEVICE IMPLT 1,C1776,HCPCS,,,,,both,, ,3586.2,2151.72,Medicaid,Illinois Medicaid,,,,,3586.2,,,,
JOINT DEVICE IMPLT 2,C1776,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,,,,4781.52,,,,
JOINT DEVICE IMPLT 3,C1776,HCPCS,,,,,both,, ,9567.67,5740.6,Medicaid,Illinois Medicaid,,,,,9567.67,,,,
JOINT DEVICE IMPLT 4,C1776,HCPCS,,,,,both,, ,11958.56,7175.13,Medicaid,Illinois Medicaid,,,,,11958.56,,,,
JOINT DEVICE IMPLT 5,C1776,HCPCS,,,,,both,, ,19130.71,11478.42,Medicaid,Illinois Medicaid,,,,,19130.71,,,,
JOINT DEVICE IMPLT 6,C1776,HCPCS,,,,,both,, ,23912.22,14347.33,Medicaid,Illinois Medicaid,,,,,23912.22,,,,
JOINT DEVICE IMPLT 7,C1776,HCPCS,,,,,both,, ,31084.37,18650.62,Medicaid,Illinois Medicaid,,,,,31084.37,,,,
JOINT DEVICE IMPLT 8,C1776,HCPCS,,,,,both,, ,38256.78,22954.06,Medicaid,Illinois Medicaid,,,,,38256.78,,,,
JOINT DEVICE IMPLT 9,C1776,HCPCS,,,,,both,, ,47819.81,28691.88,Medicaid,Illinois Medicaid,,,,,47819.81,,,,
JOINT DEVICE IMPLT10,C1776,HCPCS,,,,,both,, ,71727.14,43036.28,Medicaid,Illinois Medicaid,,,,,71727.14,,,,
JOINT DEVICE IMPLT11,C1776,HCPCS,,,,,both,, ,95629.84,57377.9,Medicaid,Illinois Medicaid,,,,,95629.84,,,,
JOINT DEVICE IMPLT12,C1776,HCPCS,,,,,both,, ,99999,59999.4,Medicaid,Illinois Medicaid,,,,,99999,,,,
LEAD AICD ENDO SN L1,C1777,HCPCS,,,,,both,, ,23599.62,14159.77,Medicaid,Illinois Medicaid,,,,,23599.62,,,,
LEAD NEUROSTIMULAT 1,C1778,HCPCS,,,,,both,, ,9563.04,5737.82,Medicaid,Illinois Medicaid,,,,,9563.04,,,,
LEAD NEUROSTIMULAT 2,C1778,HCPCS,,,,,both,, ,3586.2,2151.72,Medicaid,Illinois Medicaid,,,,,3586.2,,,,
LEAD NEUROSTIMULAT 3,C1778,HCPCS,,,,,both,, ,14344.55,8606.73,Medicaid,Illinois Medicaid,,,,,14344.55,,,,
LEAD NEUROSTIMULAT 4,C1778,HCPCS,,,,,both,, ,23907.59,14344.55,Medicaid,Illinois Medicaid,,,,,23907.59,,,,
LEAD PMKR TRNSV VDD1,C1779,HCPCS,,,,,both,, ,9194.3,5516.58,Medicaid,Illinois Medicaid,,,,,9194.3,,,,
MESH IMPLANTABLE 1,C1781,HCPCS,,,,,both,, ,717.14,430.28,Medicaid,Illinois Medicaid,,,,,717.14,,,,
MESH IMPLANTABLE 10,C1781,HCPCS,,,,,both,, ,11958.56,7175.13,Medicaid,Illinois Medicaid,,,,,11958.56,,,,
MESH IMPLANTABLE 11,C1781,HCPCS,,,,,both,, ,14349.19,8609.51,Medicaid,Illinois Medicaid,,,,,14349.19,,,,
MESH IMPLANTABLE 12,C1781,HCPCS,,,,,both,, ,19130.71,11478.42,Medicaid,Illinois Medicaid,,,,,19130.71,,,,
MESH IMPLANTABLE 13,C1781,HCPCS,,,,,both,, ,28693.74,17216.24,Medicaid,Illinois Medicaid,,,,,28693.74,,,,
MESH IMPLANTABLE 14,C1781,HCPCS,,,,,both,, ,43038.29,25822.97,Medicaid,Illinois Medicaid,,,,,43038.29,,,,
MESH IMPLANTABLE 2,C1781,HCPCS,,,,,both,, ,960.99,576.59,Medicaid,Illinois Medicaid,,,,,960.99,,,,
MESH IMPLANTABLE 3,C1781,HCPCS,,,,,both,, ,1917.35,1150.41,Medicaid,Illinois Medicaid,,,,,1917.35,,,,
MESH IMPLANTABLE 4,C1781,HCPCS,,,,,both,, ,2873.7,1724.22,Medicaid,Illinois Medicaid,,,,,2873.7,,,,
MESH IMPLANTABLE 6,C1781,HCPCS,,,,,both,, ,3830.06,2298.03,Medicaid,Illinois Medicaid,,,,,3830.06,,,,
MESH IMPLANTABLE 6,C1781,HCPCS,,,,,both,, ,3830.06,2298.03,Medicaid,Illinois Medicaid,,,,,3830.06,,,,
MESH IMPLANTABLE 7,C1781,HCPCS,,,,,both,, ,6220.69,3732.41,Medicaid,Illinois Medicaid,,,,,6220.69,,,,
MESH IMPLANTABLE 8,C1781,HCPCS,,,,,both,, ,7655.22,4593.13,Medicaid,Illinois Medicaid,,,,,7655.22,,,,
MESH IMPLANTABLE 9,C1781,HCPCS,,,,,both,, ,9567.67,5740.6,Medicaid,Illinois Medicaid,,,,,9567.67,,,,
MORCELLATOR 1,C1782,HCPCS,,,,,both,, ,1792.97,1075.78,Medicaid,Illinois Medicaid,,,,,1792.97,,,,
MORCELLATOR 2,C1782,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,,,,4781.52,,,,
MORCELLATOR 3,C1782,HCPCS,,,,,both,, ,9563.04,5737.82,Medicaid,Illinois Medicaid,,,,,9563.04,,,,
OCLR DEV INTROP DTR1,C1784,HCPCS,,,,,both,, ,15780.63,9468.37,Medicaid,Illinois Medicaid,,,,,15780.63,,,,
PMKR DUAL RATE-RS L1,C1785,HCPCS,,,,,both,, ,84273.06,50563.83,Medicaid,Illinois Medicaid,,,,,84273.06,,,,
PMKR DUAL RATE-RS L2,C1785,HCPCS,,,,,both,, ,28809.36,17285.61,Medicaid,Illinois Medicaid,,,,,28809.36,,,,
PMKR SINGL RATE-RSL1,C1786,HCPCS,,,,,both,, ,62664.69,37598.81,Medicaid,Illinois Medicaid,,,,,62664.69,,,,
PATIENT PROGR NEURO1,C1787,HCPCS,,,,,both,, ,5302.96,3181.77,Medicaid,Illinois Medicaid,,,,,5302.96,,,,
PORT 1,C1788,HCPCS,,,,,both,, ,720.74,432.44,Medicaid,Illinois Medicaid,,,,,720.74,,,,
PORT 2,C1788,HCPCS,,,,,both,, ,960.99,576.59,Medicaid,Illinois Medicaid,,,,,960.99,,,,
PORT 3,C1788,HCPCS,,,,,both,, ,1912.71,1147.62,Medicaid,Illinois Medicaid,,,,,1912.71,,,,
BREAST IMPLANT 1,C1789,HCPCS,,,,,both,, ,7833.15,4699.89,Medicaid,Illinois Medicaid,,,,,7833.15,,,,
PRSTHS PENILE INFL 1,C1813,HCPCS,,,,,both,, ,3586.2,2151.72,Medicaid,Illinois Medicaid,,,,,3586.2,,,,
PRSTHS PENILE INFL 2,C1813,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,,,,4781.52,,,,
PRSTHS PENILE INFL 3,C1813,HCPCS,,,,,both,, ,14344.55,8606.73,Medicaid,Illinois Medicaid,,,,,14344.55,,,,
PRSTHS PENILE INFL 4,C1813,HCPCS,,,,,both,, ,23907.59,14344.55,Medicaid,Illinois Medicaid,,,,,23907.59,,,,
TISSUE LOCALZ EXCISI,C1819,HCPCS,,,,,both,, ,1000,600,Medicaid,Illinois Medicaid,,,,,1000,,,,
GENRATE NEURO RECHR,C1820,HCPCS,,,,,both,, ,38545.95,23127.57,Medicaid,Illinois Medicaid,,,,,38545.95,,,,
INTERSPINOUS IMPL L1,C1821,HCPCS,,,,,both,, ,31193.29,18715.97,Medicaid,Illinois Medicaid,,,,,31193.29,,,,
INTERSPINOUS IMPL L2,C1821,HCPCS,,,,,both,, ,44561.92,26737.15,Medicaid,Illinois Medicaid,,,,,44561.92,,,,
STNT COAT/COV W/DEL1,C1874,HCPCS,,,,,both,, ,3586.2,2151.72,Medicaid,Illinois Medicaid,,,,,3586.2,,,,
STNT COAT/COV W/DEL2,C1874,HCPCS,,,,,both,, ,7172.15,4303.29,Medicaid,Illinois Medicaid,,,,,7172.15,,,,
STNT COAT/COV W/DEL3,C1874,HCPCS,,,,,both,, ,14344.55,8606.73,Medicaid,Illinois Medicaid,,,,,14344.55,,,,
STNT COAT/COV W/DEL4,C1874,HCPCS,,,,,both,, ,23907.59,14344.55,Medicaid,Illinois Medicaid,,,,,23907.59,,,,
STNT NO COCV W/DEL 1,C1876,HCPCS,,,,,both,, ,3589.81,2153.88,Medicaid,Illinois Medicaid,,,,,3589.81,,,,
STNT NO COCV W/DEL 2,C1876,HCPCS,,,,,both,, ,4786.15,2871.69,Medicaid,Illinois Medicaid,,,,,4786.15,,,,
STNT NO COCV W/DEL 3,C1876,HCPCS,,,,,both,, ,9567.67,5740.6,Medicaid,Illinois Medicaid,,,,,9567.67,,,,
STNT NO COCV W/DEL 4,C1876,HCPCS,,,,,both,, ,14344.55,8606.73,Medicaid,Illinois Medicaid,,,,,14344.55,,,,
STNT NO-COA/COV W/O1,C1877,HCPCS,,,,,both,, ,3586.2,2151.72,Medicaid,Illinois Medicaid,,,,,3586.2,,,,
STNT NO-COA/COV W/O2,C1877,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,,,,4781.52,,,,
VENA CAVA FILTER 1,C1880,HCPCS,,,,,both,, ,3586.2,2151.72,Medicaid,Illinois Medicaid,,,,,3586.2,,,,
VENA CAVA FILTER 2,C1880,HCPCS,,,,,both,, ,7172.15,4303.29,Medicaid,Illinois Medicaid,,,,,7172.15,,,,
AICD OHR THN SGL/DU1,C1882,HCPCS,,,,,both,, ,99999,59999.4,Medicaid,Illinois Medicaid,,,,,99999,,,,
EMBOLIZ PROTECT SYS1,C1884,HCPCS,,,,,both,, ,6144.21,3686.52,Medicaid,Illinois Medicaid,,,,,6144.21,,,,
EMBOLIZ PROTECT SYS2,C1884,HCPCS,,,,,both,, ,7172.15,4303.29,Medicaid,Illinois Medicaid,,,,,7172.15,,,,
CATH TRNSLUM ANG LA1,C1885,HCPCS,,,,,both,, ,7172.15,4303.29,Medicaid,Illinois Medicaid,,,,,7172.15,,,,
CATH TRNSLUM ANG LA2,C1885,HCPCS,,,,,both,, ,9563.04,5737.82,Medicaid,Illinois Medicaid,,,,,9563.04,,,,
CATHETER GUIDING 1,C1887,HCPCS,,,,,both,, ,358.7,215.22,Medicaid,Illinois Medicaid,,,,,358.7,,,,
CATHETER GUIDING 2,C1887,HCPCS,,,,,both,, ,1195.32,717.19,Medicaid,Illinois Medicaid,,,,,1195.32,,,,
CATHETER GUIDING 3,C1887,HCPCS,,,,,both,, ,1912.71,1147.62,Medicaid,Illinois Medicaid,,,,,1912.71,,,,
CATH ABLTN NOCRD ED1,C1888,HCPCS,,,,,both,, ,896.62,537.97,Medicaid,Illinois Medicaid,,,,,896.62,,,,
CATH ABLTN NOCRD ED2,C1888,HCPCS,,,,,both,, ,1195.32,717.19,Medicaid,Illinois Medicaid,,,,,1195.32,,,,
EAR TUBES DRAINAGE 1,C1889,HCPCS,,,,,both,, ,113.04,67.82,Medicaid,Illinois Medicaid,,,,,113.04,,,,
TISSUE EXP NONBREAST,C1889,HCPCS,,,,,both,, ,570.11,342.06,Medicaid,Illinois Medicaid,,,,,570.11,,,,
INF PMP NON-PROG LV1,C1891,HCPCS,,,,,both,, ,10237.17,6142.3,Medicaid,Illinois Medicaid,,,,,10237.17,,,,
PEEL-AWAY SHEATH 1,C1892,HCPCS,,,,,both,, ,179.22,107.53,Medicaid,Illinois Medicaid,,,,,179.22,,,,
PEEL-AWAY SHEATH 2,C1892,HCPCS,,,,,both,, ,478.18,286.9,Medicaid,Illinois Medicaid,,,,,478.18,,,,
PEEL-AWAY SHEATH 3,C1892,HCPCS,,,,,both,, ,1434.53,860.71,Medicaid,Illinois Medicaid,,,,,1434.53,,,,
INT SHTH FIX NO-PL 1,C1893,HCPCS,,,,,both,, ,611.31,366.78,Medicaid,Illinois Medicaid,,,,,611.31,,,,
INT SHTH FIX NO-PL 2,C1893,HCPCS,,,,,both,, ,3048.29,1828.97,Medicaid,Illinois Medicaid,,,,,3048.29,,,,
SHEATH NON-LASR 1,C1894,HCPCS,,,,,both,, ,717.14,430.28,Medicaid,Illinois Medicaid,,,,,717.14,,,,
SHEATH NON-LASR 2,C1894,HCPCS,,,,,both,, ,1434.53,860.71,Medicaid,Illinois Medicaid,,,,,1434.53,,,,
SHEATH NON-LASR 3,C1894,HCPCS,,,,,both,, ,2390.63,1434.37,Medicaid,Illinois Medicaid,,,,,2390.63,,,,
SHEATH NON-LASR 4,C1894,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,,,,4781.52,,,,
SHEATH NON-LASR 5,C1894,HCPCS,,,,,both,, ,7172.15,4303.29,Medicaid,Illinois Medicaid,,,,,7172.15,,,,
SHEATH NON-LASR 6,C1894,HCPCS,,,,,both,, ,9563.04,5737.82,Medicaid,Illinois Medicaid,,,,,9563.04,,,,
SHEATH NON-LASR 7,C1894,HCPCS,,,,,both,, ,14344.55,8606.73,Medicaid,Illinois Medicaid,,,,,14344.55,,,,
SHEATH NON-LASR 8,C1894,HCPCS,,,,,both,, ,19126.07,11475.64,Medicaid,Illinois Medicaid,,,,,19126.07,,,,
LEAD AICD END DUL L1,C1895,HCPCS,,,,,both,, ,76277.94,45766.76,Medicaid,Illinois Medicaid,,,,,76277.94,,,,
LEAD AICD END DUL L2,C1895,HCPCS,,,,,both,, ,16735.18,10041.1,Medicaid,Illinois Medicaid,,,,,16735.18,,,,
LEAD AICD NO-SING L1,C1896,HCPCS,,,,,both,, ,16206.54,9723.92,Medicaid,Illinois Medicaid,,,,,16206.54,,,,
LEAD NEUROSTM TST K1,C1897,HCPCS,,,,,both,, ,3586.2,2151.72,Medicaid,Illinois Medicaid,,,,,3586.2,,,,
LEAD NEUROSTM TST K2,C1897,HCPCS,,,,,both,, ,6646.33,3987.79,Medicaid,Illinois Medicaid,,,,,6646.33,,,,
LEAD PMKR NON-TRN L1,C1898,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,,,,4781.52,,,,
LEAD PMKR/AICD CMBL1,C1899,HCPCS,,,,,both,, ,41218.03,24730.81,Medicaid,Illinois Medicaid,,,,,41218.03,,,,
LEAD LT VENT COR LV1,C1900,HCPCS,,,,,both,, ,20278.38,12167.02,Medicaid,Illinois Medicaid,,,,,20278.38,,,,
SEALANT PULMNRY LIQD,C2615,HCPCS,,,,,both,, ,5932.54,3559.52,Medicaid,Illinois Medicaid,,,,,5932.54,,,,
STNT NONCOR TM W/O 1,C2617,HCPCS,,,,,both,, ,2963.83,1778.29,Medicaid,Illinois Medicaid,,,,,2963.83,,,,
PROBE CRYOABLATION 1,C2618,HCPCS,,,,,both,, ,3586.2,2151.72,Medicaid,Illinois Medicaid,,,,,3586.2,,,,
PROBE CRYOABLATION 2,C2618,HCPCS,,,,,both,, ,4781.52,2868.91,Medicaid,Illinois Medicaid,,,,,4781.52,,,,
PROBE CRYOABLATION 3,C2618,HCPCS,,,,,both,, ,9563.04,5737.82,Medicaid,Illinois Medicaid,,,,,9563.04,,,,
PROBE CRYOABLATION 4,C2618,HCPCS,,,,,both,, ,16735.18,10041.1,Medicaid,Illinois Medicaid,,,,,16735.18,,,,
PMKR DUL NON RAT LV1,C2619,HCPCS,,,,,both,, ,73166.31,43899.78,Medicaid,Illinois Medicaid,,,,,73166.31,,,,
PMKR SNGL NON RTE-RE,C2620,HCPCS,,,,,both,, ,45918.17,27550.9,Medicaid,Illinois Medicaid,,,,,45918.17,,,,
PMKR OTHR TH SNGL L1,C2621,HCPCS,,,,,both,, ,99999,59999.4,Medicaid,Illinois Medicaid,,,,,99999,,,,
PRSTHS PENILE NNINF1,C2622,HCPCS,,,,,both,, ,38894.09,23336.45,Medicaid,Illinois Medicaid,,,,,38894.09,,,,
WIRELESS PRESS SENS,C2624,HCPCS,,,,,both,, ,99999,59999.4,Medicaid,Illinois Medicaid,,,,,99999,,,,
STNT NON-COR TM DL 1,C2625,HCPCS,,,,,both,, ,541.52,324.91,Medicaid,Illinois Medicaid,,,,,541.52,,,,
STNT NON-COR TM DL 2,C2625,HCPCS,,,,,both,, ,722.03,433.21,Medicaid,Illinois Medicaid,,,,,722.03,,,,
STNT NON-COR TM DL 3,C2625,HCPCS,,,,,both,, ,3787.83,2272.69,Medicaid,Illinois Medicaid,,,,,3787.83,,,,
INF PMP NON-PROG LV1,C2626,HCPCS,,,,,both,, ,545.13,327.07,Medicaid,Illinois Medicaid,,,,,545.13,,,,
CATH SUPRPUBC-CYSTO1,C2627,HCPCS,,,,,both,, ,172.01,103.2,Medicaid,Illinois Medicaid,,,,,172.01,,,,
CATH SUPRPUBC-CYSTO2,C2627,HCPCS,,,,,both,, ,1075.84,645.5,Medicaid,Illinois Medicaid,,,,,1075.84,,,,
CATH OCCLUSION 1,C2628,HCPCS,,,,,both,, ,717.14,430.28,Medicaid,Illinois Medicaid,,,,,717.14,,,,
CATH OCCLUSION 2,C2628,HCPCS,,,,,both,, ,1434.53,860.71,Medicaid,Illinois Medicaid,,,,,1434.53,,,,
CATH OCCLUSION 3,C2628,HCPCS,,,,,both,, ,2390.63,1434.37,Medicaid,Illinois Medicaid,,,,,2390.63,,,,
INTRO/SHEATH LASER 1,C2629,HCPCS,,,,,both,, ,5379.18,3227.5,Medicaid,Illinois Medicaid,,,,,5379.18,,,,
INTRO/SHEATH LASER 2,C2629,HCPCS,,,,,both,, ,7172.15,4303.29,Medicaid,Illinois Medicaid,,,,,7172.15,,,,
REP DEV URNRY WO SL1,C2631,HCPCS,,,,,both,, ,8266.27,4959.76,Medicaid,Illinois Medicaid,,,,,8266.27,,,,
LC S SUB T/A/L 25S,C5271,HCPCS,,,,,both,, ,2393.6,1436.16,Medicaid,Illinois Medicaid,,,,,2393.6,,,,
LC S SUB T/A/L ADL,C5272,HCPCS,,,,,both,, ,2393.6,1436.16,Medicaid,Illinois Medicaid,,,,,2393.6,,,,
LC S SUB T/A/L 100SQ,C5273,HCPCS,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
LC S SUB T/A/L ADL,C5274,HCPCS,,,,,both,, ,6950.12,4170.07,Medicaid,Illinois Medicaid,,,,,6950.12,,,,
LC S SUB F/NK/HF/G,C5275,HCPCS,,,,,both,, ,2393.6,1436.16,Medicaid,Illinois Medicaid,,,,,2393.6,,,,
LC S SUB F/NK/HF/G EA,C5276,HCPCS,,,,,both,, ,2393.6,1436.16,Medicaid,Illinois Medicaid,,,,,2393.6,,,,
LC S SUB F/NK/HF/G 100SQ,C5277,HCPCS,,,,,both,, ,2393.6,1436.16,Medicaid,Illinois Medicaid,,,,,2393.6,,,,
LC S SUB F/NK/HF/G EA,C5278,HCPCS,,,,,both,, ,2393.6,1436.16,Medicaid,Illinois Medicaid,,,,,2393.6,,,,
MRA-ABDOMEN W,C8900,HCPCS,,,,,both,, ,1035.69,621.41,Medicaid,Illinois Medicaid,,,,,1035.69,,,,
MRA-ABDOMEN W,C8900,HCPCS,,,,,both,, ,1114.55,668.73,Medicaid,Illinois Medicaid,,,,,1114.55,,,,
MRA-ABDOMEN WO,C8901,HCPCS,,,,,both,, ,715.99,429.59,Medicaid,Illinois Medicaid,,,,,715.99,,,,
MRA-ABDOMEN WO,C8901,HCPCS,,,,,both,, ,770.45,462.27,Medicaid,Illinois Medicaid,,,,,770.45,,,,
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,,,,1197.08,,,,
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,,,,1288.29,,,,
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,2669.78,1601.86,Medicaid,Illinois Medicaid,,,,,2669.78,,,,
MR-BREAST UNI WWO,C8905,HCPCS,,,,,both,, ,3114.65,1868.79,Medicaid,Illinois Medicaid,,,,,3114.65,,,,
MR-BREAST BI WWO,C8908,HCPCS,,,,,both,, ,3115.2,1869.12,Medicaid,Illinois Medicaid,,,,,3115.2,,,,
MRA-LW EXTR WWO,C8914,HCPCS,,,,,both,, ,1197.08,718.24,Medicaid,Illinois Medicaid,,,,,1197.08,,,,
MRA-LW EXTR WWO,C8914,HCPCS,,,,,both,, ,1288.29,772.97,Medicaid,Illinois Medicaid,,,,,1288.29,,,,
MRA-LW EXTR WWO BI,C8914,HCPCS,,,,,both,, ,2394.15,1436.49,Medicaid,Illinois Medicaid,,,,,2394.15,,,,
MRA-LW EXTR WWO BI,C8914,CPT,,,,,both,, ,2576.6,1545.96,Medicaid,Illinois Medicaid,,,,,2576.6,,,,
BR-CAD MRI LESION,C8937,HCPCS,,,,,both,, ,50.52,30.31,Medicaid,Illinois Medicaid,,,,,50.52,,,,
COCAINE HCL NASL 1MG,C9046,HCPCS,,,,,both,4,ML,8,4.8,Medicaid,Illinois Medicaid,,,,,8,,,,
IDARUCIZU 2.5GM/50ML,C9399,HCPCS,,,,,both,50,ML,10077.78,6046.66,Medicaid,Illinois Medicaid,,,,,10077.78,,,,
REMDESIV 5MG/ML 20ML,C9399,HCPCS,,,,,both,, ,2878.85,1727.31,Medicaid,Illinois Medicaid,,,,,2878.85,,,,
IC-PRQ DE COR STNT,C9600,CPT,,,,,both,, ,42411.02,25446.61,Medicaid,Illinois Medicaid,,,,,42411.02,,,,
IC-PRQ DE CR REV CAB,C9604,CPT,,,,,both,, ,29428.39,17657.03,Medicaid,Illinois Medicaid,,,,,29428.39,,,,
ADMIN FLU VACCINE,G0008,HCPCS,,,,,both,, ,106.25,63.75,Medicaid,Illinois Medicaid,,,,,106.25,,,,
ADMIN FLU VACCINE,G0008,HCPCS,,,,,both,, ,106.25,63.75,Medicaid,Illinois Medicaid,,,,,106.25,,,,
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,70.81,42.48,Medicaid,Illinois Medicaid,,,,,70.81,,,,
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,70.81,42.48,Medicaid,Illinois Medicaid,,,,,70.81,,,,
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,109.18,65.5,Medicaid,Illinois Medicaid,,,,,109.18,,,,
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,143.69,86.21,Medicaid,Illinois Medicaid,,,,,143.69,,,,
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,184.63,110.77,Medicaid,Illinois Medicaid,,,,,184.63,,,,
ADMIN PNEU VACCINE,G0009,HCPCS,,,,,both,, ,106.25,63.75,Medicaid,Illinois Medicaid,,,,,106.25,,,,
ADMIN PNEU VACCINE,G0009,HCPCS,,,,,both,, ,106.25,63.75,Medicaid,Illinois Medicaid,,,,,106.25,,,,
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,109.18,65.5,Medicaid,Illinois Medicaid,,,,,109.18,,,,
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,143.69,86.21,Medicaid,Illinois Medicaid,,,,,143.69,,,,
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,184.63,110.77,Medicaid,Illinois Medicaid,,,,,184.63,,,,
HEP B VACCINE ADMIN,G0010,HCPCS,,,,,both,, ,106.25,63.75,Medicaid,Illinois Medicaid,,,,,106.25,,,,
HEP B VACCINE ADMIN,G0010,HCPCS,,,,,both,, ,106.25,63.75,Medicaid,Illinois Medicaid,,,,,106.25,,,,
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,105.06,63.03,Medicaid,Illinois Medicaid,,,,,105.06,,,,
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,109.44,65.66,Medicaid,Illinois Medicaid,,,,,109.44,,,,
PSA SCRN TO LABCORP,G0103,HCPCS,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
PSA SCRN TO LABCORP,G0103,HCPCS,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
"PSA, SCREENING",G0103,HCPCS,,,,,both,, ,135.85,81.51,Medicaid,Illinois Medicaid,,,,,135.85,,,,
"PSA, SCREENING",G0103,HCPCS,,,,,both,,,1036.25,1036.25,Medicaid,Illinois Medicaid,,35.49,,,1036.25,1036.25,1036.25,Fee Schedule,
DSMT INDIVIDUAL 30M,G0108,HCPCS,,,,,both,, ,261.62,156.97,Medicaid,Illinois Medicaid,,,,,261.62,,,,
PAP THINLAY LIQ SCRN,G0123,HCPCS,,,,,both,, ,195.06,117.03,Medicaid,Illinois Medicaid,,,,,195.06,,,,
STRNGTH TRN SLG 15MI,G0237,HCPCS,,,,,both,, ,177.16,106.29,Medicaid,Illinois Medicaid,,,,,177.16,,,,
RESP FX TRN SGL 15MN,G0238,HCPCS,,,,,both,, ,177.16,106.29,Medicaid,Illinois Medicaid,,,,,177.16,,,,
RESP FX TRAIN GROUP,G0239,HCPCS,,,,,both,, ,177.16,106.29,Medicaid,Illinois Medicaid,,,,,177.16,,,,
DIALYSIS  EMERGENT,G0257,HCPCS,,,,,both,, ,9908.34,5945,Medicaid,Illinois Medicaid,,,,,9908.34,,,,
IR-ARTHROGRAM SI JTS,G0260,HCPCS,,,,,both,, ,2101.41,1260.84,Medicaid,Illinois Medicaid,,,,,2101.41,,,,
CC-PLACE CLOS DEV,G0269,HCPCS,,,,,both,, ,22097.11,13258.26,Medicaid,Illinois Medicaid,,,,,22097.11,,,,
HBO FB 30MN,G0277,HCPCS,,,,,both,, ,265.23,159.13,Medicaid,Illinois Medicaid,,,,,265.23,,,,
BR-TOMO MAMMO BI,G0279,HCPCS,,,,,both,,,160.68,160.68,Medicaid,Illinois Medicaid,50,44.59,,,160.68,160.68,160.68,Fee Schedule,
BR-TOMO MAMMO BI,G0279,HCPCS,,,,,both,, ,160.68,96.4,Medicaid,Illinois Medicaid,,,,,160.68,,,,
BR-TOMO MAMMO UNI,G0279,HCPCS,,,,,both,,,133.9,133.9,Medicaid,Illinois Medicaid,,44.59,,,133.9,133.9,133.9,Fee Schedule,
BR-TOMO MAMMO UNI,G0279,HCPCS,,,,,both,, ,133.9,80.34,Medicaid,Illinois Medicaid,,,,,133.9,,,,
ELEC STIM-UNATTND-VI,G0283,HCPCS,,,,,both,, ,443.37,266.02,Medicaid,Illinois Medicaid,,,,,443.37,,,,
ELEC STIM-UNATTND-VI,G0283,HCPCS,,,,,both,, ,480.68,288.4,Medicaid,Illinois Medicaid,,,,,480.68,,,,
ELEC STM-UNATVI COTA,G0283,HCPCS,,,,,both,, ,515,309,Medicaid,Illinois Medicaid,,,,,515,,,,
ELEC STM-UNATVI COTA,G0283,HCPCS,,,,,both,, ,515,309,Medicaid,Illinois Medicaid,,,,,515,,,,
ELEC STM-UNAT-VI PTA,G0283,HCPCS,,,,,both,, ,37.08,22.24,Medicaid,Illinois Medicaid,,,,,37.08,,,,
ELEC STM-UNAT-VI PTA,G0283,HCPCS,,,,,both,, ,37.08,22.24,Medicaid,Illinois Medicaid,,,,,37.08,,,,
ELEC STM-UNAT-VI PTA,G0283,HCPCS,,,,,both,, ,37.08,22.24,Medicaid,Illinois Medicaid,,,,,37.08,,,,
ELEC STM-UNAT-VI PTA,G0283,HCPCS,,,,,both,, ,37.08,22.24,Medicaid,Illinois Medicaid,,,,,37.08,,,,
ELEC STM-UNAT-VI PTA,G0283,HCPCS,,,,,both,, ,474.83,284.89,Medicaid,Illinois Medicaid,,,,,474.83,,,,
ELEC STM-UNAT-VI PTA,G0283,HCPCS,,,,,both,, ,474.83,284.89,Medicaid,Illinois Medicaid,,,,,474.83,,,,
SCR FECAL OC BLD 1-3,G0328,HCPCS,,,,,both,, ,159.42,95.65,Medicaid,Illinois Medicaid,,,,,159.42,,,,
L&D OBSERV 1ST HOUR,G0378,CPT,,,,,both,, ,1189.39,713.63,Medicaid,Illinois Medicaid,,,,,1189.39,,,,
L&D OBSERV 1ST HOUR,G0378,CPT,,,,,both,, ,1189.39,713.63,Medicaid,Illinois Medicaid,,,,,1189.39,,,,
L&D OBSERV ADDL HOUR,G0378,CPT,,,,,both,, ,151.15,90.69,Medicaid,Illinois Medicaid,,,,,151.15,,,,
L&D OBSERV ADDL HOUR,G0378,CPT,,,,,both,, ,151.15,90.69,Medicaid,Illinois Medicaid,,,,,151.15,,,,
OBSRVATION ADDL HOUR,G0378,HCPCS,,,,,both,, ,141.21,84.72,Medicaid,Illinois Medicaid,,,,,141.21,,,,
DIRECT ADMIT TO OBS,G0379,HCPCS,,,,,both,, ,610.15,366.09,Medicaid,Illinois Medicaid,,,,,610.15,,,,
L&D DIRECT ADMIT OBS,G0379,HCPCS,,,,,both,, ,653.54,392.12,Medicaid,Illinois Medicaid,,,,,653.54,,,,
L&D DIRECT ADMIT OBS,G0379,HCPCS,,,,,both,, ,653.54,392.12,Medicaid,Illinois Medicaid,,,,,653.54,,,,
HOME SLEEP TYPE 3,G0399,HCPCS,,,,,both,, ,428.48,257.08,Medicaid,Illinois Medicaid,,,,,428.48,,,,
HOME SLEEP TYPE 3,G0399,HCPCS,,,,,both,, ,428.48,257.08,Medicaid,Illinois Medicaid,,,,,428.48,,,,
PROSTATE NDL BX ANY,G0416,HCPCS,,,,,both,, ,1059.54,635.72,Medicaid,Illinois Medicaid,,,,,1059.54,,,,
HIV-1 AB EIA,G0432,HCPCS,,,,,both,, ,113.39,68.03,Medicaid,Illinois Medicaid,,,,,113.39,,,,
HIV1 AG HIV1 HIV2 AB,G0433,CPT,,,,,both,, ,165.59,99.35,Medicaid,Illinois Medicaid,,,,,165.59,,,,
HIV1-HIV2 AB SNG RES,G0435,CPT,,,,,both,, ,42.66,25.59,Medicaid,Illinois Medicaid,,,,,42.66,,,,
HIV1-HIV2 AB SNG RES,G0435,CPT,,,,,both,, ,1036.25,621.75,Medicaid,Illinois Medicaid,,,,,1036.25,,,,
EVAL & MGMT LEVEL 3,G0463,HCPCS,,,,,both,, ,215.75,129.45,Medicaid,Illinois Medicaid,,,,,215.75,,,,
EVAL & MGMT LEVEL 5,G0463,HCPCS,,,,,both,, ,261,156.6,Medicaid,Illinois Medicaid,,,,,261,,,,
HOSPITAL OUTPT VISIT,G0463,HCPCS,,,,,both,, ,520,312,Medicaid,Illinois Medicaid,,,,,520,,,,
LEVEL 1 EP,G0463,HCPCS,,,,,both,, ,249.52,149.71,Medicaid,Illinois Medicaid,,,,,249.52,,,,
LEVEL 2 EP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Medicaid,Illinois Medicaid,,,,,188.75,,,,
LEVEL 2 NP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Medicaid,Illinois Medicaid,,,,,188.75,,,,
LEVEL 3 NP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Medicaid,Illinois Medicaid,,,,,188.75,,,,
LEVEL 5 EP,G0463,HCPCS,,,,,both,, ,425.91,255.54,Medicaid,Illinois Medicaid,,,,,425.91,,,,
LEVEL 5 NP,G0463,HCPCS,,,,,both,, ,324.19,194.51,Medicaid,Illinois Medicaid,,,,,324.19,,,,
LEVEL 5 NP,G0463,HCPCS,,,,,both,, ,324.19,194.51,Medicaid,Illinois Medicaid,,,,,324.19,,,,
OB TRIAGE LVL 1 EP,G0463,HCPCS,,,,,both,, ,700.4,420.24,Medicaid,Illinois Medicaid,,,,,700.4,,,,
PAT EVAL/MGM LEVEL 2,G0463,HCPCS,,,,,both,, ,325.25,195.15,Medicaid,Illinois Medicaid,,,,,325.25,,,,
PAT EVAL/MGM LEVEL 3,G0463,HCPCS,,,,,both,, ,379.5,227.7,Medicaid,Illinois Medicaid,,,,,379.5,,,,
PAT EVAL/MGM LEVEL 4,G0463,HCPCS,,,,,both,, ,433.5,260.1,Medicaid,Illinois Medicaid,,,,,433.5,,,,
PAT EVAL/MGM LEVEL 5,G0463,HCPCS,,,,,both,, ,487.5,292.5,Medicaid,Illinois Medicaid,,,,,487.5,,,,
PHYSICAL-EMPLOYMENT,G0463,HCPCS,,,,,both,, ,55.62,33.37,Medicaid,Illinois Medicaid,,,,,55.62,,,,
PHYSICAL-EMPLOYMENT,G0463,HCPCS,,,,,both,, ,55.62,33.37,Medicaid,Illinois Medicaid,,,,,55.62,,,,
PHYSICAL-SCHOOL,G0463,HCPCS,,,,,both,, ,66.95,40.17,Medicaid,Illinois Medicaid,,,,,66.95,,,,
PHYSICAL-SCHOOL,G0463,HCPCS,,,,,both,, ,66.95,40.17,Medicaid,Illinois Medicaid,,,,,66.95,,,,
PSYCH CLINIC TYPE A,G0463,HCPCS,,,,,both,, ,294.25,176.55,Medicaid,Illinois Medicaid,,,,,294.25,,,,
SUTURE REMOVAL,G0463,HCPCS,,,,,both,, ,132.61,79.56,Medicaid,Illinois Medicaid,,,,,132.61,,,,
SUTURE REMOVAL,G0463,HCPCS,,,,,both,, ,132.61,79.56,Medicaid,Illinois Medicaid,,,,,132.61,,,,
URG CARE L1 EP PROF,G0463,HCPCS,,,,,both,, ,60.5,36.3,Medicaid,Illinois Medicaid,,,,,60.5,,,,
URG CARE L2 EP PROF,G0463,HCPCS,,,,,both,, ,123.25,73.95,Medicaid,Illinois Medicaid,,,,,123.25,,,,
URG CARE L2 EP PROF,G0463,HCPCS,,,,,both,, ,123.25,73.95,Medicaid,Illinois Medicaid,,,,,123.25,,,,
URG CARE L2 NP PROF,G0463,HCPCS,,,,,both,, ,213,127.8,Medicaid,Illinois Medicaid,,,,,213,,,,
URG CARE L3 EP PROF,G0463,HCPCS,,,,,both,, ,209.75,125.85,Medicaid,Illinois Medicaid,,,,,209.75,,,,
URG CARE L3 NP PROF,G0463,HCPCS,,,,,both,, ,312.5,187.5,Medicaid,Illinois Medicaid,,,,,312.5,,,,
URG CARE L4 EP PROF,G0463,HCPCS,,,,,both,, ,309.25,185.55,Medicaid,Illinois Medicaid,,,,,309.25,,,,
URG CARE L4 NP PROF,G0463,HCPCS,,,,,both,, ,483.5,290.1,Medicaid,Illinois Medicaid,,,,,483.5,,,,
URG CARE L5 EP PROF,G0463,HCPCS,,,,,both,, ,414.25,248.55,Medicaid,Illinois Medicaid,,,,,414.25,,,,
URG CARE L5 NP PROF,G0463,HCPCS,,,,,both,, ,602.5,361.5,Medicaid,Illinois Medicaid,,,,,602.5,,,,
URGENT CARE LVL 2 EP,G0463,HCPCS,,,,,both,, ,251.84,151.1,Medicaid,Illinois Medicaid,,,,,251.84,,,,
URGENT CARE LVL 2 EP,G0463,HCPCS,,,,,both,, ,251.84,151.1,Medicaid,Illinois Medicaid,,,,,251.84,,,,
URGENT CARE LVL 2 EP,G0463,HCPCS,,,,,both,, ,251.84,151.1,Medicaid,Illinois Medicaid,,,,,251.84,,,,
URGENT CARE LVL 2 EP,G0463,HCPCS,,,,,both,, ,251.84,151.1,Medicaid,Illinois Medicaid,,,,,251.84,,,,
URGENT CARE LVL 2 NP,G0463,HCPCS,,,,,both,, ,234.07,140.44,Medicaid,Illinois Medicaid,,,,,234.07,,,,
URGENT CARE LVL 2 NP,G0463,HCPCS,,,,,both,, ,234.07,140.44,Medicaid,Illinois Medicaid,,,,,234.07,,,,
URGENT CARE LVL 3 EP,G0463,HCPCS,,,,,both,, ,281.71,169.02,Medicaid,Illinois Medicaid,,,,,281.71,,,,
URGENT CARE LVL 3 EP,G0463,HCPCS,,,,,both,, ,281.71,169.02,Medicaid,Illinois Medicaid,,,,,281.71,,,,
URGENT CARE LVL 3 NP,G0463,HCPCS,,,,,both,, ,261.88,157.12,Medicaid,Illinois Medicaid,,,,,261.88,,,,
URGENT CARE LVL 3 NP,G0463,HCPCS,,,,,both,, ,261.88,157.12,Medicaid,Illinois Medicaid,,,,,261.88,,,,
URGENT CARE LVL 4 EP,G0463,HCPCS,,,,,both,, ,311.83,187.09,Medicaid,Illinois Medicaid,,,,,311.83,,,,
URGENT CARE LVL 4 EP,G0463,HCPCS,,,,,both,, ,311.83,187.09,Medicaid,Illinois Medicaid,,,,,311.83,,,,
URGENT CARE LVL 4 NP,G0463,HCPCS,,,,,both,, ,289.69,173.81,Medicaid,Illinois Medicaid,,,,,289.69,,,,
URGENT CARE LVL 4 NP,G0463,HCPCS,,,,,both,, ,289.69,173.81,Medicaid,Illinois Medicaid,,,,,289.69,,,,
URGENT CARE LVL 5 NP,G0463,HCPCS,,,,,both,, ,317.5,190.5,Medicaid,Illinois Medicaid,,,,,317.5,,,,
URGENT CARE LVL 5 NP,G0463,HCPCS,,,,,both,, ,317.5,190.5,Medicaid,Illinois Medicaid,,,,,317.5,,,,
URGENT CARE LVL 5 NP,G0463,HCPCS,,,,,both,, ,317.5,190.5,Medicaid,Illinois Medicaid,,,,,317.5,,,,
URGENT CARE LVL 5 NP,G0463,HCPCS,,,,,both,, ,317.5,190.5,Medicaid,Illinois Medicaid,,,,,317.5,,,,
URGENT CARE- SUT REM,G0463,HCPCS,,,,,both,, ,239.73,143.83,Medicaid,Illinois Medicaid,,,,,239.73,,,,
URGENT CARE- SUT REM,G0463,HCPCS,,,,,both,, ,239.73,143.83,Medicaid,Illinois Medicaid,,,,,239.73,,,,
URGENT CARE- SUT REM,G0463,HCPCS,,,,,both,, ,239.73,143.83,Medicaid,Illinois Medicaid,,,,,239.73,,,,
URGENT CARE- SUT REM,G0463,HCPCS,,,,,both,, ,239.73,143.83,Medicaid,Illinois Medicaid,,,,,239.73,,,,
EVAL & MGMT LEVEL 4,G0463,HCPCS,,,,,Outpatient,, ,237.25,142.35,Medicaid,Illinois Medicaid,,,,,237.25,,,,
"New patient office of other outpatient visit, typically 60 min",G0463,HCPCS,,,,,Outpatient,,,317.5,317.5,Medicaid,Illinois Medicaid,,123.49,,,317.5,317.5,317.5,Fee Schedule,
"New patient office of other outpatient visit, typically 45 min",G0463,HCPCS,,,,,Outpatient,,,289.69,289.69,Medicaid,Illinois Medicaid,,90.81,,,289.69,289.69,289.69,Fee Schedule,
"New patient office or other outpatient visit, typically 30 min",G0463,HCPCS,,,,,Outpatient,,,261.88,261.88,Medicaid,Illinois Medicaid,,55.95,,,261.88,261.88,261.88,Fee Schedule,
HIV1 AG W HIV 1 2 AB,G0475,HCPCS,,,,,both,, ,166.16,99.69,Medicaid,Illinois Medicaid,,,,,166.16,,,,
HEPB SCR HI RSK NPRG,G0499,HCPCS,,,,,both,, ,570.04,342.02,Medicaid,Illinois Medicaid,,,,,570.04,,,,
ABCIXIMAB 10MG,J0130,HCPCS,,,,,both,, ,4719.72,2831.83,Medicaid,Illinois Medicaid,,,,,4719.72,,,,
ACETAMINO 10MG INJ,J0131,HCPCS,,,,,both,100,ML,3,1.8,Medicaid,Illinois Medicaid,,,,,3,,,,
ACTYLCYSTN INJ 100MG,J0132,HCPCS,,,,,both,30,ML,17.77,10.66,Medicaid,Illinois Medicaid,,,,,17.77,,,,
ACYCLOVIR 5MG INJ,J0133,HCPCS,,,,,both,, ,0.31,0.18,Medicaid,Illinois Medicaid,,,,,0.31,,,,
ACYCLOVIR 5MG INJ,J0133,HCPCS,,,,,both,10,ML,1.03,0.61,Medicaid,Illinois Medicaid,,,,,1.03,,,,
ADENOSINE 1MG INJ,J0153,HCPCS,,,,,both,4,ML,15.45,9.27,Medicaid,Illinois Medicaid,,,,,15.45,,,,
ADENOSINE 1MG INJ,J0153,HCPCS,,,,,both,4,ML,15.45,9.27,Medicaid,Illinois Medicaid,,,,,15.45,,,,
ADRENL/EPINEP 0.1MG,J0171,HCPCS,,,,,both,1,ML,2.68,1.6,Medicaid,Illinois Medicaid,,,,,2.68,,,,
ADRENL/EPINEP 0.1MG,J0171,HCPCS,,,,,both,10,ML,8.65,5.19,Medicaid,Illinois Medicaid,,,,,8.65,,,,
EPINEPHRINE INJ 30MG/30ML (1 MG/ML),J0171,HCPCS,,,,,both,30,ML,4,2.4,Medicaid,Illinois Medicaid,,,,,4,,,,
REMDESIVIR 1MG INJ,J0248,HCPCS,,,,,both,1,EA,28,16.8,Medicaid,Illinois Medicaid,,,,,28,,,,
AMKCN SULF INJ 100MG,J0278,HCPCS,,,,,both,2,ML,5.56,3.33,Medicaid,Illinois Medicaid,,,,,5.56,,,,
AMINOPHYLL 250MG INJ,J0280,HCPCS,,,,,both,20,ML,58.97,35.38,Medicaid,Illinois Medicaid,,,,,58.97,,,,
AMINOPHYLL 250MG INJ,J0280,HCPCS,,,,,both,10,ML,96.31,57.78,Medicaid,Illinois Medicaid,,,,,96.31,,,,
AMIODARONE 30MG INJ,J0282,HCPCS,,,,,both,18,ML,5.15,3.09,Medicaid,Illinois Medicaid,,,,,5.15,,,,
AMIODARONE 30MG INJ,J0282,HCPCS,,,,,both,3,ML,6.39,3.83,Medicaid,Illinois Medicaid,,,,,6.39,,,,
AMPHOTER B 50MG INJ,J0285,HCPCS,,,,,both,, ,321.36,192.81,Medicaid,Illinois Medicaid,,,,,321.36,,,,
AMPHOTER B LIPO 10MG,J0289,HCPCS,,,,,both,1,EA,211.15,126.69,Medicaid,Illinois Medicaid,,,,,211.15,,,,
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,17,10.2,Medicaid,Illinois Medicaid,,,,,17,,,,
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,26.78,16.06,Medicaid,Illinois Medicaid,,,,,26.78,,,,
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,26.78,16.06,Medicaid,Illinois Medicaid,,,,,26.78,,,,
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,57.94,34.76,Medicaid,Illinois Medicaid,,,,,57.94,,,,
AMPICILLIN/SUB 1.5GM,J0295,HCPCS,,,,,both,1,EA,23.69,14.21,Medicaid,Illinois Medicaid,,,,,23.69,,,,
AMPICILLIN/SUB 1.5GM,J0295,HCPCS,,,,,both,, ,63.09,37.85,Medicaid,Illinois Medicaid,,,,,63.09,,,,
SUCCINYLCHN 20MG INJ,J0330,HCPCS,,,,,both,10,ML,13,7.8,Medicaid,Illinois Medicaid,,,,,13,,,,
SUCCINYLCHN 20MG INJ,J0330,HCPCS,,,,,both,, ,20.34,12.2,Medicaid,Illinois Medicaid,,,,,20.34,,,,
HYDRALAZINE 20MG INJ,J0360,HCPCS,,,,,both,1,ML,101.71,61.02,Medicaid,Illinois Medicaid,,,,,101.71,,,,
AZITHROMYC 500MG INJ,J0456,HCPCS,,,,,both,1,EA,40.69,24.41,Medicaid,Illinois Medicaid,,,,,40.69,,,,
ATROPINE 0.01 MG INJ,J0461,HCPCS,,,,,both,1,ML,2,1.2,Medicaid,Illinois Medicaid,,,,,2,,,,
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,, ,0.03,0.01,Medicaid,Illinois Medicaid,,,,,0.03,,,,
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,, ,0.62,0.37,Medicaid,Illinois Medicaid,,,,,0.62,,,,
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,10,ML,1.03,0.61,Medicaid,Illinois Medicaid,,,,,1.03,,,,
DIMERCAPRO 100MG INJ,J0470,HCPCS,,,,,both,, ,198.28,118.96,Medicaid,Illinois Medicaid,,,,,198.28,,,,
DICYCLOMINE 20MG INJ,J0500,HCPCS,,,,,both,2,ML,307.46,184.47,Medicaid,Illinois Medicaid,,,,,307.46,,,,
BENZTROPN MES 1MGINJ,J0515,HCPCS,,,,,both,2,ML,263.42,158.05,Medicaid,Illinois Medicaid,,,,,263.42,,,,
PCN G BENZ/PROC 100K,J0558,HCPCS,,,,,both,, ,34.25,20.55,Medicaid,Illinois Medicaid,,,,,34.25,,,,
PCN G BENZ/PROC 100K,J0558,HCPCS,,,,,both,, ,35.54,21.32,Medicaid,Illinois Medicaid,,,,,35.54,,,,
PEN G BENZ INJ 100K,J0561,HCPCS,,,,,both,2,ML,43,25.8,Medicaid,Illinois Medicaid,,,,,43,,,,
BIVALIRUDIN 1MG INJ,J0583,HCPCS,,,,,both,1,EA,18.28,10.96,Medicaid,Illinois Medicaid,,,,,18.28,,,,
BOTULINUM TOXI A 1U,J0585,HCPCS,,,,,both,1,EA,33.48,20.08,Medicaid,Illinois Medicaid,,,,,33.48,,,,
BUTORPHANOL 1MG INJ,J0595,HCPCS,,,,,both,1,ML,17.77,10.66,Medicaid,Illinois Medicaid,,,,,17.77,,,,
CINACALC 1MG PO ESRD,J0604,HCPCS,,,,,both,, ,6.18,3.7,Medicaid,Illinois Medicaid,,,,,6.18,,,,
CALCITRIOL .1MCG INJ,J0636,HCPCS,,,,,both,, ,4.33,2.59,Medicaid,Illinois Medicaid,,,,,4.33,,,,
LEUCOVORIN 50MG INJ,J0640,HCPCS,,,,,both,1,EA,84.46,50.67,Medicaid,Illinois Medicaid,,,,,84.46,,,,
MEPIVACAINE 10ML INJ,J0670,HCPCS,,,,,both,30,ML,19.31,11.58,Medicaid,Illinois Medicaid,,,,,19.31,,,,
MEPIVACAINE 10ML INJ,J0670,HCPCS,,,,,both,20,ML,21.89,13.13,Medicaid,Illinois Medicaid,,,,,21.89,,,,
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,12.88,7.72,Medicaid,Illinois Medicaid,,,,,12.88,,,,
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,12.88,7.72,Medicaid,Illinois Medicaid,,,,,12.88,,,,
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,, ,14.94,8.96,Medicaid,Illinois Medicaid,,,,,14.94,,,,
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,, ,14.94,8.96,Medicaid,Illinois Medicaid,,,,,14.94,,,,
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,22.4,13.44,Medicaid,Illinois Medicaid,,,,,22.4,,,,
CEFEPIME 500 MG INJ,J0692,CPT,,,,,both,1,EA,9,5.4,Medicaid,Illinois Medicaid,,,,,9,,,,
CEFEPIME 500MG INJ,J0692,HCPCS,,,,,both,, ,19.06,11.43,Medicaid,Illinois Medicaid,,,,,19.06,,,,
CEFEPIME 500MG INJ,J0692,HCPCS,,,,,both,1,EA,24.72,14.83,Medicaid,Illinois Medicaid,,,,,24.72,,,,
CEFOXITIN 1GM INJ,J0694,HCPCS,,,,,both,1,EA,53.82,32.29,Medicaid,Illinois Medicaid,,,,,53.82,,,,
CEFTO50-TAZO25MG INJ,J0695,HCPCS,,,,,both,1,EA,28.84,17.3,Medicaid,Illinois Medicaid,,,,,28.84,,,,
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,8.03,4.81,Medicaid,Illinois Medicaid,,,,,8.03,,,,
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,11.59,6.95,Medicaid,Illinois Medicaid,,,,,11.59,,,,
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,12.88,7.72,Medicaid,Illinois Medicaid,,,,,12.88,,,,
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,24.72,14.83,Medicaid,Illinois Medicaid,,,,,24.72,,,,
CEFUROXIME 750MG INJ,J0697,HCPCS,,,,,both,, ,23.69,14.21,Medicaid,Illinois Medicaid,,,,,23.69,,,,
CEFUROXIME 750MG INJ,J0697,HCPCS,,,,,both,, ,45.06,27.03,Medicaid,Illinois Medicaid,,,,,45.06,,,,
BETAM ACE/SOD PHO3MG,J0702,HCPCS,,,,,both,5,ML,56.14,33.68,Medicaid,Illinois Medicaid,,,,,56.14,,,,
CEFTAROLIN 10MG INJ,J0712,HCPCS,,,,,both,, ,16.48,9.88,Medicaid,Illinois Medicaid,,,,,16.48,,,,
CEFTAROLIN 10MG INJ,J0712,HCPCS,,,,,both,, ,24.72,14.83,Medicaid,Illinois Medicaid,,,,,24.72,,,,
COLISTIME UP TO 150M,J0770,CPT,,,,,both,1,EA,236.64,141.98,Medicaid,Illinois Medicaid,,,,,236.64,,,,
PROCHLORPE UPTO 10MG,J0780,HCPCS,,,,,both,, ,39.66,23.79,Medicaid,Illinois Medicaid,,,,,39.66,,,,
COSYNTROPN .25MG INJ,J0834,HCPCS,,,,,both,1,EA,687.78,412.66,Medicaid,Illinois Medicaid,,,,,687.78,,,,
DALBAVANCIN 5MG INJ,J0875,HCPCS,,,,,both,, ,85.75,51.45,Medicaid,Illinois Medicaid,,,,,85.75,,,,
DAPTOMYCIN 1 MG INJ,J0878,HCPCS,,,,,both,1,EA,3.5,2.1,Medicaid,Illinois Medicaid,,,,,3.5,,,,
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,38.88,23.32,Medicaid,Illinois Medicaid,,,,,38.88,,,,
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,38.88,23.32,Medicaid,Illinois Medicaid,,,,,38.88,,,,
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Medicaid,Illinois Medicaid,,,,,42.75,,,,
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Medicaid,Illinois Medicaid,,,,,42.75,,,,
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Medicaid,Illinois Medicaid,,,,,42.75,,,,
ARGATROBAN 1MG NESRD,J0883,HCPCS,,,,,both,2.5,ML,18.8,11.28,Medicaid,Illinois Medicaid,,,,,18.8,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,111.5,66.9,Medicaid,Illinois Medicaid,,,,,111.5,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,111.5,66.9,Medicaid,Illinois Medicaid,,,,,111.5,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,124.37,74.62,Medicaid,Illinois Medicaid,,,,,124.37,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Medicaid,Illinois Medicaid,,,,,162.74,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Medicaid,Illinois Medicaid,,,,,162.74,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Medicaid,Illinois Medicaid,,,,,162.74,,,,
DEFEROXAMIN 500MGINJ,J0895,HCPCS,,,,,both,1,EA,66.44,39.86,Medicaid,Illinois Medicaid,,,,,66.44,,,,
DEFEROXAMIN 500MGINJ,J0895,HCPCS,,,,,both,, ,132.87,79.72,Medicaid,Illinois Medicaid,,,,,132.87,,,,
DENOSUMAB 1MG INJ,J0897,HCPCS,,,,,both,1,ML,96.31,57.78,Medicaid,Illinois Medicaid,,,,,96.31,,,,
MEDROXYPROG 1MG INJ,J1050,HCPCS,,,,,both,1,ML,4.43,2.65,Medicaid,Illinois Medicaid,,,,,4.43,,,,
TESTOSTER CYPION 1MG,J1071,HCPCS,,,,,both,, ,0.93,0.55,Medicaid,Illinois Medicaid,,,,,0.93,,,,
TESTOSTER CYPION 1MG,J1071,HCPCS,,,,,both,, ,593.28,355.96,Medicaid,Illinois Medicaid,,,,,593.28,,,,
DEXAMETH NA 1MG INJ,J1100,HCPCS,,,,,both,1,ML,6.39,3.83,Medicaid,Illinois Medicaid,,,,,6.39,,,,
ACETAZOLAMI 500MGINJ,J1120,HCPCS,,,,,both,1,EA,308.49,185.09,Medicaid,Illinois Medicaid,,,,,308.49,,,,
DIGOXIN 0.5MG INJ,J1160,HCPCS,,,,,both,2,ML,47.12,28.27,Medicaid,Illinois Medicaid,,,,,47.12,,,,
DIGOXIN IMMUNE FAB,J1162,HCPCS,,,,,both,1,EA,6881.43,4128.85,Medicaid,Illinois Medicaid,,,,,6881.43,,,,
PHENYTOIN NA 50MGINJ,J1165,HCPCS,,,,,both,5,ML,5.36,3.21,Medicaid,Illinois Medicaid,,,,,5.36,,,,
PHENYTOIN NA 50MGINJ,J1165,HCPCS,,,,,both,2,ML,12.88,7.72,Medicaid,Illinois Medicaid,,,,,12.88,,,,
DEXRAZOXANE 25OMG IJ,J1190,HCPCS,,,,,both,, ,1352.91,811.74,Medicaid,Illinois Medicaid,,,,,1352.91,,,,
DIPHENHYDRAM 50MGINJ,J1200,HCPCS,,,,,both,1,ML,13.91,8.34,Medicaid,Illinois Medicaid,,,,,13.91,,,,
DIPYRIDAMOLE 10MGINJ,J1245,HCPCS,,,,,both,, ,26.78,16.06,Medicaid,Illinois Medicaid,,,,,26.78,,,,
DOBUTAMINE 250MG INJ,J1250,HCPCS,,,,,both,20,ML,28.84,17.3,Medicaid,Illinois Medicaid,,,,,28.84,,,,
DOBUTAMINE 250MG INJ,J1250,HCPCS,,,,,both,250,ML,78.28,46.96,Medicaid,Illinois Medicaid,,,,,78.28,,,,
DOPAMIN HCL 40MG INJ,J1265,HCPCS,,,,,both,250,ML,8.55,5.13,Medicaid,Illinois Medicaid,,,,,8.55,,,,
EPTIFABITIDE 5MG IJ,J1327,HCPCS,,,,,both,, ,164.8,98.88,Medicaid,Illinois Medicaid,,,,,164.8,,,,
ERTAPENEM SOD/500MG,J1335,HCPCS,,,,,both,1,EA,298.96,179.37,Medicaid,Illinois Medicaid,,,,,298.96,,,,
ERYTHROMYC 500MG INJ,J1364,HCPCS,,,,,both,1,EA,196.99,118.19,Medicaid,Illinois Medicaid,,,,,196.99,,,,
ESTROGEN CNJ 25MGINJ,J1410,HCPCS,,,,,both,, ,1016.61,609.96,Medicaid,Illinois Medicaid,,,,,1016.61,,,,
FER CARBOXYM 1MG INJ,J1439,HCPCS,,,,,both,15,ML,7,4.2,Medicaid,Illinois Medicaid,,,,,7,,,,
TBO-FILGRASTIM 1MCG,J1447,HCPCS,,,,,both,0.8,ML,4.53,2.71,Medicaid,Illinois Medicaid,,,,,4.53,,,,
TBO-FILGRASTIM 1MCG,J1447,HCPCS,,,,,both,0.8,ML,4.53,2.71,Medicaid,Illinois Medicaid,,,,,4.53,,,,
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,200,ML,32.19,19.31,Medicaid,Illinois Medicaid,,,,,32.19,,,,
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,50,ML,84.72,50.83,Medicaid,Illinois Medicaid,,,,,84.72,,,,
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,100,ML,144.72,86.83,Medicaid,Illinois Medicaid,,,,,144.72,,,,
"FOMEPIZOLE, 15 MG",J1451,HCPCS,,,,,both,1.5,ML,43.52,26.11,Medicaid,Illinois Medicaid,,,,,43.52,,,,
FOSAPREPITANT 1MG IJ,J1453,HCPCS,,,,,both,1,EA,10.82,6.49,Medicaid,Illinois Medicaid,,,,,10.82,,,,
IVIG (PRIVIGEN)500MG,J1459,HCPCS,,,,,both,200,ML,390.89,234.53,Medicaid,Illinois Medicaid,,,,,390.89,,,,
IVIG (PRIVIGEN)500MG,J1459,HCPCS,,,,,both,200,ML,390.89,234.53,Medicaid,Illinois Medicaid,,,,,390.89,,,,
IMMU GLOB LYO 500MG,J1566,HCPCS,,,,,both,, ,270.89,162.53,Medicaid,Illinois Medicaid,,,,,270.89,,,,
IMMU GLOB LYO 500MG,J1566,HCPCS,,,,,both,, ,270.89,162.53,Medicaid,Illinois Medicaid,,,,,270.89,,,,
IVIG (OCTAGAM) 500MG,J1568,HCPCS,,,,,both,100,ML,319.82,191.89,Medicaid,Illinois Medicaid,,,,,319.82,,,,
IVIG (OCTAGAM) 500MG,J1568,HCPCS,,,,,both,100,ML,319.82,191.89,Medicaid,Illinois Medicaid,,,,,319.82,,,,
GANCICLOVI SOD 500MG,J1570,HCPCS,,,,,both,1,EA,615.94,369.56,Medicaid,Illinois Medicaid,,,,,615.94,,,,
IVIG (FLEBOGAM)500MG,J1572,HCPCS,,,,,both,200,ML,256.99,154.19,Medicaid,Illinois Medicaid,,,,,256.99,,,,
IVIG (FLEBOGAM)500MG,J1572,HCPCS,,,,,both,200,ML,256.99,154.19,Medicaid,Illinois Medicaid,,,,,256.99,,,,
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,2,ML,24.72,14.83,Medicaid,Illinois Medicaid,,,,,24.72,,,,
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,, ,27.81,16.68,Medicaid,Illinois Medicaid,,,,,27.81,,,,
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,2,ML,28.84,17.3,Medicaid,Illinois Medicaid,,,,,28.84,,,,
GLUCAGON 1MG INJ,J1610,HCPCS,,,,,both,, ,710.19,426.11,Medicaid,Illinois Medicaid,,,,,710.19,,,,
GLUCAGON 1MG INJ,J1610,HCPCS,,,,,both,1,EA,1505,903,Medicaid,Illinois Medicaid,,,,,1505,,,,
HALOPERIDOL 5MG INJ,J1630,HCPCS,,,,,both,1,ML,68.5,41.1,Medicaid,Illinois Medicaid,,,,,68.5,,,,
HALOPER DEC 50MGINJ,J1631,HCPCS,,,,,both,1,ML,183.08,109.84,Medicaid,Illinois Medicaid,,,,,183.08,,,,
HALOPER DEC 50MGINJ,J1631,HCPCS,,,,,both,1,ML,217.33,130.39,Medicaid,Illinois Medicaid,,,,,217.33,,,,
HEPARIN NA 10U FLUSH,J1642,HCPCS,,,,,both,5,ML,0.52,0.31,Medicaid,Illinois Medicaid,,,,,0.52,,,,
HEPARIN NA 10U FLUSH,J1642,HCPCS,,,,,both,3,ML,0.93,0.55,Medicaid,Illinois Medicaid,,,,,0.93,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,2.16,1.29,Medicaid,Illinois Medicaid,,,,,2.16,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,5.67,3.4,Medicaid,Illinois Medicaid,,,,,5.67,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,6.39,3.83,Medicaid,Illinois Medicaid,,,,,6.39,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,19.57,11.74,Medicaid,Illinois Medicaid,,,,,19.57,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,500,ML,27.81,16.68,Medicaid,Illinois Medicaid,,,,,27.81,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,28.84,17.3,Medicaid,Illinois Medicaid,,,,,28.84,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,41.72,25.03,Medicaid,Illinois Medicaid,,,,,41.72,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,250,ML,76,45.6,Medicaid,Illinois Medicaid,,,,,76,,,,
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.4,ML,57.17,34.3,Medicaid,Illinois Medicaid,,,,,57.17,,,,
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.3,ML,57.17,34.3,Medicaid,Illinois Medicaid,,,,,57.17,,,,
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,1,ML,57.17,34.3,Medicaid,Illinois Medicaid,,,,,57.17,,,,
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.8,ML,57.17,34.3,Medicaid,Illinois Medicaid,,,,,57.17,,,,
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.6,ML,57.17,34.3,Medicaid,Illinois Medicaid,,,,,57.17,,,,
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,38.37,23.02,Medicaid,Illinois Medicaid,,,,,38.37,,,,
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,51.24,30.74,Medicaid,Illinois Medicaid,,,,,51.24,,,,
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,76.74,46.04,Medicaid,Illinois Medicaid,,,,,76.74,,,,
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,85.49,51.29,Medicaid,Illinois Medicaid,,,,,85.49,,,,
TETANUS IG HUM 250U,J1670,HCPCS,,,,,both,1,ML,1976.31,1185.78,Medicaid,Illinois Medicaid,,,,,1976.31,,,,
HYDROCORTIS 100MGINJ,J1720,HCPCS,,,,,both,1,EA,48.15,28.89,Medicaid,Illinois Medicaid,,,,,48.15,,,,
MELOXICAM 1MG INJ,J1738,HCPCS,,,,,both,1,ML,566,339.6,Medicaid,Illinois Medicaid,,,,,566,,,,
IBUTILIDE 1MG INJ,J1742,HCPCS,,,,,both,, ,1612.21,967.32,Medicaid,Illinois Medicaid,,,,,1612.21,,,,
INFLIXIMAB 10 MG INJ,J1745,HCPCS,,,,,both,1,EA,560.84,336.5,Medicaid,Illinois Medicaid,,,,,560.84,,,,
IRON DEX165 INJ 50MG,J1750,HCPCS,,,,,both,, ,132.87,79.72,Medicaid,Illinois Medicaid,,,,,132.87,,,,
IRON SUCROSE 1MG INJ,J1756,HCPCS,,,,,both,, ,4.22,2.53,Medicaid,Illinois Medicaid,,,,,4.22,,,,
DROPERIDOL UP TO 5MG,J1790,HCPCS,,,,,both,2,ML,27.81,16.68,Medicaid,Illinois Medicaid,,,,,27.81,,,,
INSULIN 1 UNT INJ,J1815,CPT,,,,,both,10,ML,1,0.6,Medicaid,Illinois Medicaid,,,,,1,,,,
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,, ,6.39,3.83,Medicaid,Illinois Medicaid,,,,,6.39,,,,
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,1,ML,12.88,7.72,Medicaid,Illinois Medicaid,,,,,12.88,,,,
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,1,ML,25.75,15.45,Medicaid,Illinois Medicaid,,,,,25.75,,,,
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,10,ML,5.67,3.4,Medicaid,Illinois Medicaid,,,,,5.67,,,,
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,4,ML,12.88,7.72,Medicaid,Illinois Medicaid,,,,,12.88,,,,
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,2,ML,25.75,15.45,Medicaid,Illinois Medicaid,,,,,25.75,,,,
LUPR 3.75FEMALE/PEDS,J1950,HCPCS,,,,,both,1,EA,6029.88,3617.92,Medicaid,Illinois Medicaid,,,,,6029.88,,,,
LEVETIRACET 10MG INJ,J1953,HCPCS,,,,,both,5,ML,1.18,0.7,Medicaid,Illinois Medicaid,,,,,1.18,,,,
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,100,ML,58.45,35.07,Medicaid,Illinois Medicaid,,,,,58.45,,,,
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,150,ML,68.24,40.94,Medicaid,Illinois Medicaid,,,,,68.24,,,,
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,50,ML,78.28,46.96,Medicaid,Illinois Medicaid,,,,,78.28,,,,
LINEZOLID 200 MG,J2020,HCPCS,,,,,both,300,ML,225.31,135.18,Medicaid,Illinois Medicaid,,,,,225.31,,,,
LINEZOLID 200 MG,J2020,HCPCS,,,,,both,, ,258.79,155.27,Medicaid,Illinois Medicaid,,,,,258.79,,,,
LORAZEPAM 2MG INJ,J2060,HCPCS,,,,,both,1,ML,19.57,11.74,Medicaid,Illinois Medicaid,,,,,19.57,,,,
LORAZEPAM INJ 2MG/ML 10 ML MDV,J2060,HCPCS,,,,,both,, ,15.14,9.08,Medicaid,Illinois Medicaid,,,,,15.14,,,,
MANNITOL 25% 50MLINJ,J2150,HCPCS,,,,,both,50,ML,24.72,14.83,Medicaid,Illinois Medicaid,,,,,24.72,,,,
MEPERID HCL 100MGINJ,J2175,HCPCS,,,,,both,1,ML,16.48,9.88,Medicaid,Illinois Medicaid,,,,,16.48,,,,
MEROPENEMBR 100MGINJ,J2184,HCPCS,,,,,both,, ,18.28,10.96,Medicaid,Illinois Medicaid,,,,,18.28,,,,
MEROPENEM 100MG INJ,J2185,HCPCS,,,,,both,1,EA,8.96,5.37,Medicaid,Illinois Medicaid,,,,,8.96,,,,
MEROPENEM 100MG INJ,J2185,HCPCS,,,,,both,1,EA,8.96,5.37,Medicaid,Illinois Medicaid,,,,,8.96,,,,
METHYLERGONV .2MGINJ,J2210,HCPCS,,,,,both,1,ML,47.12,28.27,Medicaid,Illinois Medicaid,,,,,47.12,,,,
METHYLNALTR .1MG INJ,J2212,HCPCS,,,,,both,, ,4.33,2.59,Medicaid,Illinois Medicaid,,,,,4.33,,,,
MICAFUNGIN 1MG INJ,J2248,HCPCS,,,,,both,1,EA,11.59,6.95,Medicaid,Illinois Medicaid,,,,,11.59,,,,
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,10,ML,1.03,0.61,Medicaid,Illinois Medicaid,,,,,1.03,,,,
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,5,ML,3.09,1.85,Medicaid,Illinois Medicaid,,,,,3.09,,,,
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,2,ML,7,4.2,Medicaid,Illinois Medicaid,,,,,7,,,,
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,, ,8.34,5,Medicaid,Illinois Medicaid,,,,,8.34,,,,
MIDAZOL HCL WG 1MG,J2251,HCPCS,,,,,both,50,ML,3.25,1.95,Medicaid,Illinois Medicaid,,,,,3.25,,,,
MILRINONE 5MG INJ,J2260,HCPCS,,,,,both,100,ML,32.19,19.31,Medicaid,Illinois Medicaid,,,,,32.19,,,,
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,1.03,0.61,Medicaid,Illinois Medicaid,,,,,1.03,,,,
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,5.15,3.09,Medicaid,Illinois Medicaid,,,,,5.15,,,,
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Medicaid,Illinois Medicaid,,,,,14.94,,,,
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Medicaid,Illinois Medicaid,,,,,14.94,,,,
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Medicaid,Illinois Medicaid,,,,,14.94,,,,
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,14.75,8.85,Medicaid,Illinois Medicaid,,,,,14.75,,,,
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,14.94,8.96,Medicaid,Illinois Medicaid,,,,,14.94,,,,
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,16,9.6,Medicaid,Illinois Medicaid,,,,,16,,,,
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,, ,86.78,52.06,Medicaid,Illinois Medicaid,,,,,86.78,,,,
NALBUPHINE 10MG INJ,J2300,HCPCS,,,,,both,1,ML,25.75,15.45,Medicaid,Illinois Medicaid,,,,,25.75,,,,
NALOXONE HCL 1MG INJ,J2310,HCPCS,,,,,both,1,ML,133.9,80.34,Medicaid,Illinois Medicaid,,,,,133.9,,,,
NALOXONE HCL 1MG INJ,J2310,HCPCS,,,,,both,2,ML,139.31,83.58,Medicaid,Illinois Medicaid,,,,,139.31,,,,
OCRELIZUMAB 1MG INJ,J2350,HCPCS,,,,,both,10,ML,133.9,80.34,Medicaid,Illinois Medicaid,,,,,133.9,,,,
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,1,ML,21.37,12.82,Medicaid,Illinois Medicaid,,,,,21.37,,,,
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,1,ML,42.23,25.33,Medicaid,Illinois Medicaid,,,,,42.23,,,,
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,, ,280.16,168.09,Medicaid,Illinois Medicaid,,,,,280.16,,,,
ORPHENADR UP TO 60MG,J2360,HCPCS,,,,,both,2,ML,156.3,93.78,Medicaid,Illinois Medicaid,,,,,156.3,,,,
CHLOROPR HCL INJ 1MG,J2401,HCPCS,,,,,both,20,ML,0.3,0.18,Medicaid,Illinois Medicaid,,,,,0.3,,,,
ONDANSETRON 1MG INJ,J2405,HCPCS,,,,,both,2,ML,42.23,25.33,Medicaid,Illinois Medicaid,,,,,42.23,,,,
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.75,ML,42.23,25.33,Medicaid,Illinois Medicaid,,,,,42.23,,,,
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,1,ML,58.97,35.38,Medicaid,Illinois Medicaid,,,,,58.97,,,,
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,1.5,ML,58.97,35.38,Medicaid,Illinois Medicaid,,,,,58.97,,,,
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.25,ML,58.97,35.38,Medicaid,Illinois Medicaid,,,,,58.97,,,,
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.5,ML,61.03,36.61,Medicaid,Illinois Medicaid,,,,,61.03,,,,
PAMIDRONATE 30MG IJ,J2430,HCPCS,,,,,both,10,ML,193.64,116.18,Medicaid,Illinois Medicaid,,,,,193.64,,,,
PAMIDRONATE 30MG IJ,J2430,HCPCS,,,,,both,, ,1208.71,725.22,Medicaid,Illinois Medicaid,,,,,1208.71,,,,
PAPAVERINE UPTO 60MG,J2440,HCPCS,,,,,both,, ,302.05,181.23,Medicaid,Illinois Medicaid,,,,,302.05,,,,
PALONOSETRON 25MCG,J2469,HCPCS,,,,,both,, ,250.55,150.33,Medicaid,Illinois Medicaid,,,,,250.55,,,,
PANTOPRAZOLE SOD VL,J2470,HCPCS,,,,,both,1,EA,41.72,25.03,Medicaid,Illinois Medicaid,,,,,41.72,,,,
PARICALCITOL 1MCGINJ,J2501,HCPCS,,,,,both,1,ML,25.75,15.45,Medicaid,Illinois Medicaid,,,,,25.75,,,,
PENICI G POT .6MUINJ,J2540,HCPCS,,,,,both,, ,11.33,6.79,Medicaid,Illinois Medicaid,,,,,11.33,,,,
PENICI G POT .6MUINJ,J2540,HCPCS,,,,,both,1,EA,11.59,6.95,Medicaid,Illinois Medicaid,,,,,11.59,,,,
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,41.97,25.18,Medicaid,Illinois Medicaid,,,,,41.97,,,,
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,44.55,26.73,Medicaid,Illinois Medicaid,,,,,44.55,,,,
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,48.15,28.89,Medicaid,Illinois Medicaid,,,,,48.15,,,,
PROMETHAZI UPTO 50MG,J2550,HCPCS,,,,,both,1,ML,24.72,14.83,Medicaid,Illinois Medicaid,,,,,24.72,,,,
PHENOBARB 120MG INJ,J2560,HCPCS,,,,,both,1,ML,167.89,100.73,Medicaid,Illinois Medicaid,,,,,167.89,,,,
PHENOBARB 120MG INJ,J2560,HCPCS,,,,,both,, ,232.78,139.66,Medicaid,Illinois Medicaid,,,,,232.78,,,,
OXYTOCIN UP TO 10UN,J2590,HCPCS,,,,,both,1,ML,27.81,16.68,Medicaid,Illinois Medicaid,,,,,27.81,,,,
DESMOPRESSIN 1MCGINJ,J2597,HCPCS,,,,,both,1,ML,13.91,8.34,Medicaid,Illinois Medicaid,,,,,13.91,,,,
FLUPHENZI UP TO 25MG,J2680,HCPCS,,,,,both,5,ML,139.05,83.43,Medicaid,Illinois Medicaid,,,,,139.05,,,,
PROCAINAMID UPTO 1GM,J2690,HCPCS,,,,,both,2,ML,95.79,57.47,Medicaid,Illinois Medicaid,,,,,95.79,,,,
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,20,ML,1.44,0.86,Medicaid,Illinois Medicaid,,,,,1.44,,,,
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,100,ML,2.68,1.6,Medicaid,Illinois Medicaid,,,,,2.68,,,,
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,100,ML,2.68,1.6,Medicaid,Illinois Medicaid,,,,,2.68,,,,
NEOSTIGMINE .5MG INJ,J2710,HCPCS,,,,,both,10,ML,13.91,8.34,Medicaid,Illinois Medicaid,,,,,13.91,,,,
NEOSTIGMINE .5MG INJ,J2710,HCPCS,,,,,both,5,ML,19.57,11.74,Medicaid,Illinois Medicaid,,,,,19.57,,,,
PROTAMINE 10MG INJ,J2720,HCPCS,,,,,both,5,ML,12.88,7.72,Medicaid,Illinois Medicaid,,,,,12.88,,,,
PHENTOLAMINE 5MG INJ,J2760,HCPCS,,,,,both,1,EA,968.46,581.07,Medicaid,Illinois Medicaid,,,,,968.46,,,,
METOCLOPRAM 10MG INJ,J2765,HCPCS,,,,,both,2,ML,24.72,14.83,Medicaid,Illinois Medicaid,,,,,24.72,,,,
REGADENOSON 0.1MG IJ,J2785,HCPCS,,,,,both,5,ML,335.01,201,Medicaid,Illinois Medicaid,,,,,335.01,,,,
RHOPHYLAC 100UNT,J2791,HCPCS,,,,,both,2,ML,62.83,37.69,Medicaid,Illinois Medicaid,,,,,62.83,,,,
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,28.33,16.99,Medicaid,Illinois Medicaid,,,,,28.33,,,,
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,34.25,20.55,Medicaid,Illinois Medicaid,,,,,34.25,,,,
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,37.08,22.24,Medicaid,Illinois Medicaid,,,,,37.08,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,20,ML,1.03,0.61,Medicaid,Illinois Medicaid,,,,,1.03,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,30,ML,1.03,0.61,Medicaid,Illinois Medicaid,,,,,1.03,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,20,ML,1.03,0.61,Medicaid,Illinois Medicaid,,,,,1.03,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,, ,1.65,0.99,Medicaid,Illinois Medicaid,,,,,1.65,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,100,ML,1.96,1.17,Medicaid,Illinois Medicaid,,,,,1.96,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,10,ML,2.16,1.29,Medicaid,Illinois Medicaid,,,,,2.16,,,,
SINCALIDE INJ 5MCG,J2805,HCPCS,,,,,both,1,EA,670.53,402.31,Medicaid,Illinois Medicaid,,,,,670.53,,,,
SOD FERRIC 12.5MGINJ,J2916,HCPCS,,,,,both,5,ML,53.56,32.13,Medicaid,Illinois Medicaid,,,,,53.56,,,,
RETEPLASE 18.1MG IJ,J2993,HCPCS,,,,,both,, ,7366,4419.6,Medicaid,Illinois Medicaid,,,,,7366,,,,
ALTEPLASE RECOM 1MG,J2997,HCPCS,,,,,both,1,EA,347.11,208.26,Medicaid,Illinois Medicaid,,,,,347.11,,,,
ALTEPLASE RECOM 1MG,J2997,HCPCS,,,,,both,1,EA,353.55,212.13,Medicaid,Illinois Medicaid,,,,,353.55,,,,
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,5,ML,6.59,3.95,Medicaid,Illinois Medicaid,,,,,6.59,,,,
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,2,ML,14.42,8.65,Medicaid,Illinois Medicaid,,,,,14.42,,,,
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,1,ML,17.25,10.35,Medicaid,Illinois Medicaid,,,,,17.25,,,,
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,100,ML,20.25,12.15,Medicaid,Illinois Medicaid,,,,,20.25,,,,
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,20,ML,49.44,29.66,Medicaid,Illinois Medicaid,,,,,49.44,,,,
SUMATRIPTAN 6MG INJ,J3030,HCPCS,,,,,both,0.5,ML,631.91,379.14,Medicaid,Illinois Medicaid,,,,,631.91,,,,
TENECTEPLASE 1MG INJ,J3101,HCPCS,,,,,both,1,EA,402.47,241.48,Medicaid,Illinois Medicaid,,,,,402.47,,,,
TERBUTALINE 1MG INJ,J3105,HCPCS,,,,,both,1,ML,28.84,17.3,Medicaid,Illinois Medicaid,,,,,28.84,,,,
CHLORPROM UP TO 50MG,J3230,HCPCS,,,,,both,, ,161.71,97.02,Medicaid,Illinois Medicaid,,,,,161.71,,,,
CHLORPROM UP TO 50MG,J3230,HCPCS,,,,,both,2,ML,185.4,111.24,Medicaid,Illinois Medicaid,,,,,185.4,,,,
TIGECYCLINE 1 MG INJ,J3243,HCPCS,,,,,both,, ,11.33,6.79,Medicaid,Illinois Medicaid,,,,,11.33,,,,
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,250,ML,60,36,Medicaid,Illinois Medicaid,,,,,60,,,,
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,100,ML,75.71,45.42,Medicaid,Illinois Medicaid,,,,,75.71,,,,
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,15,ML,91.16,54.69,Medicaid,Illinois Medicaid,,,,,91.16,,,,
TRIMETHOBEN 200MGINJ,J3250,HCPCS,,,,,both,, ,26.78,16.06,Medicaid,Illinois Medicaid,,,,,26.78,,,,
TOBRAMYCIN UPTO 80MG,J3260,HCPCS,,,,,both,1,EA,71.84,43.1,Medicaid,Illinois Medicaid,,,,,71.84,,,,
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,20,ML,28.58,17.14,Medicaid,Illinois Medicaid,,,,,28.58,,,,
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,10,ML,28.58,17.14,Medicaid,Illinois Medicaid,,,,,28.58,,,,
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,4,ML,28.58,17.14,Medicaid,Illinois Medicaid,,,,,28.58,,,,
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,, ,18.28,10.96,Medicaid,Illinois Medicaid,,,,,18.28,,,,
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,, ,18.28,10.96,Medicaid,Illinois Medicaid,,,,,18.28,,,,
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,, ,18.54,11.12,Medicaid,Illinois Medicaid,,,,,18.54,,,,
DIAZEPAM 5MG INJ,J3360,HCPCS,,,,,both,2,ML,100.94,60.56,Medicaid,Illinois Medicaid,,,,,100.94,,,,
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,1,EA,58.97,35.38,Medicaid,Illinois Medicaid,,,,,58.97,,,,
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,1,EA,58.97,35.38,Medicaid,Illinois Medicaid,,,,,58.97,,,,
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,, ,62.32,37.39,Medicaid,Illinois Medicaid,,,,,62.32,,,,
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,300,ML,60,36,Medicaid,Illinois Medicaid,,,,,60,,,,
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,350,ML,68,40.8,Medicaid,Illinois Medicaid,,,,,68,,,,
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,250,ML,75,45,Medicaid,Illinois Medicaid,,,,,75,,,,
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,150,ML,95,57,Medicaid,Illinois Medicaid,,,,,95,,,,
VEDOLIZUMAB 1MG INJ,J3380,HCPCS,,,,,both,1,EA,96.31,57.78,Medicaid,Illinois Medicaid,,,,,96.31,,,,
HYDROXYZI UP TO 25MG,J3410,HCPCS,,,,,both,, ,13.91,8.34,Medicaid,Illinois Medicaid,,,,,13.91,,,,
THIAMINE 100MG INJ,J3411,HCPCS,,,,,both,2,ML,44.03,26.41,Medicaid,Illinois Medicaid,,,,,44.03,,,,
PYRIDOXINE 100MG INJ,J3415,HCPCS,,,,,both,1,ML,79.31,47.58,Medicaid,Illinois Medicaid,,,,,79.31,,,,
VIT B12 CYAN 1000MCG,J3420,HCPCS,,,,,both,1,ML,84.72,50.83,Medicaid,Illinois Medicaid,,,,,84.72,,,,
PHYTONADIONE 1MG INJ,J3430,HCPCS,,,,,both,0.5,ML,27.81,16.68,Medicaid,Illinois Medicaid,,,,,27.81,,,,
PHYTONADIONE 1MG INJ,J3430,HCPCS,,,,,both,1,ML,31.93,19.15,Medicaid,Illinois Medicaid,,,,,31.93,,,,
HYALURONID RECOM 1UN,J3473,HCPCS,,,,,both,1,ML,3.19,1.91,Medicaid,Illinois Medicaid,,,,,3.19,,,,
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,500,ML,1.13,0.67,Medicaid,Illinois Medicaid,,,,,1.13,,,,
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,20,ML,2.99,1.79,Medicaid,Illinois Medicaid,,,,,2.99,,,,
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,2,ML,12.88,7.72,Medicaid,Illinois Medicaid,,,,,12.88,,,,
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,, ,13.91,8.34,Medicaid,Illinois Medicaid,,,,,13.91,,,,
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,50,ML,14.94,8.96,Medicaid,Illinois Medicaid,,,,,14.94,,,,
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,100,ML,1.03,0.61,Medicaid,Illinois Medicaid,,,,,1.03,,,,
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,100,ML,1.03,0.61,Medicaid,Illinois Medicaid,,,,,1.03,,,,
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,, ,2.68,1.6,Medicaid,Illinois Medicaid,,,,,2.68,,,,
ZIDOVUDINE 10MG INJ,J3485,HCPCS,,,,,both,, ,12.36,7.41,Medicaid,Illinois Medicaid,,,,,12.36,,,,
ZIPRSIDNE MESYL 10MG,J3486,HCPCS,,,,,both,1,EA,77.77,46.66,Medicaid,Illinois Medicaid,,,,,77.77,,,,
ZOLEDRONIC ACID 1MG,J3489,HCPCS,,,,,both,100,ML,332.69,199.61,Medicaid,Illinois Medicaid,,,,,332.69,,,,
ZOLEDRONIC ACID 1MG,J3489,HCPCS,,,,,both,5,ML,1005.8,603.48,Medicaid,Illinois Medicaid,,,,,1005.8,,,,
BRIVARACETAM 50MG TB,J3490,HCPCS,,,,,both,60,EA,172.75,103.65,Medicaid,Illinois Medicaid,,,,,172.75,,,,
NORM SALIN 1000ML IV,J7030,HCPCS,,,,,both,1000,ML,25.75,15.45,Medicaid,Illinois Medicaid,,,,,25.75,,,,
NORM SAL STER500MLIV,J7040,HCPCS,,,,,both,500,ML,25.75,15.45,Medicaid,Illinois Medicaid,,,,,25.75,,,,
D5W/SOD CHL.9% 500ML,J7042,HCPCS,,,,,both,1000,ML,12.88,7.72,Medicaid,Illinois Medicaid,,,,,12.88,,,,
NORM SALINE 250ML IV,J7050,HCPCS,,,,,both,250,ML,26.78,16.06,Medicaid,Illinois Medicaid,,,,,26.78,,,,
SOD CHLOR .9% 100ML,J7050,HCPCS,,,,,both,100,ML,25.75,15.45,Medicaid,Illinois Medicaid,,,,,25.75,,,,
SOD CHLOR .9% 100ML,J7050,HCPCS,,,,,both,100,ML,68.5,41.1,Medicaid,Illinois Medicaid,,,,,68.5,,,,
SOD CHLOR .9% 150ML,J7050,HCPCS,,,,,both,150,ML,25.75,15.45,Medicaid,Illinois Medicaid,,,,,25.75,,,,
SOD CHLOR .9% 50ML,J7050,HCPCS,,,,,both,50,ML,25.75,15.45,Medicaid,Illinois Medicaid,,,,,25.75,,,,
SOD CHLOR .9% 50ML,J7050,HCPCS,,,,,both,50,ML,41.72,25.03,Medicaid,Illinois Medicaid,,,,,41.72,,,,
DEX 5%/WATER 500ML,J7060,HCPCS,,,,,both,, ,24.72,14.83,Medicaid,Illinois Medicaid,,,,,24.72,,,,
DEX 5%/WATER 500ML,J7060,HCPCS,,,,,both,500,ML,25.75,15.45,Medicaid,Illinois Medicaid,,,,,25.75,,,,
DEX 5%/WATER 1000ML,J7070,HCPCS,,,,,both,1000,ML,25.75,15.45,Medicaid,Illinois Medicaid,,,,,25.75,,,,
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,1000,ML,24.72,14.83,Medicaid,Illinois Medicaid,,,,,24.72,,,,
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,500,ML,25.75,15.45,Medicaid,Illinois Medicaid,,,,,25.75,,,,
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,, ,28.84,17.3,Medicaid,Illinois Medicaid,,,,,28.84,,,,
D5LR UP TO 1000ML,J7121,HCPCS,,,,,both,1000,ML,25.75,15.45,Medicaid,Illinois Medicaid,,,,,25.75,,,,
PROTHROMB COM 1UN IX,J7168,HCPCS,,,,,both,1,EA,12.25,7.35,Medicaid,Illinois Medicaid,,,,,12.25,,,,
PROTHROMB COM 1UN IX,J7168,CPT,,,,,both,1,EA,12.62,7.57,Medicaid,Illinois Medicaid,,,,,12.62,,,,
MOMETA SIN IMP 10MCG,J7402,HCPCS,,,,,both,, ,54.59,32.75,Medicaid,Illinois Medicaid,,,,,54.59,,,,
AZATHIOPRINE 50MG TB,J7500,HCPCS,,,,,both,100,EA,20.34,12.2,Medicaid,Illinois Medicaid,,,,,20.34,,,,
CYCLOSPORNE 100MG PO,J7502,HCPCS,,,,,both,, ,41.2,24.72,Medicaid,Illinois Medicaid,,,,,41.2,,,,
TACROLIMUS 1MG PO,J7507,HCPCS,,,,,both,100,EA,27.3,16.38,Medicaid,Illinois Medicaid,,,,,27.3,,,,
METHYLPREDNIS 4MG PO,J7509,HCPCS,,,,,both,, ,8.55,5.13,Medicaid,Illinois Medicaid,,,,,8.55,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.1,0.06,Medicaid,Illinois Medicaid,,,,,0.1,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.31,0.18,Medicaid,Illinois Medicaid,,,,,0.31,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.72,0.43,Medicaid,Illinois Medicaid,,,,,0.72,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,1.34,0.8,Medicaid,Illinois Medicaid,,,,,1.34,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,, ,7,4.2,Medicaid,Illinois Medicaid,,,,,7,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,, ,107.38,64.42,Medicaid,Illinois Medicaid,,,,,107.38,,,,
CYCLOSPORINE 25MG PO,J7515,HCPCS,,,,,both,, ,19.31,11.58,Medicaid,Illinois Medicaid,,,,,19.31,,,,
CYCLOSPOR PAREN250MG,J7516,HCPCS,,,,,both,, ,191.84,115.1,Medicaid,Illinois Medicaid,,,,,191.84,,,,
MYCOPHE MOF 250MG PO,J7517,HCPCS,,,,,both,100,EA,41.46,24.87,Medicaid,Illinois Medicaid,,,,,41.46,,,,
METHACHOL 1MGINH NEB,J7674,HCPCS,,,,,both,1,EA,4.84,2.9,Medicaid,Illinois Medicaid,,,,,4.84,,,,
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,, ,13.39,8.03,Medicaid,Illinois Medicaid,,,,,13.39,,,,
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,, ,49.18,29.5,Medicaid,Illinois Medicaid,,,,,49.18,,,,
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,100,EA,53.56,32.13,Medicaid,Illinois Medicaid,,,,,53.56,,,,
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,, ,0.52,0.31,Medicaid,Illinois Medicaid,,,,,0.52,,,,
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,100,EA,1.34,0.8,Medicaid,Illinois Medicaid,,,,,1.34,,,,
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,, ,3.5,2.1,Medicaid,Illinois Medicaid,,,,,3.5,,,,
METHOTREXATE 2.5MGPO,J8610,HCPCS,,,,,both,100,EA,20.34,12.2,Medicaid,Illinois Medicaid,,,,,20.34,,,,
LEUCOVOR CAL 25MG TB,J8999,HCPCS,,,,,both,20,EA,78.54,47.12,Medicaid,Illinois Medicaid,,,,,78.54,,,,
BENDAMUSTINE 1MG INJ,J9033,HCPCS,,,,,both,, ,147.81,88.68,Medicaid,Illinois Medicaid,,,,,147.81,,,,
BENDAMUSTINE 1MG INJ,J9033,HCPCS,,,,,both,, ,147.81,88.68,Medicaid,Illinois Medicaid,,,,,147.81,,,,
BORTEZOMIB .1MG INJ,J9041,HCPCS,,,,,both,, ,265.74,159.44,Medicaid,Illinois Medicaid,,,,,265.74,,,,
CARBOPLATIN 50MG INJ,J9045,HCPCS,,,,,both,45,ML,61.03,36.61,Medicaid,Illinois Medicaid,,,,,61.03,,,,
CISPLAT POW/SOL 10MG,J9060,HCPCS,,,,,both,50,ML,5.36,3.21,Medicaid,Illinois Medicaid,,,,,5.36,,,,
DOCETAXEL 1MG INJ,J9171,HCPCS,,,,,both,, ,87.81,52.68,Medicaid,Illinois Medicaid,,,,,87.81,,,,
FLUOROURACIL 500MG,J9190,HCPCS,,,,,both,, ,25.75,15.45,Medicaid,Illinois Medicaid,,,,,25.75,,,,
GEMCITABIN 200MG INJ,J9201,HCPCS,,,,,both,1,EA,616.97,370.18,Medicaid,Illinois Medicaid,,,,,616.97,,,,
GEMCITABIN 200MG INJ,J9201,HCPCS,,,,,both,, ,690.87,414.52,Medicaid,Illinois Medicaid,,,,,690.87,,,,
IPILIMUMAB 1MG INJ,J9228,HCPCS,,,,,both,40,ML,777.65,466.59,Medicaid,Illinois Medicaid,,,,,777.65,,,,
OXALIPLATIN .5MG INJ,J9263,HCPCS,,,,,both,10,ML,6.39,3.83,Medicaid,Illinois Medicaid,,,,,6.39,,,,
PACLITAXEL 1MG INJ,J9267,HCPCS,,,,,both,, ,3.71,2.22,Medicaid,Illinois Medicaid,,,,,3.71,,,,
PERTUZUMAB 1MG INJ,J9306,HCPCS,,,,,both,14,ML,61.03,36.61,Medicaid,Illinois Medicaid,,,,,61.03,,,,
TRASTUZUMAB 10MG INJ,J9355,HCPCS,,,,,both,, ,531.22,318.73,Medicaid,Illinois Medicaid,,,,,531.22,,,,
POST OP SHOES,L3260,HCPCS,,,,,both,, ,12,7.2,Medicaid,Illinois Medicaid,,,,,12,,,,
ADM IV INF CASI IMDV,M0243,HCPCS,,,,,both,, ,851.55,510.93,Medicaid,Illinois Medicaid,,,,,851.55,,,,
ADM IV INF CASI IMDV,M0243,HCPCS,,,,,both,, ,1340.29,804.17,Medicaid,Illinois Medicaid,,,,,1340.29,,,,
ADM IV INF BAM ETES,M0245,HCPCS,,,,,both,, ,1301.25,780.75,Medicaid,Illinois Medicaid,,,,,1301.25,,,,
ADM IV INF SOTROVIM,M0247,HCPCS,,,,,both,, ,1301.25,780.75,Medicaid,Illinois Medicaid,,,,,1301.25,,,,
"PAP SMEAR, SCREEN",P3000,HCPCS,,,,,both,, ,101.6,60.96,Medicaid,Illinois Medicaid,,,,,101.6,,,,
S-H CRYO EACH UNIT,P9012,HCPCS,,,,,both,, ,283.48,170.08,Medicaid,Illinois Medicaid,,,,,283.48,,,,
S-H RBC LEUKO REDU,P9016,HCPCS,,,,,both,, ,884.69,530.81,Medicaid,Illinois Medicaid,,,,,884.69,,,,
S-H 1 DONOR FFP,P9017,HCPCS,,,,,both,, ,638.53,383.11,Medicaid,Illinois Medicaid,,,,,638.53,,,,
S-H RED BLD-UNIT,P9021,HCPCS,,,,,both,, ,737.05,442.23,Medicaid,Illinois Medicaid,,,,,737.05,,,,
S-H PLAT PHERE L-R,P9035,HCPCS,,,,,both,, ,2646.2,1587.72,Medicaid,Illinois Medicaid,,,,,2646.2,,,,
S-H PLAT A-P L-R IRR,P9037,HCPCS,,,,,both,, ,2796.36,1677.81,Medicaid,Illinois Medicaid,,,,,2796.36,,,,
S-H RBC IRRAD,P9038,HCPCS,,,,,both,, ,1013.8,608.28,Medicaid,Illinois Medicaid,,,,,1013.8,,,,
S-H RBC L-R IRRAD,P9040,HCPCS,,,,,both,, ,1025.03,615.01,Medicaid,Illinois Medicaid,,,,,1025.03,,,,
S-H CRYOPRE REDU PLS,P9044,HCPCS,,,,,both,, ,614.12,368.47,Medicaid,Illinois Medicaid,,,,,614.12,,,,
ALBUMIN 5% 250ML IV,P9045,HCPCS,,,,,both,250,ML,528.13,316.87,Medicaid,Illinois Medicaid,,,,,528.13,,,,
ALBUMIN 25% 50ML IV,P9047,HCPCS,,,,,both,100,ML,408.14,244.88,Medicaid,Illinois Medicaid,,,,,408.14,,,,
ALBUMIN 25% 50ML IV,P9047,HCPCS,,,,,both,50,ML,623.92,374.35,Medicaid,Illinois Medicaid,,,,,623.92,,,,
S-H BLD L-R CMV- EA,P9051,HCPCS,,,,,both,, ,1025.03,615.01,Medicaid,Illinois Medicaid,,,,,1025.03,,,,
S-H FFP BTWN8-24HREA,P9059,HCPCS,,,,,both,, ,634.6,380.76,Medicaid,Illinois Medicaid,,,,,634.6,,,,
FERUMOXYTOL1MG NESRD,Q0138,HCPCS,,,,,both,17,ML,9.68,5.8,Medicaid,Illinois Medicaid,,,,,9.68,,,,
CHLORPROMAZIN 5MG PO,Q0161,HCPCS,,,,,both,1,EA,4.12,2.47,Medicaid,Illinois Medicaid,,,,,4.12,,,,
CHLORPROMAZIN 5MG PO,Q0161,HCPCS,,,,,both,, ,7.52,4.51,Medicaid,Illinois Medicaid,,,,,7.52,,,,
ONDANSETRON 1MG PO,Q0162,HCPCS,,,,,both,, ,33.73,20.23,Medicaid,Illinois Medicaid,,,,,33.73,,,,
ONDANSETRON 1MG PO,Q0162,HCPCS,,,,,both,50,ML,34.25,20.55,Medicaid,Illinois Medicaid,,,,,34.25,,,,
TELEHEALTH IP NEURO,Q3014,HCPCS,,,,,both,, ,83.25,49.95,Medicaid,Illinois Medicaid,,,,,83.25,,,,
TOTAL CONTACT CAST 3 INCH,Q4038,HCPCS,,,,,both,, ,456,273.6,Medicaid,Illinois Medicaid,,,,,456,,,,
TOTAL CONTACT CAST 4 INCH,Q4038,HCPCS,,,,,both,, ,469.68,281.8,Medicaid,Illinois Medicaid,,,,,469.68,,,,
TOTAL CONTACT CAST BOOT LARGE,Q4038,HCPCS,,,,,both,, ,307.8,184.68,Medicaid,Illinois Medicaid,,,,,307.8,,,,
TOTAL CONTACT CAST BOOT X-LARGE,Q4038,HCPCS,,,,,both,, ,323,193.8,Medicaid,Illinois Medicaid,,,,,323,,,,
OASIS WOUND MAT SQCM,Q4102,HCPCS,,,,,both,, ,10.82,6.49,Medicaid,Illinois Medicaid,,,,,10.82,,,,
INTEGRA BMWD SQ CM,Q4104,HCPCS,,,,,both,, ,599.72,359.83,Medicaid,Illinois Medicaid,,,,,599.72,,,,
INTEGRA SKIN SUB 5X5CM,Q4108,HCPCS,,,,,both,, ,4404,2642.4,Medicaid,Illinois Medicaid,,,,,4404,,,,
DERMACELL SQ CM,Q4122,HCPCS,,,,,both,, ,166.86,100.11,Medicaid,Illinois Medicaid,,,,,166.86,,,,
OASIS ULTRA TRI SQCM,Q4124,HCPCS,,,,,both,, ,31.93,19.15,Medicaid,Illinois Medicaid,,,,,31.93,,,,
ACELL DERM MAT 1SQCM,Q4126,HCPCS,,,,,both,, ,133.9,80.34,Medicaid,Illinois Medicaid,,,,,133.9,,,,
1AMNIOEXCEL SKIN 1.5X1.5CM,Q4137,HCPCS,,,,,both,, ,2544,1526.4,Medicaid,Illinois Medicaid,,,,,2544,,,,
AMNIOEXCEL SKIN 2X3CM,Q4137,HCPCS,,,,,both,, ,3469,2081.4,Medicaid,Illinois Medicaid,,,,,3469,,,,
AMNIOEXCEL SKIN 3.5X3.5CM,Q4137,HCPCS,,,,,both,, ,3745,2247,Medicaid,Illinois Medicaid,,,,,3745,,,,
AMNIOEXCEL SKIN 4X4CM,Q4137,HCPCS,,,,,both,, ,3928,2356.8,Medicaid,Illinois Medicaid,,,,,3928,,,,
ALLOWRAP DS/DRY SQCM,Q4150,HCPCS,,,,,both,, ,347.63,208.57,Medicaid,Illinois Medicaid,,,,,347.63,,,,
ALLOWRAP DS/DRY SQCM,Q4150,HCPCS,,,,,both,, ,506.25,303.75,Medicaid,Illinois Medicaid,,,,,506.25,,,,
HELICOLL (PER SQ CM),Q4164,HCPCS,,,,,both,, ,6211,3726.6,Medicaid,Illinois Medicaid,,,,,6211,,,,
EPIFIX SQ CM,Q4186,HCPCS,,,,,both,, ,570.11,342.06,Medicaid,Illinois Medicaid,,,,,570.11,,,,
MEMBRANE GRAFT/WRAP (PER SQ CM),Q4205,HCPCS,,,,,both,, ,5236,3141.6,Medicaid,Illinois Medicaid,,,,,5236,,,,
DERM-MAXX (PER SQ CM),Q4238,HCPCS,,,,,both,, ,3534,2120.4,Medicaid,Illinois Medicaid,,,,,3534,,,,
AMNIO-MAX (PER SQ CM),Q4239,HCPCS,,,,,both,, ,9540,5724,Medicaid,Illinois Medicaid,,,,,9540,,,,
INFLIXIMAB-DYYB 10MG,Q5103,HCPCS,,,,,both,1,EA,545.13,327.07,Medicaid,Illinois Medicaid,,,,,545.13,,,,
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,1,ML,70.81,42.48,Medicaid,Illinois Medicaid,,,,,70.81,,,,
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,, ,93.22,55.93,Medicaid,Illinois Medicaid,,,,,93.22,,,,
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,, ,93.22,55.93,Medicaid,Illinois Medicaid,,,,,93.22,,,,
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,1,ML,93.22,55.93,Medicaid,Illinois Medicaid,,,,,93.22,,,,
INJ PERFLUTRN LIP ML,Q9957,HCPCS,,,,,both,, ,1184.5,710.7,Medicaid,Illinois Medicaid,,,,,1184.5,,,,
HOCM2 250-299MGML ML,Q9961,HCPCS,,,,,both,, ,1.65,0.99,Medicaid,Illinois Medicaid,,,,,1.65,,,,
HOCM 350 MG ML 30ML,Q9963,HCPCS,,,,,both,30,ML,49.5,29.7,Medicaid,Illinois Medicaid,,,,,49.5,,,,
HOCM 350-399MGML IOD,Q9963,HCPCS,,,,,both,, ,1.65,0.99,Medicaid,Illinois Medicaid,,,,,1.65,,,,
LOC2 200-299MG/ML ML,Q9966,HCPCS,,,,,both,, ,27.81,16.68,Medicaid,Illinois Medicaid,,,,,27.81,,,,
LOCM 240MG 100ML,Q9966,HCPCS,,,,,both,100,ML,6,3.6,Medicaid,Illinois Medicaid,,,,,6,,,,
LOCM 240MG 50ML,Q9966,HCPCS,,,,,both,50,ML,6,3.6,Medicaid,Illinois Medicaid,,,,,6,,,,
LOCM 270MG 150ML,Q9966,HCPCS,,,,,both,150,ML,6,3.6,Medicaid,Illinois Medicaid,,,,,6,,,,
LOCM200MG/ML 41% 200,Q9966,HCPCS,,,,,both,200,ML,4,2.4,Medicaid,Illinois Medicaid,,,,,4,,,,
LOCM200MG/ML M41% 10,Q9966,HCPCS,,,,,both,20,ML,36.82,22.09,Medicaid,Illinois Medicaid,,,,,36.82,,,,
LOCM200MG/ML M41% 10,Q9966,HCPCS,,,,,both,20,ML,36.82,22.09,Medicaid,Illinois Medicaid,,,,,36.82,,,,
LOC2 300-399MG/ML ML,Q9967,HCPCS,,,,,both,150,ML,1337.97,802.78,Medicaid,Illinois Medicaid,,,,,1337.97,,,,
LOC3 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,60.5,36.3,Medicaid,Illinois Medicaid,,,,,60.5,,,,
LOC3 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,60.5,36.3,Medicaid,Illinois Medicaid,,,,,60.5,,,,
LOC5 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,0.7,0.42,Medicaid,Illinois Medicaid,,,,,0.7,,,,
LOC5 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,0.7,0.42,Medicaid,Illinois Medicaid,,,,,0.7,,,,
LOC6 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,0.6,0.36,Medicaid,Illinois Medicaid,,,,,0.6,,,,
LOC6 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,0.6,0.36,Medicaid,Illinois Medicaid,,,,,0.6,,,,
LOCM 300-399MG/ML ML,Q9967,HCPCS,,,,,both,50,ML,12.62,7.57,Medicaid,Illinois Medicaid,,,,,12.62,,,,
LOCM 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,1178.84,707.3,Medicaid,Illinois Medicaid,,,,,1178.84,,,,
LOCM300MG/ML 61% 50,Q9967,HCPCS,,,,,both,50,ML,7.4,4.44,Medicaid,Illinois Medicaid,,,,,7.4,,,,
LOCM300MG/ML 61% 50,Q9967,HCPCS,,,,,both,50,ML,7.4,4.44,Medicaid,Illinois Medicaid,,,,,7.4,,,,
LOCM300MG/ML 61% 50,Q9967,HCPCS,,,,,both,50,ML,7.4,4.44,Medicaid,Illinois Medicaid,,,,,7.4,,,,
LOCM300MG/ML 61% 50,Q9967,HCPCS,,,,,both,50,ML,7.4,4.44,Medicaid,Illinois Medicaid,,,,,7.4,,,,
LOCM300MG/ML 76% 125,Q9967,HCPCS,,,,,both,125,ML,4,2.4,Medicaid,Illinois Medicaid,,,,,4,,,,
LOCM300MG/ML 76% 50,Q9967,HCPCS,,,,,both,50,ML,11.07,6.64,Medicaid,Illinois Medicaid,,,,,11.07,,,,
LOCM300MG/ML 76% 50,Q9967,HCPCS,,,,,both,50,ML,11.07,6.64,Medicaid,Illinois Medicaid,,,,,11.07,,,,
LOCM300MG/ML 76% 50,Q9967,HCPCS,,,,,both,50,ML,11.07,6.64,Medicaid,Illinois Medicaid,,,,,11.07,,,,
LOCM300MG/ML 76% 50,Q9967,HCPCS,,,,,both,50,ML,11.07,6.64,Medicaid,Illinois Medicaid,,,,,11.07,,,,
LACTATION CONSULT,S9443,HCPCS,,,,,both,, ,115.88,69.52,Medicaid,Illinois Medicaid,,,,,115.88,,,,
NI-CARD REHAB PH 3,S9472,HCPCS,,,,,both,, ,2.58,1.54,Medicaid,Illinois Medicaid,,,,,2.58,,,,
NI-PULM REHAB PH 3,S9473,HCPCS,,,,,both,, ,2.58,1.54,Medicaid,Illinois Medicaid,,,,,2.58,,,,
IOP PSYCH PER DIEM,S9480,HCPCS,,,,,both,, ,872.41,523.44,Medicaid,Illinois Medicaid,,,,,872.41,,,,
CDC COVID19,U0001,HCPCS,,,,,both,, ,120.97,72.58,Medicaid,Illinois Medicaid,,,,,120.97,,,,
STATE COVID19,U0002,HCPCS,,,,,both,, ,172.81,103.68,Medicaid,Illinois Medicaid,,,,,172.81,,,,
CT-CATH FLUID DRAIN,10030,CPT,,,,,both,, ,1071.33,642.79,Medicare,Medicare,,,,,1071.33,,,,
I&D ABSCS SMPL/SGL,10060,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
I&D ABSCS COMP/MULTI,10061,CPT,,,,,both,, ,1519.68,911.8,Medicare,Medicare,,,,,1519.68,,,,
INC & REM FB SQ SMPL,10120,CPT,,,,,both,, ,1519.68,911.8,Medicare,Medicare,,,,,1519.68,,,,
INC & REM FB SQ COMP,10121,CPT,,,,,both,, ,6179,3707.4,Medicare,Medicare,,,,,6179,,,,
I&D HEMATOMA/FLUID,10140,CPT,,,,,both,, ,6179,3707.4,Medicare,Medicare,,,,,6179,,,,
PNXR ASP ABS HEM CYT,10160,CPT,,,,,both,, ,1519.68,911.8,Medicare,Medicare,,,,,1519.68,,,,
I&D CPLX PO WND INF,10180,CPT,,,,,both,, ,10829.4,6497.64,Medicare,Medicare,,,,,10829.4,,,,
DEBR EXZ/INF SKN <10%,11000,CPT,,,,,both,, ,2393.6,1436.16,Medicare,Medicare,,,,,2393.6,,,,
DEBR EXZ/INF SKN E A,11001,CPT,,,,,both,, ,2393.6,1436.16,Medicare,Medicare,,,,,2393.6,,,,
DEB SKN BONE FX SITE,11012,CPT,,,,,both,, ,10829.4,6497.64,Medicare,Medicare,,,,,10829.4,,,,
DEB SUB TIS 20 SQ CM<,11042,CPT,,,,,both,, ,1519.68,911.8,Medicare,Medicare,,,,,1519.68,,,,
DEB MUSC/FSCA <20 SQ,11043,CPT,,,,,both,, ,2393.6,1436.16,Medicare,Medicare,,,,,2393.6,,,,
DEB BONE 20 SQ CM/<,11044,CPT,,,,,both,, ,6179,3707.4,Medicare,Medicare,,,,,6179,,,,
DEB SUB TISS EA ADDL,11045,CPT,,,,,both,, ,6179,3707.4,Medicare,Medicare,,,,,6179,,,,
DEB MUSC/FSCA EA ADL,11046,CPT,,,,,both,, ,6179,3707.4,Medicare,Medicare,,,,,6179,,,,
DEB BONE EA ADDL,11047,CPT,,,,,both,, ,6179,3707.4,Medicare,Medicare,,,,,6179,,,,
PARG/CUTG B9 SGL LES,11055,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
TRIM SKIN LESION 2-4,11056,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
TRIM SKIN LESIONS >4,11057,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
TNGNTL BX SKN SGL LES,11102,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
TNGNTL BX SKN EA ADD,11103,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
PUNCH BX SKN SGL LES,11104,CPT,,,,,both,, ,1519.68,911.8,Medicare,Medicare,,,,,1519.68,,,,
PUNCH BX SKN EA ADDL,11105,CPT,,,,,both,, ,1519.68,911.8,Medicare,Medicare,,,,,1519.68,,,,
INCIS BX SKN SGL LES,11106,CPT,,,,,both,, ,2393.6,1436.16,Medicare,Medicare,,,,,2393.6,,,,
INCAL BX SKN EA ADDL,11107,CPT,,,,,both,, ,2393.6,1436.16,Medicare,Medicare,,,,,2393.6,,,,
RMV SKN TAGS<=15 LES,11200,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
RMV SKN TAGS EA ADDL,11201,CPT,,,,,both,, ,233.12,139.87,Medicare,Medicare,,,,,233.12,,,,
DEBRIDEMENT NAIL 1-5,11720,CPT,,,,,both,, ,233.12,139.87,Medicare,Medicare,,,,,233.12,,,,
DEBRIDEMENT NAIL >6,11721,CPT,,,,,both,, ,233.12,139.87,Medicare,Medicare,,,,,233.12,,,,
RMV NAIL PLATE SGL,11730,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
RMV NAIL PLATE E ADD,11732,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
EVAC SU HEMATOMA,11740,CPT,,,,,both,, ,486.84,292.1,Medicare,Medicare,,,,,486.84,,,,
TT F/C/M/N/A/G/H/F,14040,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
TT F/C/M/N/A/G/H/F AD,14041,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
WND PR T/A/L 100SQCM,15002,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
WND PR ADL 100 SQCM,15003,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
WND PREP F/N/HF/G,15004,CPT,,,,,both,, ,2393.6,1436.16,Medicare,Medicare,,,,,2393.6,,,,
WND PREP F/N/HF/G ADL,15005,CPT,,,,,both,, ,2393.6,1436.16,Medicare,Medicare,,,,,2393.6,,,,
PINCH GRFT UP TO 2CM,15050,CPT,,,,,both,, ,2393.6,1436.16,Medicare,Medicare,,,,,2393.6,,,,
SKIN SPLT GRFT T/A/L,15100,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
SKN SPLT GRF T/A/L EA,15101,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
EPIDRM AUTOGRFT T/A/L,15110,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
EPIDR AUTGF T/A/L EA,15111,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
EPIDR AGRFT F/N/H/G,15115,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
EPI AGRFT F/N/HF/G ADL,15116,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
SKN SPLT AGRFT F/N/H/G,15120,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,,,,13673.04,,,,
SKN SPLT AGRF F/N/H/G ADD,15121,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,,,,13673.04,,,,
DERM AUTOGRAF T/A/L,15130,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
DERM AGRAF T/A/L ADL,15131,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
DERM AGRF F/N/H/G,15135,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,,,,13673.04,,,,
DERM AGRF F/N/H/G ADD,15136,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,,,,13673.04,,,,
CULT SKN GRF T/A/L,15150,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
CUL SKN GRF T/A/L A,15151,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
CUL SKN GRF T/A/L +%,15152,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
CUL SKN GRF F/N/H/G,15155,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,,,,13673.04,,,,
CUL SKN GRF F/N/H/G ADD,15156,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,,,,13673.04,,,,
CUL EPIDR GRF F/N/HFG +%,15157,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,,,,13673.04,,,,
FTH GRF TRNK 20SQ/<,15200,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
FTH GRF FR TRNK EA AD,15201,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
FTH GF S/A/L 20 SQ/<,15220,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
FTH GF S/A/L 20 SQ E A,15221,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
FTH GR F/C/C/M/N/AX/G/H/F,15240,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
FTH GR F/C/C/M/N/AX/G/H/F EA,15241,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
FTH GR FR N/E/E/L 20SQ/<,15260,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
FTH GR FR N/E/E/L E A,15261,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
SKN SUB GRAFT T/A/L,15271,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
SKN SUB GRFT ADDL,15272,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
SKN S GRFT >100SQ,15273,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,,,,13673.04,,,,
SKN S GR ADD 100SQ,15274,CPT,,,,,both,, ,13673.04,8203.82,Medicare,Medicare,,,,,13673.04,,,,
SKN S GR F/NK/HF/G 25SQCM,15275,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
SKN S GR F/N/HF/G ADL,15276,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
SKN S GR F/N/HF/G CH,15277,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
SKN S GR F/N/HF/G CH ADD,15278,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
INIT TX 1ST DEG BURN,16000,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
DRS DEB PTHICK BRN S,16020,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
DRS DEB PTHICK BRN M,16025,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
DRS DEB PTHICK BRN L,16030,CPT,,,,,both,, ,1519.68,911.8,Medicare,Medicare,,,,,1519.68,,,,
DESTRCT PREMAL LES,17000,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
DESTRCT PREMAL 2-14,17003,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
DESTRCT PREMAL 15+,17004,CPT,,,,,both,, ,1519.68,911.8,Medicare,Medicare,,,,,1519.68,,,,
DESTR CV LES <=10 SQ,17106,CPT,,,,,both,, ,1519.68,911.8,Medicare,Medicare,,,,,1519.68,,,,
DESTR CV LES 10-50 SQ,17107,CPT,,,,,both,, ,2393.6,1436.16,Medicare,Medicare,,,,,2393.6,,,,
DESTR CV LES > 50 SQ,17108,CPT,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
DESTRUCT B9 LES 1-14,17110,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
CHEM CAUT GRANL TISS,17250,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
UNLISTD PROCEDURE,17999,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
S-BRST DUCTOGRM INJ,19030,CPT,,,,,both,, ,289.43,173.65,Medicare,Medicare,,,,,289.43,,,,
BX OF BREAST OPEN,19101,CPT,,,,,both,, ,14527.16,8716.29,Medicare,Medicare,,,,,14527.16,,,,
EXPL P WND EXTREM,20103,CPT,,,,,both,, ,6179,3707.4,Medicare,Medicare,,,,,6179,,,,
NJ TENDON SHEATH/LIG,20550,CPT,,,,,both,, ,1128.8,677.28,Medicare,Medicare,,,,,1128.8,,,,
S-JOINT ASP-INJ SM,20600,CPT,,,,,both,, ,487.45,292.47,Medicare,Medicare,,,,,487.45,,,,
US-DRN INJ SMAL JT W,20604,CPT,,,,,both,, ,726.15,435.69,Medicare,Medicare,,,,,726.15,,,,
S-JOINT ASP-INJ IM,20605,CPT,,,,,both,, ,700.66,420.39,Medicare,Medicare,,,,,700.66,,,,
US-DRN INJ INTM JT W,20606,CPT,,,,,both,, ,1594.18,956.5,Medicare,Medicare,,,,,1594.18,,,,
US-DRN INJ MAJR JT W,20611,CPT,,,,,both,, ,726.15,435.69,Medicare,Medicare,,,,,726.15,,,,
S-INJ TMJ ARTHROGRAM,21116,CPT,,,,,both,, ,289.43,173.65,Medicare,Medicare,,,,,289.43,,,,
S-INJ SHOULDER ARTH,23350,CPT,,,,,both,, ,289.43,173.65,Medicare,Medicare,,,,,289.43,,,,
S-INJ ELBOW ARTHRO,24220,CPT,,,,,both,, ,289.43,173.65,Medicare,Medicare,,,,,289.43,,,,
S-INJ WRIST ARTHRO,25246,CPT,,,,,both,, ,289.43,173.65,Medicare,Medicare,,,,,289.43,,,,
S-INJ HIP ARTHRO,27093,CPT,,,,,both,, ,289.43,173.65,Medicare,Medicare,,,,,289.43,,,,
S-INJ KNEE ARTHRO,27369,CPT,,,,,both,, ,289.43,173.65,Medicare,Medicare,,,,,289.43,,,,
S-INJ ANKLE ARTHRO,27648,CPT,,,,,both,, ,289.43,173.65,Medicare,Medicare,,,,,289.43,,,,
EXPLORE FOOT JOINT,28022,CPT,,,,,both,, ,12336.12,7401.67,Medicare,Medicare,,,,,12336.12,,,,
AMPUT TOE & METATRSL,28810,CPT,,,,,both,, ,12336.12,7401.67,Medicare,Medicare,,,,,12336.12,,,,
AMPUTATE TOE,28820,CPT,,,,,both,, ,12336.12,7401.67,Medicare,Medicare,,,,,12336.12,,,,
SPLNT LNG ARM S-H OT,29105,CPT,,,,,both,, ,1388.96,833.37,Medicare,Medicare,,,,,1388.96,,,,
SPLNT LNG ARM S-H OT,29105,CPT,,,,,both,, ,1388.96,833.37,Medicare,Medicare,,,,,1388.96,,,,
SPLNT LNG ARM S-H PT,29105,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
SPLNT LNG ARM S-H PT,29105,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
SPLNT LNG ARM S-H PT,29105,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
SPLNT LNG ARM S-H PT,29105,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
SPLNT LNG ARM S-H PT,29105,CPT,,,,,both,, ,1281.32,768.79,Medicare,Medicare,,,,,1281.32,,,,
SPLNT LNG ARM S-H PT,29105,CPT,,,,,both,, ,1281.32,768.79,Medicare,Medicare,,,,,1281.32,,,,
SPLNT LONG ARM S-H,29105,CPT,,,,,both,, ,1196.17,717.7,Medicare,Medicare,,,,,1196.17,,,,
SPLNT LONG ARM S-H,29105,CPT,,,,,both,, ,1296.73,778.03,Medicare,Medicare,,,,,1296.73,,,,
SPLNT SHRT ARM STATC,29125,CPT,,,,,both,, ,909.8,545.88,Medicare,Medicare,,,,,909.8,,,,
SPLNT SHRT ARM STATC,29125,CPT,,,,,both,, ,986.3,591.78,Medicare,Medicare,,,,,986.3,,,,
SPLT SHRT ARM ST OT,29125,CPT,,,,,both,, ,1056.52,633.91,Medicare,Medicare,,,,,1056.52,,,,
SPLT SHRT ARM ST OT,29125,CPT,,,,,both,, ,1056.52,633.91,Medicare,Medicare,,,,,1056.52,,,,
SPLT SHRT ARM ST PT,29125,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,,,,270.12,,,,
SPLT SHRT ARM ST PT,29125,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,,,,270.12,,,,
SPLT SHRT ARM ST PT,29125,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,,,,270.12,,,,
SPLT SHRT ARM ST PT,29125,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,,,,270.12,,,,
SPLT SHRT ARM ST PT,29125,CPT,,,,,both,, ,974.64,584.78,Medicare,Medicare,,,,,974.64,,,,
SPLT SHRT ARM ST PT,29125,CPT,,,,,both,, ,974.64,584.78,Medicare,Medicare,,,,,974.64,,,,
SPLN SHRT ARM DY OT,29126,CPT,,,,,both,, ,1611.18,966.7,Medicare,Medicare,,,,,1611.18,,,,
SPLN SHRT ARM DY OT,29126,CPT,,,,,both,, ,1611.18,966.7,Medicare,Medicare,,,,,1611.18,,,,
SPLN SHRT ARM DY PT,29126,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,,,,270.12,,,,
SPLN SHRT ARM DY PT,29126,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,,,,270.12,,,,
SPLN SHRT ARM DY PT,29126,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,,,,270.12,,,,
SPLN SHRT ARM DY PT,29126,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,,,,270.12,,,,
SPLN SHRT ARM DY PT,29126,CPT,,,,,both,, ,1486.29,891.77,Medicare,Medicare,,,,,1486.29,,,,
SPLN SHRT ARM DY PT,29126,CPT,,,,,both,, ,1486.29,891.77,Medicare,Medicare,,,,,1486.29,,,,
SPLNT SHRT ARM DYNAM,29126,CPT,,,,,both,, ,1387.43,832.45,Medicare,Medicare,,,,,1387.43,,,,
SPLNT SHRT ARM DYNAM,29126,CPT,,,,,both,, ,1504.12,902.47,Medicare,Medicare,,,,,1504.12,,,,
SPLNT FINGER STATIC,29130,CPT,,,,,both,, ,299.22,179.53,Medicare,Medicare,,,,,299.22,,,,
SPLNT FINGER STATIC,29130,CPT,,,,,both,, ,324.42,194.65,Medicare,Medicare,,,,,324.42,,,,
SPLNT FNGR STATC OT,29130,CPT,,,,,both,, ,347.63,208.57,Medicare,Medicare,,,,,347.63,,,,
SPLNT FNGR STATC OT,29130,CPT,,,,,both,, ,347.63,208.57,Medicare,Medicare,,,,,347.63,,,,
SPLNT FNGR STATC PT,29130,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,,,,141.88,,,,
SPLNT FNGR STATC PT,29130,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,,,,141.88,,,,
SPLNT FNGR STATC PT,29130,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,,,,141.88,,,,
SPLNT FNGR STATC PT,29130,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,,,,141.88,,,,
SPLNT FNGR STATC PT,29130,CPT,,,,,both,, ,320.59,192.35,Medicare,Medicare,,,,,320.59,,,,
SPLNT FNGR STATC PT,29130,CPT,,,,,both,, ,320.59,192.35,Medicare,Medicare,,,,,320.59,,,,
SPLNT FINGER DYNAM,29131,CPT,,,,,both,, ,453.68,272.2,Medicare,Medicare,,,,,453.68,,,,
SPLNT FINGER DYNAM,29131,CPT,,,,,both,, ,491.82,295.09,Medicare,Medicare,,,,,491.82,,,,
SPLNT FINGR DYNA OT,29131,CPT,,,,,both,, ,526.85,316.11,Medicare,Medicare,,,,,526.85,,,,
SPLNT FINGR DYNA OT,29131,CPT,,,,,both,, ,526.85,316.11,Medicare,Medicare,,,,,526.85,,,,
SPLNT FINGR DYNA PT,29131,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,,,,141.88,,,,
SPLNT FINGR DYNA PT,29131,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,,,,141.88,,,,
SPLNT FINGR DYNA PT,29131,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,,,,141.88,,,,
SPLNT FINGR DYNA PT,29131,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,,,,141.88,,,,
SPLNT FINGR DYNA PT,29131,CPT,,,,,both,, ,485.9,291.54,Medicare,Medicare,,,,,485.9,,,,
SPLNT FINGR DYNA PT,29131,CPT,,,,,both,, ,485.9,291.54,Medicare,Medicare,,,,,485.9,,,,
STRAPPING THORAX,29200,CPT,,,,,both,, ,377.17,226.3,Medicare,Medicare,,,,,377.17,,,,
STRAPPING THORAX PT,29200,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
STRAPPING THORAX PT,29200,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
STRAPPING THORAX PT,29200,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
STRAPPING THORAX PT,29200,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
STRAPPING THORAX PT,29200,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,,,,404.02,,,,
STRAPPING THORAX PT,29200,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,,,,404.02,,,,
STRAPPING SHOULD OT,29240,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,,,,81.37,,,,
STRAPPING SHOULD OT,29240,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,,,,81.37,,,,
STRAPPING SHOULD OT,29240,CPT,,,,,both,, ,438.01,262.8,Medicare,Medicare,,,,,438.01,,,,
STRAPPING SHOULD OT,29240,CPT,,,,,both,, ,438.01,262.8,Medicare,Medicare,,,,,438.01,,,,
STRAPPING SHOULD PT,29240,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,,,,270.12,,,,
STRAPPING SHOULD PT,29240,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,,,,270.12,,,,
STRAPPING SHOULD PT,29240,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,,,,404.02,,,,
STRAPPING SHOULD PT,29240,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,,,,404.02,,,,
STRAPPING SHOULDER,29240,CPT,,,,,both,, ,377.17,226.3,Medicare,Medicare,,,,,377.17,,,,
STRAPPING SHOULDER,29240,CPT,,,,,both,, ,408.86,245.31,Medicare,Medicare,,,,,408.86,,,,
STRAPPING ELBO-WRIST,29260,CPT,,,,,both,, ,377.17,226.3,Medicare,Medicare,,,,,377.17,,,,
STRAPPING ELBO-WRIST,29260,CPT,,,,,both,, ,408.86,245.31,Medicare,Medicare,,,,,408.86,,,,
STRPNG ELBO-WRST OT,29260,CPT,,,,,both,, ,438.01,262.8,Medicare,Medicare,,,,,438.01,,,,
STRPNG ELBO-WRST OT,29260,CPT,,,,,both,, ,438.01,262.8,Medicare,Medicare,,,,,438.01,,,,
STRPNG ELBO-WRST PT,29260,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,,,,81.37,,,,
STRPNG ELBO-WRST PT,29260,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,,,,81.37,,,,
STRPNG ELBO-WRST PT,29260,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,,,,81.37,,,,
STRPNG ELBO-WRST PT,29260,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,,,,81.37,,,,
STRPNG ELBO-WRST PT,29260,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,,,,404.02,,,,
STRPNG ELBO-WRST PT,29260,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,,,,404.02,,,,
STRAPPING HAND-FING,29280,CPT,,,,,both,, ,377.17,226.3,Medicare,Medicare,,,,,377.17,,,,
STRAPPING HAND-FING,29280,CPT,,,,,both,, ,408.86,245.31,Medicare,Medicare,,,,,408.86,,,,
STRPPNG HND-FING OT,29280,CPT,,,,,both,, ,438.01,262.8,Medicare,Medicare,,,,,438.01,,,,
STRPPNG HND-FING OT,29280,CPT,,,,,both,, ,438.01,262.8,Medicare,Medicare,,,,,438.01,,,,
STRPPNG HND-FING PT,29280,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,,,,81.37,,,,
STRPPNG HND-FING PT,29280,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,,,,81.37,,,,
STRPPNG HND-FING PT,29280,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,,,,81.37,,,,
STRPPNG HND-FING PT,29280,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,,,,81.37,,,,
STRPPNG HND-FING PT,29280,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,,,,404.02,,,,
STRPPNG HND-FING PT,29280,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,,,,404.02,,,,
APPLY RIGID LEG CAST,29445,CPT,,,,,both,, ,1023.52,614.11,Medicare,Medicare,,,,,1023.52,,,,
AP LNG LEG SPLNT PT,29505,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
AP LNG LEG SPLNT PT,29505,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
AP LNG LEG SPLNT PT,29505,CPT,,,,,both,, ,1486.29,891.77,Medicare,Medicare,,,,,1486.29,,,,
AP LNG LEG SPLNT PT,29505,CPT,,,,,both,, ,1486.29,891.77,Medicare,Medicare,,,,,1486.29,,,,
APP LNG LEG SPLINT,29505,CPT,,,,,both,, ,1387.43,832.45,Medicare,Medicare,,,,,1387.43,,,,
APPLY LNG LEG SPLNT,29505,CPT,,,,,both,, ,600.52,360.31,Medicare,Medicare,,,,,600.52,,,,
AP SHT LEG SPLNT PT,29515,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
AP SHT LEG SPLNT PT,29515,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
AP SHT LEG SPLNT PT,29515,CPT,,,,,both,, ,974.64,584.78,Medicare,Medicare,,,,,974.64,,,,
AP SHT LEG SPLNT PT,29515,CPT,,,,,both,, ,974.64,584.78,Medicare,Medicare,,,,,974.64,,,,
APP SHORT LEG SPLINT,29515,CPT,,,,,both,, ,909.8,545.88,Medicare,Medicare,,,,,909.8,,,,
APPLY SHRT LEG SPLNT,29515,CPT,,,,,both,, ,600.52,360.31,Medicare,Medicare,,,,,600.52,,,,
STRAPPING HIP,29520,CPT,,,,,both,, ,377.17,226.3,Medicare,Medicare,,,,,377.17,,,,
STRAPPING HIP PT,29520,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,,,,141.88,,,,
STRAPPING HIP PT,29520,CPT,,,,,both,, ,141.88,85.12,Medicare,Medicare,,,,,141.88,,,,
STRAPPING HIP PT,29520,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,,,,404.02,,,,
STRAPPING HIP PT,29520,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,,,,404.02,,,,
STRAPPING KNEE,29530,CPT,,,,,both,, ,377.17,226.3,Medicare,Medicare,,,,,377.17,,,,
STRAPPING KNEE PT,29530,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,,,,270.12,,,,
STRAPPING KNEE PT,29530,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,,,,270.12,,,,
STRAPPING KNEE PT,29530,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,,,,404.02,,,,
STRAPPING KNEE PT,29530,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,,,,404.02,,,,
STRAPPING ANKLE-FOOT,29540,CPT,,,,,both,, ,377.17,226.3,Medicare,Medicare,,,,,377.17,,,,
STRPPNG ANKLE-FT PT,29540,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
STRPPNG ANKLE-FT PT,29540,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
STRPPNG ANKLE-FT PT,29540,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,,,,404.02,,,,
STRPPNG ANKLE-FT PT,29540,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,,,,404.02,,,,
STRAPPING UNA BOOT,29580,CPT,,,,,both,, ,377.17,226.3,Medicare,Medicare,,,,,377.17,,,,
STRPPNG UNA BOOT PT,29580,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
STRPPNG UNA BOOT PT,29580,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
STRPPNG UNA BOOT PT,29580,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,,,,404.02,,,,
STRPPNG UNA BOOT PT,29580,CPT,,,,,both,, ,404.02,242.41,Medicare,Medicare,,,,,404.02,,,,
UNNA BOOT STRAPPING,29580,CPT,,,,,both,, ,600.52,360.31,Medicare,Medicare,,,,,600.52,,,,
UNNA WRAP,29580,CPT,,,,,both,, ,19.2,11.52,Medicare,Medicare,,,,,19.2,,,,
AP MULTLY COMP LR LEG,29581,CPT,,,,,both,, ,600.52,360.31,Medicare,Medicare,,,,,600.52,,,,
STRPPNG LOW BACK OT,29799,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,,,,270.12,,,,
STRPPNG LOW BACK OT,29799,CPT,,,,,both,, ,270.12,162.07,Medicare,Medicare,,,,,270.12,,,,
SUCTION PROC-NASOTRA,31720,CPT,,,,,both,, ,280.42,168.25,Medicare,Medicare,,,,,280.42,,,,
CT-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914,5948.4,Medicare,Medicare,,,,,9914,,,,
IR-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914,5948.4,Medicare,Medicare,,,,,9914,,,,
IR-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,9914,5948.4,Medicare,Medicare,,,,,9914,,,,
US-THORACNTSIS W IMG,32555,CPT,,,,,both,, ,5184.63,3110.77,Medicare,Medicare,,,,,5184.63,,,,
CC-PERICARDIO W/IMG,33016,CPT,,,,,both,, ,3443.03,2065.81,Medicare,Medicare,,,,,3443.03,,,,
P-IMPLNT LOOP REC,33285,CPT,,,,,both,, ,27383.32,16429.99,Medicare,Medicare,,,,,27383.32,,,,
P-REMOV LOOP REC,33286,CPT,,,,,both,, ,5044.68,3026.8,Medicare,Medicare,,,,,5044.68,,,,
CC-IMP PRESS SEN ANG,33289,CPT,,,,,both,, ,11332.83,6799.69,Medicare,Medicare,,,,,11332.83,,,,
S-INTRO NDL CATH,36000,CPT,,,,,both,, ,168.75,101.25,Medicare,Medicare,,,,,168.75,,,,
S-INTRO NDL CATH VEI,36000,CPT,,,,,both,, ,173.81,104.28,Medicare,Medicare,,,,,173.81,,,,
S-INJ VENOGRAPHY,36005,CPT,,,,,both,, ,873.46,524.07,Medicare,Medicare,,,,,873.46,,,,
S-INTROCATH SEGPULM,36015,CPT,,,,,both,, ,839.21,503.52,Medicare,Medicare,,,,,839.21,,,,
S-CATH CAROTD VERT,36100,CPT,,,,,both,, ,1013.23,607.93,Medicare,Medicare,,,,,1013.23,,,,
S-CATH EXTREM ART,36140,CPT,,,,,both,, ,399.68,239.8,Medicare,Medicare,,,,,399.68,,,,
S-THORACIC 1ST ORDER,36215,CPT,,,,,both,, ,1839.26,1103.55,Medicare,Medicare,,,,,1839.26,,,,
IR-ANG EXT CRT NS,36221,CPT,,,,,both,, ,12592.76,7555.65,Medicare,Medicare,,,,,12592.76,,,,
IR-ANG CRT EXT CC BI,36222,CPT,,,,,both,, ,31881.02,19128.61,Medicare,Medicare,,,,,31881.02,,,,
IR-ANG CARTD IPS BI,36223,CPT,,,,,both,, ,45998.14,27598.88,Medicare,Medicare,,,,,45998.14,,,,
IR-ANG CARTD IPS UNI,36223,CPT,,,,,both,, ,31746.87,19048.12,Medicare,Medicare,,,,,31746.87,,,,
IR-ANG INT CAR IP BI,36224,CPT,,,,,both,, ,51895.68,31137.4,Medicare,Medicare,,,,,51895.68,,,,
IR-ANG INT CAR IP UN,36224,CPT,,,,,both,, ,32068.51,19241.1,Medicare,Medicare,,,,,32068.51,,,,
IR-ANG SUBCL IPS BI,36225,CPT,,,,,both,, ,24740.1,14844.06,Medicare,Medicare,,,,,24740.1,,,,
IR-ANG SUBCL IPS UNI,36225,CPT,,,,,both,, ,12369.34,7421.6,Medicare,Medicare,,,,,12369.34,,,,
CTH PLC EXT CD W-ANG,36227,CPT,,,,,both,, ,9411.59,5646.95,Medicare,Medicare,,,,,9411.59,,,,
CTH PLC EXT CD W-ANG,36227,CPT,,,,,both,, ,14117.39,8470.43,Medicare,Medicare,,,,,14117.39,,,,
S-ANG EXT CD IPS BI,36227,CPT,,,,,both,, ,8060.51,4836.3,Medicare,Medicare,,,,,8060.51,,,,
S-ANG EXT CD IPS BI,36227,CPT,,,,,both,, ,12090.77,7254.46,Medicare,Medicare,,,,,12090.77,,,,
S-ABDOMEN 1ST ORDER,36245,CPT,,,,,both,, ,1979.03,1187.41,Medicare,Medicare,,,,,1979.03,,,,
S-ABDOMEN 2ND ORDER,36246,CPT,,,,,both,, ,9539.09,5723.45,Medicare,Medicare,,,,,9539.09,,,,
S-ABDOMEN 3RD ORDER,36247,CPT,,,,,both,, ,16382.99,9829.79,Medicare,Medicare,,,,,16382.99,,,,
DNA SPECIMEN COLLECTION VENI,36415,CPT,,,,,both,, ,70,42,Medicare,Medicare,,,,,70,,,,
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,, ,8.19,4.91,Medicare,Medicare,,,,,8.19,,,,
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,,,90.37,90.37,Medicare,Medicare,,90.37,,,90.37,90.37,90.37,fee schedule,Medicare APC Fee Schedule
"VENIPUNCTURE,ROUTINE",36415,CPT,,,,,both,, ,90.37,54.22,Medicare,Medicare,,,,,90.37,,,,
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,22.73,13.63,Medicare,Medicare,,,,,22.73,,,,
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,46.31,27.78,Medicare,Medicare,,,,,46.31,,,,
CAPILLARY PUNCTURE,36416,CPT,,,,,both,, ,49.96,29.97,Medicare,Medicare,,,,,49.96,,,,
BLOOD TRANSF 0 2 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicare,Medicare,,,,,2260.55,,,,
BLOOD TRANSF 2 4 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicare,Medicare,,,,,2260.55,,,,
BLOOD TRANSF 4 6 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicare,Medicare,,,,,2260.55,,,,
BLOOD TRANSF 6 8 HRS,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicare,Medicare,,,,,2260.55,,,,
BLOOD TRANSF 8 10 HR,36430,CPT,,,,,both,, ,2260.55,1356.33,Medicare,Medicare,,,,,2260.55,,,,
BLOOD TRANSFUSION,36430,CPT,,,,,both,, ,3283.64,1970.18,Medicare,Medicare,,,,,3283.64,,,,
BLOOD TRANSFUSION,36430,CPT,,,,,both,, ,3579.17,2147.5,Medicare,Medicare,,,,,3579.17,,,,
BLOOD PUSH TRAN U2YR,36440,CPT,,,,,both,, ,3579.17,2147.5,Medicare,Medicare,,,,,3579.17,,,,
THER APHERESIS WBC,36511,CPT,,,,,both,, ,5560.46,3336.27,Medicare,Medicare,,,,,5560.46,,,,
THER APHERESI PLASMA,36514,CPT,,,,,both,, ,5560.46,3336.27,Medicare,Medicare,,,,,5560.46,,,,
CC-INS NT CVC GT 5YR,36556,CPT,,,,,both,, ,4017.52,2410.51,Medicare,Medicare,,,,,4017.52,,,,
IR-RMV TUN CVC WO SQ,36589,CPT,,,,,both,, ,2370.55,1422.33,Medicare,Medicare,,,,,2370.55,,,,
BLD COLLECT VAD,36591,CPT,,,,,both,, ,445.15,267.09,Medicare,Medicare,,,,,445.15,,,,
BLD DRAW CENTRAL LN,36592,CPT,,,,,both,, ,388.45,233.07,Medicare,Medicare,,,,,388.45,,,,
IR-INJ W FLUR CV DEV,36598,CPT,,,,,both,, ,467.11,280.26,Medicare,Medicare,,,,,467.11,,,,
ARTERIAL PUNCTURE,36600,CPT,,,,,both,, ,327.26,196.35,Medicare,Medicare,,,,,327.26,,,,
S-INS ENDO VENA CAVA,37191,CPT,,,,,both,, ,29440.27,17664.16,Medicare,Medicare,,,,,29440.27,,,,
S-REDO ENDO VENA CAV,37192,CPT,,,,,both,, ,20313.85,12188.31,Medicare,Medicare,,,,,20313.85,,,,
S-REM ENDO VENA CAVA,37193,CPT,,,,,both,, ,20313.85,12188.31,Medicare,Medicare,,,,,20313.85,,,,
S-THROMBOLYSIS CEREB,37195,CPT,,,,,both,, ,860.31,516.18,Medicare,Medicare,,,,,860.31,,,,
S-ID SENTINEL NODE,38792,CPT,,,,,both,, ,1582.72,949.63,Medicare,Medicare,,,,,1582.72,,,,
S-BX NDL LIVER,47000,CPT,,,,,both,, ,1102.87,661.72,Medicare,Medicare,,,,,1102.87,,,,
CT-PERC CHOLECYSTOST,47490,CPT,,,,,both,, ,10295.62,6177.37,Medicare,Medicare,,,,,10295.62,,,,
IR-ABD PARACEN W IMG,49083,CPT,,,,,both,, ,3767.78,2260.66,Medicare,Medicare,,,,,3767.78,,,,
IR-PERITONEAL LAVAGE,49084,CPT,,,,,both,, ,3767.78,2260.66,Medicare,Medicare,,,,,3767.78,,,,
LITHOTRIPSY,50590,CPT,,,,,both,, ,54374.73,32624.83,Medicare,Medicare,,,,,54374.73,,,,
S-URETEROGRM INJ,50684,CPT,,,,,both,, ,323.94,194.36,Medicare,Medicare,,,,,323.94,,,,
S-INJ ILEAL CONDUIT,50690,CPT,,,,,both,, ,323.94,194.36,Medicare,Medicare,,,,,323.94,,,,
S-CORPCAVERNOSGR INJ,54230,CPT,,,,,both,, ,425.39,255.23,Medicare,Medicare,,,,,425.39,,,,
S-INJ CATH HYSTERSO,58340,CPT,,,,,both,, ,336.52,201.91,Medicare,Medicare,,,,,336.52,,,,
FETAL CONTRACTION ST,59020,CPT,,,,,both,, ,2089.1,1253.46,Medicare,Medicare,,,,,2089.1,,,,
FETAL NON STRESS TES,59025,CPT,,,,,both,, ,1169.57,701.74,Medicare,Medicare,,,,,1169.57,,,,
EXTERNAL CEPHALIC VE,59412,CPT,,,,,both,, ,5047.77,3028.66,Medicare,Medicare,,,,,5047.77,,,,
S-THYROID CORE BX,60100,CPT,,,,,both,, ,630.36,378.21,Medicare,Medicare,,,,,630.36,,,,
S-SPINAL TAP DIAGNST,62270,CPT,,,,,both,, ,1417.54,850.52,Medicare,Medicare,,,,,1417.54,,,,
S-INJ EPI BLD PATCH,62273,CPT,,,,,both,, ,1368.1,820.86,Medicare,Medicare,,,,,1368.1,,,,
S-MYELOGRAM INJ,62284,CPT,,,,,both,, ,629.07,377.44,Medicare,Medicare,,,,,629.07,,,,
IR-MYELO CERVICAL,62302,CPT,,,,,both,, ,2078.67,1247.2,Medicare,Medicare,,,,,2078.67,,,,
IR-MYELO THORACIC,62303,CPT,,,,,both,, ,1934.41,1160.64,Medicare,Medicare,,,,,1934.41,,,,
IR-MYELO LUMBAR,62304,CPT,,,,,both,, ,1964.44,1178.66,Medicare,Medicare,,,,,1964.44,,,,
IR-MYELO COMPLETE,62305,CPT,,,,,both,, ,4013.09,2407.85,Medicare,Medicare,,,,,4013.09,,,,
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,,,2450.37,2450.37,2450.37,fee schedule,Medicare APC Fee Schedule
IR-DI L-S INJ W IM,62323,CPT,,,,,both,, ,2450.37,1470.22,Medicare,Medicare,,,,,2450.37,,,,
IR-DI L-S INJ-IN WIM,62327,CPT,,,,,both,, ,2707.1,1624.26,Medicare,Medicare,,,,,2707.1,,,,
SPINAL TAP DIAG W-IM,62328,CPT,,,,,both,, ,1417.54,850.52,Medicare,Medicare,,,,,1417.54,,,,
IR-POSTERIOR FOSSA,70010,CPT,,,,,both,, ,2122.18,1273.3,Medicare,Medicare,,,,,2122.18,,,,
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-EYE FOREIGNBDY CR,70030,CPT,,,,,both,, ,1239.46,743.67,Medicare,Medicare,,,,,1239.46,,,,
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
HE-EYE FRGNBDY BI CR,70030,CPT,,,,,both,, ,2479.48,1487.68,Medicare,Medicare,,,,,2479.48,,,,
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,,,883.84,883.84,Medicare,Medicare,,883.84,,,883.84,883.84,883.84,fee schedule,Medicare APC Fee Schedule
HE-MANDIBLE LTD CR,70100,CPT,,,,,both,, ,883.84,530.3,Medicare,Medicare,,,,,883.84,,,,
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,,,,220.61,,,,
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,,,940.82,940.82,Medicare,Medicare,,940.82,,,940.82,940.82,940.82,fee schedule,Medicare APC Fee Schedule
HE-MANDIBLE 4VPLS CR,70110,CPT,,,,,both,, ,940.82,564.49,Medicare,Medicare,,,,,940.82,,,,
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,,,456.37,456.37,Medicare,Medicare,,456.37,,,456.37,456.37,456.37,fee schedule,Medicare APC Fee Schedule
HE-MASTOID 3VPLUS CR,70130,CPT,,,,,both,, ,456.37,273.82,Medicare,Medicare,,,,,456.37,,,,
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,,,782.23,782.23,Medicare,Medicare,,782.23,,,782.23,782.23,782.23,fee schedule,Medicare APC Fee Schedule
HE-FACIAL BNS LTD CR,70140,CPT,,,,,both,, ,782.23,469.33,Medicare,Medicare,,,,,782.23,,,,
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,,,,220.61,,,,
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,,,1128.31,1128.31,Medicare,Medicare,,1128.31,,,1128.31,1128.31,1128.31,fee schedule,Medicare APC Fee Schedule
HE-FACIAL BNES 3V CR,70150,CPT,,,,,both,, ,1128.31,676.98,Medicare,Medicare,,,,,1128.31,,,,
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-NASAL BONES CR,70160,CPT,,,,,both,,,782.23,782.23,Medicare,Medicare,,782.23,,,782.23,782.23,782.23,fee schedule,Medicare APC Fee Schedule
HE-NASAL BONES CR,70160,CPT,,,,,both,, ,782.23,469.33,Medicare,Medicare,,,,,782.23,,,,
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-ORBITS 4V CR,70200,CPT,,,,,both,,,918.37,918.37,Medicare,Medicare,,918.37,,,918.37,918.37,918.37,fee schedule,Medicare APC Fee Schedule
HE-ORBITS 4V CR,70200,CPT,,,,,both,, ,918.37,551.02,Medicare,Medicare,,,,,918.37,,,,
HE-SINUSES LTD CR,70210,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-SINUSES LTD CR,70210,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,,,936.33,936.33,Medicare,Medicare,,936.33,,,936.33,936.33,936.33,fee schedule,Medicare APC Fee Schedule
HE-SINUSES 3VPLUS CR,70220,CPT,,,,,both,, ,936.33,561.79,Medicare,Medicare,,,,,936.33,,,,
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-SKULL LIMITED CR,70250,CPT,,,,,both,,,1151.89,1151.89,Medicare,Medicare,,1151.89,,,1151.89,1151.89,1151.89,fee schedule,Medicare APC Fee Schedule
HE-SKULL LIMITED CR,70250,CPT,,,,,both,, ,1151.89,691.13,Medicare,Medicare,,,,,1151.89,,,,
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,,,,220.61,,,,
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,,,1381.48,1381.48,Medicare,Medicare,,1381.48,,,1381.48,1381.48,1381.48,fee schedule,Medicare APC Fee Schedule
HE-SKULL 4V PLUS CR,70260,CPT,,,,,both,, ,1381.48,828.88,Medicare,Medicare,,,,,1381.48,,,,
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,,,538.05,538.05,Medicare,Medicare,,538.05,,,538.05,538.05,538.05,fee schedule,Medicare APC Fee Schedule
HE-TMJ UNILATERAL CR,70328,CPT,,,,,both,, ,538.05,322.83,Medicare,Medicare,,,,,538.05,,,,
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,,,342.7,342.7,Medicare,Medicare,,342.7,,,342.7,342.7,342.7,fee schedule,Medicare APC Fee Schedule
HE-TMJ BILATERAL CR,70330,CPT,,,,,both,, ,342.7,205.62,Medicare,Medicare,,,,,342.7,,,,
IR-ARTHGRM TMJ BI CR,70332,CPT,,,,,both,, ,2353.18,1411.9,Medicare,Medicare,,,,,2353.18,,,,
IR-ARTHROGRAM TMJ CR,70332,CPT,,,,,both,, ,1176.59,705.95,Medicare,Medicare,,,,,1176.59,,,,
HE-ORTHOPANTOGRAM CR,70355,CPT,,,,,both,, ,692.14,415.28,Medicare,Medicare,,,,,692.14,,,,
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,,,757.53,757.53,Medicare,Medicare,,757.53,,,757.53,757.53,757.53,fee schedule,Medicare APC Fee Schedule
SP-NECK SOFT TISS CR,70360,CPT,,,,,both,, ,757.53,454.51,Medicare,Medicare,,,,,757.53,,,,
FL-PHX SP EV W CINE,70371,CPT,,,,,both,, ,808.06,484.83,Medicare,Medicare,,,,,808.06,,,,
IR-SIALOGRAM,70390,CPT,,,,,both,, ,1800.52,1080.31,Medicare,Medicare,,,,,1800.52,,,,
"CT scan, head or brain, without contrast",70450,CPT,,,,,both,,,1576.55,1576.55,Medicare,Medicare,,102.64,,,1576.55,1576.55,1576.55,fee schedule,Medicare APC Fee Schedule
CT-HEAD WO,70450,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,,,,307.05,,,,
CT-HEAD WO,70450,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,,,,330.63,,,,
CT-HEAD WO,70450,CPT,,,,,both,, ,1576.55,945.93,Medicare,Medicare,,,,,1576.55,,,,
CT-HEAD W,70460,CPT,,,,,both,,,1765.72,1765.72,Medicare,Medicare,,1765.72,,,1765.72,1765.72,1765.72,fee schedule,Medicare APC Fee Schedule
CT-HEAD W,70460,CPT,,,,,both,, ,1765.72,1059.43,Medicare,Medicare,,,,,1765.72,,,,
CT-HEAD WWO,70470,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,,,,680.91,,,,
CT-HEAD WWO,70470,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,,,,732.83,,,,
CT-HEAD WWO,70470,CPT,,,,,both,,,3726.8,3726.8,Medicare,Medicare,,3726.8,,,3726.8,3726.8,3726.8,fee schedule,Medicare APC Fee Schedule
CT-HEAD WWO,70470,CPT,,,,,both,, ,3726.8,2236.08,Medicare,Medicare,,,,,3726.8,,,,
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,,,,307.05,,,,
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,,,,330.63,,,,
CT-ORBIT EAR WO,70480,CPT,,,,,both,, ,2847.17,1708.3,Medicare,Medicare,,,,,2847.17,,,,
CT-ORBIT EAR W,70481,CPT,,,,,both,, ,556.01,333.6,Medicare,Medicare,,,,,556.01,,,,
CT-ORBIT EAR W,70481,CPT,,,,,both,, ,1643.07,985.84,Medicare,Medicare,,,,,1643.07,,,,
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,,,,680.91,,,,
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,,,,732.83,,,,
CT-ORBIT EAR WWO,70482,CPT,,,,,both,, ,4001.3,2400.78,Medicare,Medicare,,,,,4001.3,,,,
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,,,,307.05,,,,
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,,,,330.63,,,,
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,,,2847.17,2847.17,Medicare,Medicare,,2847.17,,,2847.17,2847.17,2847.17,fee schedule,Medicare APC Fee Schedule
CT-MAXILLOFACIAL WO,70486,CPT,,,,,both,, ,2847.17,1708.3,Medicare,Medicare,,,,,2847.17,,,,
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,,,,604.85,,,,
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,,,,650.88,,,,
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,,,3178.64,3178.64,Medicare,Medicare,,3178.64,,,3178.64,3178.64,3178.64,fee schedule,Medicare APC Fee Schedule
CT-MAXILLOFACIAL W,70487,CPT,,,,,both,, ,3178.64,1907.18,Medicare,Medicare,,,,,3178.64,,,,
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,,,,680.91,,,,
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,,,,732.83,,,,
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,,,3726.8,3726.8,Medicare,Medicare,,3726.8,,,3726.8,3726.8,3726.8,fee schedule,Medicare APC Fee Schedule
CT-MAXILLOFACIAL WWO,70488,CPT,,,,,both,, ,3726.8,2236.08,Medicare,Medicare,,,,,3726.8,,,,
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,,,,307.05,,,,
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,,,,330.63,,,,
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,,,2737.98,2737.98,Medicare,Medicare,,2737.98,,,2737.98,2737.98,2737.98,fee schedule,Medicare APC Fee Schedule
CT-NECK SOFT TIS WO,70490,CPT,,,,,both,, ,2737.98,1642.78,Medicare,Medicare,,,,,2737.98,,,,
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,,,,604.85,,,,
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,,,,650.88,,,,
CT-NECK SOFT TIS W,70491,CPT,,,,,both,,,2743.59,2743.59,Medicare,Medicare,,2743.59,,,2743.59,2743.59,2743.59,fee schedule,Medicare APC Fee Schedule
CT-NECK SOFT TIS W,70491,CPT,,,,,both,, ,2743.59,1646.15,Medicare,Medicare,,,,,2743.59,,,,
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,,,,680.91,,,,
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,,,,732.83,,,,
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,,,4317.62,4317.62,Medicare,Medicare,,4317.62,,,4317.62,4317.62,4317.62,fee schedule,Medicare APC Fee Schedule
CT-NECK SOFT TIS WWO,70492,CPT,,,,,both,, ,4317.62,2590.57,Medicare,Medicare,,,,,4317.62,,,,
CTA-HEAD,70496,CPT,,,,,both,, ,893.1,535.86,Medicare,Medicare,,,,,893.1,,,,
CTA-HEAD,70496,CPT,,,,,both,,,2355.42,2355.42,Medicare,Medicare,,2355.42,,,2355.42,2355.42,2355.42,fee schedule,Medicare APC Fee Schedule
CTA-HEAD,70496,CPT,,,,,both,, ,2355.42,1413.25,Medicare,Medicare,,,,,2355.42,,,,
CTA-NECK,70498,CPT,,,,,both,, ,893.1,535.86,Medicare,Medicare,,,,,893.1,,,,
CTA-NECK,70498,CPT,,,,,both,,,2355.42,2355.42,Medicare,Medicare,,2355.42,,,2355.42,2355.42,2355.42,fee schedule,Medicare APC Fee Schedule
CTA-NECK,70498,CPT,,,,,both,, ,2355.42,1413.25,Medicare,Medicare,,,,,2355.42,,,,
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,,,,715.99,,,,
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,,,,770.45,,,,
MR-ORBT FACE NECK WO,70540,CPT,,,,,both,, ,4042.84,2425.7,Medicare,Medicare,,,,,4042.84,,,,
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,,,,1035.69,,,,
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,,,,1114.55,,,,
MR-ORBT FACE NECK W,70542,CPT,,,,,both,, ,4293.48,2576.08,Medicare,Medicare,,,,,4293.48,,,,
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,,,,1197.08,,,,
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,,,,1288.29,,,,
MR-ORBT FAC NCK WWO,70543,CPT,,,,,both,, ,5197.81,3118.68,Medicare,Medicare,,,,,5197.81,,,,
MRA-HEAD WO,70544,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,,,,715.99,,,,
MRA-HEAD WO,70544,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,,,,770.45,,,,
MRA-HEAD WO,70544,CPT,,,,,both,, ,1631.56,978.93,Medicare,Medicare,,,,,1631.56,,,,
MRA-HEAD W,70545,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,,,,1035.69,,,,
MRA-HEAD W,70545,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,,,,1114.55,,,,
MRA-HEAD W,70545,CPT,,,,,both,, ,1938.34,1163,Medicare,Medicare,,,,,1938.34,,,,
MRA-HEAD WWO,70546,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,,,,1197.08,,,,
MRA-HEAD WWO,70546,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,,,,1288.29,,,,
MRA-HEAD WWO,70546,CPT,,,,,both,, ,2669.78,1601.86,Medicare,Medicare,,,,,2669.78,,,,
MRA-NECK WO,70547,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,,,,715.99,,,,
MRA-NECK WO,70547,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,,,,770.45,,,,
MRA-NECK WO,70547,CPT,,,,,both,, ,1334.89,800.93,Medicare,Medicare,,,,,1334.89,,,,
MRA-NECK W,70548,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,,,,1035.69,,,,
MRA-NECK W,70548,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,,,,1114.55,,,,
MRA-NECK W,70548,CPT,,,,,both,, ,1938.34,1163,Medicare,Medicare,,,,,1938.34,,,,
MRA-NECK WWO,70549,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,,,,1197.08,,,,
MRA-NECK WWO,70549,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,,,,1288.29,,,,
MRA-NECK WWO,70549,CPT,,,,,both,, ,3263.12,1957.87,Medicare,Medicare,,,,,3263.12,,,,
MR-BRAIN WO,70551,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,,,,715.99,,,,
MR-BRAIN WO,70551,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,,,,770.45,,,,
MR-BRAIN WO,70551,CPT,,,,,both,,,4941.28,4941.28,Medicare,Medicare,,4941.28,,,4941.28,4941.28,4941.28,fee schedule,Medicare APC Fee Schedule
MR-BRAIN WO,70551,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,,,,4941.28,,,,
MR-BRAIN W,70552,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,,,,1035.69,,,,
MR-BRAIN W,70552,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,,,,1114.55,,,,
MR-BRAIN W,70552,CPT,,,,,both,,,2352.06,2352.06,Medicare,Medicare,,2352.06,,,2352.06,2352.06,2352.06,fee schedule,Medicare APC Fee Schedule
MR-BRAIN W,70552,CPT,,,,,both,, ,2352.06,1411.23,Medicare,Medicare,,,,,2352.06,,,,
MR-BRAIN WWO,70553,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,,,,1197.08,,,,
MR-BRAIN WWO,70553,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,,,,1288.29,,,,
MR-BRAIN WWO,70553,CPT,,,,,both,, ,6352.79,3811.67,Medicare,Medicare,,,,,6352.79,,,,
MRI scan of brain before and after contrast,70553,CPT,,,,,both,,,6352.79,6352.79,Medicare,Medicare,,353.82,,,6352.79,6352.79,6352.79,fee schedule,Medicare APC Fee Schedule
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-CHEST 1V CR,71045,CPT,,,,,both,,,495.95,495.95,Medicare,Medicare,,495.95,,,495.95,495.95,495.95,fee schedule,Medicare APC Fee Schedule
CH-CHEST 1V CR,71045,CPT,,,,,both,, ,495.95,297.57,Medicare,Medicare,,,,,495.95,,,,
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-CHEST 2V CR,71046,CPT,,,,,both,,,750.52,750.52,Medicare,Medicare,,750.52,,,750.52,750.52,750.52,fee schedule,Medicare APC Fee Schedule
CH-CHEST 2V CR,71046,CPT,,,,,both,, ,750.52,450.31,Medicare,Medicare,,,,,750.52,,,,
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Medicare,Medicare,,,,,143.98,,,,
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Medicare,Medicare,,,,,143.98,,,,
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,143.98,86.38,Medicare,Medicare,,,,,143.98,,,,
CH-CHEST 3V CR,71047,CPT,,,,,both,,,1091.82,1091.82,Medicare,Medicare,,1091.82,,,1091.82,1091.82,1091.82,fee schedule,Medicare APC Fee Schedule
CH-CHEST 3V CR,71047,CPT,,,,,both,, ,1091.82,655.09,Medicare,Medicare,,,,,1091.82,,,,
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,143.98,86.38,Medicare,Medicare,,,,,143.98,,,,
CH-CHEST 4V CR,71048,CPT,,,,,both,,,1652.05,1652.05,Medicare,Medicare,,1652.05,,,1652.05,1652.05,1652.05,fee schedule,Medicare APC Fee Schedule
CH-CHEST 4V CR,71048,CPT,,,,,both,, ,1652.05,991.23,Medicare,Medicare,,,,,1652.05,,,,
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-RIBS UNILAT CR,71100,CPT,,,,,both,,,876.83,876.83,Medicare,Medicare,,876.83,,,876.83,876.83,876.83,fee schedule,Medicare APC Fee Schedule
CH-RIBS UNILAT CR,71100,CPT,,,,,both,, ,876.83,526.09,Medicare,Medicare,,,,,876.83,,,,
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,,,,220.61,,,,
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,260.74,156.44,Medicare,Medicare,,,,,260.74,,,,
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,260.74,156.44,Medicare,Medicare,,,,,260.74,,,,
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,,,1152.17,1152.17,Medicare,Medicare,,1152.17,,,1152.17,1152.17,1152.17,fee schedule,Medicare APC Fee Schedule
CH-RIB UNI PA CXR CR,71101,CPT,,,,,both,, ,1152.17,691.3,Medicare,Medicare,,,,,1152.17,,,,
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,,,,220.61,,,,
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,,,1381.48,1381.48,Medicare,Medicare,,1381.48,,,1381.48,1381.48,1381.48,fee schedule,Medicare APC Fee Schedule
CH-RIBS BILATERAL CR,71110,CPT,,,,,both,, ,1381.48,828.88,Medicare,Medicare,,,,,1381.48,,,,
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,,,,220.61,,,,
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,260.74,156.44,Medicare,Medicare,,,,,260.74,,,,
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,260.74,156.44,Medicare,Medicare,,,,,260.74,,,,
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,,,1877.99,1877.99,Medicare,Medicare,,1877.99,,,1877.99,1877.99,1877.99,fee schedule,Medicare APC Fee Schedule
CH-RIBS BI PA CXR CR,71111,CPT,,,,,both,, ,1877.99,1126.79,Medicare,Medicare,,,,,1877.99,,,,
CH-STERNUM CR,71120,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-STERNUM CR,71120,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-STERNUM CR,71120,CPT,,,,,both,,,947.27,947.27,Medicare,Medicare,,947.27,,,947.27,947.27,947.27,fee schedule,Medicare APC Fee Schedule
CH-STERNUM CR,71120,CPT,,,,,both,, ,947.27,568.36,Medicare,Medicare,,,,,947.27,,,,
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,,,989.38,989.38,Medicare,Medicare,,989.38,,,989.38,989.38,989.38,fee schedule,Medicare APC Fee Schedule
CH-STRNOCLAV JNTS CR,71130,CPT,,,,,both,, ,989.38,593.62,Medicare,Medicare,,,,,989.38,,,,
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,,,,307.05,,,,
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,,,,330.63,,,,
CT-CHEST DIAG WO,71250,CPT,,,,,both,,,3833.18,3833.18,Medicare,Medicare,,3833.18,,,3833.18,3833.18,3833.18,fee schedule,Medicare APC Fee Schedule
CT-CHEST DIAG WO,71250,CPT,,,,,both,, ,3833.18,2299.9,Medicare,Medicare,,,,,3833.18,,,,
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,,,,604.85,,,,
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,,,,650.88,,,,
CT-CHEST DIAG W,71260,CPT,,,,,both,,,4107.96,4107.96,Medicare,Medicare,,4107.96,,,4107.96,4107.96,4107.96,fee schedule,Medicare APC Fee Schedule
CT-CHEST DIAG W,71260,CPT,,,,,both,, ,4107.96,2464.77,Medicare,Medicare,,,,,4107.96,,,,
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,,,,680.91,,,,
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,,,,732.83,,,,
CT-CHEST DIAG WWO,71270,CPT,,,,,both,,,3833.18,3833.18,Medicare,Medicare,,3833.18,,,3833.18,3833.18,3833.18,fee schedule,Medicare APC Fee Schedule
CT-CHEST DIAG WWO,71270,CPT,,,,,both,, ,3833.18,2299.9,Medicare,Medicare,,,,,3833.18,,,,
CT-LOW DOSE CNCR SCR,71271,CPT,,,,,both,, ,273.09,163.85,Medicare,Medicare,,,,,273.09,,,,
CT-LOW DOSE CNCR SCR,71271,CPT,,,,,both,, ,273.09,163.85,Medicare,Medicare,,,,,273.09,,,,
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,,,568.92,568.92,Medicare,Medicare,,568.92,,,568.92,568.92,568.92,fee schedule,Medicare APC Fee Schedule
CT-LUNG LOWDSE SC WO,71271,CPT,,,,,both,, ,568.92,341.35,Medicare,Medicare,,,,,568.92,,,,
CTA-CHEST,71275,CPT,,,,,both,, ,708.98,425.38,Medicare,Medicare,,,,,708.98,,,,
CTA-CHEST,71275,CPT,,,,,both,, ,763.15,457.89,Medicare,Medicare,,,,,763.15,,,,
CTA-CHEST,71275,CPT,,,,,both,,,2355.14,2355.14,Medicare,Medicare,,2355.14,,,2355.14,2355.14,2355.14,fee schedule,Medicare APC Fee Schedule
CTA-CHEST,71275,CPT,,,,,both,, ,2355.14,1413.08,Medicare,Medicare,,,,,2355.14,,,,
MR-CHEST WO,71550,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,,,,715.99,,,,
MR-CHEST WO,71550,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,,,,770.45,,,,
MR-CHEST WO,71550,CPT,,,,,both,,,4042.84,4042.84,Medicare,Medicare,,4042.84,,,4042.84,4042.84,4042.84,fee schedule,Medicare APC Fee Schedule
MR-CHEST WO,71550,CPT,,,,,both,, ,4042.84,2425.7,Medicare,Medicare,,,,,4042.84,,,,
MR-CHEST W,71551,CPT,,,,,both,,,4293.48,4293.48,Medicare,Medicare,,4293.48,,,4293.48,4293.48,4293.48,fee schedule,Medicare APC Fee Schedule
MR-CHEST W,71551,CPT,,,,,both,, ,4293.48,2576.08,Medicare,Medicare,,,,,4293.48,,,,
MR-CHEST WWO,71552,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,,,,1197.08,,,,
MR-CHEST WWO,71552,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,,,,1288.29,,,,
MR-CHEST WWO,71552,CPT,,,,,both,,,5197.81,5197.81,Medicare,Medicare,,5197.81,,,5197.81,5197.81,5197.81,fee schedule,Medicare APC Fee Schedule
MR-CHEST WWO,71552,CPT,,,,,both,, ,5197.81,3118.68,Medicare,Medicare,,,,,5197.81,,,,
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,,,261.02,261.02,Medicare,Medicare,,261.02,,,261.02,261.02,261.02,fee schedule,Medicare APC Fee Schedule
SP-SPINE SNGL VW CR,72020,CPT,,,,,both,, ,261.02,156.61,Medicare,Medicare,,,,,261.02,,,,
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,,,1085.36,1085.36,Medicare,Medicare,,1085.36,,,1085.36,1085.36,1085.36,fee schedule,Medicare APC Fee Schedule
SP-CERV SP 2TO3VW CR,72040,CPT,,,,,both,, ,1085.36,651.21,Medicare,Medicare,,,,,1085.36,,,,
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,,,,220.61,,,,
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
SP-CERV SP 4TO5VW CR,72050,CPT,,,,,both,, ,1112.87,667.72,Medicare,Medicare,,,,,1112.87,,,,
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,,,,220.61,,,,
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
SP-CRV SPNE 6VPLS CR,72052,CPT,,,,,both,, ,1471.29,882.77,Medicare,Medicare,,,,,1471.29,,,,
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,,,1181.64,1181.64,Medicare,Medicare,,1181.64,,,1181.64,1181.64,1181.64,fee schedule,Medicare APC Fee Schedule
SP-T SPINE 2 VIEW CR,72070,CPT,,,,,both,, ,1181.64,708.98,Medicare,Medicare,,,,,1181.64,,,,
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,,,,220.61,,,,
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,,,1444.63,1444.63,Medicare,Medicare,,1444.63,,,1444.63,1444.63,1444.63,fee schedule,Medicare APC Fee Schedule
SP-T SPINE 3 VIEW CR,72072,CPT,,,,,both,, ,1444.63,866.77,Medicare,Medicare,,,,,1444.63,,,,
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,,,1444.63,1444.63,Medicare,Medicare,,1444.63,,,1444.63,1444.63,1444.63,fee schedule,Medicare APC Fee Schedule
SP-T SPNE 4PLUS V CR,72074,CPT,,,,,both,, ,1444.63,866.77,Medicare,Medicare,,,,,1444.63,,,,
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,139.77,83.86,Medicare,Medicare,,,,,139.77,,,,
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,149.32,89.59,Medicare,Medicare,,,,,149.32,,,,
SP-ENTIRE SPNE 1V CR,72081,CPT,,,,,both,, ,1181.91,709.14,Medicare,Medicare,,,,,1181.91,,,,
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,139.77,83.86,Medicare,Medicare,,,,,139.77,,,,
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,149.32,89.59,Medicare,Medicare,,,,,149.32,,,,
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,230.71,138.42,Medicare,Medicare,,,,,230.71,,,,
SP-ENT SPN 2OR3 V CR,72082,CPT,,,,,both,, ,1181.91,709.14,Medicare,Medicare,,,,,1181.91,,,,
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,230.71,138.42,Medicare,Medicare,,,,,230.71,,,,
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,279.26,167.55,Medicare,Medicare,,,,,279.26,,,,
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,298.64,179.18,Medicare,Medicare,,,,,298.64,,,,
SP-ENT SPN 4OR5 V CR,72083,CPT,,,,,both,, ,2363.84,1418.3,Medicare,Medicare,,,,,2363.84,,,,
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,279.26,167.55,Medicare,Medicare,,,,,279.26,,,,
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,298.64,179.18,Medicare,Medicare,,,,,298.64,,,,
SP-ENT SPNE MIN6V CR,72084,CPT,,,,,both,, ,2363.84,1418.3,Medicare,Medicare,,,,,2363.84,,,,
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,,,1504.42,1504.42,Medicare,Medicare,,1504.42,,,1504.42,1504.42,1504.42,fee schedule,Medicare APC Fee Schedule
SP-LS SPN 2 TO 3V CR,72100,CPT,,,,,both,, ,1504.42,902.65,Medicare,Medicare,,,,,1504.42,,,,
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,,,,220.61,,,,
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
SP-LS SPNE 4VPLUS CR,72110,CPT,,,,,both,, ,1968.65,1181.19,Medicare,Medicare,,,,,1968.65,,,,
"X-Ray, lower back, minimum four views",72110,CPT,,,,,both,,,1968.65,1968.65,Medicare,Medicare,,102.64,,,1968.65,1968.65,1968.65,fee schedule,Medicare APC Fee Schedule
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,,,,220.61,,,,
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
SP-LS SPINE W BND CR,72114,CPT,,,,,both,,,2229.96,2229.96,Medicare,Medicare,,2229.96,,,2229.96,2229.96,2229.96,fee schedule,Medicare APC Fee Schedule
SP-LS SPINE W BND CR,72114,CPT,,,,,both,, ,2229.96,1337.97,Medicare,Medicare,,,,,2229.96,,,,
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,,,,220.61,,,,
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
SP-LS SPINE BND CR,72120,CPT,,,,,both,,,1765.44,1765.44,Medicare,Medicare,,1765.44,,,1765.44,1765.44,1765.44,fee schedule,Medicare APC Fee Schedule
SP-LS SPINE BND CR,72120,CPT,,,,,both,, ,1765.44,1059.26,Medicare,Medicare,,,,,1765.44,,,,
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,,,,307.05,,,,
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,,,,330.63,,,,
CT-CERV SPINE WO,72125,CPT,,,,,both,,,3833.18,3833.18,Medicare,Medicare,,3833.18,,,3833.18,3833.18,3833.18,fee schedule,Medicare APC Fee Schedule
CT-CERV SPINE WO,72125,CPT,,,,,both,, ,3833.18,2299.9,Medicare,Medicare,,,,,3833.18,,,,
CT-CERV SPINE W,72126,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,,,,604.85,,,,
CT-CERV SPINE W,72126,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,,,,650.88,,,,
CT-CERV SPINE W,72126,CPT,,,,,both,,,6031.42,6031.42,Medicare,Medicare,,6031.42,,,6031.42,6031.42,6031.42,fee schedule,Medicare APC Fee Schedule
CT-CERV SPINE W,72126,CPT,,,,,both,, ,6031.42,3618.85,Medicare,Medicare,,,,,6031.42,,,,
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,,,,680.91,,,,
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,,,,732.83,,,,
CT-CERV SPINE WWO,72127,CPT,,,,,both,,,6031.42,6031.42,Medicare,Medicare,,6031.42,,,6031.42,6031.42,6031.42,fee schedule,Medicare APC Fee Schedule
CT-CERV SPINE WWO,72127,CPT,,,,,both,, ,6031.42,3618.85,Medicare,Medicare,,,,,6031.42,,,,
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,,,,307.05,,,,
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,,,,330.63,,,,
CT-THOR SPINE WO,72128,CPT,,,,,both,,,3833.18,3833.18,Medicare,Medicare,,3833.18,,,3833.18,3833.18,3833.18,fee schedule,Medicare APC Fee Schedule
CT-THOR SPINE WO,72128,CPT,,,,,both,, ,3833.18,2299.9,Medicare,Medicare,,,,,3833.18,,,,
CT-THOR SPINE W,72129,CPT,,,,,both,, ,534.96,320.97,Medicare,Medicare,,,,,534.96,,,,
CT-THOR SPINE W,72129,CPT,,,,,both,,,1786.22,1786.22,Medicare,Medicare,,1786.22,,,1786.22,1786.22,1786.22,fee schedule,Medicare APC Fee Schedule
CT-THOR SPINE W,72129,CPT,,,,,both,, ,1786.22,1071.73,Medicare,Medicare,,,,,1786.22,,,,
CT-THOR SPINE WWO,72130,CPT,,,,,both,,,2407.63,2407.63,Medicare,Medicare,,2407.63,,,2407.63,2407.63,2407.63,fee schedule,Medicare APC Fee Schedule
CT-THOR SPINE WWO,72130,CPT,,,,,both,, ,2407.63,1444.57,Medicare,Medicare,,,,,2407.63,,,,
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,,,,307.05,,,,
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,,,,330.63,,,,
CT-LUMB SPINE WO,72131,CPT,,,,,both,,,534.68,534.68,Medicare,Medicare,,534.68,,,534.68,534.68,534.68,fee schedule,Medicare APC Fee Schedule
CT-LUMB SPINE WO,72131,CPT,,,,,both,, ,534.68,320.8,Medicare,Medicare,,,,,534.68,,,,
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,,,,604.85,,,,
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,,,,650.88,,,,
CT-LUMB SPINE W,72132,CPT,,,,,both,,,1653.45,1653.45,Medicare,Medicare,,1653.45,,,1653.45,1653.45,1653.45,fee schedule,Medicare APC Fee Schedule
CT-LUMB SPINE W,72132,CPT,,,,,both,, ,1653.45,992.07,Medicare,Medicare,,,,,1653.45,,,,
CT-LUMB SPINE WWO,72133,CPT,,,,,both,, ,446.27,267.76,Medicare,Medicare,,,,,446.27,,,,
CT-LUMB SPINE WWO,72133,CPT,,,,,both,,,1126.62,1126.62,Medicare,Medicare,,1126.62,,,1126.62,1126.62,1126.62,fee schedule,Medicare APC Fee Schedule
CT-LUMB SPINE WWO,72133,CPT,,,,,both,, ,1126.62,675.97,Medicare,Medicare,,,,,1126.62,,,,
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,,,,715.99,,,,
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,,,,770.45,,,,
MR-CERV SPINE WO,72141,CPT,,,,,both,,,4941.28,4941.28,Medicare,Medicare,,4941.28,,,4941.28,4941.28,4941.28,fee schedule,Medicare APC Fee Schedule
MR-CERV SPINE WO,72141,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,,,,4941.28,,,,
MR-CERV SPINE W,72142,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,,,,1035.69,,,,
MR-CERV SPINE W,72142,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,,,,1114.55,,,,
MR-CERV SPINE W,72142,CPT,,,,,both,,,2352.06,2352.06,Medicare,Medicare,,2352.06,,,2352.06,2352.06,2352.06,fee schedule,Medicare APC Fee Schedule
MR-CERV SPINE W,72142,CPT,,,,,both,, ,2352.06,1411.23,Medicare,Medicare,,,,,2352.06,,,,
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,,,,715.99,,,,
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,,,,770.45,,,,
MR-THOR SPINE WO,72146,CPT,,,,,both,,,4941.28,4941.28,Medicare,Medicare,,4941.28,,,4941.28,4941.28,4941.28,fee schedule,Medicare APC Fee Schedule
MR-THOR SPINE WO,72146,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,,,,4941.28,,,,
MR-THOR SPINE W,72147,CPT,,,,,both,, ,1641.24,984.74,Medicare,Medicare,,,,,1641.24,,,,
MR-THOR SPINE W,72147,CPT,,,,,both,,,2351.49,2351.49,Medicare,Medicare,,2351.49,,,2351.49,2351.49,2351.49,fee schedule,Medicare APC Fee Schedule
MR-THOR SPINE W,72147,CPT,,,,,both,, ,2351.49,1410.89,Medicare,Medicare,,,,,2351.49,,,,
MRI scan of lower spinal canal,72148,CPT,,,,,both,,,4941.28,4941.28,Medicare,Medicare,,224.26,,,4941.28,4941.28,4941.28,fee schedule,Medicare APC Fee Schedule
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,,,,715.99,,,,
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,,,,770.45,,,,
MR-LUMB SPINE WO,72148,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,,,,4941.28,,,,
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,,,,1035.69,,,,
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,,,,1114.55,,,,
MR-LUMB SPINE W,72149,CPT,,,,,both,,,2352.06,2352.06,Medicare,Medicare,,2352.06,,,2352.06,2352.06,2352.06,fee schedule,Medicare APC Fee Schedule
MR-LUMB SPINE W,72149,CPT,,,,,both,, ,2352.06,1411.23,Medicare,Medicare,,,,,2352.06,,,,
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,,,,1197.08,,,,
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,,,,1288.29,,,,
MR-CERV SPINE WWO,72156,CPT,,,,,both,,,6352.79,6352.79,Medicare,Medicare,,6352.79,,,6352.79,6352.79,6352.79,fee schedule,Medicare APC Fee Schedule
MR-CERV SPINE WWO,72156,CPT,,,,,both,, ,6352.79,3811.67,Medicare,Medicare,,,,,6352.79,,,,
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,,,,1197.08,,,,
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,,,,1288.29,,,,
MR-THOR SPINE WWO,72157,CPT,,,,,both,,,6352.79,6352.79,Medicare,Medicare,,6352.79,,,6352.79,6352.79,6352.79,fee schedule,Medicare APC Fee Schedule
MR-THOR SPINE WWO,72157,CPT,,,,,both,, ,6352.79,3811.67,Medicare,Medicare,,,,,6352.79,,,,
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,,,,1197.08,,,,
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,,,,1288.29,,,,
MR-LUMB SPINE WWO,72158,CPT,,,,,both,,,6352.79,6352.79,Medicare,Medicare,,6352.79,,,6352.79,6352.79,6352.79,fee schedule,Medicare APC Fee Schedule
MR-LUMB SPINE WWO,72158,CPT,,,,,both,, ,6352.79,3811.67,Medicare,Medicare,,,,,6352.79,,,,
LE-PELVIS CR,72170,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-PELVIS CR,72170,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-PELVIS CR,72170,CPT,,,,,both,,,936.33,936.33,Medicare,Medicare,,936.33,,,936.33,936.33,936.33,fee schedule,Medicare APC Fee Schedule
LE-PELVIS CR,72170,CPT,,,,,both,, ,936.33,561.79,Medicare,Medicare,,,,,936.33,,,,
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,,,1774.99,1774.99,Medicare,Medicare,,1774.99,,,1774.99,1774.99,1774.99,fee schedule,Medicare APC Fee Schedule
LE-PELVIS 3V PLUS CR,72190,CPT,,,,,both,, ,1774.99,1064.99,Medicare,Medicare,,,,,1774.99,,,,
CT-PELVIS WO,72192,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,,,,307.05,,,,
CT-PELVIS WO,72192,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,,,,330.63,,,,
CT-PELVIS WO,72192,CPT,,,,,both,,,3285.58,3285.58,Medicare,Medicare,,3285.58,,,3285.58,3285.58,3285.58,fee schedule,Medicare APC Fee Schedule
CT-PELVIS WO,72192,CPT,,,,,both,, ,3285.58,1971.34,Medicare,Medicare,,,,,3285.58,,,,
"CT scan, pelvis, with contrast",72193,CPT,,,,,both,,,3726.8,3726.8,Medicare,Medicare,,173.19,,,3726.8,3726.8,3726.8,fee schedule,Medicare APC Fee Schedule
CT-PELVIS W,72193,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,,,,604.85,,,,
CT-PELVIS W,72193,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,,,,650.88,,,,
CT-PELVIS W,72193,CPT,,,,,both,, ,3726.8,2236.08,Medicare,Medicare,,,,,3726.8,,,,
CT-PELVIS WWO,72194,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,,,,680.91,,,,
CT-PELVIS WWO,72194,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,,,,732.83,,,,
CT-PELVIS WWO,72194,CPT,,,,,both,,,4047.33,4047.33,Medicare,Medicare,,4047.33,,,4047.33,4047.33,4047.33,fee schedule,Medicare APC Fee Schedule
CT-PELVIS WWO,72194,CPT,,,,,both,, ,4047.33,2428.39,Medicare,Medicare,,,,,4047.33,,,,
MR-PELVIS WO,72195,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,,,,715.99,,,,
MR-PELVIS WO,72195,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,,,,770.45,,,,
MR-PELVIS WO,72195,CPT,,,,,both,,,4042.84,4042.84,Medicare,Medicare,,4042.84,,,4042.84,4042.84,4042.84,fee schedule,Medicare APC Fee Schedule
MR-PELVIS WO,72195,CPT,,,,,both,, ,4042.84,2425.7,Medicare,Medicare,,,,,4042.84,,,,
MR-PELVIS W,72196,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,,,,1035.69,,,,
MR-PELVIS W,72196,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,,,,1114.55,,,,
MR-PELVIS W,72196,CPT,,,,,both,,,2940.06,2940.06,Medicare,Medicare,,2940.06,,,2940.06,2940.06,2940.06,fee schedule,Medicare APC Fee Schedule
MR-PELVIS W,72196,CPT,,,,,both,, ,2940.06,1764.03,Medicare,Medicare,,,,,2940.06,,,,
MR-PELVIS WWO,72197,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,,,,1197.08,,,,
MR-PELVIS WWO,72197,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,,,,1288.29,,,,
MR-PELVIS WWO,72197,CPT,,,,,both,,,5197.81,5197.81,Medicare,Medicare,,5197.81,,,5197.81,5197.81,5197.81,fee schedule,Medicare APC Fee Schedule
MR-PELVIS WWO,72197,CPT,,,,,both,, ,5197.81,3118.68,Medicare,Medicare,,,,,5197.81,,,,
SP-SI JOINTS 2V CR,72200,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-SI JOINTS 2V CR,72200,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,,,757.53,757.53,Medicare,Medicare,,757.53,,,757.53,757.53,757.53,fee schedule,Medicare APC Fee Schedule
SP-SI JNTS 3VPLUS CR,72202,CPT,,,,,both,, ,757.53,454.51,Medicare,Medicare,,,,,757.53,,,,
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,,,989.38,989.38,Medicare,Medicare,,989.38,,,989.38,989.38,989.38,fee schedule,Medicare APC Fee Schedule
SP-SCRM COCCYX 2V CR,72220,CPT,,,,,both,, ,989.38,593.62,Medicare,Medicare,,,,,989.38,,,,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,,,721.61,721.61,Medicare,Medicare,,721.61,,,721.61,721.61,721.61,fee schedule,Medicare APC Fee Schedule
UE-CLAVICLE BILAT CR,73000,CPT,,,,,both,, ,721.61,432.96,Medicare,Medicare,,,,,721.61,,,,
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-CLAVICLE CR,73000,CPT,,,,,both,,,353.93,353.93,Medicare,Medicare,,353.93,,,353.93,353.93,353.93,fee schedule,Medicare APC Fee Schedule
UE-CLAVICLE CR,73000,CPT,,,,,both,, ,353.93,212.35,Medicare,Medicare,,,,,353.93,,,,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,273.37,164.02,Medicare,Medicare,,,,,273.37,,,,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,273.37,164.02,Medicare,Medicare,,,,,273.37,,,,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,,,804.69,804.69,Medicare,Medicare,,804.69,,,804.69,804.69,804.69,fee schedule,Medicare APC Fee Schedule
UE-SCAPULA BILAT CR,73010,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,,,,804.69,,,,
UE-SCAPULA CR,73010,CPT,,,,,both,, ,136.68,82,Medicare,Medicare,,,,,136.68,,,,
UE-SCAPULA CR,73010,CPT,,,,,both,, ,136.68,82,Medicare,Medicare,,,,,136.68,,,,
UE-SCAPULA CR,73010,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-SCAPULA CR,73010,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-SCAPULA CR,73010,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-SCAPULA CR,73010,CPT,,,,,both,,,402.2,402.2,Medicare,Medicare,,402.2,,,402.2,402.2,402.2,fee schedule,Medicare APC Fee Schedule
UE-SCAPULA CR,73010,CPT,,,,,both,, ,402.2,241.32,Medicare,Medicare,,,,,402.2,,,,
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,,,978.43,978.43,Medicare,Medicare,,978.43,,,978.43,978.43,978.43,fee schedule,Medicare APC Fee Schedule
UE-SHOULDER 1V BI CR,73020,CPT,,,,,both,, ,978.43,587.05,Medicare,Medicare,,,,,978.43,,,,
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-SHOULDER 1V CR,73020,CPT,,,,,both,,,489.5,489.5,Medicare,Medicare,,489.5,,,489.5,489.5,489.5,fee schedule,Medicare APC Fee Schedule
UE-SHOULDER 1V CR,73020,CPT,,,,,both,, ,489.5,293.7,Medicare,Medicare,,,,,489.5,,,,
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,,,863.36,863.36,Medicare,Medicare,,863.36,,,863.36,863.36,863.36,fee schedule,Medicare APC Fee Schedule
UE-SHLDR 2VW PLUS CR,73030,CPT,,,,,both,, ,863.36,518.01,Medicare,Medicare,,,,,863.36,,,,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,,,1726.71,1726.71,Medicare,Medicare,,1726.71,,,1726.71,1726.71,1726.71,fee schedule,Medicare APC Fee Schedule
UE-SHOULDER 2V BI CR,73030,CPT,,,,,both,, ,1726.71,1036.02,Medicare,Medicare,,,,,1726.71,,,,
IR-ARTHROGM SHLDR CR,73040,CPT,,,,,both,, ,3748.7,2249.22,Medicare,Medicare,,,,,3748.7,,,,
IR-ATHGRM SHLD BI CR,73040,CPT,,,,,both,, ,7497.39,4498.43,Medicare,Medicare,,,,,7497.39,,,,
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-AC JTS BILAT CR,73050,CPT,,,,,both,,,918.37,918.37,Medicare,Medicare,,918.37,,,918.37,918.37,918.37,fee schedule,Medicare APC Fee Schedule
UE-AC JTS BILAT CR,73050,CPT,,,,,both,, ,918.37,551.02,Medicare,Medicare,,,,,918.37,,,,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,,,721.61,721.61,Medicare,Medicare,,721.61,,,721.61,721.61,721.61,fee schedule,Medicare APC Fee Schedule
UE-HUMERUS BILAT CR,73060,CPT,,,,,both,, ,721.61,432.96,Medicare,Medicare,,,,,721.61,,,,
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-HUMERUS CR,73060,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-HUMERUS CR,73060,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-HUMERUS CR,73060,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-HUMERUS CR,73060,CPT,,,,,both,,,1442.95,1442.95,Medicare,Medicare,,1442.95,,,1442.95,1442.95,1442.95,fee schedule,Medicare APC Fee Schedule
UE-HUMERUS CR,73060,CPT,,,,,both,, ,1442.95,865.77,Medicare,Medicare,,,,,1442.95,,,,
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-ELBOW 2V CR,73070,CPT,,,,,both,,,662.39,662.39,Medicare,Medicare,,662.39,,,662.39,662.39,662.39,fee schedule,Medicare APC Fee Schedule
UE-ELBOW 2V CR,73070,CPT,,,,,both,, ,662.39,397.43,Medicare,Medicare,,,,,662.39,,,,
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,,,1325.06,1325.06,Medicare,Medicare,,1325.06,,,1325.06,1325.06,1325.06,fee schedule,Medicare APC Fee Schedule
UE-ELBOW 2VW BI CR,73070,CPT,,,,,both,, ,1325.06,795.03,Medicare,Medicare,,,,,1325.06,,,,
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-ELBOW 3V CR,73080,CPT,,,,,both,,,804.69,804.69,Medicare,Medicare,,804.69,,,804.69,804.69,804.69,fee schedule,Medicare APC Fee Schedule
UE-ELBOW 3V CR,73080,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,,,,804.69,,,,
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,,,1609.11,1609.11,Medicare,Medicare,,1609.11,,,1609.11,1609.11,1609.11,fee schedule,Medicare APC Fee Schedule
UE-ELBOW 3VW BI CR,73080,CPT,,,,,both,, ,1609.11,965.46,Medicare,Medicare,,,,,1609.11,,,,
IR-ARTHROGRAM ELBOW,73085,CPT,,,,,both,, ,3748.7,2249.22,Medicare,Medicare,,,,,3748.7,,,,
IR-ARTHROGRAM ELBOW,73085,CPT,,,,,both,, ,3748.7,2249.22,Medicare,Medicare,,,,,3748.7,,,,
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-FOREARM 2V CR,73090,CPT,,,,,both,,,662.39,662.39,Medicare,Medicare,,662.39,,,662.39,662.39,662.39,fee schedule,Medicare APC Fee Schedule
UE-FOREARM 2V CR,73090,CPT,,,,,both,, ,662.39,397.43,Medicare,Medicare,,,,,662.39,,,,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,,,1325.06,1325.06,Medicare,Medicare,,1325.06,,,1325.06,1325.06,1325.06,fee schedule,Medicare APC Fee Schedule
UE-FOREARM 2VW BI CR,73090,CPT,,,,,both,, ,1325.06,795.03,Medicare,Medicare,,,,,1325.06,,,,
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,,,,220.61,,,,
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
UE-UP EXT INFANT CR,73092,CPT,,,,,both,,,721.61,721.61,Medicare,Medicare,,721.61,,,721.61,721.61,721.61,fee schedule,Medicare APC Fee Schedule
UE-UP EXT INFANT CR,73092,CPT,,,,,both,, ,721.61,432.96,Medicare,Medicare,,,,,721.61,,,,
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,441.5,264.9,Medicare,Medicare,,,,,441.5,,,,
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,475.18,285.1,Medicare,Medicare,,,,,475.18,,,,
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,,,1444.91,1444.91,Medicare,Medicare,,1444.91,,,1444.91,1444.91,1444.91,fee schedule,Medicare APC Fee Schedule
UE-UPEXT INFNT BI CR,73092,CPT,,,,,both,, ,1444.91,866.94,Medicare,Medicare,,,,,1444.91,,,,
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-WRIST 2V CR,73100,CPT,,,,,both,,,607.94,607.94,Medicare,Medicare,,607.94,,,607.94,607.94,607.94,fee schedule,Medicare APC Fee Schedule
UE-WRIST 2V CR,73100,CPT,,,,,both,, ,607.94,364.76,Medicare,Medicare,,,,,607.94,,,,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,,,1216.16,1216.16,Medicare,Medicare,,1216.16,,,1216.16,1216.16,1216.16,fee schedule,Medicare APC Fee Schedule
UE-WRIST 2VW BI CR,73100,CPT,,,,,both,, ,1216.16,729.69,Medicare,Medicare,,,,,1216.16,,,,
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,,,662.39,662.39,Medicare,Medicare,,662.39,,,662.39,662.39,662.39,fee schedule,Medicare APC Fee Schedule
UE-WRIST 3V PLUS CR,73110,CPT,,,,,both,, ,662.39,397.43,Medicare,Medicare,,,,,662.39,,,,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,,,1325.06,1325.06,Medicare,Medicare,,1325.06,,,1325.06,1325.06,1325.06,fee schedule,Medicare APC Fee Schedule
UE-WRIST 3VW BI CR,73110,CPT,,,,,both,, ,1325.06,795.03,Medicare,Medicare,,,,,1325.06,,,,
IR-ARTHROGRAM WRIST,73115,CPT,,,,,both,, ,3748.7,2249.22,Medicare,Medicare,,,,,3748.7,,,,
IR-ARTHROGRAM WRIST,73115,CPT,,,,,both,, ,3748.7,2249.22,Medicare,Medicare,,,,,3748.7,,,,
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-HAND 2V CR,73120,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-HAND 2V CR,73120,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-HAND 2V CR,73120,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-HAND 2V CR,73120,CPT,,,,,both,,,662.39,662.39,Medicare,Medicare,,662.39,,,662.39,662.39,662.39,fee schedule,Medicare APC Fee Schedule
UE-HAND 2V CR,73120,CPT,,,,,both,, ,662.39,397.43,Medicare,Medicare,,,,,662.39,,,,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,,,1325.06,1325.06,Medicare,Medicare,,1325.06,,,1325.06,1325.06,1325.06,fee schedule,Medicare APC Fee Schedule
UE-HAND 2VWS BI CR,73120,CPT,,,,,both,, ,1325.06,795.03,Medicare,Medicare,,,,,1325.06,,,,
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-HAND 3V CR,73130,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-HAND 3V CR,73130,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-HAND 3V CR,73130,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-HAND 3V CR,73130,CPT,,,,,both,,,804.69,804.69,Medicare,Medicare,,804.69,,,804.69,804.69,804.69,fee schedule,Medicare APC Fee Schedule
UE-HAND 3V CR,73130,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,,,,804.69,,,,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,,,1609.11,1609.11,Medicare,Medicare,,1609.11,,,1609.11,1609.11,1609.11,fee schedule,Medicare APC Fee Schedule
UE-HAND 3VWS BI CR,73130,CPT,,,,,both,, ,1609.11,965.46,Medicare,Medicare,,,,,1609.11,,,,
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,,,1137.3,1137.3,Medicare,Medicare,,1137.3,,,1137.3,1137.3,1137.3,fee schedule,Medicare APC Fee Schedule
UE-FINGER 2 VW BI CR,73140,CPT,,,,,both,, ,1137.3,682.38,Medicare,Medicare,,,,,1137.3,,,,
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,,,568.64,568.64,Medicare,Medicare,,568.64,,,568.64,568.64,568.64,fee schedule,Medicare APC Fee Schedule
UE-FINGER S 2VPLS CR,73140,CPT,,,,,both,, ,568.64,341.18,Medicare,Medicare,,,,,568.64,,,,
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,,,,307.05,,,,
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,,,,330.63,,,,
CT-UPPER EXT WO,73200,CPT,,,,,both,,,3015.85,3015.85,Medicare,Medicare,,3015.85,,,3015.85,3015.85,3015.85,fee schedule,Medicare APC Fee Schedule
CT-UPPER EXT WO,73200,CPT,,,,,both,, ,3015.85,1809.51,Medicare,Medicare,,,,,3015.85,,,,
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,614.4,368.64,Medicare,Medicare,,,,,614.4,,,,
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,660.98,396.58,Medicare,Medicare,,,,,660.98,,,,
CT-UPPER EXT WO BI,73200,CPT,,,,,both,, ,6031.42,3618.85,Medicare,Medicare,,,,,6031.42,,,,
CT-UPPER EXT W,73201,CPT,,,,,both,, ,556.01,333.6,Medicare,Medicare,,,,,556.01,,,,
CT-UPPER EXT W,73201,CPT,,,,,both,,,3350.14,3350.14,Medicare,Medicare,,3350.14,,,3350.14,3350.14,3350.14,fee schedule,Medicare APC Fee Schedule
CT-UPPER EXT W,73201,CPT,,,,,both,, ,3350.14,2010.08,Medicare,Medicare,,,,,3350.14,,,,
CTA-UPPER EXT,73206,CPT,,,,,both,,,1947.6,1947.6,Medicare,Medicare,,1947.6,,,1947.6,1947.6,1947.6,fee schedule,Medicare APC Fee Schedule
CTA-UPPER EXT,73206,CPT,,,,,both,, ,1947.6,1168.56,Medicare,Medicare,,,,,1947.6,,,,
CTA-UPPER EXT BI,73206,CPT,,,,,both,, ,3895.2,2337.12,Medicare,Medicare,,,,,3895.2,,,,
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,1431.72,859.03,Medicare,Medicare,,,,,1431.72,,,,
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,1540.9,924.54,Medicare,Medicare,,,,,1540.9,,,,
MR-UPPER EXT BI WO,73218,CPT,,,,,both,, ,4042.84,2425.7,Medicare,Medicare,,,,,4042.84,,,,
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,,,,715.99,,,,
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,,,,770.45,,,,
MR-UPPER EXT WO,73218,CPT,,,,,both,,,2470.5,2470.5,Medicare,Medicare,,2470.5,,,2470.5,2470.5,2470.5,fee schedule,Medicare APC Fee Schedule
MR-UPPER EXT WO,73218,CPT,,,,,both,, ,2470.5,1482.3,Medicare,Medicare,,,,,2470.5,,,,
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,2394.15,1436.49,Medicare,Medicare,,,,,2394.15,,,,
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,2576.6,1545.96,Medicare,Medicare,,,,,2576.6,,,,
MR-UPPER EXT BI WWO,73220,CPT,,,,,both,, ,5197.81,3118.68,Medicare,Medicare,,,,,5197.81,,,,
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,,,,1197.08,,,,
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,,,,1288.29,,,,
MR-UPPER EXT WWO,73220,CPT,,,,,both,,,2598.76,2598.76,Medicare,Medicare,,2598.76,,,2598.76,2598.76,2598.76,fee schedule,Medicare APC Fee Schedule
MR-UPPER EXT WWO,73220,CPT,,,,,both,, ,2598.76,1559.25,Medicare,Medicare,,,,,2598.76,,,,
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,,,,715.99,,,,
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,,,,770.45,,,,
MR-UPPER JOINT WO,73221,CPT,,,,,both,,,2523.26,2523.26,Medicare,Medicare,,2523.26,,,2523.26,2523.26,2523.26,fee schedule,Medicare APC Fee Schedule
MR-UPPER JOINT WO,73221,CPT,,,,,both,, ,2523.26,1513.95,Medicare,Medicare,,,,,2523.26,,,,
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,,,,1035.69,,,,
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,,,,1114.55,,,,
MR-UPPER JOINT W,73222,CPT,,,,,both,,,4293.48,4293.48,Medicare,Medicare,,4293.48,,,4293.48,4293.48,4293.48,fee schedule,Medicare APC Fee Schedule
MR-UPPER JOINT W,73222,CPT,,,,,both,, ,4293.48,2576.08,Medicare,Medicare,,,,,4293.48,,,,
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,,,,1197.08,,,,
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,,,,1288.29,,,,
MR-UPPER JOINT WWO,73223,CPT,,,,,both,,,4941.28,4941.28,Medicare,Medicare,,4941.28,,,4941.28,4941.28,4941.28,fee schedule,Medicare APC Fee Schedule
MR-UPPER JOINT WWO,73223,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,,,,4941.28,,,,
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,,,333.44,333.44,Medicare,Medicare,,333.44,,,333.44,333.44,333.44,fee schedule,Medicare APC Fee Schedule
LE-HIP UNILAT 1V CR,73501,CPT,,,,,both,, ,333.44,200.06,Medicare,Medicare,,,,,333.44,,,,
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,139.77,83.86,Medicare,Medicare,,,,,139.77,,,,
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Medicare,Medicare,,,,,149.32,,,,
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Medicare,Medicare,,,,,149.32,,,,
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,149.32,89.59,Medicare,Medicare,,,,,149.32,,,,
LE-HIP PV UN2OR3V CR,73502,CPT,,,,,both,, ,887.49,532.49,Medicare,Medicare,,,,,887.49,,,,
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,209.94,125.96,Medicare,Medicare,,,,,209.94,,,,
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Medicare,Medicare,,,,,224.54,,,,
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Medicare,Medicare,,,,,224.54,,,,
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,224.54,134.72,Medicare,Medicare,,,,,224.54,,,,
LE-HIP PV UNMIN4V CR,73503,CPT,,,,,both,, ,1330.96,798.57,Medicare,Medicare,,,,,1330.96,,,,
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,,,,220.88,,,,
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.8,Medicare,Medicare,,,,,238.01,,,,
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.8,Medicare,Medicare,,,,,238.01,,,,
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,238.01,142.8,Medicare,Medicare,,,,,238.01,,,,
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,,,1774.7,1774.7,Medicare,Medicare,,1774.7,,,1774.7,1774.7,1774.7,fee schedule,Medicare APC Fee Schedule
LE-HIP PLV BI 2V CR,73521,CPT,,,,,both,, ,1774.7,1064.82,Medicare,Medicare,,,,,1774.7,,,,
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,,,,220.88,,,,
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.8,Medicare,Medicare,,,,,238.01,,,,
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.8,Medicare,Medicare,,,,,238.01,,,,
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,238.01,142.8,Medicare,Medicare,,,,,238.01,,,,
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,,,1774.7,1774.7,Medicare,Medicare,,1774.7,,,1774.7,1774.7,1774.7,fee schedule,Medicare APC Fee Schedule
LE-HIP PV BI3OR4V CR,73522,CPT,,,,,both,, ,1774.7,1064.82,Medicare,Medicare,,,,,1774.7,,,,
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,442.06,265.23,Medicare,Medicare,,,,,442.06,,,,
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Medicare,Medicare,,,,,476.02,,,,
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Medicare,Medicare,,,,,476.02,,,,
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,476.02,285.61,Medicare,Medicare,,,,,476.02,,,,
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,,,3549.69,3549.69,Medicare,Medicare,,3549.69,,,3549.69,3549.69,3549.69,fee schedule,Medicare APC Fee Schedule
LE-HIP PV BI MIN5VCR,73523,CPT,,,,,both,, ,3549.69,2129.81,Medicare,Medicare,,,,,3549.69,,,,
IR-ARTHROGRAM HIP CR,73525,CPT,,,,,both,, ,3760.2,2256.12,Medicare,Medicare,,,,,3760.2,,,,
IR-ARTHROGRAM HIP CR,73525,CPT,,,,,both,, ,3760.2,2256.12,Medicare,Medicare,,,,,3760.2,,,,
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.2,88.92,Medicare,Medicare,,,,,148.2,,,,
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.2,88.92,Medicare,Medicare,,,,,148.2,,,,
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.2,88.92,Medicare,Medicare,,,,,148.2,,,,
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,148.2,88.92,Medicare,Medicare,,,,,148.2,,,,
LE-FEMUR 1V CR,73551,CPT,,,,,both,,,307.05,307.05,Medicare,Medicare,,307.05,,,307.05,307.05,307.05,fee schedule,Medicare APC Fee Schedule
LE-FEMUR 1V CR,73551,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,,,,307.05,,,,
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-FEMUR 2V CR,73552,CPT,,,,,both,,,782.23,782.23,Medicare,Medicare,,782.23,,,782.23,782.23,782.23,fee schedule,Medicare APC Fee Schedule
LE-FEMUR 2V CR,73552,CPT,,,,,both,, ,782.23,469.33,Medicare,Medicare,,,,,782.23,,,,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,,,1564.76,1564.76,Medicare,Medicare,,1564.76,,,1564.76,1564.76,1564.76,fee schedule,Medicare APC Fee Schedule
LE-FEMUR 2VW BI CR,73552,CPT,,,,,both,, ,1564.76,938.85,Medicare,Medicare,,,,,1564.76,,,,
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,,,721.61,721.61,Medicare,Medicare,,721.61,,,721.61,721.61,721.61,fee schedule,Medicare APC Fee Schedule
LE-KNEE 1 TO 2V CR,73560,CPT,,,,,both,, ,721.61,432.96,Medicare,Medicare,,,,,721.61,,,,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,,,1442.95,1442.95,Medicare,Medicare,,1442.95,,,1442.95,1442.95,1442.95,fee schedule,Medicare APC Fee Schedule
LE-KNEE 1TO2V BI CR,73560,CPT,,,,,both,, ,1442.95,865.77,Medicare,Medicare,,,,,1442.95,,,,
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-KNEE 3V CR,73562,CPT,,,,,both,,,981.24,981.24,Medicare,Medicare,,981.24,,,981.24,981.24,981.24,fee schedule,Medicare APC Fee Schedule
LE-KNEE 3V CR,73562,CPT,,,,,both,, ,981.24,588.74,Medicare,Medicare,,,,,981.24,,,,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,,,1962.48,1962.48,Medicare,Medicare,,1962.48,,,1962.48,1962.48,1962.48,fee schedule,Medicare APC Fee Schedule
LE-KNEE 3VWS BI CR,73562,CPT,,,,,both,, ,1962.48,1177.48,Medicare,Medicare,,,,,1962.48,,,,
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,,,1070.49,1070.49,Medicare,Medicare,,1070.49,,,1070.49,1070.49,1070.49,fee schedule,Medicare APC Fee Schedule
LE-KNEE 4V PLUS CR,73564,CPT,,,,,both,, ,1070.49,642.29,Medicare,Medicare,,,,,1070.49,,,,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,,,2141.27,2141.27,Medicare,Medicare,,2141.27,,,2141.27,2141.27,2141.27,fee schedule,Medicare APC Fee Schedule
LE-KNEE 4VWPLS BI CR,73564,CPT,,,,,both,, ,2141.27,1284.76,Medicare,Medicare,,,,,2141.27,,,,
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,,,721.61,721.61,Medicare,Medicare,,721.61,,,721.61,721.61,721.61,fee schedule,Medicare APC Fee Schedule
LE-KNEE BI AP STD CR,73565,CPT,,,,,both,, ,721.61,432.96,Medicare,Medicare,,,,,721.61,,,,
IR-ARTHRGRM KNEE BI,73580,CPT,,,,,both,, ,7520.68,4512.4,Medicare,Medicare,,,,,7520.68,,,,
IR-ARTHROGRAM KNEE,73580,CPT,,,,,both,, ,3760.2,2256.12,Medicare,Medicare,,,,,3760.2,,,,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,,,1442.95,1442.95,Medicare,Medicare,,1442.95,,,1442.95,1442.95,1442.95,fee schedule,Medicare APC Fee Schedule
LE-TIB FIB 2V BI CR,73590,CPT,,,,,both,, ,1442.95,865.77,Medicare,Medicare,,,,,1442.95,,,,
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-TIB FIB 2V CR,73590,CPT,,,,,both,,,721.61,721.61,Medicare,Medicare,,721.61,,,721.61,721.61,721.61,fee schedule,Medicare APC Fee Schedule
LE-TIB FIB 2V CR,73590,CPT,,,,,both,, ,721.61,432.96,Medicare,Medicare,,,,,721.61,,,,
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,,,1442.95,1442.95,Medicare,Medicare,,1442.95,,,1442.95,1442.95,1442.95,fee schedule,Medicare APC Fee Schedule
LE-LWEXT INFNT BI CR,73592,CPT,,,,,both,, ,1442.95,865.77,Medicare,Medicare,,,,,1442.95,,,,
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,,,721.61,721.61,Medicare,Medicare,,721.61,,,721.61,721.61,721.61,fee schedule,Medicare APC Fee Schedule
LE-LWR EXT INFANT CR,73592,CPT,,,,,both,, ,721.61,432.96,Medicare,Medicare,,,,,721.61,,,,
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-ANKLE 2V CR,73600,CPT,,,,,both,,,720.49,720.49,Medicare,Medicare,,720.49,,,720.49,720.49,720.49,fee schedule,Medicare APC Fee Schedule
LE-ANKLE 2V CR,73600,CPT,,,,,both,, ,720.49,432.29,Medicare,Medicare,,,,,720.49,,,,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,,,1107.82,1107.82,Medicare,Medicare,,1107.82,,,1107.82,1107.82,1107.82,fee schedule,Medicare APC Fee Schedule
LE-ANKLE 2VW BI CR,73600,CPT,,,,,both,, ,1107.82,664.69,Medicare,Medicare,,,,,1107.82,,,,
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,,,804.69,804.69,Medicare,Medicare,,804.69,,,804.69,804.69,804.69,fee schedule,Medicare APC Fee Schedule
LE-ANKLE 3VPLUS CR,73610,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,,,,804.69,,,,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,,,1609.11,1609.11,Medicare,Medicare,,1609.11,,,1609.11,1609.11,1609.11,fee schedule,Medicare APC Fee Schedule
LE-ANKLE 3VWS BI CR,73610,CPT,,,,,both,, ,1609.11,965.46,Medicare,Medicare,,,,,1609.11,,,,
IR-ARTHROGRAM ANKLE,73615,CPT,,,,,both,, ,3760.2,2256.12,Medicare,Medicare,,,,,3760.2,,,,
IR-ARTHROGRAM ANKLE,73615,CPT,,,,,both,, ,3760.2,2256.12,Medicare,Medicare,,,,,3760.2,,,,
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-FOOT 2V CR,73620,CPT,,,,,both,,,553.77,553.77,Medicare,Medicare,,553.77,,,553.77,553.77,553.77,fee schedule,Medicare APC Fee Schedule
LE-FOOT 2V CR,73620,CPT,,,,,both,, ,553.77,332.26,Medicare,Medicare,,,,,553.77,,,,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,,,1107.82,1107.82,Medicare,Medicare,,1107.82,,,1107.82,1107.82,1107.82,fee schedule,Medicare APC Fee Schedule
LE-FOOT 2VWS BI CR,73620,CPT,,,,,both,, ,1107.82,664.69,Medicare,Medicare,,,,,1107.82,,,,
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,,,662.39,662.39,Medicare,Medicare,,662.39,,,662.39,662.39,662.39,fee schedule,Medicare APC Fee Schedule
LE-FOOT 3V PLUS CR,73630,CPT,,,,,both,, ,662.39,397.43,Medicare,Medicare,,,,,662.39,,,,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,,,1250.97,1250.97,Medicare,Medicare,,1250.97,,,1250.97,1250.97,1250.97,fee schedule,Medicare APC Fee Schedule
LE-FOOT 3VWPLS BI CR,73630,CPT,,,,,both,, ,1250.97,750.58,Medicare,Medicare,,,,,1250.97,,,,
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,,,353.93,353.93,Medicare,Medicare,,353.93,,,353.93,353.93,353.93,fee schedule,Medicare APC Fee Schedule
LE-CALCANEUS 2PLS CR,73650,CPT,,,,,both,, ,353.93,212.35,Medicare,Medicare,,,,,353.93,,,,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,,,662.39,662.39,Medicare,Medicare,,662.39,,,662.39,662.39,662.39,fee schedule,Medicare APC Fee Schedule
LE-CALCNEUS 2V BI CR,73650,CPT,,,,,both,, ,662.39,397.43,Medicare,Medicare,,,,,662.39,,,,
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,278.43,167.05,Medicare,Medicare,,,,,278.43,,,,
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,,,568.64,568.64,Medicare,Medicare,,568.64,,,568.64,568.64,568.64,fee schedule,Medicare APC Fee Schedule
LE-TOE S 2VPLUS CR,73660,CPT,,,,,both,, ,568.64,341.18,Medicare,Medicare,,,,,568.64,,,,
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,299.76,179.85,Medicare,Medicare,,,,,299.76,,,,
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,,,1137.3,1137.3,Medicare,Medicare,,1137.3,,,1137.3,1137.3,1137.3,fee schedule,Medicare APC Fee Schedule
LE-TOE S 2VWS BI CR,73660,CPT,,,,,both,, ,1137.3,682.38,Medicare,Medicare,,,,,1137.3,,,,
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,,,,307.05,,,,
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,,,,330.63,,,,
CT-LOWER EXT WO,73700,CPT,,,,,both,,,3013.04,3013.04,Medicare,Medicare,,3013.04,,,3013.04,3013.04,3013.04,fee schedule,Medicare APC Fee Schedule
CT-LOWER EXT WO,73700,CPT,,,,,both,, ,3013.04,1807.82,Medicare,Medicare,,,,,3013.04,,,,
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,614.4,368.64,Medicare,Medicare,,,,,614.4,,,,
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,660.98,396.58,Medicare,Medicare,,,,,660.98,,,,
CT-LOWER EXT WO BI,73700,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,,,,4941.28,,,,
CT-LOWER EXT W,73701,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,,,,650.88,,,,
CT-LOWER EXT W,73701,CPT,,,,,both,,,3013.04,3013.04,Medicare,Medicare,,3013.04,,,3013.04,3013.04,3013.04,fee schedule,Medicare APC Fee Schedule
CT-LOWER EXT W,73701,CPT,,,,,both,, ,3013.04,1807.82,Medicare,Medicare,,,,,3013.04,,,,
CT-LOWER EXT W BI,73701,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,,,,604.85,,,,
CT-LOWER EXT W BI,73701,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,,,,604.85,,,,
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,,,,680.91,,,,
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,,,,732.83,,,,
CT-LOWER EXT WWO,73702,CPT,,,,,both,,,3013.04,3013.04,Medicare,Medicare,,3013.04,,,3013.04,3013.04,3013.04,fee schedule,Medicare APC Fee Schedule
CT-LOWER EXT WWO,73702,CPT,,,,,both,, ,3013.04,1807.82,Medicare,Medicare,,,,,3013.04,,,,
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,1361.84,817.1,Medicare,Medicare,,,,,1361.84,,,,
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,1465.68,879.4,Medicare,Medicare,,,,,1465.68,,,,
CT-LOWER EXT WWO BI,73702,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,,,,4941.28,,,,
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,,,,715.99,,,,
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,,,,715.99,,,,
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,1540.9,924.54,Medicare,Medicare,,,,,1540.9,,,,
MR-LOWER EXTR BI WO,73718,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,,,,4941.28,,,,
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,,,,770.45,,,,
MR-LOWER EXTR WO,73718,CPT,,,,,both,,,2470.5,2470.5,Medicare,Medicare,,2470.5,,,2470.5,2470.5,2470.5,fee schedule,Medicare APC Fee Schedule
MR-LOWER EXTR WO,73718,CPT,,,,,both,, ,2470.5,1482.3,Medicare,Medicare,,,,,2470.5,,,,
MR-LOWER EXTR W,73719,CPT,,,,,both,,,832.76,832.76,Medicare,Medicare,,832.76,,,832.76,832.76,832.76,fee schedule,Medicare APC Fee Schedule
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,832.76,499.65,Medicare,Medicare,,,,,832.76,,,,
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,,,,1035.69,,,,
MR-LOWER EXTR W,73719,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,,,,1114.55,,,,
MR-LOWER EXTR BI WWO,73720,CPT,,,,,both,, ,2394.15,1436.49,Medicare,Medicare,,,,,2394.15,,,,
MR-LOWER EXTR BI WWO,73720,CPT,,,,,both,, ,2576.6,1545.96,Medicare,Medicare,,,,,2576.6,,,,
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,,,,1197.08,,,,
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,,,,1288.29,,,,
MR-LOWER EXTR WWO,73720,CPT,,,,,both,,,3084.06,3084.06,Medicare,Medicare,,3084.06,,,3084.06,3084.06,3084.06,fee schedule,Medicare APC Fee Schedule
MR-LOWER EXTR WWO,73720,CPT,,,,,both,, ,3084.06,1850.43,Medicare,Medicare,,,,,3084.06,,,,
MRI scan of leg joint,73721,CPT,,,,,both,,,4941.28,4941.28,Medicare,Medicare,,224.26,,,4941.28,4941.28,4941.28,fee schedule,Medicare APC Fee Schedule
MR-LW JOINT WO,73721,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,,,,715.99,,,,
MR-LW JOINT WO,73721,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,,,,770.45,,,,
MR-LW JOINT WO,73721,CPT,,,,,both,, ,4941.28,2964.76,Medicare,Medicare,,,,,4941.28,,,,
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,1431.72,859.03,Medicare,Medicare,,,,,1431.72,,,,
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,1540.9,924.54,Medicare,Medicare,,,,,1540.9,,,,
MR-LW JOINT WO BI,73721,CPT,,,,,both,, ,9881.44,5928.86,Medicare,Medicare,,,,,9881.44,,,,
MR-LW JOINT W,73722,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,,,,1035.69,,,,
MR-LW JOINT W,73722,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,,,,1114.55,,,,
MR-LW JOINT W,73722,CPT,,,,,both,,,4293.48,4293.48,Medicare,Medicare,,4293.48,,,4293.48,4293.48,4293.48,fee schedule,Medicare APC Fee Schedule
MR-LW JOINT W,73722,CPT,,,,,both,, ,4293.48,2576.08,Medicare,Medicare,,,,,4293.48,,,,
MR-LW JOINT W BI,73722,CPT,,,,,both,, ,7641.1,4584.66,Medicare,Medicare,,,,,7641.1,,,,
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,,,,1197.08,,,,
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,,,,1288.29,,,,
MR-LW JOINT WWO,73723,CPT,,,,,both,,,5197.81,5197.81,Medicare,Medicare,,5197.81,,,5197.81,5197.81,5197.81,fee schedule,Medicare APC Fee Schedule
MR-LW JOINT WWO,73723,CPT,,,,,both,, ,5197.81,3118.68,Medicare,Medicare,,,,,5197.81,,,,
MR-LW JOINT WWO BI,73723,CPT,,,,,both,, ,10395.64,6237.38,Medicare,Medicare,,,,,10395.64,,,,
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,,,694.38,694.38,Medicare,Medicare,,694.38,,,694.38,694.38,694.38,fee schedule,Medicare APC Fee Schedule
CH-ABDOMEN 1 VIEW CR,74018,CPT,,,,,both,, ,694.38,416.62,Medicare,Medicare,,,,,694.38,,,,
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,,,1144.03,1144.03,Medicare,Medicare,,1144.03,,,1144.03,1144.03,1144.03,fee schedule,Medicare APC Fee Schedule
CH-ABDOMEN 2 VWS CR,74019,CPT,,,,,both,, ,1144.03,686.41,Medicare,Medicare,,,,,1144.03,,,,
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,,,868.4,868.4,Medicare,Medicare,,868.4,,,868.4,868.4,868.4,fee schedule,Medicare APC Fee Schedule
CH-ABDOMEN 3VWS CR,74021,CPT,,,,,both,, ,868.4,521.04,Medicare,Medicare,,,,,868.4,,,,
CH-ABD SER PA CXR CR,74022,CPT,,,,,both,,,970.85,970.85,Medicare,Medicare,,970.85,,,970.85,970.85,970.85,fee schedule,Medicare APC Fee Schedule
CH-ABD SER PA CXR CR,74022,CPT,,,,,both,, ,970.85,582.51,Medicare,Medicare,,,,,970.85,,,,
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,307.05,184.23,Medicare,Medicare,,,,,307.05,,,,
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,330.63,198.37,Medicare,Medicare,,,,,330.63,,,,
CT-ABDOMEN WO,74150,CPT,,,,,both,,,3285.58,3285.58,Medicare,Medicare,,3285.58,,,3285.58,3285.58,3285.58,fee schedule,Medicare APC Fee Schedule
CT-ABDOMEN WO,74150,CPT,,,,,both,, ,3285.58,1971.34,Medicare,Medicare,,,,,3285.58,,,,
CT-ABDOMEN W,74160,CPT,,,,,both,, ,604.85,362.91,Medicare,Medicare,,,,,604.85,,,,
CT-ABDOMEN W,74160,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,,,,650.88,,,,
CT-ABDOMEN W,74160,CPT,,,,,both,,,3726.8,3726.8,Medicare,Medicare,,3726.8,,,3726.8,3726.8,3726.8,fee schedule,Medicare APC Fee Schedule
CT-ABDOMEN W,74160,CPT,,,,,both,, ,3726.8,2236.08,Medicare,Medicare,,,,,3726.8,,,,
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,680.91,408.54,Medicare,Medicare,,,,,680.91,,,,
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,732.83,439.69,Medicare,Medicare,,,,,732.83,,,,
CT-ABDOMEN WWO,74170,CPT,,,,,both,,,4317.62,4317.62,Medicare,Medicare,,4317.62,,,4317.62,4317.62,4317.62,fee schedule,Medicare APC Fee Schedule
CT-ABDOMEN WWO,74170,CPT,,,,,both,, ,4317.62,2590.57,Medicare,Medicare,,,,,4317.62,,,,
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,893.1,535.86,Medicare,Medicare,,,,,893.1,,,,
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,893.1,535.86,Medicare,Medicare,,,,,893.1,,,,
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,,,1894.27,1894.27,Medicare,Medicare,,1894.27,,,1894.27,1894.27,1894.27,fee schedule,Medicare APC Fee Schedule
CTA-ABDOMEN PELVIS,74174,CPT,,,,,both,, ,1894.27,1136.56,Medicare,Medicare,,,,,1894.27,,,,
CTA-ABDOMEN,74175,CPT,,,,,both,, ,893.1,535.86,Medicare,Medicare,,,,,893.1,,,,
CTA-ABDOMEN,74175,CPT,,,,,both,,,1894.27,1894.27,Medicare,Medicare,,1894.27,,,1894.27,1894.27,1894.27,fee schedule,Medicare APC Fee Schedule
CTA-ABDOMEN,74175,CPT,,,,,both,, ,1894.27,1136.56,Medicare,Medicare,,,,,1894.27,,,,
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,587.17,352.3,Medicare,Medicare,,,,,587.17,,,,
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,632.08,379.24,Medicare,Medicare,,,,,632.08,,,,
CT-ABD PELVIS WO,74176,CPT,,,,,both,,,6571.44,6571.44,Medicare,Medicare,,6571.44,,,6571.44,6571.44,6571.44,fee schedule,Medicare APC Fee Schedule
CT-ABD PELVIS WO,74176,CPT,,,,,both,, ,6571.44,3942.86,Medicare,Medicare,,,,,6571.44,,,,
CT scan of abdomen and pelvis with contrast,74177,CPT,,,,,both,,,7453.61,7453.61,Medicare,Medicare,,353.82,,,7453.61,7453.61,7453.61,fee schedule,Medicare APC Fee Schedule
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,947.56,568.53,Medicare,Medicare,,,,,947.56,,,,
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,1019.69,611.81,Medicare,Medicare,,,,,1019.69,,,,
CT-ABD PELVIS W,74177,CPT,,,,,both,, ,7453.61,4472.16,Medicare,Medicare,,,,,7453.61,,,,
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,947.56,568.53,Medicare,Medicare,,,,,947.56,,,,
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,1019.69,611.81,Medicare,Medicare,,,,,1019.69,,,,
CT-ABD PELVIS WWO,74178,CPT,,,,,both,,,8364.95,8364.95,Medicare,Medicare,,8364.95,,,8364.95,8364.95,8364.95,fee schedule,Medicare APC Fee Schedule
CT-ABD PELVIS WWO,74178,CPT,,,,,both,, ,8364.95,5018.97,Medicare,Medicare,,,,,8364.95,,,,
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,715.99,429.59,Medicare,Medicare,,,,,715.99,,,,
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,,,,770.45,,,,
MR-ABDOMEN WO,74181,CPT,,,,,both,,,4042.84,4042.84,Medicare,Medicare,,4042.84,,,4042.84,4042.84,4042.84,fee schedule,Medicare APC Fee Schedule
MR-ABDOMEN WO,74181,CPT,,,,,both,, ,4042.84,2425.7,Medicare,Medicare,,,,,4042.84,,,,
MR-ABDOMEN W,74182,CPT,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,,,,1035.69,,,,
MR-ABDOMEN W,74182,CPT,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,,,,1114.55,,,,
MR-ABDOMEN W,74182,CPT,,,,,both,,,4293.48,4293.48,Medicare,Medicare,,4293.48,,,4293.48,4293.48,4293.48,fee schedule,Medicare APC Fee Schedule
MR-ABDOMEN W,74182,CPT,,,,,both,, ,4293.48,2576.08,Medicare,Medicare,,,,,4293.48,,,,
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,,,,1197.08,,,,
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,,,,1288.29,,,,
MR-ABDOMEN WWO,74183,CPT,,,,,both,,,5197.81,5197.81,Medicare,Medicare,,5197.81,,,5197.81,5197.81,5197.81,fee schedule,Medicare APC Fee Schedule
MR-ABDOMEN WWO,74183,CPT,,,,,both,, ,5197.81,3118.68,Medicare,Medicare,,,,,5197.81,,,,
FL-ESOPHAGUS,74220,CPT,,,,,both,, ,1227.11,736.26,Medicare,Medicare,,,,,1227.11,,,,
FL-MOD BA SWALLOW,74230,CPT,,,,,both,, ,391.26,234.75,Medicare,Medicare,,,,,391.26,,,,
FL-GI SERIES,74240,CPT,,,,,both,, ,1557.58,934.54,Medicare,Medicare,,,,,1557.58,,,,
FL-UPPER GI SINGLE,74240,CPT,,,,,both,, ,1818.77,1091.26,Medicare,Medicare,,,,,1818.77,,,,
FL-GI SERIES AIR,74246,CPT,,,,,both,, ,1500.93,900.55,Medicare,Medicare,,,,,1500.93,,,,
FL-UPPER GI DOUBLE,74246,CPT,,,,,both,, ,1752.53,1051.51,Medicare,Medicare,,,,,1752.53,,,,
FL-LOWER GI FOLLOW,74248,CPT,,,,,both,, ,3343.68,2006.2,Medicare,Medicare,,,,,3343.68,,,,
FL-SMALL BOWEL CR,74250,CPT,,,,,both,, ,2123.58,1274.14,Medicare,Medicare,,,,,2123.58,,,,
FL-SM BWL ENT TBE CR,74251,CPT,,,,,both,, ,2123.58,1274.14,Medicare,Medicare,,,,,2123.58,,,,
FL-BARIUM ENEMA,74270,CPT,,,,,both,, ,1890.9,1134.54,Medicare,Medicare,,,,,1890.9,,,,
FL-BARIUM ENEMA AIR,74280,CPT,,,,,both,, ,2333.25,1399.95,Medicare,Medicare,,,,,2333.25,,,,
SU-CHOLE W GRAMS DR,74300,CPT,,,,,both,, ,1968.65,1181.19,Medicare,Medicare,,,,,1968.65,,,,
FL-ENDO BILIARY,74328,CPT,,,,,both,, ,3722.58,2233.54,Medicare,Medicare,,,,,3722.58,,,,
FL-ENDO PANCREATIC,74329,CPT,,,,,both,, ,1034.01,620.4,Medicare,Medicare,,,,,1034.01,,,,
FL-ENDO BIL PANC,74330,CPT,,,,,both,, ,1304.29,782.57,Medicare,Medicare,,,,,1304.29,,,,
FL-LONG GI TUBE PLC,74340,CPT,,,,,both,, ,1359.02,815.41,Medicare,Medicare,,,,,1359.02,,,,
FL-ENTEROCLYSIS PLAC,74355,CPT,,,,,both,, ,932.4,559.44,Medicare,Medicare,,,,,932.4,,,,
FL-IVP CR,74400,CPT,,,,,both,, ,1836.17,1101.7,Medicare,Medicare,,,,,1836.17,,,,
FL-UROGRAPH RETRO CR,74420,CPT,,,,,both,, ,2105.34,1263.2,Medicare,Medicare,,,,,2105.34,,,,
FL-UROGRAPHY ANTE CR,74425,CPT,,,,,both,, ,2165.12,1299.07,Medicare,Medicare,,,,,2165.12,,,,
FL-CYSTOGRM 3VPLS CR,74430,CPT,,,,,both,, ,1407.87,844.72,Medicare,Medicare,,,,,1407.87,,,,
FL-CAVERNOSOGRAPH CR,74445,CPT,,,,,both,, ,698.32,418.99,Medicare,Medicare,,,,,698.32,,,,
FL-UCG RETRO CR,74450,CPT,,,,,both,, ,1357.62,814.57,Medicare,Medicare,,,,,1357.62,,,,
FL-UCG VOIDING,74455,CPT,,,,,both,, ,1357.62,814.57,Medicare,Medicare,,,,,1357.62,,,,
FL-UCG VOIDING CR,74455,CPT,,,,,both,, ,1162.77,697.66,Medicare,Medicare,,,,,1162.77,,,,
IR-DILATION GU,74485,CPT,,,,,both,, ,976.75,586.05,Medicare,Medicare,,,,,976.75,,,,
IR-HYSTERSALPINGO CR,74740,CPT,,,,,both,,,1704.21,1704.21,Medicare,Medicare,,1704.21,,,1704.21,1704.21,1704.21,fee schedule,Medicare APC Fee Schedule
IR-HYSTERSALPINGO CR,74740,CPT,,,,,both,, ,1704.21,1022.52,Medicare,Medicare,,,,,1704.21,,,,
IR-HYSTERSALPINGOGRM,74740,CPT,,,,,both,,,1989.98,1989.98,Medicare,Medicare,,1989.98,,,1989.98,1989.98,1989.98,fee schedule,Medicare APC Fee Schedule
IR-HYSTERSALPINGOGRM,74740,CPT,,,,,both,, ,1989.98,1193.98,Medicare,Medicare,,,,,1989.98,,,,
IR-PERINEOGRAM CR,74775,CPT,,,,,both,, ,1991.67,1195,Medicare,Medicare,,,,,1991.67,,,,
CT-HT ACC LV RV W,75573,CPT,,,,,both,, ,580.15,348.09,Medicare,Medicare,,,,,580.15,,,,
CT-HT ACC LV RV W,75573,CPT,,,,,both,, ,1696.4,1017.84,Medicare,Medicare,,,,,1696.4,,,,
CT-HT CARD FUNC W,75574,CPT,,,,,both,, ,580.15,348.09,Medicare,Medicare,,,,,580.15,,,,
CT-HT CARD FUNC W,75574,CPT,,,,,both,, ,1696.4,1017.84,Medicare,Medicare,,,,,1696.4,,,,
CATH-ABD AORTA SERIAL,75625,CPT,,,,,both,, ,8483,5089.8,Medicare,Medicare,,,,,8483,,,,
IR-ABD AORTA SERIAL,75625,CPT,,,,,both,, ,9523.86,5714.31,Medicare,Medicare,,,,,9523.86,,,,
CATH-AABF SERIAL     ,75630,CPT,,,,,both,, ,11199.75,6719.85,Medicare,Medicare,,,,,11199.75,,,,
IR-AABF SERIAL,75630,CPT,,,,,both,, ,12573.95,7544.37,Medicare,Medicare,,,,,12573.95,,,,
CTA-ABD ART W RUNOFF,75635,CPT,,,,,both,, ,650.88,390.52,Medicare,Medicare,,,,,650.88,,,,
CTA-ABD ART W RUNOFF,75635,CPT,,,,,both,, ,2355.42,1413.25,Medicare,Medicare,,,,,2355.42,,,,
CATH-ANGIO EXTREM UNI,75710,CPT,,,,,both,, ,7520.75,4512.45,Medicare,Medicare,,,,,7520.75,,,,
IR-ANGIO EXTREM UNI,75710,CPT,,,,,both,, ,8443.54,5066.12,Medicare,Medicare,,,,,8443.54,,,,
CATH-ANGIO EXTREM BI ,75716,CPT,,,,,both,, ,7520.75,4512.45,Medicare,Medicare,,,,,7520.75,,,,
IR-ANGIO EXTREM BI,75716,CPT,,,,,both,, ,8423.33,5053.99,Medicare,Medicare,,,,,8423.33,,,,
IR-ANGIO VISCERAL SE,75726,CPT,,,,,both,, ,13364.62,8018.77,Medicare,Medicare,,,,,13364.62,,,,
IR-ANG PULMONARY UNI,75741,CPT,,,,,both,, ,4237.35,2542.41,Medicare,Medicare,,,,,4237.35,,,,
IR-ANG PULMONARY BI,75743,CPT,,,,,both,, ,12357.84,7414.7,Medicare,Medicare,,,,,12357.84,,,,
IR-SHUNTOGRAM,75809,CPT,,,,,both,, ,386.21,231.72,Medicare,Medicare,,,,,386.21,,,,
CATH-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,7641.75,4585.05,Medicare,Medicare,,,,,7641.75,,,,
IR-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,8579.39,5147.63,Medicare,Medicare,,,,,8579.39,,,,
IR-VENOGRAM EXT UNI,75820,CPT,,,,,both,, ,8579.39,5147.63,Medicare,Medicare,,,,,8579.39,,,,
CATH-VENOGRAM EXT BI ,75822,CPT,,,,,both,, ,3510,2106,Medicare,Medicare,,,,,3510,,,,
IR-VENOGRAM EXT BI,75822,CPT,,,,,both,, ,3940.68,2364.4,Medicare,Medicare,,,,,3940.68,,,,
IR-VENACAVAGRAM INF,75825,CPT,,,,,both,, ,8923.22,5353.93,Medicare,Medicare,,,,,8923.22,,,,
IR-VENOUS SAMPL CATH,75893,CPT,,,,,both,, ,3915.41,2349.24,Medicare,Medicare,,,,,3915.41,,,,
IR-ANGIO EXIST CATH,75898,CPT,,,,,both,, ,513.35,308.01,Medicare,Medicare,,,,,513.35,,,,
IR-DRAIN TUBE CHANGE,75984,CPT,,,,,both,, ,2098.33,1258.99,Medicare,Medicare,,,,,2098.33,,,,
CT-ABSC DRN CATH PLA,75989,CPT,,,,,both,, ,2649.01,1589.4,Medicare,Medicare,,,,,2649.01,,,,
US-ABSC DRN CATH PLA,75989,CPT,,,,,both,, ,1120.45,672.27,Medicare,Medicare,,,,,1120.45,,,,
FL-FLUORO 1 HOUR,76000,CPT,,,,,both,, ,553.77,332.26,Medicare,Medicare,,,,,553.77,,,,
FL-FLUORO 1 HOUR CR,76000,CPT,,,,,both,, ,474.31,284.58,Medicare,Medicare,,,,,474.31,,,,
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
CH-BABYGRAM FB CR,76010,CPT,,,,,both,, ,756.41,453.84,Medicare,Medicare,,,,,756.41,,,,
IR-FISTULOGRAM CR,76080,CPT,,,,,both,, ,758.66,455.19,Medicare,Medicare,,,,,758.66,,,,
EXAM SURG SPECMN CR,76098,CPT,,,,,both,, ,1190.34,714.2,Medicare,Medicare,,,,,1190.34,,,,
TOMOGRAM ONE PLNE CR,76100,CPT,,,,,both,, ,2030.12,1218.07,Medicare,Medicare,,,,,2030.12,,,,
CT-3D W POSTPROCESS,76377,CPT,,,,,both,, ,528.5,317.1,Medicare,Medicare,,,,,528.5,,,,
CT-3D W POSTPROCESS,76377,CPT,,,,,both,, ,536.93,322.15,Medicare,Medicare,,,,,536.93,,,,
MR-3D W POSTPROCESS,76377,CPT,,,,,both,, ,491.18,294.7,Medicare,Medicare,,,,,491.18,,,,
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,193.1,115.86,Medicare,Medicare,,,,,193.1,,,,
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,207.98,124.78,Medicare,Medicare,,,,,207.98,,,,
CT-LIMITED FOLLOW UP,76380,CPT,,,,,both,, ,724.14,434.48,Medicare,Medicare,,,,,724.14,,,,
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,,,2030.68,2030.68,Medicare,Medicare,,2030.68,,,2030.68,2030.68,2030.68,fee schedule,Medicare APC Fee Schedule
US-HEAD NECK SFT TIS,76536,CPT,,,,,both,, ,2030.68,1218.4,Medicare,Medicare,,,,,2030.68,,,,
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-CHEST MEDIASTINUM,76604,CPT,,,,,both,, ,1602.93,961.75,Medicare,Medicare,,,,,1602.93,,,,
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,218.64,131.18,Medicare,Medicare,,,,,218.64,,,,
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,218.64,131.18,Medicare,Medicare,,,,,218.64,,,,
US-BREAST COMPLETE,76641,CPT,,,,,both,, ,1680.12,1008.07,Medicare,Medicare,,,,,1680.12,,,,
US-BREAST LIMITED,76642,CPT,,,,,both,, ,218.64,131.18,Medicare,Medicare,,,,,218.64,,,,
US-BREAST LIMITED,76642,CPT,,,,,both,, ,218.64,131.18,Medicare,Medicare,,,,,218.64,,,,
US-BREAST LIMITED,76642,CPT,,,,,both,,,1680.12,1680.12,Medicare,Medicare,,1680.12,,,1680.12,1680.12,1680.12,fee schedule,Medicare APC Fee Schedule
US-BREAST LIMITED,76642,CPT,,,,,both,, ,1680.12,1008.07,Medicare,Medicare,,,,,1680.12,,,,
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,437.29,262.37,Medicare,Medicare,,,,,437.29,,,,
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,437.29,262.37,Medicare,Medicare,,,,,437.29,,,,
US-BREAST LIMITED BI,76642,CPT,,,,,both,, ,3359.95,2015.97,Medicare,Medicare,,,,,3359.95,,,,
Ultrasound of abdomen,76700,CPT,,,,,both,,,2330.73,2330.73,Medicare,Medicare,,102.64,,,2330.73,2330.73,2330.73,fee schedule,Medicare APC Fee Schedule
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-ABDOMEN COMP WO,76700,CPT,,,,,both,, ,2330.73,1398.43,Medicare,Medicare,,,,,2330.73,,,,
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-ABDOMEN LTD WO,76705,CPT,,,,,both,,,1908.87,1908.87,Medicare,Medicare,,1908.87,,,1908.87,1908.87,1908.87,fee schedule,Medicare APC Fee Schedule
US-ABDOMEN LTD WO,76705,CPT,,,,,both,, ,1908.87,1145.32,Medicare,Medicare,,,,,1908.87,,,,
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-ABDOMEN RETROPER,76770,CPT,,,,,both,,,2030.68,2030.68,Medicare,Medicare,,2030.68,,,2030.68,2030.68,2030.68,fee schedule,Medicare APC Fee Schedule
US-ABDOMEN RETROPER,76770,CPT,,,,,both,, ,2030.68,1218.4,Medicare,Medicare,,,,,2030.68,,,,
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,,,1965,1965,Medicare,Medicare,,1965,,,1965,1965,1965,fee schedule,Medicare APC Fee Schedule
US-ABDOMEN RETRO LMT,76775,CPT,,,,,both,, ,1965,1179,Medicare,Medicare,,,,,1965,,,,
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-PELV PREG 14 WKS,76801,CPT,,,,,both,,,813.67,813.67,Medicare,Medicare,,813.67,,,813.67,813.67,813.67,fee schedule,Medicare APC Fee Schedule
US-PELV PREG 14 WKS,76801,CPT,,,,,both,, ,813.67,488.2,Medicare,Medicare,,,,,813.67,,,,
US-PLV PRG 14 WKS AD,76802,CPT,,,,,both,, ,329.51,197.7,Medicare,Medicare,,,,,329.51,,,,
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,76805,CPT,,,,,both,,,1931.6,1931.6,Medicare,Medicare,,102.64,,,1931.6,1931.6,1931.6,fee schedule,Medicare APC Fee Schedule
US-PELVIS PREG,76805,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
US-PELVIS PREG,76805,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-PELVIS PREG,76805,CPT,,,,,both,, ,1931.6,1158.96,Medicare,Medicare,,,,,1931.6,,,,
US-PELVS PREG GESADD,76810,CPT,,,,,both,, ,329.51,197.7,Medicare,Medicare,,,,,329.51,,,,
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,577,346.2,Medicare,Medicare,,,,,577,,,,
US-PELVIS PREG LTD,76815,CPT,,,,,both,, ,647.8,388.68,Medicare,Medicare,,,,,647.8,,,,
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,218.64,131.18,Medicare,Medicare,,,,,218.64,,,,
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,235.48,141.28,Medicare,Medicare,,,,,235.48,,,,
US-PLV PREG FU ABD,76816,CPT,,,,,both,, ,647.8,388.68,Medicare,Medicare,,,,,647.8,,,,
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-PLV PRG TRNSV,76817,CPT,,,,,both,,,655.09,655.09,Medicare,Medicare,,655.09,,,655.09,655.09,655.09,fee schedule,Medicare APC Fee Schedule
US-PLV PRG TRNSV,76817,CPT,,,,,both,, ,655.09,393.05,Medicare,Medicare,,,,,655.09,,,,
US-FETAL BIO W NST,76818,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-FETAL BIO W NST,76818,CPT,,,,,both,, ,1198.2,718.92,Medicare,Medicare,,,,,1198.2,,,,
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-FETAL BIO NONST,76819,CPT,,,,,both,, ,793.18,475.9,Medicare,Medicare,,,,,793.18,,,,
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,218.64,131.18,Medicare,Medicare,,,,,218.64,,,,
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,235.48,141.28,Medicare,Medicare,,,,,235.48,,,,
US-UMBIL ARTER ECHO,76820,CPT,,,,,both,, ,780.55,468.33,Medicare,Medicare,,,,,780.55,,,,
Ultrasound pelvis through vagina,76830,CPT,,,,,both,,,689.62,689.62,Medicare,Medicare,,102.64,,,689.62,689.62,689.62,fee schedule,Medicare APC Fee Schedule
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-TRANSVAGINAL,76830,CPT,,,,,both,, ,689.62,413.77,Medicare,Medicare,,,,,689.62,,,,
US-PELVIS NON OB,76856,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
US-PELVIS NON OB,76856,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-PELVIS NON OB,76856,CPT,,,,,both,,,1931.6,1931.6,Medicare,Medicare,,1931.6,,,1931.6,1931.6,1931.6,fee schedule,Medicare APC Fee Schedule
US-PELVIS NON OB,76856,CPT,,,,,both,, ,1931.6,1158.96,Medicare,Medicare,,,,,1931.6,,,,
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,209.94,125.96,Medicare,Medicare,,,,,209.94,,,,
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,209.94,125.96,Medicare,Medicare,,,,,209.94,,,,
US-PELVIS NON OB FU,76857,CPT,,,,,both,, ,437.29,262.37,Medicare,Medicare,,,,,437.29,,,,
US-SCROTUM,76870,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
US-SCROTUM,76870,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-SCROTUM,76870,CPT,,,,,both,,,2005.7,2005.7,Medicare,Medicare,,2005.7,,,2005.7,2005.7,2005.7,fee schedule,Medicare APC Fee Schedule
US-SCROTUM,76870,CPT,,,,,both,, ,2005.7,1203.42,Medicare,Medicare,,,,,2005.7,,,,
US-TRANSRECTAL,76872,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
US-TRANSRECTAL,76872,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-TRANSRECTAL,76872,CPT,,,,,both,, ,1300.09,780.05,Medicare,Medicare,,,,,1300.09,,,,
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
US-EXT COMP JNT UNI,76881,CPT,,,,,both,, ,378.35,227.01,Medicare,Medicare,,,,,378.35,,,,
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,189.17,113.5,Medicare,Medicare,,,,,189.17,,,,
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,218.64,131.18,Medicare,Medicare,,,,,218.64,,,,
US-EXT LTD JNT UNI,76882,CPT,,,,,both,, ,235.48,141.28,Medicare,Medicare,,,,,235.48,,,,
NI-VAS ACCSS SITES,76937,CPT,,,,,both,, ,797.67,478.6,Medicare,Medicare,,,,,797.67,,,,
NI-VAS ACCSS SITES ,76937,CPT,,,,,both,, ,710.5,426.3,Medicare,Medicare,,,,,710.5,,,,
US-GUIDE NEEDLE PLAC,76942,CPT,,,,,both,, ,2221.26,1332.75,Medicare,Medicare,,,,,2221.26,,,,
US-GUIDE AMNIOCENT,76946,CPT,,,,,both,, ,2221.26,1332.75,Medicare,Medicare,,,,,2221.26,,,,
US-GUIDE INTRAOPERAT,76998,CPT,,,,,both,, ,604.57,362.74,Medicare,Medicare,,,,,604.57,,,,
FL-FLUORO CVAD ANY,77001,CPT,,,,,both,, ,1968.65,1181.19,Medicare,Medicare,,,,,1968.65,,,,
FL-NEDL GUIDE FLUORO,77002,CPT,,,,,both,, ,521.21,312.72,Medicare,Medicare,,,,,521.21,,,,
FL-FLUORO GUIDE SPIN,77003,CPT,,,,,both,, ,553.77,332.26,Medicare,Medicare,,,,,553.77,,,,
CT-GUIDE NEEDLE BX,77012,CPT,,,,,both,, ,2649.01,1589.4,Medicare,Medicare,,,,,2649.01,,,,
CT-GUIDE TISSUE ABLA,77013,CPT,,,,,both,, ,3157.31,1894.38,Medicare,Medicare,,,,,3157.31,,,,
MR-BREAST UNI WO,77046,CPT,,,,,both,, ,674.73,404.83,Medicare,Medicare,,,,,674.73,,,,
MR-BREAST BIL WO,77047,CPT,,,,,both,, ,674.73,404.83,Medicare,Medicare,,,,,674.73,,,,
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,772.13,463.27,Medicare,Medicare,,,,,772.13,,,,
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,830.8,498.48,Medicare,Medicare,,,,,830.8,,,,
BR-DUCT GALGRM SING,77053,CPT,,,,,both,, ,1469.05,881.43,Medicare,Medicare,,,,,1469.05,,,,
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,772.13,463.27,Medicare,Medicare,,,,,772.13,,,,
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,830.8,498.48,Medicare,Medicare,,,,,830.8,,,,
BR-DUCT GALGRM MULT,77054,CPT,,,,,both,, ,1889.78,1133.86,Medicare,Medicare,,,,,1889.78,,,,
BR-TOMO MAMM SCR BI,77063,CPT,,,,,both,,,107.12,107.12,Medicare,Medicare,,107.12,,,107.12,107.12,107.12,fee schedule,Medicare APC Fee Schedule
BR-TOMO MAMM SCR BI,77063,CPT,,,,,both,, ,107.12,64.27,Medicare,Medicare,,,,,107.12,,,,
BR-TOMO MAMM SCR UNI,77063,CPT,,,,,both,, ,80.34,48.2,Medicare,Medicare,,,,,80.34,,,,
BR-TOMOSYN SCR AD BI,77063,CPT,,,,,both,, ,100,60,Medicare,Medicare,,,,,100,,,,
BR-DIG MAMMO UNI GG,77065,CPT,,,,,both,, ,411.49,246.89,Medicare,Medicare,,,,,411.49,,,,
BR-DIG MAMMO UNI GG,77065,CPT,,,,,both,, ,411.49,246.89,Medicare,Medicare,,,,,411.49,,,,
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,439.55,263.73,Medicare,Medicare,,,,,439.55,,,,
BR-DIG MAMMO UNILAT,77065,CPT,,,,,both,, ,448.82,269.29,Medicare,Medicare,,,,,448.82,,,,
Mammography of one breast,77065,CPT,,,,,both,,,448.82,448.82,Medicare,Medicare,,,,,448.82,448.82,448.82,fee schedule,Medicare APC Fee Schedule
BR-DIG MAMMO BI GG,77066,CPT,,,,,both,, ,411.49,246.89,Medicare,Medicare,,,,,411.49,,,,
BR-DIG MAMMO BI GG,77066,CPT,,,,,both,, ,411.49,246.89,Medicare,Medicare,,,,,411.49,,,,
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,439.55,263.73,Medicare,Medicare,,,,,439.55,,,,
BR-DIG MAMMO BILAT,77066,CPT,,,,,both,, ,556.97,334.18,Medicare,Medicare,,,,,556.97,,,,
Mammography of both breasts,77066,CPT,,,,,both,,,556.97,556.97,Medicare,Medicare,,,,,556.97,556.97,556.97,fee schedule,Medicare APC Fee Schedule
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,368.23,220.93,Medicare,Medicare,,,,,368.23,,,,
BR-DIG MAMMO SCRN BI,77067,CPT,,,,,both,, ,488.99,293.39,Medicare,Medicare,,,,,488.99,,,,
BR-DIG MAMMO SCRN UN,77067,CPT,,,,,both,, ,345.31,207.18,Medicare,Medicare,,,,,345.31,,,,
BR-DIG MAMMO SCRN UN,77067,CPT,,,,,both,, ,345.31,207.18,Medicare,Medicare,,,,,345.31,,,,
BR-DIG MAMMO SCRN UN,77067,CPT,,,,,both,, ,366.68,220,Medicare,Medicare,,,,,366.68,,,,
"Mammography, screening, bilateral",77067,CPT,,,,,both,,,488.99,488.99,Medicare,Medicare,,,,,488.99,488.99,488.99,fee schedule,Medicare APC Fee Schedule
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
BONE AGE STUDY CR,77072,CPT,,,,,both,,,721.61,721.61,Medicare,Medicare,,721.61,,,721.61,721.61,721.61,fee schedule,Medicare APC Fee Schedule
BONE AGE STUDY CR,77072,CPT,,,,,both,, ,721.61,432.96,Medicare,Medicare,,,,,721.61,,,,
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
BONE LENGTH STUDY CR,77073,CPT,,,,,both,,,1904.1,1904.1,Medicare,Medicare,,1904.1,,,1904.1,1904.1,1904.1,fee schedule,Medicare APC Fee Schedule
BONE LENGTH STUDY CR,77073,CPT,,,,,both,, ,1904.1,1142.46,Medicare,Medicare,,,,,1904.1,,,,
BNE SRVY LTD METS CR,77074,CPT,,,,,both,,,523.46,523.46,Medicare,Medicare,,523.46,,,523.46,523.46,523.46,fee schedule,Medicare APC Fee Schedule
BNE SRVY LTD METS CR,77074,CPT,,,,,both,, ,523.46,314.07,Medicare,Medicare,,,,,523.46,,,,
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,,,,220.61,,,,
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
BNE SRVY CMP METS CR,77075,CPT,,,,,both,,,418.2,418.2,Medicare,Medicare,,418.2,,,418.2,418.2,418.2,fee schedule,Medicare APC Fee Schedule
BNE SRVY CMP METS CR,77075,CPT,,,,,both,, ,418.2,250.92,Medicare,Medicare,,,,,418.2,,,,
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,220.61,132.36,Medicare,Medicare,,,,,220.61,,,,
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,237.45,142.47,Medicare,Medicare,,,,,237.45,,,,
BONE SRVY INFANT CR,77076,CPT,,,,,both,,,833.32,833.32,Medicare,Medicare,,833.32,,,833.32,833.32,833.32,fee schedule,Medicare APC Fee Schedule
BONE SRVY INFANT CR,77076,CPT,,,,,both,, ,833.32,499.99,Medicare,Medicare,,,,,833.32,,,,
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
JOINT SURVEY 1V CR,77077,CPT,,,,,both,,,1387.37,1387.37,Medicare,Medicare,,1387.37,,,1387.37,1387.37,1387.37,fee schedule,Medicare APC Fee Schedule
JOINT SURVEY 1V CR,77077,CPT,,,,,both,, ,1387.37,832.42,Medicare,Medicare,,,,,1387.37,,,,
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,218.93,131.35,Medicare,Medicare,,,,,218.93,,,,
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,235.77,141.46,Medicare,Medicare,,,,,235.77,,,,
CT-BONE DENSTY AXIAL,77078,CPT,,,,,both,, ,613.55,368.13,Medicare,Medicare,,,,,613.55,,,,
DEXA AXIAL,77080,CPT,,,,,both,, ,218.93,131.35,Medicare,Medicare,,,,,218.93,,,,
DEXA AXIAL,77080,CPT,,,,,both,, ,235.77,141.46,Medicare,Medicare,,,,,235.77,,,,
DEXA AXIAL,77080,CPT,,,,,both,,,430.83,430.83,Medicare,Medicare,,430.83,,,430.83,430.83,430.83,fee schedule,Medicare APC Fee Schedule
DEXA AXIAL,77080,CPT,,,,,both,, ,430.83,258.49,Medicare,Medicare,,,,,430.83,,,,
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,139.21,83.52,Medicare,Medicare,,,,,139.21,,,,
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,149.88,89.92,Medicare,Medicare,,,,,149.88,,,,
DXA BONE DENS V FRAC,77086,CPT,,,,,both,, ,266.91,160.14,Medicare,Medicare,,,,,266.91,,,,
NM-THYR UPT S-M-SUPP,78012,CPT,,,,,both,, ,1025.37,615.22,Medicare,Medicare,,,,,1025.37,,,,
NM-THYROID IMG W-BF,78013,CPT,,,,,both,, ,1365.27,819.16,Medicare,Medicare,,,,,1365.27,,,,
NM-THY UPT IMG W-BF,78014,CPT,,,,,both,, ,1719.59,1031.75,Medicare,Medicare,,,,,1719.59,,,,
NM-PAR PLAN THY IMG,78070,CPT,,,,,both,, ,1365.27,819.16,Medicare,Medicare,,,,,1365.27,,,,
NM-PARA PLN IMG SPEC,78071,CPT,,,,,both,, ,1884.64,1130.78,Medicare,Medicare,,,,,1884.64,,,,
NM-PAR PL IMG SPE CT,78072,CPT,,,,,both,, ,1884.64,1130.78,Medicare,Medicare,,,,,1884.64,,,,
NM-ADRENAL IMAGING,78075,CPT,,,,,both,, ,5329.74,3197.84,Medicare,Medicare,,,,,5329.74,,,,
NM-BONE MARROW LMTD,78102,CPT,,,,,both,, ,1409.3,845.58,Medicare,Medicare,,,,,1409.3,,,,
NM-BONE MARROW MULT,78103,CPT,,,,,both,, ,1409.3,845.58,Medicare,Medicare,,,,,1409.3,,,,
NM-BONE MARROW BODY,78104,CPT,,,,,both,, ,1409.3,845.58,Medicare,Medicare,,,,,1409.3,,,,
NM-LYMPHATICS NODES,78195,CPT,,,,,both,, ,4917.74,2950.64,Medicare,Medicare,,,,,4917.74,,,,
NM-LIVER,78201,CPT,,,,,both,, ,3830.06,2298.03,Medicare,Medicare,,,,,3830.06,,,,
NM-LIVER AND SPLEEN,78215,CPT,,,,,both,, ,3830.06,2298.03,Medicare,Medicare,,,,,3830.06,,,,
NM-HEPATOBILIARY SYS,78226,CPT,,,,,both,, ,4088.59,2453.15,Medicare,Medicare,,,,,4088.59,,,,
NM-HEPATOBIL W PHARM,78227,CPT,,,,,both,,,4088.59,4088.59,Medicare,Medicare,,4088.59,,,4088.59,4088.59,4088.59,fee schedule,Medicare APC Fee Schedule
NM-HEPATOBIL W PHARM,78227,CPT,,,,,both,, ,4088.59,2453.15,Medicare,Medicare,,,,,4088.59,,,,
NM-GI REFLUX,78262,CPT,,,,,both,, ,3415.74,2049.44,Medicare,Medicare,,,,,3415.74,,,,
NM-GASTRIC EMPTYING,78264,CPT,,,,,both,,,3415.74,3415.74,Medicare,Medicare,,3415.74,,,3415.74,3415.74,3415.74,fee schedule,Medicare APC Fee Schedule
NM-GASTRIC EMPTYING,78264,CPT,,,,,both,, ,3415.74,2049.44,Medicare,Medicare,,,,,3415.74,,,,
NM-GAST EMPT SM BWL,78265,CPT,,,,,both,, ,1543.71,926.22,Medicare,Medicare,,,,,1543.71,,,,
NM-GE SM BWL CLN MUL,78266,CPT,,,,,both,, ,2046.87,1228.12,Medicare,Medicare,,,,,2046.87,,,,
NM-GI BLOOD LOSS,78278,CPT,,,,,both,, ,3415.74,2049.44,Medicare,Medicare,,,,,3415.74,,,,
NM-MECKELS SCAN,78290,CPT,,,,,both,, ,3576.68,2146,Medicare,Medicare,,,,,3576.68,,,,
NM-BONE SCAN LMTD,78300,CPT,,,,,both,, ,2526.59,1515.95,Medicare,Medicare,,,,,2526.59,,,,
NM-BONE SCAN MULTI,78305,CPT,,,,,both,, ,2526.59,1515.95,Medicare,Medicare,,,,,2526.59,,,,
NM-BONE SCAN BODY,78306,CPT,,,,,both,,,3512.04,3512.04,Medicare,Medicare,,3512.04,,,3512.04,3512.04,3512.04,fee schedule,Medicare APC Fee Schedule
NM-BONE SCAN BODY,78306,CPT,,,,,both,, ,3512.04,2107.22,Medicare,Medicare,,,,,3512.04,,,,
NM-BONE SCAN 3 PHASE,78315,CPT,,,,,both,,,2911.81,2911.81,Medicare,Medicare,,2911.81,,,2911.81,2911.81,2911.81,fee schedule,Medicare APC Fee Schedule
NM-BONE SCAN 3 PHASE,78315,CPT,,,,,both,, ,2911.81,1747.08,Medicare,Medicare,,,,,2911.81,,,,
NM-VASCULAR FLOW,78445,CPT,,,,,both,, ,1719.84,1031.9,Medicare,Medicare,,,,,1719.84,,,,
NM-MYOCRD SPECT SNGL,78451,CPT,,,,,both,, ,3741.73,2245.03,Medicare,Medicare,,,,,3741.73,,,,
NM-MYOCRD SPECT MULT,78452,CPT,,,,,both,,,7071.47,7071.47,Medicare,Medicare,,7071.47,,,7071.47,7071.47,7071.47,fee schedule,Medicare APC Fee Schedule
NM-MYOCRD SPECT MULT,78452,CPT,,,,,both,, ,7071.47,4242.88,Medicare,Medicare,,,,,7071.47,,,,
NM-MYOCARD SINGLE,78453,CPT,,,,,both,, ,4803.15,2881.89,Medicare,Medicare,,,,,4803.15,,,,
NM-MYOCARD INFARCT,78466,CPT,,,,,both,, ,3415.74,2049.44,Medicare,Medicare,,,,,3415.74,,,,
NM-MYOCARD INF SPECT,78469,CPT,,,,,both,, ,3184.5,1910.7,Medicare,Medicare,,,,,3184.5,,,,
NM-GATED BLD POOL SN,78472,CPT,,,,,both,, ,3415.74,2049.44,Medicare,Medicare,,,,,3415.74,,,,
NM-LUNG VENT IMAGING,78579,CPT,,,,,both,,,4088.59,4088.59,Medicare,Medicare,,4088.59,,,4088.59,4088.59,4088.59,fee schedule,Medicare APC Fee Schedule
NM-LUNG VENT IMAGING,78579,CPT,,,,,both,, ,4088.59,2453.15,Medicare,Medicare,,,,,4088.59,,,,
NM-LUNG PERF PARTICU,78580,CPT,,,,,both,, ,3590.32,2154.19,Medicare,Medicare,,,,,3590.32,,,,
NM-LUNG VENT PERFUS,78582,CPT,,,,,both,,,6243.6,6243.6,Medicare,Medicare,,6243.6,,,6243.6,6243.6,6243.6,fee schedule,Medicare APC Fee Schedule
NM-LUNG VENT PERFUS,78582,CPT,,,,,both,, ,6243.6,3746.16,Medicare,Medicare,,,,,6243.6,,,,
NM-LUNG PERFVENT DIF,78598,CPT,,,,,both,, ,8897.66,5338.59,Medicare,Medicare,,,,,8897.66,,,,
NM-BRAIN CSF CISTERN,78630,CPT,,,,,both,, ,1616.07,969.64,Medicare,Medicare,,,,,1616.07,,,,
NM-KIDNEY STATIC,78700,CPT,,,,,both,, ,3590.32,2154.19,Medicare,Medicare,,,,,3590.32,,,,
NM-KIDNEY STATIC FLO,78701,CPT,,,,,both,, ,4802.63,2881.57,Medicare,Medicare,,,,,4802.63,,,,
NM-KIDNEY VF NO PHRM,78707,CPT,,,,,both,, ,4802.63,2881.57,Medicare,Medicare,,,,,4802.63,,,,
NM-KID VF PHRM SNGL,78708,CPT,,,,,both,, ,4802.63,2881.57,Medicare,Medicare,,,,,4802.63,,,,
NM-KIDNEY FUNCTION,78725,CPT,,,,,both,, ,617.74,370.64,Medicare,Medicare,,,,,617.74,,,,
NM-URIN BLDDR REFLUX,78740,CPT,,,,,both,, ,3590.32,2154.19,Medicare,Medicare,,,,,3590.32,,,,
NM-TUMOR LOC LMTD,78800,CPT,,,,,both,, ,4590.83,2754.49,Medicare,Medicare,,,,,4590.83,,,,
NM-TUMOR LOC LMTD 1D,78800,CPT,,,,,both,, ,4917.74,2950.64,Medicare,Medicare,,,,,4917.74,,,,
NM-TUMOR LOC MULTI,78801,CPT,,,,,both,, ,4917.74,2950.64,Medicare,Medicare,,,,,4917.74,,,,
NM-TUMOR LOC BDY 1D,78802,CPT,,,,,both,, ,6129.79,3677.87,Medicare,Medicare,,,,,6129.79,,,,
NM-TUMOR LOC BODY,78802,CPT,,,,,both,, ,4590.83,2754.49,Medicare,Medicare,,,,,4590.83,,,,
NM-TUMR LOC SPECT 1D,78803,CPT,,,,,both,, ,5042.88,3025.72,Medicare,Medicare,,,,,5042.88,,,,
NM-TUMR LOC BDY >1D,78804,CPT,,,,,both,, ,5251.46,3150.87,Medicare,Medicare,,,,,5251.46,,,,
NM-UNLISTED MISC,78999,CPT,,,,,both,, ,593.54,356.12,Medicare,Medicare,,,,,593.54,,,,
NUCLEAR RX IV ADMIN,79101,CPT,,,,,both,, ,1716.5,1029.9,Medicare,Medicare,,,,,1716.5,,,,
BASIC META W-ION CA,80047,CPT,,,,,both,, ,29.19,17.51,Medicare,Medicare,,,,,29.19,,,,
BASIC META W-ION CA,80047,CPT,,,,,both,, ,163.63,98.17,Medicare,Medicare,,,,,163.63,,,,
BASIC METABO CA TOTA,80048,CPT,,,,,both,, ,89.53,53.71,Medicare,Medicare,,,,,89.53,,,,
BASIC METABO CA TOTA,80048,CPT,,,,,both,, ,510.83,306.49,Medicare,Medicare,,,,,510.83,,,,
Basic metabolic panel,80048,CPT,,,,,both,,,510.83,510.83,Medicare,Medicare,,8.46,, ,510.83,510.83,510.83,fee schedule,Medicare APC Fee Schedule
GENERAL HEALTH PANEL,80050,CPT,,,,,both,,,1796.88,1796.88,Medicare,Medicare,,1796.88,,,1796.88,1796.88,1796.88,fee schedule,Medicare APC Fee Schedule
GENERAL HEALTH PANEL,80050,CPT,,,,,both,, ,1796.88,1078.12,Medicare,Medicare,,,,,1796.88,,,,
ELECTROLYTE PANEL,80051,CPT,,,,,both,, ,74.1,44.46,Medicare,Medicare,,,,,74.1,,,,
ELECTROLYTE PANEL,80051,CPT,,,,,both,, ,390.41,234.24,Medicare,Medicare,,,,,390.41,,,,
"Blood test, comprehensive group of blood chemicals",80053,CPT,,,,,both,,,630.96,630.96,Medicare,Medicare,,10.56,,,630.96,630.96,630.96,fee schedule,Medicare APC Fee Schedule
COMP METAB PANEL,80053,CPT,,,,,both,, ,111.7,67.02,Medicare,Medicare,,,,,111.7,,,,
COMP METAB PANEL,80053,CPT,,,,,both,, ,630.96,378.57,Medicare,Medicare,,,,,630.96,,,,
Obstetric blood test panel,80055,CPT,,,,,both,,,1727.55,1727.55,Medicare,Medicare,,47.81,,,1727.55,1727.55,1727.55,fee schedule,Medicare APC Fee Schedule
OBSTETRIC PANEL,80055,CPT,,,,,both,, ,350.84,210.5,Medicare,Medicare,,,,,350.84,,,,
OBSTETRIC PANEL,80055,CPT,,,,,both,, ,1727.55,1036.53,Medicare,Medicare,,,,,1727.55,,,,
"Blood test, lipids (cholesterol and triglycerides)",80061,CPT,,,,,both,,,565.84,565.84,Medicare,Medicare,,13.39,,,565.84,565.84,565.84,fee schedule,Medicare APC Fee Schedule
LIPID PANEL,80061,CPT,,,,,both,, ,86.73,52.03,Medicare,Medicare,,,,,86.73,,,,
LIPID PANEL,80061,CPT,,,,,both,, ,565.84,339.5,Medicare,Medicare,,,,,565.84,,,,
LIPID PANEL,80061,CPT,,,,,both,, ,565.84,339.5,Medicare,Medicare,,,,,565.84,,,,
Kidney function panel test,80069,CPT,,,,,both,,,570.89,570.89,Medicare,Medicare,,8.68,,,570.89,570.89,570.89,fee schedule,Medicare APC Fee Schedule
RENAL FUNCTION PANEL,80069,CPT,,,,,both,, ,91.77,55.06,Medicare,Medicare,,,,,91.77,,,,
RENAL FUNCTION PANEL,80069,CPT,,,,,both,, ,570.89,342.53,Medicare,Medicare,,,,,570.89,,,,
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,, ,282.08,169.24,Medicare,Medicare,,,,,282.08,,,,
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,,,3484.29,3484.29,Medicare,Medicare,,3484.29,,,3484.29,3484.29,3484.29,fee schedule,Medicare APC Fee Schedule
HEPATITIS ACUTE PANE,80074,CPT,,,,,both,, ,3484.29,2090.57,Medicare,Medicare,,,,,3484.29,,,,
HEPATIC FUNCTION PAN,80076,CPT,,,,,both,, ,86.45,51.87,Medicare,Medicare,,,,,86.45,,,,
HEPATIC FUNCTION PAN,80076,CPT,,,,,both,, ,450.48,270.28,Medicare,Medicare,,,,,450.48,,,,
Liver function blood test panel,80076,CPT,,,,,both,,,450.48,450.48,Medicare,Medicare,,8.17,,,450.48,450.48,450.48,fee schedule,Medicare APC Fee Schedule
OBSTETRIC PNL W HIV,80081,CPT,,,,,both,, ,1883.6,1130.16,Medicare,Medicare,,,,,1883.6,,,,
ACETAMINOPHEN QT,80143,CPT,,,,,both,, ,186.06,111.63,Medicare,Medicare,,,,,186.06,,,,
Q36298 ADM LEV IBD,80145,CPT,,,,,both,, ,174.02,104.41,Medicare,Medicare,,,,,174.02,,,,
AMIKACIN,80150,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q36721 AMIOD HPLC/LC,80151,CPT,,,,,both,, ,546.19,327.71,Medicare,Medicare,,,,,546.19,,,,
CARBAMAZEPINE TOTAL,80156,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
Q18948 CBZ FREE LCMS,80157,CPT,,,,,both,, ,88.4,53.04,Medicare,Medicare,,,,,88.4,,,,
CYCLOSPORINE,80158,CPT,,,,,both,, ,91.49,54.89,Medicare,Medicare,,,,,91.49,,,,
CYCLOSPORINE,80158,CPT,,,,,both,, ,1555.5,933.3,Medicare,Medicare,,,,,1555.5,,,,
Q15220CYC A BL LCMSM,80158,CPT,,,,,both,, ,1555.5,933.3,Medicare,Medicare,,,,,1555.5,,,,
Q8812 CYA TRGH BL IA,80158,CPT,,,,,both,, ,1555.5,933.3,Medicare,Medicare,,,,,1555.5,,,,
CLOZAPINE QT,80159,CPT,,,,,both,, ,95.43,57.25,Medicare,Medicare,,,,,95.43,,,,
CLOZAPINE QT,80159,CPT,,,,,both,, ,95.43,57.25,Medicare,Medicare,,,,,95.43,,,,
DIGOXIN TOTAL,80162,CPT,,,,,both,, ,130.23,78.13,Medicare,Medicare,,,,,130.23,,,,
DIGOXIN TOTAL,80162,CPT,,,,,both,, ,787.57,472.54,Medicare,Medicare,,,,,787.57,,,,
DIGOXIN FREE,80163,CPT,,,,,both,, ,130.23,78.13,Medicare,Medicare,,,,,130.23,,,,
Q6651 VALP ACID TOT,80164,CPT,,,,,both,, ,691.06,414.63,Medicare,Medicare,,,,,691.06,,,,
VALPROIC ACID TOTAL,80164,CPT,,,,,both,, ,132.76,79.65,Medicare,Medicare,,,,,132.76,,,,
VALPROIC ACID TOTAL,80164,CPT,,,,,both,,,711.79,711.79,Medicare,Medicare,,711.79,,,711.79,711.79,711.79,fee schedule,Medicare APC Fee Schedule
VALPROIC ACID TOTAL,80164,CPT,,,,,both,, ,711.79,427.07,Medicare,Medicare,,,,,711.79,,,,
Q6651 VALP ACID FREE,80165,CPT,,,,,both,, ,691.06,414.63,Medicare,Medicare,,,,,691.06,,,,
VALPROIC ACID FREE,80165,CPT,,,,,both,, ,132.76,79.65,Medicare,Medicare,,,,,132.76,,,,
VALPROIC ACID FREE,80165,CPT,,,,,both,, ,711.79,427.07,Medicare,Medicare,,,,,711.79,,,,
Q3081 FELBAMATE MS,80167,CPT,,,,,both,, ,191.99,115.19,Medicare,Medicare,,,,,191.99,,,,
ETHOSUXIMIDE,80168,CPT,,,,,both,, ,864.19,518.51,Medicare,Medicare,,,,,864.19,,,,
Q18883 EVEROLI LM/MS,80169,CPT,,,,,both,, ,106.93,64.15,Medicare,Medicare,,,,,106.93,,,,
GENTAMICIN,80170,CPT,,,,,both,, ,900.96,540.57,Medicare,Medicare,,,,,900.96,,,,
GABAPENTIN QT,80171,CPT,,,,,both,, ,105.53,63.31,Medicare,Medicare,,,,,105.53,,,,
L716811 GABAP LCMSMS,80171,CPT,,,,,both,, ,102.46,61.47,Medicare,Medicare,,,,,102.46,,,,
HALOPERIDOL,80173,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,,,,871.22,,,,
LAMOTRIGINE QT,80175,CPT,,,,,both,, ,105.53,63.31,Medicare,Medicare,,,,,105.53,,,,
LAMOTRIGINE QT,80175,CPT,,,,,both,, ,105.53,63.31,Medicare,Medicare,,,,,105.53,,,,
LIDOCAINE,80176,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,,,,871.22,,,,
LIDOCAINE,80176,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,,,,871.22,,,,
Q15142 LEVE LC/MS/MS,80177,CPT,,,,,both,, ,105.53,63.31,Medicare,Medicare,,,,,105.53,,,,
Lithium,80178,CPT,,,,,both,,,420.72,420.72,Medicare,Medicare,,420.72,,,420.72,420.72,420.72,fee schedule,Medicare APC Fee Schedule
LITHIUM,80178,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
SALICYLATE QT,80179,CPT,,,,,both,, ,191.99,115.19,Medicare,Medicare,,,,,191.99,,,,
Q10662 MPA LC/MS/MS,80180,CPT,,,,,both,, ,143.71,86.22,Medicare,Medicare,,,,,143.71,,,,
OXCARBAEPINE QT,80183,CPT,,,,,both,, ,122.37,73.42,Medicare,Medicare,,,,,122.37,,,,
OXCARBAEPINE QT,80183,CPT,,,,,both,, ,122.37,73.42,Medicare,Medicare,,,,,122.37,,,,
PHENOBARBITAL,80184,CPT,,,,,both,, ,120.96,72.57,Medicare,Medicare,,,,,120.96,,,,
PHENOBARBITAL,80184,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,,,,871.22,,,,
PHENOBARBITAL,80184,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,,,,871.22,,,,
PHENYTOIN TOTAL,80185,CPT,,,,,both,, ,140.05,84.03,Medicare,Medicare,,,,,140.05,,,,
PHENYTOIN TOTAL,80185,CPT,,,,,both,, ,847.64,508.58,Medicare,Medicare,,,,,847.64,,,,
PHENYTOIN TOTAL,80185,CPT,,,,,both,, ,847.64,508.58,Medicare,Medicare,,,,,847.64,,,,
Q3189 PHENY FR UF-IA,80186,CPT,,,,,both,, ,91.77,55.06,Medicare,Medicare,,,,,91.77,,,,
Q3189 PHENY FR UF-IA,80186,CPT,,,,,both,, ,91.77,55.06,Medicare,Medicare,,,,,91.77,,,,
PRIMIDONE,80188,CPT,,,,,both,, ,1757.58,1054.54,Medicare,Medicare,,,,,1757.58,,,,
Q751 PRIMIDONE,80188,CPT,,,,,both,, ,878.79,527.27,Medicare,Medicare,,,,,878.79,,,,
PROCAINAMIDE+NAPA,80192,CPT,,,,,both,, ,900.96,540.57,Medicare,Medicare,,,,,900.96,,,,
QUINIDINE,80194,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,,,,765.96,,,,
SIROLIMUS,80195,CPT,,,,,both,, ,257.1,154.26,Medicare,Medicare,,,,,257.1,,,,
SIROLIMUS,80195,CPT,,,,,both,, ,257.1,154.26,Medicare,Medicare,,,,,257.1,,,,
TACROLIMUS,80197,CPT,,,,,both,, ,822.37,493.42,Medicare,Medicare,,,,,822.37,,,,
TACROLIMUS,80197,CPT,,,,,both,, ,822.37,493.42,Medicare,Medicare,,,,,822.37,,,,
THEOPHYLLINE,80198,CPT,,,,,both,, ,149.6,89.76,Medicare,Medicare,,,,,149.6,,,,
THEOPHYLLINE,80198,CPT,,,,,both,, ,149.6,89.76,Medicare,Medicare,,,,,149.6,,,,
THEOPHYLLINE,80198,CPT,,,,,both,, ,781.11,468.66,Medicare,Medicare,,,,,781.11,,,,
TIAGABINE QT,80199,CPT,,,,,both,, ,143.71,86.22,Medicare,Medicare,,,,,143.71,,,,
TOBRAMYCIN,80200,CPT,,,,,both,, ,75.5,45.3,Medicare,Medicare,,,,,75.5,,,,
TOPIRAMATE,80201,CPT,,,,,both,, ,445.71,267.42,Medicare,Medicare,,,,,445.71,,,,
VANCOMYCIN,80202,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,,,,765.96,,,,
ZONISAMIDE QT,80203,CPT,,,,,both,, ,105.53,63.31,Medicare,Medicare,,,,,105.53,,,,
ZONISAMIDE QT,80203,CPT,,,,,both,, ,105.53,63.31,Medicare,Medicare,,,,,105.53,,,,
Q648 METHOTREXATE IA,80204,CPT,,,,,both,, ,501.1,300.66,Medicare,Medicare,,,,,501.1,,,,
L503870 INFLIXIMAB,80230,CPT,,,,,both,, ,159.65,95.79,Medicare,Medicare,,,,,159.65,,,,
L504567 VEDOLIZUMAB,80280,CPT,,,,,both,, ,198.79,119.27,Medicare,Medicare,,,,,198.79,,,,
DRUG UNSPEC QUANT,80299,CPT,,,,,both,, ,873.46,524.07,Medicare,Medicare,,,,,873.46,,,,
L7609 DOXEPIN LCMSMS,80299,CPT,,,,,both,, ,148.4,89.04,Medicare,Medicare,,,,,148.4,,,,
Q29391DEXAMET LCMSMS,80299,CPT,,,,,both,, ,342,205.2,Medicare,Medicare,,,,,342,,,,
Q78222DEXAMET LCMSMS,80299,CPT,,,,,both,, ,546.19,327.71,Medicare,Medicare,,,,,546.19,,,,
Q78222DEXAMET LCMSMS,80299,CPT,,,,,both,, ,546.19,327.71,Medicare,Medicare,,,,,546.19,,,,
Q8389 FLUOXET LCMSMS,80299,CPT,,,,,both,, ,811.42,486.85,Medicare,Medicare,,,,,811.42,,,,
PRS DRG IA VIS,80305,CPT,,,,,both,, ,137.8,82.68,Medicare,Medicare,,,,,137.8,,,,
PRS DRG IA MET,80306,CPT,,,,,both,, ,137.8,82.68,Medicare,Medicare,,,,,137.8,,,,
733726 URINE DRUG PROFILE 14/MEDWATCH,80307,CPT,,,,,both,, ,360,216,Medicare,Medicare,,,,,360,,,,
DRUGPROF ORAL FLD,80307,CPT,,,,,both,, ,116,69.6,Medicare,Medicare,,,,,116,,,,
ETHANOL UR QUAL,80307,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
ETHANOL UR QUAL,80307,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
L074401 AMPH UR SCRN,80307,CPT,,,,,both,, ,60,36,Medicare,Medicare,,,,,60,,,,
L074401 AMPH UR SCRN,80307,CPT,,,,,both,, ,60,36,Medicare,Medicare,,,,,60,,,,
L733740 ULTRM SCR UR,80307,CPT,,,,,both,, ,200,120,Medicare,Medicare,,,,,200,,,,
PRS DRG IA ANAZ,80307,CPT,,,,,both,,,1174.34,1174.34,Medicare,Medicare,,1174.34,,,1174.34,1174.34,1174.34,fee schedule,Medicare APC Fee Schedule
PRS DRG IA ANAZ,80307,CPT,,,,,both,, ,1174.34,704.6,Medicare,Medicare,,,,,1174.34,,,,
PRS DRG IA ANAZ,80307,CPT,,,,,both,, ,1174.34,704.6,Medicare,Medicare,,,,,1174.34,,,,
Q643 METHYL ALC BL C,80320,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,,,,728.07,,,,
ALKALOIDS NOS MS,80323,CPT,,,,,both,, ,713.47,428.08,Medicare,Medicare,,,,,713.47,,,,
Q90642NIC&COT S LCMS,80323,CPT,,,,,both,, ,713.47,428.08,Medicare,Medicare,,,,,713.47,,,,
Q90646NIC&COT U LCMS,80323,CPT,,,,,both,, ,713.47,428.08,Medicare,Medicare,,,,,713.47,,,,
AMPHETAMINES MS 1-2,80324,CPT,,,,,both,, ,184.68,110.8,Medicare,Medicare,,,,,184.68,,,,
AMPHETAMINES MS 1-2,80324,CPT,,,,,both,, ,184.68,110.8,Medicare,Medicare,,,,,184.68,,,,
L790600 AMPH MS 5P,80326,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
ANABOLC STRD MS 1-2,80327,CPT,,,,,both,, ,269.16,161.49,Medicare,Medicare,,,,,269.16,,,,
L790600 ANLGNO MS 6P,80331,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
ANTIDPRS SERO MS 3-5,80333,CPT,,,,,both,, ,771.01,462.6,Medicare,Medicare,,,,,771.01,,,,
L790600 AD MS 6PL,80334,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
ANTIDPRS TRIC MS 1-2,80335,CPT,,,,,both,, ,826.59,495.95,Medicare,Medicare,,,,,826.59,,,,
ANTIDPRS TRIC MS 1-2,80335,CPT,,,,,both,, ,826.59,495.95,Medicare,Medicare,,,,,826.59,,,,
Q30013 CLOMIPRA LCMS,80335,CPT,,,,,both,, ,826.59,495.95,Medicare,Medicare,,,,,826.59,,,,
Q30013 CLOMIPRA LCMS,80335,CPT,,,,,both,, ,826.59,495.95,Medicare,Medicare,,,,,826.59,,,,
Q423AMITRIP HPLC/LCM,80335,CPT,,,,,both,, ,826.59,495.95,Medicare,Medicare,,,,,826.59,,,,
Q423AMITRIP HPLC/LCM,80335,CPT,,,,,both,, ,826.59,495.95,Medicare,Medicare,,,,,826.59,,,,
ANTIDPRS TRIC MS 3-5,80336,CPT,,,,,both,, ,571.45,342.87,Medicare,Medicare,,,,,571.45,,,,
L790600 ADEP TRI 6PL,80337,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
ANTIDPRS NOS MS,80338,CPT,,,,,both,, ,928.18,556.9,Medicare,Medicare,,,,,928.18,,,,
L790600 AD NOS MS,80338,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
L790600 AED MS 7P,80341,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
ANTIPSYCH NOS MS 1-3,80342,CPT,,,,,both,, ,811.42,486.85,Medicare,Medicare,,,,,811.42,,,,
L790600 APD MS 7P,80344,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
BENZODIAZ MS 1-12,80346,CPT,,,,,both,, ,814.24,488.54,Medicare,Medicare,,,,,814.24,,,,
BENZODIAZ MS 1-12,80346,CPT,,,,,both,, ,814.24,488.54,Medicare,Medicare,,,,,814.24,,,,
L809630 FLTZP MS,80346,CPT,,,,,both,, ,600,360,Medicare,Medicare,,,,,600,,,,
L790600 BZD MS 13P,80347,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
BUPRENORPHINE MS,80348,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
BUPRENORPHINE MS,80348,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
Q93031 BUPRENOPHINE & METABOLITIES LC/MS,80348,CPT,,,,,both,, ,119.25,71.55,Medicare,Medicare,,,,,119.25,,,,
CANNABINDS NATUR MS,80349,CPT,,,,,both,, ,147.91,88.74,Medicare,Medicare,,,,,147.91,,,,
L790697 SYNCBD WB MS,80352,CPT,,,,,both,, ,300,180,Medicare,Medicare,,,,,300,,,,
L790600 COCAINE MS,80353,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
FENTANYL MS,80354,CPT,,,,,both,, ,534.41,320.64,Medicare,Medicare,,,,,534.41,,,,
L790600 FENT MET MS,80354,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
GABAPENTIN NONBLD MS,80355,CPT,,,,,both,, ,534.41,320.64,Medicare,Medicare,,,,,534.41,,,,
L790600 GPT NBLD MS,80355,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
HEROIN METABOLITE MS,80356,CPT,,,,,both,, ,227.91,136.74,Medicare,Medicare,,,,,227.91,,,,
L790600 KET NKET MS,80357,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
L790600 MTD MS,80358,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
METHADONE MS,80358,CPT,,,,,both,, ,327.54,196.52,Medicare,Medicare,,,,,327.54,,,,
L791194 MDMA MS,80359,CPT,,,,,both,, ,133.38,80.02,Medicare,Medicare,,,,,133.38,,,,
MDA MDEA MOMA MS,80359,CPT,,,,,both,, ,404.17,242.5,Medicare,Medicare,,,,,404.17,,,,
MDA MDEA MOMA MS,80359,CPT,,,,,both,, ,404.17,242.5,Medicare,Medicare,,,,,404.17,,,,
L790600 MPH MS,80360,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
L790600 OPI MS 1P,80361,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
OPIATES MS 1 PL,80361,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
Q20907 OPI MS,80361,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
L790600 OPD OPI MS5P,80364,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
L790600 OXY MS,80365,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
OXYCODONE MS,80365,CPT,,,,,both,, ,428.58,257.14,Medicare,Medicare,,,,,428.58,,,,
OXYCODONE MS,80365,CPT,,,,,both,, ,428.58,257.14,Medicare,Medicare,,,,,428.58,,,,
L790600 PGB MS,80366,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
PREGABALIN MS,80366,CPT,,,,,both,, ,811.42,486.85,Medicare,Medicare,,,,,811.42,,,,
L790600 PPX MS,80367,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
L790600 SED HYP MS,80368,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
L790600 SM RLX MS3PL,80370,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
L790600 STIM SYN MS,80371,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
L790600 TAPENTADL MS,80372,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
L761019TRAMADOL CONF,80373,CPT,,,,,both,, ,412,247.2,Medicare,Medicare,,,,,412,,,,
L790600 TRA MS,80373,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
DEF DRUG NOS MS 1-3,80375,CPT,,,,,both,, ,546.19,327.71,Medicare,Medicare,,,,,546.19,,,,
DEF DRUG NOS MS 7PL,80377,CPT,,,,,both,, ,571.45,342.87,Medicare,Medicare,,,,,571.45,,,,
L790600 DRGNOS MS 7P,80377,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
Manual urinalysis test with examination using microscope,81001,CPT,,,,,both,,,240.26,240.26,Medicare,Medicare,,3.17,,,240.26,240.26,240.26,fee schedule,Medicare APC Fee Schedule
"UA, AUTO W-SCOPE",81001,CPT,,,,,both,, ,33.39,20.03,Medicare,Medicare,,,,,33.39,,,,
"UA, AUTO W-SCOPE",81001,CPT,,,,,both,, ,240.26,144.15,Medicare,Medicare,,,,,240.26,,,,
Automated urinalysis test,81003,CPT,,,,,both,,,210.5,210.5,Medicare,Medicare,,2.25,,,210.5,210.5,210.5,fee schedule,Medicare APC Fee Schedule
"UA, AUTO, W-O SCOPE",81003,CPT,,,,,both,, ,23.85,14.31,Medicare,Medicare,,,,,23.85,,,,
"UA, AUTO, W-O SCOPE",81003,CPT,,,,,both,, ,210.5,126.3,Medicare,Medicare,,,,,210.5,,,,
URINALYSIS,81005,CPT,,,,,both,, ,180.19,108.11,Medicare,Medicare,,,,,180.19,,,,
MICROSCOPIC EX OF UR,81015,CPT,,,,,both,, ,10.55,6.33,Medicare,Medicare,,,,,10.55,,,,
MICROSCOPIC EX OF UR,81015,CPT,,,,,both,, ,180.19,108.11,Medicare,Medicare,,,,,180.19,,,,
URINE PREG TEST QL,81025,CPT,,,,,both,, ,23.58,14.14,Medicare,Medicare,,,,,23.58,,,,
URINE PREG TEST QL,81025,CPT,,,,,both,,,420.72,420.72,Medicare,Medicare,,420.72,,,420.72,420.72,420.72,fee schedule,Medicare APC Fee Schedule
URINE PREG TEST QL,81025,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
"L910235 URINE VOLUME, TIMED",81050,CPT,,,,,both,, ,30.64,18.38,Medicare,Medicare,,,,,30.64,,,,
Q91863 BRCADVAN COMP,81162,CPT,,,,,both,, ,5261.25,3156.75,Medicare,Medicare,,,,,5261.25,,,,
L480510 BCRABL1 KDMA,81170,CPT,,,,,both,, ,1792,1075.2,Medicare,Medicare,,,,,1792,,,,
Q91065 P210 BCRABL1,81206,CPT,,,,,both,, ,552.22,331.33,Medicare,Medicare,,,,,552.22,,,,
Q91065 P190 BCRABL1,81207,CPT,,,,,both,, ,487.83,292.69,Medicare,Medicare,,,,,487.83,,,,
BRAF GENE ANALY V600,81210,CPT,,,,,both,, ,393.84,236.3,Medicare,Medicare,,,,,393.84,,,,
L489450 CALR MA,81219,CPT,,,,,both,, ,675,405,Medicare,Medicare,,,,,675,,,,
Q10458 CFSCN OLA-PCR,81220,CPT,,,,,both,, ,1100,660,Medicare,Medicare,,,,,1100,,,,
L252900 CF CFTR DD,81222,CPT,,,,,both,, ,930,558,Medicare,Medicare,,,,,930,,,,
L511230 CYT P450 2D6,81226,CPT,,,,,both,, ,600,360,Medicare,Medicare,,,,,600,,,,
Q161608 CYP2C9 GN AN,81227,CPT,,,,,both,, ,610,366,Medicare,Medicare,,,,,610,,,,
EGFR GENE COM VAR,81235,CPT,,,,,both,, ,963.55,578.13,Medicare,Medicare,,,,,963.55,,,,
F2 GEN ANALY 20210GA,81240,CPT,,,,,both,, ,2183.65,1310.19,Medicare,Medicare,,,,,2183.65,,,,
Q17909 PGM HYBEACONS,81240,CPT,,,,,both,, ,1091.82,655.09,Medicare,Medicare,,,,,1091.82,,,,
F5 GENE ANALY LEID V,81241,CPT,,,,,both,, ,2183.65,1310.19,Medicare,Medicare,,,,,2183.65,,,,
F5 GENE ANALY LEID V,81241,CPT,,,,,both,, ,2183.65,1310.19,Medicare,Medicare,,,,,2183.65,,,,
FMR1 GENE ANALY AB,81243,CPT,,,,,both,, ,1863.12,1117.87,Medicare,Medicare,,,,,1863.12,,,,
HFE GENE ANALY CV,81256,CPT,,,,,both,, ,3396.72,2038.03,Medicare,Medicare,,,,,3396.72,,,,
HFE GENE ANALY CV,81256,CPT,,,,,both,, ,3396.72,2038.03,Medicare,Medicare,,,,,3396.72,,,,
Q11175AGLOB MUT PCR,81257,CPT,,,,,both,, ,477.7,286.62,Medicare,Medicare,,,,,477.7,,,,
JAK2 GEN ANALY V617F,81270,CPT,,,,,both,, ,1424.14,854.48,Medicare,Medicare,,,,,1424.14,,,,
JAK2 GEN ANALY V617F,81270,CPT,,,,,both,, ,1424.14,854.48,Medicare,Medicare,,,,,1424.14,,,,
L489421 JAK2V617F QL,81270,CPT,,,,,both,, ,1306.56,783.93,Medicare,Medicare,,,,,1306.56,,,,
L511040 CHRO ANA CMA,81277,CPT,,,,,both,, ,2260,1356,Medicare,Medicare,,,,,2260,,,,
L115101 JAK2 EX12-15,81279,CPT,,,,,both,, ,865.04,519.02,Medicare,Medicare,,,,,865.04,,,,
Q90251 IL28B RT-PCR,81283,CPT,,,,,both,, ,352.24,211.34,Medicare,Medicare,,,,,352.24,,,,
MTHFR GENE ANALY CV,81291,CPT,,,,,both,, ,3892.4,2335.44,Medicare,Medicare,,,,,3892.4,,,,
MTHFR GENE ANALY CV,81291,CPT,,,,,both,, ,3892.4,2335.44,Medicare,Medicare,,,,,3892.4,,,,
MICROSAT INSTAB VAR,81301,CPT,,,,,both,, ,960.19,576.11,Medicare,Medicare,,,,,960.19,,,,
PCA3 KLK3 RATIO,81313,CPT,,,,,both,, ,636.57,381.94,Medicare,Medicare,,,,,636.57,,,,
Q18041 SMA CAR SCN,81329,CPT,,,,,both,, ,685,411,Medicare,Medicare,,,,,685,,,,
Q15340 ALPHA-1 ANTITRYPSIN (AAT) MUTATIO,81332,CPT,,,,,both,, ,3025.5,1815.3,Medicare,Medicare,,,,,3025.5,,,,
SERPINA1 GENE ANA CV,81332,CPT,,,,,both,, ,3396.72,2038.03,Medicare,Medicare,,,,,3396.72,,,,
L489150 MPL MUT AN,81338,CPT,,,,,both,, ,675,405,Medicare,Medicare,,,,,675,,,,
Q92476 MPL MA QL,81339,CPT,,,,,both,, ,701.97,421.18,Medicare,Medicare,,,,,701.97,,,,
CSI153 UGTIA1 GEN AN,81350,CPT,,,,,both,, ,819.57,491.74,Medicare,Medicare,,,,,819.57,,,,
Q15584 HLA-B27 DETER,81374,CPT,,,,,both,, ,250.36,150.21,Medicare,Medicare,,,,,250.36,,,,
Q17135 HLA2 TYP LR 1,81376,CPT,,,,,both,, ,610.75,366.45,Medicare,Medicare,,,,,610.75,,,,
L167082 HLA2 LR1 AG,81377,CPT,,,,,both,, ,235.1,141.06,Medicare,Medicare,,,,,235.1,,,,
HLA1 TYP HR 1 AL EA,81381,CPT,,,,,both,, ,724.42,434.65,Medicare,Medicare,,,,,724.42,,,,
Q17135 HLA2 TYP HR 1,81382,CPT,,,,,both,, ,618.04,370.82,Medicare,Medicare,,,,,618.04,,,,
L167082 HLA2 HR1 AL,81383,CPT,,,,,both,, ,334.75,200.85,Medicare,Medicare,,,,,334.75,,,,
MOLEC PATH LEV 2,81401,CPT,,,,,both,, ,1062.07,637.24,Medicare,Medicare,,,,,1062.07,,,,
MOLEC PATH LEV 2,81401,CPT,,,,,both,, ,1062.07,637.24,Medicare,Medicare,,,,,1062.07,,,,
Q16536 JAK2 EX 12&13,81403,CPT,,,,,both,, ,865.04,519.02,Medicare,Medicare,,,,,865.04,,,,
Q16536 JAK2 EX 12&13,81403,CPT,,,,,both,, ,865.04,519.02,Medicare,Medicare,,,,,865.04,,,,
L630540 THRB,81405,CPT,,,,,both,, ,4320,2592,Medicare,Medicare,,,,,4320,,,,
B5306-6 ACGH MOL KAR,81406,CPT,,,,,both,, ,2000,1200,Medicare,Medicare,,,,,2000,,,,
BB893-9 UNL MOL PTH,81479,CPT,,,,,both,, ,618,370.8,Medicare,Medicare,,,,,618,,,,
NBS SCID,81479,CPT,,,,,both,, ,109.46,65.67,Medicare,Medicare,,,,,109.46,,,,
UNLIST MOLEC PATH,81479,CPT,,,,,both,, ,1145.43,687.25,Medicare,Medicare,,,,,1145.43,,,,
L140045 OVARIAN MALIGNANCY RISK - ROMA,81500,CPT,,,,,both,, ,600,360,Medicare,Medicare,,,,,600,,,,
FTL CGEN ABN 4 ANAL,81511,CPT,,,,,both,, ,466.48,279.88,Medicare,Medicare,,,,,466.48,,,,
Q30294 QUAD SCREEN,81511,CPT,,,,,both,, ,415.5,249.3,Medicare,Medicare,,,,,415.5,,,,
FTL CGEN ABN 5 ANAL,81512,CPT,,,,,both,, ,791.78,475.06,Medicare,Medicare,,,,,791.78,,,,
L550659 LIVR BIOMRKR,81517,CPT,,,,,both,, ,1143,685.8,Medicare,Medicare,,,,,1143,,,,
Q92688 LIVER FIBROS,81596,CPT,,,,,both,, ,337.09,202.25,Medicare,Medicare,,,,,337.09,,,,
ACETON-KETON SERM QL,82009,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
ACETON-KETON SERM QT,82010,CPT,,,,,both,, ,80.55,48.33,Medicare,Medicare,,,,,80.55,,,,
ACETON-KETON SERM QT,82010,CPT,,,,,both,, ,341.3,204.78,Medicare,Medicare,,,,,341.3,,,,
NBS ACYLCARNITINE QL,82016,CPT,,,,,both,, ,82.79,49.67,Medicare,Medicare,,,,,82.79,,,,
ADRENOCORT ACTH,82024,CPT,,,,,both,, ,2343.07,1405.84,Medicare,Medicare,,,,,2343.07,,,,
Q211 ACTH PL IA,82024,CPT,,,,,both,, ,334,200.4,Medicare,Medicare,,,,,334,,,,
ALBUMIN SERUM,82040,CPT,,,,,both,, ,35.08,21.04,Medicare,Medicare,,,,,35.08,,,,
ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
Q14966 ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
Q70858 ALBUMIN SERUM,82040,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
ALBUMIN FLUID,82042,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
ALBUMIN FLUID,82042,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
MICROALB QNT,82043,CPT,,,,,both,, ,77.74,46.64,Medicare,Medicare,,,,,77.74,,,,
MICROALB QNT,82043,CPT,,,,,both,,,660.98,660.98,Medicare,Medicare,,660.98,,,660.98,660.98,660.98,fee schedule,Medicare APC Fee Schedule
MICROALB QNT,82043,CPT,,,,,both,, ,660.98,396.58,Medicare,Medicare,,,,,660.98,,,,
ETHANOL IA,82077,CPT,,,,,both,, ,177.88,106.72,Medicare,Medicare,,,,,177.88,,,,
ALDOLASE,82085,CPT,,,,,both,, ,648.35,389.01,Medicare,Medicare,,,,,648.35,,,,
ALDOLASE,82085,CPT,,,,,both,, ,648.35,389.01,Medicare,Medicare,,,,,648.35,,,,
ALDOSTERONE,82088,CPT,,,,,both,, ,2366.36,1419.81,Medicare,Medicare,,,,,2366.36,,,,
Q16845 ALDOSTERONE,82088,CPT,,,,,both,, ,587.45,352.47,Medicare,Medicare,,,,,587.45,,,,
Q17181 ALDOST LCMSMS,82088,CPT,,,,,both,, ,587.45,352.47,Medicare,Medicare,,,,,587.45,,,,
Q229 ALDOSTERONE U24,82088,CPT,,,,,both,, ,587.45,352.47,Medicare,Medicare,,,,,587.45,,,,
ALPHA 1-ANTITRYP TOT,82103,CPT,,,,,both,, ,969.17,581.5,Medicare,Medicare,,,,,969.17,,,,
ALPHA 1-ANTITRYP TOT,82103,CPT,,,,,both,, ,969.17,581.5,Medicare,Medicare,,,,,969.17,,,,
ALPHA 1-ANTITRYP PHE,82104,CPT,,,,,both,, ,1051.68,631,Medicare,Medicare,,,,,1051.68,,,,
ALPHA 1-ANTITRYP PHE,82104,CPT,,,,,both,, ,1051.68,631,Medicare,Medicare,,,,,1051.68,,,,
AFP SERUM,82105,CPT,,,,,both,, ,1142.06,685.23,Medicare,Medicare,,,,,1142.06,,,,
Q237 AFP TUMR MRK IA,82105,CPT,,,,,both,, ,1142.06,685.23,Medicare,Medicare,,,,,1142.06,,,,
Q5059 MAT SER AFP IA,82105,CPT,,,,,both,, ,1142.06,685.23,Medicare,Medicare,,,,,1142.06,,,,
AFP AMNIOTIC FLD,82106,CPT,,,,,both,, ,705.89,423.53,Medicare,Medicare,,,,,705.89,,,,
AFP-L3 AND TOTL AFP,82107,CPT,,,,,both,, ,530.47,318.28,Medicare,Medicare,,,,,530.47,,,,
AFP-L3 AND TOTL AFP,82107,CPT,,,,,both,, ,530.47,318.28,Medicare,Medicare,,,,,530.47,,,,
ALUMINUM,82108,CPT,,,,,both,, ,265.51,159.3,Medicare,Medicare,,,,,265.51,,,,
NBS AMINO ACD MUL QL,82128,CPT,,,,,both,, ,82.79,49.67,Medicare,Medicare,,,,,82.79,,,,
Q10947CYSTN U24 LCMS,82131,CPT,,,,,both,, ,175.98,105.58,Medicare,Medicare,,,,,175.98,,,,
AMINO ACID QUAN 6+,82139,CPT,,,,,both,, ,873.74,524.24,Medicare,Medicare,,,,,873.74,,,,
AMMONIA,82140,CPT,,,,,both,, ,154.09,92.45,Medicare,Medicare,,,,,154.09,,,,
AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
L910235 AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q442 AMMONIA,82140,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
AMYLASE,82150,CPT,,,,,both,, ,68.48,41.08,Medicare,Medicare,,,,,68.48,,,,
AMYLASE,82150,CPT,,,,,both,, ,518.69,311.21,Medicare,Medicare,,,,,518.69,,,,
AMYLASE,82150,CPT,,,,,both,, ,518.69,311.21,Medicare,Medicare,,,,,518.69,,,,
ANDROSTENEDIONE,82157,CPT,,,,,both,, ,769.33,461.59,Medicare,Medicare,,,,,769.33,,,,
ANDROSTENEDIONE,82157,CPT,,,,,both,, ,769.33,461.59,Medicare,Medicare,,,,,769.33,,,,
ANGIOTENSIN CONV ENZ,82164,CPT,,,,,both,, ,143.71,86.22,Medicare,Medicare,,,,,143.71,,,,
ANGIOTENSIN CONV ENZ,82164,CPT,,,,,both,, ,1081.72,649.03,Medicare,Medicare,,,,,1081.72,,,,
Q34692 ACE CSF KINET,82164,CPT,,,,,both,, ,1081.72,649.03,Medicare,Medicare,,,,,1081.72,,,,
Q683 ACE SP,82164,CPT,,,,,both,, ,1081.72,649.03,Medicare,Medicare,,,,,1081.72,,,,
ANTI-MULLERIAN HORM,82166,CPT,,,,,both,, ,116,69.6,Medicare,Medicare,,,,,116,,,,
APOLIPOPROTEIN EACH,82172,CPT,,,,,both,, ,467.04,280.22,Medicare,Medicare,,,,,467.04,,,,
APOLIPOPROTEIN EACH,82172,CPT,,,,,both,, ,467.04,280.22,Medicare,Medicare,,,,,467.04,,,,
ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,,,,751.36,,,,
Q269 AS BL ICP/MS,82175,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,,,,751.36,,,,
Q36438 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,,,,751.36,,,,
Q7507 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,,,,751.36,,,,
Q7655 ARSENIC,82175,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,,,,751.36,,,,
Q929 VIT C LC/MS/MS,82180,CPT,,,,,both,, ,67.92,40.75,Medicare,Medicare,,,,,67.92,,,,
BETA-2 MICROGLOBULIN,82232,CPT,,,,,both,, ,936.89,562.13,Medicare,Medicare,,,,,936.89,,,,
BETA-2 MICROGLOBULIN,82232,CPT,,,,,both,, ,936.89,562.13,Medicare,Medicare,,,,,936.89,,,,
Q14801 BILE AC ENZ,82239,CPT,,,,,both,, ,274.77,164.86,Medicare,Medicare,,,,,274.77,,,,
BILIRUBIN TOTAL,82247,CPT,,,,,both,, ,53.05,31.83,Medicare,Medicare,,,,,53.05,,,,
BILIRUBIN TOTAL,82247,CPT,,,,,both,, ,282.92,169.75,Medicare,Medicare,,,,,282.92,,,,
BILIRUBIN DIRECT,82248,CPT,,,,,both,, ,53.05,31.83,Medicare,Medicare,,,,,53.05,,,,
BILIRUBIN DIRECT,82248,CPT,,,,,both,, ,282.92,169.75,Medicare,Medicare,,,,,282.92,,,,
NBS BIOTINIDASE,82261,CPT,,,,,both,, ,100.75,60.45,Medicare,Medicare,,,,,100.75,,,,
BLD OCCULT FECES 1-3,82270,CPT,,,,,both,, ,31.99,19.19,Medicare,Medicare,,,,,31.99,,,,
BLD OCCULT FECES 1-3,82270,CPT,,,,,both,, ,210.5,126.3,Medicare,Medicare,,,,,210.5,,,,
BLD OCCULT OTHER SRC,82271,CPT,,,,,both,, ,277.59,166.55,Medicare,Medicare,,,,,277.59,,,,
BLD OCC NON CA SCREE,82272,CPT,,,,,both,, ,210.5,126.3,Medicare,Medicare,,,,,210.5,,,,
BLD OCCULT FECES EIA,82274,CPT,,,,,both,, ,165.87,99.52,Medicare,Medicare,,,,,165.87,,,,
CADMIUM,82300,CPT,,,,,both,, ,536.08,321.64,Medicare,Medicare,,,,,536.08,,,,
CADMIUM,82300,CPT,,,,,both,, ,536.08,321.64,Medicare,Medicare,,,,,536.08,,,,
Q672 CADMIUM,82300,CPT,,,,,both,, ,125,75,Medicare,Medicare,,,,,125,,,,
L504115VITD 25-OH LC,82306,CPT,,,,,both,, ,651.73,391.03,Medicare,Medicare,,,,,651.73,,,,
VITAMIN D 25OH,82306,CPT,,,,,both,, ,279.26,167.55,Medicare,Medicare,,,,,279.26,,,,
VITAMIN D 25OH,82306,CPT,,,,,both,,,710.38,710.38,Medicare,Medicare,,710.38,,,710.38,710.38,710.38,fee schedule,Medicare APC Fee Schedule
VITAMIN D 25OH,82306,CPT,,,,,both,, ,710.38,426.22,Medicare,Medicare,,,,,710.38,,,,
CALCITONIN,82308,CPT,,,,,both,, ,297.79,178.67,Medicare,Medicare,,,,,297.79,,,,
Q30742 CALCITONIN IA,82308,CPT,,,,,both,, ,796.27,477.76,Medicare,Medicare,,,,,796.27,,,,
CALCIUM TOTAL,82310,CPT,,,,,both,, ,54.45,32.67,Medicare,Medicare,,,,,54.45,,,,
CALCIUM TOTAL,82310,CPT,,,,,both,, ,315.48,189.28,Medicare,Medicare,,,,,315.48,,,,
CALCIUM TOTAL,82310,CPT,,,,,both,, ,315.48,189.28,Medicare,Medicare,,,,,315.48,,,,
CALCIUM IONIZED,82330,CPT,,,,,both,, ,35.36,21.21,Medicare,Medicare,,,,,35.36,,,,
CALCIUM IONIZED,82330,CPT,,,,,both,,,796.27,796.27,Medicare,Medicare,,796.27,,,796.27,796.27,796.27,fee schedule,Medicare APC Fee Schedule
CALCIUM IONIZED,82330,CPT,,,,,both,, ,796.27,477.76,Medicare,Medicare,,,,,796.27,,,,
CALCIUM IONIZED,82330,CPT,,,,,both,, ,796.27,477.76,Medicare,Medicare,,,,,796.27,,,,
CALCIUM URI QN TIMED,82340,CPT,,,,,both,,,412.87,412.87,Medicare,Medicare,,412.87,,,412.87,412.87,412.87,fee schedule,Medicare APC Fee Schedule
CALCIUM URI QN TIMED,82340,CPT,,,,,both,, ,412.87,247.72,Medicare,Medicare,,,,,412.87,,,,
"L910235 CALCIUM, URINE",82340,CPT,,,,,both,, ,412.87,247.72,Medicare,Medicare,,,,,412.87,,,,
Q442 CALCIUM URI QN,82340,CPT,,,,,both,, ,412.87,247.72,Medicare,Medicare,,,,,412.87,,,,
CALCULUS INFRARED,82365,CPT,,,,,both,, ,1187.82,712.69,Medicare,Medicare,,,,,1187.82,,,,
CALCULUS INFRARED,82365,CPT,,,,,both,, ,1187.82,712.69,Medicare,Medicare,,,,,1187.82,,,,
CARBON DIOXIDE CO2,82374,CPT,,,,,both,, ,47.99,28.79,Medicare,Medicare,,,,,47.99,,,,
CARBON DIOXIDE CO2,82374,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
CARBON MONOXIDE QUAN,82375,CPT,,,,,both,, ,203.49,122.09,Medicare,Medicare,,,,,203.49,,,,
CARBON MONOXIDE QUAN,82375,CPT,,,,,both,, ,203.49,122.09,Medicare,Medicare,,,,,203.49,,,,
CARCINOEMBRYONIC AG,82378,CPT,,,,,both,, ,121.53,72.91,Medicare,Medicare,,,,,121.53,,,,
CARCINOEMBRYONIC AG,82378,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,,,,526.26,,,,
CARCINOEMBRYONIC AG,82378,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,,,,526.26,,,,
CAROTENE,82380,CPT,,,,,both,, ,1171.81,703.08,Medicare,Medicare,,,,,1171.81,,,,
L1529 CAROTENE HPLC,82380,CPT,,,,,both,, ,75.2,45.12,Medicare,Medicare,,,,,75.2,,,,
CATECHOL FRACTNTD,82384,CPT,,,,,both,, ,263.27,157.96,Medicare,Medicare,,,,,263.27,,,,
CATECHOL FRACTNTD,82384,CPT,,,,,both,, ,263.27,157.96,Medicare,Medicare,,,,,263.27,,,,
CATECHOL FRACTNTD,82384,CPT,,,,,both,, ,263.27,157.96,Medicare,Medicare,,,,,263.27,,,,
CATECHOL FRACTNTD,82384,CPT,,,,,both,, ,263.27,157.96,Medicare,Medicare,,,,,263.27,,,,
CERULOPLASMIN,82390,CPT,,,,,both,, ,859.7,515.82,Medicare,Medicare,,,,,859.7,,,,
CERULOPLASMIN,82390,CPT,,,,,both,, ,859.7,515.82,Medicare,Medicare,,,,,859.7,,,,
CHEMILUM ASSAY NOS,82397,CPT,,,,,both,, ,444.59,266.75,Medicare,Medicare,,,,,444.59,,,,
L503870 CHEM ASY NOS,82397,CPT,,,,,both,, ,444.59,266.75,Medicare,Medicare,,,,,444.59,,,,
L504567 CHEM ASY NOS,82397,CPT,,,,,both,, ,407.88,244.72,Medicare,Medicare,,,,,407.88,,,,
Q34445 INHIBIN B CL,82397,CPT,,,,,both,, ,444.59,266.75,Medicare,Medicare,,,,,444.59,,,,
Q37226 ANTI-MULLERIAN HORMONE (AMH) MALE,82397,CPT,,,,,both,, ,396,237.6,Medicare,Medicare,,,,,396,,,,
Q37226 ANTI-MULLERIAN HORMONE (AMH) MALE,82397,CPT,,,,,both,, ,396,237.6,Medicare,Medicare,,,,,396,,,,
CHLORIDE BLOOD,82435,CPT,,,,,both,, ,38.73,23.23,Medicare,Medicare,,,,,38.73,,,,
CHLORIDE BLOOD,82435,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
CHLORIDE URINE RAN,82436,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
CHLORIDE URINE RAN,82436,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
CHLORIDES OTHER FLD,82438,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
CHOLESTEROL TOTAL,82465,CPT,,,,,both,, ,49.68,29.8,Medicare,Medicare,,,,,49.68,,,,
CHOLESTEROL TOTAL,82465,CPT,,,,,both,, ,315.48,189.28,Medicare,Medicare,,,,,315.48,,,,
CHOLINESTERASE SERUM,82480,CPT,,,,,both,, ,563.6,338.16,Medicare,Medicare,,,,,563.6,,,,
Q338 CHOLINEST SER,82480,CPT,,,,,both,, ,563.6,338.16,Medicare,Medicare,,,,,563.6,,,,
Q7961 CHOLINEST SER,82480,CPT,,,,,both,, ,563.6,338.16,Medicare,Medicare,,,,,563.6,,,,
CHOLINESTERASE RBC,82482,CPT,,,,,both,, ,676.14,405.68,Medicare,Medicare,,,,,676.14,,,,
CHOLINESTERASE RBC,82482,CPT,,,,,both,, ,676.14,405.68,Medicare,Medicare,,,,,676.14,,,,
CHROMIUM,82495,CPT,,,,,both,, ,242.5,145.5,Medicare,Medicare,,,,,242.5,,,,
CHROMIUM U,82495,CPT,,,,,both,, ,202.8,121.68,Medicare,Medicare,,,,,202.8,,,,
"L910235 CITRATE, URINE",82507,CPT,,,,,both,, ,242.5,145.5,Medicare,Medicare,,,,,242.5,,,,
Q11315 CIT AC U24 SP,82507,CPT,,,,,both,, ,242.5,145.5,Medicare,Medicare,,,,,242.5,,,,
Q442 CITRATE,82507,CPT,,,,,both,, ,242.5,145.5,Medicare,Medicare,,,,,242.5,,,,
COLLAGEN CROSSLINKS,82523,CPT,,,,,both,, ,280.11,168.06,Medicare,Medicare,,,,,280.11,,,,
L500089 C-TELO ELISA,82523,CPT,,,,,both,, ,529.2,317.52,Medicare,Medicare,,,,,529.2,,,,
"N-TELOPEP (NTX), UR",82523,CPT,,,,,both,, ,186.8,112.08,Medicare,Medicare,,,,,186.8,,,,
COPPER SERUM,82525,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
COPPER SERUM,82525,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
COPPER SERUM,82525,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
COPPER SERUM,82525,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
Q11280CORTU24 LCMSMS,82530,CPT,,,,,both,, ,938.86,563.31,Medicare,Medicare,,,,,938.86,,,,
Q11280CORTU24 LCMSMS,82530,CPT,,,,,both,, ,938.86,563.31,Medicare,Medicare,,,,,938.86,,,,
Q36423 CORT FR LCMSM,82530,CPT,,,,,both,, ,939.13,563.47,Medicare,Medicare,,,,,939.13,,,,
CORTISOL TOTAL,82533,CPT,,,,,both,, ,132.19,79.31,Medicare,Medicare,,,,,132.19,,,,
CORTISOL TOTAL,82533,CPT,,,,,both,,,1343.58,1343.58,Medicare,Medicare,,1343.58,,,1343.58,1343.58,1343.58,fee schedule,Medicare APC Fee Schedule
CORTISOL TOTAL,82533,CPT,,,,,both,, ,1343.58,806.14,Medicare,Medicare,,,,,1343.58,,,,
L500179SALIV CORT MS,82533,CPT,,,,,both,, ,335.78,201.46,Medicare,Medicare,,,,,335.78,,,,
L500440 CORTISOL TOT,82533,CPT,,,,,both,, ,163,97.8,Medicare,Medicare,,,,,163,,,,
CREATINE,82540,CPT,,,,,both,, ,38.73,23.23,Medicare,Medicare,,,,,38.73,,,,
COL CHRM NODRG EA,82542,CPT,,,,,both,, ,320.53,192.31,Medicare,Medicare,,,,,320.53,,,,
COL CHRM NODRG EA,82542,CPT,,,,,both,, ,320.53,192.31,Medicare,Medicare,,,,,320.53,,,,
COL CHRM NODRG EA,82542,CPT,,,,,both,, ,320.53,192.31,Medicare,Medicare,,,,,320.53,,,,
COL CHRM NODRG EA,82542,CPT,,,,,both,, ,320.53,192.31,Medicare,Medicare,,,,,320.53,,,,
L823430 OMEGACHECK (EPA+DPA+DHA),82542,CPT,,,,,both,, ,430,258,Medicare,Medicare,,,,,430,,,,
N-METHLHIST 24H UR,82542,CPT,,,,,both,, ,600,360,Medicare,Medicare,,,,,600,,,,
CPK TOTAL,82550,CPT,,,,,both,, ,64.27,38.56,Medicare,Medicare,,,,,64.27,,,,
CPK TOTAL,82550,CPT,,,,,both,,,282.92,282.92,Medicare,Medicare,,282.92,,,282.92,282.92,282.92,fee schedule,Medicare APC Fee Schedule
CPK TOTAL,82550,CPT,,,,,both,, ,282.92,169.75,Medicare,Medicare,,,,,282.92,,,,
CPK TOTAL,82550,CPT,,,,,both,, ,282.92,169.75,Medicare,Medicare,,,,,282.92,,,,
CPK ISOENZYMES,82552,CPT,,,,,both,, ,626.18,375.7,Medicare,Medicare,,,,,626.18,,,,
CPK ISOENZYMES,82552,CPT,,,,,both,, ,626.18,375.7,Medicare,Medicare,,,,,626.18,,,,
CPK MB FRACTION,82553,CPT,,,,,both,, ,113.67,68.2,Medicare,Medicare,,,,,113.67,,,,
CPK MB FRACTION,82553,CPT,,,,,both,, ,620.56,372.33,Medicare,Medicare,,,,,620.56,,,,
CREATININE BLOOD,82565,CPT,,,,,both,, ,19.09,11.45,Medicare,Medicare,,,,,19.09,,,,
CREATININE BLOOD,82565,CPT,,,,,both,,,285.17,285.17,Medicare,Medicare,,285.17,,,285.17,285.17,285.17,fee schedule,Medicare APC Fee Schedule
CREATININE BLOOD,82565,CPT,,,,,both,, ,285.17,171.1,Medicare,Medicare,,,,,285.17,,,,
CREATININE UR-OTHER,82570,CPT,,,,,both,, ,32.84,19.7,Medicare,Medicare,,,,,32.84,,,,
CREATININE UR-OTHER,82570,CPT,,,,,both,,,285.17,285.17,Medicare,Medicare,,285.17,,,285.17,285.17,285.17,fee schedule,Medicare APC Fee Schedule
CREATININE UR-OTHER,82570,CPT,,,,,both,, ,285.17,171.1,Medicare,Medicare,,,,,285.17,,,,
Q14961 CREATININE UR,82570,CPT,,,,,both,, ,261.87,157.12,Medicare,Medicare,,,,,261.87,,,,
Q14961 CREATININE UR,82570,CPT,,,,,both,, ,261.87,157.12,Medicare,Medicare,,,,,261.87,,,,
Q1648 CREATININE UR-,82570,CPT,,,,,both,, ,285.17,171.1,Medicare,Medicare,,,,,285.17,,,,
Q17422 CREATIN PTF C,82570,CPT,,,,,both,, ,285.17,171.1,Medicare,Medicare,,,,,285.17,,,,
Q442 CREATININE UR-O,82570,CPT,,,,,both,, ,285.17,171.1,Medicare,Medicare,,,,,285.17,,,,
Q682 CREATININE UR-O,82570,CPT,,,,,both,, ,285.17,171.1,Medicare,Medicare,,,,,285.17,,,,
Q7507 CREATIN UR-OTH,82570,CPT,,,,,both,, ,285.17,171.1,Medicare,Medicare,,,,,285.17,,,,
Q8525 CREATININE UR-,82570,CPT,,,,,both,, ,285.17,171.1,Medicare,Medicare,,,,,285.17,,,,
CREATININE CLEARANCE,82575,CPT,,,,,both,,,555.45,555.45,Medicare,Medicare,,555.45,,,555.45,555.45,555.45,fee schedule,Medicare APC Fee Schedule
CREATININE CLEARANCE,82575,CPT,,,,,both,, ,555.45,333.27,Medicare,Medicare,,,,,555.45,,,,
CRYOGLOBULIN,82595,CPT,,,,,both,, ,968.6,581.16,Medicare,Medicare,,,,,968.6,,,,
CRYOGLOBULIN,82595,CPT,,,,,both,, ,968.6,581.16,Medicare,Medicare,,,,,968.6,,,,
VITAMIN B-12,82607,CPT,,,,,both,, ,111.43,66.85,Medicare,Medicare,,,,,111.43,,,,
VITAMIN B-12,82607,CPT,,,,,both,,,641.06,641.06,Medicare,Medicare,,641.06,,,641.06,641.06,641.06,fee schedule,Medicare APC Fee Schedule
VITAMIN B-12,82607,CPT,,,,,both,, ,641.06,384.63,Medicare,Medicare,,,,,641.06,,,,
VITAMIN B-12 BINDING,82608,CPT,,,,,both,, ,183.56,110.13,Medicare,Medicare,,,,,183.56,,,,
Q10570 CYSTAT C NEPH,82610,CPT,,,,,both,, ,121.25,72.75,Medicare,Medicare,,,,,121.25,,,,
"L910235 CREATININE, URINE",82615,CPT,,,,,both,, ,285.17,171.1,Medicare,Medicare,,,,,285.17,,,,
L910235 CYSTINE/HOMOCYSTINE UR,82615,CPT,,,,,both,, ,50,30,Medicare,Medicare,,,,,50,,,,
DHEA,82626,CPT,,,,,both,, ,263.55,158.13,Medicare,Medicare,,,,,263.55,,,,
DHEA,82626,CPT,,,,,both,, ,263.55,158.13,Medicare,Medicare,,,,,263.55,,,,
DHEA-S,82627,CPT,,,,,both,, ,664.35,398.61,Medicare,Medicare,,,,,664.35,,,,
DHEA-S,82627,CPT,,,,,both,, ,664.35,398.61,Medicare,Medicare,,,,,664.35,,,,
DEOXYCORTISOL,82634,CPT,,,,,both,, ,177.39,106.43,Medicare,Medicare,,,,,177.39,,,,
DIBUCAINE NUMBER,82638,CPT,,,,,both,, ,270.28,162.16,Medicare,Medicare,,,,,270.28,,,,
DIBUCAINE NUMBER,82638,CPT,,,,,both,, ,270.28,162.16,Medicare,Medicare,,,,,270.28,,,,
DIHYDROTESTOST (DHT),82642,CPT,,,,,both,, ,151.84,91.1,Medicare,Medicare,,,,,151.84,,,,
DIHYDROXY VITAMIN D,82652,CPT,,,,,both,, ,379.18,227.5,Medicare,Medicare,,,,,379.18,,,,
DIHYDROXY VITAMIN D,82652,CPT,,,,,both,, ,1307.38,784.42,Medicare,Medicare,,,,,1307.38,,,,
Q16558 VITD LCMSMS,82652,CPT,,,,,both,, ,554.89,332.93,Medicare,Medicare,,,,,554.89,,,,
Q14693 ELAST PANC QT,82653,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,,,,414.83,,,,
Q14693 ELAST PANC QT,82653,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,,,,414.83,,,,
"PANCREA ELASTAS,FEC",82656,CPT,,,,,both,, ,267.48,160.48,Medicare,Medicare,,,,,267.48,,,,
"PANCREA ELASTAS,FEC",82656,CPT,,,,,both,, ,267.48,160.48,Medicare,Medicare,,,,,267.48,,,,
Q14693 PE-1 IA,82656,CPT,,,,,both,, ,228.97,137.38,Medicare,Medicare,,,,,228.97,,,,
ERYTHROPOIETIN,82668,CPT,,,,,both,, ,1449.41,869.64,Medicare,Medicare,,,,,1449.41,,,,
ERYTHROPOIETIN,82668,CPT,,,,,both,, ,1449.41,869.64,Medicare,Medicare,,,,,1449.41,,,,
ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Medicare,Medicare,,,,,976.46,,,,
L500649 ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Medicare,Medicare,,,,,976.46,,,,
Q30289 ESTRADIOL US,82670,CPT,,,,,both,, ,976.46,585.87,Medicare,Medicare,,,,,976.46,,,,
Q36169 ESTRA FR DIR,82670,CPT,,,,,both,, ,895.84,537.5,Medicare,Medicare,,,,,895.84,,,,
Q36169 ESTRADIOL,82670,CPT,,,,,both,, ,976.46,585.87,Medicare,Medicare,,,,,976.46,,,,
Q4021 ESTRADIOL IA,82670,CPT,,,,,both,, ,976.46,585.87,Medicare,Medicare,,,,,976.46,,,,
Q36742 EST FR LCMSMS,82671,CPT,,,,,both,, ,170.36,102.21,Medicare,Medicare,,,,,170.36,,,,
ESTROGEN TOTAL,82672,CPT,,,,,both,, ,1727.55,1036.53,Medicare,Medicare,,,,,1727.55,,,,
Q439 ESTROG TOT RIA,82672,CPT,,,,,both,, ,304.53,182.71,Medicare,Medicare,,,,,304.53,,,,
ESTRIOL,82677,CPT,,,,,both,, ,317.44,190.46,Medicare,Medicare,,,,,317.44,,,,
ESTRIOL,82677,CPT,,,,,both,, ,317.44,190.46,Medicare,Medicare,,,,,317.44,,,,
ESTRONE,82679,CPT,,,,,both,, ,116.47,69.88,Medicare,Medicare,,,,,116.47,,,,
ESTRONE,82679,CPT,,,,,both,, ,116.47,69.88,Medicare,Medicare,,,,,116.47,,,,
L500649 ESTRA FR DIR,82681,CPT,,,,,both,, ,251.84,151.1,Medicare,Medicare,,,,,251.84,,,,
ETHYLENE GLYCOL,82693,CPT,,,,,both,,,1577.11,1577.11,Medicare,Medicare,,1577.11,,,1577.11,1577.11,1577.11,fee schedule,Medicare APC Fee Schedule
ETHYLENE GLYCOL,82693,CPT,,,,,both,, ,1577.11,946.26,Medicare,Medicare,,,,,1577.11,,,,
Q801 ETHYL GLY CHRMT,82693,CPT,,,,,both,, ,935.21,561.12,Medicare,Medicare,,,,,935.21,,,,
FAT-LIPID FECES QUAL,82705,CPT,,,,,both,, ,600.92,360.55,Medicare,Medicare,,,,,600.92,,,,
FAT-LIPID FECES QUAL,82705,CPT,,,,,both,, ,600.92,360.55,Medicare,Medicare,,,,,600.92,,,,
FAT-LIPID FECES QUAN,82710,CPT,,,,,both,, ,768.2,460.92,Medicare,Medicare,,,,,768.2,,,,
FAT-LIPID FECES QUAN,82710,CPT,,,,,both,, ,768.2,460.92,Medicare,Medicare,,,,,768.2,,,,
FECAL FAT QUANT 72HR,82710,CPT,,,,,both,, ,122.2,73.32,Medicare,Medicare,,,,,122.2,,,,
Q90559 VLCFA,82726,CPT,,,,,both,, ,88.69,53.21,Medicare,Medicare,,,,,88.69,,,,
FERRITIN,82728,CPT,,,,,both,, ,100.75,60.45,Medicare,Medicare,,,,,100.75,,,,
FERRITIN,82728,CPT,,,,,both,,,864.19,864.19,Medicare,Medicare,,864.19,,,864.19,864.19,864.19,fee schedule,Medicare APC Fee Schedule
FERRITIN,82728,CPT,,,,,both,, ,864.19,518.51,Medicare,Medicare,,,,,864.19,,,,
FETAL FIBRONECTIN,82731,CPT,,,,,both,, ,701.69,421.01,Medicare,Medicare,,,,,701.69,,,,
FOLIC ACID SERUM,82746,CPT,,,,,both,, ,108.61,65.16,Medicare,Medicare,,,,,108.61,,,,
FOLIC ACID SERUM,82746,CPT,,,,,both,,,735.65,735.65,Medicare,Medicare,,735.65,,,735.65,735.65,735.65,fee schedule,Medicare APC Fee Schedule
FOLIC ACID SERUM,82746,CPT,,,,,both,, ,735.65,441.39,Medicare,Medicare,,,,,735.65,,,,
FOLIC ACID RBC,82747,CPT,,,,,both,, ,627.3,376.38,Medicare,Medicare,,,,,627.3,,,,
FOLIC ACID RBC,82747,CPT,,,,,both,, ,627.3,376.38,Medicare,Medicare,,,,,627.3,,,,
NBS GALACTOSE,82760,CPT,,,,,both,, ,66.8,40.08,Medicare,Medicare,,,,,66.8,,,,
NBS GALACTOSE TRANS,82776,CPT,,,,,both,, ,49.96,29.97,Medicare,Medicare,,,,,49.96,,,,
GAMMAGLOB M-G-A-D,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,,,,220.88,,,,
GAMMAGLOB M-G-A-D,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,,,,220.88,,,,
GAMMAGLOB M-G-A-D,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,,,,220.88,,,,
GAMMAGLOB M-G-A-D,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,,,,220.88,,,,
Q38940 GAMMAGLOB M G A D,82784,CPT,,,,,both,, ,196.75,118.05,Medicare,Medicare,,,,,196.75,,,,
Q541 IGD NEPHELOMET,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,,,,220.88,,,,
Q541 IGD NEPHELOMET,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,,,,220.88,,,,
Q541 IGD NEPHELOMET,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,,,,220.88,,,,
Q541 IGD NEPHELOMET,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,,,,220.88,,,,
Q70858GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,,,,220.88,,,,
Q70858GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,,,,220.88,,,,
Q70858GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,,,,220.88,,,,
Q70858GAMMAGLOB MGAD,82784,CPT,,,,,both,, ,220.88,132.52,Medicare,Medicare,,,,,220.88,,,,
GAMMAGLOBULIN IGE,82785,CPT,,,,,both,, ,127.14,76.28,Medicare,Medicare,,,,,127.14,,,,
GAMMAGLOBULIN IGE,82785,CPT,,,,,both,, ,906.3,543.78,Medicare,Medicare,,,,,906.3,,,,
Q542 IGE IA,82785,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,,,,148.75,,,,
Q542 IGE IA,82785,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,,,,148.75,,,,
Q542 IGE IA,82785,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,,,,148.75,,,,
Q542 IGE IA,82785,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,,,,148.75,,,,
"IGG SUB 1,2,3 OR 4",82787,CPT,,,,,both,, ,389.01,233.4,Medicare,Medicare,,,,,389.01,,,,
Q143422 IGG SUB4 NEP,82787,CPT,,,,,both,, ,389.01,233.4,Medicare,Medicare,,,,,389.01,,,,
"Q7903IGG SUB 1,2,3,4",82787,CPT,,,,,both,, ,389.01,233.4,Medicare,Medicare,,,,,389.01,,,,
BLOOD PH,82800,CPT,,,,,both,, ,618.04,370.82,Medicare,Medicare,,,,,618.04,,,,
BLD GAS W-O2 SAT DIR,82805,CPT,,,,,both,, ,1760.39,1056.23,Medicare,Medicare,,,,,1760.39,,,,
"BLD GAS, O2 SAT ONLY",82810,CPT,,,,,both,, ,100.63,60.37,Medicare,Medicare,,,,,100.63,,,,
"BLD GAS, O2 SAT ONLY",82810,CPT,,,,,both,, ,100.63,60.37,Medicare,Medicare,,,,,100.63,,,,
GASTRIN,82941,CPT,,,,,both,, ,863.91,518.34,Medicare,Medicare,,,,,863.91,,,,
GASTRIN,82941,CPT,,,,,both,, ,863.91,518.34,Medicare,Medicare,,,,,863.91,,,,
Q519 GLUCAG EXT-RIA,82943,CPT,,,,,both,, ,82.51,49.5,Medicare,Medicare,,,,,82.51,,,,
GLUCOSE BODY FLUID,82945,CPT,,,,,both,, ,412.87,247.72,Medicare,Medicare,,,,,412.87,,,,
"GLUCOSE, QUANT",82947,CPT,,,,,both,, ,21.89,13.13,Medicare,Medicare,,,,,21.89,,,,
"GLUCOSE, QUANT",82947,CPT,,,,,both,,,240.26,240.26,Medicare,Medicare,,240.26,,,240.26,240.26,240.26,fee schedule,Medicare APC Fee Schedule
"GLUCOSE, QUANT",82947,CPT,,,,,both,, ,240.26,144.15,Medicare,Medicare,,,,,240.26,,,,
"GLUCOSE, POST DOSE",82950,CPT,,,,,both,,,450.48,450.48,Medicare,Medicare,,450.48,,,450.48,450.48,450.48,fee schedule,Medicare APC Fee Schedule
"GLUCOSE, POST DOSE",82950,CPT,,,,,both,, ,450.48,270.28,Medicare,Medicare,,,,,450.48,,,,
GTT 3 SPEC,82951,CPT,,,,,both,, ,758.95,455.37,Medicare,Medicare,,,,,758.95,,,,
GTT ADD SP,82952,CPT,,,,,both,, ,188.05,112.83,Medicare,Medicare,,,,,188.05,,,,
"G6PD, QUANT",82955,CPT,,,,,both,, ,1026.43,615.85,Medicare,Medicare,,,,,1026.43,,,,
"L121003 G6PD, QUANT",82955,CPT,,,,,both,, ,60,36,Medicare,Medicare,,,,,60,,,,
"GLU,HOME USE DIAGNOS",82962,CPT,,,,,both,, ,8.76,5.25,Medicare,Medicare,,,,,8.76,,,,
"GLU,HOME USE DIAGNOS",82962,CPT,,,,,both,, ,99.35,59.61,Medicare,Medicare,,,,,99.35,,,,
GGT,82977,CPT,,,,,both,, ,71.01,42.6,Medicare,Medicare,,,,,71.01,,,,
GGT,82977,CPT,,,,,both,, ,412.87,247.72,Medicare,Medicare,,,,,412.87,,,,
L7700 GSH TOT,82978,CPT,,,,,both,, ,61,36.6,Medicare,Medicare,,,,,61,,,,
GLYCATED PROTEIN,82985,CPT,,,,,both,, ,263.83,158.29,Medicare,Medicare,,,,,263.83,,,,
Q8340 FRUCTOSAMINE C,82985,CPT,,,,,both,, ,298.92,179.35,Medicare,Medicare,,,,,298.92,,,,
FOLLICLE STIM HORM,83001,CPT,,,,,both,, ,137.25,82.35,Medicare,Medicare,,,,,137.25,,,,
FOLLICLE STIM HORM,83001,CPT,,,,,both,, ,812.55,487.53,Medicare,Medicare,,,,,812.55,,,,
FOLLICLE STIM HORM,83001,CPT,,,,,both,, ,812.55,487.53,Medicare,Medicare,,,,,812.55,,,,
LEUTEINIZING HORMONE,83002,CPT,,,,,both,, ,136.97,82.18,Medicare,Medicare,,,,,136.97,,,,
LEUTEINIZING HORMONE,83002,CPT,,,,,both,, ,812.55,487.53,Medicare,Medicare,,,,,812.55,,,,
LEUTEINIZING HORMONE,83002,CPT,,,,,both,, ,812.55,487.53,Medicare,Medicare,,,,,812.55,,,,
GROWTH HORMONE,83003,CPT,,,,,both,, ,1201.85,721.11,Medicare,Medicare,,,,,1201.85,,,,
Q521 GH IA,83003,CPT,,,,,both,, ,74.86,44.91,Medicare,Medicare,,,,,74.86,,,,
Q91823 GRTH STM GN 2,83006,CPT,,,,,both,, ,189,113.4,Medicare,Medicare,,,,,189,,,,
"HAPTOGLOBIN, QUANT",83010,CPT,,,,,both,, ,1109.23,665.53,Medicare,Medicare,,,,,1109.23,,,,
"HAPTOGLOBIN, QUANT",83010,CPT,,,,,both,, ,1109.23,665.53,Medicare,Medicare,,,,,1109.23,,,,
Q14839H.PYLO UREA IR,83013,CPT,,,,,both,, ,623.38,374.02,Medicare,Medicare,,,,,623.38,,,,
"HEAVY METALS, QUANT",83018,CPT,,,,,both,, ,175.14,105.08,Medicare,Medicare,,,,,175.14,,,,
L121690 - HEMOGLOBIN ELECTRO,83020,CPT,,,,,both,, ,108.15,64.89,Medicare,Medicare,,,,,108.15,,,,
NBS HGB ELECTRO,83020,CPT,,,,,both,, ,76.9,46.14,Medicare,Medicare,,,,,76.9,,,,
"HEMOGLOBIN, CHROMA",83021,CPT,,,,,both,, ,180.6,108.36,Medicare,Medicare,,,,,180.6,,,,
"HEMOGLOBIN, CHROMA",83021,CPT,,,,,both,, ,180.6,108.36,Medicare,Medicare,,,,,180.6,,,,
"HEMOGLOB,FETGAL,QUAL",83033,CPT,,,,,both,, ,354.77,212.86,Medicare,Medicare,,,,,354.77,,,,
HEMOGLOBIN A1C,83036,CPT,,,,,both,, ,95.71,57.42,Medicare,Medicare,,,,,95.71,,,,
HEMOGLOBIN A1C,83036,CPT,,,,,both,,,454.97,454.97,Medicare,Medicare,,454.97,,,454.97,454.97,454.97,fee schedule,Medicare APC Fee Schedule
HEMOGLOBIN A1C,83036,CPT,,,,,both,, ,454.97,272.98,Medicare,Medicare,,,,,454.97,,,,
HEMOGLOBIN A1C,83036,CPT,,,,,both,, ,454.97,272.98,Medicare,Medicare,,,,,454.97,,,,
"METHEMOGLOBIN,QUAN",83050,CPT,,,,,both,, ,122.09,73.25,Medicare,Medicare,,,,,122.09,,,,
"HEMOGLOBIN, PLASMA",83051,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
"HEMOSIDERIN, QUAL",83070,CPT,,,,,both,, ,373.57,224.14,Medicare,Medicare,,,,,373.57,,,,
HISTAMINE,83088,CPT,,,,,both,, ,385.09,231.05,Medicare,Medicare,,,,,385.09,,,,
Q36586 HISTAM PL RIA,83088,CPT,,,,,both,, ,385.09,231.05,Medicare,Medicare,,,,,385.09,,,,
Q4946 HISTAM U24 IA,83088,CPT,,,,,both,, ,385.09,231.05,Medicare,Medicare,,,,,385.09,,,,
HOMOCYSTEINE,83090,CPT,,,,,both,, ,227.91,136.74,Medicare,Medicare,,,,,227.91,,,,
HOMOCYSTEINE,83090,CPT,,,,,both,, ,227.91,136.74,Medicare,Medicare,,,,,227.91,,,,
CORTICOSTEROIDS,83491,CPT,,,,,both,, ,1217.28,730.36,Medicare,Medicare,,,,,1217.28,,,,
5-HIAA,83497,CPT,,,,,both,, ,976.46,585.87,Medicare,Medicare,,,,,976.46,,,,
Q1648 5-HIAA,83497,CPT,,,,,both,, ,976.46,585.87,Medicare,Medicare,,,,,976.46,,,,
Q523 5-HIAA U24 HPLC,83497,CPT,,,,,both,, ,976.46,585.87,Medicare,Medicare,,,,,976.46,,,,
HYDROXYPROGES 17-D,83498,CPT,,,,,both,, ,600.92,360.55,Medicare,Medicare,,,,,600.92,,,,
NBS HYDROXYPROG 17-D,83498,CPT,,,,,both,, ,162.23,97.33,Medicare,Medicare,,,,,162.23,,,,
Q17180 17-OHP LCMSMS,83498,CPT,,,,,both,, ,601.2,360.72,Medicare,Medicare,,,,,601.2,,,,
"IMMUNOASSAY, OTHER",83516,CPT,,,,,both,,,765.96,765.96,Medicare,Medicare,,765.96,,,765.96,765.96,765.96,fee schedule,Medicare APC Fee Schedule
"IMMUNOASSAY, OTHER",83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,,,,765.96,,,,
L162045 IA OTH,83516,CPT,,,,,both,, ,702.72,421.63,Medicare,Medicare,,,,,702.72,,,,
L163061 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,,,,765.96,,,,
L165126 IA OTH,83516,CPT,,,,,both,, ,702.72,421.63,Medicare,Medicare,,,,,702.72,,,,
L341142 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,,,,765.96,,,,
L520057 ANTI-HMGCR,83516,CPT,,,,,both,, ,630,378,Medicare,Medicare,,,,,630,,,,
L520085 IA OTHER,83516,CPT,,,,,both,, ,702.72,421.63,Medicare,Medicare,,,,,702.72,,,,
L520139 ANTI-GP210AB,83516,CPT,,,,,both,, ,300,180,Medicare,Medicare,,,,,300,,,,
L520311 CARP AB,83516,CPT,,,,,both,, ,520,312,Medicare,Medicare,,,,,520,,,,
L6486PARIET AB ELISA,83516,CPT,,,,,both,, ,81.5,48.9,Medicare,Medicare,,,,,81.5,,,,
Q15114PARCL AB ELISA,83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,,,,765.96,,,,
Q18855 KU AUTOANTIBODIES,83516,CPT,,,,,both,, ,682.25,409.35,Medicare,Medicare,,,,,682.25,,,,
Q19899RNA P-III ELIS,83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,,,,765.96,,,,
Q34283 RIBO P AB IA,83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,,,,765.96,,,,
Q36336 IA OTHER,83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,,,,765.96,,,,
Q37056 HISTON AB EIA,83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,,,,765.96,,,,
Q39226  21OH AB,83516,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,,,,765.96,,,,
"IMMUNOASSAY, RIA",83519,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,,,,728.07,,,,
"IMMUNOASSAY, RIA",83519,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,,,,728.07,,,,
"IMMUNOASSAY, RIA",83519,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,,,,728.07,,,,
"IMMUNOASSAY, RIA",83519,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,,,,728.07,,,,
L10421 MSH,83519,CPT,,,,,both,, ,184,110.4,Medicare,Medicare,,,,,184,,,,
L504600 MUSCLE SPECIFIC KINASE,83519,CPT,,,,,both,, ,1200,720,Medicare,Medicare,,,,,1200,,,,
Q34478 PTH-RP IA,83519,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,,,,728.07,,,,
Q34478 PTH-RP IA,83519,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,,,,728.07,,,,
Q34478 PTH-RP IA,83519,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,,,,728.07,,,,
Q34478 PTH-RP IA,83519,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,,,,728.07,,,,
"IMMUNOASSAY, NOS",83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,,,,414.83,,,,
"IMMUNOASSAY, NOS",83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,,,,414.83,,,,
L117021 VEGF SER,83520,CPT,,,,,both,, ,175,105,Medicare,Medicare,,,,,175,,,,
L146795INHIBIN B EIA,83520,CPT,,,,,both,, ,380.59,228.35,Medicare,Medicare,,,,,380.59,,,,
L500016PROTHR FR 1+2,83520,CPT,,,,,both,, ,172.7,103.62,Medicare,Medicare,,,,,172.7,,,,
L500124 MMP9,83520,CPT,,,,,both,, ,170,102,Medicare,Medicare,,,,,170,,,,
L520085 IA NOS,83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,,,,414.83,,,,
L520085 IA NOS,83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,,,,414.83,,,,
NBS IMMUNOASSAY NOS,83520,CPT,,,,,both,, ,77.47,46.48,Medicare,Medicare,,,,,77.47,,,,
Q113354 IA NOS,83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,,,,414.83,,,,
Q113354 IA NOS,83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,,,,414.83,,,,
Q145128 VEGF ELISA,83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,,,,414.83,,,,
Q145128 VEGF ELISA,83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,,,,414.83,,,,
Q16136 BULLOUS PEMPHOGOID BP230 IGG,83520,CPT,,,,,both,, ,369.5,221.7,Medicare,Medicare,,,,,369.5,,,,
Q16136 BULLOUS PEMPHOGOID BP230 IGG,83520,CPT,,,,,both,, ,369.5,221.7,Medicare,Medicare,,,,,369.5,,,,
Q16136 BULLOUS PEMPHOGOID BP230 IGG,83520,CPT,,,,,both,, ,369.5,221.7,Medicare,Medicare,,,,,369.5,,,,
Q16136 BULLOUS PEMPHOGOID BP230 IGG,83520,CPT,,,,,both,, ,369.5,221.7,Medicare,Medicare,,,,,369.5,,,,
Q34458 IGFBP-3 IA,83520,CPT,,,,,both,, ,444.59,266.75,Medicare,Medicare,,,,,444.59,,,,
Q34458 IGFBP-3 IA,83520,CPT,,,,,both,, ,444.59,266.75,Medicare,Medicare,,,,,444.59,,,,
Q34484 TRYPTASE FIA,83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,,,,414.83,,,,
Q34484 TRYPTASE FIA,83520,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,,,,414.83,,,,
L121210 LTCHN KAPLAM,83521,CPT,,,,,both,, ,103.62,62.17,Medicare,Medicare,,,,,103.62,,,,
L121210 LTCHN KAPLAM,83521,CPT,,,,,both,, ,103.62,62.17,Medicare,Medicare,,,,,103.62,,,,
Q11234 LTCHN KAP LAM,83521,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
Q11234 LTCHN KAP LAM,83521,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
"INSULIN, TOTAL",83525,CPT,,,,,both,, ,53.89,32.33,Medicare,Medicare,,,,,53.89,,,,
"INSULIN, TOTAL",83525,CPT,,,,,both,, ,600.92,360.55,Medicare,Medicare,,,,,600.92,,,,
Q561 INSULIN IA,83525,CPT,,,,,both,, ,632.36,379.41,Medicare,Medicare,,,,,632.36,,,,
"INSULIN, FREE",83527,CPT,,,,,both,, ,193.94,116.36,Medicare,Medicare,,,,,193.94,,,,
L501561 INSULIN FREE,83527,CPT,,,,,both,, ,193.94,116.36,Medicare,Medicare,,,,,193.94,,,,
Q36700 INSULIN FR IA,83527,CPT,,,,,both,, ,193.94,116.36,Medicare,Medicare,,,,,193.94,,,,
IRON,83540,CPT,,,,,both,, ,63.99,38.39,Medicare,Medicare,,,,,63.99,,,,
IRON,83540,CPT,,,,,both,,,345.79,345.79,Medicare,Medicare,,345.79,,,345.79,345.79,345.79,fee schedule,Medicare APC Fee Schedule
IRON,83540,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
IRON BINDING CAPACIT,83550,CPT,,,,,both,, ,86.16,51.69,Medicare,Medicare,,,,,86.16,,,,
IRON BINDING CAPACIT,83550,CPT,,,,,both,,,526.26,526.26,Medicare,Medicare,,526.26,,,526.26,526.26,526.26,fee schedule,Medicare APC Fee Schedule
IRON BINDING CAPACIT,83550,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,,,,526.26,,,,
"17-KETOSTEROIDS, TOT",83586,CPT,,,,,both,, ,164.19,98.51,Medicare,Medicare,,,,,164.19,,,,
LACTIC ACID,83605,CPT,,,,,both,, ,105.25,63.15,Medicare,Medicare,,,,,105.25,,,,
LACTIC ACID,83605,CPT,,,,,both,,,691.29,691.29,Medicare,Medicare,,691.29,,,691.29,691.29,691.29,fee schedule,Medicare APC Fee Schedule
LACTIC ACID,83605,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
LACTATE DEHYDROLDH,83615,CPT,,,,,both,, ,59.5,35.7,Medicare,Medicare,,,,,59.5,,,,
LACTATE DEHYDROLDH,83615,CPT,,,,,both,, ,600.92,360.55,Medicare,Medicare,,,,,600.92,,,,
LACTATE DEHYDROLDH,83615,CPT,,,,,both,, ,600.92,360.55,Medicare,Medicare,,,,,600.92,,,,
LDH ISOENZYMES,83625,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q10156 LACTOFER IA,83630,CPT,,,,,both,, ,267.48,160.48,Medicare,Medicare,,,,,267.48,,,,
LEAD,83655,CPT,,,,,both,, ,56.97,34.18,Medicare,Medicare,,,,,56.97,,,,
LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q22996 LEAD,83655,CPT,,,,,both,, ,615.75,369.45,Medicare,Medicare,,,,,615.75,,,,
Q22996 LEAD,83655,CPT,,,,,both,, ,615.75,369.45,Medicare,Medicare,,,,,615.75,,,,
Q36438 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q36440LEAD U24 ICPMS,83655,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q599 PB BL ICP/MS,83655,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q601 PB U ICP/MS,83655,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q7507 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q7655 LEAD,83655,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
"FETAL LUNG,L-S RATIO",83661,CPT,,,,,both,, ,175.14,105.08,Medicare,Medicare,,,,,175.14,,,,
"FETAL LUNG, FPIA",83663,CPT,,,,,both,, ,863.91,518.34,Medicare,Medicare,,,,,863.91,,,,
LIPASE,83690,CPT,,,,,both,, ,67.92,40.75,Medicare,Medicare,,,,,67.92,,,,
LIPASE,83690,CPT,,,,,both,,,420.72,420.72,Medicare,Medicare,,420.72,,,420.72,420.72,420.72,fee schedule,Medicare APC Fee Schedule
LIPASE,83690,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
LIPOPROTEIN A,83695,CPT,,,,,both,, ,112.27,67.36,Medicare,Medicare,,,,,112.27,,,,
LIPOPROTEIN A,83695,CPT,,,,,both,, ,112.27,67.36,Medicare,Medicare,,,,,112.27,,,,
Q34604 LIPOPRT A ITA,83695,CPT,,,,,both,, ,467.04,280.22,Medicare,Medicare,,,,,467.04,,,,
Q94220 LP-PLA2,83698,CPT,,,,,both,, ,216.39,129.83,Medicare,Medicare,,,,,216.39,,,,
LIPOPROT BLD BY NMR,83704,CPT,,,,,both,, ,374.69,224.81,Medicare,Medicare,,,,,374.69,,,,
LIPOPROT BLD BY NMR,83704,CPT,,,,,both,, ,374.69,224.81,Medicare,Medicare,,,,,374.69,,,,
"LIPOPROTEIN, HDL",83718,CPT,,,,,both,, ,60.63,36.37,Medicare,Medicare,,,,,60.63,,,,
"LIPOPROTEIN, HDL",83718,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,,,,480.79,,,,
"LIPOPROTEIN, LDL",83721,CPT,,,,,both,, ,570.89,342.53,Medicare,Medicare,,,,,570.89,,,,
"L910235 MAGNESIUM, URINE",83735,CPT,,,,,both,, ,67,40.2,Medicare,Medicare,,,,,67,,,,
"L910235 MAGNESIUM, URINE",83735,CPT,,,,,both,, ,67,40.2,Medicare,Medicare,,,,,67,,,,
MAGNESIUM,83735,CPT,,,,,both,, ,49.68,29.8,Medicare,Medicare,,,,,49.68,,,,
MAGNESIUM,83735,CPT,,,,,both,,,344.1,344.1,Medicare,Medicare,,344.1,,,344.1,344.1,344.1,fee schedule,Medicare APC Fee Schedule
MAGNESIUM,83735,CPT,,,,,both,, ,344.1,206.46,Medicare,Medicare,,,,,344.1,,,,
MAGNESIUM,83735,CPT,,,,,both,, ,344.1,206.46,Medicare,Medicare,,,,,344.1,,,,
MANGANESE WHOLE BLOOD,83785,CPT,,,,,both,, ,133,79.8,Medicare,Medicare,,,,,133,,,,
L70034 I S/P ICP/MS,83789,CPT,,,,,both,, ,315,189,Medicare,Medicare,,,,,315,,,,
L70222 I U ICP/MS,83789,CPT,,,,,both,, ,390.49,234.29,Medicare,Medicare,,,,,390.49,,,,
MASS SPECTRO QUANT,83789,CPT,,,,,both,, ,402.2,241.32,Medicare,Medicare,,,,,402.2,,,,
MASS SPECTRO QUANT,83789,CPT,,,,,both,, ,402.2,241.32,Medicare,Medicare,,,,,402.2,,,,
MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,,,,751.36,,,,
Q36438 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,,,,751.36,,,,
Q636 HG BL ICP/MS,83825,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,,,,751.36,,,,
Q7507 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,,,,751.36,,,,
Q7655 MERCURY,83825,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,,,,751.36,,,,
METANEPHRINES,83835,CPT,,,,,both,, ,2599.05,1559.43,Medicare,Medicare,,,,,2599.05,,,,
Q14961 METANEPHRINES,83835,CPT,,,,,both,, ,488.65,293.19,Medicare,Medicare,,,,,488.65,,,,
Q14962MNFR U24 LCMSM,83835,CPT,,,,,both,, ,488.65,293.19,Medicare,Medicare,,,,,488.65,,,,
Q19548 MN FRC LCMSMS,83835,CPT,,,,,both,, ,488.65,293.19,Medicare,Medicare,,,,,488.65,,,,
MYELIN BASIC PROTEIN,83873,CPT,,,,,both,, ,509.14,305.48,Medicare,Medicare,,,,,509.14,,,,
MYELIN BASIC PROTEIN,83873,CPT,,,,,both,, ,509.14,305.48,Medicare,Medicare,,,,,509.14,,,,
MYOGLOBIN,83874,CPT,,,,,both,, ,627.3,376.38,Medicare,Medicare,,,,,627.3,,,,
MYOGLOBIN,83874,CPT,,,,,both,, ,627.3,376.38,Medicare,Medicare,,,,,627.3,,,,
L143000 NT-PROBNP,83880,CPT,,,,,both,, ,450,270,Medicare,Medicare,,,,,450,,,,
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,, ,279.55,167.73,Medicare,Medicare,,,,,279.55,,,,
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,,,1229.07,1229.07,Medicare,Medicare,,1229.07,,,1229.07,1229.07,1229.07,fee schedule,Medicare APC Fee Schedule
NATRIURETIC PEPTIDE,83880,CPT,,,,,both,, ,1229.07,737.44,Medicare,Medicare,,,,,1229.07,,,,
"NEPHELOMETRY, NOS",83883,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
"NEPHELOMETRY, NOS",83883,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
Q38940 NEPHELOMETRY NOS,83883,CPT,,,,,both,, ,374.75,224.85,Medicare,Medicare,,,,,374.75,,,,
NICKEL,83885,CPT,,,,,both,, ,934.09,560.45,Medicare,Medicare,,,,,934.09,,,,
NUCLEOTIDASE 5',83915,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,,,,871.22,,,,
NUCLEOTIDASE 5',83915,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,,,,871.22,,,,
OLIGOCLONAL BANDS,83916,CPT,,,,,both,, ,530.75,318.45,Medicare,Medicare,,,,,530.75,,,,
OLIGOCLONAL BANDS,83916,CPT,,,,,both,, ,530.75,318.45,Medicare,Medicare,,,,,530.75,,,,
"ORGAN ACID,SIN,QUAN",83921,CPT,,,,,both,, ,396.02,237.61,Medicare,Medicare,,,,,396.02,,,,
"ORGAN ACID,SIN,QUAN",83921,CPT,,,,,both,, ,396.02,237.61,Medicare,Medicare,,,,,396.02,,,,
L2071 OSMALALITY FPD,83930,CPT,,,,,both,, ,40.89,24.53,Medicare,Medicare,,,,,40.89,,,,
"OSMOLALITY, BLOOD",83930,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
L3442 OSMOLALI U FPD,83935,CPT,,,,,both,, ,50.9,30.54,Medicare,Medicare,,,,,50.9,,,,
"OSMOLALITY,URINE",83935,CPT,,,,,both,, ,67.07,40.24,Medicare,Medicare,,,,,67.07,,,,
"OSMOLALITY,URINE",83935,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
L10249 OSTREOC ELISA,83937,CPT,,,,,both,, ,203.6,122.16,Medicare,Medicare,,,,,203.6,,,,
OSTEOCALCIN,83937,CPT,,,,,both,, ,447.39,268.43,Medicare,Medicare,,,,,447.39,,,,
OXALATE,83945,CPT,,,,,both,, ,660.98,396.58,Medicare,Medicare,,,,,660.98,,,,
OXALATE,83945,CPT,,,,,both,, ,660.98,396.58,Medicare,Medicare,,,,,660.98,,,,
OXALATE,83945,CPT,,,,,both,, ,660.98,396.58,Medicare,Medicare,,,,,660.98,,,,
OXALATE,83945,CPT,,,,,both,, ,660.98,396.58,Medicare,Medicare,,,,,660.98,,,,
L15610 PTH INT ECLIA,83970,CPT,,,,,both,, ,420.49,252.29,Medicare,Medicare,,,,,420.49,,,,
PARATHORMONE PTH,83970,CPT,,,,,both,, ,160.55,96.33,Medicare,Medicare,,,,,160.55,,,,
PARATHORMONE PTH,83970,CPT,,,,,both,, ,1420.49,852.29,Medicare,Medicare,,,,,1420.49,,,,
"L910235 PH FLUID, NOS",83986,CPT,,,,,both,, ,240.26,144.15,Medicare,Medicare,,,,,240.26,,,,
"PH FLUID,NOS",83986,CPT,,,,,both,, ,240.26,144.15,Medicare,Medicare,,,,,240.26,,,,
"Q442 PH FLUID,NOS",83986,CPT,,,,,both,, ,240.26,144.15,Medicare,Medicare,,,,,240.26,,,,
L790600 PCP MS,83992,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
CALPROTECTIN FECAL,83993,CPT,,,,,both,, ,395.75,237.45,Medicare,Medicare,,,,,395.75,,,,
CALPROTECTIN FECAL,83993,CPT,,,,,both,, ,395.75,237.45,Medicare,Medicare,,,,,395.75,,,,
NBS PHENYLALANINE BL,84030,CPT,,,,,both,, ,32.84,19.7,Medicare,Medicare,,,,,32.84,,,,
NBS PHENYLALANINE BL,84030,CPT,,,,,both,, ,32.84,19.7,Medicare,Medicare,,,,,32.84,,,,
"PHOSPHATASE, PROSTAT",84066,CPT,,,,,both,, ,540.85,324.51,Medicare,Medicare,,,,,540.85,,,,
"PHOSPHATASE,ALKALINE",84075,CPT,,,,,both,, ,51.08,30.64,Medicare,Medicare,,,,,51.08,,,,
"PHOSPHATASE,ALKALINE",84075,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
"PHOSPHATASE,ALKALINE",84075,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
"PHOSPHATASE,ALK ISO",84080,CPT,,,,,both,, ,637.41,382.44,Medicare,Medicare,,,,,637.41,,,,
"PHOSPHATASE,ALK ISO",84080,CPT,,,,,both,, ,637.41,382.44,Medicare,Medicare,,,,,637.41,,,,
PHOSPHATIDYLGLYCEROL,84081,CPT,,,,,both,, ,389.01,233.4,Medicare,Medicare,,,,,389.01,,,,
"PHOSPHORUS, BLOOD",84100,CPT,,,,,both,, ,46.87,28.12,Medicare,Medicare,,,,,46.87,,,,
"PHOSPHORUS, BLOOD",84100,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
"L910235 PHOSPHORUS, URINE",84105,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
"PHOSPHORUS, URINE",84105,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
"Q442 PHOSPHORUS, URI",84105,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
"PORPHOBILINOGEN,QUAN",84110,CPT,,,,,both,, ,630.96,378.57,Medicare,Medicare,,,,,630.96,,,,
PAMG-1 QUALITATIVE,84112,CPT,,,,,both,, ,488.09,292.85,Medicare,Medicare,,,,,488.09,,,,
L3194 PORPH QT U24,84120,CPT,,,,,both,, ,811.43,486.85,Medicare,Medicare,,,,,811.43,,,,
"PORPHYRINS,UR,QUAN",84120,CPT,,,,,both,, ,811.42,486.85,Medicare,Medicare,,,,,811.42,,,,
POTASSIUM SER PL WB,84132,CPT,,,,,both,, ,47.15,28.29,Medicare,Medicare,,,,,47.15,,,,
POTASSIUM SER PL WB,84132,CPT,,,,,both,,,240.26,240.26,Medicare,Medicare,,240.26,,,240.26,240.26,240.26,fee schedule,Medicare APC Fee Schedule
POTASSIUM SER PL WB,84132,CPT,,,,,both,, ,240.26,144.15,Medicare,Medicare,,,,,240.26,,,,
"L910235 POTASSIUM, URINE",84133,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
"POTASSIUM, URINE",84133,CPT,,,,,both,,,345.79,345.79,Medicare,Medicare,,345.79,,,345.79,345.79,345.79,fee schedule,Medicare APC Fee Schedule
"POTASSIUM, URINE",84133,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
"Q442 POTASSIUM, URIN",84133,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
PREALBUMIN,84134,CPT,,,,,both,, ,105.25,63.15,Medicare,Medicare,,,,,105.25,,,,
PREALBUMIN,84134,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
PREGNENOLONE,84140,CPT,,,,,both,, ,164.75,98.85,Medicare,Medicare,,,,,164.75,,,,
PREGNENOLONE,84140,CPT,,,,,both,, ,164.75,98.85,Medicare,Medicare,,,,,164.75,,,,
"PREGNENOLONE,17-OH",84143,CPT,,,,,both,, ,387.89,232.73,Medicare,Medicare,,,,,387.89,,,,
PROGESTERONE,84144,CPT,,,,,both,, ,62.58,37.54,Medicare,Medicare,,,,,62.58,,,,
PROGESTERONE,84144,CPT,,,,,both,, ,1217.28,730.36,Medicare,Medicare,,,,,1217.28,,,,
PROGESTERONE,84144,CPT,,,,,both,, ,1217.28,730.36,Medicare,Medicare,,,,,1217.28,,,,
PROCALCITONIN PCT,84145,CPT,,,,,both,, ,232.11,139.26,Medicare,Medicare,,,,,232.11,,,,
PROCALCITONIN PCT,84145,CPT,,,,,both,, ,232.11,139.26,Medicare,Medicare,,,,,232.11,,,,
L4465 PROLACTI ECLIA,84146,CPT,,,,,both,, ,628.3,376.98,Medicare,Medicare,,,,,628.3,,,,
PROLACTIN,84146,CPT,,,,,both,, ,143.14,85.88,Medicare,Medicare,,,,,143.14,,,,
PROLACTIN,84146,CPT,,,,,both,, ,1077.5,646.5,Medicare,Medicare,,,,,1077.5,,,,
Q40049 PROLACTIN,84146,CPT,,,,,both,, ,959.75,575.85,Medicare,Medicare,,,,,959.75,,,,
Q40049 PROLACTIN,84146,CPT,,,,,both,, ,959.75,575.85,Medicare,Medicare,,,,,959.75,,,,
Q93958 23BPG UR,84150,CPT,,,,,both,, ,390.13,234.07,Medicare,Medicare,,,,,390.13,,,,
PSA (prostate specific antigen),84153,CPT,,,,,both,,,1036.25,1036.25,Medicare,Medicare,,18.39,,,1036.25,1036.25,1036.25,fee schedule,Medicare APC Fee Schedule
"PSA, TOTAL",84153,CPT,,,,,both,, ,135.85,81.51,Medicare,Medicare,,,,,135.85,,,,
"PSA, TOTAL",84153,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
"PSA, TOTAL",84153,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
PSA (prostate specific antigen),84154,CPT,,,,,both,,,1036.25,1036.25,Medicare,Medicare,,18.39,,,1036.25,1036.25,1036.25,fee schedule,Medicare APC Fee Schedule
"PSA, FREE",84154,CPT,,,,,both,, ,135.85,81.51,Medicare,Medicare,,,,,135.85,,,,
"PSA, FREE",84154,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
"PSA, FREE",84154,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,35.93,21.55,Medicare,Medicare,,,,,35.93,,,,
PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
Q38940 PROTEIN TOT SER PLWB,84155,CPT,,,,,both,, ,374.75,224.85,Medicare,Medicare,,,,,374.75,,,,
PROT TOTL RANDOM URI,84156,CPT,,,,,both,,,420.72,420.72,Medicare,Medicare,,420.72,,,420.72,420.72,420.72,fee schedule,Medicare APC Fee Schedule
PROT TOTL RANDOM URI,84156,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
PROT TOTL RANDOM URI,84156,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
PROTEIN TOT OTHR SRC,84157,CPT,,,,,both,, ,35.93,21.55,Medicare,Medicare,,,,,35.93,,,,
Q749 PROT TOT OTH SR,84157,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
PROTEINELECTR FR-QNT,84165,CPT,,,,,both,, ,105.81,63.48,Medicare,Medicare,,,,,105.81,,,,
PROTEINELECTR FR-QNT,84165,CPT,,,,,both,, ,609.34,365.6,Medicare,Medicare,,,,,609.34,,,,
PROTEINELECTR FR-QNT,84165,CPT,,,,,both,, ,609.34,365.6,Medicare,Medicare,,,,,609.34,,,,
PROTEINELECTR FR-QNT,84165,CPT,,,,,both,, ,609.34,365.6,Medicare,Medicare,,,,,609.34,,,,
PROTEINELECTR FR-QNT,84165,CPT,,,,,both,, ,609.34,365.6,Medicare,Medicare,,,,,609.34,,,,
Q38940 PROTEINELECTR FR QNT,84165,CPT,,,,,both,, ,542.75,325.65,Medicare,Medicare,,,,,542.75,,,,
PROT E-PHOR-URIN-CSF,84166,CPT,,,,,both,, ,429.71,257.82,Medicare,Medicare,,,,,429.71,,,,
Q749 PROT E-PHOR-URI,84166,CPT,,,,,both,, ,429.71,257.82,Medicare,Medicare,,,,,429.71,,,,
Q8525 PROT E-PHOR-UR,84166,CPT,,,,,both,, ,429.71,257.82,Medicare,Medicare,,,,,429.71,,,,
Q94685 WEST BLOT PRB,84182,CPT,,,,,both,, ,136.4,81.84,Medicare,Medicare,,,,,136.4,,,,
Q94685 WEST BLOT PRB,84182,CPT,,,,,both,, ,136.4,81.84,Medicare,Medicare,,,,,136.4,,,,
"PROTOPORPH,RBC,QUAN",84202,CPT,,,,,both,, ,199.27,119.56,Medicare,Medicare,,,,,199.27,,,,
"PROTOPORPH,RBC,QUAN",84202,CPT,,,,,both,, ,199.27,119.56,Medicare,Medicare,,,,,199.27,,,,
Q22996 PROTOPORPH RBC QUAN,84202,CPT,,,,,both,, ,177.5,106.5,Medicare,Medicare,,,,,177.5,,,,
PROINSULIN,84206,CPT,,,,,both,, ,266.91,160.14,Medicare,Medicare,,,,,266.91,,,,
Q760 PROINSULIN IA,84206,CPT,,,,,both,, ,337.09,202.25,Medicare,Medicare,,,,,337.09,,,,
VITAMIN B-6,84207,CPT,,,,,both,, ,738.17,442.9,Medicare,Medicare,,,,,738.17,,,,
VITAMIN B-6,84207,CPT,,,,,both,, ,738.17,442.9,Medicare,Medicare,,,,,738.17,,,,
PYRUVATE,84210,CPT,,,,,both,, ,1066.84,640.1,Medicare,Medicare,,,,,1066.84,,,,
"RECEPTOR, NON-ENDO",84238,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
"RECEPTOR, NON-ENDO",84238,CPT,,,,,both,, ,326.71,196.02,Medicare,Medicare,,,,,326.71,,,,
Q16846 PL REN LCMSMS,84244,CPT,,,,,both,, ,475.46,285.27,Medicare,Medicare,,,,,475.46,,,,
Q16846 PL REN LCMSMS,84244,CPT,,,,,both,, ,475.46,285.27,Medicare,Medicare,,,,,475.46,,,,
RENIN,84244,CPT,,,,,both,, ,1487.01,892.2,Medicare,Medicare,,,,,1487.01,,,,
VITAMIN B-2,84252,CPT,,,,,both,, ,180.75,108.45,Medicare,Medicare,,,,,180.75,,,,
SELENIUM,84255,CPT,,,,,both,, ,409.5,245.7,Medicare,Medicare,,,,,409.5,,,,
SELENIUM,84255,CPT,,,,,both,, ,409.5,245.7,Medicare,Medicare,,,,,409.5,,,,
SEROTONIN,84260,CPT,,,,,both,, ,94.58,56.74,Medicare,Medicare,,,,,94.58,,,,
Q14966 SEX HORM BIND,84270,CPT,,,,,both,, ,288.25,172.95,Medicare,Medicare,,,,,288.25,,,,
Q30740 SHBG IA,84270,CPT,,,,,both,, ,288.25,172.95,Medicare,Medicare,,,,,288.25,,,,
SEX HORM BIND GLOB,84270,CPT,,,,,both,, ,288.25,172.95,Medicare,Medicare,,,,,288.25,,,,
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,, ,47.43,28.45,Medicare,Medicare,,,,,47.43,,,,
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,,,345.79,345.79,Medicare,Medicare,,345.79,,,345.79,345.79,345.79,fee schedule,Medicare APC Fee Schedule
"SODIUM,SER PL OR WB",84295,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
"L910235 SODIUM, URINE",84300,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
"Q442 SODIUM, URINE R",84300,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,, ,47.99,28.79,Medicare,Medicare,,,,,47.99,,,,
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,,,345.79,345.79,Medicare,Medicare,,345.79,,,345.79,345.79,345.79,fee schedule,Medicare APC Fee Schedule
"SODIUM, URINE RANDOM",84300,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
SODIUM OTHER SOURCE,84302,CPT,,,,,both,, ,82.51,49.5,Medicare,Medicare,,,,,82.51,,,,
SOMATOMEDIN,84305,CPT,,,,,both,, ,870.37,522.22,Medicare,Medicare,,,,,870.37,,,,
SOMATOMEDIN,84305,CPT,,,,,both,, ,870.37,522.22,Medicare,Medicare,,,,,870.37,,,,
ADENO DEAMNASE BFLD,84311,CPT,,,,,both,, ,93.74,56.24,Medicare,Medicare,,,,,93.74,,,,
Q175858 CHOLEST PF C,84311,CPT,,,,,both,, ,93.74,56.24,Medicare,Medicare,,,,,93.74,,,,
"SPECTROPHOTO, NOS",84311,CPT,,,,,both,, ,93.74,56.24,Medicare,Medicare,,,,,93.74,,,,
SPECIFIC GRAVITY,84315,CPT,,,,,both,, ,210.5,126.3,Medicare,Medicare,,,,,210.5,,,,
"SUGARS, SING, QUAL",84376,CPT,,,,,both,, ,93.74,56.24,Medicare,Medicare,,,,,93.74,,,,
GLYCOMARK,84378,CPT,,,,,both,, ,224,134.4,Medicare,Medicare,,,,,224,,,,
"L910235 SULFATE, URINE",84392,CPT,,,,,both,, ,31.71,19.02,Medicare,Medicare,,,,,31.71,,,,
"L910235 SULFATE, URINE",84392,CPT,,,,,both,, ,31.71,19.02,Medicare,Medicare,,,,,31.71,,,,
Q18944 TST FREE,84402,CPT,,,,,both,, ,1017.17,610.3,Medicare,Medicare,,,,,1017.17,,,,
Q36170 TESTOST FREE,84402,CPT,,,,,both,,,1017.17,1017.17,Medicare,Medicare,,1017.17,,,1017.17,1017.17,1017.17,fee schedule,Medicare APC Fee Schedule
Q36170 TESTOST FREE,84402,CPT,,,,,both,, ,1017.17,610.3,Medicare,Medicare,,,,,1017.17,,,,
"TESTOSTERONE, FREE",84402,CPT,,,,,both,, ,1017.17,610.3,Medicare,Medicare,,,,,1017.17,,,,
Q14966 TESTOST TOTAL,84403,CPT,,,,,both,, ,968.6,581.16,Medicare,Medicare,,,,,968.6,,,,
Q36170 TESTOST TOTAL,84403,CPT,,,,,both,,,968.6,968.6,Medicare,Medicare,,968.6,,,968.6,968.6,968.6,fee schedule,Medicare APC Fee Schedule
Q36170 TESTOST TOTAL,84403,CPT,,,,,both,, ,968.6,581.16,Medicare,Medicare,,,,,968.6,,,,
"TESTOSTERONE, TOTAL",84403,CPT,,,,,both,, ,190.86,114.51,Medicare,Medicare,,,,,190.86,,,,
"TESTOSTERONE, TOTAL",84403,CPT,,,,,both,, ,968.6,581.16,Medicare,Medicare,,,,,968.6,,,,
L70282 TEST FR WB T,84410,CPT,,,,,both,, ,211.15,126.69,Medicare,Medicare,,,,,211.15,,,,
L121186VITB1 BL HPLC,84425,CPT,,,,,both,, ,1318.66,791.19,Medicare,Medicare,,,,,1318.66,,,,
Q5042 B1 BL LC/MS/MS,84425,CPT,,,,,both,, ,269.16,161.49,Medicare,Medicare,,,,,269.16,,,,
Q90353 VIT B1 LCMSMS,84425,CPT,,,,,both,, ,303.69,182.21,Medicare,Medicare,,,,,303.69,,,,
VITAMIN B-1,84425,CPT,,,,,both,, ,156.89,94.13,Medicare,Medicare,,,,,156.89,,,,
VITAMIN B-1,84425,CPT,,,,,both,, ,1437.33,862.39,Medicare,Medicare,,,,,1437.33,,,,
THIOCYANATE,84430,CPT,,,,,both,, ,174.57,104.74,Medicare,Medicare,,,,,174.57,,,,
Q15561 QT THYR WO AB,84432,CPT,,,,,both,, ,255.13,153.07,Medicare,Medicare,,,,,255.13,,,,
Q15561 QT THYR WO AB,84432,CPT,,,,,both,, ,255.13,153.07,Medicare,Medicare,,,,,255.13,,,,
"THYROXINE T4,TOTAL",84436,CPT,,,,,both,, ,38.73,23.23,Medicare,Medicare,,,,,38.73,,,,
"THYROXINE T4,TOTAL",84436,CPT,,,,,both,, ,405.57,243.34,Medicare,Medicare,,,,,405.57,,,,
"THYROXINE T4, FREE",84439,CPT,,,,,both,, ,66.52,39.91,Medicare,Medicare,,,,,66.52,,,,
"THYROXINE T4, FREE",84439,CPT,,,,,both,,,620.56,620.56,Medicare,Medicare,,620.56,,,620.56,620.56,620.56,fee schedule,Medicare APC Fee Schedule
"THYROXINE T4, FREE",84439,CPT,,,,,both,, ,620.56,372.33,Medicare,Medicare,,,,,620.56,,,,
"THYROXINE T4, FREE",84439,CPT,,,,,both,, ,620.56,372.33,Medicare,Medicare,,,,,620.56,,,,
L1735 TBG SER ICMA,84442,CPT,,,,,both,, ,195.7,117.42,Medicare,Medicare,,,,,195.7,,,,
THYROXINE BIND GLOB,84442,CPT,,,,,both,, ,213.31,127.98,Medicare,Medicare,,,,,213.31,,,,
"Blood test, thyroid stimulating hormone (TSH)",84443,CPT,,,,,both,,,737.61,737.61,Medicare,Medicare,,16.8,,,737.61,737.61,737.61,fee schedule,Medicare APC Fee Schedule
THYROID STIM TSH,84443,CPT,,,,,both,, ,124.05,74.43,Medicare,Medicare,,,,,124.05,,,,
THYROID STIM TSH,84443,CPT,,,,,both,, ,737.61,442.56,Medicare,Medicare,,,,,737.61,,,,
THYROID STIM TSH,84443,CPT,,,,,both,, ,737.61,442.56,Medicare,Medicare,,,,,737.61,,,,
Q30551 TSI IA,84445,CPT,,,,,both,, ,733.12,439.87,Medicare,Medicare,,,,,733.12,,,,
THYROID STIM IMMUNO,84445,CPT,,,,,both,, ,1178.27,706.96,Medicare,Medicare,,,,,1178.27,,,,
VITAMIN E,84446,CPT,,,,,both,, ,227.62,136.57,Medicare,Medicare,,,,,227.62,,,,
VITAMIN E,84446,CPT,,,,,both,, ,227.62,136.57,Medicare,Medicare,,,,,227.62,,,,
L500440 TRANSCORTIN,84449,CPT,,,,,both,, ,180,108,Medicare,Medicare,,,,,180,,,,
TRANSFERASE AST,84450,CPT,,,,,both,, ,38.17,22.9,Medicare,Medicare,,,,,38.17,,,,
TRANSFERASE AST,84450,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
TRANSFERASE ALT,84460,CPT,,,,,both,, ,39.29,23.57,Medicare,Medicare,,,,,39.29,,,,
TRANSFERASE ALT,84460,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
TRANSFERRIN,84466,CPT,,,,,both,, ,94.31,56.58,Medicare,Medicare,,,,,94.31,,,,
TRANSFERRIN,84466,CPT,,,,,both,, ,796.55,477.93,Medicare,Medicare,,,,,796.55,,,,
TRANSFERRIN,84466,CPT,,,,,both,, ,796.55,477.93,Medicare,Medicare,,,,,796.55,,,,
TRIGLYCERIDES,84478,CPT,,,,,both,, ,39.29,23.57,Medicare,Medicare,,,,,39.29,,,,
TRIGLYCERIDES,84478,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
T3-T4 UPTAKE,84479,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,,,,526.26,,,,
"T3,TOTAL",84480,CPT,,,,,both,, ,1039.33,623.59,Medicare,Medicare,,,,,1039.33,,,,
"T3,FREE",84481,CPT,,,,,both,, ,858.3,514.98,Medicare,Medicare,,,,,858.3,,,,
Q90963 T3 REV LCMSMS,84482,CPT,,,,,both,, ,858.3,514.98,Medicare,Medicare,,,,,858.3,,,,
"T3,REVERSE",84482,CPT,,,,,both,, ,219.2,131.52,Medicare,Medicare,,,,,219.2,,,,
"TROPONIN,QNT",84484,CPT,,,,,both,, ,133.88,80.32,Medicare,Medicare,,,,,133.88,,,,
"TROPONIN,QNT",84484,CPT,,,,,both,,,713.19,713.19,Medicare,Medicare,,713.19,,,713.19,713.19,713.19,fee schedule,Medicare APC Fee Schedule
"TROPONIN,QNT",84484,CPT,,,,,both,, ,713.19,427.91,Medicare,Medicare,,,,,713.19,,,,
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,, ,29.19,17.51,Medicare,Medicare,,,,,29.19,,,,
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,,,277.59,277.59,Medicare,Medicare,,277.59,,,277.59,277.59,277.59,fee schedule,Medicare APC Fee Schedule
"UREA NITROGEN,QUAN",84520,CPT,,,,,both,, ,277.59,166.55,Medicare,Medicare,,,,,277.59,,,,
"UREA NITROGEN,URINE",84540,CPT,,,,,both,,,345.79,345.79,Medicare,Medicare,,345.79,,,345.79,345.79,345.79,fee schedule,Medicare APC Fee Schedule
"UREA NITROGEN,URINE",84540,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
"UREA NITROGEN,URINE",84540,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
"URIC ACID, BLOOD",84550,CPT,,,,,both,, ,44.34,26.6,Medicare,Medicare,,,,,44.34,,,,
"URIC ACID, BLOOD",84550,CPT,,,,,both,,,285.17,285.17,Medicare,Medicare,,285.17,,,285.17,285.17,285.17,fee schedule,Medicare APC Fee Schedule
"URIC ACID, BLOOD",84550,CPT,,,,,both,, ,285.17,171.1,Medicare,Medicare,,,,,285.17,,,,
"L910235 URIC ACID, URINE",84560,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
"Q442 URIC ACID,URINE",84560,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
"URIC ACID,URINE RAND",84560,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
VANILLYLMANDELIC ACID (VMA) SERUM,84585,CPT,,,,,both,, ,116.7,70.02,Medicare,Medicare,,,,,116.7,,,,
"VMA, URINE",84585,CPT,,,,,both,, ,355.05,213.03,Medicare,Medicare,,,,,355.05,,,,
"VMA, URINE",84585,CPT,,,,,both,, ,355.05,213.03,Medicare,Medicare,,,,,355.05,,,,
L10397 VIP PL RIA,84586,CPT,,,,,both,, ,338.36,203.01,Medicare,Medicare,,,,,338.36,,,,
VASOINTESTINAL PEP,84586,CPT,,,,,both,, ,368.8,221.28,Medicare,Medicare,,,,,368.8,,,,
VASOPRESSIN,84588,CPT,,,,,both,, ,295.83,177.49,Medicare,Medicare,,,,,295.83,,,,
VASOPRESSIN,84588,CPT,,,,,both,, ,295.83,177.49,Medicare,Medicare,,,,,295.83,,,,
VITAMIN A,84590,CPT,,,,,both,, ,186.08,111.64,Medicare,Medicare,,,,,186.08,,,,
VITAMIN A,84590,CPT,,,,,both,, ,186.08,111.64,Medicare,Medicare,,,,,186.08,,,,
"VITAMIN ASSAY, NOS",84591,CPT,,,,,both,, ,197.03,118.21,Medicare,Medicare,,,,,197.03,,,,
VITAMIN K,84597,CPT,,,,,both,, ,188.89,113.33,Medicare,Medicare,,,,,188.89,,,,
VITAMIN K,84597,CPT,,,,,both,, ,188.89,113.33,Medicare,Medicare,,,,,188.89,,,,
VOLATILES,84600,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,,,,728.07,,,,
XYLOSE ABSORPTION,84620,CPT,,,,,both,, ,1111.47,666.88,Medicare,Medicare,,,,,1111.47,,,,
ZINC,84630,CPT,,,,,both,, ,1081.72,649.03,Medicare,Medicare,,,,,1081.72,,,,
ZINC,84630,CPT,,,,,both,, ,1081.72,649.03,Medicare,Medicare,,,,,1081.72,,,,
ZINC WHOLE BLOOD,84630,CPT,,,,,both,, ,80,48,Medicare,Medicare,,,,,80,,,,
C-PEPTIDE,84681,CPT,,,,,both,, ,898.44,539.06,Medicare,Medicare,,,,,898.44,,,,
C-PEPTIDE,84681,CPT,,,,,both,, ,898.44,539.06,Medicare,Medicare,,,,,898.44,,,,
HCG QUANT,84702,CPT,,,,,both,, ,148.47,89.08,Medicare,Medicare,,,,,148.47,,,,
HCG QUANT,84702,CPT,,,,,both,, ,758.66,455.19,Medicare,Medicare,,,,,758.66,,,,
HCG QUANT,84702,CPT,,,,,both,, ,758.66,455.19,Medicare,Medicare,,,,,758.66,,,,
"HCG, QUAL",84703,CPT,,,,,both,, ,74.1,44.46,Medicare,Medicare,,,,,74.1,,,,
"HCG, QUAL",84703,CPT,,,,,both,,,420.72,420.72,Medicare,Medicare,,420.72,,,420.72,420.72,420.72,fee schedule,Medicare APC Fee Schedule
"HCG, QUAL",84703,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
CLIN CHEM TEST NOS,84999,CPT,,,,,both,, ,274.5,164.7,Medicare,Medicare,,,,,274.5,,,,
L123413 TMAO,84999,CPT,,,,,both,, ,225,135,Medicare,Medicare,,,,,225,,,,
L123413 TMAO,84999,CPT,,,,,both,, ,225,135,Medicare,Medicare,,,,,225,,,,
BLEEDING TIME,85002,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
AUTO DIFF WBC COUNT,85004,CPT,,,,,both,, ,47.99,28.79,Medicare,Medicare,,,,,47.99,,,,
AUTO DIFF WBC COUNT,85004,CPT,,,,,both,, ,103,61.8,Medicare,Medicare,,,,,103,,,,
"WBC DIFF, MAN",85007,CPT,,,,,both,, ,33.96,20.37,Medicare,Medicare,,,,,33.96,,,,
"WBC DIFF, MAN",85007,CPT,,,,,both,, ,188.33,112.99,Medicare,Medicare,,,,,188.33,,,,
BLOOD SMEAR SCAN,85008,CPT,,,,,both,, ,112.55,67.53,Medicare,Medicare,,,,,112.55,,,,
"HEMATOCRIT, SPUN",85013,CPT,,,,,both,, ,32.84,19.7,Medicare,Medicare,,,,,32.84,,,,
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,, ,13.18,7.9,Medicare,Medicare,,,,,13.18,,,,
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,,,262.99,262.99,Medicare,Medicare,,262.99,,,262.99,262.99,262.99,fee schedule,Medicare APC Fee Schedule
"HEMATOCRIT, OTHER",85014,CPT,,,,,both,, ,262.99,157.79,Medicare,Medicare,,,,,262.99,,,,
HEMOGLOBIN,85018,CPT,,,,,both,, ,13.18,7.9,Medicare,Medicare,,,,,13.18,,,,
HEMOGLOBIN,85018,CPT,,,,,both,,,262.99,262.99,Medicare,Medicare,,262.99,,,262.99,262.99,262.99,fee schedule,Medicare APC Fee Schedule
HEMOGLOBIN,85018,CPT,,,,,both,, ,262.99,157.79,Medicare,Medicare,,,,,262.99,,,,
HEMOGLOBIN,85018,CPT,,,,,both,, ,262.99,157.79,Medicare,Medicare,,,,,262.99,,,,
L121003 HEMOGLOBIN,85018,CPT,,,,,both,, ,10,6,Medicare,Medicare,,,,,10,,,,
CBC W-PLT AUTO COMPD,85025,CPT,,,,,both,, ,28.9,17.34,Medicare,Medicare,,,,,28.9,,,,
CBC W-PLT AUTO COMPD,85025,CPT,,,,,both,, ,428.3,256.98,Medicare,Medicare,,,,,428.3,,,,
"Complete blood cell count, with differential white blood cells, automated",85025,CPT,,,,,both,,,428.3,428.3,Medicare,Medicare,,7.77,,,428.3,428.3,428.3,fee schedule,Medicare APC Fee Schedule
CBC W-PLT,85027,CPT,,,,,both,, ,24.13,14.47,Medicare,Medicare,,,,,24.13,,,,
CBC W-PLT,85027,CPT,,,,,both,, ,412.87,247.72,Medicare,Medicare,,,,,412.87,,,,
"Complete blood count, automated",85027,CPT,,,,,both,,,412.87,412.87,Medicare,Medicare,,6.47,,,412.87,412.87,412.87,fee schedule,Medicare APC Fee Schedule
MAN CELL CT ELP,85032,CPT,,,,,both,, ,466.48,279.88,Medicare,Medicare,,,,,466.48,,,,
L1917 RBC COUNT,85041,CPT,,,,,both,, ,6.06,3.63,Medicare,Medicare,,,,,6.06,,,,
"RETIC COUNT, MANUAL",85044,CPT,,,,,both,, ,489.78,293.86,Medicare,Medicare,,,,,489.78,,,,
"RETIC COUNT, FLOW",85045,CPT,,,,,both,, ,39.29,23.57,Medicare,Medicare,,,,,39.29,,,,
"RETIC COUNT, FLOW",85045,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
WBC COUNT,85048,CPT,,,,,both,, ,16.55,9.93,Medicare,Medicare,,,,,16.55,,,,
WBC COUNT,85048,CPT,,,,,both,, ,285.17,171.1,Medicare,Medicare,,,,,285.17,,,,
CBC-PLT AUTORP CDM,85049,CPT,,,,,both,, ,16.55,9.93,Medicare,Medicare,,,,,16.55,,,,
CBC-PLT AUTORP CDM,85049,CPT,,,,,both,, ,285.17,171.1,Medicare,Medicare,,,,,285.17,,,,
BONE MARROW INTERPRE,85097,CPT,,,,,both,, ,237.17,142.3,Medicare,Medicare,,,,,237.17,,,,
APIXABAN ANTI-XA,85130,CPT,,,,,both,, ,250,150,Medicare,Medicare,,,,,250,,,,
Q331 FACT II ACT PCD,85210,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,,,,74.93,,,,
FACTOR V ASSAY,85220,CPT,,,,,both,, ,121.53,72.91,Medicare,Medicare,,,,,121.53,,,,
L86249 FACT V ACT CD,85220,CPT,,,,,both,, ,121.53,72.91,Medicare,Medicare,,,,,121.53,,,,
Q344 FACT V CLOT PCD,85220,CPT,,,,,both,, ,121.53,72.91,Medicare,Medicare,,,,,121.53,,,,
FACTOR VII ASSAY,85230,CPT,,,,,both,, ,335.69,201.41,Medicare,Medicare,,,,,335.69,,,,
FACTOR VII ASSAY,85230,CPT,,,,,both,, ,335.69,201.41,Medicare,Medicare,,,,,335.69,,,,
"FACTOR VIII, AHG",85240,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,,,,728.07,,,,
L503333 FAC8 AHG,85240,CPT,,,,,both,, ,706.86,424.11,Medicare,Medicare,,,,,706.86,,,,
FACTOR VIII RISTOCET,85245,CPT,,,,,both,, ,1352.01,811.2,Medicare,Medicare,,,,,1352.01,,,,
L164509 VWF ACTIV PA,85245,CPT,,,,,both,, ,412,247.2,Medicare,Medicare,,,,,412,,,,
FACTOR VIII VW AG,85246,CPT,,,,,both,, ,1164.52,698.71,Medicare,Medicare,,,,,1164.52,,,,
FACTOR VIII VW AG,85246,CPT,,,,,both,, ,1164.52,698.71,Medicare,Medicare,,,,,1164.52,,,,
"FACT VIII,VW,MULTIME",85247,CPT,,,,,both,, ,181.59,108.95,Medicare,Medicare,,,,,181.59,,,,
FACTOR IX,85250,CPT,,,,,both,, ,151.56,90.93,Medicare,Medicare,,,,,151.56,,,,
FACTOR X,85260,CPT,,,,,both,, ,142.58,85.54,Medicare,Medicare,,,,,142.58,,,,
FACTOR XI,85270,CPT,,,,,both,, ,142.58,85.54,Medicare,Medicare,,,,,142.58,,,,
ANTITHROMBIN IIIACTI,85300,CPT,,,,,both,, ,1930.76,1158.45,Medicare,Medicare,,,,,1930.76,,,,
L015040 ANTITHROMBIN ACTIVITY,85300,CPT,,,,,both,, ,965.23,579.13,Medicare,Medicare,,,,,965.23,,,,
Q5158 ATIII AG FRNEP,85301,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,,,,72.13,,,,
"PROTEIN C, AG",85302,CPT,,,,,both,, ,1907.47,1144.48,Medicare,Medicare,,,,,1907.47,,,,
Q4948 PROT C AG IA,85302,CPT,,,,,both,, ,1942.55,1165.53,Medicare,Medicare,,,,,1942.55,,,,
"PROTEIN C, ACTIVITY",85303,CPT,,,,,both,, ,1261.35,756.81,Medicare,Medicare,,,,,1261.35,,,,
"PROTEIN C, ACTIVITY",85303,CPT,,,,,both,, ,1261.35,756.81,Medicare,Medicare,,,,,1261.35,,,,
"Q7942 PROTEIN C, ACT",85303,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
L117754 PROT S TOT,85305,CPT,,,,,both,, ,116.1,69.66,Medicare,Medicare,,,,,116.1,,,,
"PROTEIN S, TOTAL",85305,CPT,,,,,both,, ,1261.35,756.81,Medicare,Medicare,,,,,1261.35,,,,
"PROTEIN S, TOTAL",85305,CPT,,,,,both,, ,1261.35,756.81,Medicare,Medicare,,,,,1261.35,,,,
L117754 PROT S FREE,85306,CPT,,,,,both,, ,153.2,91.92,Medicare,Medicare,,,,,153.2,,,,
"PROTEIN S, FREE",85306,CPT,,,,,both,, ,151,90.6,Medicare,Medicare,,,,,151,,,,
"PROTEIN S, FREE",85306,CPT,,,,,both,, ,939.98,563.98,Medicare,Medicare,,,,,939.98,,,,
Q10170 PROT S AG ITA,85306,CPT,,,,,both,, ,939.98,563.98,Medicare,Medicare,,,,,939.98,,,,
Q1779 PROT S ACT,85306,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
"Q7942 PROTEIN S, FRE",85306,CPT,,,,,both,, ,939.98,563.98,Medicare,Medicare,,,,,939.98,,,,
PROTEIN C ACTIVATED,85307,CPT,,,,,both,, ,239.69,143.81,Medicare,Medicare,,,,,239.69,,,,
Q22 APCR RVVT-BSE AS,85307,CPT,,,,,both,, ,596.43,357.85,Medicare,Medicare,,,,,596.43,,,,
SOLUB LIV AG AB(RDL),85316,CPT,,,,,both,, ,567,340.2,Medicare,Medicare,,,,,567,,,,
COAG TIME ACTIVATED,85347,CPT,,,,,both,, ,167.84,100.7,Medicare,Medicare,,,,,167.84,,,,
FDP-FSP AGG SLIDE,85362,CPT,,,,,both,, ,691.58,414.94,Medicare,Medicare,,,,,691.58,,,,
"D-DIMER, QUANT",85379,CPT,,,,,both,, ,100.48,60.28,Medicare,Medicare,,,,,100.48,,,,
"D-DIMER, QUANT",85379,CPT,,,,,both,,,886.09,886.09,Medicare,Medicare,,886.09,,,886.09,886.09,886.09,fee schedule,Medicare APC Fee Schedule
"D-DIMER, QUANT",85379,CPT,,,,,both,, ,886.09,531.65,Medicare,Medicare,,,,,886.09,,,,
FIBRINOGEN ACTIVITY,85384,CPT,,,,,both,, ,83.64,50.18,Medicare,Medicare,,,,,83.64,,,,
FIBRINOGEN ACTIVITY,85384,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
Q14532 ADAMTS13 IA,85397,CPT,,,,,both,, ,188.05,112.83,Medicare,Medicare,,,,,188.05,,,,
Q36555 PAI-1 IA,85415,CPT,,,,,both,, ,222.01,133.2,Medicare,Medicare,,,,,222.01,,,,
FETAL HGB KLEIH-BETK,85460,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,,,,526.26,,,,
FETAL HGB KLEIH-BETK,85460,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,,,,526.26,,,,
"FETAL HGB, ROSETTE",85461,CPT,,,,,both,, ,349.72,209.83,Medicare,Medicare,,,,,349.72,,,,
HEPARIN ASSAY,85520,CPT,,,,,both,, ,1274.26,764.55,Medicare,Medicare,,,,,1274.26,,,,
L117101 HEPARIN A-XA,85520,CPT,,,,,both,, ,139.05,83.43,Medicare,Medicare,,,,,139.05,,,,
MURAMIDASE,85549,CPT,,,,,both,, ,261.02,156.61,Medicare,Medicare,,,,,261.02,,,,
RBC OSMOTIC FRAGW-IN,85557,CPT,,,,,both,, ,450.48,270.28,Medicare,Medicare,,,,,450.48,,,,
PLATELET AGGREGATION,85576,CPT,,,,,both,, ,344.67,206.8,Medicare,Medicare,,,,,344.67,,,,
PLTT NEUTRALIZATION,85597,CPT,,,,,both,, ,160.55,96.33,Medicare,Medicare,,,,,160.55,,,,
PLTT NEUTRALIZATION,85597,CPT,,,,,both,, ,160.55,96.33,Medicare,Medicare,,,,,160.55,,,,
HEXAGONAL PHOSPHOLIP,85598,CPT,,,,,both,, ,153.52,92.11,Medicare,Medicare,,,,,153.52,,,,
HEXAGONAL PHOSPHOLIP,85598,CPT,,,,,both,, ,153.52,92.11,Medicare,Medicare,,,,,153.52,,,,
L117079 HEX PHOS,85598,CPT,,,,,both,, ,179.8,107.88,Medicare,Medicare,,,,,179.8,,,,
"Blood test, clotting time",85610,CPT,,,,,both,,,430.27,430.27,Medicare,Medicare,,4.29,,,430.27,430.27,430.27,fee schedule,Medicare APC Fee Schedule
PROTHROMBIN TIME,85610,CPT,,,,,both,, ,14.6,8.76,Medicare,Medicare,,,,,14.6,,,,
PROTHROMBIN TIME,85610,CPT,,,,,both,, ,430.27,258.16,Medicare,Medicare,,,,,430.27,,,,
"PROTHROMBIN, SUBSTIT",85611,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,,,,728.07,,,,
RUSSELL VIPER VEN DI,85613,CPT,,,,,both,, ,364.88,218.92,Medicare,Medicare,,,,,364.88,,,,
RUSSELL VIPER VEN DI,85613,CPT,,,,,both,, ,364.88,218.92,Medicare,Medicare,,,,,364.88,,,,
"SED RATE, AUTOMATED",85652,CPT,,,,,both,, ,26.66,15.99,Medicare,Medicare,,,,,26.66,,,,
"SED RATE, AUTOMATED",85652,CPT,,,,,both,,,345.79,345.79,Medicare,Medicare,,345.79,,,345.79,345.79,345.79,fee schedule,Medicare APC Fee Schedule
"SED RATE, AUTOMATED",85652,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
O51226 SICKLE C  SCR,85660,CPT,,,,,both,, ,385.99,231.59,Medicare,Medicare,,,,,385.99,,,,
Q37679 SICKLE CELL SCRN WITH REFLEX HEMO,85660,CPT,,,,,both,, ,374.75,224.85,Medicare,Medicare,,,,,374.75,,,,
SICKLE CELL TEST RED,85660,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
SICKLE CELL TEST RED,85660,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
THROMBIN TIME,85670,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,,,,526.26,,,,
THROMBIN TIME,85670,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,,,,526.26,,,,
Coagulation assessment blood test,85730,CPT,,,,,both,,,480.79,480.79,Medicare,Medicare,,6.01,,,480.79,480.79,480.79,fee schedule,Medicare APC Fee Schedule
THROMBOPLAST TIMEPTT,85730,CPT,,,,,both,, ,58.94,35.36,Medicare,Medicare,,,,,58.94,,,,
THROMBOPLAST TIMEPTT,85730,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,,,,480.79,,,,
THROMBOPLAST TIMEPTT,85730,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,,,,480.79,,,,
PTT SUBSTITUT,85732,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,,,,480.79,,,,
PTT SUBSTITUT,85732,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,,,,480.79,,,,
VISCOSITY EXAM,85810,CPT,,,,,both,, ,80.27,48.16,Medicare,Medicare,,,,,80.27,,,,
ALLERGEN IGG QT,86001,CPT,,,,,both,, ,66.24,39.74,Medicare,Medicare,,,,,66.24,,,,
ALLERGEN IGG QT,86001,CPT,,,,,both,, ,66.24,39.74,Medicare,Medicare,,,,,66.24,,,,
ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,51.36,30.81,Medicare,Medicare,,,,,51.36,,,,
ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,,,,148.75,,,,
L602635 - ALLERGEN IGE QUANT,86003,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,,,,148.75,,,,
Q10643 ALG IGE QT,86003,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,,,,148.75,,,,
Q10659 ALLERGEN IGE,86003,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,,,,148.75,,,,
Q10715 ALLERGEN IGE,86003,CPT,,,,,both,, ,148.75,89.25,Medicare,Medicare,,,,,148.75,,,,
ALLG SPEC IGE REC EA,86008,CPT,,,,,both,, ,103.29,61.97,Medicare,Medicare,,,,,103.29,,,,
ALLG SPEC IGE REC EA,86008,CPT,,,,,both,, ,103.29,61.97,Medicare,Medicare,,,,,103.29,,,,
L6643 ASMA ELISA,86015,CPT,,,,,both,, ,702.72,421.63,Medicare,Medicare,,,,,702.72,,,,
Q15043 ACTIN AB EA,86015,CPT,,,,,both,, ,514.48,308.68,Medicare,Medicare,,,,,514.48,,,,
WBC AB IDENT,86021,CPT,,,,,both,, ,500.72,300.43,Medicare,Medicare,,,,,500.72,,,,
WBC AB IDENT,86021,CPT,,,,,both,, ,500.72,300.43,Medicare,Medicare,,,,,500.72,,,,
WBC AB IDENT,86021,CPT,,,,,both,, ,500.72,300.43,Medicare,Medicare,,,,,500.72,,,,
WBC AB IDENT,86021,CPT,,,,,both,, ,500.72,300.43,Medicare,Medicare,,,,,500.72,,,,
PLATELET AB,86022,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,,,,871.22,,,,
Q14627SRA UNF RB-14C,86022,CPT,,,,,both,, ,467.88,280.72,Medicare,Medicare,,,,,467.88,,,,
Q14874 PLATELET AB,86022,CPT,,,,,both,, ,467.88,280.72,Medicare,Medicare,,,,,467.88,,,,
Q414 HEP-IND PLAT AB,86022,CPT,,,,,both,, ,467.88,280.72,Medicare,Medicare,,,,,467.88,,,,
Q91740PLATELT IGG FC,86023,CPT,,,,,both,, ,83.08,49.84,Medicare,Medicare,,,,,83.08,,,,
L162045 FLUORS AB SC,86036,CPT,,,,,both,, ,486.16,291.69,Medicare,Medicare,,,,,486.16,,,,
Q70171 ANCA SCN IA,86036,CPT,,,,,both,, ,500.72,300.43,Medicare,Medicare,,,,,500.72,,,,
L163061 ANCA TITER,86037,CPT,,,,,both,, ,120.5,72.3,Medicare,Medicare,,,,,120.5,,,,
ANA,86038,CPT,,,,,both,, ,91.77,55.06,Medicare,Medicare,,,,,91.77,,,,
ANA,86038,CPT,,,,,both,, ,898.44,539.06,Medicare,Medicare,,,,,898.44,,,,
L164947 ANA IFA,86038,CPT,,,,,both,, ,824.26,494.55,Medicare,Medicare,,,,,824.26,,,,
Q16814 ANA IFA REFIA,86038,CPT,,,,,both,,,898.44,898.44,Medicare,Medicare,,898.44,,,898.44,898.44,898.44,fee schedule,Medicare APC Fee Schedule
Q16814 ANA IFA REFIA,86038,CPT,,,,,both,, ,898.44,539.06,Medicare,Medicare,,,,,898.44,,,,
Q249 ANA SCRN IFA,86038,CPT,,,,,both,, ,898.44,539.06,Medicare,Medicare,,,,,898.44,,,,
"ANA,TITER",86039,CPT,,,,,both,, ,93.46,56.07,Medicare,Medicare,,,,,93.46,,,,
"ANA,TITER",86039,CPT,,,,,both,, ,547.31,328.38,Medicare,Medicare,,,,,547.31,,,,
"ANA,TITER",86039,CPT,,,,,both,, ,547.31,328.38,Medicare,Medicare,,,,,547.31,,,,
ACETYLCH RCPT BND AB,86041,CPT,,,,,both,, ,55.2,33.12,Medicare,Medicare,,,,,55.2,,,,
ACETYLC RCPT BLCK AB,86042,CPT,,,,,both,, ,55.2,33.12,Medicare,Medicare,,,,,55.2,,,,
ACTYLC RCPT MODL AB,86043,CPT,,,,,both,, ,55.2,33.12,Medicare,Medicare,,,,,55.2,,,,
Q38321 AQP4 NMOIGG,86052,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,,,,529.91,,,,
"ASO,TITER",86060,CPT,,,,,both,, ,71.85,43.11,Medicare,Medicare,,,,,71.85,,,,
"ASO,TITER",86060,CPT,,,,,both,, ,539.45,323.67,Medicare,Medicare,,,,,539.45,,,,
Q265 ASO AB ITA,86060,CPT,,,,,both,, ,189.17,113.5,Medicare,Medicare,,,,,189.17,,,,
PHYS BB SERV TRAN RE,86078,CPT,,,,,both,, ,165.59,99.35,Medicare,Medicare,,,,,165.59,,,,
C-REACTIVE PROTEIN,86140,CPT,,,,,both,, ,51.08,30.64,Medicare,Medicare,,,,,51.08,,,,
C-REACTIVE PROTEIN,86140,CPT,,,,,both,, ,518.69,311.21,Medicare,Medicare,,,,,518.69,,,,
Q10124 HS-CRP NEPHEL,86141,CPT,,,,,both,, ,999.76,599.85,Medicare,Medicare,,,,,999.76,,,,
BETA-2 GLYCOPROT AB,86146,CPT,,,,,both,, ,252.04,151.22,Medicare,Medicare,,,,,252.04,,,,
BETA-2 GLYCOPROT AB,86146,CPT,,,,,both,, ,252.04,151.22,Medicare,Medicare,,,,,252.04,,,,
Q14890 BETA-2 GLYCOP,86146,CPT,,,,,both,, ,252.04,151.22,Medicare,Medicare,,,,,252.04,,,,
Q14890 BETA-2 GLYCOP,86146,CPT,,,,,both,, ,252.04,151.22,Medicare,Medicare,,,,,252.04,,,,
Q36553B-2-GP1 IGM IA,86146,CPT,,,,,both,, ,252.04,151.22,Medicare,Medicare,,,,,252.04,,,,
Q36553B-2-GP1 IGM IA,86146,CPT,,,,,both,, ,252.04,151.22,Medicare,Medicare,,,,,252.04,,,,
"CARDIOLIPIN AB,IGG",86147,CPT,,,,,both,, ,429.43,257.65,Medicare,Medicare,,,,,429.43,,,,
"CARDIOLIPIN AB,IGG",86147,CPT,,,,,both,, ,429.43,257.65,Medicare,Medicare,,,,,429.43,,,,
Q14890 CARDIOLIPIN A,86147,CPT,,,,,both,, ,429.43,257.65,Medicare,Medicare,,,,,429.43,,,,
Q14890 CARDIOLIPIN A,86147,CPT,,,,,both,, ,429.43,257.65,Medicare,Medicare,,,,,429.43,,,,
Q4662 C-LIPIN AB IGG,86147,CPT,,,,,both,, ,429.43,257.65,Medicare,Medicare,,,,,429.43,,,,
Q4662 C-LIPIN AB IGG,86147,CPT,,,,,both,, ,429.43,257.65,Medicare,Medicare,,,,,429.43,,,,
PHOSPHATIDYLSERIN AB,86148,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,,,,141.46,,,,
PHOSPHOLIPID AB,86148,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,,,,141.46,,,,
Q14890 PHOSPHOLIPID,86148,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,,,,141.46,,,,
CELL ENUM IS AND ID,86152,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,,,,72.13,,,,
"COLD AGG, TITER",86157,CPT,,,,,both,, ,247.83,148.69,Medicare,Medicare,,,,,247.83,,,,
L6353COLD HEMAGGL QT,86157,CPT,,,,,both,, ,40.7,24.42,Medicare,Medicare,,,,,40.7,,,,
"COMPLEMENT AG, EA",86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q19882 COMP AG,86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q34888 COMPLE C7 RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q34889 COMPLE C8 RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q351 C3 COMPL ITA,86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q353 C4C COMP ITA,86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q354 COMPLEM C5 RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q433 COMPL CP C2 RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q981 COMPL C C1Q RID,86160,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
Q297 C1 INH FUNC IA,86161,CPT,,,,,both,, ,79.99,47.99,Medicare,Medicare,,,,,79.99,,,,
"COMP, TOTAL CH50",86162,CPT,,,,,both,, ,984.32,590.59,Medicare,Medicare,,,,,984.32,,,,
"COMP, TOTAL CH50",86162,CPT,,,,,both,, ,984.32,590.59,Medicare,Medicare,,,,,984.32,,,,
Q11173 CCP AB IGG IA,86200,CPT,,,,,both,, ,242.5,145.5,Medicare,Medicare,,,,,242.5,,,,
DEOXYRIBONUCLEASE AB,86215,CPT,,,,,both,, ,198.72,119.23,Medicare,Medicare,,,,,198.72,,,,
DEOXYRIBONUCLEASE AB,86215,CPT,,,,,both,, ,198.72,119.23,Medicare,Medicare,,,,,198.72,,,,
"DNA AB,NATIVE-DOUBL",86225,CPT,,,,,both,, ,1077.5,646.5,Medicare,Medicare,,,,,1077.5,,,,
L165092 DNA DS AB,86225,CPT,,,,,both,, ,486.16,291.69,Medicare,Medicare,,,,,486.16,,,,
L96346 DSDNA AB IA,86225,CPT,,,,,both,, ,219.1,131.46,Medicare,Medicare,,,,,219.1,,,,
Q19882 DNA DS AB,86225,CPT,,,,,both,, ,1077.5,646.5,Medicare,Medicare,,,,,1077.5,,,,
Q255 DNA DS AB IA,86225,CPT,,,,,both,, ,1077.5,646.5,Medicare,Medicare,,,,,1077.5,,,,
DNA AB SINGLE STRAND,86226,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
DNA AB SINGLE STRAND,86226,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
Q14857 SSDNA ANTIBODY (IGG),86226,CPT,,,,,both,, ,923,553.8,Medicare,Medicare,,,,,923,,,,
L165126 ENDMYS AB IG,86231,CPT,,,,,both,, ,60.05,36.03,Medicare,Medicare,,,,,60.05,,,,
Q15064 ENDOMYS AB IG,86231,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,,,,529.91,,,,
Q19955 ENDOMYS AB IG,86231,CPT,,,,,both,, ,743.65,446.19,Medicare,Medicare,,,,,743.65,,,,
ANTI-ENA,86235,CPT,,,,,both,, ,174.85,104.91,Medicare,Medicare,,,,,174.85,,,,
ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,,,,274.22,,,,
L165092 ANTI-ENA,86235,CPT,,,,,both,, ,251.58,150.94,Medicare,Medicare,,,,,251.58,,,,
Q16088 CENTR B AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,,,,274.22,,,,
Q171728MI-2 AAB RIPA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,,,,274.22,,,,
Q19882 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,,,,274.22,,,,
Q19887 RNP AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,,,,274.22,,,,
Q34088 CHROMAT AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,,,,274.22,,,,
Q37923 SM AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,,,,274.22,,,,
Q38568 SS-A IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,,,,274.22,,,,
Q38569 SS-B IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,,,,274.22,,,,
Q4942 SCLEROD AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,,,,274.22,,,,
Q5810 JO-1 AB IA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,,,,274.22,,,,
Q7448 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,,,,274.22,,,,
Q7832 ANTI-ENA,86235,CPT,,,,,both,, ,548.71,329.22,Medicare,Medicare,,,,,548.71,,,,
Q7832 ANTI-ENA,86235,CPT,,,,,both,, ,548.71,329.22,Medicare,Medicare,,,,,548.71,,,,
Q94025 PM-SCL AB EIA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,,,,274.22,,,,
Q94685 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,,,,274.22,,,,
Q94777 ANTI-ENA,86235,CPT,,,,,both,, ,274.22,164.53,Medicare,Medicare,,,,,274.22,,,,
"FLUORESCENT AB,SCREE",86255,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,,,,529.91,,,,
"FLUORESCENT AB,SCREE",86255,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,,,,529.91,,,,
"FLUORESCENT AB,SCREE",86255,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,,,,529.91,,,,
"FLUORESCENT AB,SCREE",86255,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,,,,529.91,,,,
L165620 STRIATIONAL ANTIBODIES,86255,CPT,,,,,both,, ,89.9,53.94,Medicare,Medicare,,,,,89.9,,,,
LC505225 ACETYLCHOLINE RECEPT-MODULAT AB,86255,CPT,,,,,both,, ,260.64,156.38,Medicare,Medicare,,,,,260.64,,,,
Q37092 DNA DS CRITH,86255,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,,,,529.91,,,,
Q37092 DNA DS CRITH,86255,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,,,,529.91,,,,
Q37092 DNA DS CRITH,86255,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,,,,529.91,,,,
Q37092 DNA DS CRITH,86255,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,,,,529.91,,,,
Q91985 ENDOMYSIAL(IGG)ANTIBODY SCRN TITR,86255,CPT,,,,,both,, ,472,283.2,Medicare,Medicare,,,,,472,,,,
"FLUORESCENT AB,TITER",86256,CPT,,,,,both,, ,1217.28,730.36,Medicare,Medicare,,,,,1217.28,,,,
"Q261 FLUORES AB, TIT",86256,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,,,,529.91,,,,
"Q261 FLUORES AB, TIT",86256,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,,,,529.91,,,,
L165126 GLIA AB IGA,86258,CPT,,,,,both,, ,57.65,34.59,Medicare,Medicare,,,,,57.65,,,,
Q11212GLIA AB IGG IA,86258,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,,,,765.96,,,,
Q11212GLIA AB IGG IA,86258,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,,,,765.96,,,,
L143404 CA15-3 ECLIA,86300,CPT,,,,,both,, ,442.13,265.27,Medicare,Medicare,,,,,442.13,,,,
Q29493 CA 27.29 IA,86300,CPT,,,,,both,, ,481.92,289.15,Medicare,Medicare,,,,,481.92,,,,
TUMR AG CA15-3 27-29,86300,CPT,,,,,both,, ,109.46,65.67,Medicare,Medicare,,,,,109.46,,,,
Q17638 CA 19-9 PERITONEAL FLUID,86301,CPT,,,,,both,, ,716.75,430.05,Medicare,Medicare,,,,,716.75,,,,
TUMOR AG CA 19-9,86301,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,,,,804.69,,,,
TUMOR AG CA 19-9,86301,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,,,,804.69,,,,
Q29256 CA 125 IA,86304,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,,,,804.69,,,,
Q91155 TUMR AG CA125,86304,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,,,,804.69,,,,
TUMOR AG CA 125,86304,CPT,,,,,both,, ,804.69,482.81,Medicare,Medicare,,,,,804.69,,,,
Q91155 HE4,86305,CPT,,,,,both,, ,138.65,83.19,Medicare,Medicare,,,,,138.65,,,,
HETEROPHILE AB SCREE,86308,CPT,,,,,both,, ,19.09,11.45,Medicare,Medicare,,,,,19.09,,,,
HETEROPHILE AB SCREE,86308,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,,,,480.79,,,,
Q17410 ALPHA-FETOPROTEIN PERITONEAL FLUI,86316,CPT,,,,,both,, ,429.25,257.55,Medicare,Medicare,,,,,429.25,,,,
"TUMOR AG, OTHER",86316,CPT,,,,,both,, ,481.92,289.15,Medicare,Medicare,,,,,481.92,,,,
"TUMOR AG, OTHER",86316,CPT,,,,,both,, ,481.92,289.15,Medicare,Medicare,,,,,481.92,,,,
INF AGENT IMMUNO QUA,86317,CPT,,,,,both,, ,217.52,130.51,Medicare,Medicare,,,,,217.52,,,,
INF AGENT IMMUNO QUA,86317,CPT,,,,,both,, ,217.52,130.51,Medicare,Medicare,,,,,217.52,,,,
TETANUS/DIPTHERIA AB,86317,CPT,,,,,both,, ,70,42,Medicare,Medicare,,,,,70,,,,
Q15914 C4 BND PL RID,86329,CPT,,,,,both,, ,81.11,48.66,Medicare,Medicare,,,,,81.11,,,,
Q14978 IMMUNODI OUCN,86331,CPT,,,,,both,, ,69.04,41.42,Medicare,Medicare,,,,,69.04,,,,
IMMUNOFIXATION ELECT,86334,CPT,,,,,both,, ,1021.37,612.82,Medicare,Medicare,,,,,1021.37,,,,
IMMUNOFIXATION ELECT,86334,CPT,,,,,both,, ,1021.37,612.82,Medicare,Medicare,,,,,1021.37,,,,
Q38940 IMMUNOFIXATION ELECT,86334,CPT,,,,,both,, ,909.75,545.85,Medicare,Medicare,,,,,909.75,,,,
IMM E-PHORS-URIN-CSF,86335,CPT,,,,,both,, ,680.07,408.04,Medicare,Medicare,,,,,680.07,,,,
Q10640 B2TF EL-IF,86335,CPT,,,,,both,, ,680.07,408.04,Medicare,Medicare,,,,,680.07,,,,
Q213 IFE U,86335,CPT,,,,,both,, ,680.07,408.04,Medicare,Medicare,,,,,680.07,,,,
INHIBIN A,86336,CPT,,,,,both,, ,145.66,87.39,Medicare,Medicare,,,,,145.66,,,,
INSULIN AB,86337,CPT,,,,,both,, ,207.41,124.44,Medicare,Medicare,,,,,207.41,,,,
INSULIN AB,86337,CPT,,,,,both,, ,207.41,124.44,Medicare,Medicare,,,,,207.41,,,,
INTRINSIC FACTOR AB,86340,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
L10413 IFB AB ICMA,86340,CPT,,,,,both,, ,50,30,Medicare,Medicare,,,,,50,,,,
ISLET CELL AB,86341,CPT,,,,,both,, ,296.67,178,Medicare,Medicare,,,,,296.67,,,,
Q34878 GAD-65 AB RBA,86341,CPT,,,,,both,, ,728.07,436.84,Medicare,Medicare,,,,,728.07,,,,
Q36177 IA2 AB,86341,CPT,,,,,both,, ,296.67,178,Medicare,Medicare,,,,,296.67,,,,
Q36741 ISL CL AB IFA,86341,CPT,,,,,both,, ,296.67,178,Medicare,Medicare,,,,,296.67,,,,
Q93022 ZINC TRANSPORTER 8 (ZNT8)ANTIBODY,86341,CPT,,,,,both,, ,264.25,158.55,Medicare,Medicare,,,,,264.25,,,,
Q90123 LEUK HIST REL,86343,CPT,,,,,both,, ,55.95,33.57,Medicare,Medicare,,,,,55.95,,,,
L820022 CHRN URTICAR,86352,CPT,,,,,both,, ,422.3,253.38,Medicare,Medicare,,,,,422.3,,,,
"Q39588 B CELLS, TOTA",86355,CPT,,,,,both,, ,217.52,130.51,Medicare,Medicare,,,,,217.52,,,,
MONONUC CELL AG QT,86356,CPT,,,,,both,, ,308.74,185.24,Medicare,Medicare,,,,,308.74,,,,
MONONUC CELL AG QT,86356,CPT,,,,,both,, ,308.74,185.24,Medicare,Medicare,,,,,308.74,,,,
Q37088 NK CELLS CF,86357,CPT,,,,,both,, ,217.52,130.51,Medicare,Medicare,,,,,217.52,,,,
"Q39588 T CELLS, TOTA",86359,CPT,,,,,both,, ,217.52,130.51,Medicare,Medicare,,,,,217.52,,,,
"T CELL,ABSO CD4-CD8",86360,CPT,,,,,both,, ,1515.65,909.39,Medicare,Medicare,,,,,1515.65,,,,
"T CELL,ABSO CD4-CD8",86360,CPT,,,,,both,, ,1515.65,909.39,Medicare,Medicare,,,,,1515.65,,,,
Q8360 LYMP SUB P5 FC,86361,CPT,,,,,both,, ,822.94,493.76,Medicare,Medicare,,,,,822.94,,,,
"T CELL, ABSO CD4",86361,CPT,,,,,both,, ,878.79,527.27,Medicare,Medicare,,,,,878.79,,,,
Q36952 MOG AB,86362,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,,,,529.91,,,,
L165126TTG AB IGG IA,86364,CPT,,,,,both,, ,57.65,34.59,Medicare,Medicare,,,,,57.65,,,,
Q8821 TTG AB IGA IA,86364,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,,,,765.96,,,,
Q8821 TTG AB IGA IA,86364,CPT,,,,,both,, ,765.96,459.57,Medicare,Medicare,,,,,765.96,,,,
L504600 MSCLSPECKINAB,86366,CPT,,,,,both,, ,180.4,108.24,Medicare,Medicare,,,,,180.4,,,,
MICROSOMAL AB,86376,CPT,,,,,both,, ,682.88,409.72,Medicare,Medicare,,,,,682.88,,,,
MICROSOMAL AB,86376,CPT,,,,,both,, ,682.88,409.72,Medicare,Medicare,,,,,682.88,,,,
MICROSOMAL AB,86376,CPT,,,,,both,, ,682.88,409.72,Medicare,Medicare,,,,,682.88,,,,
MICROSOMAL AB,86376,CPT,,,,,both,, ,682.88,409.72,Medicare,Medicare,,,,,682.88,,,,
Q259 MITO AB IA,86381,CPT,,,,,both,, ,529.91,317.94,Medicare,Medicare,,,,,529.91,,,,
Q30321 MM2AB IGG EIA,86381,CPT,,,,,both,, ,414.83,248.89,Medicare,Medicare,,,,,414.83,,,,
"NEUTRALIZ TEST,VIRAL",86382,CPT,,,,,both,, ,224.54,134.72,Medicare,Medicare,,,,,224.54,,,,
"NEUTRALIZ TEST,VIRAL",86382,CPT,,,,,both,, ,224.54,134.72,Medicare,Medicare,,,,,224.54,,,,
PART AGGLUT.SCREEN,86403,CPT,,,,,both,, ,547.31,328.38,Medicare,Medicare,,,,,547.31,,,,
Q11196 CRYPTOC AG LA,86403,CPT,,,,,both,, ,172.9,103.74,Medicare,Medicare,,,,,172.9,,,,
Q11196 CRYPTOC AG LA,86403,CPT,,,,,both,, ,172.9,103.74,Medicare,Medicare,,,,,172.9,,,,
PART AGGLUT. TITER,86406,CPT,,,,,both,, ,147.91,88.74,Medicare,Medicare,,,,,147.91,,,,
Q37521 RA FACT QT,86431,CPT,,,,,both,, ,401.19,240.71,Medicare,Medicare,,,,,401.19,,,,
RHEUMATOID FACT QUAN,86431,CPT,,,,,both,, ,55.85,33.51,Medicare,Medicare,,,,,55.85,,,,
RHEUMATOID FACT QUAN,86431,CPT,,,,,both,, ,437.29,262.37,Medicare,Medicare,,,,,437.29,,,,
LRX182877 QTFERON TU,86480,CPT,,,,,both,, ,369.77,221.86,Medicare,Medicare,,,,,369.77,,,,
Q19453 TB GOLD BIO A,86480,CPT,,,,,both,,,403.05,403.05,Medicare,Medicare,,403.05,,,403.05,403.05,403.05,fee schedule,Medicare APC Fee Schedule
TB TEST CELL IM MEAS,86480,CPT,,,,,both,, ,403.05,241.83,Medicare,Medicare,,,,,403.05,,,,
TB TEST CELL IM MEAS,86480,CPT,,,,,both,, ,403.05,241.83,Medicare,Medicare,,,,,403.05,,,,
L006099 RFLX RPR,86592,CPT,,,,,both,, ,48.9,29.34,Medicare,Medicare,,,,,48.9,,,,
"SYPHILIS TEST, QUAL",86592,CPT,,,,,both,, ,42.1,25.26,Medicare,Medicare,,,,,42.1,,,,
"SYPHILIS TEST, QUAL",86592,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
"SYPHILIS TEST, QUAL",86592,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
L6460 RPR QT CHAR FL,86593,CPT,,,,,both,, ,412.88,247.72,Medicare,Medicare,,,,,412.88,,,,
"SYPHILIS TEST, QUANT",86593,CPT,,,,,both,, ,43.5,26.1,Medicare,Medicare,,,,,43.5,,,,
"SYPHILIS TEST, QUANT",86593,CPT,,,,,both,, ,412.87,247.72,Medicare,Medicare,,,,,412.87,,,,
VOLT-GTD CA CHNL AB,86596,CPT,,,,,both,, ,120.5,72.3,Medicare,Medicare,,,,,120.5,,,,
ASPERGILLUS AB,86606,CPT,,,,,both,, ,145.95,87.57,Medicare,Medicare,,,,,145.95,,,,
ASPERGILLUS AB,86606,CPT,,,,,both,, ,145.95,87.57,Medicare,Medicare,,,,,145.95,,,,
"BACTERUIM AB, NOS",86609,CPT,,,,,both,, ,154.09,92.45,Medicare,Medicare,,,,,154.09,,,,
"BACTERUIM AB, NOS",86609,CPT,,,,,both,, ,154.09,92.45,Medicare,Medicare,,,,,154.09,,,,
Q34329 LISTERI AB CF,86609,CPT,,,,,both,, ,770.45,462.27,Medicare,Medicare,,,,,770.45,,,,
BARTONELLA AB,86611,CPT,,,,,both,, ,348.32,208.99,Medicare,Medicare,,,,,348.32,,,,
Q34251 BARTONELLA AB,86611,CPT,,,,,both,, ,264.11,158.46,Medicare,Medicare,,,,,264.11,,,,
BLASTOMYCES AB,86612,CPT,,,,,both,, ,600.92,360.55,Medicare,Medicare,,,,,600.92,,,,
BLASTOMYCES AB,86612,CPT,,,,,both,, ,600.92,360.55,Medicare,Medicare,,,,,600.92,,,,
BORDETELLA AB,86615,CPT,,,,,both,, ,134.44,80.66,Medicare,Medicare,,,,,134.44,,,,
BORDETELLA AB,86615,CPT,,,,,both,, ,134.44,80.66,Medicare,Medicare,,,,,134.44,,,,
BORRELIA BURG.CONFIR,86617,CPT,,,,,both,, ,232.11,139.26,Medicare,Medicare,,,,,232.11,,,,
BORRELIA BURG.CONFIR,86617,CPT,,,,,both,, ,232.11,139.26,Medicare,Medicare,,,,,232.11,,,,
LYME DISEASE AB,86618,CPT,,,,,both,, ,167.84,100.7,Medicare,Medicare,,,,,167.84,,,,
LYME DISEASE AB,86618,CPT,,,,,both,, ,573.13,343.87,Medicare,Medicare,,,,,573.13,,,,
LYME DISEASE AB,86618,CPT,,,,,both,, ,573.13,343.87,Medicare,Medicare,,,,,573.13,,,,
BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Medicare,Medicare,,,,,405.29,,,,
Q91068 BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Medicare,Medicare,,,,,405.29,,,,
Q91121 BRUCELLA AB,86622,CPT,,,,,both,, ,405.29,243.17,Medicare,Medicare,,,,,405.29,,,,
CANDIDA AB,86628,CPT,,,,,both,, ,157.18,94.3,Medicare,Medicare,,,,,157.18,,,,
CHLAMYDIA AB,86631,CPT,,,,,both,, ,275.62,165.37,Medicare,Medicare,,,,,275.62,,,,
CHLAMYDIA IGM AB,86632,CPT,,,,,both,, ,286.57,171.94,Medicare,Medicare,,,,,286.57,,,,
CHLAMYDIA IGM AB,86632,CPT,,,,,both,, ,286.57,171.94,Medicare,Medicare,,,,,286.57,,,,
Q38481 C.PNEU AB IGM,86632,CPT,,,,,both,, ,743.51,446.1,Medicare,Medicare,,,,,743.51,,,,
COCCIDIOIDES AB,86635,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
COCCIDIOIDES AB,86635,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
L806606 Q FEV,86638,CPT,,,,,both,, ,120,72,Medicare,Medicare,,,,,120,,,,
Q37071 COXIELLA BRUN,86638,CPT,,,,,both,, ,69.89,41.93,Medicare,Medicare,,,,,69.89,,,,
Q30430 CRYPTO AB IFA,86641,CPT,,,,,both,, ,74.65,44.79,Medicare,Medicare,,,,,74.65,,,,
CMV AB,86644,CPT,,,,,both,, ,1113.43,668.05,Medicare,Medicare,,,,,1113.43,,,,
CMV AB,86644,CPT,,,,,both,, ,1113.43,668.05,Medicare,Medicare,,,,,1113.43,,,,
L6494 CMV IGG CLIA,86644,CPT,,,,,both,, ,1021.5,612.9,Medicare,Medicare,,,,,1021.5,,,,
"CMV AB, IGM",86645,CPT,,,,,both,, ,1277.07,766.24,Medicare,Medicare,,,,,1277.07,,,,
Q8503 CMV AB IGM IA,86645,CPT,,,,,both,, ,485.84,291.5,Medicare,Medicare,,,,,485.84,,,,
Q37512 DIPTHTHER AB,86648,CPT,,,,,both,, ,101.32,60.79,Medicare,Medicare,,,,,101.32,,,,
ENTEROVIRUS AB,86658,CPT,,,,,both,, ,375.82,225.49,Medicare,Medicare,,,,,375.82,,,,
L830764 ENTEROVIR AB,86658,CPT,,,,,both,, ,212,127.2,Medicare,Medicare,,,,,212,,,,
"EPSTEIN-BARR AB, EA",86663,CPT,,,,,both,, ,210.5,126.3,Medicare,Medicare,,,,,210.5,,,,
"EPSTEIN-BARR AB, EA",86663,CPT,,,,,both,, ,210.5,126.3,Medicare,Medicare,,,,,210.5,,,,
"EPSTEIN-BARR, EBNA",86664,CPT,,,,,both,, ,362.91,217.74,Medicare,Medicare,,,,,362.91,,,,
"EPSTEIN-BARR, EBNA",86664,CPT,,,,,both,, ,362.91,217.74,Medicare,Medicare,,,,,362.91,,,,
"EPSTEIN-BARR, VCA",86665,CPT,,,,,both,, ,362.91,217.74,Medicare,Medicare,,,,,362.91,,,,
"EPSTEIN-BARR, VCA",86665,CPT,,,,,both,, ,362.91,217.74,Medicare,Medicare,,,,,362.91,,,,
Q8426 EBV VCA IGM IA,86665,CPT,,,,,both,, ,210.5,126.3,Medicare,Medicare,,,,,210.5,,,,
Q8426 EBV VCA IGM IA,86665,CPT,,,,,both,, ,210.5,126.3,Medicare,Medicare,,,,,210.5,,,,
EHRLICHIA AB,86666,CPT,,,,,both,, ,255.98,153.58,Medicare,Medicare,,,,,255.98,,,,
EHRLICHIA AB,86666,CPT,,,,,both,, ,255.98,153.58,Medicare,Medicare,,,,,255.98,,,,
Q34271 EHRLICHIA AB,86666,CPT,,,,,both,, ,511.95,307.17,Medicare,Medicare,,,,,511.95,,,,
FRANCISELLA TULARENS,86668,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
"FUNGUS AB, NOS",86671,CPT,,,,,both,, ,284.32,170.59,Medicare,Medicare,,,,,284.32,,,,
L162045 FUNG AB NOS,86671,CPT,,,,,both,, ,260.85,156.51,Medicare,Medicare,,,,,260.85,,,,
Q10294 SCAB IGG IA,86671,CPT,,,,,both,, ,568.64,341.18,Medicare,Medicare,,,,,568.64,,,,
Q10294 SCAB IGG IA,86671,CPT,,,,,both,, ,568.64,341.18,Medicare,Medicare,,,,,568.64,,,,
Q37695 H PYLORI AB Q,86677,CPT,,,,,both,, ,56.69,34.01,Medicare,Medicare,,,,,56.69,,,,
Q91307 ECHIN IGG EIA,86682,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,,,,74.93,,,,
Q91307 ECHIN IGG EIA,86682,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,,,,74.93,,,,
Q91307 ECHIN IGG EIA,86682,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,,,,74.93,,,,
Q91307 ECHIN IGG EIA,86682,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,,,,74.93,,,,
"HEPATITIS, DELTA AGE",86692,CPT,,,,,both,, ,1381.76,829.05,Medicare,Medicare,,,,,1381.76,,,,
Q4990 HEP D AB TOTAL,86692,CPT,,,,,both,, ,725.82,435.49,Medicare,Medicare,,,,,725.82,,,,
HERPES SIMP NON-SPEC,86694,CPT,,,,,both,, ,338.21,202.92,Medicare,Medicare,,,,,338.21,,,,
L164806 HSV1/2 IGM,86694,CPT,,,,,both,, ,50.7,30.42,Medicare,Medicare,,,,,50.7,,,,
HERPES SIMP TYPE 1,86695,CPT,,,,,both,, ,129.94,77.96,Medicare,Medicare,,,,,129.94,,,,
HERPES SIMP TYPE 1,86695,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
HERPES SIMP TYPE 1,86695,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
HERPES SIMP TYPE 1,86695,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
HERPES SIMP TYPE 1,86695,CPT,,,,,both,, ,351.68,211,Medicare,Medicare,,,,,351.68,,,,
HERPES SIMP TYPE 2,86696,CPT,,,,,both,, ,190.86,114.51,Medicare,Medicare,,,,,190.86,,,,
HERPES SIMP TYPE 2,86696,CPT,,,,,both,, ,258.5,155.1,Medicare,Medicare,,,,,258.5,,,,
HERPES SIMP TYPE 2,86696,CPT,,,,,both,, ,258.5,155.1,Medicare,Medicare,,,,,258.5,,,,
HERPES SIMP TYPE 2,86696,CPT,,,,,both,, ,258.5,155.1,Medicare,Medicare,,,,,258.5,,,,
HERPES SIMP TYPE 2,86696,CPT,,,,,both,, ,258.5,155.1,Medicare,Medicare,,,,,258.5,,,,
L163006 HSV2 AB IG,86696,CPT,,,,,both,, ,300,180,Medicare,Medicare,,,,,300,,,,
Q17170 HERPES SIMPLEX VIRUS 2 (IGG),86696,CPT,,,,,both,, ,230.25,138.15,Medicare,Medicare,,,,,230.25,,,,
HISTOPLASMA,86698,CPT,,,,,both,, ,450.48,270.28,Medicare,Medicare,,,,,450.48,,,,
HISTOPLASMA,86698,CPT,,,,,both,, ,450.48,270.28,Medicare,Medicare,,,,,450.48,,,,
HEP B CORE TOT,86704,CPT,,,,,both,, ,898.44,539.06,Medicare,Medicare,,,,,898.44,,,,
HEP B CORE TOT,86704,CPT,,,,,both,, ,898.44,539.06,Medicare,Medicare,,,,,898.44,,,,
"HEP B CORE AB, IGM",86705,CPT,,,,,both,,,1047.19,1047.19,Medicare,Medicare,,1047.19,,,1047.19,1047.19,1047.19,fee schedule,Medicare APC Fee Schedule
"HEP B CORE AB, IGM",86705,CPT,,,,,both,, ,1047.19,628.31,Medicare,Medicare,,,,,1047.19,,,,
L16881 HBC IGM ICMA,86705,CPT,,,,,both,, ,70.33,42.19,Medicare,Medicare,,,,,70.33,,,,
HEP BE AB,86707,CPT,,,,,both,, ,999.76,599.85,Medicare,Medicare,,,,,999.76,,,,
HEP BE AB,86707,CPT,,,,,both,, ,999.76,599.85,Medicare,Medicare,,,,,999.76,,,,
"HEP A AB, TOTAL",86708,CPT,,,,,both,, ,547.88,328.72,Medicare,Medicare,,,,,547.88,,,,
L6726HEPA AB TOT ICM,86708,CPT,,,,,both,, ,547.88,328.72,Medicare,Medicare,,,,,547.88,,,,
Q36504 HEPA AB IGM I,86708,CPT,,,,,both,, ,547.88,328.72,Medicare,Medicare,,,,,547.88,,,,
"HEP A AB, IGM",86709,CPT,,,,,both,,,725.82,725.82,Medicare,Medicare,,725.82,,,725.82,725.82,725.82,fee schedule,Medicare APC Fee Schedule
"HEP A AB, IGM",86709,CPT,,,,,both,, ,725.82,435.49,Medicare,Medicare,,,,,725.82,,,,
L6734 HEP A IGM ICMA,86709,CPT,,,,,both,, ,70,42,Medicare,Medicare,,,,,70,,,,
L6734 HEP A IGM ICMA,86709,CPT,,,,,both,, ,70,42,Medicare,Medicare,,,,,70,,,,
INFLUENZA VIRUS AB,86710,CPT,,,,,both,, ,295.83,177.49,Medicare,Medicare,,,,,295.83,,,,
INFLUENZA VIRUS AB,86710,CPT,,,,,both,, ,295.83,177.49,Medicare,Medicare,,,,,295.83,,,,
Q91665 STRAT JCV AB,86711,CPT,,,,,both,, ,156.06,93.63,Medicare,Medicare,,,,,156.06,,,,
L164616 LEGIONELL AB,86713,CPT,,,,,both,, ,781.12,468.67,Medicare,Medicare,,,,,781.12,,,,
LEGIONELLA AB,86713,CPT,,,,,both,, ,781.11,468.66,Medicare,Medicare,,,,,781.11,,,,
LEGIONELLA AB,86713,CPT,,,,,both,, ,781.11,468.66,Medicare,Medicare,,,,,781.11,,,,
LEPTOSPIRA AB,86720,CPT,,,,,both,, ,329.51,197.7,Medicare,Medicare,,,,,329.51,,,,
L96552MUMPS IGG CLIA,86735,CPT,,,,,both,, ,540.24,324.14,Medicare,Medicare,,,,,540.24,,,,
MUMPS AB,86735,CPT,,,,,both,, ,96.55,57.93,Medicare,Medicare,,,,,96.55,,,,
MUMPS AB,86735,CPT,,,,,both,, ,588.85,353.31,Medicare,Medicare,,,,,588.85,,,,
Q36565 MUMPS IGM IFA,86735,CPT,,,,,both,, ,588.85,353.31,Medicare,Medicare,,,,,588.85,,,,
Q8624 MUMPSAB IGG IA,86735,CPT,,,,,both,, ,588.85,353.31,Medicare,Medicare,,,,,588.85,,,,
MYCOPLASMA AB,86738,CPT,,,,,both,, ,566.12,339.67,Medicare,Medicare,,,,,566.12,,,,
MYCOPLASMA AB,86738,CPT,,,,,both,, ,566.12,339.67,Medicare,Medicare,,,,,566.12,,,,
MYCOPLASMA AB,86738,CPT,,,,,both,, ,566.12,339.67,Medicare,Medicare,,,,,566.12,,,,
MYCOPLASMA AB,86738,CPT,,,,,both,, ,566.12,339.67,Medicare,Medicare,,,,,566.12,,,,
PARVOVIRUS AB,86747,CPT,,,,,both,, ,242.5,145.5,Medicare,Medicare,,,,,242.5,,,,
PARVOVIRUS AB,86747,CPT,,,,,both,, ,242.5,145.5,Medicare,Medicare,,,,,242.5,,,,
PARVOVIRUS AB,86747,CPT,,,,,both,, ,242.5,145.5,Medicare,Medicare,,,,,242.5,,,,
PARVOVIRUS AB,86747,CPT,,,,,both,, ,242.5,145.5,Medicare,Medicare,,,,,242.5,,,,
Q34278 ENTAB IGG ELI,86753,CPT,,,,,both,, ,64.27,38.56,Medicare,Medicare,,,,,64.27,,,,
Q34300 PROTOZ AB NOS,86753,CPT,,,,,both,, ,64.27,38.56,Medicare,Medicare,,,,,64.27,,,,
Q90827 T CRUZI AB IA,86753,CPT,,,,,both,, ,64.27,38.56,Medicare,Medicare,,,,,64.27,,,,
L96131 RSV AB QT,86756,CPT,,,,,both,, ,95,57,Medicare,Medicare,,,,,95,,,,
RICKETTSIA AB,86757,CPT,,,,,both,, ,242.5,145.5,Medicare,Medicare,,,,,242.5,,,,
RICKETTSIA AB,86757,CPT,,,,,both,, ,242.5,145.5,Medicare,Medicare,,,,,242.5,,,,
RICKETTSIA AB,86757,CPT,,,,,both,, ,242.5,145.5,Medicare,Medicare,,,,,242.5,,,,
RICKETTSIA AB,86757,CPT,,,,,both,, ,242.5,145.5,Medicare,Medicare,,,,,242.5,,,,
RUBELLA AB,86762,CPT,,,,,both,, ,88.69,53.21,Medicare,Medicare,,,,,88.69,,,,
RUBELLA AB,86762,CPT,,,,,both,, ,906.3,543.78,Medicare,Medicare,,,,,906.3,,,,
Q34256 MEASAB IGMIA,86765,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,,,,871.22,,,,
Q964 MEAS AB IGG IA,86765,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,,,,871.22,,,,
RUBEOLA AB,86765,CPT,,,,,both,, ,111.15,66.69,Medicare,Medicare,,,,,111.15,,,,
RUBEOLA AB,86765,CPT,,,,,both,, ,871.22,522.73,Medicare,Medicare,,,,,871.22,,,,
SALMONELLA AB,86768,CPT,,,,,both,, ,127.7,76.62,Medicare,Medicare,,,,,127.7,,,,
SALMONELLA AB,86768,CPT,,,,,both,, ,127.7,76.62,Medicare,Medicare,,,,,127.7,,,,
COVID19 AB,86769,CPT,,,,,both,, ,224.54,134.72,Medicare,Medicare,,,,,224.54,,,,
COVID19 AB,86769,CPT,,,,,both,, ,224.54,134.72,Medicare,Medicare,,,,,224.54,,,,
L164055 COVID19ABIGG,86769,CPT,,,,,both,, ,206,123.6,Medicare,Medicare,,,,,206,,,,
Q4862 TET ATOX ELISA,86774,CPT,,,,,both,, ,98.51,59.1,Medicare,Medicare,,,,,98.51,,,,
Q3679 TOXOPLAS AB IA,86777,CPT,,,,,both,, ,247.83,148.69,Medicare,Medicare,,,,,247.83,,,,
Q8636 TOXOPLASMA AB,86777,CPT,,,,,both,, ,247.83,148.69,Medicare,Medicare,,,,,247.83,,,,
TOXOPLASMA AB,86777,CPT,,,,,both,, ,247.83,148.69,Medicare,Medicare,,,,,247.83,,,,
"TOXOPLASMA AB, IGM",86778,CPT,,,,,both,, ,247.83,148.69,Medicare,Medicare,,,,,247.83,,,,
"TOXOPLASMA AB, IGM",86778,CPT,,,,,both,, ,247.83,148.69,Medicare,Medicare,,,,,247.83,,,,
L082370 TREP AB IA,86780,CPT,,,,,both,, ,132.4,79.44,Medicare,Medicare,,,,,132.4,,,,
"TREP. PALLIDUM,CONFI",86780,CPT,,,,,both,, ,172.9,103.74,Medicare,Medicare,,,,,172.9,,,,
"TREP. PALLIDUM,CONFI",86780,CPT,,,,,both,, ,172.9,103.74,Medicare,Medicare,,,,,172.9,,,,
TREPONEMAL AB,86780,CPT,,,,,both,, ,48.9,29.34,Medicare,Medicare,,,,,48.9,,,,
L96206 VZV IGG CLIA,86787,CPT,,,,,both,, ,831.47,498.88,Medicare,Medicare,,,,,831.47,,,,
Q4439 VZV AB IGG IA,86787,CPT,,,,,both,, ,906.3,543.78,Medicare,Medicare,,,,,906.3,,,,
Q8683 VZV AB IGM IA,86787,CPT,,,,,both,, ,906.3,543.78,Medicare,Medicare,,,,,906.3,,,,
VARICELLA-ZOSTER AB,86787,CPT,,,,,both,, ,111.15,66.69,Medicare,Medicare,,,,,111.15,,,,
VARICELLA-ZOSTER AB,86787,CPT,,,,,both,, ,906.3,543.78,Medicare,Medicare,,,,,906.3,,,,
Q16012 WNVAB IGM EIA,86788,CPT,,,,,both,, ,252.61,151.56,Medicare,Medicare,,,,,252.61,,,,
Q36596 WEST NILE VIR,86788,CPT,,,,,both,, ,252.61,151.56,Medicare,Medicare,,,,,252.61,,,,
WEST NILE VIR AB IGM,86788,CPT,,,,,both,, ,252.61,151.56,Medicare,Medicare,,,,,252.61,,,,
Q36596 WEST NILE VIR,86789,CPT,,,,,both,, ,219.2,131.52,Medicare,Medicare,,,,,219.2,,,,
WEST NILE VIR AB,86789,CPT,,,,,both,, ,215.84,129.5,Medicare,Medicare,,,,,215.84,,,,
L878033 HHV-7 IGM IF,86790,CPT,,,,,both,, ,615,369,Medicare,Medicare,,,,,615,,,,
Q36175HLTV I/II CL-I,86790,CPT,,,,,both,, ,124.9,74.94,Medicare,Medicare,,,,,124.9,,,,
Q36175HLTV I/II CL-I,86790,CPT,,,,,both,, ,124.9,74.94,Medicare,Medicare,,,,,124.9,,,,
Q94264 ZIKA AB IGM,86794,CPT,,,,,both,, ,97.11,58.26,Medicare,Medicare,,,,,97.11,,,,
Q90814 THYROID CANCER (THYROGLOBULIN)MON,86800,CPT,,,,,both,, ,669.25,401.55,Medicare,Medicare,,,,,669.25,,,,
THYROGLOBULIN AB,86800,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,,,,751.36,,,,
THYROGLOBULIN AB,86800,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,,,,751.36,,,,
THYROGLOBULIN AB,86800,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,,,,751.36,,,,
THYROGLOBULIN AB,86800,CPT,,,,,both,, ,751.36,450.81,Medicare,Medicare,,,,,751.36,,,,
HEPATITIS C AB TEST,86803,CPT,,,,,both,, ,698.32,418.99,Medicare,Medicare,,,,,698.32,,,,
"HEP C AB TEST,CONFIR",86804,CPT,,,,,both,, ,358.42,215.05,Medicare,Medicare,,,,,358.42,,,,
CYTOTOXIC REACTIVE AB SCREEN/STANDARD,86807,CPT,,,,,both,, ,87,52.2,Medicare,Medicare,,,,,87,,,,
"HLA  A,B,OR C,SING",86812,CPT,,,,,both,, ,1449.41,869.64,Medicare,Medicare,,,,,1449.41,,,,
"HLA  A,B,OR C,SING",86812,CPT,,,,,both,, ,1449.41,869.64,Medicare,Medicare,,,,,1449.41,,,,
HLA SOLID PHASE/CALSS I&II AB QUAL,86828,CPT,,,,,both,, ,70,42,Medicare,Medicare,,,,,70,,,,
HLA SOLID PHASE/CLASS 1 AB QUAL HIGHDEF,86832,CPT,,,,,both,, ,356,213.6,Medicare,Medicare,,,,,356,,,,
L117065 PROTH AB IGG,86849,CPT,,,,,both,, ,157,94.2,Medicare,Medicare,,,,,157,,,,
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,, ,61.75,37.05,Medicare,Medicare,,,,,61.75,,,,
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,,,318,318,Medicare,Medicare,,318,,,318,318,318,fee schedule,Medicare APC Fee Schedule
"ANTIBODY SCREEN, RBC",86850,CPT,,,,,both,, ,318,190.8,Medicare,Medicare,,,,,318,,,,
O51200 AB SCRN,86850,CPT,,,,,both,, ,291.75,175.05,Medicare,Medicare,,,,,291.75,,,,
"ANTIBODY ELUTION,RBC",86860,CPT,,,,,both,, ,174.3,104.58,Medicare,Medicare,,,,,174.3,,,,
"ANTIBODY ELUTION,RBC",86860,CPT,,,,,both,, ,174.3,104.58,Medicare,Medicare,,,,,174.3,,,,
"ANTIBODY ID,EA PANEL",86870,CPT,,,,,both,, ,488.65,293.19,Medicare,Medicare,,,,,488.65,,,,
O51108 AB ID EA PNL,86870,CPT,,,,,both,, ,475.18,285.1,Medicare,Medicare,,,,,475.18,,,,
DIRECT COOMBS TEST,86880,CPT,,,,,both,, ,250.64,150.38,Medicare,Medicare,,,,,250.64,,,,
DIRECT COOMBS TEST,86880,CPT,,,,,both,, ,250.64,150.38,Medicare,Medicare,,,,,250.64,,,,
IDAT QUAL EA RGT RBC,86885,CPT,,,,,both,, ,39.57,23.74,Medicare,Medicare,,,,,39.57,,,,
IDAT EACH AB TITER,86886,CPT,,,,,both,, ,326.14,195.68,Medicare,Medicare,,,,,326.14,,,,
"AUTO COMPONENT,PROCS",86890,CPT,,,,,both,, ,756.41,453.84,Medicare,Medicare,,,,,756.41,,,,
AUTOL BID OP SALV,86891,CPT,,,,,both,, ,3941.23,2364.73,Medicare,Medicare,,,,,3941.23,,,,
BLOOD TYPING ABO,86900,CPT,,,,,both,, ,38.73,23.23,Medicare,Medicare,,,,,38.73,,,,
BLOOD TYPING ABO,86900,CPT,,,,,both,,,97.39,97.39,Medicare,Medicare,,97.39,,,97.39,97.39,97.39,fee schedule,Medicare APC Fee Schedule
BLOOD TYPING ABO,86900,CPT,,,,,both,, ,97.39,58.43,Medicare,Medicare,,,,,97.39,,,,
BLOOD TYPING ABO,86900,CPT,,,,,both,, ,97.39,58.43,Medicare,Medicare,,,,,97.39,,,,
BLOOD TYPING RH D,86901,CPT,,,,,both,, ,38.73,23.23,Medicare,Medicare,,,,,38.73,,,,
BLOOD TYPING RH D,86901,CPT,,,,,both,,,97.39,97.39,Medicare,Medicare,,97.39,,,97.39,97.39,97.39,fee schedule,Medicare APC Fee Schedule
BLOOD TYPING RH D,86901,CPT,,,,,both,, ,97.39,58.43,Medicare,Medicare,,,,,97.39,,,,
BLOOD TYPING RH D,86901,CPT,,,,,both,, ,97.39,58.43,Medicare,Medicare,,,,,97.39,,,,
BLD TYPE DONOR EA AG,86902,CPT,,,,,both,, ,277.86,166.71,Medicare,Medicare,,,,,277.86,,,,
BLD TYPING OTHER AG,86905,CPT,,,,,both,,,217.52,217.52,Medicare,Medicare,,217.52,,,217.52,217.52,217.52,fee schedule,Medicare APC Fee Schedule
BLD TYPING OTHER AG,86905,CPT,,,,,both,, ,217.52,130.51,Medicare,Medicare,,,,,217.52,,,,
BLD TYPING OTHER AG,86905,CPT,,,,,both,, ,217.52,130.51,Medicare,Medicare,,,,,217.52,,,,
O51920 RH PHENO,86906,CPT,,,,,both,, ,224,134.4,Medicare,Medicare,,,,,224,,,,
COMPATIB TEST IS,86920,CPT,,,,,both,,,275.62,275.62,Medicare,Medicare,,275.62,,,275.62,275.62,275.62,fee schedule,Medicare APC Fee Schedule
COMPATIB TEST IS,86920,CPT,,,,,both,, ,275.62,165.37,Medicare,Medicare,,,,,275.62,,,,
COMPATIB TEST INCUB,86921,CPT,,,,,both,,,103,103,Medicare,Medicare,,103,,,103,103,103,fee schedule,Medicare APC Fee Schedule
COMPATIB TEST INCUB,86921,CPT,,,,,both,, ,103,61.8,Medicare,Medicare,,,,,103,,,,
COMPATIB TEST AHG,86922,CPT,,,,,both,,,250.07,250.07,Medicare,Medicare,,250.07,,,250.07,250.07,250.07,fee schedule,Medicare APC Fee Schedule
COMPATIB TEST AHG,86922,CPT,,,,,both,, ,250.07,150.04,Medicare,Medicare,,,,,250.07,,,,
FFP THAWING,86927,CPT,,,,,both,, ,233.8,140.28,Medicare,Medicare,,,,,233.8,,,,
PLATELETS POOLING,86965,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,,,,141.46,,,,
O51010 CHEM TREATMNT,86970,CPT,,,,,both,, ,212.44,127.46,Medicare,Medicare,,,,,212.44,,,,
RBC PRETREAT CHEM,86970,CPT,,,,,both,, ,231.55,138.93,Medicare,Medicare,,,,,231.55,,,,
RBC PRETREAT ENZ,86971,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,,,,141.46,,,,
RBC PRETREAT ENZ,86971,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,,,,141.46,,,,
O51122 RBC CELL SEP,86972,CPT,,,,,both,, ,246.99,148.19,Medicare,Medicare,,,,,246.99,,,,
"RBC PRETREAT,SER,INC",86975,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,,,,141.46,,,,
"RBC PRETREAT,SER DIL",86976,CPT,,,,,both,, ,61.8,37.08,Medicare,Medicare,,,,,61.8,,,,
RBC PRETREAT W-INHIB,86977,CPT,,,,,both,, ,218.64,131.18,Medicare,Medicare,,,,,218.64,,,,
O51234 ADSORPTION,86978,CPT,,,,,both,, ,149.35,89.61,Medicare,Medicare,,,,,149.35,,,,
RBC PRETREAT DIFF EA,86978,CPT,,,,,both,, ,162.79,97.67,Medicare,Medicare,,,,,162.79,,,,
SPLIT BLOOD OR PROD,86985,CPT,,,,,both,, ,546.75,328.05,Medicare,Medicare,,,,,546.75,,,,
Q34286 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Medicare,Medicare,,,,,177.39,,,,
Q37213 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Medicare,Medicare,,,,,177.39,,,,
Q39480 SPECIMEN CONC,87015,CPT,,,,,both,, ,177.39,106.43,Medicare,Medicare,,,,,177.39,,,,
Q4554 SPECIMEN CONCE,87015,CPT,,,,,both,, ,177.39,106.43,Medicare,Medicare,,,,,177.39,,,,
SPECIMEN CONCENTRATI,87015,CPT,,,,,both,, ,177.39,106.43,Medicare,Medicare,,,,,177.39,,,,
CULTURE BLOOD BACTER,87040,CPT,,,,,both,,,691.29,691.29,Medicare,Medicare,,691.29,,,691.29,691.29,691.29,fee schedule,Medicare APC Fee Schedule
CULTURE BLOOD BACTER,87040,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
CULT STL BACT W-ISOL,87045,CPT,,,,,both,, ,92.9,55.74,Medicare,Medicare,,,,,92.9,,,,
CULT STL BACT W-ISOL,87045,CPT,,,,,both,,,301.72,301.72,Medicare,Medicare,,301.72,,,301.72,301.72,301.72,fee schedule,Medicare APC Fee Schedule
CULT STL BACT W-ISOL,87045,CPT,,,,,both,, ,301.72,181.03,Medicare,Medicare,,,,,301.72,,,,
CULT STL BACT EA ADD,87046,CPT,,,,,both,, ,92.9,55.74,Medicare,Medicare,,,,,92.9,,,,
CULT STL BACT EA ADD,87046,CPT,,,,,both,, ,94.58,56.74,Medicare,Medicare,,,,,94.58,,,,
CULTURE BACTERIA OTH,87070,CPT,,,,,both,, ,84.76,50.85,Medicare,Medicare,,,,,84.76,,,,
CULTURE BACTERIA OTH,87070,CPT,,,,,both,,,998.91,998.91,Medicare,Medicare,,998.91,,,998.91,998.91,998.91,fee schedule,Medicare APC Fee Schedule
CULTURE BACTERIA OTH,87070,CPT,,,,,both,, ,998.91,599.34,Medicare,Medicare,,,,,998.91,,,,
L188227 CULTURE BACT,87070,CPT,,,,,both,, ,86.2,51.72,Medicare,Medicare,,,,,86.2,,,,
CULT BAC AEROB OT QT,87071,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
CULT BACT ANA ANY SO,87075,CPT,,,,,both,,,623.38,623.38,Medicare,Medicare,,623.38,,,623.38,623.38,623.38,fee schedule,Medicare APC Fee Schedule
CULT BACT ANA ANY SO,87075,CPT,,,,,both,, ,623.38,374.02,Medicare,Medicare,,,,,623.38,,,,
CULT BACT ANA ANY SO,87075,CPT,,,,,both,, ,623.38,374.02,Medicare,Medicare,,,,,623.38,,,,
CULT ANAERO IDENT EA,87076,CPT,,,,,both,, ,412.87,247.72,Medicare,Medicare,,,,,412.87,,,,
L182345 ORG ID ANAER,87076,CPT,,,,,both,, ,244.44,146.66,Medicare,Medicare,,,,,244.44,,,,
CULT AEROBIC IDENTIF,87077,CPT,,,,,both,, ,389.01,233.4,Medicare,Medicare,,,,,389.01,,,,
CULT AEROBIC IDENTIF,87077,CPT,,,,,both,, ,389.01,233.4,Medicare,Medicare,,,,,389.01,,,,
CULTURE SCREEN ONLY,87081,CPT,,,,,both,, ,65.39,39.23,Medicare,Medicare,,,,,65.39,,,,
CULTURE SCREEN ONLY,87081,CPT,,,,,both,,,420.72,420.72,Medicare,Medicare,,420.72,,,420.72,420.72,420.72,fee schedule,Medicare APC Fee Schedule
CULTURE SCREEN ONLY,87081,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
CULT URINE-COLONY CT,87086,CPT,,,,,both,, ,59.78,35.86,Medicare,Medicare,,,,,59.78,,,,
CULT URINE-COLONY CT,87086,CPT,,,,,both,,,495.95,495.95,Medicare,Medicare,,495.95,,,495.95,495.95,495.95,fee schedule,Medicare APC Fee Schedule
CULT URINE-COLONY CT,87086,CPT,,,,,both,, ,495.95,297.57,Medicare,Medicare,,,,,495.95,,,,
CULT URINE W-P ID,87088,CPT,,,,,both,, ,42.37,25.42,Medicare,Medicare,,,,,42.37,,,,
CULT SKIN FUNGI,87101,CPT,,,,,both,, ,349.99,209.99,Medicare,Medicare,,,,,349.99,,,,
CULT SKIN FUNGI,87101,CPT,,,,,both,, ,349.99,209.99,Medicare,Medicare,,,,,349.99,,,,
CULT FUNGUS ISOLATIO,87102,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
Q4553 CULT FUNGUS IS,87102,CPT,,,,,both,, ,525.7,315.42,Medicare,Medicare,,,,,525.7,,,,
CULTURE FUNGUS BLOOD,87103,CPT,,,,,both,, ,518.69,311.21,Medicare,Medicare,,,,,518.69,,,,
Q4606 FUNGUS CULT BL,87103,CPT,,,,,both,, ,478.95,287.37,Medicare,Medicare,,,,,478.95,,,,
FUNGI IDENTIF YEAST,87106,CPT,,,,,both,, ,123.21,73.92,Medicare,Medicare,,,,,123.21,,,,
FUNGI IDENTIF YEAST,87106,CPT,,,,,both,, ,123.21,73.92,Medicare,Medicare,,,,,123.21,,,,
"FUNGI IDENTIF, MOLD",87107,CPT,,,,,both,, ,123.21,73.92,Medicare,Medicare,,,,,123.21,,,,
"FUNGI IDENTIF, MOLD",87107,CPT,,,,,both,, ,123.21,73.92,Medicare,Medicare,,,,,123.21,,,,
CULT MYCOPLASMA,87109,CPT,,,,,both,, ,1404.5,842.7,Medicare,Medicare,,,,,1404.5,,,,
UREA-MYCOPLS HOM CULT,87109,CPT,,,,,both,, ,153.9,92.34,Medicare,Medicare,,,,,153.9,,,,
CULTURE CHLAMYDIA,87110,CPT,,,,,both,, ,1104.45,662.67,Medicare,Medicare,,,,,1104.45,,,,
CULTURE CHLAMYDIA,87110,CPT,,,,,both,, ,1104.45,662.67,Medicare,Medicare,,,,,1104.45,,,,
CULT MYCOBACTERIA,87116,CPT,,,,,both,,,827.43,827.43,Medicare,Medicare,,827.43,,,827.43,827.43,827.43,fee schedule,Medicare APC Fee Schedule
CULT MYCOBACTERIA,87116,CPT,,,,,both,, ,827.43,496.45,Medicare,Medicare,,,,,827.43,,,,
Q10526MBAC BL CMBCS,87116,CPT,,,,,both,, ,827.43,496.45,Medicare,Medicare,,,,,827.43,,,,
Q4554 CULT MYCOBACTE,87116,CPT,,,,,both,, ,827.43,496.45,Medicare,Medicare,,,,,827.43,,,,
CULT TYPE IMMUNOFLUO,87140,CPT,,,,,both,, ,323.34,194,Medicare,Medicare,,,,,323.34,,,,
CULT TYPE IMMUNOFLUO,87140,CPT,,,,,both,, ,323.34,194,Medicare,Medicare,,,,,323.34,,,,
"CULT TYPE,IMMUNOLOGI",87147,CPT,,,,,both,, ,547.31,328.38,Medicare,Medicare,,,,,547.31,,,,
"CULT TYPE,NUCLEIC AC",87149,CPT,,,,,both,, ,239.97,143.98,Medicare,Medicare,,,,,239.97,,,,
LRX183755 AFB ID PB,87149,CPT,,,,,both,, ,239.99,143.99,Medicare,Medicare,,,,,239.99,,,,
DNA-RNA AMPLI PROBE,87150,CPT,,,,,both,, ,339.33,203.59,Medicare,Medicare,,,,,339.33,,,,
LRX183327 MOLD ID,87153,CPT,,,,,both,, ,239.99,143.99,Medicare,Medicare,,,,,239.99,,,,
QRX9000010 AFB ID,87153,CPT,,,,,both,, ,388.45,233.07,Medicare,Medicare,,,,,388.45,,,,
MACRO EXAM ARTHROPOD,87168,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,,,,480.79,,,,
MACRO EXAM PARASITE,87169,CPT,,,,,both,, ,207.7,124.62,Medicare,Medicare,,,,,207.7,,,,
PINWORM EXAM,87172,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,,,,480.79,,,,
TISSUE HOMOGENIZ CUL,87176,CPT,,,,,both,, ,300.6,180.36,Medicare,Medicare,,,,,300.6,,,,
OVA-PARASITES SMEARS,87177,CPT,,,,,both,, ,107.21,64.32,Medicare,Medicare,,,,,107.21,,,,
OVA-PARASITES SMEARS,87177,CPT,,,,,both,, ,320.25,192.15,Medicare,Medicare,,,,,320.25,,,,
OVA-PARASITES SMEARS,87177,CPT,,,,,both,, ,320.25,192.15,Medicare,Medicare,,,,,320.25,,,,
MICROB SUSCEP DIFFUS,87181,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,,,,141.46,,,,
MICROBE SUSCEP DISK,87184,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,,,,141.46,,,,
MICROBE SUSCEP DISK,87184,CPT,,,,,both,, ,141.46,84.87,Medicare,Medicare,,,,,141.46,,,,
MICROB SUSCEP ENZYME,87185,CPT,,,,,both,, ,180.19,108.11,Medicare,Medicare,,,,,180.19,,,,
MICROBE SUSCEPT MIC,87186,CPT,,,,,both,, ,586.05,351.63,Medicare,Medicare,,,,,586.05,,,,
MICROBE SUSCEPT MIC,87186,CPT,,,,,both,, ,586.05,351.63,Medicare,Medicare,,,,,586.05,,,,
"SMEAR,GRAM STAIN",87205,CPT,,,,,both,, ,42.1,25.26,Medicare,Medicare,,,,,42.1,,,,
"SMEAR,GRAM STAIN",87205,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
SMEAR FLUORES-ACI ST,87206,CPT,,,,,both,, ,507.74,304.64,Medicare,Medicare,,,,,507.74,,,,
SMEAR FLUORES-ACI ST,87206,CPT,,,,,both,, ,507.74,304.64,Medicare,Medicare,,,,,507.74,,,,
SMEAR FLUORES-ACI ST,87206,CPT,,,,,both,, ,507.74,304.64,Medicare,Medicare,,,,,507.74,,,,
SMEAR FLUORES-ACI ST,87206,CPT,,,,,both,, ,507.74,304.64,Medicare,Medicare,,,,,507.74,,,,
"SMEAR,SPECIAL STAIN",87207,CPT,,,,,both,, ,555.45,333.27,Medicare,Medicare,,,,,555.45,,,,
SMEAR COMPLEX STN,87209,CPT,,,,,both,, ,190.86,114.51,Medicare,Medicare,,,,,190.86,,,,
SMEAR COMPLEX STN,87209,CPT,,,,,both,, ,190.86,114.51,Medicare,Medicare,,,,,190.86,,,,
SMEARWET MOUNT SAL-I,87210,CPT,,,,,both,, ,420.72,252.43,Medicare,Medicare,,,,,420.72,,,,
TISSUE EX FOR FUNGI,87220,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,,,,480.79,,,,
TISSUE EX FOR FUNGI,87220,CPT,,,,,both,, ,480.79,288.47,Medicare,Medicare,,,,,480.79,,,,
VIRUS INOCULAT TISSU,87252,CPT,,,,,both,, ,929.87,557.92,Medicare,Medicare,,,,,929.87,,,,
VIRUS INOCULAT TISSU,87252,CPT,,,,,both,, ,929.87,557.92,Medicare,Medicare,,,,,929.87,,,,
L186015 VIR INOC SHL,87254,CPT,,,,,both,, ,415.68,249.4,Medicare,Medicare,,,,,415.68,,,,
Q17495VIRUS INOCU SH,87254,CPT,,,,,both,, ,415.68,249.4,Medicare,Medicare,,,,,415.68,,,,
VIRUS INOCU SHELL VI,87254,CPT,,,,,both,, ,415.68,249.4,Medicare,Medicare,,,,,415.68,,,,
Q2649 HSV CULT WREF,87255,CPT,,,,,both,, ,470.69,282.41,Medicare,Medicare,,,,,470.69,,,,
Q841 HSV CULT HS,87255,CPT,,,,,both,, ,470.69,282.41,Medicare,Medicare,,,,,470.69,,,,
VIRUS ISOLATION GEN,87255,CPT,,,,,both,, ,470.69,282.41,Medicare,Medicare,,,,,470.69,,,,
"PERTUSSIS AG, IF",87265,CPT,,,,,both,, ,531.32,318.79,Medicare,Medicare,,,,,531.32,,,,
"PERTUSSIS AG, IF",87265,CPT,,,,,both,, ,531.32,318.79,Medicare,Medicare,,,,,531.32,,,,
INFAGT DT QLSQT CRYP,87272,CPT,,,,,both,, ,525.7,315.42,Medicare,Medicare,,,,,525.7,,,,
Q37213 INFAGT DT QLS,87272,CPT,,,,,both,, ,525.7,315.42,Medicare,Medicare,,,,,525.7,,,,
Q39480 INFAGT DT QLS,87272,CPT,,,,,both,, ,525.7,315.42,Medicare,Medicare,,,,,525.7,,,,
L188227 LEGION PNEUM,87278,CPT,,,,,both,, ,156,93.6,Medicare,Medicare,,,,,156,,,,
"LEGION PNEUMOPH AG,I",87278,CPT,,,,,both,, ,277.86,166.71,Medicare,Medicare,,,,,277.86,,,,
"LEGION PNEUMOPH AG,I",87278,CPT,,,,,both,, ,277.86,166.71,Medicare,Medicare,,,,,277.86,,,,
PNEUMOCYSTIS CAR AGI,87281,CPT,,,,,both,, ,371.89,223.13,Medicare,Medicare,,,,,371.89,,,,
PNEUMOCYSTIS CAR AGI,87281,CPT,,,,,both,, ,371.89,223.13,Medicare,Medicare,,,,,371.89,,,,
VARICELLA ZOSTER AGI,87290,CPT,,,,,both,, ,518.69,311.21,Medicare,Medicare,,,,,518.69,,,,
"ANTIB DETECT NOS, IF",87299,CPT,,,,,both,, ,159.14,95.48,Medicare,Medicare,,,,,159.14,,,,
AG DETECT POLYVAL IF,87300,CPT,,,,,both,, ,122.09,73.25,Medicare,Medicare,,,,,122.09,,,,
L185041 ADV 40/41 IA,87301,CPT,,,,,both,, ,123.6,74.16,Medicare,Medicare,,,,,123.6,,,,
Q14950ASPE AG EIA IA,87305,CPT,,,,,both,, ,111.7,67.02,Medicare,Medicare,,,,,111.7,,,,
CLOSTRIDIUM DIF TOXN,87324,CPT,,,,,both,, ,118.16,70.89,Medicare,Medicare,,,,,118.16,,,,
CLOSTRIDIUM DIF TOXN,87324,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
CRYPTOCOCCUS NEOF AG,87327,CPT,,,,,both,, ,1321.42,792.85,Medicare,Medicare,,,,,1321.42,,,,
"CRYPTOSPOR AG,EIA",87328,CPT,,,,,both,, ,64.55,38.73,Medicare,Medicare,,,,,64.55,,,,
INFAGT DT QLSQT GIAR,87329,CPT,,,,,both,, ,200.12,120.07,Medicare,Medicare,,,,,200.12,,,,
INFAGT DT QLSQT GIAR,87329,CPT,,,,,both,, ,200.12,120.07,Medicare,Medicare,,,,,200.12,,,,
Q8625 GIARDAG EIA IA,87329,CPT,,,,,both,, ,192.49,115.49,Medicare,Medicare,,,,,192.49,,,,
"HPYLORI,STOOL,EIA",87338,CPT,,,,,both,, ,183.56,110.13,Medicare,Medicare,,,,,183.56,,,,
"HPYLORI,STOOL,EIA",87338,CPT,,,,,both,, ,183.56,110.13,Medicare,Medicare,,,,,183.56,,,,
HBSAG,87340,CPT,,,,,both,,,570.04,570.04,Medicare,Medicare,,570.04,,,570.04,570.04,570.04,fee schedule,Medicare APC Fee Schedule
HBSAG,87340,CPT,,,,,both,, ,570.04,342.02,Medicare,Medicare,,,,,570.04,,,,
HBEAG,87350,CPT,,,,,both,, ,1003.97,602.38,Medicare,Medicare,,,,,1003.97,,,,
HBEAG,87350,CPT,,,,,both,, ,1003.97,602.38,Medicare,Medicare,,,,,1003.97,,,,
HISTOPLASM CAPSU AGE,87385,CPT,,,,,both,, ,322.49,193.49,Medicare,Medicare,,,,,322.49,,,,
HISTOPLASM CAPSU AGE,87385,CPT,,,,,both,, ,322.49,193.49,Medicare,Medicare,,,,,322.49,,,,
"INFLUENZA A AG,EIA",87400,CPT,,,,,both,, ,118.16,70.89,Medicare,Medicare,,,,,118.16,,,,
"INFLUENZA A AG,EIA",87400,CPT,,,,,both,, ,959.34,575.6,Medicare,Medicare,,,,,959.34,,,,
L6866 ROTAVIRUS DDIA,87425,CPT,,,,,both,, ,123.6,74.16,Medicare,Medicare,,,,,123.6,,,,
"ROTAVIRUS AG,EIA",87425,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
COVID19 AG EIA,87426,CPT,,,,,both,, ,84.2,50.52,Medicare,Medicare,,,,,84.2,,,,
COVID19 AG EIA,87426,CPT,,,,,both,, ,88.35,53.01,Medicare,Medicare,,,,,88.35,,,,
"SHIGA-LIKE TOX AG,EI",87427,CPT,,,,,both,, ,113.1,67.86,Medicare,Medicare,,,,,113.1,,,,
"SHIGA-LIKE TOX AG,EI",87427,CPT,,,,,both,, ,156.33,93.79,Medicare,Medicare,,,,,156.33,,,,
COVID19AG FLUAB SOF2,87428,CPT,,,,,both,, ,159,95.4,Medicare,Medicare,,,,,159,,,,
"AG DETEC NOS,EIA MUL",87449,CPT,,,,,both,, ,886.09,531.65,Medicare,Medicare,,,,,886.09,,,,
OXOID PBP2 MRSA SCRN,87449,CPT,,,,,both,, ,121.98,73.18,Medicare,Medicare,,,,,121.98,,,,
OXOID PBP2 MRSA SCRN,87449,CPT,,,,,both,, ,121.98,73.18,Medicare,Medicare,,,,,121.98,,,,
Q15544 NOROV EIA IA,87449,CPT,,,,,both,, ,886.09,531.65,Medicare,Medicare,,,,,886.09,,,,
Q8856 LEGIO AG U IA,87449,CPT,,,,,both,, ,886.09,531.65,Medicare,Medicare,,,,,886.09,,,,
CANDIDA DNA AMP PROB,87481,CPT,,,,,both,, ,281.8,169.08,Medicare,Medicare,,,,,281.8,,,,
L183410 M ENCEPH CSF,87483,CPT,,,,,both,, ,1650,990,Medicare,Medicare,,,,,1650,,,,
L139650 CPNEU DNA,87486,CPT,,,,,both,, ,175,105,Medicare,Medicare,,,,,175,,,,
Q37444 C PNEUMO PCR,87486,CPT,,,,,both,, ,105.27,63.16,Medicare,Medicare,,,,,105.27,,,,
CHLMYD TRACH DNA AMP,87491,CPT,,,,,both,,,968.6,968.6,Medicare,Medicare,,968.6,,,968.6,968.6,968.6,fee schedule,Medicare APC Fee Schedule
CHLMYD TRACH DNA AMP,87491,CPT,,,,,both,, ,968.6,581.16,Medicare,Medicare,,,,,968.6,,,,
CHLMYD TRACH DNA AMP,87491,CPT,,,,,both,, ,968.6,581.16,Medicare,Medicare,,,,,968.6,,,,
CHLMYD TRACH DNA AMP,87491,CPT,,,,,both,, ,968.6,581.16,Medicare,Medicare,,,,,968.6,,,,
CHLMYD TRACH DNA AMP,87491,CPT,,,,,both,, ,968.6,581.16,Medicare,Medicare,,,,,968.6,,,,
L180021 CTRACH AMPPR,87491,CPT,,,,,both,, ,888.63,533.17,Medicare,Medicare,,,,,888.63,,,,
C DIFF AMPLI PROBE,87493,CPT,,,,,both,, ,313.51,188.1,Medicare,Medicare,,,,,313.51,,,,
Q10601 CMV QL RT-PCR,87496,CPT,,,,,both,, ,1051.68,631,Medicare,Medicare,,,,,1051.68,,,,
Q10600 CMV QT RT-PCR,87497,CPT,,,,,both,, ,889.73,533.83,Medicare,Medicare,,,,,889.73,,,,
Q15082EVRNA QL RTPCR,87498,CPT,,,,,both,, ,437.85,262.71,Medicare,Medicare,,,,,437.85,,,,
INFLU DNA AMP PROBE,87502,CPT,,,,,both,, ,215.11,129.06,Medicare,Medicare,,,,,215.11,,,,
INFLU DNA AMP PROBE,87502,CPT,,,,,both,,,887.49,887.49,Medicare,Medicare,,887.49,,,887.49,887.49,887.49,fee schedule,Medicare APC Fee Schedule
INFLU DNA AMP PROBE,87502,CPT,,,,,both,, ,887.49,532.49,Medicare,Medicare,,,,,887.49,,,,
L183480 GI PRO STOOL,87507,CPT,,,,,both,, ,1090.2,654.12,Medicare,Medicare,,,,,1090.2,,,,
GARDNER VAG DNA QUAN,87512,CPT,,,,,both,, ,335.12,201.07,Medicare,Medicare,,,,,335.12,,,,
"HEPATITIS B,DNA QNT",87517,CPT,,,,,both,, ,1011.26,606.75,Medicare,Medicare,,,,,1011.26,,,,
"HEPATITIS B,DNA QNT",87517,CPT,,,,,both,, ,1011.26,606.75,Medicare,Medicare,,,,,1011.26,,,,
"HEPATITIS C,RNA,AMPP",87521,CPT,,,,,both,, ,728.91,437.34,Medicare,Medicare,,,,,728.91,,,,
"HEPATITIS C,RNA,AMPP",87521,CPT,,,,,both,, ,728.91,437.34,Medicare,Medicare,,,,,728.91,,,,
"HEPATITIS C,RNA,QUAN",87522,CPT,,,,,both,, ,2133.69,1280.21,Medicare,Medicare,,,,,2133.69,,,,
"HEPATITIS C,RNA,QUAN",87522,CPT,,,,,both,, ,2133.69,1280.21,Medicare,Medicare,,,,,2133.69,,,,
Q11348 HCV QT RT-PCR,87522,CPT,,,,,both,, ,1066.84,640.1,Medicare,Medicare,,,,,1066.84,,,,
"HSV, DNA, AMP PROBE",87529,CPT,,,,,both,, ,3455.1,2073.06,Medicare,Medicare,,,,,3455.1,,,,
"Q90570 HSV, DNA, AMP",87529,CPT,,,,,both,, ,968.6,581.16,Medicare,Medicare,,,,,968.6,,,,
"Q90570 HSV, DNA, AMP",87529,CPT,,,,,both,, ,968.6,581.16,Medicare,Medicare,,,,,968.6,,,,
"HSV, DNA, QUANT",87530,CPT,,,,,both,, ,512.23,307.33,Medicare,Medicare,,,,,512.23,,,,
"HSV, DNA, QUANT",87530,CPT,,,,,both,, ,512.23,307.33,Medicare,Medicare,,,,,512.23,,,,
"HIV-1, DNA,AMP PROBE",87535,CPT,,,,,both,, ,1718.85,1031.31,Medicare,Medicare,,,,,1718.85,,,,
"HIV-1, DNA, QUANT",87536,CPT,,,,,both,, ,1804.46,1082.67,Medicare,Medicare,,,,,1804.46,,,,
"HIV-1, DNA, QUANT",87536,CPT,,,,,both,, ,1804.46,1082.67,Medicare,Medicare,,,,,1804.46,,,,
"Q15062 LEGION PNEU,D",87541,CPT,,,,,both,, ,196.98,118.18,Medicare,Medicare,,,,,196.98,,,,
"M.TUBERCULO,DNA,AMPP",87556,CPT,,,,,both,, ,815.91,489.54,Medicare,Medicare,,,,,815.91,,,,
"M.TUBERCULO,DNA,AMPP",87556,CPT,,,,,both,, ,815.91,489.54,Medicare,Medicare,,,,,815.91,,,,
"M.AVIUM-INTR,DNA,AMP",87561,CPT,,,,,both,, ,372.45,223.47,Medicare,Medicare,,,,,372.45,,,,
"M.AVIUM-INTR,DNA,AMP",87561,CPT,,,,,both,, ,372.45,223.47,Medicare,Medicare,,,,,372.45,,,,
L180076 M GENT NAA,87563,CPT,,,,,both,, ,180,108,Medicare,Medicare,,,,,180,,,,
Q15498 MP QL RT-PCR,87581,CPT,,,,,both,, ,197.03,118.21,Medicare,Medicare,,,,,197.03,,,,
Q15498 MP QL RT-PCR,87581,CPT,,,,,both,, ,197.03,118.21,Medicare,Medicare,,,,,197.03,,,,
Q37444 MP QL RT-PCR,87581,CPT,,,,,both,, ,175.5,105.3,Medicare,Medicare,,,,,175.5,,,,
L180021 NG AMP PRB,87591,CPT,,,,,both,, ,888.63,533.17,Medicare,Medicare,,,,,888.63,,,,
"N.GONORRHO,DNA,AMPPR",87591,CPT,,,,,both,, ,968.6,581.16,Medicare,Medicare,,,,,968.6,,,,
"N.GONORRHO,DNA,AMPPR",87591,CPT,,,,,both,, ,968.6,581.16,Medicare,Medicare,,,,,968.6,,,,
"N.GONORRHO,DNA,AMPPR",87591,CPT,,,,,both,, ,968.6,581.16,Medicare,Medicare,,,,,968.6,,,,
"N.GONORRHO,DNA,AMPPR",87591,CPT,,,,,both,, ,968.6,581.16,Medicare,Medicare,,,,,968.6,,,,
L140230 ORTHOPOX VRS,87593,CPT,,,,,both,, ,308,184.8,Medicare,Medicare,,,,,308,,,,
HPV HIGH RISK TYPES,87624,CPT,,,,,both,, ,241.38,144.82,Medicare,Medicare,,,,,241.38,,,,
L199305 HPV HR,87624,CPT,,,,,both,, ,221.45,132.87,Medicare,Medicare,,,,,221.45,,,,
Q92090 HPV HIGH RISK,87624,CPT,,,,,both,, ,215,129,Medicare,Medicare,,,,,215,,,,
L507460 HPV GEN16 18,87625,CPT,,,,,both,, ,164.8,98.88,Medicare,Medicare,,,,,164.8,,,,
RESP VIRUS 3-5 TARG,87631,CPT,,,,,both,, ,570.52,342.31,Medicare,Medicare,,,,,570.52,,,,
L139250 RVP PCR,87633,CPT,,,,,both,, ,175,105,Medicare,Medicare,,,,,175,,,,
L139250 RVP PCR,87633,CPT,,,,,both,, ,175,105,Medicare,Medicare,,,,,175,,,,
Q37444 RESP VIR PCR,87633,CPT,,,,,both,, ,1250.34,750.2,Medicare,Medicare,,,,,1250.34,,,,
RSV DNA/ MA AMP PROB,87634,CPT,,,,,both,, ,157.62,94.57,Medicare,Medicare,,,,,157.62,,,,
RSV DNA/ MA AMP PROB,87634,CPT,,,,,both,, ,236.44,141.86,Medicare,Medicare,,,,,236.44,,,,
COVID19 PRB,87635,CPT,,,,,both,, ,113.3,67.98,Medicare,Medicare,,,,,113.3,,,,
COVID19 PRB,87635,CPT,,,,,both,, ,336.81,202.08,Medicare,Medicare,,,,,336.81,,,,
"STAPH A,DNA,PROBE",87640,CPT,,,,,both,, ,118.16,70.89,Medicare,Medicare,,,,,118.16,,,,
"MR-STAPH,DNA,PROBE",87641,CPT,,,,,both,, ,118.16,70.89,Medicare,Medicare,,,,,118.16,,,,
"STREP A,DNA,AMP PROB",87651,CPT,,,,,both,, ,78.78,47.26,Medicare,Medicare,,,,,78.78,,,,
"STREP A,DNA,AMP PROB",87651,CPT,,,,,both,, ,118.18,70.9,Medicare,Medicare,,,,,118.18,,,,
T VAGINALIS AMP,87661,CPT,,,,,both,,,279.55,279.55,Medicare,Medicare,,279.55,,,279.55,279.55,279.55,fee schedule,Medicare APC Fee Schedule
T VAGINALIS AMP,87661,CPT,,,,,both,, ,279.55,167.73,Medicare,Medicare,,,,,279.55,,,,
T VAGINALIS AMP,87661,CPT,,,,,both,, ,279.55,167.73,Medicare,Medicare,,,,,279.55,,,,
T VAGINALIS AMP,87661,CPT,,,,,both,, ,279.55,167.73,Medicare,Medicare,,,,,279.55,,,,
T VAGINALIS AMP,87661,CPT,,,,,both,, ,279.55,167.73,Medicare,Medicare,,,,,279.55,,,,
Q93870 ZIKA RNA QL,87662,CPT,,,,,both,, ,295.83,177.49,Medicare,Medicare,,,,,295.83,,,,
"DETECT AGNTNOS,DNAAM",87798,CPT,,,,,both,, ,2478.63,1487.17,Medicare,Medicare,,,,,2478.63,,,,
"DETECT AGNTNOS,DNAAM",87798,CPT,,,,,both,, ,2478.63,1487.17,Medicare,Medicare,,,,,2478.63,,,,
L139650 DET AGNT DNA,87798,CPT,,,,,both,, ,175,105,Medicare,Medicare,,,,,175,,,,
L180021 DET AGT NOS,87798,CPT,,,,,both,, ,696.28,417.76,Medicare,Medicare,,,,,696.28,,,,
L180021 DET AGT NOS,87798,CPT,,,,,both,, ,696.28,417.76,Medicare,Medicare,,,,,696.28,,,,
L180040 DET AGT NOS,87798,CPT,,,,,both,, ,180,108,Medicare,Medicare,,,,,180,,,,
Q10992 WNVRNA RT-PCR,87798,CPT,,,,,both,, ,1011.83,607.09,Medicare,Medicare,,,,,1011.83,,,,
Q10992 WNVRNA RT-PCR,87798,CPT,,,,,both,, ,1011.83,607.09,Medicare,Medicare,,,,,1011.83,,,,
Q11365DET AGNT DNAAM,87798,CPT,,,,,both,, ,758.95,455.37,Medicare,Medicare,,,,,758.95,,,,
Q17220 JCPV QL RTPCR,87798,CPT,,,,,both,, ,1011.83,607.09,Medicare,Medicare,,,,,1011.83,,,,
Q17220 JCPV QL RTPCR,87798,CPT,,,,,both,, ,1011.83,607.09,Medicare,Medicare,,,,,1011.83,,,,
Q34296 PARVO B19 QL,87798,CPT,,,,,both,, ,1011.83,607.09,Medicare,Medicare,,,,,1011.83,,,,
Q34296 PARVO B19 QL,87798,CPT,,,,,both,, ,1011.83,607.09,Medicare,Medicare,,,,,1011.83,,,,
Q91475 SURESWAB MYCOPLASMA GENITALIUMPCR,87798,CPT,,,,,both,, ,901.25,540.75,Medicare,Medicare,,,,,901.25,,,,
"DETECT AGNT NOS,DNAQ",87799,CPT,,,,,both,, ,454.41,272.64,Medicare,Medicare,,,,,454.41,,,,
Q10186 EBV QT RT-PCR,87799,CPT,,,,,both,, ,454.41,272.64,Medicare,Medicare,,,,,454.41,,,,
Q11274 BKV QT RT-PCR,87799,CPT,,,,,both,, ,454.41,272.64,Medicare,Medicare,,,,,454.41,,,,
"DETECT AGT MULT,DNAA",87801,CPT,,,,,both,, ,715.16,429.09,Medicare,Medicare,,,,,715.16,,,,
L180021 DET AGT MULT,87801,CPT,,,,,both,, ,656.11,393.66,Medicare,Medicare,,,,,656.11,,,,
Q15564LYME RT-PCR SF,87801,CPT,,,,,both,, ,715.16,429.09,Medicare,Medicare,,,,,715.16,,,,
Q15777LYM QL BL RTPC,87801,CPT,,,,,both,, ,715.16,429.09,Medicare,Medicare,,,,,715.16,,,,
INFLUENZA ASSAY W-OP,87804,CPT,,,,,both,, ,30.87,18.52,Medicare,Medicare,,,,,30.87,,,,
INFLUENZA ASSAY W-OP,87804,CPT,,,,,both,, ,104.12,62.47,Medicare,Medicare,,,,,104.12,,,,
RSV ASSAY W-OPTIC,87807,CPT,,,,,both,, ,44.62,26.77,Medicare,Medicare,,,,,44.62,,,,
RSV ASSAY W-OPTIC,87807,CPT,,,,,both,, ,277.86,166.71,Medicare,Medicare,,,,,277.86,,,,
STREP A ASSAY W-OPTI,87880,CPT,,,,,both,, ,41.25,24.75,Medicare,Medicare,,,,,41.25,,,,
STREP A ASSAY W-OPTI,87880,CPT,,,,,both,, ,285.17,171.1,Medicare,Medicare,,,,,285.17,,,,
AGENT NOS ASSAY W-OP,87899,CPT,,,,,both,, ,172.9,103.74,Medicare,Medicare,,,,,172.9,,,,
L183025 CRYPTO AG,87899,CPT,,,,,both,, ,158.62,95.17,Medicare,Medicare,,,,,158.62,,,,
L183025 CRYPTO AG,87899,CPT,,,,,both,, ,158.62,95.17,Medicare,Medicare,,,,,158.62,,,,
Q34949 PHENO INF DRG,87900,CPT,,,,,both,, ,773.54,464.12,Medicare,Medicare,,,,,773.54,,,,
"GENOTYPE,DNA,HIV REV",87901,CPT,,,,,both,, ,1819.9,1091.94,Medicare,Medicare,,,,,1819.9,,,,
"GENOTYPE,DNA,HIV REV",87901,CPT,,,,,both,, ,1819.9,1091.94,Medicare,Medicare,,,,,1819.9,,,,
"GENOTYPE,DNA,HEPAT C",87902,CPT,,,,,both,, ,1611.91,967.14,Medicare,Medicare,,,,,1611.91,,,,
Q37811 HCVRNA GN MPR,87902,CPT,,,,,both,, ,1611.91,967.14,Medicare,Medicare,,,,,1611.91,,,,
Q92447 HCVG1 NS5A DR,87902,CPT,,,,,both,, ,1611.91,967.14,Medicare,Medicare,,,,,1611.91,,,,
L551690PHENO DNA HIV,87903,CPT,,,,,both,, ,1465,879,Medicare,Medicare,,,,,1465,,,,
L551690PHENO DNA HIV,87904,CPT,,,,,both,, ,104,62.4,Medicare,Medicare,,,,,104,,,,
HIV GEN DNA REV OTH,87906,CPT,,,,,both,, ,856.62,513.97,Medicare,Medicare,,,,,856.62,,,,
AUTOPSY COMPL WO-CNS,88020,CPT,,,,,both,, ,3310.55,1986.33,Medicare,Medicare,,,,,3310.55,,,,
CYTOPATH FLD NOT V-C,88104,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,,,,109.74,,,,
CYTOPATH FLD FTRW-IN,88106,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,,,,109.74,,,,
CYTOPATH CONCENT TEC,88108,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,,,,109.74,,,,
CYTOCELL ENH X CR-VG,88112,CPT,,,,,both,, ,237.17,142.3,Medicare,Medicare,,,,,237.17,,,,
CYTO UR 3-5PROB EA S,88120,CPT,,,,,both,, ,368.8,221.28,Medicare,Medicare,,,,,368.8,,,,
CYTO UR 3-5 PROB CMP,88121,CPT,,,,,both,, ,368.8,221.28,Medicare,Medicare,,,,,368.8,,,,
FORENSIC CYTOPATHOLO,88125,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,,,,109.74,,,,
SEX CHROMATIN ID BAR,88130,CPT,,,,,both,, ,144.83,86.89,Medicare,Medicare,,,,,144.83,,,,
SEX CHROM ID POLYMOR,88140,CPT,,,,,both,, ,76.9,46.14,Medicare,Medicare,,,,,76.9,,,,
L192555 PAP LB,88142,CPT,,,,,both,, ,234.07,140.44,Medicare,Medicare,,,,,234.07,,,,
PAP THINLAY LIQ DIAG,88142,CPT,,,,,both,, ,189.74,113.84,Medicare,Medicare,,,,,189.74,,,,
CYTOPATH C-V THNLYRE,88143,CPT,,,,,both,, ,189.74,113.84,Medicare,Medicare,,,,,189.74,,,,
CYTOP C-V AUTOMATED,88147,CPT,,,,,both,, ,101.6,60.96,Medicare,Medicare,,,,,101.6,,,,
CYTOP C-V AUTO RESCR,88148,CPT,,,,,both,, ,101.6,60.96,Medicare,Medicare,,,,,101.6,,,,
CYTOPATH C-V MANUAL,88150,CPT,,,,,both,, ,101.6,60.96,Medicare,Medicare,,,,,101.6,,,,
CYTOP C-V AUTO REDO,88152,CPT,,,,,both,, ,101.6,60.96,Medicare,Medicare,,,,,101.6,,,,
CYTOPATH C-V REDO,88153,CPT,,,,,both,, ,101.6,60.96,Medicare,Medicare,,,,,101.6,,,,
CYTOP C-V INDX ADDON,88155,CPT,,,,,both,, ,57.81,34.68,Medicare,Medicare,,,,,57.81,,,,
CYTOP SMR OTHR SOURC,88160,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,,,,109.74,,,,
CYTOP SMR OTH PRE-SC,88161,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,,,,109.74,,,,
CYTOP SMR OTH S5SLID,88162,CPT,,,,,both,, ,237.17,142.3,Medicare,Medicare,,,,,237.17,,,,
"CYTOP TBS,C-V,MANUAL",88164,CPT,,,,,both,, ,101.6,60.96,Medicare,Medicare,,,,,101.6,,,,
"CYTOP TBS,C-V,REDO",88165,CPT,,,,,both,, ,101.6,60.96,Medicare,Medicare,,,,,101.6,,,,
"CYTOP TBS,C-V AUTORE",88166,CPT,,,,,both,, ,101.6,60.96,Medicare,Medicare,,,,,101.6,,,,
"CYTOP TBS,C-C,SELECT",88167,CPT,,,,,both,, ,101.6,60.96,Medicare,Medicare,,,,,101.6,,,,
CYTOPATH EVAL OF FNA,88172,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,,,,109.74,,,,
"CYTOP EVAL,FNA,REPOR",88173,CPT,,,,,both,, ,237.17,142.3,Medicare,Medicare,,,,,237.17,,,,
CYTO-CERVICALRP CDM,88174,CPT,,,,,both,, ,205.45,123.27,Medicare,Medicare,,,,,205.45,,,,
L199305 PAP AU MN RS,88175,CPT,,,,,both,, ,234.07,140.44,Medicare,Medicare,,,,,234.07,,,,
PAP DIAG AUTO MAN RS,88175,CPT,,,,,both,, ,255.13,153.07,Medicare,Medicare,,,,,255.13,,,,
Q92090 PAP DIAG AUTO,88175,CPT,,,,,both,, ,227.25,136.35,Medicare,Medicare,,,,,227.25,,,,
CYTO EVAL FNA ADD,88177,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,,,,72.13,,,,
CELL MRK STDY CY-DNA,88182,CPT,,,,,both,, ,69.89,41.93,Medicare,Medicare,,,,,69.89,,,,
"FLOWCYTOMET-TC,1 MRK",88184,CPT,,,,,both,, ,203.21,121.92,Medicare,Medicare,,,,,203.21,,,,
"FLOWCYTOMET-TC,1 MRK",88184,CPT,,,,,both,, ,203.21,121.92,Medicare,Medicare,,,,,203.21,,,,
"FLOWCYTOMETRY-TC,ADD",88185,CPT,,,,,both,, ,195.35,117.21,Medicare,Medicare,,,,,195.35,,,,
Q35080 FLOWCY-TC ADD,88185,CPT,,,,,both,, ,60,36,Medicare,Medicare,,,,,60,,,,
A3001780 FLWCY 16MRK,88189,CPT,,,,,both,, ,360,216,Medicare,Medicare,,,,,360,,,,
CYTOPATHOLOGY PROCED,88199,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,,,,72.13,,,,
TISSUE CULT LYMPHOCY,88230,CPT,,,,,both,, ,3469.98,2081.98,Medicare,Medicare,,,,,3469.98,,,,
TISSUE CULT LYMPHOCY,88230,CPT,,,,,both,, ,3469.98,2081.98,Medicare,Medicare,,,,,3469.98,,,,
TISSUE CULT SKIN/BIO,88233,CPT,,,,,both,, ,1353.98,812.38,Medicare,Medicare,,,,,1353.98,,,,
"TISSUE CULT, PLACENT",88235,CPT,,,,,both,, ,1416.56,849.93,Medicare,Medicare,,,,,1416.56,,,,
TISSUE CULT BONEMARR,88237,CPT,,,,,both,, ,849.04,509.42,Medicare,Medicare,,,,,849.04,,,,
TISSUE CULT BONEMARR,88237,CPT,,,,,both,, ,849.04,509.42,Medicare,Medicare,,,,,849.04,,,,
TISSUE CULTURE TUMOR,88239,CPT,,,,,both,, ,1419.09,851.45,Medicare,Medicare,,,,,1419.09,,,,
CELL CRYOPRESERV-STO,88240,CPT,,,,,both,, ,97.11,58.26,Medicare,Medicare,,,,,97.11,,,,
FROZEN CELL PREPARAT,88241,CPT,,,,,both,, ,97.11,58.26,Medicare,Medicare,,,,,97.11,,,,
CHROMOSOME ANAL20-25,88245,CPT,,,,,both,, ,1397.47,838.48,Medicare,Medicare,,,,,1397.47,,,,
CHROMOSOM ANAL50-100,88248,CPT,,,,,both,, ,1666.09,999.65,Medicare,Medicare,,,,,1666.09,,,,
CHROMOSOME ANALYS100,88249,CPT,,,,,both,, ,1666.09,999.65,Medicare,Medicare,,,,,1666.09,,,,
CHROMOSOME ANALYS  5,88261,CPT,,,,,both,, ,1700.32,1020.19,Medicare,Medicare,,,,,1700.32,,,,
CHROMOSOME ANAL15-20,88262,CPT,,,,,both,, ,4292.64,2575.58,Medicare,Medicare,,,,,4292.64,,,,
Q14596 CHR AN 15-20,88262,CPT,,,,,both,, ,1010,606,Medicare,Medicare,,,,,1010,,,,
CHROMOSOME ANALYS 45,88263,CPT,,,,,both,, ,1445.75,867.45,Medicare,Medicare,,,,,1445.75,,,,
CHROMOSOME ANAL20-25,88264,CPT,,,,,both,, ,2107.59,1264.55,Medicare,Medicare,,,,,2107.59,,,,
CHROMOSOME ANAL20-25,88264,CPT,,,,,both,, ,2107.59,1264.55,Medicare,Medicare,,,,,2107.59,,,,
CHROMOSOME ANAL-PLAC,88267,CPT,,,,,both,, ,1729.51,1037.7,Medicare,Medicare,,,,,1729.51,,,,
CHROMOSOM ANAL AMNIO,88269,CPT,,,,,both,, ,1600.13,960.07,Medicare,Medicare,,,,,1600.13,,,,
CYTOGENETICS DNA-PRO,88271,CPT,,,,,both,, ,525.7,315.42,Medicare,Medicare,,,,,525.7,,,,
CYTOGENETICS DNA-PRO,88271,CPT,,,,,both,, ,525.7,315.42,Medicare,Medicare,,,,,525.7,,,,
CYTOGENETICS 3-5,88272,CPT,,,,,both,, ,243.63,146.17,Medicare,Medicare,,,,,243.63,,,,
CYTOGENETICS 25-99,88274,CPT,,,,,both,, ,336.52,201.91,Medicare,Medicare,,,,,336.52,,,,
CYTOGENETICS 100-300,88275,CPT,,,,,both,, ,1078.63,647.17,Medicare,Medicare,,,,,1078.63,,,,
CYTOGENETICS 100-300,88275,CPT,,,,,both,, ,1078.63,647.17,Medicare,Medicare,,,,,1078.63,,,,
CHROMOSOME KARYOT ST,88280,CPT,,,,,both,, ,962.71,577.62,Medicare,Medicare,,,,,962.71,,,,
CHROMOSOM BANDINGSTU,88283,CPT,,,,,both,, ,375.26,225.15,Medicare,Medicare,,,,,375.26,,,,
CHROMOSOME CT ADDITI,88285,CPT,,,,,both,, ,182.71,109.62,Medicare,Medicare,,,,,182.71,,,,
CHROMOS STDY ADD HIG,88289,CPT,,,,,both,, ,284.04,170.42,Medicare,Medicare,,,,,284.04,,,,
CYTOGENETIC STUDY,88299,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,,,,72.13,,,,
SURG PATH GROSS LVL1,88300,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,,,,72.13,,,,
SURG PATH GROSS LVL2,88302,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,,,,109.74,,,,
SURG PATH GROSS LVL3,88304,CPT,,,,,both,, ,237.17,142.3,Medicare,Medicare,,,,,237.17,,,,
SURG PATH GROSS LVL4,88305,CPT,,,,,both,, ,398.27,238.96,Medicare,Medicare,,,,,398.27,,,,
SURG PATH GROSS LVL5,88307,CPT,,,,,both,, ,368.8,221.28,Medicare,Medicare,,,,,368.8,,,,
SURG PATH GROSS LVL6,88309,CPT,,,,,both,, ,368.8,221.28,Medicare,Medicare,,,,,368.8,,,,
DECALCIFY TISSUE,88311,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,,,,72.13,,,,
SPECIAL STAINS GRP 1,88312,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,,,,109.74,,,,
SPECIAL STAINS GRP 2,88313,CPT,,,,,both,, ,33.68,20.2,Medicare,Medicare,,,,,33.68,,,,
SPECIAL STAINS GRP 2,88313,CPT,,,,,both,, ,241.94,145.16,Medicare,Medicare,,,,,241.94,,,,
HISTOCHEMICAL STAIN,88314,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,,,,109.74,,,,
ENZYME HISTOCHEMISTR,88319,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,,,,109.74,,,,
MICROSLIDE-CONSULN-P,88321,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,,,,109.74,,,,
MICROSLID CONSUL-W-P,88323,CPT,,,,,both,, ,237.17,142.3,Medicare,Medicare,,,,,237.17,,,,
COMPRE REVIEW OFDATA,88325,CPT,,,,,both,, ,368.8,221.28,Medicare,Medicare,,,,,368.8,,,,
PATH CONSULT INTROP,88329,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,,,,109.74,,,,
PATH CONSULT INT-1BL,88331,CPT,,,,,both,, ,237.17,142.3,Medicare,Medicare,,,,,237.17,,,,
PATH CONSULT-INTRADD,88332,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,,,,72.13,,,,
INOP CYTOPAT CNSLT 1,88333,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,,,,109.74,,,,
INOP CYTOPAT CNSLT 2,88334,CPT,,,,,both,, ,109.74,65.84,Medicare,Medicare,,,,,109.74,,,,
ICC ADD AB PER SLIDE,88341,CPT,,,,,both,, ,238.01,142.8,Medicare,Medicare,,,,,238.01,,,,
1ST SEP ID AB,88342,CPT,,,,,both,, ,238.01,142.8,Medicare,Medicare,,,,,238.01,,,,
ICC MLTPX AB ST,88344,CPT,,,,,both,, ,221.17,132.7,Medicare,Medicare,,,,,221.17,,,,
IMF SPEC 1ST AB ST,88346,CPT,,,,,both,, ,270.57,162.34,Medicare,Medicare,,,,,270.57,,,,
ELECTRON MICROSCOPY,88348,CPT,,,,,both,, ,2028.15,1216.89,Medicare,Medicare,,,,,2028.15,,,,
IMF/SPEC ADD AB ST,88350,CPT,,,,,both,, ,270.57,162.34,Medicare,Medicare,,,,,270.57,,,,
ANALYSIS SKELET MUSC,88355,CPT,,,,,both,, ,237.17,142.3,Medicare,Medicare,,,,,237.17,,,,
ANALYSIS NERVE,88356,CPT,,,,,both,, ,368.8,221.28,Medicare,Medicare,,,,,368.8,,,,
ANALYSIS TUMOR,88358,CPT,,,,,both,, ,237.17,142.3,Medicare,Medicare,,,,,237.17,,,,
TUMOR IHC QT MAN,88360,CPT,,,,,both,, ,1468.77,881.26,Medicare,Medicare,,,,,1468.77,,,,
TUMOR IHC QT UTO,88361,CPT,,,,,both,, ,1468.77,881.26,Medicare,Medicare,,,,,1468.77,,,,
NERVE TEASING PREPAR,88362,CPT,,,,,both,, ,368.8,221.28,Medicare,Medicare,,,,,368.8,,,,
XM ARCHIVE TIS MOLEC,88363,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,,,,72.13,,,,
TIS HYBRD AD SNG PRB,88364,CPT,,,,,both,, ,230.71,138.42,Medicare,Medicare,,,,,230.71,,,,
TIS HYBRD SPEC INIT,88365,CPT,,,,,both,, ,304.81,182.88,Medicare,Medicare,,,,,304.81,,,,
INS HYBR AUT SP INIT,88367,CPT,,,,,both,, ,220.05,132.03,Medicare,Medicare,,,,,220.05,,,,
INS HYBRD MAN SP INI,88368,CPT,,,,,both,, ,342.7,205.62,Medicare,Medicare,,,,,342.7,,,,
INS HYBRD MAN SNG PR,88369,CPT,,,,,both,, ,342.7,205.62,Medicare,Medicare,,,,,342.7,,,,
PROTEIN-WEST BLOTTIS,88371,CPT,,,,,both,, ,209.38,125.62,Medicare,Medicare,,,,,209.38,,,,
PROTEIN ANALYSW/PROB,88372,CPT,,,,,both,, ,218.93,131.35,Medicare,Medicare,,,,,218.93,,,,
INS HYBR AUT SNG PR,88373,CPT,,,,,both,, ,220.05,132.03,Medicare,Medicare,,,,,220.05,,,,
INS HYBR AUT MUL PR,88374,CPT,,,,,both,, ,220.05,132.03,Medicare,Medicare,,,,,220.05,,,,
INS HYBR MAN MUL PR,88377,CPT,,,,,both,, ,342.7,205.62,Medicare,Medicare,,,,,342.7,,,,
MICRODISSECTION MANU,88381,CPT,,,,,both,, ,424.38,254.62,Medicare,Medicare,,,,,424.38,,,,
SURGICAL PATH PROCED,88399,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,,,,72.13,,,,
BILIRUBIN TOT TRANS,88720,CPT,,,,,both,, ,75.22,45.13,Medicare,Medicare,,,,,75.22,,,,
CELL CTW-DIF BODYFLU,89051,CPT,,,,,both,, ,54.17,32.5,Medicare,Medicare,,,,,54.17,,,,
CELL CTW-DIF BODYFLU,89051,CPT,,,,,both,, ,691.29,414.77,Medicare,Medicare,,,,,691.29,,,,
LEUKOCY ASSES FEC QL,89055,CPT,,,,,both,, ,109.46,65.67,Medicare,Medicare,,,,,109.46,,,,
"CRYSTAL ID,TISSUE,FL",89060,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
"CRYSTAL ID,TISSUE,FL",89060,CPT,,,,,both,, ,345.79,207.47,Medicare,Medicare,,,,,345.79,,,,
NASAL SMEAR-EOSINOPH,89190,CPT,,,,,both,, ,518.69,311.21,Medicare,Medicare,,,,,518.69,,,,
UNL MISC PATH TEST,89240,CPT,,,,,both,, ,72.13,43.27,Medicare,Medicare,,,,,72.13,,,,
SEMEN ANYL PRES-M-S,89321,CPT,,,,,both,, ,526.26,315.75,Medicare,Medicare,,,,,526.26,,,,
HEPATITIS B GLOB IM,90371,CPT,,,,,both,, ,679.03,407.41,Medicare,Medicare,,,,,679.03,,,,
HEPATITIS B GLOB IM,90371,CPT,,,,,both,1,ML,953,571.8,Medicare,Medicare,,,,,953,,,,
RABIES IG IM/SC 150U,90375,CPT,,,,,both,3,ML,414.33,248.59,Medicare,Medicare,,,,,414.33,,,,
RABIES IG IM/SC 150U,90375,CPT,,,,,both,, ,1385.09,831.05,Medicare,Medicare,,,,,1385.09,,,,
RABIES IG IM/SC 150U,90375,CPT,,,,,both,, ,1428.35,857.01,Medicare,Medicare,,,,,1428.35,,,,
RABIES IG IM/SC 150U,90375,HCPCS,,,,,both,5,ML,1867.13,1120.27,Medicare,Medicare,,,,,1867.13,,,,
RABIES IG IM/SC 150U,90375,HCPCS,,,,,both,1,ML,2044.81,1226.88,Medicare,Medicare,,,,,2044.81,,,,
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,143.69,86.21,Medicare,Medicare,,,,,143.69,,,,
IMM ADM 1ST VACCINE,90471,CPT,,,,,both,, ,230.72,138.43,Medicare,Medicare,,,,,230.72,,,,
IMM ADM INJ SINGLE,90471,CPT,,,,,both,, ,162.25,97.35,Medicare,Medicare,,,,,162.25,,,,
IMM ADM INJ SINGLE,90471,CPT,,,,,both,, ,162.25,97.35,Medicare,Medicare,,,,,162.25,,,,
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,119.22,71.53,Medicare,Medicare,,,,,119.22,,,,
IMM ADM EA ADD VACC,90472,CPT,,,,,both,, ,119.22,71.53,Medicare,Medicare,,,,,119.22,,,,
IMM ADM INJ EA ADD,90472,CPT,,,,,both,, ,48.75,29.25,Medicare,Medicare,,,,,48.75,,,,
IMM ADM INJ EA ADD,90472,CPT,,,,,both,, ,48.75,29.25,Medicare,Medicare,,,,,48.75,,,,
HAEMOPH B TETAN INJ,90648,CPT,,,,,both,, ,131.84,79.1,Medicare,Medicare,,,,,131.84,,,,
FLU VAC NOPRSV ANTIG,90662,CPT,,,,,both,0.7,ML,434.66,260.79,Medicare,Medicare,,,,,434.66,,,,
PNEUMOCOC 13-VAL IM,90670,CPT,,,,,both,0.5,ML,871.9,523.14,Medicare,Medicare,,,,,871.9,,,,
FLU VAC CCIIV4 PF&AB,90674,CPT,,,,,both,0.5,ML,208.06,124.83,Medicare,Medicare,,,,,208.06,,,,
RABIES VAC IM,90675,CPT,,,,,both,1,EA,1856.32,1113.79,Medicare,Medicare,,,,,1856.32,,,,
RABIES VAC IM,90675,CPT,,,,,both,, ,1941.04,1164.62,Medicare,Medicare,,,,,1941.04,,,,
FLU VAC QUAD DNA HA,90682,CPT,,,,,both,, ,383.75,230.25,Medicare,Medicare,,,,,383.75,,,,
FLU VACIIV4 PF .5ML,90686,CPT,,,,,both,, ,145.23,87.13,Medicare,Medicare,,,,,145.23,,,,
FLU VAC IIV4 .25ML,90687,CPT,,,,,both,, ,135.45,81.27,Medicare,Medicare,,,,,135.45,,,,
M-M-R II INJ,90707,CPT,,,,,both,1,EA,471.23,282.73,Medicare,Medicare,,,,,471.23,,,,
TD IM NO PRSRV GE 7Y,90714,CPT,,,,,both,0.5,ML,210.12,126.07,Medicare,Medicare,,,,,210.12,,,,
DIPH/TET/ACPERT .5ML,90715,CPT,,,,,both,0.5,ML,350.2,210.12,Medicare,Medicare,,,,,350.2,,,,
DIPH/TET/ACPERT .5ML,90715,CPT,,,,,both,0.5,ML,370.54,222.32,Medicare,Medicare,,,,,370.54,,,,
VARICELLA VIR VAC SC,90716,CPT,,,,,both,1,EA,611.56,366.93,Medicare,Medicare,,,,,611.56,,,,
PNEUMO-VAC 2YR-ADULT,90732,CPT,,,,,both,0.5,ML,544.1,326.46,Medicare,Medicare,,,,,544.1,,,,
HEP B VAC PED,90744,CPT,,,,,both,, ,194.93,116.95,Medicare,Medicare,,,,,194.93,,,,
HEP B VAC PED,90744,CPT,,,,,both,0.5,ML,204.97,122.98,Medicare,Medicare,,,,,204.97,,,,
INTERACTIVE ADD-ON,90785,CPT,,,,,both,, ,310.8,186.48,Medicare,Medicare,,,,,310.8,,,,
PSYCH DIAG EVAL,90791,CPT,,,,,both,, ,249.78,149.86,Medicare,Medicare,,,,,249.78,,,,
PSYCH DIAG EVAL,90791,CPT,,,,,both,, ,757.82,454.69,Medicare,Medicare,,,,,757.82,,,,
PSYCHOTHERAPY 30 MIN,90832,CPT,,,,,both,, ,238.96,143.37,Medicare,Medicare,,,,,238.96,,,,
"Psychotherapy, 30 min",90832,CPT,,,,,both,,,238.96,238.96,Medicare,Medicare,,139.92,,,238.96,238.96,238.96,fee schedule,Medicare APC Fee Schedule
PSYCHOTHER 30M W/E&M,90833,CPT,,,,,both,, ,301.75,181.05,Medicare,Medicare,,,,,301.75,,,,
PSYCHOTHERAPY 45 MIN,90834,CPT,,,,,both,, ,299.73,179.83,Medicare,Medicare,,,,,299.73,,,,
"Psychotherapy, 45 min",90834,CPT,,,,,both,,,299.73,299.73,Medicare,Medicare,,139.92,,,299.73,299.73,299.73,fee schedule,Medicare APC Fee Schedule
PSYCHOTHER 45M W/E&M,90836,CPT,,,,,both,, ,312.25,187.35,Medicare,Medicare,,,,,312.25,,,,
PSYCHOTHERAPY 60 MIN,90837,CPT,,,,,both,, ,359.73,215.83,Medicare,Medicare,,,,,359.73,,,,
"Psychotherapy, 60 min",90837,CPT,,,,,both,,,359.73,359.73,Medicare,Medicare,,139.92,,,359.73,359.73,359.73,fee schedule,Medicare APC Fee Schedule
PSYCHOTHER 60M W/E&M,90838,CPT,,,,,both,, ,323.75,194.25,Medicare,Medicare,,,,,323.75,,,,
FAM THERAPY W/PATIEN,90847,CPT,,,,,both,, ,842.03,505.21,Medicare,Medicare,,,,,842.03,,,,
"Family psychotherapy, including patient, 50 min",90847,CPT,,,,,both,,,842.03,842.03,Medicare,Medicare,,139.92,,,842.03,842.03,842.03,fee schedule,Medicare APC Fee Schedule
MULTI-FAM GRP PSYCH,90849,CPT,,,,,both,, ,396.04,237.62,Medicare,Medicare,,,,,396.04,,,,
Group psychotherapy,90853,CPT,,,,,both,,,220.94,220.94,Medicare,Medicare,,72.84,,,220.94,220.94,220.94,fee schedule,Medicare APC Fee Schedule
PSYCH GROUP THERAPY,90853,CPT,,,,,both,, ,220.94,132.56,Medicare,Medicare,,,,,220.94,,,,
PSYCH GROUP THERAPY,90853,CPT,,,,,both,, ,689.33,413.59,Medicare,Medicare,,,,,689.33,,,,
MEDICATION MGMT,90863,CPT,,,,,both,, ,294.25,176.55,Medicare,Medicare,,,,,294.25,,,,
TMS INITIAL & 1ST TX,90867,CPT,,,,,both,, ,955.84,573.5,Medicare,Medicare,,,,,955.84,,,,
TMS SUBSEQUENT TX,90868,CPT,,,,,both,, ,515.04,309.02,Medicare,Medicare,,,,,515.04,,,,
TMS REMAPPING & TX,90869,CPT,,,,,both,, ,515.04,309.02,Medicare,Medicare,,,,,515.04,,,,
HEMODIALY SING EVAL,90935,CPT,,,,,both,, ,9908.09,5944.85,Medicare,Medicare,,,,,9908.09,,,,
OTH DIALY SING EVAL,90945,CPT,,,,,both,, ,4956.88,2974.12,Medicare,Medicare,,,,,4956.88,,,,
SP AR MCD TRMT 15MIN,92507,CPT,,,,,both,, ,182.25,109.35,Medicare,Medicare,,,,,182.25,,,,
SP-HEAR-TX-INDI VIST,92507,CPT,,,,,both,, ,705.29,423.17,Medicare,Medicare,,,,,705.29,,,,
SP-HEAR-GROUP-VISIT,92508,CPT,,,,,both,, ,324.19,194.51,Medicare,Medicare,,,,,324.19,,,,
EV SP FLUENCY 15,92521,CPT,,,,,both,, ,135.5,81.3,Medicare,Medicare,,,,,135.5,,,,
EVAL SPEECH FLUENCY,92521,CPT,,,,,both,, ,814.22,488.53,Medicare,Medicare,,,,,814.22,,,,
EV SP PROD 15,92522,CPT,,,,,both,, ,182.25,109.35,Medicare,Medicare,,,,,182.25,,,,
EVAL SPEECH SND PROD,92522,CPT,,,,,both,, ,814.22,488.53,Medicare,Medicare,,,,,814.22,,,,
EVAL SP SND PROD CMP,92523,CPT,,,,,both,, ,814.22,488.53,Medicare,Medicare,,,,,814.22,,,,
SP SOUND LANG CMP 15,92523,CPT,,,,,both,, ,182.25,109.35,Medicare,Medicare,,,,,182.25,,,,
BEH QL ANAL VOICE 15,92524,CPT,,,,,both,, ,182.25,109.35,Medicare,Medicare,,,,,182.25,,,,
BEHAV QL ANAL VOICE,92524,CPT,,,,,both,, ,814.22,488.53,Medicare,Medicare,,,,,814.22,,,,
ORAL FUNC TX-VIS,92526,CPT,,,,,both,, ,705.29,423.17,Medicare,Medicare,,,,,705.29,,,,
EVAL VOICE PROS DEV,92597,CPT,,,,,both,, ,390.11,234.06,Medicare,Medicare,,,,,390.11,,,,
COCHLE IMP INTIL LT7,92601,CPT,,,,,both,, ,854.9,512.94,Medicare,Medicare,,,,,854.9,,,,
SP-EVAL NSG DEV 1STH,92605,CPT,,,,,both,, ,813.7,488.22,Medicare,Medicare,,,,,813.7,,,,
SP-EVAL SP DEV 1STHR,92607,CPT,,,,,both,, ,813.7,488.22,Medicare,Medicare,,,,,813.7,,,,
SP-EVAL SP DEV AD30M,92608,CPT,,,,,both,, ,763.23,457.93,Medicare,Medicare,,,,,763.23,,,,
SP-THER SVC SPCH DEV,92609,CPT,,,,,both,, ,705.29,423.17,Medicare,Medicare,,,,,705.29,,,,
SP-EVAL SWL WO RADOP,92610,CPT,,,,,both,, ,758.08,454.84,Medicare,Medicare,,,,,758.08,,,,
SP-EVAL SWL W-RADOPQ,92611,CPT,,,,,both,, ,862.63,517.57,Medicare,Medicare,,,,,862.63,,,,
AUD EVOKE HR BRD STM,92651,CPT,,,,,both,, ,567.79,340.67,Medicare,Medicare,,,,,567.79,,,,
"IC-PTCA, SINGLE",92920,CPT,,,,,both,, ,65091.11,39054.66,Medicare,Medicare,,,,,65091.11,,,,
"IC-PTCA, ADDL",92921,CPT,,,,,both,, ,65091.11,39054.66,Medicare,Medicare,,,,,65091.11,,,,
IC-PRQ CRD STN W-ANG,92928,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,,,,88719.05,,,,
IC-PRQ STNT W-ANG EA,92929,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,,,,88719.05,,,,
IC-PRQ CRD ST-AT-ANG,92933,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,,,,88719.05,,,,
IC-PRQ ST-AT-ANG EA,92934,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,,,,88719.05,,,,
IC-PRQ RV BYP GRF IN,92937,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,,,,88719.05,,,,
IC-PRQ RV BYP GRF AD,92938,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,,,,88719.05,,,,
IC-PRQ CARD REV 1 VS,92941,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,,,,88719.05,,,,
IC-PRQ REVSC CHR 1VS,92943,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,,,,88719.05,,,,
IC-PRQ REVSC CHR ADD,92944,CPT,,,,,both,, ,88719.05,53231.43,Medicare,Medicare,,,,,88719.05,,,,
CPR,92950,CPT,,,,,both,, ,382.9,229.74,Medicare,Medicare,,,,,382.9,,,,
CPR,92950,CPT,,,,,both,, ,382.9,229.74,Medicare,Medicare,,,,,382.9,,,,
CPR,92950,CPT,,,,,both,, ,6031.42,3618.85,Medicare,Medicare,,,,,6031.42,,,,
CPR ASSIST (NON ER),92950,CPT,,,,,both,, ,5533.42,3320.05,Medicare,Medicare,,,,,5533.42,,,,
NI-TEMP EXT PACE,92953,CPT,,,,,both,, ,4462.48,2677.48,Medicare,Medicare,,,,,4462.48,,,,
NI-TEMP EXT PACE,92953,CPT,,,,,both,, ,4864.09,2918.45,Medicare,Medicare,,,,,4864.09,,,,
NI-CARDIOVERSION,92960,CPT,,,,,both,, ,4603.59,2762.15,Medicare,Medicare,,,,,4603.59,,,,
NI-CARDIOVERSION,92960,CPT,,,,,both,, ,5017.9,3010.74,Medicare,Medicare,,,,,5017.9,,,,
"EP-CARDIOVER,INTERN",92961,CPT,,,,,both,, ,2378.01,1426.8,Medicare,Medicare,,,,,2378.01,,,,
IC-COR THROMBECTOMY,92973,CPT,,,,,both,, ,29086.43,17451.85,Medicare,Medicare,,,,,29086.43,,,,
CC-INTRACOR THROMBO,92975,CPT,,,,,both,, ,18741.62,11244.97,Medicare,Medicare,,,,,18741.62,,,,
CC-INTRACOR THROMBO,92975,CPT,,,,,both,, ,18741.62,11244.97,Medicare,Medicare,,,,,18741.62,,,,
"THROMBOLY,CORONRY,IV",92977,CPT,,,,,both,, ,4033.02,2419.81,Medicare,Medicare,,,,,4033.02,,,,
"IC-IVUS, INIT",92978,CPT,,,,,both,, ,537.92,322.75,Medicare,Medicare,,,,,537.92,,,,
"IC-IVUS, ADDL",92979,CPT,,,,,both,, ,433.89,260.33,Medicare,Medicare,,,,,433.89,,,,
EKG 12 LEAD ED STAFF,93005,CPT,,,,,both,, ,1530.84,918.5,Medicare,Medicare,,,,,1530.84,,,,
EKG 12 LEAD UC STAFF,93005,CPT,,,,,both,, ,65.15,39.09,Medicare,Medicare,,,,,65.15,,,,
EKG 12 LEAD UC STAFF,93005,CPT,,,,,both,, ,65.15,39.09,Medicare,Medicare,,,,,65.15,,,,
"NI-EKG, 12 LEADS",93005,CPT,,,,,both,, ,714.82,428.89,Medicare,Medicare,,,,,714.82,,,,
NI-STRESS TEST,93017,CPT,,,,,both,, ,5189.4,3113.64,Medicare,Medicare,,,,,5189.4,,,,
EP-MICROVOLT T,93025,CPT,,,,,both,, ,1128.62,677.17,Medicare,Medicare,,,,,1128.62,,,,
"NI-EKG, 1-3 LEADS",93041,CPT,,,,,both,, ,1999.49,1199.69,Medicare,Medicare,,,,,1999.49,,,,
NI-HOLT RECRD TO48HR,93225,CPT,,,,,both,, ,9701.06,5820.63,Medicare,Medicare,,,,,9701.06,,,,
NI-HOLT WSCAN TO48HR,93226,CPT,,,,,both,, ,1596.24,957.74,Medicare,Medicare,,,,,1596.24,,,,
NI-TTE 2D W DOPP,93306,CPT,,,,,both,, ,12135.98,7281.58,Medicare,Medicare,,,,,12135.98,,,,
NI-TTE 2D MM COMP WO,93307,CPT,,,,,both,, ,8910.27,5346.16,Medicare,Medicare,,,,,8910.27,,,,
NI-TTE 2D MM LTD WO,93308,CPT,,,,,both,, ,4522.73,2713.63,Medicare,Medicare,,,,,4522.73,,,,
NI-TEE COMP 2D MM WO,93312,CPT,,,,,both,, ,9011.21,5406.72,Medicare,Medicare,,,,,9011.21,,,,
US-ECHO DOPP COMP AD,93320,CPT,,,,,both,, ,1635.9,981.54,Medicare,Medicare,,,,,1635.9,,,,
NI-ECHO DOP LTD,93321,CPT,,,,,both,, ,541.78,325.06,Medicare,Medicare,,,,,541.78,,,,
US-ECHO DOP CO FL AD,93325,CPT,,,,,both,, ,616.46,369.87,Medicare,Medicare,,,,,616.46,,,,
US-TTE STRESS WO,93350,CPT,,,,,both,, ,6350.21,3810.12,Medicare,Medicare,,,,,6350.21,,,,
CC-RHC,93451,CPT,,,,,both,, ,39597.32,23758.39,Medicare,Medicare,,,,,39597.32,,,,
CC-LHC VENT PUNC,93452,CPT,,,,,both,, ,43345.75,26007.45,Medicare,Medicare,,,,,43345.75,,,,
Insertion of catheter into left heart for diagnosis,93452,CPT,,,,,both,,,43345.75,43345.75,Medicare,Medicare,,43345.75,,,43345.75,43345.75,43345.75,fee schedule,Medicare APC Fee Schedule
CC-R-L CATH LV PUNC,93453,CPT,,,,,both,, ,43345.75,26007.45,Medicare,Medicare,,,,,43345.75,,,,
CC-ANGIO CORON ONLY,93454,CPT,,,,,both,, ,34667.23,20800.33,Medicare,Medicare,,,,,34667.23,,,,
CC-S-I VNT ATR ANGIO,93455,CPT,,,,,both,, ,36140.38,21684.22,Medicare,Medicare,,,,,36140.38,,,,
CC-R HRT CORONRY ART,93456,CPT,,,,,both,, ,74264.29,44558.57,Medicare,Medicare,,,,,74264.29,,,,
CC-R HRT ART-GRF ANG,93457,CPT,,,,,both,, ,75737.7,45442.62,Medicare,Medicare,,,,,75737.7,,,,
CC-L HRT ARTERY-VENT,93458,CPT,,,,,both,, ,49262.84,29557.7,Medicare,Medicare,,,,,49262.84,,,,
CC-L HRT ART-GRF ANG,93459,CPT,,,,,both,, ,50736,30441.6,Medicare,Medicare,,,,,50736,,,,
CC-R-L HRT ART-VENT,93460,CPT,,,,,both,, ,49262.84,29557.7,Medicare,Medicare,,,,,49262.84,,,,
CC-R-L HRT ART-ANGIO,93461,CPT,,,,,both,, ,50736,30441.6,Medicare,Medicare,,,,,50736,,,,
CC-DRUM ADM-HEMODYNC,93463,CPT,,,,,both,, ,451.91,271.14,Medicare,Medicare,,,,,451.91,,,,
INSERTION FLOW CATH,93503,CPT,,,,,both,, ,13163.66,7898.19,Medicare,Medicare,,,,,13163.66,,,,
CC-INJ L VENT-ATRIAL,93565,CPT,,,,,both,, ,3748.43,2249.05,Medicare,Medicare,,,,,3748.43,,,,
CC-INJ R VENT-ATRIAL,93566,CPT,,,,,both,, ,3252.48,1951.48,Medicare,Medicare,,,,,3252.48,,,,
CC-INJ SUPRV AORTOGR,93567,CPT,,,,,both,, ,5119.62,3071.77,Medicare,Medicare,,,,,5119.62,,,,
CC-INJ PULM ART HRTC,93568,CPT,,,,,both,, ,5119.62,3071.77,Medicare,Medicare,,,,,5119.62,,,,
HEART FLOW MEASURE,93571,CPT,,,,,both,, ,709.67,425.8,Medicare,Medicare,,,,,709.67,,,,
HEART FLOW MEAS ADD,93572,CPT,,,,,both,, ,709.67,425.8,Medicare,Medicare,,,,,709.67,,,,
CC-PDA CLOSE PERC,93582,CPT,,,,,both,, ,68501.18,41100.7,Medicare,Medicare,,,,,68501.18,,,,
EP-HIS BUNDLE REC,93600,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,,,,4670.54,,,,
EP-INTRAATRIAL REC,93602,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,,,,4670.54,,,,
EP-RV RECORD,93603,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,,,,4670.54,,,,
EP-MAP TACHY,93609,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,,,,4670.54,,,,
EP-INTRAATRIAL PAC,93610,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,,,,4670.54,,,,
EP-INTRAVENT PAC,93612,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,,,,4670.54,,,,
EP-MAP ADD,93613,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,,,,4670.54,,,,
EP-ATRI RECORD ESO,93615,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,,,,4670.54,,,,
EP-ATRI REC-PAC ESO,93616,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,,,,4670.54,,,,
EP-INDUC ARRY PAC,93618,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,,,,4670.54,,,,
EP-COMP EP W-O ARRY,93619,CPT,,,,,both,, ,22625.5,13575.3,Medicare,Medicare,,,,,22625.5,,,,
EP-COMP EP W- ARRY,93620,CPT,,,,,both,, ,22625.5,13575.3,Medicare,Medicare,,,,,22625.5,,,,
"EP-LA PACING, ADD",93621,CPT,,,,,both,, ,22625.5,13575.3,Medicare,Medicare,,,,,22625.5,,,,
"EP-LV PACING, ADD",93622,CPT,,,,,both,, ,22625.5,13575.3,Medicare,Medicare,,,,,22625.5,,,,
EP-PROG STIM IV DRUG,93623,CPT,,,,,both,, ,22625.5,13575.3,Medicare,Medicare,,,,,22625.5,,,,
EP-F-U EPW-ARRY IND,93624,CPT,,,,,both,, ,22625.5,13575.3,Medicare,Medicare,,,,,22625.5,,,,
EP-INTRA OP MAPPNG,93631,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,,,,4670.54,,,,
"EP-EVAL LEAD,INDUC",93640,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,,,,4670.54,,,,
"EP-EVAL GEN, INDUC",93641,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,,,,4670.54,,,,
EP-EVAL PREV DEVICE,93642,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,,,,4670.54,,,,
EP-ABLATE AV NODE,93650,CPT,,,,,both,, ,22625.5,13575.3,Medicare,Medicare,,,,,22625.5,,,,
EP-ABLATE SPRVNT ART,93653,CPT,,,,,both,, ,46220.99,27732.59,Medicare,Medicare,,,,,46220.99,,,,
EP-ABLATE VENT TACY,93654,CPT,,,,,both,, ,46220.99,27732.59,Medicare,Medicare,,,,,46220.99,,,,
EP-ATR FIB PULM VN I,93656,CPT,,,,,both,, ,46220.99,27732.59,Medicare,Medicare,,,,,46220.99,,,,
EP-INTCRD ECHO INTER,93662,CPT,,,,,both,, ,4670.54,2802.32,Medicare,Medicare,,,,,4670.54,,,,
PAD REHB PER SESSION,93668,CPT,,,,,both,, ,169.18,101.5,Medicare,Medicare,,,,,169.18,,,,
NI-CARD REHAB W-O MO,93797,CPT,,,,,both,, ,193.64,116.18,Medicare,Medicare,,,,,193.64,,,,
NI-CARDI REHAB W- MO,93798,CPT,,,,,both,, ,296.38,177.82,Medicare,Medicare,,,,,296.38,,,,
US-CAROTID DPLX SCAN,93880,CPT,,,,,both,, ,425.13,255.07,Medicare,Medicare,,,,,425.13,,,,
US-CAROTID DPLX SCAN,93880,CPT,,,,,both,, ,457.58,274.54,Medicare,Medicare,,,,,457.58,,,,
US-CRAN DPLX SCN BIL,93880,CPT,,,,,both,, ,12714.32,7628.59,Medicare,Medicare,,,,,12714.32,,,,
US-CAROTID DUP DOPLR,93882,CPT,,,,,both,, ,425.13,255.07,Medicare,Medicare,,,,,425.13,,,,
US-CAROTID DUP DOPLR,93882,CPT,,,,,both,, ,457.58,274.54,Medicare,Medicare,,,,,457.58,,,,
NI-EXT ARTERIAL LTD,93922,CPT,,,,,both,, ,2456.29,1473.77,Medicare,Medicare,,,,,2456.29,,,,
US-EXT ARTERIAL LTD,93922,CPT,,,,,both,, ,167.38,100.42,Medicare,Medicare,,,,,167.38,,,,
NI-EXT ARTERIAL COMP,93923,CPT,,,,,both,, ,3819.24,2291.54,Medicare,Medicare,,,,,3819.24,,,,
US-NON INV ARTER EXT,93923,CPT,,,,,both,, ,268.32,160.99,Medicare,Medicare,,,,,268.32,,,,
NI-STD LE STRS REST,93924,CPT,,,,,both,, ,5693.84,3416.3,Medicare,Medicare,,,,,5693.84,,,,
NI-LW EXT DPX ART BI,93925,CPT,,,,,both,, ,5086.4,3051.84,Medicare,Medicare,,,,,5086.4,,,,
NI-LW EXT DPX ART UN,93926,CPT,,,,,both,, ,2541.53,1524.91,Medicare,Medicare,,,,,2541.53,,,,
US-LW EXT DPX ART UN,93926,CPT,,,,,both,, ,1560.19,936.11,Medicare,Medicare,,,,,1560.19,,,,
NI-UP EXT DPX ART BI,93930,CPT,,,,,both,, ,5083.05,3049.83,Medicare,Medicare,,,,,5083.05,,,,
NI-UP EXT DPX ART UN,93931,CPT,,,,,both,, ,2541.53,1524.91,Medicare,Medicare,,,,,2541.53,,,,
US-UP EXT DPX ART UN,93931,CPT,,,,,both,, ,2026.01,1215.6,Medicare,Medicare,,,,,2026.01,,,,
NI-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,5086.4,3051.84,Medicare,Medicare,,,,,5086.4,,,,
US-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,425.13,255.07,Medicare,Medicare,,,,,425.13,,,,
US-EXT VEINS DPLX WC,93970,CPT,,,,,both,, ,457.58,274.54,Medicare,Medicare,,,,,457.58,,,,
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,299.73,179.83,Medicare,Medicare,,,,,299.73,,,,
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,322.65,193.59,Medicare,Medicare,,,,,322.65,,,,
US-EXT VEINS DPX LTD,93971,CPT,,,,,both,, ,2541.53,1524.91,Medicare,Medicare,,,,,2541.53,,,,
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,425.13,255.07,Medicare,Medicare,,,,,425.13,,,,
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,457.58,274.54,Medicare,Medicare,,,,,457.58,,,,
US-DPLX SCAN ART CMP,93975,CPT,,,,,both,, ,823.23,493.93,Medicare,Medicare,,,,,823.23,,,,
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,425.13,255.07,Medicare,Medicare,,,,,425.13,,,,
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,457.58,274.54,Medicare,Medicare,,,,,457.58,,,,
US-ABD RETROPER DPLX,93976,CPT,,,,,both,, ,828.89,497.33,Medicare,Medicare,,,,,828.89,,,,
US-DPLXSCN GRFT ARTA,93978,CPT,,,,,both,, ,1665.51,999.3,Medicare,Medicare,,,,,1665.51,,,,
NI-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,1292.14,775.28,Medicare,Medicare,,,,,1292.14,,,,
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,425.13,255.07,Medicare,Medicare,,,,,425.13,,,,
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,457.58,274.54,Medicare,Medicare,,,,,457.58,,,,
US-PENIL VASCLR CMPL,93980,CPT,,,,,both,, ,841.51,504.9,Medicare,Medicare,,,,,841.51,,,,
VESS MAP HEMO ACC BI,93985,CPT,,,,,both,, ,977.58,586.54,Medicare,Medicare,,,,,977.58,,,,
VESS MAP HEMO ACC UN,93986,CPT,,,,,both,, ,977.58,586.54,Medicare,Medicare,,,,,977.58,,,,
NI-DUPSCN HEMODIAL,93990,CPT,,,,,both,, ,4623.93,2774.35,Medicare,Medicare,,,,,4623.93,,,,
MECH VENT INITIAL,94002,CPT,,,,,both,, ,4971.3,2982.78,Medicare,Medicare,,,,,4971.3,,,,
MECH VENT DAILY SUBS,94003,CPT,,,,,both,, ,4971.3,2982.78,Medicare,Medicare,,,,,4971.3,,,,
SPIROMETRY,94010,CPT,,,,,both,, ,530.45,318.27,Medicare,Medicare,,,,,530.45,,,,
BRONCHO EVAL PRE/PST,94060,CPT,,,,,both,, ,2361.28,1416.76,Medicare,Medicare,,,,,2361.28,,,,
METHACHOLINE CHALLEN,94070,CPT,,,,,both,, ,961.51,576.9,Medicare,Medicare,,,,,961.51,,,,
MAXIMUM VOLUNTARY VE,94200,CPT,,,,,both,, ,306.94,184.16,Medicare,Medicare,,,,,306.94,,,,
HAST WITH 02 TITRATE,94453,CPT,,,,,both,, ,1089.74,653.84,Medicare,Medicare,,,,,1089.74,,,,
PULM STRESS SIMPLE,94618,CPT,,,,,both,, ,459.12,275.47,Medicare,Medicare,,,,,459.12,,,,
PULM REHAB WO OXIMET,94625,CPT,,,,,both,, ,227.4,136.44,Medicare,Medicare,,,,,227.4,,,,
PULM REHAB W OXIMET,94626,CPT,,,,,both,, ,227.4,136.44,Medicare,Medicare,,,,,227.4,,,,
INHALATION TRTMT INI,94640,CPT,,,,,both,, ,569.5,341.7,Medicare,Medicare,,,,,569.5,,,,
INHALATION TRTMT INI,94640,CPT,,,,,both,, ,586.59,351.95,Medicare,Medicare,,,,,586.59,,,,
INHALATION TRTMT SUB,94640,CPT,,,,,both,, ,691.75,415.05,Medicare,Medicare,,,,,691.75,,,,
INHALATION TRTMT SUB,94640,CPT,,,,,both,, ,712.5,427.5,Medicare,Medicare,,,,,712.5,,,,
PENTAMIDINE ARSL INH,94642,CPT,,,,,both,, ,1061.67,637,Medicare,Medicare,,,,,1061.67,,,,
AEROSOL OBSTRUCT 1HR,94644,CPT,,,,,both,, ,719.71,431.82,Medicare,Medicare,,,,,719.71,,,,
CONT INH TX ED 1HR,94644,CPT,,,,,both,, ,698.75,419.25,Medicare,Medicare,,,,,698.75,,,,
AEROSOL OBSTR ADD HR,94645,CPT,,,,,both,, ,719.71,431.82,Medicare,Medicare,,,,,719.71,,,,
CONT INH TX ED AD HR,94645,CPT,,,,,both,, ,698.75,419.25,Medicare,Medicare,,,,,698.75,,,,
BIPAP/CPAP,94660,CPT,,,,,both,, ,2771.47,1662.88,Medicare,Medicare,,,,,2771.47,,,,
EVAL-DEMO INHL DEVCE,94664,CPT,,,,,both,, ,342.73,205.63,Medicare,Medicare,,,,,342.73,,,,
MANIP CHST WALL INIT,94667,CPT,,,,,both,, ,1191.45,714.87,Medicare,Medicare,,,,,1191.45,,,,
MANIP CHST WALL SBSQ,94668,CPT,,,,,both,, ,975.15,585.09,Medicare,Medicare,,,,,975.15,,,,
MECHAN CHST WALL OSC,94669,CPT,,,,,both,, ,210.89,126.53,Medicare,Medicare,,,,,210.89,,,,
PF TST PLETHYSMOGRA,94726,CPT,,,,,both,, ,548.73,329.23,Medicare,Medicare,,,,,548.73,,,,
PF TEST BY GAS,94727,CPT,,,,,both,, ,548.73,329.23,Medicare,Medicare,,,,,548.73,,,,
PF TEST OSCILLOMETRY,94728,CPT,,,,,both,, ,548.73,329.23,Medicare,Medicare,,,,,548.73,,,,
CO2-MEMBANE DIFF CAP,94729,CPT,,,,,both,, ,2800.31,1680.18,Medicare,Medicare,,,,,2800.31,,,,
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309,185.4,Medicare,Medicare,,,,,309,,,,
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309,185.4,Medicare,Medicare,,,,,309,,,,
PULSE OXIMTRY SINGLE,94760,CPT,,,,,both,, ,309,185.4,Medicare,Medicare,,,,,309,,,,
PULSE OX MULTI/EXERC,94761,CPT,,,,,both,, ,797.48,478.48,Medicare,Medicare,,,,,797.48,,,,
PULSE OX MULTI/EXERC,94761,CPT,,,,,both,, ,797.48,478.48,Medicare,Medicare,,,,,797.48,,,,
PULSE OX CONTINUOS,94762,CPT,,,,,both,, ,388,232.8,Medicare,Medicare,,,,,388,,,,
PULSE OX OVERNIGHT,94762,CPT,,,,,both,, ,468.91,281.34,Medicare,Medicare,,,,,468.91,,,,
PULSE OX OVERNIGHT,94762,CPT,,,,,both,, ,468.91,281.34,Medicare,Medicare,,,,,468.91,,,,
CAR SEAT BED TST 60M,94780,CPT,,,,,both,, ,118.19,70.91,Medicare,Medicare,,,,,118.19,,,,
CAR SE-BED TST AD 30,94781,CPT,,,,,both,, ,58.97,35.38,Medicare,Medicare,,,,,58.97,,,,
ALLERGY INJ SIM,95115,CPT,,,,,both,, ,70.56,42.33,Medicare,Medicare,,,,,70.56,,,,
ALLERGY INJ SIM,95115,CPT,,,,,both,, ,70.81,42.48,Medicare,Medicare,,,,,70.81,,,,
ALLERGY INJ MUL,95117,CPT,,,,,both,, ,70.56,42.33,Medicare,Medicare,,,,,70.56,,,,
ALLERGY INJ MUL,95117,CPT,,,,,both,, ,70.81,42.48,Medicare,Medicare,,,,,70.81,,,,
POLYSOMNO GT4 LT6YO,95782,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,,,,2570.88,,,,
POLYSOMNO GT4 LT6YO,95782,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,,,,2570.88,,,,
POLYS-CPAP GT4 LT6YO,95783,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,,,,2570.88,,,,
POLYS-CPAP GT4 LT6YO,95783,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,,,,2570.88,,,,
SLPSTDY UNATT AN-ST,95800,CPT,,,,,both,, ,428.48,257.08,Medicare,Medicare,,,,,428.48,,,,
SLPSTDY UNATT AN-ST,95800,CPT,,,,,both,, ,625,375,Medicare,Medicare,,,,,625,,,,
MULTI SLEEP LAT,95805,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,,,,2570.88,,,,
MULTI SLEEP LAT,95805,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,,,,2570.88,,,,
SLPSTDY UNATT RS EFF,95806,CPT,,,,,both,, ,428.48,257.08,Medicare,Medicare,,,,,428.48,,,,
SLPSTDY UNATT RS EFF,95806,CPT,,,,,both,, ,625,375,Medicare,Medicare,,,,,625,,,,
POLYSOMNO GT4 GE6YO,95810,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,,,,2570.88,,,,
POLYSOMNO GT4 GE6YO,95810,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,,,,2570.88,,,,
Sleep study,95810,CPT,,,,,both,,,2570.88,2570.88,Medicare,Medicare,,2570.88,,,2570.88,2570.88,2570.88,fee schedule,Medicare APC Fee Schedule
POLYS-CPAP GT4 GE6YO,95811,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,,,,2570.88,,,,
POLYS-CPAP GT4 GE6YO,95811,CPT,,,,,both,, ,2570.88,1542.52,Medicare,Medicare,,,,,2570.88,,,,
EEG 41-60 MIN,95812,CPT,,,,,both,, ,1075.58,645.34,Medicare,Medicare,,,,,1075.58,,,,
EEG GT 1 HOUR,95813,CPT,,,,,both,, ,1044.25,626.55,Medicare,Medicare,,,,,1044.25,,,,
EEG AWAKE DROWSY,95816,CPT,,,,,both,, ,1075.58,645.34,Medicare,Medicare,,,,,1075.58,,,,
EEG AWAKE ASLEEP,95819,CPT,,,,,both,, ,3362.5,2017.5,Medicare,Medicare,,,,,3362.5,,,,
EEG ASLEEP,95822,CPT,,,,,both,, ,4457.07,2674.24,Medicare,Medicare,,,,,4457.07,,,,
ROM WR EA EX-TRNK OT,95851,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,,,,486.42,,,,
ROM WR EA EX-TRNK OT,95851,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,,,,486.42,,,,
ROM WR EA EX-TRNK PT,95851,CPT,,,,,both,, ,21.12,12.67,Medicare,Medicare,,,,,21.12,,,,
ROM WR EA EX-TRNK PT,95851,CPT,,,,,both,, ,21.12,12.67,Medicare,Medicare,,,,,21.12,,,,
ROM WR EA EX-TRNK PT,95851,CPT,,,,,both,, ,21.12,12.67,Medicare,Medicare,,,,,21.12,,,,
ROM WR EA EX-TRNK PT,95851,CPT,,,,,both,, ,21.12,12.67,Medicare,Medicare,,,,,21.12,,,,
ROM WR EA EX-TRNK PT,95851,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,,,,448.57,,,,
ROM WR EA EX-TRNK PT,95851,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,,,,448.57,,,,
ROM W-R EA EXT-TRNK,95851,CPT,,,,,both,, ,418.86,251.31,Medicare,Medicare,,,,,418.86,,,,
ROM W-R EA EXT-TRNK,95851,CPT,,,,,both,, ,454.13,272.47,Medicare,Medicare,,,,,454.13,,,,
ROM W-R HND W-WO COM,95852,CPT,,,,,both,, ,418.86,251.31,Medicare,Medicare,,,,,418.86,,,,
ROM W-R HND W-WO COM,95852,CPT,,,,,both,, ,454.13,272.47,Medicare,Medicare,,,,,454.13,,,,
ROM W-R HND W-WO OT,95852,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,,,,486.42,,,,
ROM W-R HND W-WO OT,95852,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,,,,486.42,,,,
ROM W-R HND W-WO PT,95852,CPT,,,,,both,, ,16.22,9.73,Medicare,Medicare,,,,,16.22,,,,
ROM W-R HND W-WO PT,95852,CPT,,,,,both,, ,16.22,9.73,Medicare,Medicare,,,,,16.22,,,,
ROM W-R HND W-WO PT,95852,CPT,,,,,both,, ,16.22,9.73,Medicare,Medicare,,,,,16.22,,,,
ROM W-R HND W-WO PT,95852,CPT,,,,,both,, ,16.22,9.73,Medicare,Medicare,,,,,16.22,,,,
ROM W-R HND W-WO PT,95852,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,,,,448.57,,,,
ROM W-R HND W-WO PT,95852,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,,,,448.57,,,,
"EMG, 1 EXTREM",95860,CPT,,,,,both,, ,3272.05,1963.23,Medicare,Medicare,,,,,3272.05,,,,
"EMG, 2 EXTREM",95861,CPT,,,,,both,, ,5586.46,3351.87,Medicare,Medicare,,,,,5586.46,,,,
"EMG, 3 EXTREM",95863,CPT,,,,,both,, ,7162.62,4297.57,Medicare,Medicare,,,,,7162.62,,,,
"EMG, 4 EXTREM",95864,CPT,,,,,both,, ,8764.27,5258.56,Medicare,Medicare,,,,,8764.27,,,,
"EMG, W-NERVE TEST",95885,CPT,,,,,both,, ,458.87,275.32,Medicare,Medicare,,,,,458.87,,,,
EMG W-NRV TST COM,95886,CPT,,,,,both,, ,458.87,275.32,Medicare,Medicare,,,,,458.87,,,,
EMG W-NRV TST NON,95887,CPT,,,,,both,, ,242.57,145.54,Medicare,Medicare,,,,,242.57,,,,
MTR-SENS 1-2 NRV TST,95907,CPT,,,,,both,, ,821.43,492.85,Medicare,Medicare,,,,,821.43,,,,
MTR-SENS 3-4 NRV TST,95908,CPT,,,,,both,, ,821.43,492.85,Medicare,Medicare,,,,,821.43,,,,
MTR-SENS 5-6 NRV TST,95909,CPT,,,,,both,, ,821.43,492.85,Medicare,Medicare,,,,,821.43,,,,
MTR-SENS 7-8 NRV TST,95910,CPT,,,,,both,, ,821.43,492.85,Medicare,Medicare,,,,,821.43,,,,
MTR-SES 9-10 NRV TST,95911,CPT,,,,,both,, ,821.43,492.85,Medicare,Medicare,,,,,821.43,,,,
MTR-SES 11-12 NRV TS,95912,CPT,,,,,both,, ,1518.74,911.24,Medicare,Medicare,,,,,1518.74,,,,
MTR-SNS 13 OR MORE,95913,CPT,,,,,both,, ,1518.74,911.24,Medicare,Medicare,,,,,1518.74,,,,
PARASYMP-SYMP HRT RT,95924,CPT,,,,,both,, ,461.44,276.86,Medicare,Medicare,,,,,461.44,,,,
VISUAL EVOK POTENT,95930,CPT,,,,,both,, ,3397.2,2038.32,Medicare,Medicare,,,,,3397.2,,,,
"REPETIT STIM, EA NE",95937,CPT,,,,,both,, ,3199.95,1919.97,Medicare,Medicare,,,,,3199.95,,,,
CANALITH PER DAY,95992,CPT,,,,,both,, ,158.07,94.84,Medicare,Medicare,,,,,158.07,,,,
CANALITH PER DAY PT,95992,CPT,,,,,both,, ,101.97,61.18,Medicare,Medicare,,,,,101.97,,,,
CANALITH PER DAY PT,95992,CPT,,,,,both,, ,101.97,61.18,Medicare,Medicare,,,,,101.97,,,,
CANALITH PER DAY PT,95992,CPT,,,,,both,, ,169.44,101.66,Medicare,Medicare,,,,,169.44,,,,
CANALITH PER DAY PT,95992,CPT,,,,,both,, ,169.44,101.66,Medicare,Medicare,,,,,169.44,,,,
APHASIA ASSESS 1HOUR,96105,CPT,,,,,both,, ,813.7,488.22,Medicare,Medicare,,,,,813.7,,,,
DEV TEST 1ST HR,96112,CPT,,,,,both,, ,813.7,488.22,Medicare,Medicare,,,,,813.7,,,,
DEV TEST ADD 30M,96113,CPT,,,,,both,, ,763.23,457.93,Medicare,Medicare,,,,,763.23,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,253.9,152.34,Medicare,Medicare,,,,,253.9,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,253.9,152.34,Medicare,Medicare,,,,,253.9,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,487,292.2,Medicare,Medicare,,,,,487,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,487,292.2,Medicare,Medicare,,,,,487,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,501.61,300.96,Medicare,Medicare,,,,,501.61,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,501.61,300.96,Medicare,Medicare,,,,,501.61,,,,
IV HYDRATION 1 HR,96360,CPT,,,,,both,, ,1841.23,1104.73,Medicare,Medicare,,,,,1841.23,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,70.81,42.48,Medicare,Medicare,,,,,70.81,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,70.81,42.48,Medicare,Medicare,,,,,70.81,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,135.75,81.45,Medicare,Medicare,,,,,135.75,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,135.75,81.45,Medicare,Medicare,,,,,135.75,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,139.82,83.89,Medicare,Medicare,,,,,139.82,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,139.82,83.89,Medicare,Medicare,,,,,139.82,,,,
IV HYDRAT EA ADD HR,96361,CPT,,,,,both,, ,1841.23,1104.73,Medicare,Medicare,,,,,1841.23,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,412.77,247.66,Medicare,Medicare,,,,,412.77,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,412.77,247.66,Medicare,Medicare,,,,,412.77,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,928.18,556.9,Medicare,Medicare,,,,,928.18,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1301.75,781.05,Medicare,Medicare,,,,,1301.75,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1301.75,781.05,Medicare,Medicare,,,,,1301.75,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1340.8,804.48,Medicare,Medicare,,,,,1340.8,,,,
IV THERAPY DX 1 HR,96365,CPT,,,,,both,, ,1340.8,804.48,Medicare,Medicare,,,,,1340.8,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,70.81,42.48,Medicare,Medicare,,,,,70.81,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,70.81,42.48,Medicare,Medicare,,,,,70.81,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,928.18,556.9,Medicare,Medicare,,,,,928.18,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1301.75,781.05,Medicare,Medicare,,,,,1301.75,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1301.75,781.05,Medicare,Medicare,,,,,1301.75,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1340.8,804.48,Medicare,Medicare,,,,,1340.8,,,,
IV THERAPY EA AD HR,96366,CPT,,,,,both,, ,1340.8,804.48,Medicare,Medicare,,,,,1340.8,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,201.25,120.75,Medicare,Medicare,,,,,201.25,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,201.25,120.75,Medicare,Medicare,,,,,201.25,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,207.29,124.37,Medicare,Medicare,,,,,207.29,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,207.29,124.37,Medicare,Medicare,,,,,207.29,,,,
IV THER AD SEQ 1 HR,96367,CPT,,,,,both,, ,928.18,556.9,Medicare,Medicare,,,,,928.18,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,791.25,474.75,Medicare,Medicare,,,,,791.25,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,791.25,474.75,Medicare,Medicare,,,,,791.25,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,814.99,488.99,Medicare,Medicare,,,,,814.99,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,814.99,488.99,Medicare,Medicare,,,,,814.99,,,,
CONCURRENT IV THER,96368,CPT,,,,,both,, ,928.18,556.9,Medicare,Medicare,,,,,928.18,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,201.25,120.75,Medicare,Medicare,,,,,201.25,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,201.25,120.75,Medicare,Medicare,,,,,201.25,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,207.29,124.37,Medicare,Medicare,,,,,207.29,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,207.29,124.37,Medicare,Medicare,,,,,207.29,,,,
THERAPEUTIC DX SQ IM,96372,CPT,,,,,both,, ,301.16,180.69,Medicare,Medicare,,,,,301.16,,,,
S-INJ NON CHEMO IA,96373,CPT,,,,,both,, ,1355.48,813.28,Medicare,Medicare,,,,,1355.48,,,,
INJECTION IV PUSH,96374,CPT,,,,,both,, ,1477.47,886.48,Medicare,Medicare,,,,,1477.47,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,201.25,120.75,Medicare,Medicare,,,,,201.25,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,201.25,120.75,Medicare,Medicare,,,,,201.25,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,207.29,124.37,Medicare,Medicare,,,,,207.29,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,253.9,152.34,Medicare,Medicare,,,,,253.9,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,253.9,152.34,Medicare,Medicare,,,,,253.9,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,501.61,300.96,Medicare,Medicare,,,,,501.61,,,,
THERAPEUTIC IV PUSH,96374,CPT,,,,,both,, ,1355.48,813.28,Medicare,Medicare,,,,,1355.48,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,201.25,120.75,Medicare,Medicare,,,,,201.25,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,201.25,120.75,Medicare,Medicare,,,,,201.25,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,207.29,124.37,Medicare,Medicare,,,,,207.29,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,207.29,124.37,Medicare,Medicare,,,,,207.29,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,668.99,401.39,Medicare,Medicare,,,,,668.99,,,,
THERA EA AD IV PUSH,96375,CPT,,,,,both,, ,729.19,437.51,Medicare,Medicare,,,,,729.19,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,98.5,59.1,Medicare,Medicare,,,,,98.5,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,98.5,59.1,Medicare,Medicare,,,,,98.5,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,101.46,60.87,Medicare,Medicare,,,,,101.46,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,101.46,60.87,Medicare,Medicare,,,,,101.46,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
THER AD IVP SAME MED,96376,CPT,,,,,both,, ,729.19,437.51,Medicare,Medicare,,,,,729.19,,,,
CHEMO NON HORM IM SC,96401,CPT,,,,,both,, ,476.63,285.97,Medicare,Medicare,,,,,476.63,,,,
CHEMO HORMONAL IM SC,96402,CPT,,,,,both,, ,235.36,141.21,Medicare,Medicare,,,,,235.36,,,,
CHEMO IV PUSH,96409,CPT,,,,,both,, ,382.65,229.59,Medicare,Medicare,,,,,382.65,,,,
CHEMO EA AD IV PUSH,96411,CPT,,,,,both,, ,117.16,70.29,Medicare,Medicare,,,,,117.16,,,,
CHEMO IV INFU 1ST HR,96413,CPT,,,,,both,, ,1377.11,826.26,Medicare,Medicare,,,,,1377.11,,,,
CHEMO IV IN EA AD HR,96415,CPT,,,,,both,, ,234.58,140.74,Medicare,Medicare,,,,,234.58,,,,
CHEMO IV EA SEQ INF,96417,CPT,,,,,both,, ,126.18,75.7,Medicare,Medicare,,,,,126.18,,,,
IR-IRR PORT DRUG DEL,96523,CPT,,,,,both,, ,383.16,229.89,Medicare,Medicare,,,,,383.16,,,,
HOT-COLD PACKS,97010,CPT,,,,,both,, ,239.27,143.56,Medicare,Medicare,,,,,239.27,,,,
HOT-COLD PACKS,97010,CPT,,,,,both,, ,259.41,155.64,Medicare,Medicare,,,,,259.41,,,,
HOT-COLD PACKS OT,97010,CPT,,,,,both,, ,277.84,166.7,Medicare,Medicare,,,,,277.84,,,,
HOT-COLD PACKS OT,97010,CPT,,,,,both,, ,277.84,166.7,Medicare,Medicare,,,,,277.84,,,,
HOT-COLD PACKS PT,97010,CPT,,,,,both,, ,41.2,24.72,Medicare,Medicare,,,,,41.2,,,,
HOT-COLD PACKS PT,97010,CPT,,,,,both,, ,41.2,24.72,Medicare,Medicare,,,,,41.2,,,,
HOT-COLD PACKS PT,97010,CPT,,,,,both,, ,41.2,24.72,Medicare,Medicare,,,,,41.2,,,,
HOT-COLD PACKS PT,97010,CPT,,,,,both,, ,41.2,24.72,Medicare,Medicare,,,,,41.2,,,,
HOT-COLD PACKS PT,97010,CPT,,,,,both,, ,256.21,153.72,Medicare,Medicare,,,,,256.21,,,,
HOT-COLD PACKS PT,97010,CPT,,,,,both,, ,256.21,153.72,Medicare,Medicare,,,,,256.21,,,,
MECH TRACTION-VISIT,97012,CPT,,,,,both,, ,485.24,291.14,Medicare,Medicare,,,,,485.24,,,,
MECH TRACTN-VST PT,97012,CPT,,,,,both,, ,39.4,23.64,Medicare,Medicare,,,,,39.4,,,,
MECH TRACTN-VST PT,97012,CPT,,,,,both,, ,39.4,23.64,Medicare,Medicare,,,,,39.4,,,,
MECH TRACTN-VST PT,97012,CPT,,,,,both,, ,519.89,311.93,Medicare,Medicare,,,,,519.89,,,,
MECH TRACTN-VST PT,97012,CPT,,,,,both,, ,519.89,311.93,Medicare,Medicare,,,,,519.89,,,,
PARAF BATH-VISIT OT,97018,CPT,,,,,both,, ,41.2,24.72,Medicare,Medicare,,,,,41.2,,,,
PARAF BATH-VISIT OT,97018,CPT,,,,,both,, ,41.2,24.72,Medicare,Medicare,,,,,41.2,,,,
PARAF BATH-VISIT OT,97018,CPT,,,,,both,, ,347.88,208.72,Medicare,Medicare,,,,,347.88,,,,
PARAF BATH-VISIT OT,97018,CPT,,,,,both,, ,347.88,208.72,Medicare,Medicare,,,,,347.88,,,,
PARAF BATH-VISIT PT,97018,CPT,,,,,both,, ,18.54,11.12,Medicare,Medicare,,,,,18.54,,,,
PARAF BATH-VISIT PT,97018,CPT,,,,,both,, ,18.54,11.12,Medicare,Medicare,,,,,18.54,,,,
PARAF BATH-VISIT PT,97018,CPT,,,,,both,, ,320.85,192.51,Medicare,Medicare,,,,,320.85,,,,
PARAF BATH-VISIT PT,97018,CPT,,,,,both,, ,320.85,192.51,Medicare,Medicare,,,,,320.85,,,,
PARAFFIN BATH-VISIT,97018,CPT,,,,,both,, ,299.53,179.71,Medicare,Medicare,,,,,299.53,,,,
PARAFFIN BATH-VISIT,97018,CPT,,,,,both,, ,324.73,194.83,Medicare,Medicare,,,,,324.73,,,,
WHIRLPOOL THRPY-VIST,97022,CPT,,,,,both,, ,652.7,391.62,Medicare,Medicare,,,,,652.7,,,,
WHIRLPOOL THRPY-VIST,97022,CPT,,,,,both,, ,707.58,424.54,Medicare,Medicare,,,,,707.58,,,,
WHRLPL THRPY-VST OT,97022,CPT,,,,,both,, ,758.08,454.84,Medicare,Medicare,,,,,758.08,,,,
WHRLPL THRPY-VST OT,97022,CPT,,,,,both,, ,758.08,454.84,Medicare,Medicare,,,,,758.08,,,,
WHRLPL THRPY-VST PT,97022,CPT,,,,,both,, ,46.87,28.12,Medicare,Medicare,,,,,46.87,,,,
WHRLPL THRPY-VST PT,97022,CPT,,,,,both,, ,46.87,28.12,Medicare,Medicare,,,,,46.87,,,,
WHRLPL THRPY-VST PT,97022,CPT,,,,,both,, ,46.87,28.12,Medicare,Medicare,,,,,46.87,,,,
WHRLPL THRPY-VST PT,97022,CPT,,,,,both,, ,46.87,28.12,Medicare,Medicare,,,,,46.87,,,,
WHRLPL THRPY-VST PT,97022,CPT,,,,,both,, ,699.11,419.46,Medicare,Medicare,,,,,699.11,,,,
WHRLPL THRPY-VST PT,97022,CPT,,,,,both,, ,699.11,419.46,Medicare,Medicare,,,,,699.11,,,,
ELEC STIM-MAN-15 MIN,97032,CPT,,,,,both,, ,466.32,279.79,Medicare,Medicare,,,,,466.32,,,,
ELEC STIM-MAN-15 MIN,97032,CPT,,,,,both,, ,505.5,303.3,Medicare,Medicare,,,,,505.5,,,,
ELEC STM-MN-15MN OT,97032,CPT,,,,,both,, ,541.52,324.91,Medicare,Medicare,,,,,541.52,,,,
ELEC STM-MN-15MN OT,97032,CPT,,,,,both,, ,541.52,324.91,Medicare,Medicare,,,,,541.52,,,,
ELEC STM-MN-15MN PT,97032,CPT,,,,,both,, ,39.4,23.64,Medicare,Medicare,,,,,39.4,,,,
ELEC STM-MN-15MN PT,97032,CPT,,,,,both,, ,39.4,23.64,Medicare,Medicare,,,,,39.4,,,,
ELEC STM-MN-15MN PT,97032,CPT,,,,,both,, ,39.4,23.64,Medicare,Medicare,,,,,39.4,,,,
ELEC STM-MN-15MN PT,97032,CPT,,,,,both,, ,39.4,23.64,Medicare,Medicare,,,,,39.4,,,,
ELEC STM-MN-15MN PT,97032,CPT,,,,,both,, ,499.55,299.73,Medicare,Medicare,,,,,499.55,,,,
ELEC STM-MN-15MN PT,97032,CPT,,,,,both,, ,499.55,299.73,Medicare,Medicare,,,,,499.55,,,,
IONTOPHOR-15 MIN OT,97033,CPT,,,,,both,, ,764.52,458.71,Medicare,Medicare,,,,,764.52,,,,
IONTOPHOR-15 MIN OT,97033,CPT,,,,,both,, ,764.52,458.71,Medicare,Medicare,,,,,764.52,,,,
IONTOPHOR-15 MIN PT,97033,CPT,,,,,both,, ,54.59,32.75,Medicare,Medicare,,,,,54.59,,,,
IONTOPHOR-15 MIN PT,97033,CPT,,,,,both,, ,54.59,32.75,Medicare,Medicare,,,,,54.59,,,,
IONTOPHOR-15 MIN PT,97033,CPT,,,,,both,, ,54.59,32.75,Medicare,Medicare,,,,,54.59,,,,
IONTOPHOR-15 MIN PT,97033,CPT,,,,,both,, ,54.59,32.75,Medicare,Medicare,,,,,54.59,,,,
IONTOPHOR-15 MIN PT,97033,CPT,,,,,both,, ,705.04,423.02,Medicare,Medicare,,,,,705.04,,,,
IONTOPHOR-15 MIN PT,97033,CPT,,,,,both,, ,705.04,423.02,Medicare,Medicare,,,,,705.04,,,,
IONTOPHORESIS-15 MIN,97033,CPT,,,,,both,, ,658.28,394.96,Medicare,Medicare,,,,,658.28,,,,
IONTOPHORESIS-15 MIN,97033,CPT,,,,,both,, ,713.65,428.19,Medicare,Medicare,,,,,713.65,,,,
CNTRST BTH-15MIN OT,97034,CPT,,,,,both,, ,514.74,308.84,Medicare,Medicare,,,,,514.74,,,,
CNTRST BTH-15MIN OT,97034,CPT,,,,,both,, ,514.74,308.84,Medicare,Medicare,,,,,514.74,,,,
CNTRST BTH-15MIN PT,97034,CPT,,,,,both,, ,40.17,24.1,Medicare,Medicare,,,,,40.17,,,,
CNTRST BTH-15MIN PT,97034,CPT,,,,,both,, ,40.17,24.1,Medicare,Medicare,,,,,40.17,,,,
CNTRST BTH-15MIN PT,97034,CPT,,,,,both,, ,40.17,24.1,Medicare,Medicare,,,,,40.17,,,,
CNTRST BTH-15MIN PT,97034,CPT,,,,,both,, ,40.17,24.1,Medicare,Medicare,,,,,40.17,,,,
CNTRST BTH-15MIN PT,97034,CPT,,,,,both,, ,474.83,284.89,Medicare,Medicare,,,,,474.83,,,,
CNTRST BTH-15MIN PT,97034,CPT,,,,,both,, ,474.83,284.89,Medicare,Medicare,,,,,474.83,,,,
CONTRAST BATH-15 MIN,97034,CPT,,,,,both,, ,443.25,265.95,Medicare,Medicare,,,,,443.25,,,,
CONTRAST BATH-15 MIN,97034,CPT,,,,,both,, ,480.51,288.3,Medicare,Medicare,,,,,480.51,,,,
ULTRASND-15 MIN OT,97035,CPT,,,,,both,, ,611.56,366.93,Medicare,Medicare,,,,,611.56,,,,
ULTRASND-15 MIN OT,97035,CPT,,,,,both,, ,611.56,366.93,Medicare,Medicare,,,,,611.56,,,,
ULTRASND-15 MIN PT,97035,CPT,,,,,both,, ,36.57,21.94,Medicare,Medicare,,,,,36.57,,,,
ULTRASND-15 MIN PT,97035,CPT,,,,,both,, ,36.57,21.94,Medicare,Medicare,,,,,36.57,,,,
ULTRASND-15 MIN PT,97035,CPT,,,,,both,, ,36.57,21.94,Medicare,Medicare,,,,,36.57,,,,
ULTRASND-15 MIN PT,97035,CPT,,,,,both,, ,36.57,21.94,Medicare,Medicare,,,,,36.57,,,,
ULTRASND-15 MIN PT,97035,CPT,,,,,both,, ,564.18,338.5,Medicare,Medicare,,,,,564.18,,,,
ULTRASND-15 MIN PT,97035,CPT,,,,,both,, ,564.18,338.5,Medicare,Medicare,,,,,564.18,,,,
ULTRASOUND-15 MIN,97035,CPT,,,,,both,, ,526.62,315.97,Medicare,Medicare,,,,,526.62,,,,
ULTRASOUND-15 MIN,97035,CPT,,,,,both,, ,570.95,342.57,Medicare,Medicare,,,,,570.95,,,,
"Physical therapy, therapeutic exercise .",97110,CPT,,,,,both,,,342.72,342.72,Medicare,Medicare,,342.72,,,342.72,342.72,342.72,fee schedule,Medicare APC Fee Schedule
THER EXRCS-15MIN OT,97110,CPT,,,,,both,, ,398.1,238.86,Medicare,Medicare,,,,,398.1,,,,
THER EXRCS-15MIN OT,97110,CPT,,,,,both,, ,398.1,238.86,Medicare,Medicare,,,,,398.1,,,,
THER EXRCS-15MIN PT,97110,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,,,,81.37,,,,
THER EXRCS-15MIN PT,97110,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,,,,81.37,,,,
THER EXRCS-15MIN PT,97110,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,,,,81.37,,,,
THER EXRCS-15MIN PT,97110,CPT,,,,,both,, ,81.37,48.82,Medicare,Medicare,,,,,81.37,,,,
THER EXRCS-15MIN PT,97110,CPT,,,,,both,, ,367.2,220.32,Medicare,Medicare,,,,,367.2,,,,
THER EXRCS-15MIN PT,97110,CPT,,,,,both,, ,367.2,220.32,Medicare,Medicare,,,,,367.2,,,,
THERAP EXERCS-15 MIN,97110,CPT,,,,,both,, ,342.72,205.63,Medicare,Medicare,,,,,342.72,,,,
THERAP EXERCS-15 MIN,97110,CPT,,,,,both,, ,371.55,222.93,Medicare,Medicare,,,,,371.55,,,,
NEUR RE-ED-15MIN OT,97112,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,,,,486.42,,,,
NEUR RE-ED-15MIN OT,97112,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,,,,486.42,,,,
NEUR RE-ED-15MIN PT,97112,CPT,,,,,both,, ,92.19,55.31,Medicare,Medicare,,,,,92.19,,,,
NEUR RE-ED-15MIN PT,97112,CPT,,,,,both,, ,92.19,55.31,Medicare,Medicare,,,,,92.19,,,,
NEUR RE-ED-15MIN PT,97112,CPT,,,,,both,, ,92.19,55.31,Medicare,Medicare,,,,,92.19,,,,
NEUR RE-ED-15MIN PT,97112,CPT,,,,,both,, ,92.19,55.31,Medicare,Medicare,,,,,92.19,,,,
NEUR RE-ED-15MIN PT,97112,CPT,,,,,both,, ,367.2,220.32,Medicare,Medicare,,,,,367.2,,,,
NEUR RE-ED-15MIN PT,97112,CPT,,,,,both,, ,367.2,220.32,Medicare,Medicare,,,,,367.2,,,,
NEURO RE-ED-15 MIN,97112,CPT,,,,,both,, ,342.72,205.63,Medicare,Medicare,,,,,342.72,,,,
NEURO RE-ED-15 MIN,97112,CPT,,,,,both,, ,454.13,272.47,Medicare,Medicare,,,,,454.13,,,,
GAIT TRAINING-15 MIN,97116,CPT,,,,,both,, ,342.72,205.63,Medicare,Medicare,,,,,342.72,,,,
GAIT TRAINING-15 MIN,97116,CPT,,,,,both,, ,454.13,272.47,Medicare,Medicare,,,,,454.13,,,,
GAIT TRNNG-15MIN OT,97116,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,,,,486.42,,,,
GAIT TRNNG-15MIN OT,97116,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,,,,486.42,,,,
GAIT TRNNG-15MIN PT,97116,CPT,,,,,both,, ,80.34,48.2,Medicare,Medicare,,,,,80.34,,,,
GAIT TRNNG-15MIN PT,97116,CPT,,,,,both,, ,80.34,48.2,Medicare,Medicare,,,,,80.34,,,,
GAIT TRNNG-15MIN PT,97116,CPT,,,,,both,, ,80.34,48.2,Medicare,Medicare,,,,,80.34,,,,
GAIT TRNNG-15MIN PT,97116,CPT,,,,,both,, ,80.34,48.2,Medicare,Medicare,,,,,80.34,,,,
GAIT TRNNG-15MIN PT,97116,CPT,,,,,both,, ,367.2,220.32,Medicare,Medicare,,,,,367.2,,,,
GAIT TRNNG-15MIN PT,97116,CPT,,,,,both,, ,367.2,220.32,Medicare,Medicare,,,,,367.2,,,,
MASSAGE THRPY-15 MIN,97124,CPT,,,,,both,, ,294.09,176.45,Medicare,Medicare,,,,,294.09,,,,
MASSAGE THRPY-15 MIN,97124,CPT,,,,,both,, ,318.84,191.3,Medicare,Medicare,,,,,318.84,,,,
MASSG THRPY-15MN OT,97124,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
MASSG THRPY-15MN OT,97124,CPT,,,,,both,, ,341.45,204.87,Medicare,Medicare,,,,,341.45,,,,
MASSG THRPY-15MN PT,97124,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,,,,74.93,,,,
MASSG THRPY-15MN PT,97124,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,,,,74.93,,,,
MASSG THRPY-15MN PT,97124,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,,,,74.93,,,,
MASSG THRPY-15MN PT,97124,CPT,,,,,both,, ,74.93,44.95,Medicare,Medicare,,,,,74.93,,,,
MASSG THRPY-15MN PT,97124,CPT,,,,,both,, ,314.92,188.95,Medicare,Medicare,,,,,314.92,,,,
MASSG THRPY-15MN PT,97124,CPT,,,,,both,, ,314.92,188.95,Medicare,Medicare,,,,,314.92,,,,
COG SKL DV IN15 COTA,97129,CPT,,,,,both,, ,398.1,238.86,Medicare,Medicare,,,,,398.1,,,,
COG SKL DV INI15 OT,97129,CPT,,,,,both,, ,398.1,238.86,Medicare,Medicare,,,,,398.1,,,,
COG SKL DV INI15 PT,97129,CPT,,,,,both,, ,84.46,50.67,Medicare,Medicare,,,,,84.46,,,,
COG SKL DV INI15 PT,97129,CPT,,,,,both,, ,84.46,50.67,Medicare,Medicare,,,,,84.46,,,,
COG SKL DV INI15 PT,97129,CPT,,,,,both,, ,84.46,50.67,Medicare,Medicare,,,,,84.46,,,,
COG SKL DV INI15 PT,97129,CPT,,,,,both,, ,84.46,50.67,Medicare,Medicare,,,,,84.46,,,,
COG SKL DV INI15 PT,97129,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,,,,448.57,,,,
COG SKL DV INI15 PT,97129,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,,,,448.57,,,,
COG SKL DV INI15 SP,97129,CPT,,,,,both,, ,398.1,238.86,Medicare,Medicare,,,,,398.1,,,,
COG SKL DV AD15 COTA,97130,CPT,,,,,both,, ,398.1,238.86,Medicare,Medicare,,,,,398.1,,,,
COG SKL DV ADD15 OT,97130,CPT,,,,,both,, ,398.1,238.86,Medicare,Medicare,,,,,398.1,,,,
COG SKL DV ADD15 PT,97130,CPT,,,,,both,, ,84.46,50.67,Medicare,Medicare,,,,,84.46,,,,
COG SKL DV ADD15 PT,97130,CPT,,,,,both,, ,84.46,50.67,Medicare,Medicare,,,,,84.46,,,,
COG SKL DV ADD15 PT,97130,CPT,,,,,both,, ,84.46,50.67,Medicare,Medicare,,,,,84.46,,,,
COG SKL DV ADD15 PT,97130,CPT,,,,,both,, ,84.46,50.67,Medicare,Medicare,,,,,84.46,,,,
COG SKL DV ADD15 PT,97130,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,,,,448.57,,,,
COG SKL DV ADD15 PT,97130,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,,,,448.57,,,,
COG SKL DV ADD15 SP,97130,CPT,,,,,both,, ,398.1,238.86,Medicare,Medicare,,,,,398.1,,,,
MANUAL THRPY-15 MIN,97140,CPT,,,,,both,, ,342.72,205.63,Medicare,Medicare,,,,,342.72,,,,
MANUAL THRPY-15 MIN,97140,CPT,,,,,both,, ,454.13,272.47,Medicare,Medicare,,,,,454.13,,,,
MNL THRPY-15 MIN OT,97140,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,,,,486.42,,,,
MNL THRPY-15 MIN OT,97140,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,,,,486.42,,,,
MNL THRPY-15 MIN PT,97140,CPT,,,,,both,, ,73.65,44.19,Medicare,Medicare,,,,,73.65,,,,
MNL THRPY-15 MIN PT,97140,CPT,,,,,both,, ,73.65,44.19,Medicare,Medicare,,,,,73.65,,,,
MNL THRPY-15 MIN PT,97140,CPT,,,,,both,, ,73.65,44.19,Medicare,Medicare,,,,,73.65,,,,
MNL THRPY-15 MIN PT,97140,CPT,,,,,both,, ,73.65,44.19,Medicare,Medicare,,,,,73.65,,,,
MNL THRPY-15 MIN PT,97140,CPT,,,,,both,, ,367.2,220.32,Medicare,Medicare,,,,,367.2,,,,
MNL THRPY-15 MIN PT,97140,CPT,,,,,both,, ,367.2,220.32,Medicare,Medicare,,,,,367.2,,,,
GROUP THRP PROC-VIST,97150,CPT,,,,,both,, ,341.23,204.73,Medicare,Medicare,,,,,341.23,,,,
GROUP THRP PROC-VIST,97150,CPT,,,,,both,, ,369.92,221.95,Medicare,Medicare,,,,,369.92,,,,
GRP THRP PRC-VST OT,97150,CPT,,,,,both,, ,396.29,237.77,Medicare,Medicare,,,,,396.29,,,,
GRP THRP PRC-VST OT,97150,CPT,,,,,both,, ,396.29,237.77,Medicare,Medicare,,,,,396.29,,,,
GRP THRP PRC-VST PT,97150,CPT,,,,,both,, ,48.67,29.2,Medicare,Medicare,,,,,48.67,,,,
GRP THRP PRC-VST PT,97150,CPT,,,,,both,, ,48.67,29.2,Medicare,Medicare,,,,,48.67,,,,
GRP THRP PRC-VST PT,97150,CPT,,,,,both,, ,48.67,29.2,Medicare,Medicare,,,,,48.67,,,,
GRP THRP PRC-VST PT,97150,CPT,,,,,both,, ,48.67,29.2,Medicare,Medicare,,,,,48.67,,,,
GRP THRP PRC-VST PT,97150,CPT,,,,,both,, ,365.65,219.39,Medicare,Medicare,,,,,365.65,,,,
GRP THRP PRC-VST PT,97150,CPT,,,,,both,, ,365.65,219.39,Medicare,Medicare,,,,,365.65,,,,
PT EVAL- LOW CMP PT,97161,CPT,,,,,both,, ,223.77,134.26,Medicare,Medicare,,,,,223.77,,,,
PT EVAL- LOW CMP PT,97161,CPT,,,,,both,, ,223.77,134.26,Medicare,Medicare,,,,,223.77,,,,
PT EVAL- LOW CMP PT,97161,CPT,,,,,both,, ,721,432.6,Medicare,Medicare,,,,,721,,,,
PT EVAL- LOW CMP PT,97161,CPT,,,,,both,, ,721,432.6,Medicare,Medicare,,,,,721,,,,
PT EVAL- LOW COMP,97161,CPT,,,,,both,, ,673.18,403.9,Medicare,Medicare,,,,,673.18,,,,
PT-EVAL LOW 15M MCD,97161,CPT,,,,,both,, ,700,420,Medicare,Medicare,,,,,700,,,,
PT EVAL- MOD CMP PT,97162,CPT,,,,,both,, ,223.77,134.26,Medicare,Medicare,,,,,223.77,,,,
PT EVAL- MOD CMP PT,97162,CPT,,,,,both,, ,223.77,134.26,Medicare,Medicare,,,,,223.77,,,,
PT EVAL- MOD CMP PT,97162,CPT,,,,,both,, ,360.5,216.3,Medicare,Medicare,,,,,360.5,,,,
PT EVAL- MOD CMP PT,97162,CPT,,,,,both,, ,360.5,216.3,Medicare,Medicare,,,,,360.5,,,,
PT EVAL- MOD COMP,97162,CPT,,,,,both,, ,673.18,403.9,Medicare,Medicare,,,,,673.18,,,,
PT-EVAL MOD 15M MCD,97162,CPT,,,,,both,, ,350,210,Medicare,Medicare,,,,,350,,,,
PT EVAL- HGH CMP PT,97163,CPT,,,,,both,, ,224.03,134.41,Medicare,Medicare,,,,,224.03,,,,
PT EVAL- HGH CMP PT,97163,CPT,,,,,both,, ,224.03,134.41,Medicare,Medicare,,,,,224.03,,,,
PT EVAL- HGH CMP PT,97163,CPT,,,,,both,, ,721,432.6,Medicare,Medicare,,,,,721,,,,
PT EVAL- HGH CMP PT,97163,CPT,,,,,both,, ,721,432.6,Medicare,Medicare,,,,,721,,,,
PT EVAL- HGH COMP,97163,CPT,,,,,both,, ,673.18,403.9,Medicare,Medicare,,,,,673.18,,,,
PT-EVAL HGH 15M MCD,97163,CPT,,,,,both,, ,233.25,139.95,Medicare,Medicare,,,,,233.25,,,,
PT RE-EVAL-VISIT,97164,CPT,,,,,both,, ,437.36,262.41,Medicare,Medicare,,,,,437.36,,,,
PT RE-EVAL-VISIT PT,97164,CPT,,,,,both,, ,151.41,90.84,Medicare,Medicare,,,,,151.41,,,,
PT RE-EVAL-VISIT PT,97164,CPT,,,,,both,, ,151.41,90.84,Medicare,Medicare,,,,,151.41,,,,
PT RE-EVAL-VISIT PT,97164,CPT,,,,,both,, ,468.39,281.03,Medicare,Medicare,,,,,468.39,,,,
PT RE-EVAL-VISIT PT,97164,CPT,,,,,both,, ,468.39,281.03,Medicare,Medicare,,,,,468.39,,,,
OT EVAL- LOW CMP OT,97165,CPT,,,,,both,, ,223.77,134.26,Medicare,Medicare,,,,,223.77,,,,
OT EVAL- LOW CMP OT,97165,CPT,,,,,both,, ,781.77,469.06,Medicare,Medicare,,,,,781.77,,,,
OT EVAL- LOW CMP OT,97165,CPT,,,,,both,, ,781.77,469.06,Medicare,Medicare,,,,,781.77,,,,
OT EVAL- LOW COMP,97165,CPT,,,,,both,, ,729.8,437.88,Medicare,Medicare,,,,,729.8,,,,
OT-EVAL LOW 15M MCD,97165,CPT,,,,,both,, ,100,60,Medicare,Medicare,,,,,100,,,,
OT-EVAL LOW 15M MCD,97165,CPT,,,,,both,, ,759,455.4,Medicare,Medicare,,,,,759,,,,
OT EVAL- MOD CMP OT,97166,CPT,,,,,both,, ,223.77,134.26,Medicare,Medicare,,,,,223.77,,,,
OT EVAL- MOD CMP OT,97166,CPT,,,,,both,, ,390.89,234.53,Medicare,Medicare,,,,,390.89,,,,
OT EVAL- MOD CMP OT,97166,CPT,,,,,both,, ,390.89,234.53,Medicare,Medicare,,,,,390.89,,,,
OT EVAL- MOD COMP,97166,CPT,,,,,both,, ,729.8,437.88,Medicare,Medicare,,,,,729.8,,,,
OT-EVAL MOD 15M MCD,97166,CPT,,,,,both,, ,100,60,Medicare,Medicare,,,,,100,,,,
OT-EVAL MOD 15M MCD,97166,CPT,,,,,both,, ,379.5,227.7,Medicare,Medicare,,,,,379.5,,,,
OT EVAL- HGH CMP OT,97167,CPT,,,,,both,, ,223.77,134.26,Medicare,Medicare,,,,,223.77,,,,
OT EVAL- HGH CMP OT,97167,CPT,,,,,both,, ,781.77,469.06,Medicare,Medicare,,,,,781.77,,,,
OT EVAL- HGH CMP OT,97167,CPT,,,,,both,, ,781.77,469.06,Medicare,Medicare,,,,,781.77,,,,
OT EVAL- HGH COMP,97167,CPT,,,,,both,, ,729.8,437.88,Medicare,Medicare,,,,,729.8,,,,
OT-EVAL HGH 15M MCD,97167,CPT,,,,,both,, ,100,60,Medicare,Medicare,,,,,100,,,,
OT-EVAL HGH 15M MCD,97167,CPT,,,,,both,, ,253,151.8,Medicare,Medicare,,,,,253,,,,
OT RE-EVAL VISIT OT,97168,CPT,,,,,both,, ,151.41,90.84,Medicare,Medicare,,,,,151.41,,,,
OT RE-EVAL VISIT OT,97168,CPT,,,,,both,, ,151.41,90.84,Medicare,Medicare,,,,,151.41,,,,
OT RE-EVAL VISIT OT,97168,CPT,,,,,both,, ,507.79,304.67,Medicare,Medicare,,,,,507.79,,,,
OT RE-EVAL VISIT OT,97168,CPT,,,,,both,, ,507.79,304.67,Medicare,Medicare,,,,,507.79,,,,
OT RE-EVAL-VISIT,97168,CPT,,,,,both,, ,474.13,284.47,Medicare,Medicare,,,,,474.13,,,,
THER ACTVT-15MIN OT,97530,CPT,,,,,both,, ,398.1,238.86,Medicare,Medicare,,,,,398.1,,,,
THER ACTVT-15MIN OT,97530,CPT,,,,,both,, ,398.1,238.86,Medicare,Medicare,,,,,398.1,,,,
THER ACTVT-15MIN PT,97530,CPT,,,,,both,, ,104.29,62.57,Medicare,Medicare,,,,,104.29,,,,
THER ACTVT-15MIN PT,97530,CPT,,,,,both,, ,104.29,62.57,Medicare,Medicare,,,,,104.29,,,,
THER ACTVT-15MIN PT,97530,CPT,,,,,both,, ,104.29,62.57,Medicare,Medicare,,,,,104.29,,,,
THER ACTVT-15MIN PT,97530,CPT,,,,,both,, ,104.29,62.57,Medicare,Medicare,,,,,104.29,,,,
THER ACTVT-15MIN PT,97530,CPT,,,,,both,, ,367.2,220.32,Medicare,Medicare,,,,,367.2,,,,
THER ACTVT-15MIN PT,97530,CPT,,,,,both,, ,367.2,220.32,Medicare,Medicare,,,,,367.2,,,,
THERAP ACTVTS-15 MIN,97530,CPT,,,,,both,, ,342.72,205.63,Medicare,Medicare,,,,,342.72,,,,
THERAP ACTVTS-15 MIN,97530,CPT,,,,,both,, ,371.55,222.93,Medicare,Medicare,,,,,371.55,,,,
SENS INTG-15 MIN,97533,CPT,,,,,both,, ,167.89,100.73,Medicare,Medicare,,,,,167.89,,,,
SENS INTG-15 MIN OT,97533,CPT,,,,,both,, ,90.13,54.07,Medicare,Medicare,,,,,90.13,,,,
SENS INTG-15 MIN OT,97533,CPT,,,,,both,, ,90.13,54.07,Medicare,Medicare,,,,,90.13,,,,
SENS INTG-15 MIN OT,97533,CPT,,,,,both,, ,687.27,412.36,Medicare,Medicare,,,,,687.27,,,,
SENS INTG-15 MIN OT,97533,CPT,,,,,both,, ,687.27,412.36,Medicare,Medicare,,,,,687.27,,,,
SENSORY INTEG-15 MIN,97533,CPT,,,,,both,, ,641.59,384.95,Medicare,Medicare,,,,,641.59,,,,
SELF CARE MGT-15 MIN,97535,CPT,,,,,both,, ,342.72,205.63,Medicare,Medicare,,,,,342.72,,,,
SELF CARE MGT-15 MIN,97535,CPT,,,,,both,, ,371.55,222.93,Medicare,Medicare,,,,,371.55,,,,
SLF CRE MGT-15MN OT,97535,CPT,,,,,both,, ,398.1,238.86,Medicare,Medicare,,,,,398.1,,,,
SLF CRE MGT-15MN OT,97535,CPT,,,,,both,, ,398.1,238.86,Medicare,Medicare,,,,,398.1,,,,
SLF CRE MGT-15MN PT,97535,CPT,,,,,both,, ,90.13,54.07,Medicare,Medicare,,,,,90.13,,,,
SLF CRE MGT-15MN PT,97535,CPT,,,,,both,, ,90.13,54.07,Medicare,Medicare,,,,,90.13,,,,
SLF CRE MGT-15MN PT,97535,CPT,,,,,both,, ,90.13,54.07,Medicare,Medicare,,,,,90.13,,,,
SLF CRE MGT-15MN PT,97535,CPT,,,,,both,, ,90.13,54.07,Medicare,Medicare,,,,,90.13,,,,
SLF CRE MGT-15MN PT,97535,CPT,,,,,both,, ,367.2,220.32,Medicare,Medicare,,,,,367.2,,,,
SLF CRE MGT-15MN PT,97535,CPT,,,,,both,, ,367.2,220.32,Medicare,Medicare,,,,,367.2,,,,
COM-WK REIN-15MN OT,97537,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,,,,486.42,,,,
COM-WK REIN-15MN OT,97537,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,,,,486.42,,,,
COM-WK REIN-15MN PT,97537,CPT,,,,,both,, ,86.78,52.06,Medicare,Medicare,,,,,86.78,,,,
COM-WK REIN-15MN PT,97537,CPT,,,,,both,, ,86.78,52.06,Medicare,Medicare,,,,,86.78,,,,
COM-WK REIN-15MN PT,97537,CPT,,,,,both,, ,86.78,52.06,Medicare,Medicare,,,,,86.78,,,,
COM-WK REIN-15MN PT,97537,CPT,,,,,both,, ,86.78,52.06,Medicare,Medicare,,,,,86.78,,,,
COM-WK REIN-15MN PT,97537,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,,,,448.57,,,,
COM-WK REIN-15MN PT,97537,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,,,,448.57,,,,
COM-WRK REINT-15 MIN,97537,CPT,,,,,both,, ,418.86,251.31,Medicare,Medicare,,,,,418.86,,,,
COM-WRK REINT-15 MIN,97537,CPT,,,,,both,, ,454.13,272.47,Medicare,Medicare,,,,,454.13,,,,
WHEELCHR MGT-15 MIN,97542,CPT,,,,,both,, ,418.86,251.31,Medicare,Medicare,,,,,418.86,,,,
WHEELCHR MGT-15 MIN,97542,CPT,,,,,both,, ,454.13,272.47,Medicare,Medicare,,,,,454.13,,,,
WHLCHR MGT-15 MIN OT,97542,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,,,,486.42,,,,
WHLCHR MGT-15 MIN OT,97542,CPT,,,,,both,, ,486.42,291.85,Medicare,Medicare,,,,,486.42,,,,
WHLCHR MGT-15 MIN PT,97542,CPT,,,,,both,, ,87.55,52.53,Medicare,Medicare,,,,,87.55,,,,
WHLCHR MGT-15 MIN PT,97542,CPT,,,,,both,, ,87.55,52.53,Medicare,Medicare,,,,,87.55,,,,
WHLCHR MGT-15 MIN PT,97542,CPT,,,,,both,, ,87.55,52.53,Medicare,Medicare,,,,,87.55,,,,
WHLCHR MGT-15 MIN PT,97542,CPT,,,,,both,, ,87.55,52.53,Medicare,Medicare,,,,,87.55,,,,
WHLCHR MGT-15 MIN PT,97542,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,,,,448.57,,,,
WHLCHR MGT-15 MIN PT,97542,CPT,,,,,both,, ,448.57,269.14,Medicare,Medicare,,,,,448.57,,,,
WK HR-CD 1ST 2HR OT,97545,CPT,,,,,both,, ,1215.92,729.55,Medicare,Medicare,,,,,1215.92,,,,
WK HR-CD 1ST 2HR OT,97545,CPT,,,,,both,, ,1215.92,729.55,Medicare,Medicare,,,,,1215.92,,,,
WK HR-CD 1ST 2HR PT,97545,CPT,,,,,both,, ,206,123.6,Medicare,Medicare,,,,,206,,,,
WK HR-CD 1ST 2HR PT,97545,CPT,,,,,both,, ,206,123.6,Medicare,Medicare,,,,,206,,,,
WK HR-CD 1ST 2HR PT,97545,CPT,,,,,both,, ,1121.67,673,Medicare,Medicare,,,,,1121.67,,,,
WK HR-CD 1ST 2HR PT,97545,CPT,,,,,both,, ,1121.67,673,Medicare,Medicare,,,,,1121.67,,,,
WK HR-CD 1ST 2HR PT,97545,CPT,,,,,both,, ,1121.67,673,Medicare,Medicare,,,,,1121.67,,,,
WK HR-CD 1ST 2HR PT,97545,CPT,,,,,both,, ,1121.67,673,Medicare,Medicare,,,,,1121.67,,,,
WRK HAR-CND 1ST 2HRS,97545,CPT,,,,,both,, ,1047.07,628.24,Medicare,Medicare,,,,,1047.07,,,,
WRK HAR-CND 1ST 2HRS,97545,CPT,,,,,both,, ,1135.14,681.08,Medicare,Medicare,,,,,1135.14,,,,
WRK HAR-CND-ADD HR,97546,CPT,,,,,both,, ,460.55,276.33,Medicare,Medicare,,,,,460.55,,,,
WRK HAR-CND-ADD HR,97546,CPT,,,,,both,, ,567.57,340.54,Medicare,Medicare,,,,,567.57,,,,
WRK HAR-CND-ADHR OT,97546,CPT,,,,,both,, ,607.96,364.77,Medicare,Medicare,,,,,607.96,,,,
WRK HAR-CND-ADHR OT,97546,CPT,,,,,both,, ,607.96,364.77,Medicare,Medicare,,,,,607.96,,,,
WRK HAR-CND-ADHR PT,97546,CPT,,,,,both,, ,103,61.8,Medicare,Medicare,,,,,103,,,,
WRK HAR-CND-ADHR PT,97546,CPT,,,,,both,, ,103,61.8,Medicare,Medicare,,,,,103,,,,
WRK HAR-CND-ADHR PT,97546,CPT,,,,,both,, ,103,61.8,Medicare,Medicare,,,,,103,,,,
WRK HAR-CND-ADHR PT,97546,CPT,,,,,both,, ,103,61.8,Medicare,Medicare,,,,,103,,,,
WRK HAR-CND-ADHR PT,97546,CPT,,,,,both,, ,493.37,296.02,Medicare,Medicare,,,,,493.37,,,,
WRK HAR-CND-ADHR PT,97546,CPT,,,,,both,, ,493.37,296.02,Medicare,Medicare,,,,,493.37,,,,
DEBRDE LE 20SQCM OT,97597,CPT,,,,,both,, ,731.82,439.09,Medicare,Medicare,,,,,731.82,,,,
DEBRDE LE 20SQCM OT,97597,CPT,,,,,both,, ,731.82,439.09,Medicare,Medicare,,,,,731.82,,,,
DEBRDE LE 20SQCM PT,97597,CPT,,,,,both,, ,447.54,268.52,Medicare,Medicare,,,,,447.54,,,,
DEBRDE LE 20SQCM PT,97597,CPT,,,,,both,, ,447.54,268.52,Medicare,Medicare,,,,,447.54,,,,
DEBRDE LE 20SQCM PT,97597,CPT,,,,,both,, ,447.54,268.52,Medicare,Medicare,,,,,447.54,,,,
DEBRDE LE 20SQCM PT,97597,CPT,,,,,both,, ,447.54,268.52,Medicare,Medicare,,,,,447.54,,,,
DEBRDE LE 20SQCM PT,97597,CPT,,,,,both,, ,675.17,405.1,Medicare,Medicare,,,,,675.17,,,,
DEBRDE LE 20SQCM PT,97597,CPT,,,,,both,, ,675.17,405.1,Medicare,Medicare,,,,,675.17,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,252.25,151.35,Medicare,Medicare,,,,,252.25,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,252.25,151.35,Medicare,Medicare,,,,,252.25,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,259.82,155.89,Medicare,Medicare,,,,,259.82,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,259.82,155.89,Medicare,Medicare,,,,,259.82,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,630.26,378.15,Medicare,Medicare,,,,,630.26,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,683.29,409.97,Medicare,Medicare,,,,,683.29,,,,
DEBRIDE LE 20 SQ CM,97597,CPT,,,,,both,, ,861.67,517,Medicare,Medicare,,,,,861.67,,,,
SLCTV WND DEB =<20CM,97597,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
DEBRDE EA AD20CM OT,97598,CPT,,,,,both,, ,450.63,270.37,Medicare,Medicare,,,,,450.63,,,,
DEBRDE EA AD20CM OT,97598,CPT,,,,,both,, ,450.63,270.37,Medicare,Medicare,,,,,450.63,,,,
DEBRDE EA AD20CM OT,97598,CPT,,,,,both,, ,488.48,293.08,Medicare,Medicare,,,,,488.48,,,,
DEBRDE EA AD20CM OT,97598,CPT,,,,,both,, ,488.48,293.08,Medicare,Medicare,,,,,488.48,,,,
DEBRDE EA AD20CM PT,97598,CPT,,,,,both,, ,450.63,270.37,Medicare,Medicare,,,,,450.63,,,,
DEBRDE EA AD20CM PT,97598,CPT,,,,,both,, ,450.63,270.37,Medicare,Medicare,,,,,450.63,,,,
DEBRDE EA AD20CM PT,97598,CPT,,,,,both,, ,450.63,270.37,Medicare,Medicare,,,,,450.63,,,,
DEBRDE EA AD20CM PT,97598,CPT,,,,,both,, ,450.63,270.37,Medicare,Medicare,,,,,450.63,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,252.25,151.35,Medicare,Medicare,,,,,252.25,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,252.25,151.35,Medicare,Medicare,,,,,252.25,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,259.82,155.89,Medicare,Medicare,,,,,259.82,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,259.82,155.89,Medicare,Medicare,,,,,259.82,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,420.57,252.34,Medicare,Medicare,,,,,420.57,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,455.94,273.56,Medicare,Medicare,,,,,455.94,,,,
DEBRIDE EA ADD 20CM,97598,CPT,,,,,both,, ,575.1,345.06,Medicare,Medicare,,,,,575.1,,,,
SLCTV WND DEB >20 CM,97598,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
DBRD NON-SEL-VIS OT,97602,CPT,,,,,both,, ,521.7,313.02,Medicare,Medicare,,,,,521.7,,,,
DBRD NON-SEL-VIS OT,97602,CPT,,,,,both,, ,521.7,313.02,Medicare,Medicare,,,,,521.7,,,,
DBRD NON-SEL-VIS PT,97602,CPT,,,,,both,, ,447.54,268.52,Medicare,Medicare,,,,,447.54,,,,
DBRD NON-SEL-VIS PT,97602,CPT,,,,,both,, ,447.54,268.52,Medicare,Medicare,,,,,447.54,,,,
DBRD NON-SEL-VIS PT,97602,CPT,,,,,both,, ,447.54,268.52,Medicare,Medicare,,,,,447.54,,,,
DBRD NON-SEL-VIS PT,97602,CPT,,,,,both,, ,447.54,268.52,Medicare,Medicare,,,,,447.54,,,,
DBRD NON-SEL-VIS PT,97602,CPT,,,,,both,, ,481.27,288.76,Medicare,Medicare,,,,,481.27,,,,
DBRD NON-SEL-VIS PT,97602,CPT,,,,,both,, ,481.27,288.76,Medicare,Medicare,,,,,481.27,,,,
DEBRIDE NON-SELC-VIS,97602,CPT,,,,,both,, ,449.32,269.59,Medicare,Medicare,,,,,449.32,,,,
DEBRIDE NON-SELC-VIS,97602,CPT,,,,,both,, ,487.13,292.27,Medicare,Medicare,,,,,487.13,,,,
NON SELECTIVE DEBRID,97602,CPT,,,,,both,, ,158.11,94.86,Medicare,Medicare,,,,,158.11,,,,
NON SELECTIVE DEBRID,97602,CPT,,,,,both,, ,158.11,94.86,Medicare,Medicare,,,,,158.11,,,,
NSW DEB WO A/SESSION,97602,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,146.78,88.06,Medicare,Medicare,,,,,146.78,,,,
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,158.11,94.86,Medicare,Medicare,,,,,158.11,,,,
NEG PRES WND LT 50CM,97605,CPT,,,,,both,, ,158.11,94.86,Medicare,Medicare,,,,,158.11,,,,
NEG PRESS WND TX <50,97605,CPT,,,,,both,, ,763,457.8,Medicare,Medicare,,,,,763,,,,
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,241.28,144.76,Medicare,Medicare,,,,,241.28,,,,
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,259.82,155.89,Medicare,Medicare,,,,,259.82,,,,
NEG PRES WND GT 50CM,97606,CPT,,,,,both,, ,259.82,155.89,Medicare,Medicare,,,,,259.82,,,,
NEG PRESS WND TX >50,97606,CPT,,,,,both,, ,1520,912,Medicare,Medicare,,,,,1520,,,,
NEG PR WN MD LT 50CM,97607,CPT,,,,,both,, ,463.24,277.94,Medicare,Medicare,,,,,463.24,,,,
NEG PR WN MD LT 50CM,97607,CPT,,,,,both,, ,463.24,277.94,Medicare,Medicare,,,,,463.24,,,,
NEG PRES WND TX <=50,97607,CPT,,,,,both,, ,1520,912,Medicare,Medicare,,,,,1520,,,,
NEG PR WN MD GT 50CM,97608,CPT,,,,,both,, ,919.79,551.87,Medicare,Medicare,,,,,919.79,,,,
PHYS PERF-15 MIN OT,97750,CPT,,,,,both,, ,1014.55,608.73,Medicare,Medicare,,,,,1014.55,,,,
PHYS PERF-15 MIN OT,97750,CPT,,,,,both,, ,1014.55,608.73,Medicare,Medicare,,,,,1014.55,,,,
PHYS PERF-15 MIN PT,97750,CPT,,,,,both,, ,91.93,55.15,Medicare,Medicare,,,,,91.93,,,,
PHYS PERF-15 MIN PT,97750,CPT,,,,,both,, ,91.93,55.15,Medicare,Medicare,,,,,91.93,,,,
PHYS PERF-15 MIN PT,97750,CPT,,,,,both,, ,91.93,55.15,Medicare,Medicare,,,,,91.93,,,,
PHYS PERF-15 MIN PT,97750,CPT,,,,,both,, ,91.93,55.15,Medicare,Medicare,,,,,91.93,,,,
PHYS PERF-15 MIN PT,97750,CPT,,,,,both,, ,936.01,561.6,Medicare,Medicare,,,,,936.01,,,,
PHYS PERF-15 MIN PT,97750,CPT,,,,,both,, ,936.01,561.6,Medicare,Medicare,,,,,936.01,,,,
PHYSICAL PERF-15 MIN,97750,CPT,,,,,both,, ,873.68,524.2,Medicare,Medicare,,,,,873.68,,,,
PHYSICAL PERF-15 MIN,97750,CPT,,,,,both,, ,947.11,568.26,Medicare,Medicare,,,,,947.11,,,,
ORTH TRAIN INI-15 MI,97760,CPT,,,,,both,, ,342.72,205.63,Medicare,Medicare,,,,,342.72,,,,
ORTH TRAIN INI-15 MI,97760,CPT,,,,,both,, ,371.55,222.93,Medicare,Medicare,,,,,371.55,,,,
ORTH TRN INI15MI OT,97760,CPT,,,,,both,, ,398.1,238.86,Medicare,Medicare,,,,,398.1,,,,
ORTH TRN INI15MI OT,97760,CPT,,,,,both,, ,398.1,238.86,Medicare,Medicare,,,,,398.1,,,,
ORTH TRN INI15MI PT,97760,CPT,,,,,both,, ,124.12,74.47,Medicare,Medicare,,,,,124.12,,,,
ORTH TRN INI15MI PT,97760,CPT,,,,,both,, ,124.12,74.47,Medicare,Medicare,,,,,124.12,,,,
ORTH TRN INI15MI PT,97760,CPT,,,,,both,, ,124.12,74.47,Medicare,Medicare,,,,,124.12,,,,
ORTH TRN INI15MI PT,97760,CPT,,,,,both,, ,124.12,74.47,Medicare,Medicare,,,,,124.12,,,,
ORTH TRN INI15MI PT,97760,CPT,,,,,both,, ,367.2,220.32,Medicare,Medicare,,,,,367.2,,,,
ORTH TRN INI15MI PT,97760,CPT,,,,,both,, ,367.2,220.32,Medicare,Medicare,,,,,367.2,,,,
PROS TRAIN INI-15 MI,97761,CPT,,,,,both,, ,342.72,205.63,Medicare,Medicare,,,,,342.72,,,,
PROS TRAIN INI-15 MI,97761,CPT,,,,,both,, ,371.55,222.93,Medicare,Medicare,,,,,371.55,,,,
PROS TRN INI15MI OT,97761,CPT,,,,,both,, ,398.1,238.86,Medicare,Medicare,,,,,398.1,,,,
PROS TRN INI15MI OT,97761,CPT,,,,,both,, ,398.1,238.86,Medicare,Medicare,,,,,398.1,,,,
PROS TRN INI15MI PT,97761,CPT,,,,,both,, ,107.38,64.42,Medicare,Medicare,,,,,107.38,,,,
PROS TRN INI15MI PT,97761,CPT,,,,,both,, ,107.38,64.42,Medicare,Medicare,,,,,107.38,,,,
PROS TRN INI15MI PT,97761,CPT,,,,,both,, ,107.38,64.42,Medicare,Medicare,,,,,107.38,,,,
PROS TRN INI15MI PT,97761,CPT,,,,,both,, ,107.38,64.42,Medicare,Medicare,,,,,107.38,,,,
PROS TRN INI15MI PT,97761,CPT,,,,,both,, ,367.2,220.32,Medicare,Medicare,,,,,367.2,,,,
PROS TRN INI15MI PT,97761,CPT,,,,,both,, ,367.2,220.32,Medicare,Medicare,,,,,367.2,,,,
PROS-ORTH SUB-15 MIN,97763,CPT,,,,,both,, ,318.29,190.97,Medicare,Medicare,,,,,318.29,,,,
PROS-ORTH SUB-15 MIN,97763,CPT,,,,,both,, ,358.85,215.31,Medicare,Medicare,,,,,358.85,,,,
PRS-ORT SUB-15MN OT,97763,CPT,,,,,both,, ,340.93,204.55,Medicare,Medicare,,,,,340.93,,,,
PRS-ORT SUB-15MN OT,97763,CPT,,,,,both,, ,340.93,204.55,Medicare,Medicare,,,,,340.93,,,,
PRS-ORT SUB-15MN PT,97763,CPT,,,,,both,, ,131.07,78.64,Medicare,Medicare,,,,,131.07,,,,
PRS-ORT SUB-15MN PT,97763,CPT,,,,,both,, ,131.07,78.64,Medicare,Medicare,,,,,131.07,,,,
PRS-ORT SUB-15MN PT,97763,CPT,,,,,both,, ,131.07,78.64,Medicare,Medicare,,,,,131.07,,,,
PRS-ORT SUB-15MN PT,97763,CPT,,,,,both,, ,131.07,78.64,Medicare,Medicare,,,,,131.07,,,,
PRS-ORT SUB-15MN PT,97763,CPT,,,,,both,, ,384.45,230.67,Medicare,Medicare,,,,,384.45,,,,
PRS-ORT SUB-15MN PT,97763,CPT,,,,,both,, ,384.45,230.67,Medicare,Medicare,,,,,384.45,,,,
MNT INITIAL EA 15 MN,97802,CPT,,,,,both,, ,194.41,116.64,Medicare,Medicare,,,,,194.41,,,,
MNT REASSES EA 15 MN,97803,CPT,,,,,both,, ,101.46,60.87,Medicare,Medicare,,,,,101.46,,,,
MNT GROUP EA 30 MIN,97804,CPT,,,,,both,, ,223.25,133.95,Medicare,Medicare,,,,,223.25,,,,
LAB COLLECTION,99000,CPT,,,,,both,, ,70,42,Medicare,Medicare,,,,,70,,,,
SPEC CHAIN CUSTODY,99001,CPT,,,,,both,, ,21.33,12.79,Medicare,Medicare,,,,,21.33,,,,
MSED SAMEGT5 1ST15,99152,CPT,,,,,both,, ,313.38,188.02,Medicare,Medicare,,,,,313.38,,,,
MODSED SAME ADD15MIN,99153,CPT,,,,,both,, ,417.92,250.75,Medicare,Medicare,,,,,417.92,,,,
HBO COMM PER SESSION,99183,CPT,,,,,both,, ,990.13,594.07,Medicare,Medicare,,,,,990.13,,,,
PHLEBOTOMY THERAPEUT,99195,CPT,,,,,both,, ,266.77,160.06,Medicare,Medicare,,,,,266.77,,,,
BRIEF ED VISIT,99281,CPT,,,,,Outpatient,, ,1098.28,658.96,Medicare,Medicare,,,,,1098.28,,,,
BRIEF ED VISIT,99281,CPT,,,,,Outpatient,, ,1098.28,658.96,Medicare,Medicare,,,,,1098.28,,,,
LIMITED ED VISIT,99282,CPT,,,,,Outpatient,, ,1925.14,1155.08,Medicare,Medicare,,,,,1925.14,,,,
INTERMEDIATE ED VIST,99283,CPT,,,,,Outpatient,, ,3494.12,2096.47,Medicare,Medicare,,,,,3494.12,,,,
EXTENDED ED VISIT,99284,CPT,,,,,Outpatient,, ,6509.13,3905.47,Medicare,Medicare,,,,,6509.13,,,,
COMPREHENSIVE ED VST,99285,CPT,,,,,Outpatient,, ,8592.58,5155.54,Medicare,Medicare,,,,,8592.58,,,,
CRITICAL CARE LT 74M,99291,CPT,,,,,both,, ,12285.42,7371.25,Medicare,Medicare,,,,,12285.42,,,,
CRIT CARE EA 30 MIN,99292,CPT,,,,,both,, ,4418.38,2651.02,Medicare,Medicare,,,,,4418.38,,,,
BEHAV CHG SMOKE U 10,99406,CPT,,,,,both,, ,127.46,76.47,Medicare,Medicare,,,,,127.46,,,,
BEHAV CHG SMOKE GR10,99407,CPT,,,,,both,, ,127.46,76.47,Medicare,Medicare,,,,,127.46,,,,
NEWBORN RESUCITATION,99465,CPT,,,,,both,, ,2447.28,1468.36,Medicare,Medicare,,,,,2447.28,,,,
RESPIRATORY PANEL PCR,0202U,HCPCS,,,,,both,, ,500,300,Medicare,Medicare,,,,,500,,,,
COV19 FLUAB CEPHEID,0240U,CPT,,,,,both,, ,568,340.8,Medicare,Medicare,,,,,568,,,,
COV19 FLUAB RSV CEPH,0241U,CPT,,,,,both,, ,570.52,342.31,Medicare,Medicare,,,,,570.52,,,,
MVP MULTIPLEX VAGINAL DNA PROBE,0352U,HCPCS,,,,,both,, ,570.52,342.31,Medicare,Medicare,,,,,570.52,,,,
INTRATUBAL OCCLU DEV,A4264,HCPCS,,,,,both,, ,8176.4,4905.84,Medicare,Medicare,,,,,8176.4,,,,
TISSUE MARKR IMPLT 1,A4648,HCPCS,,,,,both,, ,179.22,107.53,Medicare,Medicare,,,,,179.22,,,,
TISSUE MARKR IMPLT 2,A4648,HCPCS,,,,,both,, ,1195.32,717.19,Medicare,Medicare,,,,,1195.32,,,,
TISSUE MARKR IMPLT 3,A4648,HCPCS,,,,,both,, ,2390.63,1434.37,Medicare,Medicare,,,,,2390.63,,,,
COLLAGEN WITH SILVER (PUROCOL),A6022,HCPCS,,,,,both,, ,28.28,16.96,Medicare,Medicare,,,,,28.28,,,,
ENDOFORM ANTIMICROBIAL,A6022,HCPCS,,,,,both,, ,41.56,24.93,Medicare,Medicare,,,,,41.56,,,,
COLLAGEN (PUROCOL),A6023,HCPCS,,,,,both,, ,19.8,11.88,Medicare,Medicare,,,,,19.8,,,,
CONVAMAX PAD 4X4,A6196,HCPCS,,,,,both,, ,7.68,4.6,Medicare,Medicare,,,,,7.68,,,,
CONVAMAX PAD 4X8,A6197,HCPCS,,,,,both,, ,8.88,5.32,Medicare,Medicare,,,,,8.88,,,,
CONVAMAX PAD 6X8,A6197,HCPCS,,,,,both,, ,11.76,7.05,Medicare,Medicare,,,,,11.76,,,,
DRSG GRMCDL 45X2CM AQCL AG MIC,A6197,HCPCS,,,,,both,, ,36.48,21.88,Medicare,Medicare,,,,,36.48,,,,
DRSG GRMCDL 4X5IN AQCL AG,A6197,HCPCS,,,,,both,, ,31.04,18.62,Medicare,Medicare,,,,,31.04,,,,
DRSG WND 5X4IN SQ AQCL X HDRFB,A6198,HCPCS,,,,,both,, ,11.16,6.69,Medicare,Medicare,,,,,11.16,,,,
DRSG ALG 18X.75IN AQCL HDRFB,A6199,HCPCS,,,,,both,, ,14.12,8.47,Medicare,Medicare,,,,,14.12,,,,
HYDROFERA BLUE TRANSFER 5X4,A6210,HCPCS,,,,,both,, ,24.12,14.47,Medicare,Medicare,,,,,24.12,,,,
4X4 AQUACEL FOAM NO ADHESIVE,A6211,HCPCS,,,,,both,, ,7.48,4.48,Medicare,Medicare,,,,,7.48,,,,
"DRESSING,ALLEVYN,SACRUM,SMALL",A6212,HCPCS,,,,,both,, ,21.96,13.17,Medicare,Medicare,,,,,21.96,,,,
DRSG LG QUADRILOBE 6 1/16INX6,A6212,HCPCS,,,,,both,, ,11.48,6.88,Medicare,Medicare,,,,,11.48,,,,
"HEEL,LIFE,ALLEVYN",A6212,HCPCS,,,,,both,, ,29.16,17.49,Medicare,Medicare,,,,,29.16,,,,
DRSG MED QUADRILOBE 5 1/16INX5,A6213,HCPCS,,,,,both,, ,9.8,5.88,Medicare,Medicare,,,,,9.8,,,,
SACRAL AQUACEL FOAM WITH ADHESIVE,A6213,HCPCS,,,,,both,, ,17.32,10.39,Medicare,Medicare,,,,,17.32,,,,
4X4 AQUACEL FOAM WITH ADHESIVE,A6214,HCPCS,,,,,both,, ,8.12,4.87,Medicare,Medicare,,,,,8.12,,,,
DUODERM THIN 4X2,A6237,HCPCS,,,,,both,, ,4.8,2.88,Medicare,Medicare,,,,,4.8,,,,
DUODERM THIN 4X4,A6238,HCPCS,,,,,both,, ,4.12,2.47,Medicare,Medicare,,,,,4.12,,,,
TRIAD CREAM 2.5 OUNCES,A6240,HCPCS,,,,,both,, ,3.64,2.18,Medicare,Medicare,,,,,3.64,,,,
HYDROGEL,A6248,HCPCS,,,,,both,, ,16.76,10.05,Medicare,Medicare,,,,,16.76,,,,
NO-RINSE FOAM CLEANSER,A6250,HCPCS,,,,,both,, ,7.96,4.77,Medicare,Medicare,,,,,7.96,,,,
ABD PADS 5X9,A6252,HCPCS,,,,,both,, ,0.32,0.19,Medicare,Medicare,,,,,0.32,,,,
ABD PADS 8X10,A6253,HCPCS,,,,,both,, ,0.48,0.28,Medicare,Medicare,,,,,0.48,,,,
IODOFORM PACKING 1 INCH,A6266,HCPCS,,,,,both,, ,8.76,5.25,Medicare,Medicare,,,,,8.76,,,,
IODOFORM PACKING 1/2 INCH,A6266,HCPCS,,,,,both,, ,6.84,4.1,Medicare,Medicare,,,,,6.84,,,,
IODOFORM PACKING 1/4 INCH,A6266,HCPCS,,,,,both,, ,6.56,3.93,Medicare,Medicare,,,,,6.56,,,,
STERILE 2X2 GAUZE,A6402,HCPCS,,,,,both,, ,0.08,0.04,Medicare,Medicare,,,,,0.08,,,,
STERILE 4X4 GAUZE,A6402,HCPCS,,,,,both,, ,0.16,0.09,Medicare,Medicare,,,,,0.16,,,,
PLAIN PACKING 1 INCH,A6407,HCPCS,,,,,both,, ,6.88,4.12,Medicare,Medicare,,,,,6.88,,,,
PLAIN PACKING 1/2 INCH,A6407,HCPCS,,,,,both,, ,6.28,3.76,Medicare,Medicare,,,,,6.28,,,,
PLAIN PACKING 1/4 INCH,A6407,HCPCS,,,,,both,, ,6.4,3.84,Medicare,Medicare,,,,,6.4,,,,
ACE WRAP 4 INCH,A6449,HCPCS,,,,,both,, ,1.64,0.98,Medicare,Medicare,,,,,1.64,,,,
ACE WRAP 6 INCH,A6450,HCPCS,,,,,both,, ,2.4,1.44,Medicare,Medicare,,,,,2.4,,,,
ZINC PASTE TUBES,A6456,HCPCS,,,,,both,, ,8.44,5.06,Medicare,Medicare,,,,,8.44,,,,
PICO DRESSING KIT,A9272,HCPCS,,,,,both,, ,3547.64,2128.58,Medicare,Medicare,,,,,3547.64,,,,
TC-99M SESTA / DOSE,A9500,HCPCS,,,,,both,, ,551.05,330.63,Medicare,Medicare,,,,,551.05,,,,
TC-99M TETRO/UNITDOS,A9502,HCPCS,,,,,both,, ,347.11,208.26,Medicare,Medicare,,,,,347.11,,,,
TC99M MEDRO TO 30MCI,A9503,HCPCS,,,,,both,, ,69.78,41.86,Medicare,Medicare,,,,,69.78,,,,
"TL-201, PER MCI",A9505,HCPCS,,,,,both,, ,95.53,57.31,Medicare,Medicare,,,,,95.53,,,,
TC99M PERTECHNET/MCI,A9512,HCPCS,,,,,both,, ,81.89,49.13,Medicare,Medicare,,,,,81.89,,,,
"I123 CAP,DX /100UCI",A9516,HCPCS,,,,,both,, ,312.35,187.41,Medicare,Medicare,,,,,312.35,,,,
TC99 TILMAN DX .5MCI,A9520,HCPCS,,,,,both,, ,2305.66,1383.39,Medicare,Medicare,,,,,2305.66,,,,
TC99M EXAME / DOSE,A9521,HCPCS,,,,,both,, ,17205.64,10323.38,Medicare,Medicare,,,,,17205.64,,,,
TC99M MEBROF /15MCI,A9537,HCPCS,,,,,both,, ,170.47,102.28,Medicare,Medicare,,,,,170.47,,,,
TC99M PYROPHOS/25MCI,A9538,HCPCS,,,,,both,, ,235.61,141.36,Medicare,Medicare,,,,,235.61,,,,
TC99M PENTETAT/25MCI,A9539,HCPCS,,,,,both,, ,69.78,41.86,Medicare,Medicare,,,,,69.78,,,,
TC99M MAA/10MCI,A9540,HCPCS,,,,,both,, ,62.83,37.69,Medicare,Medicare,,,,,62.83,,,,
TC99M SULF COL/20MCI,A9541,HCPCS,,,,,both,, ,83.17,49.9,Medicare,Medicare,,,,,83.17,,,,
TC99M SULFCOL2/20MCI,A9541,HCPCS,,,,,both,, ,529.68,317.8,Medicare,Medicare,,,,,529.68,,,,
IN111 PENTETAT/.5MCI,A9548,HCPCS,,,,,both,, ,12525.06,7515.03,Medicare,Medicare,,,,,12525.06,,,,
GA67 GALLIUM/MCI,A9556,HCPCS,,,,,both,, ,102.23,61.33,Medicare,Medicare,,,,,102.23,,,,
XE133 XENON 10MCI,A9558,HCPCS,,,,,both,, ,264.2,158.52,Medicare,Medicare,,,,,264.2,,,,
TC99M LABL RBC/30MCI,A9560,HCPCS,,,,,both,, ,69.78,41.86,Medicare,Medicare,,,,,69.78,,,,
TC99M OXIDRONA/30MCI,A9561,HCPCS,,,,,both,, ,148.84,89.3,Medicare,Medicare,,,,,148.84,,,,
TC99M MERTIATI/15MCI,A9562,HCPCS,,,,,both,, ,938.33,562.99,Medicare,Medicare,,,,,938.33,,,,
TC99M AEROSOL 75 MCI,A9567,HCPCS,,,,,both,, ,69.78,41.86,Medicare,Medicare,,,,,69.78,,,,
IN-111 PENTETRE/6MCI,A9572,HCPCS,,,,,both,, ,14752.18,8851.3,Medicare,Medicare,,,,,14752.18,,,,
INJ GADO DIMEG ML 15,A9577,HCPCS,,,,,both,15,ML,13.75,8.25,Medicare,Medicare,,,,,13.75,,,,
INJ GADO DIMEG ML 20,A9577,HCPCS,,,,,both,20,ML,13.75,8.25,Medicare,Medicare,,,,,13.75,,,,
INJ MULTIHANCE /ML,A9577,HCPCS,,,,,both,, ,14.16,8.49,Medicare,Medicare,,,,,14.16,,,,
INJ MULTIHANCE/ ML,A9577,HCPCS,,,,,both,, ,13.75,8.25,Medicare,Medicare,,,,,13.75,,,,
INJ GAD-MR1 CONTR ML,A9579,HCPCS,,,,,both,, ,37.6,22.56,Medicare,Medicare,,,,,37.6,,,,
INJ GAD-MR2 CONTR ML,A9579,HCPCS,,,,,both,, ,47.9,28.74,Medicare,Medicare,,,,,47.9,,,,
INJ GAD-MR3 CONTR ML,A9579,HCPCS,,,,,both,, ,40.94,24.56,Medicare,Medicare,,,,,40.94,,,,
ANCHOR/SCRW LEVEL 1,C1713,HCPCS,,,,,both,, ,129.01,77.4,Medicare,Medicare,,,,,129.01,,,,
ANCHOR/SCRW LEVEL 10,C1713,HCPCS,,,,,both,, ,2873.7,1724.22,Medicare,Medicare,,,,,2873.7,,,,
ANCHOR/SCRW LEVEL 11,C1713,HCPCS,,,,,both,, ,4069.02,2441.41,Medicare,Medicare,,,,,4069.02,,,,
ANCHOR/SCRW LEVEL 12,C1713,HCPCS,,,,,both,, ,4786.15,2871.69,Medicare,Medicare,,,,,4786.15,,,,
ANCHOR/SCRW LEVEL 13,C1713,HCPCS,,,,,both,, ,6684.19,4010.51,Medicare,Medicare,,,,,6684.19,,,,
ANCHOR/SCRW LEVEL 14,C1713,HCPCS,,,,,both,, ,9567.67,5740.6,Medicare,Medicare,,,,,9567.67,,,,
ANCHOR/SCRW LEVEL 15,C1713,HCPCS,,,,,both,, ,14349.19,8609.51,Medicare,Medicare,,,,,14349.19,,,,
ANCHOR/SCRW LEVEL 16,C1713,HCPCS,,,,,both,, ,19130.71,11478.42,Medicare,Medicare,,,,,19130.71,,,,
ANCHOR/SCRW LEVEL 17,C1713,HCPCS,,,,,both,, ,23912.22,14347.33,Medicare,Medicare,,,,,23912.22,,,,
ANCHOR/SCRW LEVEL 18,C1713,HCPCS,,,,,both,, ,31084.37,18650.62,Medicare,Medicare,,,,,31084.37,,,,
ANCHOR/SCRW LEVEL 19,C1713,HCPCS,,,,,both,, ,38256.78,22954.06,Medicare,Medicare,,,,,38256.78,,,,
ANCHOR/SCRW LEVEL 2,C1713,HCPCS,,,,,both,, ,172.01,103.2,Medicare,Medicare,,,,,172.01,,,,
ANCHOR/SCRW LEVEL 20,C1713,HCPCS,,,,,both,, ,47814.92,28688.95,Medicare,Medicare,,,,,47814.92,,,,
ANCHOR/SCRW LEVEL 21,C1713,HCPCS,,,,,both,, ,57377.95,34426.77,Medicare,Medicare,,,,,57377.95,,,,
ANCHOR/SCRW LEVEL 3,C1713,HCPCS,,,,,both,, ,243.85,146.31,Medicare,Medicare,,,,,243.85,,,,
ANCHOR/SCRW LEVEL 4,C1713,HCPCS,,,,,both,, ,411.23,246.73,Medicare,Medicare,,,,,411.23,,,,
ANCHOR/SCRW LEVEL 5,C1713,HCPCS,,,,,both,, ,602.55,361.53,Medicare,Medicare,,,,,602.55,,,,
ANCHOR/SCRW LEVEL 6,C1713,HCPCS,,,,,both,, ,841.51,504.9,Medicare,Medicare,,,,,841.51,,,,
ANCHOR/SCRW LEVEL 7,C1713,HCPCS,,,,,both,, ,1200.21,720.12,Medicare,Medicare,,,,,1200.21,,,,
ANCHOR/SCRW LEVEL 8,C1713,HCPCS,,,,,both,, ,1678.39,1007.03,Medicare,Medicare,,,,,1678.39,,,,
ANCHOR/SCRW LEVEL 9,C1713,HCPCS,,,,,both,, ,2156.56,1293.93,Medicare,Medicare,,,,,2156.56,,,,
BONE CEMENT 1,C1713,HCPCS,,,,,both,, ,884.51,530.7,Medicare,Medicare,,,,,884.51,,,,
BONE CEMENT 2,C1713,HCPCS,,,,,both,, ,2467.37,1480.42,Medicare,Medicare,,,,,2467.37,,,,
CATH TRNS ARTHR DIR1,C1714,HCPCS,,,,,both,, ,5379.18,3227.5,Medicare,Medicare,,,,,5379.18,,,,
CATH TRNS ARTHR DIR2,C1714,HCPCS,,,,,both,, ,8391.41,5034.84,Medicare,Medicare,,,,,8391.41,,,,
AICD DUAL CHAMBER L1,C1721,HCPCS,,,,,both,, ,93836.86,56302.11,Medicare,Medicare,,,,,93836.86,,,,
AICD SINGLE CHAMBER1,C1722,HCPCS,,,,,both,, ,99999,59999.4,Medicare,Medicare,,,,,99999,,,,
CATH TRNS ARTHR ROT1,C1724,HCPCS,,,,,both,, ,5379.18,3227.5,Medicare,Medicare,,,,,5379.18,,,,
CATH TRNS ARTHR ROT2,C1724,HCPCS,,,,,both,, ,16735.18,10041.1,Medicare,Medicare,,,,,16735.18,,,,
CATH-ANGIO LEVEL 1,C1725,HCPCS,,,,,both,, ,855.42,513.25,Medicare,Medicare,,,,,855.42,,,,
CATH-ANGIO LEVEL 2,C1725,HCPCS,,,,,both,, ,1728.86,1037.31,Medicare,Medicare,,,,,1728.86,,,,
CATH-ANGIO LEVEL 3,C1725,HCPCS,,,,,both,, ,2726.15,1635.69,Medicare,Medicare,,,,,2726.15,,,,
CATH-ANGIO LEVEL 4,C1725,HCPCS,,,,,both,, ,4234.59,2540.75,Medicare,Medicare,,,,,4234.59,,,,
CATH-ANGIO LEVEL 5,C1725,HCPCS,,,,,both,, ,6331.93,3799.15,Medicare,Medicare,,,,,6331.93,,,,
CATH BAL DIL NONVAS1,C1726,HCPCS,,,,,both,, ,1434.53,860.71,Medicare,Medicare,,,,,1434.53,,,,
CATH BAL DIL NONVAS2,C1726,HCPCS,,,,,both,, ,2390.63,1434.37,Medicare,Medicare,,,,,2390.63,,,,
CATH BRACHY SEED AD1,C1728,HCPCS,,,,,both,, ,717.14,430.28,Medicare,Medicare,,,,,717.14,,,,
CATH BRACHY SEED AD2,C1728,HCPCS,,,,,both,, ,956.36,573.81,Medicare,Medicare,,,,,956.36,,,,
CATH DRAINAG LEVEL11,C1729,HCPCS,,,,,both,, ,11958.56,7175.13,Medicare,Medicare,,,,,11958.56,,,,
CATH-DRAINAG LEVEL 1,C1729,HCPCS,,,,,both,, ,84.2,50.52,Medicare,Medicare,,,,,84.2,,,,
CATH-DRAINAG LEVEL 2,C1729,HCPCS,,,,,both,, ,247.72,148.63,Medicare,Medicare,,,,,247.72,,,,
CATH-DRAINAG LEVEL 3,C1729,HCPCS,,,,,both,, ,727.18,436.3,Medicare,Medicare,,,,,727.18,,,,
CATH-DRAINAG LEVEL 4,C1729,HCPCS,,,,,both,, ,1200.21,720.12,Medicare,Medicare,,,,,1200.21,,,,
CATH-DRAINAG LEVEL 5,C1729,HCPCS,,,,,both,, ,1917.35,1150.41,Medicare,Medicare,,,,,1917.35,,,,
CATH-DRAINAG LEVEL 6,C1729,HCPCS,,,,,both,, ,2634.48,1580.68,Medicare,Medicare,,,,,2634.48,,,,
CATH-DRAINAG LEVEL 7,C1729,HCPCS,,,,,both,, ,3351.88,2011.12,Medicare,Medicare,,,,,3351.88,,,,
CATH-DRAINAG LEVEL 8,C1729,HCPCS,,,,,both,, ,4786.15,2871.69,Medicare,Medicare,,,,,4786.15,,,,
CATH-DRAINAG LEVEL 9,C1729,HCPCS,,,,,both,, ,7177.04,4306.22,Medicare,Medicare,,,,,7177.04,,,,
CATH-DRAINAG LEVEL10,C1729,HCPCS,,,,,both,, ,9567.67,5740.6,Medicare,Medicare,,,,,9567.67,,,,
CATH-DRAINAG LEVEL12,C1729,HCPCS,,,,,both,, ,14344.55,8606.73,Medicare,Medicare,,,,,14344.55,,,,
CATH EP 19 OR FEW 1,C1730,HCPCS,,,,,both,, ,554.66,332.79,Medicare,Medicare,,,,,554.66,,,,
CATH EP 19 OR FEW 2,C1730,HCPCS,,,,,both,, ,1807.39,1084.43,Medicare,Medicare,,,,,1807.39,,,,
CATH EP 20 OR MORE 1,C1731,HCPCS,,,,,both,, ,6185.15,3711.09,Medicare,Medicare,,,,,6185.15,,,,
CATH EP DIG/ABL 3D 1,C1732,HCPCS,,,,,both,, ,7172.15,4303.29,Medicare,Medicare,,,,,7172.15,,,,
CATH EP DIG/ABL 3D 2,C1732,HCPCS,,,,,both,, ,15395.93,9237.55,Medicare,Medicare,,,,,15395.93,,,,
CATH HEMODIAL LT 1,C1750,HCPCS,,,,,both,, ,1434.53,860.71,Medicare,Medicare,,,,,1434.53,,,,
CATH HEMODIAL LT 2,C1750,HCPCS,,,,,both,, ,1912.71,1147.62,Medicare,Medicare,,,,,1912.71,,,,
CATH-INFUS PERIF 1,C1751,HCPCS,,,,,both,, ,89.61,53.76,Medicare,Medicare,,,,,89.61,,,,
CATH-INFUS PERIF 10,C1751,HCPCS,,,,,both,, ,2395.52,1437.31,Medicare,Medicare,,,,,2395.52,,,,
CATH-INFUS PERIF 11,C1751,HCPCS,,,,,both,, ,3351.88,2011.12,Medicare,Medicare,,,,,3351.88,,,,
CATH-INFUS PERIF 12,C1751,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,,,,4781.52,,,,
CATH-INFUS PERIF 2,C1751,HCPCS,,,,,both,, ,124.37,74.62,Medicare,Medicare,,,,,124.37,,,,
CATH-INFUS PERIF 3,C1751,HCPCS,,,,,both,, ,243.85,146.31,Medicare,Medicare,,,,,243.85,,,,
CATH-INFUS PERIF 4,C1751,HCPCS,,,,,both,, ,722.03,433.21,Medicare,Medicare,,,,,722.03,,,,
CATH-INFUS PERIF 5,C1751,HCPCS,,,,,both,, ,960.99,576.59,Medicare,Medicare,,,,,960.99,,,,
CATH-INFUS PERIF 5,C1751,HCPCS,,,,,both,, ,960.99,576.59,Medicare,Medicare,,,,,960.99,,,,
CATH-INFUS PERIF 7,C1751,HCPCS,,,,,both,, ,1200.21,720.12,Medicare,Medicare,,,,,1200.21,,,,
CATH-INFUS PERIF 8,C1751,HCPCS,,,,,both,, ,1439.17,863.5,Medicare,Medicare,,,,,1439.17,,,,
CATH-INFUS PERIF 9,C1751,HCPCS,,,,,both,, ,1673.49,1004.09,Medicare,Medicare,,,,,1673.49,,,,
CATH HEMODIAL ST 1,C1752,HCPCS,,,,,both,, ,358.7,215.22,Medicare,Medicare,,,,,358.7,,,,
CATH HEMODIAL ST 2,C1752,HCPCS,,,,,both,, ,478.18,286.9,Medicare,Medicare,,,,,478.18,,,,
CATH INTRAVAS ULTRA1,C1753,HCPCS,,,,,both,, ,3586.2,2151.72,Medicare,Medicare,,,,,3586.2,,,,
CATH INTRAVAS ULTRA2,C1753,HCPCS,,,,,both,, ,14344.55,8606.73,Medicare,Medicare,,,,,14344.55,,,,
CATHETER INTRASPINAL,C1755,HCPCS,,,,,both,, ,5259.7,3155.82,Medicare,Medicare,,,,,5259.7,,,,
CATH THRMB/EMBOL 1,C1757,HCPCS,,,,,both,, ,238.96,143.37,Medicare,Medicare,,,,,238.96,,,,
CATH THRMB/EMBOL 2,C1757,HCPCS,,,,,both,, ,1792.97,1075.78,Medicare,Medicare,,,,,1792.97,,,,
CATH THRMB/EMBOL 3,C1757,HCPCS,,,,,both,, ,2395.52,1437.31,Medicare,Medicare,,,,,2395.52,,,,
CATH THRMB/EMBOL 4,C1757,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,,,,4781.52,,,,
CATH URETERAL 1,C1758,HCPCS,,,,,both,, ,478.18,286.9,Medicare,Medicare,,,,,478.18,,,,
CATH URETERAL 2,C1758,HCPCS,,,,,both,, ,717.14,430.28,Medicare,Medicare,,,,,717.14,,,,
CATH URETERAL 3,C1758,HCPCS,,,,,both,, ,956.36,573.81,Medicare,Medicare,,,,,956.36,,,,
CATH INTRA ECHOCARD1,C1759,HCPCS,,,,,both,, ,7172.15,4303.29,Medicare,Medicare,,,,,7172.15,,,,
CATH INTRA ECHOCARD2,C1759,HCPCS,,,,,both,, ,9563.04,5737.82,Medicare,Medicare,,,,,9563.04,,,,
CLOSURE DEVIC VASC 1,C1760,HCPCS,,,,,both,, ,1634.61,980.76,Medicare,Medicare,,,,,1634.61,,,,
CLOSURE DEVIC VASC 2,C1760,HCPCS,,,,,both,, ,2504.7,1502.82,Medicare,Medicare,,,,,2504.7,,,,
CONN TISSUE HUMAN 1,C1762,HCPCS,,,,,both,, ,1438.14,862.88,Medicare,Medicare,,,,,1438.14,,,,
CONN TISSUE HUMAN 10,C1762,HCPCS,,,,,both,, ,57377.95,34426.77,Medicare,Medicare,,,,,57377.95,,,,
CONN TISSUE HUMAN 2,C1762,HCPCS,,,,,both,, ,1917.35,1150.41,Medicare,Medicare,,,,,1917.35,,,,
CONN TISSUE HUMAN 3,C1762,HCPCS,,,,,both,, ,5742.51,3445.5,Medicare,Medicare,,,,,5742.51,,,,
CONN TISSUE HUMAN 4,C1762,HCPCS,,,,,both,, ,9567.67,5740.6,Medicare,Medicare,,,,,9567.67,,,,
CONN TISSUE HUMAN 5,C1762,HCPCS,,,,,both,, ,13393.09,8035.85,Medicare,Medicare,,,,,13393.09,,,,
CONN TISSUE HUMAN 6,C1762,HCPCS,,,,,both,, ,17218.25,10330.95,Medicare,Medicare,,,,,17218.25,,,,
CONN TISSUE HUMAN 7,C1762,HCPCS,,,,,both,, ,23907.59,14344.55,Medicare,Medicare,,,,,23907.59,,,,
CONN TISSUE HUMAN 8,C1762,HCPCS,,,,,both,, ,33475.26,20085.15,Medicare,Medicare,,,,,33475.26,,,,
CONN TISSUE HUMAN 9,C1762,HCPCS,,,,,both,, ,43033.4,25820.04,Medicare,Medicare,,,,,43033.4,,,,
TISSUE NON-HUMAN 1,C1763,HCPCS,,,,,both,, ,1796.58,1077.94,Medicare,Medicare,,,,,1796.58,,,,
TISSUE NON-HUMAN 10,C1763,HCPCS,,,,,both,, ,43033.4,25820.04,Medicare,Medicare,,,,,43033.4,,,,
TISSUE NON-HUMAN 11,C1763,HCPCS,,,,,both,, ,57377.95,34426.77,Medicare,Medicare,,,,,57377.95,,,,
TISSUE NON-HUMAN 2,C1763,HCPCS,,,,,both,, ,2395.52,1437.31,Medicare,Medicare,,,,,2395.52,,,,
TISSUE NON-HUMAN 3,C1763,HCPCS,,,,,both,, ,4786.15,2871.69,Medicare,Medicare,,,,,4786.15,,,,
TISSUE NON-HUMAN 4,C1763,HCPCS,,,,,both,, ,8611.57,5166.94,Medicare,Medicare,,,,,8611.57,,,,
TISSUE NON-HUMAN 5,C1763,HCPCS,,,,,both,, ,12436.74,7462.04,Medicare,Medicare,,,,,12436.74,,,,
TISSUE NON-HUMAN 6,C1763,HCPCS,,,,,both,, ,15305.54,9183.32,Medicare,Medicare,,,,,15305.54,,,,
TISSUE NON-HUMAN 7,C1763,HCPCS,,,,,both,, ,19130.71,11478.42,Medicare,Medicare,,,,,19130.71,,,,
TISSUE NON-HUMAN 8,C1763,HCPCS,,,,,both,, ,23912.22,14347.33,Medicare,Medicare,,,,,23912.22,,,,
TISSUE NON-HUMAN 9,C1763,HCPCS,,,,,both,, ,33475.26,20085.15,Medicare,Medicare,,,,,33475.26,,,,
EVENT RECRDR CARDIAC,C1764,HCPCS,,,,,both,, ,21590.35,12954.21,Medicare,Medicare,,,,,21590.35,,,,
ADHESION BARRIER1,C1765,HCPCS,,,,,both,, ,717.14,430.28,Medicare,Medicare,,,,,717.14,,,,
ADHESION BARRIER2,C1765,HCPCS,,,,,both,, ,956.36,573.81,Medicare,Medicare,,,,,956.36,,,,
ADHESION BARRIER3,C1765,HCPCS,,,,,both,, ,8466.86,5080.11,Medicare,Medicare,,,,,8466.86,,,,
ADHESION BARRIER4,C1765,HCPCS,,,,,both,, ,4456.3,2673.78,Medicare,Medicare,,,,,4456.3,,,,
GENRATR NEUROSTM 1,C1767,HCPCS,,,,,both,, ,35861.25,21516.75,Medicare,Medicare,,,,,35861.25,,,,
GENRATR NEUROSTM 2,C1767,HCPCS,,,,,both,, ,71722.51,43033.5,Medicare,Medicare,,,,,71722.51,,,,
GRAFT VASCULAR 1,C1768,HCPCS,,,,,both,, ,1796.58,1077.94,Medicare,Medicare,,,,,1796.58,,,,
GRAFT VASCULAR 2,C1768,HCPCS,,,,,both,, ,2395.52,1437.31,Medicare,Medicare,,,,,2395.52,,,,
GRAFT VASCULAR 3,C1768,HCPCS,,,,,both,, ,4786.15,2871.69,Medicare,Medicare,,,,,4786.15,,,,
GRAFT VASCULAR 4,C1768,HCPCS,,,,,both,, ,9567.67,5740.6,Medicare,Medicare,,,,,9567.67,,,,
GRAFT VASCULAR 5,C1768,HCPCS,,,,,both,, ,14349.19,8609.51,Medicare,Medicare,,,,,14349.19,,,,
GRAFT VASCULAR 6,C1768,HCPCS,,,,,both,, ,19130.71,11478.42,Medicare,Medicare,,,,,19130.71,,,,
GRAFT VASCULAR 7,C1768,HCPCS,,,,,both,, ,23912.22,14347.33,Medicare,Medicare,,,,,23912.22,,,,
GRAFT VASCULAR 8,C1768,HCPCS,,,,,both,, ,28688.85,17213.31,Medicare,Medicare,,,,,28688.85,,,,
GUIDEWIRE LEVEL 1,C1769,HCPCS,,,,,both,, ,182.83,109.69,Medicare,Medicare,,,,,182.83,,,,
GUIDEWIRE LEVEL 10,C1769,HCPCS,,,,,both,, ,3830.06,2298.03,Medicare,Medicare,,,,,3830.06,,,,
GUIDEWIRE LEVEL 11,C1769,HCPCS,,,,,both,, ,4308.23,2584.93,Medicare,Medicare,,,,,4308.23,,,,
GUIDEWIRE LEVEL 12,C1769,HCPCS,,,,,both,, ,4786.15,2871.69,Medicare,Medicare,,,,,4786.15,,,,
GUIDEWIRE LEVEL 13,C1769,HCPCS,,,,,both,, ,7177.04,4306.22,Medicare,Medicare,,,,,7177.04,,,,
GUIDEWIRE LEVEL 14,C1769,HCPCS,,,,,both,, ,9567.67,5740.6,Medicare,Medicare,,,,,9567.67,,,,
GUIDEWIRE LEVEL 15,C1769,HCPCS,,,,,both,, ,14349.19,8609.51,Medicare,Medicare,,,,,14349.19,,,,
GUIDEWIRE LEVEL 16,C1769,HCPCS,,,,,both,, ,19130.71,11478.42,Medicare,Medicare,,,,,19130.71,,,,
GUIDEWIRE LEVEL 17,C1769,HCPCS,,,,,both,, ,23912.22,14347.33,Medicare,Medicare,,,,,23912.22,,,,
GUIDEWIRE LEVEL 18,C1769,HCPCS,,,,,both,, ,31084.37,18650.62,Medicare,Medicare,,,,,31084.37,,,,
GUIDEWIRE LEVEL 19,C1769,HCPCS,,,,,both,, ,38256.78,22954.06,Medicare,Medicare,,,,,38256.78,,,,
GUIDEWIRE LEVEL 2,C1769,HCPCS,,,,,both,, ,243.85,146.31,Medicare,Medicare,,,,,243.85,,,,
GUIDEWIRE LEVEL 20,C1769,HCPCS,,,,,both,, ,47814.92,28688.95,Medicare,Medicare,,,,,47814.92,,,,
GUIDEWIRE LEVEL 3,C1769,HCPCS,,,,,both,, ,482.81,289.68,Medicare,Medicare,,,,,482.81,,,,
GUIDEWIRE LEVEL 4,C1769,HCPCS,,,,,both,, ,960.99,576.59,Medicare,Medicare,,,,,960.99,,,,
GUIDEWIRE LEVEL 5,C1769,HCPCS,,,,,both,, ,1439.17,863.5,Medicare,Medicare,,,,,1439.17,,,,
GUIDEWIRE LEVEL 6,C1769,HCPCS,,,,,both,, ,1917.35,1150.41,Medicare,Medicare,,,,,1917.35,,,,
GUIDEWIRE LEVEL 7,C1769,HCPCS,,,,,both,, ,2395.52,1437.31,Medicare,Medicare,,,,,2395.52,,,,
GUIDEWIRE LEVEL 8,C1769,HCPCS,,,,,both,, ,3351.88,2011.12,Medicare,Medicare,,,,,3351.88,,,,
GUIDEWIRE LEVEL 8,C1769,HCPCS,,,,,both,, ,3351.88,2011.12,Medicare,Medicare,,,,,3351.88,,,,
REP DEV URINRY W/SL1,C1771,HCPCS,,,,,both,, ,2868.81,1721.28,Medicare,Medicare,,,,,2868.81,,,,
REP DEV URINRY W/SL2,C1771,HCPCS,,,,,both,, ,3825.16,2295.09,Medicare,Medicare,,,,,3825.16,,,,
REP DEV URINRY W/SL3,C1771,HCPCS,,,,,both,, ,14344.55,8606.73,Medicare,Medicare,,,,,14344.55,,,,
INF PUMP PROGRAM LV1,C1772,HCPCS,,,,,both,, ,2774.56,1664.73,Medicare,Medicare,,,,,2774.56,,,,
INF PUMP PROGRAM LV3,C1772,HCPCS,,,,,both,, ,53552.79,32131.67,Medicare,Medicare,,,,,53552.79,,,,
CATH-RETRIEVAL 1,C1773,HCPCS,,,,,both,, ,1338.74,803.24,Medicare,Medicare,,,,,1338.74,,,,
CATH-RETRIEVAL 2,C1773,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,,,,4781.52,,,,
JOINT DEVICE IMPLT 1,C1776,HCPCS,,,,,both,, ,3586.2,2151.72,Medicare,Medicare,,,,,3586.2,,,,
JOINT DEVICE IMPLT 2,C1776,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,,,,4781.52,,,,
JOINT DEVICE IMPLT 3,C1776,HCPCS,,,,,both,, ,9567.67,5740.6,Medicare,Medicare,,,,,9567.67,,,,
JOINT DEVICE IMPLT 4,C1776,HCPCS,,,,,both,, ,11958.56,7175.13,Medicare,Medicare,,,,,11958.56,,,,
JOINT DEVICE IMPLT 5,C1776,HCPCS,,,,,both,, ,19130.71,11478.42,Medicare,Medicare,,,,,19130.71,,,,
JOINT DEVICE IMPLT 6,C1776,HCPCS,,,,,both,, ,23912.22,14347.33,Medicare,Medicare,,,,,23912.22,,,,
JOINT DEVICE IMPLT 7,C1776,HCPCS,,,,,both,, ,31084.37,18650.62,Medicare,Medicare,,,,,31084.37,,,,
JOINT DEVICE IMPLT 8,C1776,HCPCS,,,,,both,, ,38256.78,22954.06,Medicare,Medicare,,,,,38256.78,,,,
JOINT DEVICE IMPLT 9,C1776,HCPCS,,,,,both,, ,47819.81,28691.88,Medicare,Medicare,,,,,47819.81,,,,
JOINT DEVICE IMPLT10,C1776,HCPCS,,,,,both,, ,71727.14,43036.28,Medicare,Medicare,,,,,71727.14,,,,
JOINT DEVICE IMPLT11,C1776,HCPCS,,,,,both,, ,95629.84,57377.9,Medicare,Medicare,,,,,95629.84,,,,
JOINT DEVICE IMPLT12,C1776,HCPCS,,,,,both,, ,99999,59999.4,Medicare,Medicare,,,,,99999,,,,
LEAD AICD ENDO SN L1,C1777,HCPCS,,,,,both,, ,23599.62,14159.77,Medicare,Medicare,,,,,23599.62,,,,
LEAD NEUROSTIMULAT 1,C1778,HCPCS,,,,,both,, ,9563.04,5737.82,Medicare,Medicare,,,,,9563.04,,,,
LEAD NEUROSTIMULAT 2,C1778,HCPCS,,,,,both,, ,3586.2,2151.72,Medicare,Medicare,,,,,3586.2,,,,
LEAD NEUROSTIMULAT 3,C1778,HCPCS,,,,,both,, ,14344.55,8606.73,Medicare,Medicare,,,,,14344.55,,,,
LEAD NEUROSTIMULAT 4,C1778,HCPCS,,,,,both,, ,23907.59,14344.55,Medicare,Medicare,,,,,23907.59,,,,
LEAD PMKR TRNSV VDD1,C1779,HCPCS,,,,,both,, ,9194.3,5516.58,Medicare,Medicare,,,,,9194.3,,,,
MESH IMPLANTABLE 1,C1781,HCPCS,,,,,both,, ,717.14,430.28,Medicare,Medicare,,,,,717.14,,,,
MESH IMPLANTABLE 10,C1781,HCPCS,,,,,both,, ,11958.56,7175.13,Medicare,Medicare,,,,,11958.56,,,,
MESH IMPLANTABLE 11,C1781,HCPCS,,,,,both,, ,14349.19,8609.51,Medicare,Medicare,,,,,14349.19,,,,
MESH IMPLANTABLE 12,C1781,HCPCS,,,,,both,, ,19130.71,11478.42,Medicare,Medicare,,,,,19130.71,,,,
MESH IMPLANTABLE 13,C1781,HCPCS,,,,,both,, ,28693.74,17216.24,Medicare,Medicare,,,,,28693.74,,,,
MESH IMPLANTABLE 14,C1781,HCPCS,,,,,both,, ,43038.29,25822.97,Medicare,Medicare,,,,,43038.29,,,,
MESH IMPLANTABLE 2,C1781,HCPCS,,,,,both,, ,960.99,576.59,Medicare,Medicare,,,,,960.99,,,,
MESH IMPLANTABLE 3,C1781,HCPCS,,,,,both,, ,1917.35,1150.41,Medicare,Medicare,,,,,1917.35,,,,
MESH IMPLANTABLE 4,C1781,HCPCS,,,,,both,, ,2873.7,1724.22,Medicare,Medicare,,,,,2873.7,,,,
MESH IMPLANTABLE 5,C1781,HCPCS,,,,,both,, ,3830.06,2298.03,Medicare,Medicare,,,,,3830.06,,,,
MESH IMPLANTABLE 5,C1781,HCPCS,,,,,both,, ,3830.06,2298.03,Medicare,Medicare,,,,,3830.06,,,,
MESH IMPLANTABLE 7,C1781,HCPCS,,,,,both,, ,6220.69,3732.41,Medicare,Medicare,,,,,6220.69,,,,
MESH IMPLANTABLE 8,C1781,HCPCS,,,,,both,, ,7655.22,4593.13,Medicare,Medicare,,,,,7655.22,,,,
MESH IMPLANTABLE 9,C1781,HCPCS,,,,,both,, ,9567.67,5740.6,Medicare,Medicare,,,,,9567.67,,,,
MORCELLATOR 1,C1782,HCPCS,,,,,both,, ,1792.97,1075.78,Medicare,Medicare,,,,,1792.97,,,,
MORCELLATOR 2,C1782,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,,,,4781.52,,,,
MORCELLATOR 3,C1782,HCPCS,,,,,both,, ,9563.04,5737.82,Medicare,Medicare,,,,,9563.04,,,,
OCLR DEV INTROP DTR1,C1784,HCPCS,,,,,both,, ,15780.63,9468.37,Medicare,Medicare,,,,,15780.63,,,,
PMKR DUAL RATE-RS L1,C1785,HCPCS,,,,,both,, ,84273.06,50563.83,Medicare,Medicare,,,,,84273.06,,,,
PMKR DUAL RATE-RS L2,C1785,HCPCS,,,,,both,, ,28809.36,17285.61,Medicare,Medicare,,,,,28809.36,,,,
PMKR SINGL RATE-RSL1,C1786,HCPCS,,,,,both,, ,62664.69,37598.81,Medicare,Medicare,,,,,62664.69,,,,
PATIENT PROGR NEURO1,C1787,HCPCS,,,,,both,, ,5302.96,3181.77,Medicare,Medicare,,,,,5302.96,,,,
PORT 1,C1788,HCPCS,,,,,both,, ,720.74,432.44,Medicare,Medicare,,,,,720.74,,,,
PORT 2,C1788,HCPCS,,,,,both,, ,960.99,576.59,Medicare,Medicare,,,,,960.99,,,,
PORT 3,C1788,HCPCS,,,,,both,, ,1912.71,1147.62,Medicare,Medicare,,,,,1912.71,,,,
BREAST IMPLANT 1,C1789,HCPCS,,,,,both,, ,7833.15,4699.89,Medicare,Medicare,,,,,7833.15,,,,
PRSTHS PENILE INFL 1,C1813,HCPCS,,,,,both,, ,3586.2,2151.72,Medicare,Medicare,,,,,3586.2,,,,
PRSTHS PENILE INFL 2,C1813,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,,,,4781.52,,,,
PRSTHS PENILE INFL 3,C1813,HCPCS,,,,,both,, ,14344.55,8606.73,Medicare,Medicare,,,,,14344.55,,,,
PRSTHS PENILE INFL 4,C1813,HCPCS,,,,,both,, ,23907.59,14344.55,Medicare,Medicare,,,,,23907.59,,,,
TISSUE LOCALZ EXCISI,C1819,HCPCS,,,,,both,, ,1000,600,Medicare,Medicare,,,,,1000,,,,
GENRATE NEURO RECHR,C1820,HCPCS,,,,,both,, ,38545.95,23127.57,Medicare,Medicare,,,,,38545.95,,,,
INTERSPINOUS IMPL L1,C1821,HCPCS,,,,,both,, ,31193.29,18715.97,Medicare,Medicare,,,,,31193.29,,,,
INTERSPINOUS IMPL L2,C1821,HCPCS,,,,,both,, ,44561.92,26737.15,Medicare,Medicare,,,,,44561.92,,,,
STNT COAT/COV W/DEL1,C1874,HCPCS,,,,,both,, ,3586.2,2151.72,Medicare,Medicare,,,,,3586.2,,,,
STNT COAT/COV W/DEL2,C1874,HCPCS,,,,,both,, ,7172.15,4303.29,Medicare,Medicare,,,,,7172.15,,,,
STNT COAT/COV W/DEL3,C1874,HCPCS,,,,,both,, ,14344.55,8606.73,Medicare,Medicare,,,,,14344.55,,,,
STNT COAT/COV W/DEL4,C1874,HCPCS,,,,,both,, ,23907.59,14344.55,Medicare,Medicare,,,,,23907.59,,,,
STNT NO COCV W/DEL 1,C1876,HCPCS,,,,,both,, ,3589.81,2153.88,Medicare,Medicare,,,,,3589.81,,,,
STNT NO COCV W/DEL 2,C1876,HCPCS,,,,,both,, ,4786.15,2871.69,Medicare,Medicare,,,,,4786.15,,,,
STNT NO COCV W/DEL 3,C1876,HCPCS,,,,,both,, ,9567.67,5740.6,Medicare,Medicare,,,,,9567.67,,,,
STNT NO COCV W/DEL 4,C1876,HCPCS,,,,,both,, ,14344.55,8606.73,Medicare,Medicare,,,,,14344.55,,,,
STNT NO-COA/COV W/O1,C1877,HCPCS,,,,,both,, ,3586.2,2151.72,Medicare,Medicare,,,,,3586.2,,,,
STNT NO-COA/COV W/O2,C1877,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,,,,4781.52,,,,
VENA CAVA FILTER 1,C1880,HCPCS,,,,,both,, ,3586.2,2151.72,Medicare,Medicare,,,,,3586.2,,,,
VENA CAVA FILTER 2,C1880,HCPCS,,,,,both,, ,7172.15,4303.29,Medicare,Medicare,,,,,7172.15,,,,
AICD OHR THN SGL/DU1,C1882,HCPCS,,,,,both,, ,99999,59999.4,Medicare,Medicare,,,,,99999,,,,
EMBOLIZ PROTECT SYS1,C1884,HCPCS,,,,,both,, ,6144.21,3686.52,Medicare,Medicare,,,,,6144.21,,,,
EMBOLIZ PROTECT SYS2,C1884,HCPCS,,,,,both,, ,7172.15,4303.29,Medicare,Medicare,,,,,7172.15,,,,
CATH TRNSLUM ANG LA1,C1885,HCPCS,,,,,both,, ,7172.15,4303.29,Medicare,Medicare,,,,,7172.15,,,,
CATH TRNSLUM ANG LA2,C1885,HCPCS,,,,,both,, ,9563.04,5737.82,Medicare,Medicare,,,,,9563.04,,,,
CATHETER GUIDING 1,C1887,HCPCS,,,,,both,, ,358.7,215.22,Medicare,Medicare,,,,,358.7,,,,
CATHETER GUIDING 2,C1887,HCPCS,,,,,both,, ,1195.32,717.19,Medicare,Medicare,,,,,1195.32,,,,
CATHETER GUIDING 3,C1887,HCPCS,,,,,both,, ,1912.71,1147.62,Medicare,Medicare,,,,,1912.71,,,,
CATH ABLTN NOCRD ED1,C1888,HCPCS,,,,,both,, ,896.62,537.97,Medicare,Medicare,,,,,896.62,,,,
CATH ABLTN NOCRD ED2,C1888,HCPCS,,,,,both,, ,1195.32,717.19,Medicare,Medicare,,,,,1195.32,,,,
EAR TUBES DRAINAGE 1,C1889,HCPCS,,,,,both,, ,113.04,67.82,Medicare,Medicare,,,,,113.04,,,,
TISSUE EXP NONBREAST,C1889,HCPCS,,,,,both,, ,570.11,342.06,Medicare,Medicare,,,,,570.11,,,,
INF PMP NON-PROG LV1,C1891,HCPCS,,,,,both,, ,10237.17,6142.3,Medicare,Medicare,,,,,10237.17,,,,
PEEL-AWAY SHEATH 1,C1892,HCPCS,,,,,both,, ,179.22,107.53,Medicare,Medicare,,,,,179.22,,,,
PEEL-AWAY SHEATH 2,C1892,HCPCS,,,,,both,, ,478.18,286.9,Medicare,Medicare,,,,,478.18,,,,
PEEL-AWAY SHEATH 3,C1892,HCPCS,,,,,both,, ,1434.53,860.71,Medicare,Medicare,,,,,1434.53,,,,
INT SHTH FIX NO-PL 1,C1893,HCPCS,,,,,both,, ,611.31,366.78,Medicare,Medicare,,,,,611.31,,,,
INT SHTH FIX NO-PL 2,C1893,HCPCS,,,,,both,, ,3048.29,1828.97,Medicare,Medicare,,,,,3048.29,,,,
SHEATH NON-LASR 1,C1894,HCPCS,,,,,both,, ,717.14,430.28,Medicare,Medicare,,,,,717.14,,,,
SHEATH NON-LASR 2,C1894,HCPCS,,,,,both,, ,1434.53,860.71,Medicare,Medicare,,,,,1434.53,,,,
SHEATH NON-LASR 3,C1894,HCPCS,,,,,both,, ,2390.63,1434.37,Medicare,Medicare,,,,,2390.63,,,,
SHEATH NON-LASR 4,C1894,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,,,,4781.52,,,,
SHEATH NON-LASR 5,C1894,HCPCS,,,,,both,, ,7172.15,4303.29,Medicare,Medicare,,,,,7172.15,,,,
SHEATH NON-LASR 6,C1894,HCPCS,,,,,both,, ,9563.04,5737.82,Medicare,Medicare,,,,,9563.04,,,,
SHEATH NON-LASR 7,C1894,HCPCS,,,,,both,, ,14344.55,8606.73,Medicare,Medicare,,,,,14344.55,,,,
SHEATH NON-LASR 8,C1894,HCPCS,,,,,both,, ,19126.07,11475.64,Medicare,Medicare,,,,,19126.07,,,,
LEAD AICD END DUL L1,C1895,HCPCS,,,,,both,, ,76277.94,45766.76,Medicare,Medicare,,,,,76277.94,,,,
LEAD AICD END DUL L2,C1895,HCPCS,,,,,both,, ,16735.18,10041.1,Medicare,Medicare,,,,,16735.18,,,,
LEAD AICD NO-SING L1,C1896,HCPCS,,,,,both,, ,16206.54,9723.92,Medicare,Medicare,,,,,16206.54,,,,
LEAD NEUROSTM TST K1,C1897,HCPCS,,,,,both,, ,3586.2,2151.72,Medicare,Medicare,,,,,3586.2,,,,
LEAD NEUROSTM TST K2,C1897,HCPCS,,,,,both,, ,6646.33,3987.79,Medicare,Medicare,,,,,6646.33,,,,
LEAD PMKR NON-TRN L1,C1898,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,,,,4781.52,,,,
LEAD PMKR/AICD CMBL1,C1899,HCPCS,,,,,both,, ,41218.03,24730.81,Medicare,Medicare,,,,,41218.03,,,,
LEAD LT VENT COR LV1,C1900,HCPCS,,,,,both,, ,20278.38,12167.02,Medicare,Medicare,,,,,20278.38,,,,
SEALANT PULMNRY LIQD,C2615,HCPCS,,,,,both,, ,5932.54,3559.52,Medicare,Medicare,,,,,5932.54,,,,
STNT NONCOR TM W/O 1,C2617,HCPCS,,,,,both,, ,2963.83,1778.29,Medicare,Medicare,,,,,2963.83,,,,
PROBE CRYOABLATION 1,C2618,HCPCS,,,,,both,, ,3586.2,2151.72,Medicare,Medicare,,,,,3586.2,,,,
PROBE CRYOABLATION 2,C2618,HCPCS,,,,,both,, ,4781.52,2868.91,Medicare,Medicare,,,,,4781.52,,,,
PROBE CRYOABLATION 3,C2618,HCPCS,,,,,both,, ,9563.04,5737.82,Medicare,Medicare,,,,,9563.04,,,,
PROBE CRYOABLATION 4,C2618,HCPCS,,,,,both,, ,16735.18,10041.1,Medicare,Medicare,,,,,16735.18,,,,
PMKR DUL NON RAT LV1,C2619,HCPCS,,,,,both,, ,73166.31,43899.78,Medicare,Medicare,,,,,73166.31,,,,
PMKR SNGL NON RTE-RE,C2620,HCPCS,,,,,both,, ,45918.17,27550.9,Medicare,Medicare,,,,,45918.17,,,,
PMKR OTHR TH SNGL L1,C2621,HCPCS,,,,,both,, ,99999,59999.4,Medicare,Medicare,,,,,99999,,,,
PRSTHS PENILE NNINF1,C2622,HCPCS,,,,,both,, ,38894.09,23336.45,Medicare,Medicare,,,,,38894.09,,,,
WIRELESS PRESS SENS,C2624,HCPCS,,,,,both,, ,99999,59999.4,Medicare,Medicare,,,,,99999,,,,
STNT NON-COR TM DL 1,C2625,HCPCS,,,,,both,, ,541.52,324.91,Medicare,Medicare,,,,,541.52,,,,
STNT NON-COR TM DL 2,C2625,HCPCS,,,,,both,, ,722.03,433.21,Medicare,Medicare,,,,,722.03,,,,
STNT NON-COR TM DL 3,C2625,HCPCS,,,,,both,, ,3787.83,2272.69,Medicare,Medicare,,,,,3787.83,,,,
INF PMP NON-PROG LV1,C2626,HCPCS,,,,,both,, ,545.13,327.07,Medicare,Medicare,,,,,545.13,,,,
CATH SUPRPUBC-CYSTO1,C2627,HCPCS,,,,,both,, ,172.01,103.2,Medicare,Medicare,,,,,172.01,,,,
CATH SUPRPUBC-CYSTO2,C2627,HCPCS,,,,,both,, ,1075.84,645.5,Medicare,Medicare,,,,,1075.84,,,,
CATH OCCLUSION 1,C2628,HCPCS,,,,,both,, ,717.14,430.28,Medicare,Medicare,,,,,717.14,,,,
CATH OCCLUSION 2,C2628,HCPCS,,,,,both,, ,1434.53,860.71,Medicare,Medicare,,,,,1434.53,,,,
CATH OCCLUSION 3,C2628,HCPCS,,,,,both,, ,2390.63,1434.37,Medicare,Medicare,,,,,2390.63,,,,
INTRO/SHEATH LASER 1,C2629,HCPCS,,,,,both,, ,5379.18,3227.5,Medicare,Medicare,,,,,5379.18,,,,
INTRO/SHEATH LASER 2,C2629,HCPCS,,,,,both,, ,7172.15,4303.29,Medicare,Medicare,,,,,7172.15,,,,
REP DEV URNRY WO SL1,C2631,HCPCS,,,,,both,, ,8266.27,4959.76,Medicare,Medicare,,,,,8266.27,,,,
LC S SUB T/A/L 25S,C5271,HCPCS,,,,,both,, ,2393.6,1436.16,Medicare,Medicare,,,,,2393.6,,,,
LC S SUB T/A/L ADL,C5272,HCPCS,,,,,both,, ,2393.6,1436.16,Medicare,Medicare,,,,,2393.6,,,,
LC S SUB T/A/L 100SQ,C5273,HCPCS,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
LC S SUB T/A/L ADL,C5274,HCPCS,,,,,both,, ,6950.12,4170.07,Medicare,Medicare,,,,,6950.12,,,,
LC S SUB F/NK/HF/G,C5275,HCPCS,,,,,both,, ,2393.6,1436.16,Medicare,Medicare,,,,,2393.6,,,,
LC S SUB F/NK/HF/G EA,C5276,HCPCS,,,,,both,, ,2393.6,1436.16,Medicare,Medicare,,,,,2393.6,,,,
LC S SUB F/NK/HF/G 100SQ,C5277,HCPCS,,,,,both,, ,2393.6,1436.16,Medicare,Medicare,,,,,2393.6,,,,
LC S SUB F/NK/HF/G EA,C5278,HCPCS,,,,,both,, ,2393.6,1436.16,Medicare,Medicare,,,,,2393.6,,,,
MRA-ABDOMEN W,C8900,HCPCS,,,,,both,, ,1035.69,621.41,Medicare,Medicare,,,,,1035.69,,,,
MRA-ABDOMEN W,C8900,HCPCS,,,,,both,, ,1114.55,668.73,Medicare,Medicare,,,,,1114.55,,,,
MRA-ABDOMEN WO,C8901,HCPCS,,,,,both,, ,715.99,429.59,Medicare,Medicare,,,,,715.99,,,,
MRA-ABDOMEN WO,C8901,HCPCS,,,,,both,, ,770.45,462.27,Medicare,Medicare,,,,,770.45,,,,
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,,,,1197.08,,,,
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,,,,1288.29,,,,
MRA-ABDOMEN WWO,C8902,HCPCS,,,,,both,, ,2669.78,1601.86,Medicare,Medicare,,,,,2669.78,,,,
MR-BREAST UNI WWO,C8905,HCPCS,,,,,both,, ,3114.65,1868.79,Medicare,Medicare,,,,,3114.65,,,,
MR-BREAST BI WWO,C8908,HCPCS,,,,,both,, ,3115.2,1869.12,Medicare,Medicare,,,,,3115.2,,,,
MRA-LW EXTR WWO,C8914,HCPCS,,,,,both,, ,1197.08,718.24,Medicare,Medicare,,,,,1197.08,,,,
MRA-LW EXTR WWO,C8914,HCPCS,,,,,both,, ,1288.29,772.97,Medicare,Medicare,,,,,1288.29,,,,
MRA-LW EXTR WWO BI,C8914,HCPCS,,,,,both,, ,2394.15,1436.49,Medicare,Medicare,,,,,2394.15,,,,
MRA-LW EXTR WWO BI,C8914,CPT,,,,,both,, ,2576.6,1545.96,Medicare,Medicare,,,,,2576.6,,,,
BR-CAD MRI LESION,C8937,HCPCS,,,,,both,, ,50.52,30.31,Medicare,Medicare,,,,,50.52,,,,
COCAINE HCL NASL 1MG,C9046,HCPCS,,,,,both,4,ML,8,4.8,Medicare,Medicare,,,,,8,,,,
IDARUCIZU 2.5GM/50ML,C9399,HCPCS,,,,,both,50,ML,10077.78,6046.66,Medicare,Medicare,,,,,10077.78,,,,
REMDESIV 5MG/ML 20ML,C9399,HCPCS,,,,,both,, ,2878.85,1727.31,Medicare,Medicare,,,,,2878.85,,,,
IC-PRQ DE COR STNT,C9600,CPT,,,,,both,, ,42411.02,25446.61,Medicare,Medicare,,,,,42411.02,,,,
IC-PRQ DE CR REV CAB,C9604,CPT,,,,,both,, ,29428.39,17657.03,Medicare,Medicare,,,,,29428.39,,,,
ADMIN FLU VACCINE,G0008,HCPCS,,,,,both,, ,106.25,63.75,Medicare,Medicare,,,,,106.25,,,,
ADMIN FLU VACCINE,G0008,HCPCS,,,,,both,, ,106.25,63.75,Medicare,Medicare,,,,,106.25,,,,
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,70.81,42.48,Medicare,Medicare,,,,,70.81,,,,
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,70.81,42.48,Medicare,Medicare,,,,,70.81,,,,
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,109.18,65.5,Medicare,Medicare,,,,,109.18,,,,
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,143.69,86.21,Medicare,Medicare,,,,,143.69,,,,
IMM ADM FLU VACCINE,G0008,HCPCS,,,,,both,, ,184.63,110.77,Medicare,Medicare,,,,,184.63,,,,
ADMIN PNEU VACCINE,G0009,HCPCS,,,,,both,, ,106.25,63.75,Medicare,Medicare,,,,,106.25,,,,
ADMIN PNEU VACCINE,G0009,HCPCS,,,,,both,, ,106.25,63.75,Medicare,Medicare,,,,,106.25,,,,
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,109.18,65.5,Medicare,Medicare,,,,,109.18,,,,
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,143.69,86.21,Medicare,Medicare,,,,,143.69,,,,
IMM ADM PNEU VACCINE,G0009,HCPCS,,,,,both,, ,184.63,110.77,Medicare,Medicare,,,,,184.63,,,,
HEP B VACCINE ADMIN,G0010,HCPCS,,,,,both,, ,106.25,63.75,Medicare,Medicare,,,,,106.25,,,,
HEP B VACCINE ADMIN,G0010,HCPCS,,,,,both,, ,106.25,63.75,Medicare,Medicare,,,,,106.25,,,,
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,105.06,63.03,Medicare,Medicare,,,,,105.06,,,,
IMM ADM HEP B VACCIN,G0010,HCPCS,,,,,both,, ,109.44,65.66,Medicare,Medicare,,,,,109.44,,,,
"PSA, SCREENING",G0103,HCPCS,,,,,both,, ,135.85,81.51,Medicare,Medicare,,,,,135.85,,,,
"PSA, SCREENING",G0103,HCPCS,,,,,both,,,1036.25,1036.25,Medicare,Medicare,,1036.25,,,1036.25,1036.25,1036.25,fee schedule,Medicare APC Fee Schedule
"PSA, SCREENING",G0103,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
"PSA, SCREENING",G0103,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
DSMT INDIVIDUAL 30M,G0108,HCPCS,,,,,both,, ,261.62,156.97,Medicare,Medicare,,,,,261.62,,,,
PAP THINLAY LIQ SCRN,G0123,HCPCS,,,,,both,, ,195.06,117.03,Medicare,Medicare,,,,,195.06,,,,
STRNGTH TRN SLG 15MI,G0237,HCPCS,,,,,both,, ,177.16,106.29,Medicare,Medicare,,,,,177.16,,,,
RESP FX TRN SGL 15MN,G0238,HCPCS,,,,,both,, ,177.16,106.29,Medicare,Medicare,,,,,177.16,,,,
RESP FX TRAIN GROUP,G0239,HCPCS,,,,,both,, ,177.16,106.29,Medicare,Medicare,,,,,177.16,,,,
DIALYSIS  EMERGENT,G0257,HCPCS,,,,,both,, ,9908.34,5945,Medicare,Medicare,,,,,9908.34,,,,
IR-ARTHROGRAM SI JTS,G0260,HCPCS,,,,,both,, ,2101.41,1260.84,Medicare,Medicare,,,,,2101.41,,,,
CC-PLACE CLOS DEV,G0269,HCPCS,,,,,both,, ,22097.11,13258.26,Medicare,Medicare,,,,,22097.11,,,,
HBO FB 30MN,G0277,HCPCS,,,,,both,, ,265.23,159.13,Medicare,Medicare,,,,,265.23,,,,
BR-TOMO MAMMO BI,G0279,HCPCS,,,,,both,,,160.68,160.68,Medicare,Medicare,,160.68,,,160.68,160.68,160.68,fee schedule,Medicare APC Fee Schedule
BR-TOMO MAMMO BI,G0279,HCPCS,,,,,both,, ,160.68,96.4,Medicare,Medicare,,,,,160.68,,,,
BR-TOMO MAMMO UNI,G0279,HCPCS,,,,,both,,,133.9,133.9,Medicare,Medicare,,133.9,,,133.9,133.9,133.9,fee schedule,Medicare APC Fee Schedule
BR-TOMO MAMMO UNI,G0279,HCPCS,,,,,both,, ,133.9,80.34,Medicare,Medicare,,,,,133.9,,,,
ELEC STIM-UNATTND-VI,G0283,HCPCS,,,,,both,, ,443.37,266.02,Medicare,Medicare,,,,,443.37,,,,
ELEC STIM-UNATTND-VI,G0283,HCPCS,,,,,both,, ,480.68,288.4,Medicare,Medicare,,,,,480.68,,,,
ELEC STM-UNAT-VI OT,G0283,HCPCS,,,,,both,, ,515,309,Medicare,Medicare,,,,,515,,,,
ELEC STM-UNAT-VI OT,G0283,HCPCS,,,,,both,, ,515,309,Medicare,Medicare,,,,,515,,,,
ELEC STM-UNAT-VI PT,G0283,HCPCS,,,,,both,, ,37.08,22.24,Medicare,Medicare,,,,,37.08,,,,
ELEC STM-UNAT-VI PT,G0283,HCPCS,,,,,both,, ,37.08,22.24,Medicare,Medicare,,,,,37.08,,,,
ELEC STM-UNAT-VI PT,G0283,HCPCS,,,,,both,, ,37.08,22.24,Medicare,Medicare,,,,,37.08,,,,
ELEC STM-UNAT-VI PT,G0283,HCPCS,,,,,both,, ,37.08,22.24,Medicare,Medicare,,,,,37.08,,,,
ELEC STM-UNAT-VI PT,G0283,HCPCS,,,,,both,, ,474.83,284.89,Medicare,Medicare,,,,,474.83,,,,
ELEC STM-UNAT-VI PT,G0283,HCPCS,,,,,both,, ,474.83,284.89,Medicare,Medicare,,,,,474.83,,,,
SCR FECAL OC BLD 1-3,G0328,HCPCS,,,,,both,, ,159.42,95.65,Medicare,Medicare,,,,,159.42,,,,
OBSERVATION 1ST HOUR,G0378,HCPCS,,,,,both,, ,1189.39,713.63,Medicare,Medicare,,,,,1189.39,,,,
OBSERVATION 1ST HOUR,G0378,HCPCS,,,,,both,, ,1189.39,713.63,Medicare,Medicare,,,,,1189.39,,,,
OBSRVATION ADDL HOUR,G0378,HCPCS,,,,,both,, ,141.21,84.72,Medicare,Medicare,,,,,141.21,,,,
OBSRVATION ADDL HOUR,G0378,HCPCS,,,,,both,, ,151.15,90.69,Medicare,Medicare,,,,,151.15,,,,
OBSRVATION ADDL HOUR,G0378,HCPCS,,,,,both,, ,151.15,90.69,Medicare,Medicare,,,,,151.15,,,,
DIRECT ADMIT TO OBS,G0379,HCPCS,,,,,both,, ,610.15,366.09,Medicare,Medicare,,,,,610.15,,,,
DIRECT ADMIT TO OBS,G0379,HCPCS,,,,,both,, ,653.54,392.12,Medicare,Medicare,,,,,653.54,,,,
DIRECT ADMIT TO OBS,G0379,HCPCS,,,,,both,, ,653.54,392.12,Medicare,Medicare,,,,,653.54,,,,
HOME SLEEP TYPE 3,G0399,HCPCS,,,,,both,, ,428.48,257.08,Medicare,Medicare,,,,,428.48,,,,
HOME SLEEP TYPE 3,G0399,HCPCS,,,,,both,, ,428.48,257.08,Medicare,Medicare,,,,,428.48,,,,
PROSTATE NDL BX ANY,G0416,HCPCS,,,,,both,, ,1059.54,635.72,Medicare,Medicare,,,,,1059.54,,,,
HIV-1 AB EIA,G0432,HCPCS,,,,,both,, ,113.39,68.03,Medicare,Medicare,,,,,113.39,,,,
HIV1 AG HIV1 HIV2 AB,G0433,CPT,,,,,both,, ,165.59,99.35,Medicare,Medicare,,,,,165.59,,,,
HIV1-HIV2 AB SNG RES,G0435,CPT,,,,,both,, ,42.66,25.59,Medicare,Medicare,,,,,42.66,,,,
HIV1-HIV2 AB SNG RES,G0435,CPT,,,,,both,, ,1036.25,621.75,Medicare,Medicare,,,,,1036.25,,,,
EVAL & MGMT LEVEL 3,G0463,HCPCS,,,,,both,, ,215.75,129.45,Medicare,Medicare,,,,,215.75,,,,
EVAL & MGMT LEVEL 5,G0463,HCPCS,,,,,both,, ,261,156.6,Medicare,Medicare,,,,,261,,,,
HOSPITAL OUTPT VISIT,G0463,HCPCS,,,,,both,, ,520,312,Medicare,Medicare,,,,,520,,,,
LEVEL 1 EP,G0463,HCPCS,,,,,both,, ,132.61,79.56,Medicare,Medicare,,,,,132.61,,,,
LEVEL 1 EP,G0463,HCPCS,,,,,both,, ,132.61,79.56,Medicare,Medicare,,,,,132.61,,,,
LEVEL 1 EP,G0463,HCPCS,,,,,both,, ,249.52,149.71,Medicare,Medicare,,,,,249.52,,,,
LEVEL 2 EP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Medicare,Medicare,,,,,188.75,,,,
LEVEL 2 NP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Medicare,Medicare,,,,,188.75,,,,
LEVEL 3 NP,G0463,HCPCS,,,,,both,, ,188.75,113.25,Medicare,Medicare,,,,,188.75,,,,
LEVEL 4 EP,G0463,HCPCS,,,,,both,, ,324.19,194.51,Medicare,Medicare,,,,,324.19,,,,
LEVEL 4 EP,G0463,HCPCS,,,,,both,, ,324.19,194.51,Medicare,Medicare,,,,,324.19,,,,
LEVEL 5 EP,G0463,HCPCS,,,,,both,, ,425.91,255.54,Medicare,Medicare,,,,,425.91,,,,
OB TRIAGE LVL 1 EP,G0463,HCPCS,,,,,both,, ,700.4,420.24,Medicare,Medicare,,,,,700.4,,,,
PAT EVAL/MGM LEVEL 2,G0463,HCPCS,,,,,both,, ,325.25,195.15,Medicare,Medicare,,,,,325.25,,,,
PAT EVAL/MGM LEVEL 3,G0463,HCPCS,,,,,both,, ,379.5,227.7,Medicare,Medicare,,,,,379.5,,,,
PAT EVAL/MGM LEVEL 4,G0463,HCPCS,,,,,both,, ,433.5,260.1,Medicare,Medicare,,,,,433.5,,,,
PAT EVAL/MGM LEVEL 5,G0463,HCPCS,,,,,both,, ,487.5,292.5,Medicare,Medicare,,,,,487.5,,,,
PHYSICAL-EMPLOYMENT,G0463,HCPCS,,,,,both,, ,55.62,33.37,Medicare,Medicare,,,,,55.62,,,,
PHYSICAL-EMPLOYMENT,G0463,HCPCS,,,,,both,, ,55.62,33.37,Medicare,Medicare,,,,,55.62,,,,
PHYSICAL-SCHOOL,G0463,HCPCS,,,,,both,, ,66.95,40.17,Medicare,Medicare,,,,,66.95,,,,
PHYSICAL-SCHOOL,G0463,HCPCS,,,,,both,, ,66.95,40.17,Medicare,Medicare,,,,,66.95,,,,
PSYCH CLINIC TYPE A,G0463,HCPCS,,,,,both,, ,294.25,176.55,Medicare,Medicare,,,,,294.25,,,,
URG CARE L1 EP PROF,G0463,HCPCS,,,,,both,, ,60.5,36.3,Medicare,Medicare,,,,,60.5,,,,
URG CARE L1 NP PROF,G0463,HCPCS,,,,,both,, ,123.25,73.95,Medicare,Medicare,,,,,123.25,,,,
URG CARE L1 NP PROF,G0463,HCPCS,,,,,both,, ,123.25,73.95,Medicare,Medicare,,,,,123.25,,,,
URG CARE L2 NP PROF,G0463,HCPCS,,,,,both,, ,213,127.8,Medicare,Medicare,,,,,213,,,,
URG CARE L3 EP PROF,G0463,HCPCS,,,,,both,, ,209.75,125.85,Medicare,Medicare,,,,,209.75,,,,
URG CARE L3 NP PROF,G0463,HCPCS,,,,,both,, ,312.5,187.5,Medicare,Medicare,,,,,312.5,,,,
URG CARE L4 EP PROF,G0463,HCPCS,,,,,both,, ,309.25,185.55,Medicare,Medicare,,,,,309.25,,,,
URG CARE L4 NP PROF,G0463,HCPCS,,,,,both,, ,483.5,290.1,Medicare,Medicare,,,,,483.5,,,,
URG CARE L5 EP PROF,G0463,HCPCS,,,,,both,, ,414.25,248.55,Medicare,Medicare,,,,,414.25,,,,
URG CARE L5 NP PROF,G0463,HCPCS,,,,,both,, ,602.5,361.5,Medicare,Medicare,,,,,602.5,,,,
URGENT CARE LVL 1 EP,G0463,HCPCS,,,,,both,, ,239.73,143.83,Medicare,Medicare,,,,,239.73,,,,
URGENT CARE LVL 1 EP,G0463,HCPCS,,,,,both,, ,239.73,143.83,Medicare,Medicare,,,,,239.73,,,,
URGENT CARE LVL 1 EP,G0463,HCPCS,,,,,both,, ,239.73,143.83,Medicare,Medicare,,,,,239.73,,,,
URGENT CARE LVL 1 EP,G0463,HCPCS,,,,,both,, ,239.73,143.83,Medicare,Medicare,,,,,239.73,,,,
URGENT CARE LVL 2 EP,G0463,HCPCS,,,,,both,, ,251.84,151.1,Medicare,Medicare,,,,,251.84,,,,
URGENT CARE LVL 2 EP,G0463,HCPCS,,,,,both,, ,251.84,151.1,Medicare,Medicare,,,,,251.84,,,,
URGENT CARE LVL 2 EP,G0463,HCPCS,,,,,both,, ,251.84,151.1,Medicare,Medicare,,,,,251.84,,,,
URGENT CARE LVL 2 EP,G0463,HCPCS,,,,,both,, ,251.84,151.1,Medicare,Medicare,,,,,251.84,,,,
URGENT CARE LVL 2 NP,G0463,HCPCS,,,,,both,, ,234.07,140.44,Medicare,Medicare,,,,,234.07,,,,
URGENT CARE LVL 2 NP,G0463,HCPCS,,,,,both,, ,234.07,140.44,Medicare,Medicare,,,,,234.07,,,,
URGENT CARE LVL 3 EP,G0463,HCPCS,,,,,both,, ,281.71,169.02,Medicare,Medicare,,,,,281.71,,,,
URGENT CARE LVL 3 EP,G0463,HCPCS,,,,,both,, ,281.71,169.02,Medicare,Medicare,,,,,281.71,,,,
URGENT CARE LVL 3 NP,G0463,HCPCS,,,,,both,, ,261.88,157.12,Medicare,Medicare,,,,,261.88,,,,
URGENT CARE LVL 3 NP,G0463,HCPCS,,,,,both,, ,261.88,157.12,Medicare,Medicare,,,,,261.88,,,,
URGENT CARE LVL 4 EP,G0463,HCPCS,,,,,both,, ,311.83,187.09,Medicare,Medicare,,,,,311.83,,,,
URGENT CARE LVL 4 EP,G0463,HCPCS,,,,,both,, ,311.83,187.09,Medicare,Medicare,,,,,311.83,,,,
URGENT CARE LVL 4 NP,G0463,HCPCS,,,,,both,, ,289.69,173.81,Medicare,Medicare,,,,,289.69,,,,
URGENT CARE LVL 4 NP,G0463,HCPCS,,,,,both,, ,289.69,173.81,Medicare,Medicare,,,,,289.69,,,,
URGENT CARE LVL 5 EP,G0463,HCPCS,,,,,both,, ,317.5,190.5,Medicare,Medicare,,,,,317.5,,,,
URGENT CARE LVL 5 EP,G0463,HCPCS,,,,,both,, ,317.5,190.5,Medicare,Medicare,,,,,317.5,,,,
URGENT CARE LVL 5 EP,G0463,HCPCS,,,,,both,, ,317.5,190.5,Medicare,Medicare,,,,,317.5,,,,
URGENT CARE LVL 5 EP,G0463,HCPCS,,,,,both,, ,317.5,190.5,Medicare,Medicare,,,,,317.5,,,,
EVAL & MGMT LEVEL 4,G0463,HCPCS,,,,,Outpatient,, ,237.25,142.35,Medicare,Medicare,,,,,237.25,,,,
"New patient office of other outpatient visit, typically 60 min",G0463,HCPCS,,,,,Outpatient,,,317.5,317.5,Medicare,Medicare,,,,,317.5,317.5,317.5,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,,,,,289.69,289.69,289.69,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,,,,,261.88,261.88,261.88,fee schedule,Medicare APC Fee Schedule
HIV1 AG W HIV 1 2 AB,G0475,HCPCS,,,,,both,, ,166.16,99.69,Medicare,Medicare,,,,,166.16,,,,
HEPB SCR HI RSK NPRG,G0499,HCPCS,,,,,both,, ,570.04,342.02,Medicare,Medicare,,,,,570.04,,,,
ABCIXIMAB 10MG,J0130,HCPCS,,,,,both,, ,4719.72,2831.83,Medicare,Medicare,,,,,4719.72,,,,
ACETAMINO 10MG INJ,J0131,HCPCS,,,,,both,100,ML,3,1.8,Medicare,Medicare,,,,,3,,,,
ACTYLCYSTN INJ 100MG,J0132,HCPCS,,,,,both,30,ML,17.77,10.66,Medicare,Medicare,,,,,17.77,,,,
ACYCLOVIR 5MG INJ,J0133,HCPCS,,,,,both,, ,0.31,0.18,Medicare,Medicare,,,,,0.31,,,,
ACYCLOVIR 5MG INJ,J0133,HCPCS,,,,,both,10,ML,1.03,0.61,Medicare,Medicare,,,,,1.03,,,,
ADENOSINE 1MG INJ,J0153,HCPCS,,,,,both,2,ML,15.45,9.27,Medicare,Medicare,,,,,15.45,,,,
ADENOSINE 1MG INJ,J0153,HCPCS,,,,,both,2,ML,15.45,9.27,Medicare,Medicare,,,,,15.45,,,,
ADRENL/EPINEP 0.1MG,J0171,HCPCS,,,,,both,1,ML,2.68,1.6,Medicare,Medicare,,,,,2.68,,,,
ADRENL/EPINEP 0.1MG,J0171,HCPCS,,,,,both,10,ML,8.65,5.19,Medicare,Medicare,,,,,8.65,,,,
EPINEPHRINE INJ 30MG/30ML (1 MG/ML),J0171,HCPCS,,,,,both,30,ML,4,2.4,Medicare,Medicare,,,,,4,,,,
REMDESIVIR 1MG INJ,J0248,HCPCS,,,,,both,1,EA,28,16.8,Medicare,Medicare,,,,,28,,,,
AMKCN SULF INJ 100MG,J0278,HCPCS,,,,,both,2,ML,5.56,3.33,Medicare,Medicare,,,,,5.56,,,,
AMINOPHYLL 250MG INJ,J0280,HCPCS,,,,,both,20,ML,58.97,35.38,Medicare,Medicare,,,,,58.97,,,,
AMINOPHYLL 250MG INJ,J0280,HCPCS,,,,,both,10,ML,96.31,57.78,Medicare,Medicare,,,,,96.31,,,,
AMIODARONE 30MG INJ,J0282,HCPCS,,,,,both,18,ML,5.15,3.09,Medicare,Medicare,,,,,5.15,,,,
AMIODARONE 30MG INJ,J0282,HCPCS,,,,,both,3,ML,6.39,3.83,Medicare,Medicare,,,,,6.39,,,,
AMPHOTER B 50MG INJ,J0285,HCPCS,,,,,both,, ,321.36,192.81,Medicare,Medicare,,,,,321.36,,,,
AMPHOTER B LIPO 10MG,J0289,HCPCS,,,,,both,1,EA,211.15,126.69,Medicare,Medicare,,,,,211.15,,,,
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,17,10.2,Medicare,Medicare,,,,,17,,,,
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,, ,26.78,16.06,Medicare,Medicare,,,,,26.78,,,,
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,, ,26.78,16.06,Medicare,Medicare,,,,,26.78,,,,
AMPICILLIN 500MG INJ,J0290,HCPCS,,,,,both,1,EA,57.94,34.76,Medicare,Medicare,,,,,57.94,,,,
AMPICILLIN/SUB 1.5GM,J0295,HCPCS,,,,,both,1,EA,23.69,14.21,Medicare,Medicare,,,,,23.69,,,,
AMPICILLIN/SUB 1.5GM,J0295,HCPCS,,,,,both,, ,63.09,37.85,Medicare,Medicare,,,,,63.09,,,,
SUCCINYLCHN 20MG INJ,J0330,HCPCS,,,,,both,10,ML,13,7.8,Medicare,Medicare,,,,,13,,,,
SUCCINYLCHN 20MG INJ,J0330,HCPCS,,,,,both,, ,20.34,12.2,Medicare,Medicare,,,,,20.34,,,,
HYDRALAZINE 20MG INJ,J0360,HCPCS,,,,,both,1,ML,101.71,61.02,Medicare,Medicare,,,,,101.71,,,,
AZITHROMYC 500MG INJ,J0456,HCPCS,,,,,both,1,EA,40.69,24.41,Medicare,Medicare,,,,,40.69,,,,
ATROPINE 0.01 MG INJ,J0461,HCPCS,,,,,both,1,ML,2,1.2,Medicare,Medicare,,,,,2,,,,
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,, ,0.03,0.01,Medicare,Medicare,,,,,0.03,,,,
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,, ,0.62,0.37,Medicare,Medicare,,,,,0.62,,,,
ATROPINE 0.01MG INJ,J0461,HCPCS,,,,,both,10,ML,1.03,0.61,Medicare,Medicare,,,,,1.03,,,,
DIMERCAPRO 100MG INJ,J0470,HCPCS,,,,,both,, ,198.28,118.96,Medicare,Medicare,,,,,198.28,,,,
DICYCLOMINE 20MG INJ,J0500,HCPCS,,,,,both,2,ML,307.46,184.47,Medicare,Medicare,,,,,307.46,,,,
BENZTROPN MES 1MGINJ,J0515,HCPCS,,,,,both,2,ML,263.42,158.05,Medicare,Medicare,,,,,263.42,,,,
PCN G BENZ/PROC 100K,J0558,HCPCS,,,,,both,, ,34.25,20.55,Medicare,Medicare,,,,,34.25,,,,
PCN G BENZ/PROC 100K,J0558,HCPCS,,,,,both,, ,35.54,21.32,Medicare,Medicare,,,,,35.54,,,,
PEN G BENZ INJ 100K,J0561,HCPCS,,,,,both,2,ML,43,25.8,Medicare,Medicare,,,,,43,,,,
BIVALIRUDIN 1MG INJ,J0583,HCPCS,,,,,both,1,EA,18.28,10.96,Medicare,Medicare,,,,,18.28,,,,
BOTULINUM TOXI A 1U,J0585,HCPCS,,,,,both,1,EA,33.48,20.08,Medicare,Medicare,,,,,33.48,,,,
BUTORPHANOL 1MG INJ,J0595,HCPCS,,,,,both,1,ML,17.77,10.66,Medicare,Medicare,,,,,17.77,,,,
CINACALC 1MG PO ESRD,J0604,HCPCS,,,,,both,, ,6.18,3.7,Medicare,Medicare,,,,,6.18,,,,
CALCITRIOL .1MCG INJ,J0636,HCPCS,,,,,both,, ,4.33,2.59,Medicare,Medicare,,,,,4.33,,,,
LEUCOVORIN 50MG INJ,J0640,HCPCS,,,,,both,1,EA,84.46,50.67,Medicare,Medicare,,,,,84.46,,,,
MEPIVACAINE 10ML INJ,J0670,HCPCS,,,,,both,30,ML,19.31,11.58,Medicare,Medicare,,,,,19.31,,,,
MEPIVACAINE 10ML INJ,J0670,HCPCS,,,,,both,20,ML,21.89,13.13,Medicare,Medicare,,,,,21.89,,,,
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,12.88,7.72,Medicare,Medicare,,,,,12.88,,,,
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,12.88,7.72,Medicare,Medicare,,,,,12.88,,,,
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,, ,14.94,8.96,Medicare,Medicare,,,,,14.94,,,,
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,, ,14.94,8.96,Medicare,Medicare,,,,,14.94,,,,
CEFAZOLIN 500MG INJ,J0690,HCPCS,,,,,both,1,EA,22.4,13.44,Medicare,Medicare,,,,,22.4,,,,
CEFEPIME 500 MG INJ,J0692,CPT,,,,,both,1,EA,9,5.4,Medicare,Medicare,,,,,9,,,,
CEFEPIME 500MG INJ,J0692,HCPCS,,,,,both,, ,19.06,11.43,Medicare,Medicare,,,,,19.06,,,,
CEFEPIME 500MG INJ,J0692,HCPCS,,,,,both,1,EA,24.72,14.83,Medicare,Medicare,,,,,24.72,,,,
CEFOXITIN 1GM INJ,J0694,HCPCS,,,,,both,1,EA,53.82,32.29,Medicare,Medicare,,,,,53.82,,,,
CEFTO50-TAZO25MG INJ,J0695,HCPCS,,,,,both,1,EA,28.84,17.3,Medicare,Medicare,,,,,28.84,,,,
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,8.03,4.81,Medicare,Medicare,,,,,8.03,,,,
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,11.59,6.95,Medicare,Medicare,,,,,11.59,,,,
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,12.88,7.72,Medicare,Medicare,,,,,12.88,,,,
CEFTRIAXONE 250MGINJ,J0696,HCPCS,,,,,both,1,EA,24.72,14.83,Medicare,Medicare,,,,,24.72,,,,
CEFUROXIME 750MG INJ,J0697,HCPCS,,,,,both,, ,23.69,14.21,Medicare,Medicare,,,,,23.69,,,,
CEFUROXIME 750MG INJ,J0697,HCPCS,,,,,both,, ,45.06,27.03,Medicare,Medicare,,,,,45.06,,,,
BETAM ACE/SOD PHO3MG,J0702,HCPCS,,,,,both,5,ML,56.14,33.68,Medicare,Medicare,,,,,56.14,,,,
CEFTAROLIN 10MG INJ,J0712,HCPCS,,,,,both,, ,16.48,9.88,Medicare,Medicare,,,,,16.48,,,,
CEFTAROLIN 10MG INJ,J0712,HCPCS,,,,,both,, ,24.72,14.83,Medicare,Medicare,,,,,24.72,,,,
COLISTIME UP TO 150M,J0770,CPT,,,,,both,1,EA,236.64,141.98,Medicare,Medicare,,,,,236.64,,,,
PROCHLORPE UPTO 10MG,J0780,HCPCS,,,,,both,, ,39.66,23.79,Medicare,Medicare,,,,,39.66,,,,
COSYNTROPN .25MG INJ,J0834,HCPCS,,,,,both,1,EA,687.78,412.66,Medicare,Medicare,,,,,687.78,,,,
DALBAVANCIN 5MG INJ,J0875,HCPCS,,,,,both,, ,85.75,51.45,Medicare,Medicare,,,,,85.75,,,,
DAPTOMYCIN 1 MG INJ,J0878,HCPCS,,,,,both,1,EA,3.5,2.1,Medicare,Medicare,,,,,3.5,,,,
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,38.88,23.32,Medicare,Medicare,,,,,38.88,,,,
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,38.88,23.32,Medicare,Medicare,,,,,38.88,,,,
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Medicare,Medicare,,,,,42.75,,,,
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Medicare,Medicare,,,,,42.75,,,,
DARBEPO 1MCG NO-ESRD,J0881,HCPCS,,,,,both,, ,42.75,25.65,Medicare,Medicare,,,,,42.75,,,,
ARGATROBAN 1MG NESRD,J0883,HCPCS,,,,,both,2.5,ML,18.8,11.28,Medicare,Medicare,,,,,18.8,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,111.5,66.9,Medicare,Medicare,,,,,111.5,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,111.5,66.9,Medicare,Medicare,,,,,111.5,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,124.37,74.62,Medicare,Medicare,,,,,124.37,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Medicare,Medicare,,,,,162.74,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Medicare,Medicare,,,,,162.74,,,,
EPO 1000UN INJ NESRD,J0885,HCPCS,,,,,both,, ,162.74,97.64,Medicare,Medicare,,,,,162.74,,,,
DEFEROXAMIN 500MGINJ,J0895,HCPCS,,,,,both,1,EA,66.44,39.86,Medicare,Medicare,,,,,66.44,,,,
DEFEROXAMIN 500MGINJ,J0895,HCPCS,,,,,both,, ,132.87,79.72,Medicare,Medicare,,,,,132.87,,,,
DENOSUMAB 1MG INJ,J0897,HCPCS,,,,,both,1,ML,96.31,57.78,Medicare,Medicare,,,,,96.31,,,,
MEDROXYPROG 1MG INJ,J1050,HCPCS,,,,,both,1,ML,4.43,2.65,Medicare,Medicare,,,,,4.43,,,,
TESTOSTER CYPION 1MG,J1071,HCPCS,,,,,both,, ,0.93,0.55,Medicare,Medicare,,,,,0.93,,,,
TESTOSTER CYPION 1MG,J1071,HCPCS,,,,,both,, ,593.28,355.96,Medicare,Medicare,,,,,593.28,,,,
DEXAMETH NA 1MG INJ,J1100,HCPCS,,,,,both,1,ML,6.39,3.83,Medicare,Medicare,,,,,6.39,,,,
ACETAZOLAMI 500MGINJ,J1120,HCPCS,,,,,both,1,EA,308.49,185.09,Medicare,Medicare,,,,,308.49,,,,
DIGOXIN 0.5MG INJ,J1160,HCPCS,,,,,both,2,ML,47.12,28.27,Medicare,Medicare,,,,,47.12,,,,
DIGOXIN IMMUNE FAB,J1162,HCPCS,,,,,both,1,EA,6881.43,4128.85,Medicare,Medicare,,,,,6881.43,,,,
PHENYTOIN NA 50MGINJ,J1165,HCPCS,,,,,both,5,ML,5.36,3.21,Medicare,Medicare,,,,,5.36,,,,
PHENYTOIN NA 50MGINJ,J1165,HCPCS,,,,,both,2,ML,12.88,7.72,Medicare,Medicare,,,,,12.88,,,,
DEXRAZOXANE 25OMG IJ,J1190,HCPCS,,,,,both,, ,1352.91,811.74,Medicare,Medicare,,,,,1352.91,,,,
DIPHENHYDRAM 50MGINJ,J1200,HCPCS,,,,,both,1,ML,13.91,8.34,Medicare,Medicare,,,,,13.91,,,,
DIPYRIDAMOLE 10MGINJ,J1245,HCPCS,,,,,both,, ,26.78,16.06,Medicare,Medicare,,,,,26.78,,,,
DOBUTAMINE 250MG INJ,J1250,HCPCS,,,,,both,20,ML,28.84,17.3,Medicare,Medicare,,,,,28.84,,,,
DOBUTAMINE 250MG INJ,J1250,HCPCS,,,,,both,250,ML,78.28,46.96,Medicare,Medicare,,,,,78.28,,,,
DOPAMIN HCL 40MG INJ,J1265,HCPCS,,,,,both,250,ML,8.55,5.13,Medicare,Medicare,,,,,8.55,,,,
EPTIFABITIDE 5MG IJ,J1327,HCPCS,,,,,both,, ,164.8,98.88,Medicare,Medicare,,,,,164.8,,,,
ERTAPENEM SOD/500MG,J1335,HCPCS,,,,,both,1,EA,298.96,179.37,Medicare,Medicare,,,,,298.96,,,,
ERYTHROMYC 500MG INJ,J1364,HCPCS,,,,,both,1,EA,196.99,118.19,Medicare,Medicare,,,,,196.99,,,,
ESTROGEN CNJ 25MGINJ,J1410,HCPCS,,,,,both,, ,1016.61,609.96,Medicare,Medicare,,,,,1016.61,,,,
FER CARBOXYM 1MG INJ,J1439,HCPCS,,,,,both,15,ML,7,4.2,Medicare,Medicare,,,,,7,,,,
TBO-FILGRASTIM 1MCG,J1447,HCPCS,,,,,both,0.5,ML,4.53,2.71,Medicare,Medicare,,,,,4.53,,,,
TBO-FILGRASTIM 1MCG,J1447,HCPCS,,,,,both,0.5,ML,4.53,2.71,Medicare,Medicare,,,,,4.53,,,,
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,200,ML,32.19,19.31,Medicare,Medicare,,,,,32.19,,,,
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,50,ML,84.72,50.83,Medicare,Medicare,,,,,84.72,,,,
FLUCONAZOL 200MG INJ,J1450,HCPCS,,,,,both,100,ML,144.72,86.83,Medicare,Medicare,,,,,144.72,,,,
"FOMEPIZOLE, 15 MG",J1451,HCPCS,,,,,both,1.5,ML,43.52,26.11,Medicare,Medicare,,,,,43.52,,,,
FOSAPREPITANT 1MG IJ,J1453,HCPCS,,,,,both,1,EA,10.82,6.49,Medicare,Medicare,,,,,10.82,,,,
IVIG (PRIVIGEN)500MG,J1459,HCPCS,,,,,both,50,ML,390.89,234.53,Medicare,Medicare,,,,,390.89,,,,
IVIG (PRIVIGEN)500MG,J1459,HCPCS,,,,,both,50,ML,390.89,234.53,Medicare,Medicare,,,,,390.89,,,,
IMMU GLOB LYO 500MG,J1566,HCPCS,,,,,both,, ,270.89,162.53,Medicare,Medicare,,,,,270.89,,,,
IMMU GLOB LYO 500MG,J1566,HCPCS,,,,,both,, ,270.89,162.53,Medicare,Medicare,,,,,270.89,,,,
IVIG (OCTAGAM) 500MG,J1568,HCPCS,,,,,both,200,ML,319.82,191.89,Medicare,Medicare,,,,,319.82,,,,
IVIG (OCTAGAM) 500MG,J1568,HCPCS,,,,,both,200,ML,319.82,191.89,Medicare,Medicare,,,,,319.82,,,,
GANCICLOVI SOD 500MG,J1570,HCPCS,,,,,both,1,EA,615.94,369.56,Medicare,Medicare,,,,,615.94,,,,
IVIG (FLEBOGAM)500MG,J1572,HCPCS,,,,,both,100,ML,256.99,154.19,Medicare,Medicare,,,,,256.99,,,,
IVIG (FLEBOGAM)500MG,J1572,HCPCS,,,,,both,100,ML,256.99,154.19,Medicare,Medicare,,,,,256.99,,,,
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,2,ML,24.72,14.83,Medicare,Medicare,,,,,24.72,,,,
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,, ,27.81,16.68,Medicare,Medicare,,,,,27.81,,,,
GENTAMICIN UPTO 80MG,J1580,HCPCS,,,,,both,2,ML,28.84,17.3,Medicare,Medicare,,,,,28.84,,,,
GLUCAGON 1MG INJ,J1610,HCPCS,,,,,both,, ,710.19,426.11,Medicare,Medicare,,,,,710.19,,,,
GLUCAGON 1MG INJ,J1610,HCPCS,,,,,both,1,EA,1505,903,Medicare,Medicare,,,,,1505,,,,
HALOPERIDOL 5MG INJ,J1630,HCPCS,,,,,both,1,ML,68.5,41.1,Medicare,Medicare,,,,,68.5,,,,
HALOPER DEC 50MGINJ,J1631,HCPCS,,,,,both,1,ML,183.08,109.84,Medicare,Medicare,,,,,183.08,,,,
HALOPER DEC 50MGINJ,J1631,HCPCS,,,,,both,1,ML,217.33,130.39,Medicare,Medicare,,,,,217.33,,,,
HEPARIN NA 10U FLUSH,J1642,HCPCS,,,,,both,5,ML,0.52,0.31,Medicare,Medicare,,,,,0.52,,,,
HEPARIN NA 10U FLUSH,J1642,HCPCS,,,,,both,3,ML,0.93,0.55,Medicare,Medicare,,,,,0.93,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,2.16,1.29,Medicare,Medicare,,,,,2.16,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,5.67,3.4,Medicare,Medicare,,,,,5.67,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,6.39,3.83,Medicare,Medicare,,,,,6.39,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,, ,19.57,11.74,Medicare,Medicare,,,,,19.57,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,500,ML,27.81,16.68,Medicare,Medicare,,,,,27.81,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,28.84,17.3,Medicare,Medicare,,,,,28.84,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,1,ML,41.72,25.03,Medicare,Medicare,,,,,41.72,,,,
HEPARIN 1000U INJ,J1644,HCPCS,,,,,both,250,ML,76,45.6,Medicare,Medicare,,,,,76,,,,
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.3,ML,57.17,34.3,Medicare,Medicare,,,,,57.17,,,,
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,1,ML,57.17,34.3,Medicare,Medicare,,,,,57.17,,,,
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.8,ML,57.17,34.3,Medicare,Medicare,,,,,57.17,,,,
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.6,ML,57.17,34.3,Medicare,Medicare,,,,,57.17,,,,
ENOXAPARIN 10MG INJ,J1650,HCPCS,,,,,both,0.4,ML,57.17,34.3,Medicare,Medicare,,,,,57.17,,,,
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,38.37,23.02,Medicare,Medicare,,,,,38.37,,,,
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,51.24,30.74,Medicare,Medicare,,,,,51.24,,,,
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,76.74,46.04,Medicare,Medicare,,,,,76.74,,,,
FONDAPARIN 0.5MG INJ,J1652,HCPCS,,,,,both,, ,85.49,51.29,Medicare,Medicare,,,,,85.49,,,,
TETANUS IG HUM 250U,J1670,HCPCS,,,,,both,1,ML,1976.31,1185.78,Medicare,Medicare,,,,,1976.31,,,,
HYDROCORTIS 100MGINJ,J1720,HCPCS,,,,,both,1,EA,48.15,28.89,Medicare,Medicare,,,,,48.15,,,,
MELOXICAM 1MG INJ,J1738,HCPCS,,,,,both,1,ML,566,339.6,Medicare,Medicare,,,,,566,,,,
IBUTILIDE 1MG INJ,J1742,HCPCS,,,,,both,, ,1612.21,967.32,Medicare,Medicare,,,,,1612.21,,,,
INFLIXIMAB 10 MG INJ,J1745,HCPCS,,,,,both,1,EA,560.84,336.5,Medicare,Medicare,,,,,560.84,,,,
IRON DEX165 INJ 50MG,J1750,HCPCS,,,,,both,, ,132.87,79.72,Medicare,Medicare,,,,,132.87,,,,
IRON SUCROSE 1MG INJ,J1756,HCPCS,,,,,both,, ,4.22,2.53,Medicare,Medicare,,,,,4.22,,,,
DROPERIDOL UP TO 5MG,J1790,HCPCS,,,,,both,2,ML,27.81,16.68,Medicare,Medicare,,,,,27.81,,,,
INSULIN 1 UNT INJ,J1815,CPT,,,,,both,10,ML,1,0.6,Medicare,Medicare,,,,,1,,,,
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,, ,6.39,3.83,Medicare,Medicare,,,,,6.39,,,,
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,1,ML,12.88,7.72,Medicare,Medicare,,,,,12.88,,,,
KETOROLAC 15MG INJ,J1885,HCPCS,,,,,both,1,ML,25.75,15.45,Medicare,Medicare,,,,,25.75,,,,
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,10,ML,5.67,3.4,Medicare,Medicare,,,,,5.67,,,,
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,4,ML,12.88,7.72,Medicare,Medicare,,,,,12.88,,,,
FUROSEMIDE 20MG INJ,J1940,HCPCS,,,,,both,2,ML,25.75,15.45,Medicare,Medicare,,,,,25.75,,,,
LUPR 3.75FEMALE/PEDS,J1950,HCPCS,,,,,both,1,EA,6029.88,3617.92,Medicare,Medicare,,,,,6029.88,,,,
LEVETIRACET 10MG INJ,J1953,HCPCS,,,,,both,5,ML,1.18,0.7,Medicare,Medicare,,,,,1.18,,,,
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,100,ML,58.45,35.07,Medicare,Medicare,,,,,58.45,,,,
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,150,ML,68.24,40.94,Medicare,Medicare,,,,,68.24,,,,
LEVOFLOXAC 250MG INJ,J1956,HCPCS,,,,,both,50,ML,78.28,46.96,Medicare,Medicare,,,,,78.28,,,,
LINEZOLID 200 MG,J2020,HCPCS,,,,,both,300,ML,225.31,135.18,Medicare,Medicare,,,,,225.31,,,,
LINEZOLID 200 MG,J2020,HCPCS,,,,,both,, ,258.79,155.27,Medicare,Medicare,,,,,258.79,,,,
LORAZEPAM 2MG INJ,J2060,HCPCS,,,,,both,1,ML,19.57,11.74,Medicare,Medicare,,,,,19.57,,,,
LORAZEPAM INJ 2MG/ML 10 ML MDV,J2060,HCPCS,,,,,both,, ,15.14,9.08,Medicare,Medicare,,,,,15.14,,,,
MANNITOL 25% 50MLINJ,J2150,HCPCS,,,,,both,50,ML,24.72,14.83,Medicare,Medicare,,,,,24.72,,,,
MEPERID HCL 100MGINJ,J2175,HCPCS,,,,,both,1,ML,16.48,9.88,Medicare,Medicare,,,,,16.48,,,,
MEROPENEMBR 100MGINJ,J2184,HCPCS,,,,,both,, ,18.28,10.96,Medicare,Medicare,,,,,18.28,,,,
MEROPENEM 100MG INJ,J2185,HCPCS,,,,,both,1,EA,8.96,5.37,Medicare,Medicare,,,,,8.96,,,,
MEROPENEM 100MG INJ,J2185,HCPCS,,,,,both,1,EA,8.96,5.37,Medicare,Medicare,,,,,8.96,,,,
METHYLERGONV .2MGINJ,J2210,HCPCS,,,,,both,1,ML,47.12,28.27,Medicare,Medicare,,,,,47.12,,,,
METHYLNALTR .1MG INJ,J2212,HCPCS,,,,,both,, ,4.33,2.59,Medicare,Medicare,,,,,4.33,,,,
MICAFUNGIN 1MG INJ,J2248,HCPCS,,,,,both,1,EA,11.59,6.95,Medicare,Medicare,,,,,11.59,,,,
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,10,ML,1.03,0.61,Medicare,Medicare,,,,,1.03,,,,
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,5,ML,3.09,1.85,Medicare,Medicare,,,,,3.09,,,,
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,2,ML,7,4.2,Medicare,Medicare,,,,,7,,,,
MIDAZOL  HCL 1MG INJ,J2250,HCPCS,,,,,both,, ,8.34,5,Medicare,Medicare,,,,,8.34,,,,
MIDAZOL HCL WG 1MG,J2251,HCPCS,,,,,both,50,ML,3.25,1.95,Medicare,Medicare,,,,,3.25,,,,
MILRINONE 5MG INJ,J2260,HCPCS,,,,,both,100,ML,32.19,19.31,Medicare,Medicare,,,,,32.19,,,,
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,1.03,0.61,Medicare,Medicare,,,,,1.03,,,,
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,5.15,3.09,Medicare,Medicare,,,,,5.15,,,,
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Medicare,Medicare,,,,,14.94,,,,
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Medicare,Medicare,,,,,14.94,,,,
MORPHINE UP TO 10MG,J2270,HCPCS,,,,,both,, ,14.94,8.96,Medicare,Medicare,,,,,14.94,,,,
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,14.75,8.85,Medicare,Medicare,,,,,14.75,,,,
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,14.94,8.96,Medicare,Medicare,,,,,14.94,,,,
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,1,ML,16,9.6,Medicare,Medicare,,,,,16,,,,
MORPHINE PF 10MG INJ,J2274,HCPCS,,,,,both,, ,86.78,52.06,Medicare,Medicare,,,,,86.78,,,,
NALBUPHINE 10MG INJ,J2300,HCPCS,,,,,both,1,ML,25.75,15.45,Medicare,Medicare,,,,,25.75,,,,
NALOXONE HCL 1MG INJ,J2310,HCPCS,,,,,both,1,ML,133.9,80.34,Medicare,Medicare,,,,,133.9,,,,
NALOXONE HCL 1MG INJ,J2310,HCPCS,,,,,both,2,ML,139.31,83.58,Medicare,Medicare,,,,,139.31,,,,
OCRELIZUMAB 1MG INJ,J2350,HCPCS,,,,,both,10,ML,133.9,80.34,Medicare,Medicare,,,,,133.9,,,,
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,1,ML,21.37,12.82,Medicare,Medicare,,,,,21.37,,,,
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,1,ML,42.23,25.33,Medicare,Medicare,,,,,42.23,,,,
OCTREOTIDE ND 25MCG,J2354,HCPCS,,,,,both,, ,280.16,168.09,Medicare,Medicare,,,,,280.16,,,,
ORPHENADR UP TO 60MG,J2360,HCPCS,,,,,both,2,ML,156.3,93.78,Medicare,Medicare,,,,,156.3,,,,
CHLOROPR HCL INJ 1MG,J2401,HCPCS,,,,,both,20,ML,0.3,0.18,Medicare,Medicare,,,,,0.3,,,,
ONDANSETRON 1MG INJ,J2405,HCPCS,,,,,both,2,ML,42.23,25.33,Medicare,Medicare,,,,,42.23,,,,
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.75,ML,42.23,25.33,Medicare,Medicare,,,,,42.23,,,,
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.25,ML,58.97,35.38,Medicare,Medicare,,,,,58.97,,,,
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,1,ML,58.97,35.38,Medicare,Medicare,,,,,58.97,,,,
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,1.5,ML,58.97,35.38,Medicare,Medicare,,,,,58.97,,,,
PALIPERIDONE 1MG INJ,J2426,HCPCS,,,,,both,0.5,ML,61.03,36.61,Medicare,Medicare,,,,,61.03,,,,
PAMIDRONATE 30MG IJ,J2430,HCPCS,,,,,both,10,ML,193.64,116.18,Medicare,Medicare,,,,,193.64,,,,
PAMIDRONATE 30MG IJ,J2430,HCPCS,,,,,both,, ,1208.71,725.22,Medicare,Medicare,,,,,1208.71,,,,
PAPAVERINE UPTO 60MG,J2440,HCPCS,,,,,both,, ,302.05,181.23,Medicare,Medicare,,,,,302.05,,,,
PALONOSETRON 25MCG,J2469,HCPCS,,,,,both,, ,250.55,150.33,Medicare,Medicare,,,,,250.55,,,,
PANTOPRAZOLE SOD VL,J2470,HCPCS,,,,,both,1,EA,41.72,25.03,Medicare,Medicare,,,,,41.72,,,,
PARICALCITOL 1MCGINJ,J2501,HCPCS,,,,,both,1,ML,25.75,15.45,Medicare,Medicare,,,,,25.75,,,,
PENICI G POT .6MUINJ,J2540,HCPCS,,,,,both,, ,11.33,6.79,Medicare,Medicare,,,,,11.33,,,,
PENICI G POT .6MUINJ,J2540,HCPCS,,,,,both,1,EA,11.59,6.95,Medicare,Medicare,,,,,11.59,,,,
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,41.97,25.18,Medicare,Medicare,,,,,41.97,,,,
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,44.55,26.73,Medicare,Medicare,,,,,44.55,,,,
PIPER/TAZOB 1G/.125G,J2543,HCPCS,,,,,both,1,EA,48.15,28.89,Medicare,Medicare,,,,,48.15,,,,
PROMETHAZI UPTO 50MG,J2550,HCPCS,,,,,both,1,ML,24.72,14.83,Medicare,Medicare,,,,,24.72,,,,
PHENOBARB 120MG INJ,J2560,HCPCS,,,,,both,1,ML,167.89,100.73,Medicare,Medicare,,,,,167.89,,,,
PHENOBARB 120MG INJ,J2560,HCPCS,,,,,both,, ,232.78,139.66,Medicare,Medicare,,,,,232.78,,,,
OXYTOCIN UP TO 10UN,J2590,HCPCS,,,,,both,1,ML,27.81,16.68,Medicare,Medicare,,,,,27.81,,,,
DESMOPRESSIN 1MCGINJ,J2597,HCPCS,,,,,both,1,ML,13.91,8.34,Medicare,Medicare,,,,,13.91,,,,
FLUPHENZI UP TO 25MG,J2680,HCPCS,,,,,both,5,ML,139.05,83.43,Medicare,Medicare,,,,,139.05,,,,
PROCAINAMID UPTO 1GM,J2690,HCPCS,,,,,both,2,ML,95.79,57.47,Medicare,Medicare,,,,,95.79,,,,
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,20,ML,1.44,0.86,Medicare,Medicare,,,,,1.44,,,,
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,50,ML,2.68,1.6,Medicare,Medicare,,,,,2.68,,,,
PROPOFOL 10MG INJ,J2704,HCPCS,,,,,both,50,ML,2.68,1.6,Medicare,Medicare,,,,,2.68,,,,
NEOSTIGMINE .5MG INJ,J2710,HCPCS,,,,,both,10,ML,13.91,8.34,Medicare,Medicare,,,,,13.91,,,,
NEOSTIGMINE .5MG INJ,J2710,HCPCS,,,,,both,5,ML,19.57,11.74,Medicare,Medicare,,,,,19.57,,,,
PROTAMINE 10MG INJ,J2720,HCPCS,,,,,both,5,ML,12.88,7.72,Medicare,Medicare,,,,,12.88,,,,
PHENTOLAMINE 5MG INJ,J2760,HCPCS,,,,,both,1,EA,968.46,581.07,Medicare,Medicare,,,,,968.46,,,,
METOCLOPRAM 10MG INJ,J2765,HCPCS,,,,,both,2,ML,24.72,14.83,Medicare,Medicare,,,,,24.72,,,,
REGADENOSON 0.1MG IJ,J2785,HCPCS,,,,,both,5,ML,335.01,201,Medicare,Medicare,,,,,335.01,,,,
RHOPHYLAC 100UNT,J2791,HCPCS,,,,,both,2,ML,62.83,37.69,Medicare,Medicare,,,,,62.83,,,,
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,28.33,16.99,Medicare,Medicare,,,,,28.33,,,,
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,34.25,20.55,Medicare,Medicare,,,,,34.25,,,,
RISPERIDONE LA 0.5MG,J2794,HCPCS,,,,,both,1,EA,37.08,22.24,Medicare,Medicare,,,,,37.08,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,20,ML,1.03,0.61,Medicare,Medicare,,,,,1.03,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,20,ML,1.03,0.61,Medicare,Medicare,,,,,1.03,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,30,ML,1.03,0.61,Medicare,Medicare,,,,,1.03,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,, ,1.65,0.99,Medicare,Medicare,,,,,1.65,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,100,ML,1.96,1.17,Medicare,Medicare,,,,,1.96,,,,
ROPIVACAINE 1MG INJ,J2795,HCPCS,,,,,both,10,ML,2.16,1.29,Medicare,Medicare,,,,,2.16,,,,
SINCALIDE INJ 5MCG,J2805,HCPCS,,,,,both,1,EA,670.53,402.31,Medicare,Medicare,,,,,670.53,,,,
SOD FERRIC 12.5MGINJ,J2916,HCPCS,,,,,both,5,ML,53.56,32.13,Medicare,Medicare,,,,,53.56,,,,
RETEPLASE 18.1MG IJ,J2993,HCPCS,,,,,both,, ,7366,4419.6,Medicare,Medicare,,,,,7366,,,,
ALTEPLASE RECOM 1MG,J2997,HCPCS,,,,,both,1,EA,347.11,208.26,Medicare,Medicare,,,,,347.11,,,,
ALTEPLASE RECOM 1MG,J2997,HCPCS,,,,,both,1,EA,353.55,212.13,Medicare,Medicare,,,,,353.55,,,,
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,5,ML,6.59,3.95,Medicare,Medicare,,,,,6.59,,,,
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,2,ML,14.42,8.65,Medicare,Medicare,,,,,14.42,,,,
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,1,ML,17.25,10.35,Medicare,Medicare,,,,,17.25,,,,
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,100,ML,20.25,12.15,Medicare,Medicare,,,,,20.25,,,,
FENTANY CIT 0.1MGINJ,J3010,HCPCS,,,,,both,20,ML,49.44,29.66,Medicare,Medicare,,,,,49.44,,,,
SUMATRIPTAN 6MG INJ,J3030,HCPCS,,,,,both,0.5,ML,631.91,379.14,Medicare,Medicare,,,,,631.91,,,,
TENECTEPLASE 1MG INJ,J3101,HCPCS,,,,,both,1,EA,402.47,241.48,Medicare,Medicare,,,,,402.47,,,,
TERBUTALINE 1MG INJ,J3105,HCPCS,,,,,both,1,ML,28.84,17.3,Medicare,Medicare,,,,,28.84,,,,
CHLORPROM UP TO 50MG,J3230,HCPCS,,,,,both,, ,161.71,97.02,Medicare,Medicare,,,,,161.71,,,,
CHLORPROM UP TO 50MG,J3230,HCPCS,,,,,both,2,ML,185.4,111.24,Medicare,Medicare,,,,,185.4,,,,
TIGECYCLINE 1 MG INJ,J3243,HCPCS,,,,,both,, ,11.33,6.79,Medicare,Medicare,,,,,11.33,,,,
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,250,ML,60,36,Medicare,Medicare,,,,,60,,,,
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,100,ML,75.71,45.42,Medicare,Medicare,,,,,75.71,,,,
TIROFIBAN 0.25MG INJ,J3246,HCPCS,,,,,both,15,ML,91.16,54.69,Medicare,Medicare,,,,,91.16,,,,
TRIMETHOBEN 200MGINJ,J3250,HCPCS,,,,,both,, ,26.78,16.06,Medicare,Medicare,,,,,26.78,,,,
TOBRAMYCIN UPTO 80MG,J3260,HCPCS,,,,,both,1,EA,71.84,43.1,Medicare,Medicare,,,,,71.84,,,,
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,4,ML,28.58,17.14,Medicare,Medicare,,,,,28.58,,,,
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,20,ML,28.58,17.14,Medicare,Medicare,,,,,28.58,,,,
TOCILIZUMAB 1MG INJ,J3262,HCPCS,,,,,both,10,ML,28.58,17.14,Medicare,Medicare,,,,,28.58,,,,
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,1,ML,18.28,10.96,Medicare,Medicare,,,,,18.28,,,,
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,1,ML,18.28,10.96,Medicare,Medicare,,,,,18.28,,,,
TRIAMCIN ACE 10MGINJ,J3301,HCPCS,,,,,both,, ,18.54,11.12,Medicare,Medicare,,,,,18.54,,,,
DIAZEPAM 5MG INJ,J3360,HCPCS,,,,,both,2,ML,100.94,60.56,Medicare,Medicare,,,,,100.94,,,,
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,1,EA,58.97,35.38,Medicare,Medicare,,,,,58.97,,,,
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,1,EA,58.97,35.38,Medicare,Medicare,,,,,58.97,,,,
VANCOMYCIN 500MG INJ,J3370,HCPCS,,,,,both,, ,62.32,37.39,Medicare,Medicare,,,,,62.32,,,,
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,300,ML,60,36,Medicare,Medicare,,,,,60,,,,
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,350,ML,68,40.8,Medicare,Medicare,,,,,68,,,,
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,250,ML,75,45,Medicare,Medicare,,,,,75,,,,
VANCOMYC X 500MG INJ,J3372,HCPCS,,,,,both,150,ML,95,57,Medicare,Medicare,,,,,95,,,,
VEDOLIZUMAB 1MG INJ,J3380,HCPCS,,,,,both,1,EA,96.31,57.78,Medicare,Medicare,,,,,96.31,,,,
HYDROXYZI UP TO 25MG,J3410,HCPCS,,,,,both,, ,13.91,8.34,Medicare,Medicare,,,,,13.91,,,,
THIAMINE 100MG INJ,J3411,HCPCS,,,,,both,2,ML,44.03,26.41,Medicare,Medicare,,,,,44.03,,,,
PYRIDOXINE 100MG INJ,J3415,HCPCS,,,,,both,1,ML,79.31,47.58,Medicare,Medicare,,,,,79.31,,,,
VIT B12 CYAN 1000MCG,J3420,HCPCS,,,,,both,1,ML,84.72,50.83,Medicare,Medicare,,,,,84.72,,,,
PHYTONADIONE 1MG INJ,J3430,HCPCS,,,,,both,0.5,ML,27.81,16.68,Medicare,Medicare,,,,,27.81,,,,
PHYTONADIONE 1MG INJ,J3430,HCPCS,,,,,both,1,ML,31.93,19.15,Medicare,Medicare,,,,,31.93,,,,
HYALURONID RECOM 1UN,J3473,HCPCS,,,,,both,1,ML,3.19,1.91,Medicare,Medicare,,,,,3.19,,,,
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,500,ML,1.13,0.67,Medicare,Medicare,,,,,1.13,,,,
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,20,ML,2.99,1.79,Medicare,Medicare,,,,,2.99,,,,
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,2,ML,12.88,7.72,Medicare,Medicare,,,,,12.88,,,,
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,, ,13.91,8.34,Medicare,Medicare,,,,,13.91,,,,
MAGNES SULF 500MGINJ,J3475,HCPCS,,,,,both,50,ML,14.94,8.96,Medicare,Medicare,,,,,14.94,,,,
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,20,ML,1.03,0.61,Medicare,Medicare,,,,,1.03,,,,
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,20,ML,1.03,0.61,Medicare,Medicare,,,,,1.03,,,,
POTASSI CHL 2MEQ INJ,J3480,HCPCS,,,,,both,, ,2.68,1.6,Medicare,Medicare,,,,,2.68,,,,
ZIDOVUDINE 10MG INJ,J3485,HCPCS,,,,,both,, ,12.36,7.41,Medicare,Medicare,,,,,12.36,,,,
ZIPRSIDNE MESYL 10MG,J3486,HCPCS,,,,,both,1,EA,77.77,46.66,Medicare,Medicare,,,,,77.77,,,,
ZOLEDRONIC ACID 1MG,J3489,HCPCS,,,,,both,100,ML,332.69,199.61,Medicare,Medicare,,,,,332.69,,,,
ZOLEDRONIC ACID 1MG,J3489,HCPCS,,,,,both,5,ML,1005.8,603.48,Medicare,Medicare,,,,,1005.8,,,,
BRIVARACETAM 50MG TB,J3490,HCPCS,,,,,both,60,EA,172.75,103.65,Medicare,Medicare,,,,,172.75,,,,
NORM SALIN 1000ML IV,J7030,HCPCS,,,,,both,1000,ML,25.75,15.45,Medicare,Medicare,,,,,25.75,,,,
NORM SAL STER500MLIV,J7040,HCPCS,,,,,both,500,ML,25.75,15.45,Medicare,Medicare,,,,,25.75,,,,
D5W/SOD CHL.9% 500ML,J7042,HCPCS,,,,,both,1000,ML,12.88,7.72,Medicare,Medicare,,,,,12.88,,,,
NORM SALINE 250ML IV,J7050,HCPCS,,,,,both,250,ML,26.78,16.06,Medicare,Medicare,,,,,26.78,,,,
SOD CHLOR .9% 100ML,J7050,HCPCS,,,,,both,100,ML,25.75,15.45,Medicare,Medicare,,,,,25.75,,,,
SOD CHLOR .9% 100ML,J7050,HCPCS,,,,,both,100,ML,68.5,41.1,Medicare,Medicare,,,,,68.5,,,,
SOD CHLOR .9% 150ML,J7050,HCPCS,,,,,both,150,ML,25.75,15.45,Medicare,Medicare,,,,,25.75,,,,
SOD CHLOR .9% 50ML,J7050,HCPCS,,,,,both,50,ML,25.75,15.45,Medicare,Medicare,,,,,25.75,,,,
SOD CHLOR .9% 50ML,J7050,HCPCS,,,,,both,50,ML,41.72,25.03,Medicare,Medicare,,,,,41.72,,,,
DEX 5%/WATER 500ML,J7060,HCPCS,,,,,both,, ,24.72,14.83,Medicare,Medicare,,,,,24.72,,,,
DEX 5%/WATER 500ML,J7060,HCPCS,,,,,both,500,ML,25.75,15.45,Medicare,Medicare,,,,,25.75,,,,
DEX 5%/WATER 1000ML,J7070,HCPCS,,,,,both,1000,ML,25.75,15.45,Medicare,Medicare,,,,,25.75,,,,
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,1000,ML,24.72,14.83,Medicare,Medicare,,,,,24.72,,,,
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,500,ML,25.75,15.45,Medicare,Medicare,,,,,25.75,,,,
RINGER LAC UP TO 1L,J7120,HCPCS,,,,,both,, ,28.84,17.3,Medicare,Medicare,,,,,28.84,,,,
D5LR UP TO 1000ML,J7121,HCPCS,,,,,both,1000,ML,25.75,15.45,Medicare,Medicare,,,,,25.75,,,,
PROTHROMB COM 1UN IX,J7168,HCPCS,,,,,both,1,EA,12.25,7.35,Medicare,Medicare,,,,,12.25,,,,
PROTHROMB COM 1UN IX,J7168,CPT,,,,,both,1,EA,12.62,7.57,Medicare,Medicare,,,,,12.62,,,,
MOMETA SIN IMP 10MCG,J7402,HCPCS,,,,,both,, ,54.59,32.75,Medicare,Medicare,,,,,54.59,,,,
AZATHIOPRINE 50MG TB,J7500,HCPCS,,,,,both,100,EA,20.34,12.2,Medicare,Medicare,,,,,20.34,,,,
CYCLOSPORNE 100MG PO,J7502,HCPCS,,,,,both,, ,41.2,24.72,Medicare,Medicare,,,,,41.2,,,,
TACROLIMUS 1MG PO,J7507,HCPCS,,,,,both,100,EA,27.3,16.38,Medicare,Medicare,,,,,27.3,,,,
METHYLPREDNIS 4MG PO,J7509,HCPCS,,,,,both,, ,8.55,5.13,Medicare,Medicare,,,,,8.55,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.1,0.06,Medicare,Medicare,,,,,0.1,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.31,0.18,Medicare,Medicare,,,,,0.31,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,0.72,0.43,Medicare,Medicare,,,,,0.72,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,100,EA,1.34,0.8,Medicare,Medicare,,,,,1.34,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,, ,7,4.2,Medicare,Medicare,,,,,7,,,,
PREDNISONE 1MG ORAL,J7512,HCPCS,,,,,both,, ,107.38,64.42,Medicare,Medicare,,,,,107.38,,,,
CYCLOSPORINE 25MG PO,J7515,HCPCS,,,,,both,, ,19.31,11.58,Medicare,Medicare,,,,,19.31,,,,
CYCLOSPOR PAREN250MG,J7516,HCPCS,,,,,both,, ,191.84,115.1,Medicare,Medicare,,,,,191.84,,,,
MYCOPHE MOF 250MG PO,J7517,HCPCS,,,,,both,100,EA,41.46,24.87,Medicare,Medicare,,,,,41.46,,,,
METHACHOL 1MGINH NEB,J7674,HCPCS,,,,,both,1,EA,4.84,2.9,Medicare,Medicare,,,,,4.84,,,,
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,, ,13.39,8.03,Medicare,Medicare,,,,,13.39,,,,
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,, ,49.18,29.5,Medicare,Medicare,,,,,49.18,,,,
CYCLOPHOSPH 25MG PO,J8530,HCPCS,,,,,both,100,EA,53.56,32.13,Medicare,Medicare,,,,,53.56,,,,
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,, ,0.52,0.31,Medicare,Medicare,,,,,0.52,,,,
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,100,EA,1.34,0.8,Medicare,Medicare,,,,,1.34,,,,
DEXAMETH 0.25MG ORAL,J8540,HCPCS,,,,,both,, ,3.5,2.1,Medicare,Medicare,,,,,3.5,,,,
METHOTREXATE 2.5MGPO,J8610,HCPCS,,,,,both,100,EA,20.34,12.2,Medicare,Medicare,,,,,20.34,,,,
LEUCOVOR CAL 25MG TB,J8999,HCPCS,,,,,both,20,EA,78.54,47.12,Medicare,Medicare,,,,,78.54,,,,
BENDAMUSTINE 1MG INJ,J9033,HCPCS,,,,,both,, ,147.81,88.68,Medicare,Medicare,,,,,147.81,,,,
BENDAMUSTINE 1MG INJ,J9033,HCPCS,,,,,both,, ,147.81,88.68,Medicare,Medicare,,,,,147.81,,,,
BORTEZOMIB .1MG INJ,J9041,HCPCS,,,,,both,, ,265.74,159.44,Medicare,Medicare,,,,,265.74,,,,
CARBOPLATIN 50MG INJ,J9045,HCPCS,,,,,both,45,ML,61.03,36.61,Medicare,Medicare,,,,,61.03,,,,
CISPLAT POW/SOL 10MG,J9060,HCPCS,,,,,both,50,ML,5.36,3.21,Medicare,Medicare,,,,,5.36,,,,
DOCETAXEL 1MG INJ,J9171,HCPCS,,,,,both,, ,87.81,52.68,Medicare,Medicare,,,,,87.81,,,,
FLUOROURACIL 500MG,J9190,HCPCS,,,,,both,, ,25.75,15.45,Medicare,Medicare,,,,,25.75,,,,
GEMCITABIN 200MG INJ,J9201,HCPCS,,,,,both,1,EA,616.97,370.18,Medicare,Medicare,,,,,616.97,,,,
GEMCITABIN 200MG INJ,J9201,HCPCS,,,,,both,, ,690.87,414.52,Medicare,Medicare,,,,,690.87,,,,
IPILIMUMAB 1MG INJ,J9228,HCPCS,,,,,both,40,ML,777.65,466.59,Medicare,Medicare,,,,,777.65,,,,
OXALIPLATIN .5MG INJ,J9263,HCPCS,,,,,both,10,ML,6.39,3.83,Medicare,Medicare,,,,,6.39,,,,
PACLITAXEL 1MG INJ,J9267,HCPCS,,,,,both,, ,3.71,2.22,Medicare,Medicare,,,,,3.71,,,,
PERTUZUMAB 1MG INJ,J9306,HCPCS,,,,,both,14,ML,61.03,36.61,Medicare,Medicare,,,,,61.03,,,,
TRASTUZUMAB 10MG INJ,J9355,HCPCS,,,,,both,, ,531.22,318.73,Medicare,Medicare,,,,,531.22,,,,
POST OP SHOES,L3260,HCPCS,,,,,both,, ,12,7.2,Medicare,Medicare,,,,,12,,,,
ADM IV INF CASI IMDV,M0243,HCPCS,,,,,both,, ,851.55,510.93,Medicare,Medicare,,,,,851.55,,,,
ADM IV INF CASI IMDV,M0243,HCPCS,,,,,both,, ,1340.29,804.17,Medicare,Medicare,,,,,1340.29,,,,
ADM IV INF BAM ETES,M0245,HCPCS,,,,,both,, ,1301.25,780.75,Medicare,Medicare,,,,,1301.25,,,,
ADM IV INF SOTROVIM,M0247,HCPCS,,,,,both,, ,1301.25,780.75,Medicare,Medicare,,,,,1301.25,,,,
"PAP SMEAR, SCREEN",P3000,HCPCS,,,,,both,, ,101.6,60.96,Medicare,Medicare,,,,,101.6,,,,
S-H CRYO EACH UNIT,P9012,HCPCS,,,,,both,, ,283.48,170.08,Medicare,Medicare,,,,,283.48,,,,
S-H RBC LEUKO REDU,P9016,HCPCS,,,,,both,, ,884.69,530.81,Medicare,Medicare,,,,,884.69,,,,
S-H 1 DONOR FFP,P9017,HCPCS,,,,,both,, ,638.53,383.11,Medicare,Medicare,,,,,638.53,,,,
S-H RED BLD-UNIT,P9021,HCPCS,,,,,both,, ,737.05,442.23,Medicare,Medicare,,,,,737.05,,,,
S-H PLAT PHERE L-R,P9035,HCPCS,,,,,both,, ,2646.2,1587.72,Medicare,Medicare,,,,,2646.2,,,,
S-H PLAT A-P L-R IRR,P9037,HCPCS,,,,,both,, ,2796.36,1677.81,Medicare,Medicare,,,,,2796.36,,,,
S-H RBC IRRAD,P9038,HCPCS,,,,,both,, ,1013.8,608.28,Medicare,Medicare,,,,,1013.8,,,,
S-H RBC L-R IRRAD,P9040,HCPCS,,,,,both,, ,1025.03,615.01,Medicare,Medicare,,,,,1025.03,,,,
S-H CRYOPRE REDU PLS,P9044,HCPCS,,,,,both,, ,614.12,368.47,Medicare,Medicare,,,,,614.12,,,,
ALBUMIN 5% 250ML IV,P9045,HCPCS,,,,,both,250,ML,528.13,316.87,Medicare,Medicare,,,,,528.13,,,,
ALBUMIN 25% 50ML IV,P9047,HCPCS,,,,,both,100,ML,408.14,244.88,Medicare,Medicare,,,,,408.14,,,,
ALBUMIN 25% 50ML IV,P9047,HCPCS,,,,,both,50,ML,623.92,374.35,Medicare,Medicare,,,,,623.92,,,,
S-H BLD L-R CMV- EA,P9051,HCPCS,,,,,both,, ,1025.03,615.01,Medicare,Medicare,,,,,1025.03,,,,
S-H FFP BTWN8-24HREA,P9059,HCPCS,,,,,both,, ,634.6,380.76,Medicare,Medicare,,,,,634.6,,,,
FERUMOXYTOL1MG NESRD,Q0138,HCPCS,,,,,both,17,ML,9.68,5.8,Medicare,Medicare,,,,,9.68,,,,
CHLORPROMAZIN 5MG PO,Q0161,HCPCS,,,,,both,1,EA,4.12,2.47,Medicare,Medicare,,,,,4.12,,,,
CHLORPROMAZIN 5MG PO,Q0161,HCPCS,,,,,both,, ,7.52,4.51,Medicare,Medicare,,,,,7.52,,,,
ONDANSETRON 1MG PO,Q0162,HCPCS,,,,,both,, ,33.73,20.23,Medicare,Medicare,,,,,33.73,,,,
ONDANSETRON 1MG PO,Q0162,HCPCS,,,,,both,50,ML,34.25,20.55,Medicare,Medicare,,,,,34.25,,,,
TELEHEALTH IP NEURO,Q3014,HCPCS,,,,,both,, ,83.25,49.95,Medicare,Medicare,,,,,83.25,,,,
TOTAL CONTACT CAST 3 INCH,Q4038,HCPCS,,,,,both,, ,456,273.6,Medicare,Medicare,,,,,456,,,,
TOTAL CONTACT CAST 4 INCH,Q4038,HCPCS,,,,,both,, ,469.68,281.8,Medicare,Medicare,,,,,469.68,,,,
TOTAL CONTACT CAST BOOT LARGE,Q4038,HCPCS,,,,,both,, ,307.8,184.68,Medicare,Medicare,,,,,307.8,,,,
TOTAL CONTACT CAST BOOT X-LARGE,Q4038,HCPCS,,,,,both,, ,323,193.8,Medicare,Medicare,,,,,323,,,,
OASIS WOUND MAT SQCM,Q4102,HCPCS,,,,,both,, ,10.82,6.49,Medicare,Medicare,,,,,10.82,,,,
INTEGRA BMWD SQ CM,Q4104,HCPCS,,,,,both,, ,599.72,359.83,Medicare,Medicare,,,,,599.72,,,,
INTEGRA SKIN SUB 5X5CM,Q4108,HCPCS,,,,,both,, ,4404,2642.4,Medicare,Medicare,,,,,4404,,,,
DERMACELL SQ CM,Q4122,HCPCS,,,,,both,, ,166.86,100.11,Medicare,Medicare,,,,,166.86,,,,
OASIS ULTRA TRI SQCM,Q4124,HCPCS,,,,,both,, ,31.93,19.15,Medicare,Medicare,,,,,31.93,,,,
ACELL DERM MAT 1SQCM,Q4126,HCPCS,,,,,both,, ,133.9,80.34,Medicare,Medicare,,,,,133.9,,,,
1AMNIOEXCEL SKIN 1.5X1.5CM,Q4137,HCPCS,,,,,both,, ,2544,1526.4,Medicare,Medicare,,,,,2544,,,,
AMNIOEXCEL SKIN 2X3CM,Q4137,HCPCS,,,,,both,, ,3469,2081.4,Medicare,Medicare,,,,,3469,,,,
AMNIOEXCEL SKIN 3.5X3.5CM,Q4137,HCPCS,,,,,both,, ,3745,2247,Medicare,Medicare,,,,,3745,,,,
AMNIOEXCEL SKIN 4X4CM,Q4137,HCPCS,,,,,both,, ,3928,2356.8,Medicare,Medicare,,,,,3928,,,,
ALLOWRAP DS/DRY SQCM,Q4150,HCPCS,,,,,both,, ,347.63,208.57,Medicare,Medicare,,,,,347.63,,,,
ALLOWRAP DS/DRY SQCM,Q4150,HCPCS,,,,,both,, ,506.25,303.75,Medicare,Medicare,,,,,506.25,,,,
HELICOLL (PER SQ CM),Q4164,HCPCS,,,,,both,, ,6211,3726.6,Medicare,Medicare,,,,,6211,,,,
EPIFIX SQ CM,Q4186,HCPCS,,,,,both,, ,570.11,342.06,Medicare,Medicare,,,,,570.11,,,,
MEMBRANE GRAFT/WRAP (PER SQ CM),Q4205,HCPCS,,,,,both,, ,5236,3141.6,Medicare,Medicare,,,,,5236,,,,
DERM-MAXX (PER SQ CM),Q4238,HCPCS,,,,,both,, ,3534,2120.4,Medicare,Medicare,,,,,3534,,,,
AMNIO-MAX (PER SQ CM),Q4239,HCPCS,,,,,both,, ,9540,5724,Medicare,Medicare,,,,,9540,,,,
INFLIXIMAB-DYYB 10MG,Q5103,HCPCS,,,,,both,1,EA,545.13,327.07,Medicare,Medicare,,,,,545.13,,,,
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,1,ML,70.81,42.48,Medicare,Medicare,,,,,70.81,,,,
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,1,ML,93.22,55.93,Medicare,Medicare,,,,,93.22,,,,
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,, ,93.22,55.93,Medicare,Medicare,,,,,93.22,,,,
EPOET ALF-EPBX 1000U,Q5106,HCPCS,,,,,both,, ,93.22,55.93,Medicare,Medicare,,,,,93.22,,,,
INJ PERFLUTRN LIP ML,Q9957,HCPCS,,,,,both,, ,1184.5,710.7,Medicare,Medicare,,,,,1184.5,,,,
HOCM2 250-299MGML ML,Q9961,HCPCS,,,,,both,, ,1.65,0.99,Medicare,Medicare,,,,,1.65,,,,
HOCM 350 MG ML 30ML,Q9963,HCPCS,,,,,both,30,ML,49.5,29.7,Medicare,Medicare,,,,,49.5,,,,
HOCM 350-399MGML IOD,Q9963,HCPCS,,,,,both,, ,1.65,0.99,Medicare,Medicare,,,,,1.65,,,,
LOC2 200-299MG/ML ML,Q9966,HCPCS,,,,,both,, ,27.81,16.68,Medicare,Medicare,,,,,27.81,,,,
LOCM 200-299MG/ML ML,Q9966,HCPCS,,,,,both,, ,36.82,22.09,Medicare,Medicare,,,,,36.82,,,,
LOCM 200-299MG/ML ML,Q9966,HCPCS,,,,,both,, ,36.82,22.09,Medicare,Medicare,,,,,36.82,,,,
LOCM 240MG 100ML,Q9966,HCPCS,,,,,both,100,ML,6,3.6,Medicare,Medicare,,,,,6,,,,
LOCM 240MG 50ML,Q9966,HCPCS,,,,,both,50,ML,6,3.6,Medicare,Medicare,,,,,6,,,,
LOCM 270MG 150ML,Q9966,HCPCS,,,,,both,150,ML,6,3.6,Medicare,Medicare,,,,,6,,,,
LOCM200MG/ML 41% 200,Q9966,HCPCS,,,,,both,200,ML,4,2.4,Medicare,Medicare,,,,,4,,,,
LOC2 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,11.07,6.64,Medicare,Medicare,,,,,11.07,,,,
LOC2 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,11.07,6.64,Medicare,Medicare,,,,,11.07,,,,
LOC2 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,11.07,6.64,Medicare,Medicare,,,,,11.07,,,,
LOC2 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,11.07,6.64,Medicare,Medicare,,,,,11.07,,,,
LOC2 300-399MG/ML ML,Q9967,HCPCS,,,,,both,150,ML,1337.97,802.78,Medicare,Medicare,,,,,1337.97,,,,
LOCM 300-399MG/ML ML,Q9967,HCPCS,,,,,both,50,ML,12.62,7.57,Medicare,Medicare,,,,,12.62,,,,
LOCM 300-399MG/ML ML,Q9967,HCPCS,,,,,both,, ,1178.84,707.3,Medicare,Medicare,,,,,1178.84,,,,
LOCM300MG/ML 61% 100,Q9967,HCPCS,,,,,both,, ,0.6,0.36,Medicare,Medicare,,,,,0.6,,,,
LOCM300MG/ML 61% 100,Q9967,HCPCS,,,,,both,, ,0.6,0.36,Medicare,Medicare,,,,,0.6,,,,
LOCM300MG/ML 61% 30,Q9967,HCPCS,,,,,both,30,ML,7.4,4.44,Medicare,Medicare,,,,,7.4,,,,
LOCM300MG/ML 61% 30,Q9967,HCPCS,,,,,both,30,ML,7.4,4.44,Medicare,Medicare,,,,,7.4,,,,
LOCM300MG/ML 61% 30,Q9967,HCPCS,,,,,both,30,ML,7.4,4.44,Medicare,Medicare,,,,,7.4,,,,
LOCM300MG/ML 61% 30,Q9967,HCPCS,,,,,both,30,ML,7.4,4.44,Medicare,Medicare,,,,,7.4,,,,
LOCM300MG/ML 76% 100,Q9967,HCPCS,,,,,both,, ,0.7,0.42,Medicare,Medicare,,,,,0.7,,,,
LOCM300MG/ML 76% 100,Q9967,HCPCS,,,,,both,, ,0.7,0.42,Medicare,Medicare,,,,,0.7,,,,
LOCM300MG/ML 76% 125,Q9967,HCPCS,,,,,both,125,ML,4,2.4,Medicare,Medicare,,,,,4,,,,
LOCM300MG/ML M61% 15,Q9967,HCPCS,,,,,both,15,ML,60.5,36.3,Medicare,Medicare,,,,,60.5,,,,
LOCM300MG/ML M61% 15,Q9967,HCPCS,,,,,both,15,ML,60.5,36.3,Medicare,Medicare,,,,,60.5,,,,
LACTATION CONSULT,S9443,HCPCS,,,,,both,, ,115.88,69.52,Medicare,Medicare,,,,,115.88,,,,
NI-CARD REHAB PH 3,S9472,HCPCS,,,,,both,, ,2.58,1.54,Medicare,Medicare,,,,,2.58,,,,
NI-PULM REHAB PH 3,S9473,HCPCS,,,,,both,, ,2.58,1.54,Medicare,Medicare,,,,,2.58,,,,
IOP PSYCH PER DIEM,S9480,HCPCS,,,,,both,, ,872.41,523.44,Medicare,Medicare,,,,,872.41,,,,
CDC COVID19,U0001,HCPCS,,,,,both,, ,120.97,72.58,Medicare,Medicare,,,,,120.97,,,,
STATE COVID19,U0002,HCPCS,,,,,both,, ,172.81,103.68,Medicare,Medicare,,,,,172.81,,,,